The Ministry of Health and Welfare inaugurated an official recognition system for spa-based health promotion facilities in 1988 as part of its health promotion program. As a result, those facilities gradually increased across the country until the number of the recognized facilities reached 17 by February 1995.
The Japan Health & Research Institute has performed factfinding surveys on the use of these recognized spa-based health promotion facilities every year from the beginning of the recognition system. This paper reports the survey results obtained during these 5 years.
During the past 5 years, 275 males and 138 females used these spa-based health promotion facilities (with tax deductions applied to madical expenses). The number of male patients was about twice as large as that of female patients. Most males used the facilities because of diseases in the field of internal medicine, and most females, because of diseases in the field of orthopedic surgery.
We are planning to prepare a manual for evaluating the effects of spa therapy and assess the efficacy of spa therapy by including a new survey item of “clinical effects of spa therapy” in a questionnaire for a nationwide survey.

We analyzed inadvertent human errors during 3-day trial examinations for the National Examination for Physicians. Sixth-year medical students sat for 2 different examinations consisting of 500 multiple-choice questions and chose either 1 or 2 correct answers. After the first examination, the students verified their errors and were provided with educational guidance to prevent inadvertent errors.1) More than half of the students made inadvertent errors during the examination.2)The errors occurred when the students solved questions or marked the answer sheets.3) Most of errors were either the selection of the wrong number of answer options (i.e., a 2-choice selection was required, but only 1 choice was selected) or the selection of choices that differed from the intended choices when the answer sheets were marked.4) After the students were taught how to avoid errors, the mean number of errors per examination per student decreased significantly from 2.1 to 1.0.5) To our knowledge, this is the first report to show the educational effectiveness of a method to decrease the rate of inadvertent errors during examinations.

A 64-year-old woman with dyspnea on exertion was referred to our hospital. CT revealed type B aortic dissection with 7cm of aneurysm including a thrombus in the false lumen at the distal aortic arch. Four intimal tears at the distal aortic arch were closed directly during hypothermic circulatory arrest, and the descending thoracic aorta was tailored without a prosthetic graft after fixation of the dissecting adventitia to the intima at the distal portion of the false lumen. The postoperative course was uneventful and this patient was discharged on the 22nd postoperative day. Three years after surgery, the postoperative CT revealed no evidence of dilatation of the descending thoracic aorta as far as the abdominal aorta although the dissection of thoracoabdominal aorta remained. This technique is effective as an surgical option for chronic type B aortic dissection to minimize operative stress and complications.

Objectives : Many reports have investigated the work environment of physicians and reported the association between work environment, burnout, and the quality of medical care. We aimed to determine the key to improving the work environment by analyzing the results of a Japanese survey for young cardiovascular surgeons. Methods : A survey on work environment was performed among the young members of The Japanese Society for Cardiovascular Surgery (≤40 years of age) to measure their job satisfaction for 9 items : operation, perioperative work, number of hours working or sleeping, board affairs (application or renewal of board certification), motivation, salary, days off, quality of life, and mental status. Univariate and multivariate analyses using 16 factors for the work environment (age, number of years in practice, gender, subspecialty, board certification in surgery, board certification in cardiovascular surgery, primary practice hospital, workdays and nights on duty in a primary practice setting, workdays and nights on duty outside primary practice, total annual income, overtime work hours, overtime entitlement, gap in overtime work and entitlement, and presence of an intensive care unit [ICU] managed by ICU physicians) were performed to identify the risk factors for dissatisfaction. Results : The survey was completed by 327 of 1,304 (25.1% response rate) young members of the Japanese Society for Cardiovascular Surgery. The respondents had an average of 8.5±3.5 years in practice, and 292 (89.3%) respondents were male. Only 14.2% of the responding young surgeons reported no dissatisfaction in any items. In all items, the young surgeons were most satisfied with operation (34.6% of all responders). Age, years in practice, female gender, board certification in surgery, working at a university hospital, workdays in a primary practice setting, and workdays outside a primary practice setting were identified as significant factors for dissatisfaction, while a subspecialty in vascular surgery, total annual income, board certification in cardiovascular surgery, and the presence of an ICU managed by ICU physicians were identified as significant factors against dissatisfaction in the work environment. Conclusions : Our analyses of the survey results identified a number of risk factors for dissatisfaction in the work environment among young cardiovascular surgeons. Regarding the quality of medical care, respondents hoped for a reduced burden on surgeons and the establishment of a work-shift system in the cardiovascular department and an interdisciplinary team including an ICU physician. Multidimensional analyses including job satisfaction, rewards as training, and a quantitative evaluation of the quality of medical care will be necessary to clarify the corresponding relationship between consumers and providers of cardiovascular surgery in the work environment.

