Chukenchuto is often reported to be useful for constipation. We experienced patients with diarrhea or loose stool, successfully treated with chukenchuto. In this report, five cases are documented. Of these, four cases did not present with constipation. We emphasize that chukenchuto is also effective for diarrhea or loose stool. Other clinical manifestations such as gargling sound or abdominal distension, tension of abdominal rectus muscle, and feeling of cold are common in cases where chukenchuto is effective.

A 58-year-old man who complained of dyspnea on effort was given a diagnosis of decompensated congestive heart failure. Echocardiography revealed severe aortic regurgitation and cardiomegaly. We decided to perform aortic valve replacement with a mechanical valve, however his past history made us suspicious of allergy to metal. From his previous patient records, we determined he was allergic to many metals : gold, iron, platinum, cobalt, chrome, bronze, and zinc. Newly performed skin patch tests showed positive reactions to aluminum, tin, palladium, indium, iridium and stainless steel. We selected a CarboMedics mechanical valve made of nickel-titanium alloy. Aortic valve replacement with a 27-mm CarboMedics mechanical valve was performed by median sternotomy. At sternum closure, we used polyester non-absorbable suture thread, instead of surgical steel wire, because it contains stainless steel. His postoperative progress was good and he was discharged on the 10th postoperative day. One year after surgery he is doing well without any allergic symptoms.

We performed the thromboexclusion procedure with reconstruction by an axillo-bifemoral bypass for unresectable abdominal aortic aneurysm combined with chronic renal faliure, and obtained satisfactory postoperative result. The patient was a 68-year-old male who suffered from a huge abdominal aortic aneurysm (AAA) and had a history of hypertension and chronic renal failure. The AAA was accompanied with a saccular portion 10cm in diameter which compressed and eroded the vertebral body. Aortic cross-clamping above the bilateral renal arteries was inevitable for resection in spite of the renal dysfunction. We decided that direct manipulation of the aneurysm was impossible despite it being on the verge of rupture, considering the high operative mortality. We employed the exclusion-bypass method to stabilize the aneurysm, that is, we constructed axillo-bifemoral bypass using a knitted Dacron T-graft 8mm in diameter and then intercepted the bilateral common iliac arteries by suture closure. Postoperative intraaneurysmal thrombosis progressed rapidly from the distal side, then it halted just below the bilateral renal arteries on the 12th postoperative day. Renal arterial flow was maintained and renal function improved. Bleeding from the operative wound occurred suddenly on the 5th postoperative day. Although this appeared to be disseminated intravascular coagulation initially, it had resulted from augmentation of fibrinolysis due do acceleration of coagulation. The markers of fibrinolysis for example α₂ plasmin inhibitor (α₂PI) and plasmin-α₂ plasmin inhibitor complex (PIC) were useful for diagnosis, and tranexam acid and aprotinin were effective for therapy. Although the exclusion-bypass method is technically less invasive and useful for high-risk AAA, the postoperative management is not easy because of the acceleration of the coagulation-fibrinolysis system.

The aim of this study is to evaluate the effects of agricultural activity on cognitive function, physical function, motivation, activity of daily living (ADL), self-efficacy and quality of life (QOL) of hospitalized elderly with dementia using multivariate statistical analysis. Elderly with dementia performed them for 2 months that replaced with agricultural activities once a week after they performed ordinary activities for 2 months. Ordinary and agricultural activities showed higher score than control condition. Two therapies are compared by principal component analysis (PCA), correlation analysis and multiple regression analysis (MRA). From the PCA analysis, motivation, muscular strength, walking ability, and mobility ability tended to improve during agricultural activities, but there was no significant difference in cognitive function, daily life, and behavioral disorders. In the correlation analysis, walking speed, walking time, timed up and go test (TUG), and grip strength showed a high score. MRA showed that improved physical function is improved during agricultural activities, but no significant improvement in cognitive function and ADL. Therefore, it was found that agricultural activities may be useful for improving physical functions. Long-term evaluation is needed for discussing the effects on cognitive functions and ADL.

