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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.
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INTRODUCTION@#The pathophysiology and mechanism of in-stent restenosis (ISR) after implantation of second-generation drug-eluting stents (DESs) are not fully clear. We compared the morphological characteristics of ISR between first- and second-generation DESs using frequency domain optical coherence tomography (OCT).@*METHODS@#Patients who underwent follow-up coronary angiography (CAG) after first-generation (CYPHER™ and TAXUS™) and second-generation (Nobori®, PROMUS Element™, Resolute Integrity and XIENCE) DES implantations were examined. ISR was defined as lesions of over 50% diameter stenosis at follow-up CAG. Frequency domain OCT was performed at the time of revascularisation of ISR. Tissue morphology was assessed at minimum lumen area. OCT images of DESs at both early (≤ 1 year) and late (> 1 year) phase follow-up were compared.@*RESULTS@#On qualitative OCT assessment, the ratios of homogeneous, layered, heterogeneous without-attenuation and heterogeneous with-attenuation morphologies were 57.1%, 17.1%, 20.0% and 5.7%, respectively, for second-generation DES ISR (n = 35), and 16.7%, 25.0%, 25.0% and 33.3%, respectively, for first-generation DES ISR (n = 36). At late phase follow-up, homogeneous morphology was significantly more common for second-generation DES ISR compared to first-generation DES ISR (first-generation: 8.0% vs. second-generation: 50.0%; p < 0.01) while heterogeneous with-attenuation morphology was significantly more common for first-generation DES ISR (first-generation: 44.0% vs. second-generation: 5.6%; p < 0.01).@*CONCLUSION@#Homogeneous tissue morphology was more frequently found for second-generation than first-generation DES ISR, especially in the late phase. This suggested that neointimal hyperplasia was the main mechanism in second-generation DES ISR, and that the neointima was stabilised, much like in bare metal stent implantation.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Constriction, Pathologic , Pathology , Coronary Angiography , Coronary Restenosis , Diagnostic Imaging , Pathology , Coronary Vessels , Diagnostic Imaging , Pathology , General Surgery , Drug-Eluting Stents , Incidence , Metals , Neointima , Retrospective Studies , Tomography, Optical CoherenceABSTRACT
Acute aortic dissection causes various complications, but rarely causes rhabdomyolysis before the operation. A 69-year-old woman was found to have fallen unconscious and was transported to our hospital. Chest contrast computed tomography revealed thrombosed type A acute aortic dissection. On admission, hypoxia with paradoxical breathing was recognized and she complained of chest and back pain, and severe leg pain. In blood examination, elevation of myogenic enzymes and acute renal dysfunction were recognized. However computed tomography showed no signs of the ischemia of the intraperitoneal organs and legs. Myogenic enzymes decreased gradually and acute renal dysfunction improved by conservative therapy. In spite of strict antihypertensive therapy, enlargement of the false lumen and re-dissection were occurred, for this reason we scheduled ascending aorta replacement. During the operation we did muscle biopsy, and myogenic changes, such as cytolysis and lymphocyte infiltration, were recognized in muscles pathologically. However all various autologous antibody examinations were negative. We concluded that rhabdomyolysis was due to transient shock and caused preoperative marked elevation of myogenic enzymes.
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Blow-out type free wall rupture is a severe complication after acute myocardial infarction and its prognosis is poor. A 68-year-old man was admitted to our hospital for extensive anterior acute myocardial infarction with cardiogenic shock. Echocardiogram and CT strongly indicated the presence of intrapericardial fluid, and we had to perform an emergency operation. Before median sternotomy, we cannulated the femoral artery and vein, and cardiopulmonary bypass was started. We resected the ruptured and necrotic left ventricular myocardium and employed the feltstrip sandwich method. Postoperative recovery of cardiac function and consciousness was satisfactory and he was discharged from hospital on the 37th postoperative day. PCPS or femoro-femoral bypass and consecutive surgical therapy can be a useful method for the treatment of left ventricular free wall blow-out rupture.
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We performed echocardiography on 19 hemodialysis patients before and after dialysis session. The patients were divided into three groups (normal pressure group; N=9, pre-dialysis hypertension group; N=6, pre-and post-dialysis hypertension group; N=4). The findings of echocardiography (Left ventricular end-diastolic dimension; LVDd, Left ventricular ejection fraction; EF, Left atrial dimension; LAD, Interventricular septal thickness; IVT) were compared in the three groups. There was no significant difference in LVDd and LAD between three groups. The mean value of EF was significantly (P=0.03) higher in the pre-dialysis hypertention group (68±9.4%) than in the normal pressure group (65±9.6%). The mean value of IVT was significantly (P=0.01, 0.01) higher in the pre-dialysis hypertention group (11±0.9 mm), pre-and post-dialysis hypertention group (11±0.6 mm) than in the normal pressure group (10±1.7 mm). These findings suggested thet hypertension may affect cardiac function. Therefore, we concluded that to keep normal blood pressure is important in hemodialysis patients.
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We reexamined the cases of renal disease found in urinalyses which had been performed as part of the mass screening, to ascertain its efficacy. During 1990, a total of 94, 913 people underwent physical checkups made by the Naganoken Kouseiren Health Screening Center. The mean positive rates of proteinuria, occult blood in urine and both were 2.4%, 6.2% and 0.5%. Of the total number of examinees, 59, 803 had undergone the previous year's checkup. The mean positive rates of proteinuria, occult blood in urine and both for two consecutive years were 0.8%, 3.4% and 0.1%. The mean positive rates of proteinuria and occult blood increased with age. The mean positive rate of proteinuria was 1.7 times higher in males than in females. On the other hand, the mean positive rate of occult blood was 2.7 times higher in females than in males. However, there was no difference what so ever between men and women in the mean positive rate of both proteinuria and occult blood.<BR>In the mean time, we reviewed the 85 cases in which renal biopsy was performed at the Saku Central Hospital from 1985 through 1990. Among them, 35 (41.2%) were the cases which had been suspected to have kidney disorder in the urinalysis conducted as part of a mass screening, and IgA nephropathy accounted for about 60% of them. The reports from medical institutions which made follow up examinations using the results of the health screening showed that the rate of renal disease was highest in the proteinuria positive cases; that of urological diseases, in the occult blood positive cases; that of chronic glomerulonephritis and urological diseases, in the proteinureal occult blood positive cases. We concluded that urinalysis included in a battery of tests at the time of the mass health screening is an effective procedure for detecting chronic glomerulonephritis and urological diseases.