Experience and the significance of cardiopulmonary arrest on arrival (CPAOA) for residents were examined through an investigation of 47 cases of CPAOA at the department of emergency medicine of Saga Medical School Hospital from December 1, 1996, through November 30, 1997. Causes of CPAOA, outcomes, issuance of death certificates or inspection certificates, and whether a judicial inspection was performed were analyzed in each case. The cause of CPAOA was intrinsic in 31 cases and extrinsic in 16 cases. Eleven patients were admitted, one of whom recovered completely. Death certificates were issued in 25 cases, of which 7 underwent judicial inspection. Inspection certificates were issued in 21 cases, all of which underwent judicial inspection. Twenty-nine residents received 3 months of clinical training in the emergency department. The percentages of residents who encountered cases of CPAOA, CPAOA caused by extrinsic factors, cases in which inspection certificates were issued, and cases in which judicial inspection was done were 51.7%, 79.3%, 82.8%, and 89.7%, respectively. These findings show that residents receive practical experience in our department of emergency medicine.

Metastasis is the chief cause of mortality in cancer patients. Recently, chemokines and chemokine receptors were shown to play an important role in the metastasis of various cancers. We examined the role of chemokine receptor-mediated signaling in the invasion potential of human oral squamous cell carcinoma (OSCC) cell lines that were derived from 5 primary tumors and 6 cervical lymph node metastases. Comprehensive analysis of the mRNAs for human chemokine receptors showed that the OSCC cell lines had uniform expression patterns of chemokine receptors. Overall, there were no consistent differences in the expression of chemokine receptors between primary site- and lymph node metastasis-derived cell lines. However, a highly invasive OSCC cell line (SAS-H1) expressed up-regulation of CCR5, CCR6, CCR7, CXCR1, CXCR6 and CX3CR1 compared to a poorly invasive OSCC cell line (SAS-L1). Then we examined whether factors in the tumor microenvironment regulated chemokine receptor expression in SAS-H1 cells. Specifically, transforming growth factor (TGF) -β1 enhanced the expression of CCR5, CCR6, CCR7 and CX3CR1. Pretreatment of SAS-H1 cells with transforming growth factor (TGF) -β1 increased the expression of CCR7 and CX3CR1, and then enhanced CCL21- and CX3CL1-induced directional migration (1.5-fold enhancement as compared with untreated control). In addition, CX3CL1 increased the adhesion of SAS-H1 cells on uncoated tissue culture plates. Neither chemokine stimulated cell proliferation. Treatment of SAS-H1 cells with CX3CL1 activated the phosphotidylinositol-3-kinase (PI3K) and MEK signal transduction pathways. Our results suggest that chemokine receptor-mediated signaling is involved in the local invasion and metastasis of human OSCC.

A 33-year-old woman underwent aortic root replacement for aortic regurgitation and an aneurysm of the ascending aorta due to annuloaortic ectasia. Ehlers-Danlos syndrome was diagnosed by skin biopsy when she was 23 years old. At operation, to avoid mechanical stress to the residual aorta, cardiopulmonary bypass was established via cannulation of the left femoral artery and we used the open distal anastomosis method under hypothermic circulatory arrest with selective cerebral perfusion. Moreover, the sutures of the aortic annulus were reinforced sewing the aortic wall together. Her postoperative course was uneventful. Despite the fragility of the cardiovascular tissues in Ehlers-Danlos syndrome, cardiac surgery could be performed safely with appropriate surgical procedures.

Farmers are constantly exposed to the hazards of agrochemicals. Especially those who regularly spray their fields with pesticides are at high risk of being contracted with pesticideinduced maladies.
During the three-year period from 1980 to 1982, health examinations were conducted, covering a total of 1, 164 pesticide sprayers in eight rural communities, Miye Prefecture. Of the number, 869 were women. Mercury residues in hair were also measured.
The findings are as follows:
1. Abnormal lipid metabolism topped the list of disorders, followed by hypertension, ECG abnormalities, anemia, albuminuria and liver dysfunction in that order.
2. The rates of detection of these abnormalities were not particularly high as compared with those in ordinary health checkups.
3. When compared with previous findings, the cases of abnormal lipid metabolism and anemia decreased in number both in men and women, whereas the cases of abnormal cholinesterase activities and albuminuria increased in both sexes.
4. The majority of pesticides used by the farmers were organophosphorous.
5. The average level of mercury residues in hair was 5.35 ppm for men and 2.97 for women. 6. More than 6.0 ppm of mercury were detected in 23.1 % of the men and 1.9% of the women. None were found to carry more than 20 ppm of mercury in their hair.

We present here a rare case of coronary artery bypass grafting through a left thoracotomy after substernal gastric interposition for esophageal cancer. A 58-year-old man, who had undergone esophagectomy and substernal gastric interposition 11 years previously, was admitted for cerebral infarction from which he made a good recovery without any complication. At this time, the patient was diagnosed as having coronary artery disease on electrocardiogram. Cardiac catheterization revealed triple vessel disease. Coronary artery bypass grafting to the left anterior descending artery and obtuse marginal branch through a left thoracotomy was performed using a radial artery Y-graft under femorofemoral bypass. The aorta was cross-clamped and the heart was arrested with antegrade cold cardioplegic solution for the distal anastomosis of the left anterior descending artery and the obtuse marginal branch which was embedded within the myocardium. The postoperative angiography showed good coronary flow. Left thoracotomy approach provides a good exposure of the left coronary artery. This approach, therefore, is advocated as an alternative method for cases requiring coronary artery bypass but in which median sternotomy is difficult, such as the present case. The appropriate procedure for the site of thoracotomy, supporting methods, choice of graft, and the site of graft anastomosis should be selected in each patient.

