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A 52-year-old man developed Stanford type A acute aortic dissection and suffered severe pain in the back and the chest, and numbness of the left lower limb. Contrast-enhanced computed tomography (CT) revealed occlusion of the left iliac artery due to dissection. The celiac artery was also obstructed and the superior mesenteric artery was severely narrowed, but there was no clear sign of organ ischemia. Endovascular treatment in the iliac artery was performed, but the patient complained of right upper abdominal pain 6 hours after the procedure. Serum liver enzyme levels were significantly elevated. Repeat contrast-enhanced CT revealed liver infarction, ischemic cholecystitis, and duodenal ischemia due to decreased collateral flow. We immediately carried out cholecystectomy and revasculariza-tion of the celiac and superior mesenteric arteries using a saphenous vein. The patient underwent central repair for aortic dissection several days after recovery of liver function, and was discharged uneventfully 24 days later.

Background: Autoimmune cerebellar ataxia (AICA) is a general term for diseases in which the cerebellum is damaged by an autoimmune mechanism. For the diagnosis of the AICA, anti-thyroid antibodies (anti-thyroid peroxidase antibody and anti-thyroglobulin antibody), anti-glutamic acid decarboxylase (GAD) antibodies, and anti-gliadin antibodies are measured. Immunotherapy is known to be effective for AICA, but some patients with effective immunotherapy lack autoantibodies associated with cerebellar ataxia. The purpose of this study was to clarify whether the effectiveness of immunotherapy in patients with suspected AICA could be predicted by anti-mouse cerebellar tissue-derived antigen antibody tests., Methods: This study was conducted on 25 patients with idiopathic cerebellar ataxia (excluding multiple system atrophy, hereditary spinocerebellar degeneration, cancer-bearing patients, and patients taking phenytoin) who received immunotherapy from 2005 to 2016 at Tokyo Medical University Hachioji Medical Center. The patients were suspected of having AICA because they were positive for cerebellar ataxia-related autoantibodies (anti-thyroid antibody, anti-GAD antibody, anti-gliadin antibody, or anti-transglutaminase 6 antibody) or other autoantibodies. Antibodies that bind to mouse cerebellar tissue-derived antigens were defined as "anti-mouse cerebellar tissue-derived antigen antibodies" in this study, and their IgG-class antibodies were comprehensively measured using a slot blot., Results: Anti-mouse cerebellar tissue-derived antigen antibody test results were correlated with immunotherapy efficacy. Furthermore, the combination of anti-mouse cerebellar tissue-derived antigen and anti-GAD antibody tests could predict the effectiveness of immunotherapy with 83% sensitivity and 100% specificity, while the combination of the anti-mouse cerebellar tissue-derived antigen, anti-GAD, and anti-gliadin (IgA class) antibody tests could predict the effectiveness of immunotherapy with 94% sensitivity and 86% specificity., Conclusion: Anti-mouse cerebellar tissue-derived antigen antibody tests could help to provide useful information for immunotherapy administration to patients with idiopathic cerebellar ataxia suspected to be AICA.

Naldemedine (Nal) is widely used as a therapeutic drug against opioid-induced constipation. However, patients in phase III trials are limited to those with good performance status (PS). Cancer patients may have inferior PS owing to progression of symptoms and adverse events from chemotherapy. Therefore, it is important to survey the efficacy of Nal in patients with poor PS. This study aimed to evaluate Nal efficacy in patients with poor PS. We retrospectively investigated patients from July 2017 to June 2019 and compared Nal efficacy between patients with good and poor PS. The efficacy of Nal was evaluated using changes in the number of spontaneous bowel movements 7 days before and after the introduction of Nal with reference to previous reports. Multivariate analysis was performed to reveal whether poor PS affects Nal efficacy. In total, 141 patients at the Hokkaido University Hospital were analyzed. The effective rate of Nal from day 1 to day 7 of administration was 71.7% and 71.4% in the patients with good and poor PS, respectively, that from day 1 to day 2 of administration was 61.1% and 57.1%, respectively, and that from day 3 to day 7 of administration was 60.2% and 71.4%, respectively, suggesting an absence of significant differences. Furthermore, results of multivariate analysis showed that "best supportive care" and "body weight (55 kg and above)" reduced Nal efficacy. In conclusion, Nal showed similar effectiveness in patients with poor PS as that in those with good PS.

The JMDC Claims Database ® contains completely anonymized receipt information on the insured members of health insurance associations. The number of registered users is approximately 9.6 million (6% of the population) as of May 2020. In this database, it is possible to track even outpatient treatment, even if the patient changes the medical facility, as long as the insurer of the subscriber's health insurance does not change, so that long-term medical treatment could be targeted as a research theme. However, as the data do not contain medical record information, it is not possible to obtain laboratory values, although it is possible to know whether clinical tests have been performed. For pharmaceutics-related research, the most suitable use of the receipt database like JMDC Claims Database ® seems to be the investigation of actual prescriptions. However, the research topics that pharmacists are interested in are probably comparisons of drug effects, drug-drug interactions, or causal analysis of drugs and side effects. However, laboratory data for evaluating drug efficacy is not available in the receipt database, and the accuracy of the disease name in the database becomes problematic when using the disease name as information indicating the occurrence of side effects. In this review, we introduce our studies performed by using JMDC Claims Database ® and how to manage the above-described problems. We hope that this study will be helpful to those who are going to engage in research using medical big data.

