Supporting Activities of Pharmaceutical Students at the Great East Japan Earthquake / 社会薬学

Following the Great East Japan Earthquake, many pharmacy students conducted support activities which was no requirement of pharmacist’s license. Although some pharmacy students reported their activities, there are no studies comprehensively analyzing this phenomenon. The purpose of this study was to survey the support activities of pharmacy students and to analyze the corresponding conditions. We conducted personal interviews with 22 pharmacy students involved in the support activities. The questionnaire included items about a student’s general attributes, activities, activity duration, and relevant locations. Further, we analyzed data on their attributes and personal information with respect to the support activities. Data on the activities were classified into 10 categories and evaluated based on pharmaceutical knowledge levels required for the support activities. According to the results of the interviews, the phases of the activities were classified into “sub-acute phase” and “chronic phase.”The relevant locations were medication collection points, shelters, and transit points for medical teams, temporary clinics, and temporary housing. Furthermore, according to the classification of activities by knowledge levels, activities depended on the students’ pharmaceutical knowledge; if they appropriately selected the activities (based on their pharmaceutical knowledge level), they could effectively participate in the support activities. The results of our survey suggest that pharmacy students can assist healthcare professionals, although the relevant activities are limited by the duration and pharmaceutical knowledge.

Simultaneous Surgical Repair of Severe Pectus Excavatum Associated with Mitral Regurgitation, Angina Pectoris and Left Atrial Tumor for an Old Non-Marfan Patient / 日本心臓血管外科学会雑誌

Patients requiring simultaneous surgical repair for severe pectus excavatum and cardiac disease are rare, and most are children with congenital heart disease and chest deformity or young adults with Marfan syndrome. We experienced an old non-Marfan patient who had cardiac disease associated with severe pectus excavatum which needed thoracoplasty to approach the heart. A 69-year-old man with pectus excavatum was admitted because of dyspnea. We diagnosed acute congestive heart failure due to severe mitral regurgitation. A left atrial tumor and coronary artery disease were also diagnosed. Because of severe pectus, the heart was displaced to the left lower chest cavity. The distance between the sternum and the vertebrae was only 1 cm. It was impossible to approach the heart without thoracoplasty. We simultaneously performed mitral valve replacement, 3-vessel coronary artery bypass grafting, resection of the left atrial tumor and thoracoplasty. His postoperative course was uneventful.

Ruptured Mycotic Aneurysm of the Deep Femoral Artery Associated with Infective Endocarditis / 日本心臓血管外科学会雑誌

We report a rare case of a ruptured mycotic aneurysm (MA) of the deep femoral artery (DFA) associated with infective endocarditis (IE). A 59-year-old woman was referred to our hospital with acute IE. Six days after anti-bacterial therapy, she complained of sudden pain in her right thigh. This condition was diagnosed as a bacterial thrombus in the right DFA. Three weeks after valve replacement, she again complained of pain and swelling of her right thigh. CT angiography revealed a ruptured MA of the right DFA. Since the infection was completely controlled at that time, we only ligated the proximal right DFA to attain hemostasis and did not attempt excision of the MA. However, because signs of recurrent infection appeared to slightly increase after surgery, we completely excised the MA to prevent infection of the prosthetic valves. Thus far, there is no evidence of recurrent aneurysm formation and infection.

A Case of Aortitis Syndrome with Annuloaortic Ectasia and Aortic Regurgitation Which Was Successfully Treated by Aortic Root Replacement with Freestyle Stentless Bioprosthesis / 日本心臓血管外科学会雑誌

A 34-year-old woman who was suffering from aortitis syndrome with annuloaortic ectasia (AAE) and severe aortic regurgitation (AR) from 18 years of age was admitted for an aortic root replacement. She has been on 5mg predonine daily. Aortography, CT and echocardiography examinations revealed dilated aortic annulus (D=30mm) and valsalva sinuses (D=43mm) and overstretched aortic valve leaflets. The ascending aorta was aneurysmal (D=50mm). Because of the patient's strong desire to have children, a Freestyle bioprosthesis was chosen for replacement. A collagen impregnated tube graft was interposed between the Freestyle and the proximal end of the transverse aorta. In order to reconstruct the coronary arteries, the Cabrol technique was utilized because of severe inflammatory adhesion of the aortic root. The patient had an uneventful postoperative course. This case shows that an aortic root replacement with Freestyle bioprosthesis offers a great benefit to those patients who are not suitable to receive postoperative anti-coagulation therapy to enable future pregnancy and child delivery.

A Case Report of Abdominal Aortic Aneurysm Associated with Crossed-Fused Ectopia of the Kidney / 日本心臓血管外科学会雑誌

A rare case of abdominal aortic aneurysm associated with crossed-fused ectopic kidney in a 74-year-old man is reported. On enhanced CT scans, the maximum diameter of his infrarenal aortic aneurysm was 55mm, and he lacked a right kidney. A crossed ectopic kidney was fused to the lower part of the left kidney. On preoperative examinations, only one feeding artery to the ectopic kidney separated from the right common iliac artery. However, laparotomy confirmed the presence of three aberrant renal arteries, the middle one of which was very slim. Aneurysmectomy and a bifurcated artificial graft replacement was performed. After proximal anastomosis, the two larger aberrant renal arteries were reconstructed under renal protection with intermittent infusion of cold Ringer's solution. The smallest aberrant renal artery was ligated. Postoperatively, this patient recovered without any complications. In operations for abdominal aortic aneurysm associated with renal anomaly including ectopic kidney, horseshoe kidney, and pelvic kidney, it is important to elucidate the anatomy of aberrant renal arteries preoperatively, and reconstruct as many of these arteries as possible. This report is apparently the fourth on abdominal aortic aneurysm associated with crossed ectopic kidney.