For medical students, death education is essential. As a part of death education in medical courses, a lecture was given about telling the truth to patients with cancer. Patients with recurrent cancer took part in this lecture and talked about their operations, informed consent, and telling the truth. From the questions of medical students to both patients and teachers (surgeons), student's opinions about telling the truth were examined. Medical students approve of telling the truth to patients with cancer and support the rights of patients to know the truth about their disease. If they have cancer, they want to be told the truth. However, they are wary of telling the truth to all patients. They think that the truth should not be told without understanding the patient's personality. Students recognized that they are not sensitive enough and want to learn sensitivity by telling the truth.

 Infertility in developing countries is important but neglected, while the issues of population growth control have been paid much attention. Female infertility rates in African countries were about 30 percent, which were three times higher than those of industrialized countries. It was reported that the most common cause of infertility was tubal dysfunction due to sexually transmitted infections, unhygienic delivery management, and unsafe abortion. The second common causes were male factors, which had been underestimated in developing countries. Thus, women were always blamed and often abused by their husbands and in-laws. Furthermore, infertile couples suffered from social discrimination and economic disadvantages.
 Infertilities were often treated without appropriate examinations of both husbands and wives. Inexpensive treatments were commonly applied: e.g., treatment of sexually transmitted infections, encouraging timing intercourse, hormonal therapies. Assisted reproductive technology (ART) would be effective in developing countries where main causes of infertility were tubal dysfunction and male factors. ART has been performed in urban areas in some developing countries. However, it is difficult to promote ART in developing countries, because of high costs and lack of sufficient technical and ethical regulations. To decrease the burden of infertility in developing countries, first, both developing and industrialized countries have to recognize the significance of the issue. Then, it is needed to evaluate accurate rates of infertility, causes of infertility, and effectiveness of current treatment, so that the countries could develop prioritized strategies and interventions.
 Infertility rates could be decreased with relatively low cost through building a system of proper diagnosis and treatment. International assistance might be required to negotiate the drug prices and to establish technical and ethical review mechanisms, which are the prerequisites of promoting ART. It is also important to provide people with knowledge and information regarding infertility, their causes and treatment.

A 69-year-old man in whom two stents had been implanted on segments 6 and 7 was admitted to our hospital with acute myocardial infarction (AMI). Coronary angiography suggested a total occlusion of the left anterior descending (LAD) between two stents. Percutaneous transluminal coronary angioplasty (PTCA) was performed, but it made an acute coronary occlusion due to a dissection of left main trunk (LMT). As cardiogenic shock occurred, he was put on percutaneous cardioplumonary support (PCPS), and a perfusion catheter was introduced to the LAD and a guide wire to the circumflex (Cx). Emergency coronary artery bypass grafting (CABG) was performed on cardioplumonary bypass (CPB). First, an SVG was grafted to the LAD on ventricular fibrillation, and the other SVG was grafted to segment 13 on cardiac arrest after the perfusion catheter and guide wire was removed. This method allowed this operation to be performed with suitable myocardial protection.

We report a case of successful one-stage resection of intravenous leiomyomatosis (IVL) with extension into the main pulmonary artery. The patient was a 50-year-old woman, who was admitted to our hospital with clinical signs of syncope. Computed tomography (CT) and 3 D helical CT images showed a tumor arising in the left side of the uterus with extension into the pulmonary outflow tract. One-stage radical operation with cardiopulmonary bypass was performed. Because IVL is related to many fields concerning various organs, it is important that general surgeons, gynecologists and cardiovascular surgeons cooperate with each other.

Seven patients underwent surgical repair of the distal aortic arch aneurysm from January 1990 to October 1997. They were 5 men and 2 women ranging from 63 to 78 years of age (mean, 72.7 years). All patients were operated with a median sternotomy only. There was one operative death, which was ruptured case. However, there were no major complications in non-ruptured cases. This retrospective study suggests that it is possible to repair the distal aortic arch aneurysm through a median sternotomy approach alone, when 1) descending aorta originates with normal size just distal to sacciform aneurysm, 2) the maximum diameter of the aneurysm is over 70mm and 3) distal involvement of the aneurysm does not extend beyond the bifurcation of the trachea. It is useful to retract descending aorta proximally by three threads with pledget for distal anastomosis in inclusion technique.

Hybrid revascularization by MIDCAB and stent was performed in a 70-year-old man for reperfusion in the treatment of graft stenosis after CABG. The right SVG, which supplied coronary blood flow, was immediately under the median incision site, and was approached safely by the present method. After intervention, bleeding in the left thoracic cavity occurred, but this was treated conservatively. During intervention after cardiac surgery, transient heparinization of blood was performed for prevention of coagulation. Since strong anticoagulative treatment was continued thereafter, the patient was easily bled. Therefore, it appeared preferable to take time after cardiac operation or insert an indwelling drainage tube into the pleural cavity to monitor hemorrhage. The present method appears useful for patients undergoing re-operation or of high risk.

A 76-year-old man was admitted to our hospital because of sudden upper abdominal pain and shock status. The patient had undergone Miles' procedure with a colostomy on the left lower abdomen due to rectal cancer at the age of 70 years. CT scans revealed a thoracoabdominal aortic aneurysm. In view of the clinical findings, ruptured aneurysm requiring emergent operation was diagnosed. A left spiral skin incision was made, keeping away from the colostomy. An extraperitoneal approach was selected. The thoracoabdominal aorta was replaced with an artificial graft under partial extracorporeal circulation with femoral arterial and venous cannulation. The postoperative course was uneventful. No paraplegia occurred in spite of no reconstruction of the intercostal arteries due to severe atherosclerotic changes of the aortic wall. The fact that bleeding due to ruptured aneurysm was localized in the extrapleural and extrapritoneal spaces seemed to be an advantageous factor for the success in this case.

Direct coronary artery reimplantation to the aorta and mitral valve repair were successfully performed in a 29-year-old female with Bland-White-Garland syndrome (BWG syndrome). Under cardiopulmonary bypass, the main pulmonary artery was completely transected and the left coronary artery was excised with a cuff of pulmonary artery wall. Then the left coronary artery was directly anastomosed to the ascending aorta. Mitral regurgitation was repaired with valvulo-annuloplasty. The post operative course was excellent.

A 44-year-old man was given a diagnosis of severe ischemic heart disease and Leriche's syndrome. He had critical ischemia in the lower extremities and ischemic gangrene in a toe of the left foot. We planned a one-stage operation for these fatal diseases. To prevent irreversible ischemia of the lower limbs after mobilization of internal thoracic arteries or during extracorporeal circulation, we performed aorto-ilio femoral bypass grafting with extra-peritoneal approach first. Then conventional coronary artery bypass grafting was carried out for three coronary arteries with bilateral internal thoracic arteries (ITAs) and the saphenous vein. The postoperative course was uneventful.