Because Japanese high school graduates have poor basic English skills they have difficulty acquiringduring the 6 years of medical school English skills sufficient to write medical papers in easily understood English and to converse with foreign medical researchers at international medical conferences in fluent English. In an attempt to improve English teaching in medical schools we analyzed the structures of sentences in high school English textbooks and compared them with those of sentences in more advanced English, as in the journals Science and Nature. We found that the English in high school textbooks has significantly lower subordination ratios. Thus, we propose that English with higher subordination ratios be taught in the 1st year of medical school.

Objective (1)To study the change of fetal middle cerebral artery pulsatility index (PI_MCA) in twin pregnancy; (2)To compare the singleton and twin pregnancies with regard of changes in PI_MCA over the course of the pregnancy. Methods Fetal middle cerebral artery flow velocity waveforms were measured in 34 cases of normal twin pregnancies and 176 cases of normal singleton pregnancies from 23～35 gestational weeks. Results PI_MCA in twin pregnancies exhibited a decrease trend toward the gestation. Before 29 weeks' gestation the PI_MCA in twin pregnancies was lower than that of the singleton pregnancies,and it was rather higher than that of the singleton pregnances after 29 weeks'gestation. Conclusions The vascular resistance in middle cerebral artery after 29 weeks of gestation was higher in twin pregnancies than that of the singleton pregnancies.

Between May in 1988 and October in 1990, simultaneous coronary artery bypass grafting (CABG) and valve surgery was performed in 14 patients. Nine patients received arterial graft conduit for CABG (AG group) and only saphenous vein graft (SVG) was used in 5 patients (SVG group). In AG group, mean age was 63.3 years and the number of distal anastomosis was 2.2/patient. In valve operation, valve replacement was performed in 5 and valve plasty was in 4, and the mean aortic cross clamping time was 116min. As AG, internal thoracic artery (ITA) was used in 8 and right gastroepiploic artery (RGEA) was in 4. Among them concomitant use of ITA and RGEA was in 3, and the use of SVG was in 5. In two patients, the AG pedicle did not reach to either left anterior descending or obtuse marginal artery and the SVG was used as a graft conduit. Between AG group and SVG group, there were no significances in the age and aortic cross clamping time. However, postoperative use of cathecholamin was in three (33%) in AG group and three (60%) in SVG group and there were significant differences between them. In AG group, there were no operative deaths and the late NYHA improved to class I in 4 and class II in 5. In simultaneous CABG with AG and valve surgery, the improvement of symptom was good and stable operative result was obtained, however, the length of the pedicled graft should be carefully considered for coronary anastomosis.

A 50-year-old man was diagnosed as having aortic valve insufficiency, complete occlusion of the right coronary artery and 75% stenosis of the left main trunk due to syphilitic aortitis. Aortic valve replacement and coronary artery bypass grafting to three vessels were successfully performed. The selection of surgical procedures for the coronary lesion with syphilitic aortitis should be made carefully, since the progression of aortic root inflammation in the acute phase and the development of atherosclerotic changes are not preventable in the future. It is most important to select effective and safe surgical interventions, especially for patients with such a low cardiac function as our patient.

Effects of three plant extracts (Hordeum vulgare L., Apocynum Venetum L., Brasenia schreberi J.F.G mel.) on human gingival fibroblasts were examined. As a result, we observed the promoting effect of the extract of Hordeum vulgare L. and the extract of Apocynum Venetum L. respectively on FGF2 and FGF7 production. Moreover, the mixture of the three plant extracts showed the effect of improving the changes in type I collagen gene expression and matrix metalloproteinase 1 gene expression by LPS addition. Next, a dentifrice containing the three plant extracts was subjected to human efficacy trials. We measured periodontal pocket depth, attachment level, bleeding on probing and saliva TNFα as an indicator of periodontal disease. The results suggest that the dentifrice formulated with the three plant extracts were effective for the improvement of periodontal disease.

