Constipation is one of the most common symptoms seen in elderly people, and is sometimes difficult to treat. Daikenchuto is a well-known Kampo formulation for treating ileus. Here, we report a case in which daikenchuto was not effective and constipation was effectively treated with kobokushokyohangeninjinkanzoto. The patient was an 81-year-old woman who had been hospitalized for treatment of a thighbone fracture. She was originally constipated, and her constipation had worsened over the course of hospitalization. Colonoscopy examination and abdominal computerized tomography showed no structural lesions. Her constipation improved after the administration of daikenchuto, but the improvement was transient. Since the constipation and abdominal distension worsened after she began eating again, we administered kobokushokyohangeninjinkanzoto. Subsequently, her condition improved remarkably. Eight days later, we changed the initial kobokushokyohangeninjinkanzoto to ninjinto and hangekobokuto. Her complaint did not recur, and she was discharged 17 days later. In case of deficiency pattern ileus, kobokushokyohangeninjinkanzoto may be considered as an alternative to daikenchuto. Furthermore, we believe that the combination of ninjinto and hangekobokuto is an effective alternative to kobokushokyohangeninjinkanzoto.

　　Mature cystic teratoma with malignant transformation is a rare disease with an incidence of about 1% among ovarian tumors. Here, we describe how we were able to diagnose pathological tissue preoperatively using colonoscopy. The patient was a 68-year-old woman (gravida 4). She presented with abdominal pain. Her general condition was poor. On examination, we found perforation of an ovarian tumor into the sigmoid colon. Lower gastrointestinal endoscopy was performed and some tissue was retrieved. Pathological analysis of the tissue revealed a diagnosis of squamous cell carcinoma.

  In our hospital the palliative care committee has been held once a month since 2000. In 2007, a total of 1,583 cancer patients were admitted to our hospital orreceived medical care at home. The average length of hospital stay was 24 days. Of the total number of patients, 88.4% was informed that they had cancer. In the latter half of the year it increased to 92.6% because the palliative caretakers gave doctors accurate information on patients' psychology and social background. In October 2007 a questionnaire survey was conducted on those who visited our palliative care section on the occasion of the hospital festival. A total of 46 responded to our survey about the knowledge of palliative care, physician's precise explanation about the illness, image of opioids, desirable place of death and so on. Twenty-eight respondents (60.9%) did not know anything about palliative care. Forty-four (95.7%) wanted precise explanation of cancer. Thirty-four (73.9%) said they had had a night image of opioids after reading the panel. Twenty-eight (60.9%) responded they would rather stay at home until death. We should give healthy people more information about palliative care and opioids.

Objective:The topic model is a well-known method used in the field of natural language processing (NLP)that defines adocument as constructed of topics that combine specific t erms. This method is used to model topic co-occurrencemathematically. In this study,we extracted topics from featu re vectors of explicit documents called medical package insertsby using cluster analysis. Methods:We counted the terms(nouns)recognized by the morphological analysis engine MeCab and created a documentterm matrix. A value of“tf・idf”was calculated in this matrix for term weighting to avoid the effect of term frequency. We reduced the dimensionality of the matrix using singular v alue decomposition,which removed unnecessary data,and weextracted feature vectors attributed to each medical package insert. The distance between feature vectors was calculatedusing cosine distance,and cluster analysis was performed based on the distance between the vectors.Results:Cluster analysis on our document-term matrix show ed that medical package inserts of drugs that have the sameefficacy or active ingredient were included in the same cl uster. Moreover, using term weighting and dimensionalityreduction,we could extract topics from medical package inserts.Conclusion:We obtained a foothold to apply our findings t o the recommendation of similar drugs. Cluster analysis ofmedical package inserts using NLP can contribute to the pro per application of drugs. In addition,our study revealed thesimilarities of drugs and suggested possibilities for new applications from several points of view.

