1.An Attempt at Objective Evaluation of the Current Situation of Concomitant Drug Use for Dementia Outpatients at Community Pharmacies
Yuka Tanaka ; Mitsuko Onda ; Yoko Nanaumi ; Rie Tanaka ; Kenichi Tsubota ; Shunya Matoba ; Yusuke Mukai ; Yukio Arakawa
Japanese Journal of Drug Informatics 2014;15(4):155-164
Objectives: The objectives of this study are to evaluate the current situation of concomitant drug use by community-dwelling elderly dementia patients, and to extract factors influencing the presence of potentially inappropriate medications (PIMs).
Method: The research subjects were patients 65 years of age or older for whom concomitant drugs were prescribed on the same prescription form as donepezil hydrochloride. One hundred and twenty community pharmacies randomly selected from 28 of the 47 prefectures throughout Japan. Main research topics were sex, age, the clinical department to which the prescribing physician belonged, daily dosage of donepezil, and concomitant drugs. Concomitant drugs were evaluated using the Beers Criteria: the Japanese Version. Furthermore, to search factors influencing the presence of PIMs, logistic regression analysis was used.
Results: Data for 335 patients were extracted. The average number of concomitant drug cases per patient were 4.2 (SD 2.6), and 109 patients (32.5%) were prescribed PIMs. A logistic regression analysis confirmed that significant factors influencing the presence of PIMs were “the clinical department to which the prescribing physician belonged” (OR 4.80, 95%CI 1.01-22.72), “concomitant drug cases” (OR 1.26, 95%CI 1.13-1.41) and “the presence of concomitant use of central nervous system agents” (OR 5.82, 95%CI 3.35-10.11).
Conclusion: This study revealed that more than a few cases of community-dwelling elderly patients of dementia were using concomitant drugs with potential risks. It suggested that influencing factors were “the specialty of the prescribing physician” and “the presence of concomitant use of central nervous system agents.”
2.The Factors that Influence the Intention of Consumers with Cold-like Symptoms Who Visited Drugstores to Purchase OTC Drugs to Consult Pharmacists or Sellers
Yusuke Naka ; Mitsuko Onda ; Yukako Yamane ; Yuji Kawaguchi ; Shota Nakano ; Yukio Arakawa
Japanese Journal of Drug Informatics 2016;18(2):81-86
Objective: The subjects of this study were consumers with cold-like symptoms who visited drugstores to purchase OTC drugs. The purpose was to elucidate the factors that influence the intention of these consumers to consult pharmacists or sellers.
Design: Analytic observational study
Method: We conducted a survey of consumers who visited pharmacies or drugstores for cold-like symptoms. Pharmacists and registered sellers (hereafter “pharmacists or sellers”) utilized tools to serve them, entering details in customer records. We handed postcards to these consumers asking them to respond to questions about the prognosis and the degree of satisfaction about the service they had received. We then used the customer records and follow-up results to perform linear regression analysis with “I would like to consult the pharmacist or seller again” (hereafter “desire for consultation”) as the dependent variable, and the usefulness of the advice and degree of satisfaction about the explanation and service as the independent variables.
Results: We analyzed the data of 81 consumers for whom we were able to match the customer records and postcards. The linear regression analysis indicated that “the usefulness of the advice (coefficient of standardization: 0.73)” affected the desire for consultation most, followed by “the degree of satisfaction about the service (coefficient of standardization: 0.24).
Conclusion: We verified that, in self-medication assistance, advice that lets consumers feel the consultation was actually “helpful” by focusing on individual needs, and good customer service were necessary to increase the desire for consultation with pharmacists or sellers, and to encourage actual consultation.
