Using radioactive isotope I¹³¹—NaI¹³¹ was mixed in 10% Na₂SO₃ solution, radio activity 100mc/ml, radio chemical purity 99.9%—, percutaneous absorption of iodide from bath water, peroral absorption after internal use of iodine containing mineral water, and the influence of absorbed iodine on the thyroid gland were studied in mice and rabbits.
Each mice was fixed in a small cage following the “bambootube” method of Masaji Seki, and bathed till the lower half of the body in the bath water at 37°-40°C, 20-30 minutes. NaI¹³¹ was added in the bath water to reach a radioactivity of 100-200μc/l. After the bath the surface of the animal body was washed out thoroughly with running water. Then the breast was cut open under anesthesia using chloroform or ether and blood was taken by heart puncture. The radioactivity (RA) of the blood was then measured by G-M counter or scintillation counter (well-typed).
Rabbit was bathed, fixed in a box, till the lower half of the body. The blood was taken from the ear vein. The radioactivity around the thyroid gland was measured by a survey meter.
For internal use of the waters, a thin polyvinyl tube with a diameter of 2mm was perorally inserted into the stomach of the mice. In the case of rabbit. Nelaton catheter was used.
To study function of the thyroid gland after serial oral administration of Mobara Mineral water, rabbits were given 5μc of I¹³¹. Then I¹³¹ uptake of the thyroid gland and plasma conversion rate after 24 hours were determined.
The investigations revealed the following results:
1. The longer was the duration of bath, the greater proved the amount of percutaneously absorbed iodine. Likewise, percutaneously absorbed iodine showed a tendency to increase as the temperature of bath water and as concentration of iodine in the bath water increased. It was recognized that iodide absorption continued still after the bath.
2. In relation to the influence of various co-existing ions upon the percutaneous absorption of I¹³¹, additon of sodium chloride, sodium sulfate, calcium chloride, or calcium sulfate at a concentration of 1g/l, showed an inhibition, while sodium bicarbonate, aluminium sulfate or pottasium bromide had a tendency to inhibit but not definitely. Especially, high concentration of sodium sulfate showed a strong inhibition, and in the case of sodium chloride similar finding was noted.
3. Concerning the effect of carbon dioxide and hydrogen sulfide an increase of percutaneous iodine absorption was demonstrated by the former.
4. After the serial daily bathings for 12 to 14 days in sodium sulfate solution, sodium chloride solution, or solution of pottasium iodide plus sodium chloride, respectively, an inhibition of percutaneous absorption of I¹³¹ was observed. As far as sodium chloride solution was concerned, the inhibition increased parallel with the length of the serial bathing period. On the other hand, after the serial bathings for 7 to 14 days in Kusatsu Hot Spring (H₂S-containing acid spring), an inhibition of percutaneous absorption of I¹³¹ was demonstrated, while after 21 days of the serial bathings an tendency of recovery in the percutaneous absorption was observed.
5. In adult rabbits thyroid uptake of iodine, in the amount corresponding to 1.8ml of bath water, was proved 48 hours after bathing for 30 minutes at 40°C in a bath water containing iodine at a concentration of 200μc/l.
6. Oral adminitstration of water containing I¹³¹ (0.25μc/l) resulted in a much more greater absorption than bathing in I¹³¹ added water (500μc/l). Oral administration of sodium bicarbonate or sodium chloride solution following the oral intake of I¹³¹ revealed no remarkable influence upon the absorption of I¹³¹
7. After oral administration of Mobara Mine

Introduction: We described a patient with lung cancer who suffered from severe pain due to pelvic bone metastasis and opioid-induced delirium. Induction of subarachnoid analgesia using implanted intrathecal catheter almost abolished his pain and enable home palliative care. Case description: Seventy-year old man was admitted for intractable leg and hip pain due to pelvic bone metastasis and delirium induced by opioid. Although he was initially administered continuous subcutaneous morphine injection for opioid titration, delirium was deteriorated. Opioid rotation to oxycodone and increase in antipsychotic drugs could not improve his delirium. Epidural analgesia with local anesthetic and small dose of morphine improve his delirium with adequate analgesic effect. Finally, he was received intrathecal catheter implantation and discharged to home palliative care. Conclusion: Neuraxial analgesia may provide not only sufficient analgesia but also lower risk of delirium in patient who was administered high dose of opioids because of intractable cancer pain.

