Acupuncture analgesia were successfuly used in dental extraction in some patients who were sensitive to local anesthetics. In this study this technique was applied to daily conservative dental treatment. Acupuncture analgesia can be established by transcutaneous electric acupuncture-like stimuration (TENS) in stead of inserting needles. The TENS were applied in Hoku point and Large Intestine # 10 with 3Hz at the ipsilateral side of the dental treatment.
Apparatus used were Tokki and Neuro-pulse acupuncture stimulator. Wave forms of both apparatus are spike wave with pulse width of 0.1msec. Plate electrodes were conductive rubber size of 3×4cm and were fixed at Hoku point and Large Intestine # 10 with adhesive tape.
Stimuration was continued from 20 to 30min with the strength of producing mild twitch while patients were sitting in the waiting room. 230 patients of dental conservative treatment were given TENS before cavity preparation, gingival plastic, tooth extraction, pulpectomy and others. Treatment was started under TENS alone, and when patient bigan to complain the intolerable pain, then the subperiosteal infiltration of local anesthetic was performed.
(1) Cavity preparation: 78 (85%) out of 92 were performed only with TENS. In 14 (15%) patients local infiltration were added.
(2) Gingival plastic: 29 Patients were given only TENS. Effect of TENS were excellent for the incision of gingiva, and there were no patients who added local infiltration.
(3) Pulpectomy: 60 Patients had pulpectomy. Only 12 (33%) out of 36 of alive pulp were done under TENS alone. As post arsenic treatment, however, in 23 patients out of 24, removal of already dead pulp was performed under TENS with good result.
(4) Dental extraction: In only 5 patients (23%) out of 22 of molar teeth extraction, extraction was performed under TENS. Non molar teeth extraction had poor results, too.
(5) Scaling caliculi: Scaling of the dental caliculi were done under TENS with excellent results. In conclusion, TENS is a simple and easy maneuver for every dentist to alleviate pains in the conservative dental treatments.

A-75-year-old man had refractory late cardiac tamponade after an off-pump coronary artery bypass grafting. He was initially treated by pericardiocentesis with oral nonsteroidal anti-inflammatory drugs, but the treatment failed. Pericardial fenestration was conducted twice for refractory pericardial effusion during his hospitalization. He presented again with recurrence of cardiac tamponade 2 months after the last pericardial fenestration. Therefore, a pleuroperitoneal shunt system was implanted. He recovered well and was discharged without reaccumulation of pericardial effusion.

To determine whether lipopolysaccharide (LPS)-induced prostaglandin (PG) E2 production is responsible for reduced spontaneous physical activity, we measured LPS ( 1 mg/kg, i. v.)-induced changes in voluntary wheel-running activity for 24 hours in both C3H/HeJ (LPS unresponsive due to a mutation in the tlr4 gene) and C3H/HeN (LPS response) mice. We also examined the effect of tlr4-gene mutation on LPS-induced PGE2 production using peritoneal macrophages from the C3H/HeJ and C3H/HeN mice. In addition, the voluntary wheel-running activity of the C3H/HeN mice, which were injected with the PGE2 inhibitor indomethacin (IM ; 0-20 mg/kg, i. p.) 30 min before injection with or without LPS ( 1 mg/kg), was monitored for 24 hours. Wheel-running activity in the C3H/HeJ mice was maintained in spite of LPS injection, but the activity in the C3H/HeN mice was significantly reduced by LPS injection. In vitro experiment showed peritoneal macrophage PGE2 production to be lower in the C3H/HeJ mice than that in the C3H/HeN mice. IM partially, but significantly, attenuated the LPS-induced reduction in wheel-running activity in the C3H/HeN mice. Our results suggest that the transient reduction in physical activity after LPS injection is partially mediated by LPS-induced PGE2 production, and that other factors also play a role.

