The patient was 70-year-old man. Distal aortic arch aneurysm of the maximum diameter of 55 mm was pointed out by Computed tomography. He underwent total arch replacement with median sternotomy. The next day, white cloudy fluid was flowing out from his left thoracic drain, and the amount increased and chylothorax was diagnosis. We selected conservative therspy with fasting and octoleotide subcutaneous injection. After 19 days chylothorax did not improve. We performed percutaneous thoracic duct embolization which is minimam invasive therapy. After embolization, he could start the meal, and the chest drain was extubated. He was discharged in good condition 49 days after first operation.

The purpose of this study was to evaluate the effectiveness of water exercise, including functional mobility in water, performed either once or twice a week in elderly who require nursing care. Twenty-one subjects were assigned to two groups. Ten subjects trained once a week for 6 months. Eleven subjects trained twice a week for 6 months. Water exercise consisted of warming up on land and walking,ADL exercise,resistance training, stretching and relaxation in water. Functional mobility was evaluated by FIM during pre-exercise,after 3 months and 6 months. There were significant improvements in functional mobility after 6 months compared to pre-exercise in both groups. Functional mobility in the group who trained once a week did not improve at 3 months compared to pre-exercise. Although the group who trained twice a week showed a dramatic improvement in functional mobility after 3 months compared to pre-exercise, and no change after 3 months compared to after 6 months. These results indicate that water exercise once or twice a week for 6 months, including functional mobility in elderly who require nursing care, can improve functional mobility, especially, exercise twice a week could improve it within 3 months.

Fibroma of the tendon sheath (FTS) involving the temporomandibular joint (TMJ) is very rare. A case of FTS arising from the synovial membrane of the TMJ is presented. The patient was a 17-year-old male with jaw opening pain and clicking in the left TMJ. MRI, arthrotomography, and arthroscopy showed a well-circumscribed mass that was localized in the superior articular cavity of the left TMJ. The tumor was removed with the attached synovial membrane. Macroscopic, histological and immunohistological features of the intra-articular tumor were identical to FTS. There have been no signs of recurrence in the 6 years since surgery.

It is said that Ryodoraku reflects the dysfunction of the autonomic nerve in spite of no objective evidence for the theory.
Using 60 patients received right stellate ganglion block, we measured 24 typical determinate points of ryodoraku with a neurometer and an electrodermometer.
With a neurometer, an average current value of 6 points of the right upper extremity decreased in 52% as well as that of 6 points of the left decreased in 62%. Both the right and the left lower extremities decreased in 91% and 85%.
With an electrodermometer, the average impedance of the right upper extremity increased in 108%.
Finally, the sympathetic blockade showed decrease in a current value with a neurometer and increase in impedance with an electrodermometer.

It has been told that acupuncture to the stellate ganglion suppresses the sympathetic activity. By using 15 patients, we made measurements of electrical current of the skin at the 24 typical determinate points of Ryodoraku with a Neurometer before and after electrical acupuncture to the right stellate ganglion.
After 20min rest in the supine position, average values of 6 points of the right and left upper extremities decreased with 30% and 27%, and those of the right and the left lower extremities decreased with 34% and 31%, respectively.
Immediately after 30min of electrical acupuncture, average values of 6 points of the right and left upper and the right and left lower extremities increased with 9%, 12%, 17% and 9%, respectively.
Twenty minutes after the right stellate ganglion block, average values of 6 points of the right upper extremity decreased with 16%, and those of the left one, the right and left lower extremities decreased with 9%, 18% and 14%, respectively.
These data suggest that acupuncture to the stellate ganglion stimulates the sympathetic tone by showing increase of electrical conductivity of the skin, while the stellate ganglion block shows the decrease.

A potential role for lysophosphatidie acid (LPA) in the regulation of malignant diseases has been widely considered. Migratory response to LPA in glioma cells was almost completely inhibited by either pertussis toxin, LPA1 receptor antagonists including Ki 16425, or an inhibitor of phosphatidylinositol 3-kinase (PI3K) wortmannin. LPA action on migration was also suppressed, though incompletely by several specific inhibitors for intracellular signaling pathways such as Racl, p38 mitogen- activatcd protein kinase (p38 MAPK) and c-Jun terminal kinase (JNK), but not extracellular signal-regulated kinase. Nearly complete inhibition of the migration response to LPA, however, required simultaneous inhibition of both the p38MAPK and JNK pathways. Inhibition of Racl suppressed JNK but not p38MAPK, and dominant-negative form of Cdc42 abrogated p38MAPK activity. These findings suggest that, in glioma cells, the PI3K/Cdc42/ p38MAPK and PI3K/Racl/JNK pathways arc equally important for LPA1 receptor- mediated migration.

