Motohiro Mishima

Dermal patch anaesthesia: comparison of 10% lignocaine gel with absorption promoter and EMLA cream

The analgesic effects of transdermally applied 10% lignocaine aquagel containing 3% glycyrrhetinic acid monohemiphthalate disodium (as an absorption enhancer) and EMLA cream were compared on the forearms of 34 adult volunteers in a double‐blind fashion. The mean pinprick pain scores (graded by noting the number of painful pinpricks out of five) at 30, 60 and 90 min after application and 30 min after removal of the anaesthetics were 3.3 (0.3) (mean SE), 1.2 (0.3), 0.3 (0.1) and 0.3 (0.1) respectively, in the lignocaine gel group. Corresponding scores were 3.5 (0.3), 1.5 (0.3), 0.7 (0.2) and 0.1 (0.1) respectively, in the EMLA group. Insertion of a 26‐gauge needle into the treated skin to a depth of 1 mm at 90 min after application was not painful in 91% of the volunteers in the lignocaine gel group and 88% of those in the EMLA group. There was no significant difference in any of the corresponding pain scores between the two groups.

A comparative study of transdermal 10% lidocaine gel with and without glycyrrhetinic acid monohemiphthalate disodium for pain reduction at venous cannulation

The clinical benefits of transdermal 10% lidocaine base gels with and without 3% glycyrrhetinic acid monohemiphthalate disodium (GAMHPh) for reduction of pain at venous cannulation were compared in a randomized, double-blind fashion in 24 surgical patients. After about 60 min of occlusive transdermal application, the mean pinprick pain score (1.3 ± 1.5) in the GAMHPh group (n = 12), graded by noting the number of painful pinpricks out of five, was significantly less than that (2.5 ± 1.7) in the control group (n = 12) (P < 0.05). Twelve patients (eight in the GAMHPh group and four in the control group) who had a pinprick score less than 1 underwent venous cannulation without intradermal injection of a local anesthetic. The pain score at venipuncture, graded by the patients on a scale of 5, was significantly less in the GAMHPh group than that in the control group (1.9 ± 1.1 vs 3.3 ± 1.0, P < 0.05). Erythema observed in 8 of the 24 patients was the only adverse local reaction. Addition of 3% GAMHPh to the lidocaine gel is useful in promoting transdermal lidocaine aosorption.

Glucagon in the metabolic and nutritional management after total pancreatectomy —A case report—

The effects of exogenous glucagon on a totally pancreatectomized patient were evaluated in both the acute postoperative and convalescent periods. In the acute postoperative phase, glucagon stabilized the blood glucose level and allowed the administration of an adequate amount of energy, while during the convalescent period, it proved useful in promoting the metabolism of lipids and amino acids and maintaining liver function. Moreover, we developed a glucagon aerosol which enabled frequent administration without causing major discomfort to the patient and raised the blood glucagon to satisfactory level.

Dermal patch anaesthesia for venous cannulation with 10% lignocaine gel containing glycyrrhetinic acid monohemiphthalate disodium as an absorption promoter

The clinical efficacy of transdermal 10% lignocaine gel mixture containing 3% w/w glycyrrhetinic acid monohemiphthalate disodium as an absorption promoter was evaluated at venous cannulation in 17 paediatric (6–11 years) and 17 adult (29–65 years) patients. After about 60 min of occlusive application, the mean (SD) pinprick pain score was 0.7 (0.7) in the paediatric group, compared with 1.4 (1.3) in the adults (p < 0.05). Twenty‐five patients (14 children and 11 adults) who had a pinprick score of 0 or 1 underwent venous cannulation without intradermal local anaesthetic. The mean (SD) pain scores at venepuncture showed no significant differences between children and adults.

Effects of three proteins on absorption of cadmium in rats.

The effects of 3 proteins on the gastrointestinal absorption of cadmium were studied. Glycinin and ovalbumin significantly decreased cadmium in liver and the total cadmium in the tissues of rats following a single oral administration of cadmium. In addition, in rats fed continuously with the experimental diets containing cadmium together with proteins, glycinin and ovalbumin significantly decreased the contents of cadmium in the tissues. These results show that the proteins depressed the gastrointestinal absorption of cadmium. Moreover, the effects of cadmium on various digestive enzymes for proteins and the pepsin or pepsin-pancreatin digestion of the proteins were examined. As a result it is likely that the inhibitory effect of cadmium on the intestinal digestion of these proteins is one of the causes of the inhibitory effects of the proteins on the intestinal absorption of cadmium in rats. The undigested oligopeptides may decrease the amount of free cadmium available to be absorbed from the intestine by binding cadmium itself, resulting in decreased intestinal absorption of cadmium.

Dermal Patch Anesthesia: Pain-Free Puncture of Blood Access in Hemodialysis Patients

Clinical application of dermal patch anesthesia to relieve pain at venous cannulation of blood-access was studied in hemodialysis patients. Aqueous gel of 10% lidocaine base with 3% glycyrrhetinic acid monohemiphthalate disodium (GA MHPh 2Na) was applied for 60 minutes to the skin of the patients. Degree of pain was expressed as a pain score. Analgesic effect of the lidocaine gel was evaluated in 16 patients in a placebo-controlled, double-blind, cross-over design by comparing the gel with lidocaine with a placebo gel without lidocaine. The mean pin-prick pain score (1.0 +/- 0.5) in the lidocaine gel patch (n = 16) was significantly lower than that (2.3 +/- 0.3) in the placebo gel patch (P < 0.01). In 8.8% of the patients, blood pressure was elevated after venous cannulation, but this tendency was modified by dermal patch anesthesia with the lidocaine gel. Plasma concentration of lidocaine was under the detection limit of assay (< 0.05 micrograms/mL) after dermal patch anesthesia in six subsequent dialysis treatments.

Evaluation of the penetration depth of transdermally applied 3% GA MHPh 2Na-10% lidocaine gel in man

In order to estimate the penetration depth of transdermal 3% GA MHPh 2Na-10% lidocaine gel mixture, the following physiological functions of the skin were examined before and after a 60 min occulusive application of the gel in 16 adult volunteers.Thermal sweat expulsins ceased completely on the gel-treated ventral surface of one forearm in all the first 5 subjects, though it continued on the untreated contrast area of the other forearm. Sympathetic skin response (SSR) was also no longer induced on the gel-treated middle finger in 1 of another 3 subjects and was severely depressed in the other 2 subjects, while the SSR on the untreated index finger appeared constantly.Vasomotion of the skin circulation on another 3 subjects, remained unaffected on both the gel-treated and the untreated fingers. Extraction of a leg-hair in the treated area did not induce pain sensation in all the last 5 subjects.In addition to the transcellular main roots, some of the transcutaneously applied gel seems to penetrate deeply into the skin through the appendageal roots such as the eccrine sweat glands and the pilosebaceous glands.