We have been studying the effect of preadministration of D-phenylalanin (DPA) on acupuncture analgesia for various types of pain. DPA is thought to suppress the activity of carboxypeptidase, which discomposes endorphins. In this double-blind placebo-controled study, clinical effectiveness of acupuncture with DPA preadministration in relieving chronic low back pain was examined.
DPA (4g) or placebo (lactose: 4g) was orally administered to thirty out patients with chronic low back or lower extremity pain 30 minutes before acupuncture treatment. A half of the patients were given placebo in the first session and DPA in the second one, and the other half were given DPA firstly and placebo secondly.
The patients were asked to rate their pain after treatment in comparison with pre-treatment condition. Successful pain relief was obtained in 60% of the patients given DPA prior to acupuncture and in 33.4% of those given placebo. Although it is said that there is a great individual variation in response to acupuncture therapy, this result demonstrates that preadministration of D-phenylalanin enhances analgesic effect of acupuncture therapy.

In the previous paper, we reported a clinical study on laser irradiation stimulation for pain diseases. In the present study, we examined the effect of laser irradiation stimulation on peripheral blood circulation and its clinical effectiveness in the treatment of shoulder stiffness.
[METHOP] Five healthy adults were irradiated with low energy semiconductor laser (Ga-Al-As, 70mw, 830nm) at the Jianjing (VF21) for ten minutes. Skin blood flow near the stimulated point was measured using Laser-Doppler method before and after (for 20min.) irradiation.
Clinical effectiveness was examined for 50 patients with clonic shoulder stiffness who visited Anesthesiological Department of Osaka Medical College Hospital. The patients were randomly devided into two groups: laser irradiation group (L group) and Non-irradiation group (C group). To the C group, the apparatus was set but no laser was irradiated. Stimulation points were Tianzhu (VU10), Jianjing (VF21), Jianwaishu (IT14) and other points commonly used for shoulder stiffness. According to the numerical scale of subjective symptom reported by the patients immediately after the stimulation, therapeutic effictiveness was rated into four grades: “marked improvement” “improvement” “slightJimprovement” and “no change”. “Marked improvement” and “improvement” were regarded as effective cases.
[RESULTS] After laser stimulation, blood flow increased several times heigher than the original level but it tended to decrease back to the original level within the measuring period. The incedence of effective cases was 58% for L group and 40% for C group.
[CONCLUSION] Laser irradiation stimulation has been reported to have same effect as acupuncture, and gathering attention as stimulation method with less adverse effects. Our study demonstrated that laser stimulation induced transient improvement of local blood circulation.

We report 2 cases of successful treatment by percutaneous catheter drainage and irrigation for methycillin-resistant Staphylococcus aureus (MRSA) prosthetic graft infection after abdominal aortic aneurysm (AAA) repair. Case 1 was a 71-year-old man in whom MRSA graft infection was diagnosed on the basis of high fever and CT-guided taps of the perigraft fluid 11 days after AAA repair, and a percutaneous catheter was inserted into the perigraft space by the CT-guided method. Case 2 was a 77-year-old man in whom MRSA graft infection was diagnosed because of high fever and purulent discharge from the wound of retroperitoneal drainage 5 days after AAA repair. A percutaneous catheter was placed into the retroperitoneal space via an extraperitoneal route. In both cases, intermittent irrigation by 0.5% Povidone-iodine solution and saline was performed as well as systemic and local antibiotic administration. The graft infection was well controlled and both patients were discharged after 4 months. Percutaneous catheter drainage and irrigation can be one of the choices for critically ill patients with graft infection after AAA repair.

We encountered 15 cases of surgical site infection (SSI) by Methicillin-resistant Staphylococcus aureus (MRSA) among 153 patients who underwent a cardiovascular operation in 2000. SSIs consisted of 5 mediastinal infections, 9 surface wound infections and 1 artificial graft infection after an abdominal aortic surgery. All infected cases had been operated on between June and December 2000. Eighty-three cases, which underwent cardiovascular operations during this period, were divided into SSI or no-SSI groups and their clinical data were analyzed. The data included age, gender, preoperative diabetes, urgency, preoperative usage of a device like Swan-Ganz catheter or IABP, preoperative albumin level, preoperative physical state by ASA score, National Nosocominal Infections Surveillance index, duration of operation, usage of a cardiopulmonary bypass, duration of bypass, type of operation, and number of distal anastomoses in CABG operations. Multivariate analysis showed gender (male), diabetes, and emergency operation as independent risk factors for the incidence of SSI by MRSA. One patient, who suffered a mediastinal infection after CABG, had confirmed as demonstrating the colonization of MRSA in sputum preoperatively. Microbiological screening of medical staff showed 2 of the 6 surgical doctors and 3 of the 25 ward nurses exhibited colonization with MRSA. DNA analysis of MRSA, harvested from 5 infected patients, indicated at least 2 strains of MRSA and 1 of the 2 strains was identical to the MRSA that was detected in a doctor. We applied prophylactic measures with reference to the guideline for prevention of surgical site infection announced by CDC in 1999, which included the following: routine work-up of MRSA-colonization, and treatment of all MRSA colonized patients and those undergoing emergency operations with Mupirocin. Preoperative patients were isolated from MRSA-infected or colonized patients. MRSA-colonized surgical personnel were treated with Mupirocin ointment. Cephazoline was administered shortly before and after the operation as a prophylactic antibiotic. Vancomycin was added to Cephazoline in patients with a history of MRSA-colonization or infection. Through hand washing before and after daily contact with patients was emphasised to all medical staff. SSI surveillance conducted by an infection control team was implemented. After the introduction of the prophylactic measurements, one MRSA-SSI was observed among 113 cases who underwent a cardiovascular operation between January and September 2001.

