We have been studying the optimal condition of low-frequency electro-acupuncture. In the present paper, clinical effect of music-rhythm low-frequency electro-acupuncture on shoulder stiffness was evaluated. In this therapy, musical rhythms was directly converted to pulse waves.
Subjects were fifty patients with chronic shoulder stiffness who visited the anesthesical department of Osaka Medical College and assented to be a subject of this experiment. Each patient underwent the following three methods in random order: conventional 3Hz continuous-wave low-frequency electro-acupuncture (C method), music-rhythm low-frequency electro-acupuncture without music sound (S method), music-rhythm low-frequency electro-acupuncture with music sound (M method). The acupoints such as “Tianzhu” and “Jianjing”, which were reported by the Acupoint Committee of Japan Acupuncturists' Association as frequently used ones, were selected as basic points. Music-rhythm low-frequency electro-acupuncture was carried out using a special signal discriminating apparatus which output alternating square waves (1-100Hz) sychronizing with a music tape. Electrical stimulation was given for 15 minutes. The music was from an album of Japanese popular songs called Enka. No. 20 needles of 30mm in length were used. The effect of each method was evaluated by the patient immediately after the treatment using a numerical scale. The numerical evaluation was classed into four grades (“remarkably effective”, “effective”, “slightly effective”, “not effective”), and “Remarkably effective” and “effective” cases were counted as effective ones. Comfortableness was rated using a visual analog scale with 11 grade {-5 (discomfort): 0: +5 (comfort)}.
As to the immediate effect, “effective” was seen in 60% cases of C method (30/50), 58% of S method (29/50) and 76% of M method (38/50). M method showed 20% higher effectiveness than C and S method. This was statistically significant. Averaged comfortableness was 2.1 in C method, 1.9 in S method and 2.7 in M method.
We demonstrated the effectiveness of music-rhythm low-frequency electro-acupuncture on shoulder stiffness. To give music sound simaltaneously is necessary to get better physical and psychological results.

A pressure pain, frequently associated by an induration, is usually perceptible in the suprascapular region of the normal subjects. We considered the relation of the pressure pain with the anatomical structures of that region, firstly by investigating the locus of the pressure pain and whether it is associated by an induration or not, using the living subjects and in several cases, followed by a X-ray examination of the final destination of the needle which was inserted in the pressure pain zone; and lastly by dissecting the anatomical structures penetrated by that needle in a woman's cadaver.
We obtained the follwing three results from the above investigation and observations. (1) The most conspicuous pressure pain was perceptible in the middle of the upper margin of the suprascapular region, and a long and slender induration extending sagitally was palpable there. (2) The second rib lay in the deepest layer of the pressure pain zone, the layer which were overlain by the serratus posterior superior muscle, the serratus anterior and the omohyoid, many branches of the transversus colli artery and vein and the accessory nerve, and the trapezius muscle with the posterior suprascapular nerves running on its superficial surface, in order of lower to upper layer. (3) The transversus colli vessels, which forms a complex network of branchings crossing sagitally above the second rib, was suggested to have some relationship to the occurence of the pressure pain associated by the induration, because only the formation of such vascular network was peculiar to the pressure pain zone.

The relation of needles inserted to the points of the posterior neck with the anatomical structures was investigated with dissection of four cadavers. The points investigated here are the five points of “Amon”, “Tenchuu”, “Fuuchi”, “Kankotsu”, and “Eifu”. The needles inserted to the respective points of the former three were found to penetrate the posterior atlantooccipital membrane and then the dura mater, and finally to reach the medulla oblongata. The depth from the inserted spots on the surface of the skin to the dura mater are 50, 51, and 49mm in the Amon, Tenchuu, and Fuuchi, respectively, in a cadaver with 39.1cm of circumference of the neck. Furthermore, it was found that the vertebral, the occipital, and the external carotid and the maxillar arteries were penetrated by or located near the needles which were inserted to the Fuuchi, Kankotsu, and Eifu, respectively.

