[Objective] To determine the long-term effect of Kampo medicine on patients with primary open angle glaucoma (POAG).
[Patients] Patient 1 was a 17-year-old male with POAG at his initial visit, having been treated using Kampo for 34 years. Patient 2 was a 56-year-old female, diagnosed with POAG 30 years before visiting our clinic, who had continued Kampo treatment for 19 years. At their first visit, these two patients had a very high risk of becoming blind, but, after long-term treatment using Kampo, their visual function was maintained and their intraocular pressure was well controlled. Patient 3 was a 23-year-old female at her initial visit, who we have been following for 27 years. During this period, her intraocular pressure returned to normal while she was taking Kampo medicine regularly, and conversely elevated when she stopped.
[Discussion] We cannot indicate the specific Kampo prescription which reduces intraocular pressure, but Kampo medicines prescribed according to the usual pattern identifications may be able to improve the intraocular pressure in the presence of POAG. In addition, Kampo medicine may be effective in maintaining the visual function of POAG patients.
[Conclusion] Kampo medicine may reduce intraocular pressure, and be effective as an add-on therapy when combined with standard treatment in patients with POAG.

[Objectives] To investigate the long-term effect of Kampo medicine on the ocular manifestations of Behçet's disease based on 30-years of experience.
[Patients] The number of patients who consulted Yamamoto Eye Clinic on Kampo medicine over a 30-year period was 24, and we investigated and reviewed these patients.
[Results] Although 11 patients discontinued treatment within a few months and 2 patients left our clinic after a short time, we were able to continue Kampo treatment in 11 patients for more than 10 years, with the longest period being 26 years. Consequently, 8 patients recovered their visual acuity.
[Discussion] Our retrospective study indicates that continuous treatment using Kampo medicine reduces the frequency of uveitis attacks and disease activity. In addition, it may be possible to discontinue Kampo medicine if patients achieve and maintain a better condition despite there being several factors that deteriorate their condition. Our study also indicates the importance of more than 10-years follow up to evaluate the efficacy of any intervention for this chronic disease.
[Conclusions] Kampo medicine is effective for preventing the recurrence of uveitis in patients with Behçet's disease.

Patients with relapsing eye diseases can be treated using Kampo medicine to prevent recurrence. In our 30-year experience, only 27 patients have been treated with a Kampo formula aimed at preventing recurrence. Their conditions have included hordeolum, multiple chalazion, subconjunctival hemorrhage, filamentary keratitis, corneal herpes, Posner-Schlossman syndrome, central serous chorioretinopathy and vitreous hemorrhage. Of our patients with these conditions, the number with a successful Kampo treatment outcome for more than 3 years has been 12, when following the principles of Kampo medicine, i.e., “treatment according to a Kampo pattern of identification.”It is considered difficult to prevent recurrence in patients with relapsing eye disease, but our results indicate the effectiveness of Kampo medicine for such patients and, therefore, we believe Kampo medicine should be used continuously for these conditions in the future.In addition, there are no standard guidelines regarding a treatment time required to confirm success in preventing a recurrence in patients with relapsing disease, but we assume that it should to be more than 3 or 4 years.

Human fetal cervical vertebrae are characterized by the large zygapophysial joint (ZJ) extending posteriorly. During our recent studies on regional differences in the shape, extent, and surrounding tissue of the fetal ZJ, we incidentally found a cervical-specific structure of synovial tissues. This study aimed to provide a detailed evaluation of the synovial structure using sagittal and horizontal sections of 20 near-term fetuses. The cervical ZJ consistently had a large cavity with multiple recesses at the margins and, especially at the anterior end, the recess interdigitated with or were located close to tree-like tributaries of the veins of the external vertebral plexus. In contrast to the flat and thin synovial cell lining of the recess, the venous tributary had cuboidal endothelial cells. No or few elastic fibers were identified around the ZJ. The venous-synovial complex seems to be a transient morphology at and around birth, and it may play a role in the stabilization of the growing cervical ZJ against frequent spontaneous dislocation reported radiologically in infants. The venous-synovial complex in the cervical region should be lost and replaced by elastic fibers in childhood or adolescence. However, the delayed development of the ligament flavum is also likely to occur in the lumbar ZJ in spite of no evidence of a transient venous-synovial structure. The cuboidal venous endothelium may simply represent the high proliferation rate for the growing complex.

