Objective : To examine the association between the combination therapy of calcium antagonists with angiotensin converting enzyme (ACE) inhibitors and underlying diseases for hypertensive patients.
Design : Cross-sectional survey of the drug utilization.
Methods : This survey included 603 hypertensive patients who had visited Toyama Medical and Pharmaceutical University Hospital, Toyama, Japan more than twice from January to June in 1996 and received the prescriptions of calcium antagonists and/or ACE inhibitors. Main outcome measure was the combined medication of calcium antagonists with ACE inhibitors. Underlying diseases under consideration were diabetes mellitus (DM), hyperlipidemia (LIPID), ischemic heart disease (IHD), chronic heart failure (CHF), and ischemic stroke (STROKE).
Results : Out of 603 hypertensive patients, 57.5% received only calcium antagonists, 23.7% received only ACE inhibitors, and 18.7% received both of them. Patients with either IHD or CHF tended to receive the combination therapy as compared to DM or LIPID. Although men tended to receive the combination therapy, a gender effect might be a confounder for the association. Logistic regression showed a 33% increase (P=0.265) in frequency of the combination therapy in patients with IHD after adjusting for age and gender.
Conclusion : Some underlying diseases were associated with more frequent prescriptions of the combination therapy for hypertensive patients, especially with ischemic heart diseases. This result should be regarded as an exploratory stage although the pattern of antihypertensive drug use could be reasonably explained from the pharmacological sense.

A clinical clerkship in medical informatics was introduced in the 5th year of medical school. One goal is computer literacy, which means comprehension of the hospital information system including security policy and privacy preservation. The other is information literacy; The students make presentations concerning the medical information system and information technology within approximately ten minutes. All participants were enthusiastic about preparing the presentation. Seventy percent of them acknowledged the significance of explaining persuasively to others what they studied and the usefulness of these skills developed in this clerkship in their future. This result implies the importance of the shift to information literacy.

Medical students must be able to access electronic medical records and to utilize the information during bedside learning. However, there are no guidelines for using the electronic medical record system in undergraduate medical education. We created and implemented a written agreement regarding regulations for using the system. To ensure system security, users are authenticated with a fingerprint mouse. The patients' information can be retrieved from an Intranetbased reference database, and students' sheets are prepared for training in writing medical records. In conclusion, this method is a way of enhancing the authenticity of clinical education.

　　A 38-year-old woman was examined at our hospital because of cough, night sweats, and facial edema. Computed tomography of the chest revealed a large mass in the anterior mediastinum measuring 8.2×12.2 cm, with multiple nodules on both lungs. Bronchoscopy revealed multiple nodules parallel to the tracheal rings and obstruction of the anterior segmental bronchus of the right lung. The histopathological features were diagnostic of primary mediastinal large B-cell lymphoma. She underwent chemotherapy followed by radiation therapy to the mediastinal mass. After 8 months, she developed right cerebellar metastasis. Eventually, she received peripheral stem cell transplantation after 17 months.

The engaging>30 minutes of physical activity (PA) at 4-6 METs has been recommended for the prevention of cardiovascular disease. We determined whether relatively low intensity (i. e., 3-5 METs) PA inhibits the age-related central arterial stiffening, a risk of cardiovascular disease. In the cross-sectional study, the association between carotid arterial properties (via ultrasound system) and daily PA (via electric accelerometer) were studied in 172 normotensive people (41-82 yrs). People engaging>30 min/day of PA corresponding to 3-5 METs had a significantly lower beta-stiffness index than sedentary peers after adjusting for covariates (i. e., age and PA time at more than 6 METs). In the interventional study, beta-stiffness index of nine normotensive postmenopausal women was significantly decreased after the 12-week aerobic training (cycling at 80% of ventiratory threshold, ≈4 METs, 30 min/day, 5 days/week). These results suggest that the increase in daily PA at 3-5 METs inhibits the age-related carotid arterial stiffening.

