We developed a VR system using hammock attached pressure sensors, and performed experiments to evaluate the system. More than half of users could feel , but remaining users couldn’t feel it. In this study, we improved this system to feel more and performed experiments to evaluate it.

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目と手と耳を使った理学的所見はたとえバスキュラーアクセス (VA) の観察であろうとも診療の基本である. 本邦においてはVAの理学的所見に関する系統的記載は少なく, しかも聴診所見に偏っている傾向が否めない. 今回, 動静脈瘻 (AVF) 狭窄の理学的所見の意義を検討した. 1996年7月より2004年12月までのI群 (102例のAVF) では聴診所見を中心にVAを観察し, その所見をretrospectiveに検討した. 2005年1月より同年12月までの1年間に観察したII群 (31例のAVF) は, 聴診に加え視診と触診の理学的所見を重視し, その所見をprospectiveに検討した. シャント造影で狭窄率が60%以上を呈した例を検討対象とした. さらに理学的所見により狭窄部位を早期かつ正確に診断するため各群を1型 (傍吻合部型), 2型 (遠位型), 3型 (1, 2型の混合型) の3型に分類した. I群ではII群にくらべ穿刺困難, 閉塞を含む血流不全など比較的重篤な所見の頻度が多かった. しかも聴診所見を主に観察したI群では1, 2, 3型の理学的所見の頻度に大きな差はなく, 各型の識別は困難であった. 一方, II群の1型ではfirst 減弱が, 2型では吻合部と狭窄部の間の静脈怒張と狭窄部のsecond の出現頻度が高かった. しかし3型ではsecond は多くみられたが, 2型にくらべ静脈怒張の頻度は少なく, むしろfirst 減弱と血流不全が比較的多くみられた. 聴診所見は重要ではあるが, その所見を経時的にまた客観的に記載することは必ずしも容易ではない. 視診, 触診を含めた理学的所見を総合的に観察することにより, 狭窄部位の推定も含めVAの血流異常を正確かつ早期に診断することが可能となり, percutaneous transluminal angioplastyなどによるVAの改善が容易になると思われる.

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右総腸骨静脈へ穿破し，動静脈瘻を形成した腹部大動脈・総腸骨動脈瘤を経験したので報告する．症例は87歳，男性．近医で著明な両下肢の浮腫，呼吸不全，腹部大動脈瘤・総腸骨動脈瘤を認めたため，当科へ紹介となった．触診上，右側腹部にを触れ，CTで腹部大動脈遠位部から総腸骨動脈の動脈瘤を認めた．術中，瘤後壁に右総腸骨静脈との瘻孔を認めた．用手的に出血をコントロールしながら瘤内腔よりフェルト片付き4-0モノフィラメント糸で瘻孔を閉鎖した．腹部大動脈以下はY字人工血管（UBE WOVEN WYK，18 × 9mm）にて置換した．術後，症状は著明に改善し，リハビリテーション目的に転院した．

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症例は73歳男性で左下肢腫脹を主訴に来院．左膝窩部に，拍動性腫瘤を触知した．造影CT検査，下肢動脈造影検査で，動静脈が大動脈分岐部から左膝窩部まで広範囲にわたり拡張，蛇行し，膝下部で動静脈瘻が認められた．膝窩動静脈瘻の診断のもとに瘻閉鎖術を施行した．手術は腹臥位で，膝下部を切開．動静脈を瘻の中枢，末梢でそれぞれ遮断後，拡張した静脈を縦切開し，約 5mmの瘻孔を 5-0 polypropylene糸で単純閉鎖した．本症例の原因は，20歳時に木刀で左膝窩部を強打され，著明に腫脹し入院したという既往があり，他に同部位に手術歴，外傷歴がないことから，このときの膝窩動脈の損傷が原因で近接している静脈と瘻孔を形成し，長い経過でこのような動静脈の変化をきたしたものと考えられた．文献上調べ得る限りでは，受傷後50年を経過してこのような形態の動静脈瘻を形成した症例はなかった．

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心理学の分野において生物が生きていくためには恐怖心を抱くことは大変重要な機能である。なぜなら恐怖心を抱くことによって生物は事前に危険から身を守ることで子孫を残すことに繋がるからである。また、恐怖心は利用方法によっては楽しいという感情を作り出すことも可能であり､擬似的な危険をもたらすジェットコースターやお化け屋敷､ホラー映画などがその例に挙げられる。しかし、中にはそれらを不快に感じる人も一定数いることは事実である｡そこでその恐怖を臨場感として捉えることで非日常的な体験をし、恐怖に対するネガティヴな印象を和らげられるのではないかと考える。 本研究の目的は「身近な恐怖心を楽しむためのデザイン体験｣を提案することである。

