<b>A Case of Pelvic Congestion Syndrome Successfully Managed with Keishibukuryogan</b> / 日本東洋医学雑誌

<p>Pelvic congestion syndrome is a condition in women caused by congestion or varicosity of the intrapelvic vein. We report a case of pelvic congestion syndrome managed with keishibukuryogan. The syndrome was diagnosed based on expansion of the left periuterine and ovarian veins.<br>A 61-year-old female presented to our clinic with left lower abdominal pain. NRS was 9 and Terasawa's oketsu score was 40, indicating marked blood stasis. A CT scan revealed vascular expansion (10 mm) of the left ovarian vein. Transvaginal ultrasonography also revealed vascular expansion (6.0 mm) of the left periuterine vein. Based on these findings, a diagnosis of pelvic congestion syndrome was established. She was treated with keishibukuryogan (7.5 g/day). NRS was improved to 1 and Terasawa's oketsu score was improved to 20. The symptoms were resolved within 6 months, and the medication was discontinued.<br>Three months after discontinuation, she presented to our clinic again with left lower abdominal pain. The medication was resumed and the symptom was improved. After 5 months, a contrast enhanced CT scan showed no change of vascular expansion of the left ovarian vein (from 10 to 9 mm). Keishibukuryogan treatment has now been continued for 10 months.</p>

<b>A Patient with Recurrent Ovarian Cancer in Whom Kamikihito was Effective for Thrombocytopenia Induced by GEM Monotherapy</b> / 日本東洋医学雑誌

The efficacy of gemcitabine (GEM) monotherapy for recurrent ovarian cancer has been confirmed. Although it induces adverse reactions due to bone marrow toxicity, such as thrombocytopenia, there are no other effective treatments other than blood transfusion. Kamikihito has been reported effective for thrombocytopenia in about 20% of idiopathic thrombocytopenic purpura (ITP) cases, but there has been no report on its efficacy for thrombocytopenia caused by GEM administration. We encountered a patient with grade-2 thrombocytopenia in whom concomitant kamikihito improved thrombocytopenia, and it was also effective in improving response to chemotherapy. A 59-year-old patient developed thrombocytopenia in the first cycle of GEM therapy, and the dose was reduced or the drug was withheld appropriately until the 8th cycle. When kamikihito was concomitantly administered in the 9th cycle, thrombocytopenia was improved. The patient is now being treated in a 17th cycle, and is in a stable disease (SD) state. This suggests that kamikihito improves GEM-induced thrombocytopenia, as well as mental symptoms.