The present study was conducted to obtain basic information about blood glucose fluctuation and relation with race performance during 100 km marathon. Subcutaneous glucose of one well-trained runner was measured by continuous glucose monitoring system (CGMS) at 5 min interval and blood samples for biochemical analysis were drawn at pre, middle and post of the race. Energy balance during one week prior to the 100 km race was recorded, and the whole energy and fluid intake during the race was analyzed. Blood glucose fluctuated reflecting duration of exercise and energy supply during the race. During the latter part of the race (65–70 km), abrupt declines in blood glucose level, which reflected insufficient carbohydrate intake before the race (119 g), were accompanied by decrease in running speed. The present report suggests that continuous glucose monitoring supplemented with standard nutritional and physiological measurement provides precise and valuable information on runner’s energy state during the ultra-endurance race, and that athletes need to reassess their preparation for the race and planning of energy intake during the race.

To evaluate training methods for basic clinical skills before bedside learning, we used questionnaires to ask students and instructors their opinions about the fixed-instructor system, in which one instructor teaches the entire course, and the rotation system, in which instructors share responsibilities for teaching according to their specialty. Students had positive impressions of training with both systems. Many students felt that communication with in structors was good inthe fixed-instructor system and that the specialized education provided by multiple instructors was good in the rotation system. However, students expressed dissatisfaction about differences in educational content between the systems. Instructors believed an advantage of the fixed-instructor system was that skills learned could be applied to all medical fields, whereas the rotation system made teaching easier because it was specialized. On the basis of this investigation, we conclude that training should establish good communication between instructors and students and should include the required educational contents. We also found that unifying educational contents is difficult, regardless of the training system. Few reports about educational methods used to teach basic clinical skills have been published in Japan, but studies focusing on this issue are becoming increasingly necessary.

The present study was conducted to obtain basic information about blood glucose fluctuation and relation with race performance during 100 km marathon. Subcutaneous glucose of one well-trained runner was measured by continuous glucose monitoring system (CGMS) at 5 min interval and blood samples for biochemical analysis were drawn at pre, middle and post of the race. Energy balance during one week prior to the 100 km race was recorded, and the whole energy and fluid intake during the race was analyzed. Blood glucose fluctuated reflecting duration of exercise and energy supply during the race. During the latter part of the race (65–70 km), abrupt declines in blood glucose level, which reflected insufficient carbohydrate intake before the race (119 g), were accompanied by decrease in running speed. The present report suggests that continuous glucose monitoring supplemented with standard nutritional and physiological measurement provides precise and valuable information on runner’s energy state during the ultra-endurance race, and that athletes need to reassess their preparation for the race and planning of energy intake during the race.

It has been reported that diabetes mellitus is a significant risk factor for adverse outcomes after conventional CABG using cardiopulmonary bypass. However, the effects of diabetes on postoperative outcomes after off-pump coronary artery bypass grafting (OPCAB) are unclear. The effects of diabetes on early and mid-term results were studied by comparing the outcomes between 82 patients (65±5 years) with diabetes and 112 patients (68±11 years) without diabetes. The diabetic group included a greater preoperative presence of renal insufficiency (22.0% vs 8.9%, p=0.011) and history of cerebral vascular accident (25.6% vs 11.6%, p=0.012). Strategies, including graft choice, were not changed by presence of diabetes. The use of bilateral internal thoracic arteries (70.7% diabetes vs 67.0% nondiabetes), and frequency of total arterial bypass were similar in the 2 groups. The number of distal anastomoses was higher in the diabetic group (3.0±0.9 vs 2.7±0.9, p=0.042). The operation time and frequency of blood transfusion were similar in both groups. There was no hospital death in either group. Although mechanical ventilation time and postoperative ICU stay did not differ, hospital stay was significantly longer in the diabetic group (16.2 vs 13.3 days, p=0.0085). Postoperative major complications including atrial fibrillation were not significantly different between the 2 groups. Minor wound infection occurred in 2 patients, 1 in each group. There was no mediastinitis in either group. During the mean follow-up period of 20.8 months (1-39), there were two sudden deaths in the diabetic group, but no other cardiac death in either group. Cardiac event-free rate did not differ between the 2 groups. Although hospital stay in diabetic patients was longer than that in nondiabetic patients, early and mid-term results of OPCAB were not significantly affected by diabetes mellitus.

