The first patient was a 33-year-old man with a history of fatty liver disease. Dynamic computerized tomography of a lesion in liver segment IV showed faint staining in the arterial phase and high signal intensity in the portal venous and equilibrium phases. The second patient was a 57-year-old woman also with a history of fatty liver disease. Magnetic resonance imaging (MRI) of a lesion in segment II in T1 out of phase revealed geographic morphology and high signal intensity. Furthermore, Gd-EOB-DTPA-enhanced MRI showed accumulation in the lesion in the hepatobiliary phase. In both cases, an aberrant left gastric vein and focal fat sparing area was diagnosed. Venous inflow to the liver other than via the portal vein may cause fatty degeneration of liver parenchymal cells or focal fat sparing due to imbalanced intrahepatic blood flow. In the present cases, imaging revealed a focal fat sparing area with an aberrant left gastric vein. Focal fat sparing area with aberrant inflow vessel identified in the background of fatty liver does not require biopsy or surgery. Therefore, further detailed evaluation of such images is warranted.

Kampo medicines have been used for treatment by an increasing number of doctors in recent years, and are becoming more frequently prescribed in combination with Western drugs. In the present study, we conducted a questionnaire of outpatients at the Kampo Clinic of Keio University Hospital in order to determine their perceptions and compliance regarding Kampo medicines.Ninety eight percent of patients used Kampo medicines in granular form, and approximately 30% of these patients reported difficulty in taking medicine due to reasons such as “bad taste”. Sixty percent of patients used Kampo medicines three times daily. Patients most often forgot to take afternoon doses, and so desired doses once daily. Furthermore, the same number of patients preferred Kampo medicines in tablet form as those who preferred Kampo medicines in granular form.The present findings clarified patients' perceptions toward Kampo medicines. Doctors and pharmacists must provide suitable treatment for patients by recognizing their perceptions of Kampo medicines.
Medicine, Kampo ; Clinic ; Use of ; percent ; therapeutic aspects

Physical examination is an important skill that is indispensable for physicians’ practice, but clinical practice tends to be a case dependent experience. In addition, there is not enough opportunity to systematically train the physical examination skills. Hypothesis is driven according to the clinical context. Our objective is to improve hypothesis-driven physical examination skills. Fifth and sixth grade medical students launched an interest group “General Medicine Interest Group” at Chiba University. Flipped classroom and peer teaching were adopted to the General Medicine Interest Group. The educational approach of incorporating flipped classroom and peer-assisted learning was considered useful for improving students’ motivation and physical examination skills. We will report on the activities and their effectiveness.

Objective: In 2013, a cohort study aimed to clarify the positive and negative effects of introducing the human papillomavirus (HPV) testing for population-based cervical cancer screening has been launched in Japan. This study included four screenings during the subsequent 7-year follow-up period. We aim to describe the results of the first round of this study on cervical cancer screening here. Methods: This study began in September 2013 with recruitment completed in March 2016.Women aged 30–49 years were divided into 2 groups: those who received uterine cervical cytology alone in the first year (control group), or those who received a combination of cytology and HPV testing (intervention group), based on their age. After first screening, women with positive result of cytology or positive HPV test required referral. We summarized the results of the first round of cervical cancer screening. Results: Of the 25,074 women who were eligible for the study, 13,845 women (55.2%) were screened with cytology alone; 11,229 women (44.8%) received a combination of cytology and HPV testing. After screening, 407 women (2.9%) in the control group and 1,003 women (8.9%) in the intervention group required referral, respectively. Adding HPV testing increased referral rate significantly (p<0.001). Conclusion After first screening, introduction of HPV testing appears to contribute to significantly higher referral rates, suggesting that the number of colposcopies as a detailed examination may increase. These preliminary findings suggest that if HPV testing is introduced into screening, medical institutions need to be prepared for an increasing number of follow-up examinations.

PURPOSE: Patients with pathological stage T1N+ or T2–3N0 gastric cancer may experience disease recurrence following curative gastrectomy. However, the current Japanese Gastric Cancer Treatment Guidelines do not recommend postoperative adjuvant chemotherapy for such patients. This study aimed to identify the prognostic factors for patients with pT1N+ or pT2–3N0 gastric cancer using a multi-institutional dataset. MATERIALS AND METHODS: We retrospectively analyzed the data obtained from 401 patients with pT1N+ or pT2–3N0 gastric cancer who underwent curative gastrectomy at 9 institutions between 2010 and 2014. RESULTS: Of the 401 patients assessed, 24 (6.0%) experienced postoperative disease recurrence. Multivariate analysis revealed that age ≥70 years (hazard ratio [HR], 2.62; 95% confidence interval [CI], 1.09–7.23; P=0.030) and lymphatic and/or venous invasion (lymphovascular invasion (LVI): HR, 7.88; 95% CI, 1.66–140.9; P=0.005) were independent prognostic factors for poor recurrence-free survival. There was no significant association between LVI and the site of initial recurrence. CONCLUSIONS LVI is an indicator of poor prognosis in patients with pT1N+ or pT2–3N0 gastric cancer.

  To evaluate the current state of the Onsen-Ryoho-Specialist (Broad Certified Fellow in Balneology, Climatology and Physical Medicine) training system, we surveyed the training facilities designated by the Japanese Society of Balneology, Climatology and Physical medicine (BCPM). Of the 24 facilities targeted by the survey, 21 responded (88%). Currently, the training curriculum for Onsen-Ryoho-Specialists consists of 8 units on diseases and 8 units on therapy methods. As shown in Figs. 1 and 2, it is difficult for a single facility on effectively cover all of these units. The most pressing need is to establish and implement a standardized curriculum across all facilities. Until now, each related academic society has selected training facilities based on its own criteria. Moving forwards, the review/accreditation body of the Japanese Medical Specialist Broad will make site visits to establish and review Onsen-Ryoho-Specialist training facilities. These efforts should lead to the development of fully qualified Onsen-Ryoho-Specialist training facilities.