We experienced two cases of postherpetic neuralgia (PHN) improved with Kampo medicines that include uzu (i.e. uzu-zai).The pain from PHN was improved via the administration of an uzu-zai in these 2 cases, worsened by its discontinuation, and improved again by its re-introduction.Case 1 : A 76-year-old male suffering from PHN of the right L 2-3 area was administered uzukeishito and obtained pain reduction. After 12 months, his prescription was changed from uzukeishito to keishikaryoju-tsubuto. Then, after only 2 days his pain worsened again. Uzukeishito treatment was re-instated, and he again obtained pain reduction. Case 2 : An 82-year-old male suffering from PHN of the right C 4-5 area was given uzuto and obtained pain relief. After 3 months his prescription was changed from uzuto to keishikajutsubuto. Then, after only1week his pain worsened again. Uzuto was then re-introduced, and pain reduction was achieved again. These two cases led to two suggestions. First, that the uzu-zais were very effective against the PHN pain. Second, that this effect of an uzu-zai against PHN pain might be a symptomatic rather than a radical treatment.These two cases highlight the fact that the use of an uzu-zai was instrumental in reducing PHN-associated pain, but further studies will be needed to determine a dosage protocol, including when and at what pace uzu-zais might be reduced/discontinued.

Pure autonomic failure (PAF) is a degenerative disorder with diverse autonomic nervous symptoms, but without somatic nervous symptoms. We encountered a patient with PAF who was successfully treated with keishikashakuyakuto. A 61-year-old man complained of diarrhea, abdominal pain, dysuria and orthostatic hypotension. PAF was strongly suspected, based on a low level of plasma noradrenalin at rest and a finding of severe diffuse sympathetic nerve injury on ¹²³I MIBG myocardial scintigraphy. Various Kampo formulas were not effective, or could not be administered continually. Urinary retention was treated with self-catheterization. After the extract of keishikashakuyakuto was administered, his complaints of diarrhea and abdominal pain gradually decreased, and he was able to eat various kinds of food. His daily living activities improved.Moreover, he could urinate by himself, so the self-catheterization was stopped. Five years later, the diagnosis of PAF was clinically confirmed, but his daily living activities did not deteriorate. This suggests that keishikashakuyakuto can be effective for diseases with diverse autonomic nervous symptoms, such as the present case.

We report a case of an obstinate belch successfully treated with goshuyuto. The patient was a 74-year-old female. She had been hospitalized seven times in the past due to the belch, abdominal distention and anorexia, and had been prescribed various Kampo formulas. But her symptoms fluctuated up and down. The obstinate belch essentially disappeared after administering goshuyuto, and her appetite improved. Many of Kampo formulas that treat belchs are related to Shoyobyo (shao yang bing), but we consider that goshuyuto may be effective for a belch, which is yin-related and accompanied with stiffness and rigidity below the heart, and fullness in the chest and hypochondrium.
Medicine, Kampo ; Treated with ; Case Report ; plastic property - rigidity ; symptoms <1>

We report a case of recurring adhesive ileus that was successfully treated with shojokito (decoction) without inserting a nasogastric tube. The patient was a 75-year-old male who had been treated for abdominal symptoms in our department after a laparotomy. He visited our hospital mainly for complaints of abdominal pain and distention, was diagnosed with adhesive ileus because of a niveau image upon abdominal X-ray, and was hospitalized the same day. We diagnosed him as Yang syndrome and excess syndrome because he had thick yellow fur of the tongue, and administered shojokito. He broke wind at 40 minutes after administration of shojokito, and had bowel movement two hours later. Furthermore, he had mass diarrhea after another administration of this formula, and the niveau image disappeared the next day. It is often considered that an ileus develops with Cold, for which daikenchuto is prescribed frequently. However, in some cases cold purgative formulas such as jokito group may be effective, if such cases are Yang syndrome and excess syndrome, and present with yellow fur of the tongue.
Intestinal Obstruction ; Syndrome ; Treated with ; Yellow color ; Yang