Lacosamide is a novel antiepileptic drug. Although many antiepileptic drugs reportedly pose a risk to fetuses, patients with epilepsy are advised to continue their medications during pregnancy. There have been few reports on lacosamide use during pregnancy, and its effects on the fetus remain unclear. Here, we report a case of lacosamide use during pregnancy. The 33-year-old patient was treated with oral lacosamide (400 mg/d) for symptomatic partial epilepsy. She was concomitantly treated with folic acid (5 mg/d) beginning 4 days before her last menstrual cycle. She was also concomitantly treated with oral perampanel (2 mg/d) at 5-7 weeks' gestation for seizure control but discontinued perampanel after the pregnancy was discovered. She progressed through her pregnancy with only mild seizures. Fetal growth was normal and ultrasonography revealed no external malformations. The patient had an elective cesarean section at 37 weeks and 2 days owing to a previous post-cesarean pregnancy. Her baby boy weighed 3025 g; his Apgar score was 8 and 9, 1 and 5 min, respectively, and his umbilical artery blood pH was 7.348. He had no congenital anomalies and no neonatal drug withdrawal symptoms. This suggests that lacosamide may have a low risk of teratogenicity and fetal toxicity. Thus, this case is valuable for clinicians who are considering the administration of antiepileptic drugs during pregnancy. In the future, more reports on the use of lacosamide during pregnancy should be collected.

A 75-year-old male with a history of allergy to iodinated contrast media was referred for the treatment of the left subclavian artery aneurysm. The aneurysm was saccular and maximum diameter over 30 mm. Stent grafting was performed with the use of gadolinium-based contrast agent and intravascular ultrasound (IVUS). Ipsilateral vertebral artery was temporarily occluded with a balloon catheter to protect against distal embolism. The IVUS reduced the amount of gadolinium-based contrast agent. There were no neurological, renal or other complications after the treatment. Stent grafting of the left subclavian artery aneurysm may be safely performed with gadolinium-based contrast agent and IVUS, even if iodinated contrast media is contraindicated.

Denosumab is a fully monoclonal antibody against the receptor activator of nuclear factor kappa-B ligand (RANKL), and prevents skeletal-related events by bone metastasis. Hypocalcemia is the most typical adverse effect of denosumab use. We have developed a management system for the more efficient and safer management of denosumab administration, and evaluated pharmaceutical interventions for the better control of hypocalcemia. All pharmaceutical interventions in the system from April 2016 to March 2020 were retrospectively evaluated. We have also assessed the incidence of hypocalcemia in 158 patients who were administered denosumab for six months or more in the period. A total of 282 pharmaceutical interventions (7.0% of the total administration) were conducted. The most conducted intervention was regarding hypocalcemia, which involved the suspension of the injection and/or the increase of calcium and vitamin D supplement with 65% adoption and 17% temporary treatment suspensions. Other interventions were about hypercalcemia, request of laboratory examination and ordering supplements, dental consultation, and poor renal function. A total of 199 interventions (70.6%) were adopted, with 33 administrations suspended. The frequency of hypocalcemia was 27.8% with just one patient having grade 2 hypocalcemia, suggesting that there were no severe cases. Moreover, hypocalcemia was significantly normalized following pharmaceutical intervention and/or handling by physicians (p=0.02) according to the system. Conversely, the normalization rate in hypercalcemia did not differ according to the countermeasures. In conclusion, pharmaceutical interventions according to our management system benefit safe denosumab treatment, especially in severe hypocalcemia prevention.

Introduction: Cystine and theanine are amino acids that contribute to the production of glutathione, which is the most potent antioxidant in the body, and it has been reported that these amino acids prevent immunosuppression, has anti- inflammatory effect, and reduce invasiveness., Objective: To evaluate the effect of oral administration of amino acids cystine and theanine on stomatitis during chemotherapy., Subjects and Methods: For 17 patients with Grade 1(CTCAE v4.0)or worse stomatitis during chemotherapy for gastrointestinal cancer or breast cancer, cystine 700 mg and theanine 280 mg/ day were orally administered for 28 days, and the degree of stomatitis was evaluated objectively and subjectively., Results: As an objective evaluation, changes in Grade showed improvement in 11 cases(64.7%), 5 cases unchanged(29.4%), and 1 case was worse(5.9%). Subjective assessment, pain was in remission(30.8%)or disappeared(61.5%)in 4 of 13 cases. Food intake increased in 5 patients(29.4%). 15 of 17 patients(88.2%)felt it was effective., Conclusion: Oral administration of amino acids cystine and theanine during chemotherapy can reduce the symptoms of stomatitis.

We present a case of complete anterior papillary muscle rupture (PMR) due to localized papillary muscle infarction, without significant coronary artery disease. A 69-year-old woman was transferred to our hospital because of acute orthopnea and cardiogenic shock. Echocardiography showed severe mitral regurgitation due to anterior PMR, and emergency coronary angiography revealed no obstructive disease in the coronary arteries. Emergency mitral valve replacement was performed with intra-aortic balloon pumping support. Intraoperatively, the anterolateral papillary muscle was found to be completely ruptured. With maximal posterior leaflet preservation, mitral valve replacement was successfully performed. Her postoperative course was uneventful. Pathologic examination showed both old fibrosis and new ischemic lesion in the same resected papillary muscle. It could be speculated that repeated localized subendocardial infarction caused so-called spontaneous PMR.

