Philip A.M. Rogers MRCVS


Anon (1992) Hepatitis B associated with an AP clinic. Commun Dis Rep CDR Wkly 27 Nov 2(48):219.

Baek_SY; Lee MG; Choi HY; Cho KS; Auh YH (1992) Radiography, US, and CT of AP needles in the abdominal organs. J Comput Assist Tomogr Sep-Oct 16(5):834-835. Dept of Diagnostic Radiology, Asan Med Centre, Univ of Ulsan College of Med, Seoul, South Korea.

Blanchard_BM (1991) Deep vein thrombophlebitis after AP [letter]. Ann Intern Med 1 Nov 1; 115(9):748.

Broch_OJ; Gogstad A; Humerfelt S (1993) [AP, quality control and ethics]. Tidsskr Nor Laegeforen 30 May 113(14):1758.

Chiu_ES; Austin JH (1995) Images in clinical medicine: AP-needle fragments. NEJM 2 Feb 332(5):304. Columbia Univ, College of Physicians and Surgeons, New York, NY 10032-3784.

Fujiwara_T; Tanohata K; Nagase M (1994) Pseudoaneurysm caused by AP: a rare complication [letter]. Am J Roentgenol Mar 162(3):731.

Garcia_AA; Venkataramani A (1994) Bilateral psoas abscesses following AP [letter]. West J Med Jul 161(1):90.

Gerard_PS; Wilck E; Schiano T (1993) Imaging implications in the evaluation of permanent needle AP. Clin Imaging Jan-Mar 17(1):36-40. Dept of Radiol, Maimonides Med Centre, Brooklyn, New York 11219. Traditional Chinese AP involves placing needles into the sc tissues along predefined Channels, and later totally removing the needles. A peculiar form of AP exists called "Hari", which involves the permanent placement of fine needles into the sc tissues. Although this form of AP is uncommon, it is still practised in both the Orient and the West. After treatment, the patient's skin is imbedded with hundreds of these fine needles, which remain in the skin for the rest of the patient's life. Several reports have appeared describing their curious radiologic appearance. We present plain films, sonograms, and CAT findings of 3 patients who have undergone this form of AP, and describe their implications in radiographic and clinical evaluation.

Gi_H; Takahashi J; Kanamoto H; Matsubayashi K; Mikuni N; Okamoto S (1994) [Spinal cord stab injury by AP needle: a case report]. No Shinkei Geka Feb 22(2):151-154. Dept of Neurosurgery, Osaka Red Cross Hospital. Neurosurgeons very rarely encounter cases of spinal cord injury caused by a broken AP needle. We report such a case in a man, aged 45-yr, referred to our clinic because of urinary retention. The problem arose circa 2 wk after AP therapy (a needle was broken during treatment). The patient showed no motor weakness, or sensory disturbance. Sensorimotor disturbances were present in all of the reported 7 cases of longitudinal stab injuries (posterior puncture). In transverse stab injuries (lateral puncture), however, 2 cases did not show motor weakness but sensory disturbance. In our case, CT imaging and X-ray showed the needle transversely stabbing the spinal cord at C1/2. The centrifugal pathway for micturition in the spinal cord lies in the middle third of the lateral columns and in the width of the central canal. Surgery relieved the patient from his complaint. The urinary retention may have been due to the needle stabbing the bilateral descending fibres.

Gray_R; Maharajh GS; Hyland R (1991) Pneumothorax resulting from AP. Can Assoc Radiol J Apr 42(2):139-140. Dept of Radiol, Wellesley Hospital, Toronto, Ont. The authors report 2 cases of pneumothorax secondary to lung puncture, which was caused by AP needles. Radiologists should be alert to this possible cause of pneumothorax, particularly when needle fragments can be seen in radiographs of the soft tissues.

