IABP has been widely used as a circulatory assist device since introduction of the percutaneous insertion method. However, vascular complications associated with IABP have remained a high incidence. We developed a new sheath for IABP insertion to maintain the lower limb perfusion in the patients with tortuous or stenotic iliofemoral arteries. The new sheath has an internal diameter of 12Fr, an outer diameter of 14Fr and has 10 side holes which serve as an internal shunt. The new sheath used for IABP presented good lower limb perfusion in three patients with tortuous or stenotic iliac arteries who presented limb ischemia with an ordinary IABP sheath. The internal shunt sheath may also be useful for diagnosis of lower limb perfusion by injection of contrast medium into a side port of the sheath in cases of leg ischemia suspected after insertion of IABP.

We treated six patients with torsade de pointes (TdP) initiated by the prolonged QT interval in our hospital over the past five years. All the patients were on antiarrhythmic therapy ; one received procainamide, one received aprindine, one received pirmenol and the remaining three patients received disopyramide. In three of the six patients, the serum drug levels were within or below the therapeutic range. Three patients had hypokalemia as another precipitating factor. Two patients developed TdP after a long-term administration of the drugs. Great care must be exercised just in case TdP showed be developed by a conbination of precipitating factors even after the long-term administration of these antiarrhythmic drugs.

Environmental contamination caused by the organochlorine pesticides (OCPs), such as BHC and DDT, as well as polychlorinated biphenyls (PCBs), is an important problem because of their accumulation in human bodies due to their high lipophilic properties and high chemical stability. In this study, we have investigated the actual condition of the BHC, DDT and PCB levels in the plasma of farmers in the three districts of Japan and in China. At the time of the blood sampling, about 10years had passed since the use of OCPs was forbidden in Japan, whereas OCPs were being used in China.
The blood samples were collected from following 4 districts:(a) Northern Kyushu (N =67), (b) Tomishiro in Okinawa prefecture (N=24), (c) Yokote in Akita prefecture (N = 36) and (d) Harbin in China (N =21).
The results are as follows:
1) β-BHC was detected in all of the 148 plasma samples with the range of 0.9-48.4 ppb. Percentage of the samples with the β-BHC level higher than 20 ppb was 2%(3 samples) for the Japanese and 57%(12 samples) for the Chinese.
2) p, p'-DDT and p, p'-DDE were detected in all samples and total-DDT was ranged from 2.4 to 49.9 ppb. Percentage of the samples with the total-DDT level higher than 20 ppb was 43%(9 samples) for the Chinese and 8%(10 samples) for the Japanese. DDT level of Chinese was significantly higher than those of farmers in Northern Kyushu and Yokote.
3) PCBs were detected in all of the Japanese samples (n=127) with the range of 1.1-22.8 ppb. Whereas the PCB level of 15 samples of Chinese women was less than 1.0 ppb and that of other 4 samples of Chinese men was higher than 10 ppb.
From these results, regional difference in the residue of OCPs and PCBs in Japanese was discussed, besides the difference in that of OCPs beteween Japanese and Chinese was discussed in relation to the history of the use of OCPs.

Six patients with malignant retroperitoneal tumor extending into the inferior vena cava (VCI) were surgically treated with use of a normothermic extracorporeal circulation (ECC). Origin of malignant tumor was renal cancer in four, adrenal cancer in one and seminoma in one. Four patients excluding two of renal cancer had metastasis to the lung or bone preoperatively. One of renal cancer with lung metastasis and invasion to the colon died six months after surgery. The remaining five patients have been alive and well with follow up of 1 year to 7 years (mean 3 years 3 months). Cytological examination of an arterial filter of ECC and intra-circuit blood was made and negative in two patients. Long term results and cytology revealed a rare chance of intraoperative dissemination of malignant cells. These results suggested feasibility of surgery using normothermic ECC for the treatment of malignant retroperitoneal tumor with extension into VCI.

A China-Japan joint project was carried out to study the incidence of fluorosis caused by coal burning in China from 1995 to 1997.
The health survey covered a control area and two flourosis areas. In those research areas, drinking water was not polluted with fluorides. The survey was designed to analyze the health status of people exposed to fluorides and evaluate the relationships between the dose and incidence of fluorosis. The concentration of airborne pollutants in both indoor and outdoor air was measured. The concentration of fluoride in the urine was analyzed and definite diagnoses for dental fluorosis and skeletal fluorosis were determined.
As a result, the incidence of coal burning fluorosis was confirmed in studied areas. Moreover, the fluorosis was caused not only by the direct inhalation of the airbone fluorides in indoor air but also by the intake of cereals polluted with fluorides. Fluoride was contained in both coal and soil. Therefore the mixture of coal and soil used for the adjustment of fire energy contributed to the air pollution to a great extent. The typical polluted crops were red pepper, corn and potato. An extremely high concentration of fluoride in the urine of residents in the polluted areas was detected.

The committee of continuing medical education in Japan Society for Medical Education discussed on PRA of American Medical Association [AMA]. We have first analyzed the brochure of PRA for the members of AMA, and then prepared the questionnaire for AMA. We were able to obtained the answers to the questionnaire which were sent to AMA through courtesy of Japanese Medical Association (JMA). It was realized that AMA emphasizes an importance of PRA for medical practice to the patients; nevertheless acquisition rate of PRA is actually low, and so AMA proceeds with efforts towards completion of PRA.

The aim of this study is to clarify the present situation of activities of continuing medical education (CME) for the primary care physicians to whom the leading hospitals, such as universities and clinical trainee hospitals perform CME in their regions. A questionaire was designed for main 4 parts, as following: 1) On the purpose of CME for the physicians. 2) On the organization (office) managing CME in the hospitals. 3) On the strategies of CME. 4) On the evaluation of CME. Answers to a questionaire were replied from 234 institutions (58.1%). Analyzing the results, we recognized that the leading hospitals actively carried out CME for the primary care physicians in the community. Furthermore, conversion to experiential learning from passive learning and establishment of evaluation methods should be promoted in CME.

Because new media have come onstage in the information technology period, also self-learning methods have been diversified. Recently, small group discussion such as clinical conference using the mailing list is lively performed among the primary care physicians, and it is considered to be useful for continuing medical education. To promote the mailing list for continuing medical education, we present as follows; 1) present situation: to show a good example of TFC-ML (total family care-mailing list), 2) usefulness: to know new medical knowledge, new medical information and literatures etc., to discuss clinical cases. 3) issues: a role of moderator, excess of information, correspondence with slander, 4) future: to reevaluate usefulness for continuing medical education. We would like to expect effectiveness of mailing list for continuing medical education.