Pulmonary tumor thrombotic microangiopathy caused by gastric cancer

Pulmonary tumor thrombotic microangiopathy [PTTM] is a fatal cancer-related pulmonary complication with rapidly progressing dyspnea, and occasionally induces sudden death. Here, we describe a postmortem-diagnosed PTTM case caused by gastric cancer, with the complaint of progressing dyspnea for 5 days.He did not have any abdominal symptoms or cancer history. PTTM should be considered in patients with rapidly worsening respiratory conditions, even if there is no cancer history

Successful Treatment of Panic Disorder with Ryukotsuto / 日本東洋医学雑誌

We encountered a patient with intractable panic disorder who responded extremely well to Ryukotsuto, a Kampo preparation. Beginning in March 2003, a 55-year-old female began to lose vigor and concentration, while developing palpitations and experiencing a rise in blood pressure (systolic pressure≥190mmHg) accompanied by sudden anxiety. When these symptoms became intense, she was brought to a hospital by ambulance. Although close examination revealed no abnormalities, on clinical diagnosis, however, autonomic imbalance was recognized. Despite treatment with antidepressants and minor tranquilizers, including selective serotonin reuptake inhibitors (SSRI), no improvement was observed. A series of medicinal Kampo preparations, prescribed one after another, also had no effect. For further treatment, she was referred to our hospital on July 22, 2005. At the first consultation, a diagnosis of panic disorder was made, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Hon-Ton disease was suspected based on clinical findings, and Ryokeikansoto was prescribed as a decoction. However, no positive effects were observed after 1 week, while marked incompetence, forgetfulness, and depression were noted. Therefore, based on the results of a self-rating depression scale (SDS), a profile of mood states (POMS), and autonomic function tests, such as pupillary dynamics at the first consultation, panic disorder accompanied by extreme tension with depression was diagnosed. Consequently, her Kampo preparation was changed to Ryukotsuto. As a result, symptoms virtually disappeared and all western drugs were discontinued. Psychological tests, autonomic function tests, and her diagnostic scores for conditions of Ki, Ketsu, and Sui also improved. We conclude that Ryukotsuto may be an effective treatment for panic disorder accompanied by depression.

Kampo Therapy for Graves' Disease Associated with Psychological Disorders / 日本東洋医学雑誌

We report 2 patients with Graves' disease and psychological disorders. In these patients, treatment did not relieve psychological disorders despite normalization of thyroid function, but kampo therapy was effective. Patient 1 was a 24-year-old female. In 2000, she was diagnosed as having Graves' disease. Treatment with an antithyroid drug normalized thyroid function, but did not relieve psychological disorders such as irritation, anxiety, or despair. In February 2005, the patient consulted our hospital. Patient 2 was a 26-year-old female. After graduating from a high school, she developed Graves' disease. Treatment with an antithyroid drug was started. However, thyroid function was unstable ; mild hyperthyroidism and hypothyroidism repeatedly occurred. During this period, irritation, fatigue, malaise, and alopecia deteriorated, and she consulted our hospital in January 2005. In the two patients, keishikanzoryukotsuboreitogohangekobokuto was prescribed (the regimen was changed during follow-up in Patient 1), and their conditions markedly subsided after 16 and 9 weeks of administration, respectively, suggesting the usefulness of kampo therapy in the treatment of Graves' disease associated with psychological disorders.