Introduction: Optimization of after-hours visits to medical institutions is one of the major problems in medical systems. The purpose of this study was to clarify the effects of the distribution of booklets about after-hours common symptom management to all residents on the number of after-hour consultations.Method: The Tadami town government distributed booklets to all town residents in July 2011. We analyzed the number of after-hours consultations per month at Tadami National Health Insurance Asahi Clinic, which is the only medical institution in the town, from January 2010 to December 2012. We employed an interrupted time series analysis.Result: The number of included after-hours consultations during the study period was 2,399. The baseline trend was 0.0071 (95% confidence interval −0.011, 0.025), and the slope change from the baseline trend was −0.0061 (−0.034, 0.022).Conclusion: On comparison of before and after the distribution of a booklet about after-hours common symptom management to all residents in the town, the number of after-hours consultations did not change significantly.

The purpose of the present study is to investigate protein metabolism during rapid weight reduction. Six male boxing players put on a restricted diet of their own accord for two weeks. Body weight changes were observed and a biochemical analysis was made of their urine and blood. The initial body weight of 66.1±3.0kg (mean±SE) decreased to 63.6±3.2 kg after two weeks (P<0.01) . The changes in lean body mass (LBM) by weight reduction were not significant, but the LBM tended to decrease after two weeks. The mean caloric intake was 2, 791±728 kcal before the study and 1, 643±548 kcal after two weeks. The reduction of carbohydrate consumption is much more than that of fat and protein consumption. The 3-Me/Cr in urine increased significantly after two weeks (348.1 ± 37.0 μol/g to 508.1 f 45.6 μmol/g, P<0.01) and the increase of Urea-N/Cr in urine (8.4±0.5mg/mg creatinine to 13.7±1.3mg/mg creatinine, P<0.01) was also significant after two weeks. Urine volume decreased significantly after two weeks (P<0.01) . There was no significant difference in the blood components during the weight reduction period. These results might suggest that rapid weight reduction and massive decrease of carbohydrate intake accelerate protein catabolism.

From January of 1987 to December 1992, twelve patients (7 males and 5 females, mean age, 52.8 years) underwent emergency surgery for DeBakey type I acute aortic dissection. The surgical procedure was resection of the initial intimal tear and replacement of the ascending aorta (four patients underwent hemiarch replacement). Operative mortality was 41.7% (5/12). Three died in the operating room due to heart failure (2) and uncontrollable bleeding (1). Another two early deaths resulted from extension of the residual false lumen. All surviving patients each had a patent double-channeled aorta and aneurysmal dilatation of the false lumen was noted in 3 patients. There were two late deaths, one due to rupture of the residual false lumen and the other, to stroke during re-operation for enlargement of the residual false lumen. It is apparent from these results that in type I acute aortic dissection extensive operation such as total arch replacement is necessary.

The purpose of this study was to examine the responses of cerebral blood flow and metabolism to changes in arterial carbon dioxide tension during moderate hypothermic cardiopulmonary bypass in patients with cerebrovascular disease undergoing open heart surgery. Computed tomography scan (CT) and single photon emission computed tomography (SPECT) were performed preoperatively for 17 patients. The patients were categorized according to their CT and SPECT findings. Ten patients were included in the normal group, 7 patients were included in the CVD group. Blood flow velocity in the middle cerebral artery (MCAv) was measured by means of transcranial Doppler ultrasonography at two different arterial carbon dioxide tensions (at a high PaCO₂ of 45-50mmHg, at a low PaCO₂ of 30-35mmHg, uncorrected for body temperature) during moderate steady-state hypothermic cardiopulmonary bypass. Simultaneously cerebral oxygen consumption was estimated by relating the arteriovenous oxygen content difference to flow velocity (D-CMRO₂). MCAv and D-CMRO₂ were expressed as percentages of the values determined at 30 minutes before cardiopulmonary bypass. In the normal group, a PaCO₂ of 47.4±2.5mmHg (mean±SD) was associated with an MCAv of 99.4±17.8% and a D-CMRO₂ of 53.4±25.5%, while a PaCO₂ of 33.7±1.3mmHg was associated with an MCAv of 64.3±18.1% and a D-CMRO₂ of 53.5±26.2%. In the CVD group, a PaCO₂ of 49.1±4.2mmHg was associated with an MCAv of 81.4±22.3% and a D-CMRO₂ of 34.0±19.4%, while a PaCO₂ of 33.6±1.3mmHg was associated with an MCAv of 54.7±23.8% and a D-CMRO₂ of 49.0±19.4%. We conclude that in patients with cerebrovascular disease cerebral blood flow is changed in response to changes in arterial dioxide tension during moderate hypothermic cardiopulmonary bypass, however a high PaCO₂ depresses cerebral oxygen consumption because hypercarbia may cause potentially harmful redistribution of regional cerebral blood flow away from marginally-perfused to otherwise well-perfused areas.

