In 1994, a basic diagnosis training course was introduced for 2nd-year medical students at Jichi Medical School (JMS) to teach basic interview and physical examination skills with an emphasis on diagnostic processes and principles. In planning and preparing the course, instructors at JMS frequently held discussions to determine learning objectives and activities. We used a comprehensive manual for small-group teaching to standardize lectures as much as possible. In all sessions of the basic physical examination, students were taught in small groups. We also constructed original models to teach palpation and percussion. These models allowed students to participate actively and helped them understand the principles, skills, and findings of palpation and percussion. Instructors at JMS concluded that the models were useful training tools.

Introduction: A clinicopathological study of diagnosis and treatment for esophageal cancer in Hiraka General Hospital was performed.Patients and Methods: We retrospectively analyzed clinical records of 417 esophageal cancer patients treated between January 1998 through December 2009.Results: It was presumed that we took care of about 10% of esophageal cancer patients in Akita prefecture. Sixty-six percent of the patients were referred to our hospital from other medical facilities during the period under review. On the other hand, those patients with esophageal cancer detected by medical examination or health screening accounted for only 9.6%. The rate of those patients who could receive definitive therapies was 75% (313 cases), and 308 cases (98%) underwent curative surgical resection in Hiraka General Hospital. Among the patients who had received therapy aimed for complete cure, 285 patient (91.1%), went through treatment as planned, and the complete response rate was 73%. Five-year survival rates of all the patients in stage 0, stage I, stage II, stage III and stage IV were 44.7%, 76.3%, 67.3%, 38.0%, 31.6% and 15.6%, respectively. These survival rates are never be inferior to those of major centers for esophageal cancer in Japan. Long term survival rates of the patients who had been diagnosed with esophageal cancer by medical examination or health screening were statistically significantly better than those of the patients who were diagonosed by another categories. Among the 209 patients who responded completely to definitive therapy, the cancer recurred in 50 patients (23.9%). Among the 50 recurrent group, recurrence has been primarily recognized in 33 patients (67%) with in 12 months after definitive therapy and in 40 patients (82%) within 24 months. Therefore, a close follow-up is very important up to 24 months after treatment. As for the cause of death in patients who underwent curative resection the death from esophageal cancer accounted for 66% whereas the death from other diseasea and/or other type of cancer accounted for 34%.

The Jichi Medical School has trained doctors for work in community health care for over 20 years.Students learn medical communication skills by role-play. In this role-play, doctors and patients areplayed by students. Discussions are also held by students. The teaching staff give additional explanations, suggestions and demonstrations. By themselves, students learn about 1) general practice, 2) theprocess of consultation, 3) medical communication and 4) patients' emotions. We plan to develop othereducational resources such as trained simulated patients.

Objective: To investigate whether postgraduate education through evidence-based medicine can affect the knowledge and behavior of residents.
Design: Self-controlled and externally controlled trial.
Setting: University hospital.
Participants: Fifteen residents specializing in family medicine.
Intervention: Four 2-hour seminars and weekly evidence-based medicine-style journal club meetings.
Main outcome measures: Scores from a test of knowledge of evidence-based medicine and the number of MEDLINE searches conducted each month.
Results: All residents improved their knowledge of evidence-based medicine and conducted more MEDLINE searches each month than did other medical residents or residents of our department last year.
Conclusion: Postgraduate education through evidence-based medicine is effective in improving residents' knowledge and behavior.

BACKGROUND: Japanese family physicians have limited psychiatric training, see a large volume of patients, and would benefit from the use of a mental-health screening tool. This study was an initial investigation into the feasibility and validity of using the Patient Health Questionnaire (PHQ) in the primary care setting in Japan.
METHODS: Feasibility was determined by surveying 149 patients from three primary care practices. Of this sample, a Japanese psychiatrist interviewed 98 participants to assess the validity of the PHQ. Based on the psychiatrist's results, sensitivity, specificity, positive predictive value, kappa statistic and the Likelihood Ratio were examined.
RESULTS: Some 83% of patients reported being “comfortable” in filling out the PHQ. Physicians (82%) reported that the information provided was “valuable” in understanding and treating the patient. The sensitivity of the PHQ in detecting any mental diagnosis was 93%, specificity was 81%, and the positive predictive value was 47%. In subjects with mood disorders, sensitivity was 75%, specificity was 88%, and the positive predictive value was 47%. The kappa reliability coefficients between the PHQ and psychiatrist diagnoses were 0.53 for any mental disorder and 0.51 for any mood disorder. In the case of any mental disorder, the Likelihood Ratio of a positive test (LR+) for the PHQ was 4.8. In the case of any mood disorder, the LR+ for the PHQ was 6.5.
CONCLUSIONS: The Japanese version of the PHQ was useful for detecting mental and mood disorders.

