Pseudoaneurysm of the uterine artery is rare as a cause to delayed postpartum hemorrhage. Nowadays, uterine pseudoaneurysm is often treated by uterine artery embolization. The outcome is favorable. Here, we report a case of delayed postpartum hemorrhage following Cesarean section, which was caused from a rupture of uterine pseudoaneurysm. The patient was at the point of death from excessive bleeding but successfully treated by uterine artery embolization (UAE). In encountering a case of postpartum hemorrhage after Cesarean delivery or Dilation & Curettage, it is indispensable to check the abnormal blood flow in a color Doppler examination.

Objective: From September 2009, the Department of Pharmacy of Kitasato University Kitasato Institute Hospital started operation room services, and the pharmacist in charge also responds to the inquiries from the operation room staff (doctors and nurses) concerning pharmaceutical compounds.  In the present study, we collected the inquiries and analyzed their contents in order to understand the information of pharmaceutical compounds required by the operation room staff.
Methods: The inquiries from operation room staff received between October 2009 and March 2012 were collected and the contents were analyzed.
Results: A total of 625 inquiries (mean, 20.8 inquiries per month) were received.  Regarding the contents of inquiry, the most frequent inquiry was on “the presence or absence of the stock” (70.7%), followed by “drug information” (17.0%), “handling of controlled substances” (5.9%), and “handling of non-controlled substances” (4.2%).  For “the presence or absence of the stock,” the most common pharmaceutical compounds inquired were antibacterial agents, anesthetics, and infusion fluids.  For “drug information,” the contents were diverse, ranging from drug efficacy to operation method, whether compounds are included in hospital drug list, in-hospital preparations, and drug selection.  For “handling of non-controlled substances,” the most frequent inquiries were associated with the expiration date after unsealing.
Conclusion: The most frequent inquiry from the operation room staff was on “the presence or absence of the stock,” and the common subject of inquiry was presumably pharmaceutical compounds frequently used at the time of surgery.  The analysis showed that the operation room requires a wide range of information.

BACKGROUND/AIMS: Colonic diverticular bleeding can stop spontaneously or be stopped by endoscopic hemostasis. We analyzed the clinical and colonoscopic features of patients with colonic diverticular bleeding to establish the predictive factors for rebleeding. METHODS: A total of 111 patients (median age, 72 years) with colonic diverticular bleeding in Aso Iizuka Hospital between April 2007 and July 2010 were enrolled. Age, sex, body mass index (BMI), comorbidity, medication, location of bleeding, colonoscopic findings and hemostatic methods were analyzed retrospectively from the hospital records. RESULTS: The most common sites of bleeding were the ascending (39.6%) and sigmoid (29.7%) colon. Overt rebleeding occurred in 30 patients (27.0%). Spontaneous hemostasis was seen in 81 patients (73.0%), and endoscopic hemostatic treatment was performed in 30 patients. The BMI in the patients with colonic diverticular rebleeding was significantly higher than in patients without rebleeding. Colonoscopic findings of actively bleeding or nonbleeding visible vessels in the responsible diverticula were more frequent in the group with rebleeding. CONCLUSIONS: A higher BMI and colonoscopic findings of actively bleeding or nonbleeding visible vessels can be used as predictive factors for colonic diverticular rebleeding. Patients with such findings should be carefully followed up after hemostasis of the initial colonic diverticular bleeding.
Body Mass Index ; Colon ; Colon, Sigmoid ; Comorbidity ; Diverticulum ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Retrospective Studies

Objective: Among the opioids used for treating dyspnea in cancer patients, the evidence for clinical use of fentanyl is not adequate. We report a case that suggested that fentanyl citrate patch improved dyspnea caused by lung metastasis of ureteral cancer.Case: An 86-year-old female was scheduled to start opioids for dyspnea caused by exacerbation of lung metastasis from ureteral cancer. Morphine hydrochloride was not chosen due to renal dysfunction, and oxycodone hydrochloride extended-release tablet was initiated. However, one day after starting medication, the patient refused to take the tablet because of vomiting. Given the difficulties in using morphine hydrochloride and oxycodone hydrochloride extended-release tablet, fentanyl citrate patch 0.5 mg/day was started for the purpose of improving dyspnea. The dose was eventually increased to 1.0 mg/day. Dyspnea improved and she was discharged.Conclusion: This case suggested the possibility that use of fentanyl citrate patch may be effective for dyspnea. Fentanyl citrate patch may provide one option when other drugs such as morphine hydrochloride and oxycodone hydrochloride cannot be used. However, since this is a report of a single case, further verification is required to clarify the effectiveness of fentanyl citrate patch for dyspnea.

