1.Prescription Questionnaires on HMG-CoA Reductase Inhibitors for General Practitioners
Kaori Kadoyama ; Akiko Kuwahara ; Yoshio Fujioka ; Nobutaka Inoue ; Mitsukazu Yamane ; Toshiyuki Sakaeda ; Yuichi Ishikawa
Japanese Journal of Drug Informatics 2010;11(4):223-231
Objective: To clarify the reason why the target levels of low-density lipoprotein (LDL)-cholesterol are hardly attained.
Methods: The questionnaire was performed for 237 general practitioners on prescription of HMG-CoA reductase inhibitors (statins), just after the publication of “Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2007”.
Results: The responses could be summarized as 1) almost all doctors recognized the significance of target levels of LDL-cholesterol; 2) however, general physicians have such a recognition to a lesser extent, compared with cardiologists; 3) when prescribing statins, 66.2% of them had concerns about drug-drug interactions; 4) as the adverse events with statins, they listed creatine kinase (CK) elevations (86.5%), hepatic dysfunction (74.3%) and myalgias/rhabdomyolysis (70.9%); 5) in contrast, less than 20% of them listed the fulminant hepatic failure, gastrointestinal symptoms and fluctuation of blood glucose levels; 6) the threshold value of CK to discontinue statins was 500 IU/L in 44.4% and 200-300 IU/L in 39.6%; and 7) 78.5% of them believed that statins have the pleiotropic ability such a anti-inflammatory effect clinically, in addition to lipid-lowering.
Conclusions: It is important to serve the drug information about the safety of statins to the general practitioners for the management of hyperlipidemia, based on original articles.
2.Successful elimination of intractable lower limb neuropathic pain by pelvic tumor invasion using ultrasound-guided sciatic nerve block
Norio Hashimoto ; Kaoru Nishijima ; Miwako Kobayashi ; Chieko Kuwahara ; Takako Morimoto ; Noriko Sakaguchi ; Akiko Nakanishi ; Yuko Tanaka ; Fumiko Koyama ; Shinichiro Zushi ; Kunitaka Shibata
Palliative Care Research 2010;6(1):313-315
We report a case whose left lower limb neuropathic pain accompanied by pelvic tumor invasion was remarkably eliminated by ultrasound-guided sciatic nerve block. Case report: The subject was a sixty year old male. Pharmacological therapy was given according to the WHO analgesic ladder, but his left lower limb pain failed to respond to drugs. His intractable lower limb neuropathic pain was alleviated by ultrasound-guided sciatic nerve block. Drug delivery can be achieved with a percutaneous catheter and a disposable infusion pump. Infusions were run at 5mlh-1 with 0.1% ropivacaine. Conclusion: Neuropahic pain is sometimes hard to be controlled only by opioids or adjuvant analgesics, but there is a possibility of providing pain relief by combination use with nerve blocks. Interventional techniques can be highly effective but also have the potentiality to produce significant adverse effects. Many patients have factors which would be considered a near absolute contra-indication to the use of nerve blocks such as immuno-compromise or impairment of coagulation. Skillful application of peripheral neural blockade with ultrasound imaging broadens the options for providing optimal pain management. Palliat Care Res 2011; 6(1): 313-315