Hasegawa_J; Noguchi N; Yamasaki J; Kotake H; Mashiba H; Sasaki S; Mori T (1991) Delayed cardiac tamponade and haemothorax induced by an AP needle. Cardiol 78(1):58-63. Dept of Int Med, Tottori Univ Sch of Med, Yonago, Japan. A 52-year-old man presented with cardiac tamponade a few years after accidental breakage of an AP needle that had not been removed. Thoracotomy showed haemopericardium with penetration of the pulmonary artery by the very fine needle which was barely detected on the chest roentgenogram. This lesion was not suspected on the basis of roentgenography, 2-dimensional echocardiography, or computed tomography, but was detected by the presence of other thick needles in the neck, chest and abdomen. This case showed a possible threat of stealthy and migrating foreign bodies, such as very fine AP needles.

Hasegawa_O; Shibuya K; Suzuki Y; Nagatomo H (1990) [AP needles, straying in the CNS and presenting neurological signs and symptoms]. Rinsho Shinkeigaku Oct 30(10):1109-1113. Dept of Neurol, Yokohama City Univ Hospital. AP is used to treat many diseases in Japan. "Okibari" is one method of AP treatment: a fine stainless steel or silver needle is inserted as a permanent implant into the sc tissue. A 57-yr-old pharmacist was knocked down by a motorcycle in 1971, since then, moderate weakness of left extremities and stiffness of muscles remained as sequelae. She was consequently treated with AP. Many small needles were inserted permanently in the nuchal, occipital and other areas of the body 10-12 yr before she developed gradual clumsiness and dysesthesia in her right hand in 1984. When she was admitted for the first time in 1985, neurological examination revealed left Horner's syndrome and diminished deep sensation in her right extremities with pseudo-athetosis of her right hand, along with spastic paresis of left extremities and right carpal tunnel syndrome. An old needle which had strayed into left dorsal medulla was considered to be the cause of these symptoms. In 1988 loss of temperature and pain sensation in the right side of her body below the shoulder, and diminished deep sensation of left extremities were appended, and weakness of her left extremities became aggravated. Pseudo-athetosis of her right hand was less prominent. Plain X-rays showed many needle shadows. CT scan also showed needle shadows in the left dorsal medulla, right cerebellum and in the subarachnoid space of left dorsal C1-C2 level. [Rogers comment: Mobile permanent metallic implants near vital structures, such as the eyes, blood vessels, spinal cord or brain, are potentially dangerous as a method of therapy].

Hollander_JE; Dewitz A; Bowers S (1991) Permanently imbedded sc AP needles: radiographic appearance. Ann Emerg Med Sep 20(9):1025-1026. Emergency Dept, Bronx Municipal Hospital Centre, Albert Einstein Coll Med, New York. During the evaluation of a victim of a motor vehicle accident, routine radiographs of the patient's cervical spine, chest, and pelvis revealed multiple radiopaque foreign bodies along his posterior neck, chest, abdomen, and pelvis. Repeat examination of the patient disclosed no evidence of foreign bodies. Further questioning revealed that the patient had received AP therapy 5 yr earlier in Korea. We discuss the radiographic findings of permanently imbedded sc AP needles and their differential diagnosis. The medical complications of AP are reviewed.

Hu_Ja1 (1990) Is it possible for AIDS to be transmitted by AP treatment?. JTCM Dec 10(4):306-307. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC.

Huet_R; Renard E; Blotman MJ; Jaffiol C (1990) [Unrecognized pneumothorax after AP in a female patient with anorexia nervosa (letter)]. Presse Med 22 Sep 19(30):1415. In French.

Hung_VC; Mines JS (1991) Eschars and scarring from hot needle AP treatment. J Am Acad Dermatol Jan 24(1):148-149. Division of Dermatology, Los Angeles County, Univ of Southern California Med Centre, CA, USA.

Johansen_M; Nielsen KO (1990) [Perichondritis of the ear caused by AP]. Ugeskr Laeger Jan 152(3):172-173. Ear Dept, Sonderborg Hospital. A case of perichondritis and necrosis of the cartilage of the outer ear after AP of the ear is presented. Repeated cultures showed growth of Pseudomonas aeruginosa. Despite intensive antibiotic treatment and extensive surgical toilet, the patient developed a severely deformed outer ear.

