We report a case of a 32-weeks pregnant woman in her early 30s. The patient experienced pregnancy-related low back pain and difficulty walking due to rapid muscular weakness in her lower limbs. She was diagnosed with lower limb paralysis caused by the spinal cord tumor and underwent emergency cesarean section for maternal indication, followed by laminectomy and tumor removal. After 3 days of surgery, rehabilitation interventions, including early mobilization, muscle strengthening training, balance training, and activities of daily living (ADL) training, were performed to improve voluntary movement and muscle strength in her lower limbs and ADL. Prior to rehabilitation, the patient showed lower limb muscle weakness in manual muscle test 1 (MMT1) due to motor paralysis, required assistance for walking, and expressed anxiety about the degree of recovery of her physical functions and her role as a mother. After approximately 1 month of rehabilitation, the patient was able to perform ADL independently and was discharged from the hospital with physical functions that allowed her to take care of her newborn baby. It is important to provide positive rehabilitation intervention from the early postoperative period, according to the guidelines for the disability caused by primary diseases, as well as care and movement guidance before discharge, considering the changes in mental and physical symptoms during the postpartum period in a woman with a spinal cord tumor.

We report the case of a patient with severe tricuspid regurgitation and severe liver dysfunction who was successfully treated by tricuspid valve repair with spiral suspension and perioperative management of high cardiac output. The patient was a 77-year-old woman who presented with chronic atrial fibrillation with bradycardia (heart rate approximately 50 bpm). She had been diagnosed with severe tricuspid valve and mitral valve regurgitation at the age of 74. As her heart failure and hepatic failure grew worse, and hepatic encephalopathy also occurred, she was admitted to the hospital. Her Child-Pugh score for liver disease was Grade C at the preoperative assessment, suggesting that she was in the high-risk category for open heart surgery. Therefore, further medical treatment was required before selecting the surgical treatment. After the implantation of a pacemaker (VVI mode, 80 bpm), the cardiac output increased with a cardiac index of 5.17 L/min/m2 compared with 2.97 L/min/m2 prior to pacemaker implantation. Furthermore, the symptoms of heart failure improved and total bilirubin decreased from 3.9 mg/dl to 1.7 mg/dl, and surgery was performed. Tricuspid regurgitation was treated with spiral suspension, and mitral regurgitation due to annular dilation was treated with annuloplasty. Following the surgery, the cardiac index was maintained from 4.3 L/min/m2 to 5.8 L/min/m2 with central venous pressure below 10 mmHg by the assistance of intra-aortic balloon pumping. The patient was extubated 30 h after surgery, and was discharged on postoperative day 54. At the time of discharge, total bilirubin was 1.5 mg/dl. At 1.5 post-operative years, the patient is New York Heart Association functional Class II and tricuspid valve regurgitation is mild.

We report a case of a 32-weeks pregnant woman in her early 30s. The patient experienced pregnancy-related low back pain and difficulty walking due to rapid muscular weakness in her lower limbs. She was diagnosed with lower limb paralysis caused by the spinal cord tumor and underwent emergency cesarean section for maternal indication, followed by laminectomy and tumor removal. After 3 days of surgery, rehabilitation interventions, including early mobilization, muscle strengthening training, balance training, and activities of daily living (ADL) training, were performed to improve voluntary movement and muscle strength in her lower limbs and ADL. Prior to rehabilitation, the patient showed lower limb muscle weakness in manual muscle test 1 (MMT1) due to motor paralysis, required assistance for walking, and expressed anxiety about the degree of recovery of her physical functions and her role as a mother. After approximately 1 month of rehabilitation, the patient was able to perform ADL independently and was discharged from the hospital with physical functions that allowed her to take care of her newborn baby. It is important to provide positive rehabilitation intervention from the early postoperative period, according to the guidelines for the disability caused by primary diseases, as well as care and movement guidance before discharge, considering the changes in mental and physical symptoms during the postpartum period in a woman with a spinal cord tumor.

A 65-year-old man, with a history of surgery for esophagogastric junction cancer in X-3, was admitted to the Department of Internal Medicine in our hospital in March for anorexia that had developed since January X. The patient was diagnosed with adhesive small bowel obstruction, and underwent surgery to relieve the obstruction in early May. However, his symptoms did not improve, and he was referred to our department in mid-June. His drooling was considered to be due to “excessive saliva secretion.” He started taking a decoction of bushirichuto for epigastric discomfort and resistance and coldness of the hands and feet. On the 5th day, he started to feel more energetic, and on the 8th day, his saliva production decreased. Furthermore, on the 12th day, his sense of taste and appetite improved. As the oral intake increased, tube feeding could be reduced and rehabilitation progressed ; from an almost bedridden state, he was able to walk continuously for 150 m with a cane. On the 29th day, he was transferred to a chronic care hospital. His weight increased from 34.1 kg, when he was referred to our department, to 39.7 kg at the discharge time. Anorexia and drooling, which had otherwise continued for 5 months, were improved within a short period of time by using bushirichuto.

