Approach for Advanced Cancer Patients with Bone Metastases by the Bone Metastasis Board: A Single-institution Retrospective Study

Prevention, early diagnosis, and early treatment of skeletal-related events (SREs) are important in the treatment of potential or current cases of bone metastasis. In August 2020, our hospital established the bone metastasis team and the bone metastasis board (BMB) started actively engaging in activities aimed at improving the outcome of bone metastasis. We retrospectively examined whether a combined modality therapy started in the diagnosis of bone metastases could prevent the onset of SREs and whether it could prolong survival and improve activities of daily living. The 75 advanced cancer patients who underwent BMB at our hospital from August 1, 2020 to July 31, 2022 were divided into two groups according to when BMB performed before and after SREs for comparative analysis. Numerical Rating Scale improved, however Performance Status did not improve in both groups, and there was no difference in survival between the both groups (15.3 vs. 9.0 months, HR: 0.74, 95%; CI: 0.42–1.29, p=0.29). In conclusion, patients who suffered from SREs from the time of bone metastasis diagnosis were treated early. However, the incidence of SREs after BMB in our hospital was 22.6%, and it is necessary to actively work to prevent SREs in the future.

A Case Report of a Successful Use of Chukenchuto for the Treatment of Functional Gastrointestinal Disorders : Functional Dyspepsia and Irritable Bowel Syndrome / 日本東洋医学雑誌

A 28-year-old man had been experiencing occasional stomach upset and heartburn for 14 years. The symptoms started after he suffered from vomiting and diarrhea in the winter when he was fourteen. He had always suffered from loss of appetite during the last couple of years, and his symptoms got worse whatever he ate. In a terrible time, he had a palpitation and grew cold his limbs. He defecated once in one or two days with painful diarrhea. These symptoms were considered as functional gastrointestinal disorders with functional dyspepsia and irritable bowel syndrome. First, saishakurikkunshito was tried but it had no effect. Shokenchuto was prescribed next and had some effect. Chukenchuto, a combination of shokenchuto and daikenchuto, showed better effectiveness. The results of this case suggest that saishakurikkunshito was ineffective because qi deficiency was not the main cause, and that chukenchuto was effective because of qi depression.

A Case Report of Fever of Unknown Origin Successfully Treated with Saikatsugekito / 日本東洋医学雑誌

A42-year-old man presented with a history of tidal fever almost every evening to night with 10-year duration. We could not find out the cause of his fever, so we thought he was classified in fever of unknown origin. The patient suffered from an anhydrosis phase during the temperature rose, but his fever broke after perspiration occurred at the end. The lack of perspiration with fever is a typical symptom of excess pattern of tai yang stage, and fever at night is suggestive of shao yang stage. Saikatsugekito was thought to be best suited as it would address both stages. The formula promoted perspiration, and the body temperature remained stable thereafter. It is not unusual to encounter complicated symptoms due to combined or overlapped pattern in clinical setting. This case represented successful outcome by identifying and analyzing the concept of gobyo and heibyo and prescribing a formula accordingly.

Two Case Studies of Fibromyalgia Successfully Treated with Kampo Medicine / 日本東洋医学雑誌

Case 1 was a 72-year-old man with a generalized pain after 6 months of heavy physical work. Kakkonto was prescribed based on his symptoms of severe shoulder stiffness and pain, and keishibukuryoganryo was added to treatoketsu. It caused dysuria because of ephedra herb, so the dosage was reduced. Atractylodes lancea rhizome and processed aconite root were added to enhance the effect of treatment. And then, his pain was alleviated. Case 2 was a 53-year-old man with a generalized pain. He had a previous history of whiplash and two surgical operations. Daisaikoto was prescribed based on his symptom of bilateral costal arch pain, and keishibukuryoganryo was added because of oketsu. It caused an increased frequency of bowel movement due to crude drug of rhuharb, so the dosage was reduced. Pueraria root was added for the purpose of relieving severe shoulder stiffness. And then, his pain went away. It is often difficult to treat fibromyalgia. The decoction can be effective with increase or decrease and deleting or adding of the dosage of crude drug. Decoctions become handy as it allows dosage adjustment of crude drug to minimize the side effects and improve the efficacy.