Ventricular septal perforation(VSP) is a catastrophic complication of acute myocardial infarction, and posterior VSP reportedly has worse outcomes. We present a case of a 79-year-old man with posterior VSP following acute myocardial infarction. He underwent percutaneous coronary intervention for acute postero-inferior myocardial infarction due to occlusion of the mid-portion of the right coronary artery. Ultrasound Cardiography (UCG) revealed the VSP on the posterior ventricular septum with right ventricle(RV) inferior wall akinesis. Surgical repair was planned 4 weeks later because his hemodynamic state remained stable without intraaortic balloon pumping (IABP) support. Post-infarction posterior VSP was successfully repaired through inferior right ventricular incision. Two patches were fixed to the ventricular septum using the sandwich patch technique with BioGlue surgical adhesive reinforcement. The postoperative course was uneventful, and there was no residual shunt after the operation. This method of approaching via right ventricular incision was considered to be useful in patients who have severe necrosis near the free-wall side of the posterior VSP.

Communication education is now necessary for pharmaceutical education since the role of pharmacists has expanded from "medicine-based" to "person-based". However, a standard for assessing the effectiveness of a communication education program has not been established. Hence, the aim of this study was to determine the effectiveness of clinical training in pharmacy for enhancing the ability of pharmacy students to communicate. Role playing with simulated patients was performed by pharmacy students before and after clinical practice for pharmacy, and the effects of learning were analyzed by Roter method of interaction process analysis (RIAS). Analysis by RIAS enabled quantification and objective evaluation of communication by pharmacy students. The results showed improvement of interactive communication, decrease of "Question asking" and "Others" including "Transition words", and increase of "Partnership behaviors" and "Counsel behaviors". The pharmacy students became skillful in communication without showing hesitation. The results therefore showed that clinical training contributes to improvement in the ability of pharmacy students to communicate.

Loeys-Dietz syndrome( LDS) is a recently recognized autosomal dominant connective tissue disorder. Mutations in the genes encoding transforming growth factor-beta( TGF-β) receptor 1 and (2 TGFBR1, TGFBR2)have been associated with LDS. We report here 2 cases of LDS in childhood. Case 1 was a 10-year-old man, who had aneurysm of both the pulmonary trunk and the ascending aorta, associated with pulmonary and aortic valve insufficiency. Surgical repair was performed successfully at the age of 17. The aortic valve was replaced with a mechanical valve. The aneurysmal ascending aorta was replaced with a Dacron graft. Pulmonary valvuloplasty and pulmonary arterioplasty was performed. Case 2 was a 3-month-old female infant, who had a patent ductus arteriosus( PDA) and aortic root dilation. A detailed physical examination revealed hypertelorism, bifid uvula, retrognathia, talipes equinovarus, and camptodactyly. Computed tomography and echocardiography demonstrated PDA, Valsalva sinus dilation, and arterial tortuosity. These findings were consistent with the clinical manifestations of LDS. Surgical ligation and clipping of the PDA was performed with good results. A molecular genetic analysis subsequently demonstrated a heterozygous missense mutation of the TGFBR2. Since aortic dissection occurs at smaller aortic diameters, early diagnosis and close monitoring are important for patients with LDS.

Extensive chest wall resection carries the risk of difficult reconstruction and surgical complications. We report our experience on chest wall reconstruction using titanium plates for a wide thoracic defect after tumor resection. A 74-year-old man was diagnosed with chondrosarcoma of the 6th rib on the right. He needed extensive chest wall resection because of skip lesions on 4th rib noted on operative inspection, leaving a defect measuring 33 × 20 cm. Reconstruction using 5 transverse titanium plates sandwiched between an expanded polytetrafluoroethylene patch and a polypropylene mesh sheet stabilized the chest wall. This reconstruction allowed successful separation from ventilatory support after operation. The postoperative course was uneventful, and he was discharged on postoperative day 20. The advantages of this form of reconstruction over conventional prostheses are rigidity, and stability and usability.

Objective: Approximately 19,000 people die in Japan each year from accidents that occur while bathing. Yamagata Prefectural Shounai public health center had educated residents about proper bathing practice. We evaluated residents' knowledge about safe bathing practices after an educational campaign in the area., Methods: We distributed a questionnaire to 3,078 people to gauge their awareness of bathing accidents in general and the effectiveness of a safety campaign from the public health center prevention. Participants included people who had attended a meeting, workshop, lecture, or event at the public health center., Results: A total of 2,697 people responded (87.6% response rate). A large majority (92%) knew about safe bathing practices in general. However, only 43% knew that bathing in hot water less than 41 degrees Celsius could help to reduce bathing accidents. Only 56% bathed in water below 41 degrees Celsius. Similarly, 81% knew about the preheating before bathing in dressing room and bathroom, but practiced only 50% of those. About recognition of the actual situation of the bathing accident and recognition of the prophylaxis, a student attending a lecture was higher than a lecture non-student attending a lecture more than 10%., Conclusion: Recognitions and practices of safe bathing practices had big difference, and development of an effective communication method will be important.

