Generally, as for the Bell paralysis in facial nerve paralysis, about 70% are cured spontaneously, and, as for the remainder, steroid and antiviral agent (aciclovir) medical treatment are taken, but treatment of the Western medicine is invalid in the serious case. As a result, the paralysis remains and the aftereffects of the morbid synkinesis is caused. Finally, it becomes the result of greatly damaging QOL because of features of a peculiar face for the patient.The case is 29-year-old pregnant woman and primipara. Abnormality was not especially found in the previous history without what had to be mentioned specially while getting pregnant. A right paralysis of facial nerve developed suddenly cold early morning of 35 gestational weeks (paralysis score 0/40). She gave birth naturally without the effect though the steroid was treated by otorhinolaryngologist. After birth, Kampo treatments were begun with Kakkonto and Saireito for two months. Place where those medicines changed to Daisangoshichisanryo and Kososan because of invalidity, an eye closure and open eyes would become smooth in two weeks, and it recovered in almost one month. Here is a first reported case that concurrent Kampo therapy with Daisangoshichisanryo and Kososan were effective for patient with paralysis of facial nerve that developed during pregnancy.

It is thought that meirouin was created by Toukaku Wada, originally. Although prescriptions were applied for ophthalmologic disease at first, such case reports have decreased recently. Here, we report that meirouinkakikuka was successful for serous retinal detachment complicated with an abnormal visual field during postpartum.
We present the case of a 34 year old Japanese woman. Tinnitus had appeared from 35 weeks of pregnancy. Blood pressure rose to 140/100 mmHg at 36 weeks of pregnancy, the patient was diagnosed with preeclampsia,and hospitalized. After hospitalization, blood pressure was rose further to 190/120 mmHg, and an emergency cesarean section was performed. On the 2 nd postpartum (post operation) day her field of view became yellowed and eyesight failure arose. She was diagnosed as hypertensive retinopathy and serous retinal detachment by an ophthalmologist. She stopped applying her eyewash treatment herself because she was feeling unwell. One week afterward, she desired Kampo treatments. Meirouinkakikuka was prescribed, the tinnitus disappeared in 2 weeks, furthermore, her retinal detachment was recovered from 4 weeks later. Thus we believe that Kampo treatments can be a viable alternative, as suggested by this case where application of an eyewash treatment was difficult.

BACKGROUND/AIMS: Evidence that general anesthesia (GA) reduces the operative time of esophageal endoscopic submucosal dissection (ESD) is currently insufficient. This study aims to evaluate the efficacy and safety of esophageal ESD under GA. METHODS: A total of 227 lesions from 198 consecutive patients with superficial esophageal neoplasms treated by ESD at 3 Japanese institutions between April 2011 and September 2017 were included in this retrospective study. For ESD, GA and deep sedation (DS) were used in 102 (51.5%, GA group) and 96 patients (48.5%, DS group), respectively. RESULTS: There were no statistically significant differences in age, sex, or comorbidities between the groups. In the GA group, the tumor size was larger (21 [3–77] mm vs. 14 [3–63] mm, p<0.001), luminal circumference was larger (≥2/3; 13.9% vs. 5.4%, p=0.042), procedure time was shorter (28 [5–202] min vs. 40 [8–249] min, p<0.001), and submucosal dissection speed was faster (25.2 [7.8–157.2] mm² /min vs. 16.2 [2.4–41.3] mm² /min, p<0.001). The rates of intraoperative perforation and aspiration pneumonia were lower in the GA group, but the difference did not achieve statistical significance (p=0.242 and p=0.242). CONCLUSIONS: GA shortens the procedure time of esophageal ESD.
Anesthesia ; Anesthesia, General ; Asian Continental Ancestry Group ; Comorbidity ; Deep Sedation ; Esophageal Neoplasms ; Humans ; Operative Time ; Phenobarbital ; Pneumonia, Aspiration ; Retrospective Studies

