[Background] Although we have demonstrated the clinical effect of acupuncture therapy with epidermal stimulation by needle penetration, its neurophysiological mechanisms are unclear. To investigate the clinical effects of epidermal stimulation by needle penetration on muscle tone, we tested the Hoffmann's reflex (Hreflex) of the soleus muscle during epidermal needle stimulation.
[Methods] Eighteen healthy participants were recruited. We tested the soleus H-reflex elicited by tibial nerve stimulation before and after epidermal stimulation by needle penetration. Epidermal stimulation was performed at several points on the Achilles tendon by needle penetration. We analyzed the amplitude ratio of H/M obtained from the waveforms of the soleus muscle before and after epidermal stimulation.
[Results] The amplitude ratio of H/M was significantly decreased during stimulation when compared with ratio during rest (p < 0.05). Each participant demonstrated a decrease in soleus muscle amplitude ratio of H/M during epidermal stimulation by needle penetration as compared with the ratio during rest.
[Discussion] Epidermal stimulation of the muscle by needle penetration activated the inhibitory interneurons of the dermatome at the stimulation site. Therefore, epidermal stimulation by needle penetration was considered as a possible method to induce muscle relaxation.
[Conclusion] It is suggested that epidermal stimulation by needle penetration for 2 minutes for the insertion of the Achilles tendon results in an inhibitory effect by stimulating the spinal cord neural mechanisms that correspond to the soleus muscle.

Objective/Design: The purpose of this study was to confirm the effect of herbal tea therapy on Ménière’s disease. We studied 15 patients with Ménière’s disease who came to the International University of Health and Welfare MITA hospital between 2007 and 2008.
Methods: According to criteria of the Japan Society for Equilibrium Research, all patients were diagnosed as having Ménière’s disease and underwent otoneurologic examination, audiometric measurements, questionnaires of functional level and tinnitus every month. Moreover, we instructed these patients to keep a record of the number of times vertigo was experienced. After 6 months of general treatment, we treated patients with herbal tea for one year. This herbal tea was effective as a diuretic, in promoting antivertigo, and relaxing. We compared results before and after herbal tea therapy.
Result: Herbal tea therapy was effective in about 10 patients, but 5 patients relapsed. However, symptom of the relapsed patients improved after using less medicine, although the quantity of medication was less than before starting the herbal tea therapy. Herbal tea therapy improved their Ménière’s symptoms, especially vertigo after 6 months from starting herbal tea therapy.
Conclusion: Our study provides evidence that herbal tea therapy is useful for preventing worsening of Ménière’s disease.

A case report of spontaneous dissection of the superior mesenteric artery (SMA) in a 53-year-old man who complained of sudden colic-midabdominal pain is presented. In this case, ultrasonography is very usefull for early diagnosis of dissection, and this is successfully treated by Ao-AMS bypass with excision of the proximal segment of SMA. Postoperatively the patient has no symptoms for 2 years.

Two cases of abdominal lymphatic disruption following surgery on the abdominal aorta are presented, one causing para-aortic lymphocyst and the other resulting in chylous ascites. The 1st patient ultimatery received operative drainage into the lymphocyst. The 2nd patient responded to twice paracentesis and total parenteral nutrition for one month. We need to be aware of these complications and pay attention to prevention and early diagnosis.

