In recent years with ever-increasing numbers of pregnant women wanting to participate in sport activities, the question as to how safe maternal exercise is for mother and fetus has become more important. The effects of pregnancy on maternal cardio-respiratory system include increases in oxygen consumption, cardiac output, heart rate, stroke volume, and plasma volume. The increase in oxygen reserve seen in early pregnancy is reduced later, suggesting that maternal exercise may present a greater physiological stress in the third trimester. The aims of this article are 1) to comment on the evidence relating to the health risks and benefits of physical activity for pregnant women and their unborn fetuses and 2) to realize guidelines for management of maternal exercise. In the absence of either obstetric or medical complications, pregnant women can continue to exercise and derive related benefits. The type, intensity, frequency, and duration of the exercise seem to be important determinants of its beneficial effects. Evidence suggests that weight-bearing exercise produces a greater decrease in oxygen reserve than non weight-bearing exercise. Furthermore, to maintain a heart rate below 150 beats per minute during pregnancy, the intensity of weight-bearing exercise must be reduced. In addition, depending on the individual's needs and the physiologic changes associated with pregnancy, women may have to modify their specific exercise regimens. Although increases in the frequency of uterine contractions have been observed during physical activities, changes are often minimal. In response to moderate exercise, the increase in frequency of uterine contractions is gestation dependent and significant in the third but not in the second trimester. The physiological adaptations to exercise during pregnancy appear to protect the fetus from potential harm and, while an upper level of safe activity has not been established, the benefits of continuing to be active during pregnancy appear to outweigh any potential risks. All decisions about participation in physical activity during pregnancy should however be made by women in consultation with their medical advisers.

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Objectives: Combination chemotherapy consisting of paclitaxel and carboplatin has recently started to be given as the regimen of first choice for epithelial ovarian cancer. One of its side effects, however, is neurotoxicity, and this neurotoxicity has been reported to be the dose-limiting factor. Since it is necessary to measure the severity of the neurotoxicity objectively and quantitatively, we evaluated it on the basis of current perception threshold (CPT) values, which is easy and non-invasive.
Method: Sixteen patients with epithelial ovarian cancer were given paclitaxel (175 mg/m², 3 hours) and carboplatin (area under the curve of 5) every three weeks, and the CPT values were measured at two sites on the day before and several times after administration.
Results: All patients exhibited mild neurotoxicity, but it was never so severe that chemotherapy could not be continued. The CPT values peaked on day 4 during one course of chemotherapy, but decreased thereafter and returned almost to the baseline by three weeks, in the same way as the patients' complaints. The CPT values decreased with the number of courses, and patients' complaints gradually increased. The CPT values increased more in the cases previously treated with cisplatin than in the other cases. These changes were seen at 2,000 Hz, which generally corresponds to large, myelinated nerves.
Conclusion: There were correlations between the changes in the patients' CPT values and their degree of neurotoxicity. We expect to be able to predict severe neurotoxicity and evaluate the effect of drug therapy for neurotoxicity by measuring CPT values.

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Numerous reports have examined the relationship between sonographically determined cervical length and spontaneous preterm birth. Moreover, large screening studies have consistently demonstrated that the shorter the cervical length, the higher the rate of spontaneous preterm delivery. However, the sensitivity and positive predictive value of the cervical length for detecting preterm birth were low. Subsequently, we developed a new sonographic parameter termed "cervical gland area (CGA)". The purpose of this study was to determine whether sonographic cervical findings (shortened cervical length or absence of CGA) at 16∼19 weeks' gestation could predict spontaneous preterm birth. The absence of CGA as compared to the shortened cervical length showed a higher sensitivity (75.0% vs. 50.0%) and a significantly elevated positive predictive value (54.5% vs. 8.3%) for preterm birth before 32 weeks' gestation. It was concluded that the absence of CGA was a novel and useful sonographic parameter for predicting early spontaneous preterm birth.

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This study examined the characteristics of Japanese patients who required psychiatric intervention through the Consulate-General Japan in New York. The findings show that 61.5% of cases were tourists in contrast with 38.5% who were residents. Seventy three point one percent of all cases had psychiatric disorders prior to traveling to the United States. Seventy one point two had schizophrenia, and 48.1% required intervention within one week stay in the United States. The study indicated cultural elements had little influence on their psychiatric crises. The dominant cases, which were schizophrenics who traveled because of their delusional symptoms, were consistent with cases of "voyage pathologique". It was also suggested that cases with personality disorders are increasing in number. And we inferred that cases with substance-related disorders, particularly among young illegal residents, must be present in greater numbers.

