Objective: In our country, the measure for the spread of the generic has been introduced over several-time as part of the moderation in health care cost plan.  However, not having related to an enough spread unlike Europe and America yet is a current state.  Then, we investigated from the view point of patients.  A detailed examination was performed for the acknowledgment level and attitude toward the generic drug.
Design and Method: The questionnaire survey was performed for the patient who used the community pharmacy for dispensing prescription.  The investigation was performed for two weeks (June and July, 2008) at the 50 drugstores in Hokkaido.  The patient attribute, source of information, and kind of the taking medicine were examined as a factor to affect decision making for generic drug substitution.
Result: The main results are as follows.  The patients who did not know generic drugs accounted 52% of the total and the patients who did not know the words called generic drugs was 16%.  This result shows that the degree of the recognition about generic drugs at that time was still low.  The information source for the patients who learned generic drugs were articles of the newspaper, a TV program, and advertising with accounted 52% of the total.  Also, the patients who prefer generic drugs in the future were 64%.  In the relationships between presence of wish for generic drugs and the source of information, the case of from the doctor, was significant (p<0.05) and the case from the pharmacist showed the tendencies of statistical significance (p=0.076).
Conclusion: From the viewpoint of medicine costs restraint in our country, it seems that the pharmacist contributes for the patient’s generic drugs selection expected positively.

We report a case of chronic mesenteric ischemia associated with severe aortic valve regurgitation and stenosis (ASR). The patient was a 76-year-old man who had been given a diagnosis of ASR in his 40s. He gradually developed heart failure and chronic kidney disorder due to deterioration of ASR. He had started hemodialysis 1 year before admission and had complained of abdominal pain after meals and weight loss during that period. He was admitted to the Department of Cardiology in our hospital for evaluation of ASR. Severe ASR with low output syndrome (C. I. 2.00 L/min/m²) were confirmed by cardiac catheter examination. In addition, abdominal angiography revealed total occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery (CA). We considered that low cardiac output due to severe ASR had exacerbated the mesenteric ischemia. We performed AVR and abdominal aorta-SMA bypass at the same time to prevent acute mesenteric ischemia in the perioperative period. The combination of valvular disease and CMI is very rare. This is the first report in Japan of simultaneous valve replacement and mesenteric artery revascularization.