A 76-year-old man with a history of total esophagectomy and retrosternal gastric tube reconstruction for esophageal cancer was transferred to our hospital because of consciousness disorder. It became an emergency operation on diagnosis of Stanford type A acute aortic dissection on enhanced CT. Because CT showed the retrosternal gastric tube ran along the right side of the body of the sternum through the back side of the manubrium, we opted for skin and the suprasternal incision on the left side from center. We could perform total aortic arch replacement without the damage of the gastric tube except that the right side of the operative view was slightly poor. We did not recognize digestive organ symptoms such as postoperative passage disorders nor mediastinitis. The patient was discharged from our hospital on postoperative day 24.

BACKGROUND/AIMS: We applied a back light system (BLS) with a magnifying glass to improve the ability to assess the adequacy of specimen sampling using endosonography. We conducted this study to evaluate the efficacy of the BLS in sampling of specimens by endoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses. METHODS: This was a prospective, randomized, crossover, single-center clinical trial. An endosonographer evaluated adequacy on gross visual inspection and identified whitish specimen sampling sites with and without the BLS according to a randomization sequence in the first and second passes with a 25-G needle. On cytological evaluation, the presence of well-defined pancreatic ductal epithelium was evaluated by a cytopathologist who was blinded to any clinical information. RESULTS: A total of 80 consecutive patients were eligible during the study period. Adequacy was observed for 52 specimens (65%) with the BLS and 54 (68%) without the BLS (p=0.88). In assessment of specimen adequacy on gross examination, only fair agreement was observed both with and without BLS (kappa score 0.40 and 0.29, respectively). CONCLUSIONS: The BLS did not influence the ability to identify specimen sampling sites or reliable assessment of specimen site adequacy using gross visual inspection.
Biopsy, Fine-Needle ; Cross-Over Studies ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Epithelium ; Glass ; Humans ; Needles ; Pancreatic Ducts ; Pancreatic Neoplasms ; Prospective Studies ; Random Allocation

A 53-year-old woman with rheumatoid arthritis had been suffering from right thumb deformity for a couple of months. Due to this, she was unable to perform the pinch movement. There were surgical options to treat the deformity, but the patient declined surgery. We therefore surmised whether we could correct the deformity with a splint. In 2012, we then proposed the use of a finger splint. The patient's finger function improved, and as of 2021, she was still using the finger splint without any problems. Thus, it is recommended to use a finger splint for thumb deformity because it is easier and less invasive than surgery.

A 53-year-old woman with rheumatoid arthritis had been suffering from right thumb deformity for a couple of months. Due to this, she was unable to perform the pinch movement. There were surgical options to treat the deformity, but the patient declined surgery. We therefore surmised whether we could correct the deformity with a splint. In 2012, we then proposed the use of a finger splint. The patient's finger function improved, and as of 2021, she was still using the finger splint without any problems. Thus, it is recommended to use a finger splint for thumb deformity because it is easier and less invasive than surgery.

Orthostatic dysregulation often occurs during adolescence and presents with symptoms such as dizziness, difficulty waking up in the morning, nausea, anorexia, general malaise, and headache. Herein we describe a case of delayed sleep-phase syndrome in a 16-year-old female who had been treated with Kampo medicine since the age of 14 for orthostatic dysregulation. After taking renjuin, her condition improved and she was able to attend school. However, two winters later, her symptoms flared up and she was hospitalized. Electro-acupuncture test revealed her severe interior cold, and a simple sleep analysis showed that she was not getting deep sleep. We hypothesized that her interior cold contributed to her sleep disorder. After taking sekiganryo for the purpose of warming therapy, her waking time and sleep depth improved. This case showed that interior cold can cause sleep disorders and that warming therapy with sekiganryo may contribute to the improvement of sleep disorders.

