Small groups of 5th-year medical students performed a survey of hospital patient services in hygiene and public health, with an emphasis on patient waiting time. The purpose of this course was to give medical students the opportunity to experience the waiting time endured by patients and to obtain some understanding of the quality of hospital services from the patient's point of view. The survey was performed as follows. Groups of five students accompanied new patients in the department of internal medicine from registration until payment. The students recorded waiting time and examination time. During the waiting time, the students asked the patient questions to evaluate service. Patients were cooperative in giving responses during the survey. After the survey, the students summary proposed how to improve services for patients. By accompanying and talking with patients, the medical students were able to understand hospital systems from the patient's point of view. This course should prove useful for these students future careers in medicine.

Twenty endurance-trained athletes (five male speed-skaters, eleven male and four female cross-country skiers, 16-18 years) ran on a treadmill by a protocol of incremental graded increase in workload until exhaustion during an endurance training period in off-season summer. Immediately after exercise, all developed peripheral leukocytosis (1.9 times; p<0.01) due mainly to lymphocytosis (2.6 times; p<0.01) with a predominant effect on large granular lymphocyte (natural killer cell) count (5.9 times ; p<0.01) . Monocyte count was also enhanced 2.3 times (p<0.01) . These increases were transitory and returned to the pre-exercise levels 1 h later. Peripheral neutrophilia was also observed by 43% (p<0.01) immediately after exercise and remained elevated by 25% (p<0.01) 1 h after exercise, but a shift to the left did not take place. The capacity of isolated neutrophils to produce reactive oxygen species was assessed by luminol-dependent chemiluminescence which detects mainly myeloperoxidase (MPO) -mediated formation of such hyperreactive oxidants as HOCl. The maximum intensity of chemiluminescence (peak height) upon stimulation with opsonized zymosan was significantly enhanced following exercise (p<0.05) . Similar results were obtained when phorbol myristate acetate was employed as nonphagocytic soluble stimulus (p<0.01), suggesting that the capacity of neutrophils to degranulate MPO rather than phagocytosis was enhanced following exercise. In addition, the enhancements of chemiluminescence were positively correlated with the increase in segmented neutrophil count. These data indicate that maximal exercise not only mobilized mature neutrophils from the marginated pool into the circulation, but also augmented their capacity to generate reactive oxygen species of higher reactivity.

We investigated both the acute effects of maximal exercise and the chronic effects of training on nonspecific immunity in 15 winter-sports athletes during different periods of training : (a) before the athletic season, in summer, when the athletes were undertaking extensive endurance training to enhance aerobic capacity, (b) during the winter sports season, in early winter, when endurance and athletic training were being undertaken, and (c) after the winter sports season, in spring, when the athletes were resting (detraining for a month) . The mean value of the maximal oxygen uptake in each training period was (a) 65.4 (SD 4.6) mL·kg^-1·min^-1, (b) 63.1 (SD 5.5) mL· kg^-1·min^-1, and (c) 58.3 (SD 5.8) mL·kg^-1·min^-1, respectively. Following maximal exercise, acute peripheral leukocytosis due to lymphocytosis and neutrophila was observed in every period. The capacity of isolated neutrophils to produce reactive oxygen species upon stimulation with opsonized zymosan measure by luminol-dependent chemiluminescence (LDCL) was significantly enhanced after maximal exercise before and during the athletic season. However, the degree of enhancement was smaller during after-season detraining, suggesting that the conditioning state affected the exercise-induced changes in neutophil functional status. Serum opsonic activity also showed a similar pattern. As for the chronic effects of training, the resting values of the neutrophil count, especially the segmented neutrophil count, the neutrophil LDCL response and the serum IgG level, declined significantly in the pre-season training period. Since the subjects were engaged in exhaustive endurance training under heat exposure at that time, the nonspecific immune status might have been partially compromised due to chronic overload.

