Growing evidences indicate that the development of mesenteric phlebosclerosis (MP) is associated with long-­term gardenia fruit (GF) intake. Besides duration and total dosage of GF ingestion, other factors associated with the development of MP or the symptoms of MP have not been known. We searched for previous case reports of MP from Japan. MP patients were divided into two groups : asymptomatic group without abdominal symptoms or symptomatic group. Age, gender ratio, body size, and duration of GF ingestion of the both groups were statistically analyzed. We evaluated concomitant diseases that can cause elevated venous pressure in the both groups. Colectomy rate were compared between symptomatic men and symptomatic women. Severe symptoms including ileus, stenosis peritonitis, and perforation were also compared between men and women. Age and sex were analyzed in all 164 cases. The gender ratio of women to men in the symptomatic group was higher than that in the asymptomatic group. However, colectomy rate in the symptomatic group was similar between men and women. Ileus, stenosis, peritonitis, and perforation were similarly found in both men and women. We found 15 symptomatic MP patients with concomitant diseases that can cause phlebostasis. None of the asymptomatic had these diseases. Concomitant diseases that can cause elevated venous pressure might be associated with symptomatic MP. The severity of MP seems to be similar between men and women. Association of gender difference with the development of MP symptoms was uncertain.

　　This paper reports a case of a transcranial surgery in a patient with a symptomatic Rathke’s cleft cyst. The patient was a 54-year-old woman visited us with a chief complaint about chronic retrobulbar pain. Goldmann visual field tests revealed visual field defects in the bitemporal upper quadrant part and enlargement of the bilateral blind spot of Mariotte. MRI demonstrated a cystic lesion in the intra suprasellar region. The cyst was located on the pipuitary gland. The content of the cyst displayed hyperintensity on T1WI and hypointensity on T2WI, respectively. The diaphragma sellae was elevated and extended by the cyst. Considering a locational relationship between the cyst and the pituitary gland, and high viscosity of the cyst content, we decided to perform a transcranial surgery for an adequate resection of the cyst wall and evacuation of the content. The patient underwent a right fronto-temporal craniotomy with extradural anterior clinoidectomy. The cyst content was evacuated and the cyst wall was resected. The content was very viscid and waxy. Pathologic examination revealed that the cyst wall consisted of single or multiple ciliated columnar cells. Inflammatory cellular infiltration was also observed in the cyst wall. Retrobulbar pain subsided just after the operation and visual field disturbance also disappeared.

A 61-year-old man underwent an emergency operation for a ruptured infrarenal abdominal aortic aneurysm. Operations included bifurcated graft replacement of the abdominal aorta, oversewing of five lumbar arteries between L3 and L5, and ligation of the occluded inferior mesenteric artery. Because of the severe adhesions and arteriosclerotic changes over the bifurcation of the abdominal aorta and both common iliac arteries, prolonged aortic cross-clamp time was needed. In spite of stable his postoperative general condition, he suffered paresthesia and complete sensory loss on the left lower leg and the right sole. Moreover he was found to have paresis on the left leg and the right thigh. Knee and ankle deep-tendon reflexes were absent on the left. Lasègue's sign was positive bilaterally, which was more brisk on the left. There was no incontinence of urine and feces. EMG showed neurogenic polyphasic potentials on the lower extremities. MRI of the thoracolumbar spine and sacrum showed no evidence responsible for this neurological deficit, but IV-DSA revealed complete occlusion of the left common and internal iliac arteries. Following the active rehabilitation, he was able to walk unaided, but remained to have residual paresthesia on the left lower leg at his discharge. It was concluded that ischemic injuries to the cauda equina resulted in this rare complication, which seemed to be secondary to oversewing of critical lumbar arteries, prolonged aortic cross-clamp time, and the acute occlusion of the left common and internal iliac arteries.

Recently, basophil activation test (BAT) has been applied to the diagnosis of drug allergy. We performed BAT for various Kampo medicines taken by 12 cooperators to evaluate the concentration which arouse nonspecific reaction during incubation in BAT. When whole blood of each was incubated for 24 hours with each Kampo medicine, false positive results were frequently observed. After 1-hour incubation with Kampo medicine at high concentration (1/312.5), false positive results were sometimes observed. These results suggest that in the diagnosis of Kampo-medicine adverse reactions, BAT should be performed in the condition of 1-hour incubation with lower concentration (1/1250 or lower).

A 47-year-old woman visited our clinic, and thereafter she had taken various Kampo medicines until she turned 58 years old. She took each medicine, containing 1-3.5 g/day of glycyrrhiza, for one or two months. Hypertension or edema was not observed in those days. From the age of 60, she took 7.5 g of tokishigyakukagoshuyushokyoto, containing 2 g of glycyrrhiza, day after day. Hypertension or edema was not observed for 35 months. However, when she was 63 years old, pseudoaldosteronism with headache, hypertension, edema,and hypopotassemia was observed for the first time. This case suggests that administration period or patient's age influences the development of pseudoaldosteronism.

