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.

Comparison of Fourth-year Comprehensive Examinations and Computer-based Testing in the Nationwide Medical and Dental Student Evaluation System / 医学教育

To demonstrate the quality assurance of comprehensive examinations for fourth-year students at Nippon Medical School, scores on comprehensive examinations were compared with those on a trial of computer-based testing (CBT) of a nationwide medical and dental student evaluation system in 2003. Pearson's correlation coefficients between scores of two comprehensive examinations and the CBT score were 0.45 and 0.67, and the correlation coefficient between the average score of the two comprehensive examinations and the CBT score was 0.55. Fourth-year comprehensive examinations are useful tools for summative evaluation and prediction of CBT performance.

A Comparative Study of Undergraduate Examinations to Evaluate Medical Students' Performance and the National Examination for Medical Practitioners / 医学教育

To demonstrate the quality assurance of the comprehensive examination of sixth-year students at Nippon Medical School, 4 undergraduate examinations were compared with the national examination for medical practitioners (NEMP) using scatter graphs and Pearson's correlation coefficient. Of the 93 sixth-year students at Nippon Medical School, 57%(n=53) reported their scores on the NEMP in response to a request from the Academic Quality and Development Office. Correlation coefficients of the grade point average (years 1 to 5), average scores on graduation examinations of 24 subjects, scores on the trial examination of NEMP, and scores on the sixth-year comprehensive examination with overall scores on the NEMP were 0.62, 0.46, 0.68, and 0.63, respectively. These results suggest that the sixth-year comprehensive examination is more suitable than are graduation examinations for predicting the NEMP score.