A Case of Successful Surgical Management of Tracheo-Innominate Artery Fistula after Endovascular Repair / 日本心臓血管外科学会雑誌

A 15-year-old girl who had undergone a tracheostomy 4 years earlier because of holoprosencephaly and severe mental and physical disabilities had tracheo-innominate artery fistula with sudden-onset bleeding after endotracheal suctioning. Due to respiratory and circulatory instability, VIABAHN® was implanted in the brachiocephalic artery, and the patient was discharged on postoperative day 33. Three months later, rebleeding from the tracheostomy site was observed, and the patient was transported to our hospital. Although the bleeding stopped spontaneously on arrival, the patient experienced multiple bleeding episodes after admission. Therefore, transection of brachiocephalic artery was performed, after which the patient was discharged on postoperative day 20. Tracheo-innominate artery fistula is a rare complication that occurs after tracheostomy, but it is associated with a poor prognosis, and has a mortality rate of 100% if left untreated. Our case suggests that endovascular treatment using VIABAHN® for tracheo-innominate artery fistula is useful for temporary hemostasis.

Reflecting on activities over the past decade and considering future developments / 全日本鍼灸学会雑誌

The safety committee has been undertaking activities, such as conducting regular workshops at the annual congresses, managing the "Safety Measures Website for Acupuncture and Moxibustion," researching the literature, conducting multicenter prospective studies on acupuncture and moxibustion-related adverse events, collecting information about medical accidents involving acupuncture and moxibustion in Japan, addressing the media pertaining to false information regarding the safety of acupuncture and moxibustion, and formulating the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice. At the 71st annual Tokyo congress workshop, activities conducted over the past decade were summarized.　Regarding the studies on acupuncture and moxibustion-related adverse events, a literature review of reports concerning acupuncture- and moxibustion-associated adverse events published globally from 2004 to 2019 was introduced. Furthermore, the results of a multicenter prospective study conducted by the safety committee were also introduced. Additionally, the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice were introduced, and the results of a questionnaire survey determining the degree of recognition of these guidelines were simultaneously reported. Moreover, regarding future developments, plans to create and publish a safety manual for acupuncture and moxibustion (provisional name) were reported.　In the second half of the workshop, reports on the past cases of needle breakage and retained needles were introduced under the topic "precautions and preventive measures regarding needle breakage and retained needles." Furthermore, the number of needle breakage claims filed under the liability insurance of acupuncture and moxibustion practitioners was reported. These details demonstrate that despite the common use of single-use acupuncture needles, accidents involving needle breakage still exist. Lastly, measures for reducing the difficulty in needle removal and preventing needle breakage were summarized, and opinions on the same were exchanged with the participants.

Essential Knowledge of Regional Anatomy for Safe Acupuncture Needling / 全日本鍼灸学会雑誌

In The 63rd Annual Congress of JSAM (Ehime 2014), the Committee for Safe Acupuncture of Research Department in the Japan Society of Acupuncture and Moxibustion (JSAM) conducted a workshop entitled "The Regional Anatomy Q&A for safety needling"which provided information on organ damage and neurological injuries that may occur after acupuncture treatments. This workshop stated the need for improvements in safe practices of acupuncture.<BR>This workshop was divided into three parts:(1) results of questionnaire surveys conducted in Japan for acupuncturists on their clinical experience of adverse events and for orthopaedic doctors on their clinical experience of patients who suffered adverse events after acupuncture treatment;(2) a literature search of severe adverse events e.g., pneumothorax and neurological injuries, associated with acupuncture treatment in Japan;(3) the regional anatomy of the upper part of the body, which is based on several anatomical studies on acupoints. <BR>The incidence of severe adverse events is considered to be very low during all acupuncture treatments;however, the real incidence is estimated to be higher than the number of case reports in the literature. In order to prevent severe adverse events, regional anatomical knowledge of needling points is very important, and furthermore, safe needling techniques are required. <BR>We hope that this workshop can aid in enhancing the knowledge and techniques and contribute to safe practices of acupuncture.

