Summary Background : Gabapentin has been shown to reduce elements of central sensitization in human experimental hyperalgesia. It remains uninvestigated whether gabapentin has beneficial effects for irritable bowel syndrome associated with visceral hypersensitivity. Aims : To evaluate the effects of gabapentin on sensory and motor function of the rectum in patients with diarrhoea‐predominant irritable bowel syndrome. Methods : Forty patients with diarrhoea‐predominant irritable bowel syndrome completed this randomized, double‐blind, placebo‐controlled, parallel‐grouped study. All patients received a barostat study and were subsequently randomized for 5‐day treatment with gabapentin 300 mg/day and then 600 mg/day or placebo. On day 6, after subjects had their morning dose, the barostat experiment was repeated. Results : The threshold pressures for bloating, discomfort and pain significantly increased after gabapentin, but not after placebo. Significant increase in the pressure and corresponding wall tension inducing discomfort or pain were observed in the gabapentin group, but not in the placebo group. Rectal compliance significantly increased after gabapentin, but not after placebo. The postprandial increase of rectal tone was not affected by gabapentin. Conclusion : Our results show that gabapentin reduces rectal sensory thresholds through attenuating rectal sensitivity to distension and enhancing rectal compliance in diarrhoea‐predominant irritable bowel syndrome patients. The clinical efficacy of this drug in irritable bowel syndrome patients warrants investigation.

Brugada syndrome is characterized by right bundle branch block, ST segment elevation in the precordial leads and sudden death caused by ventricular fibrillation. We present two successful anaesthetic management cases in patients with Brugada syndrome. Accepted for publication 8 May 2004Key words: Brugada syndrome; complications; electrocardiography; sudden death.# Acta Anaesthesiologica Scandinavica 48 (2004) I N 1992 a new syndrome was described consisting of syncope or sudden death in patients with a structurally normal heart and an electrocardiogram (ECG) characteristic of right bundle branch block with ST segment elevation in leads V 1 to V 3 . This condition was named 'Brugada syndrome' (1). The syndrome is genetically determined and caused by mutations in the gene SCN5A on chromosome 3, encoding the human cardiac sodium channel (2).There are few reports of anaesthetic management of patients with Brugada syndrome, and especially regional anaesthesia of patients with Brugada syndrome. Therefore, we report one case of regional anaesthesia and one case of general anaesthesia in patients with Brugada syndrome. Case report Case 1A 33-year-old man was presented for an emergency orthopaedic operation due to open fracture of the patella. One year ago, before admission, Brugada syndrome was diagnosed in routine cardiologic evaluation. He had no past history of syncope and there was no family history of sudden death. On admission, a physical examination revealed no abnormal findings except ECG findings showing the coved-type ST segment elevation in leads V 1 to V 3 with a right bundle branch block (Fig. 1). Echocardiography showed a normal heart with an ejection fraction of 60%. Electrophysiology study revealed normal sinus node function, but non-sustained ventricular tachycardia was induced by electric ventricular stimulation.Having been informed of the associated risks, the patient was taken to the operating room and routine monitors were applied. A radial arterial cannula was inserted under local anaesthetic. Prior to the induction of anaesthesia, an external defibrillator was prepared. Spinal tapping was carried out at the L4/5 space in right lateral position. Afterwards, 0.5% bupivacaine hydrochloride 10 mg was injected intrathecally and satisfactory spinal block was achieved up to the T 10 dermatome.During the operation, ECG and continuous blood pressure were monitored and showed no abnormalities.After a 2-h operation, the patient was transferred to the post anaesthetic care unit (PACU) and postoperative pain was controlled with intravenous patientcontrolled analgesia (PCA) using opioids and NSAID. Postoperative recovery was uneventful. Case 2A 56-year-old male with L 1 vertebral body compression fracture scheduled for spine fusion under general anaesthesia. His preoperative 12-lead ECG showed a complete right bundle branch block and ST segment elevation (Fig. 2). There was no family history of sudden death. Several years ago, before admission, he had one history of syncope attack. Echocardiogram showed no s...

Dynamic and delayed MR imaging can be useful for predicting depth of cancer invasion, perigastric infiltration (extraserosal invasion), and perigastric organ invasion by gastric cancer.

We found four distinct subtypes with different clinical/biochemical findings and asthma exacerbations in a NERD cohort. These findings suggest that stratified strategies by applying subtype classification may help achieve better outcomes in the management of NERD.

Peroral intubation of a self-expanding coil stent using a long delivery system is a safe and effective palliative technique for unresectable malignant gastric outlet obstruction, and significantly improves the quality of life of patients.

