[in Japanese]

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[in Japanese]

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Objectives; We had developed a clinical decision support system, which enabled physicians to order any medication with recommended doses based on the updated renal function of each inpatient at Shimane Prefectural Central Hospital. We launched the same system into outpatient settings, and evaluated them. 　 Methods; We developed the clinical decision support system which automatically recommended appropriate doses for any medication which needed to be adjusted for renal function for inpatients. Recommended doses were displayed on the screen for inpatients, the physician could finally select the clinical dose. Since October 2017, we installed the system in outpatients, but the recommended doses were not displayed on the screen and ran in the background to measure the baseline data. We measured the antimicrobial prescription contents for 10 months until July 2018 to predict the actual effect after system operation. Results; We obtained 35,594 drugs regulated by renal function orders for outpatients during the study period. Patients who ordered 5,675 medications （16％） did not have renal function test which was needed. In addition, 2,067 orders （6％） were incorrect dose （over or under） . 　 Conclusion; The clinical decision support system equipped with recommended antibiotics dose by renal function were useful for outpatients to reduce the inappropriate dose.

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[in Japanese]

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Between August 2002 and September 2018, sixteen patients with infected aortic aneurysm （8 thoracic aorta, 6 abdominal aorta and 2 iliac artery） underwent the operation. They comprised 14 men and 2 women, and a mean age was 73 years old. Microorganisms causing infected aortic aneurysms were 3 MRSA, 3 MSSA, 2 E.coli, 2 Campylobacter sp, 1 MRCNS, 1 CNS, 1 Streptococcus pneumoniae, 1 Pasteurella multocida, 1 Bacteroides thetaiotaomicron and 1 unknown. Surgical treatment were in situ graft replacement with rifampicin soaked vascular prosthesis and greater omental flap coverage in six, in situ graft replacement with rifampicin soaked vascular prosthesis in three, in situ graft replacement in two, endovascular repair in two, in situ graft replacement with greater omental flap coverage in one, closure of iliac artery with extraanatomical bypass in one and greater omental flap coverage in one. There were two 30-day death, three inhospital death and two remote death. None was reoperated due to recurrence of infection in remote alive patients. Although the definitive surgical treatment for infected aortic aneurysm is in situ graft replacement with rifampicin soaked vascular prosthesis and greater omental flap coverage, endovascular aortic repair is effective for old patients and infected aortic aneurysm with aorto-bronchopulmonary or aorto-enteric fistula.

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[in Japanese]

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[in Japanese]

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A 41-year-old man with a history of patch closure for a ventricular septal defect （VSD） and ligation of a patent ductus arteriosus at 3 years of age underwent a reoperation for residual VSD. Additionally he was known to have undergone aortic valve replacement （AVR） for infective endocarditis at 6 years of age. He presented to our hospital with complaints of sudden dyspnea and facial edema 35 years after the AVR. Chest computed tomography revealed an ascending aortic aneurysm measuring 13 cm in diameter. A resternotomy was performed via a femoro-femoral cardiopulmonary bypass with core cooling after the bilateral carotid arteries were accessed. We performed aortic root reconstruction ensuring that the previously implanted mechanical valve was preserved. Although the patient required percutaneous cardiopulmonary support because of a postoperative low cardiac output syndrome, he was discharged on post-operative day 71 in a stable condition.

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