Effect of low-frequency rTMS on motor neuron excitability after stroke.

OBJECTIVES: The purpose of this study was to test the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the non-lesional hemisphere on motor neuron excitability of the paretic upper limb in post-stroke patients by electrophysiological examination. MATERIALS AND METHODS: Thirteen post-stroke patients with spastic upper limb hemiparesis were studied (age, 57.5 ± 11.1 years; time after stroke, 55.2 ± 51.4 months). Low-frequency rTMS of 1 Hz was applied for 20 min to the motor cortex of the non-lesional hemisphere. The M-response amplitude and F-wave parameters were recorded in the abductor pollicis brevis muscle following stimulation of the median nerve in both the affected and unaffected upper limbs. The F-wave frequency, F-max/M ratio (ratio of maximum F-wave amplitude to M-response amplitude), and F-mean/M ratio (the ratio of mean F-wave amplitude to the M-response amplitude) were measured before and after the 20-min rTMS, analyzed for both limbs. RESULTS: Application of low-frequency rTMS did not result in significant changes in the frequency of F-wave and F-max/M ratio in both upper limbs, but significantly decreased F-mean/M ratio in the affected upper limb (P < 0.005), but not in the unaffected limb. CONCLUSIONS: Low-frequency rTMS applied to the non-lesional hemisphere might be potentially useful therapeutically for post-stroke patients with spastic upper limb hemiparesis.

High-frequency rTMS using a double cone coil for gait disturbance.

OBJECTIVE: It is difficult to stimulate leg motor areas with magnetic current using a figure-of-eight coil due to the deep anatomical location of the areas. However, a double cone coil is useful for stimulating deep brain regions. We postulated that the use of the same coil may allow repetitive transcranial magnetic stimulation (rTMS) to modulate the neural activity of the same areas. The purpose of this study is to investigate the effect of high-frequency rTMS applied over bilateral leg motor areas with a double cone coil on walking function after stroke. MATERIALS AND METHODS: Eighteen post-stroke hemiparetic patients with gait disturbances attended two experimental sessions with more than 24 h apart, in a cross-over, double-blind paradigm. In one session, high-frequency rTMS of 10 Hz was applied over the leg motor area bilaterally in a 10-s train using a double cone coil for 20 min (total 2,000 pulses). In the other session, sham stimulation was applied for 20 min at the same site. To assess walking function, walking velocity, and Physiological Cost Index (PCI) were evaluated serially before, immediately after, and 10 and 20 min after each stimulation. RESULTS: The walking velocity was significantly higher for 20 min after stimulation in the high-frequency rTMS group than the sham group. PCI was lower in the high-frequency rTMS group than the sham group, but this was significant only immediately after stimulation. CONCLUSIONS: High-frequency rTMS of bilateral leg motor areas using a double cone coil can potentially improve walking function in post-stroke hemiparetic patients.

Life after incarceration: The impact of stability on formerly imprisoned Oxford House residents.

According to the National Institute on Drug Abuse, roughly 65% of the US prison population is diagnosed with a substance use disorder (SUD) and over 600,000 individuals are released from incarceration yearly. Thus, it is important to better understand the factors that allow individuals recovering from SUD to reintegrate into communities after incarceration. This study sought to understand the relationship between a personality mediator (stability) and quality of life (QOL) and belonging support (BS), as well as the relationship between this mediator and QOL and psychological sense of community (PSOC) for 131 individuals living in Oxford House (OH) recovery homes. Stability was found to mediate the relationship between BS and QOL, as well as PSOC and QOL. The findings suggest that OH is a supportive and positive recovery community for those with criminal justice backgrounds, particularly those with higher stability.

Changes in regional cerebral blood flow in the right cortex homologous to left language areas are directly affected by left hemispheric damage in aphasic stroke patients: evaluation by Tc-ECD SPECT and novel analytic software.

