Extract preparations of Shosaiko-to and Keishi-ka-shakuyaku-to were simultaneously prescribed to 34 patients with trigeminal neuralgia. The efficacy of these kampo formulas on painful paroxysms was evaluated two weeks after commencement of formula administration.
In 11 out of 19 patients who were also taking carbamazepine (CBZ), dosage reduction or elimination of CBZ administration became possible; from the changes seen in the symptoms, Kampo treatment was thought to be effective in 14 of these cases. Of the 11 cases receiving Kampo alone, reduction in pain or elimination of pain was seen in 8 cases.
Excluding 4 cases where effectiveness could not be evaluated, the overall efficacy rate for Shosaiko-to/Keishi-ka-shakuyaku-to was determined to be 73% (22/30 cases).
Many basic and clinical studies have verified that Shosaiko-to-go-Keishi-ka-shakuyaku-to acts as an anticonvulsant. There are several common pharmacological characteristics between CBZ, the standard treatment for trigeminal neuralgia, and Shosaiko-to-go-Keishi-ka-shakuyaku-to. The formulas Shosaiko-to and Keishi-ka-shakuyaku-to used by themselves or in combination with CBZ were therefore thought to be a safe and effective option for the treatment of trigeminal neuralgia.

We experienced a case of infantile hydrocele with operation indication successfully treated with therapy based on Kampo diagnosis. The case was 4 years-old boy who was advised about an operation with the diagnosis of left hydrocele. At first, goreisan extract was administered, which resulted in a reduction of his hydrocele. However, the condition had worsened after his entrance into preschool. So, we changed the formulation to shokenchuto extract, which resulted in the disappearance of the hydrocele. Up to now, there has been no recurrence. We suggest that it is worthwhile to treat infantile hydrocele patients with Kampo medicine for a certain period of time, if their family gives consent. Moreover, shokenchuto or similar formulations might be practicable for such hydrocele, in addition to formulae which regulate body fluids.
Medicine, Kampo ; Therapeutic procedure ; Diagnostic ; Treated with ; Infantile

To investigate the difficulties of taking Japanese traditional (Kampo) medicines, questionnaires were filled out by patients under 19 years old or their families.Forty-six questionnaires were valid for analysis. The mean age of the patients was 9.7 &qlusmn; 5.3 years old (2 to 19 years old) and the percentage of male patients was high (65%). They took extract granules (n = 40) or decoction (n = 6) and most of the patients (n = 38, 83%) took medicines twice a day. Though 69% of patients under 5 years old needed direct assistance from their family to take medicines, none of over 6 years of age needed any help except to dissolve medicines in hot water, while notably 77% of the patients over 13 years old took their medicines un-aided. It was found that patients' families gave them the concrete explanations on the necessity of their medicines regardless of patients' age, so it is important for pharmacist to guide not only families but also patients themselves. Furthermore, pharmacists should understand the taste and the constituent crude drugs of Kampo medicines to improve patients' adherence in taking medicines.

A 57-year-old male had single bypass graft to the right coronary artery with a saphenous vein graft 20 years previously. He noticed recurrent anginal pain since 1991 and thoracic aortic aneurysm was also pointed out in 1993. Coronary angiography showed that the saphenous vein graft was occlusion, accompanied with the distal portion of the occluded anterior descending coronary artery perfused by collateral flow from the circumflexus branch. The left ventricular function was moderately impaired (EF=38%). Re-do of coronary artery bypass grafting was done to the AV branch of the right coronary artery with the right gastroepiploic artery and the primary sequential grafting to anterior descending coronary artery and diagonal branch with left internal thoracic artery. One month after CABG, graft replacement of descending thoracic aorta was done because of thoracic aortic aneurysm. The postoperative course was uneventful except for the complication of chylothorax after the second operation. Postoperative angiography showed good patency of the left internal thoracic artery and right gastroepiploic artery and no abnormality of the graft anastomosis.

A 61-year-old male had received aortic valve replacement due to AR in 1987 and the operative findings showed the enlargement of the ascending aorta and maximum diameters of 4cm in the ascending aorta. He had been doing well until 1992 when he sufferred cerebral infarction and aortic root dilatation reached a maximum diameter of 7.5cm demonstrated by CT. Cabrol's operation using the previously replaced aortic valve was carried out because the prosthetic valvular function was normal and the type of coronary arteries was balanced. Postoperative angiography showed good patency at anastomosis of bilateral coronary arterial orifices and he had a satisfactory postoperative course. The dilatation of the ascending aorta over 4cm accompanied with AR may need not only AVR but also aortic root replacement.

A 64-year-old woman with a diagnosis of calcified aortic valvular stenosis and unstable angina, had calcification of the aortic valve reaching the aortic annulus, and the ascending aorta had some calcifications in its lateral and posterior walls. There was a 70mmHg pressure gradient in the aortic valve and coronary angiogram showed 90% stenosis of right coronary artery #1 and total occlusion of left circumflex artery #13 perfused with collateral flow from right coronary artery. The translocation of the aortic valve was carried out. The postoperative course was uneventful and postoperative angiograms showed good patency of the double saphenous vein grafts and no abnormality of the composite graft anastomosis. Translocation of the aortic valve is effective in patients with stenotic aortic annulus caused by calcified aortic valve, although it is mainly indicated in infective endocarditis.

