Experiences at the Advanced OSCE Osaka Trial / 医学教育

We participated in the “Advanced Objective Structured Clinical Examination (OSCE) Osaka Trial, ” which was part of the 10th Medical Education Seminar and Workshop in Osaka. OSCEs have been used to assess students' clinical ability before the clinical clerkship program, where the medical interview and the medical examination are introduced as basic clinical skills. The Advanced OSCE is used to assess students' clinical ability after they have done clinical clerkships; it will soon be a part of the national board examination. In the present trial, the students and residents took the Advanced OSCE with 6 themes: pharyngeal pain, palpitations, dyspnea, abdominal pain, hypertension, and cardiac arrest. We examined questionnaires completed by students and residents just after they had taken the Advanced OSCE. We believe that the use of simulators is important for medical students and residents to improve their clinical skills and that appropriate feedback is also extremely important.

Epoprostenol therapy decreases elevated circulating levels of monocyte chemoattractant protein-1 in patients with primary pulmonary hypertension.

BACKGROUND: Primary pulmonary hypertension (PPH) is a rare disease characterized by progressively increased resistance of the pulmonary arteries associated with vascular remodeling. Infiltration of inflammatory cells in affected vessels is a common pathological finding. Monocyte chemoattractant protein-1 (MCP-1) is recognized as a potent chemotactic and activating factor for monocytes and leukocytes, but its significance in PPH is unclear. METHODS AND RESULTS: Serum MCP-1 concentrations were measured in 16 PPH patients and the results were compared with those in 16 normal controls. MCP-1 concentrations in PPH patients (265.6+/-29.5 pg/ml) were significantly elevated compared with those in normal controls (119.6+/-6.9 pg/ml, p<0.0001). In 9 patients (3 men, 6 women; mean age, 29+/-3 years), repeated MCP-1 and hemodynamic measurements were performed prior to and during intravenous epoprostenol therapy. During a mean follow-up period of 7+/-1 months, MCP-1 concentrations were significantly reduced (288.8+/-122.8 to 185.9+/-117.5 pg/ml, p<0.01). CONCLUSIONS: Circulating MCP-1 concentrations are increased in PPH patients, but can alleviated by chronic intravenous epoprostenol therapy. The increase in MCP-1 might be one of the important factors responsible for the disease development in patients with PPH.

Surgical Experience of Leiomyosarcoma of the Inferior Vena Cava. A Case Report of Successful Resection under Extracorporeal Circulation / 日本心臓血管外科学会雑誌

This is a case report of a 40-year-old man with leiomyosarcoma of the inferior vena cava. He had suffered from shortness of breath and edema on lower limbs over several months. Clinical examinations including UCG, CT and MRI revealed the mass in the right atrium. The stalk of mass was located near junction of the right atrium and inferior vena cava by cavography. He was operated upon using extracorporeal circulation. The tumor originated from inferior vena cava, measuring 8.5×5.5×4.8cm in size, 130g in weight, was successfully removed. Partial defect of anterior wall on the inferior vena cava was reconstructed using Gore-Tex patch. Histologically, the tumor was composed of the spindled cells with arranged bundles. Immunohistochemically, they were positive for Dessmin and Vimentin. Seven months after the surgery, he has been followed at OPD. In review of the Japanese literature to our knowledge, only 14 cases were reported including this case.

The curative effects of acupuncture on hypertension / 全日本鍼灸学会雑誌

The efficacy of acupuncture-moxibustion for hypertension is often experienced by many clinicians. Nevertheless the mechanism whereby the therapy improves the symptoms has been scarcely elucidated. Our present study was designed to examine some effects of acupuncture upon the organism, especially upon the renal function which is implicated in hypertension.<br>Experiment I<br>Acupuncture therapy was undertaken four times on a patient with essential hypertension who was given no hypotensive drugs. In each therapy, needles (No. 2, Seirin) were perpendicularly inserted to the depth of 1.5cm at V₂₀ Fengchi, VU₂₁ Weishu, and G₃₆ Zusanli and left there for 15 minutes. The blood samples and urine were collected three times: before the insertion, 15min. and 60min. after withdrawing the needles. At the same time, blood pressure, pulse, and the amount of urine were measured. The amount of Na, K, Cl, kallikrein, catecholamines, etc. was measured in urine. The renin activity and the concentration of aldosterone, catecholamines, and BUN were determined in the blood. Result: a marked increase was seen in the excretion of urine, Na, and Cl. An upward tendency of kallikrein excretion which is correlated with urine volume, and a downward tendency of renin in the blood were found. Blood pressure and pulse showed a slight tendency to decline. However, neither catecholamines in the blood, nor K in urine changed significantly.<br>Experiment II<br>Subjects were two healthy adult men. Urine was collected once an hour for twenty-five times by means of a balloon inserted in the bladder. Immediately after the twenty-first collection, acupuncture stimulation was given to VU₂₁ Weishu in the same manner as Exp. I. With the same measurements and determinations undertaken, a marked increase of urine, Na, and Cl excretion was observed 15min. after withdrawing the needle.<br>Experiment III<br>Subjects were three healthy adult men. Urine was collected for two days. The amount of urine and the electrolyte content were calculated on a per hour basis. Without having breakfast after rising, the subjects were given a transfusion of glucose-electrolyte solution, equivalent to the calculated urinary output, every hour for four hours. The VU₂₁ Weishu was stimulated in the same manner two hours after the onset of the first transfusion. Result: a marked increase was seen in the excretion of urine, Na, and Cl.<br>Conclusion<br>It can be seen from the above that acupuncture stimulation to the VU₂₁ Weishu facilitates the selective excretion of Na and Cl in the urinary tubule.