ガクセイ アンケート チョウサ ニヨル コウギ ヒョウカ ト ソノ モンダイテン

近年,医学教育改革が目まぐるしく行われている.その中で,学生による講義評価が行われはじめているが,まだその報告は少ない.獨協医科大学では学年委員会が主体となって,講義・実習に対するアンケート調査を第1学年から第4学年まで行った.その結果,講義に対して「十分に満足している」という学生は,どの学年においても多くはなかった.さらに,「わかりやすい講義」をしている教員の共通点は,板書・プリント・シラパスを活用しているという点であった.実習に関しては,「基礎医学」に関わる実習に対しての評価が高かった.今後の医学教育において,学生の意見の反映がよりよい講義につながるものと考えられる.Extensive innovations in medical education have been carried out in recent years in our country. Although student evaluations of lectures have been conducted, there have been few reports on this issue. Thus, our committee consisting of representatives of every grade played a leading role in making and evaluating a questionnaire investigation of the lectures and the experiments. The investigation covered students from freshmen to seniors. We found that there were few students in each grade who were satisfied with the lectures. Students gave high marks to lecturers who wrote in detail on the blackboard, distributed well-organized documents, and made practical use of the syllabus. Experiments concerning the preclinical course were also well accepted. We consider that this sort of investigation will be influential in improving the quality of lectures

シュッケツセイ ショウカセイ カイヨウ ニ タイスル アルゴン プラズマ ギョウコホウ ニヨル ナイシキョウテキ シケツジュツ ノ リンショウテキ ケントウ

出血性消化性潰瘍に対する止血法として非接触法であるアルゴンプラズマ凝固法を施行しその有用性と安全性を検討した。出血性潰瘍と診断されアルゴンプラズマ凝固法による止血術がなされた胃潰瘍17例,十二指腸潰瘍6例計23症例を対象とした。静脈性出血である湧出性出血,動脈性出血である拍動性・噴出性出血および活動性出血のない露出性血管症例に対し第一選択として,またはクリッピング術にて止血の得られなかった症例に対しアルゴンプラズマ凝固法を施行した。全体での一次止血率は83%と高率であり,再出血率は21%であった。クリッピング術にて止血困難な症例に対しても75%と有効であった。部位別では内視鏡的に正面視し難い後壁病変でも86%と高い止血率であった。潰瘍出血に対するアルゴンプラズマ凝固法は,手技的に容易で偶発症も認めず安全で有用な止血法と思われた。Background : Endoscopic treatment such as injection therapy and hemoclipping is known to be effective as hemostatic treatment for upper gastrointestinal bleeding. Argon plasma coagulation (APC) is a new modality of electrosurgery to apply high frequency electric current into tissue to cause defined thermal and coagulating effects and may be beneficial for hemostasis of gastrointestinal bleeding. The aim of the present study was to assess prospectively the usefulness of endoscopic APC for peptic ulcer bleeding. Methods Patients with upper GI bleeding manifested by hematemesis or melena were included in this study. APC was carried out with the use of argon source APC 300 and high frequency generator ICC 200 (ERBE, Germany) when active bleeding from an ulcer or a visible vessel in an ulcer bed was found. Results A total of 23 patients with bleeding from peptic ulcer underwent APC. Arterial spurting was found in 5 patients, oozing in 10 and a visible vessel in 8. Initial hemostasis was achieved in 19 of 23 patients (83%). With respect to the type of bleeding, hemostasis success was 4/5 (80%) in patients with spurting, 8/10 (80%) with oozing, and 7/8 (88%) with a visible vessel. In the particular patients in whom endoscopic clipping failed to get hemostasis, hemostasis was achieved in 6/8 (75%). In terms of location, the rate of hemostasis by APC was 8/9 (89%) for lesions located in the body, 4/4 (100%) in the angle, 3/4 (75%) in the antrum, and 4/6 (67%) in the duodenum, with no significant difference. For the posterior lesions where frontal access was hard to obtain, APC resulted in a higher rate of hemostasis (86%). Rebleeding within 10 days was observed in 4/19 (21%) after initial hemostasis. No serious complication was encountered. Conclusions Endoscopic APC for bleeding peptic ulcerations resulted in a higher rate of initial hemostasis with a considerably lower rate of rebleeding. In patients with unsuccessful hemostasis by endoscopic clipping, a high rate of hemostasis was achieved by APC. Thus, APC may provide an effective and safe modality for treatment of bleeding ulcerations

