[A project of the 6th chapter of the Oncology Research Group, Aichi Prefectural Society of Hospital Pharmacists: an attempt to make a pamphlet for patients undergoing LEED therapy, based on analysis of complications].

To date, medical guidance for patients undergoing cancer chemotherapy has mainly been with regard to individual medicines. Only a few reports have been available dealing with information on side effects by a regimen unit. Therefore, we accumulated information on side effects and made a pamphlet for patients with malignant lymphoma undergoing peripheral blood stem cell transplantation after Melphalan (L-PAM), Cyclophosphamide (Endoxan), VP-16 (etoposide) and Dexamethasone (LEED)therapy, for the purpose of explanation for patients on pharmacist's rounds. This pamphlet consists of time schedule of anticancer therapy, harmful phenomena due to cancer chemotherapy and counterplans for such side effects. Easy-to-understand graphics are used to explain the appearance and duration of side effects by anticancer agents. This pamphlet will serve to improve comprehension and the attitude of patients toward cancer chemotherapy. The pamphlets will also be a useful tool to reassure patients on pharmacist's rounds.

[Construction and evaluation of new anti-cancer drug prescription support system to promote proper use of anticancer drugs].

In the Nagoya City University Hospital, we started an Anti-cancer drug prescription support system according to which physicians input the injection prescription order from the regimen, together with the Outpatient Oncology Unit established in May, 2007. In order to prepare the anti-cancer drug more safely, we constructed a new Anti-cancer drug preparation support system(new system) at the same time. We investigated and evaluated the time and accuracy required for the preparation between the old and new systems. In the old system, we used electronic calculators or manual methods to perform calculations in the prescription procedure. In the new system, notes are automatically printed out with the kind, amount, and extraction amount of the dissolution liquid according to the dosage of the given anti-cancer drug for the injection prescription. Therefore, even a person with little experience in the preparation can confirm the preparative procedure accurately and promptly. Moreover, this system improves the efficiency of the preparation and it is thought that the utility is high as a part of the risk management.

Basal encephalocele associated with hypoplasia of the internal carotid artery.

A 22-year-old woman presented with a basal encephalocele associated with hypoplasia of the internal carotid artery (ICA) manifesting as a 6-year history of decreased vision in the right eye. She underwent encephalo-arterio-synangiosis under a diagnosis of hypoplasia of the ICA at age 6 years. Magnetic resonance imaging showed the encephalocele medial to the right temporal lobe. Frontotemporal craniotomy was performed for resection of the encephalocele and repair of the defect of the skull base. The pathogeneses of these developmental anomalies were probably related to developmental failure of the embryonic primordium during the 4th and 10th weeks.

Intraosseous cavernous hemangioma of the frontal bone.

A 32-year-old man presented with a primary intraosseous cavernous hemangioma manifesting as a small painless swelling of the right forehead. Radiography revealed a radiolucent osteolytic lesion in the right frontal region. Bone window computed tomography demonstrated a 1.5 cm mass between the outer and inner tables just lateral to the right frontal sinus. The outer and inner tables were thin and partially defective, but without bone fracture. Magnetic resonance imaging revealed a small mass lesion with bone erosion of the posterior table of the frontal bone. Preoperative examination yielded no final diagnosis. En bloc resection was performed. The histological diagnosis was primary intraosseous cavernous hemangioma. Total resection is recommended for definitive diagnosis of intraosseous tumor.

Verbal memory deficits in a preadolescent case of lesions of the left parahippocampal gyrus associated with a benign tumor.

The authors report cognitive functions of a 13-year-old boy with a cavernous angioma occupying the posterior left parahippocampal gyrus (PHG) and part of the left fusiform gyrus but not hippocampus. Neuropsychological examinations soon after the removal of the tumor showed selective deficits in semantic memory function, as evaluated by the Category Fluency Task and the Wechsler Memory Scale-Revised, while visual memory, attention, and IQ were not affected. These observations suggest the involvement of the PHG in the processing of semantic memory and provide an insight into the neural substrates underlying the distinct cognitive deficits in some of the psychiatric diseases such as schizophrenia.

Genetic basis of inosine triphosphate pyrophosphohydrolase deficiency in the Japanese population.

