Gifu University School of Medicine has introduced a new learning method for medical science, named tutorial system. To assess the efficacy of the method, we conducted a questionnaire survey of students' medical knowledge, attitudes to learning, communication ability, and social behavior. The questionnaire was given to instructors/attending physicians involved in clinical education. Results of the evaluation were compared to those of previous medical students. Our results suggest that the tutorial system in our medical school result in an improvement over the previous curricula.

We report a rare case of acute type A aortic dissection with paraplegia which was reversed using cerebrospinal fluid drainage (CFD). The patient was a 80-year-old man who was admitted with acute back pain and paraplegia. Computed tomographic scans showed an acute type A aortic dissection. Four hours after onset of paraplegia, CFD was initiated by inserting an intrathecal catheter at L3-L4. Cerebrospinal fluid was drained freely by gravity whenever the pressure exceeded 10cmH₂O. After 32h, the neurological deficit was completely resolved. CFD can be considered a useful treatment in patients with paraplegia after acute aortic dissection.

Although recent progress in surgery for acute traumatic rupture of the thoracic aorta is encouraging, hospital mortality remains high due to associated fatal lesions. Delayed repair of acute aortic rupture, after management of critical lesions, has been reported in the literature with increasing frequency. We present here a successful operative case of a 54-year-old-woman with acute traumatic aortic rupture. She was admitted to the intensive care unit with loss of consciousness, rib fracture and lung contusion in order to investigate additional critical lesions under strict control of systolic blood pressure under 120mmHg. After completion of all diagnostic procedures, aortic repair was performed 2 days after the accident. The intima of the aorta was found to be disrupted for two thirds of the circumference and pseudoaneurysm was diagnosed. A gelatin-coated vascular prosthesis with one branch was interposed under cardiopulmonary bypass during which general heparinization, systemic hypothermia (20°C) and retrograde brain perfusion method were used. She recovered uneventfully and was discharged 2 weeks after the operation.

We treated 162 patients by isolated CABG with a left internal thoracic artery (LITA) anastomosed to the left anterior descending artery and a radial artery anastomosed to the circumflex artery between August 1996 and December 2002. Late angiograms were performed 6 to 65 months (21.7±15.8) after the operation. The purpose of this study was to compare midterm results of radial arteries anastomosed to the side wall of LITA (group Y) with those anastomosed to the aorta (group AC). There were no operative deaths in either group and no difference in the postoperative complication rate including cerebral infarction. The early patency of group Y was lower than that of group AC (group AC: 97.8%, group Y: 87.1%, p=0.017), and also the late patency of group Y was significantly lower than that of group AC (group AC: 90.9%, group Y: 36.4%, p=0.0008). All of the early patent radial artery grafts in group AC were patent on late angiograms, but 3 of the 25 anastomoses in group Y which were clearly patent on early angiograms later showed a string sign later. When using a radial artery graft in circumflex artery territory, we recommend an aorto-coronary bypass graft rather than Y-graft.

1)The purpose of this study was to evaluate a role–playing class for informed consent with fifth–year students playing the role of physicians and first–year students playing the role of patients.
2)The first–year students were competent as simulated patients for the informed consent role–playing and were a worthy educational human resource.
3)This role–playing was effective for helping both first–year and fifth–year students understand informed consent and the mentality of patients and to motivate students to study informed consent. This joint class also allowed fifth–year students to review their progress over time and gave first–year students a chance to meet role models.

We performed aortic valve reconstruction (AVrC) using autologous pericardium for a patient with severe aortic stenosis and chronic renal failure, prior to kidney transplantation. The patient received kidney transplantation in the early phase after cardiac surgery. The case was a 61-year-old man with severe aortic valve stenosis who received dialysis due to chronic renal failure. We performed AVrC using autologous pericardium for the following reasons. Anticoagulant therapy is not desirable because of the need to perform kidney transplantation in the early phase after cardiac surgery. Implantation of prosthesis was not desirable because the patient requires oral immunosuppression therapy after kidney transplantation. There was no significant postoperative pressure gradient of the aortic valve orifice or aortic valve regurgitation (AR). The patient received kidney transplantation 113 days after surgery. AVrC using autologous pericardium was feasible for aortic stenosis patients in a patient waiting to receive kidney transplantation because anticoagulation therapy is not necessary after AVrC.

