Aortic dissection with multiple familial members is rare. It is commonly associated with Marfan syndrome. Several authors have reported familial aortic dissection without Marfan syndrome. We encountered 4 cases of aortic dissection in a family. The aortic dissection occurred in the mother and all of her children. No case had clinical manifestations of Marfan syndrome or other connective tissue disease. Histopathological examination of the aorta did not show cystic medial necrosis in 2 operated cases. Many members in the family had systemic arterial hypertension. The presence of multiple incidence of aortic dissection in one family suggests underlying connective tissue disease, irrespective of the absence of typical features of Marfan syndrome. Therefore we propose that other close relatives as well as the members with aortic dissection should be followed-up in the same way used for families with typical connective tissue disease like Marfan syndrome.

Objective.-To survey a broad sample of Japanese internists regarding the effects of postgraduate training on their ability to provide ambulatory care.
Design.-Analysis of internists trained at university or non-university hospitals (as designated by the Ministry of Health and Welfare) by written questionnaire.
Results.-74.0% of respondents (127 in total) had undergone ambulatory care training. 30.7% were trained in outpatient clinic sessions that were held more than once a week on average. 85.8% of respondents said they recognized the differences between ambulatory care and inpatietn care. Furthermore, the percentage of respondents who understood such differences during their postgraduate training periods was higher in the group that had had ambulatory care training than the group that had not. Many respondents also suggested the necessity of training in non-internal medicine specialties (e. g. dermatology, OB-GYN, otolaryngology, orthopedics, urology and ophthalmology) that were not popular postgraduate training programs.
Conclusion.-Postgraduate training had a large effect on the ability of internists to provide ambulatory care. Japanese postgraduate training is still not sufficient in this regard. Residency training programs should put more emphasis on ambulatory care.

Our previous study concerning evaluation methods of postgraduate clinical training showed a usefulness in improving clinical training, especially in the fields of clinical skills and knowledge. However, it also pointed out the unsolved problem of assessment of those behaviors in which no significant differences were shown throughout the residency period. In order to solve this problem, a feedback system has been introduced, consisting of self-evaluation during the residensy, and appropriate counseling regarding hortcomings.
In the present study, the effect of this feedback system on clinical training, particularly on physician behavior, has been analyzed. The study was performed by comparing evaluation scores, based on a five-point scale, from two groups: 35 residents who did not undergo the feedback system, and 84 residents who had. Clinical skills, knowledge, positiveness, behavior with patients and colleagues, and patients' records, were each evaluated after discussions by the teaching staff.
Our results showed that there was a significant improvement not only in clinical skills and knowledge, but also in physician behavior in the group using the feedback system. Thus, it appears that this feedback system is useful in improving postgraduate clinical training.

A cross-sectional study was carried out to investigate the effect of physical exercise in daily lives of healthy women on the aging process in terms of maximal aerobic capacity (VO₂max), body fat tissue mass (FTM), lean tissue mass (LTM), bone mineral density (BMD), serum triglyceride (TG), total cholesterol (TC), HDL-C and LDL-C concentrations, and systolic (SBP) and diastolic blood pressure (DBP) . These parameters are considered as risk factors of cerebrovascular disease and/or osteoporosis, which are the main causes of becoming bedridden and demented in middle-aged and older women. One hundred sixty-five healthy female volunteers aged 20 to 76 years participated in the study, 82 of whom were postmenopausal with a mean age at menopause of 49.7±3.1 years. Eighty-two of the subjects had been exercising regularly by jogging, swimming, aerobic dancing, or playing tennis more than twice a week for 2 years (Ex group), whereas 83 individuals had not been engaging in regular exercise (Cont group) . Serum lipid concentrations, SBP and DBP measurements at rest and treadmill VO₂max and HRmax measurements were determined in the morning after an overnight fast. Whole-body BMD (TBMD), head, lumbar, arm and leg BMD, FTM and LTM were measured by dual-energy X-ray absorptiometry one to two hours after a light lunch. The mean and SD of each measurement were calculated for five-year age groups between 40 and 60 years and one group each under 40 and over 60 years.
The results were as follows:
1, VO₂max (r=-0.590) and HRmax (r=-0.632) decreased significantly with age. The VO₂max of the Ex group was significantly higher than that of the Cont group in all each age groups. However, no differences in the aging process in terms of HRmax were found between the two groups.
2, Resting SBP (r=-0.391) and DBP (r=0.315) increased significantly with age. However, no hypertensive individuals (160/95 mmHg-) were found among the 165 subjects.
3. Only serum TC (r=0.346) and LDL-C (r=0.339) among the blood constituents measured changed with age. No changes in serum HDL-C were detected with age. Lower TC (189.2±23.3 mg/dl) and higher HDL-C (72.2±10.9 mg/dl) were observed in eleven runners (49.7±7.7 years) among the subjects who participated frequently in official races than in subjects of the same ages in the Cont group. The highest serum HDL-C (75.8±15.8 mg/dl) and HDLC/TC ratios (0.362) were noticed among the subjects (n=26) who both regularly exercised and consumed alcoholic beverages.
4. A tendency for FTM to increase and LTM to decrease with age were observed in both groups, and a lower %FTM (percentage of FTM to body weight) and higher %LTM were evident in the Ex group. Differences in %FTM and %LTM between the Ex and Cont groups at 40-45 years were significant.
5. Partial and whole BMDs decreased significantly with age (TBMD-Age ; r=- 0.527) . Significantly higher leg BMDs in both the 20-39-year and 40-45-year groups, and spine and TBMD in the 20-39 years in the Ex group, who were premenopausal women, were shown. No significant differences in BMDs between the two groups were observed in postmenopausal women, but the Ex group tended to have higher partial and whole BMDs. The postmenopausal official race runners (n=5.52.6-1.5years) also had higher TBMD and leg BMD values than subjects of the same ages in the Cont group.
6. Investigation of correlations between VO₂max, LTM, FTM, BMDs and serum lipid concentrations, yielded a significantly higher correlation (r=0.669) between LTM (kg) and absolute VO₂max (1/mm) . Although VO₂max per LTM (VO₂max/LTM) decreased with age (r=-0.595), VO₂max/LTM in the Ex group was significantly higher than in the Cont group in each age group. The VO₂max per body weight (ml/kg/min) was negatively correlated with %FTM (r=-0.442) and positively correlated with

