Pseudoaneurysm after the rupture of a coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We report a pseudoaneurysm of the left anterior descending artery (LAD) occurring 3 months post-PTCA, that was successfully treated by off-pump coronary artery bypass grafting (CABG) and ligation. An 84-year-old man underwent urgent PTCA for unstable angina. The LAD ruptured during this procedure, but bail-out was successfully performed by balloon catheter inflation. The patient left the hospital symptom-free. Three months later, he was rehospitalized complaining of angina. Coronary angiography revealed a 10-mm diameter pseudoaneurysm at the site of the LAD rupture as well as restenosis of the LAD and high lateral branch at the previous PTCA sites. Surgical treatment was indicated because of the difficulty in delivering a covered stent within the diffusely stenosed LAD. CABG to the distal LAD with the left internal mammary artery and ligation of the LAD pseudoaneurysm were performed. To reduce perioperative morbidity, CABG was performed without cardiopulmonary bypass. The postoperative course was uneventful, and follow-up angiography revealed a patent graft and no pseudoaneurysm. The patient has continued comfortably for 18 months postoperatively. Because off-pump CABG is less invasive than conventional surgery techniques, we believe it to be a valid option during coronary pseudoaneurysm ligation.

  We require our students in the 4th grade to take an on-site pediatric outpatient clinic course at the Teikyo University Hospital as part of a 4-week on-site training program.  This year, 64 trainees divided into groups of 3 or 4 students took the course between June and August.  In the morning, trainees were asked to conduct clinical interviews with 287 patients’ guardians in the presence of trainers.  This was followed by the observation of consultation and treatment services provided to patients.  In the afternoon, students reported the findings obtained in medical interviews, participated in group discussions, and received supplementary lectures from trainers.  After completing the course, students were asked to fill in a questionnaire.  When asked whether they were satisfied with the course, 62.5% and 37.5% of students said “very satisfied” and “satisfied,” respectively, while 64.1%, 29.7%, and 6.2% of students said the observation of consultation and treatment services was “very good,” “good,” and “cannot say which,” respectively.  About the medical interviews, 64.1% and 34.4% said that it is “very good” and “good” to conduct them, while 1.5% said “cannot say which.”  All students said they could determine the problems faced by guardians regarding drugs in the medical interview.  The on-site pediatric outpatient care course was found to be “very useful” and “useful” by 62.5% and 35.9% of patients, respectively, while 1.6% said “cannot say which.”  In conclusion, most students were greatly satisfied with the medical interview with guardians using a questionnaire and said that it made it possible for them to closely communicate with guardians.  This result was thought to be attributable to the use of the techniques of the medical interview OSCE which the students learned prior to conducing medical interviews with guardians.

Animals ; Apoptosis ; Cell Membrane ; metabolism ; Cell Nucleus ; metabolism ; Colonic Neoplasms ; etiology ; metabolism ; Cyclooxygenase 2 ; physiology ; Cytoplasm ; metabolism ; Female ; Male ; Mice ; Mice, Inbred C57BL ; Piroxicam ; pharmacology ; beta Catenin ; metabolism