Ifenprodil, NMDA receptor antagonist, was very effective in the treatment of 3 patients with severe trigeminal neuralgia. Patient 1：A 70-year-old female had been treated for macroglobulinemia in our hospital. She had been suffered from severe trigeminal neuralgia for more than ten years. Carbamazepine given in another hospital was ineffective. We gave ifenprodil to her and it reduced her pain within 4 weeks. However, her pain relapsed after 1.5 years, so we gave pregabalin instead of ifenprodil to her. Patient 2：A 89-year-old male had been treated for myelodysplastic syndrome in our hospital. He also had been treated for trigeminal neuralgia in another hospital. Carbamazepine was ineffective and nerve block relieved his pain temporarily. We gave ifenprodil to him and it reduced his pain within 2 months. Patient 3：A 62-year-old female was referred to our hospital for the treatment of trigeminal neuralgia. She had been suffered from severe pain for about 10 years. She had taken carbamazepine with no effect. We gave ifenprodil to her and it reduced her pain within 4 weeks. Ketamin, non-selective NMDA receptor antagonist, is known to be effective in neuropathic pain, but it has various side effects. Ifenprodil, specific NMDA receptor subunit NR2B antagonist, may show better separation between efficacy and side effects.

Purpose : To investigate the cooling effect on muscles prior to continuous isometric muscle contraction. Furthermore, tissue compliance, pressure pain threshold, deep tissue temperature, and tissue circulation volume were measured to investigate the cooling effect on a physical reaction. Method : The biceps brachii muscle was contracted isometrically and continuously at the 90(-) degree in flexion position with 40% of maximum contraction. The task was ceased when subjects could not keep over 70 degrees of elbow flexion. An injection type cooling stimulator was used on the biceps brachii muscle as a cooling modality. Results : The continuous contraction time in the cooled group increased significantly compared with the control group. In addition, tissue compliance and pressure pain threshold showed significant differences between the two groups. Conclusion : This study suggested that the isometric continuous contraction time in cooled muscles can be extended to 40% of MVC. The inhibition of muscle metabolism, an increase in the pressure pain threshold, and tissue compliance may affect muscle endurance.

A 42-year-old female suffered annulo-aortic ectasia (AAE) and mitral regurgitation associated with Marfan's syndrome was successfully treated by a modified Bentall procedure combined with mitral valve replacement (MVR) under continuous warm blood cardioplegia (CWBC). With the patient under total cardiopulmonary bypass and myocardial protection with CWBC, MVR with 27 mm mechanical valve was first done, followed by the total replacement of the aortic root with a composite graft made of vascular graft and an aortic mechanical valve. Anastomosis of the composite graft to the aortic valve annulus was made to guarantee a watertight closure using numerous interrupted mattress sutures and three pieces of Teflon felt strips to the annulus. Both coronary arteries were reconstructed by means of the “Interposition Graft Method” which interposes two short grafts between the composite graft and both coronary ostia. In spite of long time aortic cross clamp (235 min), cardiac function was recovered excellenthy and a peak CK-MB value was very low (23 IU/L) in the early postoperative period. Thus, CWBC provided a satisfactory myocardial protective effect. It was suggested that the modified Bentall procedure combined with MVR using CWBC was an effective therapy for a patient with AAE and mitral regurgitation associated with Marfan's syndrome.

We report three cases of panic disorder treated with kampo formulae including shohangekabukuryoto. Case One was a 47-year-old driver. Sharp rises in blood pressure caused transient ischemic attacks in the brain. We suspected that anxiety over recurrent brain attacks stagnated his water and qi below the heart and caused phlegm heat, which lead to his panic disorder. His symptoms were cured with shohangekabukuryoto and the substance of orento. Case Two was a 49-year-old homemaker. Her domestic anxiety developed into a panic disorder. We suspected that her anxiety diminished the blood and the function of her liver, as well as her splenic sufficiency. Her attacks were cured with kamishoyosan, and with bukuryoingohangekobokuto which contains shohangekabukuryoto. Case Three was a 32-year-old homemaker. Overwork through her child-raising tasks developed into a panic disorder. We suspected that fatigue caused her splenic insufficiency and resulted in blood deficiency with the extra water below the heart. Shohangekabukuryoto and juzentaihoto were very effective, and resolved her attacks.These cases suggest that shohangekabukuryoto improved epigastric discomfort, dizziness and palpitation by justifying middle-jiao dysfunction, qi and water regurgitation. In each of the three cases, shohangekabukuryoto showed efficacy for panic disorder with other kampo formulae for respective signs and symptoms.
Panic Disorder ; Three ; Water ; Anxiety ; Cases

