A woman in her 60 s presented with chest pain. The electrocardiography showed ST depressed in V3-V6, ST elevation in aVR, and negative T in I, II, aVL, and aVF. Laboratory examination revealed that creatinine kinase isoenzyme-MB and troponin I were elevated. Transthoracic echocardiography revealed moderate aortic regurgitation. Enhanced computed tomography did not show an aortic dissection. Acute coronary syndrome was suspected and cardiac catheterization was done. Aortography showed an intimal flap inside the Valsalva sinus. An emergency operation was performed. Surgical view: the intimal tear affected almost all the circumference of the aorta in the Valsalva sinus and the aortic dissection with a localized and moving intimal flap affected the coronary flow and the aortic dissection caused severe aortic regurgitation and decreased the coronary flow. An aortic root replacement was successfully performed, and the postoperative course was uneventful.

Paroxysmal atrial fibrillation (pAf) is an arrhythmia that often occurs in the elderly. The quality of life often declines due to severe palpitations caused by pAf. We present a case of recurrent pAf that occurred on postoperative day 2 of coronary artery bypass grafting and pulmonary vein isolation for unstable angina pectoris and pAf. The patient was a 62-year-old man who complained of palpitations, which was consistent with pAf on the monitor ECG. During hospitalization, the patient was constantly wearing an ECG monitor. During pAf, the heart rate was around 120 bpm, and pAf could continue for up to and beyond 24 hours. Paroxysmal atrial fibrillation with strong palpitations was observed every day, even after starting beta-blockers and anticoagulants. After discharge, a Japanese Kampo medicine called shakanzoto was taken for a month, but there was no improvement. After that, it was changed to another Japanese Kampo medicine called saikokaryukotsuboreito, because abdominal examination revealed kyokyokuman (hypochondriac discomfort and distension (resistance)) and saiboki (brisk pulsation in the para-umbilical region). Palpitations quickly improved dramatically. It was speculated that not only palpitations but also pAf had been improved.

Background : Fungal mycotic aneurysm is rare ; however, special care and treatment are required for the deep fungal infection itself. Case : The patient was a 69-year-old man with a history of sepsis due to Candida albicans. He suffered from back pain and moderate fever. CT revealed saccular-form aneurysm at the infrarenal abdominal aorta. After emergent in situ bifurcated graft replacement of the infected aneurysm, antifungal treatment was attempted in reference to the antifungal drug sensitivity of C. albicans from intraoperative cultures and findings of fungal endophthalmitis in an ophthalmic examination. After an uneventful acute course, follow up CT images after 12 months postoperatively revealed pseudoaneurysm formation proximal to the site of graft anastomosis. Reoperation was planned with a trans-thoracic and transabdominal approach because of concerns about thoracoabdominal aortic infection. However, the reoperation displayed only inflammatory tissue around the graft and aortic tissue. Removal of the previous graft and reconstruction of the bilateral renal artery, and the pararenal abdominal aorta to the bilateral common iliac artery was performed. Intraoperative tissue cultures revealed no evidence of microorganisms. He returned home with oral antifungal treatment and is doing well at 8 months after the reoperation. Conclusions : Management of fungal mycotic aneurysms requires both surgical treatment and antifungal treatment. Antifungal agents should be selected based on the results of a susceptibility test and after examinations for metastatic comorbidities.

A 62-year-old man was referred to our hospital because of dyspnea. Electrocardiogram showed chronic atrial fibrillation and echocardiogram revealed severe tricuspid regurgitation. His history included a motorbike accident at age 17, and a heart murmur was pointed out in the following year. He developed paroxysmal atrial fibrillation when he was 45 years old. Heart failure was not controlled by medication and tricuspid valve repair was indicated. At surgery, the anterior leaflet of tricuspid valve was widely prolapsed due to chordal rupture. We performed chordal reconstruction with 4 expanded polytetrafluoroethylene (CV-5®) sutures, and ring annuloplasty. Furthermore, a small fenestration at the tricuspid annulus was noticed and was closed with a direct suture. The biatrial modified Maze procedure was performed subsequently. The patient is doing well without TR recurrence, and restored sinus rhythm is maintained. We report successful repair of traumatic tricuspid regurgitation.

An 80-year-old man felt a loss of strength and sharp pain in both lower limbs while playing gate-ball, consulted a nearby doctor, and was followed up. Because the sharp pains in both lower limbs became aggravated the next day, he was given a previously prescribed medication. Both femoral pulses were absent and acute arterial obstruction of the lower limbs was suspected. A contrast-enhanced CT scan showed a thrombosed infrarenal abdominal aortic aneurysm with a maximum transverse diameter of 37 mm, and both external iliac arteries were contrast imaged by collateral circulation pathways. We diagnosed acute thrombosis of an abdominal aortic aneurysm, and was urgently transported to our hospital. We classified his lower limbs as Balas grade III and TASC classification grade IIb and Rutherford classification grade IIb. He exhibited no abdominal symptoms and since we confirmed the blood flow of his lower limbs, we decided to perform revascularization. An extra-anatomical bypass (axillo-bifemoral bypass) was conducted because he had dementia, and was old. After the operation, myonephropathic metabolic syndrome (MNMS) did not develop, and the patient was discharged on foot on the 16th postoperative day. Acute thrombosis of an abdominal aortic aneurysm is a rare disease. Because the ischemic area widens, often causing serious MNMS after the revascularization, it has a poor prognosis. Here, we report a case in which one such patient was rescued.

We report a case of a chronic contained rupture of abdominal aortic aneurysm associated with spinal caries. A giant retroperitoneal mass with bony destruction of the anterior bodies of thoracic and lumber vertebrae was detected on computed tomography in a 72-year-old woman. The patient was asymptomatic but had a history of spinal tuberculosis complicated with cold abcess 44 years earlier. Magnetic resonance imaging suggested the presence of a paravertebral retroperitoneal abscess or organized hematoma. Surgery was performed through median laparotomy and an aortotomy revealed a punched-out defect, 17mm×17mm in size, in the posterior wall of the abdominal aorta, and the large cavity of an aneurysm with an organized thrombus was observed through the defect. The abdominal aorta and common iliac arteries were replaced with a bifurcated graft. The punched-out defect was closed with the anterior wall of the aorta for the purpose of isolating the prosthesis from the aneurysm. The postoperative course was uneventful and there were no signs of prolonged inflammatory reactions. In this case, it was considered that chronic contained rupture of the abdominal aortic aneurysm resulted from spinal tuberculous osteomyelitis eroding into the aorta.

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.