Application of a Japanese insurance claims database to pharmacovigilance activities in pharmaceutical industry was discussed. Using a commercially available insurance claims database, incidences of several cancers, the number of patients who were administered anticancer agents, and possible adverse effects were studied. Cancer incidences obtained from the database were virtually equivalent to those from a traditional survey program. The number of cancer patients included in the database with one million beneficiaries, were a few thousands a year. Disorders in epithelial-derived tissue were observed more frequently in lung cancer patients after the initiation of EGF tyrosine kinase inhibitor therapy than after platinum-based therapy, suggesting possible candidates of adverse effects of the EGF tyrosine kinase. We concluded that an estimation of disease incidence and selecting candidates of adverse events with the claims database is theoretically possible. And the database is also applicable to pharmacovigilance fields. (Jpn J Pharmacoepidemiol 2012; 17(2): 145-153)

Endovascular treatment with a hand-made stent graft was performed successfully for a ruptured infected descending thoracic aortic aneurysm in the patient under chronic hemodialysis. The patient was a 77-year-old man and hemodialysis was continued with a double lumen catheter because of internal shunt occlusion since November 2005. He developed MRSA sepsis around January 2006 and was treated with antibiotics. Left pleural effusion was drained on March 1st, 2006. Initially left effusion from the left side was fluently bloody, however it became bloody the next day. Enhanced CT revealed the descending thoracic aortic aneurysm and left hemo-thorax. He was referred to our service, and was transportedly via ambulance. Home made stent graft was deployed under local anesthesia 2h after the arrival. His hemodynamic status became stable and left pleural hematoma was removed by video assisted thoracic surgery 2 days after endovascular treatment. His postoperative course was uneventful and antibiotics were continued 4 weeks. He is doing well without any recurrence of infection 23 month after the surgery. Careful follow up is mandatory, and endovascular treatment would be useful for the ruptured infected aortic aneurysm.

A 75-year-old woman required aortic valve replacement for aortic stenosis. She had undergone radical mastectomy and irradiation for left breast cancer 25 years previously, and had chest wall infection secondary to osteoradionecrosis. In spite of preoperative infection controls including surgical debridement, the chest wall was not healed well and colonized with MRSA. However, she was too ill with severe heart failure to wait until the chest wound was negative for MRSA for a valve operation. With the infection remaining, the aortic valve was approached through a right parasternal incision, to exclude the infected sternum from the surgical site, and successfully replaced with a mechanical valve. An internal mammary retractor was useful to avoid fractures of the infected sternum and provided excellent exposure of the aortic root. No mediastinitis or prosthetic valve infection was encountered postoperatively.

A 55-year old man was admitted to our hospital owing to endograft collapse after TEVAR. He had undergone total arch replacement for acute aortic type A dissection at age 39, and undergone thoracic endovascular aortic repair (TEVAR) for chronic aortic type B dissection at age 54. TEVAR was successfully performed and the false lumen was shrunk. However, one year after TEVAR, computed tomography showed endograft collapse. Technical success was not achieved by the balloon technique to treat endograft collapse, so we performed additional TEVAR. After this procedure, endograft collapse was repaired. The postoperative course was uneventful.

Aortic emergencies are surgically challenging and the mortality rate remains high. Since December 2003, we have performed endovascular treatment with a stent graft (EVT) in 15 cases of aortic emergency, including 8 cases of aortic rupture or traumatic aortic disruption, 1 case of traumatic iliac artery disruption, 3 cases of aortobronchial fistula (ABF), and 3 cases of aortoenteric fistula (AEF). In 9 cases of aortic rupture and traumatic aortic or iliac disruption, 1 patient died due to traumatic cerebral hemorrhage, but the remaining 8 patients were discharged without complications. While hemoptysis was resolved in all 3 patients with ABF, 1 patient with primary ABF died due to pneumonia, and 1 patient with secondary ABF died due to multiple organ failure. Furthermore, 1 patient with primary AEF progressed well without any evidence of postprocedural stent graft infection. In 2 patients with secondary AEF, both required secondary surgical graft excision, and 1 of these died due to the recurrence of infection. EVT has shown good results in hemostasis for aortic emergency. However, if a source of infection persists, secondary surgical intervention is required in some cases. Commercially available endovascular stent graft make it possible to treat tortuous segments of the thoracic aorta and the abdominal aorta, therefore we expect there to be more patients with aortic emergencies who require EVT.

