Parkinsonism and intractable hiccup in a patient with relapsing sarcoidosis

We describe a 56-year-old man with relapsing sarcoidosis who presented with persistent hiccup responsive to steroid and clonazepam treatments. The patient also showed parkinsonism. The interval between the initial presentation and current symptoms was about 30 years. Brain MRI demonstrated foci of abnormal signal intensity in the cerebral white matter bilaterally, with decreased signal intensity on T1-weighted imaging and increased signal intensity on T2-weighted, diffusion-weighted, and FLAIR images. Gadolinium-enhanced MRI of the brain showed diffuse linear enhancement throughout the cerebral white matter with a confi guration suggesting perivascular infi ltration. Spinal MRI revealed spotty gadolinium-enhancing lesions from C2 to T3 segments. This case suggests that in some sarcoidosis patients intractable hiccup may be associated with high spinal cord lesions and parkinsonism with frontal white matter lesions.

Evaluation of the First Trial of a White Coat Ceremony as a Ceremony of Passage: A Method for Teaching Professionalism in Undergraduate Medical Education / 医学教育

Purposes: We performed a white coat ceremony for medical students, because there had not been a definite passage ceremony to create the desire to serve and the awareness of being physician. Opinions about the ceremony were with a questionnaire survey. Methods: The ceremony of white coat conferment was performed for the first time for 112 fourth-year medical students on January 11, 2001, just before the start of clinical training. A white coat and an identification badge with photograph were presented to the medical students, who were taking the first step to becoming a physician. A questionnaire survey was performed the next day to evaluate students' feelings. The questionnaire asked about student's 1) sense of responsibility to be engaged in medical practice, 2) feelings of kindness to patient, 3) love for of their school, 4) attachment to the white robe, 5) consciousness of being a professional, 6) sense of mission as a physician, 7) motivation to learn, 8) feelings of seriousness, and 9) desire to live ethically. A listening survey for the school staff and students was also included. Results: Clear improvements in consciousness were recognized in all items of the questionnaire (P>.0001). Approximately 80% of students approved of the ceremony being performed annually from the following year. The ceremony had had no established form, but many people acknowledged its significance. However, some students who did not realize the significance of the ceremony because it was performed in the middle of the semester. Conclusions: Although this was the first experience for us, many students and teaching staff were understanding and responded favorably to this passage ceremony. The ceremony to instill medical professionalism in student doctors will be improved with further efforts and experiences.