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Peripheral nerve injury causes a progressive series of morphological changes in spinal microglia, and extracellular ATP stimulates proliferation of microglia and may be involved in neuropathic pain. We defined the precise expression of P2X7 in the spinal cord following peripheral nerve injury. We found that both P2X7 mRNA and protein increased in the spinal cord, with a peak at 7 d after injury. Double labeling studies revealed that cells expressing increased P2X7 mRNA and protein after nerve injury were predominantly microglia in dorsal horn. Pharmacological blockades by intrathecal administration of a P2X7 antagonist (A 438079 hydrochloride) suppressed the development of mechanical hypersensitivity. We present distinct evidence that increases in the number of P2X7 receptors in spinal microglia may play an important role in neuropathic pain.

一般のパルスオキシメータは体動がなければ±2%程度の誤差範囲で測定値を保証しているが, 体動や低灌流などのノイズ存在下での性能には機種により差がある. 今回, 新しいノイズ対策を施した3機種を用い, 健康成人6名を対象に, SpO2>70%の範囲で体動・低灌流条件のもと, 対照としたパルスオキシメータの測定値と比較した. その結果, 測定不能表示を出しにくい機種は誤答率が高い傾向を認めた. また, ノイズによる測定不能時にノイズ発生前の値を表示し続ける機種は, SpO2が変化していないときには有利であった. どの機種も相当の体動・低灌流条件下でも測定可能であったが, おのおのの特性を十分理解したうえで, 使用目的に合った機種を選択することが好ましいと考えた.

The phase behavior of the aqueous cholesteric mesophase composed of potassium N-dodecanoyl-l-alaninate (L-KDDA) was studied in the presence of various cations such as a cobalt(III) complex and cesium ions using multinuclear magnetic resonance and laser and X-ray scatterings. The cobalt(III) complexes used are [Co(NH3)6]Cl3, [Co(en)3]Cl3 (en = ethylenediamine), Δ-[Co(chxn)3]Cl3 (chxn = (R,R)-1,2-cyclohexanediamine), [Co(tn)3]Cl3 (tn = trimethylenediamine), and [Co(phen)3]Cl3 (phen = 1,10-phenanthroline). Transition temperatures from anisotropic to isotropic phases determined by 2H2O NMR spectra were appreciably dependent on the kinds and concentrations of the added cations. The NH3-, en-, tn-, and phen-complex ions were more favorable for stabilizing the aqueous mesophase of L-KDDA compared to the chxn-complex ion. The change in the order parameters for the surfactant aggregates was monitored by anisotropic splittings of the 1H NMR spectra envelope and was compared to structural parameters of the mesophase...

The intubating laryngeal airway, air-Q ILA, was recently introduced in Japan. It has been used in adult patients for difficult airway management; however, there are few reports available on its use in pediatric patients. We report the use of the air-Q ILA in predicted difficult airway management in a 16-month-old patient with Apert syndrome characterized by acrocephalosyndactyly undergoing a syndactyly operation. It was somewhat difficult to keep his airway with a facemask, and an air-Q ILA was inserted. Following the ventilation via air-Q ILA, tracheal intubation guided by a tracheal fiberscope was attempted through the air-Q ILA. Five months after this operation, the patient again underwent the same operation. We managed his airway in the same way as previously, and the tracheal was intubated. This case shows that the air-Q ILA can be an alternative device in pediatric difficult airway management.

An estimation of the peak areas of the 59Co NMR spectra for cobalt(III) complex ions and of the 25Mg spectra for magnesium aqua ions gave population ratios of their hidden ions, which are defined as too strongly interacting with nematic lyomesophases (composed of cationic or anionic surfactants) to contribute to the NMR spectra. The cobalt(III) complex ions used were [Co(NH3)6]3+, [Co(en)3]3+ (en = ethylenediamine), [Co(phen)3]3+ (phen = 1,10-phenanthroline), and [Co(CN)6]3−. It was revealed that appreciable amounts of multivalent ions are present as hidden ions on the lyomesophase, whose sign of charge is opposite to that of the ion in question. For such hydrophilic ions as [Co(NH3)6]3+, [Co(en)3]3+, [Co(CN)6]3−, and magnesium ions, the ions binding to the mesophases are classified into two states based on the NMR spectra: One is an outer-sphere complex (ion pair); the other is a hidden ion. In these systems the hidden ion/total ion population ratios depending on the composition of the surfactant are rou...

59Co NMR spectroscopy was used to study the interactions of cationic or neutral octahedral cobalt(III) complexes such as [Co(NH3)6]3+, [Co(en)3]3+ (en = ethylenediamine), [Co(NO2)(NH3)5]2+, and [Co(acac)3] (acac = acetylacetonato) with surfactants in their nematic liquid crystalline solutions. The specific interactions of the complexes with the surfactants were studied in a replacement of one surfactant by another that had a different polar group. The extent of the binding of these complexes was monitored through the 59Co quadrupole splittings. The relationship between the extent of the binding and the magnitude of the quadrupole splitting did not hold when comparing the three cationic complexes. A comparison between the potassium dodecanoate (KDodec)/tetradecyl (or decyl)trimethylammonium bromide (TDTMABr or DTMABr) and the cesium N-dodecanoyl-L-alaninate (CsDDA)/tetradecyltrimethylammonium bromide (TDTMABr) mixed surfactant systems in the interaction with [Co(NH3)6]3+ and [Co(en)3]3+ complexes showed th...

