Hereditary multiple exostoses (HME) is a benign hereditary disorder characterized by multiple osteochondromas. Osteochondroma appears occasionally in the spinal column as a part of HME. A 37-year-old man presented with a history of HME and cervical compressive myelopathy caused by intraspinal osteochondroma arising from the lamina of the C5 and disc herniation at the C5-6. He was treated by open-door laminoplasty at the C5 and C6 with excision of the tumor. The neurological symptoms were immediately relieved after surgery. Magnetic resonance images demonstrated a sufficient decompression of the spinal cord with a spontaneous regression of the herniated disc at one year after surgery. There was no recurrence of the tumor and no appearance of kyphosis and segmental instability of the cervical spine on postoperative imaging studies for three years after surgery. The patient could be successfully treated by laminoplasty with excision of the tumor and without removal of the herniated disc.
Adult ; Decompression ; Exostoses, Multiple Hereditary* ; Humans ; Intervertebral Disc Displacement ; Kyphosis ; Osteochondroma* ; Recurrence ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases* ; Spine

1）Relationship between Japan and The Netherland in Medical Education started when Pompe van Meerdervoort visited Japan in 19th century.
2）Medical Education in The Netherland has been changing based on evidence in medical education since 1970s.
3）Utrecht University adapts Z type curriculum, spends 4 weeks for most of the clinical rotations, and has culture in which residents teach medical students.

We sent questionnaires to clinical instructors and trainees within 2 years of the latter passing the national licensure examination for medical practitioners to investigate their opinions about the examination and to improve its style. Most instructors wanted to change the examination into an ideal style; however, the trainees had positive comments about the present examination. Several problems came to light, including whether the present examination is asking the minimum requirements for initial training and what the necessary actions are for assessing clinical skills. We must take measures to improve the examination.

The Indonesian government and authorities, moving rapidly in 2004 to rectify Indonesia's chronic shortage and regional imbalance in the number of physicians and to improve the standard of medical care, enacted the Medical Practice Act 2004 and established the Indonesian Medical Council (IMC). The IMC drew up a list of standard competencies to be acquired by all medical graduates; on the basis of this list, representatives from the Ministries of Health and National Education, medical school faculties, and the Indonesian Medical Association drew up the National Competency-Based Curriculum, which was subsequently approved by the IMC and adopted by all medical schools. This curriculum markedly improved Indonesia's core curricula for undergraduate medical education. By requiring that the medical competence of all physicians be evaluated before they receive a license to practice and requiring that all physicians renew their licenses every 5 years, the IMC has taken 2 major steps toward ensuring patient safety and improving the quality of medical services.

Clinical training programs play an extremely important role in the new postgraduate clinical training system introduced in 2004 because facilities for clinical training now include various health-related institutions in addition to the university hospitals and special hospitals for clinical training used in the previous system. Although educational goals have been established by the Ministry of Health, Labour and Welfare, trainees may have difficulty achieving these goals, even under the guidance of staff at the various facilities. There are differences in the function and quality of health-related institutions in the community. For the practical and convenient application of educational goals, we have attempted develop a “model program” to supplement the objectives indicated by the learning goals with more specific objectives. These supplementary objectives can be modified by individual institutions. We hope that this “model program” contributes to the development of objectives for each institution and helps improve the quality of the postgraduate training system in Japan.

Patients on chronic hemodialysis, undergoing coronary artery bypass grafting (CABG) have high perioperative mortality and morbidity. In order to reduce the perioperative risks, we performed intraoperative hemodiafiltration (HDF) during off-pump CABG (OPCAB). A 62 year-old-man, who had been on dialysis for 2 years, was admitted with a sensation of chest compression. A coronary angiography revealed 75% stenosis with severe calcification in the left anterior descending artery and 90% stenosis in the second diagonal branch. During the operation, veno-venous HDF was started, using a double lumen catheter that was introduced into the femoral vein at the same time that a skin incision was made. During the exposure of the diagonal branch by rotating the heart, the blood flow of HDF was decreased and dehydration was halted to avoid hemodynamic deterioration. The patient was extubated 1.5h after the operation and did not require continuous hemodiafiltration (CHDF) in the intensive care unit (ICU). Routine hemodialysis was restarted on the 3rd postoperative day. The postoperative course was uneventful, and the patient was discharged to home on the 11th postoperative day. HDF during OPCAB for this chronic dialysis patient was observed to be effective and yielded an excellent postoperative recovery without CHDF in the ICU.

