We performed a survey to assess the positions and activities of Japanese women physicians in medical societies. In June 2000, questionnaires were sent to 92 medical societies of the Japanese Association of Medical Science. The response rate was 92.4%. Fifty-four societies (63.5%) failed to provide the number of women physicians. According to the questionnaires that were fully completed and returned, women physicians were more likely to belong to societies of internal medicine, pediatrics, ophthalmology and dermatology. Women physicians were less likely to hold board positions and were underrepresented in leadership positions, even in societies with high percentages of women members. Board positions failed to provide for maternity or child-care leave, and few societies offered childcare facilities at annual meetings. Gender-disaggregated data should be made readily available and additional surveys need to be made to identify obstacles to activities in medical societies.

To provide material for a panel discussion entitled “The Image of the Female Physician Desired in the 21st Century” at the 28th Congress of the Japan Society for Medical Education, a survey was conducted on the present circumstances of female physicians practicing in Japan. The questionnaires were sent by mail to all 27, 779 female physicians residing in Japan who could be contacted. The rate of response was 29.5%. The results showed that more than 94% of female physicians currently work at institutions for medical services and that only 3.1% engage in works of basic medical research or work as public health administrators. The results also showed the necessity of providing better systems for the support of family life of female doctors to maintain their activities as precious human resources of society.

BACKGROUND: Home-visit guidance has the advantage of assisting child-raising while respecting an individual's lifestyle; however, there are many people who refuse it at present due to individual and family privacy concerns. In addition, such medical services involve individual and financial constraints; thus, the beneficial effects of the service should be clearly presented.
METHODS: During postnatal weeks 16-20, questionnaires were sent by researchers to a group that received home-visit services during postnatal weeks 2-12 to investigate their levels of satisfaction with the services. A different questionnaire was sent to those that did not receive home visits to investigate the reasons for their rejection of the services.
RESULTS: Home-visit services were highly evaluated by those mothers who received them, especially for primiparas to reduce anxiety about and improve confidence in child-raising. Also, a significant difference was observed between the “home-visit” and the “no home-visit” groups when asked, “How much are you willing to pay for home-visit guidance?” Among the “no-home visit” group, mothers who stated less than 1,000 yen and “free of charge”(59.7%) accounted for 75.8% and among the home-visit group, mothers who stated less than 1,000 yen and “free of charge” (26.0%) accounted for 50.9%, and 35.5% of mothers stated from 1,000 to 3,000 yen.
CONCLUSIONS: The level of satisfaction of mothers who received home-visits and the reasons for not receiving visits were investigated. Two problems identified were that information about this program is not provided to all mothers and the timing of home-visits does not meet the needs of mothers.

Chronic disseminated intravascular coagulation (DIC) complicates 5.7% of thoracic aortic aneurysm. DIC with thoracic aortic aneurysm is characterized by hyperfibrinolysis, but usually shows a stable condition in a state of compensated non-overt DIC with limited hemorrhagic symptoms. However, in some cases, hemorrhage caused by external factors may induce uncompensated overt DIC and lead to serious hemorrhagic tendencies. In the present study, we report a patient with a thoracic aortic aneurysm complicated by DIC who exhibited marked hemorrhagic tendencies. DIC remarkably improved following administration of recombinant human soluble thrombomodulin.

The primary aim of this study was to estimate the number of cancer patients who wanted home death based on the bereaved family survey.A postal survey performed on 1,137 bereaved family members in 4 regions to clarify the degree what they believed that the patient actually died where s/he had wanted on the Good Death Inventory, and to explore the preferred place of death. We calculated estimated number of patients who had wanted home death as a total of (1) the actual number of home death × the percentages of the family members who agreed that the patient actually died where s/he had wanted, and × the actual number of hospital death × the percentages of the family members who disagreed that the patient actually died where s/he had wanted and home was the preferred place of death. Estimated number of cancer patients who wanted home death was 32.8%［95%C.I., 31.7, 33.9］ in the surveyed regions, and 31.2%［95%C.I., 31.1, 31.4］ for national data.

Preoperative evaluation of cardiac anatomy is essential to determine the correct surgical procedure for congenital heart disease. Multi-detector row CT (MDCT) is a useful alternative imaging modality to cardiac catheterization and echocardiography. Sixteen patients (12 with total anomalous pulmonary venous return (TAPVR) and 4 with aortic arch anomalies) underwent 16-slice multi-detector row CT scanning. Three-dimensional reconstruction by MDCT was useful to determine the type of TAPVR and the presence of pulmonary venous obstruction (PVO) in TAPVR patients, as well as to detect postoperative PVO in patients who underwent intracardiac repair. In 2 patients who had asplenia associated with TAPVR III and I a, MDCT enabled an intra-atrial approach for TAPVR repair by precise preoperative determination of the relationship between the common PV chamber and single atrium. In patients with aortic arch anomalies, MDCT was useful to determine the type of anomaly, the presence of arch hypoplasia, and any associated rare vascular anomalies (including isolated subclavian artery, and the right-sided descending aorta with left aortic arch). In conclusion, MDCT provides reliable preoperative evaluation of pulmonary venous return and aortic arch anatomy, and therefore is extremely useful for surgical management of congenital heart disease.

