2.Postgraduate Japanese Medical Education in Kampo Medicine
Seiichi KOBAYASHI ; Shin TAKAYAMA ; Satoru ISHIBASHIC
Kampo Medicine 2017;68(1):60-65
Kampo medicine has been incorporated into Japan's medical curriculum nationwide. However, it has not been adopted into its postgraduate medical education. The present study assessed Kampo medicine educational needs for residents in Japanese postgraduate training programs. A questionnaire-based survey was conducted in residents at Japanese Red Cross Ishinomaki Hospital, regarding their experience in prescribing Kampo formulae and the Kampo medicine curriculum they expect in their postgraduate education. Twenty-one residents completed the questionnaires. Seventy-five percent of junior and all senior residents had used Kampo medications. They were mostly provided with on-the-job instruction by attending doctors, senior residents, and fellows during their residency rotations. All residents needed Kampo medicine education opportunities. They expected guidance with respect to the basics of Kampo medicine, and the treatment of common diseases with Kampo formulae. The results of our study demonstrates that residents believe Kampo medicine education should be provided in postgraduate training programs.
3.Decision Tree Analysis of 100 Types of Body Constitution as Factors of Adverse Drug Reaction
Shigeru Hosaka ; Midori Yamamoto ; Tatsuya Saitoh ; Shinji Oshima ; Shigeru Ohshima ; Kimie Oshima ; Nobuaki Kutsuma ; Seiichi Honma ; Daisuke Kobayashi
Japanese Journal of Drug Informatics 2013;15(2):64-70
Objective: In this study, we evaluated distinctive types of physical predisposition in patients with common side effects.
Method: We selected 500 and 1,200 individuals with and without a previous diagnosis of side effects, respectively, through web-based research. Then, we conducted a decision tree analysis for investigating the status of 100 types of physical predisposition in these individuals.
Results and Conclusion: The individuals who had suffered from hepatic disorder and answered “relevant” for “predisposition to swelling” (likelihood ratio of a positive result [LR+] 2.17; p=0.004) and “very relevant” for “predisposition to skin dryness” (LR+ 3.52; p<0.001) enhanced the probability of extracting individuals who developed side effects. The individuals who had suffered from skin disorder and answered “relevant” for “predisposition to eczema and inflammation” and “not relevant” for “predisposition to higher temperature” had an LR+ of 2.22 (p<0.001). The individuals with “predisposition to worsening of physical condition on a rainy or high-humidity day” are more likely to develop side effects with the use of antibiotics and NSAIDs, compared to those without this predisposition (antibiotics: LR+ 2.33; NSAIDs: LR+ 2.51). The results of this study indicate that we can identify patients with a high risk of side effects through an interview on predisposition.
4.Clinical Study of Placental Abruption
Tamami ODAI ; Masae SAKAMOTO ; Kaori TAKAGI ; Mayumi KOBAYASHI ; Reiko NAKAMURA ; Takanori YOSHIDA ; Kotoi TSURANE ; Fumi KURITA ; Yoko FUJIOKA ; Maiko ICHIKAWA ; Seiichi ENDO ; Koji SHIMABUKURO ; Naoyuki MIYASAKA
Journal of the Japanese Association of Rural Medicine 2014;63(2):105-113
Placental abruption occurs suddenly and may cause maternal and fetal mortality. Forced delivery is the only way to improve perinatal outcome, but the aftereffects could be severe despite a high survival rate. Our hospital manages approximately 170 cases of maternal transport annually, including cases of severe placental abruption. Longer transport time can lead to undesirable maternal and fetal outcome. Hence this study, we compared the perinatal backgrounds and outcome of placental abruption retrospectively between the cases managed by maternal transport and by the local hospital (our hospital). The study included 54 cases of placental abruption during the period from January 2008 to December 2012, of which 27 cases were managed by our hospital, the other halves were managed by maternal transport. There were 6 intrauterine fetal deaths but not a single maternal death. There were no significant differences in the amount of blood lost and obstetric DIC (disseminated intravascular coagulopathy) score between two groups (p=0.342, p=0.649), and the number of cases that needed anti-DIC therapy and blood transfusion in each group was statistically similar (p=0.807, p=0.115). The time taken from the on-set of placental abruption to delivery was significantly shorter for the cases managed by our hospital (in-hospital management 143±133 minutes, maternal transport management 265±176 minutes, p‹0.05), while obstetric DIC score and Apgar score showed no significant differences (p=0.336, p=0.780) between the two groups. Thus, it could be said there were no correlations between the time taken from onset to delivery and perinatal outcome. It should be noted, however, maternal and fetal outcome of placental abruption could be fatal even with the rapid intervention, so quick diagnosis and management at the first contact are crucial. Thus, we concluded that forced delivery managed by the local hospitals is necessary for the potential better perinatal outcome, and an ideal system to manage maternal and/or neonate transport after the delivery should be established immediately.
