The rate of mortality from paraquat poisoning is high and the principal manifestation of toxicosis is pulmonary impairment.
In this study, we measured the concentration of paraquat in the urine, blood, and some organs in 10 patients with acute paraquat poisoning in order to study the relationships of the kinetics in the body to the concentration in the lungs and to the pulmonary impairment.
The concentration of paraquat dichloride in the blood stream rapidly decreased in the first 24 hours. The half life was about 0.5 hour, within 2 hours (case 3) after intoxication, about 1 hour after 5 hours (case 5), about 2 hours after 10 hours (case 6) and after 24 hours (case 6) was prolonged to over 26 hours.
Therefore, it was suggested that half life was subsequently prolonged with the passage of time.
There were indications that renal disturbance appeared in about 5 hours after oral intake.
Accumulations of paraquat were seen in the organs examined. The largest amount within 24 hours after exposure was recognized in the lungs, and the largest amount after 271 hours was seen in the skeletal muscle. The concentration of paraquat in the lungs was higher than the concentration levels in the blood at death in all the cases.
Although excretion of paraquat from the lungs was very slow. it became faster with DHP and HD. However, excretion from the skeletal muscle was slow, Excretion from the other organs excepting the kidney was considered to be constant, being proportional to the blood concentration levels.
The pathologic examination of the lungs found congestive edema in 6 cases, which became severer with the lapse of time. Partial pulmonary fibrosis was recognized only in long-term survival cases.
The cause of irreversible pulmonary impairment was considered to be the effect of the small amount of paraquat remaining in the lungs which exceeds the concentration in the blood.

Fatal intestinal necrosis developed following off-pump CABG and implantation of a bifurcated vascular prosthesis in a 70-year-old man with unstable angina pectoris and abdominal aortic aneurysm. A CT scan with three-dimensional reconstruction (3D-CT), showed no narrowing or obstruction of the SMA. The patient was scheduled to undergo an extensive resection of the intestine on the 23rd postoperative day. The pathological diagnosis was nonocclusive mesenteric ischemia (NOMI). He died of multiple organ failure on the 38th postoperative day. Early diagnosis of NOMI is essential to lower mortality and postoperative morbidity. Invasive angiography is the gold standard in diagnosis. 3D-CT, a non-invasive method, is an increasingly useful technique, which may allow identification of vascular anatomy and pathology with sufficient detail for diagnosis. Several other causes of acute abdomen, other than mesenteric ischemia, can be ruled out. Therefore, 3D-CT might be useful in screening for NOMI.

We report two cases of unexplained thoracodorsal pain, which were successfully treated with the Kampo formulations karogaihakuhakushuto and karogaihakuhangeto. In case 1, the patient was a 67-year-old man. Left thoracodorsal pain appeared in this patient two months after the administration of chemotherapy for transverse colon cancer with hepatic metastasis. Bone metastasis was ruled out by bone scintigraphy, but the cause of the pain was still unknown. The Kampo formulation karogaihakuhakushuto was prescribed and the pain was reduced after two weeks, and disappeared within three months. In case 2, the patient was a 40-year-old man. Right thoracodorsal pain appeared in the right hypochondriac region without an apparent cause. Examinations, such as computed tomography and upper gastrointestinal endoscopy, were conducted, but the cause of the pain remained undiagnosed. The pain was not improved with pain killers, karogaihakuhakushuto was prescribed, and the pain was then reduced in about a month. The authors considered thoracodorsalpain as already described in the great classic Kinkiyoryaku (Chin Keiu Yao Lueh). We then prescribed karogaihakuhakushuto and karogaihakuhangeto, which resulted in immediate clinical improvement. These clinical courses indicate that the formulae can be effective for the treatment of thoracodorsal pain of unknown origin. Furthermore, the effect of herbal medicines and herbal decoctions boiled with rice wine may make it possible to have a more imminent effect on thoracodorsal pain.

The patient was a 45-year-old woman who began suffering from pain in her extremities 1 year and 6 months previously, and who received Oketsu-reducing Kampo. Her pain disappeared in a year. Six months after her treatment ended, she visited our hospital again complaining of the same symptom. Due to strong signs of Oketsu, we prescribed her a Kampo that reduces Oketsu, but her pain largely persisted. On re-examination, we noticed that her condition had occurred during the rainy season on both instances and speculated that high humidity and strong ‘wind' may be the reason. Therefore, Byakujutsubushito was prescribed for her, and her pain disappeared in 2 weeks. However, in the following rainy season, she visited us again complaining of the same pain, and Byakujutsubushito was again administered, and that relieved her from pain in 11 days. Although it is stated that Byakujutsubushito is useful for the treatment of pain resulting from dampness and ‘wind', there are very a few reports on this in the Kinkiyoryaku text. Nowadays, we live in air-conditioned spaces, and high humidity results in ‘cool wind’ and exterior dampness. Frequent movement in and out of such spaces worsens extremity pain, and we believe that the incidence of this condition is increasing. And we believe that Byakujutsubushito is one of the most useful formulations for the treatment of this condition that occurs during rainy season.

