An Attempt to Analyze the Transformation in the Concept of the Environment during Class Practice for a Childcare Contents “Environment”

　“Environmentˮ has special meanings in early childhood education and care in Japan. The present study, we identified characteristic that is a problem faced by students in understanding the concept of the environment in a class on child care in the context of the “environmentˮ in a training school for child care providers. Specifically, this study used a sentence completion test to detect the transformation in the concept of environment in the students. These data were quantitatively analyzed using text mining. In addition, we examined the transformation in the environmental concept qualitatively. As a result, the tendency to use the captured environment as a method was seen, and some characteristics became clear. Based on these findings, we considered it necessary for class improvement to be expedited

Pure Choriocarcinoma of the Ovary in Silver-Russell Syndrome

Pure ovarian choriocarcinoma is an extremely rare malignancy that can be gestational or non-gestational in origin. Silver-Russell syndrome (SRS) is a rare congenital developmental disorder characterized by pre- and postnatal growth failure, relative macrocephaly, a triangular face, hemihypotrophy, and fifth-finger clinodactyly. We report a rare case of pure ovarian choriocarcinoma occurring in a 19-year-old woman with SRS. Following surgery, multiple chemotherapy courses were effective and she was free of disease at the 10-month follow-up

Thymoma-associated Graft-versus-Host Disease-like Erythroderma

We report a 40-year-old woman with recurrent thymoma associated with myasthenia gravis, in whom an unusual form of erythroderma developed. A histological examination revealed a graft-versus-host disease (GVHD)-like reaction. After high-dose steroid therapy, the metastatic thymoma lesion in the abdominal cavity was reduced in size from 9.5 × 6 × 7.5 cm to 4 × 3 × 1 cm in diameter. Nevertheless, the GVHD-like erythroderma become aggravated, her condition worsened, and the patient finally suffered from respiratory failure and died of sepsis. A GVHD-like reaction may be a rare presentation of thymoma-associated immunological disorders such as myasthenia gravis or pure red cell aplasia. Herein, we discuss the present case and review pertinent reports of thymoma cases associated with GVHD

Reexpansion Pulmonary Edema after Drainage of a Spontaneous Pneumothorax

Abstract: We report a case of life-threatening reexpansion pulmonary edema following chest tube drainage of spontaneous pneumothorax. Reviewing the literature, pathophysiology, symptoms and therapy of this complication were discussed. Physicians must be aware of the occurrence of reexpansion pulmonary edema following reinflation of the collapsed lung

Left Atrial Spontaneous Echo Contrast in Hypertrophic Cardiomyopathy with Atrial Fibrillation

Transesophageal echocardiography was performed to assess the incidence of left atrial spontaneous echo contrast in patients with hypertrophic cardiomyopathy, who were divided into two groups according to the presence (group 1-A; 10 patients) or absence (group 1-B; 5 patients) of persistent atrial fibrillation. Twelve patients with atrial fibrillation (group 2) served as control. Among these, 5 patients had mitral regurgitation and 8 patients lone atrial fibrillation. Left atrial spontaneous echo contrast was detected in 8 patients (80%) in group 1-A, none in group 1-B, and 3 patients (25%) in group 2. The incidence of echo contrast in group 1-A was significantly higher than that in the other 2 groups. The size of the left atrium was not statistically different among the 3 groups. Accordingly, hypertrophic cardiomyopathy with atrial fibrillation seemed to be a specific diseased state to favor the development of the left atrial spontaneous echo contrast. Previous reports suggested that the presence of left atrial spontaneous contrast was considered as a warning sign of left atrial thrombus and would be an indicator of increased risk of embolism. 1)2)3) Three of the 8 patients who had spontaneous echo contrast in group 1-A had a history of systemic embolization. We proposed that patients with hypertrophic cardiomyopathy with atrial fibrillation were in a high risk state of thromboembolism

Pocket Creation Method of Endoscopic Submucosal Dissection to Ensure Curative Resection of Rectal Neuroendocrine Tumors

Purpose: Pancreatic/gastrointestinal tract neuroendocrine neoplasm (NEN) is divided into neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC) according to the grade of malignancy, and differences are seen in clinical prognosis. NET, and rectal NET in particular, is often treated endoscopically. Endoscopic mucosal resection (EMR) was previously the main intervention for rectal NET, but EMR with a ligation device (EMR-L) and endoscopic submucosal dissection (ESD) are now also used. However, complete resection with these therapies is not always achieved. The pocket creation method (PCM) is a safe ESD method for colon tumors that offers a high en bloc resection rate compared with conventional colonic ESD. We performed ESD using the PCM for rectal NET and evaluated the complete resection rate. Methods: We performed ESD using the PCM in 4 patients. This procedure was technically feasible in all patients. Results: Endoscopically, all cases were resected en bloc, and pathological complete resection was achieved in all cases. No complications such as perforation or delayed postoperative bleeding were encountered. Conclusions: PCM should be considered when treating NET of appropriate size

The Pilot Study for Health Check-Ups System at Elementary School in Cambodia

Background: In Cambodia, there is no national health check-ups system for the schoolchildren and the general population. This pilot study aimed to promote a school health check-ups system in collaboration with the government of Cambodia. Method: From 2016 to 2017, we conducted a survey in an elementary school in Siem Reap province, Cambodia. Two hundred and ninety-two students were eligible for data analysis. Physical examination, questionnaire and urinalysis were conducted using the Japanese school health check-ups model. Anthropometry was measured using the World Health Organization’s growth reference data for school-age children. Results: Among 292 schoolchildren, 88.7% were diagnosed as healthy. Based on the evaluation criteria of health examination in the study, two (0.7%) students with rale, one (0.3%) student with abnormal urinalysis, and another 27 students complaining of cardiopulmonary symptoms were recommended for further consultation at hospital. The prevalence of overweight (15.1%) was higher than that of underweight (8.6%). According to parents’ questionnaires responses, the coverage rate of the National Immunization Program varied from 41.8% to 79.8% depending on each particular vaccine. Conclusion: In this pilot study, we showed the prevalence of healthy among Cambodian schoolchildren and detected the students having possibility of health problem through this health check-ups and then recommended for further hospital visit. Based on the results, we assume that health check-ups system in elementary school as a whole Cambodia will be effective to assess the current health status in ordinary time and possibility of early detection of disease

Infliximab 治療中のクローン病にStreptococcus intermedius による肝膿瘍と膿胸を合併した1例

症例は31歳女性．クローン病再燃に対して抗TNF-α抗体製剤であるInfliximab治療中に，Streptococcus intermediusによる肝膿瘍と膿胸を発症し，治療に難渋するも抗菌薬治療，経皮経肝膿瘍ドレナージにて軽快した．Infliximab投与は，易感染性により様々な感染症を合併する可能性があるが，肝膿瘍の合併は非常にまれながら診断・治療の遅れが重篤になりやすく注意が必要である