Introduction: We experienced a case of pneumatosis cystoides intestinalis with intra-abdominal free air following steroid therapy for an end-stage brain tumor. Case: The patient was a 67-year-old man. He had received surgery and chemotherapy for the brain tumor, but the disease progressed and his consciousness deteriorated. Eventually, he developed aspiration pneumonia and was hospitalized. His consciousness level remained poor even after the pneumonia improved. His survival prognosis was considered to be approximately 1 month, and he was transferred to a palliative care ward. After the transfer, administration of betamethasone 8 mg/day was started for the purpose of improving his level of consciousness. Temporary improvement was observed, and administration of this drug was continued with dose adjustments, as appropriate. Six weeks after the start of betamethasone administration, when his consciousness level again deteriorated, aspiration began to recur. Chest X-rays, obtained to assess pneumonia, showed intra-abdominal free air. Pneumatosis cystoides intestinalis was confirmed by computed tomography. He had few abdominal symptoms, and was managed conservatively. He died of respiratory failure. Conclusion: Pneumatosis cystoides intestinalis is mostly secondary, and steroid therapy is considered to be one of the causes. But follow-up observation is often conservative, and judgment of discontinuation of steroid needs to be made in consideration of its effect and prognosis is there.

Typically, Japanese Kampo doctors use formulas classified for treating blood stasis, to treat pain. However,there have been few reported cases where pain was treated with formulas classified for treating qi stagnation. Here, we report a case of right lateral epicondylitis in a 48-year-old woman who was treated with a focus on qi stagnation and with uyakujunkisan. She underwent conservative treatment at an orthopedic clinic for ten months, but her pain was not relieved. Hence, she opted for Kampo treatment. She was in a state of melancholy, felt heaviness throughout her body, and had irregular menstruation. These symptoms were mainly related to qi stagnation, and hence, we chose uyakujunkisan without white silkworm, but with aconite root. One month later, the stiffness in her shoulder improved and the pain was reduced. Magnetic resonance imaging taken 2 months later showed an improvement in the lesion. Nine months later, her menstruation became regular, and 11 months later, the pain had almost completely resolved and she could comfortably perform activities of daily living. Uyakujunkisan is introduced in the classical textbooks, and we interpret uyakujunkisan as a formula that can treat pain with qi stagnation. In Kampo treatment, effective pain treatment involves consideration of not only local blood stasis but also general qi stagnation.

Although aortic annular abscess and rupture of the sinus of Valsalva are known as complications of infective endocarditis, few cases in children have been reported. We report a surgical case of a 6-year-old girl with active infective endocarditis complicated with an annular abscess and pseudoaneurysm of the sinus of Valsalva. The patient presented progressive symptoms of heart failure and a subsequent echocardiogram demonstrated severe aortic regurgitation. A computed tomography indicated pseudoaneurysm of sinus of Valsalva and an emergency operation was performed. At operation, a bicuspid aortic valve with vegetation was noted. The annular abscess caused a large tissue defect of the left coronary sinus of Valsalva and formed a pseudoaneurysm. The infected lesion was resected completely. The defective aortic annulus and sinus of Valsalva were repaired with a bovine pericardial patch and aortic valve was replaced with a mechanical valve. The postoperative course was uneventful and the patient was discharged after adequate antibiotic treatment.

The traditional Japanese diet with its high intake of fruits and vegetables that are rich in antioxidants is believed to effectively ward off cardiovascular disease. Oxidative stress, related to reactive oxygen and nitrogen species produced by aerobic organisms, is responsible for the pathogenesis of most chronic diseases. Oxidative low density lipoprotein (LDL) is thought to play a key role in the pathogenesis of early atherosclerosis. There has been increasing interest in antioxidant substances derived from edible plants. It has been suggested that the measurement of LDL antioxidant activity is physiopathologically more important and informative for screening antioxidant activity to prevent atherosclerosis than other methods. We assessed by LDL oxidation assay the antioxidant characteristics of various edible plants from rural areas. The mulberry (Morus alba L.) leaf showed comparatively high antioxidant activity. We identified the antioxidant compounds and investigated compound levels in the mulberry leaf and found the antioxidant activity of mulberry leaves to be mainly attributable to quercetin 3-(6-malonylglucoside) (Q3MG). Dietary consumption of mulberry leaves and/or Q3MG may enhance resistance to oxidative modification of LDL and attenuated atherosclerotic lesion development. However, the outcome of intervention trials suggested that a single antioxidant had little effect on the risk of developing cardiovascular disease. The synergic effect of certain combinations may determine outcome. We need to widen our understanding of the synergic effect of diets and nutrient-gene interactions related to nutrient/disease risk.
Antioxidants ; seconds ; Low density lipoprotein cholesterol measurement ; Pathogenesis ; Oxidative Dietary Supplements

