To determine the exact cause of dizziness and/or vertigo, 1000 outpatients were retrospectively studied. The most common diagnosis in all of the analyzed cases was cervicogenic dizziness (89%). Among these cases, 600 (67%) underwent magnetic resonance imaging of the cervical spine, and 542 of these (90%) showed presence of a narrow spinal canal. It was important to measure the anteroposterior diameter of the spinal canal in each case and to have an accurate diagnosis based on diagnostic criteria. Dizziness and/or vertigo develop because of long-term, inappropriate neck posture in the presence of some kind of cervical disease. Triggers of dizziness and/or vertigo were different in men and women and in each generation. In elderly women, the characteristic trigger was long-term farming, gardening, weeding. About 79% of the cases were accompanied by stiff neck and shoulder; therefore, selection of appropriate muscle relaxants at appropriate doses as well as proper advice to patients regarding neck posture and lifestyle are very important in the treatment of cervicogenic dizziness. The results of this study emphasize the importance of cervicogenic dizziness as a cause of dizziness and/or vertigo that are difficult to cure.

A 15-month retrospective study of 1,000 outpatients was conducted to determine the exact cause of general dizziness. The most common diagnosis in all analyzed cases was cervicogenic general dizziness (89%). The majority of the patients who underwent magnetic resonance imaging of the cervical spine had narrow spinal canals. Measuring the anteroposterior diameter of the spinal canal in each case was critical to obtain an accurate diagnosis in line with the diagnostic criteria used. General dizziness may develop because of inappropriate neck posture over long periods of time in individuals with some form of underlying cervical disease. The causes of general dizziness were different between male and female patients and between patients of different age groups. Triggers leading to general dizziness included engaging in farming, gardening, or weeding activities for long periods of time, particularly in elderly women. Selection of the appropriate muscle relaxant type and dosage is important in the treatment of patients with cervicogenic general dizziness who also experience a stiff neck and shoulders. Following treatment, 90% of patients no longer experienced general dizziness or exhibited clear improvements in their symptoms within 1 week. The results of this study emphasize the importance of cervicogenic general dizziness, which is due to cervical vertebral lesions and is exacerbated by excessive stress on the cervical spine.

Occasionally, standard painkillers or triptans tend to be ineffective for treating pediatric patients with recurrent headache, leading to unavoidable absence and early departure from school, or even resulting in them becoming targets of bullying. Thirty children (19 male, 11 female; mean age 10.7 years, range 4–15 years) examined at my clinic in 2018, who presented with a chief complaint of intractable headache and exhibited abnormal electroencephalogram (EEG), were retrospectively studied. Their diagnosis, treatment, and treatment efficacy were analyzed. Although all participants showed abnormal brain waves on EEG, they did not demonstrate any other symptoms beside headache. Antiepileptic drug therapy proved efficacious in 24 of the 30 cases (80%). In all successfully treated cases, a definitive improvement in headaches was confirmed within 1–2 weeks.

We investigated whether the autonomic nervous system (ANS) modulation contribute to the bradycardia induced by endurance training. First, the meta-analysis approach was used to collect group mean values of maximal oxygen consumption (Vo₂max) and heart rate variability (HRV) from 14 studies involving 30 groups and 485 subjects. Subsequently, we performed a cross-sectional (n=116) and intervention (n=training group : 10 and control group : 6) studies. In both studies, ANS modulation was estimated by spectral analysis of HRV. In the meta-analysis and cross-sectional study, HR and natural logarithmic high frequency power (In HF power) were correlated with Vo₂max or peak oxygen uptake (peak Vo₂) . The significant negative correlations were found between HR and In HF power (meta-analysis and the cross-sectional study ; r² = 0.42 and 0.44, respectively) . Endurance training in the intervention study increased peak Vo₂ and resting In HF power, and decreased resting HR. These results strongly suggest that endurance training induces an increase in resting ANS modulation especially parasympathetic modulation. Furthermore, about half of the variability of resting HR can be accounted for by difference in parasympathetic modulation.

The aim of this studv was to clarify the effects of water immersion on the cardiovascular recovery process following submaximal steady state exercise on land. Seven male subjects (23 yrs old) underwent experiments under four separate conditions on separate days (15 minutes of cycling exercise at 50% and 80% maximal oxygen consumption followed by 16 minutes of recovery in a sitting position in water and out of water) . Concerning conditions in water, mean water temperature was 29.4 degrees, and the immersion level was set at xiphoid. Mean room temperature in out of water conditions, and during all conditions of exercise, was 24.4 degrees. Oxygen consumption (VO₂), heart rate (HR) and blood pressure (systolic: SBP, diastolic: DBP) were measured under each condi tion. Mean blood pressure was calculated from SBP and DBP (MBP=1/3× ( SBP-DBP) +DBP) . Stroke volume (SV) was measured by Doppler echocardiography, and then cardiac output (CO=SV×HR), total peripheral resistance (TPR=NIBP/CO) and arteriaVmixed venous oxygen difference (a-v O₂diff=VO₂/CO) were calculated. In comparison with the same exercise intensity condition, there were no significant differences between recovery processes of VO₂, HR, SBP, DBP and MBP in and out of water. SV and CO were significantly higher (p<0.05) during the recovery process in water than out of water (SV: at 50 and 80% maximal oxygen consumption conditions, CO: at 80% condition) . The TPR and a-v O₂diff were significantly lower (p<0.05) during the recovery process in water than out of water at 80% oxygen consumption condition. These results indicate that water immersion facilitates circulating blood volume during the recovery process without increasing blood pressure, especially during recovery after high intensity exercise. Therefore, we suggest that increased left ventricular preload with immersion would be an important factor in cardiovascular regulation not only at rest but also during recovery after exercise.

