We report an extremely rare case of an abdominal aortic aneurysm with transient spinal cord ischemia. A 64-year-old male patient presented with a sudden onset of paralysis upon waking up. He was admitted to the emergency department with bilateral lower extremity paralysis. Computed tomography and ultrasonography were performed, and the findings revealed an aneurysmal dilatation. The maximum aneurysm diameter was 65×62 mm. In addition, there was a mural thrombus that was located on the posterior aspect of the wall of the aneurysmal dilatation, and part of the mural thrombus was liquefied. After admission to the hospital, although the symptoms of spinal cord ischemia began to improve, melena was observed the following day. He was subsequently diagnosed with ischemic colitis by an emergency colonoscopy. The mural thrombus had dispersed into the lumbar and internal iliac arteries, and it was postulated that this had been the cause of the spinal cord ischemia and ischemic colitis. Due to an improvement in the spinal cord ischemia and ischemic colitis, he underwent abdominal aortic replacement two weeks later. Spinal cord ischemia and ischemic colitis resolved without recurrence, and he was discharged 13 days post-operatively.

We analyzed the student self-assessment on education in cardiology using a questionnaire.
Subjects: Ninety-six 5th-year students at Saga Medical School who have completed the lectures and bedside teaching were evaluated.
Methods: A questionnaire survey of 14 topics in cardiology was performed at the finish of 3 weeks of bedside teachings. Self-assessment was categorized into 4 grades; 1) completely understood (3 points), 2) almost completely understood (2 points), 3) could be understood (1 point), and 4) could not be understood (0 point). Self-assessment scores were calculated for each topic in cardiology.
Results: Questionnaires were returned by 88 students (91.7%). Self-assessment scores were high for myocardial infarction, angina pectoris, and electrocardiogram reading. Scores were low for primary care, vascular diseases, and pericardial disease. Self-assessment scores did not significantly correlate with the length of lectures but did correlate with the number of admitted patients (r= 0.93) and scores on achievement tests (r= 0.43) in each topic.
Conclusions: Because students observed many patients with myocardial infarction and angina pectoris during bedside teaching, the self-assessment scores were high. Bedside teaching is important for medical students to understand topics in cardiology.

STUDY DESIGN: Prospective study. PURPOSE: During fluoroscopically guided spinal procedure, the hands of spinal surgeons are placed close to the field of radiation and may be exposed to ionizing radiation. This study directly measured the radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures. OVERVIEW OF LITERATURE: Fluoroscopically guided spinal procedures have been reported to be a cause for concern due to the radiation exposure to which their operators are exposed. METHODS: This prospective study evaluated the radiation exposure of the hand of one spinal interventionalist during 52 consecutive fluoroscopic spinal procedures over a 3-month period. The interventionalist wore three real-time dosimeters secured to the right forearm, under the lead apron over the chest, and outside the lead apron over the chest. Additionally, one radiophotoluminescence glass dosimeter was placed under the lead apron over the left chest and one ring radiophotoluminescence glass dosimeter was worn on the right thumb. The duration of exposure and radiation dose were measured for each procedure. RESULTS: The average radiation exposure dose per procedure was 14.9 µSv, 125.6 µSv, and 200.1 µSv, inside the lead apron over the chest, outside the lead apron over the chest, and on the right forearm, respectively. Over the 3-month period, the protected radiophotoluminescence glass dosimeter over the left chest recorded less than the minimum reportable dose, whereas the radiophotoluminescence glass ring dosimeter recorded 368 mSv for the thumb. CONCLUSIONS: Our findings indicated that the cumulative radiation dose measured at the dominant hand may exceed the annual dose limit specified by the International Commission on Radiological Protection. Spinal interventionalists should take special care to limit the duration of fluoroscopy and radiation exposure.
Fingers ; Fluoroscopy ; Forearm ; Glass ; Hand* ; Prospective Studies ; Radiation Exposure* ; Radiation, Ionizing ; Surgeons ; Thorax ; Thumb

BACKGROUND: Predictive factors for the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors for lowering glycosylated hemoglobin (HbA1c) remain unclear in patients with type 2 diabetes mellitus. The aim of this study is therefore to clarify predictive factors of the efficacy of DPP-4 inhibitors for lowering HbA1c after 12 months of treatment. METHODS: A total of 191 consecutive type 2 diabetic patients (male sex 55%, mean age, 68.3+/-35.8 years), who had been treated with DPP-4 inhibitors for 12 months, were enrolled in this study and evaluated retrospectively. RESULTS: After 12 months of DPP-4 inhibitor treatment, random blood glucose level, and HbA1c level, decreased from 167+/-63 to 151+/-49 mg/dL (P<0.01), and from 7.5%+/-1.3% to 6.9%+/-0.9% (P<0.01) respectively, without severe side effects. Multiple regression analysis showed that predictors of DPP-4 inhibitor treatment efficacy in lowering HbA1c level after 12 months were a decrease in HbA1c level after 3 months of treatment, a high baseline HbA1c level, a low baseline body mass index, and the absence of coronary artery disease. CONCLUSION: Most suitable candidates for treatment with DPP-4 inhibitors are diabetics who are not obese and do not have coronary artery disease. In addition, long-term efficacy of DPP-4 inhibitors can be predicted by decrement of HbA1c after 3 months of treatment.
Blood Glucose ; Body Mass Index ; Coronary Artery Disease ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Dipeptidyl-Peptidase IV Inhibitors ; Hemoglobin A, Glycosylated ; Humans ; Retrospective Studies ; Treatment Outcome