上腕骨悪性腫瘍に対して肩甲帯離断術を施行した患者における，術後の幻肢痛ならびに幻肢感覚に対してガバペンチンが奏効した3症例を経験したので報告する．症例1は切断後5日目にnumerical rating scale（NRS）で2-3/10の幻肢痛が出現し，オキシコドン（10 mg，分2）で対応したが，14日目より幻肢痛がNRSで8/10と増悪したためガバペンチン300 mg/日を開始したところ，痛みはNRSで0-1/10に改善した．症例2は切断前から腫瘍による神経障害痛が出現しており，ガバペンチン300 mg/日の投与によりNRSで5/10から3/10になり痛みの程度の改善を認めた．切断後9日目より生じた右上腕全体の幻肢感覚に対しても，同量のガバペンチンが奏効し幻肢感覚は消失した．症例3は切断後2日目より重量感を伴う幻肢痛が出現したが，ガバペンチン600 mg/日で痛みはNRSで6/10から2/10に改善した．四肢切断後の幻肢痛や幻肢感覚に対して，ガバペンチンは有効であることが示唆された．

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The effects of change in the concentration of Ca++ on myocardial contractility depressed by thiamylal and halothane were studied in isolated dog heart muscle. The concentration of Ca++ in the bathing medium was increased stepwise from 1.9 to 20.9 mM. An increase in Ca++ concentration resulted in an increase both in net-shortening (Δ1) and in maximum velocity of shortening at 0.4 g preload (V'max) which reached the maximum values at 11.4 mM of Ca++. A further increase in Ca++ concentration rather decreased dl and V'max. The concentration-response relation curves in the presence of thiamylal (3.3 mg%) shifted to the right almost parallel to the control curve, with the peaks at 15.2 mM of Ca++. The result indicates that the depression of myocardial contractility produced by thiamylal is counteracted competitively by Ca++. However, the curves in the presence of halothane (5.0+ 0.4 mg%) were kept lower than those of the control, with the peaks at 7.6 mM of Ca++. The result shows that the counteraction of Ca++ to the depression of myocardial contractility was limited in the presence of halothane. A similar tendency was observed in maximum force of isometric contraction (Fm). Moreover, in the presence of halothane, the administration of higher concentrations of Ca++ almost always accompanied “after-contraction”. From the result obtained and the literature concerned it was suggested that the mechanism for producing the depression of myocardial contractility might be different between thiamylal and halothane in relation to Ca++ movements at the Ca++ storage sites within the myocardium.

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All the volcanic ashes have been formed by certain developmental processes, which are continuous. Brown volcanic ash is accumulated at the foot of the Kurikoma volcanoes, but no black volcanic ash with colored minerals was found there. In the west areas at the feet of the volcanoes, the brown volcanic ash is changed into glei soil which shows a gray white color due to the underground water. Some of glei solis are formed by melting water of the remaining snow in the southern part of the summit of the volcanoes. mottles are shown in the upper part of glei horizon. The relation between gleization and the remaining snow area is an interesting phenomenon.

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We investigated the comparative effects of ketamine, flunitrazepam, diazepam and midazolam on function and metabolism in reperfused rat hearts. Seventy-two hearts were rapidly excised and perfused with buffer as a Neely''s working model. Whole heart ischemia was induced for 15 min followed by reperfusion for 20 min. Four intravenous anesthetics in 2 different concentrations (10 and 50 times of therapeutic concentrations) were administered during reperfusion. The data were compared to a control group in which intravenous anesthetics were not used. At the end of reperfusion, myocardial metabolites were measured by liquid chromatography. Cardiac outputs in the both groups given lower and higher doses of ketamine and flunitrazepam and in the groups given the higher dose of diazepam and midazolam were significantly lower than that in the control group [at the end of reperfusion: control: 60.4; ketamine: 48.8 (lower) and 14.6 (higher); flunitrazepam: 50.2 (lower) and 50.6 (higher); diazepam: 62.6 (lower) and 42.5 (higher); midazolam: 59.5 (lower) and 51.2 (higher), ml/min]. The levels of ATP in all higher concentration anesthetic groups were significantly lower than those in the control group (control: 23.7, ketamine: 17.8, flunitrazepam: 17.8, diazepam: 17.7, midazolam: 17.7, μmol/g). These results suggest that ketamine and flunitrazepam moderately depress cardiac function more than diazepam and midazolam when they are given during reperfusion.

