This study was designed to evaluate the enlargement of incision sizes before and after intraocular lens (IOL) implantation in coaxial microincision cataract surgery.　　The operation was performed on 138 eyes. NY-60 IOL was implanted with N18 cartridge, SN60WF and ZCB00 implanted with D cartridge, SN60AT implanted with C cartridge.　 Incision sizes (mean±SD) after IOL implantation of NY-60 were 2.33±0.05 (2.2mm corneal incision), 2.30±0.00 (2.1mm corneal incision), 2.26±0.05 (2.0mm corneal incision) and 2.24±0.05 (1.9mm corneal incision), SN60AT were 2.34±0.05 (2.2mm corneal incision) and 2.43±0.05 (2.2mm sclero-corneal incision), SN60WF were 2.34±0.05 (2.2mm corneal incision), 2.29±0.04 (2.1mm corneal incision), 2.20±0.00 (2.0mm corneal incision) and 2.11±0.04 (1.9mm corneal incision), ZCB00 were 2.33±0.05 (2.2mm corneal incision), 2.27±0.05 (2.1mm corneal incision), 2.33±0.05 (2.1mm sclero-corneal incision) and 2.29±0.04 (2.0mm sclero-corneal incision).　　Incision sizes were enlarged after implantation of IOLs in all cases. The incision sizes the IOL manufacturer recommended were not stress-free size during IOL implantation.

We report a case of rheumatoid arthritis (RA) that showed improvement after treatment with Daiseiryu-to-kadaiou. The patient was a 77-year-old woman diagnosed with RA in 1988. She had been visiting our department regularly since 1994. Oral steroids were used for two weeks in May 1994, but were discontinued due to a bacterial infection of the artificial femoral head. Thereafter, treatment was continued with bucillamine, nonsteroidal anti-inflammatory drugs, and various Kampo medicines. Joint pain worsened in November 2001. She was hospitalized on **********, as the CRP level had elevated to 15.2mg/dl. She had been taking bucillamine for seven years, but it had already been assessed as ineffective. It was discontinued upon hospitalization, and treatment with Daiseiryu-to-kadaiou was immediately begun. By ******, the patient judged the pain in both knees to have improved by about 50 percent. Moreover, the CRP level decreased to 2.4mg/dl by *******. The Lansbury index also improved from 100 percent to 69 percent during her hospitalization, and she was discharged on *******. Based on this experience, it is suggested that the prescription of Daiseiryu-to-kadaiou be considered in the treatment of RA patients.

Objective: There is enormous information flow via the Internet and papers.  Physicians require appropriate drug information from medical representatives (MRs), so fair promotion activities of MRs are necessary.  To clarify the activity and visiting aims of MRs, we investigated the visiting records for MRs.
Methods: We improved the visiting record form because there were some gaps in the records.  Subsequently, we investigated the validity of the records.  The correlations between visiting numbers of MRs and both purchase prices of our hospital and scale of drug companies were also investigated.  Two months after revision of the visiting records, a questionnaire survey was administered among MRs to determine their thoughts about promotion activities.
Results: The visiting numbers of MRs and companies did not change with revision of the visiting record.  Insufficient visiting records were significantly reduced from 5.1% to 0.8%.  There were no correlations between visiting numbers and purchase prices or scale of drug companies.  Meanwhile, sub-analysis of the visiting data indicated that MRs significantly promoted new drugs and drugs coming off patent.  The revision of visiting record format re-emphasized the importance of the visiting record on MRs.
Discussion: Almost all MRs promoted their products fairly, as there was no correlation between the purchase price and company scale.  However, they may actively promote new drugs and those with patents that have elapsed.  The visiting records are useful to determine the promotion activities of MRs.

We administered Bofutsushosan (Bo) to 127 obese patients who consulted our clinic, and investigated the effect of this herbal formula on reducing body weight in 33 obese patients who received continuous adminis tration for more than six months. The abdominal muscle tension of these 33 patients was assessed mainly as “strong” (four) under the five-grade scale of Kampo diagnostics, which was higher than that of 9 other patients with side effects (including diarrhea and abdominal pain) assessed mainly as “middle” (three). Sixteen patients reported a decrease in appetite following administration of Bo. Weight before medication in the patients with decreased appetite was 67.1±2.5kg, and that in 17 patients with unchanged appetite was 75.9±2.4kg. There was a significant difference between the two. Weight change in the patients with decreased appetite was -4.8±1.0kg and was significantly lower than -1.4±0.7kg in the patients with unchanged appetite. Their blood triglycerides levels decreased significantly following administration of Bo. This decrease in appetite was considered to be due not only to activation of the adrenaline β₃ receptor, through the administration of Ephedrae Herba, Schizonepetae Spica, Rhei Rhizoma, Forsythiae Fructus and Glycyrrhizae Radix but also to the psychotropic actions of Ephedra Herba, Rhei Rhizoma and Gardeniae Fructus. Recently severe side effects of Bo have been reported. This study suggested that patients showing a grade of strong (four) or more in abdominal muscle tension, were indicated for this treatment and that the long-term administration of this herbal formula should be continued in patients whose appetite was identified as being suppressed.

