Thigh muscle cross-sectional area (CSA) and maximum voluntary isometric strength of knee extensor and flexor muscles were measured in 97 men (2065 years) and 162 women (2069 years) in sedentary Japanese adults. Each subject was assigned to one of five age groups (3^rd 4^th 5^th 6^th and 7^th decade) . Thigh muscle CSA was estimated by our developmental measuring system using an ultrasonographic device, which was connected to a PC for graphical processing. Muscle CSA for the 7^th decade in men was significantly smaller than that for the 3^rd decade. For women, muscle CSA were no significant from the 3^rd to the 7^th decade. The isometric knee extensor strength showed a significant decline with age from the 7^th decade in men, whereas there was no significant change with age in women. Isometric strength of knee flexors in men showed a gradual decline from the 5_th decade. The aging-associated reduction of muscle strength per muscle CSA in the extensors and flexors started from the 6_th decade in men. It was concluded that the size and strength of the thigh muscles begin to decrease simultaneously by approximately the 6_th decade in men, whereas there are no change until the 7^th decade in women.

Objectives : Persistent coldness is a common complaint for which Kampo, traditional Japanese herbal medicine, is often tried, because there is no definition or objective measure of subjective coldness in Western medicine. The aim of this study was to evaluate the efficacy of a common Kampo agent, tokishigyakukagoshuyushokyoto, and to identify key symptoms that would predict positive treatment outcomes for coldness.
Design : A retrospective cohort study.
Setting : 181 patients who complained of coldness without any organic abnormalities self-surveyed their health using a Kampo questionnaire database system on their first visit. Another 28 patients were assigned to verify the discriminatory predictability of treatment efficacy.
Interventions : Patients were treated with extract product, 7.5 grams a day for a month.
Outcome measures : Treatment efficacy as a binary response.
Results : Frequency and severity scales (0 to 4) for coldness decreased from 3.2 ± 0.7 to 2.1 ± 0.1 (p < 0.01)and from 3.1 ± 0.7 to 2.2 ± 0.9 (p < 0.01), respectively. Improvements in both frequency and severity of coldness were observed in 74.0% of patients. The status of tenderness in the iliac region, without upset stom ach or depression, was obtained as an appropriate model for the prediction of treatment effect, and its discrimi natory predictability was calculated as 84.4%. The predictive accuracy of the model was validated with 82.1% for the 28 new patients.
Conclusions : Coldness susceptible to tokishigyakukagoshuyushokyoto was very frequently accompanied by tenderness in iliac region, without upset stomach or depression.

Objectives : We evaluated the efficacy of tokishakuyakusan and kamishoyosan for patients who complained of feeling cold, and identified key symptoms that would predict positive treatment outcomes for coldness with these medicines.
Design : A retrospective cohort study
Subjects and Methods : The subjects were 188 patients who reported feeling cold. They were treated with tokishakuyakusan or kamishoyosan according to their Sho for more than one month. The relationships between improvement of cold sensation and 62 factors, including other symptoms noted at the first medical examination, were evaluated by means of cross-sectional analysis, followed by logistic regression.
Results : The factors of coldness of the abdomen (odds ratio, 5.0), vertigo (7.7), dimness of sight (16) and blushing (5.6), without anger (0.11) or tinnitus (0.025), were found to be predictors of a positive effect with tokishakuyakusan treatment (p < 0.001). The factors of hot flushes (14), without coldness of the whole body (0.099), and faint feeling (0.21) were significant for kamishoyosan (p < 0.001). This suggests that kamishoyosan can improve subjective coldness of the extremities (AIC -8.64), especially of the legs (-2.23).
Conclusions : Coldness in the abdomen was an important indicator for treatment with tokishakuyakusan, while coldness in the legs, but not in the whole body, was important in the case of kamishoyosan.

In step with the widespread use of antimicrobial agents in medical treatment, microbial substitution and emergence of new drug-resistant bacteria have become life-threatening problem today. Both have resulted from the postopreative practice of administering prophylactic medication and long-term, desultory drug administration. Drug-resistant microbes can occur easily with the inadequate use of drug. Therefore, our hospital has held in check the incidence of drug-resistant microbial infection by letting ICT members make the rounds of the wards and go over the notifications of the prescription of specific antimicrobial agents and the reports on drug-resistant bacteria. At the begiing, the notification and the report were filed separately. Recently, the information obtained from thses two channels has become easier of access because all the necessary data appear on the same screen at once by using patients' IDs. We believe that the streamlining of work and putting two kinds of data together have proved very usefull for infection control, as it has become possible to keep careful watch over the use of specific antimicrobial agents and the detection of drug-resistant microorganism simulataneously. By sharing the information obtained by us with all the rest on the hospital staff, we will continue to make efforts along this line and contribute toward the prevention of the outbreak of nosocomial infections as well as community-acquired ones.
Microorganism ; Pharmaceutical Preparations ; Medical Surveillance ; microbial ; Bacterial

Introduction : We evaluated the efficacy of daisaikoto for patients with generalized fatigability or easy fatigability by multiple regression analysis.Subject and Methods : The subjects were fifty-three patients with generalized fatigability or easy fatigability, consisting of 6 males and 47 females, mean age 38 y/o (range 23-72), who were treated with daisaikoto according to Sho for more than one month. The relationships between the improvement of generalized fatigability or easy fatigability and 46 factors, including age, sex, height, body weight, hypertension and other symptoms noted at the first medical examination, were examined by multi-dimensional cross-sectional analysis.Results : The factors of sweating, hot flushes, sensation of something stuck in the throat, and feeling of fullness in the chest were significant. Improvement of objective tenderness on the sides of the abdomen and sweating formed the best subset of explanatory variables.Discussions : The sensation of something stuck in the throat and feeling of fullness of the chest often occur under Ki stagnation. The improvement rather than the existence of objective tenderness on the sides of the abdomen is assumed to be more important factor.

