We investigated the system of emergency medical service in the Chuno area in Gifu prefecture.It was found that about 20,000 emergency cases were carried into the Emergency Medical Center (EMC) in Chuno Kosei Hospital annually. About 90% were patitents with mild disease or injury. During the past four years an increasing number of severely ill patients such as those acute myocardial infarction and cerebral apoplexy were transfered to our EMC from other hospitals in the Chuno area.We found that many emergency patients came to our EMC, which was not staffed with so many emergency care specialists nor equiped with so many beds for emergency patients. Therefore, we requested residents, family doctors, primary care clinics, common hospitals and administrators in the Chuno area, to contribute their share to emergency medical care together with EMC.In conclusion, we thought it necessary to build a better system of emergency medical care in this area promptly.
Area ; Medical ; Central ; Bale out ; medical care

The response of systolic blood pressure (SBP) to pedalling exercise was studied in 32 healthy young men. The subjects performed the exercise at different intensities for 3 min using an incremental loading method. The first work load was 30W and increased by 30W until the heart rate (HR) reached about 170 bpm. SBP at HR 100. 160 bpm (SBP@HR 100-160) was calculated from the cubic regression equation in each subject. Mean SBP and SEM at HR 100, 110, 120, 130, 140, 150, 160 were 143.9 (2.49), 152.9 (2.79), 161.6 (3.02), 170.0 (3.16), 177.8 (3.25), 184.5 (3.34), and 189.7 (3.45) mmHg, respectively. However, the rate of elevation of SBP was zero at HR 175 bpm, which was calculated from the cubic regression equation. This may indicate that SBP is inhibited by baroreceptors and other factors at HR above 170 bpm. There were no significant relationships between SBPs@HR 100-160 and indices of aerobic capacity such as maximal oxygen consumption or PWC 170. Double product (DP) as an index of oxygen consumption by cardiac muscle increased with HR without any reduction in its rate of elevation during exercise.

A 53-year-old man underwent aortic and mitral valve replacement, but postoperative cardioangiograms unexpectedly demonstrated aneurysms that had developed right-anteriorly and exactly anteriorly to the ascending aorta. They were initially thought to be pseudoaneurysms formed at the sites of aortotomy for valve replacement and of the aortic hole made by the needle puncture for air-venting. Operative findings, however, strongly suggested that it was a DeBakey type II dissecting aneurysm with two entries at the same sites as described. It was found that almost all distal parts of the aneurysmal cavity, probably a pseudolumen, had been occluded with clots, leaving two round cavities at the entries, which were preoperatively observed as pseudoaneurysms. The entries were successfully closed with approximation of the aortic walls using cardiopulmonary bypass, and the patient survived the operation.

Case 1 presented congestive heart failure with atrial fibrillation. Echocardiography and cardiac catheterization demonstrated mitral regurgitation and communications between the right and left coronary arteries and pulmonary artery (PA). The fistula orifice was directly closed and mitral annuloplasty was done at the same time. Case 2 had a history of open mitral commissurotomy for mitral atenosis (MS), and was diagnosed as to be re-MS. Selective coronary angiography (CAG) newly documented an aberrant artery originating from the left coronary artery and draining into the distal right PA. At operation, the origin of the aberrant artery was successfully ligated, and mitral valve was replaced with a prosthetic one. This paper presented relatively rare types of coronary artery fistulae, focusing on the importance of routine CAG before open heart surgery and of consideration on the association of this anomaly in respect to perioperative myocardial protection.

Japanese medical graduates are recommended to receive clinical training for more than two years after graduation, because undergraduate clinical training is insuffiicient.
In 1976 the committee of postgraduate clinical training proposed the objectives of basic clinical training after graduation of medical schoool and in 1981 the committee proposed the objectives for the first postgraduate year of training and the methods of clinical skill assessment.
We here present the revised objectives of basic clinical training after graduation of medical school.
It is emphasized that clinical trainees should have basic clinical skills of primary and emergency care during the two year training.
These clinical skills include interviewing techniques, skills in physical examination and interpretation of physical findings, laboratory skills, skills relating to diagnosis and managements, communication skills to other doctors and to other medical co-workers and terminal care.