We assessed the minimum knowledge requirements to be satisfied by care providers for the management of a hot bathing in general medicine.
 Approximately 1.7% of outpatients questioned the propriety of hot bathing, and a greater percentage asked about the risks of hot bathing in association with several infectious disease or cardiovascular disease.
 We propose that care providers should be required to satisfy the following as the minimum knowledge requirements for the management of hot bathing; 1) Can explain the effects and risks of hot bathing, 2) Can carry out adequate management for the hot bating of patients with cardiovascular disease, 3) Can explain the propriety of hot bathing for patients with several infectious disease.

OBJECTIVE: The purposes of this study were to assess the clinical features of cardiac auscultatory events in outpatients in general internal medicine, and to make teaching suggestions for education on cardiac auscultatory skills in primary care medicine.
METHODS: The subjects included 104 consecutive outpatients with chest symptoms, and cardiac auscultatory findings were assessed prospectively.
RESULTS: Cardiac auscultatory events were found in 32 (30.8%) among the 104 subjects. The subjects with cardiac auscultatory events were significantly older than those without cardiac auscultatory events (p<0.05) . The cardiac auscultatory events of the 32 subjects were as follows; splitting of the first heart sound in 2 subjects, mid-systolic click in 2 subjects, fourth heart sound in 3 subjects, systolic murmur in 24 subjects (including one subject with both systolic and diastolic murmurs), and diastolic murmur in 2 subjects. Aortic stenosis was diagnosed in 2 subjects, and mitral regurgitation was diagnosed in one subject of the 24 subjects with a systolic murmur. One subject with both systolic and diastolic murmurs was considered to have a relative systolic murmur with aortic regurgitation. The other 20 subjects with a systolic murmur were considered to have innocent murmurs. The 2 subjects with a diastolic murmur were diagnosed as having aortic regurgitation.
CONCLUSIONS: We suggest that the following cardiac ausculatory events should be given educational priority in primary care; 1) Fourth heart sounds as an extra heart sound. 2) Innocent murmurs: characteristics of innocent murmurs and discrimination from systolic murmurs caused by organic heart disease. 3) Systolic murmurs caused by aortic stenosis or mitral regurgitation. 4) Diastolic high-pitched murmurs caused by aortic regurgitation.

The purpose of this study was to assess the usefulness of the time-axis variable function of the digital stethoscope in teaching cardiac auscultation. The subjects were 61 fifth-year medical students. The effectiveness of the time-axis variable function of the digital stethoscope for cardiac auscultation was assessed with five representative heart sounds or murmurs. The students reported that auscultatory findings were clearer at half speed than at normal speed for the following sounds, in decreasing order of frequency: systolic murmur following a systolic click, splitting of the second heart sound, systolic ejection murmur, and the third heart sound. In contrast, students frequently reported that auscultatory findings were clearer at normal speed for systolic regurgitation murmur. We suggest that the time-axis variable function is useful for improving auscultatory ability and would be particularly effective for helping students identify and understand the temporal relation of sequential heart sounds or of multicomponent murmurs.

We describe our experience with a left atrial (LA) myxoma in a 15-year-old female who experienced abdominal symptoms so prominent that she was initially thought to have an inflammatory enterocolitis.
The patient's young age and predominant abdominal symptoms in the absence of any cardiac symptoms made it difficult to diagnose the LA myxoma early in the present case. This experience underscores the need for an intensive search for cardiac myxomas in patients with findings suggestive of inflammatory diseases or collagen disorders.

Objectives: To determine the effect of hot bathing on blood circulation, we analyzed pressure wave using Wave Intensity (WI), which is defined as changes in blood pressure (dP)×changes in blood flow velocity (dV) during hot bathing, as the index for assessment.
Methods: Using a combined Doppler and ultrasonic echo-tracking system, we recorded changes in vascular diameter (dD) and dV of the common carotid artery simultaneously in six healthy subjects before (Pre-bathing), during (Bathing), and 10 minutes after bathing (41°C) (Post-bathing). We then measured the product of their changes at fixed intervals as WI and evaluated the positive component of the early systolic phase (FE) (representing the forward-traveling pressure wave), negative components following FE (B) (representing the reflection pressure wave), and the appearance time of (RT). RT was measured as the percentage ratio.
Results: 1) The magnitudes of FE and B tended to decrease during 10min of bathing (Bathing) and recover to the level of the pre-bathing stage after 10min of bathing. 2) The value of RT measured after 10min of bathing (Post-bathing) was significantly longer than the level before bathing (Pre-bathing).
Conclusion: The effect of the reflection pressure wave (i. e., the after load on the vascular system) decresses during hot bathing. We can thus conjecture that the time phase of appearance of the reflecting pressure wave is delayed when the arrival time of the forwardtraveling pressure wave to the periphery is delayed and the propagation of the reflection pressure wave from the periphery slows down due to the expansion of vessels during hot bathing. Hot bating can therefore be expected to reduce after loads of healthy adult subjects.

  A 4–year trial of an undergraduate medical care education program for smoking cessation with the participation of simulated patients is described. Simulated medical care with the participation of simulated patients is thought to motivate medical students to learn clinical skills for smoking cessation. However, simulated medical care for smoking cessation is difficult to plan when both the medical students and the simulated patients are nonsmokers.