The Factors Associated with Chill Syndrome Using Terasawa's ki, ketsu and sui (qi, blood and fluid) Diagnostic Score / 日本東洋医学雑誌

To determine the physical symptoms and ki, ketsu and sui (qi, blood and fluid) factors associated with the presence of hie-sho (chill syndrome). Total 118 healthy university students (66 males and 52 females, median age 22 years, range 21­-29) were enrolled. A cross-­sectional study about the presence of chill syndrome in par­ticipants was performed. Terasawa's ki, ketsu and sui diagnostic score was used to identify the presence of physical symptoms. Number rating scale (NRS) was used to classify the chill and NRS more than 5 was de­fined as chill syndrome based on Furuya's report. Eighteen students (4 males and 14 females) were docu­mented as chill syndrome. The multivariate analysis of physical symptoms identified female (OR 4.65, p = 0.0427), heavy sensation of head (OR 2.98, p = 0.0190) and chill of extremities (OR 1.94, p = 0.0480) as sig­nificantly associated factors with chill syndrome. The score of ki-kyo (qi deficiency), ketsu-kyo (blood defi­ciency) and suitai (fluid retention) showed higher score in students with chill syndrome compared to students without chill syndrome in univariate analysis. Being female and two indicators of qi abnormalities including heavy sensation of head and chill of extremities were associated with the presence of chill syndrome in univer­sity students.

Difficulty in Diagnosing a Case of Severe Headache Caused by Lung Cancer Metastasis to Base of Skull Due to Lack of Imaging Evidence

<p>Introduction: We report a case of severe headache caused by lung cancer metastasis to the base of the skull that was difficult to diagnose due to a lack of imaging evidence. Case: A 70-year-old man diagnosed with advanced lung cancer experienced sudden, severe headache. He was diagnosed as having a tension-type headache because magnetic resonance imaging of his head failed to detect any pathology. He was prescribed various drugs, which except for strong opioids failed to treat his headache. He referred to our palliative care unit to treat the pain. Re-evaluation of his head CT revealed metastasis to the clivas. His pain was treated with rapid titration of subcutaneous oxycodone injection. Conclusion: Even if radiographic investigations fail to identify the metastasis, the patient should be re-evaluated if the headache worsens and/or is accompanied with cranial nerve dysfunction.</p>

Opioid switching to oxycodone injection using simple conversion ratio

<b>Purpose:</b> The simple conversion ratio of 1：1：1/50 between oxycodone injection (OXJ), morphine injection and fentanyl injection is used at Saga－Ken Medical Centre Koseikan. However, there are no studies on the validity of the simple conversion ratio. <b>Methods:</b> A total of 18 patients with opioid switching to OXJ using the simple conversion ratio were reviewed in this investigation. We surveyed the change in the numeric rating scale (NRS) and adverse effects before and after opioid switching. <b>Result:</b> The average period needed to reach a stable dose of OXJ was 0.6 days. The reasons of opioid switching to OXJ were the uncontrolled cancer pain in 11 patients, the impossibility of oral administration in 6 patients, the drowsiness in 1 patient. The average NRS decreased from 3.3 to 1.1 in 11 patients with uncontrolled cancer pain <i>(p＝0.007)</i>. No obvious change in the NRS was observed in 6 patients with the impossibility of oral administration. In 18 patients, there was no significant difference in adverse effects before and after opioid switching. <b>Conclusion:</b> These results indicate that the simple conversion ratio could be safety for opioid switching between OXJ and other opioid in cancer pain treatment.

Introduction of curriculum evaluation by students / 医学教育

The curriculum evaluation by students was introduced into the two-weeks clinical curriculum of fifth years students at Saga Medical School, Department of Anesthesiology. The evaluation form is consisted of forty questions with the eleven figures from -5 to +5. These questionaries were divided into seven parts and covered instructors' evaluation and the minute course evaluation. This evaluation was done anonymously at the end of the two-weeks clinical course in Anesthesiology.<BR>The analysis was done as follows: 1) divided up into the positive group, the neutral group and the negative group; 2) difined the positive rate, the negative rate and the effective rate; 3) presented these rates visually.<BR>The result runs as follows: 1) the effective rate is proportional to the interaction between instructors and students; 2) a quick feedback can be done on instructors.<BR>Finally, the important thing for medical education is not only curriculum but the interaction between instructors and students. In this sense, this trial in Saga Medical School is significant for medical education.