A 64-year-old man was found to have a nodule in his right lung. He also complained of nausea and abdominal pain during the clinical course. Esophagogastroduodenoscopy revealed a duodenal ulcer associated with severe stenosis and a suspicion of malignancy. However, three subsequent biopsies revealed no evidence of malignancy. The fourth biopsy showed scattered large eosinophilic cells with an eccentric nucleus, leading to a diagnosis of Russell body duodenitis (RBD). RBD is an extremely rare disease, and little is known about its etiology and clinical course. The pathogenesis of RBD is discussed based on our experience with this case.
Abdominal Pain ; Biopsy ; Constriction, Pathologic ; Diagnosis ; Duodenal Ulcer ; Duodenitis* ; Endoscopy, Digestive System ; Eosinophils ; Humans ; Lung ; Middle Aged ; Nausea ; Rare Diseases

We report a pediatric baseball player having both a fracture of the posterior ring apophysis and spondylolysis. He was presented to a primary care physician complaining of back pain and leg pain. Despite conservative treatment for 3 months, the pain did not subside. He was referred to our clinic, and surgical intervention was carried out. First, a bony fragment of the caudal L5 apophyseal ring was removed following fenestration at the L5-S interlaminal space, bilaterally: and decompression of the bilateral S1 nerve roots was confirmed. Next, pseudoarthrosis of the L5 pars was refreshed and pedicle screws were inserted bilaterally. A v-shaped rod was inserted beneath the L5 spinous process, which stabilized the pars defects. After the surgery, back pain and leg pain completely disappeared. In conclusion, the v-rod technique is appropriate for the spondylolysis direct repair surgery, especially, in case the loose lamina would have a partial laminotomy.
Back Pain ; Baseball ; Decompression ; Humans ; Laminectomy ; Leg ; Physicians, Primary Care ; Pseudarthrosis ; Spondylolysis

[Objective]There are few reports of inpatients who received acupuncture treatment in departments of internal medicine in Japan. The aim of this analysis is to clarify such information by reviewing patients who received acupuncture treatment during admission to our department of internal medicine at Gifu University Hospital. Our department is organized into three subdepartments of cardiology, respirology, and nephrology.
[Methods]We surveyed the chief complaint for acupuncture treatment, basic disease for admission and the number and period of acupuncture treatment of inpatients who received acupuncture treatment in our department from July 2004 through March 2007.
[Results]Two hundred and sixty-six patients received acupuncture treatment and they had 429 symptoms.
The chief complaint was the side effects of chemotherapy for cancer treatment (n = 84), that is, nausea, anorexia, dysethesia and so on. Other symptoms were dyspnea or shortness of breath (n = 49), pain originating from cancer (n = 38), pain originating from skeletal muscle (n = 38), anorexia (n = 25), and general fatigue (n = 18). Several symptoms were cough, edema, constipation or diarrhea, conscious disturbance, insomnia, paralysis, etc.
Of the chief complaints, 86.4%were closely connected with diseases or treatments for admission.
The mean number of patients who received acupuncture was 10.0/day. This was equal to about 20%of all patients (53beds) per day in our department.
[Conclusion]There were many patients whose chief complaints for acupuncture were closely connected with disease for admission. It is suggested that acupuncture treatment is accepted as one of treatments of internal medicine for inpatients in our department.

We conduct an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorts one patient at the University of Tsukuba Hospital throughout his or her first visit. We evaluated this program from the points of view of both students and patients.
1) A questionnaire was distributed to all participating patients and students in 2006.
2) In their questionnaires, many students commented on the long waiting time, the structural problems of the hospital, and the attitudes of physicians.
3) Results of the questionnaire showed that both students and patients rated this program highly.
4) No significant differences were noted between the comments of the students and those of the patients. The patients tended to rate this program more highly than did the students. One patient, however, commented that being constantly accompanied by a stranger was somewhat stressful.
5) We conclude that this program can be efficiently carried out without being too much of a burden to patients and is a valuable part of an early exposure program for first-year medical students.