To assess the effectiveness of a problem-based learning tutorial system introduced at Gifu University School of Medicine in 1995, we conducted a questionnaire survey of medical knowledge, attitudes about learning, communication ability, and social behavior in sixth-year medical students. The questionnaire was given to instructors and attending physicians at community hospitals who were involved in clinical education. Many of the evaluators felt that students who trained with the tutorial system showed improved understanding, a more active attitude toward learning, and a better attitude toward patients than did students who received traditional, lecture-based education.

The Common Achievement Tests Organization performed the first nationwide trial of computer-based testing (CBT) used to assess students entering the clinical phase of medical education. Seventy-seven medical schools participated in the trial. We compared performance on the national CBT with performance on preclinical tests administered at Gifu University School of Medicine. Despite some methodologic differences between the national CBT and our system, the overall results correlated well. Students who did poorly on the national CBT also did poorly on Gifu University's preclinical test. Correlation of these two performance scales suggests that nationwide CBT could be used to accurately assess preclinical skills.

The purpose of this case report was to report a rare case of pyogenic spondylodiscitis caused by Campylobacter fetus. A 37-year-old male presented with fever and low back pain. By lumbar magnetic resonance imaging (MRI), no abnormal finding was observed at the first presentation. However, low back pain was aggravated, and fever did not improve. Thus, lumbar MRI was repeated on the 26 day after the onset of symptoms, showing abnormal signals at vertebrae and disc spaces, and pyogenic spondylitis was diagnosed. The possibility of pyogenic spondylodiscitis should be taken into account if a patient presents with low back pain and fever, and areas of low signal intensity on a T1-weighted MRI should be carefully examined. When initial MRI does not reveal abnormal findings, repeated MRI after one or two weeks or, more favorably, immediate gadolinium enhancement MRI, are important for patients who have persistent low back pain and fever.
Adult ; Campylobacter ; Campylobacter fetus ; Discitis ; Early Diagnosis ; Fever ; Gadolinium ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Male ; Spine ; Spondylitis

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the surgical results of cervical pedicle screw (CPS) fixation combined with laminoplasty for treating cervical spondylotic myelopathy (CSM) with instability. OVERVIEW OF LITERATURE: Cervical fixation and spinal cord decompression are required for CSM patients with instability. However, only a few studies have reported on CPS fixation combined with posterior decompression for unstable CSM patients. METHODS: Thirteen patients that underwent CPS fixation combined with laminoplasty for CSM with instability were evaluated in this study. We assessed the clinical and radiological results of the surgical procedures. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the clinical results. The percentages of sli p, difference in sli p angle between maximum flexion and maximum extension of unstable intervertebrae, and perforation rate of CPS were evaluated. RESULTS: The mean JOA scores before surgery, immediately after surgery, and at final follow-up were 9.1, 13.3, and 12.6, respectively. The mean percentages of sli p before surgery, immediately after surgery, and at final follow-up were 9.1%, 3.2%, and 3.5%, respectively; there were significant improvements immediately after surgery and at final follow-up. The difference in sli p angle between the maximum flexion and maximum extension of the unstable intervertebrae changed from 9.0degrees before surgery to 1.6degrees at the final follow-up. The perforation rate of CPS was 10.9%. CONCLUSIONS: The results suggest that CPS fixation combined with laminoplasty is an effective surgical procedure for treating CSM with instability.
Asian Continental Ancestry Group ; Decompression ; Follow-Up Studies ; Humans ; Orthopedics ; Retrospective Studies ; Spinal Cord ; Spinal Cord Diseases ; Spondylosis

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the surgical results of computer-assisted C1-C2 transarticular screw fixation for atlantoaxial instability and the usefulness of the navigation system. OVERVIEW OF LITERATURE: We used a computed tomography (CT)-based computer navigation system in planning and screw insertion in Magerl's procedure, which provides the most rigid atlantoaxial fusion, to avoid risk of vertebral artery (VA) tear by avoiding high-riding VA during screw insertion. METHODS: Twenty patients who underwent atlantoaxial fusion under the CT-based navigation system were studied. The mean observation period was 33.5 months. The evaluated items included the existence of VA stenosis by preoperative magnetic resonance angiography, surgical time, blood loss volume, Japanese Orthopaedic Association (JOA) score and Ranawat's pain criteria before surgery and at final follow-up, postoperative screw position evaluated by CT, and bony fusion. RESULTS: The mean operation time was 205 minutes, with the mean blood loss volume of 242 ml. The mean JOA score was 11.6 points before surgery and 13.7 at final follow-up. Occipital and/or cervical pain presented before operation was remitted or resolved in all patients. Evaluation of screw insertion by CT revealed correct penetration to atlantoaxial joints, with a perforation rate of 2.6%. There was no complication, including VA tear, and all patients who were followed-up during one year or more after surgery achieved bony fusion. Some subjects who appeared inappropriate for surgery from CT images were assessed as eligible for surgery based on the evaluation results obtained using the navigation system. CONCLUSIONS: It was demonstrated that the CT-based navigation system is an effective support device for Magerl's procedure.
Asian Continental Ancestry Group ; Atlanto-Axial Joint ; Congenital Abnormalities ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Magnetic Resonance Angiography ; Neck Pain ; Operative Time ; Retrospective Studies ; Vertebral Artery