BACKGROUND/AIMS: In distal malignant biliary obstruction, an antireflux metal stent (ARMS) with a funnel-shaped valve is effective as a reintervention for metal stent occlusion caused by reflux. This study sought to evaluate the feasibility of this ARMS as a first-line metal stent. METHODS: Patients with nonresectable distal malignant biliary obstruction were identified between April and December 2014 at three Japanese tertiary centers. We retrospectively evaluated recurrent biliary obstruction and adverse events after ARMS placement. RESULTS: In total, 20 consecutive patients were included. The most common cause of biliary obstruction was pancreatic cancer (75%). Overall, recurrent biliary obstruction was observed in seven patients (35%), with a median time to recurrent biliary obstruction of 246 days (range, 11 to 246 days). Stent occlusion occurred in five patients (25%), the causes of which were sludge and food impaction in three and two patients, respectively. Stent migration occurred in two patients (10%). The rate of adverse events associated with ARMS was 25%: pancreatitis occurred in three patients, cholecystitis in one and liver abscess in one. No patients experienced non-occlusion cholangitis. CONCLUSIONS: The ARMS as a first-line biliary drainage procedure was feasible. Because the ARMS did not fully prevent stent dysfunction due to reflux, further investigation is warranted.
Arm ; Asian Continental Ancestry Group ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystitis ; Drainage ; Humans ; Liver Abscess ; Pancreatic Neoplasms ; Pancreatitis ; Pilot Projects* ; Retrospective Studies ; Sewage ; Stents*

BACKGROUND/AIMS: Stent migration occurs frequently, but the prevention of complications resulting from covered self-expandable metal stents (C-SEMSs) remains unresolved. We prospectively assessed a newly developed C-SEMS, a modified covered Zeo stent (m-CZS), in terms of its antimigration effect. METHODS: Between February 2010 and January 2011, an m-CZS was inserted into 42 patients (31 initial drainage cases and 11 reintervention cases) at a tertiary referral center and three affiliated hospitals. The laser-cut stent was flared for 1.5 cm at both ends, with a 1 cm raised bank located 1 cm in from each flared end. The main outcome of this study was the rate of stent migration, and secondary outcomes were the rate of recurrent biliary obstruction (RBO), the time to RBO, the frequencies of complications, and overall survival. RESULTS: Of the 31 patients with initial drainage, stent migration occurred in four (12.9%, 95% confidence interval, 5.1% to 29.0%), with a mean time of 131 days. RBO occurred in 18 (58%), with a median time to RBO of 107 days. Following previous C-SEMS migration, seven of 10 patients (70%) did not experience m-CZS migration until death. CONCLUSIONS: m-CZSs with antimigration properties effectively, although not completely, prevented stent migration after stent insertion.
Aged ; Aged, 80 and over ; Alloys ; Carcinoma/*complications ; Cholestasis/etiology/*therapy ; Digestive System Neoplasms/*complications ; Drainage ; Equipment Design ; Feasibility Studies ; Female ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Middle Aged ; *Prosthesis Failure ; Recurrence ; Reoperation ; *Stents/adverse effects ; Time Factors

A 70-year-old woman with rheumatoid arthritis underwent above-knee amputation due to osteomyelitis after right total knee arthroplasty. After the surgery, the patient started rehabilitation for wearing a prosthetic leg. However, the patient could not wear the prosthesis by herself because of severe upper limb impairment due to bilateral finger joint deformity and muscle weakness associated with the rheumatoid arthritis. Therefore, physical therapists and prosthetists/orthotists collaborated to determine movements that could be performed, even with muscle weakness, using assistive devices such as a Velcro strip handle with the prosthesis and a prosthetic liner stand. Subsequently, repetitive training was performed in an environment similar to the setting of the patient's prosthesis use at home. Consequently, although no change in upper limb function was observed, the patient had increased independence during prosthesis attachment. As she had difficulty wearing and removing her trousers/underwear while wearing the prosthesis, she performed movements using assistive devices and made changes to the order of movements. Six months after the surgery, she could wear the prosthesis and perform self-care correctly by herself and return home. Therefore, to maximize function that enables independence after amputation, helping patients learn how to put on the prosthesis using a team approach is important.

We treated dry eyes and eyestrains successfully with electrothermo-acupuncture and Kampo medicine. The case was a 41-year-old woman who was treated with a few eye drops. She came to our hospital to receive Kampo medicine because her photophobia and eye pain got worse. After taking shimbuto, her complaint got better with improving physical fatigue. Electrothermo-acupuncture was effective for photophobia and eye pain promptly and remarkably. After we added kihito to her, she did not need to use eye drops with improving bloody urine and sleeplessness. Photophobia and eye-ache are thought to be related to the trigeminal nerve system. In this case, we consider that the point of application of electrothermo-acupuncture is the trigeminal nerve system. At the same time, “rikan” and “hikyo” might be involved in this case with the general malaise of eye.