We established the Technical Aids Support Office in our hospital to promote the introduction of and technical advice about assistive technology so as to enhance the quality of care and the functioning of patients and ensure staff safety. In this paper, we introduce two complicated cases that needed individual support. Case 1: A patient with amyotrophic lateral sclerosis. The amount of assistance required had gradually increased, but the patient still hoped to use a portable toilet. Because he could barely stand up, the height of the toilet needed adjustment. An elevated seat decreased the amount of assistance required. However, raising the bottom of the portable toilet turned out to be a challenge. Case 2: Multiple limb amputee. The patient and the caregiver experienced pain and distress during transfer between bed and chair. We tried using a lift assist device, but it the hardness of the sling worsened pain at the stump. A cushion with a sliding seat was then placed between the sling and the patient to reduce friction. The shape and hardness of cushion is a future challenge to solve. Timely individual support at each stage in their care for individual patients is indispensable for the provision of technical aid support.

Objective
The purpose of this trial was to compare the cumulative and sustained effect of repeated acupuncture treatment and repeated local injection of anesthesia for localized low back pain.
Methods
A computer program was used to randomly allocate 26 patients with low back pain to either an acupuncture group (n=13) or a local injection group (n=13). Patients in both groups received treatment at the most painful points (from 2 to 5 points) once a week for a total of 4 weeks. For the acupuncture treatment, a 0.18mm diameter stainless steel needle was inserted to a depth of 10 to 20mm and then manual stimulation using the sparrow pecking method (1Hz) was given. For the local injection, injection needle (25G, 0.5mm in diameter) was inserted to a depth of 10 to 20mm before injection of the anesthetic (a mixture of local anesthetic and neurotropin). The visual analog scale (VAS: 100mm) was used to measure subjective pain intensity before and directly after the first treatment, before subsequent treatments, and at two and four weeks after completion of the treatment. The Roland-Morris Disability Questionnaire (RDQ) and Pain Disability Assessment Scale (PDAS) were also used to evaluate Quality of Life (QOL) of the subject at before the first treatment, at the time of completion of treatment, and at two and four weeks after the completion of treatment.
Results
There was a significant difference (p=0.0016) in changes in the VAS scores between two groups, with more favorable results in the acupuncture group than in the local injection group. Calculation of the degree of change from the initial scores indicated that acupuncture group showed significantly better results than those in the local injection group at directly after the first treatment (p=0.0348), and there was a significant cumulative effect (at the end of treatment: p=0.0076) and sustained effect (two weeks after treatment: p=0.0096, four weeks after treatment: p=0.0128). Similarly, RDQ and PDAS were also better in the acupuncture group compared to the local injection group.
Discussion
Both local injection and acupuncture reduced low back pain. The superior effect of acupuncture directly after treatment and its superior cumulative and sustained effect, indicate that it could be an effective treatment for low back pain. The reason for the disparity between the effects could be due to differences in the mechanisms of pain suppression.

[Objective]As fundamental research on the acupuncture treatment to shin-splints, we studied what kind of acupuncture stimulus raises the pain threshold and deep tissue temperature of the periosteal part of the tibia.
[Methods]Twelve healthy subjects (Age: 22 ± 2years old) participated in this study. We recorded how the pain threshold of the periosteum would change under the influence of the kind of stimulus of leaving a needle, sparrow pecking a needle and no stimulation. Simultaneously, we measured the deep tissue temperature near the measured part of pain threshold with a deep tissue thermometer.
[Results]The pain threshold of leaving a needle group rose significantly (p < 0.05) as compared with the control group. The sparrow pecking group showed an upward tendency. There was no significant difference in the deep tissue temperature between each group at all times.
[Conclusion]The leaving the needle technique is suitable for needle stimulus to shin-splints. It was suggested that pain control was expected with a leaving needle stimulus. The needle stimulus did not show a remarkable effect on the reaction of regional circulation.