シンキン マデ センツウ シタ イカイヨウ ノ イチ ボウケン レイ

症例は57歳,男性。脳硬塞にて入院中であったが,吐血をきたし内視鏡検査を施行した。胃体上部前壁に活動性潰瘍を認めた。潰瘍底は発赤した隆起を形成し心拍動に一致した動揺が認められた。内視鏡治療は断念し緊急手術の予定であったが,多量の出血をきたし手術に至らず出血性ショックで死亡した。剖検にて胃壁の漿膜から横隔膜を貫き心筋まで穿通した胃潰瘍と診断した。生前には心筋障害を示唆する臨床所見はなく,胃潰瘍の心への穿通は診断困難であった。消化性胃潰瘍の心への穿通は稀であり文献的考察を加え報告する。57-year-old man was admitted to our hospital because of cerebral infarction. After admission, he had hematemesis and underwent endoscopic examination. Gastric ulcer with oozing was noted at the anterior wall of the body. The ulcer bed was reddish and protruding with heart beat. Because of the difficulty of endoscopic hemostasis, we planned to perform urgent surgery for the bleeding ulcer. However, he died from hemorrhagic shock before surgery. At autopsy, penetration of gastric ulcer into the myocardium was found. It was difficult to make accurate diagnosis before death because of the lack of ECG findings to indicate myocardial damage. Herein, a rare case of penetration of gastric ulcer into the heart (pericardium and myocardium) has been reported

カン サイボウガン ニ タイスル ラジオハ ショウシャク リョウホウ ゴ ノ キョクショ サイハツ ヨソク インシ ニ ツイテノ ケントウ

肝細胞癌(HCC)に対する経皮的ラジオ波焼灼療法(RFA)後の局所再発因子について検討した.対象はHCC43例,45結節,平均年齢66.5±10.3歳,男性29例,女性14例であった.病因はHBV4例,HCV38例,原因不明1例.平均腫瘍径は2.2±0.7(1.0～4.5)cm,単発例が14例,多発例が29例であった.RFA単独治療群が20結節,他の内科的治療併用群が25結節.治療後にダイナミックCTを施行し,遺残なしと判定された結節について多変量解析にて局所再発因子を検討した.局所再発率の算出にはKaplan-Meier法を用いた.効果判定のCTは43例45結節中,腎不全合併例2例2結節を除く43結節に施行し,39結節(90.7%)が遺残なしと判定された.遺残が疑われた4例は,他疾患合併などの理由から追加治療は施行されなかった.遺残なし群(39例)の1年,2年,3年の局所再発率は,20.5%,27.5%,27.5%,これらのうち単発例14結節の局所再発率は1,2,3年ともに16.3%であった.39例における多変量解析の結果,年齢,性差,腫瘍径,臨床病期,併用療法の有無,治療前のAFP値はいずれも統計学的には局所再発に寄与せず,治療前のPIVKA-II値のみに統計学的な有意差を認め,HCCの局所再発への関与が示唆された.We have investigated the factors underlying the local recurrence of hepatocellular carcinoma (HCC) after percutaneous radiofrequency ablation (RFA). Forty-five nodules in 43 HCC patients, consisting of 29 men and 14 women with a mean age of 66.5±10.3 years, were studied. The cause of HCC was HBV in 4 patients, HCV in 40, and cryptogenic in 1. The mean tumor diameter was 2.2±0.7cm (1.0-4.5). Fourteen patients had single HCC nodule and 29 patients had multiple HCC nodules. Two treatment groups were set up: the RFA alone group of 20 nodules and the combined group of 25 nodules that were treated with another medical therapy together with RFA. After treatment, all nodules were evaluated by dynamic CT, and those judged as having "no residual tumor" were examined for local recurrence factors using multivariate analysis. The recurrence rate was calculated by the Kaplan-Meier method. CT for outcome assessment, carried out in 43 nodules in 41 patients excluding 2 patients (2 nodules) with renal failure revealed that 39 nodules (90.7%) had no residual tumor. The 4 nodules, suspected of having a residual tumor, were not additionally treated because of the presence of complications. The local recurrence rates at 1, 2 and 3 years after treatment in the "no residual tumor" group (n=39) were 20.5, 27.5 and 27.5%, respectively. The multivariate analysis revealed that neither of age, sex, tumor diameter, clinical stage, combined therapy, nor AFP value statistically contributed to local recurrence. Only PIVKA-II value was a statistically independent factor for local recurrence of HCC. In conclusion, detailed examination with dynamic CT appears necessary for the assessment of RFA treatment for HCC. PIVKA-II value is likely the most important factor to predict the local recurrence of HCC after RFA