Human fetal cervical vertebrae are characterized by the large zygapophysial joint (ZJ) extending posteriorly. During our recent studies on regional differences in the shape, extent, and surrounding tissue of the fetal ZJ, we incidentally found a cervical-specific structure of synovial tissues. This study aimed to provide a detailed evaluation of the synovial structure using sagittal and horizontal sections of 20 near-term fetuses. The cervical ZJ consistently had a large cavity with multiple recesses at the margins and, especially at the anterior end, the recess interdigitated with or were located close to tree-like tributaries of the veins of the external vertebral plexus. In contrast to the flat and thin synovial cell lining of the recess, the venous tributary had cuboidal endothelial cells. No or few elastic fibers were identified around the ZJ. The venous-synovial complex seems to be a transient morphology at and around birth, and it may play a role in the stabilization of the growing cervical ZJ against frequent spontaneous dislocation reported radiologically in infants. The venous-synovial complex in the cervical region should be lost and replaced by elastic fibers in childhood or adolescence. However, the delayed development of the ligament flavum is also likely to occur in the lumbar ZJ in spite of no evidence of a transient venous-synovial structure. The cuboidal venous endothelium may simply represent the high proliferation rate for the growing complex.

BACKGROUND/AIMS: Diverticular bleeding can occasionally cause massive bleeding that requires urgent colonoscopy (CS) and treatment. The aim of this study was to identify significant risk factors for colonic diverticular hemorrhage. METHODS: Between January 2009 and December 2012, 26,602 patients underwent CS at our institution. One hundred twenty-three patients underwent an urgent CS due to acute lower gastrointestinal hemorrhage. Seventy-two patients were diagnosed with colonic diverticular hemorrhage. One hundred forty-nine age- and sex-matched controls were selected from the patients with nonbleeding diverticula who underwent CS during the same period. The relationship of risk factors to diverticular bleeding was compared between the cases and controls. RESULTS: Uni- and multivariate conditional logistic regression analyses demonstrated that the use of nonsteroidal anti-inflammatory drugs (odds ratio [OR], 14.70; 95% confidence interval [CI], 3.89 to 55.80; p<0.0001), as well as the presence of cerebrovascular disease (OR, 8.66; 95% CI, 2.33 to 32.10; p=0.00126), and hyperuricemia (OR, 15.5; 95% CI, 1.74 to 138.00; p=0.014) remained statistically significant predictors of diverticular bleeding. CONCLUSIONS: Nonsteroidal anti-inflammatory drugs, cerebrovascular disease and hyperuricemia were significant risks for colonic diverticular hemorrhage. The knowledge obtained from this study may provide some insight into the diagnostic process for patients with lower gastrointestinal bleeding.
Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Case-Control Studies ; Cerebrovascular Disorders/complications ; Colonic Diseases/*etiology/surgery ; Colonoscopy ; Diverticulum, Colon/*complications/pathology/surgery ; Female ; Gastrointestinal Hemorrhage/*etiology/surgery ; Humans ; Hyperuricemia/complications ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

It is unclear whether forearm and crural muscle fibers extend distally across the wrist and ankle joints, respectively.We hypothesized, in late-term fetuses, an over-production of muscle bellies extending over the joint. Muscle fibers in histological sections from unilateral wrists and ankles of 16 late-term fetuses (30–40 weeks) were examined and compared with 15 adult cadavers. Muscle fibers of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) in fetuses, especially muscle bellies to the third and fourth fingers, were found to extend far distally beyond the radiocarpal joint.The extensor digitorum and extensor pollicis longus on the extensor side of the wrist were found to carry distally-extending muscle fibers, but these fibers did not extend beyond the distal end of the radius. In the ankle, most muscle bundles in the flexor hallucis longus (FHL), fibularis brevis (FB) and extensor digitorum longus extended distally beyond the talocrural joint, with most FB muscle fibers reaching the level of the talocalcaneal joint. In adult cadavers, muscle fibers of the FDP and FHL did not reach the levels of the radiocarpal and talocrural joints, respectively, whereas the FB muscle belly always reached the talocalcaneal joint. Similarly, some of the FDS reached the level of the radiocarpal joint. Generally, infants’ movements at the wrist and ankle could result in friction injury to over-extended muscle. However, the calcaneal and FDP tendons might protect the FB and FDS tendons, respectively, from friction stress.

