We describe our surgical experience of localized thoracoabdominal aneurysm in a 60-year-old woman with hypertension and hyperlipidemia. She was admitted for severe nausea associated with uremia. The initial CT scan revealed bilateral hydronephrosis, retroperitoneal fibrosis, inflammatory abdominal aneurysm, and localized thoracoabdominal aneurysm. To resolve the bilateral urinary tract obstruction, bilateral ureteral stents were inserted. After the renal function improved, the thoracoabdominal aneurysm was removed and replaced with an 18-mm woven-Dacron graft under partial cardiopulmonary bypass. The inflammation and fibrosis along the abdominal aorta did not extend to the thoracoabdominal aneurysm. Following the case presentation, we discussed the pathophysiologic aspects of this patient.

[Objective and method] We developed a questionnaire for 117 second graders in the fiscal year of 1999 in order to perform curriculum evaluation of Meridians and Acupuncture Points. Furthermore, based on the result, a part of the curriculum was changed and the effect was examined. Curriculum evaluation, using the same questionnaire which in the fiscal year of 1999, was performed for 117 second graders in the fiscal year of 2000, and compared with the results in the fiscal year of 1999.
[Results] Of the items addressed, “Teachers were eager”, “Teachers responded to the question or consultation well”, and “Materials were useful to understanding” had higher scores. On the other hand, “Time was spent effectively”, “Progress of the lesson was suitable”, “The class was well prepared” and “Time to perform practical skills was suitable” had lower scores. After the change of the curriculum method, the results indicated that the following items; “The class was well prepared”, “Time was spent effectively”, “Teachers responded to the question or consultation well”, “Progress of the lesson was suitable”, “Time to perform practical skills was suitable” and “Materials were useful to understanding” showed a significant increase in the affirmative opinion as compared with the fiscal year of 1999.
[Conclusion] The curriculum evaluation by the students was useful for improvement of the curriculum and increased the students' motivation to study.

[Objective] Using a near infrared spectrometer and laser Doppler blood flowmeter, we investigated how the number of moxa applications influences blood flow at moxibustion and peripheral sites.
[Method] The subjects were nine healthy adult males, aged 25-28 years (average age 25.4). Skin blood flow was measured with a laser Doppler blood flowmeter while changes in the deep tissue (deep subcutaneous level and muscle surface course level) blood volume were measured with a near infrared spectroscopy. Each of the probes was located at the moxibustion treatment site and 20 mm away from the site.
On different days, measurements were taken from a control group not receiving stimulation, groups receiving five-cone and seven-cone moxibution (2 mg of moxa per application), respectively.
Measurements of the control group were taken for 25 minutes, while measurements for the other two groups were taken for 5 minutes before conducting moxibustion and for 20 minutes directly after completion of moxibustion.
[Results and Discussion] The skin blood flow demonstrated an further increased tendency after seven-cone moxibustion than five-cone moxibustion. This seemed to be due to the strong flare phenomenon affecting cutaneous blood flow quantity by increasing the number of moxibustion cones.
The effect of moxibustion on skin blood flow volume is suggested to be due to the strong flare phenomenon induced by increasing the number of moxibustion. The effect to the deep tissue indicated a tendency for the blood flow volume to decrease.
It is considered that further detailed experiment will be necessary in the future regarding these ambiguous points.

To clarify the recovery patterns of spontaneous activity and liver damage after different stressors, female Fischer 344 rats were treated with Propionibacterium aches (P, aches) or water immersion stress before lipopolysaccharide (LPS) injection. They were then examined for wheel running activity, serum corticosterone concentration, serum alanine aminotransferase (ALT) activity, histological appearance of liver and plasma tumor necrosis factor alpha (TNF-a) concentration.
The recovery in physical activity of P. aches-treated rats was faster than that of water immersion rats. One day after the stressors, serum corticosterone cancentration and ALT activity of P. acnes-treated rats were higher than that of water immersion rats. In addition, increases in serum ALT activity and plasma TNF- a, as well as massive necrosis of the liver in P. acnes-treated rats were observed seven days after stress treatment. The P. acnes-LPS rats also showed a reduction in survival rate after 24 hours. These results suggest that P. acnes stress causes serious inflammation when stimulated by LPS. Although rapid recovery in physical activity was not inhibited by P. acnes stress, it differed from the response of water immersion stress.

