[A case of trismus at anesthesia induction possibly attributable to traumatic cervical syndrome].

We recently had a 41-year-old male who developed trisms at anesthesia induction, probably due to traumatic cervical syndrome. Preoperatively, this patient had been able to open his mouth sufficiently to an extent of at least three finger breadths in width. However, when anesthesia was induced, his mouth could be manually opened only to an extent of about one finger breadth in width. As a result, intubation was difficult. As the trismus did not respond to a muscle relaxant, we were forced to use the Airwayscope for intubation. When the patient awoke from anesthesia, he was again capable of spontaneously opening his mouth to the three-finger breadth extent recorded before surgery. MRI revealed no abnormalities and the patient was diagnosed as having temporomandibular arthrosis based on clinical signs. Regarding the relationship between traumatic cervical syndrome and trismus due to temporomandibular arthrosis, while reports began to be published overseas in the 1990s, few such reports are yet available in Japan. Under the recent trend of increased day surgery, assessments made before surgery tend to be confined to routinely adopted items. Considering that even mild trauma after a car accident triggers temporomandibular arthrosis, the author proposes that preoperative examinations should include checking for a history of traumatic cervical syndrome within one year. Furthermore, the anesthetist should keep in mind the possibility of difficulty with intubation and be prepared to take appropriate measures immediately.

Effects of mastication on glucose metabolism in rats, with emphasis on differences in properties of food consumed whilst breeding.

OBJECTIVE: In this study, to elucidate the effects of preferred properties of food that affect the daily masticatory habits on the onset of lifestyle-related disease, we investigated whether groups of rats continuously fed with diet having distinct properties show differences in glucose metabolism. DESIGN: Thirty-six male Wistar rats aged 4 weeks were divided into two groups; only the pellet type feed was given to one (solid diet group), and the powdered feed to the other (powder diet group). The oral glucose tolerance test (OGTT) was performed to measure glucose metabolism. For the determination of statistical significance (p<0.05), blood glucose level and areas under the blood glucose response curve (AUC) were analysed using the Mann-Whitney U-test. RESULTS: The AUC values were significantly different between the two diet groups when the animals were 45 and 51 weeks of age. The median blood glucose level in 45-week-old rats fed with the powder diet was significantly higher than those in age-matched rats fed with solid diet 45 and 120 min after glucose load. Similarly, the median blood glucose level in the 51-week-old rats in the powder diet group was significantly higher than those in the solid diet group at 30, 45, 60, and 120 min after glucose load. CONCLUSIONS: We showed that the rats which had been fed with solid diet and therefore had been masticating the feed plentifully enhanced glucose metabolism. This can suggest the possible use of masticatory and dietary intervention, which promotes sufficient mastication of hard food, in the prevention and cure of human lifestyle-related diseases.

[Efficacy of continuous epidural saline infusion in cerebrospinal fluid hypovolemia: report of 5 cases].

We identified the sites of leakage by cisternography in 5 patients with cerebrospinal fluid hypovolemia and treated them by continuous epidural infusion with physiological saline solution. The results showed improvement in symptoms in all 5 patients, and lasting favorable results were obtained in 3 of them. Epidural saline infusion is achieved by inserting an epidural catheter that anesthesiologists routinely use, and the procedure and management are both simple. Adverse effects are the same as for ordinary epidural punctures. If the site of the cerebrospinal fluid leak has been specified and the treatment method is understood by the patient, we think that continuous epidural infusion with physiological saline is safe and effective method of treating cerebrospinal fluid hypovolemia.

[Efficacy of remifentanil in anesthetic management for living-donor renal transplantation].

BACKGROUND: We used fentanyl and remifentanil in living-donor renal transplantation patients. So, we have compared both drugs in renal function. METHODS: We used the volatile anesthetic sevoflurane as the base in 30 living-donor renal transplantation patients, dividing them into a remifentanil anesthesia group of 15 patients and a fentanyl anesthesia group of 15 patients, and compared their creatinine, BUN, and serum K values before surgery, and 1 day as well as 3 days after surgery. RESULTS: The results showed improvement in their values, and there were no significant differences between the two groups. CONCLUSIONS: Since more patients in the remifentanil group had adequate diuresis beginning immediately postoperatively without taking a diuretic, remifentanil appears to be a more suitable drug to use for anesthesia for living-donor renal transplantation.

