We reviewed the clinical course of 127 patients who underwent treatment for atherosclerotic disease between June 1993 and January 2001. There were 108 men and 19 women. The ages ranged from 49 to 88 years with a median age of 71.2 at the time of the first operation. Major risk factors included ischemic heart disease (21%) and diabetes mellitus (20%). Ninety-five percent of the patients were followed successfully and the follow-up period ranged from 0 to 90 months with a mean of 33 months. Two patients died perioperatively due to myocardial infarction. There were 29 late deaths. The overall actuarial survival rate was 69.7% at 5 years. The 5-year actuarial survival rate and the mean survival time for men and women were 71.6%, 66.1 months and 62.3%, 58.9 months. The 5-year late survival rate and the mean survival time for patients with and without ischemic heart disease were 57.0%, 57.4 months and 74.2%, 68.5 months. The differences were not statistically significant. The 5-year late survival rate and the mean survival time for patients with and without diabetes mellitus were 65.5%, 59.1 months and 70.9%, 67.4 months. The differences were not statistically significant. Amputation was performed in 7 patients, the actuarial survival rate at 1 year and the mean survival time were 42.9%, 7.1 months for patients with amputation, and 93.0%, 69.5 months without amputation (p<0.01).

Objective: It is important to prevent dispensing errors for the safety of patients.  For this purpose, it is necessary to improve the dispensing process on the basis of risk priority.  Quantitative evaluation of risk in each operation makes it possible to compare the risk relatively.  In this study, we analyzed data reported in the Pharmacy Risk Error Management System (PREM-S) to evaluate the risk priority in the medicine preparation step of the dispensing process.
Methods: Data of 1,202 cases concerning medicine preparation step were extracted from in 2,458 cases reported into PREM-S between May 2010 and April 2011.  We classified the medicine preparation step into 31 categories based on the operation.  We analyzed the levels in each category as adverse effects on patient’s health by the errors and also the relationship between adverse effect and detection time.  The level represents the degree of adverse effect for the patient.
Results: Information on levels of the 31 categories was obtained from the analysis.  Eight categories included reports of effects on the health of patients.  Three categories such as calculation of powder medicine included level 4 cases.  Detection time was significantly different between level 1 and levels 2 to 4, but there was no significant difference between levels 2 to 4.
Conclusion: The results suggest that analysis of data reported in PREM-S enables evaluation of the risk priority systematically and efficiently.  Evaluation of the risk priority will contribute to prevention of dispensing errors and health effects derived from them.

Re-do open cardiac surgery may sometimes require complete ablation around the pericardium for the 2 major reasons of attaining better myocardial protection and obtaining effective DC cardioversion. However, this ablation may increase postoperative hemorrhage which may require blood transfusion. Hypothermia is based on the concept of myocardial protection during open heart surgery by suppressing myocardial metabolism, but recently the approach has been changed to maintaining myocardial metabolism with aerobic or anaerobic energy production. We have already reported that histidine-buffered cardioplegia which promote anaerobic glycolysis, provided an excellent functional recovery of myocardium post-ischemia with lower inotropic requirements in a range from 10°C to 37°C of myocardial temperature. Based on our theoretical background and clinical data, we tested the efficacy of this type of cardioplegia in patients receiving multiple surgical procedures with minimum ablation after sternotomy. First case, who had undergone a Bentall procedure for annulo-aortic ectasia 14 years previously had a thrombotic valve and mitral regurgitation. Aortic valve plasty and mitral valve replacement (MVR) was performed. The second case who had undergone MVR 15 years previously had malfunction of the prosthetic valve and underwent re-MVR. The third and fourth cases had ventricular septal defect (VSD) which were closed using Teflon patches. The third case had patch closure during second operation for residual shunt. The fourth case received tricuspid valve replacement (TVR) for tricuspid regurgitation due to a pacemaker lead implanted into the right ventricle through the left subclavian vein. The fifth case received coronary artery bypass surgery in a second operation for restenosis of the graft and progressing atherosclerosis. All hearts started beating spontaneously without DC cardioversion after the aortic unclamp. Ventricular fibrillation occurred in the first case while the patient was weaned from cardiopulmonary bypass and treatment was performed by aortic cross clamp, infusion of the cardioplegia followed by aortic unclamp to start own beat again. Two of 3 patients who were able to donate their own blood preoperatively did not require homologous blood transfusion. Due to advantages such as excellent myocardial protection under hypothermic or normothermic condition, ease of use and relatively lower potassium concentration, histidine-buffered cardioplegia can be an excellent candidate for myocardial protection in re-do cases with less ablation technique.

　　Since February, 2012, Anjo Kosei Hospital has embarked upon a new scheme for efficiently handling narcotics during surgical operations. For the purpose pharmacists are allowed to enter the operating room for a while. At the same time, the implementation of digital record keeping for narcotics management tasks has started, making it possible to simplify the handling of a great number of patients. By reviewing the effects on narcotics handling and hours billed, we could determine the effectiveness of operating room pharmacist-led narcotics management at Anjo Kosei. Out of narcotics prescriptions (n＝647) handled in the operating room for one month, 84.7% (548/647) was accounted for by prepared narcotics and 99.8% (646/647) by post-operation management. The introduction of the digital record system resulted in a reduction from 53.3±9.6 minutes to 39.6±6.3 minutes for narcotics preparation, and a reduction from 66.8±16.1 minutes to 41.1±13.5 minutes for post-operation management (p<0.01). It has added to the work efficiency and simplification of operations. Moreover, due to the intervention of pharmacists in the operating room, 92.3% of narcotics prescriptions was performed using the new management system within a relatively short time (80.8±18.4minutes). These data show that the introduction of the new scheme has resulted in more efficient management of narcotics at Anjo Kosei.

