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A rare case of isolated right atrial thrombus under anticoagulant therapy for atrial fibrillation is reported herein. The patient was an 81-year-old man undergoing anticoagulant therapy with oral warfarin for atrial fibrillation. During preoperative screening for eye surgery, echocardiography revealed a mobile mass in the right atrium, and emergency hospital admission was indicated. Excision of the right atrial thrombus was performed, and no residual thrombus was detected on postoperative imaging studies. This case was considered a good indication for surgical resection because of potential risk of fatal embolism.

We report the case of a 49-year-old woman with a giant atherosclerotic thrombus-filled aneurysm of the right coronary artery. She was referred to our hospital because of abnormal finding of the chest X-ray. Echocardiography revealed a large cystic mass adjacent to the right atrium and computed tomography revealed a giant aneurysm of middle segment of the right coronary artery. Based on the size of the aneurysm, the patient underwent exclusion of the aneurysm by proximal and distal ligation and coronary artery bypass surgery. Giant coronary artery aneurysm is rare, and the management should be individualized depending on size, location, and clinical context.

A 65-year-old woman was admitted due to electrocardiographic abnormality and exertional dyspnea. Transthoracic echocardiography revealed quadricuspid aortic valve malformation with severe aortic regurgitation. All 4 cusps were of equal size, and the quadricuspid valve was classified as type a by Hurwitz classification. We replaced it with an 18 mm mechanical valve and her postoperative course was uneventful.

Native aortic valve thrombosis is an uncommon event with heart valve disease, during cardiac catheterization, bacterial endocarditis, or a hypercoagulative state as in antiphospholipid antibody syndrome. We report a case of thrombus formation on a native aortic valve, which was found by the transesophageal echocardiography during thrombectomy of the lower limb. We supposed that the atheromatous plaque of aortic valve was related to thrombus formation.

On June 10, 1921, a fatal drug administration case occurred in Yokohama. A nontitled dispenser of drugs with little knowledge about drugs working in a hospital dispensary gave a patient a capsule of strychnine nitrate instead of one containing strychnine hydrochloride. This patient died 20 minutes later. A pharmacist revealed the case to the public. Pharmacists insisted that this unfortunate event occurred because of a current hospital system handling both medicine and drug dispensation. Therefore they argued that the responsibilities of doctors and of drug dispensaries must immediately be separated out of respect for the lives of patients. Pharmacists publicized the importance of separating drug dispensaries from the medical practice through newspapers, magazines, and public lectures. We are quite doubtful about this appeal to the public being effective. We question how many people could understand what the pharmacists were saying under such the era when people were not much educated. It became a great fear to doctors that pharmacists appealed the necessity of the separation of drug dispensaries from medical practice directly to the public.

Doctors were very nervous about the movements of pharmacists toward achievement of the separation of drug dispensaries in the medical practices and drug dispensation in 1914 and 1915. They specifically blamed one person, Professor Tokichiro Niwa of Tokyo Imperial University who strongly advocated the separation of dispensaries in the medical practices. Furthermore, they were also very anxious that the Japan Pharmacists Association had supported legislators who had stood by the separation of dispensaries from medical practice at the twelfth general election held on March 25, 1915. They were concerned that the domain of doctors' activities would be narrowed by such a separation. Professor Kunika Katayama of the Tokyo Imperial University School of Medicine published a thesis at his own cost advocating a modification of the doctor's law to prohibit the separation of dispensaries be legislation and insisting that the right prescribe a drug to a patient must remain with the doctor. Moreover, Professor Mitsue Ichimura of Kyoto Imperial University also insisted that a doctor has the right to give drugs to patients, and that as a jurist he disagreed with the separation of dispensaries from medical practice.

At the session of the 50th Imperial Diet held on January 22, 1925, the Government submitted two drafts for a law governing pharmacists and one governing drug products. These drafts were very important for pharmacists because both the laws governing pharmacists and drug products could stipulate not only the qualifications and activities of pharmacists, but also their roles in the society. However, doctors were afraid of giving such power to pharmacists and feared that these laws might lead to a practical separation of drug dispensaries from the medical practice. Then objected that the Law of Drugs No. 10, which gave pharmacists the right to dispense drugs without a doctor's prescription, would infringe on the domain of doctor activities. Legislator also doctors strongly disagreed with both drafts presented to the Imperial Diet. Speculation was that neither draft would pass. As a result, the Law of Pharmacists, which was less damaging to the rights of doctors than the other law, was approved and ultimately became law. The Law of Drug Products was suspended.

Many cases of dispensing drugs without doctors' prescriptions were reported throughout Japan during 1914-16. Some cases were brought to the courts. Pharmacists had been selling prescription drugs to their customers without prescriptions. This dispensing act was admitted by the Ministry of Internal Affairs after 1913. However, doctors claimed that the act of dispensing drugs without a prescription infringed on Law No. 10, and the Japan Pharmacists Association hired a notable lawyer and fought a lawsuit against eight pharmacists who dispensed prescription drugs without prescription in Shiba Ward, in Tokyo. This case occurred because at that time no practice existed that allowed drugs to be dispensed separately from medical practice.

On March 30, 1914, the law of patent medicine was enacted in Japanese, though it took three years for this to be accomplished. One reason why it took such a long time for enactment is because the doctors and drugstore owners raised strong objections to the law. They feared that pharmacists might try to take over all rights to sell drugs. The pharmacists, however, believed this law to be very important, making it possible for them not only to expand the business rights and the establishment of their status, but also to hold exclusive rights to the sales of drugs. On the other hand, doctors were very cautious about this law. They considered it to be a preliminary stage toward the enactment of the separation of drug dispensing by the medical practice. On March 19, 1914, Dr. Miyake former dean of the School of Medicine, University of Tokyo, and a member of the House of Lords, delivered his opinion on the "needlessness of pharmacists" by quoting European cases in the House of Lords, to members of the Special Committee of the Drug Trade Bill. He stated that a separation of the dispensary from the medical practice was a turning point in the field of medicine that should be reconsidered, and he tried to suppress the pharmacists' movements to pursue this issue. Probably Dr. Miyake was afraid that someone might submit a bill calling for dispensary separation. The proceedings of the Imperial Diet revealed a close relation between the law and the separation of dispensaries.