There is no objective measure of pain; we can however measure different aspects of the pain perception. Earlier experimental pain models often only involved induction of cutaneous pain. Recently new experimental models have been developed eliciting deep muscle and visceral pain that may more closely resemble the clinical pain condition. It is imperative to use multi-modal and multi-structure pain induction and assessment techniques, as a simple model cannot describe the very complex and multi-factorial aspects of clinical pain.
The importance of peripheral and central hyperexcitability for acute and chronic pain has been demonstrated in animals and to some extent in humans. But in spite of our immense knowledge we still do not know how to prevent and treat this hyperexcitability. Our understanding of nociceptive mechanisms involved in acute and chronic pain and the effects of anaesthetic drugs or combinations of drugs on these mechanisms in humans may also be expanded with experimental human models. This knowledge can then help us to develop and test therapeutic regimes in patients with acute and chronic pain.

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Background: A wide QRS complex is not a rare electrocardiographic phenomenon at the termination of paroxysmal supraventricular tachycardia (PSVT), but no plausible underlying mechanism has yet been proposed. The purpose of the present study was to elucidate the frequency and the underlying mechanism of the wide QRS complexes at the termination of PSVT.
Methods: We retrospectively reviewed 305 electrocardiograms (ECGs) from 100 patients, on which PSVT termination was recorded. The frequency of the wide QRS complexes was analyzed in 181 ECGs to avoid duplication, because there were 124 ECGs obtained from the same patients with same methods. The 181 ECGs were divided by morphology into three groups: Type A, termination with wide QRS complex without pause; Type B, wide QRS complex following initial pause after termination; Type C, wide QRS complex following the first narrow QRS after termination.
Results: The wide QRS complex was recorded in 81/181 (44.8%) ECGs (Type A; 3/81 (3.7%), Type B; 44/81 (54.3%), Type C; 62/81 (55.6%) ) and its frequency was not dependent on the mechanism of PSVT. It was more frequently observed after a long pause, and was frequently induced by procedures that increase vagal tone, such as intravenous adenosine 5'-triphosphate administration (16/22: 72.7%) and vagal stimulation maneuvers (16/32: 50%). There were a total of 41 wide QRS complexes (44.6%) which had a preceding sinus P wave, out of a total of 92 wide QRS complexes in all three types. These 41 wide QRS complexes included 30/44 (68.2%) Type B wide QRS, and 11 (24.4%) Type C wide QRS complexes. Conclusion. The aberrant conduction or escaped ventricular contraction was suggested to be the underlying mechanism of the majority of wide QRS complexes and ventricular premature contraction is less frequent.

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Objective: To assess the windows of therapeutic opportunity for drugs with various chemical actions on fetal growth retardation induced by transient intrauterine ischemia in rats.
Methods: At 17 days of gestation, ischemia was induced by 30 min of right uterine artery occlusion. The administration of either α-phenyl-N-tert-butyl-nitrone (PBN), FK 506, nifedipine, or MK-801 to pregnant rats was randomly started before occlusion, 1 hour, 3 hours, or 24 hours after recirculation. All of the pups were delivered by cesarean section at 21 days of gestation and were weighed to determine the degree of fetal growth retardation.
Results: The vehicle-treated animals exposed to ischemia showed a significant decrease in fetal body weight compared with the normoxic control animals. The growth disturbances were prevented by nifedipine and MK-801 only when given just prior to ischemia. In contrast, PBN and FK 506 had a protective effect even when given 1 hour and 3 hours after the start of recirculation, respectively.
Conclusions: The present results indicate that treatment with PBN and FK 506 gives relatively wide windows of therapeutic opportunity in fetal growth retardation induced by transient intrauterine ischemia in rats and suggest the possibility of therapeutic intervention after the start of recirculation.

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This study was designed to investigate the influence of maternal aerobic exercise on lipid peroxidation levels and antioxidant enzymatic activities before and after delivery.
Predelivery and 1- and 24-hour post partum blood samples were collected from 18 nulliparous healthy pregnant women who exercised regularly throughout the whole period of pregnancy and from 22 matched controls. The plasma concentration of malondialdehyde (MDA) was measured as an indicator of lipid peroxidation. Erythrocyte enzymes, superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and catalase (CAT), were measured as intracellular antioxidant markers.
In the control group, MDA increased slightly from predelivery to 1 hour post partum and then increased significantly at 24 hours post partum, with significant increase in SOD and CAT activities. On the other hand, MDA of the exercise group remained unaltered at 1 and 24 hours after delivery. At 1 hour post partum, the SOD and CAT levels of the exercise group increased markedly and then decreased to predelivery levels.
The present results indicate that uncontrolled lipid peroxidation occurs during labor and suggest that continuing regular maternal exercise may reduce labor-induced lipid peroxidation by improving the defense capabilities against free radical generation.

