A 74-year-old woman presented to our clinic with a history of vascular-and stent-graft insertion for aortic dissection developed a tendency to bleed from a palmar wound due to chronic disseminated intravascular coagulation (DIC). Initially, she sustained the palmar wound due to a fall. On the second day after the injury, she experienced continuous bleeding and consulted the orthopedic department of a general hospital, where her dressing was changed. On the third day after injury, she sought consultation at our clinic. The clot and wound remained intact even 12 days after the injury. Therefore, the clot was removed and the bleeding was stopped surgically. On the same day, 5 hours after the surgical treatment, the patient presented to our clinic because of continuous bleeding. She was then administered kyukikyogaito and kamikihito to stop the bleeding. Her laboratory findings revealed thrombocytopenia, and additional inspection was performed. The bleeding stopped on the next day. On the third day after administration, the bleeding remained controlled and an additional inspection revealed DIC. In the cardiology hospital, the cause of tendency to bleed of chronic DIC was pointed out as being due to a leakage at the end of the stent-graft. Kampo medicine was thought to be useful for temporal hemostasis for bleeding due to chronic DIC.

In daily medical examinations of orthopedic surgery, treatment for chronic pain is sometimes needed. We report a case of chronic pain developed after an open fracture 15 years ago and successfully treated with sokeikakketsuto. A 35­-year-­old man unfortunately sustained an open fracture in his right lower leg in a traffic accident at his age of 20 years. He underwent 12­-13 surgeries for osteosynthesis, post-­operative focal infection, and leg extension. Subsequently, he developed periodic pain in his right ankle joint. He consulted our clinic because of the severe pain; although non-­steroidal anti-­inflammatory drugs were ineffective, sokeikakketsuto was dramatically effective. To treat chronic pain after an old fracture, sokeikakketsuto may be considered as a choice of treatment.

Painful orthopedic diseases are sometimes aggravated because of weather changes ; this is referred to as meteorological pain. We report two cases of great occipital neuralgia (GON) due to traffic accident in patients whose pain was aggravated by weather changes. Case 1 involved a 41-year-old woman who developed lumbago and cervical pain following a traffic accident. Two months after the accident, she had irregular occipital pain. Three months after the accident, a great typhoon occurred, and she suffered from severe occipital pain since that morning. She was diagnosed with GON as meteorological pain and was administered goreisan ; her occipital pain then improved. Case 2 involved a 31-year-old woman who developed cervical pain following a traffic accident. Three months after the accident, she experienced severe occipital pain due to weather changes. She was diagnosed with GON as meteorological pain and was administered goreisan ; her occipital pain then improved. Goreisan is dramatically effective for GON as meteorological pain caused by cervical sprain.

Eruption as a dermatological disease is often localized, which is not fully explained by Western medicine. However, localization of eruption is interpreted in Kampo medicine according to meridian and collateral theo­ries, and here, we report two cases of successful treatment with Kampo medicine. Case 1 was of a 32-year-old woman who visited our clinic because of localized eruption around her mouth and was diagnosed with acne vulgaris. She was administered rikkunshito effectively. Case 2 was of a 37-year-old man who visited our clinic because of localized eruption in the anterior portion of the neck and was diagnosed with atopic dermatitis. He was administered shin'iseihaito effectively. Rikkunshito and shin'iseihaito are generally not adapted for dermatological diseases but were effective. After treatment we considered meridian and collateral theories. These two cases are depended on stomach meridian of foot-yangming and large intestine meridians of hand­-yangming, rikkunshito and shin'iseihaito were consisted of herbs concerning with spleen and lung meridians. Two cases were successfully treated through spleen meridian of greater yin and hand great yin lung meridian, which make exterior and interior with stomach meridian of foot-yangming and large intestine meridians of hand-yangming. Kampo medicine was effective for treating these diseases based on meridian and collateral theories.

