As imaging technologies become increasingly advanced, it is possible to obtain detailed morphological information as well as functional imaging data. In some imaging technologies, the radiation dose increases with the ability to obtain better images or more detailed information. We encountered three cases of temporary bandage-shaped hair loss, which was caused by perfusion studies of the head by multi-detector row computed tomography (MDCT) for evaluation of cerebral blood flow in patients with vascular disorders. In all three patients with temporary hair loss, two angiographies of the head had been performed in the period of serial CT examinations. This suggested the possibility that radiation exposure from angiography performed in serial examinations, combined with the perfusion studies of the head with MDCT, played an important role in this temporary, bandage-shaped hair loss. Radiologists should be aware that a cumulative or multiplier effect of radiation exposure from multiple diagnostic techniques may result in hair loss and other types of radiation complications.

This study aims to compare the effectiveness of Hybrid and Pure problem-based learning (PBL) in teaching clinical reasoning skills to medical students. The study sample consisted of 99 medical students participating in a clerkship rotation at the Department of General Medicine, Chiba University Hospital. They were randomly assigned to Hybrid PBL (intervention group, n = 52) or Pure PBL group (control group, n = 47). The quantitative outcomes were measured with the students’ perceived competence in PBL, satisfaction with sessions, and self-evaluation of competency in clinical reasoning. The qualitative component consisted of a content analysis on the benefits of learning clinical reasoning using Hybrid PBL. There was no significant difference between intervention and control groups in the five students’ perceived competence and satisfaction with sessions. In two-way repeated measure analysis of variance, self-evaluation of competency in clinical reasoning was significantly improved in the intervention group in "recalling appropriate differential diagnosis from patient’s chief complaint" (F(1,97) = 5.295, p = 0.024) and "practicing the appropriate clinical reasoning process" (F(1,97) = 4.016, p = 0.038). According to multiple comparisons, the scores of "recalling appropriate history, physical examination, and tests on clinical hypothesis generation" (F(1,97) = 6.796, p = 0.011), "verbalizing and reflecting appropriately on own mistakes," (F(1,97) = 4.352, p = 0.040) "selecting keywords from the whole aspect of the patient," (F(1,97) = 5.607, p = 0.020) and "examining the patient while visualizing his/her daily life" (F(1,97) = 7.120, p = 0.009) were significantly higher in the control group. In the content analysis, 13 advantage categories of Hybrid PBL were extracted. In the subcategories, "acquisition of knowledge" was the most frequent subcategory, followed by "leading the discussion," "smooth discussion," "getting feedback," "timely feedback," and "supporting the clinical reasoning process." Hybrid PBL can help acquire practical knowledge and deepen understanding of clinical reasoning, whereas Pure PBL can improve several important skills such as verbalizing and reflecting on one’s own errors and selecting appropriate keywords from the whole aspect of the patient.

Intracystic papillary neoplasm (ICPN) of gallbladder is a comparatively new concept and is described as pre-malignant lesions in Nakanuma et al. (In: Bosman et al. (eds) WHO Classification of Tumours of the Digestive System, World Health Organization of Tumours, IARC, Lyon, 2010). ICPN with high-grade intraepithelial neoplasia is understood to include intraepithelial carcinoma or noninvasive carcinoma. And lesions with invasive cancer components are classified as ICPN with an associated invasive carcinoma [1]. According to Adsay et al., more than half of patients diagnosed with ICPN have invasive cancer components (Adsay et al., Am J Surg Pathol 36:1279-1301, 2012).Polypoid masses in the gallbladder including benign, malignant, and non-neoplastic lesions have been called gallbladder polyps, and ICPN is also a polypoid lesion in the gallbladder. However, it is difficult to differentiate between them. In the literature, it is said that the possibility of malignancy is high in lesions exceeding 1 cm (Terzi et al., Surgery 127:622-627, 2000). And there are few reports on characteristic imaging findings of ICPN.We have experienced three cases (two females and one male) of ICPN and report our imaging findings. Contrast-enhanced computed tomography revealed large papillary polypoid lesions approximately 2-4 cm in size in the gallbladder. Findings suggestive of deformation of the gallbladder wall and extrinsic progression were absent in all cases. T2-weighted magnetic resonance imaging revealed intense signals and diffusion-weighted imaging showed high intensity. Expanding of the gallbladder was seen in case 1, and a tumor stalk-like appearance was seen in the papillary mass in cases 2 and 3. Surgery was performed in all three cases and ICPN was diagnosed pathologically. The cancer was localized to the mucosa, with no infiltration of surrounding tissue in all three cases.

