[Objective]More accurate data of the relationship between the composition and distribution of the pelvic plexus and hachiryoketsu is discussed to get an effective acupuncture method.
[Methods]Detailed dissections were performed under a stereomicroscope in five cadavers belonging to the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.
[Results]1. The pelvic plexus is composed of the sympathetic hypogastric nerve and sacral splanchnic nerve, and the parasympathetic pelvic splanchnic nerve.
(1) The hypogastric nerve arises from the superior hypogastric plexus contributing constantly to the second and third lumbar splanchnic nerves, and enters the postero-superior horn of the pelvic plexus. The sacral splanchnic nerves arise from the third and fourth lumbar gangalia and enter the postero-inferior horn of the pelvic plexus.
(2) The pelvic splanchnic nerves mainly arise from the most ventral layer of the ventral primary of the third and fourth sacral nerves, and enter the postero-inferior horn of the pelvic plexus. These nerves tend to compose the common trunk with the pudendal nerve and the nerve to the levator ani.
2. The visceral branches of the pelvic plexus do not originate and distribute equally, but tend to divide into I-IV groups. Especially, group III is considered important clinically as these nerves are related to sexual and voiding functions.
[Conclusion] 1. BL33(Zhongliao, Churyo) and BL34 (Xialiao, Geryo) are suggested to have an effect on the function of the intrapelvic organs as these acupuncture points can stimulate the pelvic splanchnic nerves directly rather than BL31 (Shangliao, Joryo) and BL32 (Ciliao, Jiryo).
2. The point of the needle into the hachiryoketsu reaches the side of the rectum, so treating with a needle to the median direction should be avoided or paid attention to.

[Objective]More accurate data on the positional relationship between the acupuncture points belonging to the bladder meridian on the posterior aspect of the lower limb and their surrounding structures are discussed to get the effective methods for acupuncture.
[Methods]Detailed dissections on the surrounding anatomical structures of the acupuncture points were performed on three cadavers of the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.
[Results] 1. BL36 (Chengfu (Chinese), Shofu (Japanese)) and BL37 (Yinmen, Inmon) were situated medial to the posterior femoral cutaneous nerve and the sciatic nerve.
2. BL38 (Fuxi, Fugeki) and BL39 (Weiyang, Iyo) were situated on or near the common peroneal nerve along the media border of the biceps femoris tendon.
3. BL40 (Weizhong, Ichu), BL55 (Heyang, Goyo), BL56 (Chengjin, Shokin), BL57 (Chengshan, Shozan), BL58 (Feiyang, Hiyo), BL59 (Fuyang, Fuyo), BL60 (Kunlun, Konron), BL61 (Pucan, Bokushin) and BL62 (Shenmai, Shinmyaku) were situated along the medial sural cutaneous nerve, sural nerve and small saphenous vein.
4. BL40, BL55, BL56, BL57 were situated along the tibial nerve, the popliteal and posterior tibial arteries deep to the soleus.
[Conclusion] 1. The posterior femoral cutaneous nerve and the sciatic nerve tend to run laterally to BL36 and BL37, so it is necessary to apply the acupunctural treatment lateral to BL36 and BL37 to stimulate these two nerves.
2. The sural nerve and small saphenous vein gradually tend to approach the acupuncture points toward the distal part of the posterior aspect of the leg.
3. BL40, BL55, BL56 and BL57 are shown as the acupuncture stimulation points to the tibial nerve passing the deep part of the posterior aspect of the leg.

This report documents a case of three-channeled aortic dissection. The diagnosis of dissecting aneurysm was made by chest X-P and CT to 70-year-old man, with a chief complaint of back pain. Aortogram showed aortic aneurysm (DeBakey type IIIb), which had an entry at distal of the beginning of the left subclavian artery. Though we had given a pressure control therapy, the patient died on the 5th day of the admission. At autopsy, a new dissection was found in the chronic dissecting outer wall, forming three channeled dissection and rupture was there. Three-channeled dissection is very rare, only 8 cases including ours have been reported so far. From this case, we learned it very difficult to diagnose and treat it.

We present a rare case of a 59-year-old-man with a diagnosis of hypertrophic cardiomyopathy (HCM) complicated with left ventricular thrombus. He was admitted to our hospital because of acute re-occlusion of the right brachial artery. Thrombectomy was performed and reperfusion was obtained. Anti-coagulation therapy was started from that day. Four days after surgery, echocardiography revealed mobile thrombus in left ventricular apical aneurysm that was not detected on admission. An emergency thrombectomy and left ventriculoplasty was performed. The patient was discharged 22 days after surgery in good condition.

