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Alterations in cerebral monoamines following application of electroacupuncture were investigated using conscious rats with and without application of restraining stress. The dopamine and serotonin levels were significantly decreased in the nucleus accumbens, caudate putamen, and lateral hypothalamus and increased in the dorsal raphe nucleus by restraining stress. On the other hand, application of electroacupuncture on the lumbar and hindlimb segments eliminated the above changes in dopamine, while the changes in serotonin were attenuated by lumbar and hindlimb electroacupuncture. However, the effects of hindlimb electroacupuncture were greater than those of lumbar electroacupuncture. These results clearly indicate that lumbar and hindlimb electroacupuncture stimulations have differential effects on brain monoaminergic neurons in rats exposed to restraining stress. Moxa burning stimulation was applied to the lumbar and hindlimb segments of rats without restraining stress. The dopamine level was significantly increased in the midbrain substantia nigra-ventrotegmental area by hindlimb moxibusion. On the other hand, the serotonin levels were significantly increased in the nucleus amygdala by lumber moxibusion and decreased in the nucleus accumbens by hindlimb moxibusion. The present results indicate that electroacupuncture applied to the lumbar and hindlimb segments has an antistress effect, while the application of moxibustion to the lumbar and hindlimb segments was likely to stimulate the functions of mesocortical and mesolimbic dopaminergic and serotonergic neurons. We suggest that functional alterations in cerebral dopaminergic and serotonergic neurons are involved in the clinical efficacy of electroacupuncture and moxibustion, especially because of their antistress and psychosomatic actions.

Bacterial epidural abscess formation of cervical spine was rarely seen and all these cases were associated with osteomyelitis of the odontoid process. To the author's knowledge, only 1 case of septic arthritis of the C1-C2 lateral facet joint has been reported in the English literature. A 76-year-old woman presented with progressive neck pain and stiffness in the left side of her neck with fever. Coronal computed tomography clearly demonstrated destructive change of the atlantoaxial joint. Contrast magnetic resonance imaging demonstrated infection of the atlantoaxial joint resulting in epidural abscess formation. Because of lack of neurologic deficit, we treated her with halo-fixation together with appropriate antibiotics administration. The patient was successfully treated with antibiotics and immobilization. Septic arthritis of the lateral atlantoaxial joint should be added to the differential diagnosis of severe neck pain with fever, although it is very rare clinical entity. Early analysis of computerized tomography and magnetic resonance imaging although maintaining a high suspicion for this disease is mandatory to avoid delayed diagnosis and subsequent morbidity.

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An 11-year-old boy presented with a history of right foot pain. He had increasing pain in the medial side of the hindfoot for the preceding 4 months. Examination revealed that his foot was fixed in varus with posterior tibial muscle spasm (Figure 1, A). Forced eversion stress induced severe foot pain. CT showed medial talocalcaneal coalitions bilaterally, although the left foot was asymptomatic (Figure 1, B). Nonoperative treatment, including a short-leg walking cast, failed and operative resection of the coalition was done. The coalition was found to be nonosseous at surgery. The operation was successful and at followup 14 years later the foot was free of deformity, pain, and spasm.

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