We report a case of intractable complex regional pain syndrome (CRPS). The pain improved with regional anesthesia and physical therapy.A 24-year-old man with hemophilia A, developed throbbing pain from his left foot to the ankle, with no identifiable cause. No organic abnormalities were observed. He diagnosed with CRPS at the pain clinic and admitted to the hospital 10 months after symptom onset for physical therapy with regional anesthesia under clotting factor replacement therapy. Spinal anesthesia was administered on the first and second day of hospitalization, and plantar load stimulation and ankle stretching were performed in the operating room. Subsequently, sciatic nerve blocks and continuous epidural blocks were given, and plantar contact training, ankle joint ROM training, and parallel bar walking training were conducted with cognitive behavioral therapy. Sciatic nerve blocks were continued after discharge. Ninety-five days after onset, the patient was re-admitted for physical therapy, and ROM exercises, partial weight bearing, and gait training together with sciatic nerve blocks and cognitive-behavioral therapy. On discharge following re-admission, the pain improved. The patient walked using one crutch. One year later, the pain further improved, and the patient walked independently.The combination of regional anesthesia, physical therapy, and cognitive behavioral therapy created a virtuous cycle of pain relief, improved physical functions, and prevented withdrawal from catastrophizing, ultimately leading to overall improvement.

We report a case of intractable complex regional pain syndrome (CRPS). The pain improved with regional anesthesia and physical therapy.A 24-year-old man with hemophilia A, developed throbbing pain from his left foot to the ankle, with no identifiable cause. No organic abnormalities were observed. He diagnosed with CRPS at the pain clinic and admitted to the hospital 10 months after symptom onset for physical therapy with regional anesthesia under clotting factor replacement therapy. Spinal anesthesia was administered on the first and second day of hospitalization, and plantar load stimulation and ankle stretching were performed in the operating room. Subsequently, sciatic nerve blocks and continuous epidural blocks were given, and plantar contact training, ankle joint ROM training, and parallel bar walking training were conducted with cognitive behavioral therapy. Sciatic nerve blocks were continued after discharge. Ninety-five days after onset, the patient was re-admitted for physical therapy, and ROM exercises, partial weight bearing, and gait training together with sciatic nerve blocks and cognitive-behavioral therapy. On discharge following re-admission, the pain improved. The patient walked using one crutch. One year later, the pain further improved, and the patient walked independently.The combination of regional anesthesia, physical therapy, and cognitive behavioral therapy created a virtuous cycle of pain relief, improved physical functions, and prevented withdrawal from catastrophizing, ultimately leading to overall improvement.

Introduction：Respiratory failures are categorized into types I and II. To our knowledge, we report the first case of pulmonary rehabilitation in a patient with systemic sclerosis/polymyositis overlap syndrome who developed type II respiratory failure.Methods：The patient was a 77-year-old woman who had received treatment for systemic sclerosis and polymyositis at another hospital. When she visited our hospital to obtain a second opinion, she suddenly lost consciousness and underwent trachea intubation because of typeⅡrespiratory failure. She received physical therapy on the third day of hospitalization and underwent a tracheotomy on the 16th day. As her thoracic movement was markedly restricted, we started physical training. After she was weaned off from the ventilator on the 43rd day, we performed muscular strength training and aerobic exercise. No exacerbation of CO2 storage was observed even if chest motion training was performed. She was discharged on the 72nd day and advised to wear retina®．Administration of therapeutic drugs such as steroids was maintained at the same dose.Conclusion：Physical therapy, such as chest mobilization, was effective for marked restriction of chest movement in a patient who had both polymyositis and systemic sclerosis.

Introduction：Respiratory failures are categorized into types I and II. To our knowledge, we report the first case of pulmonary rehabilitation in a patient with systemic sclerosis/polymyositis overlap syndrome who developed type II respiratory failure.Methods：The patient was a 77-year-old woman who had received treatment for systemic sclerosis and polymyositis at another hospital. When she visited our hospital to obtain a second opinion, she suddenly lost consciousness and underwent trachea intubation because of typeⅡrespiratory failure. She received physical therapy on the third day of hospitalization and underwent a tracheotomy on the 16th day. As her thoracic movement was markedly restricted, we started physical training. After she was weaned off from the ventilator on the 43rd day, we performed muscular strength training and aerobic exercise. No exacerbation of CO2 storage was observed even if chest motion training was performed. She was discharged on the 72nd day and advised to wear retina®．Administration of therapeutic drugs such as steroids was maintained at the same dose.Conclusion：Physical therapy, such as chest mobilization, was effective for marked restriction of chest movement in a patient who had both polymyositis and systemic sclerosis.

Hyaluronan is a widely occurring extracellular matrix molecule, which is not only a supporting structural component, but also an active regulator of cellular functions. The chemophysical and biological properties of hyaluronan are greatly affected by its molecular size and several hyaluronan-binding proteins, making hyaluronan a fascinating molecule with great functional diversity. This review summarizes our current understanding of the roles of hyaluronan in cardiovascular and nervous system disorders, such as atherosclerosis, myocardial infarction, and stroke, with the aim to provide a foundation for future research and clinical trials.

