The patient was a 70-year-old man. He was injured in a motorcycle accident and was brought to the hospital suffering from pulmonary contusions, multiple rib fractures, and a dislocation fracture of the left hip joint. Mechanical ventilation and tracheostomy were performed because of decreased oxygenation. As dysphagia and gait disturbance persisted even after his respiratory condition improved, the patient was transferred to our institution for rehabilitation 63 days after the injury. Rehabilitative intervention for the patient's physical impairments progressed smoothly, and the patient regained independence in activities of daily living. However, 1 week before his scheduled date of discharge, the patient suffered from sudden heart failure at 168 days after the initial injury. Traumatic aortic regurgitation was diagnosed based on the following findings : aortic regurgitation rapidly exacerbated after heart failure, no medical history of heart disease, and no other cause for aortic regurgitation. Surgical treatment with aortic valve replacement was performed. Postoperative recovery was favorable, and the patient was discharged to his home after regaining independence in activities of daily living. Traumatic aortic regurgitation is rare, and patients with this disease often suffer heart failure from a few days to several years after injury. This condition needs to be kept in mind during the rehabilitation process following chest trauma.

View ; Japanese language ; Acupuncture

Acupuncture treatment was undertaken for 153 cases with dysurea after radical operation for carcinama of uterine cervix. Eighty-four percent of the patients were forties, fifties or sixties. Seventy percent of them underwent acupuncture treatment within two weeks after the operation. The treatment consisted of one or combination of the following methods: direct current acupuncture, in situ acupuncture, low-frequency electro-acupuncture and SSP. Acupoints considered to facilitate metabolism in the pelvic cavity and to be related to diurea were selected. The treatment group (fifty cases) had 19.7 days on which average residual urine was less than 50ml, whereas the control group 24.6 days. “Remarkable effect” and “effect” were obtained with SSP in seventy-seven percent of the cases, and with low-frequency electro-acupuncture in seventy-three percent. With the latter, “no effect” was obtained in only two percent of the cases. SSP therapy was effective and gained patients' favor because it gave no anxiety.

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.

In the present paper, we examined differences in therapeutic effectivenesses of venous methods of acupuncture, ranging from filiform needle to EAP, LFEA, laser and SSP, in cases with shoulder stiffness. The immediate and delayed effect of each method, comfortableness during treatment session, changes in temperature, blood flow, and the oxygen density at the Jianjing and Hegu point were examined.
Significant improvement was seen in every therapeutic method. Electrical acupuncture using direct current was most effective. No difference were evident among SSP, low-frequencey electro-acupuncture and filiform needle. There was a correlation between confortableness and the improvement rate in electrical acupuncture using direct current and laser acupuncture. Deep temperature, blood flow and the degree of oxygen saturation of the stimulated part tended to increasd in each case.

Introduction
It is said that D-phenylalanine improves the pain relief effect of acupuncture on pain disease. We applied it to different kinds of pain disease as preadministration and studies the clinical effectiveness.
Method
Subjects were 24 patients suffering from such comparatively chronic pain diseases as prosopalgia (2), a pain in the posterior region of neck (5), frozen shoulder (4), coxalgia with melosalgia (10) and gonalgia (3).
A. The low frequency electrical acupuncture (3Hz, sub-successive wave, 20 minutes) was applied to them on the most frequently used points by the JSA Committee of Acupoints.
B. 0.5g of DPA was administered to each patient as preadministration and acupuncture was given.
C. Lactose was administered to all of the same patients as a placebo and acupuncture was given.
D. The therapy was repeated two times.
E. We evaluated the just after effect of the therapy on both groups with the double blind experiment.
Effect
The preadministration of DPA improved the effectiveness of acupuncture against such pain disease. From our study, it was clarified that the effectiveness of DPA rose by 30% in comparison with the placebo.

The effect of acupuncture-moxibustion treatment in the control of malignant neoplasm pain was examined in 157 (36%) of 434 cases in our clinic over a 16 year period (1966-1981).
In these cases, gastric cancer (36 of 157 cases: 23%) was the largest in number, followed by uterine cancer, and lung cancer. Many of the patients treated also complained of mental changes such as sleeplessness or anxiety.
Several kinds of acupuncture and moxibustion were applied to these cases, and marked improvement was found in 14-26% of them. These treatments were more effective in the cases after radical operations than in those cases deemed inoperable due to metastasis.
10 cases (6%) were aggravated by acupuncture, though none were severe.
The side effects by acupuncture such as slight aggravation of the pain were observe in 10 cases (6%), though none were severe.

We have been studying the effect of preadministration of D-phenylalanin (DPA) on acupuncture analgesia for various types of pain. DPA is thought to suppress the activity of carboxypeptidase, which discomposes endorphins. In this double-blind placebo-controled study, clinical effectiveness of acupuncture with DPA preadministration in relieving chronic low back pain was examined.
DPA (4g) or placebo (lactose: 4g) was orally administered to thirty out patients with chronic low back or lower extremity pain 30 minutes before acupuncture treatment. A half of the patients were given placebo in the first session and DPA in the second one, and the other half were given DPA firstly and placebo secondly.
The patients were asked to rate their pain after treatment in comparison with pre-treatment condition. Successful pain relief was obtained in 60% of the patients given DPA prior to acupuncture and in 33.4% of those given placebo. Although it is said that there is a great individual variation in response to acupuncture therapy, this result demonstrates that preadministration of D-phenylalanin enhances analgesic effect of acupuncture therapy.

We encountered two patients complaining of hiccups following the resection of subaural tumor or subarachnoid hemorrhage. In one patient, we measured the autunomic nerves of Ryodoraku, and placed grains of silver on Ryodoraku points which showed abnormal values. We also used the in situ needle technique on acupoints which were considered to be closely related to the phrenic nerve. Furthermore, we inserted round-head subcutaneous needles in auricular acupoints such as “Kaku”, “Shinmon”, “Hishitsuka”, and “Jichu”. After repeating the above treatment twice, the hiccups disappeared completely. In the other patient who had difficulty even taking off clothes, a subcutaneous needle was inserted into “Kaku”, which was repeated twice a week. After five months, the hiccups disappeared completely.
Based on our experience with the two patients above, we had the impression that auricular acupuncture is particularly effective. “Kaku” was the main acupoint used, which is believed to influence the diaphragm. We believe that this technique can therefore be used clinically in the future.