THEORY AND PRACTICE OF TRAINING IN MEDICAL ETHICS CONSENSUS-BUILDING METHOD WITH SPATIOTEMPORAL PERSPECTIVE.

Today, in Japan, education in medical ethics is urgent for undergraduate and graduate students as well as for doctors, nurses, and medical staffs; however, each institution and hospital determines its own method of ethics training, and a comprehensive and consistent system has not been established yet. This study discusses the nature of the theory and practice employed by the author, as a practitioner, an educator, and a researcher of medical ethics, in providing ethics training in medical institutions and hospitals since 2005. The method, which is based on theory and practice, is characterized by a spatiotemporal perspective, that is, it considers the medical space where the patients are diagnosed and treated (space) and every stage in the patient's lifecycle (time). Therefore, medical ethics training should consist of: 1) understanding concepts and theories essential to medical ethics, 2) fostering stakeholders' ability to examine ethical issues from a spatiotemporal perspective, and; 3) improving the skills of those responsible for resolving ethical issues.

[Marfan syndrome complicated with CD5+ CD10+ diffuse large B-cell lymphoma].

Marfan syndrome (MFS) is caused by mutations in the gene encoding fibrillin. A 35-year-old man with MFS visited a local physician because of a sore throat. His left tonsil gradually became swollen and he was referred to our department. Histopathological examination of tonsil biopsy specimens showed diffuse proliferation of lymphoma cells with large nuclei. The tumor cells showed CD5+, CD10+, CD20+, BCL-6+, and MUM-1-. Based on these findings, the patient was diagnosed with CD5+ CD10+ diffuse large B-cell lymphoma (DLBCL). Chemotherapy combined with rituximab was administered and complete response was achieved. CD5+ DLBCL comprises approximately 5 approximately 10% of DLBCLs. In addition, CD5+ CD10+ DLBCL comprises about 5% of CD5+ DLBCLs. There may be a relationship between MFS and B-cell lymphoma because mutations in the gene encoding the receptor of transforming growth factor-beta (TGF-beta) have been implicated in the pathogenesis of MFS and downregulation of TGF-beta receptor expression has been described in the pathology of B-cell lymphoma.