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孤立性総腸骨動脈瘤が穿破し，動静脈瘻を形成した稀な症例を経験したので報告する．症例は80歳，男性．左下肢腫脹を主訴に来院．左下腹部にを触れ，腹部造影CTで両側総腸骨動脈瘤を認め，動脈造影早期に左腸骨静脈から下大静脈の描出を認めた．動静脈瘻の診断のもとに手術を施行した．動脈瘤後壁に7 mmの瘻孔を認めた．瘻孔を瘤内腔から縫合閉鎖し，大動脈終末部からY型人工血管で置換した．術後，左下肢・側腹部の腫脹は軽減し，術前認めた心不全症状も改善した．

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In a male Maltese two months of age weighing 700 g, patent ductus arteriosuswas diagnosed, based on the results of clinical examinations. Operation was carried out onthis case with excellent results. Characteristic findings of clinical examinations, operation, and postoperative course are summarized as follows.l. Since about l month of age, attacks of congestive heart failure had occurred fre-quently with severe dyspnea and collapse.2. Palpation revealed characteristic, intense and continuous over the precordialregion.3. Auscultation revealed loud machinery-like murmur over the cardiac base, especiallyin the aortic, pulmonic and tricuspid valve areas.4. X-ray findings in the ventrodorsal radiogram revealed the characteristic "dancing"of the main pulmonary artery and a leftward bulge of the descending aorta with the peculiarteardrop shape of the heart.5. PCG findings revealed systolic murmur which was of diamond type between heartsounds I and II.6. ECG findings revealed deviation of the electric heart axis, dilatation of the bilateralatria and ventricles, and abnormalities in the formation and conduction of stimuli.7. After thoracotomy at the left 3rd intercostal space, the ductus arteriosus was con-firmed between the descending aorta and the bifurcation of the main pulmonary artery.It was remarkably broad, about 0.5 cm in length and 0.8 cm in diameter, and cylindrical inshape.8. On the first postoperative day, hemorrhage was noted in both anterior ocular chambers. It disappeared completely within 5 days after operation.9. On the 30th posLoperative day, all abnormalities disappeared, except a slight dilataLion of the left ventricle, in clinical examinations.

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Statistical data and a visitor questionnair at a particular amusement park were analyzed on following 5 aspects. 1. A positive correlation was found between the number of amusement facilities used per visitor and the total number of facilities in the park. 2. Concerning " type" facilities, there was a positive correlation between the rate of use and the total number of people in the park, while there was a strong negative correlation between "marchen type" facilities and park occupancy. 3. When very few attractive facilities were available, a given facility's distance from a park gate had a strong influence on visitors' first choice. 4. A negative correlation was found between the total distance from the park gates and the rate of a given facility being used. 5. It was found that joint use was most likely when the facilities were close to each other. This was found to be especially true for "child type" facilities. People tend to use " type" facilities consecutively regardless of their relative locations.

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A 32-month-old spayed female Pug was referred for an MRI study due to convulsions. The MRI examination indicated encephalitis. However, echocardiography and pathological examinations revealed that this case had a ventricular septal defect and double chambered right ventricle which is a rare congenital heart disease in the dog. An anomalous muscle bundle crossed the right ventricular outflow tract, dividing the right ventricle into 2 chambers.

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  脳損傷が引き起こす認知・行動障害は単一認知能力の単純な欠損（陰性症状）として出現することは少なく，多くの場合，行動・認知能力の変容（陰性症状と陽性症状の複合）として出現する。超複雑構造である大脳が，ある程度自律性を持つ複数の機能系から成っているため，これら複数の機能系の間に損傷機能系の活動低下と非損傷機能系の相対的な活動亢進という，複雑な力動関係が発生するためである。このような力動関係の破綻を表していると考えられるさまざまな症候群のうち，筆者が個人的に経験し，論文として発表したことのあるものを 4 種に大別し，その病態メカニズムをまとめた。
  すなわち，(1) 上位神経水準と下位神経水準の統合・拮抗関係の破綻を示す症状，(2) 左右大脳半球の統合・均衡関係の破綻を示す症状，(3) 前頭葉機能と頭頂葉機能の統合・均衡関係の破綻を示す症状，そして (4) 言語機能における情報統合能力の破綻を示す症状である。

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The types of fistulae used and their complication rates are important for the hemodialysis patients. We aimed to compare retrospectively the primary and secondary patency rates and complications of upper extremity arteriovenous fistulae. Between 1984 and 2005, a total of 1,233 upper extremity arteriovenous fistulae were created in 920 patients. The mean age was 42 ± 21 years. The fistulae were divided into the 3 groups; 588 radiocephalic, 205 brachiocephalic, and 127 were created by polytetrafluoroethylene graft. The fistulae types were evaluated with regard to their primary-secondary patency rates and complications. There was a significant difference with regard to development of thrombosis in radiocephalic group compared to other two groups, respectively, p = 0.0122, p = 0.0091. In brachiocephalic fistulae group, edema and steal phenomenon were statistically significant (p < 0.0001). The aneurysm formation was statistically significant in polytetrafluoroethylene fistulae graft group (p < 0.0001). During 6 months, 2 and 5 years period, while primary patency rate was higher in three fistulae types, in radiocephalic fistulae both primary and secondary fistulae patency rates were lower (p < 0.05). To create successful arteriovenous fistulae with long-term patency, appropriate veins of patients should be carefully preserved; thus initially a distal site should be preferred, and in case of failure the next fistulae should be created proximally. In case of failure of forearm fistulae, primary fistulae with autogenous veins should be tried at the upper arm first, and if this also fails, fistulae formation with synthetic grafts should be considered.

