Risk of surgery in patients with stricturing type of Crohn's disease at the initial diagnosis: a single center experience

BACKGROUND/AIMS: It remains uncertain which patients with stricturing-type Crohn's disease (CD) require early small bowel surgery after the initial diagnosis. We aimed to clarify clinical characteristics associated with the intervention in such condition of CD. METHODS: We retrospectively evaluated the clinical course of 53 patients with CD and small bowel strictures who were initially treated with medications after the initial diagnosis. We investigated possible associations between small bowel surgery and the following: clinical factors and radiologic findings at initial diagnosis and the types of medications administered during follow-up. RESULTS: Twenty-eight patients (53%) required small bowel resection during a median follow-up period of 5.0 years (range, 0.5–14.3 years). The cumulative incidence rates of small bowel surgery at 2, 5, and 10 years were 26.4%, 41.0%, and 63.2%, respectively. Univariate analysis indicated that obstructive symptoms (P=0.036), long-segment stricture (P<0.0001), and prestenotic dilation (P<0.0001) on radiography were associated with small bowel surgery, and immunomodulatory (P=0.037) and biological therapy (P=0.008) were significant factors during follow-up. Multivariate analysis revealed that long-segment stricture (hazard ratio [HR], 4.25; 95% confidence interval [CI], 1.78–10.53; P=0.001) and prestenotic dilation (HR, 3.41; 95% CI, 1.24–9.62; P=0.018) on radiography showed a positive correlation with small bowel surgery, and biological therapy (HR, 0.40; 95% CI, 0.15–0.99; P=0.048) showed a negative correlation. CONCLUSIONS: CD patients with long-segment stricture and prestenotic dilation on radiography seem to be at a higher risk of needing small bowel surgery. For such patients, early surgical intervention might be appropriate, even at initial diagnosis.

The Change in Coloration of Aluminum Silicate Hydrate with Silicon Dioxide to Bright Blue when Cinnamon Bark and Atractylodes Rhizome are Combined / 日本東洋医学雑誌

The change in color tone of crude drugs during storage of decoctions is one of the factors leading to poor drug compliance of decoctions. We experienced a case of a decoction including Aluminum Silicate Hydrate with Silicon Dioxide (Kasseki) turned into bright blue color after it was combined with goreisan. We therefore examined to find out possible causative crude drugs using an airtight container and performed a component analysis by the TLC. As a result, we found the following: Kasseki under the coexistence of Cinnamon Bark (C. Bark) and Atractylodes Rhizome (A. Rhizome) turned into a bright blue color in several hours. In this coloration, aluminum silicate hydrate, cinnamaldehyde and atractylon, which derive from these 3 crude drugs, were involved. This coloration change of Kasseki under coexistence of C. Bark and A. Rhizome was a vivid and sharp reaction generated in several hours. From the perspective of maintaining medication compliance, it is important to provide a full explanation to patients about the change in coloration of Kasseki, when decocting crude drugs that contain C. Bark, A. Rhizome, and Kasseki. To avoid coloration, it is considered useful to put Kasseki in a separate sachet, isolated from other crude drugs in storage, and to mix in Kasseki just before decocting.

Four Cases of Anxiety Disorder Effectively Treated with Combination Use of Keishikaryukotsuboreito and Kanbakutaisoto / 日本東洋医学雑誌

We report four cases of anxiety disorder where psychiatric symptoms were effectively treated with combination therapy utilizing keishikaryukotsuboreito and kanbakutaisoto, which are two herbal formulas. The patients had common symptoms and experienced episodes leading to emotional stress. Moreover, in all four cases aggravation of psychiatric symptoms due to emotional stress, re-experience and memory retrieval were commonly observed. Additional treatment with kanbakutaisoto was effective for such aggravation. On the objective assessment, rapid pulse, deficient pulse, weak abdominal strength and brisk pulsation in the supraumbilical region were present. Yawning was not necessarily present. There are many patients with anxiety disorder or mental disorder associated with emotional stress, and Kampo treatment is often considered to be effective for these cases. However, a single administration of Kampo extract formulae does not often provide adequate results. When a single Kampo administration is ineffective, the combination of keishikaryukotsuboreito and kanbakutaisoto may be useful.