A Case of Endovascular Stent Grafting for Dissecting Brachiocephalic Artery Aneurysm Deriving from Anastomotic Leakage after Surgery for Acute Type A Aortic Dissection / 日本心臓血管外科学会雑誌

We report a case of a dissecting brachiocephalic artery aneurysm that developed at the anastomotic site following surgery for acute aortic dissection ; and which was successfully treated by stent grafting. The patient, a 62-year-old man, had undergone total arch replacement for an acute Stanford type A aortic dissection that accompanied dissection of the brachiocephalic artery. In the early postoperative period, he complained of dull pain in the right arm and fatigue on exertion. The blood pressure in the patient's right arm was found to be significantly lower than in the left. Enhanced computed tomography (CT) performed 1 month postoperatively revealed leakage at the anastomotic site of the brachiocephalic artery, leading to the formation of a false lumen and the creation of a dissecting aneurysm with a maximum short diameter of 30 mm. No re-entry was seen, and the greatly expanded false lumen was exerting pressure on the true lumen, causing ischemia of the arm. Enhanced CT performed 3 months postoperatively showed that the maximum short diameter of the aneurysm had increased to 35 mm. Because ischemic symptoms of the arm were also present, surgery was considered to be indicated, and stent grafting was performed. A stent graft was inserted via the right axillary artery and positioned to close the entry to the false lumen of the dissecting aneurysm. Symptoms resolved without any complications, and the patient was discharged 7 days after the surgery. The false lumen of the dissecting aneurysm completely disappeared, and no complications have developed during the 3-year interval since stent grafting. In this patient, stent grafting enabled minimally invasive closure of the entry to the dissecting aneurysm that had developed at the anastomosis site. We conclude that stent grafting is very useful for treating dissecting aneurysms caused by anastomotic leakage and without re-entry, as seen in this case.

Questionnaire survey on infection control and prevention education in acupuncture schools / 全日本鍼灸学会雑誌

[Objective]We performed a questionnaire for the purpose of investigating the present conditions of infection control education in Japanese acupuncture schools and to discuss the problems.<BR>[Methods]We conducted a postal survey by sending out questionnaires to 153acupuncture schools in Japan from December 2008 to March 2009.<BR>[Results]Replies were obtained from 69.9%of the schools (107 out of 153schools). In their responses, 65%of the schools taught hand-washing with soap and alcohol-based hand rub as methods of hand hygiene. Moreover 58%of the schools used only single use needles (SUNs), 40%used both reusable and single use needles, and 2%used only reusable needles. However, single use was observed only at 25%of the schools that introduced SUNs.<BR>Furthermore, we inquired whether the students were taught to use sterilized gloves and finger cots. The results illustrated that a proportion of schools provided the instruction;the proportion of constant instruction was 17%, that of the instructor's option was 35%, that of no requisite was 48%. <BR>[Conclusion]From the above-mentioned results, it became clear that the direction for use of SUNs was not instructed adequately. In addition, this aseptic technique for puncture is not yet standardized in the school's education. It is necessary to realize the measures based on evidence and to employ them in educational programs at acupuncture schools.

Pulmonary Trunk Aneurysm with Ascending Aortic Aneurysm, Concomitant with Bilateral Semilunar Valve Insufficiency / 日本心臓血管外科学会雑誌

Simultaneous pulmonary trunk and ascending aortic aneurysms are very rare, and the role of surgery in this entity is not well defined. We report a rare case of aneurysm of both the pulmonary trunk and the ascending aorta, associated with pulmonary and aortic valve insufficiency in a 17-year-old boy. Cardiac disease had been diagnosed at the age of 5, and at that time, pulmonary and aortic valve insufficiency were found by ultrasound cardiography (UCG). At regular follow-up, both cardiac valve regurgitation and the dilatation of the aneurysm gradually increased. A recent computed tomographic scan revealed that the ascending aortic aneurysm was 55 mm and the pulmonary trunk aneurysm was 60 mm. A UCG also showed severe aortic valve regurgitation and moderate pulmonary valve regurgitation with no pulmonary hypertension. Surgical repair was performed successfully. The aortic valve was replaced with a mechanical valve. The dilated ascending aortic aneurysm was excised and replaced with a Dacron graft. The pulmonary trunk aneurysm was incised longitudinally. The pulmonary valve was tricuspid, and no organic leaflets change was observed. Pulmonary valvuloplasty by commissure plication of the prolapsed cusps was performed. A large portion of the anterior pulmonary aneurysm wall was excised and plicated to reduce the radius diameter. The pathology of the aneurysm wall showed infiltration of inflammatory cells in the tunica media, fragmentation and decrease of elastic fiber, loss of muscular tissue, and increase in collagen fibers. No cystic medial necrosis was observed in the pathologic specimen. The postoperative course was uneventful, and there were no adverse events or complications at 2 years follow-up. The following image study revealed the normal size of the great vessels.

