Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.

[Introduction] Acupuncture has been used in patients with functional digestive symptoms. Acupuncture treatment was used on a patient with upper stomach pain and feeling of fullness accompanied by pain in knee, neck and shoulders. Details of the clinical experience have been written in this brief report and shows improvement in gastric symptoms and increase of normogastria in gastric electrical activities by acupuncture treatment.[Case] A 73 year-old female patient, who was 148 cm tall and 51 kg in weight, complained of some chronic pain at the first medical examination. However, in the 24th treatment, the patient complained of severe stomach pain and feeling of fullness accompanied by 36 points on the gastrointestinal symptom rating scale (GSRS). Therefore, electrogastrograms (EGG) were recorded, as a noninvasive clinical evaluation of gastric function, at 15 minutes before and after the 30th treatment for 10 minutes using the retaining needle technique at bilateral ST36 andST40.[Result] The decrease of GSRS showed improvement of gastric symptoms by acupuncture treatment. After treatment, the percentage of normogastria in EGG increased to 71% from 58%, thus stabilizing theincrease in power spectra.[Discussion] It has been suggested that the increase of nomogastria in EGGs show an improvement of gastric symptoms. Moreover, the patient was told about the positive changes in EGG by an acupuncturist, and explaining that the acupuncture treatment seemed to improve clinical symptoms. Thus, acupuncture treatment contributed to an improvement of symptoms in a patient with stomach pain and feeling of fullness.[Conclusion] Acupuncture treatment induced an increase in percentage of normogastria in EGG power and resulted in an improvement in gastric symptoms of a patient with upper stomach pain and feeling of fullness.

The saphenopopliteal junction (SPJ) is found at various levels and has various patterns compared with the saphenofemoral junction. Although this can cause difficulty in the surgical treatment of varicose veins and affect the outcome, there have been few reports on preoperative assessment of the small saphenous vein (SSV) regarding this point. This study was undertaken to evaluate three-dimensional CT venography with dual-route injection for the preoperative assessment of a small saphenous-type varicose vein. We examined a total of 15 legs in 15 patients with a small saphenous-type varicose vein, which were preoperatively evaluated by CT venography and then surgically treated. The patients included 4 men and 11 women with ages ranging from 50 to 80 years old (mean age, 66 years). The grading of varicose veins according to the CEAP classification was C2, C3, C4, and C5 in 3, 4, 6 and 2 legs, respectively. The CT imaging was performed with contrast medium diluted ten-fold, which was injected into the great and small saphenous veins simultaneously. CT venography clearly visualized the lower extremity veins. Whereas the popliteal vein coursed deep above the level of the femoral intercondylar groove, it followed a shallow course below the level of the knee joint. In 11 legs (74%), the SPJ was located in the shallow portion, whereas it was in the deep portion in 4 legs (26%). Among the former group, the SSV was connected to the great saphenous vein via the Giacomini vein in 2 cases, and the gastrocnemius vein was connected to the SSV before the SPJ in 3 cases. Among the latter group, a localized large venous aneurysm with thrombus before its termination was found in one case. In another case, the SSV showed branched termination in the deep portion. Our three-dimensional CT venography with dual-route injection provides more accurate information on venous anatomy in the lower extremity. The accuracy of images acquired by CT venography with dual-route injection was verified by intraoperative findings. Although Doppler ultrasound is essential for examining the presence of regurgitation in the veins and locating the course of a varicose vein in the surgical field, all 15 cases had scheduled surgery under local anesthesia based on accurate preoperative diagnosis. This study suggests that CT venography with dual-route injection is beneficial in preventing undesired complications during surgery and avoiding additional procedures for recurrent varicose veins.

Miriplatin is a novel lipophilic platinum complex that was developed to treat hepatocellular carcinoma (HCC). Although HCC patients frequently have coexisting chronic renal failure, little prospective data are available regarding the clinical toxicity of chemotherapeutic agents used to treat HCC patients with chronic renal failure. In a phase II study, the plasma concentration of total platinum in patients who received miriplatin was very low, and no severe renal toxicity caused by miriplatin injection was reported. Here, we present three cases of HCC with stage 4 chronic renal failure who received transcatheter arterial chemotherapy with miriplatin. All cases were male, ages 72, 84, and 83 years, and had serum creatinine levels of 2.3, 1.6, and 1.9 mg/dL, respectively. Their estimated glomerular filtration rates were 21.9, 20.3, and 22.2 mL/min, respectively. All cases were treated for unresectable HCC with transcatheter arterial chemotherapy with miriplatin. No serious adverse events were observed, and serum creatinine levels did not elevate, even in the patient who experienced renal failure caused by cisplatin administration. These results might suggest that transcatheter arterial chemotherapy with miriplatin can be safely used in HCC patients with chronic renal failure.
Carcinoma, Hepatocellular ; Cisplatin ; Creatinine ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic ; Male ; Organoplatinum Compounds ; Plasma ; Platinum ; Renal Insufficiency