We report 2 cases of successful proximal reoperations after acute type A dissection. Case 1 : A 53-year-old man underwent ascending aorta and aortic arch replacement and aortic valve re-suspension for acute type A dissection with aortic valve regurgitation in 1992. Thirteen years after the first operation, computed tomography demonstrated a Valsalva aneurysm (74 mm) and Doppler echocardiography showed moderate aortic valve regurgitation. Therefore, we performed an operation. We could not locate the dissection in the Valsalva sinus, and the aortic valve cusps had organic change. A David procedure was performed. The postoperative course was uneventful and he was discharged on the 19th postoperative day. Case 2 : A 65-year-old woman underwent ascending aorta replacement and aortic valve resuspension for acute type A dissection with aortic valve regurgitation in 1997, but 11 years after the first operation, computed tomography demonstrated a Valsalva aneurysm (55 mm) and arch aneurysm (65 mm) with stenosis of the innominate vein and she had facial and left arm edema. Doppler echocardiography showed moderate aortic valve regurgitation. We could not find the location of dissection in the Valsalva sinus or aortic arch, and aortic valve cusps had no organic change. A Bentall procedure and total arch replacement were performed and her postoperative course was uneventful.

[Objective]More accurate anatomical data is discussed to reveal the surrounding structures of the new and former BL54 (Zhibian, Chippen) according to the positional modification of acupuncture points by WHO (2006), and also to demonstrate the acupuncture stimulation points to the sciatic nerve as effective methods for acupuncture treatment of the pain in the lower back.
[Methods]Detailed dissections were performed on the surrounding structures of the acupuncture points of the bladder meridian at the gluteal region and the posterior aspect of the thigh in three cadavers at the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.
[Results] 1. The new BL54 (WHO, 2006) was situated at or near the infrapiriform foramen, with the posterior femoral cutaneous nerve, inferior gulteal nerve and vessels and sciatic nerve passing through.
2. The former BL54 was situated at or near the suprapiriform foramen with the inferior gulteal nerve and vessels passing through.
3. The acupuncture stimulation points to the sciatic nerve at the gluteal region and the posterior aspect of the thigh were as follows;(1) the initial portion of the sciatic nerve, (2) the infrapiriform foramen (new BL54, WHO), (3) the lateral one third point of the line connecting the sacrococcygeal junction and the greater trochanter, (4) the midpont of the line connecting the ischial tuberosity and the greater trochanter, (5) the point about 1 cm lateral to BL36 (Chengfu, Shofu), (6) the medial half portion of the biceps femoris muscle lateral to BL37 (Yinmen, Inmon).
[Conclusion] 1. The new and former BL54 are situated near the main nerves and vessels of the gluteal region and the posterior aspect of the thigh, so are considered as effective points for the acupunctural treatment.
2. The six positions are showed as the acupuncture stimulation points to the sciatic nerve in the gluteal region and the posterior aspect of the thigh.

There were 16 patients who developed acute renal failure (ARF) follwing cardiovascular operation using extracorporeal circulation. They were treated by either CPD or CAVH because their ARF were resistant to medical treatment. These patients were divided into three groups according to their treatment; 7 patients treated by CPD (Group A), 5 patients treated both CPD and CAVH (Group B), 4 patients treated by CAVH (Group C). The survival rate was 33% in Group A, 20% in Group B, and 0% in Group C. The prognosis of the each group was poor. CPD and CAVH were effective to control the concentration of serum potasium and water removing. But CPD and CAVH were not very effective to control the concentrations of serum creatinine and blood urea nitrogen. There were three patients who developed low proteinemia which was one of the side effects of CPD. Seven of nine patients treated by CAVH, developed bleeding. The side effects of CAVH were seemed to be more severe than those of CPD.