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Effects of ketamine on the sodium (I_Na) and L-type calcium currents (I_Ca) were examined by using whole-cell patch clamp techniques in guinea pig single ventricular myocytes. The mode of action of ketamine was compared with those of quinidine, a sodium channel blocker, and verapamil, a calcium channel blocker. Ketamine (30-300 μM) inhibited both I_Na and I_Ca in a concentration-dependent manner. Quinidine (30 μM) and verapamil (0.1 μM) produced use-dependent depression of I_Na and I_Ca, respectively. The amplitude of I_Na elicited by the first depolarizing pulse after a long quiescent period was slightly decreased by quinidine. During a train of depolarizing pulse the current amplitude decreased gradually, and reached a steady state level in the quinidine-treated cells (use-dependent block, UDB). Verapamil produced a similar mode of inhibition of I_Ca, i.e., UDB. In contrast, ketamine produced significant decrease in I_Na and I_Ca elicited by the first depolarizing pulses and the decreases of both currents were not augmented during a train of depolarizing pulses. From these results, it can be concluded that ketamine produces tonic block of the cardiac sodium and calcium channels and the mode of inhibition is clearly different from UDB by quinidine and verapamil.

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我々は全身対応の高密度集束超音波焼妁療法 : HIFU (ソニック CZ901 : 綿陽ソニックエレクトロニック : 中国) を昨年の12月に導入し, その可能性や我々の症例における適応について評価を試みている. 以来, 全身ハイパーサーミア外来に来院した12例の進行がん症例に対して, 20回のHIFUを施行し, 全身ハイパーサーミア : WBH (RHS 7500 : エンサーミクス メディカル システムス : 米国) との併用や単独治療で良好な結果を得た. 最初の1例目は上咽頭がん再発の多発性の肺, 肝臓転移の20歳女性であった. 週1回計4回のWBHで腫瘍マーカーの改善と共に肺転移は縮小し, その後, 肝臓に対して施行したHIFUにより著明な縮小効果を得られた. 2例目は頸部神経〓種の再発, 肋骨転移の65歳の男性であった. HIFU施行が不可能な頸部に対してはWBHの効果に期待し, 肋骨転移に対してはHIFUを行った. WBHの10日後に頸部腫瘍は膨大し, その後自然に破裂, 縮小した. 造影CTにおける評価ではHIFUを施行した第7肋骨腫瘍及び頸部腫瘍は著明な内部壊死に伴いサイズの縮小が認められた. 今後のHIFUの適応には, この様な他療法との併用による緩和治療や, より根治を目的とした原発臓器への治療効果が期待される.

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  57歳，男性．9年前より糖尿病に対してインスリン加療中であったが，今回，下腿の腫脹と意識障害にて救急搬送された．搬送時の意識状態はJapan Coma ScaleでII-30，血圧は73/31mmHg，血糖値は1,196mg/dl，尿中ケトン体は陽性であった．右下腿壊疽を合併しており，重症の糖尿病性ケトアシドーシスと診断し，緊急の大腿切断術が施行された．麻酔は自発呼吸下のケタミン，フェンタニル，プロポフォールによる静脈麻酔で管理した．その周術期管理において，(1)麻酔管理方法，(2)重度アシドーシスの補正，(3)手術侵襲に対する痛覚の評価，(4)意識障害と術後の痙攣重積発作，(5)術後の繰り返す心静止や難治性不整脈に苦慮したが，集学的治療により軽快し良好な結果を得た．