To determine the usefulness of arterial reconstruction, we studied the outcome of 430 patients with arteriosclerosis obliterans who had received either arterial reconstructive surgery or medical treatment. Of the 430, 301 patients were treated for intermittent claudication and 162 for limb-threating ischemia (rest pain or ischemic gangrene). Of the intermittent claudication patients 274 underwent arterial reconstruction and 27 were treated with anticoagulant therapy. In limb-threating ischemia, 137 patients underwent arterial reconstruction and 25 were treated with anticoagulant therapy. Among the 274 intermittent claudication patients treated by arterial reconstruction, none required major amputation within 30 days after surgery. Operative mortality was 1.1%. Five- and ten- year comulative patency rates were 95.4%, 94.3% in aortofemoral bypasses, 72.7%, 67.5% in aortofemoropopliteal bypasses, 79.7%, 77.9% in femoropopliteal bypasses and 92.3%, 92.3% in femorotibial bypasses, respectively. On long-term results, 86.4% improved and 5.9% deteriorated. Five patients (1.4%) underwent major amputation during the follow-up period due to graft occlusion. Four of 5 amputations involved patients whose initial reconstruction method was femoropopliteal bypass. In 27 patients treated medically, 77.8% did not show any change in symptoms and 22.2% deteriorated during the follow-up period. Two patients (5.6%) underwent bypass grafting in the late phase. Of 137 patients with limb-threating ischemia treated by arterial reconstruction, 3.3% required major amputation in the early postoperative period. Operative mortality was 5.1%. Five- and 10-year cumulative patency rates were 83.3%, 79.7% in aortofemoral bypasses, 65.5%, 65.5% in aortofemoropopliteal bypasses, 76.2%, 63.9% in femoropopliteal bypasses and 38.6% in femorotibial bypasses, respectively. In long-term results, 62.3% improved and 12.6% deteriorated. Thirteen patients (8.6%) underwent major amputation during the follow-up period. In 25 patients with limb-threating ischemia treated medically, 16.0% died during their hospital stay and 33.3% required major amputation during the follow-up period. Five- and 10-year cumulative survival rates in arterial reconstruction patients were 77.4%, 57.6% in intermittent claudication patients and 64.3%, 41.5% in limb-threating ischemia patients, respectively. The survival rate in limb-threating ischemia was significantly lower than that in intermittent claudication. The results of reconstructive surgery for intermittent claudication were better than those of medical treatment. However, 4 femoropopliteal bysass cases required major amputation in the late phase. This suggests that it is difficult to determine the indications for infrainguinal artery reconstruction in intermittent claudication. Arterial reconstructive surgery for limb-threating ischemia was useful for salvaging the limbs. In these patients, careful perioperative treatment was necessary. Limb salvage rate and survival rate in limb-threating ischemia patients were poorer than those in intermittent claudication patients. We recommend performing arterial reconstructive surgery for disabling claudication before the patient progresses to limb-threating ischemia.

In cases of stent-grafting for ruptured aneurysm, endoleak is a serious problem. We report 2 cases of ruptured aneurysms that were treated with endovascular stent-graft placement. Case 1: A 79-year-old woman had a ruptured thoracic aortic aneurysm that was treated with endovascular stent-grafting from the distal arch to the descending aorta. Although her infra-operative course was uneventful, she died suddenly the day after operation. Autopsy revealed re-rupture of the aneurysm due to endoleak from the proximal site. Case 2: An 84-year-old woman was treated with endovascular stent-grafting for ruptured abdominal aortic aneurysm. The stent-graft was inserted from the infra-renal abdominal aorta to the right common iliac artery with femoro-femoral crossover bypass placement. There was evidence of type II endoleak that occurred via the left internal iliac artery (IIA) and inferior mesenteric artery (IMA) 16 days after surgery. A CT scan performed 6 months after surgery revealed an increase in aneurysm size and persistent type II endoleak. Both embolization of the aneurysmal sac through the IMA and surgical ligation of the IMA failed, and endoleak from the IMA persisted. Re-rupture of the aneurysm occurred 10 months after initial surgery and emergency open surgery was performed. In stent-grafting for ruptured aneurysms, only the thrombus outside the graft resists the pressure caused by the endoleak. We conclude that endoleak after stent-grafting for ruptured aneurysm should be treated completely as soon as possible because of the risk of re-rupture.

A 64-year-old woman who had a fever and low back pain was referred to our institution. Abdominal computed tomography revealed a low density area around the aorta and inferior mesenteric artery and liver abscess. Under the diagnosis of mycotic abdominal aneurysm, intravenous administration of antibiotics was started and her symptoms improved. On the 12th day after admission, the patient developed hematemesis and an emergency CT scan revealed enlargement of the low density area around the aorta and dilatation of the inferior mesenteric artery diameter to 16mm. Urgent operation was performed under the diagnosis of impending rupture of the mycotic aneurysm. Necrotic tissue and hematoma was recognized outside the aorta, and this mass firmly adhered to the duodenum. Communication between the abdominal aorta and the duodenum through the inferior mesenteric artery was confirmed. The infected aneurysmal area of the aorta was almost completely resected by closing the infra-renal aorta and terminal aorta above the bifurcation and a left axillo-femoral bypass was established. The culture of the necrotic tissue revealed Klebsiella pneumoniae. Antimicrobial therapy was continued and the patient was discharged from the hospital on postoperative day 46. Because the mortality rate of mycotic aneurysm penetrating to the duodenum is high, early diagnosis and treatment is important. We present a successfully treated case of mycotic aneurysm in which the formative course was observed from an early stage of infection. We observed the process of mycotic aneurysm formation and aorto-duodenal fistula generation despite antibiotic therapy. Close observation of periaortic inflammation and early surgical intervention is necessary in such patients.