Congenital coronary artery fistula is an uncommon heart anomaly involving the coronary arteries. We report here a case of a 4-year-old boy who had a coronary fistula from the right coronary artery to the right ventricle, with a coronary aneurysm. He was asymptomatic, but the calculated ratio of pulmonary blood flow to systemic blood flow was shown to be high [pulmonary flow (Qp)/systemic flow(Qs)=1.78]. The coronary angiography showed that the right coronary artery was dilated beginning at the ostium and had an aneurysm at the acute marginal portion. A large spherical aneurysm approximately 20 mm in diameter was found to have been connected with coronary fistula opening into the right ventricle. Surgical repair by closure of the fistula under direct vision, partial resection and suture closure of the aneurysm was performed. Plication of the proximal portion of the right coronary artery was not performed, and the diffusely dilated artery was left untouched. After this operation, he recovered well under anticoagulant treatment with warfarin and aspirin. Postoperative angiography was performed 17 months after the surgery to evaluate morphological changes in the coronary artery. The angiography confirmed the closure of the fistula and the regression of coronary artery dilatation.

An 80-year-old man successfully underwent reoperative coronary artery bypass grafting( CABG) via left thoracotomy without cardiopulmonary bypass. The proximal end of the saphenous vein graft( SVG)was connected to the thoracic aorta using an automated proximal anastomosis system. Then the SVG routed beneath the pulmonary hilum was anastomosed to the high lateral branch and the anterior descending artery in a sequential mode. He recovered uneventfully and is free of chest pain after redo CABG. In selected patients, redo CABG for the left coronary artery can be safely performed through left thoracotomy.

The Great East Japan Earthquake was the first disaster we experienced after the administration of oncology care had mostly shifted from hospitals to outpatient departments in Japan. Disaster medical assistance teams(DMATs)were deployed immediately after the disaster, and actively assisted during the acute phase of the catastrophe. After experiencing the earthquake, we realized the necessity of medical support teams, even for chronic disease. Here we report a multicenter trial of regional medical cooperation for cancer chemotherapy. First, soon after the earthquake, representatives from the regional hospitals discussed the proper roles for each institution. As agreed to in the discussion, cancer patients were redistributed from a disaster base hospital to a local general hospital, and oncologists supported the other regional hospitals on a regular basis. This broad regional network functioned well and patients resumed their treatment as soon as the situation allowed. Second, we performed a survey of the patients and found that the most important problem was patients' lack of understanding of their own illnesses. Third, we conducted an opinion survey of medical professionals on regional medical cooperation. Based on the trial, we found it important in disasters to establish regional cooperation and solid communication systems, and to promote patient education.

Objective: The goal of this study was to elucidate how the subspecialty and training history of primary care physicians(PCPs) influence CKD management and medical cooperation in Japan., Methods: We conducted a nationwide questionnaire survey on CKD management for PCPs from December 2012 to March 2013. The questionnaire included 32 items about CKD management and medical cooperation. PCPs' subspecialties were categorized as follows: general internal medicine, nephrology, cardiology, diabetology/endocrinology, gastroenterology, pulmonology, neurology, neurosurgery, hematology, collagen disease/rheumatology, allergology. The PCPs' training history of nephrology was classified into three categories: none, experienced, active-nephrologist. Response distributions for each question were compared between the PCPs' subspecialties and the three categories of training history., Results: 2,287 out of 28,200 PCPs (8.1%) of all 47 prefectures responded. The majority (86.5%) of responders were PCPs at clinics, and 90.9% were non-nephrologists. The PCPs' subspecialty influenced the response distributions in the following questions: utilization of the CKD guidebook, urinalysis at the first and follow-up examinations, frequency of blood testing, counselling with eGFR, self-monitoring of blood pressure, prescription and cessation of renin-angiotensin system (RAS) inhibitors, anemia treatment with erythropoiesis stimulating agents (ESA). The PCPs' training history of nephrology had a strong impact on various aspects of CKD management. The PCPs' subspecialties also influenced the responses regarding medical cooperation of CKD: relationship with nephrologists, utilization of critical path, criterion of patient referral, requests for nephrologists, discontent with the nephrologists' response., Conclusion: We elucidated that the PCPs' subspecialty and training history of nephrology substantially influenced CKD management and medical cooperation in Japan. Effective promotion activities to improve CKD management and medical cooperation should be proposed on the basis of these data.

Objective: The goal of this study was to figure out the current status of and regional differences in CKD management and medical cooperation in Japan., Methods: We conducted a nationwide questionnaire survey on CKD management for primary care physicians (PCPs) from December 2012 to March 2013. The questionnaire included 36 items about CKD management and medical cooperation. In order to compare the current status of CKD care and cooperation, we divided the country into 11 areas; Hokkaido, Tohoku, Kanto, Koshin-etsu, Hokuriku, Chubu-Tokai, Kinki, Chugoku, Shikoku, Kyushu and Okinawa., Results: 28,200 sets of questionnaires were delivered to PCPs throughout Japan, and 2,287 (8.1%) doctors responded. Doctors at clinics accounted for 86.5%, and 90.9% were non-nephrologists. Regional differences were evident in the following items regarding CKD management; urinalysis at the first examination, measurement of urinary protein/albumin excretion, frequency of blood testing, counselling with eGFR, prescription of erythropoiesis stimulating agents (ESA). Urinalysis at the first examination was relatively rare in Koshin-etsu and Kanto (p < 0.01), and counseling with eGFR was relatively rare in Tohoku, Shikoku and Koshin-etsu (p = 0.05). Regional differences regarding medical cooperation were evident in the following items; functional level of cooperation, critical path, presence of consulting nephrologist, personal relationship, satisfaction with the nephrologists' reaction to referral, CKD involvement in Specific Medical Checkup/Specific Medical Guidance. Functional level of cooperation was higher in Chugoku, Okinawa, Chubu-Tokai and Hokuriku, and lower in Shikoku, Koshin-etsu and Kinki (p < 0.05). Serum creatinine measurement in the Specific Medical Checkup was involved more frequently in Okinawa, Shikoku, Kanto, Chubu-Tokai, Kyushu and Hokuriku, and less frequently in Tohoku, Chugoku and Kinki (p < 0.01)., Conclusion: We elucidated the current status of CKD management by PCPs and medical cooperation in Japan. Effective actions to improve CKD care must be proposed on the basis of these data, especially the existing regional differences.

