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

Fasting insulin and risk of cerebral infarction in a Japanese general population: The Jichi Medical School Cohort Study

Objective: We investigated the relation between fasting insulin (FI) and risk of cerebral infarction in a Japanese general population. Methods: The subjects were 2,610 men and women without past history of stroke or myocardial infarction and under treatment for diabetes, examined between 1992 and 1995 as part of the Jichi Medical School Cohort Study. The FI level was measured once at the baseline. Subjects were divided into quintiles by FI levels, and Cox’s proportional hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cerebral infarction. Results: During an average of 11.1 years of follow-up, 87 participants developed cerebral infarction. Crude incidence rates of FI quintiles 1-5 were 4.69, 2.35, 1.85, 2.77 and 3.30 per 1,000 person-years, respectively. The multivariate-adjusted HRs for cerebral infarction were 2.33 (95% CI, 1.10 – 4.96) in quintile 1 (Q1), 1.25 (95% CI, 0.55 – 2.84) in Q2, 1.68 (95% CI, 0.76 – 3.70) in Q4 and 2.06 (95% CI, 0.94 – 4.47) in Q5, using Q3 as the reference. Conclusions: The lowest FI level was associated with increased risk of cerebral infarction and the association between FI and risk of cerebral infarction appeared to be a U-shaped relationship.

The feasibility of an animal laboratory for teaching surgical techniques to medical students: Teaching in a non-clinical environment / 医学教育

There is a need for suitable non-clinical teaching models in undergraduate medical education.This study was undertaken to demonstrate the feasibility of using an animal model to teach surgical skills to medical students.Two gastrotomies were created in each pig, and then closed using stapled and hand-sewn techniques.Animals were sacrificed seven days later and the closures examined grossly and histologically.<BR>1) Medical students, as surgeons with minimal experience, are able to significantly reduce the time needed to perform closure of a gastrotomy in a porcine model using surgical staplers compared to a hand-sewn closure.<BR>2) Medical students can perform advanced abdominal surgery techniques with adequate instruction resulting in excellent surgical outcomes in a porcine model.<BR>3) The porcine model is a valuable tool to teach animal ethics as well as basic surgical techniques in the non-clinical environment and may help to increase interest among students in a surgical career.