Effect of pre-mixed lidocaine with propofol on propofol injection pain in elderly patients

The purpose of this study was to compare the younger and older patients in the incidence and the severity of the pain during injection of propofol. Thirty-four, elderly patients (60-80-yr-old) and 52 patients (20-40-yr-old) scheduled to undergo elective surgery were studied. We conducted a prospective, randomized and double-blinded trial. All patients were randomly allocated to one of two groups according to the agents added to 1% propofol 20 ml; Group S, normal saline 2 ml, and Group L, 2% lidocaine 2 ml. The pain on injection was rated as none, mild, moderate, or severe. Seventy percent of patients in the S group of elderly patients experienced pain, while 22% of patients experienced pain in the L group in elderly patients. The incidence of pain on injection in the S group of older patients was comparable with S group of younger patients. The severity of pain in elderly patients was significantly decreased after premixing with lidocaine. There were no significant differences between older and younger patients in the severity of propofol injection pain in both S group and L group. In conclusion, elderly patients suffered the pain on injection of propofol with the same incidence as the younger patients did. Lidocaine premixed with propofol significantly reduces the incidence and the severity of pain associated with propofol in elderly patients.     

Efficacy of axillary-axillary bypass grafting for the subclavian artery disease

Axillary-axillary bypass procedure was performed in 5 patients (3: atherosclerosis, 1: rupture of aortic arch aneurysm, 1: trauma) with the total occlusion of the subclavian artery. All the operations were performed with 6 mm ringed expanded polytetrafluoroethylene under general anesthesia. Though several types of extrathoracic procedures such as carotid-subclavian bypass, subclavian-subclavian bypass and axillary-axillary bypass are introduced, the efficacy of axillary-axillary bypass procedure is greater ease of anatomic exposure with no concern of interfering with the carotid circulation. The type of bypass to be used in a given case will depend on the individual circumstances. We suggest that this procedure is minimally invasive as well as effective for subclavian artery occlusion depending on the case.     

Maintenance and characterization of an Epstein Barr virus-infected CD56-negative T cell lymphoma.

T cell lymphoma carrying Epstein Barr virus (EBV(+) TL) is very rare among Western countries while it is much more common among Japanese. Here we report an EBV(+) TL which has been maintained for years by the use of mice with severe combined immune deficiency (SCID) mice. Lymphoma was obtained from a 55-year-old male suffering from oculomotor nerve palsy and lymphadenopathy. A small piece of biopsied tumor was transplanted into SCID mice and the lymphoma has been maintained for over 3 years with passages every 2 - 3 weeks. The maintained lymphoma, termed as TMS24, and the original lymphoma cells showed identical phenotype and genotype, including diffuse medium-sized cell morphology lacking granules, suppressor / cytotoxic immunophenotype and identical T cell receptor beta-chain gene rearrangement mode. Further, both were shown to carry an identical EBV clone in terms of the number of terminal repeats and the latency II-type restricted gene expression profile. Cytogenetically, TMS24 retained two characteristic chromosomal translocations of t(1;18)(q32;q21) and t(6;12)(p21;q24). Since only one cell line with such characters has been reported previously, TMS24 should be useful for detailed analysis of EBV(+) TL.     

Abusive Head Trauma in Infants and Children in Japan

Subdural hematoma in infants can be caused by abuse, and is thought to be more likely if subdural hematoma is associated with retinal hemorrhage and cerebral edema. In Japan, few doctors disagree that cases of subdural hematoma with retinal hemorrhage and cerebral edema with multiple findings on the body are more likely to have been caused by abuse rather than by household accident. On the other hand, in cases where there are no other significant physical findings, only subdural hematoma and retinal hemorrhage, there is a difference of opinion as to whether the injury was caused by an accident or abuse. The reason for this is that neurosurgeons in Japan promoted the concept that infants can develop subdural hematomas and retinal hemorrages due to minor trauma at home before the concept of abusive head trauma became known. In addition, the age distribution of subdural hematomas in Japan differs from that in other countries, with peaks at around 8 months, and the reason for this remains unclear. Therefore, the etiology of infant subdural hematoma in Japan needs to be investigated in greater detail.     

Complete Resolution of a Case of TAFRO Syndrome Accompanied by Mediastinal Panniculitis,Adrenal Lesion,and Liver Damage with Hyperbilirubinemia

TAFRO syndrome is a systemic inflammatory, lymphoproliferative disorder, but the pathophysiology of the disease is unknown. It is typically characterized by thrombocytopenia, anasarca, a fever, reticulin fibrosis, renal dysfunction, and organomegaly. However, other manifestations have been also reported. We encountered a 43-year-old man with TAFRO syndrome who showed mediastinal panniculitis, liver damage, and adrenal lesions in addition to the core signs. He achieved complete remission with combination therapy of corticosteroids, tocilizumab, and cyclosporin, and remission was maintained even after drug discontinuation at 15 months. Atypical manifestations and complete remission of TAFRO syndrome were remarkable features of our case.     

A case of cryopyrin-associated periodic fever syndrome during canakinumab administration complicated by inflammatory bowel disease

Clinical Rheumatology - Cryopyrin-associated periodic fever syndrome (CAPS) is a highly debilitating disorder, which is characterized by unregulated interleukin-1β production driven by...