Two Cases of Refractory Hiccups Effectively Treated with Acupuncture at the Lump of Infraspinatus Muscle (Terasawa Point) / 日本東洋医学雑誌

Hiccups can sometimes become intractable. We report two cases of hiccups in which acupuncture practices to the lump of the infraspinatus muscle (Terasawa point) were effective. Case 1 was an 85-year-old male, an inpatient with bacterial pleuritis. His hiccups had persisted for 11 days. Several pharmacotherapeutic approaches were partially effective, but the hiccups were not completely abolished. In situ acupuncture therapy to bilateral Terasawa points was done, and his hiccups disappeared the next day. Case 2 was a 68-year-old male. He experienced insufficient sleep due to hiccups. We inserted needles into bilateral Terasawa points and heated the surrounding area with an electrothermo-acupuncture device using a curved heating plate. When this combination therapy was done, his hiccups disappeared during treatment. Acupuncture at the Terasawa point is one of the therapeutic approaches for hiccups and a rapid effect can be expected.

<b>Screening for Idiopathic Mesenteric Phlebosclerosis in Outpatients Undergoing Long-Term Treatment at the Department of Kampo Medicine</b> / 日本東洋医学雑誌

<p>Idiopathic mesenteric phlebosclerosis (IMP) is a rare chronic ischemic intestinal disease, mainly in the right hemicolon, characterized by dark purple mucosa on colonoscopy and calcifications of the intestinal wall and mesenteric veins on abdominal radiography and computed tomography. In recent years, many patients who developed IMP over the long-term administration of Kampo medicines have been reported. However, the present status of IMP in patients under long-term treatment with Kampo medicines in departments specializing in Kampo therapy is unclear. We surveyed whether there were any IMP outpatients followed for 5 years or more at the Department of Oriental Traditional Medical Center, Suwa Central Hospital. We detected 2 of 257 (0.8%) patients having IMP. Both patients had undergone long-term treatment with Gardenia fruit. One of them underwent surgery due to acute abdomen, but the other was asymptomatic. The etiology and pathogenesis of IMP are still unclear. However, in patients undergoing long-term treatment with Kampo medicines, particularly containing Gardenia fruit, the possible presence of IMP should be taken into consideration, and active screening using imaging examinations is necessary even in asymptomatic patients.</p>

<b>Report on Four Cases of Chronic Renal Failure Effectively Treated with Astragali R</b><b>adix </b> / 日本東洋医学雑誌

Chinese herbal medicine has historically been used for the treatment of renal disease. There are some medi cines such as rhubarb and Ompito that delay the need for dialysis. However, they only attenuate the 1/Cr-time slope but cannot reduce the Cr level. In this study, four chronic renal failure (CRF) patients who had not responded to any Western medicine were treated effectively with Astragali Radix, a traditional herbal medi cine. Serum creatinine (Cr) was clearly improved, and necessity for dialysis was delayed. In two patients, Cr was controlled stably over four years. There were no adverse effects, and no noteworthy changes in the lev els of serum phosphorus, potassium and uric acid between before and after treatment were observed. This study suggests that Astragali Radix is a useful agent in the treatment of CRF.

