Episodic angioedema with eosinophilia (EAE) is an idiopathic condition characterized by recurrent symptoms such as angioedema, urticaria, and eosinophilia. We report a case of a 25-year-old woman with the non-episodic variant of this condition (NEAE) who was treated with acupuncture.
The patient presented with a two-week history of generalized itching and angioedema. Erythema, bilateral limb edema, and swelling and pain of both wrists and ankles were noted. As antiallergic medication administered for several days was ineffective, she was admitted to our hospital. Hematologic investigations revealed a white blood cell count of 11850/mm³ with 64.2% eosinophils (7610/mm³). Histopathologic examination of a cutaneous biopsy specimen indicated an eosinophilic infiltration localized around blood vessels in the superficial dermal layers. NEAE was diagnosed on the basis of these findings. Acupuncture treatment was performed according to Traditional Chinese Medical theory. Itching was alleviated following acupuncture treatments and relapsed on days when acupuncture was not administered. However, edema and itching gradually diminished between acupuncture treatments, in parallel with resolution of the peripheral eosinophilia. In this case, acupuncture treatment was effective for alleviating itching in NEAE.

Objective : Transarterial or transapical aortic valve replacement (TAVR) procedures have been performed for high-risk patients with severe aortic valve stenosis (AS) in western countries. A high-risk patient is defined as having an STS score greater than 10%. In Japan, aortic valve replacement (AVR) with cardiopulmonary bypass (CPB) is standard care for AS, even if the patient is at high risk of developing complications. We calculated an expected operative risk of patients using a JAPAN score established by Japanese Adult Cardiovascular Surgery Database (JACVSD). Patients and Methods : Patients were divided into three groups : score less than 5%, low risk (LR) ; score 5-10%, moderate risk (MR) ; score more than 10%, high risk (HR). We also evaluated the efficacy of conventional AVR in each group. Between January 2002 and May 2011, we performed conventional AVR in our hospital and 116 patients who underwent AVR for symptomatic AS were enrolled in this study. Results : There were 79 patients in the LR group, 30 patients in the MR group and 7 patients in the HR group. The mean score was 2.6±1.1% in the LR group, 6.8±1.4% in the MR group and 23.3±16.8% in the HR group respectively. The mean follow-up period was 7.6±0.3 years. Preoperative co-morbidity was not statistically significant among three groups, however more octogenarians were found in the HR group. The aortic valve area and left ventricular ejection fraction (LVEF) were significantly smaller in the HR group. There were 4 cancer patients. The HR group had significantly longer operation and CPB times than the LR group. The operative mortality in all cases was 1.6%. Overall survival at 5 years was 78%. Actual survival at 5 years was 77% in the LR group, 82% in the MR group and 71% in the HR group. The major adverse cardiac and cerebrovascular event (MACCE)-free ratio at 5 years was 85%. Absence of death caused by MACCE at 5 years was 93%. All cancer patients died after AVR due to advancement in cancer. Conclusion : The results of conventional AVR with CPB were satisfactory in each group. Cancer patients may be good candidates for TAVR in the future.