The effects of electro acupuncture on autonomic nerve functions associated with the pupil were examined by measuring the diameter of the iris (D1), the maximum rate of iris constriction (VC) and the maximum rate of iris dilation (VD) before, during and after electro acupuncture.
An iris recorder which can be used even in the supine position was used for measuring three parameters.
As a result, the change with the above stimulation was reflected in a diminution of D1, presumably influencing parasympathetic nerve. Besides, VC and VD tended to increase with light reflex, presumably improving pupillary reactivity.

The effects of acupuncture treatment were investigated in 292 patients (140 males and 152 females, average 9. 6 ± 1. 7 (S. D.) age) who complained of reduced visual acuity, including school boys and girls (6-12 age).
Acupuncture treatment involved leaving the needle inplace for 15min, after inserting to a depth of 10-15mm from the skin surface.
The vital points ; Taiyo (Ex-HN5), Fuchi (GB-20), Syokyu (ST-1) and Goukoku (L1-4) were the basic points used for acupuncture therapy with Ganen (GB-4), Sanchiku (BL-2), Zui (ST-8) or Kyokuchi (LI-11) as supplemental points depending on individual symptoms. These acupuncture treatments improved the mean acuity by 0.26 in the right eye and 0.22 in the left. Analysis of these results indicated that acupuncture treatment caused significant improvement of vlsual acuity (p<0.01).
Therefore, acupuncture therapy was considered an effective treatment that improved regulation of the ciliary muscle and the pupillary myosis system.

The effects of acupuncture treatment were investigated in 200 patients (99 males and 101 females, average age 16.1±0.2 (SE.)) who complained of reduced visual acuity, including juvenile myopia (age 13.25).
Acupuncture treatment involved leaving the needle in place for 15 min, after inserting to a depth of 10-5 mm from the skin surface.
The vital points Taiyo (Ex-HN5), Fuchi (GB-20), Shokyu (ST-1) and Goukoku (LI-4) were the basic points used for acupuncture therapy with Ganen (GB-4), Sanchiku (BL-2), Zui (ST-8) or Kyokuchi (LI-11) as supplemental points depending on individual symptoms. These acupuncture treatments improved the mean acuity by 0.33 in the right eye and 0.31 in the left.
Analysis of these results indicated that acupuncture treatment caused significant improvement of visual acuity (P<0.01). Therefore, acupuncture therapy was considered to be an effective treatment that improved regulation of the ciliary muscle and the pupillary myosis system.

Mitral valve reoperation through a median sternotomy is technically challenging and carries higher postoperative morbidity and mortality than the primary operation, especially for a patient with patent coronary bypass grafts. We here present 3 cases of mitral valve reoperation using the beating heart technique under normothermic cardiopulmonary bypass via a mini-thoracotomy. The reasons that precluded sternal reentry were as follows : previous coronary bypass and patent internal mammary artery grafts in 2 cases, and a history of mediastinal wound infection at the initial operation in 1 case. All cases were carried out via right mini-thoracotomy and cardiopulmonary bypass using arterial cannulation via the ascending aorta or the femoral artery, and venous cannulation via the femoral vein and the superior vena cava. Mitral valve repair was performed for 1 case, and valve replacement for 2 cases. Transfusion was not necessary, except for 1 case that had anemia due to hemolysis preoperatively. All patients were discharged without major complications. This technique is a safe and feasible option for a mitral valve reoperation that excludes re-sternotomy, extensive pericardial dissection and aortic clamping, thereby minimizing risks of bleeding, graft injury and myocardial damage.

A 61-year-old man who had hypertension and renal dysfunction (serum creatinine : 1.5-2.0 mg/dl) was referred to our hospital for an abnormal shadow on chest roentgenogram. Chest CT scan with contrast revealed a distal aortic arch aneurysm (maximum diameter 52 mm) and left subclavian artery aneurysm (maximum diameter 30 mm). For the surgical treatment of the aneurysms, left hemi-collar incision and left subclavian incision followed by median sternotomy were performed. After the left subclavian artery was secured distal to the aneurysm, a ringed dacron graft was anastomosed with the distal left subclavian artery. Cardiopulmonary bypass was commenced, and selective cerebral perfusion was instituted at 25°C. The aorta was transected at the origin of the left common carotid artery. A 30 mm stent graft (length 13 cm) was inserted and was fixed on the transected aorta using 4-0 Prolene continuous suture. Then a branched dacron graft was sewn onto the transected aorta and the stent graft. The left common carotid artery and the brachiocephalic artery were anastomosed onto side branches of the graft. The left subclavian artery was reconstructed by anastomosing the ringed bypass graft onto one of the side branches. The left subclavian artery was ligated between the aneurysm and the origin of the vertebral artery, thereby interposing the subclavian artery aneurysm. After proximal anastomosis was done and the heart was reperfused, the patient was weaned from cardiopulmonary bypass. The patient was discharged without any major complication. Two years after the operation, the patient is doing well and there is no evidence of aneurysmal dilatation or endoleak. In conclusion, frozen elephant trunk technique provides an alternative to conventional graft replacement, resulting in complete exclusion of these aneurysms in a single stage. However, long-term follow up is warranted in order to ensure the durability of the stent graft.

