Purpose: The purpose of this study was to examine the influence of the exercise program for Osteoarthritis of the knee (knee OA) which American Geriatrics Society Panel on Exercise and Osteoarthritis (AGS) recommends on physical function in Japanese independent elderly with knee joint pain.Methods: Subjects of this study were 36 (7 males : aged 74.7±5.1 years, 29 females : aged 72.3±4.6 years) community-dwelling independent elderly with knee joint pain who voluntary participated in our exercise program. The program consisted of massage around knee, flexibility exercises in knee and ankle joints, and leg muscle development exercises. They performed these exercises twelve times for a month at regular intervals. Physical function were evaluated by the muscle strength during knee extension and flexion, the range of motion of knee joint and the center of pressure during upright standing. There were three times measurements at one month before starting of the program (the 1 st), immediately before beginning of the program (the 2 nd), and just after ending of the program (the 3 rd). Difference between change in measurement values during the observation period (subtract the 1 st from the 2 nd ; Δ1) and that during intervention period (subtract the 2 nd from the 3 rd ; Δ2) were analyzed by Students't-test.Results and Conclusion: There was significant difference between Δ1 (0.01±0.05 kg/wt) and Δ2 (0.04±0.05 kg/wt) on maximal muscle strength during knee extension. This result suggested that the exercise program recommended by AGS was improved the leg muscle strength in Japanese elderly with knee joint pain. However the effects of the exercise intervention were not clarified on the other physical function. As for the reasons it seems to affect the initial level of joint pain and physical function in the subjects. Therefore, reexamination of this point with a greater number of samples which the worse level of knee joint pain is needed in the future.

Purpose: Patients who receive chemotherapy for colorectal cancer with the prophylactic dexamethasone (DEX) for antiemesis may experience an abnormal elevation in their casual blood glucose levels. The purpose of this study was to determine the frequency of such a DEX-induced elevation in patients with metastatic colorectal cancer, and to emphasize the importance of pharmaceutical care in improving the quality of life of patients. Methods: We retrospectively analyzed data from 50 patients who had received chemotherapy with or without DEX. Results: Of the 30 patients who received DEX, 8 exhibited abnormally high blood glucose levels (>200 mg/dl on more than 2 occasions); 3 of these patients also had diabetes mellitus. None of the 20 patients who did not receive DEX exhibited a remarkable elevation in the blood glucose levels. Conclusions: We confirm that patients receiving concomitant administration of DEX with chemotherapy may exhibit elevated blood glucose levels. Because an increase in the blood glucose levels may produce symptoms indicative of diabetes such as fatigue, appropriate pharmaceutical care for early detection of the abnormal elevation in the blood glucose levels may be important in preventing complications in such patients.

Objectives : A pharmacotherapeutic system for safe and proper use of warfarin was developed through physician-pharmacist cooperative practice ; its effects on patient adherence to therapeutic regimens and the therapeutic benefit of warfarin were assessed.
Methods : Subjects were 12 outpatients or home-care patients receiving warfarin. Patients' level of understanding of warfarin therapy and time in therapeutic range (TTR) were used as indices of adherence and therapeutic benefit, respectively. Before the physician examination, patients were interviewed by pharmacists using point-of-care testing with the CoaguChek ^®XS to check their prothrombin time-international normalized ratio (PT-INR). Pharmacists reported status of warfarin administration, any adverse effects, and medication management status to each patient's physician using the medication record or inter-institute information exchange sheet. Patient adherence was assessed before and after the pre-examination interview and changes in TTR were evaluated.
Results : Levels of understanding of warfarin therapy were significantly higher after pharmacists provided medication counseling (immediately before 4.8±1.9 vs 24 weeks after 6.8±2.4 ; P=0.0079, Wilcoxon signed-rank test). TTR significantly improved at 24 weeks after the interview (pre-interview 20.9±29.8% vs post-interview 60.5±30.5%, respectively ; P=0.0024, Wilcoxon signed-rank test).
Conclusion : The results suggest that patients'adherence to warfarin regimens and the therapeutic benefit of warfarin is improved by pharmacists'obtaining information on PT-INR before patients'medical examinations, as well as by utilizing this information to establish a cooperative pharmacotherapeutic system for good TTR management, as supported by a common protocol across pharmacies and medical institutions.