3.A Case of Primary Racemose Hemangioma Discovered from Abnormal Chest X-ray Finding
Ken TOMOOKA ; Makoto NAKAO ; Seiji KAMEI ; Yuto SUZUKI ; Yusuke SAKAI ; Sousuke ARAKAWA ; Yusuke KAGAWA ; Ryota KUROKAWA ; Hidefumi SATO ; Yoshimi HORIKAWA ; Hideki MURAMATSU
Journal of the Japanese Association of Rural Medicine 2017;66(1):79-85
A 56-year-old woman was referred to our hospital because of an abnormal finding in the right pulmonary hilum on chest X-ray. Enhanced chest computed tomography showed hyperplastic bronchial arteries dilating and winding around the trachea and bronchi. A racemose hemangioma of the bronchial artery with multiple bronchial artery aneurysms (diameter <20mm) was seen displacing the trachea and both main bronchi. Bronchoscopy showed submucosal tumor-like lesions at the distal trachea and in both main bronchi, and a dusky-red elevated pulsatile lesion at the orifice of the left B3b+c. We performed coil embolization of the bronchial artery aneurysm to prevent abrupt rupture of the bronchial aneurysm.
4.A case of wild-type transthyretin amyloidosis associated with organizing pneumonia
Makoto Nakao ; Hideki Muramatsu ; Eriko Yamamoto ; Yuto Suzuki ; Sousuke Arakawa ; Ken Tomooka ; Yusuke Sakai ; Kouhei Fujita ; Hidefumi Sato
Journal of Rural Medicine 2017;12(2):130-134
An 81-year-old man was referred to our hospital with bilateral multiple patchy opacities on chest radiography. His chief complaints were a few months’ history of intermittent mild cough and slightly yellow sputum. Chest computed tomography (CT) showed non-segmental air-space consolidations with ground-glass opacities. Amyloid deposition with organizing pneumonia (OP) was seen in transbronchial lung biopsy (TBLB) specimens from the left S8. Three months later, the infiltration originally seen in the left lower lobe was remarkably diminished, and new infiltrations in the lingual and right lower lobes were detected on chest CT. Amyloid deposition with OP was seen in TBLB specimens from the left S4. Transthyretin was detected following immunohistochemical examination. The presence of wild-type transthyretin (ATTRwt) was proven using genetic analysis. The present report describes a rare case of ATTRwt amyloidosis associated with OP.
5.Recent refinements and advances for pancreatoduodenectomy
Yuji Morine ; Mitsuo Shimada ; Satoru Imura ; Tetsuya Ikemoto ; Yusuke Arakawa ; Syuichi Iwahashi ; Yu Saito ; Shinichiro Yamada ; Daichi Ishikawa
Innovation 2014;8(4):136-137
Background: The technique of pancreatoduodenectomy (PD) has evolved, and
artery first’ approach was considered for the intraoperative early determination
of resectability for borderline resectable cases before the ‘point of no return’
and avoidance of blood congestion resulted in the reduction of blood loss. Also,
active application of energy device was useful for the reduced operative time and
blood loss. Recently, 3D simulation for hepatobiliary pancreatic surgery has been
useful and mandatory. In this presentation, we introduced our recent refinements
and advances for PD.
‘Artery first’ approach and vessel sealing system for PD: ‘Artery first’ approach
were considered as six different methods as follows; 1) Superior approach, 2)
Anterior approach, 3) Posterior approach, 4) Left posterior approach, 5) Right/
medial uncinate approach and 6) Mesenteric approach. A while ago, we
preferably applied the mesenteric approach to PD, and also the combination of
this approach with vessel sealing system (VSS) significantly reduced intraoperative
blood loss (Mesenteric approach with VSS, n=21 vs. non-‘Artery first’ approach
without VSS, n=78; 320±174ml vs. 486±263ml, p<0.01).
Modified de-rotation method as complete ‘Artery first’ approach: Most recently,
for further refinement of operative procedure, we refined a right/medial uncinate
and posterior approach as modified de-rotation method. Point of view in this
method was the complete clockwise rotation of small intestinal mesentery
including ascending colon, in order to linearize from duodenum to jejunum
and look at the direct front of superior mesenteric artery (SMA), vein (SMV) and
some branched jejunal vessels originated from SMA and SMV (Fig.). Thereby, in
the posterior view, the easy dissection of all pancreatic branch originated from
SMA can be done. This modified de-rotation method was possible to achieve the
complete ‘Artery first’ approach.