BACKGROUND: The objective of this study was to clarify the influence of regional cerebral blood flow (rCBF) changes in language-relevant areas of the dominant hemisphere on rCBF in each region in the non-dominant hemisphere in post-stroke aphasic patients. METHODS: The study subjects were 27 aphasic patients who suffered their first symptomatic stroke in the left hemisphere. In each subject, we measured rCBF by means of 99mTc-ethylcysteinate dimmer single photon emission computed tomography (SPECT). The SPECT images were analyzed by the statistical imaging analysis programs easy Z-score Imaging System (eZIS) and voxel-based stereotactic extraction estimation (vbSEE). Segmented into Brodmann Area (BA) levels, Regions of Interest (ROIs) were set in language-relevant areas bilaterally, and changes in the relative rCBF as average negative and positive Z-values were computed fully automatically. To assess the relationship between rCBF changes of each ROIs in the left and right hemispheres, the Spearman ranked correlation analysis and stepwise multiple regression analysis were applied. RESULTS: Globally, a negative and asymmetric influence of rCBF changes in the language-relevant areas of the dominant hemisphere on the right hemisphere was found. The rCBF decrease in left BA22 significantly influenced the rCBF increase in right BA39, BA40, BA44 and BA45. CONCLUSIONS: The results suggested that the chronic increase in rCBF in the right language-relevant areas is due at least in part to reduction in the trancallosal inhibitory activity of the language-dominant left hemisphere caused by the stroke lesion itself and that these relationships are not always symmetric.

Sleep during low-frequency repetitive transcranial magnetic stimulation is associated with functional improvement in upper limb hemiparesis after stroke.

Many studies have reported that repetitive transcranial magnetic stimulation (rTMS) is beneficial for post-stroke patients with upper limb hemiparesis. It was reported that application of rTMS during sleep could possibly strengthen neural plasticity. The purpose of this study was to investigate the relationship between sleep during low-frequency rTMS session and improvement of motor function in affected upper limb in post-stroke patients after inpatient rehabilitation combined with rTMS using the bispectral index (BIS) monitor. During 15-day hospitalization, each patient received rTMS and intensive occupational therapy. Low-frequency rTMS with 1 Hz was applied over the contralesional motor cortex. During rTMS session, adhesive sensor was put on each patient's forehead and connected to the BIS monitor. The mean score for the maximum change of BIS values during each rTMS session (ΔBIS) was calculated. We regarded the patients with and over 10 of mean ΔBIS as Asleep group and under 10 as Awake group. Fugl-Meyer assessment (FMA) and Action Research Arm Test (ARAT) were evaluated on admission and discharge. Awake group included six patients and Asleep group included seven patients. There was no significant difference in clinical characteristics and in increase of FMA between two groups. Asleep group was significantly superior to Awake group in the increase of ARAT (p < 0.05). There was a significant correlation between the mean of ΔBIS and increase of ARAT (ρ = 0.78, p = 0.002). Sleep during low-frequency rTMS may contribute to improvement of motor function in the affected upper limb.

Influence of Er, Cr: YSGG (2780 nm) and Nanosecond Nd: YAG Laser (1064 nm) Irradiation on Enamel Acid Resistance: Morphological and Elemental Analysis.

BACKGROUND: Enamel demineralisation is an initial step of the serious dental problem including dental caries, white spot lesions and dental erosion. AIM: Compare the effect of Er, Cr: YSGG (λ = 2780 nm) and nanosecond Nd: YAG (λ = 1064 nm) laser on enamel acid resistance. MATERIAL AND METHODS: Thirty non-carious human premolars, extracted for orthodontic reasons, were used. The experimental groups (n = 10 each group) were: Group I, untreated (control); Group II, Er, Cr: YSGG laser irradiation (0.75 W, 20 Hz, 140 µs, 10 s); Group III, nanosecond pulsed Nd: YAG laser irradiation (0.8 W, 10 Hz, 7 ns, 10 s). Scanning electron microscope and Energy Dispersive X-ray Spectroscopy (EDX) were used to assess acquired enamel resistance to PH cycling. RESULTS: After subjecting the three experimental groups to PH cycling, scanning electron microscopic examination revealed irregular porous dissoluted enamel surface in group I. However, groups II and III demonstrated partially dissoluted enamel surface. EDX analysis demonstrated the lowest mean percentage decrease in calcium and phosphorus content in group II followed by group III, then the highest mean percentage decrease was observed in untreated group I. One-way ANOVA revealed significant differences (p < 0.0001) between the tested groups. CONCLUSIONS: Both Er, Cr: YSSG and nanosecond Nd: YAG laser irradiation were able to improve the acid resistance of enamel. However, enamel surface treated with Er, Cr: YSSG laser showed the lowest mean percentage decrease of calcium and phosphorus (highest acid resistance).

Formation and properties of a covalent complex between elongation factor Tu and Phe-tRNA bearing a photoaffinity probe on its 3-(3-amino-3-carboxypropyl)uridine residue.

