In an attempt to improve the content of the educational programs offered by Nippon Medical School and to better prepare our students to work in the rapidly changing world of medicine, the school has recently revamped its teaching methodology. Particular emphasis has been placed on 1) simulator-based education involving the evaluation of students and residents in a new clinical simulation laboratory; 2) improving communication skills with the extensive help of simulated patients; 3) improving medical English education; 4) providing early clinical exposure with a one-week clinical nursing program for the first year students to increase student motivation at an early stage in their studies; 5) a new program called Novel Medical Science, which aims to introduce first-year students to the schools fundamental educational philosophy and thereby increase their motivation to become ideal physicians. The programs have been designed in line with 2006 guidelines issued by the Ministry of Education, Culture, Sports, Science and Technology to allow flexibility for students to take part in education outside their own departments and year groups as part of the Ministrys program to encourage distinctive education at Japanese universities.

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Background: Adjustable gastric banding is a surgical approach to weight reduction. In this study we created a gastric banding model in rats to better understand the mechanism of body weight loss.
Methods: Male Sprague-Dawley rats weighing 260 to 280 g were subjected to gastric banding (band group) (n=8) or to a sham operation (control group) (n=8). Body weights were monitored for 14 days, and daily food and water intake and nitrogen balance were monitored for 7 days.
Results: Two rats in the band group died of malnutrition due to gastric stomal stenosis and obstruction caused by the gastric banding. Body weight gain during the 14 days after the operation was less in the band group than in the control group (p<0.01). Food intake during the 7 days after the operation was significantly less in the band group than in the control group (p<0.01), and water intake during the 7 days after the operation was significantly less in the band group than in the control group (p<0.01). Cumulative nitrogen balance was significantly less in the band group than in the control group (p<0.01).
Conclusion: Gastric banding decreased the body weight gain of rats by decreasing the amount of food intake because of the creation of a small gastric pouch.

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Our institution introduced laparoscopic surgery for esophageal achalasia in 2001. The present report summarizes 15 cases of achalasia treated with laparoscopic Heller myotomy and anterior fundoplication according to the method of Dor, and we have investigated the therapeutic effects on specific symptoms such as dysphagia, reflux, and chest pain. From February 2001 through January 2007, the laparoscopic Heller-Dor operation was performed in 15 patients, including 7 men and 8 women. Achalasia was classified morphologically on esophagography as spindle type in 11 cases, flask type in 3 cases and sigmoid type in 1 case. The degree of esophageal dilatation was classified as grade I in 8 cases, grade II in 6 cases, and grade III in 1 case. Dysphagia was the main symptom and was present in all cases. The mean disease duration was 4.3 years (range, 5 months to 20 years), and the mean weight loss was 4.2 kg. All patients underwent endoscopic dilatation preoperatively. Intraoperative blood loss ranged from 0 to 100 mL (mean, 21 mL). Adequate Heller myotomy was considered more than 6 cm and more than 3 cm in the esophagus and the stomach, respectively. Injury to the esophageal mucosa occurred during the myotomy in 3 cases but could be repaired in all cases during the laparoscopic procedure. All patients reported an excellent level of satisfaction postoperatively. In conclusion, the laparoscopic Heller-Dor operation for esophageal achalasia is a useful procedure because the postoperative satisfaction level of patients is excellent. Despite the risk of mucosal injury, adequate Heller myotomy should be achieved to obtain a good prognosis. It is, therefore, of utmost importance to obtain mastery over the surgical technique to repair any mucosal injury that might occur.

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Malignant mesenchymoma is a soft-tissue tumor arising preferentially in the extremities and the retroperitoneum. We report a case of primary malignant mesenchymoma of the left side of the posterior mediastinum with local recurrence on both sides of the mediastinum. A 24-year-old woman was admitted to our hospital complaining of cough. Chest X-ray showed a giant mass in two-thirds of the left lung field, and computed tomography of the chest revealed a lobulated large mass with a fat-density area and a calcified spot in the mediastinum and left pleural space. Magnetic resonance of the chest demonstrated a large, solid mass consisting mainly of areas with the same intensity as fatty tissue and partly of areas of heterogeneous moderate intensity. The tumor was resected completely through a left posterolateral thoracotomy. The pathologic diagnosis was malignant mesenchymoma: well-differentiated liposarcoma with osteocartilagenous differentiation. The patient had local recurrence in both sides of the mediastinum 3 years and 6 months after surgery, and the recurrent tumors were completely resected again.

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A 53-year-old male presenting with anorexia, intermittent diplopia, general fatigue, headache and vertigo was admitted to our hospital. He was diagnosed as having gastric cancer by endoscopy of his upper gastrointestinal tract. Brain computed tomography (CT) showed no abnormalities, but magnetic resonance imaging (MRI) showed slight enhancement in the cerebellar sulcus. Cytological examination of cerebrospinal fluid revealed malignant cells. He became blind one week after hospitalization. We diagnosed his condition as meningeal carcinomatosis (MC) and started radiotherapy. His vision improved after four weeks of treatment, and then he became totally blind again. Since his general condition remained poor, we did not perform chemotherapy. He died on the 127^th day of hospitalization. MC is a rare pathosis of gastric cancer in comparison with leukemia and malignant lymphoma. This disease does not often show characteristic pictorial images, and early diagnosis is difficult. Moreover, it usually manifests itself in its late stages after several months or more of treatment, and it is rare for MC to be present at the time of initial diagnosis. We present a case of gastric cancer with meningeal signs present when the primary tumors were diagnosed. Radiotherapy alleviated some of the symptoms, and the patient survived for as long as patients undergoing enforced chemotherapy.

