To increase the safety and effectiveness of clinical clerkships, we have developed a 4-week preclinical training program, “Problem-Based Clinical Training, ” based on the concept of problem-based learning with the aim of encouraging life-long self-directed learning. The first week is a preparation period for clinical practice in which students are trained in problem-solving skills, basic-practice skills, and clinical reasoning. The second and third weeks are a practical training period in which students learn how be in charge of a patient's care. The fourth week was a problem-solving period without practical training in which students learned to solve problems. The students were encouraged to record daily “problem notes” describing problems and “problem solving notes” summarizing problems solved. To emphasize lessons learned, the students also presented and discussed problems. Evidence-based medicine was used as a tool for problem solving. Furthermore, medical record training based on the problem-oriented system using evaluations by other students encouraged self-development to improve clinical practice and the medical record. This curriculum should be effective for mastering the skills of self-directed learning and for motivating for advancement due to consideration of contributable proposals for the patients.

We successfully performed one-stage definitive repair for 3 infants weighing 4.2, 6.1 and 5.2kg with complex coarctation without homologous blood transfusion. The priming volume of the bypass circuits was 195ml, and their lower hematocrit values during cardiopulmonary bypass were 15, 16 and 13%, respectively. In order to diminish the aortic cross clamp time, the aortic arch was repaired with the heart beating, using isolated cerebral and myocardial perfusion methods. The base excess in each patient decreased to -9.4, -8.0 and -4.9mEq/l during the rewarming phase, however, their postoperative hemodynamic and respiratory conditions were satisfactory. They have grown without any sequelae for at least 2 months.

Staged arterial switch operation without homologous blood transfusion was successfully performed in 5 patients weighing 4.1-11.0kg (double outlet right ventricle: 2 cases, transposition of great arteries: 3 cases). The postoperative hemodynamics and respiratory status were uneventful in all patients (initial central venous pressure after ICU admission: 9.0-14.5cmH₂O, mean 12.5cmH₂O, duration of intubation: 3.5-18.0h, mean 7.8h). Autologous blood donation immediately after induction of anesthesia and minimization of bypass circuit were effective methods for open heart surgery without homologous blood transfusion, particularly in staged arterial switch operation requiring prolonged cardiopulmonary bypass.

The routine tuberculosis (TB) surveillance system in Cambodia has been strengthened under the National TB Programme (NTP). This paper provides an overview of the TB surveillance data for Cambodia at the national level for the period 2000 to 2013 and at the subnational level for 2013. The proportion of the total population that were screened for TB rose from 0.4% in 2001 to 1.1% in 2013, while the smear-positivity rate decreased from 28.9% to 8.1% in the same period. The total number of notified TB cases increased steadily from 2000; this has stabilized in recent years with 39 055 cases notified in 2013. The proportion of all TB cases that were smear-positive decreased from 78% in 2000 to 36% in 2013. Case notification rates (CNRs) for all forms of TB and new smear-positive TB in 2013 were 261 and 94 per 100 000 population, respectively. Higher CNRs were found in the north-west and south-east parts of the country and were higher for males especially in older age groups. The increase in TB screening, decline in the smear-positive rate and decline in notified smear-positive TB cases likely reflect a long-term positive impact of the NTP. A negative correlation between the proportion of the population screened and the smear-positivity rate at the subnational level helped identify where to find undiagnosed cases. Subnational differences in case notification of the elderly and in children provide more specific targets for case-finding and further encourage strategic resource allocation.

Clinical research was carried out on stomach cancer cases treated in the surgery department of our hospital, which provides medical services to the populace in the southern part of Fukushima Prefecture.
During the 10-year period between Jan. 1981 and Dec. 1990, a total of 641 cases were referred to surgery. Of the total, 568 cases or 88.6% were operated on and 501 or 78.2% were radical gastrectomy cases.
When a careful check was made on these cases with respect of staging, histology, invasion degree and lymph node metastasis, it was found that the ratio of early stage stomach cancer cases was increasing steadfastly year after year.
Regarding the 5-year survival rate, 63.7% was scored by the operated cases and 73.2% by radical gastrectomy cases. These rates were up by 18.6% and 17.0% from five years ago. The above findings indicate that improvement in treatment results is due to technical progress in detection of gastric cancer at early stages.

