We recently experienced a case of Y graft replacement for recurrent blue toe syndrome (BTS) following cardiac catheterization. A 64-year-old male, who had undergone cardiac catheterization, complained of bilateral multiple toe cyanosis and pain. Angiograms revealed that infrarenal aortic stenosis was the recurrent embolic source. He refused surgical treatment because he thought the BTS was an iatrogenic complication. No conservative therapy was effective. He finally suffered from right foot and all left toe necrosis after nine months. Then he recieved Y graft replacement. Thereafter no embolic episode was seen. Cardiac catheterization recently has become a routine examination. However, informed consent is very important because it is difficult to anticipate BTS following the examination. Surgical treatment is recommended for recurrent BTS because conservative therapy fails in most cases.

A patient with uterine cervical cancer underwent radical operation and radiotherapy in 1956 and subsequently began to suffer from impaired bowel movements. For the next 40 years, a large amount of cathartics was used to induce defecation, a urination was induced by applying abdominal pressure, but a large volume of urine remained. In this patient, the effects of acupuncture treatment were evaluated using the vesical residual urine volume as measured by abdominal ultrasonography. After acupuncture treatment, defecation became easily, and the amount of cathartics could be reduced. Simultaneously, spontaneous urination became possible, and residual urine disappeared.

[Objective and method] We developed a questionnaire for 117 second graders in the fiscal year of 1999 in order to perform curriculum evaluation of Meridians and Acupuncture Points. Furthermore, based on the result, a part of the curriculum was changed and the effect was examined. Curriculum evaluation, using the same questionnaire which in the fiscal year of 1999, was performed for 117 second graders in the fiscal year of 2000, and compared with the results in the fiscal year of 1999.
[Results] Of the items addressed, “Teachers were eager”, “Teachers responded to the question or consultation well”, and “Materials were useful to understanding” had higher scores. On the other hand, “Time was spent effectively”, “Progress of the lesson was suitable”, “The class was well prepared” and “Time to perform practical skills was suitable” had lower scores. After the change of the curriculum method, the results indicated that the following items; “The class was well prepared”, “Time was spent effectively”, “Teachers responded to the question or consultation well”, “Progress of the lesson was suitable”, “Time to perform practical skills was suitable” and “Materials were useful to understanding” showed a significant increase in the affirmative opinion as compared with the fiscal year of 1999.
[Conclusion] The curriculum evaluation by the students was useful for improvement of the curriculum and increased the students' motivation to study.

We studied the effect of acupuncture on a case of neurogenic impotence caused by surgery for ano-rectal cancer. Acupuncture needles (length: 60mm, diameter: 0.3mm) were inserted into bilateral Zhongliao (BL33) and were stimulated erectrically or rotated manually for 10 minutes. The effectiveness of acupuncture was evaluated by IMP DIARY, which was consisted of the rate of increase on Erectometer, and the changes of the subjective symptoms. We also investigated the effects of acupuncture stimulation on microcirculation of the glans penis. After the treatmeent, IMP DIARY showed improvement of nocturnal penile tumescence, morning erection and erection by masturbation. The microcirculation at the glans penis was increased significantly immediately after acupuncture therapy. From these results, acupuncture treatment to the BL-33 points for neurogenic impotence after surgery for ano-rectal cancer was considered to be useful.

[Objective] To clarify the prevalence and aim of acupuncture and moxibustion treatment as well as reasons for choosing this remedy in Japan.
[Methods] We conducted direct interviews with 2, 000 adults (aged 20 years or older) in a stratified two stage sampling in March, 2003.
[Results] Of those interviewd, 71% (1, 420 / 2, 000) responded to the survey of demographics, experience, aim and reasons for choosing acupuncture and/or moxibustion. A total of 7.5% of the population had used Acupuncture and/or Moxibustion during the past 12 months and a total of 26.4% had experienced at least one of these treatment during their lifetime. The most frequent symptoms being treated involved musculoskeletal prob-lems (81.6%), and the most frequent reason for choosing the treatment was the recommendation of family or friends (58.7%).
[Conclusion and Discussion] The prevalence of choosing acupuncture and moxibustion in Japan was higher than that in the U. S. or Europe, which might reflect the history of these methods as popular folk remedies in Japan. The most frequent reason for choosing these remedy might be related to the treatment methods requiring direct contact and stimulation of the body.

Objective : To research reports of economic analysis of acupuncture therapy.
Method : Searches were performed in Medline for reports of cost description, economic, randomized controlled trial, cost effectiveness, or cost benefit. Studies were included if they reported original data from any form of standard economic analysis.
Results : A total of 15 papers was found. These studies were investigated as follows : angina pectoris, carpal tunnel syndrome, stroke, knee osteoarthrosis, low back pain, musculoskeletal disease, migraine, acupuncture analgesia. On the other hand, only one paper was found in Japan.
Conclusion : Almost studies were noncntrolled trial, non-rigorous and retrospective studies. In future there is a need for high quality and rigorous studies of the cost and benefits of acupuncture.

For the purpose to increase peripheral blood flow of lower leg, low frequency electrical acupuncture was applied to the various meridian points such as Ciliao (B-32), Sanyinjiao (Sp-6), Xuehai (Sp-10), Zusanli (S-36), Jiexi (S-41) and Xuanzhong (G-39) on the patients of Burger's disease and intractable ulcer of lower leg. Peripheral blood flow was measu ed by a laser doppler flow meter. The results show that blood circulation of lower legs was increased by electrical acupuncture stimulation on bilateral Ciliao more than the other points and it was suggested that electrical acupuncture for bilateral Ciliao was helpful adjuncts to the treatment of ischemic disease such as Burger's disease and intractable ulcer.

Nobody studies economic evaluation of acupuncture and moxibustion in Japan. To establish a method of economic evaluation of acupuncture and moxibustion, we introduced case study of economic evaluation of acupuncture and moxibustion at work. In addition, we examined a course of study that annex economic evaluation to a study of acupuncture and moxibustion. This manuscript introduces two case studies of economic evaluation and essential points of economic evaluation.

An educational video describing the acupunctural stimulation of the pudendal nerve for treatment of urinary disturbances was produced. Treatment points on the meridian were selected within the limits of the top 1/2 to 3/5 of the line that connects the superior posterior iliac spine and the inner lower edge of the ischiatic tuberosity. Since the pudendal nerve is situated between the sacrospinous ligament in this region, it could be readily stimulated from the body surface. A 90mm (#24) acupuncture needle was used for the treatments. When the needle was inserted to a depth of 50-80mm from the body surface, the pudendal nerve was reached. Echo sensation in the penis indicated that the acupuncture needle had contacted the pudendal nerve.
Either the sparrow-pecking, needle-twisting, or the low frequency acupunctural techniques were used to delver stimulation to the pudendal nerve. In conclusion, acupunctural stimulation of the pudendal nerve was clinically useful for treatment of urinary disturbances, such as uncoordination of the detrusor muscles in neurogenic bladder and urinary incontinence.