Pregabalin for postherpetic itch: a case report.

BACKGROUND: Postherpetic itch has not commonly received attention as a complication of herpes zoster because pain predominates over itch in most patients with herpes zoster. Most cases of postherpetic itch are mild; however, cases of severe postherpetic itch reducing quality of life are rare. CASE PRESENTATION: A 52-year-old woman complained of severe itch in her left pinna and cheek 1 month after the first onset of herpes zoster at the same site. Owing to her scratching, she developed ulcers on her left pinna and cheek. Pregabalin was prescribed, and the itch subsided immediately, with the ulcers disappearing within 1 month. DISCUSSION: Severe itch was thought to be caused by neural injury from herpes zoster. Pregabalin may be a useful treatment option for neuropathic itch induced by herpes zoster.

M1 macrophage infiltration exacerbate muscle/bone atrophy after peripheral nerve injury.

BACKGROUND: Peripheral nerve injury causes limb muscle/bone atrophy, leading to chronic pain. However, the mechanisms underlying muscle/bone atrophy after peripheral nerve injury remain unknown. It was recently reported that M1 macrophages are the main factors responsible for neurogenic inflammation after peripheral nerve injury. We hypothesized that M1 macrophages are important in muscle/bone atrophy after nerve injury. Therefore, we investigated the influence of M1 macrophages on muscle/bone atrophy after nerve injury in mice to prevent muscle/bone atrophy by suppressing M1 macrophages. METHODS: Hindlimb muscle weight and total bone density were measured in a chronic constriction injury (CCI) mouse model. Immunohistochemical analysis and intravital microscopy were performed to visualize hindlimb muscles/bones, and cells were quantified using flow cytometry. We compared M1 macrophage infiltration into muscles/bones and muscle/bone atrophy between macrophage depletion and untreated groups. We also investigated muscle/bone atrophy using administration models for anti-inflammatory and neuropathic pain drugs. RESULTS: Peripheral nerve injury caused significant reduction in muscle weight and total bone density at 1 and 3 weeks after CCI, respectively, compared with that in controls. Osteoclast numbers were significantly higher at 1 week after CCI in the CCI group than in the control group. M1 macrophage infiltration into muscles was observed from 2 h after CCI via intravital microscopy and 1 week after CCI, and it was significantly higher 1 week after CCI than in the control group. In the macrophage depletion group, dexamethasone, pregabalin, and loxoprofen groups, M1 macrophage infiltration into muscles/bones was significantly lower and muscle weight and total bone density were significantly higher than in the untreated group. CONCLUSIONS: M1 macrophage infiltration exacerbates muscle/bone atrophy after peripheral nerve injury. By suppressing M1 macrophages at the neural injury local site, muscle/bone atrophy could be avoided.

Adhesions in the epidural space caused by frequent epidural blocks.

We report a case of adhesions in the epidural space caused by more than 200 times epidural blocks that were observed with epiduroscopy. A 41-year-old man had repeatedly undergone lumbar epidural blocks to treat pain in his leg, resulting in decreased efficacy of the epidural block. We described endoscopic findings that these adhesions were mostly consisted of adhesions formed from the soft connective tissue.

[Comparative study of the KingVision videolaryngoscope and Airwayscope using manikins].

BACKGROUND: KingVision (KV) is a new videolaryngoscope. In this study, we compared the ease of use of the KV with the Airwayscope (AWS) by experienced personnel in a simulated manikin. METHODS: Twenty-eight anesthesiologists participated in this study. We used an advanced patient simulator (AIRSIM) to simulate normal manikin and difficult airway scenarios including cervical spine rigidity and limited mouth opening. We compared the time required for visualization of the glottis (Tv) and tracheal intubation (Ti), and analyzed the percentage of glottic opening (POGO) score and the success rates for tracheal intubation. RESULTS: In normal manikin, the Tv and Ti with the KV were significantly shorter than with the AWS (P < 0.05). The POGO score with the KV was higher than with the AWS (P < 0.05). In difficult airway scenarios including both cervical spine rigidity and limited mouth opening, the Tv and Ti with the KV were shorter than with only the AWS (P < 0.05). There is not much difference between KV and AWS regarding the POGO score in difficult airway. CONCLUSIONS: KV may be a suitable device for routine anesthesia care and difficult airway intubation. Further studies in a clinical setting are necessary to confirm these findings.

