Background: Undergraduate education in emergency and critical care medicine (ECCM) has been provided based on aggressology and critical care medicine at Yamaguchi University.
Purpose: To elucidate how knowledge and attitude, which are less obtained at any other department are acquired in bedside learning (BSL) of ECCM.
Subjects: Medical students in the 5^th or 6^th grade participating in BSL [polyclinic (P) or clinical clerkship (CC)] of ECCM between May 2005 and October 2006.
Methods: 1) To investigate the changes of the scores between the pretest and the posttest (2 week later) which contained the same questions, but not the same to the previous group. The questions were chosen from the pooled questions written by teachers. 2) To compare the scores of the pretest between the students participating in BSL in the first semester (Group 1) and them in the second semester (Group 2). 3) To compare the scores of the pretest between the students in the 5^th grade (Group CC) and in the 6^th grade (Group P), who were concurrently participating in BSL. 4) Analyzing the incomprehensible questions to the students in the pretest.
Results: The scores of the posttest were significantly higher than those of the pretest (p<0. 001). There was no difference between in Group 1 and in Group 2. The scores were not different between in Group P and in Group CC. The incomprehensible questions were related primary survey in trauma and treatment for shock.
Conclusions: Contents of BSL in ECCM, such as trauma and shock, are less taught in the other departments. These are essential for undergraduate medical education. The students had acquired the knowledge and attitude concerning about ECCM in BSL.

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An 83-year-old man was admitted to our hospital for investigation of left, lower abdominal pain. On physical examination, the lower left quadrant was tender, but not rigid, and there was no rebound tenderness. Gastrographin-enema examination showed the bird's beak sign in the patient's sigmoid colon. We performed an emergency colonoscopy, which revealed torsion of the sigmoid colon and ulcerated mucosa with signs of ischemic change. Sigmoid detorsion was unsuccessful because of the ischemic mucosa, so we used transanal and transnasal ileus tubes for decompression. Thereafter, the patient's symptoms resolved quickly and his laboratory data improved gradually. A second colonoscopy, done on day 7 after admission, showed improvement of the ischemic lesion. We removed the transanal tube on day 17 after admission and the patient was discharged 10 days later, since when there have been no signs of recurrence. Thus, a transanal ileus tube for colon decompression can be effective in the treatment of volvulus of the sigmoid colon.

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We report a surgical case of primary adenocarcinoma of the duodenal bulb. An 80-year-old woman was found in screening with upper gastrointestinal endoscopy to have type 2 tumor in the duodenal bulb. Pancreatoduodenectomy was performed based on a diagnosis of primary duodenal cancer.
 Curative resection was performed but liver metastasis was detected 9 months after the operation. She received transcatheter arterial embolization followed by combination chemotherapy via intrahepatic arterial infusion. But she died of liver metastasis on 13 month after the operation.
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 A suitable treatment policy of primary duodenal cancer has not been established. We consider that surgical excision with lymph node dissection improve the clinical outcome of patients with primary duodenal cancer. In this case, curative resection was performed but distant metastasis developed after the operation. Our case suggests that adjuvant chemotherapy may be necessary in patients with advanced duodenal cancer.

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We had treated 43 lesions of gastric epithelial tumor using endoscopic mucosal resection (EMR) such as Strip biopsy method or endoscopic mucosal dissection (ESD) method during 8 months from April to November 2004 at Kanmon Medical Center. We experienced three cases of gastric perforation or penetration. However all three cases were successfully treated non-surgically. Careless procedure or blind dissection were thought to be related these complications.

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A 60's male was admitted to our hospital for the surgery to jejunal tumor. He received the right middle and lower lobectomy for the large cell carcinoma of right lung on March, 2003 (T2N1M0, StageIIIA). On January, 2006, he visited a hospital complaining of nausea and vomiting. Abdominal enhanced computed tomography scan suggested the presence of intussusception of the small intestine headed by a tumor in the jejunum and swelling paraaortic and mesenteric lymph nodes.
 Because of his request, he was transferred to our hospital. Surgery to the tumor was performed to repair the intussusception and to diagnose the tumor. Microscopic examination revealed the large cell carcinoma originated from the lung.
 The post operative adjuvant chemotherapy (GEM/CDDP) on the department of respiratory medicine of our hospital was not effective. Because of his request, we didn't administer another anticancer agent.

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