This article analyzes the Okada Documents that were kept by the descendents of Okada Shôshun (1827-97) for over a hundred years and recently became available for scholarly use. In the existing scholarship, Okada Shôshun was considered merely one of many practitioners of East Asian medicine in the early Meiji period. His family background was obscure. This study of the newly emerged documents shows that his family practiced medicine for six generations-from the mid-Edo until the Meiji period-and produced medical administrators in the Bakufu. Also, a book on pharmaceuticals preserved in the Documents and written by his adoptive father, Shôseki, reveals that the family originally specialized in surgery. In addition, because Shôshun studied at the Bakufu's official medical school, Igakkan, under the guidance of the Taki family, the Documents include rare books such as Taki Motonori's “Rankei sensei yakushitsu kijô” (draft), Taki Motoyasu's “Isekikô” (the first draft), “Byômei san, ” and “Qianjin yueling.” Since the mid-1870s, Shôshun participated earnestly in the movement to preserve East Asian medicine and was particularly close to Asada Sôhaku (1815-94). The Documents include Sôhaku's medical essay (untitled), a book manuscript written by Shôshun with commentary by Sôhaku, and sixty-two letters that were exchanged between Shôshun and Sôhaku.

The purpose of this study was to determine whether body composition alterations induced by aerobic exercise training show seasonal varition. Ninety-five middle-aged Japanese obese women volunteered as subjects. All subjects participated in our “exercise+diet” program for 3 months. The subjects were categorized into two groups (Summer group : S, and Winter group : W) based on the season when they participated in the program. Body composition, cardiorespiratory variables and dietary habituation were evaluated before and after the programs. More desirable changes in body composition were observed in Group W than in Group S. Group W showed a significant decrease in body mass from 62.2±8.7 kg to 60.3±8.6 kg, and in percentage body fat from 34.0±7.0% to 30.5±6.0%, while fat-free mass increased significantly from 41.0±3.9 kg 41.9±3.6 kg. However, alterations in cardiorespiratory variables were not associated with body composition alterations. It is concluded that season may have an effect on body composition alterations, but has no effect on cardiorespiratory variables, and that body composition may be improved by an exercise+diet program more effectively in winter than in summer.

Background: Laparoscopy-assisted gastrectomy requires a lot of disposable products. So we compared the cost between laparoscopy-assisted gastrectomy and open surgery.Patients and methods: For comparison we used five cases each of open distal gastrectomy (ODG), laparoscopy-assisted distal gastrectomy (LADG), open total gastrectomy (OTG) and laparoscopy assisted total gastrectomy (LATG). In this study, we defined the profit of gastrectomy as below and we used the list price for all products. Profit of gastrectomy=Fee for gastrectomy-(Costs of all single use products-Demandable fee for single-use products)Results: Mean profits of ODG and LADG were 278,756.2 yen and 190,292.8 yen. The difference was 88,463.4 yen. Mean profits of OTG and LATG were 395,922.6 yen and 330,653.6 yen. The difference was 65,269 yen. Mean hospital charges, mean length of hospital stay, mean hospital charges per day of ODG, LADG, OTG and LATG were 1,390,464 yen, 21.4 days, 65,140.0 yen and 1,484,254.0 yen, 18.8 days, 80,805.4 yen and 1,956,664.0 yen, 24.4 days, 82,397.1 yen and 1,686,936.0 yen, 18.4 days, 91,894.8 yen, respectively.Conclusion: The turnover of laparoscopic gastrectomy was higher than open gastrectomy, but, the profit was lower because of high costs of disposable products. Hospital charges were not higher but the charge per day was higher because of a shorter hospital stay.
Gastrectomy ; Laparoscopy ; Hospitals ; Mean ; Financial cost

A man in his 40s visited our hospital with a chief complaint of upper abdominal pain after defecation. His general and local conditions were good. Intraperitoneal free air was detected on an abdominal computed tomography (CT) scan, and laboratory tests revealed leukocytosis. Esophagogastroduodenoscopy showed no abnormalities. Emergent laparotomy was performed because of the suspected intestinal perforation, but neither perforation nor peritonitis was observed. Bacterial culture of intraperitoneal lavage fluid was negative. The postoperative course was uneventful and he was discharged. Because the cause of pneumoperitoneum was unknown, the diagnosis was idiopathic pneumoperitoneum. However, we had the opportunity to evaluate abdominal CT images taken with the lung window setting 4 years before the operation, which showed pneumatosis intestinalis in the ileocecal region. It has been reported that metachronous pneumatosis intestinalis is sometimes detected in cases of pneumoperitoneum with pneumatosis intestinalis. Thus, pneumatosis intestinalis was suspected as the cause of pneumoperitoneum in this case.