Previously we reported effects of acupuncture to the stellate ganglion on measurements of skin electroconductivity by a Neurometer.
By using 8 healthy adults and 23 patients, we measured effects of electrical acupuncture to the stellate ganglion on carotid blood flow, deep tissue temperature, blood pressure and pulse rate in order to clarify the influence on functions of the autonomic nervous system.
After electrical acupuncture to the right stellate ganglion (SGA), the right and left carotid blood flow decreased with 4-9% and 7-12%, respectively. Deep tissue temperature of the right anterior forearm after SGA showed a little increase (with no significance), while the temperature increased with 0.4-0.7°C after the right stellate ganglion block (SGB). Deep tissue temperature of the left anterior forearm showed no significant change after SGA, while it increased with 0.1-0.3°C significantly after SGB. Systolic blood pressure increased with 2-4mmHg after SGA and this also increased with 9-11mmHg after SGB. Those increases were significant. While the pulse rate decreased (2bpm) significantly after SGA, it increased (4-6bpm) significantly after SGB.
Except the decreased pulse rate after SGA, the other data did not support a common hypothesis that electrical acupuncture to the stellate ganglion suppresses the sympathetic system as SGB.

Previously we reported that acupuncture to the stellate ganglion stimulates sympathetic nervous system while it decreases heart rate.
As it is said that R-R intervals in electrocardiogram (ECG) reflect functions of parasympathetic nervous system, we measured effects of electrical acupuncture to the stellate ganglion (SG) or traditional acupuncture points (AP) on the meridians (H7: SHENMEN and P4: HSIMEN) on R-R intervals in ECG by using 24 patients; 12 each in SG-group and AP-group.
Results are as follows; (1) Means of heart rate (HR) decreased with 1-3bpm in the both groups; (2) Coefficients of variation (CV) of HR increased with 1-2% in the both groups; (3) Means of R-R intervals prolonged with 39-47msec in the SG-group and 20-44msec in the AP-group, respectively; (4) CV of R-R intervals increased with 1% in the SG-group only.
It is suggested that acupuncture stimulates not only sympathetic nervous system, but also parasympathetic nervous system.

An accidental break of an acupuncture needle is one of the most serious complication in acupuncture.
A German Shepherd weighed 25kg was anesthetized with pentobarbital.
Then, unused 7 needles of 1.0, 1.5, 2.0, 2.5, 3.0, 3.5 and 4.0cm long each were inserted at 7 acupuncture points.
The movement of broken acupuncture needles were observed by X-ray for 72 days and pathological examination of tissue surrounding broken needles was also done.
While broken needles inserted nearby the joints were found moving much around, others inserted in the region of straight bones stayed almost.
The dog was dissected 72 days after the preparation. Three broken needles were found just beneath the muscular fascia and two broken needles were in the subcutaneous tissue. Another broken needle in the lumbar region was penetrated into the lumbar spinal cord and the other needle in the region of neck was lost.
Pathological examination showed chronic inflammatory changes such as cellular infiltration and muscle fiber necrosis in the lumbar spinal cord and the thigh region, but little changes in the other four regions.

On twenty patients and ten healthy adult volunteers, pain threshold was measured by a dolorimeter (Pain meter NYT-5) to clarify whether analgesic effects of electrical acupuncture on various body surface may be changed by acupuncture points or not.
Electrical acupuncture was performed to the traditional acupuncture points on the two meridians. A group is the combination of LI 10 (Shousanli) and LI 14 (Hoku) on the right side, the other is the combination of ST 36 (Tsusanli) and ST 40 (Liangchiu) on the right side.
Measured points of pain threshold are (1) face, (the point 2cm above from the center of both eyelids), (2) (3) left and right upper extremities (LI 11; Chuchih) and (4) (5) left and right lower extremities (ST 41; Chiehhsi).
In the Shousanli-Hoku group, pain thresholds of face, both upper extrimities increased significantly. However, those of both lower extremities were not significantly changed.
In the Tsusanli-Liangchiu group, pain thresholds of the upper and lower extremities on both sides increased significantly. However there were no significant changes in the forehead.
In comparison of two groups, increases of pain thresholds of both lower extremities were observed in significantly more cases with acupuncture to Tsusanli and Liangchiu points than those with Shousanli and Hoku points by the Chi-square test (p<0.01). From this fact, acupuncture of Tsusanli-Liangchiu points seems to be more effective on the lower extremities than that of the Shousanli-Hoku points.
Therefore, we conclude that effects on pain threshold by electrical acupuncture depend on various points on meridians and are not evenly shown on the whole body surface.