BACKGROUND/AIMS: There are few reports on the correlation between chewing gum and the gastrointestinal functions. But previous report showed use of chewing gum to be an effective method for controlling gastrointestinal symptoms. The aim of this study was to determine the correlation between chewing gum and gastric emptying using the continuous real time 13C breath test (BreathID system). METHODS: Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to chewing gum (Xylish, 2-3/1 tablet) for an hour following intake of a test meal (200 kcal/200 mL) or intake of the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal by the 13C-acetic acid breath test performed continually using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, T1/2 (median, 111.82 vs 109.26 minutes; P = 0.575), Tlag (median, 53.28 vs 56.53 minutes; P = 0.333), gastric emptying coefficient (median, 3.58 vs 3.65; P = 0.285), regression-estimated constant beta (median, 1.85 vs 1.80; P = 0.575) and regression-estimated constant kappa (median, 0.61 vs 0.62; P = 0.959) were observed between the test meal alone group and the test meal and chewing gum group. CONCLUSIONS: This study showed that chewing gum had no effect on the rate of gastric emptying. Therefore, since chewing gum did not enhance the speed of gastric emptying, it may ameliorate gastrointestinal symptoms through other mechanisms, such as saliva and autonomic nervous system.
Autonomic Nervous System ; Breath Tests ; Chewing Gum ; Cross-Over Studies ; Gastric Emptying ; Humans ; Male ; Mastication ; Meals ; Saliva

BACKGROUND/AIMS: The aim of this study was to examine the convenience of the quality of life and utility evaluation survey technology (QUEST) questionnaire and the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) questionnaire as self-assessment diagnostic instrument. METHODS: This was a two-way crossover study conducted over 6 weeks from September 2010 to November 2010. The subjects were 60 consecutive patients admitted to the Hiratsuka city hospital with a gastrointestinal condition, regardless of the coexistence of heartburn. They were assigned to fill in both the QUEST and FSSG questionnaires in random order. We analyzed the time taken to complete the questionnaires, whether subjects asked any questions as they filled in the questionnaire, and the questionnaire scores. RESULTS: Comparison of the QUEST and the FSSG revealed significant differences in the completion time (196.5 vs. 97.5 seconds, respectively; P < 0.0001) and in whether subjects asked any questions (37 vs. 15 subjects, respectively; P < 0.0001). Completion time in QUEST scores of > or = 4 was lower than < 4 (170.5 vs. 214.0 seconds, respectively; P = 0.022), and the QUEST score was significantly higher without questions than with question (3 vs. 1 points, respectively; P = 0.025). CONCLUSIONS: This study revealed that the FSSG questionnaire may be easier for Japanese subjects to complete than the QUEST questionnaire.
Asian Continental Ancestry Group ; Cross-Over Studies ; Gastroesophageal Reflux ; Heartburn ; Hospitals, Urban ; Humans ; Quality of Life ; Surveys and Questionnaires ; Self-Assessment

BACKGROUND/AIMS: The effects of Histamine-2 receptor antagonists and proton pump inhibitors on the gastrointestinal motility have not yet been sufficiently investigated. The aim of this study was to determine the effects of intravenous bolus administration of famotidine and omeprazole on the rate of gastric emptying using the continuous 13C breath test (BreathID system, Exalenz Bioscience Ltd, Israel). METHODS: Twelve healthy male volunteers participated in this randomized, 3-way crossover study. After fasting overnight, the subjects were randomly assigned to receive 20 mg of famotidine, 20 mg of omeprazole or 20 mL of saline alone by intravenous bolus injection before a test meal (200 kcal per 200 mL, containing 100 mg of 13C-acetate). Gastric emptying was monitored for 4 hours after the ingestion of test meal by the 13C-acetic acid breath test performed using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, the T1/2, Tlag, GEC, beta and kappa, were observed among the 3 test conditions. CONCLUSIONS: The study revealed that intravenous administration of gastric acid suppressant drugs had no significant influence on the rate of gastric emptying in comparison with that of saline alone as a placebo. Our results indicating the absence of any effect of either famotidine or omeprazole on accelerating the rate of gastric emptying suggest that both medications can be administered safely to patients suffering from hemorrhagic peptic ulcers who need to be kept nil by mouth from the viewpoint of possible acceleration of gastrointestinal motility in the clinical setting.
Acceleration ; Administration, Intravenous ; Breath Tests ; Cross-Over Studies ; Eating ; Famotidine ; Fasting ; Gastric Acid ; Gastric Emptying ; Gastrointestinal Motility ; Humans ; Male ; Meals ; Mouth ; Omeprazole ; Peptic Ulcer ; Proton Pump Inhibitors ; Proton Pumps ; Protons ; Stress, Psychological