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Intrauterine inflammation/infection has been associated with prenatal mortality and morbidity. However, few studies have been performed to investigate how the fetus responds to intrauterine inflammation/infection in utero. In the present study, fetal plasma prostaglandin (PG) F_2α and cortisol responses to high-dose fetal endotoxin administration were evaluated in late gestation goats (n=8). After 160μg/kg of fetal weight of endotoxin (Escherichia coli, O111:B4 lipopolysaccharide) administration via the fetal jugular vein over a 5-min period, fetal plasma PGF_2α and cortisol levels, fetal blood gases and pH were measured periodically.
After endotoxin administration, fetal plasma cortisol levels significantly increased to 9.5±0.8 ng/mL and 9.3±0.7 ng/mL after 1 and 3h, respectively (p<0.05) and plasma PGF_2α levels did not change throughout the study. These results suggest that absent PGF_2α and attenuated cortisol responses to high-dose fetal endotoxin administration, relative to the adult, may be a self-protective mechanism that diminishes premature delivery and fetal asphyxia.

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The current drive to practice less invasive surgery is changing surgical practice towards safer and simpler procedures. The practice of coronary artery bypass grafting (CABG) on a beating heart without cardiopulmonary bypass (CPB), off-pump CABG or OPCAB, has been gaining great attention as an alternative approach to conventional CABG. Since the first adoption of OPCAB in 1997 at our department, 181 patients have undergone OPCAB. OPCAB was indicated for patients who were possibly at risk for CPB, i.e., those who were elderly, who had a history of cerebrovascular disease, whose ascending aorta was severely atherosclerotic with calcification, whose respiratory function was compromised, or whose renal function was compromised. A patient with a concomitant malignant neoplastic disorder was also a candidate for OPCAB because of the possible deleterious effect of CPB on the immune system. More recently, when the coronary anatomy was suitable for OPCAB, even in younger or less risky patients, OPCAB was indicated. The OPCAB procedure was performed through a median sternotomy in 146 patients (80.6%), a left thoracotomy in 27 (14.9%), a subxiphoid approach in 6 and a combined one in 2. One hundred and eleven patients (61.3%) received 1 or 2 grafts (Group I) and 70 (38.7%) received 3 or more grafts (Group II). The number of grafted vessels in Group II patients was 3 to 5 with a mean of 3.44. The mean operative time was 163 minutes in Group I and 209.5 minutes in Group II. The frequency of the use of arterial grafts such as LITA, RITA and RA was significantly higher in Group II than in Group I. Death occurred in 3 patients with acute coronary syndrome who had to undergo urgent surgery. Angiographic examination was performed within 3 months, postoperatively, in 98 patients (54.1%) revealing the overall patency rate of each graft: LITA82/83 (98.8%), RITA 33/33 (100%), GEA 15/16 (93.8%), RA 20/20 (100%), and SVG 15/16 (93.8%).
We conclude that, in light of our 5-year experience, off-pump CABG on a beating heart can be safely and effectively performed, with acceptable angiographic results even in patients with multi-vessel coronary disease requiring multiple revascularization.
This procedure enables us to perform successful coronary bypass surgery for those who otherwise would not have been candidates for conventional CABG.

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Maternal oxygen supplementation is commonly performed to improve fetal oxygenation and acid-base balance during fetal asphyxia. The efficiency of this treatment is controversial, which may be associated with the production of oxygen free radicals and lipid peroxidation. However, only a few studies have been performed to evaluate these issues. To clarify them, we investigated the effects of maternal oxygen supplementation on fetal oxygenation and lipid peroxidation following fetal asphyxia in late gestation goats.
We measured fetal blood gases, pH and plasma malondialdehyde (MDA), one of the endproducts of lipid peroxidation, before, during and after fetal asphyxia with and without maternal oxygenation in late gestation goats. Fetal asphyxia was induced by a single total umbilical cord occlusion of 3 minutes' duration, and maternal oxygenation was initiated at 20 min before the cord occlusion and terminated at 20 min after the release of cord occlusion.
Maternal oxygen supplementation resulted in a significant increase in fetal PaO₂ before and after the cord occlusion (p<0.05). During the cord occlusion, the extents of hypoxia and acidemia were not changed by maternal oxygen supplementation. Fetal plasma MDA levels before maternal oxygen supplementation averaged 0.80±0.04 μmol/L, significantly increased after the initiation of maternal oxygen supplementation (1.11±0.07 μmol/L), and further increased following fetal asphyxia (1.28±0.06 μmol/L), and after the release of the cord occlusion (1.58±0.7 μmol/L)(p<0.05). These values were significantly higher than those in fetuses without oxygenation. We conclude that maternal oxygen supplementation increased fetal oxygenation but caused a concomitant increase in lipid peroxidation in the fetus.