During laparoscopic hepatic resection, an abrupt decrease in FE'CO 2 (from 28 mmHg to 9 mmHg) associated with near cardiac arrest occurred concomitantly with hepatic vein laceration and the use of an argon beam coagulator system. During venous gas embolism, transesophageal echocardiography (TEE) proved the transpulmonary passage of the gas. In the post-operative period, the patient developed pulmonary edema and made a full recovery after 5 days. This is a case report of a possible paradoxic carbon dioxide (CO 2 ) and argon gas embolism by transpulmonary passage during laparoscopic hepatic resection. Accepted for publication 19 April 2007Key words: Venous gas embolism; Argon beam coagulation system; laparoscopy. used in laparoscopic procedures, there is a risk of CO 2 and/or argon gas embolism (1-3). During venous gas embolism, systemic embolization by transpulmonary passage is a rare occurrence; however, it can occur when the filtering capacity of the lungs for venous gas embolism is impaired (4-7). To the best of our knowledge, this is a rare case of CO 2 and argon gas systemic embolization by transpulmonary passage which was proved by transesophageal echocardiography (TEE). Case reportA female patient (61 years, 62 kg, ASA II) underwent resection of the left lobe of the liver for a stone in the intrahepatic duct. She had no specific medical illness on routine laboratory testing. The patient was premedicated with glycopyrrolate [0.2 mg intravenously (i.v.)]. Anesthesia was induced with thiopentone and was maintained with 1.0-2.0 vol% isoflurane in 50% oxygen with air. The fresh gas flow was 4 l/min. Muscle relaxation was carried out with rocuronium. Ventilation was mechanically controlled and adjusted to maintain an end-tidal concentration of carbon dioxide (FE' CO2 ) between 35 and 45 mmHg throughout surgery with a positive end-expiratory pressure (PEEP) of 5 cm H 2 O. Arterial blood pressure was monitored invasively from the right femoral artery, and oxygen saturation with a pulse oximeter (SpO 2 ). Central venous pressure (CVP) was measured intermittently through an indwelling catheter. After the induction of anesthesia, arterial blood gas analysis was normal. Four trocars were inserted and connected to the carbon dioxide source and were insufflated into the abdomen. Intra-abdominal pressure was regulated to less than 12 mmHg. The operation was performed in the head-up position. During dissection, the surgeon used an ABC system (Force Argon TM II; Valleylab TM , Boulder, CO). Three hours after the start of the operation, an abrupt decrease in FE'CO 2 (from 28 mmHg to 9 mmHg) and SpO 2 (from 100% to below 50%) was noted. After a few seconds, systolic blood pressure decreased from 120 mmHg to near zero, and heart rate fell from 75 beats/min to near zero. A gas embolism was suspected, and the surgeon was informed. They acknowledged the laceration of the left hepatic vein. The CO 2 gas was disconnected and 0.4 mg of atropine and 1 mg of epinephrine were given through the CVP catheter. For a moment, the lungs wer...

This study considers non-contact methods that obviate the causes of measurement error, such as thermal contact resistance and the unnecessary destruction of samples. Among the methods, the photothermal deflection method has been adopted and developed to measure the thermal conductivities of thin-film materials. To apply the developed method for thin films, bi-layered materials are manufactured by depositing the film on Corning 7740 glass plates. The study also investigates the optimal modulation frequency, as related to the thermal diffusion length of the sample, for measuring thermal conductivities of thin films.. Aluminum, TiO 2 , and Si 3 N 4 films with micro/nanometer thickness were selected as the objects for measurement; the thermal conductivities of these films were experimentally measured. Samples of thickness ranging from 1 ㎛ to 200 ㎚ were prepared to measure the variations in thermal conductivities with thickness. It was observed that the thermal conductivity in submicroscale films decreased as the thickness was reduced.

SUMMARYFree-living Naegleria fowleri causes primary amoebic meningoencephalitis (PAM) in humans and animals. To examine the effect of immunization with Nfa1 protein on experimental murine PAM because of N. fowleri, BALB ⁄ c mice were intra-peritoneally or intra-nasally immunized with a recombinant Nfa1 protein. We analysed Nfa1-specific antibody and cytokine induction, and the mean survival time of infected mice. Mice immunized intra-peritoneally or intra-nasally with rNfa1 protein developed specific IgG, IgA and IgE antibodies; the IgG response was dominated by IgG1, followed by IgG2b, IgG2a and IgG3. High levels of the Th1 cytokine, IFN-c, and the regulatory cytokine, IL-10, were also induced. The mean survival time of mice immunized intra-peritoneally with rNfa1 protein was prolonged compared with controls, (25AE0 and 15AE5 days, respectively). Similarly, the mean survival time of mice immunized intra-nasally with rNfa1 protein was 24AE7 days, compared with 15AE0 days for controls.