This case report describes the orthodontic treatment performed for open bite caused by internal derangement (ID) and osteoarthritis (OA) of the temporomandibular joint (TMJ). A Japanese woman, aged 31 years and 11 months, referred to our department by an oral surgeon had an open bite with clockwise rotation of the mandible and degeneration of the condyle. The overbite was corrected through intrusion of the maxillary and mandibular molars using mini-screw implants to induce counterclockwise rotation of the mandible. Then, the mandibular second premolars were extracted and comprehensive orthodontic treatment was performed to establish a Class I molar relationship with distalization of the maxillary arch and to eliminate anterior crowding. Following treatment, her facial profile improved and a functional and stable occlusion was achieved without recurrence of the TMJ symptoms. These results suggest that orthodontic intrusion of the molars is one of the safer and less stressful alternatives for the management of open bite due to degeneration of the condyles caused by ID and OA of TMJ.
Asian Continental Ancestry Group ; Bicuspid ; Crowding ; Female ; Humans ; Mandible ; Molar ; Open Bite* ; Osteoarthritis* ; Overbite ; Recurrence ; Temporomandibular Joint*

Corticobasal degeneration (CBD) is a rare neurodegenerative disease characterized by dystonia, cognitive deficits, and an asymmetric akinetic-rigid syndrome. Little information is available regarding anesthetic management for CBD patients. Our patient was a 55-year-old man with CBD complicated by central sleep apnea (CSA). Due to the risk of perioperative breathing instability associated with anesthetic use, a laryngeal mask airway was used during anesthesia with propofol. Spontaneous respiration was stable under general anesthesia. However, respiratory depression occurred following surgery, necessitating insertion of a nasopharyngeal airway. Since no respiratory depression had occurred during maintenance of the airway using the laryngeal mask, we suspected an upper airway obstruction caused by displacement of the tongue due to residual propofol. Residual anesthetics may cause postoperative respiratory depression in patients with CBD. Therefore, continuous postoperative monitoring of SpO₂ and preparations to support postoperative ventilation are necessary.
Airway Obstruction ; Anesthesia ; Anesthesia, General ; Anesthetics ; Cognition Disorders ; Dystonia ; Humans ; Laryngeal Masks ; Middle Aged ; Neurodegenerative Diseases ; Propofol ; Respiration ; Respiratory Insufficiency ; Sleep Apnea Syndromes ; Sleep Apnea, Central ; Tongue ; Ventilation

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.

BACKGROUND/AIMS: To confirm the feasibility of using newly developed endoscopic ultrasound (EUS) with Zone sonography(TM) technology (ZST; Fujifilm Corp.). METHODS: Seventy-five patients with pancreatic disorders were enrolled: 45 with intraductal papillary mucinous neoplasm; 15 with ductal carcinoma; five with neuroendocrine tumors; three with serous cystic neoplasms; and seven with simple cysts. The endoscopes used were EG-530UR2 and EG-530UT2 (Fujifilm Corp.). Two items were evaluated: visualization depth among four frequencies and image quality after automatic adjustment of sound speed (AASS), assessed using a 5-scale Likert scale by two endosonographers blinded to disease status. Because sound speed could be manually controlled, besides AASS, image quality at sound speeds of 1,440 and 1,600 m/sec were also assessed. RESULTS: In all cases, sufficient images were obtained in the range of 3 cm from the EUS probe. Judgments of image quality before AASS were 3.49+/-0.50, 3.65+/-0.48, respectively. After AASS, A and B scored 4.36+/-0.48 and 4.40+/-0.49 (p<0.0001). There were significant differences in the data before and after AASS and plus 60 m/sec, but no significant difference between the datasets were seen after AASS and at sound speeds manually set for minus 100 m/sec. CONCLUSIONS: EUS with ZST was shown to be feasible in this preliminary experiment. Further evaluation of this novel technology is necessary and awaited.
Endoscopes ; Endosonography ; Humans ; Judgment ; Mucins ; Pancreatic Diseases