Gastric cancer involving the placenta during pregnancy is rare; however, we present 1 such case in this report. A 31-year-old Japanese woman was referred at 26 weeks of gestation for the evaluation of a swollen left supraclavicular lymph node. Biopsy revealed poorly differentiated adenocarcinoma, and esophagogastroduodenoscopy with biopsy of the stomach confirmed the diagnosis of gastric cancer. Her epigastric and back pain became more pronounced and her general status worsened, and we performed a cesarean delivery at 29 weeks. Microscopic examination of the placental specimen revealed poorly differentiated adenocarcinoma cells diffused into the intervillous space. Postpartum chemotherapy consisted of S-1 plus oxaliplatin. Unfortunately, this treatment was ineffective, and the patient died 3 months after delivery. The infant did well, without clinical or laboratory manifestations of metastasis. In patients with advanced gastric cancer during pregnancy, it is important to perform a microscopic examination of the placenta to evaluate for metastatic involvement.
Adenocarcinoma ; Adult ; Asian Continental Ancestry Group ; Back Pain ; Biopsy ; Diagnosis ; Drug Therapy ; Endoscopy, Digestive System ; Female ; Humans ; Infant ; Lymph Nodes ; Neoplasm Metastasis ; Placenta ; Postpartum Period ; Pregnancy ; Stomach ; Stomach Neoplasms

BACKGROUND: We aimed to investigate which factors in the clinical profile of mothers with idiopathic thrombocytopenic purpura (ITP) can predict neonatal risk of thrombocytopenia. METHODS: Data was retrospectively collected from all pregnant women with ITP who presented to our institution between 2001 and 2013. Neonatal offspring of these women were classified into 2 groups based on the presence or absence of neonatal thrombocytopenia (platelet count <100x109/L). Several parameters were compared between the 2 groups, including maternal age, maternal platelet count, maternal treatment history, and thrombocytopenia in siblings. We further examined the correlation between maternal platelet count at the time of delivery and neonatal platelet count at birth; we also examined the correlation between the minimum platelet counts of other children born to multiparous women. RESULTS: Sixty-six neonates from 49 mothers were enrolled in the study. Thrombocytopenia was observed in 13 (19.7%) neonates. Maternal treatment for ITP such as splenectomy did not correlate with a risk of neonatal thrombocytopenia. Sibling thrombocytopenia was more frequently observed in neonates with thrombocytopenia than in those without (7/13 vs. 4/53, P<0.01). No association was observed between maternal and neonatal platelet counts. However, the nadir neonatal platelet counts of first- and second-born siblings were highly correlated (r=0.87). CONCLUSION: Thrombocytopenia in neonates of women with ITP cannot be predicted by maternal treatment history or platelet count. However, the presence of an older sibling with neonatal thrombocytopenia is a reliable risk factor for neonatal thrombocytopenia in subsequent pregnancies.
Child ; Female ; Humans ; Infant, Newborn ; Maternal Age ; Mothers ; Parturition ; Platelet Count ; Pregnancy ; Pregnant Women ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Risk Factors ; Siblings ; Splenectomy ; Thrombocytopenia ; Thrombocytopenia, Neonatal Alloimmune*

A 39-year-old man was admitted to our hospital with right lower abdominal pains. Physical examination revealed focal tenderness in the right lower quadrant abdomen. Abdominal CT scan demonstrated heterogeneous increased fat density in the right greater omentum. That said, we diagnosed the disease as idiopathic segmental infarc- tion of the greater omentum.　　He underwent conservative management with antibiotics and analgesics.　　With his abdominal pains dramatically resolved, the patient was discharged from our hospital ten days after hospitalization. The standard treatment for the idiopathic segmental infarction of the greater omentum has not been established. We report this case together with a review of some literature.

A 69-year-old woman underwent total colonoscopy in a health checkup at a local clinic. Colonoscopic study revealed a submucocal tumor-like lesion at the appendiceal orifice. She was admitted to our hospital for an elaborate investigation and treatment. Abdominal plain X-ray showed calcification in the right lower abdomen. Abdominal CT scan demonstrated a high density mass in the ileo-cecal region. Thus, we diagnosed the symptom as asymptomatic appendicolithiasis. She underwent laparoscopic appendectomy. As asymptomatic appendicolithiasis is very rare, we report this case with a review of some literature.

  A-77-old man was admitted to our hospital because of melena in August 2010. Colonoscopy was performed on him, and the case was diagnosed as ulcerative colitis. His symptoms did not abate despite the administration of mesaladine and steroid. He was thus diagnosed with reflactory ulcerative colitis, and underwent total proctocolectomy. The patient had an uneventaful postoperative course and was discharged from our hospital on the 31^st postoperative day. Total proctocolectomy was considerd one of the useful operative procedures for old patients with ulcerative colitis.