To assess the effects of Byakko-ka-ninjin-to on thirst and body weight gain in chronic hemodialysis patients with excessive interdialytic body weight gain, 8 patients (4 men and 4 women, ranging in age from 47 to 75) were prescribed Byakko-ka-ninjin-to extract tablets, 6-12 tablets per day, for 10 weeks. In 4 of the patients, thirst symptoms improved, resulting in significant reduction of interdialytic weight gain. This effect continued to be significant even after cessation of the agent. In the cases of 4 patients whose thirst symptoms did not improve, interdialytic weight gain was not reduced either during or after treatment. For all 8 patients, there were no significant changes in cardiothoracic index, and no adverse effects or events were observed either during or after treatment. Significant reduction in interdialytic weight gain was observed only in the patients with reduced thirst, which suggests that Byakko-ka-ninjin-to allows patients to limit their weight gain by drinking less. These results suggest that Byakko-ka-ninjin-to could be a useful and safe agent to reduce excessive interdialytic body weight gain, at least in a significant cohort of chronic hemodialysis patients.

Objective : To provide efficient medical care to patients taking warfarin by developing a system for sharing prothrombin time-international normalized ratio (PT-INR) monitoring data between clinic and pharmacy ; and to verify the functionality of this system.
Methods : Before a clinic appointment, patients visited a pharmacy to self-monitor PT-INR levels with the rapid measuring device Coagucheck. Pharmacists noted the following on a form shared between the clinic and the pharmacy : 1) compliance, 2) side effects, 3) diet, and 4) PT-INR. On the basis of this information, they noted their opinions on the appropriate warfarin dose. Each patient submitted the form to the clinic doctor, who then prescribed warfarin on the basis of the information recorded. After the consultation, the patient took this prescription to the pharmacy to obtain the required medication, and received from the pharmacist the dosage information based on the doctor's instructions. Thus, the sequence of the patient's visits was pharmacy-clinic-pharmacy.
Results : From one pharmacist's report, it was apparent that one patient whose PT-INR level was outside the target range was occasionally skipping a warfarin dose because of a misunderstanding about the treatment. The pharmacist recorded the patient's information on the form to inform the doctor. After consultation with the doctor, the pharmacist gave a detailed explanation on the purpose of taking warfarin. As a result, patient compliance improved and the PT-INR reached the target level after one month.
Discussion : Development of this system revealed that patients can receive appropriate warfarin treatment when information on PT-INR becomes available during clinical consultation and compliance is achieved. The system for sharing the patient's self-monitored PT-INR data between clinic and pharmacy is considered beneficial for the patient.

Incidence of glycyrrhiza-induced pseudoaldosteronism is not well understood. We examined relationships between pseudoaldosteronism incidence and daily glycyrrhiza dose in previous clinical studies. The incidence in patients administered glycyrrhiza 1 g/day was 1.0% (mean). The incidence with 2 g/day, 4 g/day and 6 g/day were 1.7% (mean), 3.3% and 11.1% (mean), respectively. Thus a dose-dependent trend toward pseudoaldosteronism incidence was suggested by previous literature.

Some serious infections due to Group A streptococci (Streptococcus pyogenes, GAS) manifest as primary peritonitis, which traditionally and commonly leads to the selection of laparotomy for initial treatment. We encountered a case in which laparoscopic surgery proved effective in treating primary peritonitis due to GAS. The patient was a 30-year-old woman transported via ambulance to our hospital with complaints of fever, abdominal pain, diarrhea, and vomiting on day 5 after a miscarriage. Diagnostic laparoscopy was performed under a presumptive diagnosis of acute generalized peritonitis. Accumulation of purulent ascites was found in the peritoneal cavity, but no primary lesion was identified. Peritoneal lavage and drainage were performed, and the surgery was concluded. Postoperatively, GAS were detected in blood, ascites, and vaginal discharge cultures, and primary peritonitis due to GAS was diagnosed. Antibiotics were switched to ampicillin sodium and clindamycin phosphate, and her condition started to improve. When primary peritonitis due to GAS is suspected, laparoscopic surgery can be considered for initial treatment.

Ulcerative colitis (UC) is 1 of the 2 major phenotypes of chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms that impair function and quality of life. Further, IBD often affects women during childbearing age. Indeed, UC activity frequently increases during pregnancy, and the medications used to induce remission may adversely affect the health of the mother and the unborn child. We report successful induction of a remission in a UC case who experienced a flare-up in the first trimester of pregnancy. Upon relapse, she was treated with steroids and adsorptive granulomonocytapheresis (GMA) with the Adacolumn plus tacrolimus. This combination therapy induced a stable remission that was maintained during her entire pregnancy. She gave birth to a healthy child at 36 weeks of pregnancy with no maternal or fetal complications. Our experience indicates that GMA, as a non-drug therapeutic intervention with a favorable safety profile, plus tacrolimus might be a relevant treatment option for patients with active IBD during pregnancy. A future study of a large cohort of pregnant patients should strengthen our findings.
Child ; Cohort Studies ; Colitis, Ulcerative* ; Female ; Humans ; Inflammatory Bowel Diseases ; Mothers ; Parturition ; Phenotype ; Pregnancy Trimester, First ; Pregnancy* ; Quality of Life ; Recurrence ; Steroids ; Tacrolimus* ; Ulcer*