Objective: The present study examined the status of the provision of drug information to hypertensive patients at community-based pharmacies by evaluating patients' satisfaction, understanding, and wishes.
Design: A cross-sectional study was conducted by surveying patients using a self-administered questionnaire.
Methods: Three items were evaluated: 1) the level of patient satisfaction with provision of drug information; 2) the level of patient understanding of information provided on antihypertensive drugs; and, 3) patient wishes regarding provision of drug information.
Results: The level of satisfaction with provision of drug information was high (86.6%). Although patients were found to understand the precautions for use of antihypertensive drugs, their understanding of drug efficacy was insufficient. Also, patients wished to receive more explanation from pharmacists regarding the efficacy of drugs in addition to explanations of associated adverse reactions or precautions for use of the drugs.
Conclusions: Hypertensive patients were highly satisfied with the provision of drug information at community-based pharmacies, but did not show sufficient understanding of the efficacy of antihypertensive drugs, an issue to be addressed in the future by pharmacists in their instructions to patients on the use of drugs.

Background: In Japan, although clinicians have been extremely interested in conducting clinical research, the shortage of clinical researchers is a serious problem. Therefore, it is important to explore barriers to conducting clinical research.1) We mailed a cross-sectional survey to hospital managers asking about their interest in and barriers to conducting clinical research and training clinical researchers at their hospitals.2) Of 810 eligible hospital managers, 301 completed questionnaires (response rate: 37.2%).3) The managers of university hospitals and national medical centers were more interested in conducting clinical research than were managers of other hospitals.4) Furthermore, 60.6% of managers of university hospital and 18.8% of managers of other hospitals reported the need to employ physicians who specialized in clinical research. However, given public research grants, about 50% of hospital managers were willing to employ research residents.5) Our results suggest there are still barriers to conducting clinical research, such as a lack of time set aside for clinicians and specialists to teach clinical research. A substantial strategy is needed to address the shortage of clinical researchers in Japan.

Surface induced hypothermia was introduced in six cases with low cardiac output syndrome after open heart surgery to reduce oxgen consumption. The patients were consisted of two ACBG, two LV rupture after MVR, MVR with ACBG and AVR with poor LV function. Hemodynamic changes such as heart rate, mean arterial pressure, cardiac index, systemic vascular resistance, pulmonary artery wedge pressure, were measured every 3-4 hours throughout the course of hypothermia. Acid-base balance, mixed venous oxgen saturation and oxygen consumption were also monitored. Hypothermia was induced using a blanket and ice-beutels. Temperature in hypothermia was maintained at about 33°C. We are intended to increase SVO₂ up to the level of 50% and to improve anerobic condition. Hypothermia was continued for 45 hours in the shortest and 148 hours in the longest case with a mean of 78 hours. Arrythmia was not seen. Hemodynamic and acid-base balance were in significantly changed in comparison of the control values. However, SVO₂ and VO₂ changed significantly after introduction of hypothermia. They increased from 47.8±7.5% to 58.7±7.9% and reduced from 231±29.7 to 188±31.3ml O₂/min respectively. Hemodynamic condition was improved and IABP was successfully weaned in all cases. We suggest that the use of hypothermia is one of the effective modality in the management of low cardiac output syndrome after open heart surgery.

We studied 90 consecutive cases undergoing open heart surgery with preoperative collection of autologous blood and ultrafiltration during extracorporeal circulation. Among the 58 out of 90 patients (64.4%), open heart surgeries were achieved without homologous blood. We evaluated 13 factors (age, height, weight, body surface area, cardiopulmonary bypass time, aortic cross clamping time, dilutional rate, Hct before predonation, lowest Hct during cardiopulmonary bypass, amount of predonated autologous blood, term of autologous blood predonation, amount of bleeding during surgery, amount of bleeding after surgery) in connection with open heart surgery without homologous blood. Among these factors, age, body surface area, cardiopulmonary bypass time, aortic cross clamping time, lowest Hct during cardiopulmonary bypass, amount of predonated autologous blood, amount of bleeding during surgery and amount of bleeding after surgery demonstrated differed significantly between the only autologous blood transfusion group and the homologous blood transfusion group. According to the evaluation by multivariate regression analysis of these factors, the amount of bleeding after surgery was the most contributor to open heart surgery without homologous blood, followed by amount of bleeding during surgery and body surface area. We concluded that open heart surgery without homologous blood may be achieved in more patients by understanding these factors. Autologous blood predonation by the “leapfrog” method, control of the dilution rate by ultrafiltration during extracorporeal circulation and fresh autologous blood transfusion after extracorporeal circulation were effective to achieve open heart surgery without homologous blood.

