Osaka City University Medical School is now radically reforming its undergraduate curriculum for clinical medical education. Over the next 2 years, lecture will gradually be decreased from 773 to 433 sessions (each session lasting 105 minutes) by introducing organ-based integrated lectures, while practical clinical training will be increased to 15 months and classical bedside teaching will be replaced by clinical clerkships. A new teaching building to be completed by April 1998 will contain many rooms and facilities for students to study alone or in groups. Such innovations became possible only after continuous cooperation and planning by the newly organized curriculum committee and its subcommittees.

To evaluate clinical courses at teaching hospitals outside of Osaka City University Hospital, we used a questionnaire to ask instructors and sixth-year students about practical problems immediately after the end of the semester. This course was conducted for 7 weeks during the first semester at 24 hospitals and for 5 weeks during the second semester at 23 hospitals. In each semester about 40% of clinical practice at teaching hospitals was done in the style of clinical clerkships. About 90% of students were mostly or completely satisfied with their instructors and hospitals. Furthermore, about 70% of instructors felt more or less fulfilled by working with students and about 60% of them felt working with students was rewarding. More than 95% of instructors would be willing to teach medical students again. In conclusion, most instructors and students felt that clinical courses at teaching hospitals outside of Osaka City University Hospital were conducted without problems.

No abstract available.
Foramen Magnum ; Meningioma* ; Spinal Canal*

The authors have treated eight cases of trigeminal neurinomas for the past thirteen years. We have been treating these tumors in accordance with the principle of radical resection through one-staged operation. Three were male and five were female. The age ranged from 25 to 56 years with the mean age of 41.5 years. One was a case of von Recklinghausen's disease. Topographically, the tumors were mainly located within the middle fossa in two cases, within the posterior fossa in two, and extended both supra- and infratentorially in four cases. Facial pain and hearing disturbance were the main symptoms and various other symptoms such as focal seizure, hemiparesis, gait disturbance, symptoms of increased intracranial pressure and visual disturbance were also noted. Surgical operations were performed in all cases. As a surgical approach, either transpetrosal-transtentorial or orbitozygomatic-infratemporal route was employed. The choice of the better approach depends on the topography of the tumor. Total removal was performed in all cases. Only one case, which was an early one in this series required second operation to remove the tumor completely. In one case, the tumor recurred five years after the operation. There has been no operative mortality, but the injury or permanent damage to the trigeminal branches was inevitable in many cases. Surgical results were excellent in three, good in four, and fair in one case.
Facial Pain ; Female ; Gait ; Hearing ; Humans ; Intracranial Pressure ; Male ; Mortality ; Neurilemmoma* ; Neurofibromatosis 1 ; Paresis ; Seizures

Presented here is an extremely rare case of intradural extraosseous chordoma with tenacious adhesion to the pons During the 5 years' follow-up period, the tumor has recurred locally twice in the prepontine region despite radical excisions and final irradiation with gamma knife. Magnetic resonance image obtained 1 year after radiosurgery demonstrated a new intradural mass growing above the tentorial hiatus, whereas the mass within the pons was markedly reduced. High resolution computed tomographic scan showed no evidence of bone involvement. Even though intradural location without bone involvement is a relatively benign occurrence, the recurrent pattern suggests an aggressiveness that correlates classic chordoma because of its invasion to the pons. Adjuvant radiotherapy will be required in this case for a long-term control.
Chordoma* ; Follow-Up Studies ; Pons ; Radiosurgery ; Radiotherapy, Adjuvant ; Recurrence