In order to elucidate effects of the exercise intensity on purine catabolism, we performed exhausitve exercise (Exh-ex), 80% VO₂max exercise (80%-ex) and 70% VO₂max exercise (70%-ex) test by a bicycle ergometer, and estimated the purine catabolism by the changes in blood ammonia, plasma oxypurines and urinary oxypurines in five healthy male subjects who were given allopurinol. The results were summarized as follows;
1) Plasma oxypurines concentrations (POP) increased gradually after exercise with each intensity. The order of their maximal levels and of cumulative areas under the curves of POP were exh-ex>80%-ex>70%-ex>control, respectively, and that of urinary excretions of oxypurines was exh-ex>80%-ex>70%-ex≥control.
2) Blood ammonia concentrations (BNH₃) increased sharply after exercise with each intensity. The order of their maximal levels was 80%-ex = exh-ex>70%-ex>control, and that of cumulative areas under the curves of BNH₃ was 80%-ex>exh-ex>70%-ex>control.
3) Blood lactate concentrations (BLA) increased sharply after exercise with each intensity. The order of their maximal levels and of cumulative areas under the curves of BLA were exh-ex =80%-ex>70%-ex>control, respectively.
These results suggest that the purine catabolism leading to uric acid production is activated by the physical exercise in the order of increasing intensities. The discrepancy between the increase in ammonia and those in oxypurines suggests that the increased purine catabolic pathway was mediated not only by AMP deamination but also by other factors.

We examined the effects of acupuncture therapy on 41 patients with various levels of periarthritis scapulohumeralis. These patients were classified into two groups: one consisting of 20 patients having no contracture, those of freezing type (age 61.0±9.0; suffering period 3.0±5.1 months) and the other consisting of 21 patients having contracture, those of frozen type (age 53.8±7.3; suffering period 5.8±7.8 months).
As a result, we found that acupuncture therapy relieved pain more effectively in patients having no spontaneous pain than in those having spontaneous pain regardless of the presence or absence of contracture. We next investigated the effects of this therapy by the patient types. In the group of 20 freezing-type patients, which includes only six patients having spontaneous pain, pain relief was relatively easily obtained as indicated by the pain score after the therapy of 3.6±1.8. In the group of 21 frozen-type patients, which includes 13 patients having spontaneous pain, however, it was difficult to obtain sufficient pain relief as indicated by the pain score of 5.7±2.8. There was a statistically significant difference (P<0.002) between these scores. This shows that acupuncture therapy is more effective on freezing-type patients than on frozen-type patients.
Therapy also improved the range of motion. In many freezing-type patients, the range of motion was expanded due to pain relief. The abduction ROM expanded from 151.8±39.0° before therapy to 163.8±25.0° after acupuncture therapy. In frozen-type patients, however, the range of motion did not expanded significantly (87.6±24.1° before to 94.8±21.1° after therapy). The above results suggest that acupuncture therapy is effective for relieving the pain of periarthritis scapulohumeralis and that this therapy is particularly effective when applied to those patients having no spontaneous pain before they enter into the frozen phase.

It is known that subaortic stenosis (SAS) occasionally progress after the repair of Co/A. And it may progress if the initial repair is incomplete. We successfully repaired a 6-year-old girl with recurrent SAS with aortic and mitral regurgitations and pulmonary hypertension (Pp/Ps=0.74) progressed after the initial repair for SAS. She had been operated at 4-year-old with transaortic resection of subaortic myocardium and the membrane. He SAS had progressed since the coarctectomy at 7 months of her age. At that procedure, right coronary cusp was lacerated and repaired. In may 1989, Konno operation with 21 St. Jude Medical aortic prosthesis and mitral valve replacement with 25 St. Jude Medical prosthesis were performed. Interventricular septum, aortic root and right ventricular outflow tract were reconstructed employing composite patch with preserved equine pericardium and Dacron velour. So mitral annulus was dilated because of the volume over loading due to aortic regurgitation, that complete repair was not able to do with mitral valvulo and annuloplasty. After the procedure severe cardiac and respiratory failure occurred and continued for over 10 days. And hemolytic anemia with homoglobiuria appeared. It continued for 14 days. In spite of those complications, the girl became well and goes to school with the administration of warfarin and dipyridamole. We recommend that Konno operation could be the first indication for the children with narrow aortic root when incomplete repair was made during the initial repair for subaortic stenosis.

