A 44-year-old man had been pointed out to have a heart murmur during his elementary school days. He came to us complaining of chest pain and palpitation. He was diagnosed to have severe aortic regurgitation caused by prolapse of the right coronary cusp, and the left ventricular function was depressed. At surgery, the aortic valve was repaired with the RCC resuspension technique, but regurgitation was not controlled because the RCC annulus was retracted by natural supracristal closure of the ventricular septal defect. We proceeded to the Ross procedure. A pulmonary autograft was harvested and sewed in the aortic annulus. The right ventricular outflow tract was reconstructed using a stentless bioprosthetic valve with glutaraldehyde-treated bovine pericardium. He was discharged after a straightforward postoperative course.

Extended－release Oxycodone tablet has been available for cancer pain treatment since 2003 in Japan. After pure oxycodone injection became available in 2012, we have tried to switch from oral to injection when oral intake becomes difficult because of bowel obstruction, nausea or drowsiness due to progression of the disease. There is no evidence regarding the ratio of switching from oral to injection at present in Japan. We always pay attention to avoid patients drowsiness because of an overdose of opioid, because there is not enough time left for cancer patients in the terminal stage, and drowsiness takes away from the patient’s good QOL. We switched Oxycodone from oral to injection in 8 cases from June to December in 2012. At first, we assess if the patient is well controlled by oral oxycodone or not. If the patient is not relieved from the pain enough, we switch oxycodone from oral to continuous subcutaneous injection with a dose of around 75％ at first. After that we titrate the dose little by little up to an appropriate level. We were able to evaluate 5 patients out of 8 because there were 3 patients with consciousness disorder. As a result, we were able to decrease dosage to 46.4％ on average.

Objective: To examine how best to provide information on over-the-counter (OTC) drugs in the future, the Japan Self-Medication Industry (JSMI) conducted an online survey on public attitudes toward changes in the system for controlling the sales of OTC drugs specified by the revised Pharmaceutical Affairs Act effective since June 2009.
Methods: A secure web-based questionnaire system was developed and linked to the JSMI website.  The survey was conducted between July 17 and August 31, 2009.
Results: Of the 4,257 people who responded to the questionnaire, 56.8% indicated they understood the provisions of the revised Pharmaceutical Affairs Act.  More than half of the responders had positive opinions of the revision.  They welcomed the improvement in convenience resulting from the availability of drugs at convenience stores, but “Druggists,” who are responsible for sales of the drugs, were not sufficiently represented among responders.  It was inferred that the general public feels that they should be able to purchase OTC drugs for self-medication after receiving sufficient information about the drugs from qualified sources.

In Palliative care, we meet patients with easy-bleeding superficial malignant tumors, such as head and neck cancer, skin metastasis of all kinds of cancer and unresectable breast cancer. But it is not easy to control bleeding even though we use various means, and many doctors have difficulties in stopping bleeding. We report a case with a recurrent tumor of pharyngeal cancer that showed easy-bleeding and discharged massive exudates. Although she received several alcohol local injections because of bleeding of the tumor, she needed a dressing change over 5 times in a day. It made her QOL worse. In this case, we used Mohs paste and after using it, the surface had been fixed and dried up, resulting in a decrease in bleeding, exudate, frequency of dressing change and bad odor. Mohs paste was made of distilled water, zinc chloride, zinc starch and Glycerol. Zinc chloride changes to zinc ion by water in the wound and makes protein cohere and thereafter tissues, vessels and cell membrane of bacteria are fixed chemically. We could stop bleeding for 15 days with only 20 minutes contact with Mohs paste, and massive exudates and bad odor decreased. Mohs paste, which is made in your hospital pharmacy with cheap materials, can be used for bleeding or massive exudates repeatedly if there is not a thick blood vessel anatomically under the tumor. It was effective to improve her QOL. Palliat Care Res 2009; 4(2): 346-350

OBJECTIVESTo investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) in children and its relationship to metabolic syndrome, insulin resistance, and waist circumference (WC).

METHODSThis was a population-based cross-sectional, case-control study. Cases were selected among students of a primary and junior high school, respectively, and age- and sex-matched control subjects were selected randomly (ratio of cases to control subject was 37:113).

RESULTSOf the 846 students, aged between 6 and 15 years, enrolled in the study and screened by ultrasonography, 37 children were diagnosed as having NAFLD (score >/= 1). There was a significant sex difference in the prevalence of NAFLD(P = 0.003). The trend test revealed a strong dose-response relationship (P < 0.001) between pediatric NAFLD and the number of the proposed components of pediatric metabolic syndrome in Japan (MetS-JC), such as a clustering of the components of MetS-JC. Additionally, the linear trend of the odds ratios (ORs) with increasing percentile of the homeostasis model assessment-insulin resistance (HOMA-IR) was statistically significant (P < 0.001). However, when WC was added to the logistic model, the ORs were no longer significant, whereas WC turned out to be an independent risk factor for NAFLD regardless of the HOMA-IR index.