1) Afghanistan is one of countries facing serious health situation in the world, and Japan starts support in various area after Tokyo international conference for Afghanistan reconstruction in January, 2002.
2) International Research Center for Medical Education (IRCME), the University of Tokyo, sent faculties as members of JICA expert team for Kabul in 2003 and 2004, and launched support reconstruction of medical education of Afghanistan.
3) IRCME formed consortium in cooperation with Japan Society for Medical Education, International Medical Center of Japan Bureau of International Cooperation and other institutions in order to carry out Medical Education Project to support medical education development of Kabul Medical University, Afghanistan.

A clinical clerkship program was introduced at the University of Tokyo in 2002 to help students acquire clinical knowledge, skills, and attitudes by increasing their involvement in clinical activities. We assessed the learning effectiveness of clinical clerkships at the University of Tokyo Hospital by examining evaluations of student's clinical competence by themselves and by the faculty. Methods: We evaluated each clerkship with reference to overall educational goals developed in advance. We measured students' self-evaluations and evaluatio s by the faculty before and after the clerkship. Results: At the end of the 2-month clerkship, students' self-evaluation scores (3.18) were significantly higher than before the clerkship (2.71). In particular, scores for patient care were markedly higher. Evaluation scores by the faculty were also higher during (3.64) and after (3.57) clerkships than before (3.26) clerkships. Conclusion: We will use this data to make next year's clerkship programs more effective. We should also develop more-objective strategies for evaluation and establish relevant educational goals.

The purpose of this study was to evaluate the clinical clerkship program at the University of Tokyo Hospital. We report results of course and faculty evaluations by students and of qualitative evaluations, such as students, free comments and group interviews. Methods: Each item of the course and faculty evaluations was related to the overall educational goals developed in advance. Students evaluated the course and faculty immediately after the course ended. Results: Students rated the clerkship program favorably overall, but the scores of thesecond month (3.38) were lower that those of the first month (3.63). Although learning basic clinical procedures is not the main educational goal of the clerkship, students varied widely in their opportunities to perform procedures. Scores of faculty evaluations ranged from 2.93 to 3.87 in the first month and were lower in the second month for all but two items. Interviews revealed that students had fewer learning experiences in the second month because new residents started their rotations at that time. Conclusion: The results suggest that the scheduling of clinical clerkships should be changed. The contents of clerkship need further consideration.

We studied the incidence of associated ischemic heart disease (IHD) among 143 consecutive patients (male 118, female 25, mean age 68.5±6.9 years) operated upon for abdominal aortic aneurysm (AAA), excluding ruptured aneurysms. The screening of IHD was routinely performed by using dipyridamole thallium scintigraphy, and when it was positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged positive for IHD. Sixty-two patients (43%) with AAA were simultaneously afflicated with IHD. We also compared the 62 AAA patients with IHD with the remaining 81 AAA patients in this series. The patients with IHD had higher incidences of risk factors such as diabetes mellitus (p=0.0031) and hyperlipidemia (p=0.0029) than those without IHD. Five patients were operated on for AAA after coronary artery bypass grafting (CABG), 11 were operated on for AAA and IHD (CABG) simultaneously, 10 were operated on after PTCA, thirty-two patients underwent elective surgery for AAA and four had emergency procedures due to impending rupture of AAA with continuous infusion of nitroglycerin with or without diltiazem. There was no significant difference in surgical mortality between AAA patients with IHD and those without IHD (3%vs2%), and no cardiac death in this series. When both AAA and IHD are severe enough to warrant surgical treatments at the earliest opportunity, we recommend concomitant operations for AAA and IHD (CABG) since these have been performed quite successfully in our series.