1) Clinical residency system (5 years) to study medical knowledge and technologies necessary in each field of specialty was established for young doctors who have finished their 2-year post-graduate clinical internship.
2) Post-graduate course of Tokyo Women's Medical University consist of the following divisions: internal medicine and surgery divisions as clinical medicine, morphological, functional and socio-medical divisions as basic medicine and the advanced life-science divisions.
3) Clinical residents can enter the post-graduate course of the university at the same period of their residency and engage in medical research works.
4) Post-graduate courses of Tokyo Women's Medical University are open to peoples working in industrial companies or any enterprises and promote the joint research works with the university and industrial enterprises.
5) The research works by clinical residents in the post-graduate school will encourage the research mind of young doctors and promote the progress of medical researches.

In order to obtain the basic data for the relationship between factors related to sports and bone density of high school girls, bone densities of a heel were measured, and physical characteristics and living backgrounds on exercises were surveyed. The subjects were one-hundred and forty two girls (15-18 years, mean±SD=16.5±0.84 years) of a high school in Nagano prefecture, accepted our visiting bone health check. Bone density was measured by ultrasound bone-densitometer ‘Achilles’ (Lunar) . As for the data, we obtained the stiffness index (Stiffness) with a self-registered questionnaire for the items of physical and exercise factors for the girls in puberty. High school girls who belong to a sport club have significantly higher bone density than other girls. In detail, those who do the sports which consist of mainly running or jumpping, have significantly higher bone density than others who do no sports. There also were significants on the kinds of sports, on the frequency of sports and on the duration of sports. Moreover, those who had the regular sports history have higher bone density than those who had no regular sports history, and the mean Stiffness of the group that care to do physical exercises daily was higher than those who do not care to do exercises. These results suggest that there are many kinds of factors related to sports which favourably contribute to obtain sufficient bone mass of high school girls who are in a developmental stage.

A 71-year-old man who had mitral and tricuspid regurgitations with severely calcified aorta had been called off an elective operation 4 years ago, because cardiopulmonary bypass (CPB) could not be established intraoperatively operation. This time, mitral valve replacement and tricuspid annuloplasty was performed by left axillary arterial cannulation and moderate hypothermic ventricular fibrillation after resternotomy. Calcification of the aorta is sometimes more severe than detected by preoperative CT scan, as in the present case. Therefore, it is necessary and recommended for cases of calcified ascending aorta to be fully examined and, based on the results decided alternative modalities.

To introduce problem-based learning (PBL) in small groups to medical education in Japan, a questionnaire was sent to 10 foreign medical schools where PBL has been used. Five schools in the United States and one each in the United Kingdom, Canada, and Australia responded to all 15 questions concerning their educational system, faculty training, faculty evaluation, and student evaluation. The faculty is trained in 7 medical schools, retrained in 4, and self-trained in 5. The faculty is objectively evaluated by students and a faculty committee in seven schools and the results are returned to the faculty. The students are evaluated by self-evaluation, written tests, and oral examination in al schools, and also by peer-evaluation in one school. The evaluation of students directly affects their promotion in all schools but one. Such effective evaluation and feedback systems, including evaluations of the students' learning skills and their attitude toward learning, play important roles in effective PBL.

Ionescu-Shiley pericardial xenografts implanted in the mitral position between April 1980 and October 1984 were studied. In some cases the cusp was torn in a relatively early postoperative phase, thus requiring an emergency operation. Functional disorders, such as caused by the calcification of the cusp, advance at a relatively moderate pace, and the prognosis of a second operation in cases with valve dysfunction and a chronic course was favorable. The actuarial probability of freedom from reoperation was 88.5±8.7% at 5 years and 55.7±14.5% at 10 years. The structural deterioration of the pericardial valve increased about 5 years after replacement. This tendency was the same as in other bioprostheses. At 10 years the overall actuarial survival rate was 67.2±12.1%. Freedom at 10 years from thromboembolism was 84.6±9.8%. For cases whose the course is under observation at present, the strategy is to recommend an additional operation as far as possible, while continuously observing the function of the valve.