This case report describes the effect of exercise therapy on a patient with plasmacytoma diagnosed with chemotherapy-induced peripheral neuropathy (CIPN). A man in his mid 70s was diagnosed with plasmacytoma and received outpatient chemotherapy. He developed glove-and-stocking numbness and balance disorder and underwent 16-week multimodal exercise therapy consisting of resistance and balance training, and aerobic exercise. He attended one session per week of exercise therapy at a hospital under the supervision of a physical therapist and completed five sessions of home-based exercise. His symptoms and physical function were evaluated at baseline and after intervention using the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE), Functional Assessment of Cancer Therapy-Neurotoxicity subscale (FACT-Ntx), modified Total Neuropathy Score (mTNS), Stand-up test, and Berg Balance Scale (BBS). After the 16-week intervention, clinician-assessed CIPN symptoms were stable (CTCAE：Grade 2 at baseline, Grade 2 after intervention), whereas patient-reported CIPN symptoms improved beyond the minimal clinically important difference (FACT-Ntx score increased from 22 to 29 points). Although the components of mTNS such as motor symptoms and strength improved, the total mTNS score remained stable. The Stand-up test and BBS scores improved, and better physical function led to improvements in activities of daily living. Thus, exercise therapy may effectively reduce the symptom burden and improve physical function in patients with CIPN.

This case report describes the effect of exercise therapy on a patient with plasmacytoma diagnosed with chemotherapy-induced peripheral neuropathy (CIPN). A man in his mid 70s was diagnosed with plasmacytoma and received outpatient chemotherapy. He developed glove-and-stocking numbness and balance disorder and underwent 16-week multimodal exercise therapy consisting of resistance and balance training, and aerobic exercise. He attended one session per week of exercise therapy at a hospital under the supervision of a physical therapist and completed five sessions of home-based exercise. His symptoms and physical function were evaluated at baseline and after intervention using the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE), Functional Assessment of Cancer Therapy-Neurotoxicity subscale (FACT-Ntx), modified Total Neuropathy Score (mTNS), Stand-up test, and Berg Balance Scale (BBS). After the 16-week intervention, clinician-assessed CIPN symptoms were stable (CTCAE：Grade 2 at baseline, Grade 2 after intervention), whereas patient-reported CIPN symptoms improved beyond the minimal clinically important difference (FACT-Ntx score increased from 22 to 29 points). Although the components of mTNS such as motor symptoms and strength improved, the total mTNS score remained stable. The Stand-up test and BBS scores improved, and better physical function led to improvements in activities of daily living. Thus, exercise therapy may effectively reduce the symptom burden and improve physical function in patients with CIPN.

Orento is generally used for upper gastrointestinal symptoms. We have used orento for various diseases based on “upper heat and middle cold”. As a result of the evaluation of 30 responders to orento, the most frequent sign of “upper heat” was “yellow tongue coating” (29/30 responders), while the most frequent sign of “middle cold” was “preference for warm foods and beverages” (27/30 responders). Compared with the non-­responder group, the responder group showed significantly higher frequencies of “gastrointestinal cold”, which is the sum of “preference for warm foods and beverages” and “aggravation of gastrointestinal symptoms by cold foods and beverages” (29/30 responders, p = 0.047), and “upper/lower gastrointestinal symptoms” (29/30 responders, p = 0.014). These results suggest that “yellow tongue coating” is the most important sign for “upper heat” while “gastrointestinal cold” is the most important sign for “middle cold”. As Kampo patterns for orento, gastrointestinal symptoms often occur, but there is a possibility of upper or lower gastrointestinal symptoms, skin disorders, and sleep disorders.

The patient was a 13-­year-­old male who had experienced periodic fever since he was in the 5th grade. After he moved into the 8th grade, he developed fever, abdominal pain, and vomiting continuously, which caused him to miss school or leave school early once every one to two weeks. Various Kampo extract preparations prescribed at a nearby clinic did not improve the symptoms, and the patient was referred to our hospital. Ad­ministration of bukuryoshigyakuto and shokenchuto reduced the fatigue, but the fever could not be controlled. Subsequently, a grasp of “the disease byakugobyo turned into fever” was made, and he was put on byaku­gokassekisanryo, which eliminated the fever. Therapeutic approaches for disease known as the disease ebyo that arises after treatment of cold damage diseases (shokan) are discussed in the On Pulse Syndrome Complex and Treatment of Bai He, Hu Huo, and Yin Yang Du Diseases section of the synopsis of prescriptions of the golden chamber “Kinkiyoryaku”. Children, especially adolescents, are prone to fall ill because of rapid changes of the body, including sexual maturation. Clinical manifestations of such illnesses further change with growth and maturation, and it can be difficult to find clues for treatment at first glance due to complicated states of yin­yang and deficiency-­excess. As seen in this case, illnesses of adolescence is likely to include un­diagnosed cases of byakugobyo that manifests clinical signs similar to those of ebyo.

Sokeikakketsuto was administered to 33 patients with recurrent cramps of the calf appearing once a week or more and persisting for 2 weeks or more. Treatment response was evaluated 1 month after the start of drug therapy. Patients whose cramps disappeared immediately after starting were regarded as showing a complete response, those with disappearance after 1 month as showing a partial response, those with a reduction to <50% after 1 month as showing a slight response, and those in whom 50% or more of cramps persisted after 1 month as showing no response. A complete response was achieved in 12 patients, a partial response in 11, a slight response in 9, and no response in 1. In 23 (69.6%) of the 33 patients, cramps disappeared within 1 month after the start of drug therapy. In 32 (96.9%), there was a reduction to <50%. In 29 (87.8%) of the 33 patients, cramps disappeared within 3 months, suggesting the efficacy of this drug. Two-package administration in the evening/at bedtime was more effective than 1-package administration for controlling cramps of the calf at night until early in the morning. The intensive pre-attack administration of 2 packages before sleep was the most effective. Sokeikakketsuto may be useful for treating recurrent cramps of the calf.