Guidelines for treatment of ulcerative colitis in children

This paper introduces the guidelines for treatment of ulcerative colitis in children, created by the working group of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition (Chair: Yuichiro Yamashiro) and the Japanese Society for Pediatric Inflammatory Bowel Disease (IBD) (Chair: Akio Kobayashi). The ideas of the working group, with regard to the fundamental differences in medical treatment between children and adults, included: (1) for children, intensive medical treatment including appropriate systemic management is important during the acute phase of illness. (2) Treatment with steroids, which can cause growth disturbances, should not be continued for long periods of time. (3) Pulsed steroid therapy, selective removal of blood cells, and intravenous infusion of cyclosporin should be included in the therapeutic option for severe and fluminant cases.     

Propofol anesthesia for ambulatory surgery in adults

We reported 131 cases of ambulatory surgery in adults mainly anaesthetized with propofol infusion. Without any premedication, anesthesia was induced with propofol and fentanyl. A laryngeal mask airway was inserted using intravenous injection of vecuronium. Anesthesia was maintained with continuous infusion of propofol and intermittent fentanyl administrations, and local anesthetic infiltration was combined. All patients received air and oxygen mixture (FIO2 0.4) throughout the procedure. During surgery, metoclopramide and flurbiprofen axetil were given to prevent postoperative pain, nausea and vomiting. After surgery, patients were observed at the daycare unit in ward. Average age was 42 years and ASA risk was 1.3. Operation time and anesthesia time and hospital stay were 43.4 minutes, 70.6 minutes and 332 minutes, respectively. In 25 patients (19%) analgesics were needed for postoperative pain. Although 3 patients (2.3%) were unsuccessful as ambulatory surgery due to excessive pain, all patients including these three could be discharged within 24 hours after surgery. We conclude that combined anesthesia with propofol, fentanyl and local anesthetic is suitable for ambulatory surgery in adults.     

Patent blue-induced false-methemoglobinemia

We experienced an anesthetic case, in which interference in oxygen saturation values by patent blue was mistaken for nitroglycerin-induced methemoglobinemia. A 40-year-old woman underwent mastectomy for breast cancer under general anesthesia. Nitroglycerin was infused to produce hypotensive anesthesia. Patent blue was locally injected around the cancer by a surgeon and surgery was started. A few minutes later, oxygen saturation by finger pulse oximeter suddenly decreased from 100% to 90%. And then, blood gas analysis was performed to confirm this change. The decrease of oxygen saturation and the increase of methemoglobin were also observed in the finding of blood gas analysis. At first, we judged these changes as methemoglobinemia by nitroglycerin infusion. Finally, however, we concluded that all these changes were attributable to the interference by patent blue on oxygen saturation value because we found that there had been some inconsistent findings as methemoglobinemia. The fact seems that nothing happened to the patient during the episode. This case showed us that anesthesiologists should understand the principle of hematological monitors and the meaning of the data obtained by monitors.     

Hypercapnea after minitracheotomy

Minitracheotomy is a useful procedure for the respiratory management of patients with sputum retention observed frequently in chronic lung disease and postoperative respiratory failure. However, we experienced a case of hypercapnea after minitracheotomy. An 83-year-old woman was scheduled for gastrectomy. She had respiratory failure of Hugh-Jones 5 with fibroid lungs and the infection with atypical Mycobacterium and MRSA. Her sputum was adhesive and showed persistent increase during pre- and intra-operative periods. After the operation, minitracheotomy was carried out against the sputum retention by using Portex Mini-Trach II kit. Hypercapnea, however, was observed in spite of no evidence of the surgical complications such as bleeding or inadequate care for sputum from the inserted tube. Bronchofiberscope revealed adhesive sputum stuck to the space between the inserted tube and the trachea. In this case, hypercapnea was improved by opening the top of the inserted tube and frequent care for sputum. In cases with a large amount of adhesive sputum, sputum retention may easily occur not only at the peripheral bronchial branch but also between the inserted tube and the trachea and it can cause hypercapnea which may be overlooked.     