Keane_JR; Ahmadi J; Gruen P (1993) Spinal epidural haematoma with subarachnoid haemorrhage caused by AP. AJNR Am J Neuroradiol Mar-Apr 14(2):365-366. Dept of Neurol, Los Angeles County-Univ of Southern California Med Centre. Unintentional AP needling of the thoracic spinal canal produced a spinal epidural haematoma and subarachnoid haemorrhage. This case shows that patients sometimes are reluctant to disclose folk medical treatments to Western physicians, and the proper diagnosis may depend upon the prowess of the neuroradiologist.

Matsui_S; Matsuoka K; Nakagawa K; Kohno K; Sakaki S (1992) [Cervical spinal cord injury caused by a broken AP needle: a case report]. No Shinkei Geka Apr 20(4):499-503. Dept of Neurological Surgery, Ehime Univ Med Sch, Japan. Spinal cord injury is a rare but considerable complication of AP. A case with cervical spinal cord injury caused by a broken AP needle was reported and 16 previously reported cases including our case were reviewed. A 49-yr-old woman was treated by herself with AP on the nuchal region for occipitalgia, and the needle was accidentally broken during the treatment. 6 h later she noticed pain and numbness in the right upper and lower extremities. Neurological examination revealed slight impairment of temperature, pain and touch sensation on the right extremities. Plain X-ray film and CT scan showed a broken needle in the interspinous ligament between C1/C2 vertebrae, the tip of the needle appearing to be in the spinal canal. The needle was removed surgically 19 d after the accident. Intraoperative fluoroscopic monitoring with injection of dye enabled the needle to be found without difficulty. Postoperative course was uneventful, and her pain and sensory impairment gradually disappeared. Once the diagnosis for cervical spinal cord injury by an AP needle is made, the needle should be removed surgically as soon as possible, especially before the development of motor symptoms. This is because movement of the needle in the spinal cord is considered to be a main possible cause of the development and progression of symptoms.

Morrone_N; Freire JA; Ferreira AK; Dourado AM (1990) [Iatrogenic pneumothorax caused by AP]. Rev Paul Med Jul-Aug 108(4):189-191. Clinica Pneumologica do Hospital do Servidor, Sao Paulo. A 68 year-old white male patient with previous diagnosis of pulmonary emphysema was submitted to AP. The needles were inserted into the precordial area and the patient immediately complained of worsening dyspnea. 4 d later pneumothorax was detected by chest X-rays. A thoracic tube was inserted with total lung expansion.

Murata_K; Nishio A; Nishikawa M; Ohinata Y; Sakaguchi M; Nishimura S (1990) Subarachnoid haemorrhage and spinal root injury caused by AP needle: case report. Neurol Med Chir (Tokyo) Nov 30(12):956-959. Dept of Neurosurgery, Shimada Municipal Hospital, Shizuoka, Japan. The authors report a case of subarachnoid haemorrhage and spinal root injury caused by an AP needle buried in the posterior neck circa 30 yr before onset. A 33-yr-old female presented with sudden onset of severe occipital headaches. Plain x-ray films of the cervical spine revealed a fine gold needle, circa 1.5 cm in length, between the C1 and C2 vertebrae. The needle was piercing the spinal nerve root through the dural vein, and was removed. Postoperatively, the pain exacerbated by neck movement disappeared.

Nezhentsev_MV; Suslova GA; Aleksandrov SI (1991) [Problem of combined use of drugs and AP]. Sov Med 8:34-37. In Russian.

Norheim_AJ (1994) [Complications of AP therapy: A study of the literature from 1981-92]. Tidsskr Nor Laegeforen Apr 114(10):1192-1194. Inst for samfunnsmedisin Univ i Tromso, Norway. This study presents the adverse affects of AP as recorded in the Medline database for 1981-92. Pneumothorax is the most common mechanical organ injury caused, while hepatitis dominates the infections. Neither pneumothorax nor hepatitis is reported from any Nordic country. Most of the adverse effects of AP seem to be associated with insufficient basic medical knowledge, a low standard of hygiene and inadequate education in AP. The study confirms adverse effects of AP in certain circumstances. Serious adverse effects are few, and AP can be considered as a fairly harmless form of treatment.

