A 58-year-old man was admitted with a complaint of exertional chest discomfort. A mass, 53×55×66 mm in size, was detected in the transverse sinus of the pericardium, just cranial to the inter-atrial septum with enhanced chest CT. We performed resection of the tumor under cardiopulmonary bypass. Histopathological findings showed that the tumor was angiomyolipoma originated from the heart. Angiomyolipoma is a benign tumor, most frequently found in the kidney or liver and usually associated with tuberous sclerosis. Extra-cardiac growth of the cardiac angiomyolipoma is extremely rare, and only few have been reported previously.

Objective: In recent years, the Ministry of Health, Labor and Welfare has actively promoted the use of generic drugs.  However, implementation of this policy has not progressed smoothly, and generic drug companies suggest that this is because medical staff and patients are not properly informed.  We examined pharmacists’ knowledge and opinions concerning generic drugs.
Methods: We conducteda questionnaire survey to determine community pharmacists’ opinions and understanding with regard to generic drugs.
Results: About 90% of pharmacists were apprehensive about the use of generic drugs.  All pharmacists scored low on factual questions, answering an average of 40 % correctly.  The question about the bioequivalence evaluation method in particular was poorly answered.  However, pharmacists’ anxiety about using generic drugs was not related to their knowledge.
Conclusion: Our findings suggest that community pharmacists lack sufficient knowledge about generic drugs.  It is therefore necessary to educate them on the use of generic drugs.  Also, in order to allay pharmacists’ fears, it is important to improve the comprehensiveness of information concerning generic drugs.

A 54-year-old female had left femoral incarcerated hernia. One month later, she received a radical operation for it, but was admitted to our hospital twice because of ileus. Various tests showed no mechanical intestinal obstruction, but small-intestinal edema. She was transferred to our department to receive Kampo medicine. She could not eat any food and her weight decreased from 47 to 37.5 kg. We therefore administered intravenous hyperalimentation. She had a cold sweat on her face and was prone to bed rest because of severe abdominal pain as if in labor, and general fatigue. Her skin was dry, her radial pulse was weak and her abdominal tonus was weak. In addition, lower abdominal tension was more intense than upper and we could observe bowel movements from her skin. At first, we administered bushikobeito, but it had no effect. Referring to her abdominal findings, we considered that daikenchuto and tokikenchuto were compatible in her case, and after changing to chukenchutokatoki her abdominal pain disappeared in 5 days. Thus, Kampo medicine was effective for post-operative pseudo-obstruction.

The aim of this study is to report the results of the workshop which was designed to define several indispensable conditions for the implementation of the compulsory clinical training. These conditions discussed include the guarantee of position and improvement of labor conditions for trainees, standard for the authorization of institutions receiving trainees, training curricula and teaching staff of institutions, and the certificate of qualification for the trainees after the compulsory training. The products of the workshop showed plans and guidelines to these conditions as seen in this paper.

The aim of this study is to report and analyze the results of a questionnaire concerning the present programs for the junior residents in the postgraduate clinical course in Japan.
A questionnaire was sent to the administrators or the persons in charge of the programs of 347 institutions including 80 university hospitals and 267 clinical training hospitalsas designated by the Ministry of Health and Welfare.
Answers to a questionnaire were returned by 271 institutions (78.1%). The results were analyzed and summarized as follows.
(1) About 95% of both university and clinical training hospitals have their own programs at present.
(2) In the substantial formula of programs, university hospitals have had straight or rotation form while the clinical hospitals have selected rotation or super rotate (comprehensive) form.
(3) The programs of university hospitals have started in majority before 1992 while those of clinical hospitals have began after 1993.
(4) The programs of university hospitals have contained the clinical training at the other departments or institutions in a significantly higher ratio compared to those of clinical hospitals.
(5) The check system for the evaluation of the programs has well functioned in half of both hospitals.
(6) For the assessment of the programs used, about half of the staffs of both university and clinical hospitals feel unsatisfactorily in their active programs.
(7) Concerning the intention to renewal or modification of their programs used, there were rather passive agreements in both university and clinical hospitals.

A 76-year-old man with a history of total esophagectomy and retrosternal gastric tube reconstruction for esophageal cancer was transferred to our hospital because of consciousness disorder. It became an emergency operation on diagnosis of Stanford type A acute aortic dissection on enhanced CT. Because CT showed the retrosternal gastric tube ran along the right side of the body of the sternum through the back side of the manubrium, we opted for skin and the suprasternal incision on the left side from center. We could perform total aortic arch replacement without the damage of the gastric tube except that the right side of the operative view was slightly poor. We did not recognize digestive organ symptoms such as postoperative passage disorders nor mediastinitis. The patient was discharged from our hospital on postoperative day 24.

A 68-year-old man was referred to our hospital for mitral valve stenosis, tricuspid valve insufficiency and atrial fibrillation. We performed mitral valve replacement, tricuspid valve plasty, and the MAZE operation through a right small thoracotomy under endoscopic assistance. He was discharged uneventfully 7 days after the operation. However, about 2 months later, he developed pericardial effusion, right pleural effusion, and leg edema implying as having right heart failure. Although he was treated with diuretics and steroids, improvement was temporary and he was hospitalized repeatedly. Cardiac catheterization demonstrated dip and plateau pattern of the right ventricular pressure curve. We diagnosed that he has constrictive pericarditis, although the finding of the chest CT was non-specific without remarkable thickening or calcification of the pericardium. We performed pericardiectomy through median sternotomy without pump assist. Leather-like thickening of the pericardium was recognized in the right, anterior, and inferior portion. Resection of the thickened pericardium led to instantaneous improvement of right ventricular motion and drop of central venous pressure. The patient is in NYHA Class I, one year after pericardiectomy. Constrictive pericarditis could occur even after minimally invasive surgery, and that possibility should be kept in mind if intractable right heart failure persists.