Evaluation by Students of Bedside Learning in the Department of Pediatric Surgery / 医学教育

We evaluated bedside learning in the department of pediatric surgery by conducting a questionnaire survey of senior medical students at Chiba University School of Medicine. We obtained responses from 70 of 95 students (74%). Although 84% of students responded by making lists of patients' problems. Many students indicated insufficient knowledge about diseases and insufficient technical skills for medical treatment as the reasons they could not solve these problems. This finding indicates that students do not have sufficient basic knowledge and clinical skills for bedside learning. These skills must be acquired and evaluated before bedside learning can be started.

Clinical Experience in Hyperbaric Oxygenation for Paralytic Lower Extremities after Abdominal Aortic Surgery / 日本心臓血管外科学会雑誌

Three patients, who received infrarenal aorto-iliac bifurcation grafts, complained of flaccid and insensible feeling on lower extremities immediatedly after surgery. These symptoms were supposed due, in two cases, to spinal cord ischemia or, in remaining one case, to ischemic change of the peripheral nerve, In former cases, spinal cord hypoxia might be caused by interrupted blood supply through spinal artery as it was intercepted temporarily but for about three and a half hours during surgical procedures. In the latter case, cramping of the left iliac artery lasted for five and a half hours, which might result in anoxic damage of the peripheral nerve. Hyperbaric oxygenation (HBO) at two atmospheric absolute (ATA) pressure for 75min and 3 ATA for 90min were repeated everyday for them. In all cases, almost complete sensorimotor recovery was obtained after 15 to 30 instances of HBO, which was combined with physical therapy. HBO seemed to have improved early hypoxic and edematous damages of the spinal cord or peripheral nerve. As an unfavorable complication of abdominal aortic surgery, incidence of sensorimotor disturbance of the extremities is infrequent and/or unpredictable, however, once it occurs, no effective therapeutic maneuvers were developed yet. Through these clinical data, HBO should be introduced more actively for such disorders. One of the key issues to enhance the effect of HBO is that, HBO should be introduced as soon as possible once postoperative nuerologic disorders were diagnosed.