Naoyuki Taga

Comparison of Percutaneous Electrical Nerve Stimulation with Transcutaneous Electrical Nerve Stimulation for Long- Term Pain Relief in Patients with Chronic Low Back Pain

The long-term effect of percutaneous electrical nerve stimulation (PENS) on chronic low back pain (LBP) is unclear. We evaluated the number of sessions for which PENS should be performed to alleviate chronic LBP and how long analgesia is sustained. Patients underwent treatment on a twice-weekly schedule for 8 wk. Group A (n = 18) received PENS for 8 wk, group B (n = 17) received PENS for the first 4 wk and transcutaneous electrical nerve stimulation (TENS) for the second 4 wk, and group C (n = 18) received TENS for 8 wk. Pain level, degree of physical impairment, and the daily intake of nonsteroidal antiinflammatory drugs (NSAIDs) were assessed before the first treatment, 3 days after Week 2, Week 4, and Week 8 treatments, and at 1 and 2 mo after the sessions. During PENS therapy, the pain level decreased significantly from Week 2 in Groups A and B (P < 0.05 or 0.01), and physical impairment and required NSAIDs decreased significantly from Week 4 (P < 0.05 or 0.01) in Group A but only at Week 4 in Group B (P < 0.05 or 0.01). These effects were sustained until 1-mo follow-up (P < 0.01) in Group A but not in Group B; these effects were not observed at 2-mo follow-up even in Group A. In Group C, pain level decreased significantly only at Week 8 (P < 0.05). Our results indicate that repeated PENS is more effective than TENS for chronic LBP but must be continued to sustain the analgesic effect.

Bacterial endotoxin-induced expression of metallothionein genes in rat brain, as revealed by in situ hybridization

In order to clarify acute-phase response in brain, we investigated induction of metallothionein (MT) genes by administrating an endotoxin (lipopolysaccharide) in rat intraperitoneum. We performed in situ hybridization on the serial brain sections to identify the cells expressing the MT genes in acute-phase. After endotoxin administration, transcripts of MT genes were detected in the arachnoideal, ependymal cells and glial cells around the Purkinje cells of the cerebellum, while no significant induction of the MT genes by zinc ion was observed in brain. These results suggest that the acute-phase response occurs specifically in at least these 3 non-neuronal cells.

Increased Carbon Monoxide Concentration in Exhaled Air After Surgery and Anesthesia

Heme oxygenase-1 (HO-1) is induced by oxidative stress and is thought to confer protection against oxidative tissue injuries. HO-1 catalyzes the conversion of the heme moiety of hemeproteins, such as hemoglobin, myoglobin, and cytochrome P450, to biliverdin, liberating carbon monoxide (CO) in the process. CO reacts with hemoglobin to form carboxyhemoglobin. In this study, to examine the effect of anesthesia and/or surgery on endogenous CO production, we measured the amount of exhaled CO and the arterial carboxyhemoglobin concentration of patients who underwent surgery under general or spinal anesthesia. Both CO and carboxyhemoglobin concentrations were significantly larger on the day after surgery than during the preoperative period (P <0.05) and in the recovery room (P < 0.05), regardless of anesthesia. However, neither index differed between general and spinal anesthesia. These results suggest that oxidative stress caused by anesthesia and/or surgery may induce HO-1, which catalyzes heme to produce CO, leading to increased exhaled CO concentration.

Perioperative management of Fontan operation for two patients with arrhythmogenic right ventricular dysplasia.

to drug therapy and failed to respond to catheter ablation. In June 1996, the patient was admitted to the intensive care unit (ICU) of Okayama University Medical School for further management. On admission, frequent VT had caused marked right heart failure, and the central venous pressure (CVP) was approximately 20mmHg. The patient was immediately treated with flecainide acetate, cibenzoline succinate, and metoprolol tartrate. This was followed by transjugular ventricular pacing. However, the treatment was ineffective in reducing the frequency of VT. Subsequently, VT worsened, as manifested by the appearance of five types of VT of different origin and the persistent presence of VT 9 days after admission to the ICU. The patient developed marked right heart failure on day 10, which was treated by mechanical ventilation following intratracheal intubation. However, heart failure did not improve, and there was no increase in urine volume. Deterioration of right and left heart function was probably due to persistent VT and administration of antiarrhythmic agents. Therefore, 13 days after admission, intraaortic balloon pumping (IABP) was initiated. On the next day, percutaneous cardiopulmonary support (PCPS) was implemented. PCPS produced a rapid increase in urine volume and improved respiration but did not result in amelioration of VT. Accordingly, 16 days after admission, an emergency Fontan operation was performed. The patient was transferred to the operating theater, while IABP and PCPS were being applied. Anesthesia was mainly maintained with 43 μg·kg 1 fentanyl. When the large right atrium and right ventricle were resected under cardiopulmonary bypass, VT stopped and sinus rhythm appeared. A total cavopulmonary connection (TCPC)-type Fontan operation was performed (Fig. 1). The duration of cardiopulmonary bypass was 3h 19 min. Weaning from cardiopulmonary bypass was readily achieved by inducing mild hyperventilation and lowering arterial PCO2 to approximately 35 mmHg. At the same time, dopamine, dobutamine

Anesthetic management of a patient with severe dilated cardiomyopathy and an automatic implantable cardioverter-defibrillator (AICD) during total gastrectomy

We report a case of severe dilated cardiomyopathy with an automatic implantable cardioverter-defibrillator (ICD) undergoing total gastrectomy. During the operation, the defibrillation function of the ICD was suspended and its pacing function was used solely in VOO mode. Electrodes of an external defibrillator were attached on the chest wall, and a pulmonary arterial (PA) catheter with a ventricle pacing port was inserted into the pulmonary artery. Proper perioperative management, including measures that the patient underwent the surgery uneventfully and could attain a rapid and successful discharge from the intensive care unit.