It is well known that haloperidol is effective in the management of nausea and vomiting in cancer patients and that midazolam is used for inducing sedation in patients with delirium. Both the drugs are frequently used in a clinical setting, but there have been only few reports thus far on the concomitant administration of these 2 drugs. We report the case of a patient with massive ascites due to peritoneal carcinomatosis who had severe nausea and vomiting and went into a delirious state. This patient received a concomitant continuous infusion of haloperidol and midazolam for the management of these symptoms. Both haloperidol (up to 1.87mg/h) and midazolam (up to 1.87mg/h) were infused intravenously. For about 20 days, the nausea, vomiting and delirium were well under control without the development of any life threatening toxicities. Concomitant haloperidol and midazolam infusion was found to be a safe and effective therapy for the management of nausea and vomiting in the patient. Palliat Care Res 2009; 4(1): 312-316

Opioids are potent analgesics mostly used for severe cancer and chronic noncancer pain. However, their efficacy and safety in acute noncancer pain are debatable. We describe the case of an 82-year-old male with severe back pain due to bacteremic Staphylococcus aureus spondylitis and paravertebral abscess. Pain in such cases is usually controlled by non-steroidal anti-inflammatory drugs (NSAIDs). However, this patient was administered morphine (oral, then intravenous; up to 23 mg/day) because acetaminophen and NSAIDs did not ameliorate pain. Considerable pain relief was achieved without toxicity, and the dose of morphine was tapered through 35 days. No symptoms of addiction or withdrawal were observed during or after this 35-day period. Thus, morphine appears to be safe and effective in the management of severe, acute noncancer pain in patients with bacterial spondylitis. Palliat Care Res 2010; 5(2): 327-331

Scientific elucidation of “oketsu (blood stasis)” states is very important to understanding the diagnostic methods of oriental medicine. We investigated the correlation of blood fluidity to oketsu states, by micro channel array flow analyzer (MC-FAN). Twenty-seven female patients were divided into three groups: a non-oketsu group, a mildly affected group, and a severely affected group according to the diagnostic criteria of their oketsu syndrome. Immediately after collecting their venous blood, whole blood passage time was measured by MC-FAN. And we compared and investigated the correlation with degree of oketsu state, diagnostic criteria and changes of whole blood passage time after the administration of ku-oketsu drugs. As a result, whole-blood passage time of the mildly affected group and the severely affected group were significantly longer than that of the non-oketsu group, while the [an] improvement of blood fluidity was observed after medication. This study confirms that reduced blood fluidity is seen using MC-FAN in oketsu states, and that ku-oketsu drugs are able to improve these states.

A 54-year-old woman complained of prolonged fever. Echocardiography showed severe mitral regurgitation with vegetation, and computed tomography showed right coronary artery (RCA) fistula to the coronary sinus (CS). Blood culture revealed Strep. viridans, thus a diagnosis of active infective endocarditis was established. The patient underwent urgent surgery. Surgical findings showed that vegetation was located in A3 to P3 of the mitral valve. The patient underwent mitral valve repair using a glutalualdehyde-treated autologous pericardial patch and artificial chordea. Epicardial ligation for fistula was performed. Her postoperative course was uneventful.

[Objective] Physical exercises raise more or less body temperature. A body temperature is regulated constantly generally by homeostasis mechanism. Perspiration is only heat radiation mechanism under high temperature environments. And sudoriferous water is supplied from blood. Blood flow is determined by blood fluidity, blood volume and the cardiovascular system. It was reported that strong stress decreased blood fluidity.In this experiment, we investigated the relation between blood fluidity and water supply in rats loaded with forced exercise in high temperature environment.[Methods] SPF male Wistar rats weighing 150 g were used. All animals were put in high temperature environment (Wet Bulb Globe Temperature; WBGT: 28°C) through whole experimental period. In a group of water supply, distilled water was served before and later exercise by sonde forcibly. The rats were divided into five groups randomly; Rest-Non water intake (RN), Rest-Water intake (RW), Exercise-Non water intake (EN), Exercise-Water intake (EW) and Baseline (B). The blood was collected before or later of exercise and blood fluidity or platelet aggregation was measured.[Results] In the EN, platelet aggregation, lactic acid and corticosterone increased while blood fluidity were decreased significantly compared with the RN, RW and EW. In addition, the hematocrit did not increase even if water equivalent to 8 % of body weight lost it.[Conclusion] We speculate that exercise in high temperature environment decreases blood fluidity. However, the water supply that does not completely make up for quantity of depletion in exercise may improve blood fluidity.

[Objective] Perspiration is almost only heat radiation mechanism under high temperature environments. And sudoriferous water is supplied from blood. Blood flow is determined by blood fluidity, blood volume and the cardiovascular system. It was reported that strong stress decreased blood fluidity.In this experiment, we investigated the relation between blood fluidity and water supply in rats loaded with forced exercise in high temperature environment.[Methods] SPF male Wistar rats weighing 250g were used. All animals were put in high temperature environment (Wet Bulb Globe Temperature; WBGT: 28°C) through whole experimental period. The rats were divided into four groups randomly; Suitable temperature environment-Exercise-Non water intake (SEN), High temperature environment-Exercise-Non water intake (HEN), High temperature environment-Exercise-Water intake (HEW) and Baseline (BL). In a group of water supply, distilled water was served before and later exercise by sonde forcibly. The blood was collected before or later of exercise and blood and erythrocyte suspension fluidity were measured.[Results] In the HEN, hydroperoxides, blood sodium, lactic acid and adrenaline increased while blood and erythrocyte suspension fluidity were decreased significantly compared with the BL. In addition, the hematocrit did not increase even if water equivalent to 4% of body weight lost it.[Conclusion] We speculate that exercise in high temperature environment decreases blood fluidity. However, the water supply in exercise that might not be sufficiently improve blood fluidity.

