We report a case of pyoderma chronica capillitii successfully treated with shokenchuto. The patient was a 20-­year-­old man, who had been suffering from an abscess and hair loss in the occipital region of his scalp for the past 6 months ; the lesion was gradually enlarging and was 3×3 cm in diameter at presentation. He was di­agnosed with pyoderma chronica capillitii by a dermatologist and treated with puncture and drainage, multiple courses of oral antibiotics, and focal injections of tetracycline twice, with no beneficial response. Furthermore, another similar abscess with hair loss appeared on his occipital scalp and a new similar nodule appeared on his right cheek. He consulted my clinic to receive Kampo therapy. His abdominal examination revealed spasm of the bilateral rectus abdominis ; his abdomen was remarkably hypersensitive. He felt tickling intensely on ab­dominal palpation. Based on these findings, he was treated with shokenchuto, and hainosankyuto was added to relieve his symptoms. After a month of therapy, the nodule on his cheek disappeared, and several months later, the two occipital lesions improved and growth of new hair was noted. With continued treatment, his scalp and hair lesions healed completely and no recurrence was noted. To our knowledge, there is no previous report on the treatment of pyoderma chronica capillitii with shokenchuto. Based on the Kampo diagnostic pattern, Kampo medicine can be a beneficial therapeutic option for pyoderma chronica in cases where standard treatments are ineffective.

Carbamazepine (CBZ) is widely used for the treatment of trigeminal neuralgia (TN), however, it is associated with some side effects. A 61-year-old woman was given CBZ to relieve TN pain. The pain was relieved immediately, but on the third day of CBZ treatment, skin rash developed, and the drug was discontinued. She then received the Kampo (Japanese herbal) medical formula Keishi-ka-jutsubu-to according to the principles of Kampo diagnosis. The pain was completely controlled without any side effects.
For maximum effectiveness, Kampo formulas should always be selected through the Kampo diagnostic process.

In order to clarify why orthopedic complaints such as lumbago are ameliorated by hot-spring bathing, serum levels of sialic acid and fucose, which form glycoconjugates and are markers of connective tissue metabolism, were measured before and after each hot-spring bathing. No changes were observed in serum sialic acid for persons who took hot-spring bathing more than three times per day for 10 days. However, many of them showed a decreasing tendency in serum fucose level after bathing. Although it is not clear why this tendency occurs, it strongly suggests that hot-spring bathing influences on connective tissue metabolism.

It is well known that gynecological complaints are ameliorated by hot spring bathing. We therefore investigated the changes in urinary mucin excretion before and after 14 days of daily hot spring bathing in order to clarify the relationship between hot spring bathing and complaint amelioration. Urine was collected from 28 female adults (64.3±7.0 years old) before and after the 14 days of hot spring bathing. Urinary mucins containing sialoglycopeptides and sulfated glycopeptides were separated from the urine using the ethanol and cetylpyridinium chloride precipitation methods, then indentified with two-dimensional electrophoresis on cellulose acetate membranes.
After the removal of glycosaminoglycan contamination by glycosaminoglycan-degrading enzymes, mucin amounts were determined by the phenol-sulfuric acid method. The results showed that the levels of both sialoglycopeptides and sulfated glycopeptides increased after 2 weeks of bathing. The level of urinary mucin, which is synthesized and excreted from the epithelial cells, increased as a result of hot-spring bathing. Therefore, it is highly likely that the amelioration of gynecological complaints of females is related to the chages in urinary mucin excretion brought about by hot spring bathing.

A 55-year-old man was referred to our hospital for hemolytic anemia 21 months after an ascending aortic replacement for acute type A aortic dissection. The enhanced CT revealed an aortic pseudoaneurysm formation at the proximal anastomosis. The cause of hemolysis was verified to be the pressure by an aortic pseudoaneurysm formation at the vascular graft stenosis. At the reoperation, the previous vascular graft was found to have partially detached from the aortic stump over the non-coronary cusp. Ascending aortic replacement was performed with a tailoried vascular graft in a scallop shape, corresponding to the non-coronary cusp. The postoperative course was uneventful and hemolysis diminished soon after the operation.

Objective: Taking the wrong medicine or medication error is a serious concern to patient safety.  The aim of this study was to statistically survey the relation between the placement of drugs on medicine shelf and the occurrence of error in taking a medicine.
Methods: The study comprised 2 groups.  The incident group contained 43 cases that were erroneously taken in the Obihiro Kosei General Hospital.  The control group contained 43 drug pairs matched by the similarity index of the drug names from among the drugs used in the hospital at random.  The similarity index of drug names was based on 10 quantitative indicators.  The distance of medicine shelf arrangement was represented by three variables: the horizontal distance, the vertical distance and the distance of shelf block.  Conditional logistic regression analyses of the occurrence of medication errors were performed by evaluating the three variables of the distance factor and their interaction for error in taking a similar-sounding named drugs.
Results: Conditional logistic regression analysis revealed that the vertical distance (OR: 0.64, 95%CI: 0.42-0.99) and the distance of the shelf block (OR: 0.74, 95%CI: 0.57-0.97) were significant risk-reduction factors of medication errors.  Four variables were extracted as the most suitable logistic regression model in terms of the interaction between them.  As the interaction between 3 variables (the horizontal distance, the vertical distance and the distance of shelf block) was significant (OR: 0.93, 95%CI: 0.86-0.99), they may be considered as synergistic risk-reduction factors.  Moreover, the horizontal distance was found to be a risk-enhancement factor (OR: 1.52, 95%CI: 0.93-2.48).
Discussion: In order to reduce the risk of medication errors due to similar-sounding drug names, placement of drug on the medicine shelf should take into consideration the three coordinates of the distance factor.