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To evaluate the medical effects induced by the cessation of cigarette smoking, the subjects who had been followed up in a financing company were analyzed epidemiologically. The duration of the observation period was 2 years. Two health surveys were performed for each subject. The number of nonsmokers, ex-smokers and smokers were 117, 38 and 379, respectively. The results based on the analysis of covariance using the age and value of each medical indicator measured at the first health surveys as the covariates showed that the obesity index, diastolic blood pressure and the serum level of uric acid were significantly higher in the ex-smokers than in the nonsmokers and the smokers (p<0.05). Fasting blood sugar, triglyceride and total cholesterol in the ex-smokers who had smoked 20 or more cigarettes per day (N=20) were higher than in the ex-smokers who had smoked less than 20 cigarettes per day (N=18) (p<0.05). There were no significant differences in the medical indicators among the subjects with different durations of cessation of cigarette smoking. The factor analyses con-cerning the dietary habits were calculated. The ex-smokers had significant negative trends in the second factor score and significant positive trends in the third factor score between the first and second health surveys when compared with the nonsmokers and the smokers. These trends showed that the ex-smokers seemed to make their dietary habits unhealthy and to increase their calorie intake. In view of these relationships between the medical indicators and the modification in dietary habits, health education concerning dietary habits should be carried out when cessation of smoking cigarette is recommended.

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我々は体外循環血液加温法による全身ハイパーサーミア (WBH) をより非侵襲的に改善した遠赤外線による体外照射加温法を進行癌患者を対象に施行している.WBHは41.8℃, 60～90分間の治療が一般的であったが, 近年, 40～41℃位の生理的な温度域で長時間加温 (Mild hyperthermia) の効果が注目されている.我々も, この理論に関心があり, その為に最適な全身加温法の検討を行っている.今回, 我々が通常施行している遠赤外線加温と, 検討中の近赤外線加温との比較を行った.結果, 近赤外線加温は遠赤外線と比べ, 必要麻酔量が1/2～1/3で且つ循環器系への負担も少なかった.今後, 近赤外線加温法はWhole body mild hyperthermiaの治療法の確立の上で重要な加温法であると思われた.

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Previous studies have showed that halothane has depressed ventricular activation in a canine myocardial infarction model. It is also well known that class I antiarryhthmic drugs depress ventricular activation in the infarcted myocardium. In the present study, we examined whether some electrophysiologic interactions between halothane and two class I antiarrhythmic drugs, lidocaine and procainamide, occur in a canine myocardial infarction model. Halothane, lidocaine and procainamide prolonged the activation time in the infarcted zone, and the combination of halothane and either lidocaine or procainamide markedly prolonged the activation time or blocked the delayed activation in the infarcted zone. Although the mechanism of the interaction is not clear, the present results suggest a synergistic interaction between halothane and class I antiarrhythmic drugs. Therefore, care should be taken that doses of class I antiarrhythmic drugs during halothane anesthesia will not be an overdose.

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We examined the effects of intravenous anesthetics (thiopental, fentanyl and morphine) on the ventricular activation in a canine myocardial infarction model. Thiopental at 5 and 10 mg/kg delayed or abolished the delayed activation in the infarcted zones with slight delay of activation of the normal zones. Fentanyl at 30 μg/kg slightly but significantly prolonged the activation time in both normal and infarcted zones. Morphine at 1 mg/kg did not produce any significant effect. Thiopental, but neither fentanyl nor morphine, inhibited ventricular stimulation-induced arrhythmias. Thus, thiopental, but not fentanyl nor morphine, markedly depressed the delayed activation in myocardial infarction, which may affect and probably inhibits the ventricular arrhythmias in myocardial infarction. It also should be kept in mind that thiopental may have arrhythmogic effects in myocardial infarction.

