Laser-assisted vascular anastomosis (LAVA) of arteries and veins in mongrel dogs was performed using a low-powered carbon dioxide laser. The anastomotic site was irradiated at a point 10mm distal from focus and the beam at this point was 0.8mmφ in diameter. Adequate laser power for anastomosis was 160-200mW for arteries and 120-160mW for veins, and the required duration of radiation was 5-10sec per 1mm anastomotic length for both vessels. In arteries successful anastomosis was achieved by LAVA in 44% of transverse incisions and 65% of longitudinal incisions, compared to 65% and 95% for veins, respectively. LAVA ruptured at a pressure of 102±28mmHg on average in arteries and 77±24mmHg in veins. However, LAVA reinforced with etyl 2-cyanoacrylate were safe at high pressures more than 300mmHg in arteries. Follow up has been achieved in 99 anastomotic sites for 9 months. No stenosis, occlusion, thrombus or infection were found apart from one (1%) pseudoaneurysm formation 4 months after LAVA. Angioscopic views and histological findings of anastomotic tissue welded by mean of LAVA revealed good layer-to-layer continuity of the three-layer structure of arterial wall. LAVA seems to be a useful method for vascular anastomosis.

A pilot study of the Doppler renal arterial flow pattern was done on 34 patients (68 kidneys) with benign prostatic hypertrophy, 14 patients (28 kidneys) with hydronephrosis and 22 patients (37 kidneys) with reflux nephropathy. Renal scintigraphy was also performed besides the color Doppler scanning.
Results:
Mean minimum blood flow values were significantly smaller in all the subjects than those in normal control groups with one of the three diseases respectively
In patients with reflux nephropathy, minimum blood flow values were extremely low, suggesting the severe scars and scarce blood flow. A high correlation was found between uptake rates measured by renal scintigram and minimum blood flow. This fact suggests that the blood flow scan can reveal the profile of the renal function.
We conclude that the color Doppler sonography is useful in a routine initial examination and a simple follow-up test for detecting renal dysfunction in some urological diseases.

In a 3 year-old girl with acyanotic tetralogy of Fallot, preoperative echocardiography revealed a thick fibrous tissue hanging on the right side of large ventricular septal defect. According to the definition of Kirklin, we diagnosed it as “flap valve ventricular septal defect.” And this diagnosis was supported by the findings of electrocardiogram and cardiac catheterization. At the operation, it was confirmed that the flap was only attached to the posterior margin of ventricular septal defect, and that it hardly played any part in tricuspid valve function. To our knowledge, this is the first case of “tetralogy of Fallot with flap valve ventricular septal defect” reported in Japan.

Little is studied about traditional healers‘ perceptions toward and practice of uvulectomy, which is known as a traditional surgical practice mainly in Africa and which sometimes results in severe complications. This study aimed to clarify the perceptions toward and practice of uvulectomy and the other traditional healing practices of traditional healers in a Congolese refugee camp in Tanzania. Interviews were conducted with 149 traditional healers, comprised of 59 registered, 68 non-registered and 22 faith healers. A total of 1.7% of the registered healers and 8.8% of the non-registered healers had ever conducted uvulectomy on children (a median of 2 months to a median of 3 years of age) and had received cash or domestic fowls equivalent to US$1-3 per operation. Although over 80% of the respondents believed traditional treatments to be more effective than modern medicine, less than 20% considered uvulectomy beneficial and in fact about 40% considered it to be harmful. The respondents raised cough, vomiting, appetite loss and other symptoms as an indication for uvulectomy, and death, bleeding, throat pain and other symptoms as harmful effects associated with uvulectomy. In this camp, the healers also performed other surgical procedures, such as male and female circumcision, tattoos and scarification. In conclusion, only a limited number of the traditional healers believed that uvulectomy is beneficial and performed it on infants and young children, and these were mainly non-registered healers who had relatively little collaboration with modern health professionals. In refugee settings where modern health professionals might not be familiar with traditional healing, it is considered crucial to assess the risks of ongoing traditional practices and to strive to achieve more strategic communication between modern and traditional health providers.