Background :There have been only a few comparative observational studies on the safety and effectiveness of drugs in Japan. Comparative observational studies would provide important information to address these issues and thus we need to establish a means to facilitate such studies. In comparative studies, it is important to prevent the distortion of results due to selection bias. Though we do not yet have a claims database for use in pharmacoepidemiological studies, recently many hospitals and pharmacies have computerized prescription data which may be used to minimize selection bias. Good standardized procedures for the identification of patients prescribed one of two or more drugs to compare in a study using computerized prescription data would serve as a basis for a variety of pharmacoepidemiological studies in Japan.
Methods :We carried out a questionnaire survey in 2753 hospitals and 909 community pharmacies to estimate the fraction of hospitals where computerized data can be used to identify all eligible patients who used a specific drug.
Results :Questionnaires were returned by 1942 (71%) of 2753 hospitals and 632 (70%) of 909 pharmacies. From among those which responded, patients were identified, the patient list was printed, and the electronic file of the patient list was generated in 75%, 64% and 36% of the 1942 hospitals and in 100%, 93% and 49% of the 632 pharmacies respectively.
Conclusion :With procedures using computerized prescription data, the cohort for observational comparative studies may be identified with a minimal selection bias in a majority of hospitals and pharmacies.

Objective: Currently, Risk Management Plans (RMPs), plan that provide new risk information about drugs, are published on the Pharmaceutical and Medical Devices Agency (PMDA) website.  The aim of this study was to compare enumerated risks in RMPs to the product labeling (PL) of the drug package insert.
Methods: The risks listed in RMPs on the PMDA website were assessed on February 10, 2014.  We investigated the documentation of these risks on the PL.
Results: Seven-hundred and eighty-five risks were enumerated in the RMPs of 77 drugs.  The enumerated risks were classified as “important identified risks” (66%), “important potential risks” (22%), and “important missing information” (12%).  Ninety-four percent of risks listed in RMPs were documented on the PL.  A portion of both the “important identified risks” and “important potential risks” groups were not documented on the PL.
Conclusion: This study was clearly the relation between risks listed in RMPs and documents on the PL.  Because a portion of the risks listed in RMPs was not documented on the PL, RMPs provide more safety information.  It is necessary to better understanding their characteristics, considering RMPs are a new source of drug information.

Objective: Numerous new drugs have been developed in recent years, making the available types of prescription drugs quite diverse, with increasingly more complex drug interactions.  From an operations support system perspective, hospitals that cannot incorporate a large-scale custom-order system because of financial or use-efficiency limitations have no choice but to rely on commercial products.  However, this leaves many problems unsolved, such as functional restrictions and limited specifications.  In this study, we used Microsoft®Visual Basic®for Application (VBA) to develop an economical drug discrimination system suited to our situation and equipped with original function from the perspective of clinical pharmacists.
Design: System design and development.
Methods: We prototyped the system in VBA and used Microsoft®Excel®to create Query Tables.  The utility of the new system was evaluated based on drug discrimination output and time required in each process.
Results: The new system is capable of inter-database communication and automated data analysis and uses drop-down lists of pre-defined options for data input in many places.  Compared with the conventional method, the new system enabled us to significantly reduce the average time needed to input and confirm data by as much as 61.9%.  This indicates that the new system can considerably reduce the time required for completing time-intensive processes and is also useful in preparing highly precise drug discrimination reports.
Conclusion: Based on the results obtained so far, the new, original system, developed with zero design or development costs, is more efficient and offers more reliable information in the clinical setting than the conventional system.  As a result, we are able to maintain operational quality and reduce the amount of time required for drug discrimination.

Objective: Similarity of drug names is one factor of dispensing incidents.  The aim of this study was to survey the relation between sensual similarities of drug names and the occurrence of taking errors for pharmacists who actually prepare medicine.
Methods: A pair of drugs (15 incident pairs and 104 control pairs) was displayed on a computer screen at random.  The subject’s task was to determine the sensual similarity of them.  Thirteen pharmacists who prepared these pairs and caused their incidents participated in the experiment.
Results: The result showed that the sensual similarity of drug names of incident pairs was found to be highly significant in comparison to one of the control pairs [p=0.026].  However, the similarity in incident pairs is not necessarily high.  It was suggested that the similarity of drug name was not the only factor of taking error.  Multiple linear regression analyses of the sensual similarity in control pairs were performed, in which 10 variables were reported as quantitative indicators of similarity of drug name and were able to be measured on the internet.  The correlation was good [R²=0.828].  However, this regression model was not useful when adjusting to incident pairs.  In incident pairs, the similarity value calculated by the regression model was lower than the measured sensual similarity.
Conclusion: The result suggested that measured sensual similarity includes other risk factors of taking error, such as appearance similarity and/or efficacy similarity and/or short distance arrangement.  It seemed that the pharmacist’s ability complicated the factor of taking error.