Patients' Perception in Japan Regarding the Appropriate Use of Antimicrobial Drugs: A Questionnaire Survey.

This study sought to investigate the actual status of awareness regarding the appropriate use of antimicrobial drugs among patients of a wide age range who visit dispensing pharmacies in order to explore more effective intervention methods for improving awareness of the appropriate use of antimicrobial drugs for patients. A questionnaire survey was conducted with 1301 patients who visited different Tsuruha Holdings-operated pharmacies between 1 September 2018 and 31 October 2018. Using multiple regression analysis, we calculated scores based on the patients' answers regarding their knowledge of antimicrobial drugs and antimicrobial resistance and examined factors related to these scores. Of the 1185 respondents who successfully completed the survey (mean age ± SD, 52.5 ± 18.2 years), 37.2% were 60 years old or older, 13.2% had never or were not sure whether they had taken antimicrobial drugs, and 73.2% did not understand the problem of antimicrobial resistance. Older age, the non-usage of drugs and self-reports of the "lack" of knowledge of antimicrobial resistance were identified as the group that needs education regarding the appropriate use of antimicrobial drugs. Intervention studies should be conducted to examine the efficacy of interventions based on these factors.

Impairment of changes in the diameter of the pancreatic portion of the superior mesenteric vein: an ultrasonographic sign of chronic pancreatitis or fibrosis.

OBJECTIVE: A new ultrasonographic technique for detecting parenchymal stiffness of the pancreas is proposed. This technique measures changes in the diameter of the origin of the superior mesenteric vein (SMV) induced by deep inspiration. The origin of the SMV has extensive attachments to the pancreatic parenchyma; therefore, both physiologic enlargement and shrinkage of the venous lumen cannot occur without changes in the shape of the surrounding parenchyma. Therefore, increased parenchymal stiffness due to chronic pancreatitis (CP) may result in impaired changes in the venous diameter. To confirm this hypothesis, patients with CP and those with a normal pancreas were examined in this study. METHODS: Twelve patients in each group were examined. Images of the origin of the SMV were obtained with a commercial ultrasound system. The smallest diameter of the SMV was measured during normal breathing. The patients were then asked to take a deep breath to increase the portal blood pressure followed immediately by the same measurements as performed during normal breathing, and the ratio of the change was calculated. RESULTS: In the normal group, the diameter of the SMV changed by 79.5% +/- 43.8% (mean +/- SD), whereas a change of 1.4% +/- 7.3% was observed in the CP group. The difference between the two groups was statistically significant (P < .0001). CONCLUSIONS: The physiologic change in the diameter of the origin of the SMV enhanced by deep inspiration may reflect the stiffness of the pancreatic parenchyma. Therefore, detection of an impaired diameter change may be useful for screening of CP.

Detection of hepatic metastases from colorectal carcinoma: comparison of histopathologic features of anatomically resected liver with results of preoperative imaging.

GOALS: The specificity and sensitivity of intravenous-enhanced multidetector row computed tomography (MDCT), superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI), multidetector row computed tomography with arterioportography combined with multidetector row computed tomography with hepatic arteriography (CTAP/CTHA), and intraoperative ultrasonography (IOUS) for detecting hepatic metastases from colorectal carcinoma were evaluated based on histopathologic examination of resected livers. STUDY: MDCT, SPIO-MRI, CTAP/CTHA, and IOUS were performed routinely to determine surgical indications and methods in patients with hepatic metastases from colorectal carcinoma. The resected liver specimens were then cut serially into sections 3 to 5 mm thick for routine histologic examination. RESULTS: Fifty metastatic lesions were detected by histopathologic study of a large amount of anatomically resected liver from 8 patients with colorectal liver metastasis. The tumors ranged in size from 3 to 53 mm (mean 13.8 mm) and 26 lesions (52%) were less than 10 mm in diameter. Histopathologic examination of the resected liver specimens showed that CTAP/CTHA was the most sensitive imaging modality, followed in order by IOUS, SPIO-MRI, and MDCT. Among all the tumors detected by CTAP/CTHA, SPIO-MRI overlooked 5, but all of the tumors detected by SPIO-MRI were also detected by CTAP/CTHA. The number of metastatic liver tumors detected differed significantly among MDCT, SPIO-MRI, and histopathologic examination. One false-positive lesion was detected by IOUS. CONCLUSIONS: CTAP/CTHA is a useful preoperative imaging modality for detecting small hepatic metastases from colorectal carcinoma.

Radical surgery for advanced squamous cell carcinoma of the gallbladder: a report of three cases, including a 10-year survivor.

We report three patients who underwent radical resections for advanced squamous cell carcinoma of the gallbladder, two of whom are still alive without recurrence 10 and 9 years after surgery. The other patient, who had lymph node involvement, suffered recurrence of the disease and died 9 months after surgery. Our experience indicates that radical surgery can sometimes provide a chance for long-term survival in patients with this neoplasm. Lymph node metastasis, albeit a rare event, might be a poor prognostic factor in patients with this type of gallbladder carcinoma.

[Complete disappearance with oral UFT administration of recurrent hepatocellular carcinoma of the remnant liver and multiple lung metastasis after hepatic resection].

UFT is an anti-cancer drug which combines uracil with tegafur at a mole rate of 1:4, and shows a high anti-tumor effect by raising the 5-FU level in a tumor. A 55-year-old man with hypochondriac pain was admitted to Shinshu University Hospital. The preoperative diagnosis was giant hepatocellular carcinoma (HCC) of the right hepatic anterior region, and extended anterior segmentectomy of the liver was performed. Three months later, serum alpha-fetoprotein (AFP) and PIVKA-II were elevated markedly, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed a recurrence in the remnant liver and multiple lung metastasis. Chemotherapy with oral UFT (300 mg/day) administration alone was started for the unresectable HCC. Three months later, CT and MRI showed complete disappearance of the recurrent HCC and multiple lung metastasis. Also, the titers of AFP and PIVKA-II were reduced to normal levels. This case suggests that oral UFT administration is a safe and effective therapy for postoperative HCC, even with lung metastasis.

Inhibition of urokinase-type plasminogen activator delays expression of c-jun, activated transforming growth factor beta 1, and matrix metalloproteinase 2 during post-hepatectomy liver regeneration in mice.

BACKGROUND/AIMS: Although urokinase-type plasminogen activator (u-PA) is suggested to initiate various factors in liver regeneration after hepatectomy, no corroborative evidence has been reported. In the present study, we investigated the effect of u-PA on liver regeneration after hepatectomy. METHODS: Mice were placed into either a control group or a u-PA-inhibited group that received an in vivo u-PA inhibitor, p-aminobenzamidine. After we had removed two-thirds of the liver, we examined the expressions of c-jun mRNA and activated transforming growth factor beta 1 (TGF-beta 1), matrix metalloproteinase-2 (MMP-2) activity, and the level of hepatocyte and non-parenchymal cell proliferation in the two groups. RESULTS: In the u-PA-inhibited group, the delays in c-jun mRNA expression, hepatocyte proliferation, activated TGF-1 expression, and expression of MMP-2 activity, were 2h, 1, 2, and 1 day, respectively, and the sinusoid architecture was not restored by 10 days after hepatectomy. CONCLUSIONS: u-PA inhibition delays the expression of c-jun mRNA, hepatocyte proliferation, and restoration of the sinusoid architecture, suggesting that u-PA plays important roles in liver regeneration after hepatectomy through control of a transcription factor, c-jun expression.