We developed a problem-oriented simulation system for medical diagnosis which works on personal computers without special equipment. In this simulation system the history of illness can be presented by voice, and physical findings are presented audiovisually through the student's actions, in a manner that closely resembles an actual medical examination. The laboratory findings are also presented through the student's actions. Students compile a database with information that they collect, create a problem list, and devise an initial diagnostic plan for the patient's most important problem. This computer-assisted system will help medical students learn diagnostic strategies in a simulated clinical setting. We believe that this system is a promising method that will facilitate problem-oriented learning in the virtual multimedia environment with special convenience for medical students to share time and facilities and to lower costs.

　A system for Physiology Educator Accreditation was established by the Physiological Society of Japan in 2013 and then implemented. The accreditation process starts by the applicant participating in the education program during the society’s annual meeting, after which the applicant’s teaching and research experiences are reviewed. The education program consists of model lectures to learn teaching skills and lectures to obtain up-to-date knowledge about physiology. The main purpose of the system is to provide an opportunity to obtain a wide range of knowledge and skills for physiology teaching for teachers working at medical universities and universities of life sciences and for young researchers aiming for a tenure-track academic position.

We report a relatively rare case of syphilitic aortic aneurysm that was treated by reconstruction with interposition of a prosthesis. The patient was a 72-year-old woman who presented with an abnormal shadow on chest radiograph and an abdominal pulsatile tumor. Aortography revealed double aneurysms in the descending thoracic and infrarenal abdominal regions, combined with a left common iliac artery aneurysm. Microscopic examination revealed an inflammatory infiltrate within the adventitia and destruction of the elastic fibers in the media, classical features of syphilitic aortitis. The incidence of double aortic aneurysm is expected to increase in the future, and one of the many problems involved in the management of this disorder is the correct timing for safe surgery. We prefer simultaneous surgery to secondary surgery, since this rules out the possibility of rupture of the remaining aneurysm. In order to perform this operation safely, it is necessary to treat the patient's general condition with regard to the surgical procedure and possible adjevant therapy.

Fourteen patients with 22 solitary aneurysms of the iliac artery were operated in a 16-year period (1983 to 1999). Patients were divided into two groups. The non-ruptured group consisted of 6 patients who underwent surgical intervention before aneurysm rupture, and their mean age was 78.5 years. The ruptured group consisted of 8 patients who underwent surgical intervention for aneurysm rupture, with a mean age of 68.5 years. Although seven patients underwent emergency surgery for aneurysm rupture, less than half of them were operated upon within 24hr after the onset of aneurysm rupture. The average size of aneurysms was similar in the two groups (common iliac artery aneurysms: non-ruptured 47mm vs. ruptured 44mm in diameter, internal iliac artery aneurysms: non-ruptured 55mm vs. ruptured 55mm). Two patients died in the ruptured group, in which the operative mortality rate was 25%. Six patients (75%) of the ruptured group had hypovolemic shock, and two of them died during surgical repair. Of the patients with shock, two patients had intestinal ischemia after operation. Intestinal ischemia was one of the serious complications of ruptured iliac aneurysms. These results suggest that in patients with shock from ruptured iliac artery aneurysms, strategy for treatment is an important determinant of the outcome.

Primary malignant tumors of the heart are rare and are associated with very poor survival. We retrospectively analyzed early and late results for five primary malignant tumors of the heart. There were two operative deaths and two late deaths, and the mean survival of patients who survived operation was 18.3 months. No operative survivors had symptoms of congestive heart failure during follow up period. One patient who underwent histologic biopsy received postoperative chemotherapy and is alive without recurrence 36 months after operation. The operative mortality of primary malignant tumors of the heart was high and unsatisfactory, however, surgical treatment prevented congestive heart failure during follow up and contributed to the selection of postopeative therapeutic options, with or without complete resection of the tumors.

We report a successfully treated case of double valve replacement for mucopolysaccharosis in a 27-year-old woman. Mucopolysaccharosis had been suspected since she was aged 11. Symptoms of heart failure and chest pain suggested valvular disease and she was referred to us. Echocardiography, aortography and cardioangiography showed aortic regurgitation (grade IV/IV) and mitral regurgitation (grade III/IV). She received double valve replacement and was discharged on the 38th postoperative day with symptom improvement. Although urinalysis was positive for heparan-sulfate, this case could not be diagnosed definitively as mucopolysaccharosis due to normal lymphocytic enzyme-activity. However, large amounts of mucopolysaccharoid deposits were present in her removed aortic and mitral valve leaflets, and her clinical picture corresponded with mucopolysaccharosis. Thus, it was considered that her ultimate diagnosis was combined cardiac valvular disease due to mucopolysaccharosis.

Case: We report the case of a female in her sixties with inoperable gastric cancer in which continuous bleeding from the cancer resulted in severe anemia and the need for frequent repetitive blood transfusions. In order to control the hemorrhage, radiation therapy of 30 Gy/10 fractions to the cancer was conducted. Her tarry stool soon stopped, her hemoglobin level increased and transfusion became unnecessary. One month later, gastric rebleeding derived from the marginal area of the radiation field occurred. Additional radiation therapy of 24 Gy/8 fractions was given and successful hemostasis was obtained. The patient has been well without transfusion for four months. Conclusion: It is difficult to control bleeding from advanced gastric cancer if the tumor cannot be resected. Endoscopic hemostasis is not always applicable. Interventional radiotherapy (IVR) can be indicated for arterial bleeding. However, the indication of this treatment is controversial in cases of continuous venous bleeding, as seen in our case. Successful hemostasis by radiation therapy was obtained without severe complications in our case. Therefore, it is conceivable that radiation therapy to resistant venous bleeding from unresectable advanced gastric cancer upon careful consideration of complications is a useful treatment modality.

A 49-year-old man who had no history of cardiac disease or intravenous drug abuse was referred to our hospital complaining of fever despite antibiotic chemotherapy. Blood culture was positive for Streptococcus agalactiae, and transesophageal echocardiography revealed vegetation attached to the tricuspid valve and moderate tricuspid regurgitation. Two-thirds of the anterior leaflet and a part of the posterior leaflet of the tricuspid valve were excised with the vegetation, and the remaining anterior leaflet was sutured to the posterior leaflet after annular plication. DeVega's annuloplasty was added to a diameter of two fingers. Following this procedure tricuspid regurgitation was minimal.

A 51-year-old man underwent arch replacement for a thoracic aortic succular aneurysm in December 1996. The pathological examination indicated aortitis to be the cause of the aneurysm. At that time we did not surgically treat the abdominal aortic aneurysm (AAA) which was only 32mm in diameter. Sixteen months after the first operation, he complained of a pulsatile tumor in his left leg. Angiography revealed an aneurysm of the left superficial femoral artery. The artery distal to the aneurysm was occluded, and the left popliteal artery received collateral blood flow from the deep femoral artery. The size of the AAA increased to 48mm, an indication of repair. Aneurysmectomy of the left superficial femoral artery and replacement of the abdominal aorta were performed simultaneously. The operative findings showed that the aneurysm of the left superficial femoral artery had been ruptured and formed a pseudoaneurysm. The pathological findings demonstrated both aneurysm aortitis. After the second operation, he was given steroid therapy to control the inflammatory reaction and he has been well for one year.