A 34 years old man was suffering from facial pains for last 15 years. He had been taking carbamazepine 2-3 tablets a day since 2 years ago. His father had also complained facial pains which was dianosed trigeminal neuralgia. It was successfully treated by the nerve blockings. Therefore, the patient was introduced to our pain clinic.
Precise examination including CT scan revealed a low density area. It was diagnosed as chronic arachnoid cyst or epidermoid tumor of pre-pontine region. No vascularity was observed.
On September 21, 1986, craniotomy was performed by the left trans-petrosal, transtentorial approach. However, the tumor, i.e., epidermoid tumor enlarged and passed through to the other side under chiasma. The tumor was not removed completely in one stage and liquorrhoea ensued. Five weeks later, secondary operation was done. Postoperatively, meningitis occurred and high fever continued.
To reflect this case, the cause of pain was not considered carefully for long time. Whenever we observe a young patient who suffers trigeminal neuralgia or unexpainable facial pains, its cause should be investigated thoroughly. Recently, CT, NMR and other diagnostic measures are very useful to find etiology of this kind of pain.
In conclusion, we should not loose the chance to treat the patients radically.

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A 48 years old male of laryngeal cancer was scheduled for emergency tracheostomy. He had a difficulty in breathing due to compression of trachea by the tumor and also by the tumor intubation was impossible.
To oxygenate the patient extracorporeal circulation of V-A route was used.
But right radial artery PO₂ became extreamly low during the procedure.
The author's conclusion is that, V-V method would be preferrable in this case.

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Effects of electroacupuncture on immune system in patients with various neuralgias were examined by the enumeration of lymphocyte subsets in and activated T cell peripheral bloods and the results were compared with that of controls.
Puncture needles were inserted into the sites of the GOKOKU-TESANRI and turned on electricity at 1.4Hz. The blood samples were obtained from the individuals before and after the electroacupuncture.
OKT4, 8, 9, 10 and 11 in addition to TA-75 and KOLT-2 monoclonal antibodies were used for cell maker analysis of lymphocytes and flow cytometry system (SPECTRUM III, Ortho Diagnostic System) was used for the determination and counting of percent positive cells.
The results reveal that the value of the OKT4/8 ratio was significantly increased (p<0.05) after the electroacupuncture, while no alteration of the value in the controls was observed. The results suggest that the electroacupuncture effects on the immune system of the body, in particular to the patients with a pain such as neuralgia. The treatment reconstructs the imbalanced population of the T cell subsets for the maintenance of the homeostasis of the body with the induction of defective immune cells.

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To evaluate the effect of renal failure on neuromuscular blockade and pharmacokinetics of vecuronium bromide (0.08mg/kg bolus i.v), ten patients (All were end-stage renal failure and had undergone three times hemodialysis per week.) under halothane and nitrous oxide anesthesia were studied.
Blood levels of vecuronium were measured in five patients by high performance liquid chromatography and a two compartment open pharmacokinetic model was used to evaluate data. The neuromuscular function was measured by evoked electromyogram using ABM^® in another five patients.
Elimination half-life (15.3±1.0min) and Clearance (3.0±0.7ml/kg/min) obtained by our study were similar to thoser reported by other investigators who studied in patients with normal renal function. Onset time (2.61±0.63min), recovery time (16.6±2.4min) and duraton of action (54.1±18.7min) of neuromuscular blockade by vecuronium in patients with renal failure were not different from those in patients with normal renal function.
Though further study on cumulative effects of vecuronium is necessary, we concluded that it is safe to use vecuronium as a muscle relaxant in patients with renal failure.

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We have reported that the lowest point of the skin temperature on the palmar side of the second finger tip during cold water immersion is a good indicator of the sympathetic vasomotor function of the skin. Temperature of the skin falls not only by the physical cooling in the cold water but also by the decrease of cutaneous blood flow through the effect of sympathetic vasoconstriction induced by the cold and pain sensation on the immersion. The skin temperature, the sensations and the skin color of the immersed finger were observed in 26 normal volunteers and 36 patients after stellate ganglion block (SGB).
The skin temperature fell at first and rose up again during the immersion in normal volunteers (cold induced vasodilatation; CIVD). Cold and pain sensation occurred in the falling phase of the temperature and the skin color of the immersed part changed to reddish in the phase of CIVD. Higher bottom temperature and a flat pattern of the skin temperature curve were observed in the SGB group. The painful sensation and the change of the skin color were lesser in the SGB group than those in the normal control. The higher bottom temperature was brought about by the failure of the skin sympathetic function with SGB. The lesser painful sensation and the slight change of the skin color were considered to be the secondary phenomena induced by the high skin temperature during the immersion.

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