We estimated the influence of sleep habit and nocturnal lifestyle on circadian rhythm of blood pressure by use of ambulatory blood pressure monitoring (ABPM) and self-estimating questionnaire formats. A total of 30 workers aged 21 to 58 years old voluntarily participated. None had any chronic diseases or regular medication. The average subject daily worked for 8 hours, waked-up at 6:00, went-to-bed at 23:45, and had 6.25-hour sleep (median). The subjects were divided into 3 groups according to % dipping of sleep blood pressure; 10 to 20% dipping as a dipper, <10% as a non-dipper, and > or = 20% as an extreme-dipper. This characterization resulted in 15 dippers (50%), 8 non-dippers(27%) and 7 extreme-dippers (23%). Of the parameters estimated, (1) sleeping hours of non-dippers were significantly shorter than those of dippers (p=0.02), (2) nighttime blood pressure of extreme-dippers were significantly lower than dippers (p=0.04), (3) the lowest blood pressure in nighttime of non-dippers were significantly higher when compared with the remaining 2 groups, (4) morning surges of blood pressure of non-dippers were the significantly smallest, whereas those of extreme-dippers were the greatest, and (5)refreshing scores of OSA sleep inventory MA version of non-dippers were significantly poorer when compared to extreme-dippers. This study could indicate the significant influence of nocturnal lifestyle with short sleep on circadian rhythm of blood pressure, and the extended prospective-study might be promising for a precise conclusion.

The six-year pharmacy program started in April 2006 in Japan. In the new program, students in the fifth year of the pharmacy course undergo a long-term practice experience (pharmacy clerkship) in community pharmacy and hospital pharmacy settings as compulsory 20 course credits. The new pharmacy practice experience started in May 2010. A start of the new system was a chance as for beginning movement, thus we conducted the questionnaire survey for the following steps. The finding obtained from our questionnaires indicated that many universities had already planned to execute new approaches, such as an advanced practice at outpatient units, an with medical students, and so on.

The most effective drugs based on the type of cancer are chosen for chemotherapy. Tumor cells can be targeted at the DNA, RNA or protein level, and most of the classical anticancer drugs interact with tumor DNA in a time-dependent manner or a concentration-dependent manner. However, it has been unclear to date whether a combination therapy is carried out by using exact classification. Thus it is necessary to reclassify a great number of anticancer drugs. We propose a new classification system based on pharmacological effects of anticancer drugs. Classification of four anticancer drugs (cisplatin, carboplatin, paclitaxel and gemcitabine) was performed by the 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. The four anticancer drugs were grouped by IC50 values (inhibitory concentration, 50%) in a time-dependent manner and a concentration-dependent manner. The present approach may be combined to enhance the chemosensitivity, improve the dose of cytotoxic drugs and evaluate the effects of novel anticancer drugs.

Although the 2009 edition of the Guidelines for Colorectal Cancer Therapy recommend capecitabine as a standard postoperative adjuvant chemotherapy for colorectal cancer therapy, a characteristic adverse event, hand-foot syndrome, develops at a high incidence, and appropriate management is necessary to continue therapy. We investigated countermeasures against adverse events, particularly hand-foot syndrome, in patients treated with capecitabine. The subjects were 47 patients aged 64 years (27-84 years) who underwent surgery for colorectal cancer. They received 8 (2-16) courses of drug administration. No grade 3 blood or non-blood toxicity was noted, and the therapy was relatively safe excluding an enhanced anticoagulant effect. Grade-3 hand-foot syndrome developed in 3 patients, but there were only 10 grade-2/3 cases (21.7%) because humectants and oral vitamin B6 preparation (supportive therapy) were administered from therapy initiation. The incidence increased to 32.6% (15 patients) after June. Symptoms aggravated due to mechanical stimulation of the hands and legs in 5 patients because they were farmers growing cherries, suggesting that investigation of patient living background is also important. The incidence of grade-2/3 hand-foot syndrome was 21.1 and 75% in 39 and 8 patients, respectively, who were treated with supportive therapy from the initiation of drug administration and after several courses of drug administration or development of symptoms. This suggested the usefulness of early supportive therapy. The importance of preventive measures against hand-foot syndrome will increase as capecitabine is increasingly administered. Information exchange between medical staffs and providing patients with appropriate information may lead to management of adverse events and subsequently to continuation and obtaining effects of therapy.

