Usefulness of epidural nerve stimulation to confirm epidural catheter placement

An epidural catheter must be placed in epidural space correctly to give sufficient epidural anesthesia for patients. Recently, as a technique to confirm the catheter placement, electrical stimulation of epidural nerve using an inserted epidural catheter was introduced. This study was conducted to evaluate the reliability of this simple technique in 13 patients. Immediately after an epidural catheter (19 G Arrow Flextip Plus) was placed, an adapter with electrode (Arrow-Johans ECG Adapter) was attached to its connector and nerve stimulation was performed using a peripheral nerve stimulator (1 Hz, 10 mA). Catheter placement was judged to be correct by both presence of muscle contraction in response to stimulation and occurrence of analgesia after the administration of a local anesthetic. In 5 patients, additional roentgen examinations were performed to identify the positions of catheters. In all patients except one, muscle contraction was observed by stimulation, and analgesia was confirmed in all patients after the injection of an anesthetic. X-ray examinations revealed that the tip of catheter placed at the vertebral level corresponded with the spinal segmental level where muscle movement occurred. Our study demonstrates that nerve stimulation can be a reliable method to confirm epidural catheter placement. Our results also suggest that the position of catheter tip can be estimated easily using this technique.     

Establishment and application of criteria for the elective transfer of two good-quality embryos to reduce high-order multiple pregnancies

Aim  This study was carried out to establish criteria for the elective transfer of two good-quality embryos to reduce high-order multiple pregnancy rates. The pregnancy and multiple pregnancy rates per transfer were retrospectively analyzed in 128in vitro fertilization and embryo transfer (IVF-ET) cycles. Results  The analysis revealed that the pregnancy and multiple pregnancy rates were 26.6% (34 of 128) and 23.5% (eight of 34), respectively. Five twin and three triplet pregnancies were included. The pregnancy rates in women 29 years old and younger, 30–34 years, 35–39 years, and 40 years and older were 21.2 (seven of 33), 37.0 (17 of 46), 25.8 (eight of 31), and 11.1% (two of 18), respectively. There was a significant difference of the pregnancy rates between 30 and 34-year-old and 40-year-old and older women (P < 0.05). The multiple-pregnancy rate in women 40 years and older was 0%. Three triplet pregnancies were established only in the first attempt of IVF-ET. The pregnancy rates in women, to whom good-quality embryos (0–4) were transferred, were 0% (none of 12) for 0, 17.2% (five of 29) for one, 41.2% (seven of 17) for two, 30.8% (12 of 39) for three, and 32.3% (10 of 31) for four and more embryos, respectively. The multiple pregnancy rates in women who had good-quality embryos of one, two, three, and four and more transferred were 0% (none of five), 23.5% (four of seven), 16.7% (two of 12), and 20.0% (two of 10), respectively. Conclusion  The criteria for the elective transfer of two good-quality embryos were established as follows: age < 40 years, a first treatment cycle, and more than three good-quality embryos available for transfer. After the application of the established criteria, the overall pregnancy and multiple pregnancy rates were 30.4% (14 of 46) and 14.3% (two of 14), respectively, which was satisfactory as compared with those in the 128 IVF-ET cycles before application of the criteria. An elective transfer of two good-quality embryos can be highly recommended to avoid high-order multiple pregnancies in subjects with the established criteria.     

The preventive effect of allopurinol spray on stomatitis induced by anti-cancer drugs

The present study was conducted to evaluate the effect of allopurinol spray on stomatitis induced by chemotherapy for esophageal cancer. The chemotherapeutics used consisted of 5-FU + CDDP (FC) given to 40 patients and 5-FU + ND (FN) given to 9 patients. Allopurinol solution for spray was prepared using a gelatin agent as base. The allopurinol spray was used 3-5 times daily before and after chemotherapy. The Japan Society for Cancer Therapy's criteria for stomatitis were used. With FN-therapy, no stomatitis was observed. With FC-therapy, 9 of 40 patients developed stomatitis of grade 1 (8 patients) or grade 2 (1). The incidence of stomatitis was 18.4% with all therapies and 22.5% with FC-therapy. The average graded toxicity was 0.20 for all therapies and 0.25 for FC-therapy. These results suggest that allopurinol spray is markedly effective for the prevention of stomatitis induced by chemotherapy. In addition, allopurinol spray is portable and convenient, and resulted in less nausea or vomiting than mouthwash.     

A case of congenital hydronephrosis suffering from rupture of the renal pelvis due to trauma

A 19-year-old male patient was admitted with the chief complaint of left abdominal pain. After receiving a mild punch in the abdomen during boxing exercises, he had severe abdominal pain and was brought to an emergency room. Since abdominal CT scanning revealed the retention of massive fluid in the retroperitoneum, hydronephrotic rupture due to the trauma was diagnosed and nephrectomy was performed. The removed kidney was filled as a result of urinary retention, and congenital hydronephrosis accompanied by the ureteropelvic junction obstruction was macroscopically and pathohistologically diagnosed. Postoperative course was favorable and the patient was discharged on the 10th hospital day.     

Propofol Attenuates Diaphragmatic Dysfunction Induced by Septic Peritonitis in Hamsters

Background: Sepsis or peritonitis impairs diaphragmatic contractility and endurance capacity. Peroxynitrite, a powerful oxidant formed by superoxide and nitric oxide, has been implicated in the pathogenesis. Propofol scavenges this reactive molecule. The authors conducted the current study to evaluate whether propofol prevents diaphragmatic dysfunction induced by septic peritonitis.

