I. Purpose:
Individual differences in effects of acupunctual anesthesia during uterine endometrial biopsy were tested by means of the modified methods of Cornell Medical Index (CMI-test).
II. Methods:
Two hundred forty eight patients were examined for this tests for three years since Dec. 1982. Needles for acupuncture were applied into Ashisanri (Zusanli) and Saninko (Sanyinjiao.) After careful recognition of sufficient Tokkuki (The chih) following acupuncture, stick-points of needles were lead to Neurometer NAJ.
After approximately 30 minutes of electrical induction, biopsical operation were started. Anesthetical effectiveness of acupuncture were confirmed as follows:
(1) During biopsy, facial features what to speak, body movements, sweating, and condition of anesthesia of patients were observed and checked on the specialized score table in order from zero to 28 points. Acquired points less than 11 were indicated as effective anesthesia.
(2) Following operation the inquires about grade of pain feeling during biopsical procedures were carried out and then they were classified into four ranks: no pain, slight pain. moderate pain and strong one. The last two were considered as no effective.
(3) In addition to the above mentioned two, CMI-test was performed.
III. Results:
From score points; The effectiveness was as follows, normal type group, 79%; subnormal, 77%; breaking down of autonomic nerve system, 44%; neurosis, 86%; psychosomatic type, 68%.
On the other hand, from inquires the following were obtained: normal 65%; subnormal 50%; autonomic nervous disorder, 19%; neurosis, 41% and psychosomatic type, 37%.
There is no critical differences between both results from score points and inquiry system.
It is concluded from results that acupunctual anethesia were not much effective in patients who have disorders of autonomic nervous system and psychosomatic system, while much effective in patients with neurosis.

(1) Some improvements were made in the score table used for evaluation of effectiveness in the previous studies.
(2) The number of the cases evaluated was incresed.
(3) The difference in effectiveness of acupuncture anaesthesia and the doctors' skill of operation, the factor which influences painfulness, were also examined.
(4) The measurement of palm-forearm skin potential was employed as an objective evaluation of pain.
METHODS
Acupuncture anaesthesia was undertaken using Neurometer NAJ. Induction was done through Chinese needles (2 inch no. 28) inserted on Zusanli and Sanyinjiao for 20 minutes.
The evaluation was done on 413 cases which underwent intrauterine curettage under acupuncture anaesthesia in 1982-1985.
The evaluation of the effectiveness was carried out in two ways: (1) using scores based on the observation of patient's expression of the face and other signs, and (2) subjective evaluation (questionnaire) during the operation.
The skin potential was measured between the electrodes applied to the palm and the forearm using ECG (Fukuda-DU3S).
The relationship was examined between the potential and pain during the operation was examined. (10mm-25mm/sec, 0-8mmV)
RESULT
(1) As a result of the improvement in the score table, the effectiveness rate obtained from the questionnaire and that from the score table were close enough to conough to confirm its utility.
(2) Less effectiveness of acupuncture anaesthesia was obtained in the patients classified into the “type of unbalanced autonomic nervous system” according to the classification of the CMI test modified by Majima. This result was coincide with the previous report.
(3) Among five doctors, one obtained the best effective rate of 63%, and others got those of 14-26%.
(4) In the measurement of the potential between the palm and the forearm, values of 0.1-8.0mV appeared. Although there was a tendency that the severer the pain was, the higher the potential was, the actual value of this measurement as a rating method is to be examined.

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.

Purpose:
We previously reported that using D-phenylalanine (D-PA) as a pre-medication increasingly enhanced acupuncture aneshesia effects occur. In order to investigate this effect clinically, we performed tooth extractions under acupuncture anesthesia using D-PA as a premed.
Method:
We divided the patients in the oral surgery department of our hospital for whom acupuncture-moxibustion was determined indicated, into 2 groups, a test group (9cases) to which D-PA (4.0g) was administered 30minutes prior to acupuncture anestesia, and an acupuncture anesthesia only group (about 31cases), and comparitively examined results.
The points used were: LI-4 on both sides in all cases, and indicated local points selected from among JOKAN, ST-7, GV-26, ST-2, LI-20, CV-24, ST-6, SI-18 and ST-5. Needles were inserted (in some cases a point surface electrode was used) and the acupuncture sensation aroused, following which low frequency current at 3-15Hz was administered.
The tooth extractions were begun about 30minutes later. The standard for determining results was a score of 1=absolutely no pain, 2=slight pain, 3=very painful, 4=a small amount of local anesthesia administered, as supplement, 5=attempt to use acupuncture anesthesia abandoned.
Results:
In the control group effective results (score 1 or 2) were obtained in about 30% of the cases while in the test group there was almost no need for supplementary local anesthesia and generally effective results were obtained in most cases.
Summary:
The results were more excellent in the group in which D-PA was used as a pre-med for tooth extractions with acupuncture anesthesia than in the group in which it was not used.

OBJECTIVE: It is well documented that clozapine treatment causes agranulocytosis, but it can also induce drowsiness, constipation, and hypersalivation; however, these symptoms are usually less severe. It has been reported that clozapine-treated patients with schizophrenia and psychiatric healthcare professionals consider different side effects to be important. The aim of this study was to assess current practice related to the side effects of clozapine in clozapine-treated patients with schizophrenia and psychiatric healthcare professionals in Japan. METHODS: Data were collected from January 2014 to August 2015 in Okehazama Hospital, Kakamigahara Hospital, and Numazu Chuo Hospital. Clozapine-treated patients with schizophrenia and psychiatric healthcare professionals (psychiatrists and pharmacists) were enrolled in this study. RESULTS: Of the 106 patients and 120 psychiatric healthcare professionals screened, 100 patients and 104 healthcare professionals were included in this study. We asked the patients what side effects caused them trouble and we asked psychiatric healthcare professionals what side effects caused them concern. The patients and psychiatrists held similarly positive views regarding the efficacy of clozapine. The healthcare professionals were concerned about agranulocytosis (92.4%), blood routines (61.3%). On the other hand, the patients experienced hypersalivation (76.0%), sleepiness (51.0%). A positive correlation (R=0.696) was found between patient satisfaction and DAI-10 score. CONCLUSION: Patients experienced more problems than healthcare professionals expected. However, usage experience of clozapine healthcare professionals tended to have similar results to patients. It is necessary that all healthcare professionals fully understand the efficacy and potential side effects of clozapine. This is very important for promoting clozapine treatment in Japan.
Agranulocytosis ; Clozapine* ; Constipation ; Delivery of Health Care* ; Hand ; Humans ; Japan* ; Patient Satisfaction ; Psychiatry ; Schizophrenia* ; Sialorrhea ; Sleep Stages

Clozapine has been demonstrated to be useful for treating refractory schizophrenia. However, hypersalivation occurs in 31.0-97.4% of the patients treated with clozapine. Accordingly, some patients who are disturbed by their hypersalivation refuse to continue with clozapine treatment. This study investigated the efficacy of the anticholinergic agent scopolamine butylbromide against clozapine-induced hypersalivation. Five schizophrenia patients were coadministered scopolamine butylbromide (30-60 mg/day) for 4 weeks. At the baseline and after 4 weeks' treatment, we subjectively evaluated hypersalivation using a visual analog scale and objectively assessed it using the Drooling Severity Scale and Drooling Frequency Scale. As a result, improvements in the patients' Drooling Severity Scale and Drooling Frequency Scale scores, but no improvements in their visual analog scale scores, were observed after scopolamine butylbromide treatment. These results indicate that at least some schizophrenic patients with clozapine-induced hypersalivation would benefit from scopolamine butylbromide treatment. We conclude that clozapine-induced hypersalivation is one factor of stress to patients. Subjective hypersalivation was not improved, but objective hypersalivation was, by scopolamine butylbromide treatment. However, scopolamine butylbromide and clozapine possess anticholinergic effects so clinicians should closely monitor patients who take scopolamine butylbromide.
Clozapine ; Humans ; Schizophrenia ; Scopolamine Hydrobromide* ; Sialorrhea* ; Visual Analog Scale

OBJECTIVE: This study examined the utility of adenine for preventing clozapine-induced neutropenia. METHODS: This retrospective study examined the effect of adenine on clozapine-induced neutropenia in patients with treatment-resistant schizophrenia and was conducted at Okehazama Hospital in Japan from July 2010 to June 2013. Adenine was available for use from June 2011 onwards. Twenty-one patients started receiving clozapine treatment from July 2010 to April 2011 (the pre-adenine adoption group), and 47 patients started receiving it from May 2011 to June 2013 (the post-adenine adoption group). The effects of adenine were assessed based on changes in the patients' leukocyte counts and the frequency of treatment discontinuation due to clozapine-induced neutropenia. RESULTS: Sixty-eight patients were treated with clozapine from July 2010 to June 2013. Of the 21 patients in the pre-adenine adoption group, 4 discontinued treatment due to clozapine-induced neutropenia, whereas only 2 of the 47 patients in the post-adenine adoption group discontinued treatment. The frequency of treatment discontinuation due to clozapine-induced neutropenia was significantly lower in post-adenine adoption group than in the pre-adenine adoption group (p=0.047). CONCLUSION: Adenine decreased the frequency of treatment discontinuation due to clozapine-induced neutropenia. Our data suggest that combined treatment with clozapine and adenine is a safe and effective strategy against treatment-resistant schizophrenia.
Adenine* ; Clozapine ; Humans ; Japan ; Leukocyte Count ; Neutropenia* ; Retrospective Studies ; Schizophrenia*

OBJECTIVE: The adverse effects of antipsychotic agents can have a marked influence on medication adherence. In this study, we investigated the adverse events of antipsychotics that are less likely to be reported by patients and the reasons why such symptoms remain latent. METHODS: Data were collected by interviewing patients using a subjective questionnaire, and the associations between unreported symptoms and background factors were investigated. RESULTS: A total of 306 patients with schizophrenia or schizoaffective disorder were examined. Their major symptoms were daytime sleepiness (50.0%), weight gain (42.2%), and sexual dysfunction (38.9%). Sexual dysfunction was nominal significantly more common among the patients that had been treated with antipsychotic agent polypharmacy (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.07 to 4.30), and was nominal significantly more common among outpatients (OR, 1.78; 95% CI, 1.02 to 3.13). Only approximately 30% of the patients had reported their symptoms to their physicians. CONCLUSION: Patients receiving antipsychotic treatment tolerate some symptoms and do not feel able to report them to their physicians. The most common reason for this is an insufficient patient-physician relationship. Sexual dysfunction is especially hard to identify because it is a delicate problem, and our findings demonstrate that subjective questionnaires are helpful for detecting such symptoms.
Antipsychotic Agents ; Asian Continental Ancestry Group* ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Medication Adherence ; Outpatients ; Polypharmacy ; Psychotic Disorders ; Schizophrenia* ; Surveys and Questionnaires ; Weight Gain