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This prospective, randomized, double-blinded, active controlled trial assessed whether a single preoperative administration of 40 mg of duloxetine could decrease postoperative pain and numbness after posterior lumbar interbody fusion surgery (PLIF).Patients with an American Society of Anesthesiologists physical status I or II undergoing PLIF were included. At 2 hours before inducing anesthesia, patients were administered 40 mg duloxetine or 4 mg diazepam (control drug). Postoperative pain and other symptoms were evaluated on the basis of a visual analog scale, amount of fentanyl used, fentanyl dose request times, rate of use of adjunctive analgesics (diclofenac sodium or pentazocine), and lower limb numbness score (0-3) during the first 2 postoperative days.Forty-six patients were randomly assigned to the duloxetine and diazepam groups (n = 23 each); 6 were lost to follow-up, and analysis was performed on data from 22 patients in the duloxetine group and 18 in the diazepam group. No significant differences were detected in the patient background, postoperative visual analog scale score at rest in the lumbar region and lower limbs, fentanyl use, rate of analgesic adjuvant use, or incidence of side effects. The numbness score in the lower limbs, however, was significantly lower in the duloxetine group.A single preoperative 40-mg dose of duloxetine did not improve postoperative pain after PLIF, but did improve lower limb numbness. Duloxetine may suppress neuropathic pain-like symptoms after PLIF surgery.

Study objective To determine whether single preoperative administration of 2 different doses of pregabalin (75 and 150 mg) could decrease postoperative pain intensity and opioid consumption following posterior lumbar interbody fusion surgery. Design Prospective, randomized, active placebo-controlled, double-blinded study. Setting Postoperative recovery area and patients' room. Patients Ninety-seven adult, American Society of Anesthesiologists physical status 1 and 2 patients. Interventions Patients were randomly assigned to receive diazepam 5 mg as an active placebo (D5), pregabalin 75 mg (P75), or pregabalin 150 mg (P150). The study drug was orally administered 2 hours prior to surgery and a standard anesthetic technique was used. Postoperative pain was managed using intravenous patient-controlled analgesia with morphine. Measurement The visual analog scale at rest was used to measure pain intensity immediately after extubation at the postanesthesia care unit, and then 2, 4, 6, 12, 18, 24, 36, and 48 hours after surgery. Morphine consumption and adverse effects were assessed until 48 hours after surgery. Main results The visual analog scale score at rest was lower in the P150 group than in the D5 group until 2 hours after surgery. Morphine consumption was lower in the P150 group than in the D5 from 0 to 12 hours after surgery. Conclusions Single preoperative administration of 150 mg of pregabalin 2 hours prior to surgery reduced postoperative pain intensity and morphine consumption compared with 5 mg diazepam in patients who underwent posterior lumbar interbody fusion.

ブプレノルフィン0.1mgと0.25%ブピバカイン8mlの硬膜外1回注入に引き続き,携帯型持続注入器(設定速度1ml/hr)を使用して0.25%ブピバカインを硬膜外へ持続注入したときの術後鎮痛効果を,開胸手術(A群14例),上腹部手術(B群21例),下腹部手術(C群15例)で検討した.硬膜外持続注入以外に補助的な鎮痛薬投与をまったく必要としなかった症例は,術後0～24時間においては,A群は21%,B群は24%,C群は67%であった.術後24～48時間においては,A群は43%,B群は62%,C群は67%であった.本法での術後鎮痛は,開胸手術や上腹部手術では鎮痛効果が不十分であった.下腹部手術では約半数の症例で有効であった.

A 64-year-old man, who came to us with diarrhea, presented with ectodermal changes such as hyperpigmentation, alopecia, and onychatrophy, and was affected by polyposis in the colorectum and stomach. The polyps were histologically consistent with those in Cronkhite-Canada syndrome (CCS). Interestingly, the patient also had colon cancer, as well as portal thrombosis and a high concentration of antinuclear antibody. Treatment with prednisolone ameliorated the symptoms and the gastrointestinal polyposis, while the cancer was successfully treated with a hemicolectomy. Six months after the surgery, the patient developed nephropathy, with nephrotic-range proteinuria, without recurrence of the cancer. The biopsied renal specimen showed membranous glomerulonephritis. This is a rare case of CCS associated with various complications such as colon cancer, portal vein thrombosis, a high titer of antinuclear antibodies, and membranous glomerulonephritis. Although the pathogenesis of CCS is essentially unknown, these complications might have been indicative of an underlying immunological abnormality.

Increasing evidence indicates that sevoflurane anesthesia does not impair renal function in healthy patients despite higher concentrations of plasma inorganic fluoride. However, whether sevoflurane further affects renal tubular function in patients with impaired renal function is not known. We compared the effect of sevoflurane anesthesia with that of isoflurane anesthesia on renal tubular function in patients with moderately impaired renal function. Fourteen patients with creatinine clearance between 10 and 55 mL/min were anesthetized with either sevoflurane or isoflurane using a semiclosed circuit system. Plasma inorganic fluoride concentrations and urine N-acetyl-beta-D-glucosaminidase (NAG), gamma-glutamyltranspeptidase (gamma-GTP), and beta 2-microglobulin (beta 2MG) excretions were measured up to post-anesthetic day 14. Although both the peak plasma inorganic fluoride concentrations and the areas under the curve of plasma inorganic fluoride concentration versus time were significantly greater in the sevoflurane group than in the isoflurane group, urine NAG, gamma-GTP, and beta 2MG excretions per day did not differ between the two groups. These results indicate that sevoflurane and isoflurane may have similar effects on the renal tubules in patients with moderately impaired renal function.

Antibodies against hepatitis C (HCV) in 512 patients were measured by an enzyme immunoassay (Ortho-HCV ELISA). The frequency of anti-HCV was 80%, 86%, 85% in nonB (NB) chronic hepatitis (CH), cirrhosis (LC), hepatocellular carcinoma (HCC), respectively; 70%, 90% in alcoholic (AL) LC, HCC; 15%, 33%, 58% in hepatitis B (HB) CH, LC, HCC, respectively. Anti-HCV positive cirrhotics had a shorter survival time and earlier development of HCC than anti-HCV negative cirrhotics. The findings suggest that HCV is a major cause of NB chronic liver diseases and may play a pathogenetic role in AL and HB liver diseases.

Two different anesthetic methods were employed for a patient with recessive dystrophic epidermolysis bullosa (R-DEB). One was plexus brachial block in combination with ketamine infusion. The other was general anesthesia with N2O-O2-halothane via a face mask. In the former, no particular problem developed. In the later, however, some blisters were newly formed on the region where the anesthesist's fingers were attached to hold a face mask. Although mask anesthesia was considered to be not always suitable for patients with DEB, we chose it because tracheal intubation may cause more serious damage to the upper airway leading to airway obstruction.