1.Mid-Term Results of Off-Pump Coronary Artery Bypass Grafting Assessed by Multi-Slice Computed Tomography
Seijiro Yoshida ; Yoshio Nitta ; Katsuhiko Oda
Japanese Journal of Cardiovascular Surgery 2004;33(4):227-230
Off-pump coronary artery bypass (OPCAB) has recently increased in popularity, but the longterm results are still unknown. We evaluated the mid-term results of OPCAB surgery using multi-slice computed tomography (MSCT), which is a non-invasive postoperative evaluation method. Thirty-one consecutive patients who underwent OPCAB surgery at least 2 years prior to the study were selected. The age was 50 to 79 years (66.9±6.5) and the ratio of men to women was 26: 5. Coronary angiography was performed in all patients at 2 weeks postoperatively. The follow-up was complete, and mean follow-up was 30.9 months. There were no hospital deaths and 1 non-cardiac late death. The graft patency rate in coronary angiography was left internal thoracic artery (LITA) 30/30 (100%), right internal thoracic artery (RITA) 2/2 (100%), radial artery (RA) 14/15 (93%), saphenous vein graft (SVG) 15/17 (88%). No graft became occluded on MSCT study and all patients have been angina-free during the follow-up period. We suggest that OPCAB is feasible in most patients with good patency and low mortality. MSCT is an effective follow up method for the morphological findings and noninvasive quantitative evaluation of the bypass grafts.
2.Total Aortic Arch Replacement with Open Stent-Grafting of Descending Thoracic Aorta for Chronic Type A Dissecting Aneurysm after Replacement of the Ascending Thoracic Aorta-A Case Report-
Junetsu Akasaka ; Yusuke Tsuru ; Yoshio Nitta ; Goro Takayashi ; Koichi Tabayashi
Japanese Journal of Cardiovascular Surgery 2003;32(3):168-171
A 74-year-old woman underwent ascending aortic replacement due to acute type A dissection 2 years previously. She received total aortic arch replacement with open stent grafting of the descending thoracic aorta for enlargement of the residual aortic dissection in the aortic arch and descending thoracic aorta. Operative method and, intra- and post-operative protective method of spinal cord are reported and discussed.
3.Medical education and graduate-entry program in Australia
Shuji TOHDA ; Yoshio NITTA ; Osamu FUKUSHIMA ; Nobuo NARA
Medical Education 2008;39(6):367-369
1) We visited four universities in Australia where both graduate-entry and undergraduate-entry programs are adopted.
2) Although there is not clear difference in the outcome between the two programs, preference for graduate-entry program was recognized.
4.Report of the First Trial of Nationwide Common Achievement Test-Computer-Based Testing in Medicine
Yoshio NITTA ; Nobuo NARA ; Tatsuki ISHIDA ; Osamu FUKUSHIMA ; Nobuhiko SAITO ; Yasuichiro FUKUDA ; Fumimaro TAKAKU ; Tatsuo SATO
Medical Education 2004;35(2):111-118
The first trial of common achievement test-computer-based testing was held from January through August 2002. The number of examinees was 5, 693, of whom 5, 676 were analyzed. Single-best-answer, five-choice questions were used. The highest score was 92 points, the lowest score was 19 points, and the average score was 55.9±10.2 points (standard deviation). Scores were distributed normally. The test sets did not differ significantly in difficulty, although test-set items differed for each student. The percentage of correct answers, the ∅-coefficient, and the point-biserial correlation coefficient were calculated for each category of the model core curriculum. The percentage of correct answers was highest in category A of the model core curriculum, and percentages of correct answers were similar in categories B, C, D, E, and F. The ∅-coefficient and the correlation coefficient were low in categories A and F and were highest in category C. Although the percentage of correct answers in this trial was lower than expected, many test items had discriminatory power. The Test Items Evaluation Subcommittee is now evaluating test items, determining pool items, and revising new test items for the second trial and expect to compile a useful item bank.
5.Analysis of the Questionarre for Nationwide Common Achievement Test System for Entering Clinical Clerkship in Japan
Nobuo NARA ; Tadashi ABE ; Ken TAKAMATSU ; Yoshio NITTA ; Osamu FUKUSHIMA ; Takao MORITA
Medical Education 2006;37(1):3-7
Nationwide common achievement test system for entering clinical clerkship will formally start from December 2005. Before the start, four times trial examination were carried out. Based on these trials, some problems for the test sytem were pointed out. We have analysed the problems proposed to induce more suitable examination system.
6.Trends of graduate-entry programmes in the United Kingdom
Hiroshi NISHIGORI ; Osamu FUKUSHIMA ; Yoshio NITTA ; Tadahiko KOZU ; Toshiya SUZUKI ; Nobuo NARA
Medical Education 2008;39(6):370-372
1) We reported recent movement to graduate entry program (GEP) of medical education curriculum in the UK by both interviewing faculty members who are in charge of GEP and doing literature review.
2) In GEP, we may be able to make better doctors in short term.However, as long term outcome is not known so far, further discussion is necessary.
3) Many contents can be improved by just curriculum change, not by introducing GEP.Besides it can be said that GEP can make diverse doctors.
