A 15-year-old boy who had been treated for TOF (tetralogy of Fallot) at 3 years of age was admitted with dysphagia due to esophageal stenosis. He also suffered from malrotation of the intestine. The esophageal stenosis was caused by recurrent cyclic vomiting and subsequent esophagitis. Three years earlier, he had received an implantation of a totally implantable central venous access device via the right cephalic vein. Echocardiography revealed a floating mass in his right atrium, which was assumed to be a thrombus at the catheter tip of the central venous access device. We suspected that the cause of atrial thrombus in this case was complicated by the long-term (3 years) use of the venous central port. He was suspected to have a pulmonary embolism. A perfusion lung scan (99mTc-MAA) revealed multiple diminished uptake in both lungs. The thrombus was removed successfully under partial cardiopulmonary bypass. The postoperative course was uneventful.

The internal thoracic artery is a useful conduit for coronary artery bypass grafting (CABG). Recently we have developed a method for increasing blood flow by directly injecting a phosphodiesterase III (PDE III) inhibitor into the left internal thoracic artery (LITA) to inflate the artery and prevent its contraction. In the present study we compared the reactivity of the LITA to three drugs: PDE III inhibitor, papaverine hydrochloride and isosorbide dinitrate (ISDN). Forty-two patients with a mean age of 66.8±11.5 years old who were undergoing primary CABG were enrolled in this study and were randomly separated into one of three groups based on the vasodilating drug administered. Each drug was used in 14 cases. Graft free flow (GFF) and systemic blood pressure were measured before and one minute after drug administration to calculate blood vessel resistance (R). All the drugs significantly increased GFF, and reduced both R and blood pressure. A comparison of the change rate of blood pressure did not differ significantly among the three drug groups. The PDE III inhibitor significantly increased change rates of both GFF and R, compared with the other drugs. These results indicate that PDE III inhibitor is most effective for increasing the blood flow of LITA grafts for CABG.

A 53-year-old woman was admitted because of cardiac failure caused by mitral valve stenosis and regurgitation. She had been treated by an aortic valve replacement with a Björk-Shiley convexo-concave valve (21mm) 22 years previously in our institute. Her clinical symptoms and the histological findings of the lung specimen from the operation led to a diagnosis of Swyer-James syndrome. The diagnosis was confirmed by pulmonary blood flow scintigraphy on the present admission. With her informed consent, we treated her cardiac disease by mitral valve replacement and a second aortic valve replacement was carried out because of the structural brittleness of the Björk-Shiley convexo-concave valve. She was discharged from our institute after the operation without any complications.

The working group to improve foreign language education in medical schools established in 1994 and chaired by K. Uemura, M.D. sent questionaire about their present curricula and future plans for teaching English to the deans of all 49 public and 31 private medical schools from January 9 to March 9, 1995, and collected the responses from 30 (61.2%) public, 24 (77.4%) private, in total 54 (67.5%) medical schools. The teaching of useful English includes English conversation in 37 (68.5%), medical English in 34 (63.0%), and structures of medical papers in 9 (16.7%) schools. Medical English is also taught as extracurricular and other activities in 40 (74.1%) schools. These figures have increased as compared with the ques-tionaire conducted two years previously. English conversation can be taught to junior (1st & 2nd yrs) students, for whom medical English can only be taught on general medical topics such as the medical care delivery system, bioethics, roles of physicians, and primay care. Therefore medical English is more and more taught to middle-class (3rd & 4th yrs) and senior (5th & 6th yrs) students. It seems necessary to annually conduct a workshop for medical English teachers to improve their strategies of teaching.

“The first workshop to improve ‘Medical English’ teaching” was held on October 7-8, 1995 in Hamamatsu. An invited guest was Mr. Glendinning from Institute of Applied Language Studies, University of Edinburgh. As questionnaires for this workshop were performed, we report a result of questionnaires. Most participants shared their daily wonder or questions about ‘Medical English’ with others, and this was very beneficial for them. The techniques for ‘Medical English’ education, instructed by Mr. Glendinnign, was impressive for participants. As the program of the workshop was a little conceptual rather than practical, this point should be improved for the next time because most participants expected to learn more practical skills. Participants answered that this kind of annual workshop was useful and should be continued.

The working group to improve foreign language education in medical schools established in 1994 and chaired by K. Uemura, M.D. here proposes a model curriculum for teaching useful English in medical schools at three levels. The major objectives are listening, speaking, rapid reading, and sentence structuring including paragraphing for junior (1st & 2nd yrs) students, reading medical papers and charts in English, structures of medical scientific papers, and listening to medical English for middleclass (3rd & 4th yrs) students, and writing and orally presenting papers in English on given medical subjects are for senior (5th & 6th yrs) students.

The Working Group for the Improvement of Foreign Language Education in Medical Schools in Japan, organized in 1994 and chaired by Prof. K. Uemura, M.D. lists here English teaching materials for medical purposes. More than half of the materials listed are those that one of the group members, T. Ohki, has used or wants to use in his classes. The list has been enlarged due to the responses to the questionnare sent to those who participated in the first workshop held in 1995. The list is divided into 12 categories: listening & reading, writing, medical terminology, pronunciation, textbooks for training the four skills, essays on medicine, fictional stories about medicine & medical doctors, medical ethics and terminal care, handbooks for medical students and doctors, writing medical charts, self-teaching materials. and video materials.
It is hoped that the materials listed here will supplement a model curriculum for teaching ‘useful’ English in medical schools, as proposed by the working group.

Multisite pacing has recently been available as a new treatment for patients with congestive heart failure. This study was intended to evaluate the effects of atrioventricular myocardial pacing on left or biventricular sites. Eleven patients (4 men, 7 women) who had undergone atrioventricular myocardial pacing between January 2000 and April 2002 were selected for this study. They ranged in age from 24 to 74 years (mean age 58.5 years). The diagnosis was dilated cardiomyopathy in 3 patients, ischemic cardiomyopathy in 4, complete atrioventricular heart block in 2, sick sinus syndrome in 1, and atrial fibrillation with bradycardia in 1. The method of pacemaker implantation was atrioventricular myocardial pacing on left or biventricular sites by means of mini-thoracotomy under general anesthesia. A DDD-R pacemaker was used. When biventricular pacing was employed, the ventricular pacing lead was cut, connected with a Y adapter, and implantation was made biventricularly. We analyzed pre- and postoperative hemodynamic states by means of a Swan-Ganz catheter, and clinical course (NYHA class). There was a significant difference between pre- and postoperative clinical course and hemodynamic state. The atrioventricular myocardial pacing on left or biventricular sites was a useful method of improving the clinical course and hemodynamic state. It is concluded that this method is available as a new therapeutic option in patients with congestive heart failure.