The patient is a 15-year-old female who initially presented to our hospital at the age of 6 with complaints of tachycardia. However, no significant abnormalities were identified, and she was subsequently placed under observation. At the age of 7, the patient developed symptoms including headache, chest pain, and absent pulses, accompanied by a pronounced inflammatory response. A thorough diagnostic evaluation was performed, which led to the diagnosis of Takayasu’s arteritis. At that time, computed tomography (CT) imaging revealed a fusiform aortic aneurysm with a maximum short axis diameter of 34 mm, extending from the ascending aorta to the proximal aortic arch. Under vigilant monitoring, by the age of 15, the maximum short diameter had increased to 45 mm, demonstrating progressive enlargement over time. Following a multidisciplinary discussion of treatment options in a heart team conference, it was determined that surgical intervention was warranted. Given that the patient was receiving maintenance therapy for a relapse of arteritis, the dose of prednisolone was reduced to 4 mg prior to performing an ascending partial arch aortic replacement. The postoperative course was uneventful, and the patient was discharged on postoperative day 13. She continues to receive maintenance therapy and undergoes regular CT scans at the outpatient clinic. Childhood-onset Takayasu’s arteritis is exceedingly rare, but with timely surgical intervention and sustained disease management, an improved long-term prognosis can be anticipated.

The purpose of this study was to clarify the changes in the sense of difficulty hospital staff felt toward palliative care before and after a palliative care team of the pediatric hospital started in-hospital consultation. A self-administered questionnaire about the difficulty, consisting of 21 items in five areas, was used to conduct a survey in 2015 for the pre-consultation period, and in 2018 for the post-consultation period. Responses were obtained from 222 people in the pre-consultation period (response rate of 70.9%) and from 384 people in the post-consultation period (response rate of 87.3%). Over 70% of the respondents were nurses and midwives. A lower sense of difficulty was observed in three of the items including “relief of painful symptoms”, “family care during caregiving”, and “support when oneself and surrounding staff feeling inadequate and lost”. Further, a significant decrease was observed in the sense of difficulty in six items reported by nurses and midwives in departments receiving the interventions. Eleven of the 16 cases in which the palliative care team intervened involved multiple requests for intervention for 2 patients with pain control difficulties, suggesting that the consultation activities contributed to the decrease in the sense of difficulty experienced by nurses and midwives.

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.

We experienced 8 cases of children who presented with somatic complaints and found it difficult to attend school successfully treated with Kampo medicine. We evaluated them objectively by using the evaluation scale in the guideline for medical care of school refusal. Four cases were orthostatic dysregulation, 2 cases were migraine, 1 case was involuntary movement in upper abdomen and the other case was autonomic dysfunction. Kampo medicines were selected according to conventional method, so-called sho. Among 8 cases, 5 cases had a major response, 2 cases had a minor response and one case had no beneficial response. These results suggest that Kampo therapy can be effective therapeutic means. Kampo therapy is quite personalized and beneficial especially for children who find it difficult to attend school and need individualized care. This is the first report evaluating many cases objectively by using the evaluation scale and there have been no reports similar to ours. We have to continue to enlighten general pediatricians about the effectiveness of Kampo therapy.

Background: There is increasing demand for clinical clerkships in palliative medicine, though conventional medical education has focused only on providing students with sufficient medical knowledge and skills. In Japan, there is no standard program for palliative medicine in undergraduate medical education. Our hospice, in cooperation with a clinical clerkship for palliative medicine launched by Tokyo Medical and Dental University, has developed its own comprehensive bedside learning curriculum. Aim: This study aimed to evaluate the efficacy of the program. Methods: The curriculum involves not only experience in hospice care, ward rounds, and interviews with terminally ill patients, it also provides each medical student with educational sessions moderated by certified hospice nurses and pharmacists. We conducted a self-administered five-point scale questionnaire (with a higher score indicating higher satisfaction) to assess students’ satisfaction and understanding of the program. We also conducted a questionnaire on basic palliative medicine knowledge before and after the program. Results: Twenty students took part in the program. Ratios of scores of 4 or 5 for satisfaction and understanding of the program were 100% and 95%, respectively. Mean rates of correct answers on the pre-program and post-program test were 51% and 85%, respectively; showing a marked increase and emphasizing the educational significance of our curriculum. Students evidently benefit from the experience of bedside learning, and 95% reported having recommended the program to their juniors. Conclusion: These outcomes suggest the program is effective toward developing a standard education program in palliative medicine.

Aim: We investigated what medical students learned on the clinical clerkship in our hospice and how their images of hospice care were changed, with self-reported questionnaires. Methods: Descriptions given in the contents were analyzed using a content analysis method based on Berelson’s methodology. A total of 20 students who participated in the program responded. Results: From their responses, 212 descriptions were extracted and 59 codes elicited. The codes were inductively classified and categorized based on content similarities. Eleven categories were generated: “care for quality of life of patients and families,” “characteristics and effects of palliative care” “practical approaches to end-of-life medicine,” “hospices’ positions in the healthcare system” “development of trust-based relationships with patients and their families,” “cooperation among healthcare professionals,” “appropriate attitudes toward patients and their families,” “being with patients when they pass away,” “opinions of patients and their families,” “characteristics and threats of cancer,” and “mental health for healthcare workers.”The students were found to have acquired a more positive image of hospices. Conclusion: They reported gaining valuable experience from the direct encounters with patients and their family, and that they had acquired behavior appropriate for physicians, as well as knowledge and skills about the basic palliative care.

Introduction : Catheter which strays in the ascending lumbar vein during femoral vein catheterization can cause complications such as retroperitoneal hematoma. However, not much is known of this phenomenon.
Methods : We retrospectively studied 107 patients who had indwelling femoral vein catheter in our hospital between March 2013 and April 2011.
Results : The catheter went straying in the ascending lumbar vein 11/110 times (10.0%) , 5/34 times (14.7%) on the left side, and 6/76 times (7.9%) on the right side. The possibility of the catheter straying was maximum when the catheter was displaced laterally or raised sharply towards the caudal side, as seen through abdominal radiographic examination.
Conclusion : Femoral central venous catheter misplacement in the ascending lumbar veins is fairly common. Tests such as additional abdominal CT or radiographs should be conducted if misplacement is suspected.

The purpose of this study was to establish by way of trial reference interval of serum lipids (TC, HDL-C, TG and LDL-C) for old people aged 65 or over based on the document published by America's National Committee for Clinical Laboratory Standards. For this purpose, we used the results of the mass health screening tests run on a total of 14, 738 residents in Shimane Prefecture. We selected reference sample groups by excluding those examinees who had been undergoing medical treatment, those who had taken their meal less than 12 hours before, habitual drinkers and smokers, and those whose systolic blood pressure was more than 160mmHg, diastolic blood pressure upwards of 95mmHg, obesity level downwards -20% or upwards of +20%.
T-C values peaked in the age group of 50s for men, while for women in the age group of 60s. Regarding HDL-C values, women were generally high compared withmen, but mean values for women in their 60s were significantly low (p<0.01) compared with those for women in their 50s. TG values were higher in men than in women. LDLC levels showed the same tendency as T-C levels.
We compared the mean values of adults aged 64 or below and elders aged 65 or above. In the elders, the mean values for T-C, TG and LDL-C were significantly higher (p<0.01) than in the adults, and the mean HDL-C values were significantly lower (p<0.01) than in the adults.
These results indicated that the reference interval of elders of T-C, HDL-C, TG and LDL-C could be from 147 to 289mg/dl, from 37 to 99mg/dl, from 40 to 209mg/dl and from 70 to 200mg/dl, respectively.