Association between caregivers' health-related quality of life and care recipients' health outcomes.

AIMS: This study aimed to investigate the relationship between family caregivers' health-related quality of life and health outcomes in care recipients. METHODS: A total of 160 female caregivers in Japan were initially assessed using self-reported baseline questionnaires to determine physical and mental aspects of their health-related quality of life. Based on these scores, they were divided into three groups: lower, middle, and higher quality of life. We followed up with the 133 participants (after excluding those that did not respond) 6 years later to assess the health of their care recipients; 36 caregivers continued to provide home care, while 97 reported that their care recipient had died or been admitted into institutionalized care. RESULTS: Statistically, a higher risk for care recipients' health deterioration was strongly associated with the mental component score in the lower caregivers' quality of life group of than for the middle group, after adjusting for the care recipients' age, health status, and caregivers' age at baseline. There was no significant association between deterioration of health of care recipients and physical component scores of the caregivers. CONCLUSION: Caregivers' poor health-related quality of life, particularly poor mental health, may be linked to the deterioration of care recipients' health.

Gastric tube insertion under direct vision using the King Vision™ video laryngoscope: a randomized, prospective, clinical trial.

BACKGROUND: The frequency of malpositioning of gastric tubes in the trachea has been reported to be 0.3-15%, which may cause severe complications, such as pneumonia, if not detected promptly. If a gastric tube can be guided into the esophagus under direct vision with a video laryngoscope, misplacement of the gastric tube into the trachea can be avoided. We compared gastric tube insertion under direct vision using a video laryngoscope with the conventional method of blind insertion. METHODS: We enrolled 60 patients who required a transnasal gastric tube to facilitate elective abdominal surgery under general anesthesia. The participants were recruited consecutively into one of two groups, a group of 30 patients in whom a gastric tube was inserted using a King Vision™ video laryngoscope (KV group), and a group of 30 patients who underwent conventional blind insertion of the gastric tube (Blind group). The success rate, the time taken to insert the gastric tube, and the incidence of complications were compared. RESULTS: In the KV group, the time required for gastric tube placement was 52.5 ± 17.1 seconds, with a success rate of 100%. Slight oral hemorrhage occurred in two participants and slight epistaxis in one participant. In the Blind group, the time required for gastric tube placement was 65.9 ± 39.9 seconds, with a success rate of 90% (27 out of 30 patients). Slight oral hemorrhage occurred in two participants, slight epistaxis occurred in two participants, and tracheal malposition occurred in one participant but was detected promptly and corrected using the video laryngoscope. There were no significant differences in the time required for placing the gastric tube, the success rate, or the incidence of complications between the groups. CONCLUSIONS: Gastric tube insertion using a King Vision video laryngoscope was straightforward, and was particularly useful for detecting and correcting tracheal malpositioning. TRIAL REGISTRY NUMBER: UMIN000011014.

Characteristics of hypertension-related factors in female home caregivers in Japan-comparison with general community non-caregivers.

AIMS AND OBJECTIVES: To examine the characteristics of hypertension-related factors in female family caregivers in Japan who provide care in the home, in comparison with general community non-caregivers. BACKGROUND: Hypertension is more frequently encountered in female caregivers than in non-caregivers. Lifestyle factors including sleep and eating habits differ in Japanese female caregivers and the general population. Therefore, hypertension-related factors in caregivers may also differ from those in the general population. DESIGN: A cross-sectional study. METHODS: The subjects were 150 female caregivers (aged 62·4, SD 12·2 years) who provided home care for persons with physical impairments and/or dementia and 154 female controls (aged 62·7, SD 2·2 years) who did not provide home care. Persons with a history of ischaemic heart disease or cerebral stroke were excluded. Subjects were examined using a self-reporting questionnaire that included a food frequency questionnaire and the tri-axial coping scale. Urine examinations and blood pressure measurements were also done. Logistic regression analysis was conducted for each group with the same variables as explanatory variables. RESULTS: Hypertension was present in 46·7% of caregivers and 34·4% of controls (p<0·05). Menopause was a factor related to hypertension in both the caregivers and controls. In the caregiver group, hypertension was associated with the estimated 24-h Na excretion in urine and the carbohydrate-energy ratio for nutriti. BMI was associated with hypertension in the control group, but not in the caregiver group. CONCLUSIONS: Hypertension was associated with nutritional factors, such as greater Na excretion in urine and higher carbohydrate energy ratio, in Japanese female caregivers and with obesity in non-caregivers. RELEVANCE TO CLINICAL PRACTICE: To prevent hypertension, it is necessary to carefully monitor salt intake and nutritional balance in female caregivers in Japan.