We report the rare case of a 68-year-old man, who was admitted to our hospital with a diagnosis of aortic arch anastomotic pseudoaneurysm, with concomintant aortic root enlargement and coronary artery stenosis. Eleven years previously, at age 56, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed redo total arch replacement, aortic root replacement and coronary artery bypass, making use of a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery and femoral vein before resternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation ; however, he was discharged in good condition on the 50th post-operative day. The case suggests that island reconstruction has the potential to cause an aortic arch pseudoaneurysm, particularly after a long postoperative period of time. Therefore, thorough postoperative care strategy is required. We also need to consider surgical reconstructive techniques which eliminate vascular lesions as much as possible at the time of the primary surgery, particularly in cases of chronic aortic dissection.

Various types of surgical techniques have been reported for the closure of complicated PDA, since Morrow first described an innovatory operative method. At our institute, extracorporeal circulation has been frequently used as a support measure for these operations to ensure the safety of the operation. Ten patients with complicated PDA were operated under extracorporeal circulation. All patients but one were adults. The reason for use of extracorporeal circulation included age, presence of atherosclerosis or calcification of the ductus, short neck ductus, ductal aneurysms, right sided descending aorta and recanalization after previous ligation. The ductus was approached through the left lateral thoracotomy in 8 patients and median sternotomy in 2. The Morrow procedure was performed in 2 patients. No hospital death occurred, although the mean duration of the hospital stay after the operation was longer in these cases than in cases with simple PDA. We conclude that the use of extracorporeal circulation is safe and effective for the closure of complicated PDA.

1) The faculty development at each medical school from 2003 through 2005 was analysed.
2) The major themes in faculty development were problem based learning, tutorial, computer based testing, and clinical training.
3) Faculty development is considered an effective way to enhance the contributions of faculty members to medical education.

Purpose : This study was undertaken to clarify the effect of heme-iron supplementation on the prevention of iron-deficiency anemia in male collegiate distance runners.Methods : Forty-one male collegiate runners were divided into three groups, consisting of a heme-iron group (HI), a citrate-iron group (CI), and a non-iron group (NI). Iron tablets (heme-iron or citrate-iron) were administered at a dose of 7 mg per day for two months. The blood components and nutritional intakes were estimated before and after the intervention.Results : The nutritional intakes did not differ among the three groups. The red blood cell, hemoglobin, hematocrit, ferritin, Glutamic-Pyruvate Transferase and γ-Glutamyl Transpeptidase levels were unchanged throughout the experimental periods. After the intervention, the serum iron levels significantly decreased in the NI group but not in the iron-supplemented groups, while the reticulocytes counts increased among the three groups.Conclusion : The small amount of heme-iron supplementation was thus found to have a preventive effect on iron deficiency anemia without causing any negative side affects.

The results of pulmonary function tests (PFTs) given to those inhabitants in the western part of Kanagawa Prefecture who visited our hospital for medical examinations between April 1991 and March 1992 were studied comparatively, with their occupation, age, sex, environmental factors and smoking habits taken into account. For this purpose, the subjects totaling 1, 322 were classified into three groups-those who live in the hilly area, those who live in the suburban area and those who live in the coastal area. In the present study, the results of the four PFT items-FVC, FEV 1.0%, FVC and FEV 1.0%-were checked. Careful examination brought into relief the startling fact that many aged people, non-farmers and nonsmokers in the suburban subject group have impaired pulmonary function. It is said that because of the Tokyo-Nagoya expressway and many other motorways, the air in the suburban area is fouled up with exhaust gas to a greater extent than in the other two areas. Although our finding alone could not identify the cause of impaired pulmonary function definitely, air pollution was thought to be a culprit. Further investigation should be made into the living conditions of the examinees. Moreover, environmental monitoring and data analysis have to be carried out in the future.

A 37-year-old female was admitted to our hospital because of haemoptysis. She had undergone descending thoracic aorta-abdominal aorta bypass grafting 11 years previously. Then the diagnosis was atypical coarctation due to aortitis syndrome. No follow up had been continued. Angiogram and CTscan disclosed a false aneurysm at the anastomotic site of the descending thoracic aorta, which was ruptured into the left lung. An emergency operation was performed. A new extra-anatomical ascending aorta abdominal aorta bypass was constructed using 16mm Dacron prosthesis, and three permanent clamps were employed for thromboexclusion of the descending aorta, previous bypass graft and the ruptured aneurysm. At present, three years after the operation, she is leading normal life with medication of hypotensive drugs. Pathogenesis, surgical approach and long-term postoperative care were discussed.