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.

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.

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.

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.

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.

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.

A 76-year-old man developed dysphagia and esophageal stenosis was diagnosed. A computed tomographic scan of the chest demonstrated a large aneurysm of the distal aortic arch. The patient had undergone left thoracoplasty 45 years previously for the treatment of lung tuberculosis, then the aortic arch with the aneurysm was displaced backward because of the narrowed upper thoracic cavity and the esophagus was sandwiched between the aortic arch and the spine. The patient was thought to be in danger of developing an aortoesophageal fistula, so an emergency operation was performed in spite of his age and general condition. He was successfully treated with graft replacement including reconstruction of three arch vessels and his severe dysphagia improved.

A 69-year-old woman, who had undergone mitral valve replacement, developed acute congestive heart failure and was transferred to our institution. Cineradiography demonstrated that two leaflets of the St. Jude Medical valve were stuck in a closed position. Emergency redo mitral valve replacement was performed with a CarboMedics valve. Postoperative hematological studies yielded a diagnosis of antiphospholipid syndrome. Although postoperative anticoagulant therapy was performed more carefully than usual, the prosthesis became stuck again. Therefore, a third operation was performed using a tissue prosthesis. We concluded that mitral valve plasty should be a first option for patients with antiphospholipid syndrome undergoing mitral valve surgery. Should prosthetic valve replacement be required, a tissue prosthesis would be best.