Looking back upon my 40 years of clinical and research work, I would like to describe the following five points to evoke the research volition of young medical persons. ; (1) importance of reproducibility in research, (2) encouraging studying abroad, (3) improving the Department of Internal Medicine, (4) discovery of a new appetite-regulating molecule and (5) doing one's best in the current position.
When I look back upon my 40-year research life since graduating from medical school, I realize that I had engaged in doing research in the scientific fields, most of which I was not interested in at the time. Instead, I had always done my best and made great efforts to obtain a number of clinical and research results, simultaneously putting blistering passion into education. Now a days, young persons adhere only to immediate things, and there is a tendency to complain immediately before you are satisfied with your work. However, prior to complaining, you ask yourself about whether you are doing your best in the current position.
Because there are no useless experiences or wasting time even for one second in life, the present tough experiences may lead to having great success in the future in many cases of your life.

View full abstract

Background : Legionella pneumonia (L. pneumonia) is a serious disease among patients with community-acquired pneumonia (CAP). Appropriate initial assessment of severity and admission to intensive care unit (ICU) can reduce mortality due to L. pneumonia. Here, the efficacy of using the current CAP scoring for recommending admission to ICU and other variables for initial management were evaluated. Methods : The clinical characteristics of 11 patients diagnosed with L. pneumonia at Maebashi Red Cross Hospital from November 1999 to July 2010 were examined. The scoring systems of A-DROP (A : Age, D : Dehydration, R : Respiration, O : Orientation, and P : Blood Pressure) and CURB-65 (C : Confusion, U : Urea, R : Respiratory rate, B : Blood pressure, and Age) were used. Results : Of the 11 L. pneumonia patients, 6 were admitted to the ICU. By A-DROP and CURB-65 scoring systems, 4 cases were assessed as not severe. Among the parameters used in the scores, only elevated blood urea nitrogen (BUN) had significantly predictive potential for ICU admission (sensitivity=100%, specificity=80%, P< 0.02). Both A-DROP and CURB-65 scoring systems underestimated the severity of CAP caused by L. spp .. Conclusions : In the case of L. pneumonia, elevated BUN level is important for assessing CAP severity and making ICU admission recommendations.

View full abstract

Purpose : We started performing laparoscopic liver resection in our department in November, 2010. Here, we report the indications, procedure, and the results of this operation. Method : Using laparoscopic surgery, we resected ten hepatocellular carcinomas, three cholangiocellular carcinomas, four metastatic liver tumors, and three other liver tumors. We examined the operating time, blood loss, and complications. Results : We performed 13 laparoscopy-assisted liver resections and seven pure laparoscopy liver resections in one year. The mean operating time was 6 hours and 58 minutes for laparoscopy-assisted liver resection and 5 hours and 27 minutes for pure laparoscopy liver resection ; the mean blood loss was 765 and 390 mL, respectively. Postoperative complications occurred in two patients : bile duct leakage and liver failure in one patient and pneumonia in the other. Conclusion : Once the technical procedures for laparoscopic hepatectomy are learned, laparoscopic liver resection may be applicable to hepatic tumors.

View full abstract

Objective : The present study aimed to clarify the current state of disabilities and lifestyle of junior and senior high school students (12-17 years old) attending special-needs schools for the physically disabled, and to investigate related issues. Subjects and Methods : A questionnaire survey was conducted on the parents, school nurses and homeroom teachers of junior and senior high school students attending four special-needs schools for the physically disabled in A Prefecture. Results were analyzed using simple tabulation. Results : Among the 104 respondents, cranial nerve disorders were the most commonly reported causative condition (76.9%), while 49.0% and 85.6% reported the presence of students who were bedridden and following a non-standard curriculum, respectively. Furthermore, 76.9% reported students with myotonic disorders, 73.1% had scoliosis and 62.5% had a body mass index below the 5^th percentile. The findings indicated the importance of nutritional management, relieving factors that may exacerbate myotonia, and preventing scoliosis progression in order to improve the quality of life of these students after puberty. Three lifestyle-related issues were also identified. The first lifestyle-related issue was ‘a long school day spent mainly in the same posture’, which promotes myotonia exacerbation and scoliosis progression. The second issue comprised ‘insufficient snacks’. The third issue was ‘minimal use of social services. Conclusion : Compensatory strategies such as reducing the capacity of the school bus and shortening the commuting time are required. Then, it is important to plan for the nutritional management including the provision of snacks in addition to three main daily meals. Moreover, it is important to accustom children and their families to using social services from school age to ensure that they receive sufficient lifestyle support post-graduation.

