Recent topics of biochemical and biological progress in keratinization and dyskeratosis were reviewed and discussed. The main topics were as follows: (1) what is keratin (2) Differentiation of keratinocytes (keratinization), (3) Components of horny substances and their derivation, (4) Keratin filament and keratohyaline granule, (5) Synthesis of horny cell membrane (disulfide bonds, e- (T-glutamyl) lysine bonds), (6) Biochernical analysis of dyskeratosis (harlequin fetus, ichthyosis vulgaris, X-linked ichthyosis, lamellar ichthyosis, bullous congenital ichthyosiform erythroderma, psoriasis vulgaris, Dariers disease, M:enke's syndrome, Netherton's disease, Richner-Hanhart syndrome). These findings should lead to a more cornplete understanding of the pathologic events that occur in the process of keratinization and more rational therapy for many disorders in keratinization.
Cell Membrane ; Darier Disease ; Fetus ; Hyperkeratosis, Epidermolytic ; Ichthyosis ; Ichthyosis Vulgaris ; Ichthyosis, Lamellar ; Keratinocytes ; Lysine ; Psoriasis

The purpose of this symposium was to clarify clinical significance of the pulse diagnosis at the wrist used for detecting the function of various organs. Base of the literature survey and his personal experiences, the importance of reliability (reproducibility) test of the pulse diagnosis in blinded manner and necessity of clinical trials with “_??_”-specific intervention was proposed by Ogawa. A unique training program of the pulse diagnosis was introduced by Kido, and he also demonstrated a significant positive result of “_??_”-specific intervention determined by the pulse diagnosis procedure in his program and suggested the clinical significance of the pulse diagnosis. Detection of various changes in pulse waveforms at the wrist using pressure transducer was demonstrated by Maruyama, and he also suggested a possible progress of objectivity in pulse diagnosis by various sensors and biomedical devices in future. From circulatory physiological point of view, factors which may affect the pressure pulse wave at the wrist were explained with several examples of pathologic conditions by Chihara. He also suggested a possibility of reflection of general condition in the pressure pulse at the wrist although it might be partial one, and stressed the necessity of other information for the accurate diagnosis. In general discussion, it was pointed out that evidence of the pulse diagnosis was still limited, and further experimental approaches of the pulse diagnosis will be required.

In two cases of thromboangitis obliterans (TAO) a popliteal-posterior tibial-peroneal artery sequential bypass was attempted through a median approach. The 1st case underwent the operation successfully with non-reversed saphenous vein graft. However, only popliteal-peroneal bypass was carried out in the 2nd patient because the posterior tibial artery was severely affected. In surgery of TAO patients, careful assessment of preoperative angiographic findings is important to select the site of distal anastomosis. We found that the posterior tibial artery and the peroneal artery are easily accessible through the medial route in the proximal half of the lower leg and that peroneal artery revascularization was effective for limb salvage.

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.

We report on 3 patients who presented with symptoms of Ki obstruction, Ki deficiency, and disorder of the body's fluid metabolism, successfully treated with bukuryoingohangekobokuto. In our experience, bukuryoingohangekobokuto has been effective in 25 of the 30 patients (6 men and 24 women) to whom is has been administered, who also presented with Ki obstructions, Ki deficiencies and disorders of the body's fluid metabolism as mentioned above. The most common subjective symptom in all these effectively-treated patients was hot flashes. Other signs were epigastric pain or discomfort accompanied by chest signs and symptoms, such as palpitations, heartburn, chest oppression or dyspnea. The most common objective findings in these effectively-treated patients were pulsation at the pit of the stomach and navel, and a fluid sound in the stomach upon palpation. Based on our experiences, we believe that prescription of bukuryoingohangekobokuto is best indicated when the presence of the above-mentioned symptoms and findings has been confirmed.
symptoms <1> ; Liquid substance ; Cases ; seconds ; findings

We report on a patient with residual complaints after an operation for lumber canal stenosis, successfully treated with the Kampo medicine, kigikenchutokauzu. The patient was 69 year-old woman complaining of severe coldness, numbness, and bilateral leg pain. She was diagnosed as having spinal canal stenosis when she was 67 years of age. Posterolateral fusion with laminectomy was performed at the age of 69, although severe coldness, numbness, and pain persisted even after her surgery. Also, her sutures had not healed. She was referred to our department 26 days after her surgery in order to receive Kampo therapy. Kigikenchutokauzu was prescribed, and her condition markedly improved. Her sutures healed completely 7 days after start of administration. This suggests that kigikenchutokauzu may be effective not only for the residual spinal canal stenosis symptoms, but also for the postoperative healing of sutures.
seconds ; Spinal Canal ; Surgical sutures ; Stenosis <3> ; Medicine, Kampo

We report a case with various postoperative abdominal symptoms that were successfully treated with Kampo medicine. A 58-year-old Japanese female had nausea, eructation, epigastric pain, lower abdominal pain and anorexia that appeared just after laparoscopic nephrectomy for renal cell carcinoma. No abnormal findings were discovered by gastroenterological examinations. Western medical therapy was not successful. We used bukuryoin under the interpretation that nausea and eructation represent phlegm-fluid retention in the chest. The bukuryoin therapy cleared up her nausea and eructation in about one week. Additionally, her epigastric pain, lower abdominal pain and anorexia were cured by use of anchusan.
Therapeutic procedure ; Medicine, Kampo ; symptoms <1> ; Postoperative Period ; Nausea

We reviewed the results of 14 patients who underwent the operation of thoracic aneurysms using a centrifugal pump. Nine patients had atherosclerotic aneurysms and 5 had aortic dissections. The autotransfusion system (ATS) was used to keep hemodynamic stability by rapid transfusion. The ATS consisted of a roller pump, a 2, 000ml reservoir and a heat exchanger. Two mg/kg of heparin was given to the patients to keep ACT over 400 seconds. All patients survived. Body temperature increased 0.08±0.59°C during bypass with the ATS, and no patients showed hemodynamic instability after aneurysmotomy under the help of the ATS. We conclude that 1) the centrifugal pump is a useful and safe assisting means for the surgery of thoracic aneurysms, 2) the autotransfusion system has advantages as follows: keeping stable circulation and preventing loss of body temperature during bypass.

Aims : To clarify any difficulties that pharmacists and nurses may have when prescribing Kampo medicines to newly-admitted patients with a survey questionnaire at a local hospital ward.Methods : Questions for pharmacists on the handling of Kampo herbs, any perceived risks in the preparation of Kampo formulae powder extracts/pills, or in explaining Kampo medicines, based on their experiences. Also questions for nurses on the handling of Kampo medicines, as compared to western medicines, and any perceived risks in their administration at their ward.Result : All 7 pharmacists and 14 out of the 16 nurses surveyed completed their questionnaires. The pharmacists pointed out that Kampo preparation takes more time, although none perceived an increased risk with Kampo medicines, as compared to western medicines. Only 1 pharmacist had ever had experience explaining Kampo medicines to patients. The nurses, on the other hand, felt that Kampo treatments were somewhat more difficult to use, and perceived similar risk in their administration to patients.Conclusion : Both the pharmacists and nurses surveyed believed that the handling of herb medicines was somewhat difficult, but that these difficulties could be overcome with risk management. This suggests that pharmacist, nurse and office personnel education would be useful before Kampo medicines are administered to newly-admitted hospital patients.
Medicine, Kampo ; perceived risk ; seconds ; Therapeutic procedure ; Risk