Escherichia coli Phe-tRNA, modified with the photoaffinity reagent 6-(2-nitro-4-azidophenylamino)caproate on the 3-(3-amino-3-carboxypropyl)uridine residue, was crosslinked to E. coli EFTu Section upon irradiation at 0 degree C with visible light at wavelengths greater than 400 nm. Crosslinking was dependent on irradiation, the photoaffinity probe, and was blocked by pre-photolysis. 1 mM-dithiothreitol completely quenched crosslinking. Binding of the tRNA to EFTu was a prerequisite for crosslinking, because neither EFTu . GDP nor AcPhe-tRNA could substitute; EFTu . GDPCP, however, was almost as active as EFTu . GTP. Crosslinking was complete in less than five minutes and was stable to at least 20 minutes of irradiation with a single 650 W tungsten lamp 4 cm away. The crosslinking yield ranged from 15% to 25%. The crosslinked complex possessed several remarkable properties. At 0.5 mM-Mg2+, the complex protected the AA-tRNA link to chemical hydrolysis, stabilized the bound GTP to dissociation or exchange, and was not adsorbed to cellulose nitrate filters. The purified crosslinked complex could be bound to ribosomes with concomitant hydrolysis of GTP. Extensive peptide bond formation with AcPhe-tRNA in the P site occurred despite the presence of the crosslinked EFTu. We conclude that hydrolysis of GTP is sufficient to release the 3' end of the Phe-tRNA from complexation with EFTu. Translocation of the A site bound complex did not occur. The crosslink site on EFTu is probably near the periphery of the molecule, because shortening the probe from 20 A to 14 A completely blocked crosslinking. A similar but shorter 8 A probe, p-azidophenacyl-4-thiouridine located on the opposite face of the tRNA, did not crosslink.

Efficiency and efficacy of multi-channel gastric electrical stimulation.

Gastric electrical stimulation (GES) using single channel has been under investigation for its therapeutic potential for gastroparesis. The aim of this study was to study the efficacy and efficiency of multi-channel GES in accelerating gastric emptying in dogs. The study was performed in eight dogs, and gastric emptying of liquid was assessed in three randomized sessions of control, one-channel GES and four-channel GES. It was found that (i) GES of both one-channel and four-channel was able to completely entrain the slow waves in the entire stomach. However, the stimulation energy required by four-channel GES was only 1% of that required by one-channel GES. (ii) Four-channel, but not one-channel, GES significantly and substantially accelerated gastric emptying. An increase of 121.0 and 93.9% was noted with four-channel GES at 30 and 60 min after the meal, respectively. It was concluded that four-channel GES is substantially more efficient and effective than conventional single-channel GES in improving gastric emptying. It is worthy to explore its therapeutic potential for gastroparesis in clinical settings.

Hand-assisted laparoscopic and thoracoscopic surgery (HALTS) in radical esophagectomy with three-field lymphadenectomy for thoracic esophageal cancer.

AIM: To prove the feasibility of hand-assisted laparoscopic and thoracoscopic surgery (HALTS) for radical esophagectomy with three-field lymphadenectomy to thoracic esophageal cancer. METHODS: Esophagectomy with three-field lymphadenectomy was performed using HALTS in 19 patients with thoracic esophageal cancer without distant metastasis. Five patients had chemo-radiotherapy prior to surgery. RESULTS: All operations were completed successfully without the need for open surgery. Mean surgical time was 476+/-58 min, and mean blood loss during surgery was 343+/-184 mL. All patients started tube feeding and were moved from the intensive care unit to the general surgery ward the day after surgery. Discharge occurred a median of 10 days after surgery. Fifteen patients could return to full time jobs from 8 to 62 days after surgery (median 22 days) and from 1 to 35 days after discharge (median 9 days). Other three could return to daily activities at home soon as well. No major complications occurred, except one anastomotic leak. In terms of lung function, %FEV(1) was not changed whereas %VC was reduced significantly 1 month after surgery. All but two recurrences have been healthy without a relapse for a mean of 289 days. CONCLUSIONS: These results suggest that HALTS may be a useful surgical technique to reduce the invasiveness of conventional radical esophagectomy with three-field lymphadenectomy for thoracic esophageal cancer.

Species- or isozyme-specific enzyme inhibitors. 9. Selective effects in inhibitions of rat pyruvate kinase isozymes by adenosine 5'-diphosphate derivatives.