Since 1993, we have used a clinical clerkship method in an attempt to improve the undergraduate clinical training in our department. At first, the students were given the opportunity to learn adequate basic clinical procedures (levels 1 to 3), but data on the effect of their training were lacking. Therefore, we conducted a survey to obtain the necessary information. Twenty-nine students (29 % of students in the sixth academic year) participated and wrote their survey reports at the end of the course. The reports were designed to evaluate their problem-solving skills and the effects of self-directed learning in clinical anesthesia and to obtain an overall impression of the training. The results revealed that the educational effect was insufficient for almost all students who participated because they were unable to fully solve the problems of anesthetic management from either a pathophysiologic or pathobiochemical standpoint. From these results and our further experiences from 1994 through 1996, we decided to reform our educational procedures. The important improvements are as follows. 1) Trainees must record the anesthesia course during the assigned anesthetic case and participate in the postoperative ward discussion. 2) A member of the teaching staff must discuss ways to manage and solve problems with trainees at the end of each case. 3) After the discussion, trainees must write a report about how and what they have learned.

We have investigated that individual properties and irritability to the electrical stimulation of Wenliu (Li-7) were determined by acupuncture of Hegu (Li-4) and Quchi (Li-11) as the strength-duration relations.
Results showed that reobase (27.8±1.09V, n=114), utilization time (1.38±0.13ms, n=114) and chronaxie (0.031±0.002ms, n=114), were interestingly similar as previous results of in vitro studies.
Value of chronaxie of female subjects (0.021±0.001ms, n=21) was significantly lower than male (0.053±0.010ms, n=36). So that acupuncture stimulation influenced to the chronaxie.
Hegu stimulation significantly (p<0.05) shortend than Quchi stimulation as compared to intact control group.
These results might be suggested that it has to considered responses to stimulation in the sex differences when determination of acupuncture effects in the clinical and/or research studies.

We report two cases of patch reconstruction for distal arch aneurysms. Supportive measures during operation included selective cerebral perfusion for brain protection and cardioplegic arrest for heart protection. During operation the whole body except for the heart was cooled down to 25°C, and only the heart was perfused at 36°C and kept beating. Both aneurysms were saccular, and after the resection of the aneurysm the defect of the aortic wall was reconstructed with woven double velour patches. The relationship between the pressure and the flow during coronary perfusion is not clear, but we thought the above measures should be taken when operating on distal arch aneurysm.

A 70-year-old man was found to have aortic regurgitation and underwent aortic valve replacement. About 10 minutes after disconnection from the cardiopulmonary bypass, cardiac arrest occurred suddenly and the bypass was immediately resumed. At this point, a Stanford type A aortic dissection was detected by transesophageal echocardiography, and the orifice of the left coronary artery was considered to be occluded by invasion of a hematoma. Although ascending aortic replacement with a prosthesis was performed under hypothermic circulatory arrest with selective cerebral perfusion, the heart did not resume vigorous beating. Therefore, saphenous vain graftings to the left anterior descending artery and the right coronary artery were performed. Finally, the patient could be weaned from the cardiopulmonary bypass. On postoperative digital subtraction angiography, neither occlusion nor stenosis in both coronary arteries was observed. We conclude that it would be considered to perform coronary artery bypass graftings in this particular condition.

A 61 y. o. male was admitted as a diagnosis of Stanford type A dissecting aortic aneurysm 6 day after the occurrence. An urgent operation was performed next day and the ascending aorta was replaced. Oral intake was initiated after uneventful postoperative 6 day-period. However, paralytic ileus became obvious associated with spiked fever over 38°C. Second trial after the suspension of oral intake also failed in the same result and turned out sepsis caused by Enterococcus faecium. The angiogram revealed the intact celiac axis and superior mesenteric artery (SMA), and the remarkably narrowed true lumen of the aorta. Although the clinical symptom was not typical, we thought that the ileus was induced by abdominal angina. At 78th postoperative day the fenestration of the abdominal aorta and the bypass grafting with saphenous vein between SMA and the abdominal aorta were performed. The symptom and sign of ileus subsided after the operation.