We report a case of a 74-year-old male with hyponatremia complicated with small cell lung cancer. His hyponatremia worsened even with water restriction. Oral administration of sodium was difficult because of nausea and vomiting. We recognized this patient as having illness caused by excessive water accumulation within the body, and so prescribed goreisan 7.5 g/day to treat his hyponatremia. His hyponatremia improved after the administration of goreisan. Later his hyponatremia deteriorated while being administered of meloxicam, a cyclooxygenase-2 inhibitor. This case suggests that goreisan might inhibit water reabsorption by antidiuretic hormone at the collecting duct of the kidneys via stimulation of prostaglandin synthesis.

[Objective]Using cotton to cover needle shafts when removing acupuncture needles is recommended in order to prevent blood contamination. However, the effect of risk reduction has not been confirmed by experimental studies. We, therefore, observed spreads of fluorescent agent, assumed as blood, with or without alcohol cotton to avoid direct contact between fingers and needle shaft.
[Methods]Subjects were two blind acupuncturists and two acupuncture students. We asked them to insert acupuncture needles to people who played a role of a patient. Of the five acupoints needled, we put the fluorescent agent to one point, and asked the subjects to remove the needles. After all the needles were removed, we took photographs of all points needled and the subjects'hands in order to assess the spread of the fluorescent agent. 'We performed two sessions. In Session A, the subjects used alcohol cotton to cover a needle shaft so that their fingers did not contact the needles directly. In Session B, they did not use alcohol cotton. The subjects were not told that we used the fluorescent agent.
[Results](1) In the forearm of those who were needled, adhesion of the fluorescent agent was not seen in three out of four subjects, in Session A. (2) In two of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-supporting hands was smaller in Session A compared with Session B. (3) In three of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-stimulating hands was smaller in Session A compared with Session B.
[Conclusion]It is suggested that covering needle shaft with alcohol cotton during needle withdrawal suppresses the spread of blood contamination.

We report five cases of acute hyperventilation attack, with bilateral fullness of the chest and hypochondrium, and bilateral rectus abdominis muscle strain, that were successfully treated with shigyakusan. Case 1 was a 47-year-old female ; case 2 was an 18-year-old female ; case 3 was a 23-year-old female ; case 4 was a 39-year-old male ; and case 5 was a 40-year-old male. All five patients visited the emergency department with complaints of severe dyspnea and tetany. Their abdominal signs were characteristic, with remarkable bilateral fullness of the chest and hypochondrium and bilateral rectus abdominis muscle strain. In cases 1 to 4, the patients were given 2.5 g of shigyakusan extract, and their symptoms promptly improved. In case 5, as the patient could not swallow the prescribed medication at presentation, intramuscular diazepam was given. Thereafter, he complained of continuous severe numbness ; we subsequently gave him shigyakusan, and his numbness promptly improved. In conclusion, shigyakusan seems to be a useful Kampo drug for the treatment of acute hyperventilation attack.

1) The objectives of author's present study were 42, 245 patients with ratio of males to females of 7 to 3 in 44, 327 affected locations, covering the period of 23 years from the December of 1956 to the end of March of 1979.
2) All the injuries thus treated can be classified into 18, 815 (42.5%) of sprains, 11, 838 (26.7 %) of fractures, 9, 650 (21.8%) of lacerations, 2, 812 (6.4%) of contusions, 752 (1.7%) of dislocations and 460 (1.0%) of others.
3) Looking from auther's statistical study of the ski injuries in the past 23 years, the development of the ski equipments have largely effected on the ski injuries.
4) The lacerations on the head, face and arm are increased when the safety bindings have come into wide use. So, we expect the effect of the ski-stopper replacing the strap, in order to decrease the lacerations.
5) Injuries of the ankle have been decreased because of the plastic ski boots. Especially, “the ski fractures”, or, the abducted and external rotated fractures of the lateral malleolus are decreased remarkably.
6) The knee sprains, or, the ligamentous strains of medial colateral ligament of knee joint have been increased, because the stiff and high backed plastic ski boots have come into wide use.
7) Fractures of the lower legs and boot top fractures have been increased, according the development of the ski boots, such as from the leather boots to buckled boots to plastic boots.

