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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.
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[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.
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[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.<BR>[Methods]Twenty-five female students participated in this study. <BR>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.<BR>[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. <BR>[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.
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(Object) We, in collaboration with Wacoal Corp., assessed the effects of human hemoglobin dynamics associated with pressure stimulus applied by half-ovoid protrusions lined on brassiere straps, which were developed with an intended use by females to safely alleviate shoulder stiffness and associated pain in a convenient manner, and compared them to those of conventional flat and round magnets (5 mm in diameter, 800 Gauss).<BR>(Method) Six healthy females volunteered for each of the four experiments. The participants'thoracic circumference or band size was 70 cm (B70) for experiments one and two, and 80 cm (B80) for three and four. For experiments one and three, we obtained the control hemoglobin (Hb) values, by near-infrared spectroscopy, 20 minutes after participants had worn brassieres with the newly developed straps turned inside out;and were compared to the values obtained after the straps were worn with protrusions pressing down on the skin (Protrusion-lined Strap Group, PST). For experiments two and four, the control Hb values were obtained after the participants had worn generic brassiere straps, and were compared to Hb values obtained after the magnet-lined straps were worn (Magnet-lined Strap Group, MSG).<BR>(Result) In the PSG (B70 &B80), both Oxy-Hb and Total-Hb values increased by stimulation with a 5%significant difference;however, no significant increase was observed in the MSG (B70 &B80). There was no significant difference depending on the band size.<BR><BR>(Discussion) In the present study, the post-stimulation increase of Hb values showed significant differences in PSG as a result of stimulation by protrusions. Stimulation by flat magnets demonstrated no such significance on Hb values, presumably due to the lower pressure to the skin. Stimulation by magnets showed no significant changes in total Hb values despite prior reports of it accelerating the blood flow. The shape with which pressure is applied against the skin may have relevance to the effect of stimulation.<BR>Protrusions left post-stimulation depression marks and flare on the skin surface, suggesting the possible involvement of mechanothermal polymodal receptors.<BR>(Conclusion) Stimulation with the protrusions we developed increased Hb values, showing a regional concentration of hemoglobin. This suggests that it is effective in alleviating shoulder stiffness and associated pain, and lining brassiere straps with the protrusions provides a means for females to self-apply such stimulation safely and conveniently.
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[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.<BR>[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.<BR>[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.<BR>[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.
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[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.<BR>[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.<BR>[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.<BR>[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.<BR>[Conclusion]These results suggest that acupuncture may be effective for temporomandibular disorder patients with disc disorders.
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[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.<BR>[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.<BR>[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. <BR>[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.
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[Objective]We examined the effects of acupuncture treatment at Sanyinjiao (SP6) on menstrual pain in female students. In addition, the correlation between the effects of acupuncture treatment and the neurosis were evaluated.<BR>[Methods]Fifty-one female students were participated in this study as the subject. Acupuncture treatment using Ringheaded thumbtack needle were performed to bilateral SP6 for the three months. Non-treatment periods for three months were set in before and after acupuncture period, respectively. Patients received the Ringheaded thumbtack needle through four days in a week. The effectiveness of treatment was evaluated using the categorical scale for the severity of menstrual pain accompany with numbers of taking drugs for analgesic. To evaluate the correlation between effects of acupuncture and neurosis, the tendency of neurosis was confirmed by cornel medical index (CMI) and the perimenstrual symptoms were confirmed by menstrual distress questionnaire (MDQ).<BR>[Results]Twenty-seven subjects were analyzed for evaluation in this present study. During Ringheaded thumbtack needle treatment periods (acupuncture periods), menstrual pain had reduced into 48%of subjects. The number of taking drugs for analgesic was decreased with the reduction of severity of menstrual pain during acupuncture periods (p<0.05). The correlation between the effect of acupuncture and the tendency of neurosis were observed. Acupuncture improved the menstrual pain in the subjects who belong to category I and/or II of CMI. However, no remarkable changes were observed in the III and/or IV subjects of CMI. Furthermore, the high score of fives specific pain into MDQ (shoulder pain, headache, etc) and negative feelings factor were obtained in subjects who accompany with strong menstrual pain still after acupuncture<BR>[Discussion]These findings suggest that menstrual pain was reduced by Ringheaded thumbtack needle to bilateral SP6. Additionally this result was influenced by a psychological factor and/or some kind of pain which is not only menstrual pain.