OBJECTIVES: This is an open labeled and retrospective cohort study which compared the effectiveness and safety of ibandronate (IBN) and minodronate (MIN) combined with eldecalcitol (ELD) in primary osteoporosis of women. METHODS: One hundred and forty-eight primary osteoporotic women were classified into 3 groups; 1) intravenous IBN combined with oral ELD (IBN + ELD group, N = 50; 81.8 ± 6.2 years), 2) oral MIN combined with oral ELD (MIN + ELD group, N = 50; 77.2 ± 6.9 years) and 3) oral ELD alone (ELD group, N = 48; 75.0 ± 8.3 years). For statistical analysis, L-BMD, H-BMD, serum corrected Ca, serum iP, intact-PTH, TRACP-5b, BAP, serum Hcy, eGFR and urine Ca/Cr ratio were measured until 12 months after the start of therapy. RESULTS: L-BMD values increased significantly in both IBN + ELD and MIN + ELD group, however, H-BMD increased significantly in the IBN + ELD group only. TRACP-5b values decreased rapidly during the first 6 months in both IBN + ELD and MIN + ELD group. However, BAP value in the IBN + ELD group decreased more gradually compared with that in the MIN + ELD group. Both serum Ca value and urine Ca/Cr ratio tended to increase, and the eGFR value decreased significantly in each group. CONCLUSIONS: IBN combined with ELD administration can act more effectively to increase BMD compared with MIN combined with ELD administration. Differences of decreasing rate in TRACP-5b and BAP value may lead to differences of increased rate of BMD in the IBN + ELD and MIN + ELD group. Because many cases of osteoporosis are elderly persons associated with chronic kidney disease, monitoring of kidney function and concentration of Ca in blood and urine is essential.
Aged ; Cohort Studies ; Female ; Follow-Up Studies* ; Humans ; Kidney ; Osteoporosis* ; Renal Insufficiency, Chronic ; Retrospective Studies

A pseudoaneurysm of the thoracic aorta after cardiac surgery is a rare complication, but can be life-threatening when it is ruptured. The pseudoaneurysm itself presents no symptoms in many cases, or may be similar to an atherosclerotic aortic aneurysm. Therefore, it is usually found incidently during imaging studies. We encountered 3 cases of pseudoaneurysm of the thoracic aorta that developed during the long-term follow-up after congenital cardiac surgery. None of the patients experienced specific symptoms associated with the pseudoaneurysm, and were diagnosed by chest roentgenograms and computed tomography. Most patients who undergo surgery for congenital heart defects as adolescents are free from medical treatment, and do not regularly see a doctor after the surgery. It is important to consider the possibility of a pseudoaneurysm in patients having a history of cardiac surgery.

Subclavian artery aneurysm (SCAA), a peripheral arterial aneurysm, is a rare entity. The surgical procedure and approach depend on the location of the aneurysm. We present a case of the endovascular therapy combined with cross axillary bypass. The patient was a 75-year-old man with a small abdominal aortic aneurysm. Multi-detector computed tomography (MDCT) revealed an intrathoracic right SCAA 38 mm in diameter. The operation was performed successfully under general anesthesia. After cross bypass of bilateral axillary artery, the orifice of the right subclavian artery was covered with a stent-graft inserted into the right common carotid artery-brachiocephalic artery and the right subclavian artery was occluded with coils distal to the aneurysm. Post operation angiogram showed complete exclusion of the SCAA and patency of the right common carotid and right vertebral artery. We thought this hybrid treatment for the intrathoracic SCAA could be a useful surgical strategy.

Aortic dissection with rupture into the right atrium is an extremely rare and rapidly fatal condition. We report the case of a 59-year-old man with a history of double valve replacement 2 years earlier at another hospital. Although the previous postoperative course had been uneventful, the patient had experienced facial edema and general fatigue for 10 days before admission to our hospital because of heart failure. The diagnosis of chronic aortic dissection with rupture into the right atrium was confirmed by intraoperative transesophageal echocardiography. At operation, we observed an aortic dissection that originated from a tear in the original aortic incision line. The fistula extended from the false lumen to the right atrium. The aortic adventitia were partially defective. The aortic dissection had ruptured and a pseudo-aneurysm had formed. We performed ascending aortic replacement and closure of the aorta-right atrium fistula under hypothermic arrest on cardiopulmonary bypass. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day.