We reviewed essays on clinical ethics written by 94 5th and 6th-year medical students on rotation at the Department of General Internal Medicine of Kyoto University Hospital. Issues regarding brain death, medical decisions concerning the end of life, and informed consent and truth telling were each identified as ethically important by one-third of the students. Approximately 90% of the students expressed a desire to learn more about ethical issues, including actual ethical decisions made by physicians in Japan, cross-cultural differences, medical decisions concerning the end of life, and informed consent. Most students were extremely sensitive to issues of informed consent and truth telling relevant to the patients they cared for.

Objective: In hospitals, the most recent medical information paper delivered by the hospital pharmacy is essential for obtaining information about the newest therapies and/or avoiding adverse effects of medicines.  To improve the medical information paper (hereafter, Medical News), we investigated the dissemination of Medical News delivered monthly by the Pharmaceutical Department in Oami Hospital.
Methods: Questionnaires about Medical News were distributed to each occupational category working in Ohami Hospital, and collected during June and July 2010.
Results: Responses were obtained from 127, including 19 doctors (full-time and part-time).  Ninety (70.9%) knew about Medical News, and 75 (59.1%) had read it.  It was revealed that there were differences in the familiarity with to Medical News among job classifications, and articles described on the same Medical News.
Conclusion: It insufficient to satisfied to provide drug information as a one-way provision by Medical News; however, as there are differences in the information required for each job, it is difficult to deliver a large number of copies in the small-scale hospital.  Overlooking the most up-to-date information about medicine and medical devices can lead to serious problem.  We have to review the information and provide important and accurate drug information to the staff in our hospital.

Introduction: To visualize the damage to primary care facilities in Miyazaki prefecture caused by the Nankai Trough earthquake by collating GIS data and to propose feasible countermeasures based on the estimated damage.Methods: The merged data of the estimated tsunami damage downloaded from the service for numerical information on national land use created by the Ministry of Land, Infrastructure, Transport and Tourism were combined with the data of medical institutions collected from the regional medical information system of the Japan Medical Association.Results: Of the 721 clinics and 140 hospitals, 139 clinics and 31 hospitals were affected, with 521 and 4,713 beds, respectively. By medical area, regions in which more than 50% of the clinics and hospitals were affected included the northern region of Nobeoka Nishi-usuki (clinics, 58.7%; hospitals, 60.0%) and Hyuga Irigo (clinics, 84.2%; hospitals, 61.5%), revealing a disproportionate estimate of damage.Conclusion: To deal with long-term damage, joint operation among regional facilities in neighboring prefectures is essential for a community continuity plan. Care facilities can take initiatives for cooperative disaster risk reduction planning with residents.

In order to examine the personal space perception, measurements were conducted on both elbows in 14 men and 46 women. Each subject, with his (or her) eyes closed and with his upper arm fixed horizontally, was instructed to stop the vertical and horizontal swing motion of his lower arm at the point he considered to be the middle of the range of possible motion on the front and side of plane at his shoulder, and this was repeated ten times. In various conditions, similar measurements were also done to study factors affecting the personal space perception in 14 men.
Mean values of bisected angles in percentage against range of motion were deviated from the middle points in the direction of the elbow extension, although there were large differences between the individuals. The deviation was smallest in the vertical. side of plane, and was larger in the horizontal plane than that in the vertical plane. The deviation was not so much affected by the various conditions.
It was suggested that the gain of the personal space perception is higher in the elbow extension than in the elbow flexion and its difference is larger in the horizontal plane than in vertical plane of the human elbow joint.

In the insured of the agricultural cooperative life insurance program (12, 156, 022 cases), 12, 588 persons were involved in accidents in 1973 fiscal year. The following analysis was conducted on these 12, 588 persons with special reference to the 2, 218 persons who were involved in farm machine accidents.
1. There were 3, 945 cases of traffic accidents. Of them, there were 2, 499 deaths and the fatality ratio stood at as high as 63.3%. There were 57 cases of traffic accidents involving farm machines. Of them, there were 42 deaths and the fatality rate was evidently high with 73.6%
2. There were 54 deaths caused by farm machines excluding those caused by traffic accidents. Of them, 45 were caused by cultivators. The ratio was extremely high with 83.3%.
3. Of the 45 deaths caused by cultivators, 26 were the cases in which the operators were pressed by fallen cultivators. In 13 cases, the operators were caught in between the machine and tree or building.
4. There were the other 2, 164 cases of farm machine accidents in which the patients were later seized with sequelae. Of these cases, 564 cases (26.0%) were caused by cultivators, 379 cases (17.5%) by thrashing machines and 316 cases (14.6%) by reapers. The accidents caused by these three types of machines accounted for 1, 259 cases (58.1%).
5. In the overwhelmingly large portion of the cases of accidents, sequelae broke out in fingers. Thus, 89.6% of those who were involved in machine accidents suffered from sequelae in fingers.
6. There were 1, 939 cases of finger accidents, of which 1, 032 accidents were caused by machine belts and 441 by machine blades. The accidents caused by these two items accounted for 75.9%.
7. From the statistical analysis, it might be said that the correlation coefficients between the number of farm machines available in a given area and that of accidents are less significant for cultivators and reapers, and that the environmental and working conditions are just as important elements as the number of machines.