We applied electrical acupuncture to the spinal nerve root by inserting needles under x-ray control in two cases with radicular sciatica as a non-pharmacological substitute for the lumbar spinal nerve block. In both cases, symptoms were markedly reduced after electrical acupuncture to the spinal nerve root. The sustained effect was noticeably longer than that of caudal anesthesia previously performed one time on one of the cases. We suggest that descending inhibitory control, inhibitory control at the spinal level, or changes in nerve blood flow may be involved in the mechanism of the effect of electrical acupuncture to the spinal nerve root. These results suggest that electrical acupuncture to the spinal nerve root may be superior to lumbar spinal nerve block or caudal anesthesia when it is applied appropriately in certain cases of radicular sciatica, taking into consideration of patient age, severity of symptoms and duration of the disorder.

A chronic traumatic thoracic aortic aneurysm, 19 years after a traffic accident was successfully treated. A 34-year-old man was admitted because of chest discomfort. An upper GI examination was performed and an esophageal submembranous tumor was suspected. However, a chest CT examination showed a thoracic descending aortic aneurysm, the maximum size of which was 7.5cm×5.5cm. The final diagnosis was chronic traumatic thoracic aortic aneurysm. Generally most cases of chronic traumatic thoracic aortic aneurysm have no symptoms for a long time after an accident. However, some have reported that the development of an aneurysm is due to not receiving treatment. We performed graft replacement using the temporary bypass method because it was an easy technique and required less heparinization. Chronic thoracic aortic aneurysms have lower risk of bleeding during the operation than acute cases. For chronic cases which have stable hemodynamics, adjunctive methods (e. g., partial extracorporeal bypass, left ventricular bypass and temporary bypass) may facilitate a safe operation.

Intercostal artery aneurysm is a rare disease, and is usually associated with aortic coarctation, trauma and infection. Until recently, diagnosis of the aneurysm had not been possible before rupture of aneurysm. However, recent advances in computed tomography (CT) and magnetic resonance imaging (MRI) have made it possible to diagnose this lesion. A 68-year-old man was admitted with an abnormal shadow on chest X-ray film. A chest CT scan showed an aneurysm beside the descending aorta, suggestive of intercostal artery aneurysm. Intraoperative inspection confirmed the diagnosis. The aneurysm was shown to be atherosclerotic in origin by postoperative histological examination.

The effects of electrical acupuncture at the patellar tendon and electrical stimulation of the femoral nerve on patellar tendon blood flow were evaluated using laser Doppler flowmetry in anesthetized rats. In most subjects the blood flow in the patellar tendon rapidly decreased for 30 seconds after the start of local electrical acupuncture and then increased above baseline. Changes in blood flow did not necessarily follow changes in arterial blood pressure. Changes in tendon blood flow induced by electrical stimulation of the femoral nerve were similar to those induced by electrical acupuncture at the patellar tendon. Arterial blood pressure and heart rate were not affected by electrical stimulation of the femoral nerve. Phentolamine administration abolished the decreased patellar tendon blood flow seen after initiating electrical acupuncture at the patellar tendon, whereas atropine abolished the increased patellar tendon blood flow seen after terminating electrical acupuncture at the patellar tendon. Furthermore, atropine did not evoke increased blood flow following electrical stimulation of the femoral nerve. These results suggest that the decrease of blood flow seen after initiating electrical acupuncture may be controlled by sympathetic vasoconstrictor nerves and the increase of blood flow following electrical acupuncture may be controlled by cholinergic vasodilator nerves.

