Toyo Miyazaki

Substance P receptor in U373 MG human astrocytoma cells activates mitogen-activated protein kinases ERK1/2 through Src.

Substance P (SP) acting through substance P receptor (SPR) increases the proliferation of glioblastoma cells. At the molecular level, stimulation of SPR in human U373 MG glioblastoma cells results in phosphorylation of mitogen-activated protein kinases ERK1/2. Examination of the underlying mechanism reveals that SPR mediates ERK1/2 phosphorylation in a calcium-dependent manner. Surprisingly, blockade of epidermal growth factor receptor (EGFR), which is transactivated by SPR, has a minimal effect on SPR-mediated ERK1/2 phosphorylation. However, SPR-mediated ERK1/2 phosphorylation is significantly reduced by the Src kinase inhibitor PP2. Interestingly, ERK1/2 in U373 MG cells is also activated by several other mitogenic G protein-coupled receptors (GPCRs) including α1B-adrenergic, M3-muscarinic, and H1-histaminergic in an Src-dependent manner. We conclude that c-Src is a mediator of SP-stimulated ERK1/2 phosphorylation in human U373 MG glioblastoma cells.

A clinical study on the magnetic stimulation of the facial nerve

Objectives: A clinical study on the usefulness of magnetic stimulation of the facial nerve, with special attention paid to the selection of the coil shape and stimulation procedures. Study Design: The subjects consisted of 55 patients with Bells palsy, 1 patient with a cerebellopontine angle (CPA) tumor, 1 patient with multiple sclerosis (MS), and 30 normal subjects. Three types of coils were used in this study; a 90‐mm large single coil, a 40‐mm small single coil, and a 20‐mm small double coil. Methods: The compound muscle action potentials (CMAPs) and long latency response were evoked by transcranial magnetic stimulation (TMS) with a 90‐mm large single coil. The 40‐mm small single coil was used to test blink reflex by aiming it at the supraorbital nerve as the target site. The subcutaneous activation of the infra‐auricular facial nerve was performed with the 20‐mm double coil. Results: The reproducible CMAP and long latency responses were obtained from normal subjects with TMS. However, responses were observed only in patients with relatively mild Bells palsy. The magnetic stimulation—evoked responses reflected the brainstem function in the patients with a CPA tumor and MS. Conclusion: Although magnetic stimulation remains inferior to conventional electric stimulation in some sense and requires further study, this method is potentially useful because it can stimulate the facial nerve continuously from the cortex to the periphery and can effectively evoke responses reflecting the brainstem function.

Methicillin-resistant Staphylococcus aureus sepsis resulting from infection in paravertebral muscle after continuous epidural infusion for pain control in a patient with herpes zoster

I n many cases of epidural infection, neurological symptoms caused by cord compression due to abscess formation are the major concern. Such neurological symptoms are classified as phase I (spinal ache), phase II (root pain), phase III (weakness of voluntary muscles and sphincters and/or loss of sensation), and phase IV (paralysis), which serve as guidelines for selecting appropriate therapeutic methodologies (1). There have been reports of epidural abscess formation arising from epidural catheterization (2-4). The possibility of developing epidural abscess is, however, low compared with the probability of finding microorganisms on catheter tips during catheterization (4,5), and the microorganisms discovered are usually Staph~ZOCOCCUS aureus (4 6). We present a patient who, after continuous epidural infusion for the treatment of pain associated with herpes zoster, first developed a methicillin-resistant StaphyZococcus aureus (MRSA) infection with neurological symptoms in phase I, which later progressed to sepsis.

Hemomediastinum induced by heparinization after stellate ganglion blockada.

A patient who was treated for sudden deafness by stellate ganglion blockade (SGB) receiving 6 to 8 ml of 0.25% bupivacaine complained of thoracodorsal pain after seven sessions of SGB. Considering that the patient had a prior history of percutaneous transluminal coronary angioplasty (PTCA) for a very recent episode of myocardial infarction (MI), the pain was attributed to restenosis of coronary arteries. This was concidered a case of hemomediastinum induced by heparinization.

Antibacterial activity of local anesthetics

In order to study the antibacterial activity of local anesthetics quantitatively, we procured their minimum inhibitory concentration (MIC), killing curves and postantibiotic effect (PAE), using the standard colony of Staphylococcus aureus ATCC 25923, Staphylococcus epidermidis ATCC 14990 and Pseudomonas aeruginosa NCTC 10490. Both bupivacaine and lidocaine had bactericidal activity at a clinical concentration. MIC of the former was lower than that of the latter, and it means that bupivacaine has a greater antibacterial activity than lidocaine. At the same concentration, the commercial solutions, such as Xylocaine and Marcain, which contain preservatives, showed a greater antibacterial activity than the pure anesthetic solutions which contain no preservatives. However, the preservatives had no bactericidal activity, but weak bacteriostatic activity.

Peripheral nerve blocks with local anesthetics are effective for the treatment of idiopathic trigeminal neuralgia that is not alleviated with carbamazepine

We routinely use nerve blocks with local anesthetics for trigeminal neuralgia that is not alleviated with oral analgesics, the effect of which is far longer lasting than the effectiveness duration of the local anesthetics. The present study summarizes results from 130 cases of exacerbation of trigeminal neuralgia that occurred in 53 patients. One ‘ case’ was not one patient but one division of the trigeminal nerve. The patients were given nerve block treatments with local anesthetics until sufe cient pain control could be achieved, or more radical treatment methods were considered desirable. Four categories were used to evaluate the effect of the nerve blocks. Excellent (no pain without oral analgesics): 43.8%, good (no pain with oral analgesics): 36.9%, fair (partial pain control): 6.9%, and poor (little or no effect): 12.3%. The average number of blocks required to achieve some pain control was 3 :1 § 3:6. The excellent results lasted for 187 § 155 days, the good for 229 § 296 days, and the fair for 36 § 13 days. No side effects were observed except for a slight case of subcutaneous bleeding. Although the effectiveness of the nerve block treatment with local anesthetics is limited in both the initial success rate and the effective duration, lack of side effects, relative ease of execution, low cost and fewer requirements for operational facilities may make this method an attractive candidate as a screening procedure for treating patients before using more invasive methods. summary

A patient with chronic idiopathic intestinal pseudo-obstruction treated with splanchnic nerve block

AbstractWe report here a patient presenting with long-lasting chronic abdominal pain and constipation that was successfully treated using bilateral splanchnic nerve blocks. Two laparotomies did not reveal the cause the intestinal obstruction and a diagnosis of chronic idiopathic intestinal pseudo-obstruction was made. The splanchnic nerve block is a good option in the treatment of this disease.

Two cases of bronchospasm during operation in a prone position

Case 1 The patient was a 54-year-old man who was 168 em in height and weighed 68 kg. He underwent general anesthesia for surgery via the dorsal approach (Love technique) for herniated lumbar disc. There was no past history or family history of allergic disorders or asthma. Hematological tests, electrocardiography, and lung function test performed on admission were within the normal range. He was given atropine sulfate (0.5 mg) and hydroxyzine hydrochloride (50 mg) 45 min before anesthesia. Anesthesia was induced with thiopental sodium (250 mg) and succinylcholine chloride (50 mg). After endotracheal intubation (8.0 mm i.d.