In performing FOLFOX chemotherapy (infusional 5-FU/LV with oxaliplatin) for advanced colorectal cancer, the neurotoxicity of oxaliplatin (L-OHP) is the dose-limiting factor. A retrospective study of 25 consecutive patients, receiving modified FOLFOX6 (mFOLFOX6) for advanced colorectal cancer, was conducted. From March 2006 to February 2008, we investigated the process of development of sensory neuropathy by adverse effect grading and our original interview-based intake about the afflicted regions. Neurotoxicity developed in 21 cases (84%) after 6 courses and the cumulative L-OHP dose was 410 mg/m(2) in median. In 11 cases (52%), it developed from the fingers, while in 8 cases (38%), it occurred from the fingers and toes simultaneously. It developed from the toes or tongue only in one case each. In 6 cases (55%), in which it occurred from the fingers, the symptom aggravated to grade 2 (G2) according to the Neurotoxicity Criteria of DEBIOPHARM (DEBNTC). On the other hand, in cases of coexpression of the fingers and toes, 7 cases (88%) developed G2 neuropathy, among one of whom suffered from grade 3 (G3). The coexistence of diabetes mellitus without neuropathy had no influence on the development of the neurotoxicity in the grading of DEB-NTC. One month after the last mFOLFOX6 therapy, neurotoxicity newly developed in one case, and was aggravated in two cases two months after cessation of the chemotherapy. Therefore, careful observation of the course should be continued even after the end of mFOLFOX6 therapy. Our results suggest that L-OHP neurotoxicity develops on fingers or fingers and toes simultaneously in most cases. And when it occurred on fingers and toes simultaneously, it would aggravate to G2 or G3 during the chemotherapy. The interviewed-based intake about the afflicted region, such as ours, can be used to predict the deterioration of the neurotoxicity.

Many clinical studies demonstrate that complete revascularization with total arterial grafts leads to the best late surgical results. Though off-pump coronary artery bypass grafting (CABG) is superior to on-pump CABG (ONCABG) in morbidity and mortality, some coronary surgeons feel it difficult to revascularise multi-vessel disease completely without cardiopulmonary bypass (CPB). Acute conversion from off-pump to on-pump results in increased major complications and high mortality. For the patients with high risk for CPB, coronary revascularization should be performed without CPB even if completeness is failed. It seems to be reasonable to adopt ONCABG for low risk patients who need many anastomoses in the posterior wall of the heart.

This study used the Relationship Attribution Measure (RAM), developed by Fincham & Bradbury (1992), with Japanese middle-aged couples, investigating the factor structure of the RAM, indices of reliability and concurrent validity with marital satisfaction. The confirmative factor analyses supported the two-factor structure for the Japanese version of the RAM, with similar trends as reported in Fincham & Bradbury (1992). The hypothesis model that the feeling love toward the partner affected withdrawal coping via marital attribution was tested using structural equation modeling. The results supported both the mediational role of marital attribution and the direct effect of marital love on withdrawal.Using pair data, the results suggested that wives'feeling love toward their husbands affected the husbands via negative attribution, but the husbands'feelings directly affected the wives' feelings.Thus the mediational model was supported only for wives, but not for husbands. Further research is needed to explore the relationship attribution in Japanese couples.

This study developed revised Japanese versions of the self-perception profile for Children, for Adolescents and for College Students. The original versions have an idiosyncratic and time-consuming item format, which was revised by using only one statement for each item. Subjects were fifth to sixth grade students (Boys=129, Girls= 152), tenth to twelfth grade students (Boys=112, Girls=100), and college students (Boys=96, Girls=153) in Japan. The reliability and validity measures showed that the revised versions were similar to the original versions. The present study provides some evidence for the use of these scales with Japanese students.

Background: Aspirin has been known to be an enhancer to wheat allergy, including wheat-dependent, exercise-induced anaphylaxis., Objective: To investigate whether nonsteroidal, anti-inflammatory drugs (NSAIDs) other than aspirin would enhance allergic reactions after wheat ingestion and whether antihistamines and disodium cromoglycate would prevent these reactions., Methods: Seven cases, whose reactions after wheat ingestion were enhanced by aspirin on challenge tests, were enrolled. Skin prick tests (SPT) and CAP-RAST were undergone for wheat and gluten. We used challenge tests of wheat after pretreatment of NSAIDs and preventive drugs., Results: Four cases were diagnosed with wheat allergy, 3 cases had wheat-dependent, salicylic acid-induced anaphylaxis. SPT and CAP-RAST were positive for wheat and gluten in 5 of 7 cases and 4 of 7 cases, respectively. Dicrofenac enhanced the allergic reactions after wheat ingestion in 1 of 2 cases, whereas etodolac failed to enhance the symptoms in all 5 cases performed. Furthermore, disodium cromoglycate could not completely prevent the allergic reaction in all 4 cases and even enhanced the reaction in 1 case of them. To see an inhibitory effect of antihistamines on the symptoms, fexofenadine (in 2, 1 and 1 case, respectively), olopatadine, and chlorpheniramine were administrated before the challenge test, and as a result these drugs were found to have inhibitory effects on the allergic reaction., Conclusion: In this study, it was suggested that etodolac might be a relatively safe anti-inflammatory drug on wheat allergy and antihistamines could prevent allergic reactions more than DSCG in patients with wheat allergy.

Objective: To determine the influence of carotid artery plaque (CAP) morphology on perioperative stroke in coronary artery bypass grafting (CABG)., Patients and Methods: Ninety-three patient undergoing CABG were studied. CAPs and other lesions including intima-media thickness (IMT) and stenosis were examined by using ultrasound imaging. CAPs were morphologically classified as either homogeneous (HmP) or heterogeneous (HtP)., Results: Mean and max IMT were 1.26 +/- 0.15 and 2.44 +/- 0.76 mm. Mean total plaque score was 15.75 +/- 6.82. HmP and HtP were seen in 80 (86.0%) and 54 (58.1%) patients. Stenosis greater than 50% was found in 22 (23.7%) patients. HtP was significantly associated with age (p<0.05), diabetes and severity of coronary artery disease (p<0.01) and stenosis was associated with diabetes and history of cerebrovascular events (p <0.05). Late postoperative stroke occurred in 3 (3.2%) patients during hospitalization. One of them had 90% stenosis in the carotid artery. The others had no carotid stenosis. In all of the 3, the predominant plaques were heterogeneous., Conclusion: CAP morphology in patients undergoing CABG was detailed. As well as stenotic lesion, plaque heterogeneity may be a risk factor for perioperative stroke. Diabetes is associated with severity of both plaque heterogeneity and stenosis.

