The patient was a 65-year-old man who had undergone AVR (SJM Regent : 19 mm) for AR in June 2007. Since March 2008 there had been an increase in the pressure gradient between the aorta and the left ventricle on transthoracic echocardiography (peak PG : 46 mmHg, mean PG : 27 mm Hg). Plain x-ray films of the valve showed limited opening of the metallic valve. However, no symptoms of heart failure were observed on a physical examination. Blood tests performed in December 2007 showed a PT-INR value of 1.22. Since the effects of warfarin anticoagulant therapy were insufficient, its dose was adjusted on follow-up. An examination in June revealed further stenosis of the valve (peak PG : 93 mmHg, mean PG : 58 mmHg). Valve thrombosis was suspected because the condition was poorly controlled by warfarin. Thus, thrombolytic therapy using t-PA was performed (800,000 units). However, the patient complained of chest pain 1 h 30 min after initiation of thrombolytic therapy. Twelve-lead electrocardiography was performed, and ST-segment elevations were observed in the limb and chest leads. Acute myocardial infarction due to a free-floating thrombus was suspected, and emergency cardiac catheterization was performed. Segment 7 was totally occluded, and reperfusion was achieved by thrombus aspiration. Embolization of the coronary artery was speculated to have occurred because of the improved mobility of the metallic valve and dissolution of a thrombus adhering to the valve. A case of acute myocardial infarction as a complication of thrombolytic therapy for valve thrombosis is rare. This case reaffirms the necessity of careful monitoring during thrombolytic therapy.

Background :There have been only a few comparative observational studies on the safety and effectiveness of drugs in Japan. Comparative observational studies would provide important information to address these issues and thus we need to establish a means to facilitate such studies. In comparative studies, it is important to prevent the distortion of results due to selection bias. Though we do not yet have a claims database for use in pharmacoepidemiological studies, recently many hospitals and pharmacies have computerized prescription data which may be used to minimize selection bias. Good standardized procedures for the identification of patients prescribed one of two or more drugs to compare in a study using computerized prescription data would serve as a basis for a variety of pharmacoepidemiological studies in Japan.
Methods :We carried out a questionnaire survey in 2753 hospitals and 909 community pharmacies to estimate the fraction of hospitals where computerized data can be used to identify all eligible patients who used a specific drug.
Results :Questionnaires were returned by 1942 (71%) of 2753 hospitals and 632 (70%) of 909 pharmacies. From among those which responded, patients were identified, the patient list was printed, and the electronic file of the patient list was generated in 75%, 64% and 36% of the 1942 hospitals and in 100%, 93% and 49% of the 632 pharmacies respectively.
Conclusion :With procedures using computerized prescription data, the cohort for observational comparative studies may be identified with a minimal selection bias in a majority of hospitals and pharmacies.

This study was designed to assess the role of macrophages in saphenous vein graft disease after coronary artery bypass grafting (CABG). Three newly harvested saphenous vein grafts (SVGs) and 6 SVGs removed from patients 8 to 15 years after CABG (3 were occluded soon after the operation and 3 became diseased after a long period) were immunostained for macrophages and investigated microscopically. No macrophages were detected in the newly harvested SVGs. In the grafts with early occlusion, macrophages were detected only in the superficial layer of the intima. In the grafts that became diseased after a long period, macrophage accumulation was detected at the site of atherosclerotic lesions. In the pathogenesis of arterial atherosclerotic lesions, vascular endothelial cell damage and subsequent subendothelial migration of monocytes/macrophages in the early phase are thought to be very important. This study revealed that macrophage migration into the intima of SVGs occurs soon after surgery and suggested it could be the basis of saphenous vein graft disease occurring long after CABG.

