We have managed information on adverse drug reaction using the clinical records to obtain data from within our hospital and using Medicine-Pocketbooks to obtain data outside our hospital.  Our system for management of side effect information does not require the development of a separate specialized system.  Our method of collecting side effect information was changed in April 2007.  Therefore, we evaluated our present method of collecting information on side effects by comparing the method used before the change with the new method.  The amount of side effect information collected has clearly increased since April 2007.  Although the amount of data collected directly from doctors has increased eight-fold, the amount collected from other data sources has hardly changed.  Side effect symptoms have hardly changed, with skin symptoms being the most frequent side effect.  Suspected drugs have also hardly changed, with antibiotics being the most frequently suspected drugs.  In addition, we conducted questionnaire surveys on the use of Medicine-Pocketbooks by patients who registered side effect information at our hospital to determine whether Medicine-Pocketbooks were being used effectively as a tool for the management of side effect information.  Among patients who registered their side effect information at our hospital, 76% also presented their Medicine-Pocketbooks to other medical institutions.  In addition, all patients received a change in prescription or were questioned about their side effect information when they presented their Medicine-Pocketbooks.  Our present method of collecting side effect information is considered appropriate since there was an increase in the amount of side effect information collected from doctors.  Medicine-Pocketbooks have also been effectively used as a tool for managing side effect information.

Each of the 1, 000-times dilute solution of both drugs, Salithion and Sumithion, were experimentally sprayed over rabbits in vinyl greenhouses at a rate of five hours a day for three consecutive days. Changes in the residual quantity of the drugs in the blood and also in the quantity of PNMC, a metabolite of Sumithion in urine, were measured with the passage of time after the spraying. At the same time, the liver functions of the rabbits were checked and they were also subjected to a urinalysis and a pathohistological examination. The conclusions drawn from these studies are as follows:
1) No abnormal findings were observed on the appearance of the rabbits exposed to Salithion and Sumithion. Nor were there any abnormalities in the ophthalmologic findings, especially, in the funduscopic findings, at 10 and 30 days after the spraying of these drugs.
2) The residual quantity of both drugs in all the experimented rabbit's blood was measured immediately after the spraying. However, these drugs later disappeared rapidly from the blood, and they could not be detected 10 days after the spraying.
3) There was a significant rise in the quantity of PNMC 24 hours after the spraying. Later, it decreased rapidly. Ten days after the spraying, its values returned to normal level before the spraying.
4) With respect to the serum ChE level, the changes in the groups exposed to Salithion and Sumithion were the same as those in the control groups. So, any influences were not observed on serum ChE by the spraying of these drugs.
5) In the liver function test, urinalysis and pathohistological examination, no abnomal findings attributable to the inhalation of both drugs were observed.
6) The drug concentration in the air in the vinyl greenhouses at the time of their spraying was 61.5μg/m³ for Salithion and 30.1μg/m³ for Sumithion.

In the previous report, we concluded that chances are very slim for Salithion and Sumithion to concentrate in rabbits as these organophosphorous compounds are excreted quickly. This conclusion was inferentially drawn from the results of measurements of concentration of Salithion and Sumithion residues in the blood after experimental exposures of rabbits to the pesticides.
In the present report, we will discuss the same toxicological problem based on our findings in a series of experiments using rabbits with hepatic disturbances induced by carbon tetrachloride (CCl₄).
Rabbits were divided into three groups. One consists of rabbits having light hepatic disorder. They were subcutaneously injected with 0.1ml/kg of 20% CCl4 olive oil for three days consecutively. Under the second group come rabbits with moderate liver disturbance caused by the injection of 0.3 ml/kg of 20% CCl₄ olive oil. The injection was also made for three days. The remaining group is the control group.
These rabbits were administered orally with 5mg/kg and 20mg/kg of Smithion for three days running.
The examination covered (1) Sumithion residue level in the blood, (2) PNMC level in urine, (3) hepatic function (ChE, GOT, GPT, BSP, Al-P, BUN), (4) urinalysis and (5) histopathological examination of the liver and the kidney. The results of these tests were studied in comparison with those of the control group.
The following is a summary of our conclusion:
1) In the control group, Sumithion residues in the blood disappeared quickly, and could not be detected 72 hours after administration.
2) As far as the disappearance of Sumithion and the excretion of PNMC are concerned, there was no significant difference between the control and the light and moderate liver disturbance groups of rabbits.
3) In the rabbits with CCl₄-induced liver disturbances, it was noted that the administration of Sumithion impeded serum and red-cell ChE activities to a remarkable extent, and delayed the recovery of the liver function.
4) However, the liver disturbance did not deteriorate. The histological observation of the liver and the kidney did not reveal any abnormality due to the administration of Sumithion, either.