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M. T., female, aged 19
Hypertrophy of the left lower extremity was noticed at age 12, since then it was gradually increased with fatigue. Her right leg showed obvious muscular atrophy and drop foot (resulted from polimyelitis at age 3). No other symptoms.
On the examination of heart, functional murmurs was listened. C. T. R. was 51.2% and blood pressure 136-148/80mmHg preoperatively. No pulmonary congestion. On regional findings, whole left leg showed obvious hypertrophy with increase of skin temperature and normal skin color, but with the dilatation of superficial veins.
Over the popliteal space, left inguinal region, and the anterior upper side of the left calf were felt the characteristic thrills and bruits of arteriovenous fistulae.
O₂-saturation and pH of the left femoral and dorsal veins showed respective 97%, pH 7.410 and 79%, pH 7.372.
X-ray showed discrepancy of 6.7cm in length of whole extremity. Angiogram demonstrated dilation of A. and V. femoralis and defect of dye in the peripheral artery suggested arteriovenous shunts at the level of the popliteal space.
Under epidural anesthesia, an incision was made over the popliteal space. The greatly dilated popliteal vein was exposed, in which was observed “whirlpool phenomenon”. Longitudinal suture of the defect in the wall of the vessel was performed and distal popliteal vein was ligated.

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A case of atrio-ventricular communication syndrome has been reported. The case was 24 year-old house wife, mother of a child. Necropsy has indicated the anomaly similar to the type I of GERBODE'S classification. Clinically, she had presented pansystolic murmur with intense systolic in the lower sternal region. She died of congestive heart failure. Postmortem examination had also indicated the complication of subacute bacterial endocarditis with ruptured aneurysm of Valsalva sinus resulting in communication between right atria and root of aorta. Literature review of this syndrome has been made, in which similarity of clinical picture to ASD and VSD in regard to data of right heart catheterization and heart sound finding, respectively and also rather higher incidence of complication of SBE are emphasized.

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A 24-year-old woman presented with neck bruit and . Neurological examination revealed no focal abnormality. Angiography and magnetic resonance imaging showed an arteriovenous fistula (AVF) at the C4-5 levels of the right vertebral artery (VA). The fistula had a single orifice that drained into the epidural veins via the C4-5 intervertebral foramen. A stent-graft was made of a 3.9 cm balloon-expandable stent and an expandable polytetrafluoroethylene graft sutured outside the stent. The stent-graft was advanced through the femoral artery up to the VA but did not pass far enough distally to seal the entire fistula because of the high friction between the bulky device and the small vessel. Another 2 cm stent-graft was delivered and successfully positioned across the fistula. The AVF completely disappeared and the right VA was well preserved. Follow-up angiography at 3 weeks and 5 months after the treatment showed no fistula and no stenosis inside the stent-grafts. Stent-grafts are useful to treat AVF with a large orifice. The stent-graft is a promising technology to treat neurovascular diseases, although improvement is required for use in smaller vessels.

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心筋梗塞 (以下梗塞) に合併した後乳頭筋頭部断裂の2例を報告した.症例1: 68歳, 女, 既往に弁膜症がある.胸痛発作で入院, 入院時心尖部にLevine III度の全収縮期雑音 (+) , (-) , 心電図は急性下壁梗塞心エコーでDDRの亢進, 8日後に再梗塞による心不全で死亡.心重量490g.梗塞が後乳頭筋を含む左室側壁後壁中隔と一部右室後壁にあった.また後乳頭筋頭部断裂を合併右冠動脈に血栓と左回旋枝に高度狭窄.断裂は再梗塞後に発生した.また弁膜症は乳頭筋不全によるものであった.症例2: 61歳, 男, 既往に糖尿病, 狭心症, 高血圧がある.胸痛発作で入院し, 心電図は急性下壁梗塞12日目に突然心尖部にLevine III度の全収縮期雑音 (+) . (-) .8日後に心不全で死亡.心重量490g.梗塞が後乳頭筋を含む左室後壁中隔にあった.また後乳頭筋頭部断裂を合併他に古い前壁中隔梗塞もあった.右冠動脈に血栓と左冠動脈に60%狭窄.2症例とも生前診断は出来ず, 本合併症は稀であるが, 手術により救命可能であるため早期診断が望まれる.

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