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A characteristic prenatal ultrasonographic finding of patent urachus is described. Routine obstetrical ultrasonography first revealed a cystic mass in the umbilical cord at 16 weeks of gestation. The mass spontaneously decreased in size and was undetectable at full term on serial ultrasound examination. The male newborn infant was delivered uneventfully at 38 weeks of gestation, weighing 2,774 g. He was noted to void urine from the umbilicus soon after birth, and the diagnosis of patent urachus was confirmed. On the 8th day of life, complete surgical removal of the urachus was performed, and the postoperative course was uneventful. An umbilical cystic mass which diminishes in size over the course of pregnancy is a sugesstive prenatal sonographic finding for urachal anomalies.

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In Japan, mass screening tests on newborns for Cretinism have been performed since 1984, Cretinism is a very rare condition. We report the clinical course and complications of longitudinal thyroid hormone replacement therapy (liothyronine sodium: T3) of two women with Cretinism and ectopic thyroid gland for the past 33 years until 2001.
They were born in April 1951 (Case 1) and in January 1952 (Case 2). On admission in June 1968, they were 17 and 16 years old. They had short stature, mental retardation, macroglossia, saddle nose, retardation of bone maturation, edematous face, coexistence of permanent teeth and deciduous teeth, abdominal distention, hypotonia, anemia, hypophosphatemia and hypercholesterolemia.
After admission, Case 2 had an appendectomy for appendicitis. She was found to have a right ovarian cyst, but was not operated upon. Later, the right ovarian cyst disappeared during thyroid hormone replacement therapy. The complication in this case was NIDDM. Over secretion of thyroid hormone in for example, hyperthyroidism sometimes induces NIDDM.
On their admission, a levothyroxine sodium (T4: Thyradin S) was unavailable in Japan, so we had no choice but to treat them with liothyronine sodium for thyroid hormone replacement therapy. We suspect that liothyronine sodium replacement therapy probably induced NIDDM. They experienced improved bone maturation, anemia, hypophsphatemia and hypercholesterolemia, but their intellectual and mental disabilities were not improved.

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Background: This report describes a one-step insertion of an expandable metallic stent to treat obstructive jaundice due to unresectable common bile duct carcinoma.
Methods: A percutaneous transhepatic cholangiogram is obtained, and the bile duct obstruction is negotiated with a guide wire. After advancing the catheter into the duodenum, contrast material is injected to measure the length of the stenosis. After an expandable metallic stent is positioned, an external biliary drainage catheter is left in place to provide temporary drainage. The catheter is removed after stent patency is confirmed after 3 days.
Conclusions: One-step insertion of an expandable metallic stent for biliary obstruction is a useful method that shortens hospitalization. Once it has been decided to use stent palliation, the stent should be inserted without undue delay to maximize symptomatic relief and cost benefits.

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It is very important for clinicians to recognize that some lung cancers, especially among the bronchiolo-alveolar cell carcinomas (BAC), rarely show mild improvement in opacity during the clinical course. We would like to present a 63-year-old woman who demonstrated very unusual exacerbation and improvement in lung opacity during 7 years of follows up. The abnormal chest shadows pointed out in an initial screening checkup and in a following chest CT presented 4 nodules in both lung fields; 2 of them appeared to have cavities. One of these nodules showed a definitely reduced size in a chest CT taken after one year of follow up study. We therefore determined it was probably not malignant of this time. But, after seven years the patient revisited our institute complaining of bronchorrhea. The chest CT taken immediately revealed increased size of each nodule and progression to pulmonary consolidation of the right lower lobe. A transebroncheal biopsy led to a diagnosis of bronchiolo-alveolar cell carcinoma pathologically. The incidence of BAC has recently shown a remarkable increase and radiological images of these tumors are various. It is important, therefore, to consider the possibility of BAC for differential diagnose of cases presenting abnormal pulmonary shadows.

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