Total correction for a chronic aortic dissection, producing progressive enlargement of the false lumen of the aorta involving wide range of aorta and aortic manifestation of Marfan's syndrome is a very difficult procedure. However, with the recent development in surgical techniques and management, it became possible to replace total or subtotal aorta with the prosthetic graft. Recently, we treated a 24 y/o male patient with annuloaortic ectasia, DeBakey type II+IIIb aortic dissection, and obstruction of right common iliac artery, associated with Marfan's syndrome with a two-staged operation. For the first stage, we performed Cabrol's procedure on his lesions in ascending aorta. About 2 years after that, for the second stage, replacement of total descending and abdominal aorta was pertformed.

Personal lifestyles constitute one of the strategic frontiers of preventive medicine. We carried out a survey of eating habits of people in three rural communities in the southern part of Akita Prefecture, where fundamental health screening programs have been implemented regularly. Differences in eating habits between men and women and between age groups were found. The health status of the examinees was judged by using data on blood pressure, obesity and lipid levels measured at the latest health checkup.
To find a correlation between eating habits and physical health status, the frequency of illness was examined according to the number of times of eating various kinds of food. It was found that with age, people take in fish and shellfish, cow's milk, beans, vegetables, Japanese confections and soup more frequently and eat less meat. The incidence of hypertension varied by age and sex, but was higher in those who eat less soup, pickles and milk. Likewise, abnormally high levels of total serum cholesterol were found in women who eat meat, eggs and greasy food less than twice a week. It was thought that those hypertensives and those with high cholesterol values are cuttingdown on their intake of those foods of their own accord. Therefore, we would like to point out that, in the secondary prevention setting, physicians and other health care providers should know in advance whether their patients are putting themselves on a restricted diet or not.
When the average serum lipid values were examined according to the number of times of eating meat or fish and shellfish per day, it was found that men aged 70 years or above who eat those foods more than once every day have high HDL cholesterol values and that these values significantly vary depending on the kind of meat. These findings suggested that persons of advanced age who eat well and who are not particular about their food are full of vitality. This could serve as an important point in the care of the aged with serum lipid abnormalities.
A study of evacuation and its relation to vegetable intake showed that the less the frequency of bowel movements, the smaller the amount of vegetable intake. There was a significant difference in the frequency of evacuation between vegetable eaters and those who do not consume an adequate amount of fiber.

Objective: We have used therapeutic drug monitoring (TDM) analysis software to set the initial dose of vancomycin in our hospital.  In contrast, the TDM guideline, in which the initial dose of vancomycin per body weight was set, was published in 2012.  We looked forward with utilizing the TDM guideline in the clinical setting, after which we conducted multiple surveys to determine the important points of the TDM guideline.
Methods: We surveyed patients treated with vancomycin, in whom the initial dose was set using the TDM analysis software and the concordance rate between the vancomycin dose set with the software and that set with the TDM guideline.
Results: The concordance rate of vancomycin dose was 42.1%.  The mean age of the high-dose group (vancomycin dose higher than that recommended by the TDM guideline), was younger than that of the recommended-dose group.  Additionally, the mean body weight of the high-dose group was significantly lower than that of the recommended-dose group.  The corrected creatinine clearance of the low-dose group was significantly lower than that of the recommended-dose group.
Conclusion: Our results suggest that when the initial dose is set after referring the TDM guideline in patients who are not very high age, and having low body weight and decreased renal function, the dose may differ from the dose set by using TDM analysis software.  In addition, since the recommended dose per body weight is a range and not a single value, setting the dose appropriate to target trough concentration is necessary.

There is still considerable risk when performing anastomotic procedures in the aorta and artificial vessels. The wrapping method is occasionally used as an alternative to solve the problems of hemostasis and reinforcement of the anastomotic portion, however, few data are available on the results of long-term follow up after anastomosis in this area. To define the long-term results for the wrapping method, we evaluated changes in the vascular walls of set intervals. The purpose of this study was to analyze the influence of technical factors and to sutisfy the prerequisites for an ideal wrapping method. A total of 26 mongrel dogs of both sexes were used in this study. We examined changes of the aortic walls microscopically of set intervals after a wrapping method using woven Dacron materials for 4 weeks and 4 months. Another 2 groups (Mesh group and E-PTFE group) were also included in this study. The cause of thinning phenomena of the aortic walls appears to be compression of the anastomotic portion. Wrapping materials resulting in excessively small diameters may cause deleterious compressions of the anastomotic site. Wrapping methods with materials ensuring a larger diameter may play an important role after anastomotic operations for reinforcement and hemostasis.