[McGRATH MAC Videolaryngoscope: clinical assessment of its performance in 50 surgical patients].

BACKGROUND: The aim of this study was to evaluate the utility of McGRATH MAC Videolaryngoscope in tracheal intubation of surgical patients. METHODS: McGRATH MAC Videolaryngoscope was used for the tracheal intubation in 50 surgical patients undergoing general anesthesia. We compared the percentage of glottic opening score between McGRATH MAC Videolaryngoscope and Coopdech Videolaryngoscope Portable VLP-100 by anesthesia staffs and unexperienced anesthetic trainees. The number of intubation attempts and the time to complete intubation were also recorded. RESULTS: In 49 of 50 surgical patients including 18 patients with potential difficult airways, successful intubation was performed with McGRATH MAC. Not only anesthesia staffs but also unexperienced anesthetic trainees could obtain better view of the glottis with McGRATH compared with Coopdech Videolaryngoscope Portable VLP-100. CONCLUSIONS: McGRATH MAC Videolaryngoscope facilitates tracheal intubation in surgical patients.

[GlideScope Cobalt: assessment of performance in 50 children].

BACKGROUND: GlideScope Cobalt video laryngoscope is a new type of GlideScope series. A reusable camera baton is inserted into a disposable plastic curved blade. The blade has 5 choices of size and can be used from infants to adults. The aim of the current study was to evaluate the efficacy of GlideScope Cobalt in children. METHODS: Endotracheal intubation was performed in 50 surgical children undergoing general anesthesia. The length of time in intubation, percentage of glottic opening (POGO) score and optimizing procedures were recorded. RESULTS: 100% POGO score was obtained in 42 cases. Successful endotracheal intubation was performed in 47 cases and 37 patients were intubated within 1 minute. It took over 1 minute to intubate in 13 cases, because of the difficulty of tracheal tube maneuver. Particular children, mostly aged 6-8, had difficulty in matching the size of the blade because of the large difference between the sizes of blade 2 and that of blade 3. CONCLUSIONS: GlideScope Cobalt is a useful tool in chidlren's airway management but it necessitates getting used to the tracheal tube maneuver and lacks the suitable blade size for 6-8 years old children.

[Tracheal intubation using Airtraq optical laryngoscope in an adult patient with Goldenhar syndrome].

A 23-year-old woman with Goldenhar syndrome and conductive deafness was scheduled for tympanoplasty. Goldenhar syndrome is a developmental disorder characterized by ear malformation, mandibular hypoplasia, and vertebral anomalies. Furthermore, she had micrognathia, trismus, and mandibular hypoplasia. Awake taracheal intubation was attempted to prevent airway obstruction, because we had anticipated her difficult airway (micrognathia, trismus, and mandibular hypoplasia). The vocal cords were visualized with a Cormac and Lehane grade I, using the Airtraq optical laryngoscope Small (Size 2), under sedation. Then, an endotracheal tube was inserted after induction of general anesthesia. This is the first case report on the successful orotracheal intubation using Airtraq in an adult with Goldenhar syndrome.

[The KINGVISION: clinical assessment of performance in 50 patients].

