We report a rare case of a 73-year-old man with abdominal and thoracic aortic aneurysms complicated with Buerger's disease. He complained of abdominal pain, nausea and an abdominal pulsatile mass. Computed tomography and angiography revealed an abdominal aortic aneurysm (58mm in diameter) and a thoracic aortic aneurysm (47mm in diameter). Y graft replacement was performed for abdominal aortic aneurysm. The size of the thoracic aortic aneurysm increased from 47mm to 60mm in 3 years, and hoarseness appeared. We then performed graft replacement of the thoracic aorta. In cases of Buerger's disease, we have to consider perfusion of the extremities when we need extracorporeal circulation, and we must shorten ischemic interval.

The purpose of this study was to evaluate the changes of pre-motion time (PMT), pre-motion silent period (PMSP), and switching silent period (SSP) before and after the training using balance-mat. Twenty healthy people aged 21-36 years old (average 26.5 years old) were subjected to a series of experiment. These were randomly divided into two groups (10 subjects each), control and balance-mat group. Activities of M. Soleus and M. Tibialis anterior were recorded by electromyogram (EMG) for the duration subjects were tried to raise their both heels as quick respond to a flashing lamp. Intervention consisted of 3minutes standing on the floor in control group, and 3 minutes standing on the balance-mat in balance-mat group. Then EMG was recorded as the same manner after the intervention in each group. There was no statistical difference of duration of PMSP and SSP between the two groups before intervention. On the other hand, those in balance-mat group were significantly shorter than those in control group after intervention. In addition, in balance-mat group, duration of PMSP and SSP after intervention were significantly shorter than that before intervention. There was no statistical difference of PMT between before and after the intervention. These results suggested balance-mat training was effective for shorten the duration of SSP and PMSP, that lead to control the posture function.

Reconstruction of the right ventriclar outflow tract (RVOT) in congenital heart disease often requires implantation of a valved conduit. A hand-made expanded polytetrafluoroethylene (ePTFE) trileaflet Dacron graft conduit has been used at our center since 1997, and has been implanted in 31 patients. Midterm results of this conduit were investigated in 30 of the patients who have been followed at our outpatient clinic. There were 16 males and 14 females. The mean age and body weight were 16.4±7.2 (range, 3.4-33.4) years and 41.7±13.3 (range, 13.0-64.0)kg, respectively. Diagnoses were tetralogy of Fallot with pulmonary atresia in 14 patients, RVOT reconstruction associated with Ross procedure in 8, transposition with pulmonary stenosis in 3, pulmonary atresia with intact ventricular septum in 2, tetralogy with absent pulmonary valve syndrome in 1, pulmonary regurgitation developed after tetralogy repair in 1, and hemitruncus in 1. The median size of the graft was 22 (range, 20-26)mm. All patients were in NYHA functional class I at the time of the latest follow-up. The pressure gradient across the conduit was 11.0±5.8mmHg during the same hospitalization and 13.8±6.5mmHg on the latest echocardiogram (Interval, 2.4±1.5 years, p=0.85). The valve function was well maintained in all patients, with the regurgitation graded as non-trivial in 22 patients, mild in 7, and moderate in only 1. Midterm results of hand-made ePTFE trileaflet valved cunduit was satisfactory. A longer follow-up is mandatory to assess its actual durability.

An exploratory open-label human clinical study was performed in healthy adults with shoulder stiffness to evaluate the efficacy of Astaxanthin by means of measuring blood flow change in the shoulders and subjective questionnaires on physical conditions, including alleviation of stiffness before and after treatment. Two capsules containing 3 mg Astaxanthin each (6 mg in total) were administered once daily (6 mg a day) on days 1 to 28 (4 weeks) to 13 patients (3 men/10 women). All patients were assessed for efficacy and the study demonstrated significant improvements in physical conditions such as shoulder stiffness, physical fatigue, sense of mental irritation, sense of coldness in hands and feet, eye fatigue and eye bleariness. Significant increases of blood flow in shoulders were observed at the end of treatment using laser-doppler graphics. Blood tests conducted to confirm safety before and at the end of treatment showed no clinical differences, and no adverse side effects were reported. In conclusion, Astaxanthin appeared to safely alleviate stiff shoulders and improve other physical conditions during a 4-week open-label study.

The Medication Guides for Patients (MGPs) are being offered as information on prescription drugs for patients by the Ministry of Health, Labour and Welfare (MHLW). The MHLW published the Risk Management Plan in April, 2012, and it noted that the MGPs should be utilized in usual risk minimization activities. It is not clear, however, whether the MGPs are efficiently utilized in actual settings. Hence, we conducted a questionnaire survey of the pharmacists in the pharmacies with dispensing and the hospitals in Mie and Yamagata prefectures to investigate the actual circumstances of MGPs utilization and to understand the existing barriers associated with the use of the MGPs as medication instructions for patients. We sent the questionnaires by mail and obtained responses from 444 facilities (33.9%) of 1,309 facilities. The recognition level of the MGPs was about 30 percent in the dispensing pharmacies, and about 50 percent in the hospitals. The MGPs were utilized as a common communication tool with the patients in approximately 20 percent of the facilities. Many respondents requested that the frequency of important and other adverse reactions should be described in the MGPs, and wider ranges of MGPs should be further implemented.
Moreover, our data suggests the problem is that the present MGPs are mainly applied to special types of patients, such as those with higher literacy level or those who requested a detailed explanation. Thus, it is apparent that it is necessary to review the MGPs contents again to improve their practical benefits and disseminate them more widely.

