Infective endocarditis in association with pyogenic vertebral osteomyelitis is rarely observed. We report an 80-year-old man with infective endocarditis and pyogenic vertebral osteomyelitis requiring reoperation due to aortic prosthetic valve dysfunction. He suffered from back pain as the initial symptom, and he was admitted to our hospital. On magnetic resonance imaging, vertebral osteomyelitis was revealed, and antibiotics were started. On blood sampling α-streptococcus was identified and infective endocarditis was diagnosed. He responded to the antibiotic treatment. Despite the improvement in his general condition and the inflammatory parameters of blood samples, the aortic prosthetic valve dysfunction progressed. On echocardiography, aortic regurgitation worsened to 4/4, and the ejection fraction decreased from 72 to 46%. As heart failure was apparent, we performed a redo aortic valve replacement. Tears were found in the leaflets of the removed prosthetic valve (Hancock II). The 21-mm Carpentier-Edwards PERIMOUNT valve (CEP Magna Ease TFX) was replaced. His post-operative course was uneventful, and intravenous administration of ampicillin was continued. Oral rifampicin was also continued. On the 69th post-operative day, he was discharged and was ambulatory. Although we have no evidence that the tissue valve deterioration had resulted from bacterial damage, we were able to confirm that the structural valve deterioration involved bacterial contact in this case. Patients with infective endocarditis and pyogenic vertebral osteomyelitis should be treated cautiously regardless of whether or not the inflammation is controlled.

We analyzed the student self-assessment on education in cardiology using a questionnaire.
Subjects: Ninety-six 5th-year students at Saga Medical School who have completed the lectures and bedside teaching were evaluated.
Methods: A questionnaire survey of 14 topics in cardiology was performed at the finish of 3 weeks of bedside teachings. Self-assessment was categorized into 4 grades; 1) completely understood (3 points), 2) almost completely understood (2 points), 3) could be understood (1 point), and 4) could not be understood (0 point). Self-assessment scores were calculated for each topic in cardiology.
Results: Questionnaires were returned by 88 students (91.7%). Self-assessment scores were high for myocardial infarction, angina pectoris, and electrocardiogram reading. Scores were low for primary care, vascular diseases, and pericardial disease. Self-assessment scores did not significantly correlate with the length of lectures but did correlate with the number of admitted patients (r= 0.93) and scores on achievement tests (r= 0.43) in each topic.
Conclusions: Because students observed many patients with myocardial infarction and angina pectoris during bedside teaching, the self-assessment scores were high. Bedside teaching is important for medical students to understand topics in cardiology.