Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori infection are the two major causes of peptic ulcers. At present, H. pylori eradication is widely recommended as the most effective treatment for preventing the recurrence of peptic ulcer. In Japan, the first-line regimen for H. pylori eradication, which consists of a proton pump inhibitors (PPI), amoxicillin, and clarithromycin (CAM), was approved in December 2000. However, the number of CAM-resistant strains causing eradication failure by triple therapy including CAM has been increasing. Previous studies have demonstrated that both misoprostol and PPIs are effective for preventing and curing NSAID-associated mucosal injuries. Proton-pump inhibitors have been reported to be better tolerated than misoprostol. In addition, histamine-H2 receptor antagonists (H2RA), when administered at high doses, have preventive effects. However, Japanese patients are expected that not high-dose but even standard-dose H2RAs are effective, because Japanese originally intend to be lower acidity than Westernaers, and have often severe corpus atrophy. For users of NSAIDs, H. pylori infection may additively or synergistically increase the risk of peptic ulcers or serious ulcer complications. H. pylori eradication has been shown to substantially decrease the recurrence rate of peptic ulcers in new NSAID users, but the efficacy in patients with chronic NSAID ulcers is controversial.
Midwifery care for "low-risk" pregnant women during labor is associated with high maternal satisfaction. However, low-risk pregnant women are sometimes referred from midwives to obstetricians due to a shift to the "high-risk" status. Recently, cardiotocogram (CTG) is used for standard delivery care in several Japanese maternity care units. Therefore, we retrospectively examined the influence of CTG management on perinatal outcomes among low-risk pregnant women who preferred maternity care from a midwife during labor. During the study period, from April to September 2008, 247 pregnant women chose midwifery maternity care during labor at Katsushika Red Cross maternity hospital. Of the 247 cases, 113 (45.8%) were referred from midwives to obstetricians. CTG abnormality was the main reason for referral and accounted for approximately 30% of referrals; weak labor pain was also a main reason for referral. Variable deceleration was observed in more than half of the women referred with CTG abnormality. Among the referred cases with CTG abnormality, the rate of spontaneous delivery was lower and the rate of cesarean section was higher than in referred cases without CTG abnormality. Umbilical arterial pH of cases with CTG abnormality was significantly lower than the low-risk group. Abnormal CTG findings considerably influenced referrals from midwives to obstetricians. Because of the low umbilical arterial pH in the group with CTG abnormality, our decision for operative delivery might have been correct. We conclude that evaluation and improvement of CTG management is needed in order to achieve high maternal satisfaction and safety in perinatal care.
Chronic kidney disease (CKD) is defined by two criteria. One criterion is abnormal renal function or morphology, especially proteinuria. A second criterion is an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73m2 calculated with the serum creatinine concentration. CKD is classified on the basis of eGFR from stage 1 to stage 5. CKD is a common cause of cardiovascular disease (CVD). CVD is a major cause of morbidity and mortality in patients with CKD. Management of hypertension in patients with CKD aims to prevent CVD and provide renoprotection. First-line agents for controlling blood pressure are inhibitors of the renin-angiotensin system: angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. These agents are superior to other classes of antihypertensive agents in reducing the amount of urinary protein and in preserving renal function. In CKD, the target blood pressure is less than 130/80mmHg, and 125/75mmHg, if the amount of urinary protein is more than 1g/day. To achieve the target blood pressure, other classes of antihypertensive agents, such as diuretics and calcium channel blockers, should also be administered.
In situ hybridization is a powerful method directed toward obtaining spatial and temporal information concerning the expression and distribution of RNA molecules (e.g., messenger RNA and microRNA) in vivo. In this technical note, we describe procedures for in situ hybridization with non-radioisotope labeled RNA probes, especially a digoxigenin-labeled RNA probe.
A 67-year old woman was emergently admitted because of fainting spells. Electrocardiography showed complete atrioventricular block, and echocardiography demonstrated reduced left ventricular systolic function. Decreased uptake was observed in multiple areas on thallium myocardial scintigraphy; however, coronary angiography showed no significant stenosis. Diffuse left ventricular hypokinesis and complete AV block strongly suggested cardiac sarcoidosis or amyloidosis, but a definitive diagnosis could not be established because histological evidence was lacking. Giant multinucleated cells were incidentally detected on gastric biopsy, and the diagnosis of sarcoidosis was made.
Intractable epilepsy can be divided into the following categories: epilepsy refractory to optimal treatment and epilepsy considered refractory but actually inadequately treated. It is important to assess the individual factors that contribute to making epilepsy refractory, because these factors differ between patients. We report on representative pharmaceutical care, in which a pharmacist assists an epileptologist at an outpatient clinic, to demonstrate the importance of pharmaceutical care in epilepsy treatment. The patient, a 29-year-old woman with a history of forceps delivery, first had a generalized tonic-clonic seizure (GTCS) at the age of 26 years. Several months before this first GTCS, she had had frequent sensory seizures characterized by numbness of the left arm. Magnetic resonance imaging revealed mild atrophy and broad degenerative changes in the white matter. Symptomatic localization-related epilepsy was diagnosed, but we had difficulty administering carbamazepine, zonisamide or valproate because they were poorly tolerated. We started treatment with phenytoin. The GTCSs were not controlled at a serum phenytoin level of 20μg/mL but were controlled at serum levels of 25 to 30μg/mL (275mg/day). However, the patient continued to have sensory seizures twice a month. As a result of consultation between the physician and a pharmacist, gabapentin was also prescribed. Although severe drowsiness developed in the first week after gabapentin was started, the patient could continue treatment by self-tapering the gabapentin dose as the pharmacist had instructed. This pharmaceutical care approach has greatly reduced the frequency of sensory seizures. Thus, it is critically important for pharmacists to administer pharmaceutical care in epilepsy treatment, particularly considering that drug administration is a core element of epilepsy treatment.