Methods: Forty male Golden-Syrian hamsters (120-140 g) were randomly classified into five groups. Groups sham and sham-propofol 50 underwent sham laparotomy alone, whereas groups sepsis, sepsis-propofol 25, and sepsis-propofol 50 underwent cecal ligation with puncture. Groups sham and sepsis received infusion of intralipid, whereas groups sham-propofol 50, sepsis-propofol 25, and sepsis-propofol 50 received propofol at rates of 50, 25, and 50 mg [middle dot] kg-1 [middle dot] h-1, respectively. Intralipid or propofol was subcutaneously infused from 3 h before surgery until 24 h after operation, when all hamsters were killed. Diaphragmatic contractility and fatigability were assessed in vitro using diaphragm muscle strips. Peroxynitrite formation in the diaphragm was assessed by nitrotyrosine immunostaining. Plasma nitrite-nitrate concentrations and diaphragmatic concentrations of malondialdehyde were determined. Using another set of animals, diaphragmatic inducible nitric oxide synthase activity was also measured.

Results: Twitch, tetanic tensions, and tensions during fatigue trials were reduced in group sepsis compared with group sham. In group SEPSIS, diaphragm malondialdehyde and inducible nitric oxide synthase activity, and plasma nitrite-nitrate concentrations increased, and positive immunostaining for nitrotyrosine residues was found. Propofol attenuated these changes.     

Effect of rapid-rate ventilation on the experimental diseased lung caused by meconium aspiration

We compared rapid-rate ventilation using a conventional ventilator with slow-rate ventilation in the normal lung of 7 newborn pigs and in the diseased lung model instilled with 25% meconium solution into the trachea. The flow rate (7.5 1/min) and inspiratory:expiratory ratio (1:3) were kept constant during the experiments by using a constant-flow and time-cycled ventilator; the only change in settings was the rate. Transthoracic electrical impedance at end-expiration increased in the normal and in the diseased lung. Both mean intratracheal pressure and end-expiratory esophageal pressure increased significantly (p less than 0.05) in both models upon changing to rapid-rate ventilation. Following the increase in ventilatory rates from an initial frequency of 37.5 breaths/min to a rapid rate of 150 breaths/min, there was a significant rise in both PaO2 and PaCO2 in the normal and diseased lung models. Although rapid-rate ventilation was maintained for 1 h, the improvement in oxygenation progressively deteriorated and PaCO2 also increased further. This rise in PaCO2 returned to the control levels by decreasing ventilation to the initial rate of 37.5/min. This study demonstrates that rapid-rate ventilation using a constant-flow and time-cycled ventilator is inferior to slow-rate ventilation in the diseased lung model.     

Diffuse neurofibrillary tangles with calcification (a form of dementia): X-ray spectrometric evidence of lead accumulation in calcified regions

Diffuse neurofibrillary tangles with calcification (DNTC) is a form of slowly progressive dementia in which no senile plaques are observed. The calcification is one of the most characteristic features of DNTC. We examined the elemental content of certain mineral deposits (lead, magnesium, phosphorus, calcium, iron, copper and zinc) in the calcified and non-calcified regions of eight cases of DNTC, five cases of Alzheimer's disease (AD) and in eight non-demented elderly controls. The study was performed using a combination of scanning electron microscopy and X-ray spectrometry on 10% formalin-fixed brain tissue. A marked abundance of calcium and phosphorus was observed in the calcified regions of DNTC and non-DNTC brains. Although no lead was observed in the non-calcified regions of DNTC and in non-DNTC brains, traces of lead were detected exclusively in the calcified regions of DNTC brains. The implications and possible significance of the lead accumulation in DNTC brains are discussed.     

A family with X-linked dystonia-deafness syndrome with a novel mutation of the DDP gene

BACKGROUND: X-linked dystonia-deafness syndrome (DDS) is characterized by early-onset deafness followed by progressive dystonia in adulthood. Only 4 families with the syndrome have been reported, and all were white. OBJECTIVE: To describe the first nonwhite family with X-linked DDS, involving 5 affected males in 4 generations. RESULTS: Clinical features of the family members, who were Japanese, were mostly consistent with reports of DDS in whites except for a lack of visual disturbances. Whereas microdeletions in the deafness-dystonia peptide (DDP) gene were found in 2 white DDS families, our patients showed a novel mutation (arg80ter) in exon 2 of the DDP gene. CONCLUSION: The existence of a DDS family of Japanese origin with a new kind of mutation in the DDP gene provides additional evidence that the DDP gene is a causative gene for X-linked DDS.     

Primary dermal and eye irritability tests of hydrophobically modified hydroxypropyl methylcellulose in rabbits.

Primary dermal and eye irritation tests of hydrophobically modified hydroxypropyl methylcellulose (HM-HPMC, hydroxypropyl methylcellulose modified with stearylglycidylether), a new cellulose derivative used as a thickener for topical pharmaceuticals and cosmetics, were conducted in rabbits. A dispersion of HM-HPMC (3%) was applied to intact and abraded skins and reactions were observed. A very slight erythema was observed in both skins and this polymer was categorized as a "mild irritant". In the eye irritation test, with a dispersion of the same concentration, it was categorized as "marginal" in unrinsed eyes and "negative" in rinsed eyes.