Traditional East Asian medicines, Kampo included, are to be incorporated into International Classification of Diseases11 (ICD-11) which will be released in2015.To understand the significance of this plan, ICD itself needs to be understood. In this article, we describe ICD history, its significance and problems, and why the WHO became interested in traditional medicine. In the beginning, the ICD was only for classifying causes of mortality, and has since expanded to cover disease information according to the diverse needs of a changing society. And in Japan today, it is widely used not only for death certificate and disease information, but also for research purposes. There are many problems with the ICD, however:e.g. it is not clinically convenient, and it lacks certain terminology. Revision from IDC-10 to ICD-11 is now ongoing. It will be expanded and electronic. At the same time, plans are to have it broadly implemented in Asia by including traditional East Asian medicine.

1) Osaka City University Medical School provides basic life support courses in the Skills Simulation Center. Most instructors are members of the Life Support Club, a medical students' extracurricular activity.2) We investigated the numbers and opinions of participants(December 2006 through July 2008). The numbers of trainee and instructors were 1071 and 1223, respectively. The student instructors considered their activities worthwhile.3) The trainees highly appreciated the student instructors and showed that the effectiveness of training was excellent. Our results show that basic life support courses taught by medical students are beneficial for both trainees and student instructors.

The first case was a 67-year-old woman. She had been given a diagnosis of fulminant myocarditis and received a biventricular assist device as a bridge to recovery. A Nipro ventricular assist device (VAD) was implanted into her left heart. She was also found to have moderate aortic insufficiency before the operation, so she received aortic valve replacement (AVR) with a bioprosthetic valve (CEP Magna Ease 21 mm) at the same time. Her cardiac function recovered gradually. Therefore, a weaning operation was scheduled for three months after the VAD implantation. However, her left ventricle motion was very poor when she was taken off of the extracorporeal circulation after removing the VAD, and transesophageal echocardiography (TEE) revealed severe bioprosthetic valve stenosis. When her heart was stopped again and the bioprosthetic valve was observed, the leaflets of the bioprosthetic valve were fused. Commissural fusion of bioprosthetic valve was able to be released using forceps, and the punnus extending under the leaflet was removed. In this way, the function of the bioprosthetic valve was restored. Her cardiac motion became good, and removal from extracorporeal circulation was easily achieved. She left the hospital 100 days after weaning from the VAD. The second case was a 68-year-old woman. She also had fulminant myocarditis. She underwent biventricular assist device implantation and AVR (CEP Magna Ease 19 mm). Her cardiac function recovered, and a weaning operation was scheduled on the 73rd-postoperative day. Preoperative TEE before the weaning of VAD showed severe bioprosthetic valve stenosis. The commissural fusion of the bioprosthetic valve was released and the punnus extending under the leaflet removed at the same time as the VAD was removed. Re-valve replacement was not required. We should therefore consider the possibility of bioprosthetic valve stenosis when VAD implantation and AVR with a bioprosthetic valve are performed at the same time in patients with an extremely reduced cardiac function.