1.Successful Endovascular Treatment of an Intrathoracic Left Subclavian Artery Aneurysm with TEVAR and Coil Embolism
Haruhiko Akagi ; Hiroshi Irie ; Yoshihisa Nakao ; Kei Sakai ; Shoji Sakaguchi
Japanese Journal of Cardiovascular Surgery 2013;42(3):215-218
A 77-year-old man with an abdominal aortic aneurysm, detected by abdominal ultrasonography, was referred to our hospital. Multi-detector computed tomography (MDCT) revealed an intrathoracic left subclavian artery aneurysm 30 mm in diameter and a small distal arch aortic aneurysm as well as an abdominal aortic aneurysm 40 mm in diameter. Surgery was indicated for the subclavian artery aneurysm considering the risks of rupture and distal embolism. Our choice for treatment was endovascular repair ; thoracic endovascular aortic repair (TEVAR) and coil embolism. The operation was performed successfully. Orifices of the left subclavian artery and the distal arch aneurysm were covered with a stent graft and the left subclavian artery was occluded with coils distal to the aneurysm. The operation time was 1 h and 44 min. He was extubated in the operation theater. A follow-up CT scan performed at 1 week showed the correct position of the TEVAR device, patency of the common trunk of the brachiocephalic and right common carotid arteries, and complete exclusion of the aneurysms. He was discharged on the 12th postoperative day without complication. Subclavian artery aneurysms, in particular in the intrathoracic location, are rare. Conventional surgery for this entity tends to require arch replacement to be unreasonably invasive as a therapy for peripheral artery disease. We believe this endovascular therapy can be a useful, less-invasive alternative to conventional open surgery.
2.The Aim of WHO and the Circumstances and Prospects of Activity of the Second Japan Acupuncture Points Committee
Shuichi KATAI ; Shoji SHINOHARA ; Shunji SAKAGUCHI ; Hisatsugu URAYAMA ; Yasuhiro KAWAHARA ; Toshimitsu KATORI ; Kenji KOBAYASHI
Journal of the Japan Society of Acupuncture and Moxibustion 2006;56(5):755-766
The standardization of acupuncture point locations has been a pending matter for ages and considered the difficult challenge ever since the nomenclature of meridians and collaterals and acupuncture points, including the eight extra meridians and extra points, was standardized internationally at the Geneva Meeting in 1989. 14 years since then, in 2003, the Informal Consultation on Development of International Standard Acupuncture Point Locations by Japan, China and Korea commenced under the initiative of the WHO Western Pacific Regional Office (WPRO).
The discussions were held 9 times in 3 years, making great progress toward accomplishing the standardization. The objective will finally reach fruition at the Meeting on Development of International Standard Acupuncture Point Locations which is to be held at Tsukuba-city, Japan, in the fall of 2006.
The developments thus far and future issues are summarized and reported.
3.Current Circumstances and Future of the WHO Standard Acupuncture Point Locations
Shuichi KATAI ; Shoji SHINOHARA ; Shunji SAKAGUCHI ; Hisatsugu URAYAMA ; Yasuhiro KAWAHARA ; Toshimitsu KATORI ; Kenji KOBAYASHI
Journal of the Japan Society of Acupuncture and Moxibustion 2007;57(5):576-586
1. Introduction
The Meeting on Development of International Standard Acupuncture Point Locations hosted by WHO/WPRO was held between Oct. 31 th and Nov. 2 nd in 2006 at the International Congress Center in Tsukuba City, Japan. The delegates came from nine countries, e.g. Australia, China, Japan, Korea, Mongolia, Singapore, UK, USA, Vietnam, and two organizations, e.g. WFAS (World Federation of Acupuncture Societies), AAOM (American Association of Oriental Medicine). The total number of delegates was twenty. The draft of Standard Acupuncture Point Locations, which had been discussed between three countries, Japan, China and Korea during the previous three years, was officially decided.
2. Agreement for Acupuncture Point Locations
Three hundred and sixty one Acupuncture Point Locations were decided at the meeting, the number is 7 more than the number that has been taught so far in the educational field of Japanese acupuncture. The points which differ from the current Japanese text book are 7. These points had been considered “extra points” located along meridians as well as points requiring special attention. 6 points had been the subject of debate, and as a result two locations for each point have been decided. These are LI 19, LI 20, CV 24, PC 8, PC 9, and GB 31.
3. Future Plan of WPRO
We attempted to standardize the Acupuncture Point Locations at the official meeting in Tsukuba. Moreover WHO/WPRO intends to standardize (1) Oriental Medical Terminology, (2) Oriental Medical Information, (3) Guidelines for research of Acupuncture and Moxibustion, and general thoughts, points of view, and an outline of Oriental Medicine. Then WHO hopes to encourage application of these standards to research and practice of Oriental Medicine.
