The effects of Argatroban, a selective thrombin inhibitor, in anticoagulation therapy following cardiovascular surgery is reported. The agent was administered in 28 patients by means of continuous intravenous infusion, adjusted to maintain the activated coagulation time at from 170 to 200 seconds. The activated coagulation time was well controlled at a mean rate of 0.482± 0.26μg/kg/min by intravenous drip infusion, and the dose of Argatroban reached a steady state within a few hours. Both the percent rate of prothrombin time and the activated partial thromboplastin time were significantly decreased to 49% and to 36% respectively by Argatroban, and recoverd to the normal range the day after cessation of the drug. Thrombin-antithrombin III complex, an index of coagulation activity, decreased from 35μg/l in the postoperative state to 14 μg/l 4 hours after the infusion of the drug, which demonstrated the good control of anticoagulation status. Clinically, no adverse reactions such as abnormal bleeding tendency was observed. We conclude that Argatroban is a safe and effective agent for anticoagulation therapy in the early postoperative phase.

Spa bathing at night has been thought to improve sleeping conditions and symptoms of dementia such as restlessness, wandering, and aggression in patients in our nursing home with special needs for the aged. The present study investigated patient activity using a lifestyle measurement device (Kenz Lifecorder) to examine the effects of night bathing on senile dementia by more objective methods. Nine patients with senile dementia of the Alzheimer type staying in health facility for the elderly were studied. These patients' symptoms of dementia were already incurable but daily living activities somewhat remained. The patients were divided into a night bathing group (n=5) and daytime bathing group (n=4) to study patient activity using a Kenz Lifecorder for 14 weeks, that is one week before the start of bathing, 12 weeks with bathing, and 1 week after bathing. The night bathing group had a higher rate of activity than the daytime bathing group. When comparing the daytime of night bathing patients with the daytime bathing individually, the former displayed increased activity in the daytime. As a group, the night bathing group was found to show a significant increase in the amount of daytime activity. However, the statistical significance was reached after Weeks 9-10, so 2-3 months were required to change lifestyle rhythms. The authors hope that night bathing or night bathing assistance will be received favorably by the long-term care and health care insurance systems.

A 59-year-old man presented with severe abdominal pain. CT scan showed a type A aortic dissection and pericardial effusion. As cardiac tamponade was present, emergency total arch replacement was performed. Because of his symptom, we added an exploratory laparotomy, which revealed intestinal necrosis. Therefore, necrotic intestine 4.5m in length was resected. After intensive care, he began oral feeding on the 25th day and was discharged on the 76th day postoperatively.

Objective: The purpose of this study is to identify the problems in the adverse drug report (ADR) system in early post-marketing vigilance phase (EPM phase) in Japan.
Methods: The incidence of all ADRs and the ratio of serious ADRs were compared between the new drug application phase (ND phase) and the EPM phase.  The target medicines were Moxifloxacin (Avelox®tablets, 400mg), Gatifloxacin (Gatiflo®tablets, 100mg) and Prulifloxacin (Sword®tablets, 100mg).
Results: The average incidence of all ADRs in the ND phase was 100-fold greater than that in the EPM phase.  There were also 2-fold differences in the ratio of serious ADRs of individual medicines.
Conclusion: There are several problems with the ADR system in the EPM phase in Japan.  It is currently possible that the implementation of EPM will vary between in individual medicines and companies.  This suggests that the present data cannot be applied universally.  Thus, there is an urgent need to standardize the implementation of EPM.

Since distal femoral varus osteotomy (DFO)
Asian Continental Ancestry Group ; Humans ; Japan ; Knee ; Osteoarthritis ; Osteotomy ; Tibia ; Weight-Bearing

A 57-year-old man underwent subtotal graft replacement of the thoracic aorta for aneurysms of both the ascending and descending aorta. On the 20th post-operative day, pus was found to be draining from the sternotomy wound. The wound was opened and irrigated with 2% Povidoneiodine solution for a total of 3 months. Culture of the pus from the irrigation revealed Staphylococcus epidermidis. When there were no clinical indications of infection and wound cultures were negative, the necrotic sternum and surrounding tissue were debrided and an omental graft was placed in the cavity. Upon follow-up examination, the patient is doing well 10 months after the initial surgery.

We performed a video-assisted thoracoscopic surgery (VATS) to clip the patent ductus arteriosus (PDA), which was 5mm in internal diameter, in an 11-year-old girl, who first underwent a coil embolization ending in failure. Under general anesthesia with one-lung ventilation in a right lateral decubitus position, four thoracostomies were made in the left hemithorax. The PDA was clipped by two titanium clips, the length of which is 11mm at closing. Transesophageal echocardiography confirmed the location of the PDA and the absence of a residual shunt. The patient showed neither left recurrent laryngeal nerve dysfunction nor hemorrhage after operation, and was discharged on the 9th postoperative day. The clipping of the PDA by VATS can be applied for PDA without calcification if the external diameter is up to 7mm. This technique was minimally invasive and reliable. It was excellent in terms of the high quality of life achieved by the patient.

Objective: Several drugs can cause analytical interference in clinical laboratory tests.  To prevent errors in clinical judgment as a result of false data, we investigated the information available on the interference of ethical drugs in these tests.
Methods: We examined the information available by collecting and evaluating information in package insert leaflets, collecting and evaluating clinical data on three drugs (bucillamin, captopril, and epalrestat) which affect clinical laboratory test results, and conducting a questionnaire survey of healthcare workers.
Results: From the information available on package inserts, 227 drugs were identified as having the potential to interfere with the chemical reactions used in clinical laboratory tests.  However, the insert information is not sufficient for use in clinical settings because the frequency rate and causative factors of interference are not stated clearly.  The clinical survey results reveal that 40% of patients taking bucillamine and 20% of patients taking epalrestat tested false-positive for urinary ketones.  According to the questionnaire results, medical technologists were more interested than pharmacists and physicians in how drugs affect clinical laboratory tests.
Conclusion: The information currently available on the interference of drugs in clinical laboratory tests is problematical, and it is therefore necessary to collect more clinical data for the proper interpretation and evaluation of abnormal laboratory values.