A Case Report of Exfoliative Cheilitis Successfully Treated with Hochuekkito / 日本東洋医学雑誌

A 31-year-old woman started to have a yellowish-white scab with exfoliation on her lip after delivery. Her exfoliative cheilitis did not improve with kigikenchuto nor juzentaihoto for treating deficiency of vital energy and lack of blood. After she developed upset stomach, her prescription was changed to hochuekkito which supports the digestive system. Her symptom improved dramatically. The characteristic of exfoliative cheilitis consists of chronic inflammation of lips which is considered to be yang-syndrome, therefore hochuekkito was effective as it covers yang-syndrome as well as yin-syndrome. It is suggested that psychological factors play a role for a pathogenesis of exfoliative cheilitis. We consider that antistress effect of bupleurum root and sedative effect of citrus unshiu peel in hochuekkito might also be key factors.

<b>A Case Report on Vein Authentication Error Resolution with Shimbuto</b> / 日本東洋医学雑誌

A 48-year-old woman started to have dizziness after experiencing an earthquake. Her clinical signs improved with the use of shimbuto that was prescribed based on her symptom of yin-syndrome and hypofunction. At the same time, there was a decrease in reading errors with her finger, in a vein authentication device. One of the common reading errors that the security system makes is due to a change in blood flow due to vasoconstriction caused by low temperature. It is speculated that the use of a warming formula increased peripheral blood circulation, which contributed to the improvement of vein authentication.

Giant Invasive Sacral Schwannoma Showing Chromosomal Numerical Aberrations -14,+18,+22

Here, we report on a rare case of a giant invasive sacral schwannoma. The patient was a 58-year-old woman who had a 6-year history of non-specific buttock pain. Histological investigation confirmed the diagnosis of cellular schwannoma. The following numerical aberration was detected using the GTG-banding method for karyotypes: 47,XX,-14,+18,+22. Cytogenetic studies of schwannomas have indicated a complete or partial loss of chromosome 22 as the most common abnormality, but this case is cytogenetically rare because of the recurrence of trisomy 22.

Minimum 10-Year Follow-up Study of Anterior Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Progressive Pattern of the Adjacent Disc Degeneration

STUDY DESIGN: Retrospective study. PURPOSE: The aims of the current study are to evaluate the minimum 10-year follow-up clinical results of anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. OVERVIEW OF LITERATURE: ALIF has been widely used as a treatment regimen in the management of lumbar spondylolisthesis. Still much controversy exists regarding the factors that affect the postoperative clinical outcomes. METHODS: The author performed a retrospective review of 20 patients with degenerative spondylolisthesis treated with ALIF (follow-up, 16.4 years). The clinical results were assessed by the Japanese Orthopaedic Association (JOA) score for low back pain, vertebral slip and disc height index on the radiographs. RESULTS: The mean preoperative JOA score was 7.1 +/- 1.8 points (15-point-method). At 1 year, 5 years, and 10 years or more after surgery, the JOA scores were assessed as 12.4 +/- 2.2 points, 12.7 +/- 2.6 points, 12.0 +/- 2.5 points, respectively (excluding the data of reoperated cases). The adjacent disc degeneration developed in all cases during the long-term follow-up. The progressive pattern of disc degeneration was divided into three types. Initially, disc degeneration occurred due to disc space narrowing. After that, the intervertebral discs showed segmental instability with translation at the upper level. But the lower discs showed osteophyte formation, and occasionally lead to the collapse or spontaneous union. CONCLUSIONS: The clinical results of the long-term follow-up data after ALIF became worse due to the adjacent disc degeneration. The progressive pattern of disc degeneration was different according to the adjacent levels.