A 54-year-old female had cesarean sections at ages 26 and 29, a left salpingophrectomy for left ovarian cyst at age 31, and a total abdominal hysterectomy for fibroids at age 41. After total abdominal hysterectomy, she had repeated bouts of ileus and started taking daikenchuto (DKT), which is commonly used to prevent ileus. At age 54, she visited our hospital when DKT failed to relieve her constipation and lower abdominal pain and had occasional heat flash above her neck. Tongue examination revealed pale red tongue and fissured tongue signs with yellow fur and dilation of the sublingual collateral vessels. Kampo diagnosis was blood stasis and excess heat, for which keishibukuryogan was prescribed to be taken daily and with which her symptoms dissipated after 7 days. Despite the popular use of DKT, its potential to cause excess heat after long-term use is not as well known. It is extremely important to warn clinicians who prescribe Kampo not to focus solely on a disease-to-prescription model but also to be learned of the discipline and to take measures to prevent adverse long-term effects and complications.

The purposes of this study were to examine the loss of bone mineral density (BMD) with increasing age and to investigate the relationship between the BMD and body composition. Cross-sectional measurements of total body and regional (head, arms, legs, trunk, ribs, pelvis and spine) BMD and body composition were made in 112 Japanese healthy women, aged 20 to 87 years, by dual-energy X-ray absorptiometry (DXA) . The mean peak BMD for the trunk, ribs, and pelvis was observed at the age of 40-49 years, in the arms and spine at the age of 30-39 years, and in the head, legs, and total body at the age of 20-29 years. The loss of spine BMD appears to begin prior to BMD loss in other regions and the rate of bone loss as a function of aging was readily apparent. Appendicular bone loss did not occur until age 49 yr, accelerated from ages 50 to 69 yr, and then decelerated somewhat after age 70 yr. In this cross-sectional analysis, we found cumulative loss of BMD from peak to 80-89 yr of age was 31.2% for the spine, 25.0% for the total body, and 21.5% for the ribs. To examine the relationship between the BMD and body composition, multiple regression analysis was performed with total body and regional BMD as the dependent variable and fat-free mass (FFM) and fat mass as the independent variable. From this analysis, the results indicated that FFM was a significant predictor of total body and regional BMD but did not evaluate the effects of exercise or other potential variables that might affect BMD. In conclusion, our findings indicate that spine bone loss begins prior to the loss of compact bone, and the rate of bone loss in the spine due to aging was greater than that of other specific regions. Secondly, FFM and fat mass are related to total and regional BMD in Japanese women with the strongest relationship being FFM.

Effects of cold and warm water bathing of hemiplegic lower limb on its isokinetic muscle strength were studied in 12 chronic stroke patients (9 males and 3 females, 53.3±14.2 yo, Ueda's grading 8.5±1.6 Grade).
Measurements of the isokinetic muscle strength of the knee flexion/extension were repeated three times; 1) after sitting for 10min at room temperature (21-22°C) as a control, 2) after cold water bathing (18°C) of hemiplegic lower limb for 5min, 3) after warm water bathing (41°C, 700ppm artificial CO₂ bath) of hemiplegic lower limb for 10min. The measurements were performed, using Cybex 6000 (Cybex international Co) at velocities of 60, 120, 180 and 240°/sec. Artificial CO₂ bath was prepared by dissolving Kao Babu (Kao Co) in 41°C warm water.
Peak torque of the knee flexions at any velocity decreased significantly after cold water bathing and imcreased after warm water bathing. Change in the maximum power and total work were similar to that of the peak torque. The muscle strength of the knee extension were not changed by neither cold nor warm water bathing.
The correlation coefficient between Ueda's Grade and its isokinetic muscle strength ranged from 0.3 to 0.6 and significantly improved after warm water bathing at velocity of 120 (°/second) in flexion. Warm water bathing might make it easy to exert their muscle strength at 120°/sec in flexion corresponding to their severity of their hemiplegia.
Regarding to the influence of spasticity, patients with no ankle clonus or pseudoclonus showed a tendency to increase in muscle strength of flexion and extension after warm water bathing. In patients with evident clonus, a tendency to decrease on extension and increase on flexion was seen after warm water bathing.
Further studies on the effects of warm water bathing of partial and full immersion in the treatment for spasticity of hemiplegic limb would contribute to stroke rehabilitation.

STUDY DESIGN: Retrospective analysis using magnetic resonance imaging (MRI). PURPOSE: To identify MRI features that could discriminate benign from malignant vertebral fractures. OVERVIEW OF LITERATURE: Discrimination between benign and malignant vertebral fractures remains challenging, particularly in patients with osteoporosis and cancer. Presently, the most sensitive means of detecting and assessing fracture etiology is MRI. However, published reports have focused on only one or a few discriminators. METHODS: Totally, 106 patients were assessed by MRI within six weeks of sustaining 114 thoracic and/or lumbar vertebral fractures (benign, n=65; malignant, n=49). The fractures were pathologically confirmed if malignant or clinically diagnosed if benign and were followed up for a minimum of six months. Seventeen features were analyzed in all fractures' magnetic resonance images. Single parameters were analyzed using the chi-square test; a logit model was established using multivariate logistic regression analysis. RESULTS: The chi-square test revealed 11 malignant and 4 benign parameters. Multivariate logistic regression analysis selected (i) posterior wall diffuse protrusion (odds ratio [OR], 48; 95% confidence interval [CI], 4.2–548; p=0.002), (ii) pedicle involvement (OR, 21; 95% CI, 2.0–229; p=0.01), (iii) posterior involvement (OR, 21; 95% CI, 1.5–21; p=0.02), and (iv) band pattern (OR, 0.047; 95% CI, 0.0005–4.7; p=0.19). The logit model was expressed as P=1/[1+exp (x)], x=−3.88×(i)−3.05×(ii)−3.02×(iii)+3.05×(iv)+5.00, where P is the probability of malignancy. The total predictive value was 97.3%. The only exception was multiple myeloma with features of a benign fracture. CONCLUSIONS: Although each MRI feature had a different meaning with a variable differentiation power, combining them led to an accurate diagnosis. This study identified the most relevant MRI features that would be helpful in discriminating benign from malignant vertebral fractures.
Diagnosis ; Discrimination (Psychology)* ; Humans ; Logistic Models ; Magnetic Resonance Imaging* ; Multiple Myeloma ; Neoplasm Metastasis ; Osteoporosis ; Retrospective Studies ; Spinal Fractures ; Spine

