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.

Glucocorticoid-induced osteoporosis is one of the most common and serious adverse effects of glucocorticoid use. Pharmacological treatment is strongly recommended for patients at a high risk of fracture；however, it is generally avoided during pregnancy. Here, we present the rehabilitation of a pregnant patient with multiple vertebral fractures caused by glucocorticoid-induced osteoporosis. A 27-year-old woman with systemic lupus erythematosus had an unplanned pregnancy and began receiving oral glucocorticoid therapy (15 mg/day). Pharmacological treatment of osteoporosis was not recommended during pregnancy. At 31 weeks of gestation, the patient was admitted to our hospital with severe back pain. Plain X-rays showed multiple vertebral fractures. The patient was diagnosed with glucocorticoid-induced osteoporosis. She required prolonged bed rest until birth because of severe pain and high risk of additional fractures. The therapeutic strategy after delivery was shared with the Departments of Rehabilitation, Obstetrics, and Gynecology, Rheumatology, and Orthopedic Surgery. At 37 weeks of gestation, she gave birth by cesarean section, and teriparatide administration was started immediately. Six days after delivery, computed tomography showed multiple vertebral fractures from Th5 to L5, and L2-L4 bone mineral density was 0.798 g/cm2, which was 67％ of the young adult mean. She wore a corset and began a rehabilitation program. Frequent consultations were conducted with an orthopedic surgeon, and the patient carefully proceeded with getting out of bed. She gradually regained the ability to sit, stand, and walk. Sixty-three days after delivery, she could walk with a cane and was discharged from our hospital.

Glucocorticoid-induced osteoporosis is one of the most common and serious adverse effects of glucocorticoid use. Pharmacological treatment is strongly recommended for patients at a high risk of fracture；however, it is generally avoided during pregnancy. Here, we present the rehabilitation of a pregnant patient with multiple vertebral fractures caused by glucocorticoid-induced osteoporosis. A 27-year-old woman with systemic lupus erythematosus had an unplanned pregnancy and began receiving oral glucocorticoid therapy (15 mg/day). Pharmacological treatment of osteoporosis was not recommended during pregnancy. At 31 weeks of gestation, the patient was admitted to our hospital with severe back pain. Plain X-rays showed multiple vertebral fractures. The patient was diagnosed with glucocorticoid-induced osteoporosis. She required prolonged bed rest until birth because of severe pain and high risk of additional fractures. The therapeutic strategy after delivery was shared with the Departments of Rehabilitation, Obstetrics, and Gynecology, Rheumatology, and Orthopedic Surgery. At 37 weeks of gestation, she gave birth by cesarean section, and teriparatide administration was started immediately. Six days after delivery, computed tomography showed multiple vertebral fractures from Th5 to L5, and L2-L4 bone mineral density was 0.798 g/cm2, which was 67％ of the young adult mean. She wore a corset and began a rehabilitation program. Frequent consultations were conducted with an orthopedic surgeon, and the patient carefully proceeded with getting out of bed. She gradually regained the ability to sit, stand, and walk. Sixty-three days after delivery, she could walk with a cane and was discharged from our hospital.

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.

Objectives: Postmenopausal women with osteoporosis are frequently underdiagnosed. In Japan, general dental practitioners have begun using the cortical shape of the mandible on dental panoramic radiographs (PRs) to identify and refer women at risk of osteoporosis to medical professionals. It remains unclear whether dental students, after relevant education, possess the ability to identify these at-risk individuals. This study evaluated the ability of dental students to screen for osteoporosis on PRs. Methods: A cohort of 113 fifth-year dental students participated in a lecture on osteoporosis screening using PRs.The students then categorized the mandibular inferior cortex on PRs from 30 postmenopausal women (11 with osteoporosis) as normal, mildly to moderately eroded, or severely eroded. Interobserver agreement between the students and an expert oral radiologist using two cortical groups (normal to moderately eroded and severely eroded) was assessed through kappa statistics. Screening ability for osteoporosis detection by identifying severely eroded cortices was calculated and compared with that of the Osteoporosis Self-assessment Tool for Asians (OSTA). Results: Twenty-one (18.6%) students demonstrated moderate to substantial agreement with the expert. The mean sensitivity, specificity, and positive and negative predictive values for these students in identifying osteoporosis were 60.2%, 88.0%, 76.3%, and 80.0%, respectively. For the OSTA, sensitivity, specificity, and positive and negative predictive values were 27.3%, 68.4%, 33.3%, and 61.9%, respectively. Conclusions Even with minimal education, approximately one-fourth of dental students may accurately identify postmenopausal women with osteoporosis on PRs, outperforming questionnaire-based screening tools.

Objectives: Postmenopausal women with osteoporosis are frequently underdiagnosed. In Japan, general dental practitioners have begun using the cortical shape of the mandible on dental panoramic radiographs (PRs) to identify and refer women at risk of osteoporosis to medical professionals. It remains unclear whether dental students, after relevant education, possess the ability to identify these at-risk individuals. This study evaluated the ability of dental students to screen for osteoporosis on PRs. Methods: A cohort of 113 fifth-year dental students participated in a lecture on osteoporosis screening using PRs.The students then categorized the mandibular inferior cortex on PRs from 30 postmenopausal women (11 with osteoporosis) as normal, mildly to moderately eroded, or severely eroded. Interobserver agreement between the students and an expert oral radiologist using two cortical groups (normal to moderately eroded and severely eroded) was assessed through kappa statistics. Screening ability for osteoporosis detection by identifying severely eroded cortices was calculated and compared with that of the Osteoporosis Self-assessment Tool for Asians (OSTA). Results: Twenty-one (18.6%) students demonstrated moderate to substantial agreement with the expert. The mean sensitivity, specificity, and positive and negative predictive values for these students in identifying osteoporosis were 60.2%, 88.0%, 76.3%, and 80.0%, respectively. For the OSTA, sensitivity, specificity, and positive and negative predictive values were 27.3%, 68.4%, 33.3%, and 61.9%, respectively. Conclusions Even with minimal education, approximately one-fourth of dental students may accurately identify postmenopausal women with osteoporosis on PRs, outperforming questionnaire-based screening tools.