Objective: Of the total number of prescriptions received, the percentage of refill prescriptions in May-June 2022 was 0.053%. In order to speculate on the reasons for the low utilization rate of the refill system and future developments, we surveyed patients who have been receiving continuous drug treatment for more than 6 months to determine their attitudes toward the refill system.Methods: The survey was conducted on the Web and valid responses were obtained from 290 respondents.Results: The respondents were 44.8% male and 55.2% female, with a mean age of 45.6 ± 10.5 years. Respondents' diseases included hypertension (32.1%), dyslipidemia (15.9%), diabetes (15.2%), psychiatric diseases (10.0%), skin diseases (9.3%), and others. Of the respondents, 83.4% had no prescription change within 6 months, and 69.0% had access to treatment medications for the purpose of going to the hospital, indicating that their symptoms were stable and they could use the refill system. In addition, we found that only 17.2% were aware of the refill system. However, 73.4% of respondents indicated their intention to use the refill system in the future. Therefore, our results strongly suggest that the reason for the lack of its use is due to a lack of awareness of it.Conclusion: It is expected that the refill system will be promoted in the future through awareness-raising events and education of the public. It is thought that the use of the refill system may cause delays in the detection of adverse drug reactions and the overlooking of worsening health conditions. The issue is whether pharmacists can appropriately judge whether or not to continue refill prescriptions.

The Laparoscopic Approach to Cervical Cancer (LACC) trial demonstrated that minimally invasive radical hysterectomy was inferior to the open approach [1]; this unexpected result could be attributed to the spillage of cancer cells [2]. Following the LACC trial, laparoscopic radical hysterectomy without an intrauterine manipulator upon completion of a vaginal cuff closure became the new standard treatment method [3]. However, the lack of intrauterine manipulator results in poor visualization and inadequate paracervical tissue resection. This study describes the no-look no-touch technique to address this difficulty. The core procedures in our no-look, no-touch laparoscopic radical hysterectomy are: (Step 1) Creation and closure of a vaginal cuff; (Step 2) Manipulation of the uterus without an intra-uterine manipulator; and (Step 3) Exposure of the paracervical tissues by the suspension technique. The patient eligibility for our procedure is as follows: 1) previously untreated cervical cancer (those who underwent diagnostic conization could be included); 2) clinical stage IA2, IB1, IB2, and IIA1 based on the 2018 International Federation of Gynecology and Obstetrics staging system; 3) histologically confirmed cervical cancer, including squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. The important indication for this procedure is in cases where the tumor is less than 4 cm in diameter. We previously reported that our no-look no-touch technique enables smooth performance of laparoscopic radical hysterectomy without worsening oncologic outcomes [4]. According to a recent systematic review and meta-analysis [5], minimally invasive radical hysterectomy with vaginal cuff closure is a safe treatment option; however, it involves a steep learning curve, which has impeded its increased application. This video will hopefully make minimally invasive radical hysterectomy with protective maneuvers against cancer cell spillage more accessible. Based on our experiences, we propose that our transvaginal cervical tumor-concealing no-look no-touch technique will mitigate the risk of surgical spill of tumor cells during minimally invasive radical hysterectomy. The informed consent for use of this video was taken from the patient.

Coronary arteriovenous fistula (CAVF) is defined as an abnormal communication between the coronary artery and a cardiac cavity or a major blood vessel. It is the most common congenital anomaly of the coronary arteries, but it is relatively rare, accounting for only approximately 0.4% of all congenital heart diseases. Most cases of CAVF are clinically asymptomatic in young patients, but with increasing age, symptoms begin to appear and surgical treatment is required. In rare cases of CAVF, however, symptoms may appear in the neonatal period and early surgery may be required. In this article, we report the case of a 12-day-old patient diagnosed after birth with CAVF between the aneurysmatic left anterior descending artery and the right ventricle. This patient required early surgical intervention due to concerns about worsening heart failure and developing coronary artery ischemia. Although various surgical options were considered, we opted for an arteriotomy of the left anterior descending artery and closed the fistula with two autologous pericardial patches. There has been no signs of postoperative ischemic changes or enlargement of the coronary aneurysm during the 4 years of follow up, and careful monitoring will continue.

Purpose: Most studies have investigated the differences in postgastrectomy quality of life (QOL) based on the surgical procedure or reconstruction method adopted; only a few studies have compared QOL based on tumor location. This large-scale study aims to investigate the differences in QOL between patients with esophagogastric junction cancer (EGJC) and those with upper third gastric cancer (UGC) undergoing the same gastrectomy procedure to evaluate the impact of tumor location on postoperative QOL. Methods: The Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire was distributed in 70 institutions to 2,364 patients who underwent gastrectomy for EGJC or UGC.A total of 1,909 patients were eligible for the study, and 1,744 patients who underwent total gastrectomy (TG) or proximal gastrectomy (PG) were selected for the final analysis. These patients were divided into EGJC and UGC groups; thereafter, the PGSAS-45 main outcome measures (MOMs) were compared between the two groups for each type of gastrectomy. Results: Among the post-TG patients, only one MOM was significantly better in the UGC group than in the EGJC group. Conversely, among the post-PG patients, postoperative QOL was significantly better in 6 out of 19 MOMs in the UGC group than in the EGJC group. Conclusions Tumor location had a minimal effect on the postoperative QOL of post-TG patients, whereas among post-PG patients, there were definite differences in postoperative QOL between the two groups. It seems reasonable to conservatively estimate the benefits of PG in patients with EGJC compared to those in patients with UGC.

