A 77-year-old man with an abdominal aortic aneurysm, detected by abdominal ultrasonography, was referred to our hospital. Multi-detector computed tomography (MDCT) revealed an intrathoracic left subclavian artery aneurysm 30 mm in diameter and a small distal arch aortic aneurysm as well as an abdominal aortic aneurysm 40 mm in diameter. Surgery was indicated for the subclavian artery aneurysm considering the risks of rupture and distal embolism. Our choice for treatment was endovascular repair ; thoracic endovascular aortic repair (TEVAR) and coil embolism. The operation was performed successfully. Orifices of the left subclavian artery and the distal arch aneurysm were covered with a stent graft and the left subclavian artery was occluded with coils distal to the aneurysm. The operation time was 1 h and 44 min. He was extubated in the operation theater. A follow-up CT scan performed at 1 week showed the correct position of the TEVAR device, patency of the common trunk of the brachiocephalic and right common carotid arteries, and complete exclusion of the aneurysms. He was discharged on the 12th postoperative day without complication. Subclavian artery aneurysms, in particular in the intrathoracic location, are rare. Conventional surgery for this entity tends to require arch replacement to be unreasonably invasive as a therapy for peripheral artery disease. We believe this endovascular therapy can be a useful, less-invasive alternative to conventional open surgery.

Objective
 We examined the effects of acupuncture electrotherapy in young women with hie symptoms (excessive sensitivity to cold), presented in conjunction with vasomotor dysfunction as determined by the postural change test.
Subjects and Methods
 Subjects comprised 20 women (mean age, 20.6 years; range, 18-26 years) who exhibited symptoms of hie, evaluated as toe skin temperature after standing for 5 mins or a temperature difference between the right and left toes as compared to before standing. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in SP6 (Shangqui). Acupuncture electrotherapy connected an acupuncture electrode to SP6 and a non-feeling electrode to lateral of the tibial tuberosity, and was undertaken at a frequency of 1 Hz for 20 mins. Therapy was provided as a total of 5 sessions, with 1 session each week, and the postural change test was performed before and after therapy. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a medical thermography device, and mean skin temperature was calculated in selected regions of the toes, metatarsals, ankle, and tibial aspect of the lower leg. Therapy was evaluated using a questionnaire with two originally designed scales: a categorical scale of 14 symptoms including hie; and degree of hie on a visual analogue scale (VAS). Subjects completed the questionnaire every day during a period from 1 week before therapy sessions began until 1 week after completion of all 5 sessions. Scores for hie symptoms were calculated as mean values from the total score of the 14 symptoms and VAS each week. Changes in health-related quality of life with acupuncture were evaluated using the SF-8 Standard Edition.
Results
 Toe skin temperature just after standing was not significantly increased by therapy as compared to before standing. Skin temperature on the tibial aspect of the lower leg 20 mins after standing was significantly increased as compared to the adaptation period. In terms of hie, VAS and SF-8, no significant changes were seen before and after therapy, but total score for the 14 symptoms decreased significantly.
Conclusions
 Acupuncture electrotherapy to SP 6 did not appear to exacerbate hie symptoms after reductions in air temperature, while normalizing the postural vascular reflex and improving hie-related symptoms.

PURPOSE: Since a patient's obesity can affect the mortality and morbidity of the surgery, less drastic surgeries may have a major benefit for obese individuals. This study evaluated the feasibility of performing a totally laparoscopic distal gastrectomy, with intracorporeal anastomosis, in obese patients suffering from gastric cancer. MATERIALS AND METHODS: This was a retrospective analysis of the 138 patients, who underwent a totally laparoscopic distal gastrectomy from April 2005 to March 2009, at the National Kyushu Cancer Center. The body mass index of 20 patients was > or =25, and in 118 patients, it was <25 kg/m2. RESULTS: The mean values of body mass index in the 2 groups were 27.3+/-2.2 and 21.4+/-2.3. Hypertension was significantly more frequent in the obese patients than in the non-obese patients. The intraoperative blood loss, duration of surgery, post-operative complication rate, post-operative hospital stay, and a number of retrieved lymph nodes were not significantly different between the two groups. CONCLUSIONS: Intracorporeal anastomosis seemed to have a benefit for obese individuals. Totally laparoscopic gastrectomy is, therefore, considered to be a safe and an effective modality for obese patients.
Body Mass Index ; Gastrectomy ; Humans ; Hypertension ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Obesity ; Retrospective Studies ; Stomach Neoplasms ; Stress, Psychological