Ogata_M; Kitamura O; Kubo S; Nakasono I (1992) An asthmatic death while under Chinese AP and moxibustion treatment. Am J Forensic Med Pathol Dec 13(4):338-341. Dept of Legal Med, Faculty of Med, Kagoshima Univ, Japan. A 29-yr-old Japanese man with bronchial asthma died while undergoing Chinese AP and moxibustion treatment. The autopsy findings of the lungs were compatible with a diagnosis of severe asthma. Further, on immunohistochemical examination, hypoxic brain damage and an unusual distribution of pulmonary surfactant were found. In contrast, only minor haemorrhages in the right semispinal muscle and round-shaped bruises were seen due to Chinese AP and moxibustion treatment. Thus, it was concluded that the man had died from a severe asthmatic attack.

Otsuka_N; Fukunaga M; Morita K; Ono S; Nagai K; Katagiri M; Harada T; Morita R (1990) Iodine-131 uptake in a patient with thyroid cancer and rheumatoid arthritis during AP treatment. Clin Nucl Med Jan 15(1): 29-31. Dept of Nuclear Med, Kawasaki Med Sch, Okayama, Japan. On whole body scan, a patient with thyroid carcinoma had abnormal accumulation of I-131 in areas of both feet and hands. The sites of abnormal accumulation of I-131 were similar to those on bone scintigraphy. Radiography of the lesions showed typical findings of rheumatoid arthritis, and the presence of small gold needles for AP treatment was shown. There were no findings of bone metastases. Although the mechanism of accumulation of I-131 in this patient is unknown, interpreters of I-131 whole body scintigraphs should keep this case in mind when viewing the graphs of patients which have had AP treatment. The authors can only speculate on a common blood flow mechanism for enhanced HMDP and I-131 uptake in this arthritic patient who had been treated by AP.

Phoon,_WO; Phoon FN; Lee J (1998) History of blood transfusion, tattooing, AP and risk of hepatitis B surface antigenaemia among Chinese men in Singapore. American Journal of Public Health Aug 78:958-960.

Rosted_P (1994) [Risks and adverse effects of AP therapy]. Ugeskr Laeger Dec 156(49):7335-7339. 40 published articles on side-effects related to AP are reviewed. Several serious complications of AP are described, e.g. pneumothorax, bacterial endocarditis, hepatitis and spinal lesion. Contraindications for the use of AP are discussed.

Sakai_Y; Watanabe E; Kobayashi S; Sekiguchi J; Ohmori K (1994) Removal of a retained AP needle in the paraspinal muscle using a neuronavigator [letter]. Plast Reconstr Surg Dec 94(7):1097-1098.

Sato_M; Yamane K; Ezima M; Sugishita Y; Nozaki H (1991) [A case of transverse myelopathy caused by AP]. Rinsho Shinkeigaku Jul 31(7):717-719. Dept of Neurol, Ota-Atami Hospital. A 54-yr-old man received insertion of an AP needle into the region extending from the posterior neck to the back on 2 occasions to treat shoulder stiffness. 2 wk after the 2nd AP, he developed fever, dysarthria and disturbance of micturition, finally reaching the condition of tetraplegia. He was immediately admitted to an emergency room in our hospital, and was diagnosed as sepsis with DIC, ARDS, heart failure, renal failure, liver failure, and myelitis. After 4 wk, he recovered with transverse myelopathy as a residual deficit. Neurological findings showed transverse myelopathy below the level of Th2 at that time. Cervical CT scan revealed an irregular low density at the periphery of the cervical vertebra from the C2-C4 level. Cervical MRI revealed an irregular swelling of his spinal cord from the C2-C7 level. We explained the mechanism of transverse myelopathy in this case as follows. After the AP, he suffered a focal infection of the region of needle insertion, and then the infection expanded to the cervical vertebra, thus causing osteomyelitis, sepsis, and finally cervical myelitis. Direct injury of the spinal cord and nerve roots as a complication of AP was previously reported, but indirect injury of the spinal cord due to myelitis had not been reported except our present case. Careful attentions should be paid to the complications of AP.