Students in their 5th and 6th year of University of Tsukuba, School of Medicine, enter into a clinical clerkship. They record medical charts and flow sheets and they present at clinical rounds.
1) From 2000 to 2005, a questionnaire survey was conducted to evaluate the clinical clerkship in the rheumatology division. We also evaluated the influence of the introduction of infliximab therapy (October 2003) on the students' experience.
2) Evaluation of the clinical clerkship by the students was improved by attending the infliximab ward. Students felt more involved in the treatment of the patients by preparing drip infusion sets, disssolving infliximab, assisting with the drawing of blood and drip infusions, checking of the vital signs every 30 minutes, and recording charts.
3) Students realized the improvement of rheumatoid arthritis with therapy and the changes in the patients' emotional status after the introduction of infliximab.

We examined the clinical effect of a functional food containing both soy isoflavone and black cohosh extract (test food) on Simplified Menopausal Index (SMI) in a double blind study. Twenty four peri-menopausal women were divided into two groups and four capsules of either the test food or placebo were ingested everyday for eight weeks. The daily intakes of soy isoflavone and black cohosh extract were 50.0 mg and 80.0 mg respectively. As compared with placebo group, the scores of menopausal symptoms such as “stiff neck” and “backache” significantly improved (p<0.05), and the score of “irritation” tended to improve in test food group but not significant statistically. When these results were stratified according to the severity of pretrial menopausal symptoms, the effects of test food were shown to be more effective in mild case group. These results suggest that the functional food containing soy isoflavone and black cohosh extract alleviate menopausal disturbances and improve the quality of life for peri-menopausal women.

One of the characteristics of the diagnostic method in Oriental medicine is a pulse diagnosis. In this technique, the examiner places his index, middle and ring fingers on the wrist of the patient's hand above the radial artery and determines the fullness or emptiness of the six Meridians on each hand. In order to make this subjective method more objective, three pressure transducer sensors were placed over the radial artery and its method was previously described.
In this study, we used this objective pulse diagnosis and selected the proper Meridian points according to 5 element theory and improper points without considering it. Then we investigated the changes of the pain threshold by the thermo-dolorimetric method before and after the acupuncture stimulation.
An allergic patient who developed athmatic attack by many drugs was going to have nasal polypectomy. Acupuncture points were selected by this pulse diagnosis. 9 healthy volunteers were examined whether five element or non-five element points would elevate pain threshold.
Results
(1) The elevation of pain threshold by thermo-dolorimetric method before and after the acupuncture stimulation were observed only when the proper Meridian points were stimulated.
(2) Nasal polypectomy was performed under acupuncture analgesia without pain following the selection of 5 element points by this objective pulse diagnosis.

Acupuncture analgesia were successfuly used in dental extraction in some patients who were sensitive to local anesthetics. In this study this technique was applied to daily conservative dental treatment. Acupuncture analgesia can be established by transcutaneous electric acupuncture-like stimuration (TENS) in stead of inserting needles. The TENS were applied in Hoku point and Large Intestine # 10 with 3Hz at the ipsilateral side of the dental treatment.
Apparatus used were Tokki and Neuro-pulse acupuncture stimulator. Wave forms of both apparatus are spike wave with pulse width of 0.1msec. Plate electrodes were conductive rubber size of 3×4cm and were fixed at Hoku point and Large Intestine # 10 with adhesive tape.
Stimuration was continued from 20 to 30min with the strength of producing mild twitch while patients were sitting in the waiting room. 230 patients of dental conservative treatment were given TENS before cavity preparation, gingival plastic, tooth extraction, pulpectomy and others. Treatment was started under TENS alone, and when patient bigan to complain the intolerable pain, then the subperiosteal infiltration of local anesthetic was performed.
(1) Cavity preparation: 78 (85%) out of 92 were performed only with TENS. In 14 (15%) patients local infiltration were added.
(2) Gingival plastic: 29 Patients were given only TENS. Effect of TENS were excellent for the incision of gingiva, and there were no patients who added local infiltration.
(3) Pulpectomy: 60 Patients had pulpectomy. Only 12 (33%) out of 36 of alive pulp were done under TENS alone. As post arsenic treatment, however, in 23 patients out of 24, removal of already dead pulp was performed under TENS with good result.
(4) Dental extraction: In only 5 patients (23%) out of 22 of molar teeth extraction, extraction was performed under TENS. Non molar teeth extraction had poor results, too.
(5) Scaling caliculi: Scaling of the dental caliculi were done under TENS with excellent results. In conclusion, TENS is a simple and easy maneuver for every dentist to alleviate pains in the conservative dental treatments.