Graft Infection in Femorofemoral Crossover Bypass, First Presenting as Septic Distal Emboli / 日本心臓血管外科学会雑誌

We report a case of graft infection long after femorofemoral crossover bypas grafting (FFBG), first presenting as septic distal emboli without any infective signs in the groin. A 71-year-old man who had undergone FFBG visited our hospital because of sudden pain in his right foot. No infective signs were found in the graft route from physical examination. However, computed tomography demonstrated perigraft fluid and graft thrombi. Graft excision and extra-anatomic revascularization were successfully done. Light micrography showed <i>Staphylococcus aureus</i> extensively infiltrating in the expanded polytetrafluoroethylene graft wall.

Coronary Artery Bypass Grafting in Situs Inversus Totalis / 日本心臓血管外科学会雑誌

Cardiovascular surgery in situs inversus totalis (SIT) is unusual. We report a case of coronary artery bypass grafting (CABG) in SIT. A 67-year-old man with unstable angina pectoris was admitted to our hospital. Coronary arteriography demonstrated three-vessel disease in the mirror-image heart. CABG with 4 distal anastomosis was carried out with conventional methods. Careful observation based on complete understanding for preoperative images could minimize operative difficulties caused by mirror-image heart.

The Health-Related Quality of Life Evaluation in the Patients who Receive the Acupuncture Treatment / 日本温泉気候物理医学会雑誌

The largest percentage of patients receiving acupuncture treatment in Japan are those with chronic aches. Aches are major factors of QOL, and the pain-killing effect of acupuncture treatment has a large clinical significance. In the study, therefore, we expressed the QOL of the patients who received acupuncture treatment as scores using SF-36 and then examined the effect of acupuncture treatment on improving the QOL. Each score of SF-36 was rated from 0 to 100, where higher points represent better states of health.<br>The study was conducted on 60 patients who received acupuncture treatment in our facility from Oct. 2002 to Jan. 2003.<br>All scores before the start of treatment were low, and all score fell below the national standard value. Physical functions (PF), bodily pain (BP), and generally view of healthiness (GH) of the physical component summary (PCS) and vitality (VT) of mental component summary (MCS) showed particularly low scores relative to other scores. Comparison of scores before the start of treatment with those 1 month after the treatment revealed that BP among the eight sub-scales was improved significantly (p<0.05). In conclusion, these results suggest that receiving acupuncture treatment can contribute to improving a patient's QOL.

Assessment and Treatment of Chronic Pain / 全日本鍼灸学会雑誌

The definition of Pain, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (International Association for the Study of Pain : IASP, 1994), which is often used to explain its subjectivity. It is necessary to evaluate the pain objectively for diagnosis and effectiveness of therapy.<BR>As an evaluation method of chronic pain, Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) are used. Recent years, face visual analog scale and Current Perception Threshold (CPT) testing are also used commonly. Drug challenge test draws attention as it combines an evaluation method and an effective therapy. Meanwhile as a therapy of chronic pain, the reports of epiduroscopy and phototherapy are increasing. The epiduroscopy is an endoscopic operation for patients with the chronic low back pain. In Japan the therapy is performed increasingly for patients with the low back pain of spinal canal stenosis, failed back syndrome and lumbar disc herniation. Regarding the phototherapy, the reports which show the effectiveness of linear polarized infrared raytherapy and xenon phototherapy are mainly observed. Though the nerve block is still the dominant therapy in pain clinics, acupuncture therapy and phototherapy are prospected to increase their demands in future.

Acupuncture Treatment in a Peripheral Facial Paralysis with the Sequelae / 全日本鍼灸学会雑誌

Bell's palsy, most frequently occurring in peripheral facial paralysis, is a well-recoverable disease showing spontaneous healing in 70% of patients. This chronic patient of Bell's palsy has persisted for more than two years. Many medical institutes have diagnosed that it was very difficult to remedy completely. The rating score was 24 (full score : 40 points), having sequelae of synkinesis, facial spasm, crocodile tears and other problems. By thermography, the temperature difference between the normal side and the paralyzed side was 0.9°C, and the paralyzed side's temperature was lower. To improve microcirculation on the paralyzed side, electro-acupuncture treatment has been applied to the facial nerve and facial expression muscles. <BR>After evaluating mainly the score for facial paralysis and thermography, the score was increased with disappearance of the temperature difference between the normal side and the paralyzed side. Subjectively, it also became easier to move facial expression muscles, and the phenomenon of crocodile tears was decreased. Long-term electro-acupuncture treatment is considered to be effective for improving the microcirculation and enhancing the QOL of the patient.

