Schamberg disease is a subtype of idiopathic pigmentary purpura, which manifests with petechiae. It is assumed to be caused by venous microcirculatory disturbance, or an immunological and allergic mechanism. We report a 55-year-old Japanese male with Schamberg disease successfully treated with keishibukuryogan prepared at a hospital pharmacy. The patient had purpuric eruptions in his both lower legs at first, and brownish pigmentation enlarged with purpura. A dermatologist had diagnosed this, from the clinical findings, as Schamberg disease. We administered keishibukuryogan to the patient because his pathological condition was considered as oketsu. In order to improve effectiveness, keishibukuryogan was manufactured according to our own modification. The eruptions have reduced gradually, and about four months later, have mostly resolved. A Kampo therapy utilizing unseiin has been reported to be effective against idiopathic pigmentary purpura in previous studies. We suggest that a Kampo treatment with keishibukuryogan seems to be effective against idiopathic pigmentary purpura through improvements of microcirculation and inflammation.

There have been an apparent trend in the decline of back-lift strength of young people during recent years. The purpose of this study was to investigate the cause-effect relationship of such a trend using young peoples and university students. In order to examine the characteristics of activities in the lumber back muscles during various physical activities, the surface electromyography (EMG) was obtained from the trapezius, latissimus dorsi, and elector spinae muscles for individuals with poor back-lift strength (5 male children and 4 university male students) and individuals with relatively strong back-lift strength (5 male children and 2 male university students) . The children with poor back-lift strength had significantly less EMG activities in both the trapezius and elector spinae muscles during the measurement of back-lift strength using a dynamometer than the strong back-lift strength children. The former children also had a less EMG activities in elector spinae muscle and a greater EMG activities in trapezius muscle during cycling the bicycle elgometer. Such a trend became more distinct when the load was increased. The university students with poor back-lift strength had a less EMG activity in the elector spinae muscle during the measurement of back-lift strength than those with strong back-lift strength. During running, there was not a distinct difference in the EMG activities of the muscles in the back between the poor and strong strength students. However, as the running speed increased, a greater EMG activity in the trapezius muscle or the latissimus dorsi muscle were observed for the poor back-lift strength students than the stronger back-lift strength students.
These results indicated that the individuals with poor back-lift strength relied more on the upper portion of the back muscle group than the lower portion of the back muscle group during both static and dynamic activities, suggesting that the trend in the decline of back-lift strength of children and students was due to a lack of opportunity to use the lower back muscles in the daily physical activities.

The relationship between bone strength and bone quality in rats fed with a low-magnesium (low-Mg) diet was examined. Twenty four-week-old male Wistar rats were divided into a control group (n = 10) and a low-Mg group (n = 10). Each group was fed with a conventional diet or a low-Mg diet (Mg, 6 mg/100 g diet) for 8 weeks, respectively. After the rats were sacrificed, bone strength, bone mineral content (BMC) and three-dimensional (3D) trabecular structure of the lumbar vertebra were measured, respectively. The results showed that the values of the BMC were almost the same between the control and the low-Mg diet groups. On the other hand, the bone strength of the low-Mg diet group was significantly lower than that of the control group (p < 0.01). 3D trabecular structure analysis showed a significant decrease (p < 0.05 or 0.01) in the trabecular structure of the low-Mg diet group as compared to the control group. These findings suggest that the bone strength in this model is not affected by the BMC but is strongly affected by the trabecular structure. The low-Mg diet model is considered to be an excellent model for examining bone quality.

From January 1982 to August 1993, 23 cues of advanced renal cell carcinoma with tumor thrombus in the inferior vena cava (IVC) were treated surgically. In terms of clinical stage, 12 cases were in stage III and 11 cases were in stage IV. The 23 cases were divided into three groups according to the location of the tumor thrombus in the IVC. In two cases, the tumor thrombus extended to near the right atrium or the hepatic vein, and in six cases, the thrombus extended to the hepatic IVC. All these tumor thrombus with invasion to the IVC wall were removed under partial cardiopulmonary bypass. In 15 cases, tumor thrombus were limited to near the junction of the renal vein, which were removed by balloon catheter or finger after clamping of proximal and distal side of IVC and renal vein. Direct suture of the IVC wall in 12, patch repair with EPTFE in 10 and graft replacement with EPTFE graft in 1 were performed. Eight patients who had distant metastasis, regional lymph node metastasis and extracapsular invasion died within one year, but 4 patients were alive more than four years. Survival rate at three years and five years according to the Kaplan-Meier method was 37.5% and 18.8%, respectively. In conclusion 1) partial cardiopulmonary bypass was useful and could control bleeding when tumor thrombus in the IVC extended to the junction of the hepatic vein or right atrium. 2) long term survival cases were recognized in cases with no distant metastasis, no regional lymph node metastasis and no extracapsular tumor invasion. 3) nephrectomy associated with tumor thrombectomy in the IVC was valuable on the basis of long-term prognosis.

At the request of the gynecology deparment, ten patients who were suffering from edema of the legs after undergoing radical operative hysterectomy and radiotherapy were treated with a combination of Oriental medical therapies, namely acupuncture, moxibustion and ‘Toeki’ (a form of internal treatment more commonly known as Kampo formulas, or decoctions of combinations of crude drugs). The average patient age was 54±3.7 years of age and the average morbid period was 180 days.
Although this therapy did not appear to produce any remarkable change in the leg diameter (measured at the thigh, largest diameter of the crus and leg joints), relief from subjective symptoms such as pain associated with the swelling (swelling pain), muscle stiffness and improved bowel function were evident.
These findings indicate that Oriental medical treatment has therapeutic value for alleviating the patients' discomfort and improving the quality of life.