We studied whether exercise fatigue affects somatosensorv input using somatosensory evoked potential (SEP) . Sixteen subjects performed intermittent grip strength exercises with muscle fatigue while ignoring electrical stimulation given to an elbow. We induced SEP in the exercise task (during contraction) in every stage (first stage, middle stage and final stage) . In addition, we induced SEP in the exercise task during relaxation in the first stage and final stage. As a result, the early component amplitude of SEP decreased with the progress of exercise (manifestation of muscle fatigue) during contraction and relaxation. Our findings suggested that somatosensory input decreased with the manifestation of muscle fatigue. Somatosensory input is necessary for control of voluntary movement. Therefore, we speculate that these factors play a role in decreased performance of athletes competing in long-duration events.

The purpose of this study was to observe the effect on the change of heart rate and respiratory function by four kinds of different stimulation. We applied low frequency stimulation (1-30Hz) to 15 healthy volunteers. Each subject received stimulation at both 1Hz and 30Hz on Hegu (LI4)/Kong zui (L6) and rhomboids muscles.
The results indicated that a 1Hz current injection on the rhomboids muscle was the most effective for the respiratory function. An increase in the forced vital capacity (FVC) and the forced expiratory volume in one second (FEV1), and a decrease in the peak expiratory flow (PF) were observed. The change showed a similar tendency to that of a 1Hz stimulation to the rhomboids muscles of the patients wish asthma. This results suggests that the clinical application of acupuncture stimulation is feasible for respiratory diseases.
We also observed a correlation between the respiratory function and the autonomic function of heart on the 30Hz stimulation using points Hegu (LI4) and Kong zui (L6).

PURPOSE: Atrial natriuretic peptide (ANP) has a variety of pharmacologic effects, including natriuresis, diuresis, vasodilatation, and suppression of the renin-angiotensin system. A recent study showed that ANP infusion improved hypoxemia and pulmonary hypertension in a lung injury model. On the other hand, the pulse contour cardiac output (PiCCO(TM)) system (Pulsion Medical Systems, Munich, Germany) allows monitoring of the intravascular volume status and may be used to guide volume therapy in severe sepsis and critically ill patients. MATERIALS AND METHODS: We treated 10 pulmonary edema patients without heart disease with human ANP (HANP). The patients were divided into two groups: a group with normal Intrathoracic Blood Volume (ITBV) (900-1100 mL/m2) (n = 6), and a group with abnormal ITBV (n = 4), as measured by the PiCCOtrade mark device; the extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI) in the two groups were compared. RESULTS: The average patient age was 63.9 +/- 14.4 years. The normal ITBV group showed significant improvement of the EVLW (before, 16.7 +/- 2.7 mL/kg; after, 10.5 +/- 3.6 mL/kg; p = 0.0020) and PVPI (before, 3.2 +/- 0.3; after, 2.1 +/- 0.7; p = 0.0214) after the treatment. The abnormal ITBV group showed no significant improvement of either the EVLW (before, 16.3 +/- 8.9 mL/kg; after, 18.8 +/- 9.6 mL/kg; p = 0.8387) or PVPI (before, 2.3 +/- 0.8; after, 2.7 +/- 1.3; p = 0.2782) after the treatment. In both groups, the EVLW and PVPI were strongly correlated with the chest X-ray findings. CONCLUSION: We conclude that HANP supplementation may improve the EVLW and PVPI in pulmonary edema patients without heart disease with a normal ITBV. The PiCCO(TM) system seems to be a useful device for the management of pulmonary edema.
Aged ; Atrial Natriuretic Factor/administration & dosage/*therapeutic use ; Cardiac Output/*drug effects/*physiology ; Female ; Humans ; Injections, Intravenous ; Male ; Middle Aged ; Monitoring, Physiologic/*instrumentation ; Pulmonary Edema/*drug therapy/*physiopathology