Quantitative specification of color of the tongue was performed by chroma meter (Minolta CR-100) according to the Commission Internationale de l'Eclarirage 1976 (L*a*b*) Space, the color was analyzed with digital expressions as L* (value), a* (hue of red-green), b* (hue of yellow-blue) and c* (chroma) values.
The difference of the color of the tongue of the patients before and after administration of herbal medicine extracts for 12 weeks was detected by the chroma meter with statistical significance. The change of the color of the tongue of a diabetic female was also able to record on the course of the cerebrovascular accident.
To analyze the correlation between these quantified values and the findings of the tongue by inspection, 116 patients were devided into four groups (whitish, red, dark and violet) according to the color of the tongue by inspection. Most patients in the violet tongue group showed small b* value. As a group the violet group showed significantly smaller b* value than those of the whitish, red and dark groups. In the L*a*b* space as the b* value becomes small the hue becomes blue.
Analyzing the relationship between the diabetic retinopathy and the b* value, color of the tongue of 21 diabetics was examined by the chroma meter. As the result eight patients with diabetic retinopathy indicated significantly smaller b* value than those of 13 patients without retinopathy.
These obsevations suggest that the color of the tongue would be able to specificate quantitatively by chroma meter, the value measured would be correlated to the finding by inspection of the tongue, and that diabetic retinopathy would related with the hue of blue of the tongue detected by this specification system.

In Japan, doctors inexperienced stent-graft new devices are required to secure agreement on criteria and choice of the device size in endovascular aneurysm repair (EVAR) from experienced doctors. It was hoped that strict patient selection might reduce the learning curve for initial successes in given procedures. In a leading center in Japan, a number of cases which were scheduled for operation at other institutes were evaluated anatomically. We surveyed the initial success of Zenith AAA system implantation in the remaining cases by inexperienced doctors and evaluated the results. This study aimed to verify the validity of strict patient selection in improving the success rate of inexperienced doctors. We enrolled 112 consecutive patients from 19 institutes, who were scheduled for repair between January and October in 2007. All patients were evaluated on the basis of a less-than-3mm reconstructed CT image. Mean patient age was 76±5.7 years. All cases satisfied the Zenith's anatomic prerequisites. Fifteen cases were excluded for various reasons, the major reason being insufficiency of the proximal landing zone (LZ) length, angle and contour. The second reason was difficulty to approach via the iliac artery. Ninety seven cases were included, of which 17 cases were low-risk candidates for EVAR. Medium-risk seventy two cases requiring some advice to avoid problems with device size, technique of implantation and choice of main-body side. Eight cases were high-risk, requiring the presence of an experienced surgeon. Excluded cases had significantly shorter proximal LZ, larger aortic diameters 15mm below the renal artery and tortuous access routes on preliminary measurement by inexperienced doctor. Perioperative mortality was 0%, while the major complications were injury to the iliac artery in one high-risk case and thromboembolism of the superficial femoral artery in another. Perioperative proximal type I endoleak occurred in 5 cases. In 3 of these cases, the endoleak was eliminated by implantation of a Palmatz stent. In the other 2 cases, it disappeared within a month without additional procedures. These cases had a significantly greater angle between the proximal LZ and the suprarenal aorta and significant amount of mural thromboses in the proximal LZ. Perioperative type III endoleak occurred in 3 cases. In all cases the endoleak was eliminated by additional procedure. Perioperative type II endoleak occurred 8 cases. In 3 of these cases, the endoleak disappeared within a month. In the 5 other cases, the endoleak did not disappear. Mid-term results showed iliac leg thromboembolism in one case and new type II endoleaks in 3 cases. Type II endoleak occurred in cases which had significantly greater angles between the proximal LZ and the aneurysm. The results which were evaluated in our center had excellent perioperative and mid-term outcomes. We think this evaluation system is effective for risk assessment and reduces the learning curve in EVAR. In anatomically marginal cases, it is possible for proximal type I endoleak and injury of the iliac artery to occur. It is impossible to exclude these marginal cases if treatment need for EVAR is a priority. In these cases, lessexperienced operators should be trained in troubleshooting techniques in advance.

A questionnaire survey of risk management systems for medical products was conducted with the cooperation of domestic and foreign pharmaceutical companies. As for the foreign companies, it was revealed that specialized safety management teams and data-management committees are established to formulate risk management plans in order to create systems that assure consistent risk management for each company. In addition, it was revealed that toxicologists are incorporated in the central decision making organization. As for domestic companies, it turned out that no less than half of the respondents pay attention to consistent risk management from the development stage through the post marketing stage. From now on, it will be essential to consolidate safety data, improve the accessibility of centralized safety data from the relevant departments, and establish systems to provide consistent risk management from the development stage to the post marketing stage.