Objective: Pharmacist interventions are effective for appropriate medical management.  The Japanese Society of Hospital Pharmacists has recommended the “pre-avoid report” to foster appropriate pharmacotherapy since 1999.  The “pre-avoid report” format consists of two forms : “serious report” and “preventive report.”  The number of “preventive reports” has comprised about 90% of “pre-avoid reports.”  However, this format of the “preventive report” since 1999 has shown inadequacy due to changes in pharmacists’ ability.  In the present study, we conducted a re-modification of the “preventive report” format using an assay to create the present “preventive report” format.
Methods: We retrospectively reviewed the pharmacists’ “preventive report” of the “pre-avoid report” from January 2014 to December 2014 in the Department of Pharmacy, Okayama University Hospital.
Results: The present format included 101 cases of “others” in the “preventive report” format.  This “others” section consisted of “non-intervention of pharmacotherapy” (51%), “forget to stop pre-operation drugs” (14.7%), and “inadequate treatment (wrong administration day, unnecessary treatment).  These factors were not identified with the present format of the “preventive report.”
Conclusion: In the present study, we suggested that it is necessary to revise the format of the “preventive report” to reflect.

There are many acquired and hereditary coronary risk factors, and the gender is known as a factor influencing the development of acute myocardial infarction (AMI). To evaluate the role of the gender in the occurrence of AMI, we compared patient backgrounds, their clinical manifestations, outcomes, and coronary angiographic findings between 390 male and 110 female AMI patients, who had been admitted to the coronary care unit (CCU) of the Tsuchiura Kyodo General Hospital and undergone coronary angiography on an emergency basis. The incidence of AMI was the highest in the age group of 60s for males, while for females in the age group of 70s. As coronary risk factors, smoking habit was more common in males, while hypertension, hyperlipidemia and diabetes meritus were more common in females. Coronary angiograms revealed no differences in the number of diseased vessels and location of infarction. Frequencies of urgent PTCA were also identical between the two groups. In clinical outcomes, elder females had poorer prognosis mainly due to a higher incidence of death caused by cardiac rupture. It has been reported that definite increase of AMI after menopause is attributable to disturbed lipid metabolism due to a reduced estrogen level. Our study showed that aged female AMI patients had poorer prognosis possibly due to associated multiple risk factors, mutiple organ disorders and delayed admission to hospital and higher risk of cardiac rupture. Therefore, in the treatment of aged female AMI patients, these tendencies must be taken into account.

BACKGROUND/AIMS: The relationship between the appearance of an ulcer and postoperative bleeding after gastric endoscopic submucosal dissection (ESD) is not well understood. To explore this potential relationship, we retrospectively analyzed the short-term healing process of ESD. METHODS: A total of 520 consecutive lesions in 434 patients seen between January 2004 and December 2009 were retrospectively investigated. At the second-look endoscopy, which occurred between 1 and 8 days after ESD, artificial ulcers were categorized into 6 patterns according to Forrest's classification: spurting bleeding, oozing bleeding, non-bleeding visible vessel, adherent clot, black base/spot, and clean base. From these data, a short-term healing model of the artificial ulcer was generated. RESULTS: Ulcer base changed gradually from a bloody to a clean one. The bleeding or non-bleeding visible vessel categories, which occurred in approximately one quarter of the ulcers within 3 days of ESD, were rarely observed 4 days after ESD. CONCLUSIONS: Ulcers that occur after gastric ESD heal in line with a specific time course, and it appears that most healing occurs without massive bleeding.
Endoscopy ; Glycosaminoglycans ; Hemorrhage ; Humans ; Retrospective Studies ; Stomach Neoplasms ; Ulcer

BACKGROUND/AIMS: The gastrointestinal motility effects of endogenous incretin hormones enhanced by dipeptidyl peptidase-IV (DPP-IV) inhibitors have not yet been sufficiently investigated. The aim of this study was to determine whether single pre-prandial sitagliptin, the DPP-IV inhibitor, administration might have an effect on the rate of liquid gastric emptying using the 13C-acetic acid breath test. METHODS: Ten healthy male volunteers participated in this randomized, two-way crossover study. The subjects fasted for overnight and were randomly assigned to receive 50 mg sitagliptin 2 hours before ingestion of the liquid test meal (200 kcal per 200 mL, containing 100 mg 13C-acetate) or the test meal alone. Under both conditions, breath samples were collected for 150 minutes following the meal. Liquid gastric emptying was estimated by the values of the following parameters: the time required for 50% emptying of the labeled meal (T1/2), the analog to the scintigraphy lag time for 10% emptying of the labeled meal (Tlag), the gastric emptying coefficient and the regression-estimated constants (beta and kappa), calculated by using the 13CO2 breath excretion curve using the conventional formulae. The parameters between the 2 test conditions were compared statistically. RESULTS: No significant differences in the calculated parameters, including T1/2, Tlag, gastric emptying coefficient or beta and kappa, were observed between the 2 test conditions. CONCLUSIONS: The present study revealed that single-dose sitagliptin intake had no significant influence on the rate of liquid gastric emptying in asymptomatic volunteers.
Breath Tests ; Cross-Over Studies ; Eating ; Gastric Emptying ; Gastrointestinal Motility ; Humans ; Incretins ; Male ; Meals ; Pyrazines ; Triazoles ; Sitagliptin Phosphate

Objectives: Duodenal perforation as a complication of endoscopic ultrasound-guided fine needle aspiration may progress to acute peritonitis and septic shock. Open surgery, the standard treatment, can be avoided by performing closure during endoscopy using endoscopic clips.Patient: A 77-year-old woman was referred to our hospital with salivary gland swelling. She had elevated hepatobiliary enzymes and jaundice. Computed tomography (CT) revealed pancreatic head swelling and bile duct dilation. Endoscopic ultrasonography revealed a hypoechoic mass in the pancreatic head. The pancreatic head mass was punctured twice using a 22-gauge Franchine-type puncture needle at the duodenal bulb. The endoscope was advanced to the descending part of the duodenum, and part of the superior duodenal angle was perforated (diameter approximately 15 mm) with the endoscope. The duodenal mucosa around the perforation was immediately closed using endoscopic clips.Results: Abdominal CT showed gas in the peritoneal and retroperitoneal spaces. The patient experienced abdominal pain and fever and was treated with fasting and antibiotics. The gas gradually decreased, symptoms improved, and she was discharged 18 days after the perforation. Histopathologically, the pancreatic tissue was consistent as autoimmune pancreatitis.Conclusion: Endoscopic closure using endoscopic clips may be a better therapeutic option for duodenal perforation caused by endoscopy.