Surveys on the snail intermediate hosts were undertaken in the paddy fields in Yatomi-cho, Aichi Prefecture, once a year over a 5-year period (1983-1987).
And the cercariae of two different avian schistosomes were detected from snails in paddy fields.
The cercariae from Polyplis haemisphaerula were identified as species beloning to the genus Gigantobilharzia and the cercariae from austropeplea ollula as species belonging to the genus Trichobilharzia.
It was concluded that the paddy field dermatitis occurring in Yatomi-cho was proved to be caused by the invasion of these cercariae.

A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.

Objective : Carvedilol is a non-selective β blocker with an α blocking activity. Since this drug is highly fat-soluble, it can pass through the blood-brain barrier, and thus may induce depression and lower QOL. In the present study, physicians and pharmacists collaborated to evaluate the antihypertension effect of carvedilol and post-administration changes in QOL. Furthermore, the relationship between QOL and antihypertension effect was analyzed.
Design : Self-controlled study.
Patients and Methods : Subjects were outpatients with hypertension above the age of 70 years who visited one of 42 medical institutions in Japan between April 1995 and March 1996. A total of 243 patients were registered, and 10-20 mg of carvedilol was administered once a day for six months. Pharmacists assessed the QOL of these patients by asking 82 questions on three separate occasions : before administration and one and six months after administration. The antihypertensive effect of this drug was investigated in patients in whom all three QOL questionnaires were collected. The main test items were antihypertensive effect, changes in QOL (subjective QOL with a special emphasis on patient psychology), and the relationship between antihypertensive effect and QOL. The antihypertensive effect of this drug was statistically analyzed by a paired t-test, and changes in QOL were statistically analyzed using generalized estimating equations.
Results : All three QOL questionnaires were collected from a total of 146 patients. Their pre-administration systolic blood pressure was 159.6±1.4 mmHg, and diastolic blood pressure 94.0±0.9 mmHg, and their blood pressure decreased significantly one month after the start of administration. This antihypertensive effect of carvedilol persisted, and the systolic and diastolic blood pressure of these patients six months after the start of administration was 141.1±1.2 and 85.2±0.7 mmHg, respectively (significant decreases when compared to pre-administration levels ; both p<0.05).
Subjective QOL improved significantly after carvedilol administration. And, changes were not seen in sexual function. Changes in the five categories of subjective QOL were as follows : psychological stability, disease-induced inconvenience, and independence improved significantly after carvedilol administration, but changes were not seen in gratification or vitality. However, improvements in subjective QOL did not correlate with improvements in blood pressure.
Conclusions : The results of the present study showed that carvedilol improved QOL without negatively affecting sexual function. Subjective QOL reflects the psychological well-being of patients. In the present study, psychological stability, disease-induced inconvenience, and independence improved significantly, but changes were not seen in gratification or vitality. Since β blockers can suppress the central nervous system, they can reduce psychological stability, gratification and vitality. Even though carvedilol is highly fat-soluble, the results of non-clinical studies have shown that it does not suppress the central nervous system as much as propranolol. The results of the present study showed that carvedilol does not strongly suppress the central nervous system of humans. Moreover, significant changes in QOL were not seen between one and six months after the start of administration of carvedilol, suggesting that it is possible to estimate the QOL of patients on antihypertensive therapy after six months of administration by assessing their QOL one month after administration.

A statistical study on effects of laser-puncture was carried out. In addition, an attempt was made to compare between the effect of acupuncture and this method. The treatments were under-taken for various chronic and acute cases with pain. In the laser-puncture treatment, two types of laser (i, e. low energy 10mW laser and 70mW sharp laser) were used. Laser-beam was given to 20-30 points which were located in painful areas, innervating nerve areas and remote areas for 40 sec for each.
In the open study, 10mW laser-puncture was effective (including ‘rather effective’) in 64% of the cases, and 70mW laser-puncture 73%. In the blind test, ‘the day’ evaluation showed that the laser-punctures were more effective than placebo treatment: 10mW laser-puncture was effective in 80% of the cases, and placebo in 67%. 70mW laser-puncture was effective in 87% of them, and placebo in 80%. In situ acupuncture was effective in 97%, and no effect was seen in 7%.
Only ‘the day’ evaluation in the open study showed that 70mW laser-puncture was more effective than 10mW one. In the blind best, 10mW and 70mW laser-puncture were more effective than placebo, and in situ acupuncture was more effective than the laser-punctures, but there were no significant differences among the three treatmets.