[Drug eruption during living-donor renal transplantation in which it was difficult to identify the causative drug: a case report].

A 59-year-old man with renal failure given oral medication for the symptoms associated with it had no drug allergies before surgery. The patient received 8 units of FFP for a surgery of gastric tumor. The stomach tumor was benign, and living-donor renal transplantation was performed. After the living-donor transplantation, extensive reddening and swelling were observed over the patient's entire body. Anaphylaxis due to drug allergy was considered, and the patient's course was monitored. The flare and swelling tended to regress, and after about 3 hours they were resolved. The following day the drugs used intraoperatively were tested, but it was difficult to identify any allergy-inducing drugs. Ultimately, the FFP was suspected as the cause, and the patient appeared to have been saved by the methylprednisolone used as an immunosuppressive agent.

[Prospective study on anesthesia for lumbar spine surgery--the effectiveness of the perioperative epidural anesthesia with buprenorphine].

We prospectively evaluated the efficacy of perioperative epidural buprenorphine for lumbar spinal surgery under general anesthesia. Twenty-eight patients were allocated into two groups; in one group (buprenorphine group), patients underwent the surgery under general anesthesia with perioperative epidural buprenorphine 0.2 mg, in the other group (control group), patients underwent the surgery under general anesthesia only. The epidural injection was within 2 levels of the cephalad segment of the operating site. In both groups, fentanyl and flurbiprofen were intravenously injected intermittently in the same manner. In buprenorphine group, requirement of analgesics was less during and after surgery compared with the control group. Neurological evaluation immediately after surgery revealed no neurological side effects in both groups. We conclude that general anesthesia with perioperative epidural buprenorphine for lumbar spinal surgery is safe and useful.

[Anesthetic management of a patient with mitochondrial encephalomyopathy for renal transplantation].

A 52-year-old man with mitochondorial encephalomyopathy was scheduled for renal transplantation from a living donor. He had some characteristic features including muscle weakness, deafness, cerebellar ataxia, diabetes meritus and renal failure. Anesthesia was induced with bolus infusion of propofol 1 mg x kg(-1) and continuous infusion of remifentanil at 0.15 microg x kg(-1) x min(-1) was started. After supporting ventilation for three minutes, the trachea was intubated without any muscle relaxant. Anesthesia was maintained with sevoflurane (0.4-1.0%), air and oxygen (33-50%) and with continuous infusion of 0.1-0.15 microg x kg(-1) x min(-1) of remifentanil without any muscle relaxant. The circulatory status was maintained with 1-5 microg x kg(-1) x min(-1) of dopamine depending on changes of CVP and BP. At the conclusion of the operation, respiratory depression lasted for about 25 minutes. After administration of naloxone 40 microg to antagonize the action of remifentanil, the patient recovered fully from the respiratory depression. The urine output was depressed initially after implantation of donor's kidney, but gradually increased to a usual recovery pattern. This case suggests that careful administration of remifentanil is mandatory in a patient with mitochondorial encephalomyopathy which enhances respiratory depression from opioids.

Type 2 diabetes impairs implant osseointegration capacity in rats.

PURPOSE: The effect of type 2 diabetes mellitus (adult-onset non-insulin-dependent), which is the most common form of diabetes in humans, on osseointegration capacity has not been addressed in an appropriate animal model. This study histologically and histomorphometrically examines bone healing around titanium implants in the type 2 diabetes rat model. MATERIALS AND METHODS: Titanium implants with a chamber were placed into the femurs of normal male rats and genetically modified male rats with a close symptomatic resemblance to human type 2 diabetes, as characterized by late-onset hyperglycemia and obesity. Cross-sectional histology for the tissue grown into the implant chamber was examined. RESULTS: Bone volume around implants was consistently (from weeks 4 to 8 postimplantation) smaller for the diabetes group than for the control group in the cortical area, while the bone volume in the marrow area was not affected by the diabetes. Bone-implant contact percentage was considerably lower for the diabetes group in both the cortical and marrow areas, with the week 4 bone-implant contact in the cortical area being 12% for the diabetes group and 61% for the control group. A 2-fold difference remained at week 8. Bone morphogenesis in the diabetic rats was characterized by fragmented bone tissues and extensive soft tissue intervention. CONCLUSIONS: Type 2 diabetes mellitus impaired osseointegration capacity disproportionally between the cortical bone and bone marrow areas. The reduction of the bone quantity in the cortical area and the bone-implant contact in both the cortical and marrow areas was remarkable.

