With the development of sophisticated medical technologies, there has been a tendency to belittle the taking of the “history and physical, ” even in the field of cardiology. We have been holding cardiology case conferences for general medical residents, with the main focus on history taking and physical examination since 1992, so that all residents are able to provide a certain level of primary care for patients with cardiac diseases regardless of his or her future sub-speciality. We present our methods and the educational effect of these conferences.

To improve the ability of 1st-year medical residents to take histories from patients with chest pain we had residents re-interview patients in a senior cardiologist's outpatient department who had had chest pain of known origin. Three medical residents participated in this training program just after obtaining their licenses to practice medicine. Each resident took histories from approximately 25 consecutive patients during a 1-month period. Causes of chest pain included angina pectoris (38 cases), acute myocardial infarction (16 cases), pulmonary embolism (10 cases), and dissecting aortic aneurysm (4 cases).
Each of the three residents stated that they recognized the importance of taking histories from patients with ischemic heart disease and became confident doing so after having interviewed about 15 patients. What they learned in this training program was considered useful when they interviewed new patients in an emergency room who complained of chest pain. One resident wished that this training had started several months after receiving his license because they had little experience taking histories from patients while in medical school. Four months after this training, the senior cardiologist tested the three residents by having them interview new patients with chest pain and found their abilities to be satisfactory.
Twenty consecutive cases appears to be a satisfactory number for medical residents to become confident in taking histories from patients with ischemic heart disease. This training program should be started within 3 months after residents receive their medical licenses.

Eleven 2nd-year medical residents were given the opportunity to take histories and give physical examinations for patients whose complaints included chest pain, palpitations, dyspnea on exertion, fainting, asymptomatic electrocardiographic abnormalities, and hypertension. Each resident took part in this program in an instructor's outpatient clinic twice a week for 2 consecutive months; each resident saw an average of 19 patients. The instructor discussed with the residents how to make diagnoses logically and the necessity of emergency treatment. The residents learned that taking histories accurately is an extremely important diagnostic tool, that a systematic approach is important, and that clinical decisions are often influenced by nonmedical factors. Medical residents need to have experience with such patients to improve their ability to take histories and perform physical examinations; however, proper supervision by an instructor in more important.

We conducted an anonymous questionnaire survey to examine the results of regularly drinking FFC beverage. Over 70% of participants reported a positive reaction through consumption. By contrast, few negative reactions were recorded (0.7%). These would suggest its effectiveness as a health drink. Positive reactions were significantly related to the amount of FFC beverage consumed each day, the reason for starting to drink FFC beverage, participant’s age, the amount of FFC beverage consumed each time, and the no use of the other functional foods.

A 16-year-old girl with aortitis syndrome under treatment with a low dose of prednisolone was admitted because of severe headache and intermittent claudication. Angiography revealed diffuse stenosis of the thoracoabdominal aorta and the bilateral renal arteries. Extra-anatomical bypass grafting from the ascending to the abdominal aorta was first made with a 14mm woven Dacron graft through a midline sternolaparotomy. Bilateral renal arteries were difficult to dissect due to periarterial adhesion. Bypass grafting for the left renal artery could be performed with a 5mm external velour wrap-knit Dacron graft (Sauvage, Bionit); however, the right renal artery was so thin that bypass was made with a 4mm EPTFE graft which was demonstrated to be occluded by follow-up angiography 3 years after surgery. The postoperative course has been uneventful and she has been free from symptoms up to now. The good long-term function of the bypass graft from the ascending aorta holds promise for diffuse coarctation of the thoracoabdominal aorta due to aortitis syndrome.

We have conducted weekly 40-minute training session of ECG diagnosis for lst-year postgraduate medical trainees for 6 months. Their abilities to read ECGs were tested before and after training sessions. Before training (just after graduation from medical school) they were able to diagnose typical ECGs if each tracing had only one abnormality and if enough time was given for interpretation. However, they frequently misdiagnosed even ECGs that they had correctly diagnosed on pre-tests if they were presented with many other ECGs and the time for interpretation was limited. Post-tests by students and teachers showed that our training of systematic and orderly reading of ECGs has enabled students to describe ECG findings fairly accurately but could not teach them to diagnose underlying cardiac disorders.