A 78-year-old man underwent successful removal of a contaminated pacemaker in a case of methicillin-resistant Staphylococcus aureus (MRSA) septicemia. Septicemia was due to a subcutaneous abscess at the site of old cut electrodes. Following debridement of the infected pacemaker pocket, residual leads and the pacemaker system were removed under cardiopulmonary bypass. Bacterial examination of arterial blood and vegetation attached to the leads showed septicemia caused by MRSA. After the operation, antibiotic therapy with vancomycin, arbekacin and minocycline was performed for several weeks. His postoperative course was uneventful without the recurrence of infection. In cases of pacemaker contamination, with septicemia, total removal of the pacemaker system and adequate antibiotic therapy are necessary.

The preoperative pulmonary arterial pressure of 38 patients aged over 50 undergoing surgical closure of a secundum atrial septal defect was studied. They were divided into three groups according to systolic pulmonary arterial pressure (PAP): Group A (PAP<30mmHg, n=14), Group B (30≤PAP<50mmHg, n=16), and Group C (PAP≥50mmHg, n=8). The mean age of group C patients was older than that of group A patients. With higher PAP, the Pp/Ps, Rp/Rs and cardiothoracic ratios increased, atrial fibrillation and heart failure (NYHA≥2) were more frequent, and PaO₂ levels declined. There were no differences in left to right shunt ratio and Qp/Qs among the three groups. The PAP and Rp/Rs were under 70mmHg and 0.30, respectively in all patients. High pulmonary blood flow seems to be the cause of pulmonary hypertension in most elderly patients because PAP and Rp/Rs decreased after surgery in all groups. Findings of cardiomegaly and heart failure also improved after surgery. Surgical intervention is recommended even in elderly patients with a ASD.

A 61-year-old man was found to have an abdominal aortic aneurysm (AAA) during follow-up for ischemic heart disease. On admission, ultrasonograms and computed tomograms revealed a thickened aortic wall surrounded by a soft tissue (so-called mantle). The obstructive right anterior brain artery and stenotic right internal carotid artery were also detected by angiography. Coronary angiography demonstrated multiple stenotic lesions of the coronary arteries. The excised AAA was replaced with an prosthetic graft. The mobilization of the adjacent viscera was kept as little as possible in order to prevent injury to them. We reported a case of “inflammatory” abdominal aneurysm associated with various atherosclerotic lesions.

A non-anastomotic false aneurysm occurred in a 77-year-old male 11 years after bypass grafting between the left external iliac artery and the right femoral artery using a Cooley double velour knitted Dacron graft. The false aneurysm was caused by rupture of an artificial graft. A partial resection of the graft and its replacement using a Hemashield^® graft were successfully performed. It was speculated that the mechanical stress by the inguinal band degenerated graft fibers and developed aneurysmal formation.

As of 2011, about 12.8 million people in Japan had osteoporosis, which is a social issue in that it increases the number of patients who are bedridden or require residential care and its poor prognosis increases the mortality rate. We delivered a presentation on osteoporosis prevention to residents;the presentation consisted of ultrasound bone densitometry readings followed by a slide show, based on the readings. This report summarizes the presentation and considers whether it was effective in enhancing awareness of osteoporosis. The presentation was given to 39 residents, who were asked to complete a questionnaire before and after it. Of the 31 female respondents, 16.1 percent had bone density in the “low or caution” range;for all eight male respondents, it was “sufficient” or “average.” After the presentation, over 90 percent of respondents selected “agree” or “slightly agree” in response to the statements “I want to have regular exercise and participate in sports,” “I want to eat nutritionally sound meals,” and “understanding one’s bone density is useful for the prevention of osteoporosis.” In addition, 97.4 percent of the residents responded that the lecture was “useful” or “somewhat useful,” and 94.9 percent indicated satisfaction with it. The presentation was considered to be useful in enhancing residents’ awareness of osteoporosis.