As globalization also influences medical education, Chiba University has provided extensive study abroad programs. This paper reports a medical student's methods to prepare for using such programs and improve his English level, and outlines his actual experience of studying abroad during a 6-year period. It also discusses the significance of medical study abroad, focusing on the following 3 points: meeting medical leaders in other countries; establishing friendships with international medical students of similar age groups, while comparing Japanese students' abilities with international standards; and taking full advantage of being a student, as one is allowed to flexibly develop global perspectives only in his/her school days before starting a long career as a medical professional, to provide guidance for medical students toward such experience and career development based on it.

1)We applied a spiral curriculum devised by Harden to plan a sequential curriculum in outcome–based medical education at the Chiba University School of Medicine.
2)To plan a sequential curriculum, Miller's pyramid was applied to create a model for developing the competencies of physicians.
3)Competence levels based on the developmental model were used to plan learning objectives for each unit, and students and teachers were encouraged to understand the relevance of each lesson to competencies.

A total of 56 patients undergoing coronary artery bypass grafting were allocated to two groups: the Cold group (28 patients) with cold (4°C) crystalloid cardioplegia and topical ice slush, and the Tepid group (28 patients) with tepid (32°C) blood cardioplegia delivered intermittently antegrade. The two groups were comparable in terms of preoperative New York Heart Association classification, age, gender, and number of grafts. Intraoperatively, tepid blood cardioplegia was associated with a significantly shorter cardiopulmonary bypass time and nearly uniform return of normal sinus rhythm. Cardiac output after bypass was significantly higher than before bypass only in the Tepid group. The absolute peak levels in the myocardial-specific isoenzyme of creatine kinase were higher in the Cold group (70±8IU/l) than in the Tepid group (31±5IU/l). There was a trend toward reduced incidence of perioperative myocardial infarction (0% versus 7.1%) and need for intraaortic balloon pump support (0% versus 3.6%) associated with the use of tepid blood cardioplegia. Our results suggest that intermittent tepid blood cardioplegia is a safe and effective technique for coronary artery bypass grafting.

This experimental study was conducted to histopathologically determine whether the low-dose irradiation of donor hearts before transplantation can inhibit graft vasculopathy. Immediately after donor F 344 rat hearts were removed, they were treated with a single dose of radiation using 7.5Gy, 15Gy, or no radiation (control group). The F 344 hearts were transplanted into Lewis rats heterotopically, and cyclosporine A was injected intramuscularly for 20 days after transplantation in all groups. The hearts were harvested 90 days after transplantation, and examined for intimal thickening using elastica van Gieson staining. Severe intimal thickening was observed in both the irradiated groups, the percent intimal area of the coronary arteries was significantly increased in both these groups, to 34.3±12.9 in the 7.5Gy group and 37.0±8.9 in the 15Gy group, compared with 23.1±9.8 in the control group (p<0.01). In conclusion, these findings show that low-dose irradiation to donor hearts before transplantation does not inhibit graft vasculopathy.

A 72-year-old woman had undergone resection and graft replacement of the proximal ascending aorta for a DeBakey type II aortic dissection. She presented again 7 years later with progressive dyspnea and a cough. Computed tomography confirmed an aortic arch aneurysm and Doppler echocardiography demonstrated aortopulmonary shunting. Cardiac catheterization revealed a fistula between the aorta and pulmonary artery with a 54.3% left-to-right shunt and a Qp/Qs of 2.19. Operative repair was performed under profound hypothermic circulatory arrest with selective cerebral perfusion. The aortopulmonary artery fistula was closed from within the aneurysm using an equine pericardial patch and the transverse aortic arch was resected and replaced with a graft. The patient recovered uneventfully and was discharged on postoperative day 43.

A 62-year-old man presented with hemoptysis and hoarseness. He was diagnosed with an aortopulmonary fistula due to a thoracic aortic aneurysm rupture and was referred to our department. Emergency in-situ reconstruction of the aorta and pulmonary lobectomy were performed. Nine days postoperative, he developed empyema. Intrapleural urokinase and antibiotic therapy were selected as management instead of a video-assisted thoracoscopic debridement and decortication due to his worsening condition. The treatment was successful, and he was discharged from the hospital without any further complications. This study highlights the benefit of intrapleural administration of urokinase and antibiotics in patients with acute empyema, when surgical treatment is inappropriate.