Idiopathic thrombocytopenic purpura is an autoimmune disease and is caused by a blood antiplatelet antibody that reacts to thrombocyte membrane. The platelet associated immunoglobulin G (PAIgG) is admitted in idiopathic thrombocytopenic purpura.
Adrenocortical steroids are our first choice as a treatment for idiopathic thrombocytopenic purpura.
However, a sufficient thrombocyte increase is not obtained even when adrenocortical steroids are administered to the idiopathic thrombocytopenic purpura patient.
On the other hand, we use Kampo medicine widely clinically. We are admitting the effectiveness of Kampo medicine in treating many refractory diseases. Even if it corresponds to idiopathic thrombocytopenic purpura that is one of a chronic refractory disease effective Kampo medicine is reorted several Kampo pharmaceutical preparations that are assumed when it is effective in idiopathic thrombocytopenic purpura are Sairei-to, Sho-saiko-to, Kami-kihi-to, etc.
This time we carried out Kampo therapy (Rikkunshi-to, Shimatsu-to) on patients with digestive and cutaneous problems but no other symptoms of hemopathy. A blood specialist at this university hospital tentatively diagnosed the patients' condition as thrombocytopenic purpura. Kampo therapy increased the thrombocyte count and alleviated the symptoms.
This result might suggest the possibility of a therapy for idiopathic thrombocytopenic purpura and even the importance of the therapy in accordance with the oriental medical syndromes.

A 51-year-old woman suffered from a sudden onset of anterior chest pain and was referred to our hospital on the suspicion of an anginal attack. The exercise ECG showed findings of an anterior lesion and ischemia. Coronary angiography also revealed left anterior descending branch fistula and circumflex branch fistula connecting to the main pulmonary artery trunk. Direct closure was performed for both intra-pulmonary openings under cardiopulmonary bypass. The postoperative course was uneventful and the patient did not show any precordial pain. Coronary angiography showed no coronary organic narrowing, but contrast medium remained in the fistulae although there was no left to right shunt. Ligation of the fistulae had to be performed simultaneously to confirm complete obstruction of the coronary-pulmonary arterial fistulae. The antiplatlet agent is administered to the patient to prevent occurring myocardial infarction caused by thrombus which might be formed in fistulae.

Introduction : To promote disease management in the community, general physicians should refer their patients to specialists in a timely and appropriate manner. In this study, we propose an indicator for evaluation of such referrals.
Methods : We analyzed all referrals in an urban clinic from September 1, 2011 to August 31, 2012. Symptoms and diagnoses documented by general physicians were collected from medical records, and the final diagnoses by specialists were collected from their reports. The symptoms and diagnoses were classified using the International Classification of Primary Care second edition (ICPC-2). Referral rates, hospitalization rates, and place of referral were analyzed.
Results : The average number of encounters in the candidate clinic was 1402 per month, and the mean number of referrals was 23 (1.6% of encounters). Of patients who received a referral, 6.75 (29.1%) were admitted to hospitals. The symptoms and diagnoses of the referred patients were distributed across all chapters (A to Z) of ICPC-2. Diagnoses of admitted patients included pneumonia (R81) (24%), urinary tract infection (U70 and U71) (9%), and acute gastroenteritis with dehydration (D73 with T11) (9%).
Conclusion : We identified the referral rates, hospitalization rates, and distribution of referral patients as indicators of the triage function of primary care physicians. These should be evaluated further as potential indicators of “the quality of medical care.”