This study was designed to evaluate the myocardial protection with observation of the monophasic action potential (MAP) which was recorded by suction electrode. Using the isolated working rabbit hearts, amplitude, duration of MAP at 50% repolarization level (MAPD₅₀), aortic flow and heart rate were measured after reperfusion. The comparative study obtained for all five groups under the following various conditions of the aortic cross clamping are stated as follows. Myocardial temperature were maintained at 20°C during aortic cross clamping. Group I was treated with St. Thomas' Hospital cardioplegic solution. The cardioplegic solution was infused every 20min during ischemia and kept at 20°C. The hearts of group I was divided into four sub-groups, all of which were infused with different concentration of diltiazem (D) in cardioplegia: group Ia D=0μg/ml (n=10), group Ib D=1μg/ml (n=5), group Ic D=5μg/ml (n=5). group Id D=10μg/ml (n=5), and in group II cardioplegic solution was not used. The amplitude of MAP following 30min working mode of reperfusion in group I showed a significantly higher recovery compared to those in group II. The MAPD₅₀ of MAP following 30min working mode of reperfusion in group I showed a significantly lower recovery compared to those in group II, and 10min Langendorff mode in group I a showed a significantly higher recovery compared to those in group Ib, group Ic and group Id. 20min working mode in group Ia and group Ib showed a significantly higher recovery compared to those in group Ic and group Id. The heart rate following 30min working mode of reperfusion in group Ia and group Ib showed a significantly higher recovery compared to those in group Ic and group Id. The aortic flow following 30min working mode of reperfusion in group Ia and group Ib showed a significantly higher recovery compared to those in group Ic, group Id and group II. We would like to conclude that the permeability of large amount of calcium across myocardial cell membrane seems to be depressed by diltiazem added to cardioplegia. But when the concentrations of diltiazem in cardioplegia was over 5μg/ml, it showed negative inotropic action and negative chronotropic action.

Those cases in which a dissected lumen closes early in the onset of acute aortic dissection and produce a“dissected lumen with no blood flow”are regarded as a clinico-pathological entity and are called a“closing aortic dissection”, and the clinical picture and clinical course of 14 cases in which the clinical course could be observed from early onset were reported. Although 13 cases resulted in complete closure of the dissected lumen, one case initially showed incomplete closure, but subsequently closed completely. Two cases resulted in reopening of the blood flow, but the disease recurred, and by four and six weeks each had incompletely or completely reclosed. Consequently, there were three cases of entry observed and scars of entry were found in three other cases. And in eight cases, there was nothing observed at all. Although one patient died because of complications of secondary type I acute dissection, all the others survived. All told, the developmental mechanism of this disease was alluded to.

Sixteen patients with congenitally corrected transposition of the great arteries (CTGA) underwent operative closure of ventricular septal defects (VSD). Ages of the patients ranged from 10 months to 25 years. Three different approaches were employed to access to the defect: through right ventriculotomy 3, through left ventriculotomy 5, and de Leval's maneuver 8. Here, right or left ventricle refers to its anatomic morphology. Early postoperative death occurred in a patient who concomitantly underwent extracardiac couduit repair between left ventricle and pulmonary trunk. Late death occourred in 5 (left ventriculotomy in 1 and righ ventriculotomy in 4), among whom 2 expired suddenly of unknown cause (one in each of the right and left ventriculotomy), and 1 expired of pneumonia. Two other deaths were related to their reoperations for replacement of the incompetent left atrioventricular (AV) valve. Another patient who had been repaired by de Leval's maneuver also underwent replacement of the left AV valve and survived. Two patients who had undergone left ventriculotomy developed com-plete heart block leading to implantation of permanent pacemaker. Postoperative complete heart block was temporarily noted in a patient who had been repaired by de Leval's maneuver but returned to sinus rhythm on the 10th postoperative day. Late postoperative function of the systemic ventricle was assessed in 8 by gated radionuclide ventriculography. Calculated ejection fractions in each of the methods were the followings. Left ventriculotomy: 0.38, 0.47. Right ventriculotomy: 0.13. de Leval's maneuver: 0.29, 0.54, 0.66, 0.47, 0.36. These results draw us to the following conclusions that either ventriculotomy holds its drawbacks, that is, left ventriculotomy is apt to develop complete heart block and right ventriculotomy can predispose incompetent left AV valve ultimately leading to the fatal congestive heart failure. de Leval's maneuver, however, is rare to be complicated by the above morbidity and is considered to be the best operative method currently available.