Between 1996 to 2000, 12 patients with arteriosclerotic thoracic aortic aneurysm underwent surgery with cardiopulmonary bypass using the right axillary artery as an arterial inflow. All patients received total arch replacement with selective cerebral perfusion and deep hypothermic circulatory arrest. One patient with occlusion of the left carotid artery died of postoperative stroke. There were no postoperative complications or deaths related to axillary artery perfusion except for cerebrovascular accidents. Perfusion through the axillary artery, providing antegrade aortic flow, is a safe and effective procedure to avoid stroke owing to retrograde arterial perfusion. We believe that the axillary artery could be an alternative to conventional femoral artery cannulation in the setting of aortic arch operations.

A 2-year-old girl who had been followed because of pulmonary valve stenosis since birth, underwent unsuccessful balloon valvuloplasty twice. The angiographic study showed thin cusps and remarkably thick and immobile filling defects in the main pulmonary artery, which indicated supravalvular PS or pulmonary valve dysplasia. Operation was done under conditions of a beating heart and total cardiopulmonary bypass. Pulmonary valve dysplasia was localized on the edge of all three cusps. After resection of the dysplastic lesion, the stenosis was released and slight regurgitation was observed by ultrasonography study.

A 75-year-old woman underwent endovascular stent-grafting for a descending thoracic aortic aneurysm, followed by video-assisted thoracoscopic right upper lobectomy for concomitant lung cancer in a later procedure. Two custom-made endovascular spiral Z stents covered with woven Dacron (DuPont Co., Wilmington, DE, USA) were delivered via the femoral artery under local anesthesia using pull-through technique. Intraoperative angiograms showed successful exclusion of the aneurysm without any endoleakage. Conventional surgical treatments for both diseases in this patient would have required bilateral thoracotomy either in a simultaneous or staged fashion and entail risks of postoperative pulmonary dysfunction and progression of the cancer. Endovascular stent-grafting offered potential superior operative results and quality of postoperative life in this patient with concomitant descending thoracic aortic aneurysm and cancer of the right lung.

Continued from the previous year's theme of our workshop, we collected various information and ideas for safer acupuncture practice. Subjects and presentations of the present workshop were as follows:
1. Literature review of papers on adverse events published between 2003and 2006
1) Papers in domestic journals (by Ishizaki and Egawa)
2) Papers in foreign journals (by Yamashita and Umeda)
2. Debate on wearing sterilized fingerstall or glove
1) Present status of the use of fingerstall in acupuncture practice (by Katai and Minowa)
2) Practical side of clinical education of acupuncture using fingerstall (by Hatakeyama and Furuya)
3) Problem of using individual fingerstalls in acupuncture practice (by Handa and Miyamoto)
We will continue to provide information and discuss solutions in order to reach a common understanding and specific methods for safer acupuncture practice.

OBJECTIVESTo assess trends in smoking prevalence among Japanese adolescents and to analyze possible causal factors for the decrease in smoking prevalence observed in a 2004 survey.

METHODSNationwide cross-sectional surveys were conducted in 1996, 2000 and 2004. Survey schools, both junior and senior high schools, considered to be representative of the whole of Japan were sampled randomly. Enrolled students were asked to complete a self-reporting anonymous questionnaire on smoking behavior. The questionnaires were collected from 115,814 students in 1996, 106,297 in 2000, and 102,451 in 2004. School principals were asked about the policy of their respective school on smoking restrictions.

RESULTSCigarette smoking prevalence (lifetime, current, and daily smoking) in 2004, based on the completed questionnaires, had decreased relative to previous years in both sexes and in all school grades. The most important trends were: a decrease in smoking prevalence among the fathers and older brothers of the students; an increase in the proportion of students who did not have friends; a decrease in the proportion of current smokers who usually bought cigarettes in stores decreased in 2004, in particular for the oldest boys. An association was found between a lower smoking rate at a school and a smoke-free school policy.

CONCLUSIONSJapan has experienced a decrease in the prevalence of smoking among adolescents. A decrease in smoking prevalence among the fathers and older brothers, limitations to minors' access to tobacco, an increase in the proportion of students without friends, and a school policy restricting smoking may have contributed to this decreasing trend.