The purpose of this study was to assess the negative effects of some factors on medicine-taking behavior. For the patients taking oral medication who visited a health insurance pharmacy, we enacted the actual situation of medication and conducted an attitude survey on the feeling of burden and resistance of taking the drugs. The survey also covered the factors that can influence medicine-taking behavior and the extent of the influence. For differences in each factor such as patient characteristics, lifestyle, and medication status, we used the 2 test to analyze the association with medicine-taking behavior. We found significant differences in age, dietary habits, occupation, periodic consultation with the pharmacy/doctor, and unpleasant experiences. In addition, in patients with multiple factors that cause noncompliance with medication, we observed a strong influence of age and occupation. From the factor analysis, we obtained data on time, quantity, and pharmaceutical factors (three factors called regular factors). These factors negatively influenced the use of medication by the patients. Next, in the covariance structure analysis, the influence of time and the quantity factor on medication-related stress was the observed to be the strongest, whereas the influence of the regular factors was not significant. Furthermore, there were differences in the influence of these factors depending on patient characteristics.

Taping is widely used in sports medicine to prevent injury, protect affected sites post injury and relieve pain. However, it is not clear whether taping affects the perception of noxious stimulation because in previous studies, it was difficult to selectively activate Aδ fibers. A recently developed, useful, new tool named intra-epidermal electrical stimulation (IES) can preferentially activate Aδ fibers. We aimed to clarify the effect of taping on pain-related somatosensory evoked potentials (pSEPs) using IES. We recorded pSEPs following IES of the right medial forearm in twelve healthy volunteers. pSEPs were recorded from 9 electrodes on the scalp under control, elastic-taping and white-taping conditions. Under the control condition, subjects relaxed on a comfortable reclining seat without taping, whereas under the taping conditions, they were subjected to taping along the forearm with tension (elastic-taping) and without tension (white-taping). Subjects were asked to assign a visual analog scale (VAS) score after each session. The peak amplitudes of N2-P2 were significantly lower under the elastic-taping and white-taping conditions than those under the control condition. VAS was significantly lower elastic-taping condition than those under the control and white-taping conditions. Moreover, there was a significant positive correlation between the amplitude of N2-P2 and VAS. We revealed that taping along the forearm decreased pSEPs and subjective pain perception under the white-taping and elastic-taping conditions. The underlying mechanism of pain relief was the distraction effect in both taping conditions. In addition, elastic-taping with tension changes afferent inputs mainly from the skin, and this might more effectively decrease the subjective pain perception than that achieved under the white-taping condition.

Medical education in Japan has centered upon Western medicine since the Meiji Era. Nevertheless, because patients have a great interest in Oriental medicine, many physicians have treated patients with traditional Chinese medicine. The Oriental Medicine Research Institute of Tokyo Women's Medical University opened in 1992, when education in Oriental medicine became a part of the curriculum. To understand the status of education in Oriental medicine in Japan, we conducted a questionnaire survey of all medical schools in the nation. With a response rate of 97.5%, the survey found that one university in four teaches Oriental medicine.
Since 1990, recognition of “alternative medicine, ” in contrast to “modern medicine, ” has gradually increased in both research and education around the world. In Germany, which was the model for the introduction of western medicine to Japan, the use of traditional herbs and spa treatment is already taught in medical school. In the United States, where the National Institutes of Health have established an alternative treatment clinic, research and education are already ongoing at many medical schools.
In such a global situation, the need for education in traditional Oriental medicine will increase, and systematizing such education may become a great challenge. We expect that Oriental medicine will one day be taught at all medical schools in Japan and will become part of the state medical examination.

A 59-year-old man was admitted to our hospital with severe mitral incompetence. Mitral valve repair, tricuspid annuloplasty and the Maze procedure were performed. After weaning from cardiopulmonary bypass, his systolic blood pressure (SBP) dropped to 40 mmHg. Immediate administration of catecholamines markedly increased SBP but his continuing low blood pressure required additional treatment with vasopressin and hydrocortisone. On postoperative day 12 in the general ward, he suddenly lapsed into an intractable hypoglycemic coma. Endocrine function tests revealed adrenocorticotropic hormone deficiency. Since the time of writing has been doing well with 20 mg of hydrocortisone.

