With a view to weighing the clinical significance of asymptomatic cerebral infarction, we analyzed the usefulness of the fluid attenuated inversion recovery method in magnetic resonance imaging. The subjects wee composed of 94 outpatients who participated in our screening program for brain troubles. Indications of asymptomatic cerebral infarction were registered on T2-weighted images of 21 subjects (22%) and on FLAIR images of 31 subjects (33%). The FLAIR method, in which the signals from the cerebrospinal fluid are checked, excelled at detecting lesions, especially those under the cerebral cortex which are almost indistinguishable from gray matter and sulci. The subjects with asymptomatic cerebral infarction had significantly many risk factors for stroke including hypertension and hyperlipidemia. Thus, we concluded that the FLAIR method is very useful in diagnosing asymptomatic cerebral infarction.

Using RIBA NS5 antibody was measured in 31 HCV RNA positive serotype 1 patients, and the serum levels of ALT were monitored for an average of three years. As a result, 22 asymptomatic HCV carriers (group A) were found to be NS5 antibody negative (-) and nine to be NS5 antibody positive (4+). By contrast, in 25 patients with chronic inactive hepatitis C (group B), three patients were NS5 antibody negative (-), and 22 patients were NS5 antibody positive (4+), indicating a significant difference between the two groups (p<0.01 chi square test).Furthermore, in group A, 22 NS5 antibody (-) patients (group I) maintained normal serum levels of ALT significantly longer than the 9 NS5 antibody (4+) patients (group II) (p<0.01, Kaplan-Meier Method). Therefore, the measurement of NS5 antibody of RIBA was clinically useful in identifing asymptomatic (HCVRNA positive, serotype 1) HCV carriers.
Antibodies ; Hepatitis C virus ; Absence of symptoms ; Measurement ; Confirmation of

Cardiac fibromas are rare tumors. A 12-year-old girl who had no cardiac symptoms was evaluated because of her abnormal ECG. Physical examination revealed a grade 1/6 systolic murmur. Routine laboratory examination results and the chest X-ray films were normal. The ECG showed a negative T wave at leads II, III, aVF and V_3-4. Two-dimensional echocardiography demonstrated a tumor in the lower right ventricular free wall. Operation was performed on July 12, 1990. Sharp dissection was used to remove the tumor through right ventriculotomy. She had an uneventful postoperative course and is well 7 years later with no evidence of recurrence. Pathological findings including immunohistochemical studies revealed cardiac fibroma. The 22 reported cases of cardiac fibroma in Japan were reviewed.

Left ventricular myxoma is very rare and only 13 cases have been reported in Japan. A 14-year-old girl was admitted to a local hospital in November, 1983, with a sudden onset of right hemiparalysis. Two-dimensional echocardiograms and left ventricular angiograms revealed two left ventricular tumors. The patient was transferred to our hospital for the operation which was performed one month later. Two tumors originating from the apical interventricular septum were removed with resection of the septum through a left ventriculotomy. The tumors were 2.0×1.7cm in size and 1.9g in weight, 1.9×1.5cm in size and 1.1g in weight, respectively. The pathological diagnosis was myxoma. Her postoperative course was uneventful, and there has been no recurrence for 15 years after surgery. Japanese literature on the subject was reviewed.

Urgent surgical repairs were successfully performed in four patients with blunt traumatic ruptures of the thoracic aorta. All 4 patients were involved in traffic accidents and had ruptures immediately distal to the aortic isthmus. The diagnoses were achieved by IV-DSA in case 1, by IV-DSA and enhanced CT in case 2 and by enhanced helical CT in cases 3 and 4. Intraoperative transesophageal echocardiography was performed in case 4. Operations were accomplished with the aid of temporary shunt in case 1, pulmonary-femoral artery bypass in case 2 and partial left heart bypass in cases 3 and 4. Prosthetic graft interposition was performed in cases 1, 3 and 4 and end-to-end aortic anastomosis was performed in case 2. There was no postoperative paraplegia in any patient. Early diagnosis and urgent surgical repair are important in treating blunt traumatic rupture of the thoracic aorta. Enhanced helical CT and transesophageal echocardiography are useful for the diagnosis of this type of injury.

　To improve hospital quality, the development of authorized clinical instructors is urgently needed. Therefore, we held a workshop to develop clinical instructors. At a monthly meeting of the clinical training committee in June 2014, an agenda for holding a workshop was proposed. At the meeting in July 2014, most committee members said they were reluctant to hold a workshop because of heavy clinical duties. However, the hospital president strongly suggested that a workshop might be a foundation for reforming the stagnated hospital and persuaded committee members to hold a workshop to improve the instructors’ skill in teaching residents. At the September meeting, the workshop schedule was discussed. All members of the taskforce, except the chief coordinator and a lecturer, were selected from hospital physicians, and 3 preparatory meetings and 1 rehearsal were held. With the help of administrative staff, our first workshop for clinical instructors was held at Daido Hospital in February 2014. Our workshop helped create new hopes for improving educational tasks at our teaching hospital and improved the educational skills of participants. We also achieved mutual understanding as a team to accomplish a single goal.

　The higher level postgraduate education hospitals are required to have a system with well-developed programs, instruction, and supervision of doctors in clinical training. The Social Medical Corporation Kojunkai Daido Hospital has been maintaining efforts to be a clinical training hospital of excellence.

　In order to nurture supervisory doctors, the first workshop for supervisory doctors in clinical training was held at Daido Hospital on February 22nd and 23rd, 2014. With consciousness reform in mind, interprofessional relations between the many types of medical professional were established.

　Daido Hospital was evaluated by the Japan Council for Evaluation of Postgraduate Clinical Training on December 12th, 2014. It was an opportunity to recognize the need for further improvement as a clinical training hospital.

　On March 7th, 2015 the Objective Structured Clinical Examination for the second year of training doctors in Daido Hospital was held. Clinical training guidance doctors, Nurses, and paramedics learned the skills necessary for the methods and the evaluation in clinical teaching and evaluation.

　Daido Hospital continues making efforts by conducting a review of the clinical training based on the evaluation of the clinical ability of residents, the ability for education and the clinical skill of teaching doctors, and the training environment.

　Social Medical Corporation Kojunkai Daido Hospital is aiming to be the best training hospital. By enhancing seminars in the hospital, we commenced a postdoctoral training program for medical instructors in February 2014 and November 2015. Since we received an accreditation for the clinical training program in 2014, we created an OSCE program on our own for trainees in August 2015 and June 2016. We also collaborated with the University of Nagoya for the OSCE program and held seminars in August 2015 and June 2016. We introduced the EPOC system for the evaluation of trainees in 2014, and Cybouze® for the constructive evaluation of and sharing of information on trainees in April 2016. Our residents obtained high scores for in the examination to evaluate knowledge of trainees held in February 2016, which shows the high quality of our educational program, established by the endless efforts of the educational committee and instructors.