Preoperative 3D simulation of arterial and venous anatomy:
Until now, we applied 3D volumetery software (SYNAPSE VINCENT®) as
preoperative simulation for hepatic resection. And recently, for evaluation of the
position relationship between arteries and veins surround pancreas head, we
adopted this software before PD. As first step, arteries and veins are automatically
identified, and small vessels are manually traced on the axial CT view. After
that, 3D arterial and venous simulations are combined. Grasp of detailed vessel
anatomy and its relationship using preoperative 3D simulation enable to safely
perform PD, even in young surgeons (operative time; young 512±49 vs. senior
445±41 min, p<0.01), (blood loss; young 353±203 vs. senior 246±109 ml,
p=0.16).
Conclusion: Those refinements and advances are possible to safely and easily
perform pancreatoduodenectomy.
6. Recent refinements and advances for pancreatoduodenectomy
Yuji MORINE ; Mitsuo SHIMADA ; Satoru IMURA ; Tetsuya IKEMOTO ; Yusuke ARAKAWA ; Syuichi IWAHASHI ; Yu SAITO ; Shinichiro YAMADA ; Daichi ISHIKAWA
Innovation 2014;8(4):136-137
Background: The technique of pancreatoduodenectomy (PD) has evolved, andartery first’ approach was considered for the intraoperative early determinationof resectability for borderline resectable cases before the ‘point of no return’and avoidance of blood congestion resulted in the reduction of blood loss. Also,active application of energy device was useful for the reduced operative time andblood loss. Recently, 3D simulation for hepatobiliary pancreatic surgery has beenuseful and mandatory. In this presentation, we introduced our recent refinementsand advances for PD.‘Artery first’ approach and vessel sealing system for PD: ‘Artery first’ approachwere considered as six different methods as follows; 1) Superior approach, 2)Anterior approach, 3) Posterior approach, 4) Left posterior approach, 5) Right/medial uncinate approach and 6) Mesenteric approach. A while ago, wepreferably applied the mesenteric approach to PD, and also the combination ofthis approach with vessel sealing system (VSS) significantly reduced intraoperativeblood loss (Mesenteric approach with VSS, n=21 vs. non-‘Artery first’ approachwithout VSS, n=78; 320±174ml vs. 486±263ml, p<0.01).Modified de-rotation method as complete ‘Artery first’ approach: Most recently,for further refinement of operative procedure, we refined a right/medial uncinateand posterior approach as modified de-rotation method. Point of view in thismethod was the complete clockwise rotation of small intestinal mesenteryincluding ascending colon, in order to linearize from duodenum to jejunumand look at the direct front of superior mesenteric artery (SMA), vein (SMV) andsome branched jejunal vessels originated from SMA and SMV (Fig.). Thereby, inthe posterior view, the easy dissection of all pancreatic branch originated fromSMA can be done. This modified de-rotation method was possible to achieve thecomplete ‘Artery first’ approach.Preoperative 3D simulation of arterial and venous anatomy:Until now, we applied 3D volumetery software (SYNAPSE VINCENT®) aspreoperative simulation for hepatic resection. And recently, for evaluation of theposition relationship between arteries and veins surround pancreas head, weadopted this software before PD. As first step, arteries and veins are automaticallyidentified, and small vessels are manually traced on the axial CT view. Afterthat, 3D arterial and venous simulations are combined. Grasp of detailed vesselanatomy and its relationship using preoperative 3D simulation enable to safelyperform PD, even in young surgeons (operative time; young 512±49 vs. senior445±41 min, p<0.01), (blood loss; young 353±203 vs. senior 246±109 ml,p=0.16).Conclusion: Those refinements and advances are possible to safely and easilyperform pancreatoduodenectomy.
7.Anococcygeal Raphe Revisited: A Histological Study Using Mid-Term Human Fetuses and Elderly Cadavers.