Atypical Shone's Complex Diagnosed at 70 Years Old: Presenting with Double-orifice Mitral Valve,Bicuspid Aortic Valve,and Aortic Coarctation

Atypical Shone''s complex is a rare congenital anomaly involving a left-sided obstructive lesion of two or three cardiovascular levels. A 70-year-old man with dyspnea on exertion was diagnosed with severe aortic stenosis (AS) with a bicuspid valve, complicated by severe aortic coarctation (CoA) and a double-orifice mitral valve. He underwent surgery for AS and CoA in one session. It is important to search for complicated malformations, even in cases of bicuspid aortic valve found in old age.     

Assessment of pharmacy students' communication competence using the Roter Interaction Analysis System during objective structured clinical examinations

Objective

To determine the value of using the Roter Interaction Analysis System during objective structured clinical examinations (OSCEs) to assess pharmacy students'' communication competence.

Methods

As pharmacy students completed a clinical OSCE involving an interview with a simulated patient, 3 experts used a global rating scale to assess students'' overall performance in the interview, and both the student''s and patient''s languages were coded using the Roter Interaction Analysis System (RIAS). The coders recorded the number of utterances (ie, units of spoken language) in each RIAS category. Correlations between the raters'' scores and the number and types of utterances were examined.

Results

There was a significant correlation between students'' global rating scores on the OSCE and the number of utterances in the RIAS socio-emotional category but not the RIAS business category.

Conclusions

The RIAS proved to be a useful tool for assessing the socio-emotional aspect of students'' interview skills.     

Label‐free multiphoton excitation imaging as a promising diagnostic tool for breast cancer

Histopathological diagnosis is the ultimate method of attaining the final diagnosis; however, the observation range is limited to the two‐dimensional plane, and it requires thin slicing of the tissue, which limits diagnostic information. To seek solutions for these problems, we proposed a novel imaging‐based histopathological examination. We used the multiphoton excitation microscopy (MPM) technique to establish a method for visualizing unfixed/unstained human breast tissues. Under near‐infrared ray excitation, fresh human breast tissues emitted fluorescent signals with three major peaks, which enabled visualizing the breast tissue morphology without any fixation or dye staining. Our study using human breast tissue samples from 32 patients indicated that experienced pathologists can estimate normal or cancerous lesions using only these MPM images with a kappa coefficient of 1.0. Moreover, we developed an image classification algorithm with artificial intelligence that enabled us to automatically define cancer cells in small areas with a high sensitivity of ≥0.942. Taken together, label‐free MPM imaging is a promising method for the real‐time automatic diagnosis of breast cancer.     

Acute promyelocytic leukemia: an unusual cause showing prolonged disseminated intravascular coagulation after placental abruption

Background Disseminated intravascular coagulation (DIC) caused by placental abruption usually improves rapidly after prompt delivery and adequate anti-DIC treatment. Case A 30-year-old nulliparous woman suffered from placental abruption at the 25th week of pregnancy, and emergent cesarean section was done immediately. She exhibited DIC, which continued even after termination of the pregnancy and anti-DIC treatment. She also showed neutropenia. We closely observed her, and at the 58th day postpartum, blast cells appeared in the peripheral blood and she was diagnosed with acute promyelocytic leukemia (APL). Induction chemotherapy was done successfully. The close observation after delivery enabled us to make the prompt diagnosis/treatment, leading to the complete remission. Conclusion APL should be added to the list of differential diagnosis when DIC persists even after prompt delivery and appropriate anti-DIC treatment after placental abruption.     

Femur fracture during abdominal breech delivery

BACKGROUND: While vaginal breech delivery, although rare, can cause femur fracture, abdominal breech delivery is not expected to cause it. CASE: A 2,490-g female infant was delivered at term by elective cesarean section for breech presentation. She sustained a fracture of the femur shaft. A simple splinting led to a complete healing of the fracture without sequelae. CONCLUSION: Although abdominal breech delivery reduces the risk of birth trauma, we must be aware that femur fracture can occur regardless of the mode of delivery.     

Über Entwicklung von Granulationsgewebe und von Teercarcinomen bei gespeicherten Tieren

Ohne ZusammenfassungMit 5 Textabbildungen.