A 81-year old woman had hypertensive heart failure. She had a history of intermittent claudication for 5 years. Her ankle brachial pressure index (ABI) was 0.53 on the right and 0.58 on the left side. Coarctation of the descending aorta with severe calcification was found by a whole body CT. After medical therapy for heart failure, axillo-bifemoral artery bypass using an 8 mm ringed expanded polytetrafluoroethylene (ePTFE) graft was performed. Postoperatively, ABI improved to 0.83 on the right and 0.87 on the left side. The patient is doing well without any signs of heart failure or intermittent claudication. Although it is a palliative operation, axillo-bifemoral artery bypass is an effective and less-invasive procedure and appropriate for elderly patients.

Yokukansan (YKS), one of the traditional Japanese “Kampo” medicines, is a mixture of extract powders from seven kinds of medicinal herbs (Atractylodis Lanceae Rhizoma, Hoelen, Cnidii Rhizoma, Uncariae Uncis Cum Ramulus, Angelicae Radix, Bupleuri Radix, and Glycyrrhizae Radix). YKS has been administered to fragile habitus patients who show symptoms such as emotional irritability, neurosis and insomnia, and to infants who suffer from night crying and convulsions. In recent years, YKS has been reported to be effective against pain disorders such as headache and chronic pain, but the mechanism underlying these beneficial effects is still unclear. In this study, the effect of YKS on chronic inflammatory pain and stress caused by pain were investigated using rats with adjuvant arthritis.
Male Wistar rats were injected with complete Freund's adjuvant into the plantar surface of the right hindpaw, and then pain thresholds and stress markers were measured. The thermal pain threshold measured with the plantar test significantly decreased, and the level of salivary chromogranin A (CgA), which is used as a mental stress marker, was significantly increased in this model. The administration of YKS controlled the activation of spinal microglia involved in the expression of chronic pain, and significantly reduced a decrease in the pain threshold. Moreover, an increase in the level of salivary CgA was significantly inhibited. The authors concluded that YKS has effects in reducing chronic inflammatory pain and the stress caused by pain.

It has been reported that the effect of shoseiryuto, a traditional Japanese “Kampo” medicine, on allergic rhinitis depends on several mechanisms. Previously, we reported that shoseiryuto administered in an allergic rhinitis rat model, inhibited increases of substance P (SP) and calcitonin gene-related peptide (CGRP) in the nasal mucus, which in turn are involved in the exacerbation of rhinitis symptoms and allergic symptoms. In the present research, we looked into whether the secretion of SP and CGRP are directly inhibited by the administration of shoseiryuto.
Histamine solution 5µl (10 mg/ml) was instilled in both nostrils of healthy, male SD rats, thereby inducing allergic symptoms, and for the group to which shoseiryuto had been pre-administered, increase in the concentration of SP and CGRP in the nasal mucus was significantly inhibited. Moreover, upon investigating SP and CGRP production in the trigeminal ganglia by means of immunostaining, it was found to be similarly significantly inhibited. The above results indicate that shoseiryuto directly inhibits the secretion of SP and CGRP in the C-fibers of nasal mucosa.

Objective: In general, antiallergic drugs, steroids, and autonomic drugs are administered for patients with allergic diseases, but the chronic administration of these medicines may occasionally induce side effects. As such, several complementary and alternative medicine (CAM) are used, even though their effectiveness has not been established by a significant amount of evidence. Health food, herbal medicines, herbal tea, and aromatherapy, etc., are used for the treatment of allergic rhinitis (AR) as CAM. Rosmarinic acid is a type of polyphenol, and is reported to have antiallergic, antioxydative and anti-inflammatory properties. Rosmarinic acid is included in Perilla Herbs, which are used in health foods and herbal medicines (Kampo medicines), Rosemary and Lemon balm, which are used as herbal teas and essential oils of aromatherapy. This study was performed to evaluate the effect of rosmarinic acid on AR using AR model rats.
Methods: Six-week-old male Sprague-Dawley rats were sensitized with toluene 2,4-diisocyanate (TDI) to induce AR. Rosmarinic acid (1 mg/kg i.p. or 3 mg/kg i.p.) is administrated for 21 days. On day 22, the symptom of nasal allergy was evaluated by counting the number of sneezes within 10 minutes. Substance P (SP), calcitonin gene-related peptide (CGRP) and nerve growth factor (NGF) in the nasal lavage fluids were also measured.
Result: SP and CGRP take part in the exacerbation of rhinitis symptoms, and are secreted from the nerve ending following nerve stimulation by chemical mediators such as histamine. The administration of Rosmarinic acid had no effect on NGF, but significantly suppressed increases of sneezes, SP and CGRP dose-relatedly. Conclusion: Rosmarinic acid could control the symptom of nasal allergy, and one of the mechanisms was suppressing of the secretion of SP and CGRP.