The Ministry of Health and Welfare of Japan is planning a pooling system for multiple-choice questions (MCQs) for the national examination for medical practitioners. To clarify possible problems of such a system, a field study was performed by 10 medical schools in Japan using 90 MCQs from previous examinations. Nine hundred twenty-four 6th-year students participated in the field test. For each MCQ, the correct-response rates at the originating school and those obtained in the field test were significantly correlated. Thus, the correct-response rates to questions on the field test could be predicted from the rates at the originating schools. However, for each question the correct-response rate was significantly higher for students of the originating school than for students of other schools. In the national examination, care should be taken to prevent differences in scores on the basis of question sources.

　　Epidermal growth factor receptor (EGFR) gene mutation examination is now performed in most medical institutions in order to select the molecular targeted medicine for lung cancer. It became clear that the positive rate of the biopsy material was lower than that of the surgical sample in this hospital. The cause was attributed to false negatives due to low tumor cell content in biopsy specimens. We investigated the presence of the mutation using surgical samples and preoperative biopsy specimens from the same patients in 13 cases. Furthermore, we investigated the tumor cell content of the biopsy specimens by cell counting. Results showed that 3 of 6 biopsy specimens that were associated with positive surgical samples were judged to be negative. The tumor cell content was less than 5% in all negative cases. Regarding EGFR gene mutation examination, we should carefully determine tumor cell content when using biopsy specimens.

This study evaluated factors influencing residual aortic regurgitation (AR) after valve re-suspension surgery for acute type A aortic dissection. From January 1996 through December 2002, 63 patients were treated for acute type A dissection at our institution. Among these 63 patients, pre-and postoperative echocardiograms were available in 38 patients who underwent surgery combined with native aortic valve re-suspension. These 38 patients were divided into 2 groups according to the postoperative AR grade, i. e.: AR group: AR grade≥II (n=6), no-AR group: AR grade≤I (n=32). The severity of pre and postoperative AR was assessed by transthoracic or transesophageal echocardiography. The preoperative diameters of mid ascending aorta and sinotubular junction, and the percentage of the circumference of the dissection at the sinotubular junction level was measured by enhanced CT scan. Preoperative patient backgrounds were similar in both groups. The preoperative AR grade in the AR group was significantly greater than that of the no-AR group (2.25±1.17: 0.69±0.91, p<0.001). The tear was more frequently located in the ascending aorta in the AR group than in the no-AR group (66.7%: 37.5%, p<0.05). The percentage of circumference of the dissection at the sinotubular junction level did not affect the preoperative AR grade, but it did show a tendency to influence the severity of postoperative AR, though the difference was not significant. Three patients (7.9%) had AR grade III at the time of discharge, but did not clinically require further surgical intervention. Preoperative significant AR and the location of the tear in the ascending aorta are associated with postoperative residual AR after aortic valve re-suspension. The percentage of circumference of the dissection at the sinotubular junction level might influence the severity of postoperative AR.

A 64-year-old man was found to have a nodule in his right lung. He also complained of nausea and abdominal pain during the clinical course. Esophagogastroduodenoscopy revealed a duodenal ulcer associated with severe stenosis and a suspicion of malignancy. However, three subsequent biopsies revealed no evidence of malignancy. The fourth biopsy showed scattered large eosinophilic cells with an eccentric nucleus, leading to a diagnosis of Russell body duodenitis (RBD). RBD is an extremely rare disease, and little is known about its etiology and clinical course. The pathogenesis of RBD is discussed based on our experience with this case.
Abdominal Pain ; Biopsy ; Constriction, Pathologic ; Diagnosis ; Duodenal Ulcer ; Duodenitis* ; Endoscopy, Digestive System ; Eosinophils ; Humans ; Lung ; Middle Aged ; Nausea ; Rare Diseases