A 75-year-old male visited Fuchu general hospital on foot because of possible acute mushroom poisoning. He had no symptom on admission. He twice ate some toxic mushrooms for lunch and for dinner on the previous day with his wife, who was found dead in her bed on the morning of his admission. A legally ordered autopsy was held on his wife, and a-amanitin was detected in her liver, brain and blood samples. Detection of a-amanitin in blood samples has never been reported in the literature. His liver and kidney failure rapidly progressed. He died on the 10th hospital day despite intensive treatment including hemodialysis and plasma exchange. On histological examination, his necropsy liver specimen revealed massive liver necrosis and new growth of pseudocholangioles, which apparently bore testimony to acute toxic mushroom poisoning.

　　The platelet counts documented in most of the studies using the fully automated hematology analyzer XE-5000 are values measured by impedance technology (PLT-I). If blood specimens showing an anomalous particle-size distribution curve in the area where platelet counts are low are used (exceptionally low platelet count samples), the counting method is automatically switched over to an optical method (PLT-O). In the present study, we examined the usefulness of the XE-5000 by comparing PLT-I with PLT-O, using blood samples with low platelet counts collected from patients who visited our hospital between January 1 and March 31, 2012. Dilution linearity left nothing to be desired in either of the two, but simultaneous reproducibility was higher in PLT-O than in PLT-I. The correlations of PLT-I and PLT-O with visual counts were high, working out at r＝0.889～0.984. In the exceptionally low platelet count samples, the correlation coefficient was high in PLT-O than in PLT-I. The cases showing low platelet counts frequently presented giant platelets and/or red cell fragments. Therefore, measuring the samples with low platelet counts requires a high degree of precision. In the samples with exceptionally low platelet counts, PLT-O exceeded PLT-I in simultaneous reproducibility and correlation with visual counts. Thus, our study demonstrated the usefulness of the XE-5000 that could enumerate PLT-O automatically and speedily.

Fulminant myocarditis is known as a disastrous disease that requires intensive care with mechanical cardiopulmonary support. Percutaneous cardiopulmonary bypass (PCPS), which is referred to as extracorporeal membrane oxygenation, is usually used for fulminant myocarditis. However, in some cases, PCPS may be ineffective because of circulatory insufficiency and could be associated with various severe complications such as multiple organ failure or leg ischemia. In such cases, placement of a ventricular assist device (VAD) is required. A 46-year-old man with fever and severe fatigue was admitted to a local hospital and diagnosed as having fulminant myocarditis. Although an intra-aortic balloon pump and PCPS were introduced, cardiac function was not recovered, causing multiple organ failure and leg ischemia. Hence, he was transferred to our hospital for further mechanical support. Transesophageal echocardiography (TEE) revealed severe biventricular cardiac dysfunction, and radiography showed pulmonary edema. His total bilirubin level was 6.9 mg/dl and platelet level was 3,300/μl. Thus, we implanted a biventricular assist device (BiVAD). At 12 days after the implantation, TEE revealed improvement of cardiac function, and blood biochemical examination revealed recovery of multiple organ function. Thereafter, the patient was weaned from the BiVAD successfully. After the operation, the patient underwent a long rehabilitation. He was discharged 51 days after the operation, without any neurological or cardiac complication.

A 52-year-old man presented with a pulsatile mass in the right groin. He had undergone lumbar sympathectomy and aorto-right femoral artery bypass using an 8mm Microvel double velour graft, 14 years previously, for aortoiliac occlusive disease caused by thromboangiitis obliterans. Based on a clinical diagnosis of an anastomotic aneurysm, an operation was performed. When the aneurysm was incised, it was found that the anastomosis of the graft to the femoral artery was intact and that the graft itself had a defect, 3cm in size on the anterior wall, 1.5cm proximal to the distal anastomosis. The final diagnosis was a nonanastomotic false aneurysm due to prosthetic graft failure. The failed portion of the graft was resected, and a 10mm Hemashield Gold woven double velour graft was interposed between the old graft and the right femoral artery. Generally, arterial grafts below the groin are subject to high levels of mechanical stress, and graft failure is not uncommon. Vascular surgeons should keep in mind that graft failure is not rare in patients with long-standing prosthetic grafts.