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To overcome the limitation of low network density and sparse distribution of meteorological stations, spatial interpolation is being performed for estimating meteorological variables that are not geographically covered by existing observation network. While there are several readily available spatial interpolation techniques, it is still difficult to determine which one best estimates actual observation. Considering the stimulus for disaster risk reduction, hydrological, agricultural, and other applications of interpolated data, this study compared six interpolation techniques (Inverse Distance Weighted (IDW), Completely Regularized Spline (CRS), Tension Spline (TS), Ordinary Kriging (OK), Universal Kriging (UK), and ANUSPLIN) that have been recommended in tropical maritime region. Validation results comparing historical monthly and interpolated rainfall data from 1981-2010 in 65 stations in the Philippines show that OK has the best performance among the aforementioned techniques followed by ANUSPLIN and TS. Ultimately, this study is a contribution to the existing inadequate literatures that have documented and evaluated interpolation techniques that can be used in archipelagic regions with prominent climate variability.

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There exsists several evidences supporting that hyperthermia may be useful as a new modality of cancer treatment. The details of the mechanisms of thermal cell killing are not clarified yet. In in vitro studies, however, it has been demonstrated that (1) cell in radioresistant S phase are thermosensitive, (2) thermal cell killing is enhanced by lowering medium pH, and (3) a transient thermotolerance is induced by hyperthermic treatment. The data suggest that the primary target of thermal cell killing may include the plasma membrane and/or chromatin. On the other hand, it has been reported that many chemical agents enhance cellular thermosensitivity. These agents are called as “hyperthermic sensitizers”. In this report, the author introduces several hyperthermic sensitizers, such as (1) inhibitors of polyamine synthesis, (2) inhibitors of poly (ADP-ribose) synthesis, (3) hypoxic cell sensitizers, (4) SH-compounds and its modifying agents, (5) anaesthetics, and (6) chemical agents modifying membrane ion-transports. Chemotherapeutic agents, which have anti-tumor toxicity by themselves, are not included in these groups. Hyperthermic sensitizers would be helpful to analize the mechanisms of thermal cell killing, and also have some possibility to be utilized in clinical hyperthermia.
The future prospects of hyperthermic sensitizers are discussed.

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Induction of membrane-associated responses, a leg-shaking, a knock-down and a killing, by γ-ray irradiation was investigated in Shaker (Sh) mutants of Drosophila melanogaster in which the gene cords for the A-current K^† channel. Sh mutants were more sensitive in the knock-down response after γ-ray irradiation than wild types. There were a great amount of sex difference in the knock-down response, males being more sensitive than females, but not in the killing response. The sex difference was larger than gene dosage effect on X chromosome in females. Genetical analysis revealed that the sensitivity of the knock-down response is an incompletely dominant character without maternal effects . The leg-shaking response, which had previously been reported to be induced by ether treatment, was demonstrated in the head-removed flies of Sh mutants. It was found to be the most sensitive among the responses tested, and may involve changes in K^† channel. The knock-down response may be related to expansion of the leg-shaking response. The killing response should have causes different from the leg-shaking and the knock-down responses judging from the lack of correlation with them.

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口蓋扁桃摘出術は，耳鼻咽喉科で一般的に行われている手術である。術後は非常に疼痛が強く，数日間は食事摂取が困難となる場合も多々ある。今回我々は，立効散が疼痛管理に有効であった口蓋扁桃摘出症例を経験した。症例は23歳女性。習慣性扁桃炎の診断で口蓋扁桃摘出術を行った。術後疼痛が強かったが，非ステロイド性消炎鎮痛剤，アセトアミノフェンともに薬疹歴があり使用困難であった。ツムラ立効散エキス顆粒（2.5g/包）を1包，10秒間の含み飲みを行い，服用直後より疼痛が軽減した。その後も立効散の頓用使用により疼痛管理を行い，良好な術後経過をたどり，術後6日目に退院した。

