This is a case report of a 57-year-old woman with high aortic occlusion (HAO) who had acute symptoms of severe ischemia of the lower extremities and the intrapelvic organs. Generally, HAO is a chronic ischemic disease of the lower extremities and the intrapelvic organs; therefore, acute HAO is relatively rare. Acute thrombotic occlusion of a major collateral artery might be the cause of acute HAO. Laser Doppler flowmetry of the sigmoid colon was useful to evaluate the ischemia of intrapelvic organs. Thrombectomy of the juxtarenal portion with the suprarenal aortic cross clamp was performed within four minutes, then the clamp was moved to the infrarenal portion. The remaining occluded aorta was replaced with a Y-shaped knitted Dacron graft. She had no symptoms after the surgery except renovascular hypertension. Seventy five percent stenosis of the right renal artery was exacerbated to 99%. Vascular clamping of the right renal artery might have been the cause of severe stenosis. Percutaneous transluminal renal angioplasty was successfully performed after the surgery. Aggressive renal artery reconstruction during surgery is recommended in cases with moderate or severe renal artery stenosis.

Background and purpose: With the increase in the number of international medical students, there is an urgent need to develop programs to foster communication skills in Japanese, but the communication problems of international medical students are not clear. Methods: Semi-structured interviews and questionnaires were conducted with 10 international students to identify communication difficulties during clinical practice. Results: Regarding communication with patients, the frequently reported difficulties were difficulty in hearing elderly voices, difficulty with dialects, and difficulty with onomatopoeia. As for communication with health care professionals, the top concerns were not being able to understand jargon and difficulty in speaking concisely using technical terms. Discussion: Language input is a major problem. In educational institutions, they need to listen to a variety of speakers, learn frequent onomatopoeia, and practice oral case reports.