Internal medicine
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A 55-year-old man underwent radiation therapy due to malignant lymphoma of the neck. Eight years after the therapy he developed tetanus. ⋯ However in spite of injections of tetanus toxoid, symptoms of tetanus returned when the administration of metronidazole was discontinued because the infectious focus could not be completely removed. This is the first report of chronic relapsing tetanus associated with radiation-induced mandibular osteomyelitis, and demonstrates that tetanus can occur due to mandibular focus but the chronic administration of metronidazole can prevent relapse.
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To contribute to reforming the medical education system in Japan, we visited overseas medical schools and observed the methods utilized in medical education. ⋯ In contrast to overseas medical schools, simulation-based learning is not common in Japan. There remain many barriers to introduce simulation-based education in Japan, such as a shortage of medical tutors, staff, mannequins and budget. However, enhancing the motivation of tutors is likely the most important factor to facilitate simulation-based education in Japanese medical schools to become common place.
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Case Reports
A rare initial manifestation of acute lymphocytic leukemia: bilaterally enlarged kidneys and liver.
A case with early presentation of acute lymphocytic leukemia with bilaterally enlarged kidneys and liver is presented. Both hepatic and renal infiltration with leukemic cells is a rare manifestation of acute lymphocytic leukemia.
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New serum markers (1-->3) beta-D-glucan (beta-D-glucan) and KL-6 are reported to be useful for the clinical diagnosis of Pneumocystis jirovecii pneumonia (PCP). However, the utility of these markers in PCP with HIV infection (HIV PCP) and without HIV (non-HIV PCP) is unknown. This study was aimed to evaluate the utility of beta-D-glucan and KL-6 for the diagnosis of PCP in patients with HIV infection (HIV PCP) and non-HIV PCP. ⋯ In conclusion, beta-D-glucan was a reliable diagnostic marker for PCP. However, the detection rate of beta-D-glucan and KL-6 in non-HIV PCP was lower than in HIV PCP. Neither beta-D-glucan nor KL-6 was associated with the outcome of PCP.