ABSTRACT : Both primary biliary cirrhosis (PBC) and autoimmune hemolytic anemia (AIHA) are uncommon diseases. Immunological dysregulation is suggested as a causative factor for both diseases. We report a 77-year-old woman who suffered from warm type AIHA complicated by PBC. Her direct antiglobulin test was positive for IgG, and negative for C3. Both anti-mitochondrial antibody and its M2 component were detected. Both alkaline phosphatase (Alp) and IgM were elevated in the serum. She was initially treated with steroids for 8 months. Her steroids were discontinued when she underwent a laparoscopic splenectomy. Ursodeoxycholic acid was discontinued due to an allergic skin reaction. Her Alp improved with bezafibrate.

A 55-year old man was admitted to our hospital owing to endograft collapse after TEVAR. He had undergone total arch replacement for acute aortic type A dissection at age 39, and undergone thoracic endovascular aortic repair (TEVAR) for chronic aortic type B dissection at age 54. TEVAR was successfully performed and the false lumen was shrunk. However, one year after TEVAR, computed tomography showed endograft collapse. Technical success was not achieved by the balloon technique to treat endograft collapse, so we performed additional TEVAR. After this procedure, endograft collapse was repaired. The postoperative course was uneventful.

We investigated the relationship between the electrical and the mechanical responses of the frog sartorius in situ in isometric reflex contraction. All the thigh muscles other than the sartorius were dennervated. Mechanical stimulations were applied mainly on the dorsal skin of the ipsilateral foot. The electrical response led from the surface electrode was integrated by means of the Miller integrator. The mechanical response was recorded by the mechano-electric transducer, and its impulse was measured by the planimeter.
A very high positive correlation was found between the integrated value of the EMG and the mechanical impulse. It was found that the quantitative measurement of the electrical response of the muscle could be made in more accurate and efficient way by the Miller integrator than the other methods discussed in this paper.

We experienced a case of severe alcoholic hepatitis. Combination treatment of continuous hemodiafiltration and steroid hormone was started immediately after admission. This treatment was very effective for severe alcoholic hepatitis, resulting in the shortening of the length of hospital stay. The reasons why this treatment was effective were; 1. The patient was younger, so the regeneration ability of liver cells was stronger. 2. The infection and bleeding of digestive organs except for acute renal failure were not found, resulting in the enhancement of the effectiveness for steroid hormone treatment. 3. The intensive blood purification treatment was started immediately. From this experience, we realized again that a fine collaboration of doctors, nurses and clinical engineers was very important in the intensive care of the severe diseases.
therapeutic aspects ; Steroid hormone, NOS ; Hepatitis, Alcoholic ; Combined ; Review [Publication Type]

We report two cases of paraganglioma originating in the paraseller region (case 1) and in the urinary bladder (case 2). The subject in case 1 was a 59-year-old man who was admitted into the hospital with dizziness, muscular weakness of the left extremities and cold sweating. Magnetic resonance imaging (MRI) revealed a tumor in the parasellar region. The subject in case 2 was a 39-year-old man who was hospitalized because he had a sense of residual urine. Computed tomography and MRI showed a mass of tumor tissue in the posterior region of the left ureteric orifice of the bladder. Imprint cytology of both tumors showed isolated, loosely attached sheet-like cells with abundant cytoplasm and round or oval nuclei. Histologically, both tumors consisted of round or polygonal cells in small packets separated by vascular fibrous septa. Immunohistochemically, both tumor cells were positive for NSE, S-100 protein, chromogranin A, and synaptophysin. Electron microscopic examination revealed neurosectretory granules in the cytoplasm of tumor cells in either of these two cases.

The first trial of common achievement test-computer-based testing was held from January through August 2002. The number of examinees was 5, 693, of whom 5, 676 were analyzed. Single-best-answer, five-choice questions were used. The highest score was 92 points, the lowest score was 19 points, and the average score was 55.9±10.2 points (standard deviation). Scores were distributed normally. The test sets did not differ significantly in difficulty, although test-set items differed for each student. The percentage of correct answers, the ∅-coefficient, and the point-biserial correlation coefficient were calculated for each category of the model core curriculum. The percentage of correct answers was highest in category A of the model core curriculum, and percentages of correct answers were similar in categories B, C, D, E, and F. The ∅-coefficient and the correlation coefficient were low in categories A and F and were highest in category C. Although the percentage of correct answers in this trial was lower than expected, many test items had discriminatory power. The Test Items Evaluation Subcommittee is now evaluating test items, determining pool items, and revising new test items for the second trial and expect to compile a useful item bank.

Though preoperative autologous donation is not acceptable for all cases partly because some are preoperatively in a severe condition, intraoperative predonation is possible in almost all cases. We retrospectively evaluated the major factors related to the prevention of homologous blood transfusion by intraoperative predonation in 25 cases following valvular surgery without preoperative autologous donation. Homologous blood was not transfused in 18 cases {Group-(-)} but in 7 cases only after CPB {Group-(+)}. The male/female ratio, type of operation, body weight, CPB dilution, CPB duration, and perioperative change in hematocrit were comparable in the 2 groups. However, the autologous blood pooled before CPB in Group-(-) was significantly more than in Group-(+) (11.3±2.5 vs 7.3±1.8ml/kg, p<0.001). In conclusion, homologous blood transfusion may be prevented by appropriate intraoperative predonation during surgery for valvular disease.

The aim of this study is to clarify the present situation of activities of continuing medical education (CME) for the primary care physicians to whom the leading hospitals, such as universities and clinical trainee hospitals perform CME in their regions. A questionaire was designed for main 4 parts, as following: 1) On the purpose of CME for the physicians. 2) On the organization (office) managing CME in the hospitals. 3) On the strategies of CME. 4) On the evaluation of CME. Answers to a questionaire were replied from 234 institutions (58.1%). Analyzing the results, we recognized that the leading hospitals actively carried out CME for the primary care physicians in the community. Furthermore, conversion to experiential learning from passive learning and establishment of evaluation methods should be promoted in CME.