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A 70-year-old man was admitted to our hospital for evaluation of multiple pancreatic tumors. Twelve years earlier he had undergone left radical nephrectomy for renal cell carcinoma (RCC). Computed tomography revealed two well-defined mass lesions in the head and tail of the pancreas, with strong contrast enhancement in the arterial phase. Fluorine-18 fluorodeoxyglucose positron emission tomography detected an elevated uptake within the lesions but no extrapancreatic uptake. The preoperative diagnosis was isolated multifocal metastatic pancreatic tumors from RCC. The patient underwent total pancreatectomy with splenectomy. Both of the tumors were well-demarcated, gray-white, and firm on gross observation. Microscopic examination, meanwhile, revealed solid tumors consisting of clear oval cells with severe nuclear atypia. These pathologic findings were consistent with the preoperative diagnosis of pancreatic metastasis from RCC. Radical resection improves the long-term survival of patients, and total pancreatectomy may be an appropriate procedure.

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We report a case of Diphyllobothrium nihonkaiense infection in a 2-year-old Japanese girl. When infection occurs in early childhood, it is necessary to offer supportive care in addition to standard treatment with oral praziquantel or with of a duodenal tube using a radiopaque contrast medium. We treated D. nihonkaiense infection in a 2-year-old girl successfully treated with oral praziquantel and a laxative.

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We report on a 78-year-old woman patient with macrothrombocytopenia with leukocyte inclusions (MTCP, May-Hegglin anomaly/Sebastian syndrome), who had no history of hemorrhagic symptoms and had a platelet count of 10,000 or less, but had a cerebral infarction. The patient was found to have idiopathic thrombocytopenic purpura, hypertension, and atrial fibrillation 16 years ago, yet received no medication. She was found to have had a cerebral infarction with aphasia as the chief complaint and was admitted to our hospital. Thrombocytopenia was found in three family members. Blood examinations revealed normal bleeding time and platelet aggregation ability. The patient was found to have the triad of giant platelets, thrombocytopenia, and inclusion bodies in leukocytes. Genetic analysis showed a mutation of the MYH-9 gene in the patients second daughter. Consequently, this patient received a diagnosis of MTCP. There have only been a few reports of the onset of thrombosis in patients with MTCP and no reports of the onset of cerebral infarction. Our report is the first case of MTCP in a patient with cerebral infarction.

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A case of refractory rheumatoid arthritis with a rapid destruction of the hip joint and an enlarged iliopsoas bursa is presented. Rapidly destructive coxarthrosis, chondrocalcinosis, suppurative arthritis, and pigmented villonodular synovitis were the differential diagnoses. Radiological examination showed that rheumatoid arthritis was most likely diagnosis. The patient was treated with total hip arthroplasty and etanercept, with good results.

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Cardiac papillary fibroelastomas are rare benign tumors with frond-like growths that typically involve the native valve tissue. Papillary fibroelastomas originate less commonly in the ventricular septum. We report a rare case of fibroelastoma arising from the left ventricle.

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Adenocarcinoma accounts for most of the malignant tumors originating from the colon, whereas adenosquamous carcinoma is rare, accounting for about 0.1% of all colon cancers. We present herein a case of adenosquamous carcinoma of the ascending colon. The patient was a 94-year-old woman who presented with a chief complaint of lower abdominal pain. A barium enema examination and lower gastrointestinal endoscopy showed a type 3 tumor in the ascending colon, and a biopsy confirmed the diagnosis of adenosquamous carcinoma. Right hemicolectomy was performed, and the tumor was diagnosed as a stage III advanced colon cancer. The patient had postoperative aspiration pneumonia and died 35 days after surgery. A search of Japanese literature over the past 25 years yielded 70 patients with adenosquamous carcinoma of the colon, and the clinicopathological features are discussed herein.

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We examined deliveries of twins to identify factors most strongly associated with an increased risk of transfusion. We reviewed the obstetric records of 511 twin deliveries at the Japanese Red Cross Katsushika Maternity Hospital from 2003 through 2007. After 18 (3.5%) of these deliveries, transfusions were required. Transfusion was significantly more likely after elective cesarean delivery at a gestational aged of 37 weeks or more (odds ratio, 4.85; 95% confidence interval, 1.87-12.61). Emergency cesarean delivery (at ≥37 weeks' gestation) was not associated with an increased risk of transfusion. The delivery mode of twins should be carefully considered because of the increased risk of transfusion after elective cesarean delivery at a gestational age of 37 weeks or more.

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