An investigation on the efficacy of preoperative autologous blood donation in open-heart surgery was made using frozen red blood cells and MAP red blood cells in cooperation with the Red Cross Blood Center. In 109 cases which received the donation, the rate of cases which received no homologous blood transfusion was 93.6% (35.3% in the cases without donation). Even in the cases of redo operation or aortic surgery, in which extensive blood loss is expected, 75% of those given a donation of 1600-2000ml frozen blood required no homologous blood transfusion. The hemoglobin concentration in the cases which received blood donation for more than 4 weeks did not decrease, indicating that safe donation is feasible. The aforementioned frozen and MAP blood preparations can be preserved for a long period so that blood donation can be started even before deciding on the date of operation. Also, its usefulness is not affected by the postponement of the operation. Furthermore, there was no problem in safety with respect to transfer, treatment, and storage of the autologous blood in cooperation with the Red Cross Blood Center, suggesting that this is useful as a preoperative donation method, especially in small- and middle-scale hospitals, which have no separate blood centers. However, there were 2 cases in which aggravated symptoms were noted after blood collection. Therefore, it is important to carefully select cases for autologous blood donation in open-heart surgery and it is desirable to set up appropriate donation schedules.

A 59-year-old man presented with severe abdominal pain. CT scan showed a type A aortic dissection and pericardial effusion. As cardiac tamponade was present, emergency total arch replacement was performed. Because of his symptom, we added an exploratory laparotomy, which revealed intestinal necrosis. Therefore, necrotic intestine 4.5m in length was resected. After intensive care, he began oral feeding on the 25th day and was discharged on the 76th day postoperatively.

A 73-year-old woman was referred to our hospital for angina pectoris due to triple-vessel-disease. She underwent off-pump coronary artery bypass grafting ×3 (RITA-LAD, LITA-OM, SV-PDA). Her vital signs were stable during the operation and the postoperative status was steady in the ICU. However, on the next day, she suddenly had severe back pain with markedly elevated blood pressure. Urine output immediately shut down and respiratory failure progressed with time. An enhanced CT scan revealed aortic dissection (DeBakey type I and Stanford type A). An emergency operation was performed via re-sternotomy. Cardiopulmonary bypass was initiated and the body was cooled down to 20°C. Under circulatory arrest with isolated cerebral perfusion, the ascending aorta was replaced using a one-branched Hemashield graft (26mm in diameter). The entry of the dissection was located at the proximal anastomosis site of the vein graft. The postoperative course was uneventful and she was discharged on the 24th postoperative day.

A 68-year-old man was referred to our hospital with an abnormal shadow on chest X-ray film. Enhanced chest CT scan revealed intrathoracic left subclavian artery aneurysm (maximum diameter 4cm) just above the aortic arch. Surgery was indicated considering the risks of aneurysm rupture and distal embolism, although he was asymptomatic. Under left 4th posterolateral thoracotomy, the aneurysm was exposed. Cardiopulmonary bypass was initiated with cannulation of the left femoral artery and vein (to the right atrium). Circulatory arrest and isolated cerebral perfusion were achieved at 25°C core-temperature. The distal arch was replaced using a 26mm Hemashield graft and the left subclavian artery was reconstructed interposing an 8mm graft. The postoperative course was uneventful: he was extubated at 8h and was sent to the ward the next day. He was given an ambulatory discharge on the 13th postoperative day.

A 92-year-old woman was referred to our hospital with lower abdominal pain and lumbago. Her vital signs were stable at an emergency outpatient-clinic. An enhanced CT scan showed a sealed rupture of a right internal iliac artery aneurysm (85×73mm in diameter). An emergency operation was performed via median laparotomy. As predicted pre-operatively, a large hematoma was found in the retroperitoneal space and mesenterium surrounding the right internal iliac artery aneurysm (sealed rupture). Y-grafting was performed using a 16×8mm Intergard: proximal and distal ends of the graft were the abdominal aorta and bilateral femoral arteries, respectively. Left common iliac artery, right external iliac artery and right internal arterial aneurysm were suture-closed. The postoperative course was uneventful and she was discharged on the 13th postoperative day on foot.