Derivatives of adenosine 5'-diphosphate (ADP) with a substituent of 1-4 atoms at any of eight positions have been synthesized and evaluated as substrates and inhibitors of the liver (L), muscle (M), and kidney (K) isozymes of rat pyruvate kinase (PK). Inhibitory potencies of the compounds were expressed as KM (ADP)/Ki or as KM (ADP)/KM when no Ki value was available. Nine of 14 ADP derivatives exhibited differential inhibitions. The M and K isozymes, which cross-react immunologically with each other but not with the L form, were inhibited differentially by 5 of the 14 derivatives. PK-K was preferentially inhibited by two derivatives, PK-L by three derivatives, and PK-M by two derivatives. Among the most selective and/or effective inhibitors were 3'-OMe-ADP [KM (ADP)/Ki = 0.07 with PK-K; inhibitory potency, K/M/L, 7.6:6.0:1], N6-Me,N6-(CH2)4N(Me)COMe-ADP (prepared previously) [KM (ADP)/KM = 0.43 with PK-L; inhibitory potency, L/K/M, 3:2:1], and 8-NHEt-ADP [KM (ADP)/Ki = 1.0 with PK-M; inhibitory potency, M/K/L, 7.1:1.2:1]. These and previous studies with two other enzymes indicate that monosubstituted substrate derivatives that bear short substituents (usually 1-4 atoms) at various positions are potentially useful probes in early stages of the attempted design of isozyme-selective inhibitors.

Species- or isozyme-specific enzyme inhibitors. 7. Selective effects in inhibitions of rat adenylate kinase isozymes by adenosine 5'-phosphate derivatives.

Monosubstituted derivatives of adenosine 5'-phosphate (AMP) with substituents of 1-3 atoms or group replacements at any of 11 positions have been synthesized and examined as substrates and inhibitors of the rat muscle adenylate kinase isozyme (AK-M), and the rat AK II and III isozymes predominant in poorly differentiated hepatoma tissue and normal liver tissue, respectively. Inhibition indexes of the compounds were expressed as KM (AMP)/Ki for competitive inhibition or as KM (AMP)/KM when only KM was available. Substituents at N(1), N6, or C(8) or on ionizable phosphate oxygen reduced inhibition below measurable levels; 2'-deoxy-AMP and adenosine 5'-sulfate had identical inhibition indexes with all three isozymes; compounds with substituents at C(2), O(2'), O(3'), C(4'), C(5'), or O(5') had higher inhibition indexes with AK-M than with AK II or III and the same or similar indexes for AK II and III. The most effective and/or selective inhibitors were 2-NHMe-AMP (index with AK-M, 0.2; index ratio, AK-M/AK III, 9.1), 2'-O-Me-AMP (index with AK-M, 0.14; index ratio, AK-M/AK III, 8.2), 2',3'-O-CMe2-AMP (index with AK-M, 0.25; index ratio, AK-M/AK II, 6.6), 4'-allyl-AMP (index with AK-M, 0.97; index ratio, AK-M/AK III, 8.1), and 5'(S)-Et-AMP (index with AK-M, 0.64; index ratio, AK-M/AK II, 11.2). The study provides additional evidence that the attachment of simple substituents to various atoms in turn of a substrate is a potentially useful approach in early stages of the attempted design of isozyme-selective inhibitors.

Use of adenine nucleotide derivatives to assess the potential of exo-active-site-directed reagents as species- or isozyme-specific enzyme inactivators. 3. Synthesis of adenosine 5'-triphosphate derivatives with N6- or 8-substituents bearing iodoacetyl groups.

