A pilot study of the Doppler renal arterial flow pattern was done on 34 patients (68 kidneys) with benign prostatic hypertrophy, 14 patients (28 kidneys) with hydronephrosis and 22 patients (37 kidneys) with reflux nephropathy. Renal scintigraphy was also performed besides the color Doppler scanning.
Results:
Mean minimum blood flow values were significantly smaller in all the subjects than those in normal control groups with one of the three diseases respectively
In patients with reflux nephropathy, minimum blood flow values were extremely low, suggesting the severe scars and scarce blood flow. A high correlation was found between uptake rates measured by renal scintigram and minimum blood flow. This fact suggests that the blood flow scan can reveal the profile of the renal function.
We conclude that the color Doppler sonography is useful in a routine initial examination and a simple follow-up test for detecting renal dysfunction in some urological diseases.

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.

Medical professionalism, which is of great interest in most countries, underpins the relationship between patients and doctors. The concepts of medical professionalism should be understandable not only by physicians but also by patients. However, there are few studies that evaluate the concept of medical professionalism from patients' perspective.a) We conducted two focus group interviews with 12 people who were not health care professionals. One interview was done with people who were living in Tokyo and one with people living in Osaka. Each interview was one hour long. During the interviews, we explored themes related to medical professionalism from patients' perspectives.b) We qualitatively analyzed response data from audio records of the interview and inductively extracted categories pertaining to medical professionalism. We compared our findings with the domains of the American Board of Internal Medicine's Charter on Professionalism (CP).c) We found 5 themes; 1) Primacy of patient welfare 2) Fairness 3) Social responsibility 4) Maintaining appropriate relations with industry 5) Maintaining appropriate relations with patients.d) Although our themes are almost equivalent to the principles cited in CP, there are some differences, such as the importance of maintaining appropriate relations with patients.e) Given the current findings, medical educators and trainers should continue to develop the Japanese concepts of medical professionalism in a manner that takes into consideration patients' perspectives.

We investigated the outcomes of nephron-sparing surgery in patients with small renal cell carcinomas by retrospectively reviewing the records of 20 elective cases of nephron-sparing surgery performed from 1994 to 2003. All patients had low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas. There were no significant differences between mean preoperative serum creatinine levels and postoperative levels. Nephron-sparing surgery may be safe and curative treatment for low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas.
Surgical aspects ; Carcinoma, Renal Cell ; Nephron brand of racepinephrine hydrochloride ; seconds ; Small

Laparoscopy-assisted distal gastrectomy (LADG) has been advocated as a minimally invasive operation for early gastric cancer which needs regional lymph node resection. However, since it is technically too complicated and difficult to perform all laparoscopic procedures within the abdominal cavity, LADG has not become the standard surgical procedure for early gastric cancer. Moreover, a skin incision of approximately 5cm is required to allow the reconstruction of the digestive tract after gastrectomy. Therefore, we have developed an operative procedure which we call hand-assisted laparoscopic distal gastrectomy (HALDG). In this procedure we make a skin incision of 6cm, and the surgeon inserts his/her left hand into the abdomen to assist the laparoscopic procedure. The surgeon can move his/her left hand freely, to palpate and explore the organs, as in an open surgery. Therefore, the operation time can be shortened. Our results thus far obtained demonstrated that HALDG was as safe and effective as open distal gastrectomy. HALDG assures the patients a better quality of life, --less surgical trauma, less pain, speedy return to dialy life activities. Thus, it is beneficial to the patients with early gastric cancer. We, therefore, advocate the use of HALDG in such cases.
Gastrectomy ; Stomach Cancer ; Hand ; Procedures ; Pulmonary evaluation

BACKGROUND : Previous studies have suggested positive association between residents' workload and medical errors. However, few studies have investigated the possible associations between procedural errors, workload, and the individual characteristics of residents, including personality, mental state and job satisfaction.
OBJECTIVE : To explore possible associations of workload and individual characteristics of residents with their procedural error rates.
DESIGN : Prospective observational study based on a daily questionnaire.
PARTICIPANTS : Residents of postgraduate year 1 and 2.
MEASUREMENTS : Residents' workload (on-calls, work hours, sleep and napping hours), residents' physical and mental health state, personality inventory, and procedural error rate (defined as procedural error counts divided by overall procedural attempts).
RESULTS : On average, the residents (N=49) were responsible for 9.8 inpatients per day (range, 1.9-23.1), worked for 16.0 hours per day (range, 12.6-19.8), slept for 4.4 hours per day (range, 2.8-5.7), napped for 0.2 hours per day (range, 0-0.7), and experienced 1 overnight work shift every 7.2 days. The procedural error rate was 2.2 per 10 procedures (range, 0.4-5.0). Using a multivariable adjusted regression model, significant factors associated with lower error rates included : longer napping ; reflective personality ; better mental state ; higher job satisfaction ; and, less on-call frequency.
CONCLUSIONS : Procedural error of residents is positively associated with higher on-call frequency and inversely associated with napping, reflective personality, better mental state, and higher job satisfaction. For reducing procedural error among residents, improvement of modifiable factors, such as workload and mental health, is needed.