View full abstract

Background and Aims : The purpose of the present study was to compare the activity of the frontal lobe when performing tasks at two paces by functional near-infrared spectroscopy (fNIRS). Methods : Fifty healthy students from A University participated in the study. Oxygenated hemoglobin (oxy-Hb) concentrations (Δ[oxy-Hb]) were monitored during 30s finger-tapping with the non-dominant hand. There were two paces for finger-tapping : one pace the subject decided by themselves and the other pace given by metronome. The subjects answered a questionnaire after fNIRS measurement. Results : Performing tasks at Preferred Pace (PP) activates the frontal lobe of the orbito-frontal cortex area, and it tends to induce a feeling of difficulty, especially in females. Conclusions : Performing repetitive tasks at PP activates the frontal lobe. This finding will enable occupational therapists to select the subject's optimal pace according to the degree of attentional dysfunction.

View full abstract

Objective : The present study analyzed and investigated issues and coping techniques among novice surgical nurses in order to obtain data regarding measures for preventing early job resignation. Subjects and Methods : Qualitative induction analysis was conducted on data from interviews with 13 surgical nurses[Consider clarifying the career stage of the subjects.]. Results : The following seven categories of issues were identified : ‘retaining large amounts of information’, ‘coping with unfamiliar tasks’, ‘lack of knowledge and experience’, ‘fatigue due to operating room working conditions’, ‘workplace relationships’, ‘dealing with patients’, and ‘tasks with no room for error’. The five categories of coping strategies comprised ‘talking to someone’, ‘perceiving issues in a positive light’, ‘physical refreshment’, ‘acquiring knowledge through study’, and ‘interacting with colleagues while considering how to treat them’. Conclusion : In order to support prevention of early job resignation of novice surgical nurses, opportunities for nurses to express their feelings and acquire knowledge and skills should be created, while raising awareness[Consider clarifying whose awareness needs to be raised. For example, "among nursing students".] regarding the expertise of surgical nurses is also important.

View full abstract

We describe a patient with biphenotypic acute leukemia (BAL) with T-lymphoid lineage and myeloid lineage differentiation [BAL (T/M)]. Cytogenetic analysis revealed complex chromosomal abnormalities, including der(2)t(2 ; 11)(p21 ; q23). Neither leukemia cells nor T-cell receptor gene rearrangements were detected in the bone marrow samples after four courses of high dose cytosine arabinoside regimen. However, der(2)t(2 ; 11)(p21 ; q23) anomaly persisted in most of metaphases. Fluorescence in situ hybridization (FISH) analysis with a probe for MLL did not detect the split signal. Forty-five cases of hematological disorder with t(2 ; 11)(p21 ; q23) abnormality have been previously reported. The majority of such cases have been classified as myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). This is the first case BAL (T/M) associated with a t(2 ; 11)(p21 ; q23) anomaly.

View full abstract

A 72-year-old male underwent a distal gastrectomy (pT2, N0, H0, P0, M0, pStage IB) for gastric cancer in 2004. Gastrointestinal endoscopy indicated early gastric cancer in the remnant stomach in August 2005, and he underwent endoscopic submucosal dissection. In January 2006, computed tomography showed a metastasis in the liver S4 segment. He was treated with S-1 and radiofrequency ablation (RFA). Subsequently, there was a liver recurrence. We administered various chemotherapies, transarterial infusion chemotherapy, RFA, and partial hepatic resection. This achieved survival for 4 years and 11 months after the liver metastasis.

View full abstract

The patient was a 54-year-old man diagnosed with nonresectable ascending colon cancer and multiple liver metastases in August 2010, so we started treating him with chemotherapy on bevacizumab+XELOX. After the third chemotherapy cycle, he developed acute epigastric pain and tenderness with muscular guarding. A computed tomography scan showed a significant amount of free air in the abdomen, and fluid accumulation around the hepatoduodenal ligament. Under the diagnosis of generalized peritonitis due to a digestive tract perforation, an emergency operation was performed. Intraoperatively, contaminated ascites had accumulated, and a 2 mm in diameter orifice was found in the anterior duodenal bulb. We performed a peritoneal lavage, closure of the perforated lesions in the duodenum, and an omental implantation repair. When a patient undergoing chemotherapy with bevacizumab develops acute abdominal pain, attention should be paid to a major complication such as a digestive tract perforation.