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We have been collecting various ideas on safer acupuncture practice from participants in our workshop as well as members of the committee. Subjects and presentations of the present workshop were as follows:<br>1. Forgotten needles<br> 1) Ideas of prevention based on a questionnaire survey (Egawa and Ishizaki)<br> 2) Effect of incident reporting system (Yamashita)<br>2. Cleaner method of needle insertion and Oshide (needle-supporting fingers)<br> 1) Merits and demerits of sterilized fingerstall and glove (Miyamoto)<br> 2) History of the clean needle development (Umeda)<br> 3) A novel clean acupuncture needle device (Imai and Ishizaki)<br>Although there was not enough time for discussion, we collected some useful ideas from the participants. A novel clean needle invented by Imai gave a strong impression to the audience. We should continue to discuss a diverse impact when such new devices and concepts become widespread in traditional acupuncture practices. We welcome more ideas and opinions from relevant facilities, clinics and fields in order to further improve safety of acupuncture.
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A seminar was held with “the development of research on auricular acupuncture” as the main theme. In this seminar, the recent development of auricular acupuncture in Japan and abroad, its action mechanism, and clinical effects were reviewed, and the findings were comprehensively evaluated.<BR>Concerning basic research on the effects of auricular acupuncture on obesity, the relationship between the auricle and hypothalamo-autonomic system and individual variation associated with differences in the condition of patients receiving the treatment were reported. As for the action mechanism, leptin expressed in white adi-pose tissue (WAT) due to acupuncture stimulation of the auricle was reported to bind to leptin receptors (Ob-R) in both peripheries and the center and suppress food intake.<BR>Concerning clinical effects of auricular acupuncture, the results reported in Japan indicating its effectiveness for the treatment of obesity were presented. However, no overall conclusion was reached, because papers published abroad were not consistent in the therapeutic procedure or evaluation parameters. Auricular acupuncture appeared to be clinically effective for analgesia and the treatment of drug addiction but ineffective as an anti-smoking treatment.
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Effects of acupuncture and moxibustion on chronic pain in human and animals were reviewed. Firstly, the role of sensitization of pheripheral and/or central nervous systems on the mechanisms of chronic pain was introduced based on the basic researches in experimental animals. Secondly, the effects of acupuncture on neuropathic pain and postoperative pain patients were reviewed and its possiblemechanisms were discussed. Finally, effectiveness of acupuncture and moxibustion on several kinds of chronic nociceptive pain (low back pain, neck pain, headache) was systematically reviewed based on the online database
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[Objective] The effects of acupuncture on muscular blood flow, muscular weight, and muscular dynamics were investigated in the rat hindlimb with induced hypoemia. In addition, the optimal conditions for acupuncture in the model were investigated.<BR>[Methods] In male SD rats, the right femoral artery was cut, and a No. 20 40-mm stainless needle was inserted about 3-5 mm into the anterior tibial muscle of the ischemic hindlimb for acupuncture. During acupuncture, the needle was indwelled or electric current was passed, and various stimulations (5h/day, 1 h × 5 times/day, 15 min × 5 times/day, 1 h/day, and 15 min/day) were applied for 5 consecutive days. Seven days after cutting the artery, blood flow was measured by the radioactive microsphere method, and the degree of muscular atrophy was investigated by the weight ratio of the ischemic hindlimb to the contralateral healthy limb, and findings in the intact, hypoemia, hypoemia + indwelled needle, and hypoemia + various current groups were compared. In addition, the anterior tibial muscle was stained to observe the condition of muscular fibers.<BR>[Results and Discussion] In the ischemic group, muscular blood flow was decreased. In the hypoemia+current groups, blood flow was increased. In the groups that received electric current for a prolonged period, 5 h/day and 1 h ×5 times/day, the blood flow was increased but the muscular weight ratio was decreased. However, in the group that received stimulation for 15min×5 times/day, the muscular blood flow was markedly higher that those in the other groups, and the muscular weight ratio was not changed, showing that muscular atrophy did not occur. On staining, capillary neovascularization and VEGF production were greater than those in the hypoemia group, suggesting that these factors were closely involved in the increase in blood flow.
