A 71-year-old woman was admitted with severe back pain. She was diagnosed of type A dissecting aortic aneurysm and two-vessel coronary disease by CT scan and angiography. An acute-phase operation was started 32 hours after onset, performing replacement of ascending aorta and a two-vessel bypass. The affected aortic wall was so thin and fragile that the cut ends of these wall were treated with 25% solution of glutaraldehyde, a fastacting crosslinking agent, for 7min. As a result, a sufficient degree of reinforcement was obtained to complete the anastomotic procedure safely. She made a good recovery of cardiac function after the surgery, but was left with such complications as permanent complete atrioventricular block and a little aortic regurgitation. Following pacemaker insertion she was discharged and has returned to her normal activity. It appears that when treating the affected aortic wall with glutaraldehyde, a piece of gauze placed in the left ventricular cavity stopped up the aortic valve by half. As a result, glutaraldehyde was perhaps transferred from the gauze to the aortic valve and a part of the conduction system, causing injury to them. If meticulous care is exercised during the procedure to avoid unnecessary invasion of surrounding tissues, this technique will provide a useful means to accomplish safe anastomoses of cardiac vessels.

1) The faculty development at each medical school from 2003 through 2005 was analysed.
2) The major themes in faculty development were problem based learning, tutorial, computer based testing, and clinical training.
3) Faculty development is considered an effective way to enhance the contributions of faculty members to medical education.

Medtronic Freestyle Stentless bioprosthesis as well as stented bioprosthesis, can lead to structural valve deterioration (SVD) or disruption of the porcine aortic root. Seventeen years ago, a 52-year-old woman with aortitis syndrome underwent aortic root replacement in a full-root fashion for aortic regurgitation (AR) with a Freestyle aortic bioprosthesis. A recent follow-up echocardiogram revealed severe AR due possibly to SVD. Thus, we planned an aortic valve replacement (AVR) for AR with possible leaflet tear of the prosthesis. Upon completion of AVR while the aortotomy was being closed, however, a disruption in the porcine aortic wall was found. Root replacement had to be performed because of this finding. In stentless valve reoperation long after AVR with the full-root method, both the porcine aortic root and leaflets can be disrupted. Aortic root replacement may be necessary if preoperative images reveal dilatation, as well as disruption of the sinus of Valsalva.

Objective: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant B.1.1.529 (Omicron) was first detected in Japan in November 2021. In Osaka, public health centres subsequently increased active case finding and encouraged self-isolation. This study investigated the effectiveness of these countermeasures. Methods: Cases targeted for analysis were persons who had neither recently travelled abroad nor had contact with foreign tourists but tested positive for SARS-CoV-2 between 24 November 2021 and 4 January 2022 and were suspected or confirmed to have the Omicron variant. We performed a descriptive analysis and calculated the reproduction number (R) for each generation using the branching process method. Genomic sequencing data were analysed to plot a haplotype network. Results: A total of 251 cases were analysed. The median age was 30 years, and 46% (115/251) were in their 20s or younger. The first Omicron case in Osaka was detected on 21 December 2021. Local public health centres conducted health monitoring and contact tracing. We analysed R, using information from six clusters, including 42 pairs with a clear relationship between the case and the infected contact (infector–infectee pairs); the clusters had 19, 21 and 2 cases in each subsequent generation. The basic R (t = 0) was estimated to be 3.2, and subsequent generations (t = 1, 2) of R decreased to 1.1 and 0.1, respectively. The haplotype network showed that these cases constituted a monophyletic group with others detected around Osaka, indicating that these case-related clusters had been contained and were not involved in the nationwide Omicron waves. Discussion: Active case finding and self-isolation were found to be effective in limiting the spread of an emerging novel variant.