As is evident from the Oriental Medical phrase “the mind and body are one”, the body and mind are thought to mutually influence each other. Based on this assumption, the authors studied the psychotropic effects of Kampo formulas that are commonly used for physical disorders. The effects were rapid and remarkable. However, just as individual Kampo formulas are effective for specific organs, the effect of each formula was found to be limited to a certain mental state. Since each mental state was thought to correspond to one of the elements in the Five Element theory there were five mental states identified, i. e.: 1. Will, 2. Anxiety, 3. Irritation, 4. Manic mood, 5. Sociability. Tonifying Kampo formulas seemed to affect two states, one of which was suppressed. The Mutually Destructive Aspects (Sokoku) of the Five Element theory was useful in explaining this. Further studies were made of the psychotropic effects of one Kampo formula, Hachimi-jio-gan. The results indicated that Hachimi-jio-gan had the mutually opposing psychotropic effects of facilitating the will and suppressing the irritation. From these results and the study of various other Kampo formulas, it was suggested that the Mutually Destructive Aspects of the Five Element theory may be useful in gaining an understanding of their psychotropic effects.
In this study, since we were afraid that the psychotropic effects of Hachimi-jio-gan might be due to the presence of Aconiti Tuber, it was removed from the formula, along with the Cinnamomi Cortex. The effects of the remaining formula, Rokumi-gan, were then studied. Twelve patients suffering mainly from depressive neurosis were given Rokumi-gan, and the five mental states evaluated. The states affected were thought to be the loss of will and irritation. After two weeks (four weeks), the efficacy rates were 66.7% (91.7%) and 66.7% (83.3%), but after four weeks, slight mood deterioration (depression) was seen in five of the twelve cases.
Long administration of such tonifying formulas seemed to bring about another improvement without the two mental states. From these findings and a summary of the results obtained from this stuby, the Mutually Creative Aspects (Sosei) of the Five Element theory seems to be useful after the 2-4 week point. In addition, from the study of many formulas, the psychotropic effect of Aconiti Tuber was thought to be a tonifyer of the Five element. Some observations were also made concerning the mutual relationship between the Yin/Yang Deficient/Excessive table and the Five Element theory.
*1 The Five Element theory: In ancient China, the universe was thought to consist of five elements. Mental states were also considered to correspond to the five elements. The five elements are: Wood (Moku), Fire (Ka), Earth (Do), Metal (Kon) and Water (Sui).
*2 The Mutually Destructive Aspect of the Five Element theory: The five elements were thought to have a special relationship. Wood suppresses Earth, Fire suppresses Metal, Earth suppresses Water, Metal suppresses Wood and Water suppresses Fire. This relationship keeps the universe in balance.

During the past four years authors encountered a total of 25 tourists suffered from cerebral (CI: 14 cases) and acute myocardial infarction (AMI: 11 cases) while staying in Kusatsu Hot Spring. The subjects consisted of 13 males and 12 females, ranging from 49 to 85 years old (mean 68±9.5). Analytical study relating to the time of onset of diseases, bathing, drinking and others was performed in these patients. The results obtained were as follows.
1) Higher incidence was observed from May to October in CI, while from March to April and in September in AMI. A majority of the subjects suffered from CI or AMI within two days after arrival in Kusatsu. Attack occurred during bathing in one subject, within six hours after bathing in one, and from six to 24 hours after bathing in the others, respectively. Furthermore, a hourly distribution of the onset of disease showed the high incidence of CI between 3:00 and 9:00, and of AMI between 21:00 and 0:00.
2) Bathing was done one to four times within 24 hours before onset in all subjects. Meanwhile, drinking was in 56% of the subjects.
3) Out of 21 subjects investigated six cases were under medication with hypotensive drugs.
From the results above described, a role of bathing playing in pathogenetic mechanism in thrombotic diseases such as CI and AMI was briefly discussed.

We report a rare case of primary cardiac angiosarcoma in the right atrium. A 47-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography revealed a tumor in the right atrial cavity. We performed tumor resection to confirm the histological diagnosis, to prevent tumor embolism, and to increase the possibility of improving the prognosis. The tumor was resected with the right atrial wall and right pericardium. The right atrium was then reconstructed with a bovine pericardial patch. The pathological diagnosis was angiosarcoma. The patient survived only about 6 months after surgical resection, but there was no local recurrence. This report presents a very rare case of cardiac angiosarcoma associated with cardiac tamponade.

In a 63-year-old male patient Jehovah's witness, IABP was introduced due to acute myocardial infarction and cardiogenic shock, and PCI (BMS) was carried out to CAG #7 100%. Stent placement was carried out and his hemodynamics stabilized. A left-to-right shunt was observed upon carrying out LVG, so the patient was referred to our hospital for surgery purposes due to a diagnosis of ventricular septal perforation (VSP). Upon transferring the patient to hospital, his PA pressure elevated to 53 mmHg although the blood pressure was maintained, and no findings of right heart failure were observed. His respiratory condition was stable. Emergency surgery was considered, but the patient was taking Clopidogrel following PCI, and so VSP repair (extended endocardial repair) was carried out following 4 days discontinuation of Clopidogrel. Preoperative anemia was not observed ; however, postoperative hemorrhagic anemia improved due to iron preparation administration, and the patient was discharged from hospital 22 days following surgery without blood transfusion.