BACKGROUND: The aim of this study was to evaluate the suitability of the KINGVISION videolaryngoscope for tracheal intubation. METHODS: Endotracheal intubation was performed using the KINGVISION in 50 patients undergoing general anesthesia. We compared the percentage of glottic opening score between Coopdech Videolaryngoscope Portable VLP100 and the KINGVISION with staff anesthesiologist and novice personnel. The time to complete instrumentation and optimizing procedures were also recorded. RESULTS: The KINGVISION allowed visualization of the glottis and successful intubation in all patients, including 11 patients with difficult airway. There were no differences in the time to intubation between staff anesthesiologist and novice personnel. Furthermore, percentage of glottic opening score was higher with KINGVISION than with Coopdech Videolaryngoscope Portable VLP100 among staff anesthesiologist and novice personnel. CONCLUSIONS: The KINGVISION could be an effective aid to airway management in surgical patients.

[Anesthetic management of a morbidly obese patient in prone position for lumbar laminectomy].

A 22-year-old man weighing 188.7kg, 170cm tall (body mass index 65.2 kg x m(-2)) with bladder and rectal disturbances due to lumbar disc hernia (L4/5 and L5/S1) was scheduled for L4-5 laminectomy under general anesthesia. Awake fiberoptic intubation was attempted to prevent airway obstruction because we predicted difficult airway. During fiberoptic tracheal intubation, we easily succeeded in the insertion of the fiberscope itself into the trachea, and we succeeded in placing the reinforced tube into the trachea. Fentanyl and sugammadex were calculated with total body weight, but, remifentanil, propofol, and rocuronium were re-calculated with ideal body weight. They were given intravenously. Anesthesia was maintained with sevoflurane (1.5 to 2.0%), the fraction of inspiratory oxygen (about 0.6), remifentanil (0.1 to 0.4 microg x kg(-1) x min(-1)), and fentanyl (100 to 150 microg) as needed. After turning to prone position, severe physiological abnormal signs were not recognized. We concluded that awake fiberoptic intubation was useful and safe; moreover, anesthetic agents were administrated appropriately for morbid obesity.

[The C-MAC videolaryngoscope: its utility in tracheal intubation by novice personnel].

BACKGROUND: The aim of this study was to evaluate the suitability of the C-MAC videolaryngoscope for the tracheal intubation especially by novice personnel. METHODS: Endotracheal intubation was performed using the C-MAC videolaryngoscope in 40 patients undergoing general anesthesia. We compared the percentage of glottic opening score between Macintosh laryngoscope and the C-MAC videolaryngoscope by anesthesia staff and novice personnel. The time to complete instrumentation and optimizing procedures were also recorded. RESULTS: The C-MAC videolaryngoscope allowed visualization of the glottis and successful intubation in 39 patients. There was no difference in the time to intubation between anesthesia staff and novice personnel. Furthermore, there was significant difference in percentage of glottic opening score between Macintosh laryngoscope and the C-MAC videolaryngoscope in novice personnel, because of appropriate guidance by anesthesia staff. CONCLUSIONS: The C-MAC videolaryngoscope is a useful device in education of endotracheal intubation by novice personnel.

[GlideScope Ranger: clinical assessment of the performance in 100 patients].

To evaluate the suitability of GlideScope Ranger, endotracheal intubation was performed in 100 surgical patients undergoing general anesthesia. The time to complete intubation, percentage of glottic opening score and optimizing procedures were recorded. GlideScope Ranger allowed visualization of the glottis and successful intubation in all 100 patients, including two patients with difficult airway. Endotracheal intubation was performed within one minute in 81 cases, and percentage of glottic opening score of 75% or more was obtained in 75 cases. It was easily handled not only by experienced anesthetists but also by novice personnel. GlideScope Ranger could be an effective aid to airway management in surgical patients.

[Glidescope: a comparison of percentage of glottic opening score between middle size and large size handles].

BACKGROUND: The aim of the present study was to compare the percent of glottic opening score between middle-size (#3) and large-size (#4) handles during laryngoscopy using the GlideScope videolaryngoscope (GVL) in Japanese women. METHODS: In 80 Japanese women receiving general anesthesia for surgical procedures, laryngoscopy was performed using GVL #3 handle and GVL #4 handle. We compared the percentage of glottic opening score between the two handles on each patient. RESULTS: The percentage of glottic opening score was higher with GVL #3 handle than with GVL #4 handle [66 +/- 28% (mean +/- SD), vs. 53 +/- 34%, P < 0.05). CONCLUSIONS: The use of GVL #3 handle is recommended for tracheal intubation for Japanese women.