Acute pulmonary embolism (PE), usually secondary to deep venous thrombosis (DVT), is a serious disease which may cause sudden death. An inferior vena cava filter (IVCF) is placed in certain circumstances to prevent recurrence of PE. However, some complications of IVCF have been reported and the indications of IVCF should be reviewed. We encounted a case of IVCF migration which required surgical removal through right intercostal thoracotomy. The patient was a 53-year-old woman. She had undergone the placement of IVCF for DVT followed by anticoagulant therapy. Eight days after, CT revealed IVCF migrated above renal veins. As percutaneous extraction was attempted unsuccessfully, the direct approach to remove IVCF between the hepatic vein and renal vein was indicated. Through the right side thoracotomy at the seventh intercostal space with the division of costal arch, the inferior vena cava (IVC) was exposed near the right atrium. The diaphragm was longitudinally divided straight to IVC and the liver was retraced anteriorly after the careful dissection of the venous plexus on the back of the liver. IVCF could be palpated and just below the branch of the caudate rami and above the right renal vein. After systemic heparinization, IVC and branches were clamped simply and IVC was incised longitudinally. The proximal tip of the IVCF dug into the intima and the distal hook penetrated the vein. IVCF was carefully removed and incision and penetration of IVC were repaired. Her postoperative course was unremarkable, and the patient was discharged without any complications.

Persistent or intractable hiccups worsen the activity of daily life and the quality of life of patients, but are sometimes difficult to treat. There are no recommended therapies in Western medicine for hiccups, and Kampo medicine can often be used. However, there have been no case reports on keishininjinto for hiccups. We experienced two cases of hiccups successfully treated with keishininjinto. Case 1 was a 68-year-old man who continued intractable hiccups for 3 years. Case 2 was an 81-year-old man who developed persistent hiccups during mechanical ventilation. Both cases had spontaneous sweat, tendency of diarrhea, epigastric discomfort and resistance, and cold of epigastrium, so we diagnosed them as keishininjinto-sho. It took 6 months to improve hiccups after administration of keishininjinto in case 1 and 1 week in case 2. Keishininjinto can be effective for hiccups with interior and cold pattern.

Keishininjinto has been used for those who have both interior cold pattern of ninjinto and exterior pattern, but there were no reports on improvement of hypertension. We experienced two cases that treatment with keishininjinto was effective for hypertension. The complaint of one case was dizziness, and the other was diarrhea. Both cases had epigastric discomfort and resistance, cold of epigastrium, and upper heat and lower cold. Treatment with keishininjinto was effective not only for the complaints but also for improvement of hypertension. Hypertension can be managed by Kampo therapy with keishininjinto in accordance with traditional sho indications. We consider that there were interesting clinical cases treated with Kampo medicine based on the theory whereby sho correlates with a formulation.

As the elderly society grows, polypharmacy becomes a problem in clinical practice. Until now, some Kampo treatments have been reported to be useful for polypharmacy caused by western-­style medicines. But this report shows that Kampo medicines in themselves could be the cause of polypharmacy. In fact, multiple Kampo prescriptions from several medical agencies are given to one patient in Japan. From the view point of proper use of Kampo prescriptions, medical experts and entire business fields related to Kampo medicine should take measures rapidly for so­-called “Kampo polypharmacy” after analyzing the actual situation.

Hypertensive urgency is sometimes repeated and difficult to treat with anti-hypertensive agents or anxiolytics. There were few reports on treatment of hypertensive urgency with Kampo medicine. We experienced five cases of frequent hypertensive urgency, successfully treated with shichimotsukokato only. All cases had deficiency pattern and symptoms of blood deficiency. It took relatively short term to stabilize blood pressure after taking shichimotsukokato, and the efficacy of this drug had been continued. Shichimotsukokato can attribute to rapid and continuous stabilization of blood pressure for frequent hypertensive urgency of those who have deficiency pattern and blood deficiency.

Although saikanto has often been used for infectious pleuritis, there are few reports on the usefulness of it in recent years. We experienced a patient successfully treated with saikanto, who was suffering from bacterial pleuritis with residual pleural effusion, which was difficult to drain and treat with antibacterial drugs. Kampo treatment including saikanto should be used for pleuritis that is not sufficiently improved by Western medical treatment alone.