Inosine triphosphate pyrophosphohydrolase (ITPase) is an enzyme that catalyzes the conversion of inosine triphosphate (ITP) to inosine monophosphate and pyrophosphate. In Caucasian populations it is reported that the frequency of cases showing decreased ITPase activity is 5%. The structure of ITPA gene along with five single nucleotide polymorphisms has been reported in Caucasians. We examined ITPase activity and frequency of two polymorphisms (94C>A and IVS2+21A>C) in 100 Japanese individuals. Among these individuals, we observed that three cases with zero activity were homozygote for 94C>A, and were accompanied by abnormal accumulation of ITP in erythrocytes. The cases included in the low ITPase activity group were heterozygote for 94C>A polymorphism. The activity of the heterozygote cases was approximately 27% of the mean value of the wild type. The allele frequency of the 94C>A polymorphism was 0.155, which was 2.6 times higher than that of the Caucasians (0.06). The IVS2+21A>C was not detected in Japanese cases, although it occurred with a frequency of 0.130 in Caucasians. Furthermore, we identified a novel mutation IVS2+68T>G in intron 2 in the case with the lowest enzyme activity in the 94C>A wild type. Since the frequency of ITPA 94C>A polymorphism is higher in the Japanese population than that in Caucasians, it is more important to examine ITPA 94C>A polymorphism in the Japanese population to prevent thiopurine drug toxicity. Pretherapeutic screening of individuals for ITPA polymorphisms should be considered for safer and more tolerable treatment with thiopurine drugs.

[Dural arteriovenous fistula involving the cavernous sinus as the cause of intracerebral venous hemorrhage: a case report].

A case of cavernous sinus dural arteriovenous fistula (CS-DAVF) presenting intracerebral venous hemorrhage was reported. An 81-year-old woman was suffered from generalized convulsion accompanied by right conjunctival hyperemia and edema. Computed tomography scan revealed intracerebral hematoma involving right putamen and perifocal edema extraordinarily expanded to inferior part of the right frontal lobe and insular cortex. Cerebral angiography showed a CS-DAVF with retrograde leptomeningeal venous drainage (RLVD) not only to superficial middle cerebral vein but to basal vein of Rosenthal (BVR). Transvenous embolization was performed using mechanically detachable coils and free fibered platinum coils. After embolization, RLVD disappeared and conjunctival symptoms were improved. Hemorrhagic risk of this patient was discussed, based on her angiographical findings. We speculated that deep venous drainage to BVR through uncal vein, in case with poor venous collateral geometry, is one of the risk factor of cerebral hemorrhage.

Automated graphic image generation system for effective representation of infectious disease surveillance data.

Infectious disease surveillance schemes have been established to detect infectious disease outbreak in the early stages, to identify the causative viral strains, and to rapidly assess related morbidity and mortality. To make a scheme function well, two things are required. Firstly, it must have sufficient sensitivity and be timely to guarantee as short a delay as possible from collection to redistribution of information. Secondly, it must provide a good representation of the results of the surveillance. To do this, we have developed a database system that can redistribute the information via the Internet. The feature of this system is to automatically generate the graphic images based on the numerical data stored in the database by using Hypertext Preprocessor (PHP) script and Graphics Drawing (GD) library. It dynamically displays the information as a map or bar chart as well as a numerical impression according to the real time demand of the users. This system will be a useful tool for medical personnel and researchers working on infectious disease problems and will save significant time in the redistribution of information.

[Traumatic vertebral arteriovenous fistula caused by an injury due to penetration by pieces of glass: case report].

We reported a case of a 79-year-old male with traumatic vertebral arteriovenous fistula. The patient was admitted with hemorrhagic shock due to arterial bleeding caused by a penetrating injury of the neck. Cervical CT showed free air at the level of the lamina of C1. Injury of the vertebral artery was suspected. The right vertebral angiogram showed an arteriovenous fistula between the V3 portion of the right vertebral artery and the suboccipital venous plexus with retrograde intracranial venous drainage. The patient underwent endovascular treatment of the parent vertebral artery occlusion, which successfully obliterated the arteriovenous fistula.