[Airtraq optical laryngoscope: clinical assessment of its performance in 100 children].

BACKGROUND: The aim of the present study was to evaluate the suitability of Airtraq optical laryngoscope for the tracheal intubation in children. METHODS: Endotracheal intubation was performed using the Airtraq optical laryngoscope in 100 pediatric patients undergoing general anesthesia. The time to complete tracheal intubation and optimizing procedures were recorded. RESULTS: The Airtraq optical laryngoscope allowed visualization of the glottis and successful intubation in the 100 patients, including three patients with difficult airway. Utilization of a gum elastic bougie was helpful to introduce a tube tip to the trachea. CONCLUSIONS: The Airtraq optical laryngoscope might be an alternative apparatus for endotracheal intubation in pediatric patients.

[Airtraq optical laryngoscope: clinical assessment of its performance in 300 surgical patients].

BACKGROUND: The Airtraq optical laryngoscope allows visualization of the glottis through a non-line-of sight view. The aim of the present study was to evaluate the suitability of this device for the tracheal intubation of surgical patients. METHODS: The Airtraq was used for the endotracheal intubation in 300 surgical patients. RESULTS: The Airtraq optical laryngoscope allowed visualization of the glottis and successful intubation in 298 out of 300 patients. Endotracheal intubations were easily performed both with normal and difficult airways. CONCLUSIONS: The Airtraq optical laryngoscope consistently permitted a better intubation environment. With its potential advantages, the Airtraq optical laryngoscope could be an effective aid to airway management in surgical patients.

[Airtraq optical laryngoscope].

BACKGROUND: We described an early experience of Airtraq laryngoscope in 20 patients receiving general anesthesia. METHODS: In all, 2 staff anesthesiologists, 3 anesthesia residents and 10 non-anesthesia residents performed endotracheal intubation with 14 polyvinyl chloride tubes with inside diameter of 7-8 mm, 5 double lumen 37-F tubes and 1 preformed nasotracheal tube. RESULTS: Every endotracheal intubation was achieved at the first trial, and the mean time to secure the airway was 46 +/- 18 seconds. CONCLUSIONS: Airtraq laryngoscope is a useful novel device for tracheal intubation.

Plasma obestatin concentrations are negatively correlated with body mass index, insulin resistance index, and plasma leptin concentrations in obesity and anorexia nervosa.

BACKGROUND: Obestatin is a recently identified ghrelin gene product that was reported to inhibit appetite and gastric motility in contrast to ghrelin. We investigated fasting obestatin and ghrelin levels in patients with obesity and anorexia nervosa. METHODS: Fasting plasma obestatin, acyl-ghrelin, desacyl-ghrelin, leptin, glucose serum adiponectin, and insulin were measured in 10 obese subjects, 11 restricting-type anorexics, and 11 control subjects. RESULTS: Obese group had significantly lower levels of obestatin (p < .01), while anorexic group had significantly higher levels (p < .01). Obestatin was negatively correlated with body mass index (BMI) (r = -.74), glucose (r = -.56), insulin (r = -.55), leptin (r = -.66), and also with the homeostasis model assessment of insulin resistance (HOMA-R) (r = -.49) and was positively correlated with acyl-ghrelin (r = .65) and desacyl-ghrelin (r = .60). No correlation was seen between obestatin and adiponectin, but the latter was negatively correlated with both acyl-ghrelin and desacyl-ghrelin. Desacyl-ghrelin to acyl-ghrelin ratio was significantly different between anorexic and control groups (p < .05), while no difference was seen between obese and control groups. CONCLUSIONS: Both obestatin and ghrelin are increased in anorexic and decreased in obesity. We suggest that obestatin is a nutritional marker reflecting body adiposity and insulin resistance.