　To effectively educate medical teachers for clerkship and residency training, the international faculty development program was developed. Ten faculties of the School of Medicine participated in the program and learned about clinical education through lectures and direct observations, transforming their educational perspectives. Factors to optimize such an international faculty development program were discussed: 1) Authentic educational institution and environment, 2) matching the participants' specialty and subject at the observation site, 3) optimal combination of lectures, direct observations, and debriefing sessions, 4) mutual understanding of cultural differences, and 5) sense of community cultivated by experiencing the program for a week. Those factors suggest ways for further improvement to reform the program, promote better management, and conduct educational research on faculty development.

Objectives: A survey was conducted to investigate the usability and safety of fentanyl sublingual tablets (FST) and to examine problems associated with their proper use.

Methods: Subjects were 18 cancer inpatients who received FST for breakthrough pain in their pharmacological cancer pain management. Changes in the pain score and the occurrence of adverse effects (nausea, vomiting and somnolence) were compared before and after FST administration.

Results: The pain score before FST administration was 6.4±2.4, and this was significantly improved to 3.4±2.8 at 30 min after administration (p<0.01). Somnolence occurred significantly more often 30 min and 2 h after FST administration than immediately before administration (p<0.05). There were no differences in the occurrence of nausea and vomiting before or after FST administration. Nine patients receiving FST therapy developed xerostomia, but there were no significant changes in the pain score or occurrence of adverse effects while they had xerostomia.

Conclusion: It is essential to observe the oral condition to judge whether FST therapy is indicated, and FST should be administered after providing sufficient oral care. The results indicate the possibility of increased occurrence of somnolence as an adverse effect.

For diagnosis of prostate cancer, MRI was performed in 91 patients prior to prostate biopsy, and prostate cancer was detected in 37 patients. The ability of MRI diagnosis compared with biopsy was accuracy 0.84, sensitivity 0.95, and specificity 0.76.In 26 patients (14 patients with prostate cancer) from whom MR images were obtained by diffusion weighted imaging, ADC value and PSA value showed a reverse correlation significantly.The ADC value was 0.97±0.23-3mm2/sec in the cancer area, 1.51±0.20-3mm2/sec in the normal peripheral zone, and 1.47±0.12-3mm2/sec in the normal central zone. The ADC value in the cancer area was smaller than that in the normal peripheral area or in the normal central zone significantly (p<0.001).The relation between ADC value and Gleason score did not show any correlation. However, when the Gleason score was under 6, ADC value was 1.11±0.20-3mm2/sec, and when it was over 7, ADC value was 0.81±0.19-3mm2/sec which showed a lower value than the ADC value with Gleason score under 6 significantly (p<0.05).MRI was effective for visualization of prostate cancer. We concluded that pre-biopsy MRI in prostate cancer would allow not only systemic-biopsy but also accurate targeting-biopsy, and it would improve the diagnosric ability of biopsy.
Cancer of Prostate ; biopsy characteristics ; Magnetic Resonance Imaging ; GLEASON GRADING FOR PROSTATIC CANCER ; lower case pea

1) Japan Society for Medical Education launched a committee for the graduate education of medical educationists in Japan. The committee proposed a direction toward establishing the system, by way of discussion among the members, needs assessment, information gathering of overseas master courses, and discussion at the open meeting.2) To promote medical education in Japan, we should establish 2 systems concurrently: (1) a graduate education for medical educationists who have a broad base of theories and can lead future medical education, and (2) a broader certificate system for medical teachers who have good practical teaching skills.

1) The committee for the graduate education of medical educationists, Japan Society for Medical Education, investigated needs for the education system of medical educationists.2) A questionnaire was sent to 1831 leaders in healthcare education and the society members, and 644 replied (recovery rate 35.2%). Fifty % of the respondents agreed the necessity of medical educationists. Certificate level was most popular, however, master and PhD degrees were also considered to be necessary. 3) These results support the establishment of educational system for medical educationists in Japan.