We attempted to produce an animal model of trigeminal neuralgia by chronic nerve constriction injury (CCI) and investigated the time course of pain thresholds in the chronic state. Adult male Wistar rats (250 to 300 g) were used in these experiments. All rats were anesthetized with pentobarbital before surgery. Two ligatures 2 mm apart were made loosely around the unilateral supraorbital nerve with 4-0 silk (n=21) . Control animals underwent a sham operation (n= 6) . In the ligation group, carbamazepine was administered intraperitoneally to 15 rats every day for 10 days from the 10th postoperative day. The sham group (n=6) and the ligation group (n=6) to which carbamazepine was not administered were observed for 40 days after the surgery. Heat and pressure stimulation tests wer performed on these animals. The carbamazepine group (n=15) was observed for 20 days and heat stimulation was performed on this group. Both the avoidance latency to heat stimulation and the avoidance threshold to pressure stimulation were significantly lower on the CCI operation side than on the intact side. The short latency and low threshold lasted for 40 days. In the carbamazepine group the latency of the avoidance response to heat stimulation on the intact side was dose-dependently prolonged. However, on the CCI side 5 mg/kg carbamazepine had the same effect as 10 mg/kg. We believe this to be the first study of neuralgia in the region of the supraorbital nerve and of the estimation of the therapeutic effect of carbamazepine against chronic neuropathic pain. The model is easy to produce and might be useful for investigating the pathophysiology, etiology, and treatment of trigeminal pain.

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Temporomandibular disorders (TMD) are characterized by periauricular pain, clicking during condylar movements, and a restricted mouthopening capacity. The relationship between bulimia nervosa (BN) and TMD has seldom been studied, although the excessive jaw movements that accompany binge eating and vomiting aggravate the symptoms of TMD. TMD should be noted as a complication of BN. This paper describes a young woman with BN who was later found to have TMD.

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CD1a⁺ epidermal Langerhans cells (ELCs) are depleted during graft-versus-host disease (GVHD) in humans. However, the mechanism of CD1a⁺ cell depletion in GVHD remains obscure. The aim of the present study was to elucidate the sequential evolution of the ultrastructure of ELCs in experimental acute GVHD. The B10.D2→DBA/2 (900 cGy) strain combination was used for studies of CD4⁺ T-cell-mediated GVHD (n=3), whereas the B10. BR→CBA (800 cGy) strain combination was used for studies of CD8⁺ T-cell-mediated GVHD (n=3) . In CD4⁺ T-cell-mediated GVHD, Birbeck granules in ELCs started to decrease at day 7 and were not detectable after day 14. The numbers of Golgi apparatuses and related vesicles were also decreased, while rough endoplasmic reticulum, ribosomes, and vacuolated mitochondria were increased after day 14. In contrast to CD4⁺ T-cell-mediated GVHD, in which tumor necrosis factor-α is an essential cytokine, CD8⁺ T-cellmediated GVHD caused only slight changes in ELCs and tumor necrosis f actor-α seemed to be irrelevant. These data suggest that most ELCs do not migrate into the dermis immediately after the onset of GVHD but remain within the epidermis at least until day 14 and presumably beyond.

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Precise detection of a lesion leaking air during thoracoscopic surgery is sometimes difficult. We used a small electret condenser microphone to detect points of air leakage. To our knowledge this is the first report of the use of a microphone for detecting air leakage in thoracoscopy. The microphone is small enough to pass through an 11.5-mm trocar. The sound of leaking air can be detected by passing the microphone over the surface of the lung under thoracoscopic observation. We performed 30 thoracoscopic operations for spontaneous pneumothorax and 1 for giant bulla using this microphone system. The sound picked up by the microphone was helpful for discovering ruptured blebs in two cases and in checking suture lines of a resected bulla in one case. This small condenser microphone system proved useful in detecting some sources of air leakage.

