Interpretation of Knee Anterior Pain in Handball Players Focusing on the Infrapatellar Fat Pad / 日本農村医学会雑誌

The infrapatellar fat pad is functionally deformed with joint movement and is involved in adjusting the internal pressure of the knee joint. On the other hand, it can also become a source of anterior knee pain due to inflammation and degeneration. A young female handball player experienced anterior knee pain. No obvious abnormality was observed on basic X-ray and magnetic resonance images. Dynamic observation using ultrasonic diagnostic imaging showed poor kinetics with infiltration of the infrapatellar fat pad into the patellar ligament and the tibial condyle, with the knee joint in extension on the affected side compared with the normal side. Knee joint range of movement (affected side vs. normal side) was restricted to 140° p / 150° flexion and extension - 10° p / 5°, and there was infrapatellar tenderness in the affected region. Patella baja was confirmed compared with the normal side. In addition, the flexibility of the infrapatellar fat pad was reduced. From these findings, it was inferred that the cause of pain was restriction of knee joint extension due to reduced flexibility of the infrapatellar fat pad. Treatment of the infrapatellar fat pad, joint range training exercises, and muscle strengthening training exercises were carried out. Pain and restricted range of joint movements improved and the patient could returned to competitive sports.

The Surveillance for Contents of Pharmacogenomics Information in Package Inserts and Interview Forms / 医薬品情報学

<b>Objective: </b>Pharmacogenomics (PGx) is the study of the relationship between the efficacy and/or safety of drugs and the genetic polymorphism.  Since PGx information can be used to personalize medical treatments, there has been a recent increase in the development of drug and companion diagnostic devices based on genome-wide analyses.  Therefore, we surveyed the contents of PGx information in package inserts and interview forms (IF) of Japanese pharmaceuticals, and investigated potential problems with the PGx information supplied by Japanese pharmaceuticals.<br><b>Methods: </b>PGx information content in package inserts and the IF used by Japanese pharmaceuticals was compared with that listed in the U.S. pharmaceuticals “Table of Pharmacogenomic Biomarkers in Drug Labeling.”<br><b>Results: </b>There were 166 PGx information content listings for 137 drugs described in the “Table of Pharmacogenomic Biomarkers in Drug Labeling.”  However, there were 31 PGx information content listings for 20 biomarkers of 24 drugs that were described in the U.S. but not the Japanese package inserts.  In addition, there was no PGx information for 17 biomarkers of 20 drugs in both the Japanese package inserts and the IF.  We additionally found that 57.7% of the biomarkers with PGx information listed in the package inserts were for drugs that are normally covered by <i>in vitro </i>diagnostic medical insurance.  These biomarkers were mainly the gene mutations and expression of the target molecules.<br><b>Conclusions: </b>The Japanese PGx information associated with gene mutations and expression of the target molecules was similar to the U.S. PGx information.  However, the contents of the PGx information for drug-metabolizing enzymes differed widely among each of the drugs.  In order to more effectively use PGx information, a more careful inspection of the information regarding efficacies and side effects will need to be undertaken to ensure better evaluations of patient therapies.

The Role of On-Call Duty at the Tenri Hospital Emergency Department in Clinical Training in a General Outpatient Setting / 医学教育

Objective: To investigate the role of postgraduate clinical training at the emergency department of Tenri Hospital in teaching the diagnostic process in the general outpatient department.<BR>Method: Patients seen by 11 first-year residents at the emergency department were consecutively registered with summary sheets. Further information was added, and an analysis was performed of: 1) the distribution of chief complaints in the emergency and general outpatient departments and 2) initial diagnoses and the diagnostic process in the emergency department and the final diagnoses.<BR>Results: The distributions of chief complaints in 89 cases in the emergency department and in 183 cases in the general outpatient department were closely correlated (p=0.0016). Diagnoses in the emergency department were correct in 58% of cases. Treatment was incorrect in 3% of cases.<BR>Conclusion: The distributions of chief complaints in the emergency and general outpatient departments were similar. In our hospital the emergency department plays a major role in postgraduate clinical training by teaching the diagnostic process for the general outpatient department. Clinical management, including decision making for further tests and consultation, in the emergency department by first year residents did lead to any major adverse events.