Synthesis, structural characterization and antimicrobial activities of 12 zinc(II) complexes with four thiosemicarbazone and two semicarbazone ligands.

Twelve zinc(II) complexes with thiosemicarbazone and semicarbazone ligands were prepared and characterized by elemental analysis, thermogravimetric and differential thermal analysis (TG/DTA), FT-IR and 1H and 13C NMR spectroscopy. Seven three-dimensional structures of zinc(II) complexes were determined by single-crystal X-ray analysis. Their antimicrobial activities were evaluated by MIC against four bacteria (B. subtilis, S. aureus, E. coli and P. aeruginosa), two yeasts (C. albicans and S. cerevisiae) and two molds (A. niger and P. citrinum). The 5- and 6-coordinate zinc(II) complexes with a tridentate thiosemicarbazone ligand (Hatsc), ([Zn(atsc)(OAc)](n) 1, [Zn(Hatsc)(2)](NO(3))(2).0.3H(2)O 2, [ZnCl(2)(Hatsc)] 3 and [Zn(SO(4))(Hatsc)(H(2)O)].H(2)O 4 [Hatsc=2-acetylpyridine(thiosemicarbazone)]), showed antimicrobial activities against test organisms, which were different from those of free ligands or the starting zinc(II) compounds. Especially, complex 2 showed effective activities against P. aeruginosa, C. albicans and moderate activities against S. cerevisiae and two molds. These facts are in contrast to the results that the 5- or 6-coordinate zinc(II) complexes with a tridentate 2-acetylpyridine-4N-morpholinethiosemicarbazone, ([Zn(mtsc)(2)].0.2EtOH 5, the previously reported catena-poly [Zn(mtsc)-mu-(OAc-O,O')](n) and [Zn(NO(3))(2)(Hmtsc)] [Hmtsc=2-acetylpyridine (4N-morpholyl thiosemicarbazone)]), showed no activities against the test microorganisms. The 5- and 6-coordinate zinc(II) complexes with a tridentate 2-acetylpyridinesemicarbazone, ([Zn(OAc)(2)(Hasc)] 6 and [Zn(Hasc)(2)](NO(3))(2) 7 [Hasc=2-acetylpyridine(semicarbazone)]), showed no antimicrobial activities against bacteria, yeasts and molds. Complex [ZnCl(2)(Hasc)] 8, which was isostructural to complex 3, showed modest activity against Gram-positive bacterium, B. subtilis. The 1:1 complexes of zinc(II) with pentadentate thiosemicarbazone ligands, ([Zn(dmtsc)](n) 9 and [Zn(datsc)](n) 10 [H(2)dmtsc=2,6-diacetylpyridine bis(4N-morpholyl thiosemicarbazone) and H(2)datsc=2,6-diacetylpyridine bis(thiosemicarbazone)]), did not inhibit the growth of the test organisms. On the contrary, 7-coordinate zinc(II) complexes with one pentadentate semicarbazone ligand and two water molecules, ([Zn(H(2)dasc)(H(2)O)(2)](OAc)(2).5.3H(2)O 11 and [Zn(H(2)dasc)(H(2)O)(2)](NO(3))(2).H(2)O 12 [H(2)dasc=2,6-diacetylpyridine bis(semicarbazone)]), showed modest to moderate activities against bacteria. Based on the X-ray structures, the structure-activity correlation for the antimicrobial activities was elucidated. The zinc(II) complexes with 4N-substituted ligands showed no antimicrobial activities. In contrast to the previously reported nickel(II) complexes, properties of the ligands such as the ability to form hydrogen bonding with a counter anion or hydrated water molecules or the less bulkiness of the 4N moiety would be a more important factor for antimicrobial activities than the coordination number of the metal ion for the zinc(II) complexes.