[Aim] Diffuse pan-bronchiolitis (DPB) causes severe respiratory dysfunction and severely limits a patient's daily activities. Case: This paper reports a case of a DPB patient whose respiratory symptoms were successfully improved by acupuncture. In a case report in January 2002, a 62-year-old male visited the Department of Respiratory Internal Medicine at Gifu University Hospital, complaining of cough, pumlent sputum and dyspnea on exercise. His general condition had worsened despite ordinary medical treatment. Thus acupuncture was added to the treatment in August, 2001. Intervention: The patient received acupuncture treatments once a week for 50 weeks. The acupuncture treatment was based on the Chinese medicine theory. Measurements: Outcome measures were respiratory symptoms using the Fletcher-Hugh-Jones (F-H-J) classification, 6-minute walking distance (6 MWD), blood test, arterial blood gas and pulmonary function tests. Computed tomography (CT) was assessed. Each evaluation was done after 15 weeks and 50 weeks later.
[Results] After 15 weeks of acupuncture treatment, cough, pumlent sputum, walking distance, the Borg scale and respiratory function were significantly improved compared with the baseline. Moreover, the effect of the acupuncture treatment continued for 50 weeks.
[Conclusion] This suggests that acupuncture treatment was effective in treating the advanced case of DPB.

Branching morphogenesis of the fetal mouse submandibular gland (SMG) is regulated by signaling through the ErbB and FGF families of tyrosine kinase receptors, whose members activate the ERK-1/2 pathway. The four Sprouty (Spry) proteins are inhibitory modulators of ERK-1/2. There is little information on their expression during pre- and postnatal development of the SMG. Qualitative RT-PCR detected mRNAs for Spry1, 2, and 4 from embryonic day 13 (E13) through postnatal day 7 (P7), but only trace amounts of Spry1 and 2 in adult SMGs. More sensitive quantitative RT-PCR revealed that transcripts for all four Spry isoforms are expressed, and each shows individual patterns of variation across fetal and early postnatal stages, and that there are very low levels of Spry1 and 2, but no Spry3 and 4, in adult glands. EGF, FGF7 and FGF10 upregulate expression of mRNA for Spry1, but only FGF7 upregulates Spry2 mRNA. EGF strongly induces an activating phosphorylation of all four Spry isoforms, but both FGFs do so only minimally. Quantitative RT-PCR of samples collected by laser capture microdissection showed that transcripts for Spry1 are confined to the epithelium of E13 SMG rudiments. The isoform-specific temporal variation in the patterns of expression of Spry1, 2, 3 and 4 suggests a potentially important role for these negative modulators of growth-factor driven ras/ERK-1/2 signaling at stages when the SMG is most actively undergoing branching morphogenesis.

A new technique of left atrial plication (LAP) for giant left atrium (GLA) resulting from mitral regurgitation (MR) is reported. A 66-year-old man was found to have NYHA class III resulting from severe MR, mild TR and GLA with a left atrial diameter (LAD) of 107mm on echocardiogram. Chest X-ray showed the cardiothoracic ratio (CTR) to be 92%, and the right side CTR was 88.4%. Surgery was performed under general anesthesia with endotracheal intubation. Under cardiac arrest established by antegrade and retrograde cardioplegia, mitral repair was performed first through a superior transseptal approach. Left atrial resection was continued paralell to the mitral posterior annulus and to the right side wall of the left atrium, following the right side resection. Simultaneously the left atrial wall was incised 3 to 4cm in width all the way along the resection line and it was closed by a running suture of 3-0 prolene. The continuous line of the left atrial plication formed a spiral shape. A prominent portion of the atrial septum resulted from the LAP and the right atrial wall was also resected and plicated. The postoperative course was uneventful, and the postoperative CTR reduced to 71% with a right side CTR of 54.4% with reduction of LAD to 67mm on ultrasound cardiogram (UCG). This spiral LAP was considered more effective to reduce all dimensions of the giant left atrium dilated in all directions in comparison with other LAP methods previously reported.

Wells' syndrome (eosinophilic cellulitis), whose etiology is idiopathic, is clinically characterized by solitary or multiple cellulitis-like eruptions which occur on the extremities and trunk. Corticosteroids are usually used for palliative treatment, but relapses are often observed. We observed an 8 year-old patient with Wells' syndrome successfully treated with Kampo medicines. In 2001, skin eruptions appeared on his extremities. In 2002, a histopathologic examination determined his disease to be Wells' syndrome, and corticosteroids were subsequently used for treatment. In January 2007, his skin eruptions worsened, and he first visited our outpatient clinic in May. After oral administration with keigairengyoto, his skin eruptions were slightly improved, but afterwards, they again worsened. In June, jumihaidokuto was administered instead of the former prescription, and the skin conditions had begun to improve. Because dry skin appeared in November, keigairengyoto was again added. With these treatments, his skin eruptions stably improved. In previous reports, Kampo medicines had not been used for the treatment of Wells' syndrome. This case, however, suggests that Kampo medicines are a candidate for the treatment of Wells' syndrome.