Yusuke KINUGASA ; Takashi ARAKAWA ; Hiroshi ABE ; Shinichi ABE ; Baik Hwan CHO ; Gen MURAKAMI ; Kenichi SUGIHARA
Yonsei Medical Journal 2012;53(4):849-855
PURPOSE: We recently demonstrated the morphology of the anococcygeal ligament. As the anococcygeal ligament and raphe are often confused, the concept of the anococcygeal raphe needs to be re-examined from the perspective of fetal development, as well as in terms of adult morphology. MATERIALS AND METHODS: We examined the horizontal sections of 15 fetuses as well as adult histology. From cadavers, we obtained an almost cubic tissue mass containing the dorsal wall of the anorectum, the coccyx and the covering skin. Most sections were stained with hematoxylin and eosin or Masson-trichrome solution. RESULTS: The adult ligament contained both smooth and striated muscle fibers. A similar band-like structure was seen in fetuses, containing: 1) smooth muscle fibers originating from the longitudinal muscle coat of the anal canal and 2) striated muscle fibers from the external anal sphincter (EAS). However, in fetuses, the levator ani muscle did not attach to either the band or the coccyx. Along and around the anococcygeal ligament, we did not find any aponeurotic tissue with transversely oriented fibers connecting bilateral levator ani slings. Instead, in adults, a fibrous tissue mass was located at a gap between bilateral levator ani slings; this site corresponded to the dorsal side of the ligament and the EAS in the immediately deep side of the natal skin cleft. CONCLUSION: We hypothesize that a classically described raphe corresponds to the specific subcutaneous tissue on the superficial or dorsal side of the anococcygeal ligament.
Aged, 80 and over
;
Anal Canal/*anatomy & histology/embryology
;
*Cadaver
;
Female
;
*Fetus
;
Humans
;
Male
;
Muscle, Smooth/*anatomy & histology/embryology
;
Rectum/*anatomy & histology/embryology
8.Female Longitudinal Anal Muscles or Conjoint Longitudinal Coats Extend into the Subcutaneous Tissue along the Vaginal Vestibule: A Histological Study Using Human Fetuses.
Yusuke KINUGASA ; Takashi ARAKAWA ; Hiroshi ABE ; Jose Francisco RODRIGUEZ-VIZQUEZ ; Gen MURAKAMI ; Kenichi SUGIHARA
Yonsei Medical Journal 2013;54(3):778-784
PURPOSE: It is still unclear whether the longitudinal anal muscles or conjoint longitudinal coats (CLCs) are attached to the vagina, although such an attachment, if present, would appear to make an important contribution to the integrated supportive system of the female pelvic floor. MATERIALS AND METHODS: Using immunohistochemistry for smooth muscle actin, we examined semiserial frontal sections of 1) eleven female late-stage fetuses at 28-37 weeks of gestation, 2) two female middle-stage fetus (2 specimens at 13 weeks), and, 3) six male fetuses at 12 and 37 weeks as a comparison of the morphology. RESULTS: In late-stage female fetuses, the CLCs consistently (11/11) extended into the subcutaneous tissue along the vaginal vestibule on the anterior side of the external anal sphincter. Lateral to the CLCs, the external anal sphincter also extended anteriorly toward the vaginal side walls. The anterior part of the CLCs originated from the perimysium of the levator ani muscle without any contribution of the rectal longitudinal muscle layer. However, in 2 female middle-stage fetuses, smooth muscles along the vestibulum extended superiorly toward the levetor ani sling. In male fetuses, the CLCs were separated from another subcutaneous smooth muscle along the scrotal raphe (posterior parts of the dartos layer) by fatty tissue. CONCLUSION: In terms of topographical anatomy, the female anterior CLCs are likely to correspond to the lateral extension of the perineal body (a bulky subcutaneous smooth muscle mass present in adult women), supporting the vaginal vestibule by transmission of force from the levator ani.
Anal Canal/*anatomy & histology/embryology
;
Female
;
Fetus/anatomy & histology
;
Humans
;
Male
;
Muscle, Smooth/*anatomy & histology/embryology
;
Pelvic Floor/anatomy & histology
;
Sex Characteristics
;
Vagina/*anatomy & histology/embryology
9.Analysis of medical records and prescription data from long-term disaster medical support following the subacute phase of the Great East Japan Earthquake on March 11, 2011
Yusuke Shiba ; Ryota Sakai ; Ryota Watano ; Yasunari Okuda ; Hiroumi Wakabayashi ; Masashi Arakawa ; Tomohito Nakazawa ; Toshiaki Sudo ; Hideharu Kajii ; Tsuyoshi Hasegawa ; Masanobu Okayama
An Official Journal of the Japan Primary Care Association 2013;36(1):23-26
Abstract
Introduction : There are few reports of long-term medical support activities in disaster areas. We analyzed drug-related data using medical records and prescriptions obtained during the long-term medical support of patients impacted by the Great East Japan Earthquake, which occurred on March 11, 2011.