We did Oriental medical treatment to intractable atopic dermatitis patients. The number of cases is twenty. We divided them into two groups, namely the group of the combined treatment of acupuncture and “Toeki” (internal remedy), the “Toeki” treatment group, and compared the effective rates of the two. The combined treatment of acupuncture and “Toeki” is effective in seven cases out of eirht, and the effective rate is 88%, while the “Toeki” treatment is effective in eight out of twelve, and the effective rate is 67%. We think that both of the combined treatment of acupuncture and “Toeki” and “Toeki” treatment are both effective, but that the former is more effective than the latter.

Introduction: This study aimed to survey patients on polypharmacy regarding their own intention and inclination to reduce medication use, and their subjective understanding of drug effectiveness and side effects. We aimed to contribute to the establishment of an information base to address polypharmacy.Methods: We enrolled 100 adult patients who had been admitted and administered ≥ 5 oral medications. A questionnaire was utilized to assess their willingness and inclination to reduce their medications, as well as their subjective understanding of drug effectiveness and side effects.Results: Sixty-two patients expressed an intention to reduce their medication use, citing reasons including medication management, drug combinations, and side effects. The proportion of patients with this intention increased as the number of prescribed medications increased. Of the 38 individuals who responded that they had no intention of reducing their medication, 21 (55.3%) cited the reason as being that they received the prescription from a physician. The level of understanding about the effectiveness of their own medications was significantly lower among those aged ≥ 75 years. However, the level of understanding of side effects did not vary based on age or number of prescriptions.Conclusion: To promote the optimization of prescriptions, it is necessary to ascertain patients' intentions, and the relationship between patients and prescribing physicians.

Liver metastases from colorectal carcinoma commonly form nodular lesions in the liverparenchyma. We report a case of liver metastasis from rectal adenocarcinoma that extendedpredominantly into the bile duct. A 62-year-old Japanese man underwent low anteriorresection for rectal adenocarcinoma 9 years ago. Approximately 3 years later, he underwentradiofrequency ablation therapy for a metastatic liver tumor. Nine years after surgery, atumor in liver segment III exhibiting intrabiliary extension was discovered; it wasunclear if this was a metastatic liver tumor or intrahepatic cholangiocarcinoma.Accordingly, we performed a left hepatectomy with lymph node dissection. The tumor wasnegative for cytokeratins 7 and 20, and was histologically similar to the primary rectaladenocarcinoma; it was diagnosed as rectal carcinoma metastasis. The patient has survivedfor 3 years after the hepatic surgery, for 9 years after radiofrequency ablation therapy,and for 12 years after the primary surgery. This case shows that liver metastasis fromcolorectal carcinoma can present as a predominantly intrabiliary growth that mimicsintrahepatic cholangiocarcinoma on imaging. Moreover, our case provides evidence for thesuperiority of anatomical hepatectomy over partial hepatectomy for metastatic liver tumorswith intrabiliary growth arising from rectal adenocarcinomas.

We studied the mechanism for slowing surface electromyography (EMG) during fatiguing contraction using superimposed M-wave analysis. Seven healthy male subjects exerted 60% maximum voluntary contraction of isometric abductions in the left first dorsal interosseous muscle (FDI) until exhaustion. Simultaneously with voluntary contractions, the ulnar nerve was electrically stimulated at supramaximal intensity, and volitional EMG and superimposed M-waves were obtained. We examined the behavior of muscle fiber conduction velocity (MFCV) and median frequency (MDF) for both EMG, with the following results:
1) MFCV calculated from volitional EMG of FDI was about 6 m/s during 60% MVC.
2) The waveform of voluntary EMG detected from FDI slowed in all subjects during fatiguing contraction at 60% MVC, indicating fatigue had developed in the muscle.
3) As fatigue progressed, the waveform of the superimposed M-wave tended to decrease in amplitude and increase in duration.
4) As fatigue progressed, MDF and MFCV in volitional EMG decreased significantly (p<0.04) . The rate of change was larger in MDF than in MFCV (p<0.01) .
5) As fatigue progressed, MDF and MFCV in the superimposed M-wave decreased significantly (p<0.01) . The rate of change was larger in NIDF than in MFCV (p<0.05) .
These results suggested that MFCV and other peripheral factors affected the slowing of volitional EMG. Elongation of the depolarization zone in muscle fiber is proposed as a peripheral factor.

The purpose of this study was to examine the effects of short-term immobilization on the maximum voluntary contraction (MVC) force. The first dorsal interosseus (FDI) of 10 healthy male adults was immobilized for 1 week using casting tape. Atrophy of the muscle was estimated from a cross sectional view of magnetic resonance images (MRI) . To clarify the factors of a peripheral neuromuscular system contributing to the change in the MVC force, twitch force at rest was measured. The contribution of central factors was estimated from a voluntary activation (VA) index, which was obtained by the twitch interpolation method.
The MRI showed no significant changes in the cross sectional area. The MVC force declined after immobilization (p<0.01), and recovered after 1 week from the termination of immobilization (p<0.01) . Both the twitch force at rest and the VA at MVC declined after immobilization (p<0.01), and recovered after 1 week (p<0.05) .
The results indicate that the temporary decline of the MVC force was not accompanied by atrophy of the muscle. Furthermore the decline of the MVC was caused both by the deterioration of peripheral and central functions in the neuromuscular system. Possible factors in the peripheral and central neuromuscular systems affected by the immobilization were discussed.