We report a case in which an undernourished female patient underwent drainage for gingivitis, and subsequently suffered S. intermedius-induced subdural abscess, meningitis and transverse sinus thrombosis. A few days after drainage, she had a fever of 39°C and became lethargic with non-fluent aphasia. Cerebrospinal fluid revealed pleocytosis of 1269/μl, protein 222 mg/dl (normal 15-45mg/dl), glucose 33 mg/dl (ratio to blood glucose: 0.37). The diffusion-weighted MRI brain showed an area of abnormally high signal along the left brain surface. In the magnetic resonance venography, the left transverse sinus was not well delineated. After treatment with antibiotics (meropenem, vancomycin) and heparin, craniotomy was performed to remove the abscess. Culture of the abscess tissue detected S. intermedius. After surgery she gradually improved. To our knowledge, this is the first report of subdural abscess and transverse sinus thrombosis caused by S. intermedius occurring as a result of drainage treatment for gingivitis.

An attack of Raynaud's Phenomenon (RP) is characterized by blanching of the fingers in response to cold or emotional stimuli.
We analyzed the effect of ninjinyouei-to on RP in patients with MCTD. Subjects in this study comprised 19 patients, two males and 17 females, with a mean age of 38 years, and a mean duration of disease of 57.6 months. The study was performed at a time when RP occurred frequently in our country, that is in the period from November 1992 to March 1993.
We administered 9.0g of ninjinyouei-to to each case for four weeks and measured the surface skin temperature of the hands before and after medication with a thermograph using a Thermoviewer-JTG 3300.
There was a significantly higher temperature on the left first finger-tip after medication. Our thermographic findings in this study demonstrate a quantitative efficacy of ninjinyouei-to on RP in MCTD.

A case of a 51-year old male with pulmonary valve endocarditis accompanied by aortic regurgitation, and ruptured aneurysm of Valsalva sinus was reported. Repeated blood cultures grew α-streptococcus on a single occasion. After medical treatment, resection of pulmonary valve vegetation, resection and patch closure of aneurysm, and aortic valve replacement were performed successfully. Twenty one cases of pulmonary valve endocarditis reported in Japan, including our case, were collected and reviewed. Causative organism was streptococcus in 93% of cases. No case of intravenous drug abuse was found in this series. A variety of preexisting heart diseses were found in 20 cases out of 21 (95%). All these diseases were congenital ones, such as ven-tricular septal defect, patent ductus arteriosus, pulmonary stenosis and ruptured aneurysm of Valsalva sinus. This fact means that jet lesion of pulmonary valve is a major predisposing factor of pulmonary valve endocarditis. Surgical procedures were reported in 12 cases: resection of vegetation in 4 cases, resection of pulmonary valve in 2, and pulmonary valve replacement in 5. Appropriate surgical procedures should be chosen, depending upon the activity of infective endocarditis, severity of destruction of the valve, and pulmonary vascular resistance.

The primary aim of this study was to compare the ratios of specialized palliative care use to all cancer death using 2 methods: 1) total number of patients who received either of specialized palliative care services (unadjusted), and 2) number of patients after adjustment of potentially duplicated counts (adjusted). The research team obtained patient list from all specialized palliative care services, and counted the number of the patients who received any specialized palliative care services. The ratio of adjusted value to unadjusted value was 0.59, and had large region differences.Unadjusted values had, although overestimated, essentially similar trends in changes by year and differences in the regions. In conclusion, total number of patients who received either of specialized palliative care services could be simple and feasible indicator to roughly determine the activity of specialized palliative care services, but exact number of the patients who received specialized palliative care services should be determined on the basis of the patient lists without duplicated counts.

We experienced a case of polymyalgia rheumatica (PMR) which responded to Kampo medicine. A 53-year-old female patient first complained of stiffness and pain in the neck. Myalgia was severe and gradually eypanded to both shoulders and both upper extremities. Body weight decreased, and the erythrocyte sedimentation rate (ESR) was greater than 100mm/hour. Because her condition tended to improve when treated with prednisolone 10mg/day, she was diagnosed as having PMR. Her condition was well controlled until the dose of prednisolone decreased. Myalgia then recurred, and the ESR increased to 83mm/hour. The patient visited our outpatient department for treatment with Kampo therapy. Two months after treatment with Sairei-to plus Yokuinin-to, all signs and symptoms disappeared other than the stiff neck. Her body weight showed a tendency to increase. Six months after she first visited us, prednisolone was decreased and then stopped. Her condition still remains well controlled with this Kampo therapy alone. She has no clinical signs and symptoms, and the ESR has improved to 16mm/hour.

In 1984 a 42-year-old female complaining of general malaise and loss of strength in the proximal muscles of the limbs came to the 2nd Department of Internal Medicine for an examination. From her high CPK value, electromyogram, muscle biopsy, etc., she was diagnosed as having polymyositis. Initially she responded well to steroids, but a year later the condition recurred. Treatment with various methods such as the immunosuppressants methotrexate and azathioprine, steroid pulse therapy and plasma replacement were tried without success. In September 1991, the patient's CPK value remained abnormal at about 800mU/ml. According to the Oriental Medical viewpoint, the condition was diagnosed as Kidney yin Deficiency. Rokumi-gan was therefore administered daily (7.5g/day) for a period of 80 days. The CPK value was brought down to the vicinity of 200mU/ml, and the feeling of general malaise and lack of strength in the proximal muscles of the limbs was improved. However, due to the persistence of edema in the lower limbs, the Kampo formula was changed from Rokumigan to Chorei-to, also administered at a dosage of 7.5g/day. This reduced the edema and normalized the CPK value to the 100mU/ml range. During this period, steroid administration was maintained with prednisolone (30mg/day). At present, with the improvement in the CPK value, steroid administration is gradually being reduced.

Twenty-two patients with chronic glomerulonephritis were treated with Sairei-to (7.5g/day), either alone or in combination with camostat mesilate (600mg/day), to determine the efficacy and adverse effects of these regimens. Although there was significant improvement in proteinuria (p<0.05) after 8 weeks of treatment with Sairei-to alone, this was not longlasting. Combination therapy resulted in sustained significant improvement (p<0.03; there were two dropouts). No adverse effects were seen with either regimen. The results suggest that combination therapy using Sairei-to and camostat mesilate may be a safe and efficacious method of treatment for patients with chronic glomerulonephritis.