A 77-year-old Japanese woman presented with peripheral oedema following COVID-19 vaccination. Three weeks before, the day after the second dose of BNT162b2 mRNA COVID-19 vaccination, she presented with low-grade fever, peripheral oedema and arthralgia of the bilateral foot joint. Fever and arthralgia were relieved spontaneously within a week. Since there was no improvement in the peripheral oedema, she was referred to our department. Her medical history revealed type 2 diabetes mellitus and dyslipidaemia, for which she had been prescribed 500 mg/day of metformin and 10 mg/day of atorvastatin. Physical examination revealed symmetrical non-pitting oedema of her legs (Figure 1a). Laboratory tests showed blood eosinophilia (3750/ll). The serum IgM level was within normal. Non-episodic angioedema with eosinophilia (NEAE) was diagnosed. Her symptoms improved quickly with prednisolone administration (20 mg/day) (Figure 1b). She has been recurrence-free after tapering off prednisolone.Angioedema with eosinophilia is of two types: episodic angioedema with eosinophilia (EAE; Gleich's syndrome) and NEAE. 1-3 EAE has been reported mainly in Europe and the USA, whereas NEAE in Korea and Japan. 4 EAE is characterized by recurrent episodes of angioedema, urticaria, fever and increased body weight, with markedly high peripheral blood eosinophil count and serum IgM levels. 1,2 NEAE is characterized by a single episode of persistent oedema of the extremities, peripheral eosinophilia, transient arthralgia, lack of increased serum IgM levels and a less severe clinical course than that of EAE. 2,3 NEAE can occur after influenza vaccination; however, NEAE after COVID-19 vaccination has not been previously reported. 5 NEAE is also characterized by the effectiveness of low-dose prednisone or spontaneous remission within 2-3 months. 2,3 In conclusion, non-pitting oedema of the extremities with eosinophilia should be considered eosinophilic angioedema, which can occur after COVID-19 vaccination.

The CT features of poor contrast enhancement, thin rim enhancement, and dark fan sign are valuable for identifying acute torsion of USL.

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Objective This case series aimed to investigate the clinical and pathological characteristics of persistent postural perceptual dizziness (PPPD). Methods We retrospectively examined the medical records of patients with chronic dizziness in our department, and tracked the percentage of PPPD, the age and sex, disorder duration, exacerbating factors for dizziness, and duration of momentary worsening dizziness. We also examined the duration of momentary worsening dizziness in cases of depression, anxiety disorder, and somatic symptom disorder. Results Among 229 patients with chronic dizziness, 14.4% (33/229) met the diagnostic criteria for PPPD. PPPD was the second most common disorder of patients with chronic dizziness after depression. The median age of patients with PPPD was 75 (75.8% female) and the median duration of the disorder was 60 months (range: 3-360 months). The exacerbating factors were motion without regard to direction or position (90.9%), upright posture (66.7%), and exposure to moving visual stimuli or complex visual patterns (30.3%). While the duration of momentary worsening dizziness was less than 10 minutes in 93.9% of patients with PPPD, the duration in patients with depression, anxiety disorder, and somatic symptom disorder were 3.6 % (2/55), 16.1% (5/31), and 0% (0/11), respectively. When the duration was less than 10 minutes, the odds ratios of PPPD for depression and anxiety disorder were 46.5 (95% CI: 6.1-362.0) and 40.3 (95% CI: 7.4-219.3), respectively. Conclusion Short episodes of momentary worsening dizziness constitute a distinctive feature of PPPD that may be useful for differentiating PPPD from other types of psychogenic dizziness.