Several series of N6- or 8-substituted derivatives of adenosine 5'-triphosphate (ATP) were synthesized. N6-(omega-Aminoalkyl) derivatives of adenosine 5'-monophosphate (AMP) were converted into their omega-N-carbobenzyloxy derivatives, and these were converted, via the 2',3'-O-carbonyl derivatives of their 5'-phosphorimidazolidates, into the corresponding ATP derivatives. Hydrogenolytic removal of the carbobenzyloxy groups, followed by iodoacetylation of the omega-amino groups with N-(iodoacetoxy)succinimide, gave N6-R-ATP, where R = (CH2)nNHCOCH2I (n = 2--8) or (CH2)nCON)CH3)(CH2)mN(CH3)CO(CH2)nNHCOCH2I (n = m = 3; n = 3, m = 4; n = 4, m = 3; n = m = 4). Condensation of N6-(omega-aminoalkyl) derivatives of AMP with N-hydroxysuccinimide esters of omega-[N-(carbobenzyloxy)amino] carboxylic acids gave N6-(CH2)nNHCO(CH2)mNH-Cbz derivatives of AMP which, upon conversion to the corresponding derivatives of ATP, followed by removal of the carbobenzyloxy group and iodoacetylation, as described above, gave N6-(CH2)nNHCO(CH2)mNHCOCH2I-ATP derivatives (n = 3, m = 5 or 6; n = 4, m = 5; n = 6, m = 1--6). The same sequence of reactions starting with N6-[omega-(methylamino)alkyl] derivatives of N6-CH3-AMP gave N6-CH3, N6-(CH2)nH(CH3)CO(CH2)mNHCOCH2I derivatives of ATP (n = 4, m = 3, 5 or 6; n = 6, m = 5 or 6). Reaction of alpha, omega-diaminoalkanes with 8-Br-ATP gave 8-NH(CH2)nNH2 derivatives of ATP, which upon iodoacetylation gave 8-NH(CH2)nNHCOCH2I derivatives of ATP (n = 2, 4, 6, or 8). Substrate and inhibitor properties indicated that the ATP derivatives are potential exco-ATP-site-directed inactivators of hexokinases, adenylate kinases, and pyruvate kinases.

Video-assisted thoracoscopic surgery for catamenial hemoptysis.

Catamenial hemoptysis is a rare condition, and only 36 cases have been reported since the first published case. We describe a woman with catamenial hemoptysis recurring over 8 years. The lesion was diagnosed using chest CT scan during menses and was also visualized clearly via thoracoscopy. The patient was treated successfully with a partial resection of the lung using video-assisted thoracic surgery (VATS) and has been asymptomatic for 14 months since the operation. We suggest that VATS for catamenial hemoptysis is a more effective treatment than medical therapy.

Functional recovery after brain lesion--contralateral neuromodulation: an fMRI study.

Behavioral recovery takes place even after permanent damage to the entire brain region normally controlling sensorimotor hind limb function in the rat. In our study, 2 weeks after full behavioral recovery from an experimental unilateral permanent brain damage, the topographic representation of the previous paretic hindlimb was investigated by fMRI. The analysis showed that during electrical stimulation of the previously paretic hindlimb, two normally inactive brain regions were now being activated. One region was the non-damaged contralateral sensori-motor cortex and the other region was located lateral to the lesion. These results suggest that behavioral recovery can be explained by functional reorganization and neuromodulation of the brain.

Effect of a cysteinyl leukotriene antagonist, pranlukast hydrate, on acetaldehyde-induced bronchoconstriction in asthmatic patients.

Acetaldehyde is a main factor of alcohol-induced asthma. We previously reported that the cysteinyl leukotriene (cys-LT) receptor antagonist, pranlukast hydrate, inhibits acetaldehyde-induced airway hyperresponsiveness in guinea pigs. The purpose of this study was to evaluate the involvement of cys-LT on bronchial responsiveness to acetaldehyde in asthmatic patients. We investigated the bronchial response to inhalation of acetaldehyde in 10 asthmatic patients, who were treated with placebo or pranlukast hydrate (225.5 mg), a cys-LT receptor antagonist, twice a day for 1 wk using a double-blind, randomized, placebo-controlled, cross-over design. Although a remarkable improvement of acetaldehyde bronchoconstriction was observed in 3 out of 10 subjects, PC(20)-AcCHO values were identical between placebo [12.0 (GSEM, 1.192) mg/ml] and pranlukast [14.7 (GSEM, 1.245) mg/ml] groups. The changes in bronchial responsiveness to acetaldehyde were similar in the six patients who had never experienced alcohol-induced asthma and the four who had. In conclusion, cys-LTs are not involved in acetaldehyde-induced bronchoconstriction.

Management of post-traumatic vascular malformations of the liver by catheter embolization.

Trauma to the liver occasionally produces vascular malformations, usually pseudoaneurysms of the hepatic artery and sometimes arteriovenous fistulas. Hemorrhagic complications, usually in the form of hemobilia, can result, and portal hypertension is a late complication of an arterial-portal vein fistula. The true incidence of these post-traumatic lesions is apparently much higher than previously realized, and they can regress spontaneously. A case is presented in which both complications appeared simultaneously after a stab wound to the liver. Treatment using selective arterial catheterization and embolization with thrombogenic material was successful. The literature on the use of catheter embolization in hepatic trauma is reviewed. We suggest that catheter embolization be added to the standard therapeutic armamentarium for these lesions. Selective catheter embolization is suggested as the initial therapeutic maneuver in treating both of these lesions because of the relatively low morbidity, the great precision available in limiting the area of devascularization and the good expectation of success on the basis of the reported results of this technique in other traumatized organs, as well as the initially promising reports of its use in hepatic lesions. It should be considered at the time of diagnostic arteriography.

