A pilot study of the Doppler renal arterial flow pattern was done on 34 patients (68 kidneys) with benign prostatic hypertrophy, 14 patients (28 kidneys) with hydronephrosis and 22 patients (37 kidneys) with reflux nephropathy. Renal scintigraphy was also performed besides the color Doppler scanning.
Results:
Mean minimum blood flow values were significantly smaller in all the subjects than those in normal control groups with one of the three diseases respectively
In patients with reflux nephropathy, minimum blood flow values were extremely low, suggesting the severe scars and scarce blood flow. A high correlation was found between uptake rates measured by renal scintigram and minimum blood flow. This fact suggests that the blood flow scan can reveal the profile of the renal function.
We conclude that the color Doppler sonography is useful in a routine initial examination and a simple follow-up test for detecting renal dysfunction in some urological diseases.

ABSTRACT : Both primary biliary cirrhosis (PBC) and autoimmune hemolytic anemia (AIHA) are uncommon diseases. Immunological dysregulation is suggested as a causative factor for both diseases. We report a 77-year-old woman who suffered from warm type AIHA complicated by PBC. Her direct antiglobulin test was positive for IgG, and negative for C3. Both anti-mitochondrial antibody and its M2 component were detected. Both alkaline phosphatase (Alp) and IgM were elevated in the serum. She was initially treated with steroids for 8 months. Her steroids were discontinued when she underwent a laparoscopic splenectomy. Ursodeoxycholic acid was discontinued due to an allergic skin reaction. Her Alp improved with bezafibrate.

Medical professionalism, which is of great interest in most countries, underpins the relationship between patients and doctors. The concepts of medical professionalism should be understandable not only by physicians but also by patients. However, there are few studies that evaluate the concept of medical professionalism from patients' perspective.a) We conducted two focus group interviews with 12 people who were not health care professionals. One interview was done with people who were living in Tokyo and one with people living in Osaka. Each interview was one hour long. During the interviews, we explored themes related to medical professionalism from patients' perspectives.b) We qualitatively analyzed response data from audio records of the interview and inductively extracted categories pertaining to medical professionalism. We compared our findings with the domains of the American Board of Internal Medicine's Charter on Professionalism (CP).c) We found 5 themes; 1) Primacy of patient welfare 2) Fairness 3) Social responsibility 4) Maintaining appropriate relations with industry 5) Maintaining appropriate relations with patients.d) Although our themes are almost equivalent to the principles cited in CP, there are some differences, such as the importance of maintaining appropriate relations with patients.e) Given the current findings, medical educators and trainers should continue to develop the Japanese concepts of medical professionalism in a manner that takes into consideration patients' perspectives.

BACKGROUND : Previous studies have suggested positive association between residents' workload and medical errors. However, few studies have investigated the possible associations between procedural errors, workload, and the individual characteristics of residents, including personality, mental state and job satisfaction.
OBJECTIVE : To explore possible associations of workload and individual characteristics of residents with their procedural error rates.
DESIGN : Prospective observational study based on a daily questionnaire.
PARTICIPANTS : Residents of postgraduate year 1 and 2.
MEASUREMENTS : Residents' workload (on-calls, work hours, sleep and napping hours), residents' physical and mental health state, personality inventory, and procedural error rate (defined as procedural error counts divided by overall procedural attempts).
RESULTS : On average, the residents (N=49) were responsible for 9.8 inpatients per day (range, 1.9-23.1), worked for 16.0 hours per day (range, 12.6-19.8), slept for 4.4 hours per day (range, 2.8-5.7), napped for 0.2 hours per day (range, 0-0.7), and experienced 1 overnight work shift every 7.2 days. The procedural error rate was 2.2 per 10 procedures (range, 0.4-5.0). Using a multivariable adjusted regression model, significant factors associated with lower error rates included : longer napping ; reflective personality ; better mental state ; higher job satisfaction ; and, less on-call frequency.
CONCLUSIONS : Procedural error of residents is positively associated with higher on-call frequency and inversely associated with napping, reflective personality, better mental state, and higher job satisfaction. For reducing procedural error among residents, improvement of modifiable factors, such as workload and mental health, is needed.

Purpose: The Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) is designed to investigate an individual's perspective on their own quality of life (QOL) and has been used widely among various clinical populations, including cancer patients and those with chronic kidney disease, in addition to healthy participants. While the original SEIQoL-DW is a semi-structured interview, other formats have been developed; recently computer-based versions have yielded equivalent results comparable to paper-based versions. However, no previous study has examined differences between the computer-based version and its original interview-based design. The purpose of this study is to assess the feasibility and validity of a computer-based version of the SEIQoL-DW, compared with the original interview-based format.
Methods: We conducted a non-randomized crossover study with 13 medical students from November 2008 to January 2009 at a municipal university in Yokohama, Japan. Both the computer-based and interview-based versions of SEIQoL-DW were administered to all study participants. Wilcoxon-signed rank test was used to compare differences in mean SEIQoL Index score between computer-based and interview-based results. The intra-class correlation coefficient and the Bland and Altman limits of agreement methods were used to compare formats.
Results: No significant differences were found in the SEIQoL-DW Index between the computer-based and interview versions after analysis with Wilcoxon-signed rank test (p = 0.501). The intra-class correlation between formats was 0.94 (CI: 0.81–0.98). The limit of agreement analysis showed that 53.3% of the observations were within ±1–5 units of the average score, while 46.7% were within ±5–10 units. In total, 100% of observations were within ±1–10 units.
Conclusions: The computer-administered version of SEIQoL-DW may be feasible and acceptable and provides a valid alternative, at least in healthy subjects, to the more cumbersome interview version. Use of the computer-based version will facilitate its application to larger patient populations in various clinical settings.

BACKGROUND: The existence of a gap between research evidence and clinical practice has been described recently. Several drugs are effective in preventing secondary events after acute myocardial infarction (AMI), but it is not certain whether this evidence is employed in daily practice. We investigated the drugs currently employed for patients with a history of AMI in Japan.
METHODS: Medical records of patients who developed AMI during the calendar year of 1999 were retrospectively identified at three teaching hospitals in Japan. We collected data on drugs prescribed at three time points (upon admission for AMI, at the time of discharge, and one year after discharge) for each patient.
RESULTS: Data were available for 149 patients with AM!. Drugs prescribed at the time of discharge were aspirin (77.5%), nitrates (68.3%), and angiotensin converting enzyme inhibitors (52.8%) . β-blockers were prescribed for only 12.0% of patients. The drugs used one year after discharge were to a large extent similar to those at the time of discharge. There were no significant correlations between the use of these drugs and comorbidity.
CONCLUSION: Despite established evidence that β-blockers offer benefits to patients with a history of AMI, they have not been prescribed frequently, for reasons that remain unclear. To improve the quality of clinical care, further systematic effort is needed to bridge this evidence to practice gap.