Background/Aims: This study aims to evaluate the presence of laryngopharyngeal reflux (LPR) and to investigate the use of hypopharyngeal baseline impedance (BI) for assessing swallowing dysfunction and gastroesophageal reflux disease (GERD) using hypopharyngeal multichannel intraluminal impedance and pH (HMII-pH) monitoring in neurologically impaired patients (NIPs). Methods: The study population in this retrospective study comprised 20 NIPs (mean age, 36.1 ± 15.0 years; age range, 13-64 years) who underwent multichannel intraluminal impedance and pH (MII-pH), HMII-pH, and laryngoscopy using the Hyodo scoring method from December 2016 to April 2019. The MII-pH and HMM-pH parameters were compared in the NIPs, whereas hypopharyngeal BI values were compared between NIPs with ≥ 5 and < 5 in Hyodo scores. Correlations between the hypopharyngeal BI values and the Hyodo score were analyzed using Spearman’s correlation coefficient. A receiver operator characteristic curve was created to determine the optimum cut-off of hypopharyngeal BI value to discriminate SD. Results: Three NIPs were diagnosed with pathological LPR and GERD by the HMII-pH monitoring. No significant differences in parameters were observed between MII-pH and HMII-pH monitoring. The correlation analysis demonstrated a significant negative correlation between the hypopharyngeal BI values and Hyodo scores. The optimal cutoff value for hypopharyngeal BI was 1552 Ω. Conclusions This study demonstrated the usefulness of HMII-pH monitoring in identifying NIP with pathological LPR. Considering the difficulties in performing examinations in NIPs, HMII-pH monitoring may be a potentially useful technique for the simultaneous evaluation of swallowing dysfunction, LPR, and GERD in NIP.

Background/Aims: This study aims to evaluate the presence of laryngopharyngeal reflux (LPR) and to investigate the use of hypopharyngeal baseline impedance (BI) for assessing swallowing dysfunction and gastroesophageal reflux disease (GERD) using hypopharyngeal multichannel intraluminal impedance and pH (HMII-pH) monitoring in neurologically impaired patients (NIPs). Methods: The study population in this retrospective study comprised 20 NIPs (mean age, 36.1 ± 15.0 years; age range, 13-64 years) who underwent multichannel intraluminal impedance and pH (MII-pH), HMII-pH, and laryngoscopy using the Hyodo scoring method from December 2016 to April 2019. The MII-pH and HMM-pH parameters were compared in the NIPs, whereas hypopharyngeal BI values were compared between NIPs with ≥ 5 and < 5 in Hyodo scores. Correlations between the hypopharyngeal BI values and the Hyodo score were analyzed using Spearman’s correlation coefficient. A receiver operator characteristic curve was created to determine the optimum cut-off of hypopharyngeal BI value to discriminate SD. Results: Three NIPs were diagnosed with pathological LPR and GERD by the HMII-pH monitoring. No significant differences in parameters were observed between MII-pH and HMII-pH monitoring. The correlation analysis demonstrated a significant negative correlation between the hypopharyngeal BI values and Hyodo scores. The optimal cutoff value for hypopharyngeal BI was 1552 Ω. Conclusions This study demonstrated the usefulness of HMII-pH monitoring in identifying NIP with pathological LPR. Considering the difficulties in performing examinations in NIPs, HMII-pH monitoring may be a potentially useful technique for the simultaneous evaluation of swallowing dysfunction, LPR, and GERD in NIP.

BACKGROUND/AIMS: The aim of this study is to investigate the degree of delayed gastric emptying (DGE) and evaluate how the severity of DGE affects gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients utilizing 24-hour multichannel intraluminal impedance pH measurements (pH/MII) and ¹³C-acetate breath test (¹³C-ABT) analyses. METHODS: ¹³C-ABT and pH/MII were conducted in 26 NI patients who were referred to our institution due to suspected GERD. At first, correlation analyses were performed to investigate the correlation between the ¹³C-ABT parameters and the clinical or pH/MII parameters. Thereafter, all patients were divided into 2 groups (DGE and severe DGE [SDGE] group) according to each cut off half emptying time (t(1/2), 90–170 minutes). Each pH/MII parameter was compared between the 2 groups in each set-up cutoff t(1/2). RESULTS: The mean t(1/2) of all patients was 215.5 ± 237.2 minutes and the t(1/2) of 24 (92.3%) patients were > 100 minutes. Significant moderate positive correlations were observed between both t(1/2) and lag phase time and the non-acid reflux related parameters. Furthermore, the patients in the SDGE group demonstrated higher non-acid reflux related parameters than those of the DGE groups when the cutoff was t(1/2) ≥ 140 minutes. CONCLUSION: The present study demonstrated that GE with t(1/2) ≥ 140 minutes was related to an increase of non-acid exposure reaching up to the proximal esophagus in NI patients, and indicating that NI patients with SDGE might have a high risk of non-acid GERD.
Breath Tests ; Electric Impedance ; Esophagus* ; Gastric Emptying* ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration