Ectopic Varices Rupture in the Gastroduodenal Anastomosis Successfully Treated with N-butyl-2-cyanoacrylate Injection

The term &#34;ectopic varices&#34; is used to describe dilated portosystemic collateral veins in unusual locations other than the gastroesophageal region. We recently experienced a rare case of ectopic varices that developed in the gastroduodenal anastomosis after subtotal gastrectomy. A 70-year-old male with liver cirrhosis due to hepatitis C virus infection was admitted for hematemesis and tarry stool. He had received a subtotal gastrectomy with the Billroth-I method for gastric ulcer at 46 years of age. Although emergency endoscopy revealed esophageal and gastric fundal varices, there were no obvious bleeding points. After removal of the coagula, ectopic varices and a fibrin plug were observed on the gastroduodenal anastomosis. During the observation, blood began to spurt from the fibrin plug. N-butyl-2-cyanoacrylate with lipiodol injection succeeded in hemostasis. Splenic angiography showed gastric varices feeding from a short gastric vein and the posterior gastric vein. The blood flow around the bleeding point, as indicated by lipiodol deposition, had decreased, and no feeding vein was observed. Endoscopic and angiographic findings are shown and the treatment for such lesions is discussed.</p

Effects of students introduced “Operating Room Visits Observation item List” in a Nursing Practicum

周手術期看護を体験的に理解することを目標にした成人看護学実習に「手術室見学実習観察項目表」（以下観察項目表とする）を導入して３年になる．この観察項目表は，手術室見学実習時の見学の視点を明確にするために，実習指導に携わる看護師（以下指導者とする）と共同作成したもので，体位固定方法など手術室看護に特有な学習視点としてあげた２６項目からなる見学視点ガイドである．学生から研究への使用に同意が得られた観察項目表（学生用）は，２００８年は６２名（回収率：９１％），２００９年は５２名（８４％），２０１０年は５６名（９５％）であった．指導者から研究への使用に同意が得られた観察項目表（指導者用）は２００８年は４３名（６３％），２００９年は３５名（５６％），２０１０年は５８名（９８％）であった．これらを分析した結果，２６項目のうち，３年間を通して，学生は１７項目を８０％以上見学できたと答えた．２００８年と２０１０年では［ドレーン挿入］と［出血量の確認］，２００９年と２０１０年では［全身麻酔の導入］と［硬膜外カテーテルの挿入介助］を見学できたと答えた学生の割合が有意に上昇していた（P＜０．０５）．また，指導者が説明できたと回答した割合が有意に高くなっていた項目は，２００８年と２０１０年では９項目，２００９年と２０１０年では１９項目であった．今回の結果から学生が見学できていた項目の割合は３年間で差がない項目がほとんどであったが，指導者が指導できたとする項目は増加していた．また２００９年以降観察項目表の導入の効果について５段階評価で確認したところ，約９０％の学生が役立ったと回答した．以上のことから，手術室見学実習において，見学する視点を明確にするために「手術室見学実習観察項目表」を導入することは，学生と指導者の双方にとって，手術室見学実習を行う上で見学や指導を行う視点が明確になるため，効果的なツールであるといえる．今後は手術室看護師に分析結果のフィードバックを行い，学生が学習する機会の少ない項目については，ビデオ等の教材などを臨床とともに開発する必要があると考える．This study aimed to clarify the effects of Students Introduced “Operating room visits observation item list” in a Nursing Practicum for three years. As a result of having analyzed these, among ２６ items, there was not the thing which was more than ８０％ in the item where we answered that both of a student and the nurse came by a visit / explanation through three years. However, we answered it that the student was able to observe １７ items more than ８０％. It rose significantly［the drain insertion］and［amount of bleeding］in ２００８ and ２０１０, ［induction of general anesthesia］ and［assistance of epidural catheter by confirmation］ in ２００９ and ２０１０. In addition, the item where a ratio rose was１９items about the explanation of the operating room nurse significantly by nine items, ２００９ and ２０１０ by ２００８ and ２０１０. The ratio of the item which was able to observe the student from this result was three years, and items without a difference were often found, but the items which did it when we was able to teach a nurse increased. When we confirmed the effects of students introduced “Operating room visits observation item list” by ５-point scale, about ９０％ of students answered that the list was useful. It is an effective tool to introduce “an operating room visit observation item list” to make a viewpoint to observe in operating room visits in a nursing practicum both students and leaders. The study findings suggested that we fed back the analysis, and the necessity of we got a clinical cooperation, and developing the educational materials such as videos was suggested in future about few items of the opportunity when a student learned it by an operating room nurse

Review Article : Feudalism or Absolute Monarchism?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68809/2/10.1177_009770049001600304.pd

Effect of Different Dosages of ST36 Indirect Moxibustion on the Skin Temperature of the Lower Legs and Feet

Background: Indirect moxibustion (IM) has been previously performed between the spinous process while recording skin temperature of the trunk. However, moxibustion is often applied not only to acupuncture points on the back, but also to points located on the limbs. Thus, there is a need to investigate skin temperature (ST) responses following IM applied to the limbs. Methods: In Experiment 1 (Exp 1), subjects were randomly assigned to three groups: the left IM stimulation, right IM stimulation and control groups. In Experiment 2 (Exp 2), the subjects underwent two experimental sessions consisting of a single stimulation of IM or triple stimulations of IM. The IM stimulation was administered to the ST36 acupuncture point. A thermograph was used to obtain the ST on the lower limbs. Results: In Exp 1, the ST of the lower limbs increased in the stimulation groups whereas there was no increase in the non-stimulation group. In Exp 2, no significant response occurred between the single and triple stimulation of IM groups for all observed sites except for the left ankle ST. Conclusions: Lower limb ST increased following IM application to the ST36 point. No difference was observed between the dosage of the stimulation and ST responses