The purpose of this study was to investigate the effects of combined resistance training and aerobic training with protein intake after resistance training on body composition in obese middle-aged women. The subjects were 42 middle-aged women (age : 56.5±4.3 years, BMI : 26.6±2.3 kg/m²), who were classified into three supplementation groups: Protein group (PG), Isocalorie placebo group (IG), and Noncalorie placebo group (CG) by Double Blind Randomized Trial. The training program consisted of combined resistance training and aerobic training for 10 weeks, 5 times per week: twice a week in a university training room and 3 times per week at home. The subjects took the nutrient supplement immediately after each resistance training session. We measured body weight (Bw), body fat volume (Bf) by bioelectrical impedance analysis (BIA), and cross-sectional area (CSA) of muscle of the thigh extensor group (Te), flexor group (Tf), and psoas major (Pm) by magnetic resonance imaging (MRI) before and after the 10-week training period. Irrespective of group, Bw and Bf showed a significant decrease after the training period compared to before (p<0.001), and the CSA of Te muscle showed a significant increase after the training period (p<0.01). Moreover, the interaction of time×group was accepted in the CSA of Pm muscle (p<0.05), and the increase in muscle volume for PG was the highest increase among the three supplementation groups (p<0.05)(PG : 2.1±0.8 cm², IG : 1.3±1.0 cm², CG : 1.3±0.9 cm²). These results suggest that combined training in middle-aged obese women improves body composition, and resistance training with protein intake may increase the CSA of muscle of psoas major.

A 25-year-old man was admitted with high fever and heart murmur. Echocardiogram showed left ventricular chamber dilatation and vegetations attached to the aortic valve. Blood cultures obtained on admission revealed Streptococcus viridans. Despite adequate antibiotic therapy, congestive heart failure progressively worsened and large splenic abscesses were detected by computed tomography. Urgent aortic valve replacement and splenectomy were performed. The aortic valve was bicuspid and markedly destroyed. Pathology of the spleen showed findings consistent with large infarct and abscesses due to septic emboli. The postoperative course was uneventful.

Circadian rhythms have been shown to regulate several physiological functions including body temperature, sleep/wake cycle, physical activity, and cognition. These functions are controlled by circadian clock genes, and the circadian clock system in the body is classified into two clocks which are the central clock in the suprachiasmatic nucleus (SCN) of the hypothalamus and peripheral clocks in peripheral tissues such as the liver and skeletal muscle. Therefore, many researchers are conducting basic and applied research on the relationship between circadian rhythm in peripheral tissues and physiological functions including sports performance and effects of acute exercise and exercise training. On the other hand, it has been shown that abnormal circadian rhythms and disturbance of circadian rhythms can lead to the development of several diseases such as diabetes, cancer, sarcopenia, depression, and dementia. Thus, it is also important to regulate individual circadian rhythm by considering for timing of exercise and daily physical activity. Exercise and physical activity are found to have an influence on circadian rhythms regulation (Chrono-exercise) and accumulate evidences between timing of exercise and health outcomes. This review aims to introduce evidence for chrono-exercise and suggests the importance for considering the timing of exercise and physical activity.

Spinal cord ischemia is a very rare and unpredictable complication in surgery of infrarenal abdominal aortic aneurysms. A 65-year-old man who had a history of CABG (LITA-LAD, LITA-Y composite RA-OM) underwent resection of an abdominal aortic aneurysm. Postoperatively, he developed paraplegia and hypoesthesia with associated fecal incontinence. Reduction of collateral flows of patent lumbar arteries probably caused serious ischemia of the spinal cord. A standard infra-renal abdominal aorta surgery still has the risk of postoperative paraplegia, which should be incorporated in the preoperative informed consent.