Quality of care associated with number of cases seen and self-reports of clinical competence for Japanese physicians-in-training in internal medicine.

Background: The extent of clinical exposure needed to ensure quality care has not been well determined during internal medicine training. We aimed to determine the association between clinical exposure (number of cases seen), self- reports of clinical competence, and type of institution (predictor variables) and quality of care (outcome variable) as measured by clinical vignettes.

Methods: Cross-sectional study using univariate and multivariate linear analyses in 11 teaching hospitals in Japan.

Guidewire-induced coronary artery perforation treated with transcatheter delivery of subcutaneous tissue.

In three cases of small coronary artery perforation by guidewires during percutaneous coronary intervention, coronary leakage continued despite prolonged balloon inflation and reversal of heparin. Subcutaneous tissue was selectively delivered to perforated vessels by means of microcatheters in a successful attempt to stop leakage. This method appears to be extremely effective for treating guidewire-induced perforations of distal coronary arteries.

Endovascular stent-grafting for recurrent aneurysm in Behcet's disease.

Arterial aneurysms represent a severe complication of Behcet's disease. A 42-year-old woman with Behcet's disease had a recurrence of an aneurysm after two surgical repair attempts using grafts. A covered stent-graft was implanted in her iliac external artery to occlude the neck of the aneurysm at the anastomosis of the bypass graft to her external iliac artery.

Aortocoronary dissection resolved by coronary stenting guided by intracoronary ultrasound.

Percutaneous coronary intervention (PCI) was performed for chronic total occlusion of the proximal right coronary artery in a 70-year-old male with unstable angina. The forceful manipulation of the guide catheter led to an aortocoronary dissection involving the right Valsalva sinus and the ascending aorta. Intracoronary ultrasound (ICUS) showed the important characteristics of the dissection, enabling successful coronary stenting under ICUS guidance.

Obstinate thrombosis during percutaneous coronary intervention in a case with heparin-induced thrombocytopenia with thrombosis syndrome successfully treated by argatroban anticoagulant therapy.

We describe a case of massive coronary thrombus after the coronary stenting due to heparin-induced thrombocytopenia with thrombosis syndrome (HITTS). Only argatroban was able to resolve the thrombus. This is the first case in which argatroban successfully treated massive thrombus during percutaneous coronary intervention in a patient with HITTS.

Highly vascular pelvic tumor causing high-output heart failure because of massive arteriovenous shunting: a case report.

A 53-year-old Japanese woman underwent investigation of her heart murmur. A continuous abdominal bruit was heard. Blood gas analysis and chest X-ray showed congestive heart failure.