We retrospectively studied the surgical treatment for pulmonary metastases from colon and rectal cancer. A total of 24 patients (9 males and 15 females; mean age 61 years) underwent 29 thoracotomies for metastatic colon carcinoma, while 22 patients (16 males and 6 females; mean age 63 years) underwent 29 thoracotomies for metastatic rectal cancer. The median interval between the primary procedure and lung resection for metastases was 26 months in the patients with colon carcinoma and 32 months in the patients with rectal cancer. In the patients with colon carcinoma, 16 underwent wedge resection or segmentectomy (including 4 video-assisted procedures) and 13 (54%) underwent lobectomy or pneumonectomy. In the patients with rectal cancer, 15 underwent wedge or segmentectomy (including 1 video-assisted procedure), 13 (59%) underwent lobectomy or pneumonectomy, and 1 underwent exploratory thoracotomy. All procedures except exploratory thoracotomy were curative operations. There was no mortality. Overall 5-year survival was 56% (n=46). Five-year survival was 65% for patients with colon metastases (n=24) and 45% for patients with rectal metastases (n=22), and there was no significant difference. Recurrent sites were 4 lungs (36%), 4 livers (36%), 1 bone, 1 uterus, and 1 peritoneum in patients with colon carcimoma, and 10 lungs (43%), 5 brains (22%), 3 livers (13%), 1 bone, and 1 vagina in patients with rectal cancer. Pulmonary resection for metastases from colon carcinoma may have better prognosis than that from rectal cancer. However, further investigation may be required to obtain convincing conclusions.

Subject: Along with the promotion of "home medical care", an increasing number of clinics provide home medical care as part of their services or are dedicated to home medical care partly as a result of the reform of the healthcare system. This is considered to be the manifestation of the desire of patients to live their own lives and the intention of the healthcare professionals to satisfy patient needs. We examine what insurance pharmacies should and must do to provide higher-quality services to satisfy such patient needs, this time focusing on the community coordination for the purpose of providing the services which can give sense of security to patients., Method: Cases of HPN during the period from July 2002 to June 2003 were subdivided into those in which we were involved before and after the discharge from the hospital and those in which we were involved only after the discharge from the hospital to home medical care and comparatively studied from various perspectives. Existing coordination systems are introduced and discussed to achieve the desirable coordination systems., Present and Future: In the home guidance service, some patients consult with us on the issues on which they hesitate to consult with doctors or nurses. This suggests that we can contribute to the mental care for patients and their care givers. In order to make the best use of our position, the coordination with hospitals is essential for insurance pharmacies. The degree of contribution to the improvement of QOL or the mitigation of anxiety over inexperienced issues is considered to differ depending on the preparatory period between the cases in which we were involved before and after the discharge from the hospital and those in which we were involved only after the discharge from the hospital to home medical care. The analysis of the differences in the actual cases is considered to be significant to seek for the ideal coordination.

Objective: We hypothesized that the cause of one-lobe intrapulmonary metastasis of primary lung cancer is mainly lymphatic, and investigated by means of the long-term outcome., Methods: From 1988 to 2000, 860 patients underwent complete resection of primary lung cancer patients in our hospital without neoadjuvant therapy. Patients were classified into 4 groups: group A (n 0 pm 0, n = 573), group B (n 0 pm 1, n = 37), group C (n 1 pm 0-1, n = 122), and group D (n 2 pm 0-1, n = 128)., Results: No significant difference was seen between groups in median age, sex ratio, histological cell type, or pathological tumor-size and p-factor. The rates of bi-lobectomy and pneumonectomy were higher in groups C and D than in groups A and B. The 5-year survival rate was 73% for group A, 57% for group B, 43% for group C, and 28% for group D. The 10-year survival rate was 57% for group A, 45% for group B, 20% for group C, and 16% for group D. There was a significant difference (p < 0.0001) between 4 groups in the 5- and 10-year survival rate., Conclusion: The hypothesis that the cause of one-lobe intrapulmonary metastasis may be lymphatic was not incompatible with the long-term results.

A 72-year-old woman developed left pneumothorax 14 months after the first operation of a gingival carcinoma. The chest X-ray films and computed tomographic scans on admission revealed left pneumothorax and 2 lesions with a thin-walled cavity in the upper lung field. They seemed to be pulmonary metastasis from a carcinoma of gingiva and one of them ruptured into the pleural cavity. As airleak continued after tube thoracostomy, wedge resections of 2 lesions were performed through thoracotomy. Postoperative histological examination revealed that both of the lesions were moderately differentiated squamous cell carcinoma and they were the same histological findings as the gingival carcinoma excised previously. Pulmonary metastasis from a carcinoma of gingiva is rare, while it may be thought 1% of metastatic lung tumors. And also pulmonary metastasis is unusual cause of pneumothorax, especially without chemotherapy for it. We reported the very rare case of pneumothorax due to pulmonary metastasis from a carcinoma of gingiva.