In previous papers, we experimentally demonstrated the enhancing effect of D-phenylalanine (DPA) administration on the analgesic effect of acupuncture by the increase of pain threshold. In the present study, we examined the effect of administration manners in the patients with chronic lumbago who visited our anaesthesiological department. We conducted a double-blind study with two different administration manners: “previous-day” and “just-before”.
METHODS
Fifty-six patients suffering from chronic low back pain for more than three months were devided into two groups. DPA or placebo was orally administered intwo different manners prior to low-frequency electro-acupuncture treatment. Group I patients (26 cases), took 0.5g three times (i. e. a total of 1.5g): after the evening meal and before go to bed on the day before, and after the beakfast on the day of acupuncture (“previous-day” administration). Group II patients (30 cases), took 4.5g 30 minutes before acupuncture treatment “just-before” administration. The treatment was undertaken twice with DPA administration and twice with placebo administration for each group. “Direct effect” was determined by the number scale method and a comparison between the two groups was made. In the additional experiment, three volunteers were orally given 4.0g or 1.5g DPA, and blood phenylalanine level was determined two hours, four hours and one month later.
RESULTS
In the group I (previous-day administration), “DPA+acupuncture” produced the following result: excellent 7.8%, good 69.2%, moderate 19.2%, (significantly different from placebo administration). In the group II (just-before administration), “DPA+acupuncture” produced the following result: excellent 23%, good 37%, moderate 20%, and no-effect 20% (significantly different from placebo administration). Comparing group I with group II, the percentage of the “excellent” or “good” cases in the former was larger than that of the latter (+17%). Blood phenylalanine level showed its high value 2-4 hours after administration of 4g DPA, whereas 2 hours after that of 1.5g DPA.
Conducting a clinical investigation into the effectual administration (timing and doses) of DPA, we found that previous-day administration is more effective than “just-before” administration in enhancing effect of acupuncture analgesia. Although there is room for further studies with a larger number of cases, considering that DPA has a “slow onset long acting” effect (Ehrenpreis), we can conclude that the series administration of DPA on the day before acupuncture treatment is advisable.

No abstract available.
Aortic Valve Insufficiency* ; Aortic Valve* ; Echocardiography, Transesophageal ; Vena Cava, Inferior*

A statistical study on effects of laser-puncture was carried out. In addition, an attempt was made to compare between the effect of acupuncture and this method. The treatments were under-taken for various chronic and acute cases with pain. In the laser-puncture treatment, two types of laser (i, e. low energy 10mW laser and 70mW sharp laser) were used. Laser-beam was given to 20-30 points which were located in painful areas, innervating nerve areas and remote areas for 40 sec for each.
In the open study, 10mW laser-puncture was effective (including ‘rather effective’) in 64% of the cases, and 70mW laser-puncture 73%. In the blind test, ‘the day’ evaluation showed that the laser-punctures were more effective than placebo treatment: 10mW laser-puncture was effective in 80% of the cases, and placebo in 67%. 70mW laser-puncture was effective in 87% of them, and placebo in 80%. In situ acupuncture was effective in 97%, and no effect was seen in 7%.
Only ‘the day’ evaluation in the open study showed that 70mW laser-puncture was more effective than 10mW one. In the blind best, 10mW and 70mW laser-puncture were more effective than placebo, and in situ acupuncture was more effective than the laser-punctures, but there were no significant differences among the three treatmets.

Objective: This study aimed to reveal the relationship between anxiety and depression and personal attributes or difficulties in daily life in patients after total laryngectomy. Methods: An anonymous questionnaire was mailed to 135 members of a self-help patient group. The questionnaire included the following items: personal attributes, difficulties in daily life, and anxiety and depression (according to the Nottingham Adjustment Scale-Japanese Laryngectomy Version). Multiple regression analysis was conducted with anxiety-depression score as the dependent variable and personal attributes and difficulties in daily life as independent variables. Results: Among the 57 patient respondents, 43 provided valid answers and were selected for analysis (valid response rate: 36.8%, 41 men and 2 women, mean age: 67.5±10.6 years). Results revealed that presence of anxiety and depression were significantly associated with patient age (β=−0.369, p=0.004) and difficulties pertaining to speech/performance during outings and engaging in hobbies (β=0.419, p=0.002). Conclusions: Our findings indicate that there is an increased risk of anxiety and depression in patients are young or middle aged and have difficulties in outings and engaging hobbies. Therefore, in clinical practice, nurses should carefully assess the mental state and difficulties in daily life in these patients after total laryngectomy. Moreover, nurses should continuously provide psychosocial support to patients and their families in order to help patients prevent psychological problems even after they are discharged from hospital.