Effects of intravenously administered lidocaine on pulmonary vagal afferents and phrenic nerve activity in cats

The ability of lidocaine to suppress activity of single vagal afferent fiber and that of phrenic nerve was studied in 20 cats anesthetized with pentobarbital. Slowly adapting stretch receptors (SAR, n = 16) and rapidly adapting stretch receptors (RAR, n = 7) were identified by their discharge pattern to pulmonary inflation. Intravenous lidocaine (1mg·kg^–1 or 2mg·kg^–1) produced a suppression of SAR activity but not of RAR activity. Suppression of phrenic nerve activity lasted much longer than that of SAR. These findings indicate that iv lidocaine acts more dominantly on CNS than on peripherals. We conclude that iv lidocaine prevents cough and hemodynamic changes caused by airway manipulation mainly through its action on CNS and not on peripherals (peripheral nerves or their receptor).(Aoki M, Harada Y, Namiki A, et al.: Effects of intravenously administered lidocaine of pulmonary vagal afferents and phrenic nerve activity in cats. J Anesth 6: 395–400, 1992)     

Brain lesion in congenital myotonic dystrophy

Congenital myotonic dystrophy (CMyD) affects the brain, causing mental changes and psychomotor retardation. However, the pathophysiology of the brain dysfunctions in CMyD remain to be clarified. We described two cases of CMyD with brain abnormalities. Case 1 was diagnosed as having ventricular dilation at 17 days after birth, and died at 3 years and 6 months. Case 2 was diagnosed as having ventricular dilation at birth, and died at 1 year and 3 months. Pathologically, both cases showed remote hypoxic ischemic brain damage and leptomeningeal glioneuronal heterotopia (LGH). In our patients, the white matter changes may have been caused by perinatal asphyxia, and LGH by embryological abnormalities. Taken our data and those of previous reports together, it is suggested that cerebral abnormalities in CMyD are ascribed to both hypoxic ischemic changes and histogenetic abnormalities.     

Biomechanics and Classification of the Cartilaginous Structures to Project the Nasal Tip

The present paper is the long-term conclusion of our preliminary presentation at the 1992 ISAPS Congress (Guadalajara, Mexico). This is the result of 29 cadaver dissections of different ages and both sexes. We have observed that length, thickness, and resistance correlate with the possibility to project the nasal tip with the mere structure of the alar cartilage and its medial crurae. We also demonstrated the existence and antagonistic action of Pitanguy's ligament as well as the depressing ligament to project the nasal tip. In this study, besides focusing on classifying the medial crus according to its thickness, length, and resistance, which is already different from any previous classification, we also focused on its surgical utility, and its interaction with other anatomic elements, to achieve the desired projection. Clinically, we present a 12-year experience with 1653 cases operated under this premise.     

Primary bone tumors of the femur presenting with spinal symptoms: a report of two cases and review of the literature

Two case reports of femoral bone lesions simulating lumbar spinal disease are presented. Physical examination and case history were strongly suggestive of lumbar spinal pathology. In case 1, surgical resection of a venous hemangioma in the lumbar epidural space was performed but did not relieve pain. In case 2, conservative treatments for a protruded disk were performed for 3 months before an accurate diagnosis was made. After correct diagnoses were made, excision of the femoral tumors brought rapid relief of all abnormal findings in both cases. Compared with other causes of sciatica, femoral bone tumors are rare. However, careful attention should be paid to rule out these lesions if the diagnosis of a lumbar spinal disease is uncertain. Bone scintigraphy seems to be a sensitive diagnostic method to detect extraspinal osseous lesions.     

Ultrasonographic evaluation of gastric emptying in normal children and children after pyloromyotomy

Gastric emptying in the fundus, body, and antrum of the stomach was evaluated by ultrasonography (US) in 41 control children aged 2 to 18 years and 30 patients aged 1 to 19 years who had undergone pyloromyotomy because of hypertrophic pyloric stenosis. The gastric emptying curve decreased in an exponential manner for both control children and patients, while there was no significant difference in gastric emptying time (GET) between control children and patients within any of the age groups. However, GET was faster for younger children in both groups. An X-ray contrast study of the stomach performed in 2 patients who showed markedly delayed GET showed delayed gastric emptying but no significant deformities of the prepylorus. Our results suggest that US is a reliable method of measuring GET in children.     