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we evaluated stellate ganglion block (SGB) as the initial treatment for severe Bell's palsy. Twenty-nine patients with Bell's palsy who initially exhibited an electroneurographic ratio of less than 10% were divided into two groups: an immediate-treatment group, who underwent SGB within 3 days after symptoms first appeared, and a late-treatment group, who underwent SGB 4 or more days after symptoms first appeared. For the following 12 months the palsy score (Yanagihara's 40-point grading system) was measured and electroneurography was performed to assess recovery. Twelve months after onset, palsy scores in the two groups were similar. However, the electroneurographic ratio was significantly higher in the immediate-treatment group (42.8±18.8%) than in the late-treatment group (27.2±18.9%; P<0.05) . Furthermore, the incidence of sequelae was significantly lower in the immediate-treatment group (75.0%) than in the late-treatment group (100%; P<0.05) . These results suggest that earlier SOB did not affect symptomatic recovery but improved electrodiagnostic recovery and prevented sequelae. Because patients with Bell's palsy are always at a risk for more severe palsy with an electroneurographic ratio of less than 10%, we suggest that SOB be performed in all patients as the initial treatment.

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After the cessation of circulation, organ function deteriorates. In cadaveric lung transplantation, protecting the endothelium of the pulmonary artery (PA) from warm ischemic injury is important. We studied the effects of flush height, reperfusion flow rate, and magnesium on the PA in an isolated, non-blood-reperfused lung model (rabbits, n=6 in each group) . A lowpotassium dextran solution was infused into the PA from a height of 60 cm (groups 1 and 2) or 30 cm (groups 3 through 5), immediately (group 1) or 2 hours (groups 2 through 5) after death. The heart-lung bloc was excised, ventilated, and reperfused at a flow rate of 100 ml/minute (groups 1 through 3) or 50 ml/minute (groups 4 and 5) for 30 minutes. MgCl₂ was added to the flush solution (10 mmol/1) in group 5. The pulmonary arterial pressure (PAP) during the flush period (PAPFP) and the flush flow rate (FFR) were recorded. Airway pressure (AWP) and PAP were monitored during the 30-minute reperfusion. After reperfusion, the wet/dry weight ratio (W/D) of the left lung was calculated as an estimate of the extent of lung edema. In group 2, lung failure, indicated by a frothy bronchial exudate, appeared in all animals during the flush period. In group 3, PAPFP was higher and FFR was lower than in group 1, and all lungs failed during the reperfusion period. In group 4, although all lungs were reperfused for 30 minutes, AWP and W/D were higher than in group 1. In group 5, W/D was lower than in group 4. To avoid PA damage caused by overperfusion of the graft, flush height and reperfusion flow rate should be lowered in cadaveric lungs. Magnesium in the flush solution was an effective means of preventing pulmonary edema.

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Because a mixture of sodium nitroprusside (SNP) and trimetaphan (TMP) induces hypotension at a dose much lower than that of either agent, SNP and TMP are believed to act synergistically. However, the mechanism of this synergy remains to be elucidated. Sixteen dogs were anesthetized with halothane in oxygen. After a baseline period, mean arterial pressure (MAP) was reduced to 60 mmHg for 60 minutes by infusion of 0.02% SNP (n=8) or a SNP (0.02% ) -TMP (0.2%) mixture (n= 8) . The MAP in both groups decreased to approximately 50% of baseline values (P<0.01) . Hypotension induced by SNP and by the SNP-TMP mixture was associated with similar reductions (P<0.01) in systemic vascular resistance. The cardiac index (CI) increased during the hypotensive period (P<0.05) and 10 minutes (P<0.05) after infusion of SNP was stopped. In contrast, CI decreased at 30 minutes (P<0.01) and 60 minutes (P<0.05) of the hypotensive period in the SNP-TMP group. Furthermore, CI was significantly lower in the SNP-TMP group than in the SNP group. Stroke volume index (SVI) increased (P<0.01) during and after hypotension induced with SNP, whereas SVI remained unchanged during the hypotensive period in the SNP-TMP group. With the SNP-TMP mixture, decreases (P<0.01) in heart rate (HR) were observed throughout the observation period. In contrast, HR did not change during hypotension induced by SNP. This study shows that both SNP and a SNP-TMP mixture were equally effective in reducing afterload during induced hypotension but had different effects on CI. The differences in CI between SNP and the SNP-TMP mixture may be attributed to different effects on SVI and HR.

