We report a clinical case of adhesive ileus that was treated with daikenchuto during pregnancy, and post cesarean section. A 29-year woman, who had undergone a laparotomy for small intestinal volvulus at the age of 15, was referred to our hospital for abdominal distention at11weeks gestation. Her severe abdominal distention led to the intestinal adhesive ileus finding. After treatment with daikenchuto, she had mass diarrhea while the abdominal symptoms disappeared. Afterwards, the prenatal course was uneventful. Spontaneous labor began at 36 weeks gestation. Under the indication of fetal distress, an emergent cesarean section was performed. There was widespread adhesion between the small intestine and abdominal wall. On post operative day 4, nausea and vomiting increased. Daikenchuto was orally administered with the diagnosis of recurrent adhesive ileus. On day 6, flatus and soft stool were passed. On day 9, oral food ingestion was begun. Her post operative course was uneventful beyond this, and she was discharged on day 25. Recently, clinical reports of adhesive ileus during pregnancy have been increasing as average maternal ages rise. Adhesive ileus during pregnancy tends to be critical for mothers and babies, so a surgical procedure is necessary in many cases. This report suggests the usefulness of daikenchuto for adhesive ileus during the perinatal period.
Intestinal Obstruction ; Pregnancy ; Cesarean Section ; Adhesives ; After values

Background : Perioperative care in congenital heart surgery has evolved in recent years, and it was considered a contributive factor to improve surgical outcome and prognosis. Objective : To extract perioperative clinical protocols that have been applied in our hospital, then assess their usefulness for better clinical outcome. Methods : We retrospectively reviewed our patients' records to analyze representative perioperative protocols that might have contributed to surgical outcome, such as intraoperative transesophageal echocardiography (ITEE), extubation in the operating room on patients of atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF), Glenn procedure and Fontan procedure. We also assessed clinical pathway of ASD and VSD, and each protocol was individually explored to calculate achievement ratio in order to show its adequacy. Results : This study included 482 of on-pump surgery patients and 146 of off-pump surgery patients from June 2007 to June 2014. ITEE was performed in 474 of on-pump surgery patients and 102 of off-pump surgery patients. No case had a residual lesion immediately after operation. Extubation in the operating room was performed in cases without severe pulmonary hypertension (PH). The extubation ratio was 94.7% (ASD repair), 60.0% (VSD repair), 50.0% (TOF repair), 42.5% (Glenn procedure), and 45.2% (Fontan procedure), respectively. Clinical pathways of ASD and VSD included patients without severe PH. Achievement ratio of the clinical pathway was 98.2% in ASD and 94.2% in VSD patients, respectively. Four patients were excluded because of high c-reactive protein (CRP), and one patient because of familial circumstance. Conclusion : ITEE was useful in evaluation of cardiac function, residual issue and residual air at weaning of cardiopulmonary bypass. Reintubation did not occur in any clinical course of extubation in the operating room, but the extubation rate was not high because of safety concerns. Achievement ratio of the clinical pathways of both ASD and VSD was more than 90%, therefore, application of the clinical pathway was considered appropriate.

Objective: Drug information literacy is necessary for pharmacists.  This study investigated the effect of practical training on the drug information literacy of pharmacy students.
Methods: We conducted practical training in the drug information room of hospital pharmacy.  Then we asked the students two questions before and after the training.  We scored the drug information responses of students using four-point rating scales based on objective criteria.  We compared the scores obtained before and after training.  In addition, we researched the realization of several secondary and tertiary sources using a visual analog scale (VAS).  We then compared VAS findings before and after the training.
Results: The score for drug information responses was significantly improved.  For sources other than MEDLINE (Pub Med), the VAS score also improved.  The students were aware of the information on package inserts before training.  There was significant improvement in awareness of books about pregnancy and lactation (e.g. Drugs in Pregnancy and Lactation) after training.  However, there were significant individual differences in awareness of MEDLINE, Up To Date, and the Cochrane Library.
Conclusion: This practical training experience improved the drug information literacy of pharmacy students.  Before training, there were significant deficiencies in the process of literature search.  Therefore, this training was effective for advancement in drug information literacy of pharmacy students.

Tuberculous spondylitis, or so-called Pott's disease, seems to be overlooked because of a lack of severe inflammation in the insidious generating process and tends to cause non-specific symptoms, such as back pain, fever, weakness, and weight loss. Diagnostic delay is common and the results can be disastrous. Discriminating between Pott's disease and other diseases, such as malignancy and pyogenic infection, is difficult. However, the inflammatory process in Pott's disease tends to spare the disk space, while that of pyogenic infection typically affects the area. Herein, we present a patient with Pott's disease who showed the characteristic clinical and radiological findings.

