Objective
 To examine the effects of the educational status of mothers and outreach services on childhood mortality in a Zambian village
Methods
 The study design was a cross-sectional descriptive study. A survey was carried out in a village of Zambia in 2007. Five Japanese medical and nursing students interviewed mothers who had children under five years old. A structured questionnaire was used to collect information on social and educational factors and their experience of child deaths. In total, 73 mothers were interviewed, but three subjects were excluded because their records were inadequate. Information on the remaining 70 subjects was analyzed. The relationship between the dependent variable (child death rate per household) and independent variables (mother's characteristics, community circumstances) was examined. In this study, we used “the numbers of babies or young children who had died without defining age by care takers in a household” (child death rate per household) as a measure of child mortality.
Results
 Of the 70 mothers, 30 were literate (42.9%). 33 mothers received health information from an outreach program and 22 from community health workers (CHWs).
 The mother's education and the availability of health information from the outreach program were significantly related to lower child death rate per household (p=0.015 and p=0.019 respectively). The relationship between the mother's literacy and child death rate per household also showed an inverse tendency. Mothers with some education who received health information from the outreach program had reduced child death rate per household.
 After stratification by maternal age (younger or older than 30 years), greater education, literacy and outreach program of the younger mothers were more strongly associated with decreased child death rate per household.
Conclusions
 Education and community learning are important for the health of children. Maternal educational level and a community-based approach have strong impacts on child survival.

Primary cardiac angiosarcoma is very rare and its prognosis was reported to be very poor (average survival period 7 months). A 46-year-old woman with angiosarcoma was admitted for recurrent symptoms of cardiac tamponade. Surgical excision of the tumor was performed 5 months after initial presentation and irradiation therapy was added. Thereafter, immunotherapy, and transcatheter arterial embolization were performed for liver metastasis. Despite this multidisciplinary therapy, she passed away 355 days after surgery. In our report, we described our multidisciplinary approach to this highly malignant tumor and the treatment strategy was discussed.

A tutorial education system for medical students was introduced at Kinki University in 1998. To evaluate the efficacy and to identify problems of the system, questionnaires were given to both students and tutors. Many students (approximately 80%) enjoyed the system and felt that tutorial lectures were effective. Many students believed that their selflearning time had increased and that they had developed the ability to think scientifically. However, they also thought that the material for tutorials was insufficient and that some tutors lacked teaching ability. Tutors thought that students had developed motivation (52%), problem-solving ability (58%), and debating skills (77%). Tutors also pointed out several problems, e.g., that some students had not developed self-leaning ability. Also, some tutors were poorly motivated. These findings suggest that we need to improve tutorial materials and the quality of tutors as well as fostering the self-learning ability of students.

Recently, with the advent of medical devices and minimally invasive operations, endoscopic saphenous vein harvesting (EVH) in coronary artery bypass grafting has been widely accepted. Although EVH has short-term advantages of less wound morbidity and better cosmetic results compared with open vein harvesting (OVH), several studies have demonstrated that the mid- and long-term patency rate of EVH veins is significantly lower than that of OVH veins, therefore the role of EVH is currently controversial. The purpose of this study was to investigate the early results of EVH compared with the OVH group. Between April 2011 and December 2012, 115 consecutive patients underwent coronary artery bypass grafting (CABG) in our institution. Of these, EVH was performed in 62 patients and OVH in 53. In EVH groups, all 50 patients were men, and mean age was 71.3±7.8 years. A total of 211 coronary anastomoses, 109 SVGs anastomoses were assessed for patency postoperatively by angiography or enhanced computed tomography before discharge. The mean vein harvesting time was 26.0±8.1 min, and the mean number of ostial branch tear was 0.34±0.59. The overall SVG patency rates at discharge were 95.4% in EVH and 92% in OVH, respectively (p=0.24). There was a significant reduction in the incidence of leg wound complications in the EVH group (EVH : 1.6% ; OVH : 13.2% ; p=0.038). In conclusion, the short-term result of EVH was satisfactory. EVH reduces leg wound complications compared with OVH.

A 27-year-old woman was given a diagnosis of infectious endocarditis with severe tricuspid regurgitation. Despite adequate antibiotics therapy, her general condition did not improve, and moreover multiple pulmonary abscesses were detected by computed tomography. Therefore surgery was indicated. Surgery consisted of removal of vegetation and tricuspid valve plasty with autologous pericardial patch augmentation of the anterior leaflet. Tricuspid valve plasty was carried out without prosthetic materials. Her postoperative course was uneventful with only mild tricuspid regurgitation. One year after surgery, neither recurrence of infection nor worsening of tricuspid regurgitation was noted. This method could be a useful technique for young patients with severe infection.

We described a patient with free wall rupture followed by papillary muscle rupture due to acute myocardial infarction. A 69-year-old man was transferred complaining of transient unconsciousness. His clinical history, electrocardiogram, and chest CT showed myocardial infarction with free wall rupture indicated that several days had passed since the onset. Coronary angiography showed occlusion of the right coronary artery and severe stenosis of the left anterior descending artery. Since cardiac rupture was at inferior wall and hemorrhage wasn't active, repair of the rupture using fibrin glue and fibrin sheet and coronary artery bypass grafting to the left anterior descending artery was performed without cardiopulmonary bypass. On the 10th postoperative day, his arterial oxygen saturation suddenly deteriorated. Transesophageal echocardiography revealed papillary muscle rupture and severe mitral regurgitation. Emergency mitral valve replacement was performed. After two emergency operations, he gradually recovered and were discharged to home. In three months after discharge, he was admitted again due to congestive heart failure with left ventricular aneurysm at inferior wall and recovered in response of conservative treatment. Surgical experience of double rupture is rare. Based on this case, it may be necessary to perform reperfusion therapy toward even this case of recent myocardial infarction, to prevent papillary muscle rupture. It also may be better to use a patch on free wall rupture to prevent cardiac aneurysm.