Anticoagulation management in cardiac surgery can be difficult in patients with heparin-induced thrombocytopenia (HIT). We report a patient who underwent reoperation of cardiopulmonary bypass (CPB) using argatroban in combination with nafamostat mesilate. A bolus of 0.25 mg/kg argatroban was administered, followed by continuous infusion of 5-10 μg/kg/min argatroban and 100 mg/h nafamostat mesilate. No complications such as thrombosis were observed during either CPB or the perioperative period. Although we used argatroban and nafamostat mesilate, which has a shorter half-life than argatroban, the anticoagulant effect was prolonged, and the patient had an uneventful postoperative course despite requiring substantial blood transfusion.

We report the findings in a 75-year-old woman who was given diagnosis of rupture of the internal thoracic artery (ITA) and was successfully treated by coil embolization. The patient suddenly felt chest pain, and a chest CT revealed a mediastinal hematoma. She was suspected to have an acute aortic dissection, and therefore transferred to our hospital. Upon careful examination, a CT showed a hematoma in the superior mediastunum and the extravasation of the left internal thoracic artery. Emergency coil embolization was thus performed to stop the bleeding. After the embolization, no further hemorrhaging was observed. The patient was uneventfully discharged in a healthy state 2 weeks later. Rupture of the internal thoracic artery is rare. However, it is important to include this potential disease in the differential diagnosis when encountering a patient presenting with an atraumatic mediastinal hematoma.

Objective: In 2000, the Ministry of Health and Welfare issued an advisory that recommended intake of 0.4mg of folic acid in dietary supplements to reduce the risk of development of neural tube defects.  Since subsequent reports of questionnaire surveys by various investigators showed a low in the intake rate, we surveyed and evaluated the folic acid intake rate among the pregnant women consulting the Japan Drug Information Institute in Pregnancy.
Methods: We evaluated differences in folic acid intake rate according to the consulting women’s background factors. i.e., age, pregnancy planning, pregnancy history, and taking of anticonvulsant drugs in the 1053 women capable of participating in the survey among the 1061 pregnant women who requested a consultation with the Japan Drug Information Institute in Pregnancy between April 2006 and August 2008.
Results: According to the result of our survey, the intake rate of folic acid was 29% of the 1053 pregnant women.  The only 3 women of the 42 pregnant women taking anticonvulsant drugs took folic acid before they got pregnant.
Conclusion: Even now, 8 years after the Ministry of Health and Welfare advisory, the folic acid intake rate is low.  Drawing upon successful measures promoting intake in the U.S. and Canada,we play a vital role in delivering this critical health information to pregnant women.