We report two cases of farm chemical poisoning which were treated successfully. Two elderly men separately swallowed down paraquat/diquat solutions in an attempt to kill themselves, and resultantly developed pulmonary fibrosis. After steroid therapy, clinical symptoms desappeared, although a slight degree of abnormality remained on chest X-rays. Case 1: a 57-year-old man; the amount of ingestion, 100 ml; hospitalized 2 hours after ingestion; shock, (-); urinary PQ reactoin, (2); serum PQ level, 1.14 ug/ml; pulmonary injury at first examinatoin, (-); pulmonary manifestation of symptoms, at day 3 after hospitalization; minimum Pao₂, 67.6 mmHg. Case 2: a 65-year-old man; the amount of ingestion, one gulp; hospitalized 27 minutes after ingestion ; shock, (-); urinary PQ reactoin, (3+); serum PQ level, 6.6ug/mg; pulmonary injury at first examination, (-); pulmonary manifestation of symptoms, at day 5 after hospitalization; minimum Pao₂, 58.3mmHg. For treatment, gastrointestinal lavage, forced diuresis and direct hemoperfusion were performed in both cases. Steroid pulse therapy was followed by repeated oral administration of large doses of steroid.
Hepatic and renal disorders were transient. Pao₂ was normal when the patients were discharged. The primary reasons we could save their lives are probably that the amount of PQ ingestion was relatively small, hemodialysis was performed repeatedly at early stages, and that large amounts of steroid were used immediately after the onset of pulmonary fibrosis.

Personal lifestyles constitute one of the strategic frontiers of preventive medicine. We carried out a survey of eating habits of people in three rural communities in the southern part of Akita Prefecture, where fundamental health screening programs have been implemented regularly. Differences in eating habits between men and women and between age groups were found. The health status of the examinees was judged by using data on blood pressure, obesity and lipid levels measured at the latest health checkup.
To find a correlation between eating habits and physical health status, the frequency of illness was examined according to the number of times of eating various kinds of food. It was found that with age, people take in fish and shellfish, cow's milk, beans, vegetables, Japanese confections and soup more frequently and eat less meat. The incidence of hypertension varied by age and sex, but was higher in those who eat less soup, pickles and milk. Likewise, abnormally high levels of total serum cholesterol were found in women who eat meat, eggs and greasy food less than twice a week. It was thought that those hypertensives and those with high cholesterol values are cuttingdown on their intake of those foods of their own accord. Therefore, we would like to point out that, in the secondary prevention setting, physicians and other health care providers should know in advance whether their patients are putting themselves on a restricted diet or not.
When the average serum lipid values were examined according to the number of times of eating meat or fish and shellfish per day, it was found that men aged 70 years or above who eat those foods more than once every day have high HDL cholesterol values and that these values significantly vary depending on the kind of meat. These findings suggested that persons of advanced age who eat well and who are not particular about their food are full of vitality. This could serve as an important point in the care of the aged with serum lipid abnormalities.
A study of evacuation and its relation to vegetable intake showed that the less the frequency of bowel movements, the smaller the amount of vegetable intake. There was a significant difference in the frequency of evacuation between vegetable eaters and those who do not consume an adequate amount of fiber.

We reviewed 223 cases of surgical treatment for abdominal aortic aneurysm in octogenarians in this hospital between 1981 and 2000, and investigated the characteristic features, complications, and indications of the operation. The cases were divided into two age groups. Group O included 23 cases of octogenarians, and Group Y included 200 cases of patients under 80 years old. The average age was 68.6 years old in group Y (33-79 years old), and 83 years old in group O (80-93 years old). The hospital mortality rate was 0% in elective operation cases. In emergency operation case, Group O had a hospital mortality rate of 57.1%, significantly higher than the 6.1% for group Y. The hospital mortality rate was 17% in group O and 0.5% in group Y. The rate of emergency operation case was significantly higher in group O (30.4%) compared to group Y (16.5%). As for the preoperative complications, group O had more cases of renal dysfunction, COPD and gastrointestinal complication. As for the coronary artery disease and other cardiovascular complications, there were no significant differences between the groups. In the postoperative complication, group O had more cases of ileus, pneumonia, and cardiovascular disease. These complications were fatal in group O. These results suggest that surgical treatment for abdominal aortic aneurysm was performed safely in both groups for elective operations. Because the results of emergency operations are poor, early diagnosis and treatment seem to be important for the improvement of operative results.

The approach for the heart and proximal aorta in a patient with a tracheostomy poses difficult problems such as mediastinitis and inadequate operative exposure. We report a case of successful surgical treatment for type A aortic dissection in a patient with tracheostomy using a Y shaped skin incision and median full-sternotomy. A 63-year-old woman with a tracheostomy was referred to our hospital because of type A thrombosed aortic dissection and cardiac tamponade. At first we treated the patient conseservatively, but follow-up CT taken on the 20th day after onset revealed that false lumen of the ascending aorta was patent and the size of ascending aorta had increased to 6cm in diameter. We therefore performed hemiarch replacement (24mm Hemashield gold graft) through a Y shaped skin incision and median full-sternotomy. The postoperative course was uneventful and she was discharged on the 19th postoperative day.