In Japan, infective endocarditis (IE) or prosthetic valve endocarditis (PVE) due to intravenous drug use (IDU) is rare. We report the case of a patient with PVE due to IDU who required mitral valve replacement (MVR) and tricuspid valvoplasty (TVP). A 21-year-old woman with an IDU history had earlier acquired IE, and had undergone MVR using a bioprosthetic valve and TVP in November, 2010. She was transferred to our institute because of fever and general fatigue in February, 2012. Echocardiography revealed vegetation on the mitral bioprosthetic valve, and antibiotic administration was started. Although the infectious condition improved, the vegetation became more mobile. A second MVR, using a bioprosthetic valve, and TVP were performed 18 days after admission. The patient's postoperative course was uneventful, and she was discharged on postoperative day 32. At one and a half years after the second surgery, the patient is currently followed-up regularly at our department, and PVE recurrence has not been observed.

A 74 year-old man visited our hospital complaining of increasing sensory disorder of the left lower extremity. On physical findings, a pulsatile mass was detected in abdomen, but he had been aware of it for 5 years. Further examination revealed on inferior mesenteric artery aneurysm 8 cm in diameter. It had no communication with other visceral arteries or veins. Surgical treatment was performed to resect the aneurysm without revascularization. The postoperative course was uneventful. The pathological examination of the aneurysm showed atherosclerotic change. The chief complaint on admission was unchanged following surgery and was thought to have no relation to the aneurysm. It was thought that to derive from lumbar vertebral disease. After operation, regular follow-up is necessary to check for pseudoaneurysms formation at the surgical margin and development of other visceral artery diseases.

Objective : To elucidate the availability and applicability of the information contained in health insurance claims to pharmacoepidemiological studies with particular reference to the computerization of insurance claims submitted by dispensing pharmacies.
Data Sources : Outpatient insurance claims of two health insurance societies based in the Kanto region. The survey, funded by the Federation of Health Insurance Societies, was undertaken as part of a demonstration project to develop methodologies for insurers to evaluate the clinical performance of providers.
Study Selection : Disease-specific, provider-specific and clinical procedure specific comparison of the per-claim cost. All claims from pharmacies were matched with the prescribing hospitals or clinics to capture the entire medication.
Data Extraction : All claims were reviewed by trained reviewers and procedure specific costs were classified into five disease categories to obtain the best estimate of disease-specific cost.
Results : Inter-provider variations were assessed based on overlapping of the overall average and the confidence interval of the doubled standard error after adjusting for age. Contrary to popular belief, academic medical centers showed significantly lower medication cost than clinics for the treatment of acute upper respiratory infection. Prescription pattern to favor high cost antibiotics accounted for higher per-claim medication cost of clinics with concentration of high cost claims.
Conclusion : Based on the authors' experience and methodologies developed, computerization of insurance claims will achieve consistency, efficiency and timelines which are of utmost importance for pharmacoepidemiological studies. On the other hand, insurers may preempt the claims review and reimbursement organizations by appealing to the pharmacy claims through electronically matching the prescribing claims. The nature of evidence sought by both pharmacoepidemiological researchers and insurers, whether it be for the purpose of post-marketing survey or cost cutting, would eventually converge.

Immunoglobulin G4 (IgG4)-related disease is a chronic disease characterized by fibrotic mass and/or thickened lesions with elevated serum IgG4 concentrations, and infiltrations of IgG4 positive plasma cells. Since it has recently been reported to occur in the cardiovascular system, therapeutic strategy needs to be established. We report a case of IgG4-related thoracic aortic aneurysm (IgG4-R TAA) which was diagnosed postoperatively though suspected as aortic intramural hematoma preoperatively. A 70-year-old man who has medical histories of retroperitoneal fibrosis twice visited our hospital with chief complaints of cough and a CT scan was performed. Though there had been no episodes related to the onset of aortic dissection such as chest pain, an ascending aortic intramural hematoma of 52 mm in diameter was suspected and we planned to perform hemi-arch replacement. Intraoperative findings suggested that it was a true aneurysm and there was no sign of dissection. Histopathologically, the adventitia was obviously thickened with infiltrations of IgG4 positive plasma cells without infiltrations and dissection findings in the tunica media. In addition, serum IgG4 exceeded the normal value, thus it was diagnosed as IgG4-R TAA on the basis of the comprehensive diagnostic criteria. Great caution should be taken in IgG4-R TAA because it may show intramural hematoma on imaging and may develop aortic dissection and rupture as well.

Three human taeniid species, Taenia solium, Taenia saginata and Taenia asiatica are distributed in Indonesia. A field survey conducted in Bali from 2002 to 2006 showed that the prevalence of taeniasis was highly variable among four districts (1.1-27.5%), and only two cysticercosis cases due to T. solium infection were detected. All tapeworms (n = 66) expelled from 66 tapeworm carriers were confirmed to be T. saginata by mitochondrial DNA analysis. A total prevalence of 13.0% (19⁄146) for T. solium taeniasis was found in Jayawijaya District, Papua (Irian Jaya). It included 14 of 88 (15.9%) in 1999 and 5 of 58 (8.6%) in 2001, while the seroprevalence of cysticercosis in humans by sub-district in Papua ranged from 0.0% in a non-endemic area to 48.5% in an endemic area from 1996 to 2005. The seroprevalence of cysticercosis in pigs and dogs in Jayawijaya ranged from 8.5% to 70.4% (1998-1999) and 4.9% to 33.3% (2000-2002), respectively. A 2003-2006 survey of 371 local people in Samosir island, north Sumatra revealed 6 of 240 (2.5%) to be infected with T. asiatica; 2 of 58 (3.4%) and 4 of 182 (2.2%) cases were detected in 2003 and 2005, respectively. This brief review summarizes the present situation of taeniasis and cysticercosis, the distribution of three human taeniid species, and the risk factors⁄transmission aspects of these tapeworm infections in Bali, Papua, and north Sumatra regions of Indonesia.