Aim of the present study was to statistically evaluate the examination rule with use of a questionnaire obtained from physicians regarding treatment for chillness of the limbs, and to prove the clinical usefulness of the database. The database showed that tokishigyakukagoshuyushokyoto was the most frequently used to treat chillness of the limbs, and subsequently keishikajutsubuto, hachimijiogan, and tokishakuyakusan were ranked as drugs with wide use. When physicians determined a kampo formulation suitable for each patient, they used findings specific for the kampo formulation, but not uniform findings obtained from the four traditional examination methods (i.e., inspection, listening and smelling, interviewing, palpitation). There was a statistical difference in the selection mode of drugs among physicians. In a simulation obtained from a questionnaire, there was a positive association between time (time X) to the start of becoming physically warm in the limbs, and time (time Y) to remission (R² = 0.971, P = 0.014). The formula (Y = 4.379 X−0.519), which could predict time Y on the basis of information on time X, was able to accurately monitor the clinical courses of 7 responders to treatment for chillness of the limbs. Taken together, these results strongly suggest that the database constructed in the present study may be useful for evaluation of traditional Kampo medicine, and might allow us to perform more fittingly personalized Kampo medicine in the near future.

Introduction: Tramadol (TRM) has been included as a weak opioid at the second step of the WHO analgesic ladder and has been widely used in palliative medicine. Here we report a case of amelioration of cancer pain by TRM therapy in a female patient with myasthenia gravis (MG). Case:The patient was a 70’s woman who was diagnosed with advanced endometrial carcinoma and suffered from chest pain caused by chest metastasis. 25 mg of a TRM capsule was orally administered three times a day. The dose was increased to 50 mg twice a day. It was resulted in sound pain relief with transient muscle weakness but without a myasthenic crisis.

It is thought that meirouin was created by Toukaku Wada, originally. Although prescriptions were applied for ophthalmologic disease at first, such case reports have decreased recently. Here, we report that meirouinkakikuka was successful for serous retinal detachment complicated with an abnormal visual field during postpartum.
We present the case of a 34 year old Japanese woman. Tinnitus had appeared from 35 weeks of pregnancy. Blood pressure rose to 140/100 mmHg at 36 weeks of pregnancy, the patient was diagnosed with preeclampsia,and hospitalized. After hospitalization, blood pressure was rose further to 190/120 mmHg, and an emergency cesarean section was performed. On the 2 nd postpartum (post operation) day her field of view became yellowed and eyesight failure arose. She was diagnosed as hypertensive retinopathy and serous retinal detachment by an ophthalmologist. She stopped applying her eyewash treatment herself because she was feeling unwell. One week afterward, she desired Kampo treatments. Meirouinkakikuka was prescribed, the tinnitus disappeared in 2 weeks, furthermore, her retinal detachment was recovered from 4 weeks later. Thus we believe that Kampo treatments can be a viable alternative, as suggested by this case where application of an eyewash treatment was difficult.

Most obstetricians rarely encounter a case of placenta accrete, where the placenta does not detach after childbirth. If placenta accrete attachment is deep, it is likely to lead to poor prognoses such as massive bleeding and shock. With western medicine, it is currently accepted that the only medical intervention is doing a simple total hysterectomy. Our patient was a 27 year old, primiparous Japanese woman. Signs of placental separation were not seen after birth, and conservative medical management for also ended up failing. This was then diagnosed as placenta accrete via sonography and an MRI, and simple total hysterectomy was recommended. She hoped to keep her uterus, however, and she was prescribed tokakujokito Kampo therapy. Her postpartum period passed without abnormality, and the placenta, which had remained intact to the 50 th day after birth, was removed. There is not literature on Kampo therapy as it applies to placenta accrete, and we believe this case to be the first valuable report.

Generally, as for the Bell paralysis in facial nerve paralysis, about 70% are cured spontaneously, and, as for the remainder, steroid and antiviral agent (aciclovir) medical treatment are taken, but treatment of the Western medicine is invalid in the serious case. As a result, the paralysis remains and the aftereffects of the morbid synkinesis is caused. Finally, it becomes the result of greatly damaging QOL because of features of a peculiar face for the patient.The case is 29-year-old pregnant woman and primipara. Abnormality was not especially found in the previous history without what had to be mentioned specially while getting pregnant. A right paralysis of facial nerve developed suddenly cold early morning of 35 gestational weeks (paralysis score 0/40). She gave birth naturally without the effect though the steroid was treated by otorhinolaryngologist. After birth, Kampo treatments were begun with Kakkonto and Saireito for two months. Place where those medicines changed to Daisangoshichisanryo and Kososan because of invalidity, an eye closure and open eyes would become smooth in two weeks, and it recovered in almost one month. Here is a first reported case that concurrent Kampo therapy with Daisangoshichisanryo and Kososan were effective for patient with paralysis of facial nerve that developed during pregnancy.