In order to determine the effectiveness of Orengedoku-to in the treatment of schizophrenia, Orengedoku-to was added to the drug regimens of 10 patients who had been hospitalized with onset episodes or acute exacerbation of this condition. Before Orengedoku-to was added, the schizophrenic symptoms associated with the active phase had already been ameliorated with administration of antipsychotic drugs such as haloperidol for 4-12 weeks, with administration continuing at least two weeks after these symptoms had stabilized. Symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS) three times: before Orengedoku-to was added, immediately following cessation of administration, and four weeks after administration had ended. The BPRS scores indicated significant decreases both immediately following cessation of administration and four weeks later (from 36.3±9.8 to 30.5±6.7). In particular, significant improvement was noted for the symptoms of guilt feelings, depressive mood, suspiciousness and excitement. These improvements were not thought to be due to haloperidol, because the plasma haloperridol levels did not change. No adverse effects were noted.

It has been experienced that Kampo, with its philosophy that every disease is psychosomatic in origin and that herbs affect both the psyche and the soma, sometimes has a dramatic effect on somatoform disorders, though there has been no study examining the effects of Kampo on somatoform disorders. In this preliminary study, the morbidity of somatoform disorders among patients who visited the Keio Kampo Clinic and the patients' psychological well-being were examined.
One hundred patients (17 males and 83 females; mean age [±SD], 39±16) who sought Kampo treatment for the first time at Keio University Hospital participated in this study. A Japanese checklist derived from the somatoform disorders schedule (version 1.1) was used to check the somatoform symptoms. To assess psychological well-being, the subjective well-being inventory (SUBI) was performed. The subjects' clinical records were examined afterwards to rule out symptoms which could be medically explained.
Somatoform patients and medically ill (non-somatoform) patients were 65% and 26% of the total respectively. The somatoform patients showed significantly lower SUBI positive scores than the non-somatoform patients (p=0.042), while SUBI negative scores were significantly higher (p=0.001). Among the somatoform patients, there was a negative correlation between numbers of somatoform symptoms and SUBI positive scores (r=0.267; p=0.032), and a positive correlation between numbers of somatoform symptoms and SUBI negative scores (r=0.337; p=0.006).
Following the SUBI scores through treatment courses may lead to a better understanding of the pathology of somatoform disorders and to more effective use of Kampo.

Eighteen untreated patients with schizophrenia and other psychotic disorders, all of whom had insomnia among their chief complaints, were randomly divided into two groups. For four weeks, nine patients (group A) were treated with neuroleptics (haloperidol) and Orengedokuto, and the remainder (group B) were treated with neuroleptics alone. Changes in schizophrenic symptoms and the number of doses of hypnotics (nitrazepam) were examined. In group A, the thought disturbance (conceptual disorganization, grandiosity, hallucinatory behavior, unusual thought content) aspect of schizophrenic symptoms improved (p=0.06), and the number of doses of hypnotics (mean=1.9) was smaller (p=0.06), as compared with group B (mean=7.7). These observations suggest that augmentation therapy with Orengedoku-to is potentially effective for the treatment of insomnia associated with schizophrenia and other psychotic disorders.

We attempted to analyze “Kyo-kyo-kuman, ” using biochemical and psychiatric approaches. One hundred and twenty patients (23 males, 97 females) with a mean age of 42.4±16.2 years were evaluated for their levels of Kyo-kyo-kuman, using blood biochemical tests, depression levels as measured by Zung's Self Depression Scale (SDS), and subjective well-being levels as measured by the Subjective Well-being Inventory (SUBI) scale. Ninety-three patients (77.5%) had the Kyo-kyo-kuman. Plasma creatinine level and a score of factor 11 (general well-being-negative affect) of SUBI were significantly lower in patients who had the right Kyo-kyo-kuman than in patients who did not have the right Kyo-kyo-kuman. Scores of factor 9 (perceived illhealth) and factor 11 of SUBI were significantly lower in patients who had the left Kyo-kyo-kuman than in patients who did not have the left Kyo-kyo-kuman. In conclusion, patients under the strong stressors tended to have Kyo-kyo-kuman.

Basic procedures that cardiovascular surgeons routinely perform are rarely discussed, despite the great variability among facilities. We conducted a questionnaire survey on Extracorporeal Membrane Oxygenation (ECMO) targeting under-forty cardiovascular surgeons and obtained responses from 53 surgeons. We report the questionnaire results.

Background: Cell blocks (CBs) from pleural fluid are frequently used in the practice of respiratory medicine, but there have been few reports on the use of CBs from forceps and brush washing fluid in bronchoscopy for pathological diagnosis. We retrospectively analyzed the usefulness of CBs from forceps and brush washing fluid. 　Patients and Methods: Patients who underwent bronchoscopy and had CBs made from forceps and brush washing fluid in bronchoscopy at our institution between June 2016 and May 2021 were included. Cases in which additional information was obtained from CBs were reviewed in detail. 　Results: In total, 138 patients had CBs made from forceps and brush washing fluid in bronchoscopy during the study period. EBUS-GS (endobronchial ultrasound-guide sheath) was used for 102 of these patients. The final diagnosis was lung cancer in 114 cases, infection disease in 10 cases, metastatic lung tumor in 8 cases, lymphoproliferative disease in 2 cases, sarcoidosis in 1 case, and organizing pneumonia in 1 case. There were 13 cases with additional information obtained from CBs, all of which were cases of malignant tumors. 　Conclusions: CBs from forceps and brush washing fluid in bronchoscopy were useful for pathological diagnosis in some cases.

At Anjo Kosei Hospital, all staff has been working concertedly on a project to establish a community hospital in line with our future vision. Hospital staff in charge of the Medical Affairs Division has been involved in measures aimed at achieving the slogan “health and happiness of local residents” as part of this project. To address this, three goals were set as follows: improvement of recoveries in accounts receivable management, a reduction of money held in trust, and a decrease in the number of outsourced transactions. To achieve the goals described above, the following specific measure were carried out: (1) collection of accounts receivable using convenience store settlement; (2) collection of high-cost medical expenses by wider use of Eligibility Certificates for Ceiling-Amount Applications and promotion of the Major Medical Cost Loan System for national health insurance holders; and (3) support in acquiring family registration for nonregistered family members and for health insurance benefits. Recoveries of accounts receivable through convenience store settlement was about 90,000 yen/month, and our support activities for family registration and health insurance benefits provided the recoveries of about 80,000 yen/month. Furthermore, the promoted use of the certificate and loan system resulted in recoveries of about 17 million yen/year. The average commission fee and number of outsourcing was 890,188 yen and 12 cases, respectively, from April to August 2016. However, in 2017, it was 305,615 yen and 10 cases, respectively. Our project aimed at achieving slogan-elicited patient voluntary payment of medical expenses, leading to improved recoveries, with reduced money held in trust and fewer outsourced transactions.