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.

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.

The primary aim of this study was to collect the views of physicians and nurses in the regions where community-based palliative care intervention trial, the OPTIM-study, was performed. A content analysis of free comments of the questionnaire survey was conducted. Questionnaires were mailed to 1,763 physicians and 3,156 nurses after the intervention, and 706 and 2,236 responses were obtained, respectively. A content analysis identified 327 free comments from physicians and 737 from nurses. As favorable effects, the categories [Multidisciplinary teams and community networks were established] [Home-based care is widespread] [Medical knowledge and skills are acquired just as those involved in palliative care] emerged. The main effects of the community palliative care program included the establishment of multidisciplinary teams and community networks, development of home-based care, and increasing knowledge, skills, and awareness about palliative care.

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.

An 83-year-old female was referred to our hospital because of a swelling and pain of the left lower extremity. An endoaneurysmorrhaphy and bypass surgery between the left common iliac artery and the external iliac artery were performed under the diagnosis of deep vein thrombosis associated with a left isolated internal iliac aneurysm. Forty patients with isolated internal iliac aneurysm were reported in Japan and deep vein thrombosis occurred only in our patient. The external growth of the aneurysm behind the external iliac artery might cause compression, congestion and phlebitis of the common iliac vein, resulting in deep vein thrombosis.

We report a case of surgical treatment for mitral valve papillary fibroelastoma which is an uncommon and rare benign tumor. The patient was a 62-year-old woman who had TIA (paralysis of left leg) and was admitted with the diagnosis of cardiac tumor. Before operation, the tumor was detected in the left atrium two-dimensional echocardiography, attached to the anterior leaflet of the mitral valve. At operation, the tumor was 11×8mm in size, with a yellow jelly-like and fragile appearance, attached to the same position as indicated by echocardiography. As the tumor occupied over one third of the leaflet, it was excised including all the anterior leaflet of the mitral valve and a prosthetic valve was replaced leaving the posterior leaflet intact. The tumor was diagnosed as papillary fibroelastoma by pathological examination. The postoperative course was uneventful.

In order to find an effective way to detect bacteria responsible for respiratory tract infections in children, we first examined as pharyngeal swabs, epi-pharyngeal swabs and nasal aspirates obtained from children hospitalized at our pediatric service during these five months from December 1997 to April 1998. In the rate of bacterial infection, it was found that nasal aspirates came out on top with 92.6%(25/27), followed by epipharyngeal swabs with 71.6%(53/74) and pharyngeal swabs with 26.2%(38/145). Single-species bacteria were found in 78.9%(30/38) of pharyngeal swabs, where as 45.3% of epi-pharyngeal swabs (24/53) and 52.0% of nasal aspirates (13/25) proved mixed infections with two-or three-defferent species. Thus it was suggested that nasal aspirates and epi-pharyngeal swabs would be far more adequate than pharyngeal swabs to detect bacteria with accuracy.
Next, based on the efficiency of bacterial detection, we compared culture media for the specimen obtained from in-patients and out-patients at our pediatric service. The rate of isolation of gram-negative rods was as low as 0.3%(1 of 314 strains) even when BTB agar plate, a selective medium for these bacteria, was employed. The sensitivety was not much different from those observed with nonselective blood agar plate. These results suggest that the conventional blood agar media can substitute for the more expensive type of BTB agar medium for the diagnosis of infections diseases of the airwaysin children.

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.