1.Use of Models in Teaching Palpation and Percussion in a Basic Diagnosis Training Course.
Yasuhiro ASAI ; Naoki NAGO ; Masato SASAKI ; Masahiro IGARASHI
Medical Education 1997;28(1):53-58
In 1994, a basic diagnosis training course was introduced for 2nd-year medical students at Jichi Medical School (JMS) to teach basic interview and physical examination skills with an emphasis on diagnostic processes and principles. In planning and preparing the course, instructors at JMS frequently held discussions to determine learning objectives and activities. We used a comprehensive manual for small-group teaching to standardize lectures as much as possible. In all sessions of the basic physical examination, students were taught in small groups. We also constructed original models to teach palpation and percussion. These models allowed students to participate actively and helped them understand the principles, skills, and findings of palpation and percussion. Instructors at JMS concluded that the models were useful training tools.
2.Postgraduate Education Through Evidence-Based Medicine: Short-Term Effects on Knowledge and Behavior.
Naoki NAGO ; Yasuhiro ASAI ; Junichi MISE ; Fumie TAKAGI ; Masato SASAKI ; Masataka OKUNO ; Masahiro IGARASHI
Medical Education 1998;29(4):215-220
Objective: To investigate whether postgraduate education through evidence-based medicine can affect the knowledge and behavior of residents.
Design: Self-controlled and externally controlled trial.
Setting: University hospital.
Participants: Fifteen residents specializing in family medicine.
Intervention: Four 2-hour seminars and weekly evidence-based medicine-style journal club meetings.
Main outcome measures: Scores from a test of knowledge of evidence-based medicine and the number of MEDLINE searches conducted each month.
Results: All residents improved their knowledge of evidence-based medicine and conducted more MEDLINE searches each month than did other medical residents or residents of our department last year.
Conclusion: Postgraduate education through evidence-based medicine is effective in improving residents' knowledge and behavior.
3.Patients' Views about Undergraduate Clinical Training: Targeting Improved Clinical Clerkship Training on the Ward.
Nobutaro BAN ; Tsukasa TSUDA ; Yoshikazu TASAKA ; Ryuki KASAI ; Hiroki SASAKI ; Mitsuru WAKUNAMI ; Noriaki OCHI ; Yasuhiro YAMAMOTO ; Katsuhiro ITO ; Tatsuki KATSUMURA
Medical Education 1994;25(1):35-42
4.Angiosarcoma of the scalp diagnosed by the presence of neck inflammation: a case report.
Rei KARUBE ; Hiroyoshi SASAKI ; Keiji SHINOZUKA ; Yasuhiro FUJISAWA ; Toru YANAGAWA ; Kenji YAMAGATA ; Kojiro ONIZAWA ; Fujio OTSUKA ; Hiroki BUKAWA
International Journal of Oral Science 2012;4(3):166-169
Angiosarcoma is an uncommon malignancy, which spread out from the endothelial cells of vessels. Scalp angiosarcoma with cervical lymph node metastasis is particularly rare. This article describes a rare case of angiosarcoma of the scalp, presenting as neck inflammation. Imaging procedures such as computed tomography (CT), magnetic resonance image (MRI) and ultrasonography (US) were not sufficient to diagnose this case. A needle biopsy provided an effective and accurate diagnosis of cervical lymph node metastasis. Additional observation and physical examination was required to diagnose the origin of the primary cancerous lesion. Once the angiosarcoma diagnosis was confirmed histologically, sequential weekly and monthly docetaxel (DTX) treatment was effective in preventing reoccurrence. Nonetheless, the optimization of angiosarcoma treatment remains a future goal. Although patients generally describe pain and swelling at the primary lesion site, this patient complained only of painful neck inflammation, without any indication of pain or swelling of the scalp. A revised diagnostic protocol should note that cervical lymph node metastasis of unknown primary origin may result from angiosarcoma of the scalp.