We report a case of serous gonarthritis with nonproductive cough successfully treated with Eppikajutsuto. A 37-year-old Japanese man developed a right genicular arthrocele with nonproductive cough, in October X. Over 100 ml of serous synovial fluid was drained via an arthrocentesis puncture procedure. Although he was treated with nonsteroidal anti-inflammatory agents by an orthopedist, under a diagnosis of serous gonarthritis, his symptoms did not improve. Laboratory findings suggested inflammatory conditions (serum CRP 3.4 mg/dl, ESR 76 mm/h). At the time of his first visit in January X+1, orthopedic examinations revealed that rheumatoid arthritis was unlikely, based on negative physical and laboratory findings. A contrast MRI knee joint scan did not demonstrate any tumor-like mass of synovium which would indicate pigmented villonodular synovitis. And orthopedists found it difficult to specify the cause of his serous gonarthritis. After a common cold in December X, cough stimulated by cold exposure was superimposed on serous gonarthritis.We utilized Eppikajutsuto under the interpretation that both his genicular arthrocele and nonproductive cough were due to a “sui” disturbance. This Eppikajutsuto therapy reduced his genicular arthrocele and nonproductive cough in1month. His symptoms and inflammatory reactions were completely improved in 3 months, regardless of gradual withdrawal of his medication.
Coughing ; Upper case ecks ; symptoms <1> ; Serous ; Treated with

We demonstrated two patients with fibromyalgia syndrome (FMS), successfully treated with Kampo medicine, and considered the resemblance between the clinical manifestation of FMS and SHO for Kanzo-bushi-to.The first case was a 52-year-old women who consulted a local hospital in 2001 due to althralgia and myalgia in the left hand, bilateral elbows, shoulders and foot. Her condition was diagnosed as FMS without abnormal findings in the thorough medical examination. Treatment with NSAIDs was not effective, so she consulted our department in 2004. She was treated with Keishi-ni-eppi-itto-ka-ryojutsu-ka-boi-ogi-kakkon. After two mouths, her symptoms had reduced to 50% by visual analog scale (VAS). By March 2006, her symptoms had significantly decreased to 20% by VAS and NSAIDs became unnecessary.The second case was a 58-year-old woman who had suffered from tolerable pain in her right elbow for 10 years. In 2004, she visited the Department of Orthology at her local hospital due to pain in the neck, bilateral arms and shoulders. There were no findings on cervical X-ray or neurological examination, and NSAIDs were administered. Her symptoms did not resolve, therefore, she consulted our department in 2005. She was diagnosed with FMS, based on fulfilling the diagnostic criteria for FMS of ACR (American college of rheumatology) in 1990. She was treated with Kanzo-bushi-to. After 3 months, her symptoms had reduced to 30% by VAS. By Mar. 2006, her pain had redused to 25% by VAS and she was physically fit enough for a daily life.
CSF1-R ; symptoms <1> ; Medicine, Kampo ; Pain ; Fibromyalgia

We report a case with an intractable jugular sense of discomfort, with dryness and nonproductive cough successfully treated with soshikokito. A 62-year-old Japanese man developed jugular sense of discomfort with dryness and nonproductive cough, after odontotherapy in October. Although he was treated with Western drugs by an otolaryngologist, under the diagnosis of xerostomia with no mechanical problems, his symptoms did not disappear. The symptoms followed a protracted course, and he further developed a loss of appetite. At the time of first visit in October, otorhinolaryngological studies showed no structural lesions or problems, with the exception of minimum salivation in the normal range on a gum test. There was no evidence of dry eyes. With the diagnosis of xerostomia, Bakumondoto-go-hangekobokuto was administered for a month but showed no sign of improvement. Making a shift to bukuryoin-go-hangekobokuto regained his appetite, but did not produce any improvement on dryness. We then utilized soshikokito under the interpretation that both dryness and nonproductive cough is ki-gyaku. The soshikokito therapy reduced his dryness in a month's time. Additionally, his nonproductive cough gradually decreased, and within 11 months after, he had no symptoms, regardless of a gradual medication withdrawal.
Coughing ; symptoms <1> ; seconds ; month ; Peripartum discomfort

