Papillary fibroelastoma (PFE) is the second most common type of benign cardiac tumor after myxoma, and is most commonly found in the left side of the heart. In this study, we report a case of PFE located in the tricuspid valve chordae. The patient was a 65-year-old woman in whom a heart murmur was detected during a routine medical examination. A follow-up examination identified a cardiac tumor, and she was subsequently referred to our medical department. Echocardiography and contrast-enhanced computed tomography indicated a mobile mass of approximately 1 cm in the right ventricle, and she was determined to be a candidate for surgery. After cardiopulmonary bypass, we instigated cardioplegic arrest, made an incision in the right atrium, and observed the right ventricle through the tricuspid valve. We observed a yellowish sea-anemone-like mass approximately 9 mm from the chordae of the anterior leaflet of the tricuspid valve. Thus, the mass was resected with the chordae and tricuspid annuloplasty. Postoperative progress was satisfactory, and the subject was discharged on the 19th day of hospitalization. Histopathological examination indicated a mixture of thick fibrous and adipose tissues, which led to the diagnosis of PFE. PFE is a relatively rare disease that comprises 8% of primary cardiac tumors. IA often occurs in the left heart and can cause cerebral infarction, myocardial infarction, and other symptoms of embolism. However, because small masses and those that occur in the right heart are not accompanied by clinical symptoms, such cases are often discovered during routine echocardiography. The present study reports a case of PFE that occurred in the tricuspid valve chordae that was diagnosed via echocardiography.

It is difficult to treat vulvar pain of an unknown cause. We report a case of vulvodynia with dysuria treated effectively with goshajinkigan. The case was 92 years-old female who could not sleep well because of vulvar pain. She did not have inflammation of the vulva or vagina. Moreover, she was sometimes treated with urethral catheterization for urinary retention. Goshajinkigan was prescribed, and her pain was decreased so much, that she could sleep well. Furthermore, she was relieved of her urinary retention.

1) Although many people all over the world are aware of traditional Chinese medicine, kampo medicine is not as well known. Kampo, traditional Japanese herbal medicine, is an integral part of medical practice in Japan and deserves greater attention. 2) In response to increasing interest in kampo we have created a web-based virtual class as a reliable source for information about kampo medicine. This virtual class incorporates the latest data on kampo and numerous features to pro- mote a basic understanding of kampo. 3) Through this website and virtual class for health professionals, knowledge of the reliability, usefulness, and safety of kampo will be shared with the world.

1) For third-year students at Keio University Medical School, 10 lectures are given about why kampo medicine is effective, Fourth-year students receive 8 lectures on kampo medicine and participate in independent study sessions 3 times a week for 4 months.
2) In lectures entitled “Why Is kampo Medicine Effective?”we introduce the functional mechanism of action of kampo medicine and address the skepticism of medical students. In the lecture series entitled “Kampo Medicine, ”we introduce the clinical foundations of kampo practice and provide students with a checklist of the key points of each lecture.
3) In the independent study sessions, several students perform mentored basic-science research into kampo's mechanism of action.

[Purpose]We report a case concerning 5 months of left elbow and knee joint pain thought to be caused by repetitive use at work. Symptoms were improved successfully (checked by M-test) by a single acupuncture treatment.
[Case]We used acupuncture to treat a 50-year-old woman who visited our Acupuncture and Moxibustion Centerwith complaints of increasing elbow and knee joint pain in the left side. Since 4 months ago, her job involved frequent stair-climbing while carrying an 18-liter can of cooking oil. The soft tissues seemed to be damaged and caused pain due to the repeated lifting of heavy cans at work. Acu-points were decided by M-Test to check limitations of movement, which identified damaged regions and provided feedback for optimal treatment. According to the specific operations of the patient's work, we identified limited movements of left-elbow joint flexion-extension, left-shoulder joint extension, and left hip joint inner rotation and external gyration. These were regarded as target motions for the treatment. Her Visual Analog Scale (VAS) scores before treatment were 90 mm in the left elbow and 80 mm in the left knee. Despite only a single round of acupuncture treatment, the respective values dropped to 18 mm and 15 mm.
[Consideration and Conclusion]The limited movement identified by M-Test could expose the affected areas and help in treating the appropriate acu-points. Therefore, acupuncture using M-Test might improve painful motions of the body.

This study was conducted to assess the appropriateness of preparation fees for dispensing herbal medicines, which were revised in 2006. We investigated the amount of time needed to dispense herbal, and general medicines. For prescriptions of1to 15 days length, the average time needed for herbal prescriptions was 13.4 minutes, which was about 3 times longer than for other prescriptions, which took only 4.4 minutes. For prescriptions of over 30 days length, this was about 7 times longer. Next we comparatively investigated fees charged per minute to prepare herbal medicines, with those for other medicines. Fees for all prescriptions of 1 to 15 days length were nearly equal, while fees for herbal prescriptions of over 15 days length were approximately 1/3 to 1/5l ess. Finally, we investigated the number of prescriptions filled out at one university hospital. In 2003 the number of herbal prescriptions exceeding 30 days length was 2.7% overall, while in 2008 this had increased approximately 14 times, to 42%. We would like to recommend an increase in herbal medicine preparation fees, based on the number of days a prescription is for, as the number of long-term prescriptions is increasing.

