Objective: The purpose of this survey is to identify the individuals responsible for providing drug information (DI) services in medical institutions across the nation and understand their work conditions. Method: This survey was conducted across medical institutions nationwide, each with at least 200 general hospital beds. The survey focused on personnel in charge of DI services at medical institutions. Results: Responses were collected from 181 facilities, representing a response rate of 13.7%. The median number of full-time equivalent DI personnel at each facility was 1.2 (ranging from 0.2 to 7 (n = 180)). Among the respondents, 90 (49.7%) individuals learned their DI responsibilities from their predecessors, 81 (44.8%) individuals learned through participation in academic societies (excluding the Japanese Society for Drug Information), and 61 (33.7%) individuals gained their knowledge from academic journals, with these methods listed in their order of prevalence. The most sought-after knowledge and skills for DI personnel included the knowledge of adverse drug reaction reporting system (134 (74.0%)), basic PC skills (130 (71.8%)), knowledge of medical fees (128 (70.7%)), and expertise in disease treatment methods (125 (69.1%)). Results and Conclusion: The findings of the survey revealed that several medical institutions with 200 or more beds have only one or two individuals in charge of DI duties. Apart from their core role in drug information, the DI staff members are expected to possess extensive knowledge concerning medical fees and related matters. However, they predominantly rely on their skills for DI operations. The tasks identified in the survey are tasks that are presently being performed by DI personnel at medical institutions. This underscores the pressing need for immediate attention to be given to acquiring the essential knowledge and education required for these tasks.

Left-sided gallbladder is a rare finding that is mostly discovered incidentally during surgery and is often associated with anatomic anomalies. We herein report a case in which laparoscopic cholecystectomy and common bile duct exploration were achieved for an 89-year-old female patient with left-sided gallbladder. Surgery was carried out using our usual trocar position.Calot triangle was covered by the body of the gallbladder and could not be detected. We dissected the gallbladder from the fundus towards the neck. The cystic duct joined the common bile duct from the right side, and common bile duct exploration was performed routinely without perioperative comorbidities. Although the preoperative diagnosis rate is low and the risk of intraoperative bile duct injuries in patients with left-sided gallbladder is high, laparoscopic cholecystectomy and common bile duct exploration can be safely performed by understanding the location and bifurcation of the cystic duct.

A42-year-old man presented with a history of tidal fever almost every evening to night with 10-year duration. We could not find out the cause of his fever, so we thought he was classified in fever of unknown origin. The patient suffered from an anhydrosis phase during the temperature rose, but his fever broke after perspiration occurred at the end. The lack of perspiration with fever is a typical symptom of excess pattern of tai yang stage, and fever at night is suggestive of shao yang stage. Saikatsugekito was thought to be best suited as it would address both stages. The formula promoted perspiration, and the body temperature remained stable thereafter. It is not unusual to encounter complicated symptoms due to combined or overlapped pattern in clinical setting. This case represented successful outcome by identifying and analyzing the concept of gobyo and heibyo and prescribing a formula accordingly.

Background/Aims: 5-Aminosalicylic acid (ASA) causes intolerance reactions in some patients. This study was performed to examine the prognosis of patients with ulcerative colitis (UC) and 5-ASA intolerance, and to evaluate the potential interaction between 5-ASA intolerance and the intestinal microbiota. Methods: We performed a retrospective cohort study of patients with UC who visited participating hospitals. The primary endpoint was to compare the incidence of hospitalization within 12 months between the 5-ASA intolerance group and the 5-ASA tolerance group. The secondary endpoint was to compare the risk of adverse clinical outcomes after the start of biologics between the 2 groups. We also assessed the correlation between 5-ASA intolerance and microbial change in an independently recruited cohort of patients with UC. Results: Of 793 patients, 59 (7.4%) were assigned to the 5-ASA intolerance group and 734 (92.5%) were assigned to the 5-ASA tolerance group. The admission rate and incidence of corticosteroid use were significantly higher in the intolerance than tolerance group (P< 0.001). In 108 patients undergoing treatment with anti-tumor necrosis factor biologics, 5-ASA intolerance increased the incidence of additional induction therapy after starting biologics (P< 0.001). The 5-ASA intolerance group had a greater abundance of bacteria in the genera Faecalibacterium, Streptococcus, and Clostridium than the 5-ASA tolerance group (P< 0.05). Conclusions In patients with UC, 5-ASA intolerance is associated with a risk of adverse clinical outcomes and dysbiosis. Bacterial therapeutic optimization of 5-ASA administration may be important for improving the prognosis of patients with UC.

Case 1 was a 72-year-old man with a generalized pain after 6 months of heavy physical work. Kakkonto was prescribed based on his symptoms of severe shoulder stiffness and pain, and keishibukuryoganryo was added to treatoketsu. It caused dysuria because of ephedra herb, so the dosage was reduced. Atractylodes lancea rhizome and processed aconite root were added to enhance the effect of treatment. And then, his pain was alleviated. Case 2 was a 53-year-old man with a generalized pain. He had a previous history of whiplash and two surgical operations. Daisaikoto was prescribed based on his symptom of bilateral costal arch pain, and keishibukuryoganryo was added because of oketsu. It caused an increased frequency of bowel movement due to crude drug of rhuharb, so the dosage was reduced. Pueraria root was added for the purpose of relieving severe shoulder stiffness. And then, his pain went away. It is often difficult to treat fibromyalgia. The decoction can be effective with increase or decrease and deleting or adding of the dosage of crude drug. Decoctions become handy as it allows dosage adjustment of crude drug to minimize the side effects and improve the efficacy.

