There are some methods of evaluating teaching: student-, self-, peer- and third person-evaluation etc. Validity, reliability and feasibility are required for assessing the quality of teaching. Therefore, we examined the reliability of teaching evaluation by medical students in Nippon Medical School in comparison with peer evaluation.
1) Twenty-four clinical lectures during the same school year were arbitrarily chosen as objectives. Correlations between student- and peer-evaluations in both generalized ratings and global assessment were analyzed by Pearson's correlation coefficient and Spearman's correlation coefficient by rank.
2) In generalized ratings, a significant correlation between the evaluations was demonstrated (r=0.532, p=0.0056), while a marginal correlation between the evaluations was observed in global assessment (p=0.0492).
3) The results probably provide evidence of the reliability of teaching evaluation by medical students.
4) The criteria for evaluation and the validity of questionnaires should be defined for a more reliable teaching evaluation by medical students.

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be life-threatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.
Aged, 80 and over ; Anesthesia, General ; Aneurysm ; Angiography ; Arteries ; Consciousness ; Headache ; Hematocrit ; Hematoma ; Heparin ; Humans ; Intracranial Aneurysm ; Multiple Organ Failure ; Physical Examination ; Radiology, Interventional ; Subarachnoid Hemorrhage

We performed the thromboexclusion procedure with reconstruction by an axillo-bifemoral bypass for unresectable abdominal aortic aneurysm combined with chronic renal faliure, and obtained satisfactory postoperative result. The patient was a 68-year-old male who suffered from a huge abdominal aortic aneurysm (AAA) and had a history of hypertension and chronic renal failure. The AAA was accompanied with a saccular portion 10cm in diameter which compressed and eroded the vertebral body. Aortic cross-clamping above the bilateral renal arteries was inevitable for resection in spite of the renal dysfunction. We decided that direct manipulation of the aneurysm was impossible despite it being on the verge of rupture, considering the high operative mortality. We employed the exclusion-bypass method to stabilize the aneurysm, that is, we constructed axillo-bifemoral bypass using a knitted Dacron T-graft 8mm in diameter and then intercepted the bilateral common iliac arteries by suture closure. Postoperative intraaneurysmal thrombosis progressed rapidly from the distal side, then it halted just below the bilateral renal arteries on the 12th postoperative day. Renal arterial flow was maintained and renal function improved. Bleeding from the operative wound occurred suddenly on the 5th postoperative day. Although this appeared to be disseminated intravascular coagulation initially, it had resulted from augmentation of fibrinolysis due do acceleration of coagulation. The markers of fibrinolysis for example α₂ plasmin inhibitor (α₂PI) and plasmin-α₂ plasmin inhibitor complex (PIC) were useful for diagnosis, and tranexam acid and aprotinin were effective for therapy. Although the exclusion-bypass method is technically less invasive and useful for high-risk AAA, the postoperative management is not easy because of the acceleration of the coagulation-fibrinolysis system.