A 28-year-old man was involved in a traffic accident that sandwiched his chest between a wall and a truck. Shortness of breath and other symptoms started to appear several years later. Echocardiography at that time showed severe tricuspid regurgitation due to a failed valve and ruptured chordae in the anterior leaflet. He was followed up with medication. Leg edema developed at the age of 62 years and worsening symptoms of heart failure over a period of 6 months indicated a need for surgery. Intraoperative findings revealed the ruptured chordae attached to the anterior leaflet and a scarred myocardium at the septomarginal trabeculation. The tricuspid valve was surgically repaired, the anterior leaflet chordae were surgically reconstructed, an annuloplasty ring was implanted to address the tricuspid regurgitation and atrial fibrillation was treated using the Maze procedure. Surgery 34 years after trauma has improved hemodynamic cardiac function and normalized the cardiac rhythm in this patient.

Objective: Prescription check and inquiry is one of the most important operations of pharmacists to provide optimal drug therapy to the patient.  Although a number of studies related to inquiries of prescriptions have already been reported, there is little report about requests for doctor and hospital based on the examples.  Therefore, this study aimed to clarify the current problems revealed by inquiries about prescriptions by not only analyzing these inquiries but also investigating requests for doctors and hospitals.
Methods: We investigated 6,255 inquiries about prescriptions and requests for doctors and hospitals at 584 insurance pharmacies from August 4 to 10, 2014.  Then, the inquiries about prescriptions and requests for doctors and hospitals were categorized.
Results: The most frequent category of inquiries about prescriptions was “Questions about administration and dosage” (21.5%).  On the contrary, the most frequent request for doctors was “Efficiency in gathering information from and providing information to a patient” (2,067 cases).
Conclusions: The present study clarified current problems revealed by inquiries about prescriptions by investigating requests for doctors and hospitals that were based on examples.  Furthermore, the problems were classified into ten categories, and these should be noted by doctors and hospitals at the time the prescription was issued.

Objective: Many of the elderly patients are suffering from constipation, are using the oral laxative.  However the risk assessment of the oral laxative is not performed.  Therefore, we used Japanese Adverse Drug Event Report database (JADER) and examined for the safety of the oral laxative in the elderly patients.
Methods: Since the analysis target medicines; 12 oral laxatives and target ADEs; “digestive disorders” and “electrolyte abnormality,” the JADER database for April 2004 to January 2015 were analyzed in adults of age exceeds 60.  We used the reporting odds ratio for a safety index of drugs, using reporting odds ratio, when the Lower bound of the 95% two-sided confidence interval exceeds 1, it is the signal detection of ADE.
Results: The oral laxatives detected the signal of “digestive disorders” were three medicines, and “electrolyte abnormality” were five medicines.  Especially, for electrolyte abnormalities not only increases the blood magnesium values as magnesium oxide, that there is also affect other electrolyte revealed.
Conclusion: Some oral laxatives were also intended to signal detections of the adverse events that are not listed in the attached document, it is necessary to pay attention to the use of them for the elderly patients.

Objective: Elderly patients commonly experience adverse drug events (ADEs) owing to their poor drug metabolizing and excretion ability, and these often cause multiple organ dysfunction syndrome.  Therefore, it is important that we identify the adverse drug events early on during prognosis.  We searched for oral medicines that might exacerbate the prognosis of ADEs in elderly patients.
Methods: The objects under analysis were oral medicines that were registered in the Japanese Adverse Drug Event Report database (JADER).  The associations between the elderly/non-elderly patients and exacerbation risk/non-exacerbation risk were analyzed by risk ratios (RR).  The signal detection of exacerbation risk was defined as 95% confidence interval of lower limit of risk ratio>1 and χ²≥4.
Results: The oral medicines that might markedly exacerbate the prognosis of ADEs in the elderly patients in comparison with the ADEs of young patients included 84 items, of which 63 have not been described as potentially inappropriate medicines in all guidelines for medical treatment of the elderly patients.
Conclusion: In this study, while we could not search for oral medicines having a high risk of ADEs, we were able to search for oral medicines that might exacerbate the prognosis of ADEs in elderly patients.  This result could contribute to the proper use of medicines in the elderly patients.

The patient was a 57-year-old man who, in 1973, at 19 years of age, had undergone mitral valve replacement for mitral valve stenosis using a Björk-Shiley Delrin (BSD) valve. When the patient visited our hospital, he was living in an assisted-living facility due to paresis of the right side of the body, dysarthria, and other sequelae of cerebral infarction. The patient was referred to and visited our hospital with a chief complaint of chest pain in 2011, 38 years after the BSD valve was implanted. In 2012, mitral valve re-replacement, aortic valve replacement, and tricuspid annuloplasty were performed for congestive heart failure associated with prosthetic valve failure, combined aortic stenosis and insufficiency, and tricuspid insufficiency, which were identified by transesophageal echocardiography. The patient's postoperative course was generally favorable. The disc of the resected prosthetic valve showed a groove and bidirectional cracks caused by wear, and its condition suggested a risk of potential rupture. Transthoracic echocardiography on admission showed mild to moderate prosthetic transvalvular regurgitation, and the symptoms were therefore unlikely to have resulted from the prosthetic valve failure alone at this time. Consequently, it was considered that the heart failure was attributed to the prosthetic transvalvular regurgitation caused by the disc abnormalities in addition to the combined valvular disease by transesophageal echocardiography. In this case, detailed investigation of the heart failure by transesophageal echocardiography led to the discovery of prosthetic valve abnormalities, thus enabling the prevention of a serious cardiac accident due to disc rupture. Detailed examination by transesophageal echocardiography is essential, and early surgical intervention should also be considered if transthoracic echocardiography suggests even a minor prosthetic valve abnormality in a patient who has had this prosthetic valve implanted for such a long time.