Our hospital is located in the prefectural capitol of Fukushima, where tremors just below magnitude six were recorded during the Great East Japan Earthquake of March 11, 2011. The building was spared major damage, but for safety, patients hospitalized at the Kaifukuki rehabilitation ward were evacuated within the hospital to rehabilitation rooms in the new annex, where they spent two nights. The day after the earthquake, a group rehabilitation session was conducted, but because patients showed signs of exhaustion from lack of sleep and anxiety, it was switched to individual rehabilitation. On a questionnaire, many patients noted that conversations with the staff helped ease their anxiety. This suggests that, although group rehabilitation can be efficient and effective in providing psychological support to patients, individual rehabilitation tends to be more favorable in disaster situations where patients suffer from exhaustion and psychological stress. Accordingly, disaster rehabilitation should be conducted on a patient-by-patient basis. In comparison with patients from the same time the previous year, the number of rehabilitation intervention units per day was one less, but the period of hospitalization was longer. A similar improvement in FIM was also achieved. At the time of an earthquake, although it is important for hospitals that escape structural damage to accept new patients, it is also important to continue treating the patients who were already there. Furthermore, hospitals should always have stockpiles of meals on hand and form cooperative relationships with the community to ensure that they can continue to provide service after an earthquake.

We encountered a 24-year-old female patient with anorexia nervosa and a 25-year-old male patient with depressive neurosis, both of whom failed to respond to an antidepressant or an antianxiety drug but improved significantly with Rikkunshi-to (Tsumura's extract granules) given three times a day between meals in a daily dose of 7.5g.
In order to determine the effect of this Kampo formulation, we evaluated their mental condition weekly using the HDRS, BDI, and MAS scales. Although the MAS, which assesses anxiety, did not change very much, the HDRS and BDI, which assess depression, improved significantly. The evaluation was indicative of problems in personality formation originating from the patients' complicated life history. We had the impression that while in both cases Rikkunshi-to was ineffective in relieving anxiety related to personality factors, it was effective with depressive symptoms (anorexia, fatigue, malaise, insomnia etc.) occurring secondarily to anxiety.

We encountered three patients with schizophrenia diagnosed by DSM-III-R and/or ICD-9, all of whom improved significantly with Daisaiko-to. Psychiatric presentations evident were irritability, face-to-face tension and agitation, and constipation was present a somatic disturbance.
The psychiatric symptoms were associated with anger, the specific emotion corresponding to the orbis hepaticus, based on the Five Evolutive Phases (wu-hsing). Therefore, these symptoms were thought to be caused by dysfunction of Liver Ki (Qi) (energetic configuration). Daisaiko-to was prescribed in order to improve the function of Liver Ki based on the concept that the disorder was related to Kankao (a flaming up of Liver Fire). The effectiveness of this formula suggested that both Bupleuri Radix and Raeoniae Radix, which are components of Daisaiko-to, were important herbal drugs to alleviate “flaming up of the Liver Fire, ” in the treatment of schizophrenia.

In step with the widespread use of antimicrobial agents in medical treatment, microbial substitution and emergence of new drug-resistant bacteria have become life-threatening problem today. Both have resulted from the postopreative practice of administering prophylactic medication and long-term, desultory drug administration. Drug-resistant microbes can occur easily with the inadequate use of drug. Therefore, our hospital has held in check the incidence of drug-resistant microbial infection by letting ICT members make the rounds of the wards and go over the notifications of the prescription of specific antimicrobial agents and the reports on drug-resistant bacteria. At the begiing, the notification and the report were filed separately. Recently, the information obtained from thses two channels has become easier of access because all the necessary data appear on the same screen at once by using patients' IDs. We believe that the streamlining of work and putting two kinds of data together have proved very usefull for infection control, as it has become possible to keep careful watch over the use of specific antimicrobial agents and the detection of drug-resistant microorganism simulataneously. By sharing the information obtained by us with all the rest on the hospital staff, we will continue to make efforts along this line and contribute toward the prevention of the outbreak of nosocomial infections as well as community-acquired ones.
Microorganism ; Pharmaceutical Preparations ; Medical Surveillance ; microbial ; Bacterial

A 55-year old man was admitted to our hospital owing to endograft collapse after TEVAR. He had undergone total arch replacement for acute aortic type A dissection at age 39, and undergone thoracic endovascular aortic repair (TEVAR) for chronic aortic type B dissection at age 54. TEVAR was successfully performed and the false lumen was shrunk. However, one year after TEVAR, computed tomography showed endograft collapse. Technical success was not achieved by the balloon technique to treat endograft collapse, so we performed additional TEVAR. After this procedure, endograft collapse was repaired. The postoperative course was uneventful.