Prevalence of Helicobacter pylori infection measured with urinary antibody in an urban area of Japan, 2008-2010.

Helicobacter pylori (H. pylori) has expanded to infect about half the world's population. Although there were many studies on the prevalence of H. pylori infection for defined areas in the 1990s throughout the world, there were only limited sources tracking its latest prevalence among large populations. In the present study, we estimated the prevalence of H. pylori among the inhabitants of Nagoya, an urban area of Japan. Study subjects were 5167 participants (1467 males and 3700 females) aged 35 to 69 years from the Daiko Study, a part of the Japan Multi-Institutional Collaborative Cohort Study (J-MICC Study). A urinary anti-H. pylori antibody was used to detect H. pylori infection. The history of eradication treatments for H. pylori infection was obtained using self-administered questionnaires. The prevalence detected by the urinary test included 19.6% (95% confidence interval; 16.8-22.6%) for those aged 35-39 years, 25.8% (23.5-28.2%) for 40-49 years, 39.4% (36.8-42.1%) for 50-59 years, 50.3% (47.8-52.7%) for 60-69 years, and 36.4% (35.1-37.7%). Among 5167 participants, 266 (5.1%) stated that they had received an eradication treatment. Since 167 subjects with negative urinary tests replied that they had been seropositive for H. pylori in the past, they were included among the ever-infected inhabitant group. Consequently, the overall rate of those with a history of persistent infection was 39.6% (38.3-40.9%). The prevalence of H. pylori infection observed in Nagoya seemed to be lower than the corresponding prevalence reported in other studies of Japan. That lower rate might be due to the reduced exposure from improved urban sanitary conditions.

Physical and psychological health problems among Japanese family caregivers.

The authors commenced research in 2005 with the goal of on constructing a health support system for primary caregivers. This ongoing study aims to develop a health support program and construct a system of regional assistance based on examining the health situation of family caregivers. Furthermore, it aims to present proposals that will put the minds of citizens at ease in respect to their ability to live in a super aging society. A survey was conducted with 213 male and female caregivers and a control group of 477 community residents not engaged in care. This paper collates the various research findings reported in journals and conference presentations by the authors. Among both male and female caregivers, blood pressure levels required regulation. Among female caregivers, grip strength and musculoskeletal symptoms were worse than those in the control group, even when participants were matched for age. We attempted to determine the characteristics of caregivers who have strong feelings of responsibility and obligation toward their provision of care. Age was a significantly higher factor in the group with stronger feelings in that regard. The group with weaker feelings of responsibility and obligation was younger. The percentage of participants who were caring for a spouse, living with a spouse, had no secondary caregivers, or were providing all-day care, was significantly higher in the group with stronger feelings of responsibility and obligation. There was no significant difference between the groups in the mean total score on the J-ZBI-8 that measures burden of care. As the aging population of Japan grows larger, support for caregivers with physical and psychological health problems, and at the very least, concern of government administrators and the general public, will assume greater importance.

Study profile on baseline survey of Daiko Study in the Japan Multi-Institutional Collaborative Cohort Study (J-MICC Study).

