We determined cross sectional area of stent and lumen of iliac arterial lesions before and after deployment of Palmaz stents using intravascular ultrasound (IVUS). Stent deployment was performed in 43 patients with 47 lesions. Cross sectional images were recorded using IVUS in the proximal (P), center (C), and distal portion (D) of the stent in the iliac lesions before, immediately after, and 6 months after the deployment of stent. The initial success rate was 100%. Ultrasound images were analyzed for lumen, intra-stent and intimal proliferation area.The lumen area dilated significantly from 9.9±7.1mm² to 32.7±9.4 after the stent deployment. The intra-stent cross sectional area right after the treatment did not show any difference among the 3 portions. The mean stent area after 6 months was 32.8±8.4mm², without significant stent recoil. The lumen (=intra-stent) area after stent deployment were P: 338±9.7mm², C: 30.9±9.0, and D: 32.7±8.6. The lumen of the center portion had a tendency to be smaller than that of the proximal or distal portions. After 6 months, the intra-stent area was P: 33.5±9.2mm², C: 31.5±7.7, and D: 33.3±8.3 and the lumen area was P: 31.3±10.4mm², C: 28.2±8.9, and D: 29.4±10.5. Stent recoil was not observed but minimal dilatation was noted in the center and distal portions. The lumen area after 6 months became smaller than that immediately after the treatments due to intimal proliferation and stent deformation. The lumen area in the center portion had a tendency to be smaller than that of the proximal portion. The rates of change in the lumen area were P: -6.7±5.6%, C: -98±6.4% and D: -12.4±9.9. This showed a tendency for the lumen of the distal portion to be smaller than that of the proximal portion due to intimal proliferation. The intimal proliferation rates showed a tendency to be higher toward distal sites, but the narrowest portion in the stent was its center. The long-term patency diagnosed by angiography was 92.3% in 6 months and 89.5% in 12 and 24 months. IVUS is useful for evaluation of iliac stent deployment. The Palmaz stent was a very effective treatment for the iliac arterial lesions, protecting against vascular recoil.

A 52-year-old male was diagnosed as having aortic stenosis secondary to a bicuspid aortic valve associated with Klippel-Feil syndrome. Aortic valve replacement was successfully performed without any problems in the surgical or anesthesiological management. Only five such cases including ours, who underwent cardiac surgery have been reported. It is possible to perform cardiac surgery for patients with Klippel-Feil syndrome of their cardiac function can be well preserved.

A non-anastomotic false aneurysm occurred in a 77-year-old male 11 years after bypass grafting between the left external iliac artery and the right femoral artery using a Cooley double velour knitted Dacron graft. The false aneurysm was caused by rupture of an artificial graft. A partial resection of the graft and its replacement using a Hemashield^® graft were successfully performed. It was speculated that the mechanical stress by the inguinal band degenerated graft fibers and developed aneurysmal formation.

The importance of promoting self-medication is increasing, and the active participation of pharmacies is required to support this. We developed a training program based on the Attention, Relevance, Confidence, and Satisfaction (ARCS) model, which is a motivational design process to train pharmacists who support the proper use of OTC drugs, and for insurance pharmacists who usually perform dispensing work. In the six months of training, we conducted six sessions for insurance pharmacists on the subject of colds and constipation. In addition to conducting lectures and exercises on OTC drugs, we provided pharmacists with an opportunity to practice the training content during their daily work, and discuss solutions to the problems that they encountered. Of the eight participants who attended all workshops and were part of the final evaluation, seven provided OTC drugs after considering whether it was necessary to provide them. A total of six advised patients who came to the pharmacy to have their prescription medications dispensed that there were OTC medications that they should be careful about taking. These results suggest the usefulness of this training program based on the ARCS motivational design model.

To improve the quality of palliative care in the Kyoto region, we thought that closely connecting hospice and palliative care units (PCU) is necessary. Subsequently, we established the Kyoto PCU Liaison Committee in September 2017. This committee was created as a place to casually discuss the problems that individual PCU facilities have, deliberate on their worries together, grow and develop, and support newly launched facilities. Furthermore, discussions were held on current topics (emergency hospitalization, blood transfusion, smoking, bereaved family meetings, etc.) at the liaison meetings. While meetings were adjourned in 2020 due to the COVID-19 pandemic, we continued to exchange opinions on infection control, PCU management, etc., using the email network at first. Later, these meetings resumed via web conference systems. Thus, by having face-to-face relationships on a daily basis, we were able to maintain cooperation between PCUs even during the pandemic, and collaborate with cancer treatment hospitals. Overall, by forming a team of PCUs in Kyoto Prefecture, we aim to enable patients and their families to live with peace of mind wherever they are.