A cervical aortic arch is a very rare congenital malformation of aortic arch. A case is reported of a 42-year-old woman with an extensive circular aneurysm of a left-sided cervical aortic arch. The arch aneurysm was successfully removed surgically and replaced with woven Dacron graft. Histologic examination of the aneurysm revealed atherosclerosis and intimal defect.

In a consecutive series of 160 surgically treated abdominal aortic aneurysm, four patients with acute aortic thrombotic occlusion of an abdominal aortic or iliac aneurysm were encountered. Three of four aneurysms were 7cm in diameter or smaller. Also, 3 of 4 patients had chronic occlusive disease of legs. Our mortality rate was 75%. The recommendation is made that all abdominal aortic aneurysms be resected if there is substantial associated distal occlusive disease.

A 44-year-old woman with over 20 years history of rheumatic heart disease developed progressive heart failure from aortic stenosis and mitral restenosis after open mitral commissurotomy. In December, 1986, she underwent aortic and mitral valve replacements with Medtronic Hall prosthesis (aortic: 21mm, mitral: 27mm). Following an eventful recovery, she was discharged from the hospital and continued on a regimen of Coumadin. In February, 1991, the patient developed chest and back pain, which necessitated her emergency admission to our clinic. During the coronary examination, the aortic prosthetic occluder was not moving, fixed in the opening position, lasting from one to several minutes. She underwent emergency operation for replacement of the defective valve. At operation, we noted the pannus formation into the valve orifice on the inflow side of aortic prosthesis. She made a satisfactory recovery and has enjoyed good health since that time.

To investigate the effect of nafamostat mesilate (FUT) for disseminated intravascular coagulation (DIC) after surgery using cardiopulmonary bypass, we studied DIC scores and parameters of coagulation and fibrinolysis in the DIC cases. Although 12 patients developed DIC, the platelet counts improved by administration of FUT apart from one complicated by sepsis. The DIC scores decreased as a result of the increase of platelets and fibrinogen and improvement of FDP. Thrombin-antithrombin III complex, D-dimer and plasmin-α₂ plasmin inhibitor complex showed an even higher value at the endpoint of FUT administration. These results indicate that patients with DIC after cardiopulmonary bypass may have severe fibrinolytic acceleration and that administration of FUT can be useful in those cases.

This is a case report of a rare combination of a single coronary artery and a coronary artery fistula. An 8-year-old girl was asymptomatic with a grade II continuous murmur in the third left intercostal space. Selective coronary angio-graphy revealed that a single coronary artery arising from the left aortic sinus was dilated and ended as a fistula to the outflow tract of the right ventricle. At operation, the fistula could not be exposed on the surface of the heart. On cardiopulmonary bypass, the aorta was clamped, and the fistula was closed by direct suture in the right ventricle. The postoperative course was uneventful with no complications.

  In Japan, few health care professionals have a basic understanding（core competency）of the design of clinical research and statistical analysis. We developed a blended distance–learning program comprising face–to–face lectures with e–learning for busy health care professionals who work in the clinical settings to achieve core competency in clinical research. The purpose of this study was to examine the educational effects of this program.
1）Four months after the end of the program, 64％ of the participants had started to conduct clinical research.
2）This program may increase the number of research colleagues that can discuss clinical research.
3）This program could enhance the confidence（self–efficacy）of health care professionals in clinical research.