 We examined changes in the apparent whole-blood viscosity (aWBV) of healthy subjects using non-anticoagulated specimens during Japanese style bathing. We have developed a falling needle rhemeter (FNR) that is able to measure several terminal velocities with resin needles in various densities within 210 s. When a needle falls into whole blood in the columnar container, the parameters of aWBV, shear stress and shear rate can be calculated using the blood density, needle density and terminal velocity of the needle as measured by the FNR. Multiple measurements can be made in one whole-blood fluidity analysis, using only a small amount of specimen without any anticoagulant. In this study, several non-eldery healthy adults remained immersed up to the armpits in a sitting posture in the bathtub. In order to maintain a constant bath temperature, heated tap water kept being added. Whole-blood fluidity was analyzed with several aWBVs at various shear rates measured using the FNR. Referring to a previous study reporting on conditions of hemodynamic change, our preliminary examination found that observation of a change in blood fluidity required 10 min of bathing in water at 42 degrees Celsius. Eight healthy men and one healthy woman therefore took a single-bath for 10 min at 42 degrees Celsius for the single-bathing examination. Six of these nine subjects, including the female subject, showed increased aWBVs in the high-shear-rate region with a single bath. And one subject showed increased aWBVs in the high-shear-rate region, 10 min after bathing. These subjects showed altered whole-blood fluidity in the low-shear-rate region at the time of changing aWBVs in the high-shear-rate region. Six healthy men were enrolled in a double-bathing examination, first bathing for 10 min, then taking a break for 5 min and taking a second bath for 5 min. All subjects showed increased aWBVs in the high-shear-rate region: two of the six enrolled subjects showed increases after the first bath; three subjects showed increases after the second bath; and the remaining subject showed an increase at 10 min after the second bath. All subjects showed increased aWBVs in the high-shear-rate region, and a simultaneous change in whole-blood fluidity in the low-shear-rate region. Notably, the time needed for a change in whole-blood fluidity was very short. To implement the present study, non-elderly adult volunteers were enrolled to reduce the risk of accidents and some limitations were placed on bathing conditions. As changes in blood fluidity were observed under bathing conditions with water temperature over 42 degrees Celsius and immersion up to the armpits in a sitting posture, we concluded that prolonged Japanese-style bathing in water exceeding 42 degrees Celsius is dangerous.

Purpose: The albumin-to-globulin ratio (AGR) is a recognized chronic inflammation marker. No evidence regarding the relationship between AGR level and ulcerative colitis (UC) exists. The aim of this study was to evaluate the association between AGR and clinical outcomes among Japanese subjects with UC. Methods: The study subjects consisted of 273 Japanese individuals with UC. AGR was divided into 4 categories (low, moderate, high, and very high). The definition of complete mucosal healing (MH) was based on the Mayo endoscopic subscore of 0. Clinical remission (CR) was defined as no rectal bleeding and no abnormally high stool frequency (<3 times per day). Results: The percentage of MH was 26.4%. High AGR and very high AGR were significantly positively correlated with CR (adjusted odds ratio [OR], 5.85; 95% confidence interval [CI], 2.52–14.18 and adjusted OR, 4.97; 95% CI, 2.14–12.04) and complete MH (adjusted OR, 4.03; 95% CI, 1.56–11.51 and adjusted OR, 5.22; 95% CI, 1.97–14.89), respectively after adjustment for confounding factors (P for trend=0.001). Only in the low C-reactive protein (CRP) group (≤0.1 mg/dL), very high AGR was significantly positively correlated with complete MH but not CR (adjusted OR, 4.38; 95% CI, 1.06–21.77; P for trend=0.017). In the high CRP group, no correlation between AGR and complete MH was found. Conclusion Among Japanese patients with UC, AGR may be independently positively correlated with complete MH. In particular, among UC patients with low CRP, AGR might be a useful complementary marker for complete MH.