Medicine, Kampo ; Metabolic ; Therapeutic procedure ; Syndrome

Objective: Aerobic exercise on land decreases arterial stiffness, however, the effect of exercise in water on arterial stiffness has not been clear. This study investigated the effect of a 15-min cycling exercise on land and that in water on pulse wave velocity (PWV) as an index of arterial stiffness. Methods: Nine healthy young men were randomly performed exercise on land and exercise in water equivalent to 50% of each maximum oxygen uptake on separate days. The PWV from carotid to femoral artery (aortic PWV) and femoral to posterior tibial artery (leg PWV) were measured at baseline and 15, 30, 60 min after exercise. Results: The heart rate in water was significantly lower during exercise than that on land. In addition, the carbon dioxide output and respiratory exchange ratio during exercise were significantly greater in water. Body temperature increased after the exercise on land but decreased after the exercise in water. Although the aortic PWV and leg PWV decreased concomitantly with decrease in SBP and DBP after the exercise on land, there were no significant changes after the exercise in water. Conclusion: Although acute exercise on land decreased arterial stiffness after exercise, acute exercise in water of the same exercise load did not. The differences in body temperature and blood pressure after exercise may result in diverse arterial stiffness after exercise.

Objective:It is well known that the use of benzodiazepines is associated with falling in elderly people, but there have been few researches focused on changes in the dose of benzodiazepines and falls. If the association between changes in the dose of benzodiazepines and falling becomes clear, we may take an action to prevent falling.In this study, we investigated the association between changes in the dose of benzodiazepines and falling among elderly inpatients in an acute-care hospital.
Design:Falling generally results from an interaction of multiple and diverse risk factors and situations, and medication history of each subject must be considered in this study. We conducted a case-crossover study in which a case was used as his/her own control at different time periods. Therefore covariates that were not time-dependent were automatically adjusted in this study.
Methods:Subjects were patients who had falling at one hospital between April 1, 2008 and November 30, 2009. Data were collected from incident report forms and medical records. Odds ratio for changes in the dose of benzodiazepines were calculated using conditional logistic regression analyses.
Results:A total of 422 falling by elderly people were eligible for this study. The odds ratio for increased amounts of benzodiazepines was 2.02(95% Confidence Interval(CI):1.15, 3.56). On the other hand, the odds ratio for decreased amounts of benzodiazepines was 1.11(95%CI:0.63,1.97).
Conclusion:There was an association between increased amounts of benzodiazepines and falling. Hence, it is considered meaningful to pay attention to falling when amounts of benzodiazepines are increased to prevent falling in hospitals.

We report a case of serous gonarthritis with nonproductive cough successfully treated with Eppikajutsuto. A 37-year-old Japanese man developed a right genicular arthrocele with nonproductive cough, in October X. Over 100 ml of serous synovial fluid was drained via an arthrocentesis puncture procedure. Although he was treated with nonsteroidal anti-inflammatory agents by an orthopedist, under a diagnosis of serous gonarthritis, his symptoms did not improve. Laboratory findings suggested inflammatory conditions (serum CRP 3.4 mg/dl, ESR 76 mm/h). At the time of his first visit in January X+1, orthopedic examinations revealed that rheumatoid arthritis was unlikely, based on negative physical and laboratory findings. A contrast MRI knee joint scan did not demonstrate any tumor-like mass of synovium which would indicate pigmented villonodular synovitis. And orthopedists found it difficult to specify the cause of his serous gonarthritis. After a common cold in December X, cough stimulated by cold exposure was superimposed on serous gonarthritis.We utilized Eppikajutsuto under the interpretation that both his genicular arthrocele and nonproductive cough were due to a “sui” disturbance. This Eppikajutsuto therapy reduced his genicular arthrocele and nonproductive cough in1month. His symptoms and inflammatory reactions were completely improved in 3 months, regardless of gradual withdrawal of his medication.
Coughing ; Upper case ecks ; symptoms <1> ; Serous ; Treated with