Anastomotic aneurysm was diagnosed in a 77-year-old man following graft replacement of the distal aortic arch aneurysm using the inclusion method in 1991, Enhanced CT demonstrated the aneurysm of the distal anastomotic site with a maximum diameter of 5cm between the graft and the aneurysmal wall. On left thoracotomy the aneurysm was found to severely adhere to the lung, so it was difficult to dissect its adhesion and clamp the proximal aorta. The rectal temperature was cooled to 18°C with the aid of femoro-femoral bypass. We anastomosed the previous graft-end to the new graft with one side branch during simple hypothermic retrograde cerebral circulation (RCC). RCC time was 16min and the distal end was anastomosed to the descending thoracic aorta. Though it took a long time to undertake systemic cooling and rewarming, intraoperative bleeding was small and the postoperative course was satisfactory without cerebral complication.

We evaluated basic surgical skills in students using the Objective Structured Clinical Examination (OSCE). The study was conducted on 101 sixth-grade medical students (67 males, 34 females) at Kawasaki Medical School in 1993. Theme A (tying of a silk suture) was given to 44 students, and theme B (tying of nylon suture using surgical instruments) was given to 57 students. The following items were evaluated (1) handling of surgical instruments, (2) suturing, (3) knot tying, and (4) suture removal. The average score for theme B was slightly lower than that for theme A. The average score for knot tying was lower than scores for the other items. Thus, it was revealed that all students were not good at tying knots. These scores for minor surgery correlated with the scores for other skills as evaluated by the OSCE. In conclusion, the OSCE appears to be an appropriate method for evaluating basic surgical skills.

We evaluated the interview skills of 46 sixth year medical students (32 men, 14 women) in our outpatient clinic. Six items were evaluated, including the manner in which students responded to patients, the number of times students interrupted patients' statements with closed-ended questions, and the extent to which students maintained eye contact with patients. We found that students interrupted patients every 46.2 seconds on average, and often did not make eye contact with tha patients. It became clear that, although we teach medical interview skills to students, students do not learn these skills very well. We suggest that in order to properly educate medical students, close cooperation between departments is needed.

Objective: The present study investigated awareness and knowledge about clinical trials among pharmacists working in the Nagano Hokushin area as well as their contribution to the enlightenment of clinical trial.
Methods: A questionnaire survey of clinical trials was conducted to evaluate levels of interest, impressions, sources of information, and knowledge among hospital and community pharmacists.
Results: We received responses from 77 hospital and 67 community pharmacists.  The levels of interest in clinical trials were not significantly different between hospital and community pharmacists.  About impressions, hospital pharmacists thought that clinical trials were “a new development.”  Contrarily, community pharmacists thought that clinical trials were “a field that they were seldom concerned with.”  About sources of information, hospital pharmacists found that “study meetings” were the most informative.  More community pharmacists than hospital pharmacists chose “general reports, for example, newspapers and televisions” as a source of information, and similarly more community pharmacists indicated that they had “few opportunities for obtaining information about clinical trials.”  About knowledge, the percentage of correct answers about clinical trials between hospital and community pharmacists was not significantly different.  A higher percentage of community pharmacists than hospital pharmacists answered unknown.
Conclusion: Hospital and community pharmacists had different impressions and knowledge about clinical trials probably because of differences in sources of information and its access.  Henceforth, study meetings involving educational material about clinical trials should be held for discussing fundamental knowledge about the methods and structure of clinical trials and for discussing case studies wherein patients consult pharmacists about clinical trials.

We report a case of successful surgical treatment for an aortic anastomotic false aneurysm associated with a graft-duodenal fistula after abdominal aortic aneurysm repair. A 63-year-old man was admitted with melena and an aortic anastomotic false aneurysm after prosthetic graft replacement 8 years previously. CT scan demonstrated an aneurysm with a maximum diameter of 70mm at the proximal anastomotis of the prosthetic graft. Gastroduodenoscopy revealed no bleeding site in the stomach or the first and second portions of the duodenum. Therefore, we performed an emergency operation under a diagnosis of an aortic anastomotic false aneurysm associated with a graft-duodenal fistula. The aneurysm was replaced with interposition of a new prosthetic graft via a thoracoabdominal approach. The fistula was repaired by covering the duodenum with the jejunum through a left pararectal laparotomy. The postoperative course was uneventful, and there was no evidence of graft infection at 14 months after the operation.

Two months ago, a 9-year-old boy experienced intermittent abdominal pain regardless of food intake, without diarrhea, bloody stool, or nausea. Blood test results revealed a peripheral blood eosinophil count of 660 cells /µL, which was marginally elevated, without inflammatory reaction, occult blood, or enteric pathogens. The intestinal mucosa from the terminal ileum to the rectum was endoscopically normal, but mucosal biopsy revealed eosinophilic infiltration of the terminal ileum and whole colon with ≥20 eosinophils/high power field (HPF). Subsequent upper gastrointestinal endoscopy revealed normal endoscopic mucosa from the esophagus to the second part of the duodenum, but mucosal biopsy showed an eosinophil infiltration of ≥20 eosinophils/HPF. Based on the above findings, he was diagnosed with eosinophilic gastroenteritis (EGE). The cause of EGE and mechanisms of eosinophil infiltration have yet to be fully elucidated. For these nonspecific abdominal symptoms, evidence of eosinophilic infiltration of the gastrointestinal mucosa, specifically 20 eosinophils/HPF in each intestinal mucosa, is required for the definitive diagnosis of EGE. Even if only persistent abdominal pain develops, EGE diagnosis should be confirmed with the analysis of mucosal biopsy in addition to the review of allergic disease history and peripheral blood eosinophil counts.

The Saku Central Hospital classified muscular relaxants, potassium products and the like as “high-risk medicines”, but when it came to insulin, did not take any standardized measure against it to prevent accidents. Having organized a team of personnel from a wide variety of job, our hospital has recently carried out a campaign for improvements in medical care. With pharmacists playing a leading role, we grappled with measures for the prevention of errors in the administration of insulin using quality control (QC) methods. As a consequence, the campaign served to decrease the number of medical mistakes. As there still occur many incidents involving medication, the role played in risk management by pharmacists remains significant. In future, pharmacists will hopefully play a constructive role in risk management to prevent medical incidents involving medical supplies. That said, a campaign for improvements inmedical care through the practical use of QC methods seems likely to bring about favorable results.
Role ; Quality Control ; Analysis ; Avoidance ; ERROR