Ryoukeigomikanzoto is a Kampo formulation originally described in the text Kinkiyouryaku. This formulation has also been described as an indication for respiratory disease in some texts, because it was classified under respiratory diseases in the Kinkiyouryaku.
The authors, however, considered that indications for ryoukeigomikanzoto could be wider than previously thought. The composition of this formulation is very similar that of ryokeimikanto and ryokeijutsukanto. And we have prescribed ryokeigomikanzoto for patients with a reddish face and coldness of the legs, whose chief complaints were a reddish nose, coldness of the leg, dysuria, spioncerebellar degeneration and ringing of the ears. Moreover, we have obtained good results from the current trial. This report is intended to elucidate indications for this formulation by means of past clinical results and our own experience.

Previously, the authors reported that a painful point at the epigastrium may be closely related with the term “shinkashiketsu” for the Kampo formulation saikokeishito (SKT) which was described in the textbook, shoukanron. In order to find conclusive evidence for our hypothesis, we tried SKT in four patients, whose chief complaints were headache, epigastralgia with headache, irritable bowel syndrome, and anorexia due to Behcet's disease. In this trial, we obtained satisfactory clinical results, which strongly suggest that the symptom of a painful epigastral point correlates with the term shinkashiketsu in the shoukanron description.

A survey has been under way on the incidence of cerebral apoplexy among the inhabitants (pop. 105, 185, National Census, 1970) of the Saku district of Nagano Prefecture since April 1972.
This survey, which constitutes a WHO cooperative study, has been under way with cooperation rendered by the local Medical Association, Association of Public Health Nurses in Saku District and Saku Public Health Center with the Saku Central Hospital acting as the survey center.
In the period of two years till March 1974, 585 persons were registered as having been seized with cerebral apoplexy. The annual incidence rate stood at 265 per 100, 000 population. Classified by types of cerebral apoplexy, cerebral hemorrhage accounted for 26%, cerebral thrombosis for 57%, cerebral embolism for 3%, subarachnoid hemorrhage for 9%, and other types for 5%.
By sexes, the incidence rate among males was 1.3 times higher than among females. By ages, the incidence was highest in the seventies.
When the prognosis of cerebral apoplexy is viewed in terms of deaths in the early period of less than three weeks after the onset, the mortality rate stood at 45%.
The hospitalization rate of patients seized with cerebral apoplexy was 55%. There was a significant difference in the mortality rate between inpatients (with 28%) and outpatients (65%).
The ratio of concurrence of autopsy and clinical diagnosis stood at 83% with Okinaka's criteria and 79% with Ikeda's CVD index.
The incidence of hypertension before the onset of cerebral apoplexy was extremely high among the patients seized with cerebral hemorrhage and cerebral infarction.With respect to the treatment of hypertension, the discontinuance of treatment and the failure to undergo it are high in percentage among the patients seized with cerebral hemorrhage. With reference to cerebral infarction patients of 70 years and older in age, there is little defference between the group who discontinued or failed to undergo treatment and the group who underwent it.
The recurrence of cerebral apoplexy stood at 11% for cerebral hemorrhage, 19% for cerebral infarction, and 11% for subarachnoid hemorrhage.

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.

We report a case of obstructive sleep apnea syndrome effectively treated with Hange-koboku-to. A 32-year-old male suffered from globus syndrome (globus hystericus), excessive daytime sleepiness and snoring. He underwent uvulopalatopharyngoplasty at the age of 27, but the symptoms did not improve after surgery. Nocturnal polysomnography, performed before administration of Hange-koboku-to, confirmed the diagnosis of obstructive sleep apnea syndrome. After 1-month-administration of Hange-koboku-to extract (Tsumura Co. Ltd., 7.5g/day), his complaints almost disappeared. After 5-month-administration of Hange-koboku-to, nocturnal polysomnography was performed again. As a result, the apnea index fell from 19.2 events/hour to 10.3 events/hour, and the apnea-hypopnea index also fell from 19.2 events/hour to 12.8 events/hour. He was not obese (body mass index: 23.0kg/m²), and no significant body weight change was observed after administration. No adverse effect was observed. To our knowledge, there is no other report on the treatment of sleep-related breathing disorders with Hange-koboku-to. We presume that Hange-koboku-to may decrease the upper airway resistance, especially at the lower part of the upper airway.

