Twelve patients with chronic renal diseases who underwent hemodialysis in the Oriental Medicine Outpatient Clinic of a general hospital were analyzed. The ratio of female to male patients was high, and patients' ages ranged from 31 to 71 years, with a mean age of 53.3 years. Many patients had been receiving hemodialysis for a relatively long time at a frequency of three times a week in most cases. They thus had to maintain a fixed posture for 4-5h per day several times a week. Underlying diseases were chronic glomerulonephritis, diabetic nephropathy, polycystic kidney and nephrosclerosis. Blood biochemical examination revealed high levels of BUN, CRE and UA, while K, Na, Ca and Pi electrolytes were almost normal. The drug therapy consisted mainly of urate biosynthesis inhibitors and electrolyte metabolism amelioraters. Symptoms resulting from long-term maintenance of a fixed posture and abnormalities in K, Na, Ca and Pi electrolytes included headache, stiffness in the neck and shoulder, pain in the arms, low back pain, pain in the legs and pain in the knee joint. Acupuncture was slightly effective or better in 73.1% of the patients, and none of them showed aggravation.

The effect of acupuncture electrotherapy (AET) on siccative symptoms (dry eye, dry mouth) of patients with Sjögren's syndrome (SjS) was examined using changes in the lacrimary secretion volume, the salivary secretion volume, and the skin temperature on the face as well as the dry score.
1) The control group (n=10) was subjected to 1-Hz/30-Hz AET on the face and 1-Hz AET on the posterior neck and upper scapula region. Though, the 30-Hz AET on the face resulted in a significant increase in the lacrimary secretion volume, salivary secretion voloume, and skin temperature on the face, no clear changes were observed in response to stimulus at the posterior neck and upper scapula region.
2) In one group of SjS patients (n=15), 30-Hz AET on the face significant increased the lacrimary secretion volume and salivary secretion volume.
3) In a second group of SjS patients (n=7), no significant difference in effects with elapsed time was observed immediately after, 30 minutes after. 1 hour after, and 2 hours after applying 30-Hz AET on the face.
4) In a third groups of SjS patients (n=10), no significant difference in the cumulative effect of 30-Hz AET applied to the face was observed after the first, fifth and tenth treatments. However, the dry mouth score significantly decreased from the first treatment to the tenth treatment.
The above observations indicate that the effect of AET on siccative symptoms of SjS patients occurs in the order of trigeminal nerve, facila nerves, and glosspharygeal nerve reflexes (somatic-parasympathetic nerve reflex). They also indicate that the reactivity varies according to the frequency of stimulation provided, with high-frequency stimulation being particularly effective in salivation, suggesting that acupuncture may contribute to improving the QOL of patients by mitigating the subjective siccative symptoms experienced by them.

Malignant pericardial mesothelioma was successfully resected in a 70-year-old man, who had been admitted complaining of palpitation. Chest X-ray films showed slight cardiac enlargement. A moderate amount of pericardial effusion was noted by echocardiography. Chest X-ray commputed tomography and MRI revealed a localized pericardial tumor. Total excision of the tumor was accomplished through a left thoracotomy approach because the tumor showed neither invasion to the myocardium nor dissemination to the pericardium. The patient was discharged following an uneventful postoperative course. No sign of recurrence has been encountered for nine months after surgery. However careful observation is needed.

An attack of Raynaud's Phenomenon (RP) is characterized by blanching of the fingers in response to cold or emotional stimuli.
We analyzed the effect of ninjinyouei-to on RP in patients with MCTD. Subjects in this study comprised 19 patients, two males and 17 females, with a mean age of 38 years, and a mean duration of disease of 57.6 months. The study was performed at a time when RP occurred frequently in our country, that is in the period from November 1992 to March 1993.
We administered 9.0g of ninjinyouei-to to each case for four weeks and measured the surface skin temperature of the hands before and after medication with a thermograph using a Thermoviewer-JTG 3300.
There was a significantly higher temperature on the left first finger-tip after medication. Our thermographic findings in this study demonstrate a quantitative efficacy of ninjinyouei-to on RP in MCTD.

[Object]Any reports on acupuncture for patients with POEMS syndrome, which almost manifests disturbance of peripheral nerve in all cases and is known as a very rare disease together with disturbance of multiple organs, are not yet found. The present paper is concerned with a case report that improvement of symptoms and progress of ADL were brought out by acupuncture.
[Case]A sixty year-old man who was diagnosed as POEMS syndrome and received rehabilitation therapy after treatment with autologous peripheral blood stem cell transplantation complained of difficulty in walking with numbness in the lower legs at rest time and with numbness and muscular tension in the same sections after walking. Therefore, acupuncture was practiced once or twice per week for the patient in order to raise the threshold of pain and to relax muscular tension in the lower extremities.
[Results]After acupuncture, the patient could lengthen the walking distance, had reduced numbness in the soles and relaxation of muscular tension in the lower legs at rest time, and improved numbness after walking.
[Discussion and Conclusion]Acupuncture for a patient with POEMS syndrome resulted in improved symptoms and progress of ADL without severe side effects. From the above results, acupuncture is considered to be a useful therapeutic method used together with present medical treatment.

