Aplastic anemia is a syndrome characterized by pancytopenia, and performing an open heart operation for patients with this syndrome may be associated with an increased surgical risk for both bleeding and post-surgical infection. We report a case of mitral regurgitation complicated with aplastic anemia that underwent a mitral valve repair via a right lateral minithoracotomy. The patient was a 70-year-old woman who presented with shortness of breath on exertion. She was found to have aplastic anemia based on pancytopenia (WBC 2,150/µl, Hgb 8.8 g/dl, PLT 5.0×10⁴/µl) and the results of a bone marrow biopsy. Echocardiography showed severe mitral valve insufficiency at the same time, and the patient was referred for surgery. To deal with the decrease in white blood cells and platelets, prior to surgery, a granulocyte colony-stimulating factor was administered, 30 units of platelet concentrate were transfused during the operation, and mitral valve repair via a right lateral minithoracotomy was performed. After surgery, there were no complications due to infection or bleeding, and the subsequent course was favorable. Several studies have reported the advantages in right minithoracotomy of less intraoperative bleeding and a lower infection rate compared with full sternotomy. In cases of this kind, in which there is a tendency toward bleeding and ease of infection, we believe that right lateral minithoracotomy may be a useful option to consider.

There is a need for suitable non-clinical teaching models in undergraduate medical education.This study was undertaken to demonstrate the feasibility of using an animal model to teach surgical skills to medical students.Two gastrotomies were created in each pig, and then closed using stapled and hand-sewn techniques.Animals were sacrificed seven days later and the closures examined grossly and histologically.
1) Medical students, as surgeons with minimal experience, are able to significantly reduce the time needed to perform closure of a gastrotomy in a porcine model using surgical staplers compared to a hand-sewn closure.
2) Medical students can perform advanced abdominal surgery techniques with adequate instruction resulting in excellent surgical outcomes in a porcine model.
3) The porcine model is a valuable tool to teach animal ethics as well as basic surgical techniques in the non-clinical environment and may help to increase interest among students in a surgical career.

Objective: At Kitasato Institute Hospital, Kitasato University (henceforth, the hospital), the first edition of an antimicrobial use guidebook (henceforth, the guidebook) was produced in 2000.  This time, the Pharmaceutical Department’s members on the hospital’s Infection Control Committee (ICC) took the lead and revised the guidebook so that it better conforms to clinical conditions and assessed the guidebook they created.
Methods: A Working Group (WG) consisting of two ICC Pharmaceutical Department members and two members of the Medical Products Information Office staff examined the items to be listed in the guidebook.  These items were approved by the ICC and then assigned to physicians and pharmacists to be written up.  A questionnaire survey was conducted on the physicians and pharmacists in the hospital as to their assessment of the content and the conditions of use of the guidebook created.
Results: In the revised edition, “Antimicrobials PK/PD,” “TDM,” “Empiric Therapy for Infections in Each Department,” etc. have been added, the physicians wrote “Empiric Therapy for Infections in Each Department” and everything else was written by the WG.  The return rate of the questionnaire was 65.7% (N=99), and the guidebook utilization rate was 75.4%.  Frequently viewed items were “List of Antimicrobials Used In-Hospital,” “How to Administer Medication during Decreased Renal Function,” “Empiric Therapy for Infections in Each Department,” etc. by the internal medicine physicians, “List of Antimicrobials Used In-Hospital” and “How to Administer Medication during Decreased Renal Function,” etc. by the surgeons, and “Classification of Antimicrobials,” “List of Antimicrobials Used In-Hospital,” “When Renal Function is Decreased,” “TDM,” and “Empiric Therapy for Infections in Each Department,” etc. by the residents.  Furthermore, there were no items deemed “not necessary for inclusion” for a clear reason.  As to be expected in this guidebook, 72.3% of all respondents mentioned it was “a source of information on basic antimicrobial use” and next, “a source of information for treating infections outside one’s area of specialty.”
Conclusion: The items listed in the guidebook are thought to be appropriate, and its usage conditions are also good.  As they are specialists on antimicrobials, the pharmacists playing a central role while cooperating with the physicians on the ICC led to the creation of a highly useful guidebook.

Six (1.2%) of 501 patients sustained phrenic nerve injury during operation for congenital heart disease at our institutions between 1992 and 1998. The diagnosis was confirmed by percutaneous stimulation of the phrenic nerve. All but 1 patient were less than 9 months old, and the average weight was 3.6kg. All 6 patients underwent diaphragmatic plication and were extubated by 7 days after operation. Percutaneous stimulation of the phrenic nerve allowed direct assessment of phrenic nerve function which was difficult to detect by clinical and radiological evidence. This method can be non-invasively used at the bedside to facilitate early and accurate diagnosis of phrenic nerve palsy.

Objective: As part of the revision on remuneration for medical services in 2012, a new system has been implemented to allow an additional fee for inpatient pharmaceutical services to be added to the basic hospitalization fee.
Methods: We at Kitasato University Kitasato Institute Hospital satisfied all institutional requirements for the new system and were preparing to introduce it from April 2012; however, there was concern about the increased workload due to the additional work of preparing diaries for pharmaceutical services used in calculating the additional fee.
Results: We therefore developed a database titled Diary System for Inpatient Pharmaceutical Services for the preparation and management of diaries.  This system allows pharmacists from various divisions to enter data simultaneously and realizes the unified management of records of services performed at various places in the pharmacy.
Conclusions: Since entered data are automatically reflected in the inpatient pharmaceutical service diary and the monthly summary, an advantage compared to paper diaries in terms of efficiency may be expected.  Furthermore, the monthly summary of the number of service hours by ward and service type may also be used for service analysis.

OBJECTIVE: In the present study, we evaluated changes in CA-125 cut-off values predictive of complete interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) using receiver operating characteristic (ROC) analysis. METHODS: This retrospective single-institution study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer and a pre-NAC serum CA-125 level of greater than 40 U/mL who were treated with neoadjuvant platinum-based chemotherapy followed by IDS between 1994 and 2009. Logistic regression analysis was used to evaluate univariate and independent multivariate associations with the effect of clinical, pathological, and CA-125 parameters on complete IDS, and ROC analysis was used to determine potential cut-off values of CA-125 for prediction of the possibility of complete IDS. RESULTS: Seventy-five patients were identified. Complete IDS was achieved in 46 (61.3%) patients and non-complete IDS was observed 29 (38.7%). Median pre-NAC CA-125 level was 639 U/mL (range, 57 to 6,539 U/mL) in the complete IDS group and 1,427 U/mL (range, 45 to 10,989 U/mL) in the non-complete IDS group. Median pre-IDS CA-125 level was 15 U/mL (range, 2 to 60 U/mL) in the complete IDS group and 53 U/mL (range, 5 to 980 U/mL) in the non-complete IDS group (p<0.001). Multivariate analyses performed with complete IDS as the endpoint revealed only pre-IDS CA-125 as an independent predictor. The odds ratio of non-complete IDS was 10.861 when the pre-IDS CA-125 level was greater than 20 U/mL. CONCLUSION: The present data suggest that in the setting of IDS after platinum-based NAC for advanced ovarian cancer, a pre-IDS CA-125 level less than 20 U/mL is an independent predictor of complete IDS.
Gynecology ; Humans ; Logistic Models ; Multivariate Analysis ; Neoplasms, Glandular and Epithelial ; Obstetrics ; Odds Ratio ; Ovarian Neoplasms ; Retrospective Studies ; ROC Curve