An 87-year-old woman with unknown fever origin was admitted to our internal department. We could not determine the fever origin from clinical findings, serious blood data, urine data, bacteriological data, and images obtained by ultrasonography, computed tomography and magnetic resonance. Body inflammatory findings did not respond to several antibiotics we used. Gallium scintiphotography revealed abnormal radioisotope uptake in the bilateral inguinal region. And ultrasonography and enhanced computed tomography showed tumors in front of the bilateral femur neck. Moreover, bone scintiphotography (^99mTc) revealed abnormal radioisotope uptake in the bilateral hip joints. We performed resection of the right inguinal tumor. The tumor was solid mass 30×20×20mm in size. It was covered with an articular capsule in front of the right femur neck. We identified the mass as bilateral tuberculous granulation with Langhans-type giant cells pathologically. It was only with difficulty that we firmly diagnosed the case as tuberculous arthritis of bilateral hip joints because the fever origin was unknown. It is important to diagnose tuberculous arthritis by use of various imaging techniques. We should take tuberculous infection into consideration when we encounter a case of arthritis of unknown fever origin or a case of antibiotics resistant arthritis.

Upper gastrointestinal endoscopy is an invasive examination. Cardiovascular and respiratory adverse effects are commonly observed in patients undergoing endoscopy. We investigated prospectively the cardiovascular and respiratory changes every oneminute before, during and after routine endoscopy. Sixteen healthy adult patients were enrolled in this study. Systolic blood pressure, diastolic blood pressure, pulse rate and percutaneous arterial oxygen saturation (SpO₂) were recorded every one-minute throughout the procedure. Systolic and diastolic blood pressure increased significantly one minute after the insertion of the endoscope. Increases in pulse rate were noted after the insertion of the endoscope. Rate pressure product increased significantly one minute after the insertion of the endoscope. No significant change in SpO₂ was observed during endoscopy. Our results indicated that upper gastrointestinal endoscopy might induce cardiovascular stress and abnormality. Therefore, we should carefully insert and manipulate upper gastrointestinal endoscope.

We conduct an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorts one patient at the University of Tsukuba Hospital throughout his or her first visit. We evaluated this program from the points of view of both students and patients.
1) A questionnaire was distributed to all participating patients and students in 2006.
2) In their questionnaires, many students commented on the long waiting time, the structural problems of the hospital, and the attitudes of physicians.
3) Results of the questionnaire showed that both students and patients rated this program highly.
4) No significant differences were noted between the comments of the students and those of the patients. The patients tended to rate this program more highly than did the students. One patient, however, commented that being constantly accompanied by a stranger was somewhat stressful.
5) We conclude that this program can be efficiently carried out without being too much of a burden to patients and is a valuable part of an early exposure program for first-year medical students.