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The stiffness of the elbow flexor muscle (biceps brachii) was measured in male and female long distance runners with the static loading method using a newly devised simple apparatus with different joint angles. The stiffness of the biceps was the greatest when the elbow joint was completely extended. Muscle stiffness decreased with increased elbow flexion. Muscle stiffness was the least at an elbow joint angle of 60°in both males and females. There were significant differences in muscle stiffness at joint angles between 0°and 30° (p<0.01), between 0°and 90° (p<0.01) and between 0°and 60° (p<0.001) in male runners, and between 0°and 60° (p<0.01) in female runners. In many athletes relaxed muscles are necessary for high performance. At flexion angles of 60°to 90°the biceps muscle was softer than at other angles. At these angles the biceps shows almost body length in which the muscle generates the maximal active tension. These results support the correlation between performance and muscle softness. Furthermore, these results suggest that the simple static loading device used in this study provides information for the quantitative analysis of muscle stiffness in humans.

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Ischemia-reperfusion injury resulting from production of reactive oxygen intermediates is one of the most likely pathophysiologic causes of liver dysfunction after liver transplantation. Glutathione is an essential endogenous antioxidant, and N-acetylcysteine (NAC) is a nontoxic precusor of glutathione. The aim of the present study was to examine whether NAC administration protects against cold ischemia-reperfusion injury in the rat liver. An isolated perfused rat liver model subjected to prolonged hypothermic ischemia, 48-hour cold storage, and 120 minutes of reperfusion was employed. Administration of NAC 15 minutes before liver harvest significantly reduced concentrations of liver enzymes released into perfusate samples and significantly increased glutathione concentration in liver tissue specimens compared with those after administration of 5 % dextrose. A glutathione-depleted liver was produced with intraperitoneal injection of buthionine sulfoximine, an inhibitor of γ-glutamylcysteine synthetase, 2 hours before intraportal administration of either NAC or 5% dextrose. Administration of NAC also reduced concentrations of liver enzymes released into perfusate samples compared with those after 5 % dextrose injection. These results suggest that NAC administration reduces cold ischemiareperfusion injury in the rat liver by acting as a substrate for glutathione synthesis and also as a self-scavenger of reactive oxygen intermediates.

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To investigate the cell proliferative ability of uterine cervical dysplasia and carcinoma in situ (CIS), the numbers of argyrophilic nucleolar organizer regions (AgNORs) and MIB-1-positive cells were determined in 76 precancerous and cancerous lesions. When AgNORs and MIB-1-positive cells were counted from the basal to superficial layers, the greater the degree of dysplasia, the higher the AgNOR number and MIB-1 labeling index. However, neither measurement differed significantly between severe dysplasia and CIS. The number of MIB-1-positive cells increased in the superficial layer as histologic grade increased. When only cells nearest to the epithelial-stromal junction (the basal layer) were examined, MIB-1-positive cells were rare in nondysplastic and mildly dysplastic epithelium and increased in number in grades above moderate dysplasia. Moreover, both AgNOR number and MIB-1 labeling index differed significantly between severe dysplasia and CIS. These results suggest that as dysplasia progresses, prolif erative cells first appear from the parabasal layer to the superficial layer and that cells of the basal layer enter the cell cycle later than do adjacent cells of the parabasal layer. Moreover, we believe that dysplasia and CIS differ in the number of basal layer cells that enter the cell cycle.

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The use of steroid inhalation therapy for controlling infantile asthma has been controversial because the initial and maintenance doses that will not induce systemic side effects have not been determined. In this report, we administered beclomethasone dipropionate to infants with severe asthma who had been hospitalized for severe attacks and studied its efficacy and side effects. We found that this therapy was extremely useful in these cases and produced no side effects, such as suppression of adrenal function or growth. Therefore, beclomethasone dipropionate inhalation therapy was extremely effective and safe in severe infantile asthma.

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This report describes two patients with Rathke's cleft cyst in whom spontaneous reduction could be demonstrated with magnetic resonance (MR) imaging. The first patient was a 31-year-old woman and the second patient was a 17-year-old girl. Both patients complained of headache. Initial MR images revealed a cyst visualized as a ring enhancement in the sella turcica. The MR images obtained 5 weeks after the onset of symptoms revealed cyst reduction in both patients. These two cases strongly suggest the spontaneous course of Rathke's cleft cyst.

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