The Japan Multi-Institutional Collaborative Cohort Study (J-MICC Study) is a long-term cohort study to investigate the interactions among genotypes, lifestyles, and lifestyle-related diseases, especially cancer. This article reports the outline of the baseline survey of the Daiko Study, one site of the J-MICC Study. That survey was conducted between June 9, 2008 and May 31, 2010 at the Daiko Medical Center of Nagoya University in Nagoya, Japan. Subjects were registered residents of Nagoya City aged 35 to 69 years who had not participated in other J-MICC sites. Recruitment was mainly announced through leaflets distributed in mailboxes citywide, personal communications, and regional information, such as posters in public or commercial facilities. Participants provided blood plasma, serum, buffy coat, urine, and data on health check-ups. They also completed a self-reported questionnaire on lifestyle, disease history, family history, and for women, reproductive history. As of the end of September 2010, 4 out of 5172 registered participants had withdrawn from the study, leaving data from 5168 participants (1467 males and 3701 females) available for analysis. Mean age +/- standard deviation (SD) was 52.5 +/- 10.3 years. Current smokers accounted for 24.1% (n=354) of males and 6.9% (n=256) of females. Current drinkers included 74.9% (n=1099) of males and 45.9% (n=1699) of females. Lifestyle data and specimens were successfully collected to examine any associations among disease biomarkers, lifestyles, and genotypes.

[Subjective physical and mental health characteristics of male family caregivers].

OBJECTIVES: Due to the increased population of elderly people requiring care and assisted living care, as well as changes in the social structure, the number of males playing a role in home care has therefore been increasing each year. The purpose of this study was to clarify characteristics related to subjective mental and physical health of male family caregivers based on a comparison with male non-caregivers. METHODS: The subjects comprised 52 male family caregivers (caregiver group) who provide care for those requiring at-home care at level 3 or above, or who provided care for people with dementia in cases at a level below 3, with an average age and standard deviation of 69.3 +/- 10.9 years old. The comparison group comprised 52 people who underwent regular health checkups in K city, whose gender and ages, by 10-year age group, were matched to the subjects on a 1:1 basis, and whose average age and standard deviation were 69.2 +/- 11.1 years old. The research was conducted over ther period from December 2005 to April 2007. The survey was conducted with a self-answering format, and subjects were asked questions about such matters as lifestyle, QOL, psychosocial stress and coping with stress. RESULTS: The average age of people requiring care was 75.7 +/- 9.5 years old, and it became apparent that elderly caregivers generally provide care for other elderly people. In a health-related QOL (SF-8), care-giver group were significantly low in "General Health" and "Bodily Pain" in the physical health domain. In the mental health domain, "Mental Health" and mental health summary score of the care-giver group were significantly low. Regarding lifestyle, it was apparent that the care-giver group had significantly fewer sleeping hours than the control group and the PSQI score was also lower. Coping scores were significantly low for the caregiver group regarding 2 items, "Evasive Thinking" and "Recreation", and this indicated a tendency toward not adopting an evasive type of coping. CONCLUSION: It became clear that male caregivers have low subjective health and experience problems about sleep and stress. In addition, they tended not to take coping of evasion type and a need of comprehensive support was suggested.

[Blood pressure control through awareness of hypertension among female in-home caregivers].

OBJECTIVES: Our purpose was to clarify the situation regarding blood pressure control through awareness of hypertension among female groups of in-home caregivers and non-caregivers. METHODS: We used one existing data generated between December 2005 and April 2007. The subjects were females who were suffering from hypertension (66 caregivers were aged 49-84 years; 52 non-caregivers were aged 47-81 years). We defined persons suffering from hypertension on the basis of results of a self-administered questionnaire and blood pressure values. On the question of awareness of hypertension, we defined the persons who replied positively to any one of "I have hypertension," "I have suffered from hypertension," or "I take antihypertensive agents" as belonging to the "awareness group." We categorized the other respondents, who replied to all three questions in the negative as belonging to the "non-awareness group." We used blood pressure values, to build an index of the control with the chi2 test and the t-test for statistical comparisons. Values of P < 0.05 were considered statistically significant. RESULTS: The results showed that blood pressure values of caregivers in both the awareness group and the non-awareness group were high (awareness group vs non-awareness group overall SBP: 148 +/- 20 mmHg vs 154 +/- 9 mmHg, DBP: 79 +/- 13 mmHg vs 82 +/- 10 mmHg, P > 0.05). Furthermore, values were significantly lower for the awareness than non-awareness group with respect to the non-caregivers (SBP: 135 +/- 15 mmHg vs 149 +/- 7 mmHg, DBP: 73 +/- 10 mmHg vs 78 +/- 6 mmHg). Caregivers who took the antihypertensive agent in the awareness group demonstrated high values exceeding SBP 140 mmHg, which was the hypertensive standard value, not different from the values for caregivers not taking such medication. (taking vs non-taking SBP: 148 +/- 21 mmHg vs 149 +/- 8 mmHg). CONCLUSION: Among the caregivers, it was not only the members of the non-awareness group but also those of the awareness group who were found to have high blood pressure values. Though the caregivers took antihypertensive agents, their blood pressure values remained high.