It is well known that haloperidol is effective in the management of nausea and vomiting in cancer patients and that midazolam is used for inducing sedation in patients with delirium. Both the drugs are frequently used in a clinical setting, but there have been only few reports thus far on the concomitant administration of these 2 drugs. We report the case of a patient with massive ascites due to peritoneal carcinomatosis who had severe nausea and vomiting and went into a delirious state. This patient received a concomitant continuous infusion of haloperidol and midazolam for the management of these symptoms. Both haloperidol (up to 1.87mg/h) and midazolam (up to 1.87mg/h) were infused intravenously. For about 20 days, the nausea, vomiting and delirium were well under control without the development of any life threatening toxicities. Concomitant haloperidol and midazolam infusion was found to be a safe and effective therapy for the management of nausea and vomiting in the patient. Palliat Care Res 2009; 4(1): 312-316

Opioids are potent analgesics mostly used for severe cancer and chronic noncancer pain. However, their efficacy and safety in acute noncancer pain are debatable. We describe the case of an 82-year-old male with severe back pain due to bacteremic Staphylococcus aureus spondylitis and paravertebral abscess. Pain in such cases is usually controlled by non-steroidal anti-inflammatory drugs (NSAIDs). However, this patient was administered morphine (oral, then intravenous; up to 23 mg/day) because acetaminophen and NSAIDs did not ameliorate pain. Considerable pain relief was achieved without toxicity, and the dose of morphine was tapered through 35 days. No symptoms of addiction or withdrawal were observed during or after this 35-day period. Thus, morphine appears to be safe and effective in the management of severe, acute noncancer pain in patients with bacterial spondylitis. Palliat Care Res 2010; 5(2): 327-331

PREAVOID is pharmaceutical intervention that is utilized to illustrate pharmacists’ contributions to medical care.  Currently, there is a great need for pharmacists to provide good medical services to inpatients; as a result, many pharmacists conduct pharmaceutical management in hospital wards.  However, pharmacists who have limited experience in working in the ward do not know exactly what they should check with respect to pharmaceutical management.  To resolve this problem, we determined 16 pharmaceutical-management items based on PREAVOID that was conducted at Nagara Medical Center.  Moreover, we conducted a pre-questionnaire survey assessing whether pharmacists who had worked in the ward for fewer than 4 years attended to these 16 check items in their daily work prior to our introducing the list to them.  The results indicated that pharmacists who had fewer than 2 years of experience working in wards attended to the 16 check items less than those who had more than 2 years of experience, and approximately half of the pharmacists had not received adequate guidance before beginning work at the ward.  In addition, most pharmacists indicated that clear check points were useful for conducting pharmaceutical management and the 16 check items were useful for their daily work.  These results indicate that the 16 check items are a useful educational tool for enabling pharmacists to conduct high quality pharmaceutical management from the initial stage and that using the 16 check items is superior to pharmacists only gaining this ability via prolonged experience working in the ward.

OBJECTIVE: To compare the survival outcomes of patients with cervical squamous cell carcinoma (SCC) and adenocarcinoma/adenosquamous carcinoma (AC/ASC) among patients with locally advanced cervical cancer that were treated with definitive radiotherapy. METHODS: The baseline characteristics and outcome data of patients with locally advanced cervical cancer who were treated with definitive radiotherapy between November 1993 and February 2014 were collected and retrospectively reviewed. A Cox proportional hazards regression model was used to investigate the prognostic significance of AC/ASC histology. RESULTS: The patients with AC/ASC of the cervix exhibited significantly shorter overall survival (OS) (p=0.004) and progression-free survival (PFS) (p=0.002) than the patients with SCC of the cervix. Multivariate analysis showed that AC/ASC histology was an independent negative prognostic factor for PFS. Among the patients who displayed AC/ASC histology, larger tumor size, older age, and incomplete response to radiotherapy were found to be independent prognostic factors. PFS was inversely associated with the number of poor prognostic factors the patients exhibited (the estimated 1-year PFS rates; 100.0%, 77.8%, 42.8%, 0.0% for 0, 1, 2, 3 factors, respectively). CONCLUSION: Locally advanced cervical cancer patients with AC/ASC histology experience significantly worse survival outcomes than those with SCC. Further clinical studies are warranted to develop a concurrent chemoradiotherapy (CCRT) protocol that is specifically tailored to locally advanced cervical AC/ASC.
Adenocarcinoma ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell* ; Cervix Uteri ; Chemoradiotherapy ; Disease-Free Survival ; Epithelial Cells* ; Female ; Humans ; Multivariate Analysis ; Radiotherapy* ; Retrospective Studies ; Uterine Cervical Neoplasms*

The interval between undergraduate medical education and graduate medical education causes residents to become disorganized when they start their first-year residency programs.This disorganized transition may be stressful for residents and preceptors and may cause resident to make medical errors.We performed a pilot study to examine the degree to which program directors agree about the abilities required for the start of the first of year residency.
1) We asked the residency directors at university hospitals and residency hospitals nationwide (343 institutions) to indicate what abilities residents were expected to have at various stages of the residency program.The data received were then analyzed.
2) A total of 134 residency directors (39%) returned the questionnaire.We calculated the percentage (expectation rate) of institutions that reported expected prerequisites at the start of the first year of residency and calculated the accumulated values (cumulative rate) of the percentages.
3) Only 43 (30%) of 141 abilities upon the completion of residency-preparatory programs had a cumulative rate of more than 50%.
4) Domains for which the expectation rate was more than 50% at the start of residency were medicine and related knowledge and practical skills for obtaining physical measurements.
5) Physical examination and practical skills for which the cumulative rate was less than 50% on completion of residency-preparatory programs were those for the reproductive and urinary systems and pediatrics and the insertion and maintenance of intravenous lines and indwelling urinary catheters.
6) Disparities are likely between the abilities of residents and the tasks expected of them upon entry into a residency program.This problem must be urgently addressed through medical education and graduate medical education.