There have been some reports that keishikaryukotsuboreito improves climacteric symptoms such as palpita tion, but none have reported coldness successfully treated with this formulation. We report a case of palpita tion and coldness, successfully treated with keishikaryukotsuboreito.
The patient was a 48-year-old female. She complained of palpitation and coldness for 2 to 3 years. She had coldness of the hands and feet without hot flushes. She consulted our clinic on May 8, XXXX. We prescribed keishikaryukotsuboreito (7.5 g/day) because of suggestive symptoms of insomnia, as well as palpitation in the abdomen. Her symptoms improved in 2 weeks. Keishikaryukotsuboreito is usually prescribed for cold feet with hot flushes. The results experienced in this case suggest that keishikaryukotsuboreito may be effective for cold feet without hot flushes, especially with palpitation and pulsation at the navel, which are known symp toms of qi counterflow in Kampo medicine.

A 82-year-old patient with congestive heart failure visited our hospital complaining of dyspnea and orthopnea. Initially, treatment was given based on the western medicine. She responded very well to a diuretic, with her congestive heart failure improving in a relatively short period of time. However, she could not adhere to the restriction of water intake she was supposed to follow was hospitalized repeatedly. While she was in hospital, just rest and water restriction alone improved dyspnea. Although she was discharged from hospital and was given increased doses of a diuretic and a vasodilator, congestive heart failure recurred. Since there was moderate discomfort of the hypochondrium and disturbance of the body's fluid metabolism, we added Sairei-to to her treatment. Six weeks later, the discomfort of the hypochondrium cleared. Her appetite started to improve and she had less severe dryness of the mouth. she was therefore gradually able to follow the water restriction and has not had recurrence of heart failure since then. Although Moku-boi-to is frequently used in the treatment of heart failure, it is assumed that a formulation with a diuretic action such as Gorei-san was effective because heart failure represents a disturbance of the body's fluid metabolism.

The term “half exterior half interior” is not found in the Oriental Medical Classic, the ‘Shang Han Lun’. Rather, the phrase “half outside and half inside” appears. It was Cheng Wu Ji that first used the term “half exterior half interior” in the phrase “Those in whom the disease-causing agent is half in the exterior and half in the interior are considered to be of the fever manifestation-type” appearing in his ‘Shang Han Ming Li Lun’. In the ‘Zhu Jie Shang Han Lun’ which Cheng Wu Ji wrote shortly afterwards, he explains that the phrase “half outside and half inside” found in the ‘Shang Han Lun’ means half exterior and half interior. Since this commentary on the ‘Shang Han Lun’ was more frequently published and more widely circulated than the original text, it is thought to be this explanation that accounts for the popularization of the term “half exterior half interior”.

Hyaline ring granuloma (HRG) is a comparatively rare inflammatory condition occurring mainly in the oral region, and is characterized by hyaline rings (HRs) formed in the granulation tissue. This study describes a case of HRG occurring in the mandibular periosteum of an 18-year-old male. Histopathologic, histochemical and electron microscopic studies were performed on surgically excised materials. Histopathologically, ovoid bodies (OBs) surrounded by thin hyaline walls and HRs showing pale-stained eosinophilic thick hyaline walls were both detected. Histochemical study revealed that the OBs contained many granules chiefly composed of starch. Ultrastructurally, the HRs presented a stratiform structure due to the accumulation of cross-banded collagen fibrils with a basement membrane-like lining containing cellulose microfilaments. These results suggest that HRs are formed as follows: the exogenous vegetable materials are encapsulated by collagen, then the component is gradually degraded; the residual cellulose fraction adheres to the inner surface of the collagenous capsules, and the continuous deposition of collagen at the outer surface of the capsules increases its thickness. Finally, thick hyaline walls of HRs are formed. The possible pathogenesis of this curious lesion is discussed for stomatologists.

A 55-year old man was admitted to our hospital owing to endograft collapse after TEVAR. He had undergone total arch replacement for acute aortic type A dissection at age 39, and undergone thoracic endovascular aortic repair (TEVAR) for chronic aortic type B dissection at age 54. TEVAR was successfully performed and the false lumen was shrunk. However, one year after TEVAR, computed tomography showed endograft collapse. Technical success was not achieved by the balloon technique to treat endograft collapse, so we performed additional TEVAR. After this procedure, endograft collapse was repaired. The postoperative course was uneventful.