Objective: A perception survey of healthcare providers and pharmaceutical industries about the current package insert (PI) was conducted to evaluate whether its layout and issues such as the contents concerning drug-drug interactions are found appropriate.
Methods: A questionnaire was sent via the Internet to physicians of various subspecialties, or via the postal service to pharmacy-employed pharmacists and pharmaceutical industries.  It consisted of questions regarding the PI layout, the information contents on drug-drug interactions and other matters about PI revision.
Results: The survey showed that the PI is a major source of drug information for physicians (82.4%) and pharmacists (98.7%).  The layout (order of appearance of headings and information about drug interactions in a tabular format) of the current PI is widely accepted by physicians, pharmacists, and pharmaceutical industries.  There was, however, some degree of disagreement within these three groups in the perceptions about the presentation/contents of the several drug interactions, as well as about the timing for its updating.  Around 24% of physicians and 35% of pharmacists view that the content of drug interactions is insufficient, and that information about adverse drug reactions and drug interactions is not enough updated in the PIs.  On the other hand, near 86% of pharmaceutical industries were prone to wait for accumulation of enough data until revising the information in PIs.
Conclusions: Differences of perception were found between healthcare providers (i.e., PI users) and industries.  Our survey revealed that the basic layout of the current PI should be preserved, but there are issues such as the contents and updating of information regarding drug interactions and adverse drug interactions that may require modifications according to the healthcare providers’ point of view.

OBJECTIVETo evaluate relative factors affecting contralateral cervical lymph node metastasis in piriform sinus carcinoma.

METHODSNinety-six cases of piriform sinus carcinoma with no preoperative treatments were selected. The contralateral cervical lymph node metastasis and relative factors were analyzed during operation or postoperative follow-up. The contralateral cervical metastasis was defined as followed: 1 contralateral cervical metastasis was confirmed pathologically after bilateral neck dissection (pN2c) or 2 contralateral cervical metastasis was found firstly during postoperative follow-up and the recurrence of primary lesion was excluded.

RESULTSThe incidence of contralateral cervical metastasis was 32% (31/96). According to the T stage, the incidence of contralateral cervical metastasis was T1: 0% ,T2: 18%, T3: 37%, T4: 32% and to the N stage N0: 12%, N1: 13%, N2a: 17%, N2b: 39%, N2c: 100%, and N3: 75%. For primary lesions beyond midline the incidence of contralateral cervical metastasis was 52% but for those remaining on ipsilateral side it was 18%.

CONCLUSIONSContralateral cervical lymph node showed higher metastatic incidence with higher T and N stage. When the primary lesions invaded beyond midline, the contralateral cervical metastasis increased greatly and neck dissection should be selected positively.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; surgery ; Female ; Humans ; Hypopharyngeal Neoplasms ; pathology ; surgery ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Treatment Outcome

Palliative care is sometimes difficult for medical staff to say to patients with cancer and their families. The late of using the term “palliative care” decrease the opportunity to know about palliative care for the patients and their families. The primary aims of this study were to reveal physicians’ and nurses’ usage of the term “palliative care”, time to use the term for the first time, and a synonym. We conducted a questionnaire survey to 387 physicians and 518 floor nurses at Hiroshima University Hospital in February, 2010. We analyzed the results of physicians and nurses separately. Two hundred and seventy-two physicians (response rate 70.3%) and 284 nurses (54.8%) answered the questionnaire. Many physicians (77.2%) and the majority of nurses (56.0%) explain with the term “palliative care”. the majority of physicians use the term when cancer cause any symptoms and at early stage. Some nurses (31.4%) couldn’t use the term “palliative care” before physicians explained the term. Nurses having longer experience tend to use the term regardless of physicians’ use. Many physicians use the term “palliative care” at early stage of cancer. Many nurses also use the term at early stage of cancer, but some nurses couldn’t use before physicians’ use.

A 17-year-old male was admitted to our hospital because of strong abdominal pain. His symptoms gradually worsened even after hospitalization, and contrast computed tomography (CT) revealed hemorrhage in the abdominal cavity. Interventional radiology (IVR) was performed to identify the bleeding site. No obvious source of bleeding was identifiable on IVR, so we opted to perform laparoscopic examination and hemostasis. The intraperitoneal finding was hematoma in the omentum, and omentectomy was performed for idiopathic omental hemorrhage because there was no history of trauma. The postoperative course was good and the patient was discharged after postoperative day 4. Performing laparoscopic surgery for omental hemorrhage facilitated minimally invasive treatment with a short hospital stay.