Risk Factors for Excessive Sensitivity to Cold and Physical Characteristics:A Prospective Cohort Study / 日本東洋医学雑誌

PURPOSE : To determine risk factors for excessive sensitivity to cold (ESC) in relation to physical features.DESIGN : A prospective cohort study carried out between July 7 and November 14,2008.PARTICIPANTS AND METHODS : Seventy female junior college students with no ESC at baseline, and a median age of 20 years, participated. We used a numerical rating scale (NRS) to classify each ESC sensation over the five days in this July-November period.To confirm physical symptoms, we used Terasawa's diagnostic scores for ki, ketsu, and sui. We defined ESC as mean NRSgeq ≥ 5.RESULTS : We documented 17 participants with ESC in November. The multivariate adjusted odds ratio for ESC was11.6 (95% CI 1.9 to 97.5) for the physical characteristic “edema”. Participants with ESC were shorter in stature than participants without ESC (-5.9cm ; 95% CI -8.6 to -3.1).CONCLUSION : Participants with edema and short stature have a high risk for ESC.

Case Reports of Polymyalgia Rheumatica Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

We report 5 patients with polymyalgia rheumatica (PMR) successfully treated with Kampo medicines. In total, we investigated 10 patients with PMR, including the 5 patients here treated in our department. Results showed that Kampo medicine was effective in 6 cases. One of the 6 refused steroid drug administration, and tapering dosage steroid was difficult in the other 5 patients due to myalgia or inflammation. Except for one case, C-reactive protein in most of the effective cases was below 3.0 mg/dl. On the other hand, the non-effective cases had severe inflammation levels and needed steroid therapy. The effective cases were treated with sokeikakketsuto, tokakujokito, keishibukuryogan, choyotokasyakuyaku, yokuibushihaishosan and tokishakuyakusan, which have the effect of improving oketsu states. Thus, it was considered that Kampo medicine has the potential for treatments in PMR patients who have difficulty tapering steroid dosage and mild inflammation. Moreover, this suggests Kampo medicines that improve oketsu state are useful for PMR treatment.

Trial of the Treatment of Kampo Medicines for Thalamic Pain / 日本東洋医学雑誌

Thalamic pain is known as intractable central pain caused by thalamic bleeding and infarction. Although some physical and surgical therapies have been tried, there is no established method for its improvement. We attempted the treatment of 6 cases of thalamic pain, and 4 of them showed improvements in their symptoms. Our patients were aged 27-70 years, 4 men and 2 women. Their diagnoses were 3 cases of right thalamic bleedings, 1case of left thalamic bleeding, and 2 cases of right thalamic infarctions. The periods from onset to consulting our department were from6months to 12 years. In the 4 cases whose symptoms improved, the symptoms had almost disappeared or were decreased by at least 40%. These improved cases used formulas containing uzu or bushi. Yokukansankachimpihange was effective for two cases with mental disturbances. One case showing major improvement was treated by only the formula against oketsu. The cases whose symptoms had continued for a long time were more intractable, with the symptoms remaining to some degree in spite of their decreasing tendency. Finally, in intractable cases, their symptoms remained fixed and they had severe paralysis.

Two Cases of Water Polo Athletes Successfully Treated with the Acupuncture and Moxibustion Therapy / 日本東洋医学雑誌

Recently, the number of athletes who receive acupuncture therapy is increasing. However, most of these athletes receive acupuncture therapy with single-acupuncture and/or electro-acupuncture to a local point, or a trigger point. We experienced two water polo athletes who were improved using acupuncture and moxibustion therapy with “zuisho” therapy. Case 1 was 16 year old man. He became aware of pain in his right thumb after training, which continued with extended training time, a numbness in his left hand appeared more, and he received acupuncture and moxibustion therapy. These symptoms disappeared immediately with acupuncture and moxibustion therapy using the standard traditional methods, such as contact needling to a yuan point, and in situ acupuncture to a back shu point, etc. Case 2 was 17 year old man. He received acupuncture and moxibustion therapy for lumbago and stiffness of the neck. These symptoms disappeared immediately after acupuncture and moxibustion therapy using the standard traditional methods such as contact needling to a yuan point, and inserting needles into a back shu point, an extra meridian, etc. In these two cases, symptoms were improved with “zuisho” therapy, and both could continue with longer and more strenuous training. This suggests that acupuncture and moxibustion therapy using the standard traditional methods are useful for athletes.