Clinical research is essential for the practice of evidence-based medicine. This study reports on our current practice of clinical research support in Mito Kyodo General Hospital and discusses future challenges. In April 2013, the University of Tsukuba hired a clinical research assistant to provide clinical research support in Mito Kyodo General Hospital. The clinical research assistant worked full-time in the hospital in collaboration with 3 university faculty members. The target population for this study comprised 450 medical personnel including doctors, nurses, and other medical staff. From April 2014, 1 of the 3 faculty members visited the hospital once a month to offer clinical research consultations and deliver a lecture on nursing research. We analyzed past records of clinical research support and conducted a questionnaire survey to explore the level of satisfaction of the medical personnel. Four-hundred and ninety records of 91 research topics proposed by 68 medical personnel were identified. Of these, 93.4% were proposed by doctors or nurses. Most studies employed an observational study design (64.8%) and were conducted in order to make a presentation at an academic conference (51.1%). The consultation sessions were held 1–5 times, for 40–405 min, and lasted from 1–84 days per research topic. Consultations mostly pertained to research design and protocol planning (57.1%). Forty-seven clients were invited to participate in the questionnaire survey, 30 of whom provided valid responses. The results showed that 96.6% of the clients were satisfied with the consultations. The number of clients who participated in the consultations comprised only 15.1% of the target population. These practice biases need to be addressed in future. However, nearly all respondents were satisfied with the consultations. These findings suggest that our clinical research support was beneficial to medical personnel.

We reviewed 632 cases which had undergone ultrasonograpy for thyroid disorders.(1) The sonographic examination found nodular lesions in 157 cases (including 52 solid tumor cases) and diffuse enlargement in 38 cases. No abnormalities were found in the remaining437 cases.(2) Further examination revealed that the cases of nodular lesions included 7 thyroid cancer cases (6 papillary carcinomas and 1 follicular carcinoma), 2 cases of hyperthyroidism, and 3 cases of hypothyroidism.(3) Diffuse enlargement cases included 5 cases of overactive thyroid (1 subacute thyroiditis and 5 Graves' diseases), 2 cases of underactive thyroid (chronic thyroiditis). Assays for antithyroid autoantibodies showed positive results even in the 31 cases of normal thyroid function.(4) Four in 7 cases diagnosed as thyroid cancer and 5 in 12 cases diagnosed as thyroid dysfunction (4 of 5 cases were elderly people 60 years of age or over) were screened by ultrasonography.
We concluded that ultrasonography is a valuable diagnostic procedure for early detection of not only thyroid malignancies but also disordered thyroid function. Abdominal sonography is often used for screening. The use of ultrasound for the thyroid gland is recommended as a standard procedure in the regular health screening program.

Case: A 40-year-old woman. Clinical diagnosis: Autistic disorder with mild mental retardation. Case report: The patient underwent pancreaticoduodenectomy for the treatment of her pancreatic cancer. We held several conferences with individuals from different medical fields and examined the influence of the patient's autistic disorder on the perioperative conditions. The senior author, a clinical psychologist, conducted repeated individual, acceptive, and sympathetic interviews with the patient and her family and maintained supportive relationships with them as an honorary family member. Thus, the clinical psychologist helped reduce the patient's anxiety about the medical treatment. Conclusion: The participation of a clinical psychologist in the medical conferences enabled the medical staff to understand the complications involved and provide mental support to the patient and her family. Palliat Care Res 2010; 5(2): 323-326

Introduction: This study reports on a case of SAPHO syndrome in a patient in the palliative care unit who had multiple bone metastases of an unknown primary carcinoma. Case: A 74 year old male presented with broken eleventh thoracic and third lumbar vertebrae. Magnetic resonance imaging (MRI) revealed multiple lesions, which were thought to be bone metastases of a carcinoma, in the thoracic and lumbar spine. Attempts to identify the location of the primary lesion were unsuccessful. Therefore, the differential diagnosis was multiple bone metastases of an unknown primary carcinoma. The patient was transferred to the palliative care unit. The patient’s condition remained largely unchanged for several years; therefore, a second set of clinical examinations was conducted. Computed tomography revealed sternocostoclavicular hyperostosis, and there was symmetric uptake on bone scintigraphy. Further MRI studies revealed that the spinal lesions were comparatively reduced, leading to a diagnosis of SAPHO syndrome. Discussion: SAPHO syndrome is a rare, benign disease that presents as a variety of osteoarticular disorders with specific dermatoses. SAPHO syndrome is difficult to diagnose; therefore, it is important to consider it as a differential diagnosis in patients with bone lesions.