Objective  We examined the effects of low frequency electro-acupuncture therapy (EAT) on young women who suffered from‘Hie’symptoms, which were judged according to the national normal value of bodily pain (BP) scores from a ”Medical Outcomes Study Short-Form-8 Survey“ (SF-8). Subjects and Methodology  The experimental subjects were 20 women (mean age: 21.2 years old; range: 18-26 years old) who exhibited symptoms of ‘Hie’ symptoms (vasomotor dysfunction) and whose toes’skin temperature increased or showed a different reaction between right and left during a postural change test. A stainless steel acupuncture needle (length: 40 mm; diameter: 0.2 mm) was inserted approximately 15 mm deep at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (the needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg was applied at a frequency of 1 Hz for 20 minutes. The therapy was provided one session per week for a total of five sessions. Effects of the therapy were evaluated by using an original questionnaire (‘Hie’diary), which consisted of six categorical of 14 symptoms (including of‘Hie’) and Visual Analogue Scale (VAS) of‘severity of Hie’. Moreover, changes in health-related quality of life (HRQOL) by acupuncture were evaluated by using the SF-8 Standard Edition. Results  Subjects were grouped according to their SF-8 BP scores before the therapy: 12 subjects (L group) whose scores were less than the national normal value (42.75 points), and eight subjects (H group) whose scores were more than the national normal value. For both groups VAS levels showed no statistically significant changes, but for the L group the total score of 14 symptoms significantly decreased after the second therapy session compared with scores before the therapy. Moreover, the statistically significant decrease in the total score lasted for one month after the therapy had been finished. Compared with before therapy, the score of ‘vitality’ (VT) significantly increased for the L group one month after the therapy, and those of BP and ‘mental health’ (MH) significantly increased for the L group just after and one month after the therapy. Conclusions  EAT at SP6 on young women with ‘Hie’ symptoms (vasomotor dysfunction) contributes to improvement in overall condition and health-related QOL, and it is occluded that the effect of the EAT was high, because HRQOL was low (the score of BP was low).

Objective: We examined the effects of low frequency electro-acupuncture therapy (EAT) in young women with‘Hie’symptoms, which were classified according to the presence of the vasomotor dysfunction as determined by the postural change test. Subjects and Methods: Subjects were 43 women (mean age, 21.2 years) who exhibited‘Hie’symptoms. The postural change test was performed in five-minute-loads in a standing position after a rest period of 10 minutes in a spine position. The skin temperature in the lower limbs was measured before and after the test. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in depth at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg were carried out at a frequency of 1 Hz for 20 minutes. The therapy was provided in a total of 5 sessions, with 1 session per week, and the postural change test was performed after 5 sessions. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a thermography device, and mean skin temperature was calculated in selected regions of the toes and tibial aspect of the lower leg. Effects of the therapy were also evaluated using an original questionnaire (‘Hie’diary) concerning‘Hie’symptoms, which consists of six categorical scales of 14 symptoms including‘Hie’and severity of‘Hie’on a Visual Analogue Scale (VAS) was used. Moreover, changes in health-related quality of life by acupuncture were evaluated using the SF-8 Standard Edition. Results: Subjects were classified according to the results of the postural change test: 23 people (no vasomotor dysfunction group; non-vd group) whose skin temperature in the toe decreased after the postural change and 20 people (vasomotor dysfunction group; vd group) whose skin temperature in the toe increased after the load or showed a different reaction between right and left. In the vd group, the total score of 14 symptoms in the‘Hie’diary was significantly higher, and subjective‘Hie’symptoms showed a more severe score than that in the non-vd group. The bodily pain score in the SF-8 in vd group was significantly lower than a national reference value. After an EAT session, the vd group’s skin temperature on the tibial aspect of the lower leg at 20 minutes after completion of the load was significantly higher than that before the load. Moreover, changes in the VAS score and SF-8 score showed no statistical significant in both groups, but the total score of 14 symptoms decreased significantly in the vd group. Conclusions: We suggested that normalization in the blood vessel reaction in lower limbs by EAT at SP6 contributed to the improvement in the systemic condition that was determined by the postural test. The issue of further investigation is to elucidate the pathogenesis andor establishment of the treatment in the subjects with‘Hie’symptom whose vasomotor function was within normal limits.