Three essential factors of the sympathetic nervous functions, sympathetic nervous tone (β-, α-secretion), adrenoceptor sensitivity (β-, α-sensitivity) and adrenergic manifestations, were assessed integratedly by the sequential administration of specific adrenoceptor agonists and blockers. The examination procedures were designed to provide all parameters under the blockade of the autonomic regulation without affecting the basic sympathetic nervous functions.
Decrease in β- and α-secretion associated with the increase in β- and α-sensitivity in patients with diabetic neuropathy, idiopathic orthostatic hypotension and cervical radiation myelopathy were exactly compatible with the autonomic dysfunctions of them and convinced the validity of the methods. Synchronized firings of the sympathetic nerves of the cardiovascular system and harmonized regulation of the adrenoceptor sensitivity were shown by the positive correlations between β- and α-secretion and between β- and α-sensitivity, respectively. Negative correlations between “secretion” and “sensitivity” over wide ranges of these parameters suggested that the concept of denervation hypersensitivity was not specific for patients with organic autonomic neuropathies but was commonly avairable for usual subjects in proportion to the sympathetic nervous tone of the individual subject.

BACKGROUND: Epidural anesthesia is widely used to provide pain relief, whether for surgical anesthesia, postoperative analgesia, treatment of chronic pain, or to facilitate painless childbirth. In many cases, however, the epidural catheter is inserted blindly and the indwelling catheter position is almost always uncertain. METHODS: In this study, the loss-of-resistance technique was used and an imaging agent was injected through the indwelling epidural anesthesia catheter to confirm the position of its tip and examine the migration rate. Study subjects were patients scheduled to undergo surgery using general anesthesia combined with epidural anesthesia. Placement of the epidural catheter was confirmed postoperatively by injection of an imaging agent and X-ray imaging. RESULTS: The indwelling epidural catheter was placed between upper thoracic vertebrae (n = 83; incorrect placement, n = 5), lower thoracic vertebrae (n = 123; incorrect placement, n = 5), and lower thoracic vertebra-lumbar vertebra (n = 46; incorrect placement, n = 7). In this study, a relatively high frequency of incorrectly placed epidural catheters using the loss-of-resistance technique was observed, and it was found that incorrect catheter placement resulted in inadequate analgesia during surgery. CONCLUSIONS: Although the loss-of-resistance technique is easy and convenient as a method for epidural catheter placement, it frequently results in inadequate placement of epidural catheters. Care should be taken when performing this procedure.
Analgesia ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Catheters ; Catheters, Indwelling ; Chronic Pain ; Humans ; Parturition ; Spine ; Thoracic Vertebrae ; Triiodobenzoic Acids

BACKGROUND/AIMS: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrom-botic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. METHODS: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. RESULTS: Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. CONCLUSIONS: The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
Abscess ; Asian Continental Ancestry Group ; Endoscopic Ultrasound-Guided Fine Needle Aspiration* ; Endoscopy, Gastrointestinal ; Erythrocyte Transfusion ; Fibrinolytic Agents* ; Hemorrhage* ; Hemothorax ; Humans ; Incidence ; Japan ; Male ; Melena ; Prospective Studies*