　　Although axillary lymph node dissection (ALND) is conventionally indicated for metastasis in the sentinel lymph node (SLN), the omission of ALND is being discussed more often in recent years. However, because of the lack of specific guidelines, it is unclear which cases should be treated without ALND. In this study, we performed one-step nucleic acid amplification of the SLN with metastasis to determine the total tumor load (TTL), that is, the number of cytokeratin (CK) 19 mRNA copies. After ultrasonography (US) of ALN, the ultrasonographic findings were combined with TTL to rate SLN metastasis. In the rating, a total score was obtained by assigning 1 point each for (a) TTL of ≥15000 copies/μL, (b) US findings of a long-to-short LN diameter ratio of ≤2, and (c) US findings of no echogenic hilus. We then investigated the association between the total score and metastasis in the non-SLN. Results showed that while 87.5% (5/6) of patients with positive non-SLN scored ≥2 points, only 3.1% (1/34) of patients with negative non-SLN did so, suggesting that a total copy number of CK19 mRNA, US findings of a long-to-short LN diameter ratio, and the presence/absence of echogenic hilus are important predictors for non-SLN metastasis. This novel scoring system is expected to help determine which patients need ALND or what postoperative therapy is necessary.

Elderly people with chronic lung diseases are always suffered from dyspnea, so they also have much troubles in gastrointestinal functions on the basis of anxiety and insomnia. As a result, they become malnourished with a weakened immune system and are often hospitalized due to respiratory infections for a long time. Their quality of life deteriorates. This time, we experienced an elderly female patient with old pulmonary tuberculosis who was generalized weakness, showed improved appetite loss, physical activity, and dementia symptoms by taking ninjin'yoeito and kososan. She could avoid re-hospitalization due to respiratory infections. Ninjin'yoeito enhanced her energy and physical strength. As a result, she seems to have become markedly healthy. This prescription is expected to be useful for the rapidly increasing number of elderly patients with chronic lung diseases.

Number of chronic obstructive pulmonary disease (COPD) patients tend to increase in middle and older aged people. They have shown a certain degree of improvement with various Western medicine treatments including smoking cessation guidance, rehabilitation, home oxygen therapy, inhalation therapy and so on. However, it is a clinical problem that some elderly people have acute exacerbations frequently due to infectious diseases and have poor prognoses. This time, we experienced an elderly COPD patient with type II respiratory failure. He was repeatedly hospitalized and needed treatment with a ventilator temporarily. We conducted Kampo medical examination on him, and diagnosed that he had cold state in the lungs. So, we administered ryokankyomishingeninto to him. As a result, he recovered dramatically, and he was never hospitalized again due to respiratory failure for a long time. It is suggested that ryokankyomishingeninto may be effective for some COPD patients who have cold state in the lungs.

The number of elderly people with chronic heart failure is increasing ; they have acute exacerbations at a high rate due to mergers of infections and others. At that time, they received furosemide intravenous injection and tolvaptan oral medication as internal treatments. However, there are refractory patients (tolvaptan nonresponder) at a certain frequency. In these cases we experienced two cases in which goreisan were effective for untreatable congestive heart failure. Goreisan administration resulted in an increase in urine volume in both cases, marked improvements in symptoms, physiological findings and various laboratory findings. In addition, they continued taking these medicines after discharge. As a result, for about a year, they were never rehospitalized due to heart failure. It is conceivable that goreisan normalized the uneven distribution of water in organs and tissues, and reactivated the action of tolvaptan in the renal collecting duct. These results suggest that the combined use of goreisan will be useful for untreatable congestive heart failure.

Background/Aims: 5-Aminosalicylic acid (5-ASA) is a basic drug for inducing and maintaining remission for ulcerative colitis. One of its formulations has a coating with a pH-dependent degradation that ensures the release 5-ASA at the terminal ileum. No evidence has been shown concerning the effects of proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) on the clinical course of ulcerative colitis patients in remission. The present study assessed the effect of PPIs or H2RAs on the relapse of ulcerative colitis patients in clinical remission maintained by pH-dependent released 5-ASA. Methods: Ulcerative colitis patients who had been prescribed time- or pH-dependent-released 5-ASA between January 2015 and December 2018 were enrolled in this multicenter retrospective study. The period of remission until relapse occurred was analyzed among the patients taking time-dependent-released 5-ASA or pH-dependent-released 5-ASA with/without PPIs or H2RAs. Results: One hundred and nineteen patients were analyzed in this study. In the primary endpoint, the relapse rate was higher in patients taking pH-dependent-released 5-ASA and PPIs or H2RAs than in those taking the pH-dependent-released 5-ASA without PPIs or H2RAs, while the relapse rate was similar in patients taking the time-dependent-released 5-ASA with or without PPIs or H2RAs concomitantly. Patients with a short duration of disease and middle-aged patients more frequently showed relapse with PPIs or H2RAs than the other patients. Conclusions The coadministration of PPIs or H2RAs affects the clinical course of ulcerative colitis in remission maintained by pH-dependent-released 5-ASA.