It is difficult to study the fundamental of echocardiography without three-dimensional images of the whole internal structure of the heart. However, presently no such images could be found in textbooks or literature of fundamental echocardiography for the novice student.
After a search of available literature, I attempted to develop three-dimensional illustrations by induction utilizing the tomographic and plane figures found in the available literature. Frank H.Netter, M.D. had an illustration in the volume on the heart in “The Ciba Collection of Medical Illustrations” that came closest to my objectives. However, important aspects for my work were obscure, for example, the right ventricular outflow tract. I continued to expand on this illustration without contradicting Netter's work.
From the echo-figure of the short axis at the aortic base, one curved line was supposed by induction. This line is the demarcation between the upper corner and the anterior wall of the left ventricle. This line was incorporated in the drawing, adding to the Netter illustration of the four valves. This allows one to be able to comprehend the ventricular outflow tract. Additions of lines at other minute portions of the illustrations completed the objective. While this task was acomplished over several years, it appears that the gist of the change to the work of Netter was only one curved line, the border between the upper corner and the anterior wall of the left ventricle.

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Absolute risk of coronary heart disease was investigated through a cohort study in a district of Niigata Prefecture, Japan. Among 7, 263 participants, 17 acute myocardial infarction, 13 coronary deaths and 14 cases of angina pectoris were observed during 5 years from the baseline survey. Multivariate analysis by the Cox proportional hazard model revealed that serum total cholesterol over 250 mg/dl was a risk factor for acute myocardial infarction. The role of high serum cholesterol in risk, however, was evident only for subjects with one or more other risk factors, such as diabetes, obesity, high systolic blood pressure, low serum HDL-cholesterol and low frequency of vegetable intake, simultaneously. Absolute risk of coronary heart disease, including acute myocardial infarction, coronary death and angina pectoris, over 5 years exceeded 10% only for males 65 years of age or older, if they also had high serum total cholesterol and one of the other risk factors simultaneously. The absolute risk for males younger than 65 years and for females did not reach 10% regardless of their risk factor status. Thus, drug therapy for high serum total cholesterol should be considered only for very limited group of subjects, if the European guidelines are applied. We should take these results into consideration in daily health guidance for subjects with high serum total cholesterol aimed for primary prevention of coronary heart disease.

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Recently in Japan, cerebro-cardiovascular accidents during bathing have increased in the elderly. By habit most Japanese prefer hot water bathing to lukewarm bathing, and most of them usually bathe without immersion of their head. Bathing Holter Electrocardiographic examinations were performed in 60 patients with angina pectoris.
The subjects were divided into 3 groups ; effort angina (n=28), rest angina (n=16) and effort-rest angina (n=16). Water-proof Holter Electrocardiographic recorders (Marquette) were attached to the subjects from three hours before bathing until about a half an hour after bathing.
Behavior of bathing was arbitrary, but actions of the patient and water temperature of bath-tub were recorded in detail. Analyses were performed by SERIES 8200/T HOLTER ANALYSIS SYSTEM. Significant ischemic ST-T changes and prominent arrhythmias were considered positive on ECG. Positive ECG changes appeared in 7% of the patients with effort angina (2 out of 28), 38% of rest angina (6 out of 16) and 81% of effort-rest angina (13 out of 16). Positive ECG changes in the patients with rest angina occurred in the hot water during bathing and during the standing position immediately after they exited the bath-tub. To the contrary, all positive patients with effort angina and effort-rest angina, had ischemic changes recorded while in the bath-tub. Main cause of these ischemic changes on ECG in the patients with rest angina during bathing was speculated to be coronary spasm that might occur when the blood pressure abruptly dropped when in the standing position during the course of hot water bathing.
In several positive cases of the rest angina, coronary spasms were detected by coronary angiography. The patients with effort angina seemed to get rid of ischemic changes on ECG in the bath-tub in contrast with the patients with effort-rest angina. While the cause of this difference is unclear, patients with effort angina may be able to manage the balance of oxygen demand and supply of the heart while in the bath-tub much more efficiently than the patients with effort-rest angina.
An important observation is that none of the positive patients of angina complained of any chest pain during bathing, so they may be classified as having “Silent Myocardial Ischemia”.

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The utilization of ambulances in Yokohama city, Japan is projected to increase rapidly with the advance of aging in the society. Ambulance use caused by diseases of cardiovascular system (DCS) is also increasing. The increasing demand of emergency medicine on DSC may affect the regional emergency medical system because emergency medicine for DSC often requires special knowledge and techniques. This study predicts that the demand of emergency medicine for DSC in Yokohama will be 1.4 times in 2015 and 1.7 times in 2030 that of the demand in 2001.Futher research is necessary to develop appropriate systems that can efficiently cope with the rapid increase of the demand for emergency medicine.

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[in Japanese]

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Lifestyle is an important factor for elderly people to live healthy and abundant lives. Although obesity is associated with lifestyle and is a factor in chronic diseases, there remain many questions regarding the association between obesity and blood pressure or metabolism of the elderly. This study was done to elucidate the association of obesity on blood pressure and metabolic factors in the elderly. Subjects were elderly persons in Hanazono Village, Japan.
We enrolled individuals aged over 40 years old who had undergone physical examinations in 2001. We also used a questionnaire to survey daily activity. We divided the subjects into two groups by BMI over 25 (obese) and under 25 (lean).
The results indicated that even in the normotensive blood pressure in the early morning, insulin resistance index HOMA, plasma leptin concentration and urinary microalbumin excretion in the obese were significantly higher than in the lean. This suggests that morning elevation of blood pressure, insulin resistance and leptin may interrelate with one another in the normotensive elderly obese subjects, and the possibility exists that they have renal diseases even if they don't present with the typical physical findings in the present study.

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