[Analysis of inquiries about prescriptions at the pharmacy of Gifu Pharmaceutical University].

The Ministry of Health, Labour and Welfare explains the objectives of promotion of separation of the pharmacy and clinics as the elimination of duplicated prescription of similar drugs and drug interactions caused by treatment at several departments or hospitals, and sufficient guidance in the use of drugs by pharmacists. The Pharmacy of Gifu Pharmaceutical University has dispensed prescriptions by outside medical organizations as its routine activity. In this study, the contents of question inquiries handled in routine activities were compiled and analyzed, and their meaning was evaluated. The contents of question inquiries were accumulated using data cards. The data obtained during 2 and a half years (562 cases) were analyzed. The percentage of the number of inquiries relative to the number of prescriptions was highest at 1.86% during the first 3 months and was 1.05-1.71% per 3 months thereafter. The inquiries were most frequently about "the dosage/regimen" (153 cases), followed by "discrepancy between the contents of prescription and understanding of the patient" (88 cases) and "problems about insurance coverage" (80 cases). There were also 16 inquiries about "the possibility of contraindications and adverse reactions" and 15 inquiries about "duplicated prescription", which may have exerted serious effects on the patients. Eighty nine % of the inquiries have led to changes in the prescriptions, and about half of these cases were discovered by consultation with the patients or a review of the drug history. Proper and positive execution of these operations in routine pharmacy work is considered to lead to appropriate inquiries about problems with prescriptions and, thus, contribute to the proper use of drugs and prevention of malpractice.

Heavily T2 weighted MR assessment of fornical injury after anterior interhemispheric approach for large suprasellar tumors.

Fornical injury in transforaminal approach is well known. Its injury in the anterior interhemispheric approach (AIA) has been rarely highlighted. We report 2 cases with a large suprasellar tumor who underwent AIA. Postoperative heavily T2 weighted reversed (T2R) MR images demonstrated its unilateral injury. The clinical significance of symptom-free fornical injury after AIA is discussed. Cases 1 and 2 were a 15 year-old girl with a meningioma and a 49-year-old woman with a craniopharyngioma, respectively. They underwent AIA. Postoperative T2R images revealed unilateral fornical crus atrophy. They did not present associated memory deficits. Case 1 had the injury of both fornical column and anterior commissure. They were speculatively torn by intra-operative lateral retraction of the frontal lobes. Case 2 had unilateral atrophy of the mammillary body and postcommissural fornix, which were probably caused by ischemic damage related to surgical manipulation, since case 2 had an associated anterior thalamic infarct. During the operation for large suprasellar tumors, excessive laterally directed brain retraction should be avoided, since such manipulation may easily tear the overstretched anterior commissure and fornical column. Once we notice or suspect fornical injury on MR studies in cases of re-operation, we have to choose a surgical approach and operative manipulation to preserve an intact fornix. The MR evaluation of fornix should be included in the perioperative radiological assessment, since patients with unilateral fornical injury were free of memory disturbance, and T2R imaging is a useful MR sequence for depicting the anatomy related to the fornix.

Treatment of asymptomatic unruptured intracranial aneurysms. A clinical decision analysis.

SUMMARY: The indication of preventive surgery for patients who harbor asymptomatic un ruptured intracranial aneurysms remains controversial. To evaluate the benefit of this treatment, we investigated the management outcome in 128 patients with 157 unruptured aneurysms. Surgery was planned in patients 70 years old or younger without serious systemic complications. A total of 77 patients underwent surgery including four endovascular interventions, and conservative management was chosen in 51 patients. There was no mortality and 6.5% morbidity as postoperative results, and no complication was found after endovascular treatment. Among the patients in conservative management, four patients suffered from subsequent rupture during the total follow-up period of 148 person-years. The annual rupture rate was estimated at 2.7%. According to the clinical decision analysis based on our data, preventive surgery is beneficial for a Japanese 70 years old or younger. However, the expected utility decreases if the rupture rate is set at 0.5% or 0.05%, posing a doubt about the benefit of the surgery. Decision analysis provides an aid for logical and objective choice in the management of unruptured aneurysms. The actual risk of rupture has a major impact on decision making in therapeutic strategy.

