Thirty (n=30) seven week old male Sprague-Dawley rats were divided into six groups of five rats (n=5) in each group. The groups were designated Sc=sea level controls; St=sea level trained; Fc=hypoxic exposed (16% O₂) controls; Ft =hypoxic exposed (16% O₂) trained; Pc=intermittent hypoxic exposed (18%, 16%, 14%, 16%, 18% O₂ for two days each) controls; and Pt=intermittent hypoxic exercise trained. Exercise training consisted of 45min/day running on a rat treadwheel for 24 consecutive days. Fiber type distribution, succinate dehydrogenase (SDH) activity and glycogen content of the soleus muscle and the oxidative enzyme activity of the motoneurons of the soleus were measured in each group after the 24 days of hypoxic exposure and exercise training. In comparison to each training group's control the glycogen concentration of the soleus muscle was increased (P<0.05) regardless of hypoxic exposure. Only the intermittently hypoxic exercise trained group (Pt) demonstrated a fiber type shift of slow-twitch oxidative to fast-twitch oxidative glycolytic fibers. Neither hypoxia or exercise training altered the oxidative enzyme capacity of the soleus motoneurons.

We report our experience of successful hemostasis after dental extraction with the use of rFVIIa in a FVII deficient patient. Preoperative PT% was 25%, and FVII was less than 3%. Thirty minutes before tooth extraction, 1.2 mg of rFVIIa was injected. At the beginning of the operation, PT% was more than 200%, FVII was 336%, and the hemostasis after dental extraction was excellent. rFVIIa was used effectively and safely for dental extraction in this case of FVII deficiency.

Objective : To evaluate the long-term benefit and risk of interferon (IFN) therapy for chronic hepatitis C.
Methods : Seventy-five patients with chronic hepatitis C who were treated with IFN at our hospitals in 1992 and 1993 were enrolled. Observation of general condition, incidence of hepatocellular carcinoma (HCC) and all events were followed up for ten years.
Results : HCC was observed in 12 patients (16%), six of whom died. In two cases, HCC was suspected and could not be ruled-out, and four patients died of other causes. Adverse events which needed continuous treatment or follow-up were observed in 34 cases (45%). No HCC was observed in cases whose ALT was maintained within the normal range. Sixteen cases (19%) have been in stable good condition, free from HCC or adverse events.
Discussion : Adverse events including drug adverse reactions after IFN were varied and some were irreversible. Patients who had such adverse reactions were forced to continue some treatments for adverse reactions and had difficulties in daily life. It is desirable that treatments for refractory cases are developed, but there are also new risks with long-term treatment. Monitoring and analysis of the adverse events and the total death rate will be more important.

Enterovaginal fistula, which causes uncontrollable symptoms such as gas release, vaginal defecation, perineal erosion, and vaginitis, markedly reduces patients' quality of life. In this report, we present a case of successful treatment for enterovaginal fistula with Kampo medicine.
A 62 year-old female who had ileoanal canal anastomosis for ulcerative colitis developed symptoms of gas release and defecation from the vagina. Although these symptoms had disappeared with conventional medicine previously, they recurred 7 years later. There was no medical indication for surgery because the fistula could not be located by barium enema or endoscopic examination. She, therefore, visited our outpatient clinic 1 and a half years after all conventional management had ended in vain.
Her symptoms were slightly improved by the administration of ifutokaogi, a Kampo formula, although they persisted. Three months after switching her prescription to another Kampo formula, goreisan, her symptoms completely disappeared.
In recent years, there has been no report on goreisan for the successful treatment of enterovaginal fistulae. Our case suggests that Kampo medicine can be an option for the treatment of enterovaginal fistula refractory to conventional treatments.

We reported a case of a 69-year-old male who had been diagnosed with left eye glaucoma with surgical indication complicated by an eyesight view obstacle. His left intraocular pressure did not decrease regardless of the eye drop treatment he underwent at another hospital. At the initial visit to our hospital, his left intraocular pressure was 27 mmHg. As we noted marked tympanitic sounds in his abdomen, we prescribed hangekobokuto. After one month of his medication, his left eye intraocular pressure fell to 22 mmHg ; furthermore, the marked abdominal tympanitic sounds disappeared. Two years after his initial treatment, his left intraocular pressure still stayed generally within the normal range, and it did not require surgery. In this case, predominant sympathetic nervous system may have been the mechanism behind some cases of increased intraocular pressure ; therefore, the possibility that hangekobokuto reduces intraocular pressure by acting on this was suggested. As there have been no such reports that hangekobokuto itself has an effect on intraocular pressure decrease, this is considered as a novel case.