In recent years, an increasing number of researchers have warned that depltion of the Earth's ozone layer by chlorofluorocarbons allows extra ultraviolet radiation from space to strike our planet, causing a rise in the incidence of skin cancers and precancerous dermatoses worldwide. This motivated us to perform a series of screening for skin cancers on the inhabitants at age 40 and above of the Saku District, Nagano Prefecture, where the intensity of the sun's harmful ultraviolet radiation is thought to be relatively high.
The first screening was carried out from 1993 through 1995. The number of subjects totaled 7, 528-2, 658 men and 4, 870 women-which represents 7.4% of the populace. Of the total, 67 people had a histopathological examination. The result revealed that there were four cases of malignancy and 45 cases of precancerous dermatosis. The malignant cases were made up of one case of malignant melanoma and three cases of basal-cell carcinoma, while the precancerous cases were one case of Bowen's disease and 44 cases of solar keratosis.
The follow-up examination was conducted in 1996 on 93 subjects (40.6%) of the 229 examiness who had been found to need to be watched in the first screening. Biopsy was indicated in five subjects. Treatment was suggested to 11 subjects. A visit to the department of dermatology at Sake Central Hospital was recommended to 10 people. Further observation was needed in 24 cases.
The screening project for skin cancers under a long-range plan would raise awareness of the diseases among the people and contribute to the early detection, treatment and prevention of various forms of skin cancer. It could also serve the purpose of protecting the environment from deterioration on n global srnle.

This paper describes a clinical review of cases of gastric cancer treated surgically at the Department of Surgery of the Shirakawa Kosei General Hospital, the core medical institution in the southern part of Fukushima Prefecture.
During the period of 20 years from January 1981 through December 2000, a total of 1, 132 cases were operated on for gastric carcinoma. Surgical resection cases totaled 1, 023 (resection ratio: 90.4%); curative resection cases, 894 (curative resection ratio: 79.0%); 5-year survival rate for resection cases, 68.3%; and 5-year survival rate for curative resection cases, 75.6%. When the cases were divided into those treated during the first half of the 20 years nad those treated during the latter half of the 20 years, the number or resection cases was smaller during the latter than during the first half but the resection ratio was larger. The early stomach cancer cases in terms of the degree of progress, histological classification, depth and metastasis to lymph nodes have been increasing and the 5-year survival rate has been on the rise.

A 20-year-old male was referred to our hospital to undergo operative treatment due to aortic valve insufficiency which had gradually worsened. The patient's chief complaint was a loss of breath upon effort which had progressively worsened after undergoing aortic valve plasty (AVP) for aortic valve insufficiency with infective endocarditis at another institution. AVP by the cusp extension method had been performed because of the patient's youth and there had been no change in the morbid state, except for the presence of a non-coronary cusp. In addition, the aortic valve insufficiency was controlable and postoperative course was also excellent. The cusp extension method was therefore considered to be an appropriate procedure for this case since it would allow the patient to return it to a state with a more normal heart, since the valve organization after this procedure would be able to reach a maximum level.

Objective: Both infected subdural hematoma (ISH) and Edwardsiella tarda infections are rare in humans. E. tarda is a motile, facultative anaerobic, gram-negative rod bacterium, which is isolated from fresh or brackish water, but not usually from humans. Extra-intestinal E. tarda infections are rare and might cause severe clinical symptoms. However, ISH caused by E. tarda has not been reported previously. We report the first case of ISH due to E. tarda.Patient: A 76-year-old man was admitted to our hospital with a headache, loss of appetite, and nausea. Computed tomography revealed bilateral subdural hematoma.Results: We performed burr hole drainage. A hematoma with pus was found on the left side and chronic hematoma was found on the right side. Consequently, we diagnosed him with ISH on the left side and chronic subdural hematoma on the right side. E. tarda was detected in a culture from the hematoma with pus on the left side. As postoperative antibiotic therapy, we administered ceftriaxone and metronidazole for 47 days. The patient was discharged with no residual neurological deficit.Conclusion: Our case implied that favorable outcomes can be obtained by drainage and appropriate antibiotic therapy for ISH caused by E. tarda.