A new technique of left atrial plication (LAP) for giant left atrium (GLA) resulting from mitral regurgitation (MR) is reported. A 66-year-old man was found to have NYHA class III resulting from severe MR, mild TR and GLA with a left atrial diameter (LAD) of 107mm on echocardiogram. Chest X-ray showed the cardiothoracic ratio (CTR) to be 92%, and the right side CTR was 88.4%. Surgery was performed under general anesthesia with endotracheal intubation. Under cardiac arrest established by antegrade and retrograde cardioplegia, mitral repair was performed first through a superior transseptal approach. Left atrial resection was continued paralell to the mitral posterior annulus and to the right side wall of the left atrium, following the right side resection. Simultaneously the left atrial wall was incised 3 to 4cm in width all the way along the resection line and it was closed by a running suture of 3-0 prolene. The continuous line of the left atrial plication formed a spiral shape. A prominent portion of the atrial septum resulted from the LAP and the right atrial wall was also resected and plicated. The postoperative course was uneventful, and the postoperative CTR reduced to 71% with a right side CTR of 54.4% with reduction of LAD to 67mm on ultrasound cardiogram (UCG). This spiral LAP was considered more effective to reduce all dimensions of the giant left atrium dilated in all directions in comparison with other LAP methods previously reported.

Detection of the coronary artery is usually an easy procedure in the coronary artery surgery. However in cases with an intra-muscular and/or intra-fat coronary artery, it requires special skill and experience. Dissection of epicardial adipose tissue and/or muscle along the epicardial groove is a common procedure to reach such coronary artery in conventional CABG (C-CABG). Recently, off-pump CABG (OPCAB) has become a standard operation, and detection of such a coronary artery is difficult under the beating heart. Then conversion to the C-CABG becomes necessary to avoid ventricular rupture. We report a new procedure to easily detect such a coronary artery in OPCAB, using an ultrasonic Fowmeter used in neurosurgery. Because the tip of the probe is small (2mm in diameter) and flexible, its handling is quite similar to that of the micro-blade knife. Furthermore, audiable Doppler flow sound allows detection and dissection of the coronary artery without looking away from the operative field to check the coronary flow. In our case, use of the instrument enabled us to detect the anterior descending branch of the left coronary artery which was very deep in adipose tissue. Therefore, application of this ultrasound instrument is beneficial in OPCAB with an intra-muscular and/or intra-fat coronary artery.

[Purpose] We know of no reports on the effects of electro-acupuncture (EA) stimulation, on human skeletal muscle blood flow (MBF), examined quantitatively with a direct method. Therefore, we investigated changes in MBF before, during and after EA with a new clearance method. [Methods] Ten healthy adult volunteers (8 men and 2 women; median age 30.5 years) were given EA to the trapezius at the BL 10 and GB 21 acupoints, employing the left trapezius as the non-EA side to contrast with the right trapezius as the EA side, and using stainless needles of 50 mm length and 0.18 mm gauge. MBF data were surveyed for 2 minutes before EA, for 4 minutes during EA, and for 4 minutes after EA, and a total of10minutes were analyzed l(?). Blood pressure and heart rate were simultaneously measured. [Results] MBF on the EA side increased significantly during EA (p < 0.05). On the other hand, diastolic blood pressure and heart rate were shown to decrease during EA (p < 0.05). [Discussion] These results, showing that MBF increased on the EA side, while diastolic blood pressure and heart rate decreased, suggest a regional muscle pump action with EA. [Conclusion] In evaluating a new, direct means of quantitatively examining _99mTc0_4- clearance, an increase in MBF with right side EA stimulation was clearly shown. Because the present method is simpler and easier, and higher in accuracy than past methods, we believe it may be used more aggressively in future clinical studies of acupuncture/moxibustion.

OBJECTIVESExposure misclassification is a major obstacle to obtain accurate dose-response relationships. In order to solve this problem, the impact of hair treatment on total mercury in hair was assessed in Japanese women.

METHODSA cross-sectional study was carried out among 327 women at age 24-49 years to determine hair mercury levels and estimate daily mercury intakes from seafood by using a food frequency questionnaire.

RESULTSHair mercury levels in the women and daily mercury intake ranged from 0.11 to 6.86 (median 1.63) μg/g and from 0.77 to 144.9 (median 15.0) μg/day, respectively. The hair mercury was positively correlated with the daily mercury intake (p<0.001). When the women were divided into two subgroups based on artificial hair-waving, hair coloring/dyeing, residence (non-fishing and fishing areas), and working status, a significant difference in the hair mercury level was observed between the women with and without artificial hair-waving only (p<0.001). The multiple regression analysis showed that the log-transformed hair mercury level was significantly related to the log-transformed daily mercury intake (standardized regression coefficient βs=0.307) and artificial hair-waving (βs=-0.276); but not to hair coloring/dyeing, residence, working status or age. Permanent hair treatment was estimated to reduce total mercury in hair by approximately 30%, after adjusting for daily mercury intake and other possible factors.

CONCLUSIONSThese findings suggest that hair mercury is not the best biomarker of methylmercury exposure when a study population includes women with artificial hair-waving.