5.Clinical Study of Catamenial Pneumothorax
Mayumi KOBAYASHI ; Takuya ONUKI ; Masaharu INAGAKI ; Yasuko NISHIDA ; Kaori TAKAGI ; Yoshihide SAGAWA ; Reiko NAKAMURA ; Tamami ODAI ; Yoko FUJIOKA ; Maiko ICHIKAWA ; Seiichi ENDO ; Masae SAKAMOTO ; Koji SHIMABUKURO
Journal of the Japanese Association of Rural Medicine 2015;64(1):56-60
Catamenial pneumothorax (CP) is defined as a form of thoracic endometriosis syndrome (TES) and the clinical manifestations and management of this disease are not consensual. Successful treatment depends on how closely pulmonary specialists and gynecologists work together. Such being the circumstances, we reviewed our experience with CP in terms of treatment and follow-up. We treated surgically many patients with pneumothorax during the period from 1989 to 2014, of which eight cases had endometriosis on the diaphragm, lung or pleura histologically. The median age at the time of operation was 37 (range, 17 to 41). CP was right-sided in seven of the eight patients (87.5%). Six patients underwent an examination with diagnostic laparoscopy and five had positive findings. The median period of follow-up after surgery was 33.5 months (range, 4 to 129 months). Two patients had no recurrence without hormonal therapy. Six other patients experienced a recurrence of pneumothorax, although two patients received dienogest after surgery. The use of only dienogest or both GnRHa and dienogest prevented recurrence in all patients. CP is a critical condition that requires prompt action, so after surgical treatment, the choice of hormonal therapy with a high rate of patient compliance are needed. No recurrence occurred in young patients who had only surgical treatment, suggesting that there were some associations between age and recurrence. Since we succeeded in preventing recurrence after using GnRHa in all cases, we recommend GnRHa or dienogest following GnRHa for the first choice of hormonal therapy after surgery. However, treatment with only dienogest could achieve successful results with no recurrence, so more case studies need to be done to make the best treatment choice for each case.
6.Our Experience with Hyaluronic Acid-Carboxymethylcellulose Membrane in Cesarean Sections
Koji SHIMABUKURO ; Seiichi ENDO ; Yasuko NISHIDA ; Yoshihide SAGAWA ; Kaori TAKAGI ; Mayumi KOBAYASHI ; Reiko NAKAMURA ; Tamami ODAI ; Kotoi TSURANE ; Fumi KURITA ; Yoko FUJIOKA ; Maiko ICHIKAWA ; Naoyuki MIYASAKA ; Masae SAKAMOTO
Journal of the Japanese Association of Rural Medicine 2015;64(2):125-130
Adhesion formation after abdominal surgery is a commonly recognized entity. Many studies have shown that women giving birth by cesarean section are at the risk of developing complications related to the postoperative formation of adhesions including ileus, bowel obstructions, impaired fertility, and chronic abdominal pain. Among several adhesion barriers, one that has been tested in randomized, controlled trials is the hyaluronic cid-carboxymethylcellulose (HA/CMC) membrane (Seprafilm®: Genzyme, Cambridge, MA, USA). This bioresorbable membrane serves as a mechanical barrier between surgically damaged tissues and resorbs afterwards. At our institution, we have used HA/CMC in cesarean sections. We report our experience with this patient population using placement of HA/CMC. This study enrolled 45 women who had undergone cesarean sections twice or more who had received HA/CMC during the previous cesarean section between January 2013 and November 2014. The incidence of adhesions to the area of abdominal wall incisions and uterine surface, intestinal obstructive symptoms, and adverse events were studied. The incidence of adhesions to midline incisions was 4.4% (n=2). The filmy adhesion by major omentum was detected in these two cases. The incidence of adhesions to uterine surface was 2.2% (n=1). The moderate thickness adhesion was detected at the left side of the vesico-uterine peritoneal incision by pelvic peritoneum which did not affect the operative procedure. No symptoms related to intestinal obstructions such as abdominal pains, nausea and vomiting were observed. No adverse events were observed. These three cases had fever which had nothing to do with HA/CMC applications but was attributable respectively to influenza infection, mastitis, phlebitis associated with a needle procedure. HA/CMC was considered a useful adhesion barrier membrane for use in cesarean sections as an adjunct intended to reduce the incidence of postoperative adhesions between the abdominal wall and the underlying viscera such as omentum, small bowel, and between the uterus and surrounding structures.