Methods : Using medical records and prescriptions, the dispensing frequency of each drug was calculated and usage trends of the top three most frequently dispensed drugs are described here. All data was collected from March 26, 2011 onwards after the medical support activity commenced.
Results : In the first week of data acquisition, a total of 166 patients visited the medical support team (median 48.5, range 14-166). Following that, the number of patients decreased with a median of 24 people per day (range 0-47). The number of prescriptions for common cold medication was the highest, followed by antihypertensive and anti-allergic medications, respectively. The usage of antihypertensive drugs and common cold medications decreased over time, whereas anti-allergic medications were prescribed on a continuous basis.
Conclusion : Disaster medical support teams should not only be prepared to support the acute phase but also long-term phase, which depends heavily on the restoration of local medical services. The earlier the intervention to provide support, the greater the likelihood that the disaster medical support team will require to provide treatment for both acute and chronic illness.
10.Элэгний мэс засалд гарсан сүүлийн үеийн ололт амжилтууд: Элэгний үйл ажиллагааны нөөцийг үнэлэх, загварчлах болон чиглүүлэх
Satoru Imura ; Mitsuo Shimada ; Tohru Utsunomiya ; Yuji Morine ; Tetsuya Ikemoto ; Yusuke Arakawa ; Mami Kanamoto ; Shuichi Iwahashi, ; Yu Saito ; Daichi Ishikawa, ; Batsaikhan Bat-Erdene.
Innovation 2013;7(3):8-12
INTRODUCTION:
Recent technical innovation in liver surgery is remarkable. Now, for example, a preoperative 3D-simulation of the liver is a routine modality, and indispensable (or essential) for liver surgery. The aim of this presentation is to clarify various kinds of progresses and future perspective in liver surgery.
PREOPERATIVE MODALITIES
1) One-stop shopping of 3D-simulation of the liver: We newly developed 3D-simulation using a software of SYNAPSE VINCENT Ver. 3.1 (Fujifilm Medical, Tokyo, Japan), in which biliary system is simultaneously reconstructed in one dynamic MD-CT. This technique avoids position error which occurred in 3D fusion image using another modality such as DIC–CT or MRCP, as well as unnecessary radiation exposure.
2) Assessment of partial functional reserve: We have reported new methods to astimate regional hepatic functional reserve using hepatocyte-phase of EOB-MRI (J Gastroenterol 2012), and fusion image of 3D-CT and asialoscintigraphy using 99m-Tc galactosyl human albumin. The method of EOB-MRI utilized character of hepatocyte-uptake of EOB through membrane transporters on hepatocytes. The other used fusion of both asialoscintigram of hepatic functional reserve and 3D-simulation by the above-mentioned software. Those techniques provided accurate estimation of partial functional volume, and help surgeons’ decision making of resection volume.
INTRAOPERATIVE MODALITIES:
1) Navigation using iPad: navigation using iPad in which preoperative 3D-image data are uploaded in advance, tumor location, accurate and anatomical orientation can confirm in the operative field during operation. This technique enable not only operators also assistants or students to better understand precise anatomy.
2) Indocyanine green (ICG) fluorescent image-guided navigation: this technique using HyperEye Medical System (MIZUHO IKAKOGYO Co., Ltd. Tokyo, Japan) help us to confirm tattooing of target segment and parenchymal intersegmental plane, and detect hepatic tumors (metastatic and HCC) near liver surface as well as invisible tumor inside the liver.
CONCLUSIONS:
Various advancements such as preoperative 3D-simulation including partial functional reserve estimation and intraoperative navigation techniques enabled surgeons to easily and safely perform hepatic resection.