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Objective : To investigate the effect of acupuncture stimulation at PC6 (Neiguan, Naikan) on optokinetic motion sickness, motion sickness scores were evaluated and changes in electrogastrograms (EGG) were analyzed in each subject.<BR>Methods : Thirty-six normal volunteers were randomly divided into three groups : electrical acupuncture group, retaining needle group, and no treatment group.<BR>Subjects were exposed to a rotating optokinetic drum to induce vection. EGG was recorded continuously before, during, and after the rotation exposure, each period being fifteen minutes in length. To evaluate the severity of motion sickness in each subject, subjective symptoms of motion sickness (SSMS) score and visual analogue scale (VAS) were obtained.<BR>Results : The severity of nausea which is one of main symptom of motion sickness was suppressed, and the percentage of normal 2?4 cpm band of EGG activity was increased earlier after drum rotation exposure in the retaining needle group than in the no treatment group.<BR>Conclusion : From these results, we conclude that the retaining needle stimulation of the PC6 acupoints was effective for optokinetic motion sickness possibly by suppressing abnormal gastric myoelectric activities.
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This study investigated the population prevalence of chronic arterial occlusion (CAO) using the ankle pressure index (API) of patients with lower back pain in an acupuncture clinic. The API was measured in 60 lumbago patients ≥ 50 years old at the Meiji College of Oriental Medicine Acupuncture Center. There were 19 patients (31.7%) with unilateral or bilateral API < 0.9, which was presumed to indicate CAO. Thirty-four patients had symptoms in the lower limbs, and 17 of 34 patients showed an API below 0.9. In all but 4 patients (13 of 17, or 76.5%), laterality of the lower API and the symptoms were noted. In conclusion, API measured noninvasively might be useful as a predictor of CAO in acupuncture clinics.
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A patient with uterine cervical cancer underwent radical operation and radiotherapy in 1956 and subsequently began to suffer from impaired bowel movements. For the next 40 years, a large amount of cathartics was used to induce defecation, a urination was induced by applying abdominal pressure, but a large volume of urine remained. In this patient, the effects of acupuncture treatment were evaluated using the vesical residual urine volume as measured by abdominal ultrasonography. After acupuncture treatment, defecation became easily, and the amount of cathartics could be reduced. Simultaneously, spontaneous urination became possible, and residual urine disappeared.
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The effect of acupuncture on the autonomic nervous system was analyzed by simultaneous measurement of sympathetic skin response (SSR), sympathetic flow response (SFR) and Palmer emotional sweating evoked with electric stimuli to the forehead at random interval and intensity. The mutual relation of measurements by those parameters was examined electrophysiologically.<BR>The subjects were ten healthy male volunteers. SSR at the left palm and SFR at the fingertip of the left forefinger were measured using laser doppler flowmetry, and emotional sweating at teh right palm was measured with the ventilated capsule method (hydrography). The measurements were performed in two sessions, with and without acupuncture stimulation that was given at L14 with the technique of sparrow picking (1Hz) for 1 minute and retaining the needle for 10 minutes. The amplitude of SSR, the reduction rate of SFR, and the sweat rate were measured before and after acupuncture stimulation, while those were measured before and after resting in the other session as a control study. As a result, habituation in each response was not seen and the correlation coefficient in each index was low, while SSR and Palmar sweating were inhibited significantly in the stimulation group only, and SFR was inhibited in both groups.<BR>These results suggested that acupuncture stimulation might inhibit the activity of the skin sympathetic nerve system.