The patient was a 70-year-old man. He was injured in a motorcycle accident and was brought to the hospital suffering from pulmonary contusions, multiple rib fractures, and a dislocation fracture of the left hip joint. Mechanical ventilation and tracheostomy were performed because of decreased oxygenation. As dysphagia and gait disturbance persisted even after his respiratory condition improved, the patient was transferred to our institution for rehabilitation 63 days after the injury. Rehabilitative intervention for the patient's physical impairments progressed smoothly, and the patient regained independence in activities of daily living. However, 1 week before his scheduled date of discharge, the patient suffered from sudden heart failure at 168 days after the initial injury. Traumatic aortic regurgitation was diagnosed based on the following findings : aortic regurgitation rapidly exacerbated after heart failure, no medical history of heart disease, and no other cause for aortic regurgitation. Surgical treatment with aortic valve replacement was performed. Postoperative recovery was favorable, and the patient was discharged to his home after regaining independence in activities of daily living. Traumatic aortic regurgitation is rare, and patients with this disease often suffer heart failure from a few days to several years after injury. This condition needs to be kept in mind during the rehabilitation process following chest trauma.

Tuberculous spondylitis, or so-called Pott's disease, seems to be overlooked because of a lack of severe inflammation in the insidious generating process and tends to cause non-specific symptoms, such as back pain, fever, weakness, and weight loss. Diagnostic delay is common and the results can be disastrous. Discriminating between Pott's disease and other diseases, such as malignancy and pyogenic infection, is difficult. However, the inflammatory process in Pott's disease tends to spare the disk space, while that of pyogenic infection typically affects the area. Herein, we present a patient with Pott's disease who showed the characteristic clinical and radiological findings.

We evaluated our undergraduate clinical clerkship system in 1992, using the multiplication method advocated by the Working Group on “Evaluation of clinical skills of medical students ” of the Japan Society for Medical Education. We divided the clinical training period into three terms: the first term was held from May through June, the second from September through October, and the third from December through January. We determined scores using checklists and rating scales in ten categories, totalled the scores for each period, and compared them between periods. The total scores for the third period were the highest, followed by those for the second period. Scores for basic knowledge, data gathering, and basic technical procedures increased with increase in the number of training hours. However, scores for manner, attitude, and interviewing skills were already high in the first period. We conclude that the multiplication method is useful for objectively evaluating students' clinical skills.

At institutions in 9 areas of all over Japan, epidemiological and clinical surveys and investigations have been performed on the relationship between alcohol drinking and health for inhabitants in agricultural and fishing villages. The ethanol cutaneous patch test showed about 40% ALDH2 defficiency in these subjects. There were remarkable defferences in the drinking behavior between these positive and negative 2 groups. Various factors affecting the drinking behavior of subjects are there congenital diathesis, sexual difference, natural and social differences as well as age and occupation. By drinking, various abnomalities have been observed in various indexes such as medical examinations namely, hepatic functions (γ-GTP, GOT, GTP, etc), lipids (HDL-C, TG, etc), circulating functions (blood pressure, pulse, etc), metabolisms (uric acid, blood sugar, etc), and pancreatic functions. Most of them are risk factors in adult diseases. Accordingly, through collective education for drinking, its effect can be observed earlier and it will be very important to educate individuals for health control.

OBJECTIVE: A recent study suggested that rs6504340, a polymorphism within the homeobox B (HOXB) gene cluster, is associated with the susceptibility for malocclusions in Europeans. The resulting malocclusions require orthodontic treatment. The aim of this study was to investigate the association of rs6504340 and other dentition-implicated polymorphisms with dental and occlusal traits in Korean and Japanese populations. METHODS: The study participants included 223 unrelated Koreans from the Busan area and 256 unrelated Japanese individuals from the Tokyo metropolitan area. DNA samples were extracted from saliva specimens. Genotyping for rs6504340 and four single nucleotide polymorphisms (SNPs) that have been shown to be associated with the timing of first tooth eruption and the number of teeth at 1 year of age (rs10506525, rs1956529, rs9674544, and rs8079702) was performed using TaqMan assays. The Index of Orthodontic Treatment Need (IOTN), overjet, overbite, arch length discrepancy, crown sizes, and length and width of the dental arches were measured. Spearman's correlation coefficients were calculated to evaluate relationships between rs6504340 and these dental/occlusal traits. RESULTS: We evaluated the aesthetic components and dental health components of the IOTN in the Korean and Japanese populations and found that neither rs6504340 nor the other four SNPs showed any association with dental and occlusal traits in these East Asian populations. CONCLUSIONS: These negative results suggest that further research is needed to identify the genetic determinants of malocclusions in order to reach a consensus.
Asian Continental Ancestry Group* ; Busan ; Consensus ; Crowns ; Dental Arch ; DNA ; Genes, Homeobox ; Genetics ; Humans ; Index of Orthodontic Treatment Need ; Malocclusion ; Multigene Family ; Overbite ; Polymorphism, Single Nucleotide ; Saliva ; Tooth Eruption* ; Tooth*

High-dose methotrexate-based chemotherapy has extended survival in patients with primary central nervous system lymphoma (PCNSL). However, although salvage treatment is necessary in recurrent and refractory PCNSL, this has not been standardized. We herein describe the efficacy of a combination of rituximab and temozolomide (TMZ) in two consecutive patients with recurrent and refractory PCNSL. Based on the immunohistochemical study, case 1 had a non-germinal center B-cell-like (non-GCB) subtype, was positive for bcl-2 and negative for O6-methylguanine-DNA methyltransferase (MGMT). Case 2 was GCB subtype, bcl-2-, and MGMT+. Because of the positive expression of MGMT, interferon-beta was additionally given in case 2. Complete responses and partial responses were obtained after the third and fourth cycles of combination therapy, respectively. This was maintained for 12 months, with acceptable toxicity. The combination of rituximab and TMZ was effective in tumors with different immunohistochemical profiles. This combination therapy warrants further study in a larger population.
Aged ; Antibodies, Monoclonal, Murine-Derived/*therapeutic use ; Antineoplastic Agents/*therapeutic use ; Central Nervous System Neoplasms/*drug therapy ; Dacarbazine/*analogs & derivatives/therapeutic use ; Drug Therapy, Combination/*methods ; Humans ; Lymphoma/*drug therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local/drug therapy

A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.