[A questionnaire survey for pharmacists participating in a home medical care training workshop].

To clarify the issues associated with promoting pharmacists' participation in home medical care(HMC), we performed a questionnaire survey for pharmacists who participated in a HMC training workshop. The cumulative number of participants in the workshop was 284; the majority of the participants was from mid-sized pharmacies and had been working for over 10 years. The rate of pharmacists engaged in HMC was 69% and their main practices were "drug delivery to patients" and "drug administration guidance for patients at home". Many participants responded that the key items for HMC were "cooperation with people with different type of jobs", "a wide pharmaceutical knowledge", and "effective involvement with patients and their families". The present main issues regarding HMC were "low pharmaceutical care fees", "deficiency of pharmacists", and "insufficient collaboration with people with different type of jobs". In order to resolve these issues, it is necessary to construct a cooperation system with other medical and welfare-related societies and to continuously organize such workshop.

Acute renal failure after exercise in a Japanese sumo wrestler with renal hypouricemia.

Familial renal hypouricemia is a hereditary disease characterized by extraordinary high renal uric acid clearance and is associated with acute renal failure (ARF). An 18-year-old sumo wrestler developed ARF after anaerobic exercise. Several hours after the exercise, he had a pain in the loins with oliguria, headache, and nausea. On admission, his serum uric acid was decreased despite the elevation of serum creatinine (9.5 mg/dL). The level of creatine kinase was normal and there was no myoglobinuria or urolithiasis. Magnetic resonance imaging showed no significant abnormality. Renal function improved completely within 2 weeks of hydration treatment. After remission, hypouricemia became obvious (1.0 mg/dL) from the initial level of uric acid (6.1 mg/dL) and fractional excretion of uric acid was 49%. Polymerase chain reaction of a urate anion exchanger known to regulate blood urate level (SLC22A12 gene: URAT1) demonstrated that homozygous mutations in exon 4 (W258X). Both parents showed heterozygous mutation of the URAT1 gene, but both siblings showed no mutation. Thus, we describe a Japanese sumo wrestler of familial renal hypouricemia complicated with anaerobic exercise-induced ARF, with definite demonstration of genetic abnormality in the responsible gene, URAT1.

Rapid recovery from coma with multifocal PLEDs in a patient with severe dementia and transient hypoxemia.

We report a patient with severe dementia who acutely developed transient coma following possible acute anoxic encephalopathy, and presented multifocal periodic lateralized epileptiform discharges (PLEDs) on EEG, who had a good recovery from the acute state. Two EEGs were recorded from this patient. In the first EEG taken immediately after admission, multifocal PLEDs were prominent, and the background activity consisted of low voltage, continuous and irregular theta activity (4-6 Hz). The patient recovered from coma (GCS-3) to the conscious state (GCS-15) within 14 hours and was not associated with newly developed focal or global neurological deficits except for stable severe dementia which had developed in the previous several years. Another EEG taken 5 days later showed disappearance of multifocal PLEDs. Transient appearance of multifocal PLEDs might represent at least the transient, vulnerability associated with underlying dementia in this particular patient. We concluded that multifocal PLEDs do not always indicate a poor outcome in patients with possible acute anoxic encephalopathy, and rapid diagnosis and appropriate treatment should be done even if the initial EEG shows multifocal PLEDs.