A 64-year-old female was admitted due to iliopsoas abscess caused by misplacement of a central venous catheter (CVC) into the ascending lumbar vein (ALV). Despite removing the CVC and administering an antimicrobial agent, her general condition did not improve. Therefore, we performed a contrast-enhanced head computed tomography (CT) scan. The CT scan revealed a cerebellum abscess. Surgical cerebellum abscess drainage was thus performed urgently. We recommend using anteroposterior radiographs, J-guide wire catheter and ultrasound guidance to prevent misplacement. If misplacement of the CVC is suspected, it should be removed and a CT scan performed without hesitation as soon as possible.

A number of studies have shown that sleep disordered breathing (SDB) has a strong relation with obesity. The purpose of this study was to examine the effect of a short-term weight-loss program in obese men with SDB. In our 14-week weight-loss program, forty-one obese men (mean±SD, age ; 49.6±10.8 yr, body mass index ; 27.9±2.5 kg/m²) were assigned to 2 subgroups : diet only (DO ; n=19) and diet plus aerobic exercise (DE ; n=22). 2%, 3%, and 4% oxygen desaturation index (ODI) were measured by pulse oximetry before and after the weight-loss program. Weight and %fat significantly (p<0.05) decreased in the total subject pool consisting of DO plus DE (weight ; -8.4±3.5 kg, %fat ; -7.5±3.5%). 2%, 3%, and 4% ODI significantly decreased by -3.46±5.01 event/hour, -2.37±3.57 event/hour, and -1.99±2.84 event/hour, respectively. Significant correlations were found between 2%, 3%, and 4% ODI at baseline and changes of 2%, 3%, and 4% ODI during the weight-loss program (2% ODI ; r=0.48, 3% ODI ; r=0.51, 4% ODI ; r=0.67). Weight loss and %fat loss did not differ significantly between DO and DE (DO : -7.6±3.2 kg, -6.8±3.2%, DE : -9.2±3.7 kg, -8.1±3.7%). The increase in maximal oxygen uptake was slightly larger for DE (4.7±4.6 ml/kg/min) compared to DO (2.5±3.3 ml/kg/min), but there was no significant interaction. Changes of 2%, 3%, and 4% ODI did not differ significantly between groups. These results suggest that for obese men with SDB, the weight-loss program is an effective method, leading to improvement in SDB, although the combination of aerobic exercise to diet may not produce additional effects to SDB, compared with the diet only.

High-sensitivity C-reactive protein (CRP) is a novel risk factor for coronary artery disease. It is well known that body weight loss is effective in reducing serum CRP concentration ; however, the effect of exercise training on serum CRP concentration has not been fully elucidated. The purpose of this study was to examine the effect of a 24-week exercise training program on serum CRP concentration in 169 healthy middle-aged and elderly subjects (65.9±6.4 years). Each subject underwent baseline testing (peak oxygen uptake, daily physical activity, body weight, and serum CRP levels), and repeated these tests on completion of the training program. The subjects were classified into 2 groups based on initial CRP levels : normal<1.0 mg/L, n=139, and high≥1.0mg/L, n=30. On completion of the program, both daily physical activity and peak oxygen uptake increased significantly (+33.9±72.4%, p<0.0001, +5.4±14.7%, p=0.014, respectively). However, body weight did not change significantly. In addition, CRP levels of the entire group did not change significantly. However, CRP levels significantly decreased among the high baseline CRP group (from 1.82±0.81 mg/L to 0.98±0.59 mg/L, p<0.0001). It was concluded that serum CRP levels are reduced without body weight loss in response to exercise training in healthy middle-aged and elderly subjects with high initial CRP levels.

An 80-year-old male patient had complained of left abdominal pain since 1990, and an abdominal aortic aneurysm (AAA) 5.3cm in diameter was diagnosed by computed tomography (CT). The patient was NYHA class III with complaints of chest pain during exercise. Coronary arteriography showed that he had three-vessel disease. At that time, aneurysmectomy was not anticipated due to his age and because the AAA showed no tendency to enlarge. However, in October 1993, CT showed that the AAA rapidly enlarged to 6.8cm in diameter. Due to the greater risk of rupture of the AAA, aneurysmectomy was considered necessary. The operative mortality associated with aneurysmectomy in patients with coronary artery disease (CAD) is higher than that in patients without CAD. Therefore, coronary artery bypass grafting (CABG) was indicated prior to aneurysmectomy. The patient underwent CABG (two vessels) in December 1993, and aneurysmectomy was successfully performed in February 1994. He was discharged uneventfully 17 days after the operation.