In this report, we describe three hemodialysis patients with carpal tunnel syndrome (CTS) that were successfully treated with Goshakusan, one of the well-known traditional Japanese herbal (Kampo) medicines.
Case 1 was a 77-year-old woman suffering from sleep disorder due to night pain in the bilateral forearms. Case 2 was a 66-year-old woman complaining of sleep disorder due to lancinating pain in right upper and lower limb. They had undergone surgical decompression procedures for CTS several times in the bilateral forearms. However, they still needed a periodical injection of glucocorticoid into the region of carpal tunnel for the relief from pain. Case 3 was a 54-year-old man, who has been suffering from the recurrence of numbness of the left fingers since surgical treatment for CTS.
We diagnosed that the symptom of CTS in those three patients may be due to kan-shitsu (damp-cold or interior cold with dampness), because all of them were anuric hemodialysis patients, who tend to easily acquire phlegm and dampness, and their symptom was partially relieved by warming the forearm and fingers. Therefore, they were prescribed an oral goshakusan extract formula to remove kan-shitsu. Soon after they started taking the formula, the intensity of their pain or numbness markedly decreased. Taken together, our report suggests that it is worth trying to remove kan-shitsu by Kampo medicines for the conservative treatment of CTS.

The objective of this study was to test our preliminary in vivo evaluations of central cholinergic abnormalities in schizophrenia patients. Short latency afferent inhibition (SAI) is based on coupling peripheral nerve stimulation with motor cortex Transcranial Magnetic Stimulation (TMS), which has been shown to be a putative marker of central cholinergic activity. Methods: We evaluated SAI in 5 patients with schizophrenia and 5 healthy subjects. Results: The level of SAI was significantly lower in the patients with schizophrenia than in the controls (p=0.008). Conclusion: Our findings suggest involvement of central cholinergic neurotransmission in schizophrenia, which indicates a possible approach for treatment of cognitive dysfunction related to the disease.

In this report, we describe four hemodialysed patients with upper abdominal discomfort successfully treated with Heiisan, one of the known traditional oriental herbal medicine.Case 1 was a 61-year-old man suffering from upper abdominal discomfort after each meal even though daily taking some medicine for gastritis. Case 2 was a 45-year-old man, who has also been suffering from upper abdominal discomfort after breakfast and supper despite daily taking H₂-blocker. Case 3 was a 61-year-old man complaining of upper abdominal discomfort. He has had loss of appetite despite being treated with H₂-blocker and gastroprokinetic medication. Case 4 was a 69-year-old woman complaining of upper abdominal discomfort with dull pain before eating. She was diagnosed as chronic gastritis and healing stage of duodenal ulcer and prescribed H₂-blocker. However, this medicine did not work.We diagnosed that upper abdominal discomfort in all the patients came from shitsu-jya (pathogenic dampness) in hii (Spleen-Stomach functional unit), and treated them with Heiisan, which was popular to remove shitsu-jya in Hii. Their symptom disappeared soon after taking this medicine.It is also difficult for hemodialysed patients to control their weight due to anuria and they tend to easily gain the weight due to inappropriate eating and drinking, leading to shitsu-jya in such patients. Therefore, our reports suggested that Heiisan was good for hemodialysed patients to control various upper abdominal symptoms that might be caused by shitsu-jya in Hii.

Renal plasma flow (RPF) and glomerular filtration rate (GFR) are decreased in patients with heat stroke. Heat stroke after prolonged exercise under high temperatures is usually associated with hypotension and dehydration, leading to decreased RPF. However, whether renal blood flow (RBF), RPF, and GFR are increased or decreased during immersion in mild warm water remains unknown.
Para-aminohippurate clearance (C_PAH), sodium thiosulfate clearance (C_thio), and creatinine clearance (C_cr) were determined in 14 healthy men aged 19 to 27 years old (mean±SD, 22±2), 161 to 181cm (171.5±6.3) tall, and weighing 52 to 78kg (64.2±7.4) without immersion at about 25°C (room temperature) and during immersion in water at 41±0.5°C.
C_PAH, C_thio, and RBF significantly increased during immersion compared with those without immersion (P<0.0001, P<0.03, P<0.0001, respectively). C_cr did not change (P=0.108). The filtration fraction (FF) was significantly decreased (P<0.001). Levels of plasma atrial natriuretic peptide, aldosterone, anti-diuretic hormone and renin did not significantly differ between these two conditions.
This investigation suggests that daily immersion at 41°C is beneficial for renal function.