Taking charge of in-vitro fertilization and embryo transfer in the laboratory per se amounts to a form of clinical support. To infertile patients, it would be of great benefit if laboratory technicians make direct contact with them and give a full account of the procedure.The apprehensions entertained by them regarding infertility treatment would be removed by hearing what they want to know.In hopes of dispelling the patients' fears and doubts, we have recently started to dialogue with the patients. The face-to-face interview has made us feel confident in what we are doing aside from the lab work and feel a sense of responsibility. Moreover, we have become aware of the need to further devote ourselves to reproductive medicine in order to improve the treatment outcome.One third of the questions frequently asked by patients concerns the quality of embryos and the risk of birth defects, which are issues that challenge us involved in reproductive medicine. To give answers to these and other questions most aptly, it is necessary to share all the up-to-date information, data and knowledge among members of the staff concerned.As the tasks to be grappled with fromnow on, there are problems with unsuccessful cases after repeated IVF trials and an increasing number of patients rangingin age from 45 to 49 years. Where the infertility treatment stops is yet to bedecided in the case of elder women.For providing information and psychological support sought by patients, we keenly felt that there is a necessity to establish a closer collaborative inter-departmental relationship.
Clinical ; Fertilization ; Laboratory culture ; Support ; therapeutic aspects

The purpose of this study was to clarify the effects of and factors that influence the burden of caregiving in relation to the caregiver's personality and interpersonal trust. The study targeted family members who were primary caregivers of elderly patients with dementia living at home and using care services such as home-visit nursing services and outpatient rehabilitation in Prefecture A. The survey was conducted using a self-administered questionnaire battery delivered to and completed at the subject's home. The battery contained questions about the subject's personal profile, the Interpersonal Trust Scale, Zarit-8 (Japanese version), the Family Adaptation and Cohesion Evaluation Scales (FACES III Japanese version), and the Medical Outcome Study MOS 8-Item Short-Form Health Survey (Japanese version SF-8). We made a comparison of the sense of care burden for elderly dementia patients living at home after dividing the subjects into two groups based on the average caregiver score on the Interpersonal Trust Scale. The group with higher interpersonal trust scores reported a significantly lower sense of care burden. It was speculated that the ability to consult with family and friends about how to build trust with others and cope with the needs of nursing care was related to the caregiver's sense of interpersonal trust. The study found that influencing factors for a sense of care burden were interpersonal trust, supporters other than family members, and family type. The findings also suggest that interpersonal trust could influence the sense of care burden.

The purpose of this study was to evaluate the stress accompanying behavioral and psychological symptoms of dementia (BPSD) and to validate the care that brings eustress through physical and emotional interventions. The participants were 57 elderly people with BPSD who used or lived in long-term care facilities, group homes, small-scale multifunctional home care services, and community-based specified facilities in prefecture X. The study included a 2-week control period and a 12-week intervention period in which square-stepping exercise (SSE) was introduced and the validation method was used for communication. Results showed that stress levels were higher when BPSD appeared. After SSE, amylase activity levels decreased in 70% of the participants, although the decrease was not statistically significant, and facial expression significantly improved in Face Scale (FS) assessment. Also, after validation communication, amylase activity levels showed a significant decrease and facial expression significantly improved in the FS assessment. Even though most of the participants in this study were elderly people with moderate dementia, SSE appeared effective for enjoying physical activity and making friends, and validation can be expected to have the effect of sharing time and relieving stress.

