We successfully treated two chronic hepatitis B patients with Hochuekkito-go-Keishibukuryogan. Case 1 was a 27-year-old male diagnosed with chronic hepatitis B in 1998, who had received interferon (IFN) therapy. Liver function tests did not improve with this therapy. He visited the department of Japanese Oriental Medicine at Yukiguni-Yamato Hospital, complaining of fatigue, on **********. We initiated treatment with Hochuekkito-go-Keishibukuryogan. At two months of treatment, marked improvement in liver function tests was noted, with normalization of ALT, seroconversion (SC) and negative HBV-DNA. Case 2 was a 26-year-old male diagnosed with chronic hepatitis B in 2001 who had received IFN therapy. Seven months after termination of this therapy, on **********, he visited our department for a flare-up of hepatitis. Treatment with Hochuekkito-go-Keishibukuryogan was begun. Almost immediately, marked improvements were observed in the form of ALT and SC normalizations, and only slightly positive HBV-DNA.

Purpose: To investigate the indications for use of the Japanese version of the Liverpool Care Pathway (LCP), we evaluated the conditions of patients using and those not using the LCP. Methods: We retrospectively investigated the medical records of 71 LCP patients and 60 non－LCP patients who died in our palliative care unit between March and December 2013. Results: There was no significant difference in patients’ background between the LCP and non－LCP groups. For patients in the non－LCP group, sudden changes in condition were significantly more frequent and deep continuous sedation was used significantly less than in the LCP group. In the LCP group, the average duration on the LCP was 4.0 days, and the beginning criterion was met by three－point or more of all the patients. The initial assessment was achieved except for one case. In the non－LCP group, reasons for not using the LCP were a sudden change in condition (35 patients), a rapid change in medical condition (14), and a risk of falling (4). Conclusions: The LCP met the beginning criterion and was started at suitable time in the LCP group. The LCP is not useful for all patients; it cannot be used for a patient with sudden or rapid changes in condition, or at a risk of falling.

It is reported that the administration of Seinetsu-hoketsu-to has been effective in four cases of recurrent aphthous stomatitis. The literature states that Seinetsu-hoketsu-to is indicated for “blood deficiency and the combination of pathogenic dryness and heat in blood which causes ulceration or erosion with scaling pain in the tongue and oral mucosa, and its healing is often prolonged.” All four cases the patients are female. Their aphthous stomatitis is often exacerbated during pregnancy, childbirth, and/or each menstruation. In one case aphthous stomatitis reoccurred after the remission of general symptoms due to high fever and inflammation in the acute phase of Beçhet disease. The conclusion is that Seinetsu-hoketsu-to would be useful to patients with recurrent aphthous stomatitis in conditions where blood deficiency is worsening.

Repeated relapses of vomiting were treated with Bukuryo-takusha-to in a patient with resistant gastric ulcer. A 77-year-old woman, who had been admitted to our hospital due to manic disorder, presented tarry stool in February 1997. Gastrointestinal endscopy revealed an active gastric ulcer. The ulcer remained at the healing stage even after three years of treatment with H₂ receptor antagonist or proton pump inhibitor. She developed vomiting attacks in February 1998; thereafter, these vomiting episodes recurred repeatedly. During one three-day episode, she vomited the contents of breakfast every evening. Therefore, we regarded this attack as “ihon” from the view of Kampo diagnosis. After the administration of Bukuryo-takusha-to, the vomiting attacks disappeared within a day. The gastric ulcer then reached the scarring stage. In this patient, Bukuryo-takusha-to might have been effective in treating the resistant gastric ulcer as well as the recurring vomiting attacks.

The administration of Bukuryo-shigyaku-to has been effective in five cases of chronic headache. All five patients visited our department because of unsatisfactory results using Western medicine. They suffered from severe migraines with restlessness, and they were treated effectively with Bukuryo-shigyaku-to. In four of all cases (cases 1-4), symptoms and signs related to coldness were obvious, and especially cases 1 and 3 complained about undesirable coldness on their backs. It is suggested that Bukuryo-shigyaku-to can be useful against severe migraine with restlessness caused by exposure to strong coldness. Case 5 was initially thought to have a status of heat and excess, but the effect of Bukuryo-shigyaku-to revealed the existence of cold and deficiency. Case 5 emphasizes the importance of being aware of the possibility of hidden coldness and deficiency, and that Bukuryo-shigyaku-to can be useful in such a case.

We treated one rheumatoid arthritis (RA) patient with Toki-shakuyaku-san-ka-bushi. A 51-year-old woman was diagnosed as RA in another hospital and was treated with salazosulfapyridine (SASP) and methotrexate (MTX). She was living a restricted daily life while taking MTX. She had to lie down for almost 48 hours after taking MTX once a week because of general fatigue. She was also suffering from depression. After the administration of Toki-shakuyaku-san-ka-bushi, her malaise after taking MTX and her depressive-mood disappeared. Her quality of life improved measurably.

The effect of endurance training on aerobic power and the relationship between aerobic power and running performance were investigated longi tudinally on eleven junior runners for 5-7 years, starting from the age of 14, 15 yr. Maximal aerobic power was measured with the subject running on a motor-driven treadmill. The subjects were divided into two groups (Group I, II) .
The results were as follows ;
1) Group I (superior junior runners) showed greater aerobic power and better running performance compared to Group II (good junior runners) . The values for Group II were between those for Group I and for ordinary school boys.
2) Aerobic power for Group I increased from 14, 15 to 18, 19 years old, while aerobic power for Group II decreased to the similar values of the ordinary school boys after stopping the running training.
3) Greatest value for aerobic power was obtained on Subject A as follows : 3.63 1/min (61.5 ml/kg. min) at 14.7 yr of age, 4.67 1/min (74.6 ml/kg. min) at 17.8 yr, 5.04 1/min (76.3 ml/kg. min) at 20.7 yr.
4) Improvement in running performance was closely related to the increase in aerobic power (1/min) for the junior runners during the age of 14 to 18 yr.

Purpose：We evaluated that the current state from which a palliative care unit receives emergency admission of cancer patients at home. Methods：We retrospectively investigated the medical records of 393 cancer patients who hospitalized in our unit between January 2013 and December 2014. The patients were shared with a group of two, schedule admission (schedule group) and emergency admission (emergency group), and it was compared with a result on discharge and with a hospitalization period. We investigated admission process, the date and time of admission, and reason for admission in emergency group. Results：The number of patients was 224 of schedule group and 169 of emergency group. The mortality rates were 81% in schedule group and 78% in emergency group (not significant). An emergency group for an average of 24.3 days was shorter for 9 days than schedule groups in a hospitalization period of dead leaving patients (p<0.05). In emergency group, admission process included 128 completed-interviews with the hospitalization, 11 incompleted-interviews before admission and 30 first visits, and 129 patients (76％) admitted within the weekday daytime. Many patients had a complaint of severe pain, appetite loss and oral absorption difficulty, and so much. Conclusions：An emergency group admitted the various processes and the much symptom. There were a lot of cases of early hospital death, but also admitted return at home, and our unit played the role of emergency admission.

Among 62 patients who underwent hybrid arch TEVAR, which is a combination of supra-aortic bypass and TEVAR to treat arch aneurysm, 5 patients encountered postoperative cerebral infarction. In 2 patients, whose thoracic aorta were extremely shaggy, cerebral infarction were multiple and fatal. Other 3 patients, whose aorta were not shaggy, developed visual disturbance after TEVAR and minor cerebral infarction were detected in the area of vertebral artery. To prevent cerebral infarction after hybrid arch TEVAR, the blood flow from the left subclavian to vertebral artery is considered to be significant.