Soshikokito is a Kampo formulation used in the treatment of bronchial asthma, especially in those patients with hot flushes and cold sensation in their feet. But there is also a description in classical textbooks for its usage for the treatment of tinnitus. We report two typical cases of prolonged tinnitus treated successfully with soshikokito. Case1was a 70-year-old woman who visited our clinic complaining of tinnitus, dizziness and insomnia. She had a history of bilateral otitis media in her childhood, and had been suffering from tinnitus after being operated for it. The tinnitus had worsened during the three months prior to her first visit to us. After 3 months' treatment with soshikokito with additional shisoyo, her symptoms improved, so much so that after 8 months, she could live her life normally. Case 2 was a 58-year-old man who presented with tinnitus, hearing disturbance and a sense of irritation. He also complained of insomnia and cold sensation in his limbs. After1month's treatment with soshikokito with additional shisoyo and bushi, most all of his symptoms resolved. In addition, we also evaluated the clinical efficacy of soshikokito for prolonged tinnitus, retrospectively, and found that it was effective in five out of the ten cases we treated with this formulation. Most of the successfully treated patients presented with hot flushes or cold sensation in their feet. These case reports suggest that soshikokito may be a useful formulation for the treatment of not only bronchial asthma, but also of prolonged tinnitus.
Tinnitus ; therapeutic aspects ; seconds ; month ; Esthesia

We report four cases which were successfully treated with keishikyokeikabukuryobyakujutsuto. Case 1 was a 53-year-old female who presented with a 15-year history of fatigue, headache and shoulder stiffness. After 1 month's treatment with keishikyokeikabukuryobyakujutsuto, her complaints improved remarkably. Case 2 was a 29-year-old female who was suffering from allergic rhinitis. After 6 month's treatment with keishikyokeikabukuryobyakujutsuto, her symptoms completely resolved. Case 3 was a 37-year-old female who was diagnosed with Meniere's disease. Some formulas had been prescribed before, but provided no relief. After the start of treatment with keishikyokeikabukuryobyakujutsuto, however, the patient's symptoms resolved completely within 2 weeks. Case 4 was a 50-year-old female who presented with tension headache. After 2 week's treatment with keishikyokeikabukuryobyakujutsuto, her headache had almost completely resolved. Most of the cases presented with slight epigastric tenderness and superficial-like symptoms such as headache and shoulder stiffness. Many of them also showed symptoms suggestive of fluid imbalances in the body, such as dizziness, rhinorrhea and teeth marks on both sides of the tongue. Keishikyokeikabukuryobyakujutsuto is a useful formula for patients with superficial-like symptoms accompanied by disorders of the body fluid homeostasis.
symptoms <1> ; seconds ; therapeutic aspects ; Female ; Headache

A 60-year-old male patient visited the Oriental Medicine Research Institute of the Kitasato on ***** because of abdominal discomfort. Hangeshashin-to was administered to him and the abdominal discomfort was relieved. He continued to take Hangeshashin-to from June to August 1997. He had chills, high fever, and fatigue from ********. He stopped Hangeshashin-to and took Shosaiko-to for five days because of liver dysfunction. He was admitted to our hospital on ********. Antibiotics and stronger neo-minophagen C were administered to him. A chest roentgenogram revealed a ground-glass shadow on the left upper lung, and Shosaiko-to was discontinued. The patient began to complain of dyspnea and had fine crackles on the chest. A chest roentgenogram and chest CT showed interstitial pneumonitis. Oral predonisolone therapy was started for hypoxemia and the patient improved. A drug lymphocytes stimulation test revealed that lymphocytes were stimulated by Shosaiko-to and its components, Saiko and Ogon. A chest roentgenogram just before ingesting Hangeshashin-to revealed the interstitial change of the lung. Taken all together, this patient suffered from druginduced hepatitis and pneumonitis as a result of ingesting Hangeshashin-to and Shosaiko-to.

 This cross-sectional study examined cigarette smoking knowledge, attitudes, and practices among medical students in a southwestern region of China. The subjects included 557 and 223 first and fourth year Chinese medical students, respectively. Comparison data were collected from 74 Japanese and 90 Vietnamese fourth year medical students. The smoking rate among the fourth year medical students in China (7.0%) was significantly higher than among the first year medical students (2.8%), and higher than among the medical students from Vietnam, but lower than the medical students from Japan. The fourth year Chinese students had a more permissive attitude toward cigarette smoking by physicians compared with the first year students, and the lowest knowledge base on cigarette smoking-related diseases among the students from all three countries. Based on a multivariate analysis, the factors associated with cigarette smoking were male gender, having friends who smoked, and exhibiting a permissive attitude toward smoking. Implementations aimed at improving tobacco education and addressing the gender differences and peer influences related to cigarette smoking are needed to improve Chinese medical students’ knowledge and attitudes about cigarette smoking, and to prevent students from starting to smoke cigarettes.

We report 4 cases of valvular injury following nonpenetrating cardiac trauma in 3 men and 1 woman ranging in age from 24 to 72 years. In all cases the cause of trauma was blunt chest trauma. One patient was operated in 4h, but the other 3 patients were operated on more than 6 months after the accidents. Lacerated aortic cusp was observed in 2 patients, ruptured anterior papillary muscle of mitral valve, and ruptured chordae tendinae of the tricuspid vale were observed in 1 patient each respectively. Three patients underwent valve replacement (2 aortic and 1 mitral valves), and another patient underwent chordoplasty in the tricuspid valve. Their post-operative courses were uneventful. Careful observation, such as echocardiography, were required following the blunt chest trauma.