The effects of auricular acupuncture on weight reduction and feeding-related cytokines: a pilot study.

OBJECTIVE: Auricular acupuncture is a common therapy used to control appetite; however, the underlying mechanism(s) of action is unclear. The present study examined changes in feeding behaviour and in the levels of several appetite-related hormones in response to auricular acupuncture, and attempted to identify the mechanism(s) by which this traditional medical treatment exerts its effects. METHODS: Ten healthy adult volunteers (nine female and one male) were recruited by the KOSAI Oriental Healthcare Center. The participants were randomly assigned to one of two groups (n=5 per group): an acupuncture group and a placebo group. Each received detention needle stimulus on a weekly basis for 1 month. Changes in diet, body weight, blood pressure and blood biochemistry were evaluated before treatment and at 1 week after the start of treatment. RESULTS: The difference in weight before treatment and after 1 week of treatment was significant for all participants in the acupuncture group (p=0.02). The percentage changes in active ghrelin in the acupuncture group were no significant changes observed in active ghrelin levels at 1 week after acupuncture in any individual participant (p=0.89). By contrast, the percentage changes in active ghrelin levels in the placebo group at 1 week after the start of acupuncture were significant (p=0.04). The insulin, adrenocorticotropic hormone, leptin and adiponectin levels did not change significantly in either group. CONCLUSIONS: There was a statistically significant difference in the percentage change in body weight and active ghrelin levels in each individual participant in auricular acupuncture groups. This is a pilot study and the sample number is small; however, auricular acupuncture may reduce appetite by suppressing ghrelin production.

Atypically located pericardial cyst in a patient who underwent off-pump myocardial revascularization.

Pericardial cysts are rare benign mediastinal lesions and most commonly located at the cardiophrenic angle. We present a case of an atypically located pericardial cyst in a patient who underwent myocardial revascularization. A 61-year-old man with acute myocardial infarction was scheduled for coronary artery bypass grafting (CABG). Preoperative chest computed tomography revealed a homogenous cystic lesion in the superior mediastinum. The mass was located between the ascending aorta, the superior vena cava, and the left innominate vein. It was growing to the anterior of the aorta and to the right anterior paratracheal area. The density of the mass was close to that of water; thus, the contrast medium failed to enhance its visualization. A concomitant resection of the mass and the CABG was scheduled. After a medial sternotomy and bypass graft harvest, a median pericardectomy was performed. The surgeon found the cystic mass along the roof of the pericardium and located between the ascending aorta and superior vena cava. There was no adhesion between the mass and cardiovascular components. The mass was resected en bloc; therefore, off-pump CABG was completed. Histopathological examination of the resected specimen confirmed diagnosis of a pericardial cyst.

Effect of rotational atherectomy on the coronary microcirculation in patients with angina pectoris.

OBJECTIVES: The coronary microcirculation can be impaired by ablated debris just after a rotational atherectomy procedure, but the specific effects of rotablation on the microcirculation have not been investigated. The present study examined the effects of rotational atherectomy on the coronary microcirculation by analyzing coronary flow reserve (CFR) and the component parameters of the coronary flow-pressure loop. METHODS: This study included 31 patients with angina pectoris who underwent stent implantation after rotational atherectomy and with < 50% diameter stenosis at 6-month follow-up (i.e. without clinical restenosis). The CFR, the flow-pressure slope index (FPSI) and zero-flow pressure were measured using the FloWire Doppler guidewire in both treated and untreated reference vessels without stenosis immediately after and on 6 months from the rotational atherectomy procedure. RESULTS: CFR and FPSI in the treated vessels were significantly lower than in the untreated reference vessels without stenosis just after rotational atherectomy (CFR: 2.1 +/- 0.5 vs 2.6 +/- 0.7, p < 0.05; FPSI: 1.61 +/- 0.8 vs 2.35 +/- 0.9 cm/sec/mmHg, p < 0.05), but no significant differences were observed in CFR or FPSI between these same sets of arteries at follow-up. There was also a significant correlation between the extent of attenuation of CFR and total ablation time (r = - 0.54, p < 0.01). CONCLUSIONS: Rotational atherectomy attenuates CFR by reducing coronary artery conductance, probably due to coronary microvessel obstruction with the debris ablated during the procedures of rotational atherectomy.

Primary cardiac lymphoma presenting clinically as restrictive cardiomyopathy.

An unusual case of primary cardiac lymphoma presenting as restrictive cardiomyopathy with arrhythmia is reported in a 72-year-old woman who was admitted for evaluation of exertional dyspnea and palpitations. Electrocardiography (ECG) showed atrioventricular dissociation and right heart cardiac catheterization revealed a typical 'dip-and-plateau' waveform. Restrictive cardiomyopathy was suspected because computed tomography (CT) did not reveal pericardial thickening, calcifications, or an effusion. Heart failure initially improved with diuretic therapy, but subsequently worsened, and the patient experienced a syncopal episode. ECG showed atrial fibrillation, and CT revealed a large mass in the right atrium and multiple tumors in the liver, which needle biopsy confirmed as diffuse large B-cell lymphoma. Chemotherapy induced complete remission, and her heart failure markedly improved. The 'dip-and-plateau' waveform was no longer detected on repeat cardiac catheterization and the ECG showed restoration of sinus rhythm. Clinically, the diagnosis was primary cardiac lymphoma.