Ischemic heart disease (IHD) poses a major complicating factor for abdominal aortic aneurysm (AAA) repair. To identify patients with IHD, we evaluated patients scheduled to undergo AAA repair with dipyridamole-thallium scintigraphy (DTS) and coronary angiography (CAG). If indicated, coronary revascularization was performed. Finally, an assessment of the effectiveness of these preventive measures was made. One hundred and ten patients scheduled to undergo AAA repair were identified and treated accordingly over a 20-year period. As the pre-operative evaluation and prophylactic surgical revascularization strategies were instituted in 1983, the patients were divided into 2 groups: 25 patients between 1973-1982 (group A) and 85 patients between 1983-1992 (group B). The mean age of patients in group A was 65.3 years. The male/female ratio within this group was 21:4. One patient in the group had a history of IHD and 9 had hypertention. The mean age of patients in group B was 67.7 years. The male/female ratio within this group was 77:8. Fourteen patients in this group had a history of IHD and 27 had hypertension. Screening and treatment of IHD in group B was as follows. All patients with a history of IHD underwent CAG. Of the 32 patients with cardiac risk factors, including hypertension and hyperlipidemia, or ECG abnormalities who underwent DTS, 8 were referred for CAG. Thirty-nine patients with no risk factors and a normal ECG proceeded to AAA repair without further workup. Perioperative myocardial infarction occurred in 2 patients in grouzp A, leading to death in 1 patient. Coronary revascularization was performed in 5 patients in group B. No perioperative myocardial infarction occurred in this group. Pre-operative identification of high-risk cases with DTS, CAG, and coronary revascularization in patients with IHD may prevent cardiovascular complications in patients undergoing AAA repair.

PURPOSE: Monomeric IgE molecules, when bound to the high-affinity receptor, exhibit a vast heterogeneity in their ability to induce survival promotion and cytokine production in mast cells. At one end of this spectrum, highly cytokinergic (HC) IgEs can induce potent survival promotion, degranulation, cytokine production, migration, etc., whereas at the other end, poorly cytokinergic (PC) IgEs can do so inefficiently. In this study, we investigated whether IgEs recognize autoantigens and whether IgEs' binding of autoantigens correlates with difference s in HC versus PC properties. METHODS: Enzyme-linked immunosorbent assays were performed to test whether IgEs bind antigens. Histamine-releasing factor in human sera was quantified by western blotting. Cultured mast cells derived from human cord blood were used to test the effects of human sera on cytokine production. RESULTS: Most (7/8) of mouse monoclonal HC IgEs exhibited polyreactivity to double-stranded DNA (dsDNA), single-stranded DNA (ssDNA), beta-galactosidase, thyroglobulin and/or histamine-releasing factor. By contrast, mouse PC IgEs failed to react with these antigens. A human monoclonal HC IgE also showed polyreactivity to histamine-releasing factor, dsDNA and ssDNA. Interestingly, sera from atopic dermatitis patients showed increased reactivity to ssDNA and beta-galactosidase and increased levels of histamine-releasing factor. Some atopic dermatitis patients, but not healthy individuals, had substantial serum levels of HRF-reactive IgE. Sera from atopic dermatitis patients with high titers of DNA-reactive IgE could induce several fold more IL-8 secretion in human mast cells than sera from healthy individuals. CONCLUSIONS: The results show that most HC, but not PC, IgEs exhibit polyreactivity to autoantigens, supporting the autoimmune mechanism in the pathogenesis of atopic dermatitis.
Animals ; Autoantigens ; beta-Galactosidase ; Blotting, Western ; Dermatitis, Atopic ; DNA ; DNA, Single-Stranded ; Enzyme-Linked Immunosorbent Assay ; Fetal Blood ; Humans ; Immunoglobulin E ; Interleukin-8 ; Mast Cells ; Mice ; Population Characteristics ; Thyroglobulin

Since the Infection Control Team (ICT) was organized in 1999, our hospital has been engaged in evidence-based operations against nosocomial infections. The ICT's major activities included guidance in preventive measures against infections, surveillance involving continuous environmental monitoring, proposition as regards prescription of antibacterial medicines, and consultation with clinicians about prophylaxis. The team comprising physicians, nurses, pharmacists and clinical laboratory technicians has made expert propositions to clinicians. To be concrete, the team members, with the liaison clerk playing a central role, met with physicians in charge or with other staff members of the hospital, studied the infection cases in question, and presented the study findings to the clinicians. Fundamentally, therefore, it is not that the ICT intervenes in the affairs of the clinical department by way of directions but that it presents clinicians with the ideas gained through discussion between ICT members and physicians and other hospital staffers. While cementing a relationship of mutual trust between hospital employees, the ICT is expected to engage in nosocomial infection prevention activities by joining forces transdeoartmentally.
Clinical ; Hospitals ; Infection Control ; seconds ; Prophylactic