Blepharospasm is characterized by dystonic movement of periorbital muscles with unknown etiology, and the treatment of this condition has been disappointing. Since botulinum toxin injection was commenced in 1997, a great advancement has been seen in the management of this disease. The fact that blepharospasm is a complicated neural disorder, which often is associated with dystonia of multiple facial muscles and with psychiatric change, mere relaxation of periorbital muscles dose not always lead to successful treatment. Still, botulinum toxin is the best agent ever existed in the treatment of blepharospasm.

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We conducted a survey by questionnaire on the evaluation criteria, or category used for pain treatment efficacy in 110 hospitals. Results were as follows: Low level laser therapy (LLLT) was used at 72 hospitals (65.5%), of which 32 hospitals used LLLT alone and 40 hospitals used LLLT and near-infrared polarized ray (Super Lizer) therapy. The other 48 hospitals used Chinese acupuncture, anesthetic block, and oral drugs such as tranquilizers. The visual analogue scale (vas) was most widely used to evaluate pain attenuation-used by 73 hospitals (34.4%)-followed by the pain relief score (PRS)-used by 53 hospitals (25.0%). Degrees of effect were divided into 5 categories-excellent, good, fair, no change and worse-at 59 hospital (58.4%), and into 4 categories-excellent, good, no change and worse-at 36 hospitals (35.6%). Regardless of the number of classifications, most hospitals used “excellent”+“effective” as “effective”. We propose the effect of evaluating pain treatment based on therapeutic conditions as follows:
1. Radiation time per one point of about 10 seconds.
2. One therapy session of about 10 minutes.
3. Treatment frequency of 2 or 3 times per week.
4. Total therapy sessions of about 10, as determined by the therapist or physician.
5. Pain score with 10 categories.
6. Recording effects by PRS immediately after each treatment.
7. Recording continuous effects by VAS immediately after a complete course of treatment or a certain period after treatment is completed.
8. VAS rated as 0-2 for excellent and 3-5 as effective.

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Purpose: When two patterns of behavior, forepaw licking and jumping, were used as criteria for the hot-plate test, a disagreement between the results was reported. We hypothesized that the two behavior patterns represent different indexes for pain sensitivity, pain threshold and pain tolerance level The aim of the present study was to investigate this hypothesis. Methods: Latency until forepaw licking and jumping was measured in each mouse using the hot-plate test at times between 10:00 and 12:00h. The latency times were compared for several stimulation intensities (45-65°C). Results: Both reaction times based on forepaw licking and jumping increased as the stimulation intensity decreased (one-way ANOVA, p<0.05). The jumping response was more sensitive to changes in stimulation intensity than the forepaw licking response. The series of jumping reaction times was longer than the forepaw licking reaction times (two-way ANOVA, p<0.01). A significant correlation between the licking and jumping latencies was not observed at any stimulation intensity. Conclusion: Forepaw licking and jumping are the recommended indexes for pain threshold and pain tolerance level, respectively, during the hot- plate test.

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We experienced a case of intraoperative awareness during general anesthesia in a patient taking a large dose of morphine. A 31-year-old woman underwent general anesthesia for femoral head replacement. She was taking oral morphine sulfate (MS contin^™) 960mg daily for control of cancer pain from a huge sacral chondrosarcoma. She took her regular dose of morphine 3.5 hours before arriving at the operating room, but no sedative drugs preoperatively. Anesthesia was induced with intravenous administration of fentanyl 100μg, droperidol 2.5mg, and propofol 80mg (1.86mg/kg) followed immediately by inhalation of 60% nitrous oxide and 1.0% isoflurane. After facilitation with vecuronium 7mg, the patient was intubated easily with permissible hemodynamic change. Anesthesia was maintained with 60% nitrous oxide and 0.4-1.0% isoflurane in oxygen. The patient remained hemodynamically stable throughout the case. After completion of surgery, she emerged from anesthesia rapidly. She was extubated and returned to the ward thereafter. Thus, intraoperative anesthetic management seemed uneventful. The next day, however, at the postoperative round, she complained voluntarily that she had been aware of being intubated. She recalled no other events during anesthesia. Her postoperative mental state remained unchanged from the preoperative one, and no psychiatric sequelae developed. After the experience of this case, we gave the same induction protocol to other ten patients (aged 18-43) under processed-EEG monitoring. The data obtained suggested adequate depth of anesthesia during tracheal intubation in all cases. Nevertheless the patient recalled the sensation of tracheal intubation clearly. This means that the depth of anesthesia obtained from our induction protocol was sufficient for normal patients but insufficient for her, that is, the induction dose of propofol 80mg was too small for her. Therefore, we extrapolate the possibility that she had developed cross-tolerance to propofol in consequence to a large dose of morphine intake over a long period. Intraoperative awareness is one of the most serious complications of general anesthesia and occasionally results in emotional injuries or medicolegal problems. In performing general anesthesia to a patient taking a large dose of morphine, it is necessary to manage the patient carefully, keeping in mind the possible development of tolerance to opioids and cross-tolerance to other anesthetics.

