Rinsho byori. The Japanese journal of clinical pathology
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Japanese medical graduates are recommended to receive clinical training for more than two years after graduation, because undergraduate clinical training is insufficient. In 1979, the educational committee of the Japan Society of Clinical Pathology (JSCP) proposed the objectives of postgraduate training for clinical pathologist, and the minimal training period should be 5 years of which at least 1 year should be completed in internal medicine or anatomic pathology or clinical physiology. ⋯ This training in general internal medicine should be the precondition for further postgraduate training in clinical pathology or laboratory medicine. It is emphasized that clinical trainees should have basic clinical skills which include interviewing techniques, skills in physical examination and communication skills to other doctors and other medical co-workers in POS (Problem Oriented System).
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Recent developments in medical care have required certified clinical laboratory physicians. The background of the "Certification System for Certified Clinical Laboratory Physicians" and the "Curriculum for Postgraduate Training in Clinical Pathology/Laboratory Medicine" was reviewed. The Education Committee of the Japan Society of Clinical Pathology is offering a new curriculum. ⋯ The "Guidelines for Basic Postgraduate Clinical Training" has already offered. The advanced training program includes seven required courses which will be planned according to seven basic GIOs as well as specific GIOs and SBOs. This forum is expected to be useful in planning the new curriculum.
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Case Reports
[Studies on the fragments of FDP in 3 patients with DIC associated with acute promyelocytic leukemia].
We previously reported a study on fibrinolysis and fibrinogenolysis that analyzed fragments of fibrin/fibrinogen degradation products (FDP) using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting. In this report, we characterized the fragments of FDP in three patients with disseminated intravascular coagulation (DIC) associating with acute promyelocytic leukemia (APL). D, Y, DD, DY/X and high molecular weight fragments were observed in sera of all the patients obtained at the onset of APL. ⋯ At that time, serum LDH levels and plasma polymorphonuclear elastase (PMN-Ela) were increased presumably due to the release of these enzymes from necrotic bone marrow, and the levels of CRP and plasma fibrinogen were increased probably due to an infectious complication. In non-DIC period of case 3, FDP and FDP-D dimer were spontaneously decreased without reduction of PMN-Ela levels, after three weeks of chemotherapy for microbial agents. Taken together, characteristics of FDP fragments were unique to each case of APL-DIC, probably because many factors differently affected the degradation of fibrin and/or fibrinogen.
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Eighty six plasma samples from 41 patients with suspected disseminated intravascular coagulation (DIC) were divided into 3 groups as follows: Group A, 53 samples from established DIC; Group B, 19 samples from possible DIC; and Group C, 14 samples from probable DIC. The following parameters of coagulation and fibrinolysis were evaluated: thrombin/antithrombin III complex (TAT), plasmin/alpha 2 plasmin inhibitor complex (PIC), D-dimer (D-D) and fibrin monomer (FM). ⋯ In all groups abnormal TAT, PIC and D-D findings were observed in many samples (86-100%), and FM was present in 83%, 63%, and 29% of samples in Groups A, B, and C respectively. In Groups B and C, abnormal findings for TAT, PIC, D-D, FM and alpha 2PI apparently indicated hypercoagulability and accelerated fibrinolysis, even though fibrinogen and platelet count were within normal limits.