An observation of the therapeutic effects of the parallel use of acupuncture/moxibustion and medicine (mainly herbs) on 8 patients with chronic liver disorders at our clinic was done for a period of one year. The basic therapeutic points were: Right Chimen (LV), Right Puyung (ST), Chungwan (CV), Tsu sanli (LU), Sanyinchiao (SP), Taichong (LV), Chihyang (GV), Keshu (BL) and Pishu (BL); and other points were determined according to the subjective symptoms of each patient. Treatments were done 2 times a week as a basic rule. Significant improvements were observed in serum GOT, GPT and γ-GTP, and an increase was observed in serum protein. Also, a significant improvement was observed in the subjective symptoms of patients.
Judging from these results, it is suggested that the parallel use of acupuncture/moxibustion and medicine proves to be effective in the treatment of chronic liver disorders.

As regards to low back pain of agricultural worker, there are many problems still as to a syndrom of “Nofusho” in rural medicine, a disease in ocupational medicine and clinic of orthopedic.
Agricultural worker who complained of low back pain varies with their country and farm products, and it tend to increase with adding to their age. Further, the female rate of low back pain showed slightly high tendency than the made rate, 8.5-12.5 % of male, 6.5-13.4 % of female always complained of low back pain.
According to the findings of roentogenographic examination of back bone, the deformed vertebrae was found clearly, especially, low back pain caused by a trauma of soft tissue and iscogenic pain showed in farmers. Therefor, it is necessary to be improved working posture and condition.
In comparrison with non-farmer, it is located in order of truck drivers. bus drivers and repairmen.

　　We describe a case of Inose-type hepatic encephalopathy due to congenital gastro-renal shunt that was effectively treated with balloon-occluded retrograde transvenous obliteration (B-RTO). An 80-year-old woman repeatedly experienced syncope. Her plasma concentration of NH₃ was elevated to 2363 level and syncope attacks improved after the gastro-renal shunt was closed by B-RTO. Although a congenital gastro-renal shunt is usually treated by surgical ligation, B-RTO is can be effective and less invasive treatment for such cases.

Enteral feeding is generally accepted in patients who cannot take nutrients orally. Percutaneous endoscopic gastrostomy (PEG) is a major enteral means for the introduction of nutritional solutions. However, jejunal feeding is sometimes employed instead of gastric feeding in cases of post-gastrectomy or repeated aspiration after PEG. The digestion and absorption of nutrients in trans-jejunal feeding might be different from those in trans-gastric feeding. In the present study, we measured the serum concentations of micronutrients and vitamins in the cases of direct percutaneous endoscopic jejunostomy (D-PEJ), compared to those of PEG. The enteral feeding has been continued for more than six months in all the cases. Serum copper and zinc concentration were significantly decreased in the D-PEJ group, whereas no significant difference in the concentrations of iron, selenium, vitamins A, B12 and E was ovserved between the two groups. Anemia and neutropenia were frequently observed in many patients with D-PEJ. These conditions were associated with copper deficiency. Much attention should be paid to copper and zinc deficiency in long-term trans-jejunal feeding.
Upper case dee ; Percutaneous endoscopic jejunostomy [PEJ] ; Percutaneous endoscopic gastrostomy ; Serum ; Feeding

Among early colorectal carcinoma, endoscopic treatment is generally indicative for cases with intramucosal to submucosal (SM) superficial invasion, because cases with SM deep invasion should be treated surgically due to the risk of lymph node metastasis. It is important, therefore, to distinguish between superficial and deep SM invasion in early colorectal carcinoma prior to treatment. In this review we assessed the clinical usefulness and knack of pit pattern and narrow band imaging (NBI) diagnosis using magnifying observation. VN type pit pattern, type C3 in NBI Hiroshima classification and NBI type 3 in NBI international colorectal endoscopic (NICE) classification are useful predictors of SM deep invasion. In NBI magnifying observation evaluation of both the vascular pattern and surface pattern are important. We have to use pit pattern diagnosis and NBI magnifying diagnosis as the situation demands with the knowledge of both advantage and disadvantage in each diagnostic method.
Colonoscopy ; Colorectal Neoplasms ; Imidazoles ; Lymph Nodes ; Narrow Band Imaging ; Neoplasm Metastasis ; Nitro Compounds

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.
Parkinson Disease

OBJECTIVE: To analyze patient characteristics of cancer rehabilitation and outcomes at our hospital. METHODS: This retrospective study analyzed 580 patients, who underwent cancer rehabilitation at our hospital and rehabilitation outcome after therapy were investigated. The relationship between the initial Barthel index and discharge outcomes was investigated, with a special focus on cancer patients with bone metastasis. The Barthel index and performance status (Eastern Cooperative Oncology Group) before and after rehabilitation were analyzed, and threshold value of home discharge was calculated from a receiver operating characteristic curve (ROC). General criteria for home discharge from our hospital included independence in performing basic activities of daily living such as bathing, feeding, and toileting or availability of home support from a family member/caregiver. RESULTS: The outcomes after rehabilitation among all the patients were as follows: discharge home 59%, death 13%, and others 27%. Statistical differences were observed between the initial and final values of the Barthel index in patients with bone metastasis, who could be discharged home (p=0.012). ROC analysis of the initial Barthel index for predicting home discharge revealed a threshold value of 60, sensitivity of 0.76, and specificity of 0.72. CONCLUSION: The patients with bone metastasis had a lower rate of home discharge and a higher rate of mortality than all the study patients who underwent cancer rehabilitation at our hospital. It is proposed that at the time of initiation of rehabilitation for patients with bone metastasis, an initial Barthel index lower than 60 might predict a worse outcome than home discharge.
Activities of Daily Living ; Asian Continental Ancestry Group* ; Baths ; Humans ; Mortality ; Neoplasm Metastasis* ; Rehabilitation ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Treatment Outcome

Background/Aims: Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract. Some patients with this condition have been reported to present with immunoglobulin A nephropathy (IgAN), a renal complication that can cause end-stage renal failure, but the frequency of this comorbidity has not been described. Thus, the aim of this study was to investigate the frequency of IgAN in patients with IBD. Methods: This study included 620 patients with IBD (338 with ulcerative colitis [UC] and 282 with Crohn’s disease [CD]) from the Hiroshima University Hospital outpatient department. IgAN cases were identified from medical interviews, blood examinations (serum immunoglobulin A), and urinalyses (occult blood, proteinuria). Definitive IgAN cases were diagnosed by renal biopsies, while those detected through the clinical course and test results, but not clinically recommended for renal biopsy, were defined as suspected IgAN. Results: We analyzed 427 cases meeting the inclusion criteria (220 with UC and 207 with CD). The incidence of IgAN across all patients with IBD was 3.0%. The frequency of IgAN was significantly higher in patients with CD (11/207, 5.3%) than in those with UC (2/220, 0.9%) (P< 0.01). Moreover, a significant correlation was found between CD patients with ileostomy or colostomy and a diagnosis of IgAN. Conclusions Patients with IBD present a high incidence of IgAN, especially those with CD who have undergone ileostomy or colostomy.