We experienced three cases of triple shunts (VSD+ASD+PDA) for past ten years. All three cases admittied with cardiac failure and respiratory distress early in the infant period. Ligation of PDA, suture closure of ASD and patch closure of VSD were performed in the two cases. Another case was performed ligation of PDA because of low body weight (1, 700g). Triple shunts were correctly diagnosed in only one case. Another two cases were diagnosed VSD and PDA at operative period. The patient with low body weight was lost at 38 days after operation. Post operative course were uneventfull in the two cases of total repair. Triple shunts should be repaired in the same time. But two staged operations are consider to perform in the low body weight infant and patients with major general pediatric surgical disease.

Screening of carotid and intracranial artery diseases by magnetic resonance angiography (MRA) was performed in forty-one adult patients prior to elective cardiovascular surgery. In twenty patients (48.8%), MRA demonstrated significant cerebrovascular lesions: carotid or main cerebral artery stenosis in 7, diffuse cerebral arteriosclerotic change in 6, vertebral artery lesion in 5 and berry aneurysm in 2. Advanced age (over 70 years) and previous cerebrovascular events increased the incidence of cerebrovascular lesions on MRA. Forty patients underwent scheduled surgery under cardiopulmonary bypass, and pulsatile flow perfusion was used in patients in whom significant cerebrovascular lesions were demonstrated on MRA. One patient with aortic arch aneurysm was judged to be an unacceptable candidate for surgery in light of his marked diffuse arteriosclerotic lesions on MRA. In five patients, staged operation was performed from 10 to 30 days after cerebrovascular surgery (bypass surgery for internal carotid occlusion in 2, aneurysm clipping in 2, carotid endarterectomy in 1). Postoperative neurological complications occurred in one patient (2.5%). In conclusion, screening of carotid and intracranial artery diseases by MRA is a safe and useful method for evaluation of cerebrovascular lesions in patients with advanced age, previous cerebrovascular events and/or arteriosclerotic diseases.

We treated two cases of Stanford type A acute dissecting aortic aneurysm with the adventitial inversion technique. Both case 1) a 65-year-old woman and 2) a 74-year-old woman underwent emergency operation. After cardiopulmonary bypass was established as usual, the diseased aorta was resected, and the intima was trimmed about 10mm shorter than the transected adventitial line in both proximal and distal ends. After GRF glue was employed, the adventitia was inverted inward over the false-lumen, and then tacked with horizontal continuous mattress sutures using 5-0 polypropylene. The graft was then anastomosed with continuous sutures using 3-0 polypropylene. No bleeding occurred from the anastomosis site in both cases. This method was completed without the use of artificial reinforcement, nevertheless patent anastomosis was possible. This simple method was easily performed and proved to be safe and useful.

The posional relation of the bifurcation of the common carotid artery to the needle which was inserted to the position of the bifurcation presumed from the level of the hyoid bone, as well as its relation to the hyoid bone and the transverse process of the cervical vertebra, has been studied bilaterally with dissection of 19 cadavers.
Though most of the inserted needles missed medially from the bifurcation of common carotid artery, all of them were located about the level of the bifurcation in the up-to-downward direction, with two cases directly pricking the bifurcation.
The bifurcation of the common carotid artery was mostly located about the level of hyoid bone. Thus, 17 cases out of 19 on the right side and 13 cases out of 18 on the left side were within a range of 1.0mm above or below the hyoid bone.
The height of the bifurcation of the common carotid artery against the cervical vertebrae was mostly located between the transverse process of the 3rd and that of the 4th cervical vertebra, 21 cases out of 28 being included within this range.