case of successful treatment with vasopressin for severe acute pancreatitis in a melancholic patient administrated antipsychotic agents

We report a 50-year-old woman with severe acute pancreatitis induced shock, who was successfully treated with vasopressin. She took some antipsychotic agents for depression. Although treatment was started with continuous intravenous dopamine and noradrenaline, hypotension was not controlled. After continuous intravenous vasopressin was initiated, arterial blood pressure [BP] was raised and maintained. Vasopressin was effective to catecholamine-resistant shock in severe acute pancreatitis of the melancholic patient

Effect of removal of subglottic blood during endoscopic sinus surgery

Postoperative pulmonary complications may occur after endoscopic sinus surgery, secondary to leakage of blood into the trachea from the surgical field. We investigated the effects of removal of subglottic fluid, including blood, during endoscopic sinus surgery on the incidence of postoperative hypoxia and high fever. We first retrospectively confirmed whether the incidence of fever >38°C and hypoxia [SpO[2]< 95%] in the first 24 h after endoscopic sinus surgery was higher than that after tympanoplasty [total n=99]. Next, the amount and characteristics of subglottic fluid were prospectively evaluated in the two groups, and the incidences of fever and hypoxia in the first 24 h postoperatively were compared between the two groups [total n=90].Data were analyzed using SPSS for Windows version 11.0 [SPSS Inc., Chicago, IL, USA]. Normally distributed continuous data were analyzed using Student's /-test. Continuous data not normally distributed were analyzed using the Mann-Whitney U-test. Categorical data were analyzed using the x[2] test. Statistical significance was defined as p< 0.05. The retrospective study showed that the incidences of fever and hypoxia were significantly higher after endoscopic sinus surgery than tympanoplasty [fever, p=0.001; hypoxia, p=0.024]. The prospective study showed that the amount of subglottic secretions was significantly higher after endoscopic sinus surgery than tympanoplasty [p=0.006]. The pH values of subglottic and oral fluid were significantly higher after endoscopic sinus surgery than tympanoplasty [subglottic fluid, p=0.04; oral fluid, p<0.001]. However, there were no significant differences between the two groups in the incidence of fever over 38°C and hypoxia in the first 24 h postoperatively. An increase in subglottic fluid, including blood, during endoscopic sinus surgery might cause fever and hypoxia postoperatively. Removal of the fluid is likely an effective technique for preventing pulmonary complications

Successful treatment of severe legionella pneumonia and acute kidney injury with polymyxin B-immobilized fiber column direct hemoperfusion

Legionella pneumonia is often complicated by multiple organ failure. Although acute kidney injury is relatively rare in the context of Legionella pneumonia, it is associated with an increase in mortality rate. This report describes a case of a patient with Legionella pneumonia and acute kidney injury who was successfully treated with polymyxin B-immobilized fiber column direct hemoperfusion [PMX-DHP]. We conclude that PMX-DHP may be a useful therapeutic modality in patients with Legionella infection and acute kidney injury

Report on Undergraduate Clinical Training in Anesthesiology: The Clinical Clerkship Point of View / 医学教育

Since 1993, we have used a clinical clerkship method in an attempt to improve the undergraduate clinical training in our department. At first, the students were given the opportunity to learn adequate basic clinical procedures (levels 1 to 3), but data on the effect of their training were lacking. Therefore, we conducted a survey to obtain the necessary information. Twenty-nine students (29 % of students in the sixth academic year) participated and wrote their survey reports at the end of the course. The reports were designed to evaluate their problem-solving skills and the effects of self-directed learning in clinical anesthesia and to obtain an overall impression of the training. The results revealed that the educational effect was insufficient for almost all students who participated because they were unable to fully solve the problems of anesthetic management from either a pathophysiologic or pathobiochemical standpoint. From these results and our further experiences from 1994 through 1996, we decided to reform our educational procedures. The important improvements are as follows. 1) Trainees must record the anesthesia course during the assigned anesthetic case and participate in the postoperative ward discussion. 2) A member of the teaching staff must discuss ways to manage and solve problems with trainees at the end of each case. 3) After the discussion, trainees must write a report about how and what they have learned.