[Industrial hygienic study on nursing activities. II. Investigation on heart rate and energy expenditure of ward nurses on shift].

By using a Holter electrocardiograph (ECG), we calculated the heart rates of ward nurses on day shift which included different activities. Energy expenditure was calculated from the heart rate data and nurse work load was evaluated. The following results were obtained. 1) Average heart rates during working hours were 86 (beats/min) in children ward nurses, 77 in ophthalmology ward nurses, 85 in surgery ward nurses, 85 in mixed ward nurses, 85 in neurosurgery ward nurses, 81 in circulatory organs ward nurses and 83 in ICU ward nurses. 2) The energy expenditures were calculated to be 1,891 kcal in children ward nurse on day shift, 1,866 kcal in ophthalmology ward nurses, 1,969 kcal in surgery ward nurses, 1,899 kcal in mixed ward nurses, 1,976 kcal in neurosurgery ward nurses, 1,873 kcal in circulatory organs ward nurses and 1,744 kcal in ICU ward nurses. 3) The highest energy expenditures in direct nursing care were 918 kcal (48.3%) in mixed ward nurses; in assisting medical examination and treatment, 770 kcal (39.1%) in surgery ward nurses and in indirect nursing care, 679 kcal (35.9%) in children ward nurses. 4) The longest working hours in direct nursing care were 217 min (42.5%) in neurosurgery ward nurses; in assisting medical examination and treatment, 193 min (37.8%) in surgical ward nurses and in indirect nursing care, 207 min (40.5%) in children word nurses. The results indicated that the energy expenditure calculated from the average heart rate of ward nurses on day shift was very high in all wards. The attributable causes are discussed in this report.

[Correlation of regional wall motion and fatty acid metabolism in coronary artery disease, hypertension, and hypertrophic cardiomyopathy: assessment by dual-isotope SPECT with thallium-201 and iodine-123 beta-methyl fatty acid analogue].

In order to investigate the correlation between cardiac fatty acid metabolism and regional wall motion, dual-isotope tomography using thallium-201 and iodine-123 labeled 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP), was performed in 15 patients with coronary artery disease (CAD), hypertension, or hypertrophic cardiomyopathy (HCM). The uptake of thallium and BMIPP was scored and compared with left ventricular regional wall motion assessed by 2-dimensional echocardiography and radionuclide ventriculography. The incidence of a complete agreement of thallium and BMIPP scores was significantly higher in hypertension (64%) and CAD (63%) groups compared to HCM patients (24%), while a lower BMIPP uptake compared to that of thallium (mismatching) was observed more frequently in HCM (65%) than in hypertension (31%) or CAD (33%). Only 3 infarct patients had regional wall motion abnormality which was detected in 20 (95%) of 21 segments with a low BMIPP uptake. Furthermore, compared to thallium perfusion, decreased BMIPP uptake much more corresponded to reduced wall motion in 8 of 11 segments with mismatching. Thus, metabolic abnormality assessed by BMIPP is well associated with asynergy in CAD patients, whereas the discrepancy of fatty acid metabolism and contraction is more dominant in HCM, suggesting that the combined assessment of thallium perfusion, BMIPP uptake, and regional wall motion might contribute to better understanding the pathogenesis of various cardiac disorders.

[Assessment of myocardial perfusion abnormality and hibernating myocardium by gated blood pool and exercise-stress thallium tomographies after successful coronary angioplasty].

Cardiac function and myocardial perfusion were assessed by exercise-stress thallium SPECT and resting gated blood pool SPECT techniques before and after 47 successful coronary angioplasties. Thallium perfusion was analyzed visually and quantitatively in stress and resting studies. Left ventricular ejection fraction (LVEF) and peak filling rate (PFR) were calculated and regional wall motion was scored by amplitude and phase images in radionuclide planar and tomographic imagings. The thallium redistribution in delayed or resting SPECTs was more sensitive (87%) for detecting myocardial ischemia compared to symptoms (36%) and ECG changes (60%). An exercise capacity, LVEF, PFR, and the scores of perfusion and regional wall motion were improved significantly after coronary angioplasty. Stress thallium and gated blood pool SPECTs showed the improvements of myocardial perfusion in 159 (79%) of 201 segments and regional wall motion in 47 (51%) of 92 segments, respectively. These results suggest that the combined use of stress thallium SPECT, gated blood pool planar and SPECT techniques can contribute not only to the assessment of the efficacy of coronary angioplasty but also to detecting the mismatching of myocardial perfusion and contraction ("myocardial hibernation") in infarct-related myocardial lesions.