[Objective]To clarify the effects of electroacupuncture (EA) on the menstrual cycle at puberty, we investigated whether or not EA influences the menstrual cycle, the number of ovulations, and the duration of the high-temperature phase. Also we investigated the improvement of menstrual disorder and changes in body mass index (BMI) by EA treatment.
[Methods]Twenty-five female students participated in this study.
Non-treatment periods from three to four months were evaluated before EA treatment. During treatment, EA was performed once a week. We compared the menstrual cycle, the number of ovulations, and the duration of the high temperature phase for non-treatment and EA treatment periods. To evaluate the relation between BMI and improvement of menstrual disorder by EA, female students were divided into two groups, improvement or not-improvement group.
[Results]Twenty female students were analyzed in this study. In those with extended periods of amenorrhea, the menstrual cycle became significantly shorter during EA (P< 0.001). In those with polymenorrhea, the menstrual cycle became significantly longer during EA (P< 0.05), reaching a normal cycle length. Improvement of the menstrual cycle was found in 30.0%of the subjects. However, an increase in the number of ovulations and extended duration of the high temperature phase were found in 20.0%and 25.0%of the subjects, respectively. Although BMI did not vary significantly between the improvement and the not-improvement groups, the percentage of those with normal weight tended to be higher in the improvement group than in the not-improvement group.
[Conclusion]These findings suggest that EA influences follicular growth. However, it had been thought that EA could not influence ovulation or affect luteal function. Additionally, when BMI is nearly normal, it appears more likely that acupuncture is effective for menstrual disorder at puberty.

[Purpose]The reason is uncertain though it is assumed that to young people that there are a lot of Temporomandibular disorders (TMD). Then, the questionnaire survey concerning the mandible function was administered for university students, and the clinical trial of the acupuncture treatment that used sham acupuncture for the one where the problem was seen in the mandible function was tried.
[Method]We questioned students at Meiji University of Integrative Medicine by answer selection type concerning the mandible function. The acupuncture treatment was done on 16 students (21.5 ± 1.7 years old;mean ±S.D.) who had problems in the mandible function. The group was divided into two groups (the acupuncture group and the sham acupuncture group) at random. Each group received five acupuncture treatment sessions several times week in total. Outcome measures were pain intensity (visual analogue scale) and function of jaw (mouth opening and muscle power). Each evaluation was assumed to be done before beginning the treatment, and the effect of treatment was assumed to be the one evaluated as a therapeutic gain after one week.
[Result]University students who had some problem in the mandible function were 50%or more of the whole, and a lot of problems were joint noises. On the other hand, the acupuncture group was 67.1 ± 19.1 mm and the sham group was 65.6 ± 15.2 mm. Both groups showed reduction tendencies as the acupuncture group was 9.3± 7.8 mm and the sham group was 40.5 ± 16.7 mm. The acupuncture group reported less pain intensity than the sham acupuncture group (p = 0.0152, Mann-Whitney). However, the true and sham acupuncture groups did not change the function of the jaw.
[Conclusion]A lot of university students who had mandible function problems were unexpectedly regarded as necessary to treat at the early stage. On the other hand, these results suggest that true acupuncture procedures may be more effective on TMD in young patients than sham acupuncture procedures.

[Objective]Acupuncture has been reported to be useful for temporomandibular disorders. There have been many reports on muscle problems in temporomandibular disorders (TMD) but only a few reports on disc problems. We report on the use of acupuncture in a temporomandibular disorder patient with disc disorders.
[Case]A 19-year-old female complained of pain upon opening her mouth and trismus. We applied acupuncture with the aim of resolving the disc problems and providing analgesia by a contributing muscle needling approach.
[Methods]The following were measured:intensity of jaw pain, anxiety and satisfaction (visual analogue scale:VAS), position and form of disc and caput mandibulae (MRI) and presence of jaw deviation.
[Results]The following were improved after acupuncture treatments:intensity of jaw pain, anxiety and satisfaction, limitation of jaw movement and jaw deviation. However, the positions of the discs did not change.
[Conclusion]These results suggest that acupuncture may be effective for temporomandibular disorder patients with disc disorders.

[Objective]To aleviate incidents and prevent medical accidents in acupuncture and moxibustion therapy, we constructed an incident report (IR) system at the Center of Acupuncture Science, Meiji University of Integrative Medicine.
[Methods]The IR system was operated with the center staff as reporters. The staff reported incidents when encountered or found. The cases of incidents were added up per item, and the contents of incidents fed back per month to staff and students. The feedback was given orally at a morning assembly, and a feedback poster was put up.
[Results]There were 146 cases from July 2004 to September 2005. The contents of incidents were 96 cases concerning the environment of treatment, 0for incidents before treatment and 50 during or after treatment. The largest number of incidents in the environment of treatment was 66 cases for inappropriate disposal of instruments. The largest number of incidents during or after treatment was 12 cases in nearly forgetting to remove acupuncture needles from the body.
[Discussion]Ten mean cases per month occurred as incidents. However, it was clear that the incidents in most cases could have been prevented if the acupuncturist had been noticed and took measures to deal with the situation. To prevent medical accidents, we consider a need to continuously feed back the contents of incidents to instructors and students and call them to their attention.