CONCLUSIONThe prevalence of NAFLD in children and adolescents is closely related to metabolic syndrome, insulin resistance, and WC.

Idiopathic hypereosinophilic syndrome (IHES) is a rare systemic disease, but frequently associated with the eosinophil-infiltrated end organ (cardiac, hematologic, cutaneous, neurologic, pulmonary, splenic and thromboembolic) failure. Mechanical valve replacement for valvular heart disease in cases of IHES has the potential of thromboembolic accidents in the early post-operative period, even though the strict anti-coagulant therapy was performed. We reported a younger IHES case with congestive heart failure due to severe mitral regurgitation who underwent mitral valve repair instead of replacement. In this case, only the lateral scallop of the posterior mitral leaflet was involved with endocarditis due to the eosinophyl infiltration, with no other symptoms, i.e., initial hyperplasia and thrombus in the left ventricle that were detected in the most cases with IHES endocarditis. Mitral annuloplasty with the complete ring was simply performed because of the presence of sufficient intact anterior leaflet. The eosinophil count had been strictly controlled with imatinib mesilate in addition to the anti-coagulant therapy, and any thromboembolic event had been detected post operatively. In case of valvular heart disease due to IHES endocarditis, valve repair should be firstly attempt and imatinib mesilate is very useful and effective for preventing from post-operative thromboembolic accidents in FIP1L1-PDGFRα gene positive cases.

The purpose of this study was to investigate differences between first-year (n=97) and second-year medical students (n=102) in their reactions to a community-based early clinical exposure program. Questionnaires completed after their participation in the program showed that first-and second-year students did not differ in their interest in practical training in nursing homes and wards of the university hospital or in a presentation given by a family member of a cancer patient who had died in the hospital (Chi square test, p<0.05). However, second-year students were more likely to report that they understood the family's presentation well, whereas first-year students were more likely to report they could communicate with elderly or disabled persons. Several facilities in the community criticized the students' attitudes toward practical training. We believe the reason for the criticism was insufficient advance preparation.

Bronchial asthma is manifested pathophysiologically by a narrowing of air passages with eosinophilic inflammation, and clinically by paroxysmal dyspnea. Usually, the treatment of asthma is governed by the Japanese guidelines for the prevention and control of bronchial asthma. We report two cases of bronchial asthma attack successfully treated with Kampo medicine. For their safety, the patients were hospitalized with informed consent, and evaluated carefully by means of various measures, such as pulse oximeter and peak expiratory flow rate.
In both cases, no application of additional occidental agents was made, except those used before current episode.
However, while modern Western medicine now sweeps over in the treatment of bronchial asthma attack, it is suggested that the Kampo medicine is comparable, in cases where the patients are hospitalized with informed consent, and evaluated carefully. Nevertheless it is proper that the therapy should be intensified in accordance with the guidelines in case of deterioration against the Kampo treatment.

Medical students at Kurume University begin practical training in clinical skills in their fourth year. At that time, students use the skills laboratory to improve their clinical skills. Medical education resources in the skills laboratory include simulators for emergency resuscitation and heart diseases, wireless stethoscopes, and videotapes. All students use the skills laboratory for 2 months, and its usefulness was evaluated with questionnaires after practical training. More than 50 % of students approved of their practice in the skills laboratory. However, some students were unsatisfied because they were unable to make effective use of the simulators. In the future, an improved skills laboratory will be necessary to improve practical training in the clinical skills for medical students.

The effects of high concentration mineral water bating (31.16g/kg, mainly composed of Na, Ca, Mg chloride and sulfate) were studied in 13 healthy men (44.9±16.3y.o.). The subjects took 41°C, 10min bathing and kept warmth by a blanket for 30min. Blood pressure (BP), Heart rate (HR), cardiac output (CO), total peripheral resistance (TPR) and sublingual temperature by electric thermista as deep body temperature were measured during and after bathing. Skin blood flow by LASER doppler flow meter and venous partial gas pressure and pH were also measured.
Sublingual and forehead temperature was increased significantly by +1.4°C after 10min bathing and +0.9°C increase continued even after 30min. Diastolic BP and TPR were significantly decreased, and HR and CO were significantly increased by +20bpm and +2.7l/min, respectively. Significant increase of skin blood flow was also demonstrated. Significant increase of venous pO₂ (+20 Torr) and decrease of pCO₂ (-8.0 Torr) suggested the improvement of peripheral oxidative metabolism due to increased CO.
High concentration mineral water bathing was highly effective than simple water bathing probably due to the thick coating effect by binding concentrated minerals with skin furface protein.