An 11-year-old boy, who underwent a Rastelli operation using a 14mm artificial graft and left pulmonary artery (PA) plasty with an autologous pericardium patch 7 years previously, had severe recurrent left pulmonary stenosis. Reoperation was performed including right ventricular outflow tract reconstruction and left PA plasty. The PA at the most stenotic site was only 2mm in diameter; it was enlarged to 10mm by good exposure and an incision on the pulmonary intima. A bovine pericardium patch with a handmade ePTFE valve was sutured onto the autologous tissue not onto the pulmonary intima to avoid restenosis and in expectation of the growth of the pulmonary orifice. On postoperative 3-D CT, the left pulmonary artery was patent and 9mm in diameter. Pulmonary scintigraphy showed an improvement in the left pulmonary perfusion. This sutureless technique was useful in this case of severe pulmonary stenosis.

Purpose : This study aims to measure the peak cough flow (PCF) in patients with subacute myelo-optic neuropathy (SMON) and study its relation with muscle strength, functional ability and vocal cord function. Methods : We performed a cross-sectional study in 7 patients with SMON (2 men and 5 women, mean age (SD) 81.6 (7.2) years) and in 7 age- and gender-matched patients with orthopedic problems as a control group. Their PCF, ability to walk, the Barthel Index, grip strength and maximum phonation time were assessed. Results : Mean PCF was 218.6± 66.2 L/min (110-300) for the SMON group and 267.1±76.3 L/min (170-360) for the control group (ns). The PCF was correlated with the maximum phonation time (r = 0.91 ; p<0.01), but not with grip strength, the Barthel Index or the ability to walk scale. Conclusion : The PCF in patients with SMON tended to be lower compared to the control group. Therefore, evaluating PCF is suggested to be necessary to assess the risk of pneumonia.

Objective: In The Hospital of Hyogo College of Medicine, a oral rinse containing polaprezinc (PZ), a zinc-containing drug for gastric ulcers, was used as a hospital preparation to treat radiotherapy-related oral mucositis, and its efficacy was reported.  However, the dispersibility of PZ for carboxymethylcellulose sodium (CMC), which was used as the base of the oral rinse, was unfavorable, raising an issue.  In this study, we newly prepared a PZ oral rinse containing carboxyvinyl polymer (CP) as a base, and examined its usefulness.
Methods: A questionnaire survey regarding the usefulness involving 10 healthy volunteers and a pharmaceutical test were conducted.
Results: The results of the questionnaire survey showed that the optimal concentration of CP was 0.5%.  There were no serial changes in the pH, adhesiveness, or PZ content for 7 days after preparation.  Furthermore, there were no differences between CMC and CP.  The dispersibility of PZ in the oral rinse containing CP as a base was more favorable than that in the oral rinse containing CMC.
Conclusion: The results of this study suggest that the PZ oral rinse containing 0.5% CP as a base is useful, and that its stability is similar to that of the oral rinse containing CMC as a base.

Objective: Oral mucositis is one of the serious and frequent acute side effects due to chemoradiotherapy (CRT) for head and neck cancer.  In this study, we prepared an oral rinse as a hospital preparation for the treatment of oral mucositis, which was a suspension of polaprezinc (PZ), a zinc-containing therapeutic agent for gastric ulcer, in carboxyvinyl polymer (CP), a water-soluble large molecule.
Methods: We carried out stability tests of the PZ-CP oral rinse, and investigated its effects on the radiation-induced oral mucositis in patients who received CRT for head and neck cancer.
Results: In the stability test, the pH, viscosity, adhesion and PZ content in the preparations did not change throughout 28 days after preparation.  In the clinical evaluation on the basis of the distribution of the Grade of oral mucositis, the Grade of oral mucositis in the PZ group was significantly lower than in the control group at 6 and 7 weeks (p=0.016, p=0.018).  The incidence of severe oral mucositis of Grade 3 was 15.0% (3 cases) in the PZ group and 41.7% (10 cases) in the control group at 6 weeks, and was 15.0% (3 cases) in the PZ group and 33.3% (8 cases) in the control group at 7 weeks.
Conclusion: These results suggest that PZ-CP oral rinse inhibits the aggravation of oral mucositis induced by CRT or promotes its healing.

No abstract available.