We report a rare case of trigeminovagal reflex (TVR) resulting from stimulation of the mandibular division of the trigeminal nerve under general anesthesia. Although general anesthesia reportedly prevents TVR, it should be part of the differential diagnosis in all cases of unexplained sinus arrest during oral and maxillofacial surgery.

Introduction: Tramadol (TRM) has been included as a weak opioid at the second step of the WHO analgesic ladder and has been widely used in palliative medicine. Here we report a case of amelioration of cancer pain by TRM therapy in a female patient with myasthenia gravis (MG). Case:The patient was a 70’s woman who was diagnosed with advanced endometrial carcinoma and suffered from chest pain caused by chest metastasis. 25 mg of a TRM capsule was orally administered three times a day. The dose was increased to 50 mg twice a day. It was resulted in sound pain relief with transient muscle weakness but without a myasthenic crisis.

BACKGROUND/AIMS: Oral mesalazine is an important treatment for ulcerative colitis (UC), and non-adherence to mesalazine increases the risk of relapse. Controlled-release (CR) mesalazine has 2 formulations: tablets and granules. The relative acceptabilities of these formulations may influence patient adherence; however, they have not been compared to date. This study aimed to evaluate the acceptabilities of the 2 formulations of CR mesalazine in relation to patient adherence using a crossover questionnaire survey. METHODS: UC patients were randomly assigned to 2 groups in a 1:1 ratio. Patients in each group took either 4 g of CR mesalazine tablets or granules for 6 to 9 weeks, and then switched to 4 g of the other formulation for a further 6 to 9 weeks. The acceptability and efficacy were evaluated by questionnaires, and adherence was assessed using a visual analog scale. The difference in acceptabilities between the 2 formulations and its impact on adherence were assessed. RESULTS: A total of 49 patients were prospectively enrolled and 33 patients were included in the analysis. Significantly more patients found the tablets to be less acceptable than the granules (76% vs. 33%, P=0.0005). The granules were preferable to the tablets when the 2 formulations were compared directly (73% vs. 21%, P=0.004), for their portability, size, and numbers of pills. The adherence rate was slightly better among patients taking the granules (94% vs. 91%) during the observation period, but the difference was not significant (P=0.139). CONCLUSIONS: CR mesalazine granules are more acceptable than tablets, and may therefore be a better option for long-term medication.
Colitis, Ulcerative ; Drug Compounding ; Humans ; Medication Adherence ; Mesalamine ; Patient Acceptance of Health Care ; Patient Compliance ; Prospective Studies ; Recurrence ; Tablets ; Ulcer ; Visual Analog Scale

BACKGROUND/AIMS: Mesalazine is an effective drug for treating ulcerative colitis (UC), but causes allergic symptoms in a few cases. Therefore, the objective of this study was to evaluate the usefulness of the drug-induced lymphocyte stimulation test (DLST) for the diagnosis of mesalazine allergy. METHODS: Patients with UC treated with mesalazine with or without a history of associated adverse events (AEs) were enrolled at Kyorin University Hospital from July 2016 to April 2017. RESULTS: The DLST was performed in 104 patients with UC, of which 24 had a history of AEs due to mesalazine treatment. The control value of DLST was 337.4±296.3 counts per minute (cpm) in the AE+ group and 408.0±371.9 cpm in the AE− group. The measured value of DLST was 578.8±424.7 cpm in the AE+ group and 476.5±471.8 cpm in the AE− group. The stimulation index (SI) was 243.9%±291.1% in the AE+ group and 119.8%±53.0% in the AE− group. The SI value and DLST positivity were significantly higher in the AE+ group than in the AE− group (P=0.030 and P=0.029, respectively). The test sensitivity and specificity were 0.240 and 0.805, respectively, and the false-positive and false-negative rate was 0.195 and 0.760, respectively. CONCLUSIONS: The DLST for mesalazine showed low sensitivity and high specificity, suggesting that it may be useful for the definitive diagnosis of allergy to mesalazine.
Colitis, Ulcerative ; Diagnosis ; Humans ; Hypersensitivity* ; Lymphocyte Activation* ; Lymphocytes* ; Mesalamine* ; Sensitivity and Specificity

A questionnaire-based survey of board-certified rehabilitation physicians was conducted to identify issues in multidisciplinary interprofessional collaboration and to assess the abilities of board-certified rehabilitation physicians needed to develop assistive devices for individuals requiring long-term care. From the 366 responses, it was revealed that they consider “the ability to gain an insight into what patients need from assistive devices” and the “ability to communicate” as essential abilities needed to develop assistive devices. The respondents considered the ability to communicate and convey information important to overcome differences in thought-process between disciplines；the sharing of information, objectives, and knowledge as a requirement for teamwork；and collaboration, including with the patients, to be important. This approach to device development fits well with “design thinking” and “biodesign.” Unfortunately, more than 70％ of the respondents were unfamiliar with these concepts. Therefore, it is necessary to provide opportunities for rehabilitation physicians to learn innovative biodesign approaches.

A questionnaire-based survey of board-certified rehabilitation physicians was conducted to identify issues in multidisciplinary interprofessional collaboration and to assess the abilities of board-certified rehabilitation physicians needed to develop assistive devices for individuals requiring long-term care. From the 366 responses, it was revealed that they consider “the ability to gain an insight into what patients need from assistive devices” and the “ability to communicate” as essential abilities needed to develop assistive devices. The respondents considered the ability to communicate and convey information important to overcome differences in thought-process between disciplines；the sharing of information, objectives, and knowledge as a requirement for teamwork；and collaboration, including with the patients, to be important. This approach to device development fits well with “design thinking” and “biodesign.” Unfortunately, more than 70％ of the respondents were unfamiliar with these concepts. Therefore, it is necessary to provide opportunities for rehabilitation physicians to learn innovative biodesign approaches.