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.

Carotid atherosclerosis and arterial peripheral pulse wave velocity in cerebral thrombosis.

Stiffening and thickening of the arterial walls are two important components of atherosclerosis. A better understanding of the relationship between stiffening and thickening of the large arteries might lead to optimal strategies for the prevention of cerebrovascular disease. However, there have been few investigations of the correlation between carotid artery wall thickening and arterial stiffness. In this study, we investigated the relationship between arterial stiffness (assessed by the ankle-brachial pulse wave velocity) and carotid plaque (detected by high-resolution real-time B-mode ultrasonography) in patients with cerebral thrombosis. The subjects were 109 patients with cerebral thrombosis aged 40-80 years. Fifty-six subjects had carotid plaque (27 had low-grade plaques (plaque score<7.0) and 29 had high-grade plaques (plaque score >or=7.0)) and 53 subjects did not have plaques. High pulse wave velocity was found to be significantly associated with existence of carotid plaque (p<0.001), but was not associated with the severity of the plaque (p=0.14) in multivariate logistic regression models. This study shows that the pulse wave velocity is associated with the existence of carotid atherosclerosis, but not with the severity of carotid atherosclerosis, in patients with cerebral thrombosis.