PURPOSE: To evaluate the status of number 3b lymph node (LN) station in patients with adenocarcinoma of the esophagogastric junction (AEG) and to investigate the optimal indications for radical proximal gastrectomy (PG) for AEG. MATERIALS AND METHODS: Data of 51 patients with clinically advanced Siewert types II and III AEG who underwent total gastrectomy (TG) between April 2010 and July 2017 were reviewed. The proportion of metastatic LNs at each LN station was examined. Number 3 LN station was separately classified into number 3a and number 3b. The risk factors for number 3b LN metastasis and the clinicopathological features of number 3b-positive AEG patients were investigated. RESULTS: The incidences of LN metastasis were the highest in number 1 (47.1%), followed by number 2 (23.5%), number 3a (39.2%), and number 7 (23.5%) LN stations. LN metastasis in number 3b LN station was detected in 4 patients (7.8%). A gastric invasion length of more than 40 mm was a significant risk factor for number 3b LN metastasis. All 4 patients with number 3b-positive AEG had advanced cancer with a gastric invasion length of more than 40 mm. The 5-year survival rate of patients with a gastric invasion length of more than 40 mm was 50.0%. CONCLUSIONS: Radical PG may be indicated for patients with AEG with gastric invasion length of less than 40 mm.
Adenocarcinoma* ; Esophagogastric Junction* ; Gastrectomy* ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Risk Factors ; Survival Rate

Several prospective studies on laparoscopy-assisted distal gastrectomy for early gastric cancer have been initiated, but no prospective study evaluating laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy has been completed to date. A non-randomized confirmatory trial was commenced in April 2015 to evaluate the safety of laparoscopy-assisted total gastrectomy and laparoscopy-assisted proximal gastrectomy for clinical stage I gastric cancer. A total of 245 patients will be accrued from 42 Japanese institutions over 3 years. The primary endpoint is the proportion of patients with anastomotic leakage. The secondary endpoints are overall survival, relapse-free survival, proportion of patients with completed laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy, proportion of patients with conversion to open surgery, adverse events, and short-term clinical outcomes. The UMIN Clinical Trials Registry number is UMIN000017155.
Anastomotic Leak ; Asian Continental Ancestry Group ; Conversion to Open Surgery ; Gastrectomy* ; Humans ; Japan* ; Laparoscopy ; Medical Oncology* ; Non-Randomized Controlled Trials as Topic ; Prospective Studies ; Stomach Neoplasms*

Background/Aims: The adenoma detection rate (ADR) of screening colonoscopies performed by trainees is often lower than that of colonoscopies performed by experts. The effcacy of cap-assisted colonoscopy (CAC) in adenoma detection is well documented, especially that of CACs performed by trainees. Endocuff, a new endoscopic cap, is reportedly useful for adenoma detection; however, no trials have compared the effcacy of Endocuff-assisted colonoscopy (EAC) and CAC conducted by trainees. Therefore, the present study retrospectively compared the effcacy between EAC and CAC in trainees. Methods: This was a single-center, retrospective study involving 305 patients who underwent either EAC or CAC performed by three trainees between January and December 2018. We evaluated the ADR, mean number of adenomas detected per patient (MAP), cecal intubation rate, cecal intubation time, and occurrence of complications between the EAC and CAC groups. Results: The ADR was significantly higher in the EAC group than in the CAC group (54.3% vs. 37.3%, p=0.019), as was the MAP (1.36 vs. 0.74, p=0.003). No significant differences were found between the groups with respect to the cecal intubation rate or cecal intubation time. No major complications occurred in either group. Conclusions Our results suggest that EAC exhibits increased ADR and MAP compared to CAC when performed by trainees.

Purpose : Recently, the Japanese government has promoted reform of working practices. The working environment of medical professionals was no exception. In the present study, we investigated the current working environment and issues of cardiovascular surgeons, who are supposed to be working in one of the most demanding circumstances in Japan. Methods : In December 2018, the Japanese Society for Cardiovascular Surgery (JSCVS) sent a questionnaire to all JSCVS members via the internet to obtain basic data on the working environment including working hours, working items, income, and the issues to be solved for cardiovascular surgeons in Japan. Results : The JSCVS received responses from 634 cardiovascular surgeons (response rate 17%, 589 males/38 females). Respondents were primarily mid-career surgeons in their age of 40 s and 50 s. Four hundred seventy-three respondents (75.5%) and 176 respondents (28.2%) answered that they worked an average of 60 and 80 h a week, respectively. In addition, 249 respondents (40.4%) reported receiving no allowance for on-call work during off hours, after midnight, or on a holiday, while 345 respondents (56.6%) reported receiving no allowance for emergency surgery during off hours, after midnight, or on a holiday. Conclusion : Over 75% of cardiovascular surgeons reported being overworked without receiving an appropriate amount of income. Along with the reform of working style being made for the Japanese people, improving the working environment of cardiovascular surgeons is also an urgent matter to maintain healthcare for cardiovascular disease. Facilitating understanding of the issue by the Japanese people is of the utmost importance for the JSCVS.

Objective: In this study, we investigated the occurrence of skin damage following the initiation of low-dose lamotrigine.Methods: We retrospectively analyzed the incidence of skin disorders within 8 weeks of the start of lamotrigine administration, prescribing for 3 years from July 2014 to June 2016.In addition, we also confirmed the onset time of skin disorders in the low- and normal-dose groups.Results: The incidence of skin damage was 7.7 and 24.6 % in the low- and normal-dose lamotrigine start groups, respectively. The onset of skin disorders was relatively early in the normal-dose lamotrigine start group.On the other hand, no tendency was found in the low-dose lamotrigine start group because the number of cases was small.Conclusion: The initiation of low-dose lamotrigine and extension of introduction period might reduce the onset of early skin damage.