The importance of cooperation among the staffs of various medical specialties has been recognized.However, medical students have little chance to study with students of other specialties.We planned and held an interdisciplinary freshman seminar based on problem-based group learning for health science students.
1) All freshmen entering the Shinshu University School of Medicine were divided into 20 groups and participated in a group-learning program.
2) Students watched video material focusing on medical communication and were asked to investigate and discuss this issue in greater detail to deepen their understanding.
3) Questionnaires filled out by students after the course revealed that most students were satisfied with the program because they could deepen their partnership with students of other specialties but were unsatisfied with the program's tight schedule and the inefficiency of discussions.
4) Many instructors felt that the number of students in each group (12 or 13) was too large for effective group discussion.
5) This program helped students understand the importance of communication in medicine but did not encourage students to study for themselves.

　　This study investigated data on cardiopulmonary exercise testing (CPX) indices in order to estimate exercise intensity and ramp load from maximum walking speed (MWS) in elderly hospitalized patients with acute coronary syndrome (ACS). Subjects were 66 male patients hospitalized with ACS (49 young-old patients and 17 old-old patients). We measured exercise intensity by CPX using a cycle ergometer and MWS over 10 m, and examined the patients’ clinical characteristics. Stepwise multiple regression analysis was performed to identify variables that most closely predicted exercise intensity. We then estimated the ramp load from the relationship between exercise load at anaerobic threshold and MWS. The results indicated that MWS was an independent predictor of exercise intensity in old-old patients (adjusted R²=0.278, p=0.037) but not in young-old patients. The regression formula predicted the proper ramp load to be 5 and 10 watts as MWS was less than 1.5m/s or more than 1.5m/s, respectively. MWS was related to exercise intensity and could be used to consider the ramp load in CPX in old-old male patients with ACS.

1) In 2004, Shinshu University School of Medicine started a program for third-year medical students to experience nursing services during both the day and night shifts. The program included lectures on nursing sciences before practice and debriefing sessions after practice.2) Most students viewed this program favorably and felt that the night-shift training was particular meaningful. They also had favorable opinions about the nurses who taught them.3) Some practical issues remain to be solved, such as security during the night shift and the possible excessive burden upon nurses.

We report a case of unilateral tonic pupil in spinocerebellar ataxia without brainstem atrophy in a 42- year-old man. On neurological examination, he showed cerebellar symptoms and unilateral tonic pupil. Deep tendon reflexes were normal except for brisk patellar tendon reflexes. Brain MRI demonstrated cerebellar atrophy only. There was neither orthostatic hypotension nor bowel and bladder failure. The right pupil constricted from 5.0 mm to 1.7 mm 60 minutes after 0.125% pilocarpine administration, whereas the left pupil did not change, remaining at 3.7 mm. Although it is not proven that tonic pupil is causally related to spinocerebellar ataxia, physicians must remain aware of spinocerebellar ataxia as a disease that can demonstrate tonic pupil.

Purpose: To compare the effects of aging in patients with acute myocardial infarction (AMI) on their clinical background and hospitalization progress, and to examine the relationships between age and these factors.
Subject: One hundred and fifty-three patients who experienced cardiac rehabilitation after percutaneous coronary intervention (PCI) (63.8±11.1 y.o, 126 men, 27 women).
Method: The patients were divided into the middle aged group (<65 y.o, n=84), young old group (65 to 74 y.o, n=44), and old group (75 y.o≥ n=25). The differences between groups were examined in respect of 13 items about clinical backgrounds (responsibility coronary arteries, CKmax, LVEF, residual stenosis, hypertension, diabetes, hyperlipemia, smoking, and BMI) and hospitalization progress (cardiac complications, locomotorium disabilities, abnormality as 200mECG, and duration of hospitalization).
Results: Left veticular ejection fraction (LVEF) was significantly lower in the old group than in the young old group. The old group had a high rate of residual stenosis. In the coronary risk factors, all of the groups had hypertension at a high rate of 54.5% or over. The middle aged group and young old group had diabetes at about 38%. The middle aged group was prone to hyperlipemia, and had significantly a high smoking rate. Body mass index (BMI) was significantly higher in the middle aged group than in the old group. In hospitalization progress, the old group had a high rate of cardiac complications and locomotorium disability. The duration of hospitalization was significantly longer in the old group than in the other groups.
Conclusion: It would be necessary to give middle-aged persons educational guidance for the improvement of the coronary risk factors, and to provide the old persons with the suitable rehabilitation programs considering various complications.