We describe a case of meningeal carcinomatosis of the internal auditory meatus presenting as sudden deafness accompanied by dizziness. A 54-year-old woman complained of acute right-side hearing loss in October 2014. The pure tone audiometry test revealed right-side hearing loss of 47.5 dB. She was treated with oral steroids. Her hearing as well as her symptoms of dizziness worsened and she was admitted for further examination. Her right and left-side hearing had worsened to 105.0 dB and 47.5 dB, respectively. A magnetic resonance imaging scan of the head revealed bilateral enhancement of the internal auditory canal and multiple brain metastases. The chest radiograph revealed a mass in the left lung. Adenocarcinoma of the lung was diagnosed. Lumbar puncture yielded no evidence of carcinoma cells in the cerebrospinal fluid, but an increased number of lymphocytes was confirmed. A diagnosis of multiple brain metastases and leptomeningeal metastasis from the adenocarcinoma of the lung was considered. Whole-brain radiation therapy (30 Gr/10 fractions) was administered. Progressive bilateral hearing loss is a rare first manifestation of meningeal carcinomatosis. It is quite important to consider the possibility of this condition when patients present with sudden deafness.
Adenocarcinoma ; Audiometry ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Dizziness ; Ear, Inner ; Female ; Head ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sudden ; Humans ; Lung ; Lymphocytes ; Magnetic Resonance Imaging ; Meningeal Carcinomatosis ; Middle Aged ; Neoplasm Metastasis ; Radiography, Thoracic ; Spinal Puncture ; Steroids ; Temporal Bone

Sixteen cases of malignant soft tissue sarcoma (STS; 10 canines and six felines) were treated with a novel triple therapy that combined photodynamic therapy, hyperthermia using indocyanine green with a broadband light source, and local chemotherapy after surgical tumor resection. This triple therapy was called photodynamic hyperthermal chemotherapy (PHCT). In all cases, the surgical margin was insufficient. In one feline case, PHCT was performed without surgical resection. PHCT was performed over an interval of 1 to 2 weeks and was repeated three to 21 times. No severe side effects, including severe skin burns, necrosis, or skin suture rupture, were observed in any of the animals. No disease recurrence was observed in seven out of 10 (70.0%) dogs and three out of six (50.0%) cats over the follow-up periods ranging from 238 to 1901 days. These results suggest that PHCT decreases the risk of STS recurrence. PHCT should therefore be considered an adjuvant therapy for treating companion animals with STS in veterinary medicine.
Animals ; Antineoplastic Agents/*therapeutic use ; Cat Diseases/drug therapy/surgery/*therapy ; Cats ; Combined Modality Therapy/veterinary ; Dog Diseases/drug therapy/surgery/*therapy ; Dogs ; Hyperthermia, Induced/veterinary ; Indocyanine Green/*therapeutic use ; Photochemotherapy/veterinary ; Photosensitizing Agents/*therapeutic use ; Sarcoma/drug therapy/surgery/therapy/*veterinary

A 67-year-old man with ascending aortic aneurysm was referred to our hospital. Transthoracic echocardiography showed severe aortic regurgitation with annuloaortic ectasia and transesophageal echocardiography revealed a quadricuspid aortic valve. This patient underwent aortic root replacement with a valve sparing technique. Under deep hypothermic circulatory arrest with retrograde cerebral perfusion, replacement of the ascending aorta was successfully performed. The postoperative course was uneventful. This patient is doing well 6 months after surgery without recurrence of aortic regurgitation.

Purpose: We assessed the efficacy of a palliative care team (PCT) in improving quality of life (QOL) among Japanese cancer patients. Patients and methods: This prospective study involved adult patients treated in the Division of Respiratory Medicine and Medical Oncology/Hematology at Kobe University Hospital between November 1, 2009 and March 30, 2010. Every patient had requested intervention by the PCT. Patients were asked to complete the EORTC QLQ-C15-PAL questionnaire at baseline and 1 and 4 weeks after initiation of the PCT intervention. Result: Of the 35 patients enrolled, 26 patients and 15 patients completed the assessments at 1 and 4 weeks after starting the intervention, respectively. Pain subscale (PA) was improved at 1 week after starting the intervention (p<0.05). Dyspnea subscale (DY) and PA were improved at 4 weeks after starting the intervention (p<0.05). Conclusion: We prospectively showed that QOL of cancer patients was improved with the intervention of the PCT, using the Japanese version of the EORTC QLQ-C15-PAL. Even if the PCT can only provide short-term care for cancer patients, this intervention appears worthwhile to improve QOL of cancer patients.

The purpose of this study was to elucidate the relationship between plasma free amino acid (PFAA) levels and the clinical stages of mammary gland tumors (MGT) in dogs. PFAA levels in canines with malignant mammary tumors were decreased compared to those of healthy animals. The levels of aspartate and ornithine, in the dogs with tumor metastasis were significantly decreased when compared to those of dogs that did not have metastases. Results of this study indicate that PFAA levels could be a risk factor or biomarker for canine MGT metastasis.
Animals ; Aspartic Acid ; Dogs ; Mammary Glands, Human ; Neoplasm Metastasis ; Ornithine ; Plasma ; Risk Factors