[Propofol does not induce retrograde amnesia at the hypnotic dose].

BACKGROUND: We evaluated retrograde amnesic effects of propofol at the hypnotic dose on 28 healthy medical personnel volunteers (17 men, 11 women). METHODS: Explicit memory function was measured after the emergence from bolus infusion of propofol 2 mg x kg(-1); how one could answer the correct number and symbol of 5 playing cards which he had picked up randomly and intentionally memorized before induction? As control, one also took the same test during working hour without any drugs. RESULTS: After infusion of propofol, the rate of correct answers was 96.4 +/- 9.1% and in control, it was 92.1 +/- 18.3% (P = 0.297142). There was no significant difference among two situations. CONCLUSIONS: These results suggest that propofol dose not induce retrograde amnesia at hypnotic dose.

Evaluation of the light intensity of high intensity light units.

PURPOSE: To determine the intensity of PAC (plasma arc curing) light compared with conventional QTH (Quartz tungsten halogen) light using a hardness test. METHODS: The spectral distribution of two light sources was analyzed with a spectroradiometer, after the light intensity was determined. AP-X composite was packed into a black mold (4 mm in diameter and 4 mm in depth) to prepare a cylindrical specimen. The irradiating conditions for the PAC unit in the current study were fixed at 6-second irradiation with 600 mW/cm2 (P600-6), 900 mW/cm2 (P900-6), 1200 mW/cm2 (P1200-6), 1500 mW/cm2 (P1500-6), 1800 mW/cm2 (P1800-6) and 40-second irradiation with 600 mW/cm2 (P600-40). The conventional irradiating condition for QTH was 600 mW/cm2 for 40 seconds (Q600-40). After storage in 37 degrees C water for 24 hours, the hardness of the resin composite was measured with a nanoindentation testing machine. Triplicate readings were made at a distance of every 0.5 mm down to 3.0 mm from the top irradiated surface. The comparison of means was statistically analyzed applying one-way ANOVA and Fisher's PLSD test at a significant level of P< 0.05. RESULTS: Although the peak height of the PAC lamp was different due to the light intensity, the waveforms were parallel with one another and the wavelength of peaks was located at the same number. The hardness value at a depth of 2.0 mm and at values of P1800-6 was not significantly different from the control.

[Prolonged respiratory depression after fentanyl administration in a patient with mitochondrial encephalomyopathy].

A 21-year-old man with mitochondrial encephalomyopathy underwent surgery for removal of a maxillary cyst. During the induction of anesthesia, the patient fell into the state of apnea after intravenous administration of fentanyl 100 microgram. Trachea was successfully intubated followed by propofol 50 mg without any muscle relaxants. Anesthesia was maintained uneventfully under sevoflurane (1-2%), nitrous oxide (30%), and oxygen (70%). The respiratory depression lasted for about 120 minutes after administration of fentanyl, and was antagonized by naloxone 40 microgram. This case suggests that careful administration of fentanyl is mandatory in a patient with mitochondrial encephalomyopathy.

Identification and characterization of two phage-type RNA polymerase cDNAs in the moss Physcomitrella patens: implication of recent evolution of nuclear-encoded RNA polymerase of plastids in plants.

We isolated two cDNAs for the genes PpRPOT1 and PpRPOT2 that encode phage-type RNA polymerases (RPOTs) from Physcomitrella patens. Transcriptional activity of the encoded proteins was demonstrated by an in vitro transcription assay. Transiently expressed RPOT green fluorescent protein fusion proteins were both targeted to mitochondria. These results suggest that both PpRPOT1 and PpRPOT2 proteins function as mitochondrial RNA polymerases. Detailed phylogenetic analysis using neighbor-joining and maximum-likelihood methods with both DNA and protein sequences indicated that the two genes of P. patens form a sister group to all flowering plant genes. This suggests that the gene duplication leading to the production of plastid-type isozymes occurred after the separation of vascular plant lineage from bryophyte lineage. We therefore suggest that the generation of nuclear-encoded RNA polymerase of chloroplast is a rather recent event during the evolution of land plants.