Aged
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Antineoplastic Agents
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therapeutic use
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Cranial Irradiation
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Head and Neck Neoplasms
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diagnostic imaging
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pathology
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therapy
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Hemangiosarcoma
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diagnostic imaging
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pathology
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therapy
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Humans
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Lymphatic Metastasis
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Male
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Neck
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pathology
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Positron-Emission Tomography
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Radiography
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Scalp
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pathology
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Skin Neoplasms
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diagnostic imaging
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pathology
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therapy
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Taxoids
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therapeutic use
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Ultrasonography
5.Introducing the Objective Structured Clinical Examination to Evaluate Students' Interviewing and Physical Examination Skills.
Nobutaro BAN ; Tsukasa TSUDA ; Yoshikazu TASAKA ; Hiroki SASAKI ; Ryuki KASSAI ; Mitsuru WAKUNAMI ; Satoru AZUMA ; Kazunori Aoi ; Noriaki OCHI ; Yasuhiro YAMAMOTO ; Katsuhiro ITO ; E. K. Kachur
Medical Education 1994;25(6):327-335
6.Splenic infarction associated with acute infectious mononucleosis.
Yuji SUZUKI ; Keisuke KAKISAKA ; Hidekatsu KURODA ; Tokio SASAKI ; Yasuhiro TAKIKAWA
The Korean Journal of Internal Medicine 2018;33(2):451-452
No abstract available.
Infectious Mononucleosis*
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Splenic Infarction*
7.Overlap Between Constipation and Gastroesophageal Reflux Disease in Japan: Results From an Internet Survey
Naotaka OGASAWARA ; Yasushi FUNAKI ; Kunio KASUGAI ; Masahide EBI ; Yasuhiro TAMURA ; Shinya IZAWA ; Makoto SASAKI
Journal of Neurogastroenterology and Motility 2022;28(2):291-302
Background/Aims:
Detailed evaluations of overlapping constipation and gastroesophageal reflux disease (GERD) have not been conducted in Japan. The REACTION-J2 study examined the overlap of these diseases in Japan.
Methods:
This internet-based survey recruited participants from general public survey panels. Questions included demographic and medical data and assessments based on validated measures for constipation and GERD. Associations between background factors affecting constipation/GERD overlap, disease measures, and treatment were also evaluated.
Results:
Among 10 000 survey responses received, functional constipation (Rome IV diagnostic criteria) was reported by 439 participants; chronic constipation (Japanese guidelines) by 3804 participants; and subjective constipation symptoms by 2563 participants. The number of participants with constipation/GERD overlap ranged from 73 to 1533 depending on the criteria used. Regardless of the definition used, all GERD groups had significantly higher odds of being constipated than non-GERD participants: the OR (95% CI) for all 9 combinations of definitions ranged between 1.56 (1.21, 2.01) and 2.67 (2.44, 2.92) (all P ≤ 0.001). Straining, hard stools, and sensations of incomplete evacuation and anorectal obstruction/blockage, according to chronic constipation criteria, were common.Participants with constipation/GERD overlap had poorer quality of life (P < 0.001) and worse GERD symptom scores (P < 0.001). The frequency of abnormal stools was highest (P < 0.001) in the constipation/GERD overlap group. In the overlap group, 52.4% and 26.0% used gastric and constipation medication, respectively.
Conclusion
Individuals with constipation/GERD overlap tend to have worsened symptoms and quality of life.
8.Prototype single-balloon enteroscopy with passive bending and high force transmission improves depth of insertion in the small intestine
Yasuhiro MORITA ; Shigeki BAMBA ; Osamu INATOMI ; Kenichiro TAKAHASHI ; Takayuki IMAI ; Masaki MURATA ; Masashi OHNO ; Masaya SASAKI ; Tomoyuki TSUJIKAWA ; Akira ANDOH
Intestinal Research 2020;18(2):229-237
Background/Aims:
We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE.
Methods:
Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points.
Results:
The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon’s signed-rank test).
