A system of collecting student class evaluations was introduced at Nippon Medical School in February 2004: students initially submitted their responses to a questionnaire on paper via multiple-choice answer sheets and free comment forms, but recently, the Jenzabar system has been used to allow students to submit their answers by cellular phone. When a 10-point index was applied to an overall evaluation of teaching performance in the 2004 through 2008 academic years, the overall evaluation of the same teachers was found to have risen by an average of 0.12 point (n=165, Student's paired t-test, p<0.05); when applied to the same subjects/courses, the overall evaluation was found to have fallen by 0.10 point (n=53, Student's paired t-test, not significant). Although a large amount of time and effort is required to collect and compile student evaluations of 80 or more class projects and 230 or more individual teaching staff each year, we feel that the effort involved in providing early feedback to the students and making their education more interactive is worthwhile.

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Pelvic organ prolapse is characterized by a lack of pelvic floor support causing the pelvic organs and vaginal wall to protrude. For many decades, suture repair techniques have been the primary choice of surgical treatment when indicated. Traditional surgical techniques are, however, frequently associated with high rate of anatomical recurrence. Since 2004, vaginal mesh surgery with a tension-free vaginal mesh has emerged as an effective method of pelvic floor reconstruction, applicable to most types of pelvic organ prolapse. Gynemesh^®, a thin, highly porous synthetic polypropylene prosthesis, is inserted as a hammock under the bladder, applied laterally on the arcus tendineus fascia pelvis, and retained by 2 nonsecured bilateral transobturator arms. A posterior interrectovaginal prosthesis is inserted in front of the rectum and applied laterally on the levatores ani and is retained by bilateral lateral arms secured to the median part of the sacrospinous ligament. Laparoscopic sacrocolpopexy is another new procedure for the treatment of pelvic organ prolapse. This method is especially suitable for patients younger than 50 years. Because of possible complications, surgeons must learn the technical details of these procedures before performing them and choose the best surgical method according to patient's age, symptoms, and complications.

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Current antigen retrieval techniques include the use of citrate buffer, Tris-HCl containing 5% urea, and EDTA solutions combined with heating in a microwave oven or autoclave. These methods must be adjusted for a given tissue or antigen. To improve the efficiency of antigen retrieval for immunohistochemical staining, we developed a new method using citraconic anhydride. We describe this new antigen retrieval method using 0.05% citraconic anhydride solution of pH 7.4 and heat. This antigen retrieval method produced satisfactory staining results for a wide variety of antigens.

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A 2-year-old girl was admitted to our hospital because of prolonged seizures (right hemiconvulsions) and high-grade fever. A diazepam suppository was ineffective in treating the seizures, because an acetaminophen suppository had already been administered in an attempt to control the fever; thus, both suppositories were ineffective. An intravenous injection of flunitrazepam finally inhibited the hemiconvulsions, which had lasted 70 minutes. Thereafter, no jerking was observed, but the right hemiparesis and depressed consciousness persisted. The fever abated on the 5th day, and rashes developed over the entire body surface on the 6th day. Electroencephalograms (EEGs) recorded on the 5th day showed continuous irregular sharp waves in the left frontal area, suggesting non-convulsive status epilepticus. A further intravenous injection of flunitrazepam attenuated the paroxysmal EEG discharges and revived her consciousness, but the right hemiparesis remained. Human herpes virus 6 (HHV-6) DNA was detected in a blood sample, so exanthema subitum was diagnosed. Hemiconvulsion-hemiplegia syndrome was also diagnosed, because diffusion weighted magnetic resonance imaging on the 15th day showed high intensity areas in the cortices of the left-hemisphere and in the subcortical white matter of the left occipital lobe. Exanthema subitum is a common infectious disease in infants, and accompanying febrile seizures are not unusual in those affected. However, when febrile seizures are accompanied by such symptoms as prolonged seizures, hemiconvulsions followed by hemiparesis, and persistent depressed consciousness, early EEG recordings should be made.

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We performed a new technique of laparoscopic gastrostomy in a 69-year-old man with far-advanced esophageal cancer that was difficult to treat with percutaneous endoscopic gastrostomy. The operation time was 23 minutes, and blood loss was a few milliliters. The postoperative course was uneventful, and no infection was observed at the site of gastrostomy insertion. Laparoscopic gastrostomy is a safe, minimally invasive surgery.

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