Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
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Partial peripheral nerve injury produces a persistent neuropathic pain which is difficult to relieve. In order to determine whether different degrees of peripheral nerve injury are related with the severity of neuropathic pain, we examined pain-related behaviors, histological changes and NGF in the skin in rats treated with different types of spinal nerve injury: tight ligation of the left L5 spinal nerve, incomplete ligation of the left L4 and L5 spinal nerves and incomplete crush of the left L4 and L5 spinal nerves. In all model rats, the thresholds of paw withdrawal in response to mechanical and heat stimuli began to decrease on the injured side 1 day after the operation, and the decreases in the thresholds persisted for more than 1 month. ⋯ Nerve growth factor (NGF) in the skin of the hindpaw on the injured side was accumulated after incomplete ligation and incomplete crush of the left L4 and L5 spinal nerves, but not tight ligation of the left L5 spinal nerve, on day 15 after the operation, possibly due to impairment of transport via unmyelinated primary afferents. Regeneration of the sciatic nerve alleviated the accumulation of NGF in the injured side hindpaw skin on day 32. The present results suggested that the severity of neuropathic pain was related with the degrees of both degeneration and/or regeneration of myelinated fibers and of functional damage of unmyelinated fibers.
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To analyze our hospital laboratory microbiological data by using WHONET 5-Microbiology laboratory database software-, and to acquire information about antimicrobial resistance of Staphylococcus aureus strains among every ward. ⋯ Variation of resistant degree among wards were very obvious and large. We could survey the wards where patient-to-patient transmission of resistant organisms might occur along the moving lines of inpatients. WHONET 5 will be recognized as an analysis and surveillance tool for every infection control team to survey the suspicious wards.
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In 2002, the Centers for Disease Control and Prevention (CDC) published guidelines for surgical handwashing and hand antisepsis on the Internet. According to these guidelines, we revised our surgical handwashing method from scrubbing with brushes to rubbing with antiseptic. The new method consists of scrubbing around the nails with brushes and rubbing the hands and arms with antiseptic from the elbow to the antebrachium. ⋯ For long surgical procedures, CHG should be used as an antiseptic and gloves should be changed every 3 hours, alcohol-based hand rubbing should also be performed 3 hours after the initial handwashing. This new technique will be included in the OSCE curriculum to ensure its standardization. Moreover, in-depth education regarding central operating-room practices is desired.
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Comparative Study Clinical Trial Controlled Clinical Trial
Effect of low-dose ketamine on redistribution hypothermia during spinal anesthesia sedated by propofol.
Mild hypothermia is a common complication during spinal anesthesia and may induce a serious adverse outcome. We investigated the effect of low-dose ketamine infusion on the core temperature during spinal anesthesia sedated by propofol infusion. Twenty patients who were scheduled to undergo spinal anesthesia were assigned to one of two groups: after intrathecal injection of bupivacaine, patients who received infusion of ketamine (0.3 mg/kg/hr) and propofol (initial rate of 10 mg/kg/hr) (KP group), and patients who received infusion of placebo (saline) and propofol (initial rate of 10 mg/kg/hr) (P group). ⋯ The delta CT at 15, 30, 45, and 60 minutes was significantly smaller in the KP group than in the P group. There were no significant differences in the forearm-fingertip temperature gradient between the two groups over the study period. In conclusion, low-dose ketamine administration may confer thermoprotection during spinal anesthesia sedated by propofol.
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Randomized Controlled Trial Clinical Trial
Oral clonidine premedication exacerbates hypotension following tourniquet deflation by inhibiting noradrenaline release.
Clonidine premedication prevents tourniquet pain and reduces sympathetic nerve activity. We evaluated hemodynamic changes and catecholamine release following tourniquet deflation during spinal anesthesia in patients who received oral clonidine premedication. The final analysis included 24 otherwise healthy patients undergoing lower-limb surgery randomly assigned to two groups: those receiving approximately 5 micrograms/kg of oral clonidine 1 hr before anesthesia (clonidine group, n = 12), and those receiving no premedication (control group, n = 12). ⋯ After receiving clonidine premedication, the plasma noradrenaline concentrations in the clonidine group were significantly lower than those in the control group. Noradrenaline concentration increased in the control group from 162.3 +/- 89.2 pg/mL before tourniquet deflation to 199.3 +/- 95.7 pg/mL afterward (P < 0.01), but there was no significant change in noradrenaline concentration after tourniquet deflation in the clonidine group. We conclude that oral clonidine premedication exacerbated the reduction in mean blood pressure following tourniquet deflation by inhibiting noradrenaline release.