The curricula for Japanese medical schools are being dramatically reformed. Under these conditions, the number of hours allocated to the anatomical dissection course has decreased in the last decade. In the current environment of understaffing, we face a conflict between good educational practice and superior research performance at the University of Yamanashi. To address this problem and to cultivate research-oriented thinking and the teaching ability of medical students, we introduced a novel teaching system in which senior students (3rd to 6th years) serve as teaching assistants (TAs) in the dissection course. In this trial, we undertook the following procedures.1) We performed two surveys of 2nd-year students and TAs to evaluate the performance of the system during the middle and late phases of the laboratory course.2) By referring to the results of the first survey, we simultaneously improved the system.3) Research topics related to anatomy were assigned to the TAs.4) Overall, this system was viewed favorably by both the second-year students and the TAs, although the consistent participation of TAs throughout the term remains to be addressed. By taking these issues and evaluations into account, we will improve the system and propose it as a new elective educational style for Japanese medical schools.

BACKGROUND:Splenectomy in patients with liver cirrhosis (LC) is expected to become more common owing to its efficacy on portal hemodynamics. In this report we describe an alarming case of group B streptococcus (GBS) infection after splenectomy in a patient with LC. METHODS:A 72-year-old woman with a history of LC was admitted to our emergency department because of respiratory failure. The patient had received left lateral segmentectomy of the liver and splenectomy three months before admission. Pulmonary examination revealed significant wheezing during inspiration and expiration, but no crackles and stridor. Chest radiography and CT showed no infiltrates. A presumptive diagnosis of bronchial asthma caused by upper respiratory infection was made. Four days after admission, GBS infection was confirmed by blood culture and penicillin G was administered. Antibiotics were given intravenously for a total of 12 days. RESULTS:The patient was discharged on the 12th day after admission. CONCLUSIONS:Although efficacy of splenectomy in patients with LC has been reported, immune status should be evaluated for a longer period. Patients who have undergone splenectomy are highly susceptible to bacteria; moreover, LC itself is an independent risk factor for mortality in patients with sepsis. Since prophylaxis against GBS has not been established, immediate action should be taken. Emergency physicians should be aware of invasive GBS infection in the context of the critical risk factors related to splenectomy and LC, particularly the expected increase of splenectomy performed in LC patients.

A woman in her 80s developed a feeling of abnormal sensation in her face and excessive salivation. She was diagnosed with right facial nerve paralysis and was admitted to a local hospital. On admission, serum creatinine level was 0.54mg/dL and estimated glomerular filtration rate was 79mL/min/1.73m2. She was started on oral valacyclovir at a dose of 3,000mg/day to treat the right facial nerve paralysis. However, 5 days after starting oral administration, she developed generalized fatigue, vertigo, and vomiting. Serum creatinine level rose to 4.99mg/dL with mild disturbance of consciousness, so she was transported to our hospital on suspicion of acyclovir-induced encephalopathy. We performed hemodialysis for 3 consecutive days to remove the acyclovir from the circulation, which subsequently improved all her symptoms. She was later diagnosed with allergic tubulointerstitial nephritis based on renal biopsy.After discharge from our hospital, laboratory data showed a serum creatinine level of 0.67mg/dL. We later confirmed that the serum acyclovir level before the first hemodialysis session had been very high (11.9μg/mL).