Background/Aims: The objective of this research is to examine factors related to irritable bowel syndrome (IBS) prevalence in a large population-based study. Methods: A cross-sectional study was conducted with participants in the Miyagi part of the Tohoku Medical Megabank Project CommunityBased cohort study who completed the Rome II Modular Questionnaire. Multivariate odds ratios (ORs) for the presence of IBS and 95% confidence intervals (95% CIs) for the reference group were calculated for each factor. Additionally, a stratified analysis was performed by sex and age group (20-49 years, 50-64 years, and ≥ 65 years). Results: Among 16 252 participants, 3025 (18.6%) had IBS, comprising 750 men (15.5%) and 2275 women (19.9%). Multivariate ORs for the presence of IBS decreased significantly with each year of age (OR, 0.98; 95% CI, 0.98-0.99). Moreover, compared with the reference group, ORs for the presence of IBS were significantly higher in individuals whose home was partially damaged by the Great East Japan Earthquake, those with < 16 years of education, those who spent less time walking, those with high perceived stress (1.77, 1.57-2.01), those with high psychological distress (1.58, 1.36-1.82), and those with high symptoms of depression (1.76, 1.60-1.94). In stratified analyses, a significant relationship was found between psychological factors and IBS prevalence in all sex and age groups. Conclusions This large cross-sectional population-based cohort study identified several factors associated with IBS prevalence. Psychological factors were significantly associated with IBS prevalence across all age groups and sexes.

Purpose: General surgeons at regional hospitals should have the primary trauma care skills necessary to treat critically ill trauma patients to withstand transfer. This study was conducted to identify a consensus on primary trauma care skills for general surgeons. Methods: An initial list of acute care surgical skills was compiled, and revised by six trauma experts (acute care surgeons); 33 skills were nominated for inclusion in the Delphi consensus survey. Participants (councilors of the Japanese Society for Acute Care Surgery) were presented with the list of 33 trauma care skills and were asked (using web-based software) to rate how strongly they agreed or disagreed (using a 5-point Likert scale) with the necessity of each skill for a general surgeon. The reliability of consensus was predefined as Cronbach’s α ≥ 0.8, and trauma care skills were considered as primarily required when rated 4 (agree) or 5 (strongly agree) by ≥ 80% participants. Results: There were 117 trauma care specialists contacted to participate in the Delphi consensus survey panel. In the 1st round, 85 specialists participated (response rate: 72.6%). In the 2nd round, 66 specialists participated (response rate: 77.6%). Consensus was achieved after two rounds, reliability using Cronbach’s α was 0.94, and 34 items were identified as primary trauma care skills needed by general surgeons. Conclusion A consensus-based list of trauma care skills required by general surgeons was developed. This list can facilitate the development of a new trauma training course which has been optimized for general surgeons.

[Introduction] In accordance with the 2018 revision of the Medical Care Act, prefectures have established career development programs for regional quota physicians aimed at both securing physicians committed to regional medical care and fostering their career development. We have surveyed and reviewed these programs across each prefecture.[Methods] The authors gathered information on the programs, which includes the acquisition of medical specialties, as well as the timing and duration of regional assignments, from the websites of each prefecture. The analysis of start timing and duration was limited to internal medicine.[Results] All prefectures have formulated programs. In more than 30% of the prefectures, regional quota physicians can choose any specialty from all available specialties. The regional assignment typically begins three years post-graduation, with a duration of four years in most cases.[Discussion] This nationwide trend provides a resource to evaluate the state of post-graduate education for regional quota physicians and to consider the future enhancement of these programs.