Metastasis to the iris in squamous cell lung cancer

A 72-year-old Japanese woman, suffering from squamous cell lung cancer with brain metastasis, underwent 2 courses of combination chemotherapy, consisting of cisplatin and vindesine. Although both the primary tumor and the brain metastasis regressed markedly, she developed left ocular pain with blurred vision. An abnormal mass was found in the left iris, and cytologic examination of the aqueous aspirate revealed a few malignant cells, which, when examined by electron microscopy, were considered to be derived from squamous cell carcinoma of the lung.     

Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis

OBJECTIVE: The purpose of this study was to clarify whether bone marrow edema is detectable on initial MR imaging of steroid-induced osteonecrosis of the femoral head. SUBJECTS AND METHODS: Forty-eight hips with osteonecrosis were examined consecutively with MR imaging and radiography. In a previously reported screening program, osteonecrosis was diagnosed on MR imaging when subchondral bands of abnormal signals were present. In the screening program, the MR images of 200 hips of 100 patients receiving high-dose steroid therapy were examined prospectively. Subchondral bands were detected in 48 hips at a mean of 14 weeks after the initiation of steroid therapy. RESULTS: On follow-up MR imaging of 47 hips (one hip excluded) bone marrow edema was initially observed in 13 hips after the onset of hip pain. MR imaging of the remaining 34 hips did not reveal bone marrow edema and the patients were all asymptomatic. MR imaging of 31 of the 34 hips continued to show subchondral bands and MR imaging of the other three hips indicated that the subchondral bands had disappeared. When bone marrow edema was detectable, abnormal findings on radiography were slight but 11 (85%) of the 13 hips progressed to advanced osteonecrosis. Bone marrow edema was highly correlated with the subsequent collapse of the femoral head (p<0.0001). CONCLUSION: Bone marrow edema was not present on initial MR imaging of osteonecrosis. Bone marrow edema should be considered a marker for potential progression to advanced osteonecrosis, and careful examinations for osteonecrosis are necessary when bone marrow edema is seen.     

Involvement of M3 muscarinic receptors of the spinal cord in formalin-induced nociception in mice

Subcutaneous injection of formalin into a paw of mice caused two distinct phases of licking and biting, first phase (1-5 min) and the second phase (7-30 min) after the injection. The muscarinic antagonist atropine (0.1-10 ng, i.t.) and the M(3) receptor antagonist 4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP) (0.1-20 ng, i.t.) inhibited the second phase of this response, whereas higher doses of atropine (20-100 ng, i.t.) did not cause inhibition. The M(1) muscarinic receptor antagonist pirenzepine (10-100 ng, i.t.) did not inhibit either the first or the second phase response, but a high dose of pirenzepine (1000 ng, i.t.) tended to inhibit the second phase response. On the other hand, the M(2) muscarinic receptor antagonist 11-?(2-[(diethylamino)methyl]-1-piperidinyl?acetyl)-5, 11-dihydro-6H-pyrido(2,3-b)(1,4)benzodiazepine-6-one (AF-DX116; 10-1000 ng, i.t.) had no effect on either the first or the second phase of response. The opioid receptor antagonist naloxone did not affect the 4-DAMP-induced anti-nociceptive response. The i.t. injection of the acetylcholinesterase inhibitor neostigmine (25 ng) significantly inhibited only the second phase. The acetylcholine (ACh) depletor hemicholinium-3 (HC-3) (1 microg, i.t.) completely abolished the 4-DAMP-induced anti-nociceptive response. The ACh content of the spinal cord was significantly increased 14 min after formalin injection. This significant increase in the ACh content was inhibited by pretreatment with 4-DAMP (10 ng, i.t.). These results suggest that endogenous ACh in the spinal cord acts as a transmitter anti-nociception, and that ACh release regulated by presynaptic M(3) muscarinic receptors in the spinal cord is involved in the second phase of nociception induced by formalin.     

Differences in water diffusion and lactate production in two different types of postinfectious encephalopathy

We compared two different types of postinfectious encephalopathy using magnetic resonance imaging (MRI), including diffusion-weighted images and MR spectroscopy. Acute disseminated encephalomyelitis (ADEM) and acute necrotizing encephalopathy (ANE) showed different distribution of abnormal intensity areas and different diffusion of water measured by diffusion-weighted imaging (DWI). Proton MR spectroscopy (MRS) showed lactate production in both cases, which returned to a normal range; the rate of increased lactate production was much lower in the ANE case. Water diffusion showed a difference in pathophysiological background between the two encephalopathies, but the lactate elevation observed by proton MRS did not correlate with clinical severity.