Higher brain dysfunction generally refers to cognitive and/or behavioral changes resulting from stroke, traumatic head injury, hypoxic encephalopathy, or any other of a number of cerebrovascular events. In 2004, the Ministry of Health, Labour and Welfare of Japan released a provisional figure of the probable prevalence of higher brain dysfunction in Japan as some 300,000 individuals. The aim of this study was to provide an estimate of the number of people with higher brain dysfunction in Tokyo. All 651 hospitals in Tokyo were surveyed between January 7, 2008 and January 20, 2008 by questionnaire. Analysis of the data showed 118 incidents of brain damage which resulted in higher brain dysfunction. This roughly converts to 3,010 incidents per year in Tokyo. Taking life expectancy into consideration, we estimate the current number of higher brain dysfunction survivors to be 49,508 (male : 33,936, female : 15,572) in Tokyo. The social impact of higher brain dysfunction has recently emerged amid growing recognition that disturbances of attention, memory, and behavior overshadow the contribution of focal motor deficits to chronic dependency. Our data provide information about the number of people that may require appropriate provision in the community.

To clarify the views and needs on Rx-to-OTC switches in patients afflicted with lifestyle-related diseases such as hypertension, diabetes and/or hyperlipidemia, our survey was conducted with 199 patients at a pharmacy in Tokyo, Japan.Of the 199 patients, 159 people were patients afflicted with lifestyle-related diseases.One hundred and ten patients afflicted with lifestyle-related diseases were seventy-year-old and older, and 149 of the patients have been to a hospital at least once in the past year.Thirty-six point five percent of the patients afflicted with lifestyle-related diseases replied that they wanted to use Rx-to-OTC switches when they had been ill and/or injured.The main reasons that they wanted to use Rx-to-OTC switches were “convenience” and “always the same drugs”.On the other hand, the main reason that they did not want to use Rx-to-OTC switches was “I want to have a detailed examination”.Twenty-three point nine percent of them replied that they wanted to switch their prescription drugs to Rx-to-OTC switches. We believe that the usage of Rx-to-OTC switches after the establishment of a support system to secure safety can be the answer to the issues of the rise in medical care expenditures and doctor shortage.

A 73-year-old woman was admitted to undergo three simultaneous operations: aortic valve replacement (AVR), coronary artery bypass grafting (CABG) and abdominal aortic aneurysm repair. She had previously undergone percutaneous catheter intervention in the left coronary anterior descending artery. Computed tomography revealed an abdominal aortic aneurysm 5cm in diameter. Aortic valve stenosis (AS) was shown with a pressure gradient of 60mmHg, and 90% stenosis of the distal right coronary artery was also shown. CT scan and aortography revealed porcelain ascending aorta. The patient underwent simultaneous operations because of severe AS, coronary artery disease and abdominal aortic aneurysm. An aortic cannula was placed in a position higher in the ascending aorta with no calcification. Cardiopulmonary bypass was started using a two-staged venous cannula through the right atrium. At first, AVR was performed with cardioplegic solution and ice slush. Because it was difficult to inject the cardioplegic solution into the coronary artery selectively due to the calcified orifice of coronary artery, we closed it immediately by removing the calcified intima of the porcelain aorta after completion of AVR. The second cardioplegic solution was injected through the ascending aorta. Next, CABG to RCA was performed using the right gastroepiploic artery without anastomosis to the ascending aorta. Cardiac surgery was first performed, followed by abdominal aortic aneurysm repair after discontinuation of cardiopulmonary bypass. The patient was extubated the next day and stayed for two days in the intensive care unit. She is very well now one year after the operation.

Recently, with the increase of laparoscopic surgery, there has also been an increase in the number of surgeries that require the head-down position for a long duration and left-right rotation. We have encountered 3 cases of brachial plexus neuropathy that was thought to be caused by such surgical positions in our institute. Currently, we have improved the fixation method and fixtures and created a neuropathy checklist, and we are conducting standardized observation and decompression programs within the team. We examined whether our current programs are effective using a body pressure measuring device for 20 patients undergoing headdown lithotripsy surgery under general anesthesia. The correlation between the mean body pressure on the right shoulder after 30 min and body tilt angle was studied. We also observed changes in body pressure before and after manual decompression every 30 min while the patient was in the head-down position. Before that study, we conducted an experience questionnaire survey of 10 operating room nurses. The results indicated that there was no increase in body pressure in proportion to the body tilt angle (15-20 deg). The body pressure after decompression decreased significantly at 30, 60, and 120 min after placing the patient in the head-down lithotripsy position. There was no significant correlation between body pressure and the headdown positioning time. There was a significant correlation between body mass index (BMI) and body pressure at 30 min (r=0.474, p=0.035). Complaints of trunk displacement, shoulder pain and pressure, and head and neck traction were often noted in the nurse questionnaire. These complaints were more frequently seen in cases with a larger right-down rotation angle and higher BMI. From these results, it was concluded that decompression of the body with the current fixtures and our regular observation and decompression program using the neuropathy checklist is effective for preventing brachial plexus injury in patients undergoing lithotripsy laparoscopic surgery in the head-down position and with left-right rotation.