The case presented is a 76-year-old woman with a ruptured abdominal aortic aneurysm. We tried to pass a Fogarty balloon catheter from the left subclavian artery for proximal occlusion of the ruptured aneurysm but failed to inset the balloon into the descending aorta. Although the aneurysm was safely replaced with a gelatine coated dacron graft, she developed cerebral embolism and never regained consciousness and died two months later. Balloon insertion through the subclavian artery may cause complication through dislodgement of atheromatous plaque and may induce cerebral embolism.

We present a rare case of acute type A dissection which developed compression of the true lumen after starting cardiopulmonary bypass (CPB) with femoral arterial return. In this case, the entry was located in the proximal descending thoracic aorta, and the dissection expanded up to the ascending aorta in a retrograde direction. After starting CPB, the false lumen suddenly enlarged and the true lumen was compressed. We observed those changes by intraoperative transesophageal echocardiography, so the perfusion was stopped immediately. A long arterial cannula (Wessex) was inserted from the left ventricular apex with the tip of the cannula remaining in the true lumen of the ascending aorta, and antegrade perfusion was restarted. After that we could maintain adequate extracorporeal perfusion and the replacement of the total aortic arch was completed uneventfully.

Ten patients, aged 3 to 43 years, with the tetralogy of Fallot underwent in situ pulmonary valve replacement (PVR) 13 times. The implanted valves were a St. Jude Medical prosthesis (3 times) and a bioprosthetic valve (10 times). In 5 patients PVR was performed at the time of radical repair and in the remaining 5 patients PVR was performed after radical repair. Three patients underwent re-PVR at 6 to 13 years after the first PVR. There was one operative death in re-PVR 14 years after the first PVR and one patient died from congestive heart failure 4 years after PVR. In the patients with the tetralogy of Fallot, the rate of PVR in those who had undergone open Brock's operation were significantly higher than that of the patients without open Brock's operation (p<0.05). Actuarial survival rates at 5 years and 10 years were 88.9% and 88.9%, respectively. Rates of freedom from reoperation at 5 years and 10 years were 88.9% and 59.3%, respectively. Although the early operative results are satisfactory, re-PVR is mandatory in the future. Thus the indications of PVR should be considered carefully.

Adult ; Aged ; Aged, 80 and over ; Audiometry, Evoked Response ; Ear, Inner ; Female ; Glycerol ; Humans ; Lymph ; Magnetic Resonance Imaging ; Male ; Meniere Disease ; diagnosis ; Middle Aged ; Young Adult

Surgery for a shaggy aortic aneurysm requires a meticulous strategy to prevent embolic complications since the complications are associated with longer length of hospital stay and higher mortality. However, until now, there are no established treatment options to prevent embolic complications. We report a case of a 75-year-old man with a descending aortic aneurysm and a shaggy aorta who underwent thoracic endovascular aortic repair (TEVAR) with major branch artery protection. During the procedure, we placed balloon catheters in the left subclavian and left common iliac arteries, a filter device in the superior mesenteric artery, and a sheath at the ostium of the right common iliac artery. The patient did not develop embolic or other complications and was discharged on the eighth postoperative day. Our strategy of using the balloon occlusion technique and filter placement at the major vessels effectively prevented embolic complications during TEVAR for a shaggy aorta.