Pouchitis is the most common complication following ileal pouch-anal anastomosis in patients with ulcerative colitis and is strongly correlated with the risk of pouch failure and malignant mucosal transformation in the pouch. Here we report a case treated successfully with the Kampo decoction, daitokato. A 41-year-old male treated with ileal pouch-anal anastomosis due to severe ulcerative colitis suffered from repeated pouchitis and stenosis of the ileal pouch post-operatively. He complained of general fatigue, chills, continuous lower abdominal pain and discomfort, and severe pain with evacuation. Initial treatment with antibiotics and painkillers was ineffective, so the patient came to our hospital's Kampo clinic, where he was initially prescribed the decoction, shokenchuto. This proved ineffective at resolving his fatigue. Subsequent treatment with ogikenchuto improved physical strength but was ineffective for pouchitis. Antibiotic resistant pouchitis occurred afterwards and we attempted treatment with saikokeishito decoction and the extracts, hochuekkito and juzentaihoto, which similarly improved fatigue but not pouchitis. Following administration of daitokato, instances of pouchitis were reduced with no recurrence 6 months post-treatment. This case illustrates the therapeutic efficacy of daitokato in improving ileal pouch disorders resistant to treatment with Western medicine.

From a point of stress, the competitive sports are totally different from exercises for the health promotion. It would be even harmful especially for middle-distance or long-distance women runner. It brings them paramenia, defatigation and other orthopedic troubles which makes them unable to exercise further more.We have investigated the possibility of the preventive use of Kampo Medicine for those athletes and found that it is useful. The nine women who belong to the Tohoku-Region women team of long-distance relay road race had received Kampo medical treatment for 7 months. Serum CPK and AST were elevated with training exercise. In the cases whose CPK level was above 500 IU/l, most of them suffered from fatigue, leg pain, low back pain, and lower abdominal pain, which is very important for Kampo diagnosis. Because these symptoms unable athletes to exercise as planned, we understand that for the improvement of physical capacity, it is important to prevent those symptoms. For the treatment and prevention of the symptoms, we prescribed Keishibukuryogan, Rikkunshito, and Shimotsuto. We defined preventive medication period as “Mibyou” and continued to use Kampo medicine for 7 months. During the period, they were free from any troubles that would make them unable to exercise. These medicines enabled them to improve their records drastically. This study shows that preventive use of Kampo Medicine is extremely effective for any athletes to maintain their good conditions.
Medicine, Kampo ; athlete ; Exercise ; symptoms <1> ; Human Females

Background : Since 2002, Keio University Hospital's Kampo Clinic has promoted itself actively through the media, public presentations, faculty outreach and an internet home page. However, the relative value of these promotions is unknown. Additionally, the range and prevalence of presenting concerns, and the ages and the gender ratio of the patients served at Keio is unknown.Objective and Methods : To better understand and better serve the patients, the medical charts of every new patient who presented to Keio University Hospital's Kampo Clinic from November 2004 to November 2005 (n=791) were retrospectively analyzed for 1) referral source, 2) age, 3) gender, and, 4) disease category.Results : The internet webpage was by far the best source of new patient referrals. The out-of-hospital referral rate to the clinic was remarkably low. Women exceeded men by a 3 : 1 ratio. Most women were in their thirties but male patients were fairly evenly distributed across the age spectrum. Patients under 16 and over 70 were gender-balanced. The vast majority of patients presented with general medicine/pediatric, dermatological or gynecological problems.Conclusion : A patient-oriented internet home page provides a good source of new patient referrals. Given the low rate of referrals from outside hospitals and physicians, additional outreach directed at internal medicine, dermatology or obstetrics/gynecology physicians appears warranted.
Clinic ; Hospitals ; Medicine, Kampo ; seconds ; Universities

The case is a 38-year-old obese woman with complications such as idiopathic thrombocytopenic purpura, thyroid dysfunction, endometriosis, and uterine myoma. She had a wide variety of medical histories and had a long history of infertility treatment, and received various treatments. She has also undergone laparotomy for uterine myoma after the start of infertility treatment. We treated her with Kampo medicine for multiple complaints that appeared during infertility treatment. She received a combination therapy of tokishakuyakusan and shokenchuto, and after about 3 months, her symptoms improved and she became pregnant. In addition, bukuryoin and ryokankyomishingeninto, which were additionally used for hyperemesis gravidarum and cough during pregnancy, were also effective. The course of the pregnancy was uneventful and she gave birth to a girl at term. The girl is growing and developing normally without asphyxia, malformations, etc. It was suggested that it is necessary to pay attention not only to blood stasis and renal deficiency but also to spleen deficiency and consumptive disorder in Kampo medicine treatment for infertility and recurrent miscarriage.