Headache is one of patients' major complaints at medical examination. And in Kampo medicine, we select prescriptions for them by taking not only headache, but also other symptoms into consideration.We present five patients with headache, whose symptoms were improved with tokishakuyakusan. Four patients (cases 1 to 4) had a background of menopausal symptoms and one (case 5), menstrual pain. Besides headache, other symptoms, such as vertigo, edema, and numbness of the fingers, were improved with tokishakuyakusan. Goshuyuto was not effective for headache in case 4, though it was effective to some extent in case 5, except for headache during her menstrual period. Headache during the ovulatory phase and/or pre- and early menstrual period disappeared when tokishakuyakusan was added to goshuyuto.Eleven cases of headache treated with toshakuyakusan, including these five cases, revealed that tokishakuyakusan was efficacious against migraine-type headache, which becomes worse during the menstrual period, and coldness. Although tokishakuyakusan should sometimes be distinguished from goreisan or hangebyakujyutsutenmato, it may be effective in patients with so-called “blood pattern” headache, associated with menstrual period and menopausal symptoms, and in patients with a heavy feeling of the head and vertigo.

Small groups of 5th-year medical students performed a survey of hospital patient services in hygiene and public health, with an emphasis on patient waiting time. The purpose of this course was to give medical students the opportunity to experience the waiting time endured by patients and to obtain some understanding of the quality of hospital services from the patient's point of view. The survey was performed as follows. Groups of five students accompanied new patients in the department of internal medicine from registration until payment. The students recorded waiting time and examination time. During the waiting time, the students asked the patient questions to evaluate service. Patients were cooperative in giving responses during the survey. After the survey, the students summary proposed how to improve services for patients. By accompanying and talking with patients, the medical students were able to understand hospital systems from the patient's point of view. This course should prove useful for these students future careers in medicine.

Background : Menstrual migraine is more resistant to treatment than that of nonmenstrual episodes. Hormonal progesterone changes may cause sui (water/fluid) disturbance, in Kampo medicine terms. We therefore treated patients with menstrual migraine in which goshuyuto was ineffective, with the combination of goreisan and goshuyuto.
Subjects & Methods : Subjects were 37 female patients with coldness (mean age 37 years, age range 23-48 years), whose migraine during their intra-menstrual periods was successfully treated with goshuyuto for 3 months. In order to treat migraine in the menstrual period, goreisan was added to goshuyuto from 1 week before onset, until the end of their menstrual period. Results : Among 37 patients, the treatment was effective in 26 patients (70%). Significant variables were found to be dull headache (p = 0.003), edema (p = 0.006), vertigo (p = 0.014) and oliguria (p = 0.014) during attacks, as well as worsening before rain (p = 0.004). Conclusion : The periodical combination of goreisan and goshuyuto seems to be effective in patients with menstrual migraine who report symptoms of sui disturbance, such as dull headache and oliguria during their attacks.

In Kampo, “lung medicines” are usually used to treat patients with bronchial asthma, according to the type of cough and sputum, and the degree of dyspnea which presents. However, it is also important to exclude exacerbating factors. In Kampo, the lungs and large intestine are thought to have a close relationship. We report three bronchial asthma patients whose cough and dyspnea were ameliorated by improving bowel movements. We discuss the types of bronchial asthma patients who might be effectively treated by controlling their defecation. We suggest that, when patients with mild bronchial asthma who have not previously had trouble with their bowel movements complain of respiratory distress with abnormal bowel movement, it might be effective to apply “large intestine medicines” to relieve their respiratory problems. (122 words)
Asthma ; Respiratory ; Bowel action ; Defecation ; Cases

It is important to treat patients with spleen qi deficiency not only with formulations for their deficiency, but also with formulations to improve qi stagnation.Rikkunshito plus Cyperi Rhizoma, Amomi Semen and Agastache rugosa, which improve qi circulation, was effective in cases 1 and 2 herein.We examined when and how to prescribe kososan with formulations for spleen qi deficiency, with reference to kosharikkunshito. Kososan and rikkunshito were effective in cases 3 and 4.Based on rikkunshito indication, a patient with weaker constitution was prescribed shikunshito (case 8), a patient with diarrhea and vertigo was prescribed shinbuto (cases 5 and 6), and a patient with severe coldness was prescribed ninjinto (case 7).Kososan played a supplementary role in treatment, and can be prescribed with other medicines.Not only gastrointestinal symptoms, but also various other complaints were improved by adding kososan to prescriptions for spleen qi deficiency.