A 73-year-old woman was referred to our hospital with a feeling of chest compression. Coronary angiography revealed a giant coronary artery aneurysm, located in the middle of a coronarypulmonary artery fistula originating at the left anterior descending artery. Also another fistula was shown between the right coronary artery and the pulmonary artery. Surgical correction was indicated due to the risks of the aneurysm rupture and coronary events. Under cardiopulmonary bypass, suture-closure of the coronary artery aneurysm and ligation of the fistulae were carried out with success. Transesophageal echocardiography was useful to confirm disappearance of the abnormal shunts after the operative procedures. The postoperative course was uneventful. Postoperative coronary angiography showed no aneurysm or fistula. She was discharged on the 11th postoperative day on foot.

Seventy patients with liver cirrhosis hospitalized into our clinic were divided into a compensatory group and a decompensatory group according to three clinical findings, ascites, hepatic encephalopathy and bleeding from gastrointestinal tract. It was suggested that five items of biochemical data for liver function were very important on discriminating these two grops. The five items were cholinesterase, indocyanine green test, albumin, prothrombin time and hematocrit.
We have tried to devise a new staging system for liver cirrhosis by scoring method using the five items. According to the total score calculated from scoring method, clinical stages were divided into four such as stage I, stage II, stage III, and stage IV. It was suggested that cases of stage III had to be treated very carefully.
Liver and spleen volume of patients with liver cirrhosis were calculated by computed tomography. It was suggested that liver volume/spleen volume ratio was very important on discriminating these two groups.

Abstract
Objective : In this study, we conducted a survey on both the use of supplements by customers and information provided by pharmacists, to clarify customer understanding. We also sought to ascertain the actual current state of information provided by pharmacists to customers, as well as investigating both how, and to what extent, pharmacists should be involved in customers 'use of supplements.
Methodology : During regular pharmacy visits, pharmacists used a questionnaire to interview 1,253 customers, in 14 community pharmacies, in Tokyo and Hokkaido, respectively. A different questionnaire, designed for pharmacists, was also given to 289 pharmacists who were either working in those same pharmacies, or who attended the Conference on Pharmaceutical Sciences in Hokkaido (2011, Sapporo).
Results : The results of the survey showed that approximately 50％ of consumers greatly desired the provision of safety and efficacy information about supplements by pharmacists. However, few pharmacists answered customers' questions satisfactorily (only 7.3％ of total responses).
 The results also indicated that only 30％ of pharmacists actively gathered information about supplements, despite the fact that 67.5％ of pharmacists were aware that they were expected to do so by customers, in their roles as primary information providers regarding such treatments. Furthermore, even those pharmacists who checked information regarding supplements depended mostly on information acquired from the Internet.
Conclusion : There is a large gap between customers' expectations for explanation of supplements and the reality of such explanations, and the information actually provided by pharmacists. In order to live up to their customers' expectations, pharmacists should foster both wider dissemination and better understanding of evidence-based information about supplements. Pharmacists should also provide integrated management of drugs and supplements for patients.

Although the Outpatient Cancer Chemotherapy (OCC) Unit was established with in Anjo-Kosei Hospital in 2006, its real worth remains to be elucidated. To address this, the following subjects were examined;effective usage of hospital beds changes in the number of outpatients given to chemotherapy, length of hospitalization, the number of patients transferred by ambulance to the hospital, hospital occupancy rate, and the number of frequently used chemotherapy regimens.Since the establishment of the OCC Unit, the number of patients transferred by ambulance has increased and length of hospitalization has gradually decreased, accompanied by the increase in the number of outpatients treated at the OCC Unit. Additionally, no significant change was observed in the hospital occupancy rate. Furthermore, of the frequently used chemotherapy regimens, nine regimens were available for 62.4% of the total number of outpatients of the OCC Unit.These results indicated the useful effect of the establishment of the OCC Unit on the usage of hospital beds, and provided significant information helpful in promoting the effective and safe chemotherapy for outpatients in the OCC Unit.
Chemotherapy-Oncologic Procedure ; Unit ; seconds ; Outpatients ; Malignant Neoplasms

We performed a survey on actual circumstances of work style of under-40 cardiovascular surgeons and obtained responses from 51 surgeons. We report the results and discussion about the questionnaire.