Multilevel analyses of effects of variation in body mass index on serum lipid concentrations in middle-aged Japanese men.

For the effective use of the annual workplace health checkup data, we tried to perform multilevel analyses to explore whether the year-to-year weight variation causes any concurrent effects on the lipid profiles among middle-aged Japanese workers. Subjects were 1939 healthy male workers 40-59 in age from whom serial data of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) were collected during health checkups conducted in the years 1997-2000. The effects of body mass index (BMI) on serum concentrations of those lipids were investigated by statistical analysis with multilevel modeling to distinguish multiple levels of information with individual repeated measurements within individuals. A significant increase of TC and TG, and decrease of HDL-C with BMI increase were confirmed. Subanalyses according to both the baseline BMI status (< 25 kg/m2 or > or =25 kg/m2) and smoking status (never, former, or current) yielded the same BMI-dependent changes of lipid profiles, but obese never smokers failed to show significant effects of BMI on HDL-C concentrations. Multilevel analyses of annual health checkup data linked at individual levels indicated that year-to-year weight variation, though usually in a much narrower range than the between-individual variation, had a strong impact on the corresponding changes of serum concentrations of TC, HDL-C, and TG. This result supports the public health significance of intervention into weight control to prevent the development of atherogenic risks among a healthy workplace population.

Three-dimensional computed tomography imaging of the eustachian tube lumen in patients with patulous eustachian tube.

BACKGROUND: The eustachian tube (ET) has a complicated anatomy, which is related to middle ear pathology. The anatomy of the ET has been well investigated in cadavers, but may not accurately reflect that in living subjects. Three-dimensional (3D) computed tomography (CT) was used to examine the ET in patients with patulous ET. METHOD: The subjects were 35 patients (17 males, aged 59 +/- 16 years, and 18 females, aged 44 +/- 15 years) with patulous ET which could be continuously traced from the pharyngeal orifice to the tympanic orifice (53 ears). CT was performed in the sitting position at rest, followed by 3D reconstruction. The course of the ET from the middle ear to the pharynx was visualized in 3D surface images. Morphological measurements of the curvature angle (angle C) and the inclination angle (angle I) were determined from 3D coordinates on the CT images. RESULTS: The full length of the ET could be visualized in most patients suffering from patulous ET in the sitting position. Angle C was 21.7 +/- 5.8 degrees in the patients aged <40 years (n = 20), which is significantly larger than 16.7 +/- 6.8 degrees in the patients aged >59 years (n = 18; Student's t test, p < 0.05). Angle I was 26.5 +/- 4.2 degrees in the patients aged <40 years (n = 20), also significantly larger than 21.6 +/- 5.8 degrees in the patients aged >59 years (n = 18; Student's t test, p < 0.05). CONCLUSION: CT in the sitting position is a potential diagnostic tool of the ET and middle ear pathology.

[Physical and mental health characteristics of female caregivers].