View full abstract

Published studies report the incidence of pannus formation with the St. Jude Medical^R prosthetic mitral valve to be 0.02%. The following report details a mitral valve malfunction due to pannus formation and thrombosis in a 70-year-old woman which occurred 16 months after the initial operation (SJM^R 27mm) using Dacron-cuff. A second replacement using a mitral valve prosthesis (SJM^R 27mm) using Teflon-cuff was successfully performed and the postperative course was uneventful. The possibility of pannus formation of St. Jude Medical^R aortic valve and its mechanism are discussed in this report.

View full abstract

We herein report a case of useful treatment for removal of a piece of iron from the body by a neodymium magnet in a 62-year-old man. A pressing machine exploded during work, and innumerable pieces of iron scattered within his limbs and trunk. Neither peripheral circulatory failure nor peripheral nerve disorders were present. Computed tomography and X-rays showed no pieces of iron in his internal organs. Although foreign substance removal was immediately attempted under fluoroscopy, the iron was present within the deep muscle layer. To keep the wound as small as possible and prevent further damage, we decided to perform the iron removal with a neodymium magnet. We succeeded in the removal of two pieces of iron from the smaller wound using a neodymium magnet at the tip of an index finger during a clean operation. The foreign substances were able to be removed from the wound, which was about 1 cm in diameter. This minimally invasive removal method was useful because it lessened any adverse cosmetic effects.

View full abstract

A 79-year-old male with a history of syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) was admitted to our hospital. He had limb weakness, right-side-dominant sensory disturbance, and bladder and rectal dysfunction. Magnetic resonance imaging (MRI) indicated the presence of short, discontinuous, and lateralized lesions of varying size at the C3, C4, and C5/6 spinal levels. A blood test was positive for neuromyelitis optica (NMO)-IgG, leading to a diagnosis of NMO spectrum disorder (NMOSD). The patient's symptoms improved slightly after methylprednisolone pulse therapy. NMOSD should be considered even when elderly patients have short, discontinuous, and lateralized spinal cord lesions on MRI.

View full abstract

Background and Objectives : This study aimed to evaluate the level of satisfaction of patients attending Diabetic Counseling Services in A Hospital. Subjects and Methods : The subjects were 24 patients who received Diabetic Counseling Services, and consented to participating in the study. We designed our own questionnaire items based on previous studies, and analyzed the data quantitatively. Results : The highest level of satisfaction was noted for the category of "VI : medical expense", which was followed by the categories of "I : humanity (humanistic aspects of nursing care)" and "IV : physical environment" in that order. There were no marked differences in the mean values for each category. Regarding the relations between the satisfaction levels for categories I through VII and each category, significantly high correlations were found among "II : technical competency (technical aspects of nursing care)", "III : information provision", and "IV : physical environment". Conclusion : The findings revealed that professional expertise, including technical competency and information provision, and the development of an appropriate environment are instrumental in improving the level of patient satisfaction with counseling and care services provided in Diabetic Counseling Services.

View full abstract

The present study aimed to clarify the efficacy and issues of a confirmation system involving video-based self-evaluation regarding nursing students' skill in changing the sheets of bedridden patients. Skill acquisition status, students' ability to deliver accurate self-evaluations consistent with those of their teachers, and students' perceptions of the system were analyzed for 14 first-year students at N University. The system was positively perceived by the majority of students, and comparison of initial and repeat technique implementation after video-based confirmation revealed improved ability in all students. Particular improvements and a certain level of learning effect were observed for aspects of the nursing technique that demonstrated comparatively high degrees of consistency between student self-evaluations and teacher evaluations, specifically ‘creases and slackness’, ‘consideration given to avoiding jolting the patient’, ‘position and balance’, and ‘making corners’. These aspects were also visually easy to perceive. Conversely, little improvement was observed for aspects for which there was low consistency between student and teacher evaluations, specifically ‘observing and talking to patients’ and ‘body mechanics’. Further research is required regarding issues such as efficient confirmation methods and examining teaching materials and methods for more deliberately teaching these important points.

View full abstract