We report a case of right cervical (C2-C4 area) acute herpetic pain successfully treated by therapeutic selective nerve blocks. A47-year-old man complained of right cervical persistent pain and frequent intermittent pain associated with herpes zoster. This pain was resistant to standard therapies such as satellite ganglion block and epidural block. On the 10th day after onset, the patient was treated by X-ray-guided therapeutic C3 and C4 selective nerve root blocks, resulting in an almost immediate relief of pain. The patient remained pain-free, and postherpetic neuralgia (PHN) was prevented. Although there are various treatments for PHN, none produces definitive effects. Relief of acute herpetic pain and prevention of PHN are important in the treatment of herpes zoster.
Pain ; Postherpetic neuralgia ; Nerve ; Herpes Zoster ; Plant Roots

We have studied post tetanic count (PTC) and single twitch height at the onset of reflex movement to carinal stimulation after administration of vecronium to 10 female patients under total intravenous anesthesia. During spontaneous recovery from vecronium-induced neuromuscular block, the carina was stimulated at every 120s. It took 18.7±5.5 minutes before reflex movement started, T1% was 1.9±2.2%, and PTC was 11.59±5.3 counts. In 5 cases, T1% did not appear at the onset of reflex movement.

We experienced 6 cases of intractable perioperative myocardial ischemia with coronary spasm that was successfully treated with fasudil, a Rho-kinase inhibitor. Three of the patients (aged 49-81 years) showed ST elevation on electrocardiograms and abrupt circulatory collapse after off-pump coronary artery bypass grafting. Emergeny coronary angiogram revealed severe spasm of their own coronary arteries and/or bypass grafts. Since intracoronary and/or intragraft injection of isosorbide dinitrate (ISDN) was ineffective, we administered fasudil into the spastic vessels, and that completely resolved the spasm. The other 3 patients (aged 55-77 years) suffered myocardial ischemia during the operation, though intravenous vasodilators including ISDN, diltiazem and nicorandil had been administered continuously. Their ischemia occurred when the aorta was declamped, the pericardium opened, or the bypass graft was anastomosed, respectively. We decided to use fasudil in these cases since ISDN was ineffective, or severe spasm was found on intraoperative inspection. Administration of fasudil successfully relieved the ischemia, and subsequently all 3 patients could be weaned from the cardiopulmonary bypass during the operation. Fasudil completely resolved the myocardial ischemia in all 6 patients. In conclusion, fasudil, a Rho-kinase inhibitor, is a useful agent for perioperative myocardial ischemia including coronary spasm that is resistant to intensive conventional vasodilator therapy. We should administer fasudil and relieve spasms as early as possible to rescue patients with intractable ischemia.

STUDY DESIGN: Experimental human study. PURPOSE: To determine whether angiopoietin-like protein 2 (ANGPTL2) is highly expressed in the hyperplastic facet joint (FJ) synovium and whether it activates interleukin-6 (IL-6) secretion in FJ synoviocytes. OVERVIEW OF LITERATURE: Mechanical stress-induced synovitis is partially, but significantly, responsible for degenerative and subsequently osteoarthritic changes in the FJ tissues in patients with lumbar spinal stenosis (LSS). However, the underlying molecular mechanism remains unclear. IL-6 is highly expressed in degenerative FJ synovial tissue and is responsible for local chronic inflammation. ANGPTL2, an inflammatory and mechanically induced mediator, promotes the expression of IL-6 in many cells. METHODS: FJ tissues were harvested from five patients who had undergone lumbar surgery. Immunohistochemistry for ANGPTL2, IL-6, and cell markers was performed in the FJ tissue samples. After cultured synoviocytes from the FJ tissues were subjected to mechanical stress, ANGPTL2 expression and secretion were measured quantitatively using real-time quantitative reverse-transcription–polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA), respectively. Following ANGPTL2 administration in the FJ synoviocytes, anti-nuclear factor-κB (NF-κB) activation was investigated using immunocytochemistry, and IL-6 expression and secretion were assayed quantitatively with or without NF-κB inhibitor. Moreover, we assessed whether ANGPTL2-induced IL-6 modulates leucocyte recruitment in the degenerative process by focusing on the monocyte chemoattractant protein-1 (MCP-1) expression. RESULTS: ANGPTL2 and IL-6 were highly expressed in the hyperplastic FJ synovium samples. ANGPTL2 was co-expressed in both, fibroblast-like and macrophage-like synoviocytes. Further, the expression and secretion of ANGPTL2 in the FJ synoviocytes increased in response to stimulation by mechanical stretching. ANGPTL2 protein promoted the nuclear translocation of NF-κB and induced IL-6 expression and secretion in the FJ synoviocytes. This effect was reversed following treatment with NF-κB inhibitor. Furthermore, ANGPTL2-induced IL-6 upregulated the MCP-1 expression in the FJ synoviocytes. CONCLUSIONS: Mechanical stress-induced ANGPTL2 promotes chronic inflammation in the FJ synovium by activating IL-6 secretion, leading to FJ degeneration and subsequent LSS.
Chemokine CCL2 ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunohistochemistry ; Inflammation ; Interleukin-6 ; Spinal Stenosis ; Stress, Mechanical ; Synovial Membrane ; Synovitis ; Zygapophyseal Joint