7.Rapid Expansion of the Descending Thoracic Aortic Aneurysm and Aneurysm-Induced DIC Following Total Arch Replacement with a Long Elephant Trunk
Ken-ichiro Takahashi ; Yuji Maruyama ; Takahide Yoshio ; Motoko Morishima ; Takashi Nitta
Japanese Journal of Cardiovascular Surgery 2017;46(3):130-133
A 74-year-old woman presented to our hospital with complaints of dysphagia. On examination, we diagnosed extensive thoracic aortic aneurysm and esophageal compression due to a descending thoracic aortic aneurysm. We planned a two-stage approach for repairing the extensive thoracic aortic aneurysm ; the first stage involving the repair of the ascending and arch segments, and the second stage involving the repair of the descending aorta. In the first stage, we performed the Bentall procedure and total arch replacement with a long elephant trunk. Following this, her dysphagia resolved, although the size of the descending aortic aneurysm was the same as that before the procedure (49 mm in diameter). We decided to treat her conservatively in the outpatient clinic without the second stage, because the descending aorta was asymptomatic and not sufficiently large. One year later, she presented with a sudden recurrence of dysphagia and swelling of buttocks. She was diagnosed with an expansion of the descending aortic aneurysm (62 mm in diameter) and a hematoma in the gluteal muscle due to aneurysm-induced disseminated intravascular coagulation (DIC). After emergency admission, she underwent a successful thoracic endovascular aortic repair and was discharged following a smooth recovery from dysphagia and aneurysm-induced DIC. We report this case along with a review of the literature.
8.Problems in Preparing Multiple Choice Questions for Computer-based Testing Used in the Nationwide Common Examination before Clinical Clerkships
Nobuo NARA ; Yoshio NITTA ; Tatsuki ISHIDA ; Osamu FUKUSHIMA ; Eiji GOTOH ; Nobuhiko SAITO ; Yasuichiro FUKUDA ; Fumimaro TAKAKU ; Tatsuo SATO
Medical Education 2003;34(5):335-341
In 2002, Japanese medical students began computer-based testing (CBT) to assess their basic and clinical medical knowledge, based on the model core-curriculum, before starting clinical clerkships. Of 9, 919 multiple choice questions submitted by 80 medical schools, 2, 791 were used for CBT and 7, 128 were rejected. To improve the quality of future CBT, we analyzed why questions were rejected. The most commons reasons were difficulty, length, and inappropriate choice of answers. A training course may be needed to improve the ability of medical school staff to devise questions.
9.Suppression of Neointimal Hyperplasia by External Application of Cilostazol-Eluting Film at Anastomotic Sites in a Canine Model
Tomoaki Kagatani ; Katsuhiko Oda ; Satoshi Kawatsu ; Naotaka Motoyoshi ; Syunsuke Kawamoto ; Junetsu Akasaka ; Yoshio Nitta ; Yoshikatsu Saiki ; Atsushi Iguchi ; Koichi Tabayashi
Japanese Journal of Cardiovascular Surgery 2010;39(4):162-171
Neointimal hyperplasia is the principal mechanism of graft failure in coronary artery bypass surgery. Systemic administration of cilostazol has been reported to suppress neointimal hyperplasia in some vascular injury models. We sought to deliver cilostazol locally in an attempt to augment its beneficial effect to inhibit neointimal hyperplasia at an anastomotic site. We examined whether the external application of a novel cilostazol-eluting film can inhibit neointimal hyperplasia in a vascular anastomosis model. Canine femoral artery graft interposition was performed in 20 beagle dogs, assigned to 4 groups of 5 dogs each : a graft interposition without copolymer of L-lactide and ε-caprolactone (P (LA/CL) ) film (control group) and groups with P (LA/CL) film containing cilostazol of either 10 mg, 40 mg, or 80 mg doses. All the cilostazol-eluting film with 10 mg, 40 mg, and 80 mg dose groups had a reduced intima/media ratio compared to the control group (0.15±0.03, 0.11±0.03, and 0.12±0.03, vs. 0.31±0.03, p<0.05). Immunohistochemical analyses for proliferating cell nuclear antigens revealed reduced cellular proliferating activity associated with decreased α-actin positive cells in the cilostazol-eluting film groups compared to the control group. External application of cilostazol-eluting film can inhibit neointimal hyperplasia, at least in part, by inhibiting smooth muscle cell proliferation in the intima.
10.Effect of Workshops for Preparing Multiple-Choice Questions for Computer-Based Testing Used in the Nationwide Common Examination Before Clinical Clerkships
Nobuo NARA ; Nobuhiko SAITO ; Shu KURAMOTO ; Eiji GOTOH ; Hiroaki NAKAJIMA ; Osamu FUKUSIMA ; Saburo HORIUCHI ; Toshimasa YOSHIOKA ; Yoshio NITTA ; Tatsuki ISHIDA ; Takeshi ASO ; Yasuichiro FUKUDA ; Fumimaro TAKAKU
Medical Education 2005;36(1):11-16
Computer-based testing (CBT) has been used in Japan since 2002 to assess medical students' basic and clinical medical knowledge, based on the model core-curriculum, before they start clinical clerkships. For effective CBT, multiplechoice questions must accurately assess the knowledge of students. Questions for CBT are submitted by all medical schools in Japan. However, only 40% of questions are chosen for CBT and used at random; the other 60% of questions are rejected because of poor quality. Toimprove the ability of medical staff to devise questions, workshops were held at 30 medical schools. The acceptance rate of questions from schools where workshops were held was significantly increased. The workshops were extremely effbctive for improving the quality of questions.