The purpose of our lectures on “Igaku-gairon” as a series of medical education is to consider “ What is the medicine?”, “What is the medical treatment?”, “How should the doctor be?”, and “What should be learned at the medical school?”.
Each group of the students consider “What should the doctor be?”, thus selecting the theme. The students in each group inquire into the theme, present the results thus obtained and discuss each other as a form of workshop. The teachers give some comments to supplement and amend the students' opinions, thus leading the workshop. While having these lectures, the students make a model committee on the ethics of medicine, watch videofilms showing patients in the vegetable state and those in the terminal stage of cancer, being sentensed as having cancer, and organize symposia on medicine on death problems including terminal care.
On the other hand, as a early clinical exposue, the students, wearing eyemasks and getting on the wheelchair, experience the handicapped, or help such model patients. They also do some practice to help the severely mentally and physically disabled persons at the institutes, escort the outpatients at the university hospital and do the nurse practice as assistance of nurses at the ward.
It is important for the students to think and experience a variety of medical problems by themselves, being motivated to learn medicine and treatment and not to be given lectures by the teachers passively.

A 69-year-old woman was referred on suspicion of multiple bone metastases. She had undergone modified radical mastectomy for right breast cancer at age 40 years. Positron emission tomography revealed multiple bone metastases, and serum levels of CEA, CA15-3, and NCCST439 were elevated. The diagnosis was metastatic breast cancer. Pathological re-examination confirmed that the tumor cells were positive for estrogen receptor and progesterone receptor, and negative for HER2. Endocrine therapy with letrozole was initiated, followed by toremifene citrate as second-line therapy and exemestane as third-line therapy. Seventeen months later, she developed trouble walking because of lower-extremity edema, which was caused by a synovial cyst of the left hip joint. Although no other metastases were detected, S-1 was introduced (2 weeks followed by 1 week of rest) due to severe decline in quality of life. Six months after initiation of S-1, the synovial cyst disappeared and lower-extremity edema was improved. At 11 months after initiation of S-1, serum CA15-3 level had fallen to approximately within normal limits. As of now, although the tumor marker level has been rising gradually, no other metastases except for bone metastases have been detected and treatment is continuing.

BACKGROUND: Recent studies indicate that the timing of introduction of potentially allergenic food is crucial for the development of food allergy in children. This cross-sectional study aimed to clarify the reality of allergen food intake in a general population of young children in Japan. METHODS: A questionnaire survey of caregivers was conducted at health checkups for 1.5-year (18-month)-old and 3-year-old children in the fall of 2020. The caregivers were asked about (1) the presence/absence of allergic disease symptoms based on the ISAAC questionnaire, and (2) foods that caregivers avoided giving their children. Ordinal logistic regression analyses were periformed to determine factors associated with food avoidance. RESULTS: Questionnaires were distributed to 1720 caregivers, and 1603 (93%) responded. The responders consisted of 771 and 832 caregivers who participated in 1.5-year-old and 3-year-old checkups, respectively. The prevalence of allergic diseases was comparable to recent epidemiological studies in Japan, indicating that the population may be representative. At 1.5 years old, more than 50% of the children were not exposed to peanuts, tree nuts, fish eggs, shellfish, and buckwheat. At 3 years old, the avoidance rates of the foods had decreased but were still between 18.8% and 32.0%. On the other hand, the avoidance rates of chicken egg and cow's milk, the top 2 common allergenic foods in Japan, were much lower at 2.8% and 1.5% at 1.5 years, and they decreased to 1.4% and 0.7% at 3 years old, respectively. Ordinal logistic analysis showed that avoidance of chicken egg, cow's milk, and wheat was associated with food allergy diagnosis and chicken egg avoidance with eczema, but avoidance of other foods showed no associations with any risk factors for food allergy. CONCLUSION Caregivers avoided giving various foods, independent of allergy risk factors, to their young children. Since delayed introduction of an allergenic food has been reported to increase the risk of developing an allergy to the food, the results warrant future investigation of the development of food allergies in relation to current eating habits and recommendations.
Female ; Animals ; Cattle ; Humans ; Cross-Sectional Studies ; Japan/epidemiology* ; Food Hypersensitivity/complications* ; Risk Factors ; Food ; Allergens