In atrioventricular (AV) discordance, a morphologic tricuspid valve functioning as a systemic AV valve often becomes incompetent and needs to be replaced. However, mitral valve replacement concomitant with tricuspid valve replacement is unusual in the disease. Here, we report a case of successful double AV valve replacement long after functional biventricular repair in AV discordance. A 32-year-old man with AV discordance was admitted with orthopnea. He had undergone the Rastelli procedure at age 10 and removal of the deteriorated conduit valve at age 24. Preoperative examinations revealed not only tricuspid but also mitral regurgitation. Both deteriorated valves were replaced with mechanical valves. In AV discordance after Rastelli procedure, a non-valved conduit may accelerate mitral deterioration because pulmonary hypertension from tricuspid regurgitation increases the afterload of the pulmonary ventricle.

Cardiovascular surgery in situs inversus totalis (SIT) is unusual. We report a case of coronary artery bypass grafting (CABG) in SIT. A 67-year-old man with unstable angina pectoris was admitted to our hospital. Coronary arteriography demonstrated three-vessel disease in the mirror-image heart. CABG with 4 distal anastomosis was carried out with conventional methods. Careful observation based on complete understanding for preoperative images could minimize operative difficulties caused by mirror-image heart.

We report a case of graft infection long after femorofemoral crossover bypas grafting (FFBG), first presenting as septic distal emboli without any infective signs in the groin. A 71-year-old man who had undergone FFBG visited our hospital because of sudden pain in his right foot. No infective signs were found in the graft route from physical examination. However, computed tomography demonstrated perigraft fluid and graft thrombi. Graft excision and extra-anatomic revascularization were successfully done. Light micrography showed Staphylococcus aureus extensively infiltrating in the expanded polytetrafluoroethylene graft wall.

[Objective]The purpose of this study is to evaluate an effect of electroacupuncture therapy on low back pain of collegiate athletes.
[Methods]Subjects were 28 collegiate athletes with low back pain who gave informed consent. They consulted a medical doctor beforehand. The electroacupuncture therapy was performed as acupuncture. The evaluation items were as follows:Visual Analogue Scale (VAS) which expresses the state of the pain (Pain-VAS), VAS which shows a training state (Training-VAS), five phases of evaluations to show a training state, pain at the time of the trunk movements, Roland-Morris Disability Questionnaire (RDQ), and Japanese Orthopedic Association (JOA) score. The correlation of each item was estimated.
[Results]The chief complaint of 27 people was low back pain, and one person had pain of the low back and the lower extremities. In the diagnosis, 16 people had non-specific low back pain, 5people had lumbar vertebrae discopathy, and 3had a lumber vertebrae herniated disk. As a result of acupuncture, the training-VAS and five phases of evaluations to show the training state and JOA score were significantly improved. However, as for the pain-VAS and pain at the time of trunk movements and RDQ, a significant difference was not accepted.
[Conclusion]Training-VAS is useful for measuring the outcome of an athlete with low back pain. It is important that athletes with low back pain evaluate their training.

A 41-year-old woman with neurofibromatosis (NF) was admitted to our hospital for severe pain and right leg swelling of 5 days duration. Paralysis of the right leg due to compartment syndrome was also recognized. She had been diagnosed as von Recklinghausen's neurofibromatosis, previously. 3 D-computed tomography showed a ruptured anterior tibial artery aneurysm. There was a normal patent posterior tibial artery. Since her complaint of pain was severe, we performed an emergency operation. Under the pneumatic tourniquet technique, the aneurysm was resected, and both the proximal and distal sides of the anterior tibial artery were ligated. A massive hematoma was completely removed. Postoperatively, the dorsalis pedis and posterior tibial pulses remained palpable. The paralysis improved considerably and she was given an ambulatory discharge from our hospital 21 days after the operation. Histological examination revealed proliferating wavy spindle cells infiltrating between the adventitia and mesothelium of the aneurysmal wall and staining positively for S 100 immunoperoxidase.