The NMR peak of 59Co(III) cationic complexes shifts upfield upon interacting with anions when the interaction is mainly electrostatic; it shifts downfield when the hydrophobic interaction acts additively with the electrostatic interaction. These trends are enhanced in micellar solution systems.

A radical hysterectomy was performed in a patient complicated with bronchiectasis, under combined spinal-epidural anesthesia. The patient was asymptomatic and preoperatively diagnosed with bronchiectasis on an anesthetic consultation with an anesthesiologist. An epidural catheter was inserted between T12 and L1, and spinal anesthesia was subsequently performed with 0.5% bupivacaine 2.8 ml and fentanyl 10 microg. It was necessary to administer a supplemental epidural dose of 0.375% ropivacaine fifty minutes after the start of the operation. Postoperative epidural analgesia was effective and no perioperative complications were observed.

We report a case of the intra-atrial vegetation removal under cardiopulmonary bypass (CPB) in a case complicated with left middle cerebral artery embolism caused by postoperative infective endocarditis. The patient was a 14-month-old boy. Two months after intracardiac repair for a complex congenital heart disease, he presented with low-grade fever and was placed on oral antibiotics. A month later an echocardiography revealed 2 vegetations on the tricuspid valve. Although the vegetations became smaller with intravenous antibiotics, right hemiplegia was noted 5 weeks later. Brain CT and MR-angiography demonstrated left middle cerebral artery embolism. For fear of another embolism caused by a remaining movable vegetation on the tricuspid valve, intra-atrial vegetation removal under CPB was performed 5 days after cerebral infarction. Intraoperative transesophageal echocardiography was utilized to locate the vegetation and confirm its removal. His postoperative course was uneventful without a recurrence of cerebral infarction or bleeding. He was weaned from the ventilator on postoperative day (POD) 1, started to move the right extremities on POD 5 and was discharged home on POD 66.

In our institution, spinal anesthesia is the first choice for cesarean section. After the introduction of bupivacaine in 2000 in Japan, the intrathecal anesthetic agent shifted from tetracaine to bupivacaine. We analyzed the anesthesia for cesarean section in recent 7 years and compared the anesthetic quality of tetracaine with that of bupivacaine.The anesthetic records were reviewed in the patients who had received cesarean section between January 1998 and December 2004 at our institution.There were 10456 deliveries during the study period with a cesarean section rate of 28.2% (2947 cases). Ninety-one percent of cesarean section was performed under spinal anesthesia. Spinal anesthetic agent shifted from tetracaine to bupivacaine in 2000-2001, both of which was prepared as a hyperbaric solution and supplemented with 0.1 mg of morphine hydrocloride. Of the 2711 patients in whom a cesarean section was started under spinal anesthesia, 20 (0.7%) required conversion to general anesthesia. Three hundred eighteen patients (11.7%) required some analgesic supplementation. The incidence of intra-operative analgesic supplementation was greater in the patients anesthetized with hyperbaric tetracaine and morphine than in those anesthetized with hyperbaric bupivacaine and morphine (22.96% vs 4.20% ; P0.01). The conversion rate from spinal to general anesthesia for cesarean section was 0.7%.Comparing these two intrathecal anesthetic agents, the rate of analgesic supplementation in those anesthetized with bupivacaine was lower than in those anesthetized with tetracaine. This suggests that bupivacaine provides the more profound blockade of the visceral pain than tetracaine, and is superior as a local anesthetic.

Noonan syndrome is characterized by facial, skeletal and cardiovascular anomalies. We describe the anesthetic management of a one-year-old boy with Noonan syndrome and hypertrophic obstructive cardiomyopathy scheduled for tonsillectomy and adenoidectomy under general anesthesia. He had a history of congestive heart failure at 5 months of age. Preoperative echocardiogram revealed a hypertrophied septum (12.8 mm) with concentric hypertrophy of the left ventricle. Mild mitral regurgitation was also noted. Our anesthetic goal was set to maintaining adequate preload and afterload as well as adequate anesthesia depth to avoid LV outflow tract obstruction. Intravenous fluid was started the day before surgery. Anesthesia was induced with fentanyl 30 microg and midazolam 2 mg and maintained with propofol 8 mg x kg(-1) x hr(-1), fentanyl 30 microg, ketamine 4 mg, and sevoflurane 1-2%. Intraoperative monitoring included 12-lead electrocardiogram and direct measurement of arterial pressure. Intra- and post-operative course was uneventful.