The present experiment aims to examine the efficiency of estrus synchronization using progesterone and equine chorionic gonadotrophin (eCG) and to look at luteal function. During the non-breeding and breeding season, 5 adult female Korean native goats were injected intramuscularly with 2.5 ml of physiological saline as the control. A progesterone impregnated intravaginal sponge was then kept in the same goats for 10 days followed, after a week, by an intramuscular injection of 500 IU eCG. Five adult female Nubian goats were mated with a fertile buck during the non-breeding season. During the non-breeding season 2 of the 5 goats showed a normal estrous cycle (ranging from 18 to 21 days) and 3 a short estrous cycle (ranging from 3 to 6 days). During the breeding season the equivalent figures were 1 and 2. The major axes of the corpus luteum (CL) were measured by means of calipers built into the ultrasonography system, and the concentrations of plasma progesterone (P(4)) were determined by double antibody radioimmunoassay. The mean major axes of the CL in goats showing the short cycle (6.1 +/- 0.5 mm) was significantly smaller than in those showing the normal cycle (8.9 +/- 0.5 mm; p < 0.01) and also the value of P4 in goats showing the short cycle (4.2 +/- 2.1 ng/ml) was significantly lower than for those showing the normal cycle (10.3 +/- 4.3 ng/ml; p < 0.05) at day 3 following ovulation. Three out of 5 Nubian goats became pregnant but only one goat carried to full term. The present experiment indicated that a combination of progesterone and eCG was effective in inducing estrus, although it resulted in a high incidence of short luteal lifespan. The low kidding rate and high incidence of embryonic loss may be due to the instability of the luteal lifespan.
Animals ; Chorionic Gonadotropin/*pharmacology ; Corpus Luteum/*drug effects/*physiology ; Estrus Synchronization/*drug effects/physiology ; Female ; Fertility/*drug effects ; Fertility Agents, Female/pharmacology ; Goats/*physiology ; Horses ; Pregnancy ; Progesterone/blood/*pharmacology

Health support activities for residents were held three times during a period from June, 2016 to November, 2017. The residents registered in order to participate through 11 community pharmacies. Participant’s blood pressure values were measured at the venue of health support activities by pharmacists. The blood pressure values in 66 of the 106 participants were analyzed, excluding 40 participants receiving medical treatment. The rate of participants with hypertension, systolic blood pressure (SBP)≧140 mmHg or diastolic blood pressure (DBP)≧90 mmHg, was 32% (21／66). Of those with hypertension, 43% (9／21) had hypertension of a high risk level, SBP≧160 mmHg or DBP≧100 mmHg. Pharmacists provided lifestyle counseling and encouraged them to make changes in order to achieve tighter blood pressure control. The data of their blood pressure values were provided to community pharmacies for continuing support of their blood pressure control. With the pharmacist’s support, the median value of blood pressure of participants who had hypertension decreased in the second event. In addition, 50% (3／6) of participants who attended the second event with hypertension of high risk level, visited the hospital for a consultation with a doctor after getting pharmacist’s advice. These results indicate that greater access to community pharmacists improved blood pressure control of residents with hypertension. However, there were many residents who consider it difficult to use pharmacies without a prescription. Hence, friendly relationship to residents on their utilizing pharmacies is needed for providing them lifestyle counseling such as preventing hypertension by pharmacists.

As a screening tool for detecting latent pre-locomotive syndrome (latent pre-LS) in women over the age of 40, measuring handgrip strength with a cut-off value of 26 kg was proposed in a previous report. However, this screening method missed 22% of latent pre-LS. It would be beneficial to screen almost persons with latent pre-LS in community pharmacies. In this study, it was investigated whether screening using the combination of measuring handgrip strength and the questionnaire, “Loco-check,” which was proposed by the Japanese Orthopaedic Association, improved the detection of latent pre-LS in the same group mentioned above. Combining only one of the “Loco-check” questions, “I cannot put on a pair of socks while standing on one leg,” with the measurement of handgrip strength with the cut-off value of 26 kg, the detection of latent pre-LS was increased to 90.2%. The odds ratio was 9.72 in logistic regression analysis. Using the combination of the measurement of handgrip strength and the response to one question is both rapid and convenient. Therefore, in this study, this screening combination is proposed to be a useful tool in community pharmacies for detecting early latent pre-LS.