Although the Outpatient Cancer Chemotherapy (OCC) Unit was established with in Anjo-Kosei Hospital in 2006, its real worth remains to be elucidated. To address this, the following subjects were examined;effective usage of hospital beds changes in the number of outpatients given to chemotherapy, length of hospitalization, the number of patients transferred by ambulance to the hospital, hospital occupancy rate, and the number of frequently used chemotherapy regimens.Since the establishment of the OCC Unit, the number of patients transferred by ambulance has increased and length of hospitalization has gradually decreased, accompanied by the increase in the number of outpatients treated at the OCC Unit. Additionally, no significant change was observed in the hospital occupancy rate. Furthermore, of the frequently used chemotherapy regimens, nine regimens were available for 62.4% of the total number of outpatients of the OCC Unit.These results indicated the useful effect of the establishment of the OCC Unit on the usage of hospital beds, and provided significant information helpful in promoting the effective and safe chemotherapy for outpatients in the OCC Unit.
Chemotherapy-Oncologic Procedure ; Unit ; seconds ; Outpatients ; Malignant Neoplasms

BACKGROUND: Patients may receive negative results from a specific IgE (sIgE) test such as the ImmunoCAP (CAP) despite a documented history of systemic reaction to a Hymenoptera sting. Thus, further testing may be required using another serological method or venom skin prick tests to confirm allergy diagnosis and correct species. OBJECTIVE: To evaluate the sensitivity and the specificity of CAP and IMMULITE 3gAllergy (IMMULITE) for detecting sIgE to Paper wasp (WA) and Yellow Jacket (YJ) venoms using patient clinical history as the comparator. METHODS: Sera from 70 participants with a history of systemic reactions (SR) to WA and/or YJ stings were tested using CAP and IMMULITE. Fifty participants from this group had negative results on CAP. To assess specificity, sera from 71 participants who had never experienced either a WA or YJ sting were tested using CAP and IMMULITE. Fifty participants from this group tested positive using CAP. RESULTS: In participants with a history of systemic reaction to a Hymenoptera sting, yet who tested negative for WA and/or YJ sIgE according to CAP, the positivity rate according to IMMULITE was 20-42% using 0.10 IUA/mL as the limit of detection (LoD), per the manufacturer's specification. When the LoD for CAP (0.35 IUA/mL) was applied to the IMMULITE results, positivity according to IMMULITE was 14-26%. Overall, sensitivity, specificity, and agreement with SR were greater for IMMULITE than for CAP. For YJ: sensitivity (IMMULITE:CAP), 42.8%:28.5%; specificity, 53.5%:39.4%; agreement, 48.2%:34%. For WA, sensitivity (IMMULITE:CAP), 58.6%:28.5%; specificity, 49.3%:47.8%; agreement, 43.9%:38.3%. CONCLUSION: The IMMULITE performed well for detecting sIgE to Hymenoptera venom
Bites and Stings ; Diagnosis ; Humans ; Hymenoptera ; Hypersensitivity ; Immunoglobulin E ; Limit of Detection ; Methods ; Sensitivity and Specificity ; Skin ; Venoms ; Wasps

We would like to report the following errata in Table 4, and request that these items be revised appropriately.

OBJECTIVEExposure to polychlorinated biphenyls (PCBs) is considered to have culminated between 1950 and 1970 in Japan, and exposure through diet, the major exposure route, has decreased significantly over the last 10 years. The primary goal of the present study was to investigate the long-term trends and congener profiles of serum and dietary levels of PCBs using historical samples.

METHODSUsing banked samples collected in 1980, 1995, and 2003 surveys, we determined the daily intakes and serum concentrations of 13 PCB congeners (#74, #99, #118, #138, #146, #153, #156, #163, #164, #170, #180, #182, and #187) in women.

RESULTSThe total daily PCB intake [ng/day, geometric mean (geometric standard deviation)] decreased significantly from 523 (2.5) in 1980 to 63 (3.2) in 2003. The serum total PCB level (ng/g lipid) in women <40 years of age decreased significantly from 185 (1.8) in 1980 to 68 (1.8) in 2003. In contrast, the level in women >50 years of age increased significantly from 125 (1.7) in 1980 to 242 (1.7) in 2003. Specifically, the serum concentrations of hexa (#138, #146, #153, #156, #163, and #164) and hepta (#170, #180, #182, and #187) congeners increased significantly. A comparison of the serum PCB levels of women born from 1940 to 1953 revealed that their serum total PCB level was significantly higher in the 2003 survey [242 (1.7), n = 9] than in the 1995 [128 (2.0), n = 17] surveys. This increase in the total PCB level was attributable to increases in the hepta congener groups.

CONCLUSIONPresent results suggest a decreased rate of elimination of hepta congeners with aging in females, rather than a birth-generation phenomenon.