The saphenopopliteal junction (SPJ) is found at various levels and has various patterns compared with the saphenofemoral junction. Although this can cause difficulty in the surgical treatment of varicose veins and affect the outcome, there have been few reports on preoperative assessment of the small saphenous vein (SSV) regarding this point. This study was undertaken to evaluate three-dimensional CT venography with dual-route injection for the preoperative assessment of a small saphenous-type varicose vein. We examined a total of 15 legs in 15 patients with a small saphenous-type varicose vein, which were preoperatively evaluated by CT venography and then surgically treated. The patients included 4 men and 11 women with ages ranging from 50 to 80 years old (mean age, 66 years). The grading of varicose veins according to the CEAP classification was C2, C3, C4, and C5 in 3, 4, 6 and 2 legs, respectively. The CT imaging was performed with contrast medium diluted ten-fold, which was injected into the great and small saphenous veins simultaneously. CT venography clearly visualized the lower extremity veins. Whereas the popliteal vein coursed deep above the level of the femoral intercondylar groove, it followed a shallow course below the level of the knee joint. In 11 legs (74%), the SPJ was located in the shallow portion, whereas it was in the deep portion in 4 legs (26%). Among the former group, the SSV was connected to the great saphenous vein via the Giacomini vein in 2 cases, and the gastrocnemius vein was connected to the SSV before the SPJ in 3 cases. Among the latter group, a localized large venous aneurysm with thrombus before its termination was found in one case. In another case, the SSV showed branched termination in the deep portion. Our three-dimensional CT venography with dual-route injection provides more accurate information on venous anatomy in the lower extremity. The accuracy of images acquired by CT venography with dual-route injection was verified by intraoperative findings. Although Doppler ultrasound is essential for examining the presence of regurgitation in the veins and locating the course of a varicose vein in the surgical field, all 15 cases had scheduled surgery under local anesthesia based on accurate preoperative diagnosis. This study suggests that CT venography with dual-route injection is beneficial in preventing undesired complications during surgery and avoiding additional procedures for recurrent varicose veins.

Objective: To nurture pharmacists capable of contributing to the prevention of adverse reactions to psychotropic agents, the Sapporo Hospital Pharmacist Association has been holding a seminar for psychiatric pharmacy specialist.  A questionnaire survey was conducted to clarify the usefulness of this seminar and its future direction, and evaluate the necessity of providing information on psychotropic drugs.
Methods: An anonymous 21-item questionnaire was distributed to participants in the 2008 Sapporo Hospital Pharmacist Association seminar for psychiatric pharmacy specialist.
Results: The mean recovery rate was 76.3%, and the respondents had a broad background in terms of age, gender, etc.  The seminar was identified as being beneficial, and the participants’ awareness of the accreditation of Board Certified Pharmacist in Psychiatric Pharmacy showed regional characteristics.
Conclusion: Based on the survey results, guidelines on conducting the seminar in the future were successfully developed.  From now on, it is important to create an environment to nurture psychiatric pharmacy specialist in the Sapporo area.  Additional efforts should be made so that the provision of information on psychotropic drugs in the seminar can contribute to the prevention of adverse reactions to them.

A 43-year-old woman underwent aortic valve replacement for aortic regurgitation causing aortitis syndrome. The postoperative course had been uneventful and inflammation was controlled by steroid therapy. She developed a moderate degree of dyspnea with cardiomegaly. Two years after the first aorta valve replacement (AVR), severe aortic regurgitation was observed on both echocardiography and aortography. Dehiscence of the prosthetic valve was suspected and an emergency operation was performed. To secure the reimplanted prosthetic valve, we applied the technique of passing felt-pledgeted sutures through the aortic wall in the vicinity to the right coronary cusp and the noncoronary cusp and others through the left coronary cusp with everting mattress sutures. The postoperative course of the second AVR has been uneventful for two months. Since prosthetic valve detachment can occur even if inflammation of aortitis is well controlled, strict management of inflammation is recommended for a prolonged period to prevent reccurence of aortitis and subsequent valve dehiscence.

Infected femoral artery aneurysm is difficult to treat because of the risk of reinfection and anastomosis. The treatment of choice has been a topic of much controversy. Revascularization is mandatory for limb salvage after excision of infected grafts. Revascularization requires various ingenious techniques such as retro-sartorius bypass and obturator bypass. We treated a patient with suspected infection of an aorta-femoral graft, using femoro-femoral crossover bypass in front of the pubis and inside of the thigh muscle. We performed complete debridement of infected tissue. After resterilization of the operative field once more and exchange of all the instruments we performed revascularization detouring around areas of focal infection, using autogenious vein graft through the front of the pubis and inside of the thigh muscle to reach the left superficial femoral artery.