A ranula is a pseudocyst that originates from the sublingual gland after trauma. Acute cases of ranulas that progress rapidly and cause respiratory distress are rare. Holoprosencephaly is a complex brain malformation caused by incomplete cleavage of the prosencephalon. Children with holoprosencephaly may experience upper airway obstruction due to the associated dentoalveolar malformations and oromotor dysfunctions. We present the case of an eight-year-old female patient with holoprosencephaly and a plunging ranula that manifested as an acute course due to difficult airway management. She required gastrostomy for oromotor dysfunctions related to feeding and swallowing and difficulty managing oral secretions. The sublingual gland and ranula were removed under general anesthesia. Postoperatively, urgent reintubation and close monitoring in the intensive care unit were required due to upper airway obstruction. We successfully managed the patient with close cooperation of a pediatrician and an anesthetist, and no recurrence was observed at the one-year follow-up. A ranula can be caused by trauma to the floor of the mouth in association with lingually inclined mandibular teeth, a type of dentoalveolar compensation seen in maxillary hypoplasia associated with holoprosencephaly. Careful consideration is needed in such cases since airway management can be difficult due to postoperative swelling and oromotor dysfunctions.

The Ministry of Health and Welfare of Japan is planning a pooling system for multiple-choice questions (MCQs) for the national examination for medical practitioners. To clarify possible problems of such a system, a field study was performed by 10 medical schools in Japan using 90 MCQs from previous examinations. Nine hundred twenty-four 6th-year students participated in the field test. For each MCQ, the correct-response rates at the originating school and those obtained in the field test were significantly correlated. Thus, the correct-response rates to questions on the field test could be predicted from the rates at the originating schools. However, for each question the correct-response rate was significantly higher for students of the originating school than for students of other schools. In the national examination, care should be taken to prevent differences in scores on the basis of question sources.

We collected and analyzed large-scale data concerning the fall of stroke inpatients in convalescent rehabilitation wards. Three hundred seventy-four of 1,107 inpatients experienced one fall or more, and 16 factors associated with falls were clarified by the chi-square test. To extract the significant item from a multifactor, the logistic regression analysis of 16 factors was carried out, and we developed an assessment sheet for the risk degree of first fall prediction in stroke inpatients. We selected eight variables as the items on the assessment sheet : history of previous falls, central paralysis, visual impairment, sensory disturbance, urinary incontinence, use of psychotropic medicines, mode of locomotion, and cognitive impairment. The total score of the assessment sheet was ranged from 0 to 10 and the mean score of fallers (6.4±1.5) among subjects was significantly higher than that of non-fallers (5.1±1.9) (p <0.001). When the subjects were classified into three groups, a significant difference (p<0.001) in the tendency of fall incidence in term of days after admission was found among the three groups on the basis of the Kaplan-Meier survival curve.

BACKGROUND/AIMS: This study compared the efficacy of multimatrix mesalazine 2.4 g/day and 4.8 g/day with controlled-release mesalazine 2.25 g/day. METHODS: In this multicenter, randomized, double-blind study, 251 patients with mildly to moderately active ulcerative colitis received multimatrix mesalazine 2.4 g/day once daily (Multimatrix-2.4), 4.8 g/day once daily (Multimatrix-4.8), or controlled-release (time-dependent) mesalazine 2.25 g/day 3 times daily (Time-2.25) for 8 weeks. The primary efficacy endpoint was the change in the ulcerative colitis-disease activity index (UC-DAI) score. RESULTS: The mean change in the UC-DAI score and standard deviation in the per protocol set was −1.9±2.5 for Multimatrix-2.4 and −2.4±2.8 for Time-2.25. The difference between Multimatrix-2.4 and Time-2.25 was 0.3 (two-sided 95% confidence interval [CI], −0.5 to 1.1), thus non-inferiority was not demonstrated based on the pre-defined non-inferiority margin (1.0). In the full analysis set, the difference between Multimatrix-4.8 and Time-2.25 was −1.2 (two-sided 95% CI, −2.0 to −0.5), and the mean change in UC-DAI score in the FAS was −3.3 (two-sided 95% CI, −3.9 to −2.8) for Multimatrix-4.8 and −1.9 (two-sided 95% CI, −2.5 to −1.3) for Multimatrix-2.4, indicating that Multimatrix-4.8 was more effective than Time-2.25 and Multimatrix-2.4. There was no difference among the treatment groups in terms of safety. CONCLUSIONS: This study showed that the efficacy of multimatrix mesalazine 2.4 g/day was comparable to controlled release mesalazine 2.25 g/day, although non-inferiority was not demonstrated. Importantly, this was the first study to indicate that multimatrix mesalazine 4.8 g/day was more effective than 2.4g/day with no associated safety concerns.
Colitis, Ulcerative* ; Double-Blind Method* ; Humans ; Mesalamine* ; Ulcer*

　The education program in all medical schools in Japan has been studied and analyzed every 2 years since 1974 by the curriculum committee of the Association of Japan Medical Colleges. Based on the most recent analysis in 2015, the marked innovation of medical education, such as an integrated curriculum, active learning, and clinical clerkship, was recognized.