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CT,小腸造影にて術前診断し,待期手術を行った左傍十二指腸ヘルニアの1例を報告する.症例は50歳,男性.食直後の左上腹部痛と嘔吐を主訴に“原因不明のsubileus”として前医より紹介された.腹部所見は左上腹部の軽い圧痛のみであった.非発作時CTでは小腸の拡張はみられないが,左上腹部にループ状の小腸とその腸間膜の血管の集中像がみられた.発作時CTでは膵胃間に著しい小腸の拡張と壁肥厚を認めた.小腸造影では空腸は左上腹部に塊状に描出され,狭小化した輪出腸管も造影された.これらの所見から左傍十二指腸ヘルニアと診断し,待期手術を行った. Treitz靱帯の左側の径4cmの裂孔より,空腸が約40cm陥入していた.腸管を整復しヘルニア門を閉鎖した. CT検査はイレウス発作時のみならず,非発作時においても何らかの異常所見が存在する場合があり有用である.また患者の訴えから内ヘルニアの存在を想定し,小腸造影を行うことが重要である.

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To clarify whether cigarette smoke stimulates the sympathetic nervous system (SNS) and thermogenesis in interscapular brown adipose tissue (IBAT), we measured norepinephrine (NE) turnover, an indicator of SNS activity, guanosine-5'-diphosphate (GDP) binding, a thermogenic indicator, and oxygen consumption in IBAT in monosodium-L-glutamate (MSG)-induced obese and saline control mice following a two-week exposure to cigarette smoke. Cigarette smoke significantly increased NE turnover, GDP binding and oxygen consumption in IBAT, and significantly reduced body weight in MSG obese mice as well as in control mice. However, food intake was unchanged in the MSG group.
These results suggest that cigarette smoke stimulates NE turnover and thermogenesis in BAT, which contribute to the mitigation of obesity.

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The effects of halothane on the effective refractory period (ERP) and the ventricular activation were examined in a canine myocardial infarction model, and compared with those of propranolol. Halothane reduced the heart rate and prolonged the ERP in both normal and infarcted zones. A prolongation of ERP with halothane was also observed during atrial pacing at the same rate as in control, but the effect was less than during sinus rhythm. Halothane (1 MAC) further delayed or blocked the delayed activation in the infarcted zones with only slight effects on the activation of the normal zones. Propranolol (0.2 mg/kg) prolonged ERP during sinus rhythm, but it did not affect either the ERP or ventricular activation during atrial pacing. In conclusion, halothane produced a selective depression of the delayed activation and the prolongation of ERP, which may be caused by both direct effects on the myocardium and secondary effects such as a reduction of the heart rate. These effects of halothane may contribute to its antiarrhythmic effects in the myocardial infarction model which have been previously reported.

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Previous studies showed that volatile anesthetics depressed ventricular delayed activation in a canine myocardial infarction model. It is well known that class I antiarryhthmic drugs depress the ventricular activation in the infarcted myocardium. In the present study, we examined the electrophysiologic interaction between volatile anesthetics (sevoflurane, isoflurane) and class I antiarrhythmic drugs (lidocaine, procainamide) in effects on the ventricular delayed activation in a canine myocardial infarction model. The conduction time of the premature stimulation-induced ventricular excitation was measured in both normal and infarcted zones of the ventricle. An interval from the premature stimulus artifact to the epicardial activation was measured on bipolar electrograms as an index of conduction time, i.e., activation time. In the infarcted zone, the volatile anesthetics and class I antiarrhythmic drugs prolonged the activation time in the infarcted zone, and the combination of the volatile anesthetics and the class I antiarrhythmic drugs markedly prolonged the activation time or blocked the delayed activation. In the normal zone, a similar synergistic interaction was observed, but the effect of these drugs was less compared with that in the infarcted zone. From these results, possible mechanisms to explain the synergistic interaction were discussed.

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