We investigated the incidence of surgical site infection and the number of days required for recuperation in patients who used open drains or closed drains after genitourinary tract surgery. As the method of (statistical) examination, Mann-Whitney's U test was used. Enrolled in this study were 14 patients (mean age:66.3 years) using open drains during the period from May to October 2001 (group A) and another 14 patients (mean age:64.9 years) using closed drains during the period from December 2001 to May 2002 (group B). Using gauze and drains, germ culture was made. From cultures it was found that six out of the 14 group A patients (42.8%) had been infected with Staphylococcus epidermidis, enterococcus and/or MRSA (methicillin-resistant Staphylococcus aureus) but that all of the group B patients had been were negative, thus marking a statistically significant difference between the two groups (p<0/01). A check on the duration of the administration of antibiotics showed 7-42 days (mean:24.5 days) for group A as against 4-11 days (mean:6.1 days) for group B. It was also revealed that there was a significant difference (p<0.01) between the two groups in the number of the days when gauze was exchanged:10-31 days (mean:19.1 days) for group A versus 3-10 days (mean:7.9 days) for group B. In many other respects, the closed drainage group was found to be doing well postoperatively compared with the open drainage group.It was also noted that the patients of the open drainage group had run into a lot of difficulties eating, sleeping, excreting and doing daily activities due to bacterial infections.By switching from open drainage to closed drainage in postoperative procedures,our department has succeeded in reducing the incidence of surgical site infections, thus making it possible to obtain a remarkably favorable result in terms of recuperation.
Discharge, Body Substance ; Upper case Bee ; Genitourinary ; Postoperative Period ; Infections of musculoskeletal system

We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-old girl presented with EN as an initial manifestation of KD. At the initial visit, she showed high fever of 40℃, injection of the oropharynx, cervical lymphadenopathy, and red-purple cutaneous nodules, particularly on the lower limbs. She complained of severe pain in the neck and cutaneous lesions. Initially, the development of EN was attributed to Salmonella spp infection, which was detected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the Salmonella spp is sensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the left anterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should be considered in the differential diagnosis of refractory EN in pediatric patients.
Aneurysm ; Arteries ; Bacterial Infections ; Child, Preschool ; Coronary Vessels ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Erythema Nodosum ; Erythema ; Exanthema ; Female ; Fever ; Fever of Unknown Origin ; Humans ; Lower Extremity ; Lymphatic Diseases ; Masks ; Mass Screening ; Mucocutaneous Lymph Node Syndrome ; Neck ; Oropharynx ; Salmonella ; Skin ; Subcutaneous Tissue

Headaches caused by metastatic brain tumors result from dural tension and traction of the sites of nociceptive nerves that originates from displacement of cerebral vessels and intracranial hypertension caused by the tumor. Causes of such headaches also include meningeal irritation resulting from intrathecal dissemination of tumor and carcinomatous meningitis.Treatment of headaches resulting from intracranial hypertension involves alleviation of cerebral edema and reduction of intracranial pressure using hyperosmolar therapy and steroid administration, but treatment is often complicated by a lack of pressure reduction. We encountered 2 cases of headaches with intracranial hypertension that did not improve following hyperosmolar therapy and steroid administration, but resolved with increased opioid dose.In cases where intracranial pressure does not decrease, or for headaches attributed to direct stimulus of intracranial nociceptive nerves rather than intracranial hypertension, attempts to treat the patient with initiation or increased dosage of opioids may prove effective from a clinical standpoint.

1) The central venous catheterization (CVC) training program for 2 trainees involves an instructor, a CVC insertion simulator (Kyoto Kagaku Co., Ltd), and a simulated patient.
2) The questionnaire filled out by trainees after the program showed favorable opinions, particularly the method of learning after the practice.
3) It is important that effective simulation programs for trainees are designed to develop practical procedures and professional attitudes as a physician using both a simulator and a simulated patient.

Since students who would like to study Kampo medicine more have no opportunity to communicate each other in Northern Japanese Universities, we newly started joint study conferences held by medical students in 2013. The objectives of this paper are to report on these annually held student-based Kampo study conferences in the Hokkaido and Tohoku areas, and the ways each university studies Kampo medicine. In the conference, the students reported on their club activities. Then they studied the history of Kampo medicine and simulation of abdominal diagnosis, and performed group work on case reports together. The number of student participants in these conferences has tripled over 3 years from 18 to 58 (for a total of 111 participants). All members were satisfied with the content. And this reflects medical students' need for a wider perception of Kampo medicine, rather than a limited one gained in their university club activities. We hope this conference will play a major role in other nationwide student-based Kampo study conferences in the years to come.