[Quantitative assessment of the infarct size with the unfolded map method of 201Tl myocardial SPECT in patient with acute myocardial infarction].

The unfolded map method of 201Tl single photon emission computed tomography (SPECT) was evaluated as to the ability to quantify and the clinical reliability in estimation of infarct size. At first, the following results were obtained in basic experiments using thoracic phantom: 1) the defect area estimated by the unfolded map method was well correlated with the real defect area in spite of overestimation of the defect area, when the defect area was determined by an isocount method (below 80% of maximum count) (y = 1.941 + 2.29x, r = 0.971, p less than 0.001); 2) the defect volume estimated by short-axis images of 201Tl SPECT was closely correlated with real defect volume in spite of overestimation of defect volume (y = 0.762 + 2.156x, r = 0.982, p less than 0.001); 3) when the defect area was estimated by division of the defect volume by the mean myocardial compartment thickness, it was closely correlated with real defect area (y = 0.946 + 1.232x, r = 0.990, p less than 0.001); 4) when the volume was calculated from the summation of voxels in the regions districted by isocount threshold level at each section of the 99mTc SPECT, the optimal isocount threshold level (percentage to maximum count) was 55%. In addition, the clinical reliability of the unfolded map method as infarct sizing was evaluated in 26 patients with acute myocardial infarction by comparing it with enzymatic method, Bull's eye method, and 99mTc pyrophosphate (PYP) SPECT method. In 14 first attack cases of patient without right ventricular infarction, infarct area (IA) of the unfolded map method correlated most closely with the accumulated creatine kinase MB isoenzyme release (CK-MBr) (r = 0.897), compared with the extent score (ES) (r = 0.853) and the severity score (SS) (r = 0.871) of Bull's eye method and the infarct volume (IV) (r = 0.595) of 99mTc PYP SPECT. In conclusion, although the unfolded map method of 201Tl SPECT has the tendency which overestimate infarct size, it is accurate and clinically reliable method in estimating infarct size.

[Industrial hygienic study on nursing activities. I. Investigation on heart rate and energy expenditure of ward nurses by nursing activity].

Using a Holter electrocardiograph (ECG), we recorded the heart rates of ward nurses by working hours and nursing activity. Energy expenditure was calculated from the heart rate data and nurse work lord was evaluated. The following results were obtained. 1) Average heart rates were 77 (beats/min) for day-shift nurse in surgical ward, 76 for evening-shift nurse in mixed, ward, and 74 for night-shift nurse in mixed ward. 2) The energy expenditures per day were calculated to be 3,474 kcal for day-shift nurse in surgical ward, 3,060 kcal for evening-shift nurse in mixed ward, and 3,238 kcal for night-shift nurse in mixed ward. 3) The energy expenditures during working hours were 2,110 kcal/510 min for day-shift nurse in surgical ward, 1,805 kcal/495 min for evening shift nurse, and 2,014 kcal/570 min for night-shift nurse in mixed ward. 4) The highest energy expenditures of nurse engaged in direct nursing care were 834 kcal (39.5%) for day-shift nurse in surgical ward, 632 kcal (34.9%) for evening-shift nurse in mixed ward, and 790 kcal (39.2%) for night-shift nurse in mixed ward. 5) The longest working hours were 174 min (34.1%) in assisting with medical examinations and treatment by day-shift nurse, 155 min (31.3%) in direct care by evening-shift nurse, and 222 min (39.0%) by night-shift nurse. The results indicate that the energy expenditure calculated from the average heart rate of ward nurses in higher than that of other types of workers. The reason for this difference is discussed in this report. Also, this study showed that the energy expenditure determined by this method does not necessarily increase in proportion to working hours.

[Assessment of infarct-related coronary arteries using the bull's eye view method and unfolded surface mapping in thallium-201 myocardial tomography].