Kampo medicine containing Gardeniae Fractus is often used for agony of the chest, but there are few case reports about shishikankyoto. Here, we report a case of a 73-year-old woman with heat sensation in the chest and severe malaise successfully treated with shishikankyoto. She suffered from lung cancer five years previously, and received chemoradiation treatment. One year later, radiation pneumonitis developed, which was resolved naturally. After another year, she began to develop a slight fever, burning sensation and general malaise, which disappeared and recurred in cycles of about six months. She received Kampo medicine treatment for one year at another hospital, but lacked in improvement and was introduced to our hospital. We thought her symptoms were caused by deficiency heat pattern in the chest and cold in the epigastric region. By giving shishikankyoto in reference to a sentence in the Shang Hang Lun, her symptoms improved in about two weeks. Although, shishikankyoto is a prescription medicine with few reports, it is effective in a short period of time and is useful for similar symptoms.

Hangekobokuto is often used for globus sensation. We herein describe two cases in which ryokeijutsukanto was effective for globus sensation, for which hangekobokuto was ineffective. Case 1 was a 28-year-old woman. She had been suffering from postprandial belching, fullness and stuffy throat for a year. She underwent examination, but could not find the cause of her symptoms and visited our department. She was prescribed hangekobokuto, but the feeling of stuffiness in her throat did not improve. Case 2 was a 50-year-old woman. She had been afflicted with a feeling of fullness in the ears, tinnitus, and pain in the back of the eyes for two weeks. She visited the otolaryngology department, but no abnormalities were found so she visited our department. She was prescribed kamishoyosan, and although her ear fullness and tinnitus improved by about 60%, she began to complain of dizziness and throat stuffiness. This did not improve even though she used hangekobokuto with kamishoyosan. In both cases, after changing treatment to ryokeijutsukanto, the symptoms were improved. For globus sensation, it is necessary to select Kampo medicines while paying attention to qi deficiency, qi depression, qi counter flow, static blood, liver depression, lack of fluid, fluid toxicity, and gastrointestinal disorders. We thought that ryokeijutsukanto could be a candidate.

We report a case of post coronavirus disease 2019 (COVID-19) condition, in which the patient suffered from a severe sense of fatigue and brain fog that was successfully treated with Kampo therapy. The patient was a 21-year-old man. He had been diagnosed with COVID-19 and hospitalized for follow-up examinations. He recovered without any complications and was discharged from the hospital, but continued to suffer from a severe sense of fatigue, coldness, dizziness, and a loss of concentration. Because of these symptoms, he had to spend most of the day lying down. One month later, he was hospitalized to receive Kampo therapy. We administered bukuryoshigyakuto for 2 weeks referring to his severe coldness and fatigue and then changed to renjuin for his fluid disturbance and blood deficiency. After starting Kampo therapy, his fatigue and dizziness gradually improved. He was discharged after 3 weeks of hospitalization and received Kampo therapy as an outpatient. One month later, he reported a dull feeling in his stomach and depression. We switched to kamikihitogohangekobokuto and added hachimigan. His activities of daily living improved and he could take 4.5-kilometer walk. He could return to work 4 months later. Kampo therapy may be useful for post COVID-19 condition that causes a sense of fatigue and brain fog.

We report a case of a 49-year-old woman who presented with 6-month period menopausal syndrome including excessive sweating and hot flushes in her face, chest and back. She was also frustrated with her sons, but she reflected on her own anger and wondered why she got so irritated with them. We prescribed yokukansan to her and her all symptoms improved one month later. We need to differentiate between yokukansan and kamishoyosan in the treatment of menopausal syndrome and irritation, and it may be useful to evaluate the detail of irritation in selecting formula.

The persistent genital arousal disorder (PGAD) is a condition in which intense abnormal sensations and pain appear in the genital area without sexual stimulation. Here, we report two cases of PGAD successfully treated with tokishigyakukagoshuyushokyoto. Since dysfunction of nerves and blood vessels is thought to be involved in the cause of PGAD, we believed that tokishigyakukagoshuyushokyoto, which improves ischemia of the pelvic cavity organs, would be a good indication for this treatment. Tokishigyakukagoshuyushokyoto should be considered especially when tenderness in the inguinal region is observed.