Videotape feedback reportedly improves communication skills in students learning to conduct medical interviews. We carried out a study of videotape feedback in the undergraduate training program of the department of neuropsychiatry. To evaluate the interviews, we used objective structured clinical examinations and feedback from interviewed patients. The students showed several shortcomings, such as passive investigation into symptoms, past history, family history and explanatory models; poorly expressed empathy; unclear summation; poor explanation about what interviewees should do after the interview; and infrequent use of specific probes and silence skills. Feedback from patients was more favorable than that from instructors. Because our program asking psychiatric patients to participate as interviewees seems to have both advantages and disadvantages, using simulated patients would be helpful for examining the validity of our program.

A 65-year-old woman was admitted with a diagnosis of unstable angina after PTCA. She was diagnosed with acromegaly 8 years ago. She underwent an emergency coronary artery bypass grafting (LITA-LAD, SVG-HL-Cx). Serum growth hormone (GH) levels were 65.5ng/ml (normal limit<5ng/ml) before the operation. During a cardiopulmonary bypass GH levels elevated to 92.7ng/ml, but decreased to 15.9ng/ml after the operation. After 3 postoperative days GH levels increased gradually again and blood sugar levels became unstable. Finally it was necessary to increase the dose of bromocriptine. To our knowledge, there are only a few patients who have undergone coronary artery bypass grafting associated with acromegaly. This case suggests it is important to control GH levels at the operation and during the postoperative period.

A 71-year-old woman underwent mitral valve replacement with Carpentier-Edwards Pericardial Xenograft for mitral regurgitation on January 8, 1987. She had nocturnal hematuria and paroxysmal nocturnal hemoglobinuria was diagnosed in November, 1992. She had congestive heart failure in February, 1993. Cineradiographical analysis revealed a fracture of the wireform in three locations of the Xenograft and the stent was distorted inward. A second mitral valve replacement was successfully performed on March 16, 1993. She was discharged 45 days after operation after an uneventful course.

A 31-year-old woman complained of dizziness. Preoperative aortogram revealed a saccular type of aneurysm of the aortic arch and abnormal origin of the left subclavian artery. She underwent reconstruction of the aortic arch through 4th intercostal thoracotomy on August 10th, 1996. The aneurysm originated distally to the left common carotid artery and its wall was very thin. Aortic arch replacement with woven Dacron prosthesis was performed between the left common carotid artery and the left subclavian artery using the inclusion method under hypothermic circulatory arrest. The post operative course was uneventful. Cystic medial necrosis of the aneurysmal wall, and normal arterial findings of the left femoral artery were recognized by the pathohistological examinations. Kinking of the aorta is a congenital disease due to abnormal embryonal development. The aortic arch elongates between the left common carotid artery and the left subclavian artery, and arch aneurysm originates in this portion, because the aneurysmal wall is very thin and fragile when accompanied with cystic medial necrosis. Therefore, it is important that the left subclavian artery originating distally to the arch aneurysm in this category of the aortic arch aneurysm be recognized. There are 11 cases which were successfully operated for aortic arch aneurysm associated with congenital kinking of the aorta in Japan.

Between March 1976 and February 1996, 17 patients underwent surgical treatment for cardiac myxomas. There were 5 men and 12 women with a mean age of 55 years (range: 22 to 78 years). The location was the left atrium in 13, right atrium in 2, right ventricle in 1 and multiple locations in 1. Since 1978 the standard operative method to treat left atrial myxoma has been a biatrial approach with complete removal of cardiac myxoma and partial resection of the atrial septum. There were no perioperative deaths, but 1 patient had a permanent pace-maker implantation, 2 had transient atrial fibrillation during the early postoperative period, and 1 had acute pulmonary edema after resection of a right ventricular myxoma. There were two late deaths, not related to cardiac event and one recurrence with multiple myxomas. Overall with long term follow-up, the actual survival rate at 10 years was 75% (n=6), with a mean follow-up of 7.1 years, with a 100% follow-up ratio (17 patients). We conclude that the biatrial approach with complete removal of the left atrial myxomas and partial resection of the atrial septum is one of the best procedures for surgical treatment.

Objective: This retrospective study was conducted to investigate whether medical students have ever bandaged patients' limbs, whether they feel confident in their ability to bandage, and whether their bandaging skills are adequate.Methods: The study included consecutive fifth-year medical students who had not been taught bandaging knowledge and skills. In total, 232 students (163 men, 69 women) participated in the study. Prior to the practical session, the students' experiences and confidence in bandaging were assessed. During the practical, an evaluator assessed the students' bandaging skills, determining the correct application of bandages and assigned a numerical score. Correlations were analyzed using the Chi-square test.Results: Of the medical students in this study, 60% had not bandaged a limb by their fifth year, and 91% lacked confidence in their bandaging ability. Only 32% of students could correctly apply a bandage with a perfect score. No significant relationships were identified between experience and bandaging skill (P = 0.64) or confidence and bandaging skill (P = 0.36).Conclusions: Bandages must be applied perfectly to prevent loosening and contamination of the wound. Nevertheless, most medical students had not bandaged a limb, lacked confidence in their bandaging abilities, and were unable to correctly apply a bandage. It is imperative that medical educators teach bandaging skills to medical students and provide ample opportunities for practice.