From 1986 to 2000, 42 patients (3.7%) underwent resection for intrathoracic recurrence or second primary lung cancer. Survival in 27 patients with recurrent diseases was 60% at 5 years and 35% at 10 years compared with 65% at 5 and 10 years for 15 patients with metachronous lung cancers morphologically. Ten patients had the second operation less than 2 years since the first operation, 19 patients between 2 and 5 years, and 13 patients more than 5 years, while these 5-year survivals were 72%, 53%, 67% respectively. At the first operation lobectomy was performed in 39 patients (93%), wedge resection or segmentectomy in 3. The reoperation was 14 lobectomy or completion pneumonectomy, 24 wedge or segmentectomy (57%), and 4 other procedures, while these 5-year survivals were 35%, 73%, and 100% respectively. The 5-year survival was 78% for 27 patients with stage I disease and 26% for 10 patients with stage III disease at the first operation, compared with 55% for 30 patients with stage I and 53% for 9 patients with stage III at the reoperation. These data suggest that limited resection is recommended for intrathoracic recurrent diseases and metachronous multiple lung cancers whenever possible.

Between 1988 and 2000, 1,040 patients with primary lung cancer underwent pulmonary resection at Nagaoka Red Cross Hospital. Thirty-one (2.9%) patients had synchronous primary lung cancer (group A) and 78 patients (7.5%) had intrapulmonary metastases (group B). The 5-year and 10-year survival rate for group A was 64% and 56% respectively and for group B 37% and 32% respectively. The patients in group A showed a better survival rate in the different lobes (80% at 5 years) than in the same lobe (55%), while those in group B gave reverse results (31% and 42%). In group A, the patients had a better survival rate in the different histology (73% at 5 years) than in the same histology (45%). The 5-year survival was 65% for 20 patients with stage I disease, 75% for 4 patients with stage II disease, 43% for 75 patients with stage III and 25% for 10 patients with stage IV. These data suggest that synchronous primary lung cancer had a better prognosis than primary lung cancer with satellite nodules, but the histological discrimination between multiple lung cancers and intrapulmonary metastases was uncertain.

Thirteen patients with tetralogy of Fallot underwent reconstruction for hypoplastic right ventricular outflow tract using a preserved homograft or xenograft patch with single or double cusps. Homografts and xenografts preserved in 70% ethanol were implanted in 10 patients, and xenografts treated with glutaraldehyde were used in 3 patients. All the patients are doing well in their profession without one who died 18 years after operation. Valve-retaining homograft and xenograft patches provided excellent early hemodynamic function, but did not prevent pulmonary insufficiency late after the operation. Both homograft and xenograft cusps tended to degenerate several years after implantation, but cusp failure was not accompanied by outflow stenosis.

Twelve patients with stage IIIb non-small cell lung cancer underwent induction therapy and resection from January 1990 to July 1998. They were divided into two groups; group A (n = 5) received two (to four) preresectional cisplatin and videsine chemotherapy, group B (n = 7) received chemoradiotherapy (radiation with concurrent low-dose-daily cisplatin). All patients in both groups had clinically down-stage and had no major side effects preventing surgery. 3 patients underwent radical pneumonectomy and 9 patients had radical lobectomy with no operative mortality. In 9 patients the disease was pathologically downstaged. Overall five-year survival was 27%, while in group A it was 50%. In group B 2-year survival was 18% and the longest survivor had pulmonary recurrence four years after surgery. Our data show better prognosis in group A than in group B. This results suggest that chemotherapy may be superior pre-resectional therapy to chemoradiotherapy.

The effect of chemotherapy as the adjuvant therapy to bulky N2 disease (stage IIIA) non-small-cell lung cancer was examined. From January 1992 to December 1996, 464 patients with non-small-cell lung cancer underwent surgery. Seven patients (1.5%) with N2 disease (stage IIIA) received two cycles of preresectional cisplatin and vindesin chemotherapy, followed by standardized surgical resection (Group A). 46 patients (9.9%) had pathological N2 disease (T1-3, M0) after surgery (Group B). In Group A a complete resection was accomplished in two patients (28.6%), and five patients had incomplete resection with a deseased margin, followed thoracic irradiation 60 to 75 Gy. In three patients in Group A the N2 disease was pathologically downstaged to N1 or N0 disease. Overall survival at five years in Group A and in Group B was 48% and 39%, and median survival time was 49 months and 38 months. Although complete resection rate was lower in Group A (28.6%) than in Group B (78.2%), there was no significant difference between five year survival and median survival time in Group A and Group B. These data may be thought to suggest that induction chemotherapy in Group A was effective on occult micrometastatic disease.

To provide a genetic survey of hereditary ataxia, we performed PCR screening of SCA1, SCA2, MJD1 (SCA 3), SCA6, DRPLA, with 71 patients in 61 families living in Akita prefecture (1,205,571 population in 1997) in Japan. Of 71 patients in 61 families, 18 MJD1, 14 SCA6, 5 DRPLA, 1 SCA1 and 1 SCA2 patients were detected. Eighty percent of autosomal dominant inherited spinocerebellar degeneration (AD-SCD) including 7 spoladic patients genetically diagnosed as AD-SCD was MJD1 (45.7%) and SCA6 (34.3%). These suggest the prevalence rate of hereditary ataxias in Akita prefecture; 1.5 and 1.2/100,000 of MJD1 and SCA6, respectively. Only one patient of SCA1 was detected, which was frequently reported in Hokkaido and Tohoku area in Japan.