The Role of Pharmacies for Elderly Individuals with Complex Issues: Promotion of Support Tools by a Community Pharmaceutical Association / 社会薬学

The aging population in Japan continues to grow, leading to the emergence of complex issues. To understand the current awareness of these issues among member pharmacies of the Fukuoka City Minami Ward Pharmaceutical Association and promote various initiatives, support tools such as the “Consultation Flowchart” and “Consultation Checklist” were distributed to share information about the elderly with the local comprehensive support center. A survey was conducted to assess the awareness of complex issues and support tools. The survey revealed that about half of the pharmacy pharmacists were aware of the complex issues themselves, but the Consultation Flowchart had a recognition rate of 35.34%, and the Consultation Checklist had a recognition rate of 31.03%. It was also found that pharmacies with higher participation in regional collaboration meetings and a greater number of visits for medication management counseling had higher awareness of complex issues and support tools. To enhance efforts in addressing complex issues, the Fukuoka City Minami Ward Pharmaceutical Association needs to approach pharmacies with limited participation in regional collaboration meetings and a lower number of visits for medication management counseling. Building visible relationships with diverse professions in the community is crucial for improvement initiatives related to complex issues.

Transient forebrain ischemia induces impairment in cognitive performance prior to extensive neuronal cell death in Mongolian gerbil (Meriones unguiculatus)

In Mongolian gerbils, bilateral common carotid artery occlusion (BCCAO) for several minutes induces ischemia, due to an incomplete circle of Willis, resulting in delayed neuronal cell death in the Cornet d'Ammon 1 (CA1) region of the hippocampus. Neuronal cell death in the hippocampus and changes in behavior were examined after BCCAO was performed for 5 min in the gerbils. One day after BCCAO, the pyramidal neurons of the CA1 region of the hippocampus showed degenerative changes (clumped chromatin in nuclei). At 5 and 10 days after BCCAO, extensive neuronal cell death was observed in the hippocampal CA1 region. Cognitive performance was evaluated by using the radial maze and passive avoidance tests. In the radial maze test, which examines win-stay performance, the number of errors was significantly higher in ischemic gerbils than in sham-operated gerbils on days 1 and 2 post-operation. In the passive avoidance test, the latency and freezing times were significantly shorter in ischemic gerbils than in sham-operated gerbils on the days 1, 2, and 4–6 post-operation. These results indicate that transient forebrain ischemia impairs cognitive performance, even immediately after the ischemic insult when there are only subtle signs of neuronal cell death.

Infected Abdominal Aneurysm Caused by Bacteroides / 日本心臓血管外科学会雑誌

A 73-year-old man complained of pain in the right lower abdomen with hypotension. The result of abdominal computed tomography (CT) suggested a rupture of an abdominal aortic aneurysm. Emergency Y graft replacement was performed. During surgery, a perforation of about 1cm in diameter was found in the posterior wall of the abdominal aorta just above the iliac bifurcation. The patient developed postoperative complication of retroperitonitis. The cultures of blood clots collected during surgery grew <i>Bacteroides fragilis</i>, as did postoperative drainage fluid from the retroperitoneum. On the 10th day of illness, axillo-bifemoral bypass was performed and the Y graft was removed. Although continuous lavage of the retroperitoneum was performed, he did not recover from retroperitonitis and died of sepsis 2 months after surgery. Infected abdominal aneurysm is rarely caused by <i>Bacteroides</i>. We discussed the infectious route and treatment of this rare condition with a review of the literature.

Retroaortic Left Renal Vein Associated with Juxtarenal Aortic Abdominal Aneurysm Repair / 日本心臓血管外科学会雑誌

A 53-year-old man who had angina pectoris and juxtarenal aortic abdominal aneurysm was referred to our department. Because the coronary angiography showed severe triple vessel disease, coronary bypass grafting was performed prior to aneurysmectomy. Contrast enhanced computed tomography revealed a retroaortic left renal vein located behind the posterior wall of the aneurysm. The postoperative course was uneventful. Because of its complicated embryological development, the anatomy of the renal veins shows extensive variability. The incidence of retroaortic left renal vein was 2%. Large lumbar and retroperitoneal veins often joined it to form a complex retroaortic venous system. These veins are particularly vulnerable to injury during circumferential dissection of the proximal parts of the aorta. Unawareness of this anomaly and vigorous attempts at encircling the aorta with clamps can result in laceration of the vein. Subsequent catastrophic hemorrhage may lead to unfavorable results, nephrectomy or death. Therefore, preoperative evaluation by a contrast enhanced CT scan and adequate intraoperative management based on a understanding of the potential anatomical variations are imperative. We recommend crossclamp of the aorta proximally with a vertical clamp to avoid circumferential dissection with possible injury to a retroaortic left renal vein. Injury may necessitate division of the aorta to obtain exposure for venous repair. In addition, this anomaly may be related to aorto-left renal vein fistula syndrome and left renal vein entrapment syndrome.

A Case of Ruptured Aortic Aneurysm Presenting as a Closing Aortic Dissection on Chest CT / 日本心臓血管外科学会雑誌

A 68-year-old male was admitted as an emergency case because of two severe back pain episodes in one week. Chest X-ray showed a marked prominence of the aortic knob. A remarkable bulging of the distal aortic arch and a crescentic low density area along the descending aorta on enhanced chest CT suggested a closing aortic dissection. Operation revealed extensive collapse of the very fragile intima of the aneurysmal wall and extraluminal hematoma along the descending aorta due to bleeding from the ruptured site. The ruptured aneurysm of this type should be accurately differentiated from the DeBakey type III closing aortic dissection which can be followed up medically.