First performed in the early 1950s in children with a large left-to-right shunt or single ventricle and excessive pulmonary blood flow, pulmonary artery banding (PAB) is a palliative surgery designed to relieve symptoms. After advances in cardiopulmonary bypass techniques in the 1980s allowed surgeons to perform corrective surgery even in infants, PAB has continued to play a palliative role in balancing the pulmonary to systemic blood flow ratio in critical situations. PAB is also used to retrain the left ventricle in patients with transposition of the great arteries to prepare them for the arterial switch procedure, either following late presentation or following prior atrial repair. Another role played by PAB is to train the left ventricle in patients with congenitally corrected transposition of the great arteries, not only for the purpose of retraining the sub-pulmonary left ventricle but also as an early prophylactic approach in newborns to avoid the severe tricuspid regurgitation sometimes associated with a morphologic right ventricle in the systemic position. Currently, PAB has two indications: 1. to reduce the pulmonary blood flow and relieve the symptoms of congestive heart failure, and 2. to train the sub-pulmonary ventricle for future corrective surgery. Recently, PAB has been successfully employed to treat children with dilated cardiomyopathy (DCM), a disease that has shown considerably increased morbidity and mortality rates and indications for heart transplantation; some of the patients thus treated have shown improved left ventricular function, allowing them to be taken off the waiting list for heart transplantation. In this paper, we review the original and current indications for PAB and explain the surgical technique and strategy. We also present a literature review of the new indications for PAB in patients with pediatric DCM, and compare outcomes in Japan with those in other countries.

Currently, the only reliable treatment for glaucoma is intraocular pressure (IOP) -lowering therapy. Guidelines recommend setting a target IOP for each patient prior to starting treatment. Previous randomized controlled study results have shown that the lower the target IOP is set, the greater the suppression of glaucoma progression. In addition to lowering the mean clinical IOP, there also needs to be increased attention to IOP fluctuations, such as 24-hour and long-term IOP fluctuations. Although first-line drugs normally administered include prostanoid FP receptor agonists (FP agonists), EP2 receptor agonists (EP2 agonists), which do not lead to the periorbitopathy (PAP) associated with prostaglandin, are sometimes prescribed in Japan as first-line drugs. From an adherence viewpoint, the second-line drug is often changed to a fixed combination eye drop, with a fixed combination of an FP receptor agonist and a β-blocker. The IOP-lowering effects of glaucoma eye drops involve specific 24-hour variations that are dependent on the type of drug. While β-blockers have less nighttime IOP-lowering effects, FP agonists, the EP2 agonist, carbonic anhydrase inhibitors and ROCK inhibitors exhibit significant 24-h IOP-lowering effects. Unfortunately, even with multidrug therapy, the maximum 24-hour IOP tends to occur in the middle of the night. However, the use of selective laser trabeculoplasty and physiological outflow pathway reconstruction has been shown to not only reduce daytime IOP-lowering, but also nighttime IOP-lowering and 24-hour IOP fluctuations. In addition, trabeculectomy combined with mitomycin C has been shown to exhibit the greatest reduction in the preoperative mean IOP and 24-hour IOP fluctuation. Nevertheless, as the IOP is known to clinically increase postoperatively, multidrug therapy often needs to be restarted, thereby leading to increases in the 24-hour IOP fluctuations that will ultimately reduce the quality of the IOP-lowering effect.

In recent years, the number of pharmaceutical products has continued to increase, and with it, the volume of information has inevitably grown as well. This section introduces some of the efforts made in our DI office to handle appropriate drug information to support the ever-changing medical care and busy clinical practice. The types of drug information include safety information, information on the efficacy and effectiveness of drugs, and information on drugs adopted by facilities. We determine the immediacy of such information and endeavor to communicate and disseminate it. As a means of providing this information, the company produces a pharmacy department news and a monthly pharmaceutical information magazine. The department also responds to questions from physicians and other healthcare professionals regarding pharmaceuticals. It is necessary to understand the background of the problem to be solved and to collect, process, and provide appropriate information. The DI Office participates in committees related to the proper use and safety management of pharmaceuticals in hospitals, such as the Pharmaceutical Affairs Committee, which is responsible for the selection of drugs to be used, and the Drug Safety Management Committee. The DI Office also prepares materials for these committees and monitors the use of drugs for off-label use, thereby contributing to the proper use and safety management of drugs in hospitals. In the ever-changing healthcare environment, we will continue to promote the proper use of pharmaceuticals and actively provide information to help ensure appropriate drug treatment in clinical settings.

A 3-year-old boy with a history of four febrile convulsions since the age of 1 year was admitted to the hospital after experiencing a cluster of tonic seizures. Treatment was started with valproic acid (VPA), which proved to be ineffective, so carbamazepine (CBZ) was administered instead. This was judged to be effective because the tonic seizures disappeared temporarily. The patient was discharged, but he then had a similar cluster of tonic seizures and was consequently readmitted. Zonisamide (ZNS) was administered, which resolved the tonic seizures. CBZ was discontinued because we thought it would exacerbate the myoclonic seizures he was experiencing. The myoclonic seizures disappeared, and the addition of ethosuximide (ESM) completely resolved his tonic seizures. In this patient, the onset of tonic seizures was characterized by clusters, but because myoclonic seizures were not prominent initially, we were unable to diagnose Doose syndrome early. However, ESM proved remarkably effective, and the patient has remained seizure free.