This study aimed to develop a scale for identifying care needs to enable family caregivers to provide appropriate care to community-dwelling elderly people with early cognitive dysfunction. We developed a draft scale taking into account 32 items of care needs for elderly people with early cognitive dysfunction based on previous studies, and we conducted a questionnaire survey with 86 primary caregivers of elderly people who attended memory loss consultations at Regional Comprehensive Support Center A and the Outpatient Memory Loss Clinic in the Department of Neurology at University Hospital B. Exploratory factor analysis revealed 3 factors consisting of 14 items: (1) family's lack of understanding of early cognitive dysfunction and caregiving, (2) confusion about caregiving and consultations, and (3) caregiving methods and prevention of deterioration with early cognitive dysfunction. Cronbach’s alpha was calculated to be 0.83 for all items, confirming the reliability of the results. In the results of confirmatory factor analysis, the model fit was goodness of fit index (GFI) = 0.89, adjusted GFI = 0.88, comparative fit index = 0.90, and root mean square error of approximation = 0.08. The Care Needs Scale for Elderly People with Early Cognitive Dysfunction consists of 14 items, and this study suggests that the scale can be used to help caregivers of elderly people with early cognitive dysfunction provide appropriate care.

An abdominal advancement flap (AAF) is a flap that pulls the elevated abdominal skin up and creates the shape of the inferior portion of the breast by making a neo-inframammary fold. Seven patients underwent remodeling using an AAF or a method combining an AAF with other volume displacement techniques after partial mastectomy. The excision volume ranged from 15% to 35%. AAF with only mobilization of the gland flaps was performed in two cases, with lateral mammoplasty in one case, with the round block technique (RBT) in one case, with a modified RBT in one case, and with medial mammoplasty in two cases. Although one patient treated with a RBT had a partial blood-flow insufficiency of the nipple-areola complex, it improved with conservative treatment. The cosmetic results were found to be excellent in three cases, good in three, and fair in one case.
Breast ; Cosmetics ; Displacement (Psychology) ; Female ; Humans ; Mammaplasty ; Mastectomy, Segmental ; Skin ; Surgical Procedures, Operative

We introduce a method combining two oncoplastic techniques for breast-conserving reconstruction. The procedure is as follows: first, an extended glandular flap is made by undermining the breast from both the skin and the pectoralis fascia to the upper edge of the breast at the subclavicular area. After modeling the breast mound with the extended glandular flap, an inframammary adipofascial flap is made. The flap is reflected back to the breast area remodeled using the extended glandular flap. After reshaping the breast, the inframammary line is then re-shaped. This method is indicated for patients with breast cancer in the outer portion of the breast, who have small dense breasts, and have undergone a large excision of about 40% of their breast volume. We treated four patients, all of whom had either excellent or good cosmetic results with no fat necrosis.
Breast ; Breast Neoplasms ; Cosmetics ; Fascia ; Fat Necrosis ; Female ; Humans ; Mammaplasty ; Mastectomy, Segmental ; Skin

PURPOSE: Although various strategies have been reported, there are no defined criteria for cosmetic evaluation methods after breast-conserving surgery (BCS). Since Asians tend to have smaller breasts, indistinct inframammary folds, and conspicuous scars, differences in the cosmetic results are expected. So we examined two subjective methods and one objective method to determine the differences, and elements necessary for a cosmetic evaluation after BCS. METHODS: Frontal photographs of 190 Japanese were evaluated using the Harris scale (Harris) and the evaluation method proposed by the Japanese Breast Cancer Society Sawai group (Sawai group) as the subjective methods, and the Breast Cancer Conservation Treatment cosmetic results (BCCT.core) as the objective method, respectively. In order to examine the necessary elements for developing a new ideal method, 100 out of 190 were selected and assessed separately by six raters using both the Harris and modified Sawai group methods in the observer assessment. The correlation between the two methods was examined using the Spearman rank-correlation coefficient. RESULTS: The results of the BCCT.core and the other two methods were clearly different. In the observer assessment, the consensuses of the six raters were evaluated as follows: 27, 27, 26, and 20 cases were evaluated as "excellent," "good," "fair," and "poor," respectively. For the Spearman rank-correlation coefficient, values higher than 0.7 indicated a strong correlation, as seen by the values of 0.909 for the breast shape and 0.345 for the scar. The breast shape accounted for the most significant part of the evaluation, and the scar had very little correlation. CONCLUSION: In this study, we recognized a clear difference between the subjective and objective evaluation methods, and identified the necessary elements for cosmetic evaluation. We would like to continue developing an ideal cosmetic evaluation that is similar to subjective one and is independent from raters.
Asian Continental Ancestry Group* ; Breast ; Breast Neoplasms ; Cicatrix ; Consensus ; Esthetics ; Humans ; Mastectomy, Segmental*