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We report possible colonic herpes zoster in a 60-year-old woman with skin lesions typical of herpes zoster corresponding to the 10th right thoracic dermatome. She had right lower abdominal pain, lumbago and constipation for 3 days before the onset of skin rash. An endoscopic examination revealed redness and edematous changes of the mucosa in the ileocecal valve and the cecum. Colonic biopsies showed non-spesific chronic inflammatory changes including infiltrates of inflammatory cells (neutrophils and lymphocytes) and lymph nodules. Abdominal pain and lumbago disappeared after oral acyclovir and continuous epidural block. She was discharged without any sequelae.

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Occurence of transient neurologic symptoms (TNS) after spinal anesthesia has been reported with several local anesthetics such as lidocaine, prilocaine, mepivacaine, tetracaine, and bupivacaine. Although hyperbaric bupivacaine is known to cause TNS less frequently (0-3% incidence) than lidocaine (10-40%), there is scarcely any report of TNS with isobaric 0.5% bupivacaine. We reported a case of TNS after spinal anesthesia with isobaric 0.5% bupivacaine.
A 40-year-old, obese woman (156cm, 80kg) underwent cervical conization under spinal anesthesia. A 23G Quincke needle was placed into the sub-arachnoidal space through the L₄₅ interspace at the depth of 7cm, followed by injection of 3.6ml of 0.5% isobaric bupivacaine with no paresthesia. The anesthesia was adequately obtained below the level of T₆ bilaterally. She was placed in the lithotomy position during surgery for 25 minutes.
On the first postoperative day she complained of dysesthesia in her legs. Neurological examination revealed sensory deficit restricted within bilateral L₅ dermatome with no motor weakness. The dysesthesia and sensory loss subsided without any treatment or no sequelae within a week.
We report a case of TNS that lasted a week following spinal anesthesia with 3.6ml of 0.5% isobaric bupivacaine.

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Purpose: To evaluate objectively the amount of perspiration in palmar hyperhidrosis, the local perspiration volume was recorded continuously by the evaporimeter. The effects of polarized infrared ray irradiation around the stellate ganglion (PIRISG) were also recorded.
Methods: The local perspiration volume was measured continuously at both palms of two hyperhidrotic subjects and was compared with that of two healthy subjects. Psychological perspiration was stimulated by mental arithmetic workload. The volume of palmar perspiration stimulated by the mental workload was compared before and after PIRISG.
Results: Rate of perspiration was similar in both subjects at resting. Mental workload elicited significant increases in perspiration in palmar hyperhidrosis compared with that of the healthy subjects. In healthy subjects, the rate of perspiration promptly decreased at the end of mental workload. On the contrary, the increases in rate of perspiration continued much longer after mental workload had ended in hyperhidrotic subjects. Therefore, the amount of perspiration in palmar hyperhidrosis increased more compared with that in the healthy subject. After PIRISG, the volume of perspiration stimulated by mental workload decreased in all subjects. The same phenomenon was observed on the opposite palm of irradiation.
Conclusions: In hyperhidrotic subjects, it was confirmed objectively that the rate of perspiration was greater than that in healthy subjects when mental workload was applied, so that the total perspiration volume increased.

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