There is a theory that excessive treament for terminally ill patients is one of the factors in soaring medical costs. To evaluate this theory, we examined the changes in medical expenditures for our inpatients: 41 patients with lung cancer and 69 patients with liver cancer hospitalized for treatment of the department of internal medicine, and 90 patients with stomach cancer and 100 patients with colon cancer hospitalized for surgery from July to December 1997. They were divided to two groups: the patients of group A received active treatment, and the patients of group B received conservative treatment. We selected 10 people randomly from each group, and compared the changes in medical costs.
The cost was significantly low in group B compared with group A. We examined the change in the cost every 5 days. Until 6 days before leaving our hospital, the cost is high sugnificantly in group A compared with group B. The difference between group A and group B in the cost of treatment for lung cancer, and stomach cancer patients disappeared in 5 days before leaving hospital. The cost of treatment for lung and liver cancer patients of group A was a little higher than the average hospitalization fee of internal medicine. Also, the cost of group A stomach cancer patients was a little higher than the averge hospitalization fee of surgery, though there was no difference between the cost of treatment for group A colon cancer patients and the average hospitalization feeof surgery. The fee of group B of either disease was half or less of an average fee for medical treatment.
From this study, no evidence was found that the excessive life prolongation treatment for terminally ill patients was done. So, using authentic data, we should discuss the justifiability of the theory that the excessive treatment for terminally ill patients is one of the factors contributing to a boost in medical costs.

The combination effects of chloroquine with Cepharanthin^® or minocycline hydrochloride were evaluated against a blood-induced infection with chloroquine-resistant P. berghei NK 65 in ICR mice. The infected mice in an untreated control group showed a progressively increasing parasitemia leading to mouse death. A two-day dosage of 20 mg base/kg of chloroquine alone produced little effect against P. berghei NK 65 infection, and all mice died from day 13 to 15 with an increasing parasitemia. A four-day dosage of 4 mg/kg of Cepharanthin^® alone produced no antimalarial activity, and all mice died by day 10. A four-day dosage of 50 mg/kg of minocycline hydrochloride alone produced a slight effect, but all mice died by day 18. Furthermore, mice given chloroquine in combination with Cepharanthin^® died from day 14 to 15. Mice given Cepharanthin^® plus minocycline hydrochloride also died from day 15 to 17. On the other hand, infected mice treated with chloroquine plus minocycline hydrochloride survived during the experiment. All mice treated with chloroquine alone, minocycline hydrochloride alone, chloroquine plus Cepharanthin^® or Cepharanthin^® plus minocycline hydrochloride showed low parasitemia levels during drug administration and a few subsequent days, but then malaria parasites re-increased in the bloodstream of the treated mice until death. On the other hand, malaria parasites in the mice given chloroquine plus minocycline hydrochloride decreased on day 6 and then could not be detected by microscopic examination during the observation period. This finding strongly suggests that the combination effects of chloroquine and minocycline hydrochloride are worthy of evaluation in human malaria. The results also clearly demonstrate the necessity and importance of in vivo experiments in estimating the activities of drugs.

A 47-year-old male complaining of dyspnea and fever was admitted to our hospital and regurgitation of the aortic and mitral valves with mitral valve aneurysm due to infective endcarditis was diagnosed. The non-coronary and the right coronary cusps of the aortic valve had amount of vegetations, and also the anterior leaflet of the mitral valve had an aneurysm with vegetations. Both aortic and mitral valve replacement were performed. The postoperative clinical course was uneventful.