We report a case of prolonged lumbago with severe cold intolerance successfully treated with keppuchikuoto and uzushakusekishigan. The patient was a 71-year-old female with lumbar spinal canal stenosis which was refractory to several nerve and intervertebral disc block therapies and oral medications. She had been also suffering from constipation, leg cramps, intermittent chest pains, and severe cold intolerance. We prescribed keppuchikuoto for chronic blood stagnation and deficiency and uzushakusekishigan for intermittent chest pains in order to improve those symptoms all together. The severity of her lumbago and severe cold intolerance were remarkably reduced after the administration of the two formulas. This case suggests that the two formulas exerted their effectiveness by ameliorating chronic severe cold intolerance, blood stagnation, and blood deficiency and resulted in remarkable improvement in lumbago.

We experienced a case of post-operative complication and chronic pain due to left pyeloplasty and uterine myomectomy successfully treated with Kampo medicine. A 55-year-old woman underwent pyeloplasty for ureteropelvic junction obstruction, and ureteral stent for ureteral stenosis caused by synechia after uterine myomectomy. She suffered from post-operative complication and chronic pain, which was becoming severe, and had a depressed mood. She visited our outpatient clinic for Kampo therapy. We prescribed bukuryoingohangekobokuto on the diagnoses such as qi deficiency, qi stagnation, and water retention. Her symptoms disappeared with this formulation. This case suggests the importance of considering qi disturbance when we treat patients with chronic pain using Kampo medicine.

In the Guideline for treatment of chronic headache published by Japanese Headache Society, Ibuprofen and Acetaminophen are proposed for the acute treatment of migraine in children. But prophylactic treatment of pediatric migraine is not established. We report the efficacy of Kampo medicine for preventing migraine in children and childhood periodic syndromes. We use a variety of Kampo medicine for 9 pediatric migraine and periodic syndromes patients from 8 to 15 years old. All 9 patients improve their headache and associated symptoms including abdominal pain, vertigo, nausea and vomiting. After treatment the mean average of Headache Impact Test-6 (HIT-6) improve from 63.66 points to 45.77 points. Kampo medicines is effective for migraine in children and childhood periodic syndromes.

We investigated the history and indications of Toenho, Kinseiho, and Cho-Sanshaku-Shinteiho, which are different formulae with the same name of seishoekkito. According to the description in “Futsugoyakushitsuhokankuketsu” written by Sohaku Asada, Kinseiho exhibits an immediate effect, while Toenho has preventive effects. However, according to the original text, Kinseiho was formulated such that it could be administered regularly in the summer for prophylaxis. Furthermore, Kinseiho is regarded as a simplified formula with the central structure of Toenho. This implies that Kinseiho is composed of selected crude drugs used in Toenho that are responsible for the main effects of Toenho, such as invigorating spleen energy, clearing fever and generating body fluids. Moreover, there is an instruction to arrange Kinseiho to fit each patient’s condition. In this study, it was found that Cho-Sanshaku-Shinteiho described in “Futsugoyakushitsuhokankuketsu” is a modification of Kinseiho prescribed by Katsuki Gyuzan for patients with fever, consistent with the concept of personalized medicine. The medical extract preparation seishoekkito, which is currently widely used, is Kinseiho. We may use it with heat-clearing formula, fluid-regulating formula or some modifications to make the appropriate formulation based on the patient's symptoms.

Soshikokito has long been used to treat cough in frail patients with cold sensation in their feet, based on the Japanese traditional Kampo textbook “Iryo-Shuhou-Kiku”. In many old documents including “Wazai-Kyokuho,” where soshikokito was first described, it is suggested that airways obstructed by a large quantity of watery expectoration should be the proper indication for the use of this formula. However, in the five cases that we successfully treated, the quantity of sputum was relatively small. To determine the practical indications for this, we examined their abdominal strength and the presence or absence of “cold feet” sensation. In addition, we investigated the nature of sputum in the past clinical reports in which successful treatment using soshikokito was described. It has become clear that we can prescribe soshikokito as an antitussive regardless of the patients' physical fitness as deduced from the abdominal strength. The “cold feet” sensation was not an essential symptom and was regarded as one of the symptoms of qi counterflow. Regarding the properties of sputum, it was viscous and small in quantity. In the cases where soshikokito was effective, it was speculated that viscous sputum would result in airway obstruction, coughing, and wheezing. These conditions will be ameliorated by the antitussive and expectorant effect of this formula, which improves qi counterflow and mildly tonifies water. In the treatment of cough with respiratory distress, “sputum with high viscosity and hard to discharge” is considered to be the targeted symptom in the practical usage of soshikokito.