We report on 3 patients who presented with symptoms of Ki obstruction, Ki deficiency, and disorder of the body's fluid metabolism, successfully treated with bukuryoingohangekobokuto. In our experience, bukuryoingohangekobokuto has been effective in 25 of the 30 patients (6 men and 24 women) to whom is has been administered, who also presented with Ki obstructions, Ki deficiencies and disorders of the body's fluid metabolism as mentioned above. The most common subjective symptom in all these effectively-treated patients was hot flashes. Other signs were epigastric pain or discomfort accompanied by chest signs and symptoms, such as palpitations, heartburn, chest oppression or dyspnea. The most common objective findings in these effectively-treated patients were pulsation at the pit of the stomach and navel, and a fluid sound in the stomach upon palpation. Based on our experiences, we believe that prescription of bukuryoingohangekobokuto is best indicated when the presence of the above-mentioned symptoms and findings has been confirmed.
symptoms <1> ; Liquid substance ; Cases ; seconds ; findings

We report on a patient with residual complaints after an operation for lumber canal stenosis, successfully treated with the Kampo medicine, kigikenchutokauzu. The patient was 69 year-old woman complaining of severe coldness, numbness, and bilateral leg pain. She was diagnosed as having spinal canal stenosis when she was 67 years of age. Posterolateral fusion with laminectomy was performed at the age of 69, although severe coldness, numbness, and pain persisted even after her surgery. Also, her sutures had not healed. She was referred to our department 26 days after her surgery in order to receive Kampo therapy. Kigikenchutokauzu was prescribed, and her condition markedly improved. Her sutures healed completely 7 days after start of administration. This suggests that kigikenchutokauzu may be effective not only for the residual spinal canal stenosis symptoms, but also for the postoperative healing of sutures.
seconds ; Spinal Canal ; Surgical sutures ; Stenosis <3> ; Medicine, Kampo

We report a case with various postoperative abdominal symptoms that were successfully treated with Kampo medicine. A 58-year-old Japanese female had nausea, eructation, epigastric pain, lower abdominal pain and anorexia that appeared just after laparoscopic nephrectomy for renal cell carcinoma. No abnormal findings were discovered by gastroenterological examinations. Western medical therapy was not successful. We used bukuryoin under the interpretation that nausea and eructation represent phlegm-fluid retention in the chest. The bukuryoin therapy cleared up her nausea and eructation in about one week. Additionally, her epigastric pain, lower abdominal pain and anorexia were cured by use of anchusan.
Therapeutic procedure ; Medicine, Kampo ; symptoms <1> ; Postoperative Period ; Nausea

We experienced four cases of perniosis successfully treated with bukuryoingohangekobokuto, or hangekobokuto. Swollen tongue, pulsation at the pit of the navel, and tympanitic abdominal sounds were taken as common objective findings in all four cases. In addition, decreased surface body temperature was diagnosed at the bilateral hands and feet, so as to be distal from the trunk in palpation. These four cases had both symptoms of an eminent Ki obstruction, and a disorder of body fluid metabolism. For the two cases administered bukuryoingohangekobokuto especially, a state of strong Ki deficiency was diagnosed. Efficacy in each case was prompt. Thus, we consider bukuryoingohangekobokuto and hangekobokuto to be prescriptions worth trying for perniosis that does not responding to the usual Western medicines, or Kampo treatment.
Obstruction ; Application, NOS ; Chilblains ; Medicine, Kampo ; Western Herbs and Botanicals

It is essential to prolong the term as possible in the treatment of threatened premature delivery. We report a case of threatened abortion successfully treated with hochuekkito. The patient was 31 year-old pregnant woman with lower abdominal pain. She was diagnosed to be at the risk of premature delivery on 21 weeks and 5 days of gestation. Intravenous ritodrine hydrochloride was started and she had to stay in bed. Severe side effects of ritodrine hydrochloride such as palpitation, tachycardia, tremor, nausea, and loss of appetite were appeared and she was consulted to our department on 23 weeks and 1 day of gestation. Those symptoms were markedly improved after administration of hochuekkito extract. She delivered a male infant of 1230g birth weight on 28 weeks of gestation. Hochuekkito suppressed severe side effects, and enabled to continue the infusion of ritodrine hydrochloride, suggesting the usefulness of Kampo therapy in the treatment of threatened premature delivery.

Methods: Sagittal spinopelvic alignment was evaluated in 110 subjects using radiographs of the whole spine. Parameters measured in this study included sagittal vertical axis (SVA), LL, sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). The distribution of sagittal plane modifier grade was evaluated according to the Scoliosis Research Society-Schwab classification of adult spinal deformity (ASD). Consequently, personal history related to LBP was obtained, and the association of pre- and postoperative LBP and spinopelvic alignment was investigated. Results: Preoperatively, 66% of all subjects showed LBP and mostly exhibited anteriorly shifted global imbalance associated with a decrease in LL and knee flexion contractures, and the subject who had severe flexion contracture of the knee joint showed more forwardly shifted global balance with backward PT and decrease in LL. After TKAs, the knee flexion contractures were eliminated in most cases, and one-third of subjects experienced decrease in LBP. However, SVA increased more and associated with slight decrease of PT and increase of SS. No significant differences were confirmed between pre- and postoperative values of LL and PI. In addition, there were no significant differences in postoperative values of spinopelvic parameters between subjects with and without relieved LBP. Conclusions Although one-third of subjects experienced decrease of LBP after TKAs, the sagittal global imbalance was not restored through the removal of knee flexion contracture.