We reported a rare case of myxoma originating from the anterior leaflet of the mitral valve. A 65-year-old woman was admitted with sympotomes of easily fatigability and palpitation. On auscultation, a grade II/IV systolic murmur was audible at the apex. Echocardiography demonstrated a dense mass arising from the anterior mitral leaflet. The tumor (16×13×10mm in size) was resected from the anterior leaflet of the mitral valve. There was no definite evidence of a tumor stalk on the mitral valve nor valve regurgitation after the operation. Microscopically, polyhedral cells were recognized, indicating myxoma. The postoperative course was uneventful and no recurrence has been noticed during the past 6 years.

We report 5 patients with polymyalgia rheumatica (PMR) successfully treated with Kampo medicines. In total, we investigated 10 patients with PMR, including the 5 patients here treated in our department. Results showed that Kampo medicine was effective in 6 cases. One of the 6 refused steroid drug administration, and tapering dosage steroid was difficult in the other 5 patients due to myalgia or inflammation. Except for one case, C-reactive protein in most of the effective cases was below 3.0 mg/dl. On the other hand, the non-effective cases had severe inflammation levels and needed steroid therapy. The effective cases were treated with sokeikakketsuto, tokakujokito, keishibukuryogan, choyotokasyakuyaku, yokuibushihaishosan and tokishakuyakusan, which have the effect of improving oketsu states. Thus, it was considered that Kampo medicine has the potential for treatments in PMR patients who have difficulty tapering steroid dosage and mild inflammation. Moreover, this suggests Kampo medicines that improve oketsu state are useful for PMR treatment.

We report two cases of chest and abdominal symptoms, the causes of which can not be established in a medical sense, successfully treated with daisaikoto. The first case was an 81-year-old male. He complained of tightness in his chest. Since the frequency of his symptom was increasing, he underwent further evaluation in hospital, but no abnormalities were found. We administered daisaikoto with reference to his constipation and kyo-kyo-kuman (subchondrial resistance and discomfort), the tightness in his chest disappeared and three months later his qi stagnation score and SDS score had improved.
The second case was an 83-year-old male. He had been suffering epigastric pain, tightness of chest and abdomen and a feeling of fullness in the abdomen since two years previously, when he suffered multiple traumatic injuries. We administered daisaikoto in light of his epigastric pain, constipation and kyo-kyo-kuman.The epigastric pain and tightness of the chest and abdomen gradually disappeared, and the number of his unscheduled visits to the clinic decreased.
Thus, daisaikoto may be used to treat patients with chest or abdominal symptoms and depression, the cause of which can not be established in any medical sense.

We report five cases of painful swelling caused by hymenoptera stings and centipede bites treated with ourengedokuto and inchingoreisan soon after the time of injury. The first case was a 70-year-old male. He was stung by a hornet on the left hand 30 minutes prior. The second case was a 45-year-old male. He was stung by a hornet on the left face 20 minutes prior. The third case was a 55-year-old male. He was stung by a hornet on the left lower thigh 10 minutes prior. The fourth case was a 39-year-old male. He was stung by a hornet on the right thigh 60 minutes prior. The fifth case was a 35-year-old male. He was bitten by a centipede on the right first toe 20 minutes prior. All cases received Kampo therapies immediately and continued them every few hours. In all cases, their pain, redness and swelling at the site of injury were relieved by the next day. We consider Kampo therapies can contribute to the healing of hymenoptera stings and centipede bites at an early stage.

Sokeikakketsuto was administered to 33 patients with recurrent cramps of the calf appearing once a week or more and persisting for 2 weeks or more. Treatment response was evaluated 1 month after the start of drug therapy. Patients whose cramps disappeared immediately after starting were regarded as showing a complete response, those with disappearance after 1 month as showing a partial response, those with a reduction to <50% after 1 month as showing a slight response, and those in whom 50% or more of cramps persisted after 1 month as showing no response. A complete response was achieved in 12 patients, a partial response in 11, a slight response in 9, and no response in 1. In 23 (69.6%) of the 33 patients, cramps disappeared within 1 month after the start of drug therapy. In 32 (96.9%), there was a reduction to <50%. In 29 (87.8%) of the 33 patients, cramps disappeared within 3 months, suggesting the efficacy of this drug. Two-package administration in the evening/at bedtime was more effective than 1-package administration for controlling cramps of the calf at night until early in the morning. The intensive pre-attack administration of 2 packages before sleep was the most effective. Sokeikakketsuto may be useful for treating recurrent cramps of the calf.

We report a case of an obstinate belch successfully treated with goshuyuto. The patient was a 74-year-old female. She had been hospitalized seven times in the past due to the belch, abdominal distention and anorexia, and had been prescribed various Kampo formulas. But her symptoms fluctuated up and down. The obstinate belch essentially disappeared after administering goshuyuto, and her appetite improved. Many of Kampo formulas that treat belchs are related to Shoyobyo (shao yang bing), but we consider that goshuyuto may be effective for a belch, which is yin-related and accompanied with stiffness and rigidity below the heart, and fullness in the chest and hypochondrium.
Medicine, Kampo ; Treated with ; Case Report ; plastic property - rigidity ; symptoms <1>