4. The themes after deciding the Acupuncture Point Locations
Subjects for further discussion include: (1) Research on acupuncture point locations, (2). Encouraging the use of Standardized locations, (3). Clarifying “Japanese Acupuncture” and its supporting its use all over the world, etc.
4.Commemorative Lecture Meeting for Publication of "WHO Standard Acupuncture Point Locations in the Western Pacific Region"
Shuichi KATAI ; Shoji SHINOHARA ; Shunji SAKAGUCHI ; Hisatsugu URAYAMA ; Yasuhiro KAWAHARA ; Toshimitsu KATORI ; Kenji KOBAYASHI
Journal of the Japan Society of Acupuncture and Moxibustion 2008;58(4):680-683
The (First) Japan Acupuncture Point Committee was established in 1965 and the nomenclature for meridians and acupuncture points was standardized at the meeting in Geneva in 1989. After that the first Informal Consultation on Development of International Standard Acupuncture Points Locations was organized by WHO/WPRO and held in Beijing (2003). In Japan the (second) Japan Acupuncture Point committee started April in 2004. Japan, China and Korea held nine meetings and made a draft for the Locations of Acupuncture Points. According to the draft made at the official meeting of 'the Development of Standard Acupuncture Point Locations'held in Tsukuba, Japan (2006), Acupuncture Point Locations were further standardized. Finaly, the book "WHO Standard Acupuncture Point Locations in the Western Pacific Region"was published on May 16th, 2008. Here, we want to report on the Commemorative Lecture Meeting for Publication of WHO Standard Acupuncture Point Locations held on May 30th, 2008.
5.Assessment and future development of the WHO/WPRO standardization of acupuncture point locations
Shunji SAKAGUCHI ; Toshimitsu KATORI ; Kenji KOBAYASHI ; Yasuhiro KAWAHARA ; Hisatsugu URAYAMA ; Yosuke AMANO ; Midori ARAKAWA ; Daiki TAKAHASHI ; Shoji SHINOHARA ; Shuichi KATAI
Journal of the Japan Society of Acupuncture and Moxibustion 2012;62(3):205-215
[Introduction] In 2006 the WHO and WPRO agreed on standard acupuncture point locations. To promotepagate these standards, in 2009 the Second Japan Acupuncture Standardization Committee published a Japanese edition of 'WHO STANDARD ACUPUNCTURE POINT LOCATIONS FOR THE WESTERN PACIFIC REGION.' Based on this Japanese edition, a new textbook was published by the Japan Association of Massage & Acupuncture Teachers and the Japan College Association of Oriental Medicine. Since one year has passed since the start of education based on standard acupuncture point locations at Japanese universities, colleges, vocational schools and training centers for anma (Japanese traditional massage), massage, and shiatsu (acupressure); acupuncture; and moxibustion therapies, we administered a questionnaire survey as an evaluation of international standardization and the problems of introducing standard acupuncture point locations .
[Subjects and methods] Subjects were mainly teachers and included a small number of researchers, clinicians, and other groups concerned with acupuncture and moxibustion. We used a questionnaire that we originally created at the Second Meeting of the Japan Standardization of Acupuncture Point Locations Committee.
[Results] Among the 180 institutions surveyed, we obtained answers from 149 people from 93 institutions in total. Agreement on the question of standard acupuncture points, "functional existence" (44.3%) was most common, and "anatomical existence" came next at 26.6%. For the question on acupuncture treatment, 82.4% replied with "use ofboth acupuncture points and reaction points." For the answers to agreeing with international standardization, "no opinion" was 41.7% and 51.7% for "appreciate." However, both of those groups appreciated globalization of acupuncture and moxibustion by a common language. There were many opinions on proportional bone measurement. Specifically, opinions indicated a change "from the cubital crease to the wrist crease" (from 10B-cun to 12B-cun) and a need for proportional bone measurement of the upper arm. Whereas, for individual acupuncture points, opinions expressed the difficulty of locating application points and not understanding reasons for change and notations including body surface segments.
[Discussion] We were able to classify the opinions collected into the following groups: (1) problems that can be corrected immediately, including typographic errors, (2) problems that need to be reviewed at the next international gathering, and (3)problems that need to be understood by making full use of related documents.
[Conclusion] We were able to determine primarily for a wide range of teachers, problems understanding individual acupuncture point locations, including consideration of acupuncture points, evaluation of standardization of acupuncture point locations, and other guidelines