Two years have passed since a patient who started to use the respirator for a tuberculosis sequela and chronic respiratory failure at home. During this period, the patient got several short-term admissions into the hospital. After his first discharge, the patient and his family felt anxiety about recupration at home. It was the first time for us to provide home care services to a respirator wearing patient. However, the shift to recuperation at home was realized as an understanding was reached between physicians who decided upon care home and the patient's wife who wished “to live with the husband together”. The patient is now playing a role as a father and as a husband, and he is leading a full life. In this study, the personal and familial circumstances of the patient, decision-making about home care and community support were analized. We coucluded that there were several important factors for successful recuperation at home:specification of contents of concrete medical support to a patient and a family;an immediate suitable action at the time of change of a patient's condition;taking periodic rests of a patient and a family;and a good family relationship.
Patients ; Ventilators, Mechanical ; seconds ; Family ; Home

We report a case of reactive hypoglycemic coma in a 77-year-old man. Seven months after partial gastrectomy for early gastric cancer, he presented with syncopal attacks and seizure. His plasma glucose and insulin levels at coma were 18 mg/dl and 27μU/ml. Insulinoma was neglected with computerized tomography, magnetic resonance imaging and angiography. Because dietary control was insufficient, oral diazoxide therapy was done. But diazoxide did not protectthe overresponse of the insulin and reactive hypoglycemia in 75 g GTT. Octreotide (100 micrograms IM) inhibited insulin release and prevented hypoglycemia. Acarbose delayed the response of insulin butdid not inhibited insulin release. However, acarbose also prevented reactive hypoglycemia. We concluded that acarbose is an effective therapy for reactive hypoglycemic coma.

The decoctions of unprocessed aconite root (uzu) were prepared with the tap water samples collected in Tianjin and Shanghai in China, and the contents of alkaloids in the decoctions were compared to those prepared with purified water or with tap water collected in Niigata, Japan. The contents of aconitine-type diester alkaloids (ADA) in the decoctions prepared with tap water collected in China were significantly lower than those with purified water or tap water in Niigata. It was speculated that this difference appeared by buffering effect of bicarbonic anion in tap water in China to decline pH of the decoction. When uzu was decocted with glycyrrhiza, ginger, or jujube, the contents of ADA in the decoctions exhibited the tendency to have higher levels than those prepared using unprocessed aconite root singly, and also this tendency was observed more remarkably when the decoctions were prepared with tap water collected in China. It was suggested that even the decocting period was fixed, unexpected change of the contents of ADAs might be induced by the differences in the properties of water used for decoction or the crude drugs decocted with aconite root. The physicians in the era when “Songban Shanghanlun” had established may have adjusted the contents of ADA in the decoction by carefully choosing the crude drugs combined to aconite root.

Although the descriptions of shigyakukachotanto in “Waitaimiyaofang” and tsumyakushigyakukachotanjuto in “Songban Shanghanlun” are quite similar to each other, the specifications of the dosages of crude drugs and the water volume in the books were considerably different. Focused on the specified water volume to decoct these formulas, each reasonable decocting period was estimated, then the decoctions were prepared using hard water that was common in mainland China. The dosages of aconite root were 2­-fold different between these two formulas, but the contents of aconitine-­type diester alkaloids (ADA) in both decoctions were found in the range of 1.2—1.4­-fold. It was suggested that in order to control the efficacy and the safety of aconite, the decocting period was well regulated by the specification of water volume for decocting at this ancient era. Moreover, the dosages of aconite root and glycyrrhiza in bukuryoshigyakuto (BSGT) formula of “Songban Shanghanlun” are equal to those of shigyakuto (SGT) but the specified water volume to begin decocting is as about twice as that of SGT. When prepared using hard water, BSGT resulted to make the contents of ADA lower and those of non-­ester alkaloids higher compared with those of SGT decoction. It was suggested the spe­cific water volume for each formula prescribed in classical Chinese medicine had considerable significance to determine the dosages of chemical ingredients in the decoctions especially in the circumstances using hard water to prepare them.

This study investigated the characteristics of emergency patients, including walk-in patients and those brought in by ambulance, who visited Akita Kousei Medical Center in the 6 months from April 2019, and the clinical features of elderly patients with heart failure. Elderly patients above 70 years of age accounted for 38.7% of emergency cases and up to 61.7% of ambulance cases. The most common diseases and disorders were orthopedic, digestive, otorhinolaryngeal, respiratory, neurological, dermatological, and cardiovascular disease, in that order. In total, 56 patients with heart failure were admitted during this period (age 83.5±8.3 years, male: female ratio, 1:1.67). Hospitalization from homes accounted for 66.1% of admissions, with the remainder from nursing homes. After treatment, 35.7% of patients moved to nursing homes and 19.6% died despite in-hospital care. Because heart failure is one of the most common conditions in elderly patients, it is pertinent to recognize the importance of quality of outpatient care to prevent hospitalization and also to preserve quality of life by focusing on alleviating overall pain and discomfort.