We set out to assess our treatment strategy of acute aortic dissection associated with atherosclerotic aortic aneurysm, and to assess its results. A total of 228 patients with acute aortic dissection were admitted to our hospital between 1994 and 2009. Among these, 30 cases were associated with atherosclerotic aortic aneurysm and we retrospectively analyzed their patient data. Of these, 5 patients received diagnoses of Stanford A dissection and 25 patients demonstrated Stanford B. Coexisting aneurysms consisted of postabdominal aortic replacement in 9 patients, ascending aortic aneurysm in 1, arch aortic aneurysm in 6, descending aortic aneurysm in 2, thoracoabdominal aortic aneurysm in 3, and abdominal aortic aneurysm in 9. Patients were divided into 3 groups based on the relationship between aneurysm and dissection : acute aortic dissection occurred after graft replacement of an aortic aneurysm (Group 1, n=9), dissection coexisted with aneurysm in a different segment of the aorta (Group 2, n=8), and dissection extended to or involved the aneurysm (Group 3, n=13). Our treatment strategy for all patients excluding those with aortic rupture or malperfusion is described below. In the cases of Stanford A dissection, emergency ascending aortic replacement or total arch replacement was performed. In cases of Stanford B, patients were treated conservatively in the acute phase. Surgery for the coexisting aortic aneurysm was then performed in the chronic phase, if the aneurysm was large. We think that the interval between dissection onset and aneurysm surgery should be extended to at least 1 month, because the aortic wall was too fragile to perform anastomosis in the acute phase in the present cases. As a result, there were 2 hospital deaths in Group 3, but there was no aortic rupture during treatment in the acute phase in any of these 3 groups. There were no vascular-related deaths during follow up. Our treatment strategy obtained favorable outcomes.

Object: A multicenter survey was conducted to investigate the status of use of supplements and related problems in patients with diabetes mellitus.
Methods: A questionnaire was mailed to institutions where members of the Drug Information Section, Tokyo Hospital Pharmacists Association, worked, and hospitalized patients with diabetes mellitus were surveyed with a questionnaire.
Results: The response rate of the questionnaire was 85%, and 22 patients reported taking supplements.  The most common motivation to purchase supplements was a recommendation from an acquaintance, followed by a recommendation from a family member and TV. Only 9.1% of the patients consulted healthcare professionals when purchasing supplements.  The patients who did not follow the dosage and administration instructions and those who were not aware of precautions regarding proper use accounted for 31.8% and 63.6%, respectively.  The proportion of patients who did not inform their physicians about the use of supplements was 65.2%, and 4.5% reported some health damage (rash).
Conclusion: Our results revealed that supplements were used without careful consideration and were not administered properly, suggesting that scientific evaluation of efficacy and safety was warranted in future studies.  It is important for pharmacists to actively collect information on patient use of supplements and share the information within the medical team.

Objective: This report presents a case of supracondylar femur fracture with finite element analysis and discusses its causes and prevention.Patient and Methods: A 53-year-old man presented with right talar osteonecrosis after osteosynthesis for a talus fracture. A medial femoral condyle-free vascularized bone graft (size, 20 × 12 × 17 mm) from the contralateral femur was performed, including the posteromedial cortical corner. The patient suffered a donor-site supracondylar femoral fracture while standing up from a cross-legged sitting position on the bed on postoperative day 6. The fracture was treated with intramedullary nailing. We analyzed the effects of the location of the bone graft harvest in an intact model using the three-dimensional finite element method (FEM).Results: The talar necrosis and the femur fracture healed. The FEM result revealed that the longitudinal axial pressure had minimal effect on the femur; however, the stress around the bone defect increased with rotation, especially in the posteromedial bone defect model.Conclusion: Harvesting the bone graft should not include the posteromedial corner of the supracondylar femur. The patient should strictly limit the motion of torsional stress, such as standing from a cross-legged sitting position or pivoting turn.