Purpose: Incisional hernia (IH) is a frequent complication following laparoscopic colorectal surgery. The present study investigated the risk factors for IH after laparoscopic surgery for colorectal cancer. Methods: A retrospective study was conducted on 202 patients who underwent laparoscopic surgery for colorectal cancer. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with IH. Results: The overall incidence of IH was 25.7% (52 of 202). The univariate analysis showed that female sex (P=0.004), a high body mass index (P<0.001), noncurrent smoking habit (P=0.043), low level of hemoglobin (P=0.035), high subcutaneous fat area (P<0.001), high visceral fat area (P=0.006), low skeletal muscle area (P=0.001), long distance between the inner edges of the rectus abdominis muscle (P=0.001), long protrusion of the peritoneum at the umbilical site (P<0.001), and lymph node metastasis (P=0.007) were significantly more frequent in the group with IH than in the group without it. The multivariate logistic regression analysis revealed an older age (10-year increments: odds ratio [OR], 1.576; 95% confidence interval [CI], 1.027–2.419; P=0.037), lymph node metastasis (OR, 2.384; 95% CI, 1.132–5.018; P=0.022) and lengthy protrusion of the peritoneum at the umbilical site (10-mm increments: OR, 5.555; 95% CI, 3.058–10.091; P<0.001) were independent risk factors for IH. Conclusion Our findings suggest that older age, lymph node metastasis, and lengthy protrusion of the peritoneum at the umbilical site are risk factors for IH after laparoscopic surgery for colorectal cancer. An assessment using these factors before the operation and the implementation of countermeasures might help prevent IH.

In an analytical study of microbial broths, the actinomycete strain Kitasatospora sp. P07101 was found to produce three new congeners, which were designated hazimycins B (1), C (2), and D (3), together with the previously reported hazimycin (renamed hazimycin A (4)). The structures of these hazimycins were examined using various spectroscopic methods including nuclear magnetic resonance (NMR), and the results revealed that 1-3 were analogues of hazimycin with the replacement of one of the two isonitrile groups in 4 by an NH-formyl group in 1, the two isonitrile groups and an amide group by two NH-formyl groups and a nitrile group in 2, and the two isonitrile groups and two amide groups by two NH-formyl groups and two nitrile groups in 3. Only hazimycin A exhibited moderate antimicrobial activities against Gram-positive bacteria and Candida albicans. These results indicated that the presence of two isonitrile groups in the hazimycin structure is essential for antimicrobial activity.

BACKGROUNDMultislice helical computed tomography (MSCT) has been used to depict coronary anatomy noninvasively, and proved useful for evaluating ventricular function. The aim of our study was to assess the accuracy of ventricular volume as measured by MSCT.

METHODSFourteen human left ventricular (LV) and 15 right ventricular (RV) casts were scanned by MSCT. A series of LV and RV short-axis images were reconstructed later with slice thickness of 2.0 mm, 3.5 mm, 5.0 mm, 7.0 mm, and 10.0 mm. Ventricular volume was calculated by the multislice tomographic Simpson's method. True LV and RV cast volumes were determined by water displacement.

RESULTSBoth calculated LV and RV volumes correlated highly with the corresponding true volumes (all r >0.95, P <0.01). But with slice thickness from 2.0 mm to 10.0 mm, MSCT scanning overestimated the corresponding true volume by (3.21 +/- 5.95) ml to (12.58 +/- 8.56) ml for LV and (10.22 +/- 8.45) ml to (23.91 +/- 12.24) ml for RV (all P <0.01). There was a very high correlation between the overestimation and the selected slice thickness for both LV and RV volume measurements (r=0.998 and 0.996, P <0.01, respectively). However, when slice thickness was reduced to 5.0 mm, the overestimation for both LV and RV volume measurements became nonsignificant for slice thickness from 2.0 mm to 5.0 mm.

CONCLUSIONSBoth LV and RV volumes can be accurately estimated by MSCT. Thinner slice has more accurate calculated volume. However, 5.0 mm slice thickness is thin enough for an accurate measurement of LV or RV volume.

Adolescent ; Adult ; Aged ; Cardiac Volume ; Child ; Child, Preschool ; Female ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, Spiral Computed ; methods