We performed waiting time prediction using the data collected from prescription pick-up. A regression equation was used to predict waiting time. An explanatory variable was adopted as “a number of retention prescriptions at the time of acceptance”, “the variety of drug to dispense”and “the presence or absence of a particular task of time-consuming work in computing multiple medications into one package”. Using waiting time as an objective variable, three regression equations were formulated. Method ①: A single regression equation using the number of retention prescriptions with only one explanatory variable. Method ②: Multiple regression equation using factors such as number of prescriptions and variety of drugs to be dispensed as explanatory variables. Method ③: Multiple regression equation using number of prescriptions, variety of drugs and the presence or absence of particular tasks involved in the preparation of the prescription. Compared to the prediction of Method ①, the prediction of Method ② resulted in better accuracy. Compared to Method ①, Method ② resulted in better accuracy, and Method ③ resulted in even better accuracy than Method ②, as predicted.

Medicine, Kampo ; Metabolic ; Therapeutic procedure ; Syndrome

We report 2 patients with Graves' disease and psychological disorders. In these patients, treatment did not relieve psychological disorders despite normalization of thyroid function, but kampo therapy was effective. Patient 1 was a 24-year-old female. In 2000, she was diagnosed as having Graves' disease. Treatment with an antithyroid drug normalized thyroid function, but did not relieve psychological disorders such as irritation, anxiety, or despair. In February 2005, the patient consulted our hospital. Patient 2 was a 26-year-old female. After graduating from a high school, she developed Graves' disease. Treatment with an antithyroid drug was started. However, thyroid function was unstable ; mild hyperthyroidism and hypothyroidism repeatedly occurred. During this period, irritation, fatigue, malaise, and alopecia deteriorated, and she consulted our hospital in January 2005. In the two patients, keishikanzoryukotsuboreitogohangekobokuto was prescribed (the regimen was changed during follow-up in Patient 1), and their conditions markedly subsided after 16 and 9 weeks of administration, respectively, suggesting the usefulness of kampo therapy in the treatment of Graves' disease associated with psychological disorders.
Therapeutic procedure ; Graves' Disease ; seconds ; Patients ; Mental disorders

Aerobic exercise is known to reduce pulse wave velocity (PWV), which reflects arterial stiffness. However, aerobic exercise has a depressor effect, and PWV strongly depends on blood pressure (BP). Therefore, improvement of PWV with aerobic exercise may have an indirect effect on reducing BP. In this study, the relationship between changes in BP and regional PWV measured by oscillometric and tonometry sensors before and after exercise therapy emphasizing aerobic exercise was evaluated in 46 elderly people receiving outpatient treatment for lifestyle-related diseases (7 males and 39 females, mean age : 68 years). In all subjects, BP and PWV measurements were performed before and after exercise therapy. PWV was measured between the brachium and ankle (baPWV), between the heart and femoral artery (hfPWV), and between the femoral artery and ankle (faPWV). During 6 months of exercise therapy, BP, baPWV, hfPWV and faPWV decreased significantly. By multiple regression analysis, the changes in systolic BP were extracted as factors correlated with changes in baPWV and faPWV. The changes in baPWV (r=0.639, p<0.01) and faPWV (r=0.649, p<0.01) correlated significantly with changes in systolic BP. However, changes in hfPWV were not extracted as a factor correlated with changes in systolic BP (r=0.228, p=n. s). In conclusion, exercise therapy emphasizing aerobic exercise was suggested to reduce the stiffness of both the lower limb artery (peripheral artery) and the aorta (central artery). Peripheral arterial stiffness improved concurrently with a reduction in BP as a result of exercise therapy ; but there is a possibility that the improvement of central arterial stiffness is not dependent on reducing BP.

Cardiac surgery associated with idiopathic thrombocytopenic purpura (ITP) is rare, and only 10 cases have been reported in the literature. In this report, we described the successful surgical management of a patient with ITP, diabetes mellitus and malfunction of mitral bioprosthetic valve. A 62-year-old male, who underwent mitral valve replacement (MVR) by means of a Carpentier-Edwards valve prosthesis and CABG ten years ago, developed malfunction of mitral prosthetic valve. The preoperative platelet count was 52, 000/mm³ and PA-IgG elevated markedly. The diagnosis of ITP was based on findings of bone marrow examinations. Thrombocytopenia was treated by steroids for 4 weeks and large dose γ-globulin (20g/day) for 5 days preoperatively, but platelet count did not increase. Platelet rich plasma (PRP) was transfused prior to cardiopulmonary bypass (CPB) and fresh blood was added to the priming material of CPB. Re-MVR was performed by means of mechanical valve prosthesis. After operation, large doses of γ-globulin and transfusion of PRP were performed for 3 days, and the postoperative course was uneventful. Other reports in addition to this study reveal that cases of cardiac surgery associated with ITP should be initially controlled preoperatively with steroids or high-dose γ-globulin, and if these treatments are harmful or ineffective, splenectomy should be considered.

We describe a 38-year-old, severely emaciated female with slowly progressive type 1 diabetes mellitus (SPIDDM), who had hypoglycemia due to fasting and an extremely low energy intake. After being diagnosed with diabetes mellitus (DM), she took in only 300-500 kcal per day and her weight had decreased to 30 kg, with a body mass index (BMI) of 11.4 kg/m². She was admitted with hypoglycemia, and SPIDDM was confirmed by nearly-completely ceased insulin secretion and seropositivity towards anti-GAD antibody. After appropriate dietary therapy and insulin administration, she recovered from a state of emaciation and her glucose metabolism was restored. With this patient it proved very effective for the general physician to coordinate treatment for both diabetes and an eating disorder.

A 74-year-old man was admitted to our hospital to undergo an operation for distal aortic arch aneurysm with chronic aortic dissection. The first operation was attempted through left lateral thoracotomy. Since the aorta had a severely calcified false lumen, conventional aortic replacement was considered to entail greater risk and graft replacement was given up. As an another option, endovascular stent grafting via the aortic arch through median sternotomy was selected as a second operation. Deep hypothermic circulatory arrest with selective cerebral perfusion was used during delivery and deployment of the stented graft through the aortotomy site. The distal stented graft was deployed into the true lumen at the ninth thoracic vertebral level. Neither endoleaks nor complications were observed. Postoperative computed tomography showed complete thrombosis of the distal aortic arch aneurysm and the false lumen. The postoperative course was uneventful. Transaortic endovascular stent grafting is an effective and less invasive treatment for aortic arch aneurysms with severely calcified aorta.

1) We conducted a randomized controlled trial in medical education area and explored practical issues through reflection on the processes.
2) In February 2007, 39 fourth-year medical students in Nippon Medical School listened to the lecture about how to ask key questions for the diagnosis. Shortly after they had medical interview with a standardized patient for measurement purpose. They were randomly allocated to study and control groups. The lecture content for the intervention group corresponded to the interview but the one for the control group did not correspond to the interview.
3) We identified the issues related with ethical review for research, how to mask the information of randomization out of assessors, and equity of educational intervention and assessment offered to both groups.