The skin condition of patients with senile pruritus is considered to be in the state of “Kekkyo” in oriental medicine. For the treatment of this disease, “Ho-ketsu-zai” has been primarily used in the past in the therapy of oriental herbal medicine. There have been reports describing “Jyuzen-taiho-to” as effective in healing itchiness among patients with atopic dermatitis, but not very much is known about the results of the use of this drug for the treatment of senile pruritus. I have encountered four cases of senile pruritus, for which the administration of “Jyuzen-taiho-to” extract preparation was effective. These cases included two male and two female patients with an average age of 79 years. In all cases, skin dryness was observed and “Kikyo” and “Kekkyo” were present. To these patients, 1/3-1/2 of the normal dosage of the extract preparation was given, and the effects appeared within two to six weeks. “Jyuzen-taiho-to” seems to be one of the drugs very useful for the treatment of the patients with senile pruritus. The presence of “Kikyo” is suggested as an index for the administration of the drug.

1) The historical development to date of the systems of medical education and medical licensure were reviewed, and the quantitative and qualitative evolution of medical schools was divided into 7 stages.2) In the early Meiji era, persons who had already practiced medicine could apply to receive a medical license. Until the Taisho era, medical licenses were granted either to graduates of medical universities and relevant special schools or to those who passed the national examination. Thus, the criteria for medical license were not uniform during this period.3) Before the end of World War II, medical schools aimed to improve the quality of medical education so that their graduates could receive medical licenses without taking the national examination and to raise their status to the level of universities. However, because the types of medical schools during this period varied and included imperial universities, colleges, and specialty schools, the quality of medical education also varied.4) After World War II, the introduction of the state examination for the license to practice medicine and a new university system standardized medical education to guarantee its quality.5) The quantitative expansion of the medical education occurred mainly in the 12 years after 1919, in the 7 years after 1939 and during the war, and in the 10 years after 1970, and, except for the years of violent change before 1887, the number of medical schools has otherwise remained stable.

A 79-year-old woman with degenerative mitral regurgitation and secondary tricuspid regurgitation underwent mitral and tricuspid repair. Massive and intractable endobronchial hemorrhage occurred during weaning from cardiopulmonary bypass (CPB). Bronchoscopic examination during CPB revealed that the right distal bronchus was the probable bleeding point. We then performed a double-lumen endotracheal tube and a bronchial blocker in the distal portion of the right main bronchus. In addition, extracorporeal membrane oxygenation (ECMO) with a heparin-coating system was performed for 11 h, without extra heparinization because of severe hypoxia. The bronchial blocker was removed 14 h later, and the patient was weaned from ECMO 19 h after admission into ICU. Postoperative computed tomography (CT) revealed a pseudoaneurysm of the right pulmonary artery (A⁵b) corresponding with the probable site of bronchial bleeding (B⁵). We speculate that a pulmonary artery catheter induced this endobronchial hemorrhage. At 3 months after surgery the patient was doing well with no symptoms of airway bleeding, and her abnormal CT findings had disappeared.

We developed a new double-lumen balloon catheter for retrograde cerebral perfusion (RCP) via jugular vein cannulation. Between November 1996 and September 2000, 34 of 73 patients treated with surgical procedures for thoracic aortic aneurysms underwent RCP using the new catheter during circulatory arrest under deep hypothermia. Nine patients underwent a median sternotomy, and 25 underwent a left thoracotomy. In all cases, the new catheter installation under fluoroscopy was easy, and it took about 15min. The mean RCP time, pressure, and flow rate were 26.8min, 20.0mmHg, and 202.6ml/min, respectively. Our procedure using the new catheter was safe and easy in RCP during circulatory arrest in aortic arch replacement regardless of surgical approaches such as a left thoracotomy or median sternotomy.

In this revision, we have attempted to align the Model Core Curriculum for Medical Education competency, "problem-solving ability based on specialized knowledge," with the "Standards of National Examination for Medical Practitioners." The major diseases and syndromes in "Essential Fundamentals" correspond to the basic diseases in Table 1 of the Core Curriculum, symptoms, physical and laboratory examinations, and treatment in "General Medicine" correspond to the items in Table 2 of the Core Curriculum, and the diseases in "Medical Theory" correspond to the diseases in PS-02 of the Core Curriculum. The validity of the diseases in the Core Curriculum was verified using the evaluation results of the examination level classification of the "Research for Revision of National Examination Criteria." Approximately 690 diseases were conclusively selected. This revision mentions the number of diseases in the Core Curriculum for the first time. Hopefully, this will lead to a deeper examination of diseases that should be studied in medical schools in the future.