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Background: Pancreaticoduodenectomy (PD) has become a standard operation for malignant and benign periampullary diseases. Although the operative mortality of PD has decreased to less than 4% in hospitals with many cases of PD, the leakage of pancreaticointestinal anastomosis (PIA) still carries a substantial risk of lethal outcome. The aim of this study was to evaluate the local factors that affect the incidence of PIA leakage by evaluation of exocrine function and fibrosis in the pancreatic remnant following PD.
Method: Twenty-eight patients (17 pancreatic disease, 8 bile duct cancers and 3 ampullary cancers) underwent PD with complete extracorporeal pancreatic juice drainage. The cut-end of the pancreatic remnant was histologically studied for its grade of fibrosis in comparison with the exocrine activity of the pancreatic remnant (EAPR) calculated by the value of the product of volume of drained pancreatic juice and its amylase activity. The influences of those factors and other clinicopathologic data on PIA outcome were evaluated.
Results: The histological grade of fibrosis in the pancreatic stump was inversely correlated with EAPR (rs=0.5848, p=0.0011). Three patients had major leakages and 6 had minor leakages of PIA; all the patients with leakages had biliary or ampullary diseases, but not pancreatic diseases. The incidence of leakage of PIA was significantly higher in the patients with high values of EAPR (p<0.05). None with EAPR less than 10⁷ had PIA leakage. The incidence of PIA leakage in low-grade fibrosis of the pancreatic stump was significantly higher than that in high-grade fibrosis (p<0.05). Other clinicopathologic data did not influence the incidence of leakage of PIA.
Conclusions: The degree of fibrosis in the pancreatic stump is significantly related to the EAPR and affects the development of PIA insufficiency as a local factor.

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Immunoadsorption plasmapheresis (IAPP) is a method of removing circulating immune factors that is used to treat Guillain-Barré syndrome (GBS). We retrospectively analyzed the data on our GBS patients. In 21 patients treated with IAPP, linear regression analysis showed that the time from the onset of symptoms to the initiation of IAPP was correlated with the time required for improvement by one Hughes functional grade. We investigated the critical day for initiating treatment, which we defined as the day when initiation of IAPP was significantly more likely to improve function by at least one Hughes grade when compared with the outcome in patients receiving supportive therapy (non-IAPP group). The critical day was found to be day 6 after the onset of GBS.

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Several different laser systems are currently used to remove unwanted hairs. In this study, we studied follicular changes following hair removal with ruby or alexandrite lasers at different fluences.
Unwanted hairs were treated with a ruby laser (ICN, Photon Ics, UK) at 10, 14, 18 J/cm² or an alexandrite laser (Cynosure, USA) at 11, 14, 17 J/cm². A 3 mm punch biopsy was taken immediately after each laser exposure and one month later. Specimens were stained for histological observations. They were observed using immunohistochemistry to Factor VIII related antigen and PCNA, and also by the TUNEL method.
Immediately after the laser exposure, moderate follicular damage was observed following treatment with either laser. One month later, cystic formation of hair follicles and foreign body giant cells were observed in skin treated with either laser. The similar influence of each laser treatment resulted in similar histological changes.
In this study, the histological changes following treatment with a ruby or an alexandrite laser at the same fluence were considered to be similar.

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The goal of this study was to determine a T1-weighted magnetic resonance (MR) imaging sequence appropriate for evaluating the longitudinal relaxation effect of superparamagnetic iron oxide (ferumoxides) in a phantom study. An agarose phantom that included various concentrations of ferumoxides (0∼0.5 mmol/l in 0.05 mmol/l increments) was examined for six types of T1-weighted imaging sequences using a 1.5-T MR unit. Three-dimensional (3D) fast spoiled gradient-echo (SPGR) imaging with a short echo time showed a strong linear correlation between the concentration of ferumoxides and the enhancement ratio. Two-dimensional (2D) fast SPGR imaging showed a high signal-to-noise ratio of the phantom even at low ferumoxides concentrations. These results suggest that 3D fast SPGR imaging is an appropriate technique for the evaluation of the longitudinal relaxation effect of ferumoxides, and that 2D fast SPGR imaging can be useful for evaluating the longitudinal relaxation effect at lower ferumoxides concentrations.

