A Case of Successful Treatment by Cervical Nerve Root Blocks for Acute Pain Associated with Herpes Zoster / 日本農村医学会雑誌

We report a case of right cervical (C2-C4 area) acute herpetic pain successfully treated by therapeutic selective nerve blocks. A47-year-old man complained of right cervical persistent pain and frequent intermittent pain associated with herpes zoster. This pain was resistant to standard therapies such as satellite ganglion block and epidural block. On the 10th day after onset, the patient was treated by X-ray-guided therapeutic C3 and C4 selective nerve root blocks, resulting in an almost immediate relief of pain. The patient remained pain-free, and postherpetic neuralgia (PHN) was prevented. Although there are various treatments for PHN, none produces definitive effects. Relief of acute herpetic pain and prevention of PHN are important in the treatment of herpes zoster.

Post Tetanic Count and Single Twitch Height at the Onset of Reflex Movement After Administration of Vecronium Under Total Intravenous Anesthesia / 日本農村医学会雑誌

We have studied post tetanic count (PTC) and single twitch height at the onset of reflex movement to carinal stimulation after administration of vecronium to 10 female patients under total intravenous anesthesia. During spontaneous recovery from vecronium-induced neuromuscular block, the carina was stimulated at every 120s. It took 18.7±5.5 minutes before reflex movement started, T1% was 1.9±2.2%, and PTC was 11.59±5.3 counts. In 5 cases, T1% did not appear at the onset of reflex movement.

Two Cases of Post-Extubation Pulmonary Edema Following Endoscopic Mucosal Resection for Early Hypopharyngeal Cancer / 日本農村医学会雑誌

Case 1: The patient, a 73-year-old male with early hypopharyngeal cancer, underwent endoscopic mucosal resection (EMR) under general anesthesia. Coming out from under the anesthetic, the patient was extubated in the operating room. Then, he suddenly developed severe inspiratory stridor, followed by tachypnea, and began to complain strongly of dyspnea. Case 2: The patient, a 67-year-old male with early hypopharyngeal cancer, underwent EMR under general anesthesia. Immediately after extubation following successful surgery, the patient developed respiratory distress with vigorous inspiratory efforts. Because severe laryngo-pharyngeal edema was found in both cases, these tracheae were orally re-intubated under direct laryngoscopy. Both patients were transferred to the intensive care unit (ICU). In case 2, chest X-rays immediately after re-intubation revealed bilateral diffuse alveolar infiltration. The diagnosis was interstitial pulmonary edema. The lung edema was considered to be induced by strong inspiratory efforts. The patient required mechanical ventilatory support in ICU for several days. It was strongly recommended that the entire laryngo-pharyngeal space be examined at the completion of hypopharyngeal endoscopic mucosectomy before extubation. If any signs of laryngo-pharyngeal edema exist, the endotracheal tube was to be left in place and the patient carefully observed in the ICU until the next morning.