Retroperitoneal Hematoma as a Serious Complication of Endovascular Aneurysmal Coiling

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be life-threatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.

Investigation on the reliability of teaching evaluation by medical students / 医学教育

There are some methods of evaluating teaching: student-, self-, peer- and third person-evaluation etc. Validity, reliability and feasibility are required for assessing the quality of teaching. Therefore, we examined the reliability of teaching evaluation by medical students in Nippon Medical School in comparison with peer evaluation.<BR>1) Twenty-four clinical lectures during the same school year were arbitrarily chosen as objectives. Correlations between student- and peer-evaluations in both generalized ratings and global assessment were analyzed by Pearson's correlation coefficient and Spearman's correlation coefficient by rank.<BR>2) In generalized ratings, a significant correlation between the evaluations was demonstrated (r=0.532, p=0.0056), while a marginal correlation between the evaluations was observed in global assessment (p=0.0492).<BR>3) The results probably provide evidence of the reliability of teaching evaluation by medical students.<BR>4) The criteria for evaluation and the validity of questionnaires should be defined for a more reliable teaching evaluation by medical students.