ABSTRACT: The prognosis of invasive aspergillosis in immunocompromised hosts is extremely gruesome. We described a 56-year-old man who suffered from invasive pulmonary aspergillosis. He had immunological impairment caused by neutropenia due to hemophagocytic syndrome and high dose glucocorticoid therapy. On the day after his chest radiograph revealed abnormal shadow in the left lung, we detectedAspergillushyphae in his Gram's-stained sputum under a microscope. Thanks to this prompt diagnosis, we could save him without any sequelae. Microscopic examination of sputum without delay is highly recommended when invasive pulmonary aspergillosis is suspected in patients at risk for this macabre disease.

An 18-year-old woman was admitted to our hospital because of headache and double vision. One year before, she had experienced similar symptoms which were ameliorated spontaneously. Before admission, she had been experiencing throbbing headaches for 20 days and double vision for 7 days, respectively. A brain magnetic resonance imaging (MRI) study, performed at another hospital 6 days before admission, showed no abnormality. On admission, she had paralysis of the left abducens nerve and papillaedema of the bilateral optic fundi. Magnetic resonance venography (MRV) revealed areas of signal loss expanding from the confluence of sinuses to the right transverse sinus, which confirmed the diagnosis of cerebral sinus thrombosis. Her symptoms improved dramatically with anticoagulation therapy. The present case suggests that the exploration of papillaedema of optic fundi is of paramount importance in the diagnosis of cerebral sinus thrombosis, and MRV can be definitely diagnostic despite the normal findings of conventional MRI.

Objective: Securing a sufficient number of medical residents to work in rural areas is an urgent issue. This study sought to clarify the factors that cause medical students at a rural university in Japan to select a particular place for their initial clinical training.Materials and Methods: A questionnaire was administered to all medical students at Saga University between February and March 2021. Participants were divided into two groups based on their training location choice: those who chose Saga Prefecture (Saga group) and those who selected other prefectures (non-Saga group). Then, logistic regression analysis was performed.Results: The questionnaire was answered by 300 students (46.3% response rate), of whom 291 agreed to participate in the study; 122 (41.9%) and 169 (58.1%) students were allocated to the Saga and non-Saga groups. Within the Saga group, the following factors were statistically significant: being admitted to Saga University’s medical school through the system of special allotment of admission to applicants pledging to work in Saga Prefecture following graduation (or regional quota programs for admission) (odds ratio [OR], 19.18; 95% confidence interval [CI], 6.99–52.60); and being from Saga Prefecture (OR, 6.05; 95% CI, 2.24–16.35). With the non-Saga group, the desire to work in an urban area (OR, 0.03; 95% CI, 0.00–0.37) was statistically significant.Conclusion: To encourage medical residents to choose this prefecture for their initial clinical training, the focus should be on medical students who are from Saga Prefecture or admitted through the regional quota program.