The results of a trial treatment of primary biliary cirrhosis using combined Kampo and conventional drug therapy are reported.
A 79-year-old female with a chief complaint of pruritis was diagnosed as having primary biliary cirrhosis because of elevations in serum alkaline phosphatase, serum bilirubin, serum IgM, and positive tests for antimitochondrial antibodies and anti-M2.
In accordance with the Kampo diagnosis, she was first treated with Shinbu-to, which, however, did not cause any clinical alleviaton of the itching. Shishihakuhi-to was then given concomitantly, which resulted in the disappearance of the pruritis on the second day. Ursodeoxycholic acid was also added to her treatment from the 2nd month on. The serum level of bilirubin was observed to decrease gradually thereafter.
This case suggests that Kampo therapy, combined with the Western medical drug ursodeoxycholic acid, may be effective in the treatment of primary biliary cirrhosis.

Recently, patient safety has become a social concern in Japan. Even though cases of “incidents” and “accidents” by interns have been collected and analyzed in each hospital, few published reports have concerned teaching hospitals. The purpose of this study was to identify the incidence of “incidents” and “accidents” by first-year and second-year interns in Japan.
1) In August 2005, a questionnaire was mailed to 231 interns at 14 teaching hospitals. A total of 192 interns participated in this study, with a response rate of 83.1%.
2) The number of cases of “incidents” and “accidents” involving interns since the start of their training was collected.An “incident” was defined as an error that was prevented before occurrence, whereas an “accident” was defined as an unplanned, unexpected, and undesired event with adverse consequences.
3) Among first-year interns, “incidents” occurred at a rate of 0.79 per resident-month (95% confidence interval [CI]: 0.30-1.28), while “accidents” were observed at a rate of 0.13 per resident-month (95% CI: 0.06-0.20).
4) Among second-year interns, “incidents” occurred at a rate of 0.24 per resident-month (95% CI: 0.14-1.34), and “accidents” were observed at a rate of 0.06 per resident-month (95% CI: 0.01-0.11).
5) There was no significant difference in the number of cases of “incidents” and “accidents” in regards to sex, age, or the number of beds of teaching hospitals.

A 53-year-old woman underwent mitral valve replacement for congestive heart failure due to mitral stenosis and regurgitation. She had been receiving hemodialysis because of diabetic nephropathy since 1993, and had had congestive heart failure since 1999. Echocardiography demonstrated mitral stenosis (MVA; 1.10cm²) and regurgitation with a severely calcified mitral annulus. Annular calcification extended to the posterior wall of the left ventricle and the base of bilateral papillary muscles. After removing all calcium from the mitral annulus to the base of the papillary muscle, the left ventricular posterior wall and mitral annulus were reconstructed by glutaraldehyde-preserved autologous pericardium. Then, a Carbo-Medics mechanical valve was placed at the mitral annulus using everting mattress sutures. Although her hemodynamics were stable, bacteremia and multi-organ failure developed 3 months after surgery and she died. Autopsy showed that the reconstructed left ventricular posterior wall and mitral annulus using glutaraldehyde preserved autologous pericardium were in excellent condition without any thrombus. No dehiscence was found at the suture line of the mechanical valve. Mitral annulus reconstruction with glutaraldehyde preserved autologous pericardium is thought to be effective for patients with calcified mitral annulus who require mitral valve surgery.