Thalamic pain is known as intractable central pain caused by thalamic bleeding and infarction. Although some physical and surgical therapies have been tried, there is no established method for its improvement. We attempted the treatment of 6 cases of thalamic pain, and 4 of them showed improvements in their symptoms. Our patients were aged 27-70 years, 4 men and 2 women. Their diagnoses were 3 cases of right thalamic bleedings, 1case of left thalamic bleeding, and 2 cases of right thalamic infarctions. The periods from onset to consulting our department were from6months to 12 years. In the 4 cases whose symptoms improved, the symptoms had almost disappeared or were decreased by at least 40%. These improved cases used formulas containing uzu or bushi. Yokukansankachimpihange was effective for two cases with mental disturbances. One case showing major improvement was treated by only the formula against oketsu. The cases whose symptoms had continued for a long time were more intractable, with the symptoms remaining to some degree in spite of their decreasing tendency. Finally, in intractable cases, their symptoms remained fixed and they had severe paralysis.

This study aimed to clarify whether a regional palliative care intervention program, the OPTIM project, increased home hospice utilization, and explore the potential association between the home hospice utilization and the hospital staff's perceptions on home care. A questionnaire survey was conducted involving 154 physicians and 469 nurses. The rate of patients who made the transition to home-based care increased 967% in A Hospital, 295% in B Hospital, and 221% in C Hospital in 2010 compared to 2007, which was assumed to be 100. Staff of a hospital where many patients made the transition to home-based care were more likely to agree with the following statements concerning home care perspectives: “I started to consider that even cancer patients can be treated at home until the last moment of their life”, “I usually ask patients whether they wish to receive home-based care”, “We decided on coping strategies for sudden changes in the course of disease and a place to contact in advance”, and “I started to simplify treatment procedures, such as prescriptions during hospitalization for patients and their families to prepare for home-based care“.

Purpose: Quantitative elastography methods, such as ultrasound two-dimensional shear-wave elastography (2D-SWE) and magnetic resonance elastography (MRE), are used to diagnose liver fibrosis. The present study compared liver stiffness determined by 2D-SWE and MRE within individuals and analyzed the degree of agreement between the two techniques. Methods: In total, 888 patients who underwent 2D-SWE and MRE were analyzed. Bland-Altman analysis was performed after both types of measurements were log-transformed to a normal distribution and converted to a common set of units using linear regression analysis for differing scales. The expected limit of agreement (LoA) was defined as the square root of the sum of the squares of 2D-SWE and MRE precision. The percentage difference was expressed as (2D-SWEMRE)/ mean of the two methods×100. Results: A Bland-Altman plot showed that the bias and upper and lower LoAs (ULoA and LLoA) were 0.0002 (95% confidence interval [CI], -0.0057 to 0.0061), 0.1747 (95% CI, 0.1646 to 0.1847), and -0.1743 (95% CI, -0.1843 to -0.1642), respectively. In terms of percentage difference, the mean, ULoA, and LLoA were -0.5944%, 19.8950%, and -21.0838%, respectively. The calculated expected LoA was 17.1178% (95% CI, 16.6353% to 17.6002%), and 789 of 888 patients (88.9%) had a percentage difference within the expected LoA. The intraclass correlation coefficient of the two methods indicated an almost perfect correlation (0.8231; 95% CI, 0.8006 to 0.8432; P<0.001). Conclusion Bland-Altman analysis demonstrated that 2D-SWE and MRE were interchangeable within a clinically acceptable range.

Objectives: To assess the perception of care and outcomes of end-of-life palliative care by bereaved family members to determine differences in care provided to patients with and without cancer. Methods: This cross-sectional, anonymous survey using a self-reporting questionnaire for bereaved family members was conducted online. Care was assessed using overall satisfaction score and the care evaluation scale (CES) and outcomes were assessed using good death inventory (GDI). Results: The present study included data from 118 patients with cancer and 299 patients without cancer (103, heart failure; 71, stroke; and 125, pneumonia). The overall satisfaction score was not significantly different between patients with and without cancer. Conversely, physical care score in the CES and autonomy score in the GDI were significantly lower in patients without cancer than in patients with cancer (p<0.05). Conclusion: The satisfaction with end-of-life care was comparable between the bereaved family members of patients without cancer and those of patients with cancer. However, results related to some items of CES and GDI suggest that some components of end-of-life care for patients without cancer might require attention. Not only treatment of the underlying disease but also relief of suffering is important to improve end-of-life care.