Recently, the number of physicians using Kampo (Japanese traditional herbal) medicines has been increasing in Japan, and it is becoming more common for pharmacists to dispense Kampo medicines. As Kampo medicines become more popular, in addition to extract formulae, the use of decocting formulae that are more suited to each patient's predisposition and symptoms has increased. Therefore, more pharmacists are dispensing such decocting formulae. However, dispensing decocting formulae can be a complicated task. The risk of dispensing errors is not small. In present paper, we examined preventive measures based on investigations of errors involving decocting formulae in our Kampo clinic. From 1990 to 1999, there were 54 cases in which errors were found after patients received their medicines, and 44 of these cases were dispensing errors. To prevent such errors, in addition to having the knowledge of Kampo medicine and medicinal herbs that is needed for dispensing decocting formulae, it is also necessary to understand the contents of the prescription. The most important preventive measures are to re-inspect the weight and contents of the prescription after preparing it, and to do a final inspection of the medicine contents with the patient. It is expected that this report will play a role in preventing dispensing errors of Kampo medicines by pharmacists.

For the dispensing of Kampo formulas, only an adult dose is described by conventional formulary. Therefore a child's dose is often prescribed by reducing instructions for the fraction-times of an adult dose. However, it is necessary to study whether the content of Kampo-extract pharmaceutical preparations at a child's dose, are similar to decoctions prepared by reducing the dose of crude drugs, and reducing the quantity of water by fraction-times. Therefore it was compared whether the constituents of a decoction liquid at an adult dose, were equal to those of a child's dose. In the decoction method of our clinic, adult doses are decocted with an initial 600mL quantity of water to half volume, as per the normal decoction method, whereas children's doses are reduced to 2/3 or 1/3 times that of adult dose, and decocted to half of the early-stage quantity of water that they are with adults. In the present study, three Kampo formulas which have been used frequently in our clinic and have different prescription weights i.e., Oren-gedoku-to (9g), Keishi-bukuryo-gan-ryo (20g), and Juzen-taiho-to (33g) were studied. When child and adult doses were compared, a difference was noted in pH, extraction rate and extracted constituents. Extraction rates for a child's dose of Oren-gedoku-to and Juzen-taiho-to were lower than that of an adult dose. Extraction rates of component gradients? ferulic acid in Oren-gedoku-to, pae-oniflorin in Keishi-bukuryo-gan-ryo, and paeoniflorin and liquiritin in Juzen-taiho-to? for a child's dose were lower than those of an adult dose. However, extraction rates of component gradients? albiflorin in Keishi-bukuryo-gan-ryo and albiflorin and trans-cinnamic acid in Juzen-taiho-to ? for a child's dose (quantity of 1/3 times) were higher than those of an adult dose. These results suggest that the content of a decoction, which was prepared by reducing an adult dose to the fraction-time of a child's dose, is not the same as reducing the amount of Kampo-extract pharmaceutical preparation to the fraction-time of a child's dose.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.