In order to study the physical fitness of rural children in Gifu prefecture, a total of 128 rural boys and girls aged 8-14 years old in the Tokuyama-Elementary School and-Middle School, which are in a far rural district from busy civilized urban distriet, were measured for the developmental status, i. e, physique, examination of physical fitness, maximum working capacity, cardiorespiratory function and urinary excretion in summer, 1962, and the comparison was made on the results obtained there with those of the average Japanese children of the same age.
The results obtained were as follows:
1) Little or no difference was found between physical development of rural children and that of average Japanese boys and girls ; i. e, the physique of rural children was not superior nor inferior to the value of the average Japanese children.
2) The record of sprint games, such as 50m-sprint-run, broad jumping, ball throwing, Sargent-jump, grip strength and back strength of rural children was lower than that of the Japanese average. Whereas, the endurance ability measured with a long-distance running (1500m for boys and 1000m for girls) was tended to be higher in the rural children, especially in the girls, than the average Japanese value. However, no significant difference was presented in the flexibility test (forward bending of the upper-body in standing posture) between rural and average Japanese values.
3) The examination of cardiopulmonary function : i.e. E.C.G., blood pressure, heart rate, vital capacity and maximum expiratony flow rate exhibited no abnormal sign. The systolic and diastolic blood pressure tended to increase with age, but the heart rate tended to decrease. The examination of the urinary glucose, protein and occult-blood remained normal, and most of the urine pH of the girls were within the range between 6 and 7, whereas, those of boys were between 5 and 6.
4) The maximum working capacity (maximum oxygen intake, vital capacity) showeda linear increase proportional to age and physique (body height, body weigmt, body surface, etc, ) over the range of the age tested. Sexual difference appeared after 12 years of age.
5) The possibility was suggested that the maximum O₂ intake could be predicted from the vital capacity of the same individual regardless of age, sex and physique, and a theoretical background for that was discussed.

Objective: Similarity of drug names is one factor of dispensing incidents.  The aim of this study was to survey the relation between sensual similarities of drug names and the occurrence of taking errors for pharmacists who actually prepare medicine.
Methods: A pair of drugs (15 incident pairs and 104 control pairs) was displayed on a computer screen at random.  The subject’s task was to determine the sensual similarity of them.  Thirteen pharmacists who prepared these pairs and caused their incidents participated in the experiment.
Results: The result showed that the sensual similarity of drug names of incident pairs was found to be highly significant in comparison to one of the control pairs [p=0.026].  However, the similarity in incident pairs is not necessarily high.  It was suggested that the similarity of drug name was not the only factor of taking error.  Multiple linear regression analyses of the sensual similarity in control pairs were performed, in which 10 variables were reported as quantitative indicators of similarity of drug name and were able to be measured on the internet.  The correlation was good [R²=0.828].  However, this regression model was not useful when adjusting to incident pairs.  In incident pairs, the similarity value calculated by the regression model was lower than the measured sensual similarity.
Conclusion: The result suggested that measured sensual similarity includes other risk factors of taking error, such as appearance similarity and/or efficacy similarity and/or short distance arrangement.  It seemed that the pharmacist’s ability complicated the factor of taking error.

Interventional radiology (IR) embolization requires image guidance to steer catheters to the site of bleeding, where embolic agents such as Gelfoam or coils are administered to stem blood flow. In addition to treating iatrogenic trauma, embolization is suitable for injuries precluding surgery such as blush-bleeding of the liver or kidney and for locating and treating intimal blood vessel tears. However, during hospital off-hours (such as nights and holidays), experienced IR personnel are not always available. In such situations, there is a dire need to build a coordinated IR team to treat seriously injured patients rapidly and reliably. This article reviews the current principles and techniques used in IR such as virtual fluoroscopy and their usefulness, and makes a convincing case for emergency IR.

To evaluate the extension of the indications for operation and up-to-date problems in the surgical therapy of the acquired valvular disease, 581 consecutive patients of prosthetic valve replacement from January 1974 through December 1987 were analysed. The age at operation was 39.1 years (range 22 to 68) at 1974, but increased to 51.9 years (range 9 to 75) at 1987 (p<0.05). Early mortality was 3 deaths in 9 patients (33.3%) who were older than 70 years old, but its range was 0% through 7.7% in the younger patient group (p<0.05). Hospital mortality of the combined valve procedure for aortic, miral and tricuspid valvular disease was analysed. It was higher in the group of tricuspid valve replacement (30.0%) than the group of tricuspid annuloplasty (8.3%) (p<0.01). The former group was in poor preoperative state (cachexia, total bilirubin>2mg/dl, mean right atrial pressure>10mmHg and systolic pulmonary artery pressure >75mmHg), compared to the latter group. The cases of re-replacement of the prosthetic valve increased since 1985. The incidence of poor prognosis after operation, that included early death, late death and retire from society, was 47.1% in NYHA Class TV, and from 0 to 15.8% in NYHA Class I to Class III (p<0.01). 60 cases underwent valve replacement for infective endo-carditis, and 16 urgent operations were required in 23 active stage operations. Total early and late mortality was higher in active stage operation (30.0%) than in healed stage operation (2.7%) (p<0.01). In these way, the extension of the indications for operation was carried on the patients of advanced age, combined valve procedure for multiple valve disease, valve re-replacement and infective endocarditis. The operative risk was high in the patients older than 70 years old, the patients who had the risk factors of multiple organ failure after operation, valve re-replacement in NYHA Class IV, and the urgent operation at active stage of infective endocarditis.