Objective: In recent years, the Ministry of Health, Labor and Welfare has actively promoted the use of generic drugs.  However, implementation of this policy has not progressed smoothly, as information on generic drugs is poorly organized.  As a result, it is difficult for pharmacists to select the appropriate generic drugs.  Therefore, we attempted to develop a code system to organize information on generic drugs.
Methods: We analyzed the guidelines used for the approval of generic drugs.  We then identified the important aspects for comparison of generic drugs and developed a code system.  Next, we tested this code system using temocapril hydrochloride tablets, which is a generic drug.
Results: We were able to develop a code system for selection of generic drugs.  Furthermore, we confirmed the utility of this code system for selecting generic drugs in the case of temocapril hydrochloride tablets.
Conclusion: We believe that this code system with be useful for pharmacists, but further development is necessary for other generic drugs.

We report a case of cholesterol crystal embolism (CCE) after endovascular aortic repair for abdominal aortic aneurysm (AAA). A 68-year-old man with AAA underwent endovascular aortic repair. He complained of left lower abdominal pain after the operation. Abdominal CT showed renal infarction on postoperative day 10. Renal dysfunction developed after postoperative day 17. A biopsy of the renal infarct lesion demonstrated characteristic cholesterol clefts in the small arteries. We diagnosed CCE. Steroid therapy was administered and the patient's condition improved remarkably. Diagnosis of CCE is difficult and its prognosis still remains poor. Therefore, we should keep this unusual complication in mind.

Immunoglobulin G4 (IgG4)-related disease can occur in various organs, most of which comprise glandular or ductal tissue. We report a case of IgG4-related disease which occurred in a cardiovascular lesion. A 69-year-old man was found to have a tumorous lesion around the coronary artery. Open chest biopsy showed the diffuse lymphoplasmacytic infiltration, occasional eosinophils and numerous IgG4-positive plasma cells within the lesions. The serum concentration of IgG4 in the postoperative period was 1,080 mg/dl (reference range, <135). We diagnosed IgG4-related periarteritis manifesting as a tumor around the coronary artery. This case suggests that IgG4-related disease can occur around the coronary artery and manifest as a periarterial mass lesion.

Background: Blood culture is an essential examination for diagnosis of causative microorganisms and determination of optimal antimicrobials in serious cases of infectious diseases. We examined temporal trends in the number and multiplicities of blood culture submission, two pre-analytic parameters indicating quality of the examination, in the Minami Ibaraki Area.
Methods: We reviewed all computerized and available paper-based laboratory records of microbiological examination in five hospitals in the area between 2002 and 2011.
Results: Blood culture submissions, estimated to be 2.4–7.3 (median: 5.1) sets per hospital bed, 8.6–23 (17) per 1,000 inpatient-days, and 0.13–0.41 (0.25) per newly admission in 2011, almost constantly increased during the study period in all hospitals. Proportions of blood specimens to all materials for microbiological cultures also increased up to 15–30% (20%) in 2011. In contrast, it was not until the latter half of the study period that solitary submission, accounting for 26–56% (35%) in 2011, decreased. Positive blood cultures were between 11 and 28% through the study period. Coagulase-negative staphylococci accounted for approximately one fourth of recovered organisms in 2006 and 2011.
Conclusion: Frequency and multiplicity of blood culture submission markedly increased in hospitals in the Minami-Ibaraki Area of Japan.

We describe a case of meningeal carcinomatosis of the internal auditory meatus presenting as sudden deafness accompanied by dizziness. A 54-year-old woman complained of acute right-side hearing loss in October 2014. The pure tone audiometry test revealed right-side hearing loss of 47.5 dB. She was treated with oral steroids. Her hearing as well as her symptoms of dizziness worsened and she was admitted for further examination. Her right and left-side hearing had worsened to 105.0 dB and 47.5 dB, respectively. A magnetic resonance imaging scan of the head revealed bilateral enhancement of the internal auditory canal and multiple brain metastases. The chest radiograph revealed a mass in the left lung. Adenocarcinoma of the lung was diagnosed. Lumbar puncture yielded no evidence of carcinoma cells in the cerebrospinal fluid, but an increased number of lymphocytes was confirmed. A diagnosis of multiple brain metastases and leptomeningeal metastasis from the adenocarcinoma of the lung was considered. Whole-brain radiation therapy (30 Gr/10 fractions) was administered. Progressive bilateral hearing loss is a rare first manifestation of meningeal carcinomatosis. It is quite important to consider the possibility of this condition when patients present with sudden deafness.
Adenocarcinoma ; Audiometry ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Dizziness ; Ear, Inner ; Female ; Head ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sudden ; Humans ; Lung ; Lymphocytes ; Magnetic Resonance Imaging ; Meningeal Carcinomatosis ; Middle Aged ; Neoplasm Metastasis ; Radiography, Thoracic ; Spinal Puncture ; Steroids ; Temporal Bone

Objective: Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were based on clinical or basic studies with specific conditional settings and were not sufficiently based on real-world clinical practice. In particular, there was little information on the doses of mood stabilizers. Methods: The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. The questionnaire included patient characteristics such as comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment. Results: Most patients received mood stabilizers such as lithium (n = 1,317), valproic acid (n = 808), carbamazepine (n = 136), and lamotrigine (n = 665). The dose of lithium was correlated with age, body weight, number of episodes, depression and GAF. The dose of valproic acid was correlated with body weight, number of episodes, presence of a rapid cycle and GAF. The dose of carbamazepine was correlated with age, mania, and the presence of a rapid cycle. The dose of lamotrigine was correlated with the number of episodes, depression, mania, psychotic features, and the presence of a rapid cycle. Doses of coadministered mood stabilizers were significantly correlated, except for the combination of valproic acid and lamotrigine. Conclusion The dose of mood stabilizers was selectively administered based on several factors, such as age, body composition, current mood status and functioning. Further prospective studies are required to confirm these findings.

Objectives: Increasing activity levels in older people is important for maintaining quality of life and ameliorating the risks of morbidity related to falls, depression, and dementia. This study aimed to clarify the seasonal variation effects on total energy expenditure, number of steps, time spent in low- and moderate- or high-intensity physical activities, and daily activities performed.Patients and Methods: This was a cross-sectional study of 22 community-dwelling older individuals (3 men, 19 women; mean age, 75.1 ± 7.3 years) living in three districts of Gero, Gifu, who participated in the Gero Salon Project hosted by the Social Welfare Councils. Evaluations were conducted in each season from September 2016 to August 2017. We used a uniaxial accelerometer, the Lifecorder device, which measures physical activity, and the Physical Activity Scale for the Elderly to evaluate activities of daily living. Data were analyzed using the multiple comparisons (Bonferroni correction) method.Results: Total energy expenditure and time spent in moderate- or high-intensity activities did not show seasonal variations. However, the lowest number of steps was taken during the winter, and the number of steps increased significantly from winter to spring. The time spent in low-intensity physical activities was significantly longer in the spring and summer than in the winter. There was no significant seasonal difference in total Physical Activity Scale for the Elderly score, leisure activities, domestic activities, or work-related activities. However, there was a significant difference between the summer and winter scores in “outdoor gardening,” with the lowest score observed during the winter.Conclusions: With climate changes in the winter months, “outdoor gardening” becomes difficult, thus decreasing the number of steps taken. Therefore, it is necessary to identify other ways for older people to maintain physical activity during the winter season.