A male infant was diagnosed with aorto-left ventricular tunnel (ALVT) because of advanced left ventricular hypertrophy and massive reflux from the aorta to the left ventricle during the fetal period. Aorto-left ventricular tunnel closure was emergently performed 2 h after birth in cooperation with the hospital where he was born. The aortic end of the ALVT was located above the right-left coronary commissure, and the measured diameter was 8 mm. The aortic valve was tricuspid, but it was thickened and the opening was limited ; it was further complicated by a right coronary artery anomaly. Taking the valve distortion and surgical invasion into consideration, only the aortic end was closed using an autologous pericardial patch. Although mild aortic valve stenosis and regurgitation remained after surgery, the postoperative course was uneventful, and the left ventricular hypertrophy and cardiac function were improved.

Objective: There have been reports of health hazards caused by medical devices, cosmetics, quasi-drugs, daily necessities, hygiene products, etc. (health-related products) sold in pharmacies and drugstores. However, the role pharmacists play in dealing with the health hazards caused by health-related products has not been clarified. Therefore, we conducted a survey on the cases of health hazards related to health-related products and the views of pharmacists.Methods: A questionnaire was administered anonymously by email to 601 pharmacists working in community pharmacies or drugstores between December 11 and 20, 2019.Results: The number of valid responses was 585. The breakdown of health hazard cases where pharmacists counseled customers were 60 for medical devices, 31 for cosmetics, 18 for quasi-drugs, 9 for hygiene products, and 20 for daily necessities and others. Of those 138 cases, 19 cases of medical devices were estimated to have an intermediate risk as a health hazard, and the other 119 cases were all classified as low. Of the cases that the pharmacists were not approached for help, but were aware of, 57 were medical devices (21 high, 31 intermediate, 5 low), 44 were cosmetics (12 intermediate, 32 low), 12 were quasi-drugs (7 intermediate, 5 low), 7 were hygiene products (7 low), and 64 were daily necessities and others (26 high, 34 intermediate, 4 low). With regard to health-related products, 95% of the respondents indicated that they had responded to customer questions with advice.Conclusion: Our results show that there are various cases that could develop into health hazards due to health-related products, and most respondents felt a need to alert the public. As such, pharmacists and other staffs in drugstores will continue to provide health support functions to their customers by advising them on not only pharmaceuticals but also these health-related products.

A nine-month-old boy with a prenatal diagnosis of aorto-left ventricular tunnel (ALVT) and aortic valve disease underwent an urgent ALVT patch closure approximately 2 h after birth. The patient subsequently developed airway compression due to the progressive dilatation of the ascending aorta postoperatively associated with aortic regurgitation and stenosis. After 9 months of prolonged respiratory symptoms following the ALVT repair, he underwent a posterior plication of the ascending aorta. After plication, the tracheal compression and respiratory symptoms improved. A computed tomography (CT) scan 1 month after surgery revealed significant free space between the aorta and the trachea, which relieved the aortic compression. Posterior plication of the ascending aorta is achieved by resecting the posterior aortic wall adjacent to the airway. It is the procedure of choice for longer and more effective relief of airway compression compared to other procedures such as anterior aortopexy, the lateral sliding technique, and side clamp plication.

Palmoplantar pustulosis is a chronic inflammatory skin disease involving the palms and soles where mild accumulation of helper T cells and neutrophils in the dermis histologically are observed. Leukoencephalopathy is a brain disease affecting white matter but is rarely accompanied by skin lesion. Here we report a unique case of leukoencephalopathy accompanied by palmoplantar pustulosis with identical pathological feature of helper T cell accumulation in both the brain and skin, suggesting a possible link in the pathogenesis.

OBJECTIVES: Intraoperative tumor manipulation and dissemination may possibly compromise survival of women with early-stage cervical cancer who undergo minimally-invasive radical hysterectomy (RH). The objective of the study was to examine survival related to minimally-invasive RH with a “no-look no-touch” technique for clinical stage IB1 cervical cancer. METHODS: This retrospective study compared patients who underwent total laparoscopic radical hysterectomy (TLRH) with no-look no-touch technique (n=80) to those who underwent an abdominal radical hysterectomy (ARH; n=83) for stage IB1 (≤4 cm) cervical cancer. TLRH with no-look no-touch technique incorporates 4 specific measures to prevent tumor spillage: 1) creation of a vaginal cuff, 2) avoidance of a uterine manipulator, 3) minimal handling of the uterine cervix, and 4) bagging of the specimen. RESULTS: Surgical outcomes of TLRH were significantly superior to ARH for operative time (294 vs. 376 minutes), estimated blood loss (185 vs. 500 mL), and length of hospital stay (14 vs. 18 days) (all, p < 0.001). Oncologic outcomes were similar between the 2 groups, including disease-free survival (DFS) (p=0.591) and overall survival (p=0.188). When stratified by tumor size (<2 vs. ≥2 cm), DFS was similar between the 2 groups (p=0.897 and p=0.602, respectively). The loco-regional recurrence rate following TLRH was similar to the rate after ARH (6.3% vs. 9.6%, p=0.566). Multiple-pelvic recurrence was observed in only 1 patient in the TLRH group. CONCLUSION: Our study suggests that the no-look no-touch technique may be a useful surgical procedure to reduce recurrence risk via preventing intraoperative tumor spillage during TLRH for early-stage cervical cancer.
Cervix Uteri ; Disease-Free Survival ; Female ; Humans ; Hysterectomy ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Operative Time ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms