At the acupuncture clinic, we sometimes eneounted some out patients who complained that their symptoms did not improve in spite of treatment and medication.
Two patients that we had treated several times complained they were not any better. They had chronic obstinate pain.
We examined them carefully, and found one of them had cancer of the sacrum, the other had a braintumor.
It is necessary to suspect the existence of organic disease when examining a patient who has chronic obstinate pain.
From this case report, we emphasize some effects of therapeufic diagnosis during acupuncture therapy.

The combined superior transsseptal approach (CSTA) has been used for 12 mitral or left atrial myxoma operations. This approach provided excellent exposure of the mitral valve or myxoma. This approach was compared with the transseptal and left atrial approaches in 1 and 3 cases, respectively. There were no differences in operative time, cardiopulmonary bypass time, anoxic time, bleeding volume, blood transfusion volume and postoperative arrhythmic complications. We use CSTA for cases with tricuspid valve disease, small left atrium, reoperation and left atrial myxomas.