Purpose: A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods: We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared. Results: The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Along with clinical practice and education, research is among the most important activities for medical doctors. The same is true in cardiovascular surgery: Young cardiovascular surgeons are expected to improve their surgical techniques and prioritize their clinical practice. However, their perspective on the role of research in their field of expertise is unknown. Therefore, we conducted a survey of and discussion with young cardiovascular surgeons to clarify their thoughts and concerns about performing research. Here we review and report the survey and discussion results.

BACKGROUND/AIMS: Sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) has a potent effect on internal hemorrhoids. In this retrospective study, we compared the effects of endoscopic ALTA therapy and standard ALTA therapy.METHODS: We investigated patients who underwent treatment for internal hemorrhoids at our institution between 2014 and 2016. They were divided into a standard ALTA group (n=33, treated using proctoscopy) and an endoscopic ALTA group (n=48). We compared the clinical findings between the 2 groups.RESULTS: There were no intergroup differences in background factors. The mean ALTA dose was 21.9±7.2 mL and 17.8±3.4 mL in the standard and endoscopic ALTA groups, respectively (p<0.01). Adverse events occurred in 4 patients (12.1%) from the standard ALTA group and 6 patients (12.5%) from the endoscopic ALTA group. In both groups, the patients reported good satisfaction with the therapeutic effect at 1 month after the procedure. Hemorrhoids recurred in 2 patients (6.3%) from the standard ALTA group and 4 patients (8.3%) from the endoscopic ALTA group.CONCLUSIONS: Endoscopic ALTA sclerotherapy is equivalent to standard ALTA therapy in terms of efficacy, adverse events, and recurrence. Therefore, it is a useful non-surgical option for patients with internal hemorrhoids who prefer a less invasive treatment.
Aluminum ; Endoscopy ; Hemorrhoids ; Humans ; Potassium ; Recurrence ; Retrospective Studies ; Sclerotherapy ; Tannins

Methods: A total of 224 consecutive patients with OVFs aged ≥65 years who received treatment within 2 weeks after the occurrence of injury were enrolled. The patients were followed up for 6 months thereafter. The criteria for evaluating the degree of independence were applied to evaluate ADLs. Multivariable analysis with a logistic regression model was performed to evaluate the risk factors for ADL decline. Results: In total, 49/224 patients (21.9%) showed a decline in ADLs. Of these, 23/116 patients (19.8%) in the rest group and 26/108 patients (24.1%) in the no-rest group experienced a decline in ADLs. In the logistic regression analyses, a diffuse low signal on T2- weighted magnetic resonance imaging (MRI) (odds ratio, 5.78; 95% confidence interval, 2.09–16.0; p=0.0007) and vertebral instability (odds ratio, 3.89; 95% confidence interval, 1.32–11.4; p=0.0135) were identified as independent factors in the rest and no-rest groups, respectively. Conclusions In patients with acute OVFs, a diffuse low signal on T2-weighted MRI and severe vertebral instability were independently associated with ADL decline in patients treated with and without initial bed rest, respectively.

Objective: The clinical course of human metapneumovirus (hMPV) infection is similar to that of coronavirus 2019 disease (COVID-19). However, community-acquired hMPV infections in adults have not yet been sufficiently investigated. We examined the detection status of hMPV antigens and the clinical features of positive patients during the first wave of COVID-19, which coincided with the epidemic season of hMPV infection in Japan.Methods: In this cross-sectional, observational, and single-center study, we recruited consecutive individuals who visited the Japan Agricultural Cooperatives Kochi Hospital due to fever, respiratory symptoms, or close contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected persons during the period from January to May 2020.Results: The positive rate of immunochromatography for hMPV antigens from nasopharyngeal swabs was 9.5% (4/42), and four positive cases were community-acquired pneumonia (CAP) (5.3% of all CAP). The positive rate of hMPV antigens in the CAP group (30.8%, 4/13) was higher than that in the non-pneumonia group (0.0%, 0/19) (p < 0.05). The average age of the four adult patients with CAP was 69.8 years (range 35–93). Mean white blood cell counts and C-reactive protein blood levels were 6,250 cells/μL (3,500–12,180) and 4.30 mg/dL (4.05–7.04), respectively. Chest computed tomography images were diverse and two patients showed dense consolidation. No multi-organ disorder was noted during the clinical course in any of the four cases, and their prognoses were good.Conclusion: hMPV infection may be considered in the differential diagnosis of COVID-19 and CAP in Japan under the preventive measures for SARS-CoV-2 infection, at least during the epidemic season of hMPV infection.