A 58-year-old man was admitted because of enlargement in diameter of the descending thoracic aorta. Six years previously, he had undergone graft replacement of the proximal descending aorta due to a chronic dissecting aneurysm. During that surgery, distal fenestration involving resection of the intimal flap of the distal anastomotic site and graft replacement with distal anastomosis of the true and false lumen were performed. Our preoperative enhanced computed tomography (eCT) revealed a thoracic aortic aneurysm 58mm in diameter at the site of distal fenestration. Graft replacement through left lateral thoracotomy was considered difficult because of previous occurrence of methicillin-resistant Staphylococcus aureus (MRSA) empyema after the previous operation: hence, endovascular repair was done using a handmade stent graft to interrupt blood flow into the false lumen. The postoperative course was uneventful. Postoperative eCT showed the thrombosed false lumen and the shrinkage of the aneurysm from 58 to 38mm in diameter over a period of 18 months.

The aim of this study is to report the results of the workshop which was designed to define several indispensable conditions for the implementation of the compulsory clinical training. These conditions discussed include the guarantee of position and improvement of labor conditions for trainees, standard for the authorization of institutions receiving trainees, training curricula and teaching staff of institutions, and the certificate of qualification for the trainees after the compulsory training. The products of the workshop showed plans and guidelines to these conditions as seen in this paper.

The aim of this study is to report and analyze the results of a questionnaire concerning the present programs for the junior residents in the postgraduate clinical course in Japan.
A questionnaire was sent to the administrators or the persons in charge of the programs of 347 institutions including 80 university hospitals and 267 clinical training hospitalsas designated by the Ministry of Health and Welfare.
Answers to a questionnaire were returned by 271 institutions (78.1%). The results were analyzed and summarized as follows.
(1) About 95% of both university and clinical training hospitals have their own programs at present.
(2) In the substantial formula of programs, university hospitals have had straight or rotation form while the clinical hospitals have selected rotation or super rotate (comprehensive) form.
(3) The programs of university hospitals have started in majority before 1992 while those of clinical hospitals have began after 1993.
(4) The programs of university hospitals have contained the clinical training at the other departments or institutions in a significantly higher ratio compared to those of clinical hospitals.
(5) The check system for the evaluation of the programs has well functioned in half of both hospitals.
(6) For the assessment of the programs used, about half of the staffs of both university and clinical hospitals feel unsatisfactorily in their active programs.
(7) Concerning the intention to renewal or modification of their programs used, there were rather passive agreements in both university and clinical hospitals.