An 80-year-old woman presented with dilatation of the distal aortic arch due to chronic type B aortic dissection. She underwent thoracic endovascular aortic repair (TEVAR) in zone 2 with GORE TAG thoracic endoprostheses (40 mm-15 cm and 34 mm-20 cm) for closure of the entry site at the proximal descending aorta. TEVAR was successfully performed and blood flow in the false lumen stopped. Two months after TEVAR, she was admitted to our hospital owing to syncope. A CT scan revealed type A aortic dissection, and emergency surgery was performed. The entry was proximal to the stent graft, and we performed total arch replacement with preservation of the stent graft. Retrograde type A aortic dissection is a rare but lethal complication of TEVAR. Careful consideration of the device selection is needed, and attention should be paid to the placement of the stent graft.

　　With the introduction of digital medical examination vehicles, we intended to increase the efficiency of the mass health screening services by building up an environment convenient to study radiographic images and to make them available promptly for diagnosis and treatment. However, the result was not as good as we had expected. A number of problems came up. Although high precision monitoring devices were installed for radiographic interpretations, lists of examinees expressed only in figures for identification and texts superimposed on radiographic images became so small in type size that the risks of making medical errors and mistaking one examinee for another were increased.　　Therefore, we connected a laptop computer as a portable MWM server to the console to take in information about the examinee when he or she has an X-ray. If the examinee had no hospital ID cards, we issued a provisional ID. To differentiate the examinee with the provisional ID from the individual on the list of the examinees, the running numbers were issued, using the accession numbers indicating the date and time of examination and the kind of modality. Thanks to these new systems, it has been made possible to include information about individuals such as ID, name and sex on X-ray photos. Thus, the reliability of radiologic interpretation has been assured.

To evaluate clinical courses at teaching hospitals outside of Osaka City University Hospital, we used a questionnaire to ask instructors and sixth-year students about practical problems immediately after the end of the semester. This course was conducted for 7 weeks during the first semester at 24 hospitals and for 5 weeks during the second semester at 23 hospitals. In each semester about 40% of clinical practice at teaching hospitals was done in the style of clinical clerkships. About 90% of students were mostly or completely satisfied with their instructors and hospitals. Furthermore, about 70% of instructors felt more or less fulfilled by working with students and about 60% of them felt working with students was rewarding. More than 95% of instructors would be willing to teach medical students again. In conclusion, most instructors and students felt that clinical courses at teaching hospitals outside of Osaka City University Hospital were conducted without problems.

A program for early-exposure of first-year medical students to nursing and patient care was started at Osaka City University in 1994. Eighty students completed the program in the 2002 academic year. To improve methods of teaching and evaluation, we analyzed the responses of students and nursing instructors to questionnaires about satisfaction with the program after each practice session. Students were randomized to four settings (university hospital, general hospital, general emergency hospital, and general geriatric hospital). Responses of students and instructors did not differ between settings suggest that early exposure was uniform. Medical students gave higher scores for interest in and significance of early exposure, although nursing instructors did not. The success of the program of early exposure of medical students to nursing care will be used to further improve the curriculum.

Whipple disease is a systemic chronic infection caused by Tropheryma whipplei. Although chronic diarrhea is a common gastrointestinal symptom, diagnosis is often difficult because there are no specific endoscopic findings, and the pathogen is not detectable by stool culture. We present a female patient with Whipple disease who developed chronic bloody diarrhea and growth retardation at the age of 4 years. Colonoscopy showed a mildly edematous terminal ileum and marked erythema without vascular patterns throughout the sigmoid colon and rectum. Subsequently, a primary diagnosis of ulcerative colitis was made. Histopathological analysis of the terminal ileum showed the presence of foamy macrophages filled with periodic acidSchiff-positive particles. Polymerase chain reaction using DNA from a terminal ileum biopsy sample amplified a fragment of 16S rRNA from T. whipplei. Antibiotic treatment relieved the patient’s symptoms. There was no evidence of immunodeficiency in the present case. Since Whipple disease worsens after anti-tumor necrosis factor inhibitor therapy, considering this infection in the differential diagnosis may be important in patients with inflammatory bowel disease, especially before initiation of immunotherapy.

Objectives: The aim of this study was to investigate the relationship between preoperative 10m gait speed and ADL disability in patients undergoing cardiovascular surgery. Methods: There were 131 patients who underwent scheduled cardiovascular surgery and pre and postoperative ADL evaluation from June 2014 to December 2017 in our hospital. A total of 19 patients, including 13 whose Barthel Index (BI) was lower than before surgery at discharge and 6 who had a long-term hospital stay of 6 weeks or more after surgery, was defined as the ADL disability group. The other 119 patients were defined as the control group. We retrospectively compared the two groups and searched for predictors of postoperative ADL disability. Results and Conclusions: An independent predictor of postoperative ADL disability was identified: more than 7.04seconds for walking 10m.

BACKGROUND: In health examinations for local inhabitants in cadmium-polluted areas, only healthy people are investigated, suggesting that patients with severe cadmium nephropathy or itai-itai disease may be overlooked. Therefore, we performed hospital-based screening to detect patients with cadmium nephropathy in two core medical institutes in cadmium-polluted areas in Akita prefecture, Japan. METHODS: Subjects for this screening were selected from patients aged 60 years or older with elevated serum creatinine levels and no definite renal diseases. We enrolled 35 subjects from a hospital in Odate city and 22 from a clinic in Kosaka town. Urinary ß-microglobulin and blood and urinary cadmium levels were measured. RESULTS: The criteria for renal tubular dysfunction and the over-accumulation of cadmium were set as a urinary ß-microglobulin level higher than 10,000 μg/g cr. and a blood cadmium level higher than 6 μg/L or urinary cadmium level higher than 10 μg/g cr., respectively. Subjects who fulfilled both criteria were diagnosed with cadmium nephropathy. Six out of 57 patients (10.5% of all subjects) had cadmium nephropathy. CONCLUSIONS: This hospital-based screening is a very effective strategy for detecting patients with cadmium nephropathy in cadmium-polluted areas, playing a complementary role in health examinations for local inhabitants. REGISTRATION NUMBER No. 6, date of registration: 6 June, 2010 (Akita Rosai Hospital), and No. 1117, date of registration: 26 December, 2013 (Akita University).
Aged ; Aged, 80 and over ; Cadmium ; adverse effects ; urine ; Cadmium Poisoning ; blood ; complications ; urine ; Creatinine ; urine ; Environmental Exposure ; adverse effects ; Environmental Monitoring ; Environmental Pollutants ; adverse effects ; urine ; Female ; Hospitals ; Humans ; Japan ; Kidney Diseases ; chemically induced ; urine ; Male ; Middle Aged ; Sex Distribution