Effects of Electro Acupuncture on the Sensory Nerve Conduction Velocity / 日本温泉気候物理医学会雑誌

Electro-nerve stimulation is an Electro Acupuncture (EA) method that is clinically applied to treat periphral neuropathy. We examined the effects of electro-nerve stimulation on the Sensory Nerve Conduction Velocity (SCV). The changes in SCV caused by applying electro-nerve stimulation to the peripheral nerves were measured.<br>Al-Hz EAT was applied for 10min to the right upper arms of healthy adult volunteers (n=12). The SCV in the median nerve and the skin temperature of the forearm were measured before and after the application. The SCV and skin temperature were found to exhibit asignificant decrease after the electricity was turned on. Therefore, we concluded that EAT caused the decrease in skin temperature of the forearm and, as a result, lowered the SCV in the median nerve.

A Report on the Treatment of Meige Syndrome with Electro-Acupuncture Therapy / 全日本鍼灸学会雑誌

Meige syndrome is a disease which is characterized by blepharospasm. We report thefavorable effects of Electro-acupuncture therapy (EAT) on a patient with Meige syndrome.<BR>This patient, a 56-year-old female, received standard medical treatments for 3 months, however the treatementsdid not relieve her from the distress of blepharospasm.<BR>After three months, EAT treatments was included. EAT was applied to the orbicularis ocule muscles and thefacial nerves. The treatment indexes of both the average number of blinks and the Jankovic score were improvedafter EAT, though there had been no changes in the indexes in the first three months without the additional EATtreatment.<BR>The results suggest that EAT is an effective treatment for Meige syndrome.

Transcatheter Embolization of Aortopulmonary Collateral Arteries Prior to Intracardiac Repair in Patients with Congenital Heart Disease / 日本心臓血管外科学会雑誌

Transcatheter embolization of 25 aortopulmonary collateral arteries (7 bronchial arteries and 18 intercostal arteries) was attempted prior to intracardiac repair in 7 patients. The underlying disease was tetralogy of Fallot in 3 patients, pulmonary atresia with ventricular septal defect in 2, double-outlet right ventricle with ventricular septal defect and pulmonary stenosis in 1 and tricuspid stenosis with pulmonary atresia in 1. The intervals between embolization and intracardiac repair ranged from 0 to 17 days (mean 4.5 days). Embolization resulted in total occlusion in 7 bronchial arteries and 17 intercostal arteries, with an overall success rate of 96%. Complications included a coil dislodgement from a collateral artery into the aorta in one patient, necessitating surgical removal of the dislodged coil from the femoral artery, an exacerbation of cyanosis and dyspnea on exercise in 5, and slight fever in 2. In one patient with tetralogy of Fallot, who had 5 collateral vessels, transcatheter embolization caused hypoxemia, bradycardia and hypotension and therefore intracardiac repair was performed immediately after embolization. Aortopulmonary collateral arteries in patients with congenital heart disease can be effectively treated by transcatheter embolization. Embolization should be performed just before intracardiac repair because an excessive decrease in arterial oxygen saturation after embolization may require an emergency operation.

The Efficacy of Ultrafiltration after Cardiopulmonary Bypass without Homologous Blood Transfusion for Pediatric Cardiac Surgery / 日本心臓血管外科学会雑誌

Thirty-four patients with congenital cardiac disease were studied to evaluated the role of ultrafiltration after cardiopulmonary bypass without homologous blood transfusion. We used either polypropylene microporous hollow fiber hemoconcentrator (HC-30M or 100M) or polyacrylonitrile microporous hollow fiber hemoconcentrator (PHC-500). Ultrafiltration was useful in the reduction of fluid overloading after cardiopulmonary bypass with extreme hemodilution. Thirty-two patients tolerated the procedure uneventfully without donor blood transfusion and were discharged from the hospital. The values of hematocrit, serum protein and free hemoglobin increased significantly after ultrafiltration with either type of hemoconcentrator. However the degree of concentration of blood components was significantly higher with polyacrylonitrile hemoconcentrator than those with polypropylene hemoconcentrator. These results indicated that ultrafiltration was useful for maintaining water balance after cardiopulmonary bypass without homologous blood transfusion in pediatric cardiac surgery and that polyacrylonitrile microporous hollow fiber hemoconcentrator should be employed in patients with shorter bypass time and less hemolysis.