Conclusions
In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102)
9.A Case of Adult T-Cell Leukemia/Lymphoma with Intestinal Perforation
Kenji HIRAU ; Yutaka HIRANO ; Kasumi TOZAWA ; Kimito ORINO ; Shinichi SASAKI ; Yasuhiro SASAKI ; Yoshiaki ISHII ; Takatoshi YONEYA ; Yusuke MINAMIZUKA
Journal of the Japanese Association of Rural Medicine 2018;67(4):521-
A 78-year-old man was diagnosed with adult T-cell leukemia/lymphoma (ATL) and was started on standard chemotherapy 1 year earlier. However, treatment was discontinued because of adverse drug reactions and worsening delirium. Thereafter, he remained stable and was followed up while receiving etoposide. He then visited our hospital because of acute abdominal pain and underwent surgery with a diagnosis of gastrointestinal perforation. Intraoperative observation showed a reddened, concentric wall thickening measuring 4 cm and a perforation site in the ileum, and thus partial resection of the small bowel was performed. The histological diagnosis was small bowel perforation due to tumor cell invasion. Two months postoperatively, he started a less intensive chemotherapy regimen along with palliative care, and died due to the primary disease approximately 5 months postoperatively. ATL involves systemic organs because of its high organ-affinity. Once it involves the gastrointestinal tract, various gastrointestinal symptoms can occur. Patients with ATL are at risk of developing gastrointestinal perforation at any time during the clinical course. Therefore, clinicians should be aware that once gastrointestinal perforation develops, the prognosis becomes extremely poor. Assessment of the disease state, early detection of gastrointestinal lesions, and prevention of opportunistic infections appear to be important in the management of patients with ATL.
10.Internet Survey of Japanese Patients With Chronic Constipation: Focus on Correlations Between Sleep Quality, Symptom Severity, and Quality of Life
Sayuri YAMAMOTO ; Yurika KAWAMURA ; Kazuhiro YAMAMOTO ; Yoshiharu YAMAGUCHI ; Yasuhiro TAMURA ; Shinya IZAWA ; Hiroaki NAKAGAWA ; Yoshinori WAKITA ; Yasutaka HIJIKATA ; Masahide EBI ; Yasushi FUNAKI ; Wataru OHASHI ; Naotaka OGASAWARA ; Makoto SASAKI ; Masato MAEKAWA ; Kunio KASUGAI
Journal of Neurogastroenterology and Motility 2021;27(4):602-611
Background/Aims:
Chronic constipation and lifestyle factors can affect sleep quality. We evaluated the relationship between chronic constipation and sleep in the Japanese population.
Methods:
This cross-sectional internet-based survey included 3000 subjects with constipation, classified according to sleep status (good/poor).Primary endpoints were Bristol stool form scale (BSFS) score and correlations between sleep disorder criteria of the Pittsburgh Sleep Quality Index (PSQI) and sleep status (good/poor sleep). Secondary endpoints included correlations between quality of life (QOL) and mood, medical, lifestyle, and sleep factors.
Results:
The proportion of participants with BSFS category 4 (normal stool) was significantly higher in the good sleep group (P < 0.001). Sleep disturbance (P < 0.05), sleep quality, and duration, use of hypnotic medication, and daytime dysfunction of PSQI (all P < 0.001) significantly correlated with poor sleep. In the poor sleep group, QOL was significantly worse and anxiety and depression levels were significantly higher (allP < 0.001) compared with the good sleep group. Anemia and smoking (both P < 0.05), recent body weight increases, and poor eating habits (all P < 0.001) were significantly higher in the poor sleep group. Male sex, onset associated with change in frequency of stools, sensation of incomplete evacuation for at least 25% of defecations, and manual maneuvers to facilitate at least 25% of defecations correlated with poor sleep.
Conclusions
Subjects with constipation and poor sleep experienced severe symptoms and had poor QOL. These data support the need for a multifocal treatment approach, including lifestyle advice and pharmacotherapy.