Background/Aims: Transabdominal ultrasonography (US) helps evaluate Crohn’s disease (CD) activity. We investigated whether the US could predict subsequent adverse outcomes for patients with CD in clinical remission. Methods: This single-center retrospective study included patients with CD in clinical remission who underwent US between April 2011 and April 2021, focusing on the predictability of subsequent adverse outcomes within 5 years. We used the US-CD, which was calculated using multiple US findings. Predictive variables were assessed using Cox proportional hazards regression analysis, and the predictive value was evaluated using receiver operating characteristic curves. Results: Seventy-three patients were included. During a median follow-up of 1,441 days (range, 41–1,825 days), 16.4% (12/73) experienced clinical relapse, 9.6% (7/73) required endoscopic balloon dilation (EBD), 58.9% (43/73) required enhanced treatment, and 20.5% (15/73) underwent surgery. In the multivariate analysis, US-CD was significantly associated with clinical relapse (P= 0.038) and the need for enhanced treatment (P= 0.005). The area under the receiver operating characteristic curve for predicting clinical relapse and the need for EBD was 0.77 and 0.81, respectively, with US-CD (cutoff value = 11), and that for requiring enhanced treatment was 0.74 with US-CD (cutoff value = 6). Patients with US-CD ≥ 11 demonstrated a significantly higher occurrence of clinical relapse (P= 0.001) and EBD (P= 0.002) within 5 years. Patients with US-CD ≥ 6 experienced a significantly higher likelihood of requiring enhanced treatment (P< 0.001) within 5 years. Conclusions High US-CD is associated with subsequent adverse outcomes in patients with CD.

In the areas of home medical care and self-medication, the role of the pharmacist is growing, partly as a result of Japan’s aging society and the need to reduce medical costs. In response, the Kinki University Faculty of Pharmacy implemented a physical assessment practical training seminar in order to improve the physical assessment skills of practicing pharmacists. A series of questionnaires were conducted among pharmacists to investigate their perceptions of physical assessment practical training seminars. The results of the questionnaires were analyzed using Customer Satisfaction (CS) analysis and text mining. Based on a 5-point scale (1-low∼5-high), questionnaires revealed satisfaction for physical assessment practical training seminars was 4.6±0.6 (Ave.±S.D.). CS analysis revealed that the items “lectures” and “case seminars” had the highest level of satisfaction. However, items showing low levels of satisfaction were “auscultation of respiratory sounds” and “SBAR (Situation, Background, Assessment, Recommendation).” Results of text mining suggested a relationship between “physical assessment” and “difficult”. Analysis of the questionnaires showed a high level satisfaction with physical assessment practical training seminars, notably physical assessment practice methods. However, CS analysis and text mining indicate the finer techniques of physical assessment were difficult to acquire.

Background/Aims: The usefulness of ultrasonography (US) in diseases of the gastrointestinal tract has been reported recently. This prospective study aimed to determine the features of US findings in immune-mediated colitis (IMC), an adverse event induced by immune checkpoint inhibitor, and examine the correlation between US findings, colonoscopy (CS) findings, and severity of colitis. Methods: We studied patients examined using CS and US upon suspicion of IMC in Hokkaido University Hospital between April 2018 and February 2021. Endoscopic findings of IMC were assessed using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). The severity of US findings in IMC was evaluated using US grade, which is the ultrasonographic grading scale in ulcerative colitis. Bowel wall thickness and the intensity of the color Doppler signal were also analyzed. Severity of colitis was evaluated using Common Terminology Criteria for Adverse Events (CTCAE) grade version 5. Results: Fourteen patients with IMC were enrolled. The US findings were bowel wall thickening, loss of stratification, ulceration and increased blood flow signal. The US grade was moderately correlated with the UCEIS (r=0.687, p=0.009) and CTCAE grade (r=0.628, p=0.035). Bowel wall thickness and UCEIS (r=0.628, p=0.020), as well as color Doppler signal grade and CTCAE grade (r=0.724, p=0.008), were significantly correlated. Conclusions US findings in IMC were mainly similar to those of ulcerative colitis, but there were some findings that were characteristic only of IMC. Significant correlation was found between US findings, CS findings, and severity of colitis. Hence, US could be useful for the evaluation of IMC.