Kakkonkajutsubuto belongs to the Ephedra herb drug group and has useful properties for stiff shoulders, scapular neuralgia, and rheumatoid arthritis of the upper body. In this study, we assessed the effectiveness of kakkonkajutsubuto in patients with neck, shoulder, and upper-extremity pain from the viewpoint of decrease in a Visual Analog Scale (VAS) and adverse reactions. One hundred and twenty-four patients who had no gastrointestinal disorder, hot flashes, excessive sweating or other select symptoms were treated with kakkonkajutsubuto (5.0-7.5g/day). The VAS was used for the assessment of pain-relieving effect.Eighty-one patients improved dramatically (their pre/post administration VAS ratio was less than 50%), 21 improved (between 51 to 75%), and 22 did not improve (more than 76%). Eighty-two point three percent of patients improved in total. Five patients showed adverse reactions, such as general fatigue, stomachache, and edema, but these were not clinically significant. This study suggests that kakkonkajutsubuto can be used more widely for neck, shoulder, or upper-extremity pain.

Vascular ring is a congenital anomaly of the aorta and its branches that compresses the trachea and/or esophagus. Infants with vascular ring may have critical dyspnea due to airway obstruction, which is called a dying spell. In addition, vascular ring leads to secondary malacia of the trachea and bronchus. To prevent dying spells and progression of malacia, vascular ring should be diagnosed as soon as possible. We report here a case of a 5-month-old girl with vascular ring affecting the right aortic arch, aortic diverticulum, and ligamentum arteriosum. She had stridor from birth and afebrile convulsions due to dying spells at 5 months of age. Transthoracic echocardiography revealed right aortic arch, and plain computed tomography (CT) revealed severe tracheal stenosis. Finally, we diagnosed vascular ring based on contrast-enhanced CT imaging. We should consider vascular ring when we encounter infants with stridor. Echocardiography is helpful for examining the structure of aorta, and if an aortic anomaly is noted, contrast-enhanced CT should be performed to diagnose vascular ring immediately.

Introduction: This study aimed to determine the trends in the use of medicines that can affect the recognition function of patients aged ≧70 years. Since 2015 when the “Safe Drug Treatment Guidelines for the Elderly” was revised, these medicines are dispensed at a community pharmacy located in a satellite city. Methods: We compared the dispensing results from 2014 to 2015-2019 and investigated the ratio of prescriptions containing the medicines that can affect the recognition function using the clinical department and medicine type. Results: Prescriptions containing medicines that can affect recognition function have been on a downward trend since 2015. During this period, the number of medicines per prescription did not decrease, and the medicines that can affect recognition function were replaced with other medicines. On the other hand, no decrease in the number of medicines that can affect recognition function was observed in internal medicine. In medicine type, the ratio of benzodiazepines drugs decreased; however, it increased again in 2019. Conclusion: There was a decreasing trend in the use of medicines that can affect recognition function of the elderly in departments other than internal medicine after 2015.