Eosinophillic glanuromatosis with polyangitis (EGPA) usually occurs in patients with a recent history (usually less than 10 years) of uncontrolled bronchial asthma. Here we describe a case of EGPA that occurred in a 68-year-old female who had well-controlled bronchial asthma for 17 years. A leukotriene receptor antagonist that had been prescribed one week before onset might have triggered the disease. Our case shows that there is a wide spectrum of clinical characteristics of EGPA, making diagnosis difficult in a primary care setting.

The preparation for influenza pandemic has become very important. However, no standardized educational package against pandemics has been established to date. We developed a simulation–based education drill for Japanese medical students based on the package developed by U.S. medical school. The drill was adapted to 201 medical students, and was evaluated by self–administered questionnaires.
1)More than 90% of the students indicated that the use of this drill is appropriate to experience a simulated pandemic situation, and to learn skills and attitudes such as teamwork and communication.
2)Up to 65% of the students answered they learned a "very clear image" for the "Importance of working as a team with other professionals".
3)The results suggest that this simulation–based education drill make the students aware not only of the need for the preparation for pandemic but also the importance of team–based approach.

BACKGROUND: In general practice, though patients often stop visiting ambulatory clinics of their own vo-lition despite the need for ongoing medical treatment, there is little reported research on the reasons for nonattendance in Japan. In this study, we investigated whether the patient/doctor relationship influences nonattendance rates in general practice. In addition, we investigated the reasons why patients stopped visiting the hospital.
METHODS: We collected data from 115 patients (58 males, 57 females; age range: 16 to 94 years old, median age: 52 years old) whose initial diagnoses were made in our department from June to July 2000. We classified the patients into five groups based on the level of their complaints concerning the initial consultation (‘A’ representing the highest degree of complaint, ‘E’ representing the lowest) and determined the relationship between the strength of complaints and the non-attendance rate. Furthermore, we investigated the reasons for non-attendance concerning 28 patients who stopped visiting the hospital from April 2000 to November 2001.
RESULTS: The non-attendance rates were 0% (014) for group A, 14.3% (2114) for group B, 5.6% (5189) for group C, 33.3% (216) for group D, and 50% (1/2) for group E. The rate tended to be higher in groups with fewer complaints. The reasons for non-attendance were the following: remission of symptoms (9 patients), request for another hospital or department (6 patients), relief due to consultation at the university hospital (6 patients), and lack of time to come to the particular hospital (5 patients) . In contrast, the most common reason for satisfaction at the time of consultation was ‘enough explanation and listening to complaints well’ in 7 of 11 patients who were satisfied with the consultation.
CONCLUSIONS: The level of patient's complaints at the time of consultation is related to the non-attendance rate. However, sufficient explanation about symptoms and careful listening to complaints are important for establishing a good patient/doctor relationship.

Introduction: The aim of this study is to explore career perceptions of male and female medical students.
Methods: Semi-structured interviews to 16 medical students (9males, 7 females) were undertaken.
Results: Qualitative data analysis showed that development of their career perceptions were affected by “gender view”, “interests in medicine” as well as their “perceptions of family”. Specifically, female students in the lower grades felt difficulty in making decisions on career choices due to the conflict between carrying out family responsibilities (e.g., housework and childcare) and interests in medicine. After clinical clerkships, their perceptions of a career were formed in one of two ways: giving priority to family responsibilities or interest in medicine. On the other hand, male students in lower and higher grades consistently gave priority to their interests in medicine for their career choices.
Conclusion: Differing career perceptions between male and female medical students emerged from this study, and supports the need for undergraduate education on gender-equality in society.