Salt-stress-responsive membrane proteins in Rhodobacter sphaeroides f. sp. denitrificans IL 106.

The salt-mediated-stress response in Rhodobacter sphaeroides f. sp. denitrificans IL 106 was investigated by culturing cells in the presence and in the absence of NaCl in growth media. Fractionation of cells followed by SDS-PAGE and 2D-PAGE revealed an increase in the levels of membrane proteins of 39 and 50 kDa and a decrease in the level of a membrane protein of 52 kDa with increasing levels of external NaCl. The proteins were isolated and sequenced. The polypeptide of 50 kDa in the inner membrane was assigned to an ATP synthase beta chain and that of 52 kDa in the outer membrane to a flagellar filament protein. As the N terminal of the 39 kDa protein in the outer membrane was blocked, partial proteolysis was carried out and four peptides were sequenced. Each sequence exhibited no significant homology with those available in databases, suggesting that the polypeptide of 39 kDa (named SspA) is a novel salt-stress-induced protein.

Dissociation of brain edema induced by cold injury in rat model: MR imaging and perfusion studies with 14C-iodo-antipyrine.

The purpose of this study is to confirm whether T2-weighted imaging and perfusion imaging, i.e. autoradiogram of 14C-iodoantipyrine, on the course of brain edema correspond to each other or not. Cold injured rat brains were used as a model and were sequentially examined by both methods and compared with each other and with histological specimens. Special focus relies on the time changes in the lesions. High SI of T2-weighted images were observed and the percentages in the high SI area to the total brain area in the same slice were 4.7 +/- 0.31, 5.6 +/- 0.46 and 3.4 +/- 0.42 for 6, 24 and 48 hours, respectively. By contrast, low perfusion areas were indicated in the perfusion study and their percentages were 4.6 +/- 0.55, 5.6 +/- 0.86 and 2.4 +/- 0.35 for 6, 24 and 48 hours, respectively. At 48 hours after cold injury, low perfusion areas were smaller than hi

Application of capillary electrophoresis to the simultaneous determination of betaines in plants.

The simultaneous determination of betaines, the key compounds for osmotic regulation in plants, was established by capillary electrophoresis (CE). After four betaines, glycine betaine (GB), beta-alanine betaine (AB), proline betaine (PB), and 2-hydroxyproline betaine (HPB), were esterified with p-bromophenacyl bromide, the esters were electrophoresed in 100 mM sodium phosphate at pH 3.0. A low-pH condition in CE and esterification gave an advantage of resolving each of the ester peaks as well as those of the unreacted reagent and other components. Furthermore, the addition of 4% polyethylene glycol (PEG) gave a better resolution of 4 peaks, resulting in the separation of the overlapped peaks of PB and AB. It was found from the standard addition method being applied to barley leaves that the GB content in plants could be evaluated by using a calibration curve of the GB standard solution. The extraction of GB from plant leaves was also improved by adopting water as the extraction solvent instead of a mixture of organic solvents. The present method was suitably applied to actual plant specimens collected from a saline area of China.

[A case of relapsing polychondritis monitored by daily peak flow measurement].

A 55-year-old man was admitted to our hospital with dyspnea and stridor. At presentation, he also had a low grade fever, arthralgia and nasal obstruction. His chest roentgenogram showed diffuse tracheal narrowing, and chest CT revealed a thickened tracheal wall and fractured cricoid and thyroid cartilages. A diagnosis of relapsing polychondritis was made on the basis of his symptoms and in accordance with Damiani's criteria and CT findings. Daily peak flow (PEF) monitoring was carried out to assess the disease condition of the trachea. Methylprednisolone pulse therapy was started, and was followed by oral prednisolone, which improved his condition immediately, but reduction of oral prednisolone led to recurrence. The clinical course was clearly evaluated by PEF monitoring, but the change was undetectable on chest CT. Dapson, cyclophosphamide, and inhaled steroid were administered with oral prednisolone and the patient's condition has since been fair and stable. PEF monitoring may be useful for the early detection of recurrence in cases of relapsing polychondritis.