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In this paper, about the left lumber ectopic kidney of a 87-years-old Japanese woman, we observed the size of her kidney, the form of her renal hilum, and the form of her calicopelvic system. In addition, we measured the index of cortex and medulla (C/M), and examined the difference between the lumber ectopic and the normal kidney.
There was no significant difference in the size (length, width, thickness, weight), without the external form was the distorted oval of lumber ectopic kidney. The renal hilum was divided into the upper and lower parts by the septum consisted of the parenchyma of kidney. In the calicopelvic system of the left lumber ectopic kidney, an obstructive distension due to the oppression by branch of the renal vein was observed in the superior minor renal calices. It seemed that it was Fraley's syndrome. From the viewpoint of C/M in the lumber ectopic kidney, it was suggested that there was no difference in the renal function, because the C/M was within a normal range.

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Lumbar spinal canal stenosis (LSCS) was first described in 1954 by Verbiest, followed by the currently accepted international classification of LSCS in 1976 by Arnoldi. Briefly, LSCS is a nervous system syndrome that is characterized by neural symptoms in the lower extremities due to tightened cauda equina and spinal nerve root involvement. LSCS international classification consists of: (1) degenerative, (2) congenital developmental, (3) combined, (4) spondylolytic spondylolisthesis, (5) iatrogenic and (6) post traumatic stenosis. Degenerative stenosis-the most common type of LSCS-is caused by disc degeneration, osteoarthritis of the facet joint and hypertrophy of the ligamentum flavum. LSCS may also be the result of intervertebral disc degeneration, protruded intervertebral disc and/or bony spur compress cauda equina and spinal nerve root anteriorally, while degenerated facet joint and hypertrophied the ligamentum flavum compress cauda equina and spinal nerve root posteriorally? Most often, spondylolytic spondylolisthesis occurs at the fourth lumbar vertebrae in middle-aged women. As a result of a slipping forward of the vertebra, cauda equina and spinal nerve roots can be tightened between the edge behind the top of lower vertebra and frontal edge of the lower part of upper lamina. Typical clinical symptoms of LSCS are low back pain, leg pain and intermittent claudication. Low back pain is chronic with secondary radiating pain in the buttock. The leg pain is called "sciatica", which tends to appear on the back of thigh, in the lateral aspect of lower leg and calf muscles, and which intensifies when the patient is fatigued. Intermittent claudication is a symptom associated with this syndrome. Often, patients with LSCS find it impossible to walk because of increased numbness and pain in their leg. Many patients report that after squatting for a few minutes they are able to resume walking. LSCS patients may also report dysaesthesia in the perineum area, and may also report urinary dysfunction ranging from extreme urgency to urinary delay. Patients who present with symptoms of LSCS should be seen by an orthopedic surgeon. Correct diagnosis by imaging and clinical examination, with appropriate conservative or operative treatment in a timely fashion should be encouraged in order to prevent irreversible nerve damage.

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Low back pain is one of the most prevalent complaints in clinical medicine. Sensations from the axial skeleton and the surrounding tissues are only vaguely somatotopic and are non-specific in quality. The diagnosis of the mechanism or source of low back pain is therefore very challenging. The treatment of low back pain that recurs, persists or intensifies is also formidable, because there has been no evidence of various therapies for chronic back pain. From the prophylactic viewpoint of chronic pain, the most considerable matter is early elimination of severe pain under certain diagnosis. In this article, the mechanisms of passing into the chronic state, especially the development of neuropathic pain, and the utilities of diagnostic and therapeutic neural blockade for low back pain are discussed.

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A 7 year-old girl was admitted to our hospital with high grade fever and redness, swelling and tenderness in left neck. CT scan revealed cyst formation (4.5×3 cm) in left lobe of thyroid with swelling of surrounding lymphonodes. We diagnosed her as acute suppurative thyroiditis and treated her with intravenous antibiotics infusion and incisional drainage. After the treatment, the clinical course was uneventful. Pharyngograph revealed left piriform sinus fistula.

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