In the past 2 years, five 1st-year medical trainees with excellent knowledge and attitude trained with an instructor supervision in the physical examination of the heart with 4 to 5 patients a week. Despite their undergraduate medical education, these medical trainees could not detect abnormal physical findings of the heart. As much as 5 months of training was required before they could satisfactorily detect such abnormalities.

  One patient was intervened by our palliative care team (PCT) to relieve neuropathic pain due to postoperative recurrence of rectal cancer. The dosage controlled-release oxycodone was increased, analgesic adjuvant drugs were changed and the administration of betamethasone were started. Furthermore, the number of times the patient took controlled-release oxycodone increased two to three times a day. These changes in medication resulted in relief of symptoms. Cetuximab therapy was given twice during the course. The other patient was intervened by the PCT for right upper limb pain and dyspnea due to postoperative recurrence of breast cancer. Morphine sulfate hydrate and analgesic adjuvant were additionally given. As pain increased three days after the administeration of transdermal fentanyl patches, the patches were changed every other day, instead of every three days. FEC100 therapy was given twice during the course. In the present two cases, the PCT was intervened with great zeal and rapid relief of symptoms resulted. In the meantime chemotherapy proceeded uneventfully. We thought that trust of the chief doctor in the PCT was most important for effective intervention.

From 1986 to 1991, 49 malignancies were found in sonographic examination of 53, 788 subjects carried out by the Kumamoto Prefectual Welfare Federation of Agricultural Cooperatives. The cases were composed of 12 hepatocellular carcinomas, 11 metastatic liver tumors, 11 renal cell carcinomas, 6 gall bladder carcinomas, 3 gastric carcinomas and 6 ether malignancies including metastatic pancreas tumors and ovarian tumors. A follow-up survey was made in 37 cases. All the case of renal cell carcinoma were found in an early stage and showed the best prognosis; the 2-year survival rate was 100%(n=7). In hepatocellular carcinomas 1-year and 2-year survival rates were 85% and 33%, respectively. Eight of 11 metastatic liver tumors were f rom gastrointestinal malignancies, and prognosis was poor; 1-and 2-year survival rates were 44% and 37%, respectively. Gastric carcinomas were found with lymphadenopathy or the thickening of the gastric wall, so prognosis was quite poor. Abdominal sonography has proved to be a very convenient and safe procedure to find out malignancies in the early stage. In detected (asymptomatic) cases of renal cell carcinoma, prognosis was excellent.

BACKGROUND/AIMS: Mucosal healing (MH) is a proposed therapeutic goal for patients with ulcerative colitis (UC). Whether MH is the final goal for UC, however, remains under debate. Therefore, to elucidate clinical variables predicting relapse after MH in UC could be useful for establishing further therapeutic strategy. The aim of this study is to evaluate the predictive variables for relapse in UC-patients after achieving MH. METHODS: From April 2010 to February 2015, 298 UC-patients treated at Kitano Hospital were retrospectively analyzed. MH was defined as Mayo endoscopic subscore of 0 or 1. The cumulative relapse free rate after achieving MH was evaluated. Predictive variables for relapse in UC-patients were assessed by Cox regression analysis. RESULTS: Of 298 UC-patients, 88 (29.5%) achieved MH. Of the 88 UC patients who achieved MH, 21 (23.9%) experienced UC-relapse. Based on Kaplan-Meier analysis, the cumulative relapse free rate at 1, 3, and 5 years after achieving MH was 87.9%, 70.2%, and 63.8%, respectively. The cumulative relapse free rate tended to be higher in the Mayo-0 group (76.9%) than in the Mayo-1 group (54.1%) at 5 years, although the difference was not statistically significant (P=0.313). Cox regression analysis indicated that the use of an immunomodulator was a predictive variable for relapse in UC-patients after achieving MH (P=0.035). CONCLUSIONS: Our data demonstrated that the prognosis of UC patients after achieving endoscopic MH could be based on UC refractoriness requiring an immunomodulator.
Colitis, Ulcerative* ; Endoscopy ; Humans ; Kaplan-Meier Estimate ; Prognosis ; Recurrence* ; Retrospective Studies ; Ulcer*