Incidence of glycyrrhiza-induced pseudoaldosteronism is not well understood. We examined relationships between pseudoaldosteronism incidence and daily glycyrrhiza dose in previous clinical studies. The incidence in patients administered glycyrrhiza 1 g/day was 1.0% (mean). The incidence with 2 g/day, 4 g/day and 6 g/day were 1.7% (mean), 3.3% and 11.1% (mean), respectively. Thus a dose-dependent trend toward pseudoaldosteronism incidence was suggested by previous literature.

A case of ascites and pitting edema from hepatocellular carcinoma treated with Boi-shomoku-teireki-daio-gan-ryo was reported.
An 80-year-old female presented progressive gait disturbance and dysuria in April 2002. Neurological examination revealed paraparesis, hypesthesia inferior to lumber level and sphincter dysfunction. An MRI revealed a solid mass arising from lamina at the right Th 12, extending into the spinal canal. Surgery was performed, but paraparesis continued. In addition, the patient developed ascites and pitting edema of the legs. An abdominal CT suggested liver cirrhosis and hepatocellular carcinoma. Some Kampo formulas were not effective. Boi-shomoku-teireki-daio-gan-ryo was administered on the basis of symptoms such as ascites, dry mouth and constipation, and then the pitting edema improved rapidly. In addition, the abdominal CT revealed the decrement of ascites. Unfortunately the treatment was effective for only one month. Ascites with malignant tumor is very difficult to treat. However, Boi-shomoku-teireki-daio-gan-ryo is clearly useful for treatment of ascites and edema.

We report the case of a 77-year-old female with subacute thyroiditis who was successfully treated with traditional herbal medicine (Kampo-therapy). On 18th December 2001, the patient was admitted to our hospital because of malaise and loss of appetite.
The patient complained of what she thought was a sore throat that began one month prior to admission, with a fever rising to 37.8°C 4 days before admission. Physical examination showed tenderness and swelling of the thyroid. Blood examination showed hyperthyroidism (TSH 0.02μIU/ml fT₃ 20.18ng/dl fT₄ 5.21ng/dl) and high inflammation (CRP 13.7 ESR 122mm/hr). We then diagnosed subacute thyroiditis and treated her with Kampo-therapy only. We arranged herbs according to the “Sho-kan-ron (_??__??__??_)” and gave her Keishi-ni-eppi-ichi-to (_??__??__??__??__??__??__??_) and Choi-joki-to (_??__??__??__??__??_). Four days after admission, her intermittent fever disappeared. After 10 days, her CRP became negative. After 13 days, almost all the symptoms had disappeared. Thyroid function (fT₃, fT₄) returned to normal after 17 days of Kampo-therapy. Subacute thyroiditis is a self limiting disease, but steroid therapy is often needed to reduce the symptoms and avoid thyrotoxicosis. In this case, the patient made a relatively quick recovery without steroid therapy. We suggest Kampo-therapy can be an effective treatment for subacute thyroiditis.

Ogikeishigomotsuto is a Kampo formula used for numbness or body pains. We experienced 29 cases in which attending physicians believed the drug would be effective. In 18 cases the drug was effective and in 11 cases it was not. We analyzed the difference in subjective symptoms between the responder group and the non-responder group. We concluded that some symptoms could be indicators for choosing the formula. Hypersensitivity to cold and heaviness of the whole body has previously been reported in many articles. In our cases, we observed a high incidence and specificity of the symptoms reported above, as well as arthralgia, dry skin and irritability in the responder group compared to the non-responder group. We believe these newly detected subjective symptoms can also be indicators for choosing Ogikeishigomotsuto.

We present a case of megacolon successfully treated with Kampo medicine. A 65-year-old male diagnosed with megacolon in 1999, came to our department in July 2003 complaining of severe abdominal distention. We successively used different Kampo formulae, in accordance with the diagnostic standard known as “SHO” which were: Daikenchu-to, Koboku-sanmotsu-to, Chukenchu-to, and Koboku-sanmotsu-to again. Daikenchu-to was only partly effective. Koboku-sanmotsu-to made the abdominal distention worse, forcing a change of drug. Chukenchu-to relieved the symptoms for some time, but the patient had to be hospitalized because of pseudoaldosteronism caused by the drug. Koboku-sanmotsu-to, however, worked smoothly on the second occasion and the symptoms disappeared. The efficacy of Koboku-sanmotsu-to was completely different on the two occasions it was used. This suggests that the pathological conditions were in a state of change, and these changes were identical to changes of SHO. This case reinforces the importance of detecting changes of the SHO accurately.