7.Clinical study on the prevention of recurrent tonsillitis by acupuncture (II)
Keishi YOSHIKAWA ; Kazushi NISHIJO ; Kazuhiro YAZAWA ; Hidetoshi MORI ; Tomomi SAKAI ; Kazuo SASAKI ; Akihiro OGATA ; Toshikazu SHIMA ; Katsumi KURIHARA ; Takeshi TOMIYASU ; Shuichi KATAI ; Yoshitsugu OHIRA ; Seiichi KOBAYASHI ; Akemi YAMAMOTO
Journal of the Japan Society of Acupuncture and Moxibustion 1984;34(1):8-14
We have continued a study on the preventive effects of acupuncture on recurrent tonsillitis. Among 239 patients with tonsillitis examined in 1980, 200 were included in the category of recurrent tonsillitis, showing a fever four or more times a year.
The preventive effects of acupuncture in these 200 patients are reported in this paper.
The subjects were 200 patients with recurrent tonsillitis treated in our department in 1980. The frequency, number of days and severity of fever and other symptoms (conditions of the nose and throat, snoring, colds and general condition) were followed for one year after the acupuncture treatment.
Of the 200 patients, 171, excluding the 29 in whom the results of research could not be obtained, were analyzed. With regard to the frequency of fever, the number of patients with a fever 12 or more times a year decreased from 102 before acupuncture therapy to nine after the treatment. The number of patients who did not have any fever and who had a fever one to three times after treatment was 30 and 69, respectively. Thus, 40.4% were not included in the category of recurrent tonsillitis, even though fever was present. In addition, there was a decrease in the severity and number of days of fever.
Favorable effects of the treatment on symptoms other than fever, such as conditions of the nose and throat, snoring, resistance to colds and general condition, were noted in more than 50% of the patients who did not have any fever after treatment or had a fever half as frequently as before treatment.
When the preventive effects on fever were determined according to age, improvement was observed in all age groups. From the viewpoint of the prevention of repetition of a high fever, the best results were obtained in patients 6-11 years of age, followed by those five years old or less.
Acupuncture treatment for recurrent tonsillitis is not so effective as tonsillectomy. However, we consider that acupuncture treatment is worth using prior to tonsillectomy to prevent the relapse of recurrent tonsillitis, taking into account operative stress on the living body and economic and personal problems arising from tonsillectomy.
8.Effects of Anti-Oketsu Drugs, Keishibukuryogan and Tokishakuyakusan on Platelet Aggregation in Normal Human Volunteer
Shizuko TAKANO ; Kozue SUZUKI ; Akiko FUJISAKI ; Miho FUTAGAMI ; Fumihito ITO ; Yuko ONO ; Shinichi SAI ; Makiho KATAKURA ; Tomoko OISHI ; Kenta SUGAYA ; Seiichi ISHIBASHI ; Yuuko KOBAYASHI ; Michiko ABE ; Yuhko DAIGAKU ; Satomi MIYAMOTO
Kampo Medicine 2005;56(4):561-566
Effects of anti-oketsu drug, Keishibukuryogan (Gui-zhi-fu-ling-wan) and Tokishakuyakusan (Dang-gui-shao-yao-san) in vivo and in vitro on platelet aggregation were investigated in normal volunteers.
Of 20 volunteers who were given Keishibukuryogan, there were 6, 3 and 11 subjects whose dose-response curves of collagen-induced aggregations were shifted to the right, to the left, or who had no shift, respectively. The control aggregations of these 20 people were in the same range. In ADP-induced aggregation, there were 5 curves shifted to the right. Their potencies in the control aggregation were higher than those of 9 subjects who were not affected by the drug. There were 6 curves shifted to the left, and their potencies were lower than those of the 9 unaffected subjects. Of 12 volunteers who were given Tokishakuyakusan, there were 2, 2 and 8 subjects whose dose-response curves in collagen-induced aggregation were shifted to the right, the left, or who had no shift respectively. With ADP-induced aggregation, there were 1, 1 and 10 subjects whose doseresponse curves were shifted likewise. In vitro, Keishibukuryogan caused inhibition of ADP-induced aggregation but not that of collagen-induced aggregation.