A 9-month-old boy who had been given a diagnosis of double outlet right ventricle (DORY), partial anomalous pulmonary venous return (PAPVR), ventricular septal defect (VSD), pulmonary hypertension (PH) and polysplenia with azygos connection, underwent pulmonary artery banding at the age of 6 months. At 2 months after surgery, a chest computed tomogram revealed a main pulmonary artery aneurysm and a main pulmonary artery-right pulmonary artery fistula caused by bacterial endocarditis due to a methicillin-resistant Staphylococcus epidermidis. We performed pulmonary arterioplasty and re-pulmonary artery banding for acute aggravation of cardiac insufficiency and obtained good results. This is an extremely rare case that was treated infectious pulmonary artery aneurysm and fistula after pulmonary artery banding.

Vitronectin (VN) is an extracellular matrix protein with a crucial role in regulating bone remodeling. In this study, we aimed to investigate the effect of VN deficiency in a mouse model of osteoporosis induced by ovariectomy (OVX).The findings revealed that the absence of VN led to an increase in the activity of tartrate-resistant acid phosphatase (TRAP), a marker for osteoclasts, in the plasma of OVX-operated mice. TRAP staining further demonstrated that VN deficiency resulted in a higher number of osteoclasts within the femurs of OVX-operated mice. X-ray micro-computed tomography analysis of the femurs in OVX-operated mice indicated that VN deficiency significantly suppressed the OVX-induced increase of marrow area and total volume of bone. Additionally, we assessed structural model index (SMI) and degree of anisotropy (DA) as indices of osteoporosis. The results showed that VN deficiency effectively attenuated the OVX-induced increase in SMI and DA among OVX-operated mice. In summary, our study demonstrates the vital role of VN in regulating osteoclastogenesis and bone remodeling in the mouse model of osteoporosis.

Prepulse inhibition (PPI) is considered to be one of the most promising neurophysiological indexes for translational research in psychiatry. Impairment of PPI has been reported in several psychiatric diseases, particularly schizophrenia, where PPI is considered a candidate intermediate phenotype (endophenotype) of the disease. Recent findings from a variety of research areas have provided important evidence regarding PPI impairment. Human brain imaging studies have demonstrated the involvement of the striatum, hippocampus, thalamus and frontal and parietal cortical regions in PPI. In addition, several genetic polymorphisms, including variations in the genes coding for Catechol O-methyltransferase, Neuregulin 1, nuclear factor kappa-B subunit 3 and serotonin-2A receptor were related to PPI; and these findings support PPI as a polygenetic trait that involves several neurotransmitter pathways. Early psychosis studies suggest that PPI disruption is present before the onset of psychosis. Also, discrepancy of PPI impairment between children and adults can be found in other psychiatric diseases, such as autistic spectrum disorders and posttraumatic stress disorder, and comprehensive investigation of startle response might contribute to understand the impairment of the neural circuitry in psychiatric diseases. Finally, recent studies with both Asian and Caucasian subjects indicate that patients with schizophrenia exhibit impaired PPI, and impaired sensorimotor gating might be a global common psychophysiological feature of schizophrenia. In conclusion, studies of PPI have successfully contributed to a better understanding of the fundamental neural mechanisms underlying sensorimotor gating and will certainly be most valuable in devising future approaches that aim to investigate the complex pathogenesis of psychiatric diseases.
Adult ; Asian Continental Ancestry Group ; Catechol O-Methyltransferase ; Catechols ; Child ; Clinical Coding ; Endophenotypes ; Hippocampus ; Humans ; Mental Disorders ; Neuregulin-1 ; Neuroimaging ; Neurotransmitter Agents ; Phenotype ; Polymorphism, Genetic ; Psychophysiology ; Psychotic Disorders ; Schizophrenia ; Sensory Gating ; Startle Reaction ; Stress Disorders, Post-Traumatic ; Thalamus ; Translational Medical Research

A 50-year-old woman had a percutaneous endoscopic gastrostomy (PEG) tube placed after surgery for pharyngeal cancer. After 21 months, the PEG tube was removed due to improvement of per-oral ingestion. She had taken prednisolone for 31 years for systemic lupus erythematosus. The post-PEG fistula did not close spontaneously. The cause of the fistula was slow wound healing and gastrostomy site inflammation due to long-term steroid therapy. We were able to close the fistula with an over-the-scope clipping (OTSC) system. This case suggests that OTSC is useful for closing persistent post-PEG fistulas in patients receiving long-term prednisolone therapy.
Eating ; Female ; Fibrosis ; Fistula* ; Gastrostomy* ; Humans ; Inflammation ; Lupus Erythematosus, Systemic ; Middle Aged ; Pharyngeal Neoplasms ; Prednisolone ; Steroids ; Wound Healing