Scheel_O; Sundsfjord A; Lunde P; Andersen BM (1992) Endocarditis after AP and injection-treatment by a natural healer [letter]. JAMA 1 Jan 267(1):56.

Sorensen_T (1990) [Ear perichondritis caused by AP therapy (letter)]. Ugeskr Laeger 12 Mar 152(11):752-753. In Danish.

Southworth_SR; Hartwig RH (1990) Foreign body in the median nerve: a complication of AP. J Hand Surg [Br] Feb 15(1):111-112. Med Coll of Ohio, USA. Fracture of an AP needle caused a foreign body within the carpal tunnel of a patient who then developed median neuropathy. The needle fragment was recovered from within the median nerve during carpal tunnel release, with rapid post-operative relief of symptoms. Development of peripheral neuropathy is a potential complication of AP.

Sullivan-Fowler_M; Austin TL; Hafner AW (1988) Alternative therapies, unproven methods, and health fraud: a selected annotated bibliography. Am Med Assoc, Div of Library and Info Management, 47 pp. Chicago, Ill.

Suzuki_H; Baba S; Uchigasaki S; Murase M (1993) Localized argyria with chrysiasis caused by implanted AP needles: Distribution and chemical forms of silver and gold in cutaneous tissue by electron microscopy and x-ray microanalysis. J Am Acad Dermatol Nov 29(5 Pt 2):833-837. Dept of Dermatol, Surugadai Nihon Univ Hospital, Tokyo, Japan. A case of localized argyria with chrysiasis caused by implanted AP needles in a 41-yr-old Japanese woman was studied by electron microscopy and x-ray microanalysis. Large amounts of Ag granules with Se and S were detected around eccrine secretory cells in much greater amounts than around ductal cells. Many granules were also observed along the outer edge of the basement membrane but never within cells or intercellular spaces. The granules were also present around blood vessels, lymphatics and nerve fibres and in elastic fibres. Small numbers of Au fragments were also seen, mostly within macrophages. Ag deposited extracellularly as selenide and sulphide, whereas free Au was found intracellularly.

Tanii_T; Kono T; Katoh J; Mizuno N; Fukuda M; Hamada T (1991) A case of prurigo pigmentosa considered to be contact allergy to chromium in an AP needle. Acta Derm Venereol 71(1):66-67. Dept of Dermatol, Osaka City Univ Med Sch, Japan. A 53-yr-old male developed prurigo pigmentosa on his back, after undergoing AP for 3 yr. The eruptions were ceased on discontinuing the therapy but recurred with its resumption. The AP needle contained 18% chromium. Erythema was induced by patch testing with potassium dichromate, and a flare-up was observed in the area of the patch test on resumption of AP. We consider that the eruptions were induced by contact allergy to the chromium component of the AP needles.

Wright_RS; Kupperman JL; Liebhaber MI (1991) Bilateral tension pneumothoraces after AP [see comments]. Comment in: West J Med Jun 154(6):736-737. West J Med Jan 154(1):102-103. Dept of Med, UCLA Med Centre.

Yuzawa_M; Hara Y; Kobayashi Y; Ishiyama S; Tozuka K; Nakamura S; Tokue A (1991) [Foreign body stone of the ureter as a complication of AP: report of a case]. Hinyokika Kiyo Oct 37(10):1323-1327. Dept of Urol, Jichi Med Sch, Japan. A 47-yr-old female was admitted to our clinic with the suspicion of ureteral foreign body. She had undergone AP for left lumbago 12 yr earlier. Plain X-ray film revealed a linear shadow and calcified shadows laterally to left third lumber vertebra. Computed tomographic scan and pyelogram showed them located in the left ureter. Left ureterolithotomy was performed successfully. The removed stone was accompanied by an AP needle. Including our case, 12 cases of foreign bodies as a complication of AP in the upper urinary tract reported in the Japanese literature were reviewed.