Infarct-related coronary lesions and collaterals were assessed by the bull's eye view and the unfolded surface map derived from thallium-201 myocardial tomography (Tl-201 SPECT) in 25 patients with anterior myocardial infarction. The patients were categorized in six groups according to their cine-angiographic findings: locations of stenosis (proximal or distal portions of the first diagonal branch or distal site of the first septal branch), and the presence or absence of collaterals. The anterior half of the left ventricle on the bull's eye view map was divided into eight regions from the anterior septum to the lateral wall and from the apex to the cardiac base. Tl-201 SPECT images were expressed as functional maps using maximum-count circumferential profile analysis: an "extent image" showing the extent of perfusion defect, and a "severity image" demonstrating the degree of hypoperfusion. The following results were obtained: 1. Perfusion defect of the "extent image" at the basal portion of the anterior septum reflected poor collaterals, with a sensitivity of 81.3%, a specificity of 77.8%, and a diagnostic accuracy of 80.0%. 2. Coronary stenosis at segment 6 (AHA classification) was differentiated from that at segment 7 by detecting hypoperfusion at the basal septum on the "severity image", with a sensitivity of 71.4%, a specificity of 77.8%, and a diagnostic accuracy of 75.0%. 3. Perfusion defect at the basal section of the proximal portion of the anterior wall on the "extent image" indicated stenosis at the proximal segment 6, with a sensitivity of 57.1% and a specificity of 88.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Quantitative assessment of myocardial viability following coronary artery bypass grafting using exercise thallium-201 myocardial single photon emission computed tomography and left ventricular regional wall motion].

Using exercise thallium-201 myocardial single photon emission computed tomography (SPECT) and % radial shortening (%RS), 58 patients were evaluated before and after coronary artery bypass grafting (CABG) to quantitatively assess myocardial viability and the effect of CABG. The patient was classified, according to redistribution pattern, as group I with only complete redistribution (20 cases) and group II with including incomplete redistribution (22 cases) and group III with no redistribution (16 cases). 1. Group I was expected complete improvement of ischemic myocardium after CABG but regional left ventricular wall motion was unchanged (sigma i%RS: 142.5 +/- 54.7----138.4 +/- 39.6, sigma a%RS: 201.2 +/- 51.1----238.2 +/- 68.2). 2. Group II was expected to diminish ischemic size after CABG and left ventricular regional wall motion was significantly improved (sigma i%RS: 68.8 +/- 25.9----154.9 +/- 42.6 p less than 0.01, sigma a%RS: 108.4 +/- 62.3----178.9 +/- 77.6, p less than 0.05). 3. Group III was no significant change of ischemic size and left ventricular wall motion after CABG (sigma i%RS: 67.8 +/- 24.1----83.9 +/- 19.2, sigma a%RS: 86.0 +/- 29.0----94.0 +/- 33.9). The present study suggests that quantitative assessment of myocardial viability using exercise thallium-201 myocardial SPECT and %radial shortening was useful method to determine the indication and to assess the effect of CABG.

Morphological assessment of left ventricular wall and ventricular aneurysm by thallium-201 myocardial emission computed tomography.

To evaluate the influence of left ventricular (LV) aneurysm on non-infarcted ventricular wall, the shape of the left ventricular wall was assessed by thallium-201 single photon emission computed tomography (SPECT). From the morphology of the ventricular wall close to the apex, the rest images along the transaxis, horizontal long axis and vertical long axis were classified into 4 types: convergent, parallel, divergent and completely defective. LV aneurysm was detected by 2-dimensional echocardiography and/or contrast left ventriculography in 39 of 80 patients with previous myocardial infarction. Although convergence in the normal configuration of ventricular walls close to the apex, 4 of 39 patients with LV aneurysm showed this pattern. The divergent type was very specific (100%) and the most sensitive (56.4%) of the 4 for identifying LV aneurysm. Moreover, the parallel configuration indicated aneurysm in cases of inferoposterior infarction and all the completely defective cases exhibited this abnormality. Thus, thallium-201 SPECT is suitable for observing the morphology of the ventricular wall and can provide highly reliable information for detecting postinfarction ventricular aneurysm with a sensitivity of 89.7%, a specificity of 87.8% and a diagnostic accuracy of 88.8%.