The patient was a 68-year-old woman with chief complaints of severe lumbago, left lateral abdominal pain and high fever. Computer tomography (CT) at a local hospital showed a left psoas abscess and a low density area around the terminal aorta. Blood tests indicated a high inflammatory response and MSSA was detected in a blood culture. Control of the infection was first attempted with antibiotics, but CT showed a pseudoaneurysm at the terminal aorta, and therefore she was transferred to our hospital. We diagnosed infected abdominal aortic and left common iliac aneurysms complicated by an MSSA psoas abscess, and performed extra-anatomic reconstruction with axillo-bifemoral bypass, aneurysmectomy and omentopexy in the psoas abscess cavity. Because of massive intestinal edema and mesentery, we attempted temporary abdominal closure with the vacuum-assisted closure (VAC) technique, and finally succeeded in closing without abdominal infection in the 6th operation, 42 days after the first operation. Infected abdominal aortic aneurysm complicated by psoas abscess is extremely rare and life threatening. The VAC technique is very effective not only in avoiding abdominal compartment syndrome but also in avoiding abdominal infection.

We report a rare case of acute type A aortic dissection with paraplegia which was reversed using cerebrospinal fluid drainage (CFD). The patient was a 80-year-old man who was admitted with acute back pain and paraplegia. Computed tomographic scans showed an acute type A aortic dissection. Four hours after onset of paraplegia, CFD was initiated by inserting an intrathecal catheter at L3-L4. Cerebrospinal fluid was drained freely by gravity whenever the pressure exceeded 10cmH₂O. After 32h, the neurological deficit was completely resolved. CFD can be considered a useful treatment in patients with paraplegia after acute aortic dissection.

We reexamined the cases of renal disease found in urinalyses which had been performed as part of the mass screening, to ascertain its efficacy. During 1990, a total of 94, 913 people underwent physical checkups made by the Naganoken Kouseiren Health Screening Center. The mean positive rates of proteinuria, occult blood in urine and both were 2.4%, 6.2% and 0.5%. Of the total number of examinees, 59, 803 had undergone the previous year's checkup. The mean positive rates of proteinuria, occult blood in urine and both for two consecutive years were 0.8%, 3.4% and 0.1%. The mean positive rates of proteinuria and occult blood increased with age. The mean positive rate of proteinuria was 1.7 times higher in males than in females. On the other hand, the mean positive rate of occult blood was 2.7 times higher in females than in males. However, there was no difference what so ever between men and women in the mean positive rate of both proteinuria and occult blood.
In the mean time, we reviewed the 85 cases in which renal biopsy was performed at the Saku Central Hospital from 1985 through 1990. Among them, 35 (41.2%) were the cases which had been suspected to have kidney disorder in the urinalysis conducted as part of a mass screening, and IgA nephropathy accounted for about 60% of them. The reports from medical institutions which made follow up examinations using the results of the health screening showed that the rate of renal disease was highest in the proteinuria positive cases; that of urological diseases, in the occult blood positive cases; that of chronic glomerulonephritis and urological diseases, in the proteinureal occult blood positive cases. We concluded that urinalysis included in a battery of tests at the time of the mass health screening is an effective procedure for detecting chronic glomerulonephritis and urological diseases.

A 79-year-old woman with prosthetic valve endocarditis (PVE) on aortic position underwent re-aortic valve replacement. Although emergency operation was indicated due to huge vegetation over 20 mm in diameter attached to the prosthesis shown by preoperative transesophageal echocardiography, intraoperative transesophageal echocardiography showed disappearance of the vegetation. The prosthesis was carefully removed and replaced by a new bioprosthesis, though only small vegetation was observed on the removed prosthesis. Sudden blue toe 11 h after the operation and diminished pulse on right pedal artery suggested an acute arterial occlusion of a right lower extremity, requiring an emergency thrombectomy. Pathology diagnosed bacterial embolus with fresh thrombus that was considered apart from the prosthesis at the time of operation.

Background: Because generic medicines reduce the financial burden on patients and medical insurance providers, they become more popular year after year.  However, there are still few reports that analyze the efficacy and safety of generic medicines, especially in terms of their characteristics and side effects.
Methods: Paclitaxel is an antineoplastic frequently used with good results in the treatment of breast cancer, ovarian cancer, gastric cancer, and angiosarcoma, but fat solubility is high and various kinds of adverse events, such as myelosuppression and arthralgia, peripheral neuropathy, and alcohol hypersensitivity are known to develop.  We investigated the efficacy, characteristics, and the incidence of adverse events for the generic product of paclitaxel.
Results: Differences were found for the generic version in terms of the characteristics and preparation time.
Conclusion: The incidence of adverse events was not significant, suggesting that the generic version could be a reasonable substitute.