To clarify the recovery patterns of spontaneous activity and liver damage after different stressors, female Fischer 344 rats were treated with Propionibacterium aches (P, aches) or water immersion stress before lipopolysaccharide (LPS) injection. They were then examined for wheel running activity, serum corticosterone concentration, serum alanine aminotransferase (ALT) activity, histological appearance of liver and plasma tumor necrosis factor alpha (TNF-a) concentration.
The recovery in physical activity of P. aches-treated rats was faster than that of water immersion rats. One day after the stressors, serum corticosterone cancentration and ALT activity of P. acnes-treated rats were higher than that of water immersion rats. In addition, increases in serum ALT activity and plasma TNF- a, as well as massive necrosis of the liver in P. acnes-treated rats were observed seven days after stress treatment. The P. acnes-LPS rats also showed a reduction in survival rate after 24 hours. These results suggest that P. acnes stress causes serious inflammation when stimulated by LPS. Although rapid recovery in physical activity was not inhibited by P. acnes stress, it differed from the response of water immersion stress.

Those women underwent removal of splenic artery aneurysm. One of them was admitted because of intraperitoneal bleeding. Further examination showed rupture of a splenic artery aneurysm with the delayed rupture phenomenon. Emergency laparotomy was perfomed. Splenic aneurysmectomy and splenectomy were successfully carried out. The two other cases of splenic artery aneurysm were detected accidentally. One was complicated by aortic abdominal aneurysm and the other by cholelithiasis. Each patient received two different types of operations at the same time. Splenic aneurysm is likely to be overlooked because of lack of symptoms. However, even a small aneurysm has the possibility of rupture. Therefore, an early operation is recommended.

[Objective]The present study investigated the relationship between subjective symptoms of katakori (shoulder stiffness) and shoulder hardness which was examined both with clinical palpation and a mechanical device, as well as the correlation between these two measurements.
[Methods]Subjects were enrolled to the study if they had a stiff shoulder on the day of the visit (katakori group, n = 60) or if they had no experience of katakori in their lifetime (non-katakori group, n = 10). The intensity of the katakori was evaluated with a visual analogue scale (VAS). Shoulder hardness was evaluated at acupoint Jianjing (GB21) and at the point where the subject felt the most intensive symptom by both palpation of experienced acupuncturists who were unaware of the allocation and a hardness meter. The method of acupuncture treatment was decided by acupuncturists who were not an evaluator of the hardness.
[Results and Discussion]There was no significant relationship in the hardness measured with the device and palpation between the katakori group and non-katakori group. Also, the intensity of katakori (VAS) and the changes after treatment showed no significant correlation with the hardness and its changes. These results support the validity of our clinical experience that patients who complain of severe shoulder stiffness do not always have a hard shoulder.

We evaluated the efficacy of evoked spinal potential (ESP) monitoring during thoracoabdominal aortic replacement to prevent intra-operative spinal ischemia. Nine patients underwent intraoperative ESP monitoring. The ESP was unchanged in 5 patients and decreased in 4 patients. However, ESP recovered in 2 of them by the following techniques: (1) perfusion of intercostal arteries, (2) elevation of distal bypass perfusion pressure, (3) slight hypothermia. Postoperative paraplegia occurred only 1 patient of the 2 whose ESP was not restored. The sensitivity and specificity of the efficacy of ESP monitoring were 100% and 87.5%, respectively. We concluded that ESP is the most useful monitoring for prevention of operative spinal ischemia during thoracoabdominal aortic replacement.

Effects of acupuncture on SHENSHU were examined in Gromerular Filtration Rate (GFR) by creatinine clearnce tests, urinary volume, urinary substancce (Na, K, Cl, Cre, BUN, UA) and plasma substance (the same substance as urines) on 7 normal examinees. The subjects were divided in two experimental groups (control and stimulation on SHENSHU).
Except for K level in plasma, there had not been found a significant change. However, urinary volume had a tendency to increase. Plasma K level at 90 minute in stimulation group showed a statitical increase. The results were as follows. Compared with control group, There was no significant change in GFR, urinary volume, urinary substance levels, plasma levels except for plasma K level.