Pharmacological and psychosomatic treatments for an elderly patient with severe nausea and vomiting in reaction to postoperative stress.

Here we present a case of successful treatment employing a mixed approach including pharmacological and psychosomatic treatments for a 72-year-old woman who experienced severe nausea and vomiting in reaction to postoperative stress from gastric cancer surgery. This case demonstrates that appropriate provision of psychosomatic treatments, including a psychotherapeutic session and autogenic training, enhances the efficacy of pharmacotherapy.

Effect of low-voltage electrical stimulation on angiogenic growth factors in ischaemic rat skeletal muscle.

1. Low-voltage electrical stimulation (LVES) in skeletal muscle at a level far below the threshold of muscle contraction has been reported to promote local angiogenesis. However, the mechanism underlying the promotion of local angiogenesis by LVES has not been fully elucidated. In the present study, we evaluated whether angiogenic factors, such as vascular endotherial growth factor (VEGF), hepatocyte growth factor (HGF) and fibroblast growth factor (FGF), as well as other disadvantageous factors, such as inflammation (interleukin (IL)-6) and hypoxia (hypoxia-inducible factor (HIF)-1alpha), contribute to the local angiogenesis produced by LVES. 2. We completely excised bilateral femoral arteries of male Sprague-Dawley rats. After the operation, electrodes were implanted onto the centre of the fascia of the bilateral tibialis anterior (TA) muscles, tunnelled subcutaneously and exteriorized at the level of the scapulae. The right TA muscles of rats were stimulated continuously at a stimulus frequency of 50 Hz, with a 0.1 V stimulus strength and no interval, for 5 days. The left TA muscles served as controls. 3. We found that both VEGF and HGF protein were significantly increased by LVES in stimulated muscles compared with control. The VEGF level of the LVES group was 89.10 +/- 17.19 ng/g, whereas that of the control group was 65.07 +/- 12.88 ng/g, as determined by ELISA (P < 0.05). The HGF level of the LVES and control groups was 8.52 +/- 1.96 and 5.80 +/- 2.14 ng/g, respectively (P < 0.05). In contrast, there was no difference in FGF, IL-6 and HIF-1alpha between the LVES and control groups. 4. These results suggest that LVES in a hindlimb ischaemia model of rats increases not only VEGF, but also HGF, production, which may be the main mechanism responsible for the angiogenesis produced by LVES.

Effects and indications of sacral surface therapeutic electrical stimulation in refractory urinary incontinence.

OBJECTIVE: To describe the effects and indications of sacral surface therapeutic electrical stimulation (SS-TES) for refractory urinary incontinence. DESIGN: Evaluation before and after therapy. SETTING: On clinical site and at nursing home. SUBJECTS: Seven neurogenic bladder, five unstable bladder and six nocturia cases were investigated. Twelve were outpatients and six were residents. INTERVENTIONS: Surface electrodes were placed at the posterior sacral foramens of S2 and S4. Stimulation conditions were duration 0.3 ms, frequency 20 Hz and maximum intensity. The stimulation was continued for 15 min twice daily for over one month. MAIN OUTCOME MEASURES: Therapeutic effects were evaluated on the basis of voiding charts as subjective findings and urodynamic study as objective findings before and after therapy. RESULTS: Subjective findings showed incontinence frequency significantly decreased from 2.3 +/- 1.4 times/day before therapy to 1.3 +/- 2.0 times/day after therapy (p < 0.01); 55.5% of patients were improved or greatly improved. Objective findings showed that maximum vesical capacity (MVC) significantly increased from 208.2 +/- 94.5 ml before therapy to 282.1 +/- 66.8 ml (p < 0.001). Uninhibited contraction significantly decreased from 40.4 +/- 31.4 cmH2O before therapy to 25.7 +/- 23.9 cmH2O (p < 0.01); 44% of patients were improved or greatly improved. This therapy was effective in particular for cases whose MVC was small before applying SS-TES. CONCLUSION: SS-TES was effective in some patients with refractory urinary incontinence.

Task dependent motor strategy of human triceps surae muscle.

Even though many investigators have analyzed the functional difference of the three heads of triceps surae in human, none of them succeeded to clarify the distinctive functional difference of those three muscles. The aim of this study was to investigate whether the integrated EMGs (IEMGs) of the triceps surae muscle, gastrocnemius and soleus, were task dependent. IEMGs of the medial head of the gastrocnemius (GM), lateral head of the gastrocnemius (GL), and soleus (SO) were investigated at three different knee joint angles, at four different duration of ramp contraction, with the generation of a single ongoing force, from 0 to the maximum voluntary contraction (MVC). Three-way ANOVAs for repeated measures were used to estimate differences in IEMG values in each of the GM, GL, and SO, taken at four different durations of ramp contraction (5, 10, 15 and 20 s), at three different knee joint angles (0 deg, 30 deg and 90 deg), across ankle plantar flexion levels of force (10, 20, 30, 40, 50, 60 and 70% MVC). According to three-way ANOVAs for repeated measures, IEMG of the GM muscle showed a first-order interaction between force and knee joint angle. In addition, IEMG of the GL muscle showed first-order interactions between the level of force and knee joint angle, and between the level of force and duration of ramp contraction. Furthermore, IEMG of the SO showed a main effect only on level of force. These results suggest that the each head of the triceps surae may work task dependently.