Biomedical subjects

Kazuo Higa

Publications and source records attributed to Kazuo Higa.

39 records · Page 3Linked to original sources

PubMed1988

Factors influencing the duration of treatment of acute herpetic pain with sympathetic nerve block: importance of severity of herpes zoster assessed by the maximum antibody titers to varicella-zoster virus in otherwise healthy patients.

Antibody responses to varicella-zoster virus (VZV) were serially investigated by the complement-fixation test in 72 Japanese of both sexes, suffering from herpes zoster (HZ), but otherwise healthy. Our objective was to elucidate whether there were mutual relationships among severities of skin lesion, maximum antibody titers to VZV, and duration of treatment for acute herpetic pain (AHP). Patients were divided into 3 groups: mild group (n = 26), moderate group (n = 26) and severe group (n = 20), according to the severity of the skin lesions. The 3 groups did not differ significantly with respect to age (P greater than 0.6). All patients were treated with regional sympathetic nerve blocks (SNBs) until pain relief was achieved. The durations of treatment for AHP became significantly longer as HZ increased in severity; the mean log10 durations of treatment (+/- S.E.) for the mild, moderate, and severe groups were 1.383 +/- 0.037, 1.616 +/- 0.055, and 1.888 +/- 0.069 days, respectively (P less than 0.01 for the mild group vs. the moderate group, and P less than 0.001 for the moderate group vs. the severe group). Irrespective of age, the maximum antibody titers closely paralleled the severities of the skin lesion of HZ; the mean maximum log2 antibody titers (+/- S.E.) for the mild, moderate, and severe groups were 5.12 +/- 0.24, 6.73 +/- 0.20, and 8.00 +/- 0.18, respectively (P less than 0.001 for the mild group vs. the moderate group and for the moderate group vs. the severe group).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMedDate not supplied

Splanchnic neurolysis using carbon dioxide as the contrast agent.

BACKGROUND AND OBJECTIVE: Iodinated contrast agents are usually used to verify correct spread of injectate during splanchnic neurolysis. We performed a splanchnic neurolysis by using carbon dioxide as the contrast agent in a patient who was allergic to iodinated contrast agents. CASE REPORT: A 49-year-old man had severe upper abdominal and back pain due to chronic pancreatitis. Because slow-release morphine 360 mg a day and epidural fentanyl 500 microg a day did not relieve the pain, a splanchnic neurolysis was performed by the posterior approach. The needle tip was placed into the retrocrural space under fluoroscopic guidance. Fifteen milliliters of carbon dioxide was injected as the contrast agent. It gave a less clear image than that obtained by iodinated contrast agents; however, the correct spread of the gas was easily visible under continuous fluoroscopy. Six percent aqueous phenol 8 mL was injected after confirming relief of the pain with a local anesthetic. The dose of slow-release morphine was gradually decreased after the procedure. His abdominal and back pain was controlled with slow-release morphine 120 mg a day. CONCLUSION: Carbon dioxide was useful as the contrast agent to perform splanchnic neurolysis.

Abdominal Pain↗

PubMedDate not supplied

Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain.

OBJECTIVE: To investigate effects of continuous epidural infusion (CEI) of 0.5% bupivacaine added to intermittent epidural boluses (IEB) on the duration of zoster-associated pain (ZAP), as compared with continuous infusion of normal saline placebo added to IEB. DESIGN: A prospective, double-blind, randomized, placebo-controlled study. SETTING: A university hospital and an affiliated clinic in Japan from 1996 through 1999. PATIENTS: 56 immunocompetent herpes zoster (HZ) patients, 50 years or older, within 10 days of rash onset and with severe pain and eruption. INTERVENTIONS: Patients were hospitalized and randomly allocated into 2 groups. CEI group given CEI of 0.5% bupivacaine (0.5-1.0 mL/h) plus IEB of 0.5% bupivacaine 4 times daily (n = 29). IEB group given normal saline infusion plus IEB of 0.5% bupivacaine 4 times daily (n = 27). All patients received oral acyclovir 800 mg, 5 times daily, for 7 days. OUTCOME MEASURES: The number of days required for complete cessation of ZAP and the proportion of subjects with allodynia beyond 30 days. RESULTS: The median time to cessation of ZAP was significantly shorter in the CEI group than in the IEB group (29 days vs. 40 days, P = 0.002). The number of patients whose allodynia persisted beyond 30 days of treatment was significantly lower in the CEI group than in the IEB group (10% vs. 37%, P = 0.027). CONCLUSIONS: CEI of 0.5% bupivacaine plus IEB was associated with a shorter duration of ZAP and fewer patients with allodynia beyond 30 days, compared with IEB plus normal saline infusion. Patients at high risk for developing postherpetic neuralgia (PHN) can be managed with intensive therapies at the early stage of disease, such as CEI, which maintains effective analgesia and may reduce the burden of PHN.

Aged↗