Dear EditorJapan’s Ministry of Health, Labor and Welfare published a report on the ‘Practical recommendation on medical practice during clinical clerkship’ (Ministry of Health, Labor and Welfare, 2...
Dear Editor, Airway management is considered an essential element of both in-hospital and pre-hospital cardiopulmonary resuscitation for infants, with manual mask ventilation being a primary and essential component of infant rescue airway management for medical professionals.1 An essential consideration for infant mask ventilation safety is whether sufficient ventilation has been achieved or not.1 Here, we conducted a survey on the subjective difficulty of evaluating the quality of mask ventilation by medical students, from various viewpoints. Ethical approval was deemed unnecessary by the Research Ethics Committee of Osaka Medical College. On November 2019, we conducted a simulation-based cross-over trial with 18 3rd year medical students who had no experience with infant resuscitation. The Baby Anne (Laerdal, Sentrum, Stavenger, Norway) manikin was used to perform mask ventilation. Students visually evaluated the quality of manual standard mask ventilation conducted by the resuscitation instructor (NK), from four different viewpoints: headside-upward, headside-horizontal, lateral-upward, and lateral-horizontal (Fig. 1A). The resuscitation instructor performed bag-valve-mask ventilation five times (approximately 30s for each attmpt) in each viewpoint according to the current guideline.1 The ventilation time was determined according to a preliminary study. The order of viewpoint was randomized by a random number table. After being taught the evaluation method, students rated the difficulty of evaluating the quality of ventilation by the same instructor from the four viewpoints on a visual analog scale, which ranged from 0 (extremely easy) to 100 (extremely difficult).2 Results obtained from each trial were compared using the Kruskal–Wallis test. P < 0.05 was considered statistically significant. The subjective difficulty of evaluating the quality of ventilation from the lateral-horizontal viewpoint was significantly lower compared to the other three viewpoints (P < 0.001 compared to headside-upward, P = 0.005 compared to headside-horizontal, and P = 0.007 compared to lateral-upward) (Fig. 1B). There were no significant differences in subjective difficulty among headside-upward, headside-horizontal, and lateral-upward viewpoints. One limitation of this study is that there are some confounders, such as height of medical student. Further standardization is warranted in future studies. Our results indicate that the lateral-horizontal viewpoint is the most effective for evaluating the quality of infant manual mask ventilation by medical students. Approval of the research protocol: Deemed unnecessary by the Research Ethics Committee of Osaka Medical College. Informed consent: N/A. Registry and the registration no. of the study/trial: N/A. Animal studies: N/A. Conflict of interest: None.
A case of unresectable advanced gastric cancer (portion A, Min, S3 infiltrating into pancreas, N3, por., Borrmann III-type, hen's egg size) was treated with cis-dichlorodiammine platinum (CDDP) at a dosage of 30 mg/day for five days every month following surgery. After three courses of administration, examinations revealed that the tumor had disappeared and an evaluation of complete response was made. Four months later, a second-look operation was performed. It was found that the cancer was less than thumbsize and was able to be resected radically. No significant side effects were observed during CDDP therapy.
Facial palsy in acute lymphoblastic leukemia (ALL) patients is diagnosed as tumor cell invasion of the central nervous system (CNS) following the ALL guidelines. Facial palsy in a 6-year-old ALL patient was diagnosed as leukemia cell invasion into the CNS by hemato-oncologists. Pretreatment magnetic resonance image (MRI) revealed gadolinium enhancement of the first genu and meatal portion of the facial nerve. After chemotherapy, although the ALL tumor cells disappeared from both the blood and the cerebrospinal fluid, and the facial palsy resolved, a posttreatment MRI showed no change in terms of enhancement of the facial nerve. These findings indicated the possibility of herpetic viral reactivation in the geniculate ganglion of the facial nerve. We must be aware and discuss with hemato-oncologists the possibility that not only tumor cell invasion into the CNS, in accordance with the guidelines, but also that herpetic virus reactivation arising in the facial nerve may be causes of facial palsy.
Objective 1) Describe the first case of inoperative squamous cell carcinoma (SCC) in the skull base recurring after surgery, conventional radiotherapy, and chemotherapy, which was treated using 2‐stage boron neutron capture therapy (BNCT). 2) Determine the effectiveness of BNCT for head and neck cancer. Method We present a case of inoperative recurrent SCC in the right temporal bone involving the occipital condyle. The patient underwent BNCT twice in 1 month in 2007 at Research Reactor No. 4 of the Japan Atomic Energy Research Institute to ensure neutron capture in the deep lesion. Results An epithermal neutron beam was used as the neutron source. The total estimated radiation dose of the BNCT to the tumor beneath the skin, at the deepest point of the tumor, and in the skin around the right auricle was 41.8, 36.9, and 15.8 Gy‐Eq, respectively. After the BNCT, the tumor became necrotic and shrank immediately and disappeared 6 months after the first BNCT. Radiological studies performed 5 years after the first BNCT showed no evidence of residual or recurrent tumors. Conclusion Total resection of SCC deeply invading the skull base is difficult. Surgical complications can leave patients in critical condition. Two‐stage BNCT might be an effective treatment for patients with SCC deep in the skull base.