We investigated the effects of rewarming speed on cerebral circulation and oxygen metabolism during cardiopulmonary bypass (CPB). Twenty-four adult patients who had undergone open heart surgery with moderately hypothermic CPB were divided into two groups. In the slow rewarming group (group S), the rates of increase of blood temperature were under 0.1°C/min. In the rapid rewarming group (group R), they were more than 0.1°C/min. Mean blood flow velocity in the middle cerebral artery (mean MCAv) was measured by transcranial Doppler ultrasonography, and the index of cerebral oxygen consumption was evaluated by Doppler-estimated cerebral metabolic rate for oxygen (D-CMRO₂). The change of oxyhemoglobin level in the brain (Oxy Hb) was monitored by near-infrared spectroscopy. In group S, mean MCAv and D-CMRO₂ changed in a parallel manner following the changes of the rectal temperature throughout the periods, and mean MCAv was always higher than D-CMRO₂. In group R, however, the rate of increase of D-CMRO₂ was more rapid than that in group S from the beginning of rewarming, and D-CMRO₂ exceeded the level of mean MCAv just before termination of CPB. In addition, Oxy Hb in group R showed more rapid changes than that of group S. In conclusion, rapid rewarming during CPB may cause the disruption of cerebral flow-metabolism coupling.

Objective: To investigate frequency of adverse drug reactions (ADR) on HIGURD ®
, a switch OTC product of azelastine hydrochloride, in a three-year post-marketing surveillance study.
Methods: We conducted two surveys in this study a solicited survey with a questionnaire and a survey of spontaneous ADR reports.
Results: A total of 183 cases with 293 ADRs were reported in the solicited survey on 3,453 consumers and a total of 29 cases with 37 ADRs were reported from spontaneous sources.  No serious ADRs were reported.  Most frequently reported ADRs were somnolence, thirst, malaise, and dysgeusia, all of which are common on azelastine hydrochloride.  This study indicated that HIGURD ®
is well tolerated.
Conclusion: This study suggested that efficacy and safety of HIGURD ®
depend on how much consumers understand the contents of “Precautions for Use” section of package insert.  It is considered to be effective for safety assurance in an early post-marketing phase that pharmacists inform consumers about appropriate use of HIGURD ®
and ask for the occurrence of ADRs.

We report two patients with ventral schwannoma in the thoracolumbar region manifesting as low back pain with or without paraparesis. In both patients magnetic resonance imaging (MRI) revealed a heterogeneously-enhanced intradural extramedullary mass in the thoracolumbar region. The tumors were successfully removed via the posterior approach. Their histology was consistent with schwannoma. Postoperative MRI showed no evidence of a tumor in either patient. Spinal schwannomas are common benign intradural extramedullary spinal neoplasms; most arise from the dorsal- and very few from the anterior roots. A literature review revealed that ventral schwannomas, including giant tumors as in the one from case 2 in our study, affect mainly the cervical region, and most are surgically addressed via the posterior approach. Careful handling of the spinal cord is mandatory for satisfactory surgical results.
Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Neurilemmoma* ; Paraparesis ; Spinal Cord ; Spinal Neoplasms ; Spine*

Purpose: The objective of this study was to investigate whether body fat rate (BFR) and triceps skinfold thickness (TSF) are associated with estimated fentanyl absorption in patients treated with the fentanyl transdermal matrix patch for moderate to severe cancer pain, by measuring the residual content of fentanyl in used matrix patches. Methods: Adult Japanese inpatients experiencing chronic cancer-related pain and receiving treatment for the first time with a transdermal fentanyl matrix patch (Durotep®MT patch) were included in the present study. During the initial application period, BFR was measured using a body fat scale, and TSF was measured by an experienced nurse with an adipometer. One patch was collected from each patient. The residual fentanyl content in used matrix patch was determined by high-performance liquid chromatography. The transdermal fentanyl delivery efficiency was estimated based on the fentanyl content of the used matrix patches. Results: Fifteen adult patients (5 males and 10 females) were included in this study. Nine patches with a release rate of 12.5μg/h and 6 patches with a release rate of 25μg/h were collected. The application site was the chest or upper arm. BFR and TSF both showed a significant positive correlation with delivery efficiency. Conclusion: In malnourished or low-body fat patients receiving DMP, pain intensity should be more carefully monitored, and fentanyl dose adjustment may be required. Additional parameters, such as nutritional status including body fat change, the degree of dry skin, and plasma fentanyl concentration, also require detailed evaluation. Palliat Care Res 2010; 5(2): 206-212

Objectives: Chronic obstructive pulmonary disease (COPD) is a risk factor for osteoporosis. Nevertheless, much remains unclear regarding the bone metabolism dynamics associated with COPD. The present study focuses on the associations between the COPD severity and serum bone metabolism biomarkers. Methods: We enrolled 40 patients who visited the orthopedics departments at our institutions and underwent dual-energy X-ray absorptiometry between September 2015 and December 2017. Only male osteoporosis patients over 45 years of age were included, and 5 patients were excluded due to disease or use of internal medicines affecting bone metabolism. All subjects underwent lung function testing, spine radiography, and blood tests. We measured percent forced expiratory volume in 1 second (%FEV1), which reflects COPD severity, and we examined the relationships between %FEV1and serum levels of bone metabolism biomarkers. Results: All subjects were diagnosed with osteoporosis based on T-scores. %FEV1 correlated with body weight, body mass index (BMI), and Z-score/T-scores. %FEV1 moderately correlated with serum levels of alkaline phosphatase (ALP), procollagen type 1 N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b in the partial correlation analysis adjusted for BMI or T-score in the lumbar vertebrae. We performed a hierarchical multiple regression analysis to identify that serum ALP and P1NP were the independent explanatory variables to %FEV1 independent of other factors. Conclusions The data suggest that the COPD severity in middle-aged and older men with osteoporosis associates with decreased bone formation. COPD patients may exhibit bone metabolism dynamics characterized by low bone turnover with osteogenesis dysfunction as COPD becomes severe.