OBJECTIVE: In Japan, research into physical conditions or illnesses of female caregivers focusing on biological markers in biological materials such as blood and urine has been limited. Therefore, the present study was conducted to clarify the physical and mental characteristics of female caregivers in comparison with the general population, using biological markers and self-answered questionnaires. METHODS: The subjects were 161 female in-home primary caregivers for persons requiring care at level 3 or more or less than 3 if suffering from dementia (caregiver group). The control group consisted of females matched 1 : 1 in the same decade of life who received medical checkups in K city. The survey period was from December 2005 to April 2007. The methods were self-answered questionnaires, including lifestyle, caregiving conditions, the Pittsburgh Sleep Quality Index (PSQI) and frequency of taking food, and common parameters for lifestyle diseases using blood and urine and blood pressure, taken by trained investigators at the subjects homes. RESULTS: Average age was 62.8 +/- 11.9 years in the caregiver group and 63.2 +/- 12.4 years in the control group. 46.0% had 5 or more years experience in caregiving and 8.7% had less than 1 year. The required care level most common was 5 at 33.8%, with levels 3 and 4 the next most common. 46.0% of the caregiver group had hypertension, significantly higher than the 34.2% in the control group. The prevalence of glucose intolerance and hypo-HDL-cholesterolemia was also high in the caregiver group, but without significant difference. The caregiver group had lower HDL-cholesterol values than the control group. In lifestyle, the two groups differed in exercise, PSQI, proportion of energy from carbohydrates and estimated 24-hour excretion of sodium (Na) in urine. In particular, it was clear that Na was undesirable for caregiver,s even using urine samples for examination. Although more in the caregiver group described themselves as unhealthy, fewer of them received annual health checkups than in the control group. More in the caregiver group felt stress about their health or aging or depression, with few opportunities for diversion. CONCLUSIONS: Hypertension, the most important risk factor for brain and cardiovascular disease, is significantly high in caregivers, suggesting the need for preventive measures. Similar findigns were also obtained with other biological markers and more in the caregiver group felt stress about their health or aging or depression, pointing to a nee for health support.

Magnetic resonance imaging of the eustachian tube cartilage.

CONCLUSION: No useful examination was available for morphological assessment of the eustachian tube cartilage (ETC) in living subjects, but evaluation of magnetic resonance (MR) imaging enables useful assessment of the eustachian tube (ET) and ETC during preoperative examination before ET surgery. OBJECTIVES: The objective of this study was to investigate the usefulness of MR imaging for analysis and assessment of the ETC. SUBJECTS AND METHODS: Analysis of MR images. RESULTS: The ETC could be demonstrated by oblique parasagittal MR imaging in most subjects, but was poorly defined in others, particularly in aged subjects. The ETC appeared as a hook-shaped structure with wide variability.

Three-dimensional computed tomography imaging in the sitting position for the diagnosis of patulous eustachian tube.

OBJECTIVE: Computed tomography (CT) in the sitting position was useful for detecting patulous Eustachian tube (ET). STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: Eighty-seven patients divided into two groups. The patulous ET group consisted of 111 ears of 67 patients with patulous ET. The control group consisted of 30 ears of 20 patients without symptoms characteristic of patulous ET or abnormal findings in ET function tests. MAIN OUTCOME MEASURES: CT was performed under the resting condition and during Valsalva maneuver (Valsalva condition). The multiplanar reconstruction technique was used to reconstruct 1-mm-thick gapless images parallel to and perpendicular to the ET long axis. The open tubal distance (OTD) and average ET-gram were examined. RESULTS: The OTD was significantly longer in the patulous ET group than in the control group under both resting and Valsalva conditions (both p < 0.001). The OTD was also significantly longer under the Valsalva condition than under the resting condition in both groups (p < 0.01 in the patulous ET group, p < 0.001 in the control group). The average ET-gram showed an occlusive zone in the cartilaginous portion medial to the isthmus under both the resting and Valsalva conditions in the control group (n = 30). However, the occlusive zone could not be observed under either the resting or Valsalva conditions in the patulous ET group (n = 111). Completely patent (open) ET was observed with continuous hyperlucency from the pharyngeal to the tympanic orifices in 88 of 111 patients in the patulous ET group, but in none of the control group, indicative of 100% specificity. CONCLUSION: Computed tomography in the sitting position employing Valsalva maneuver is useful for the diagnosis of patulous ET.

Involvement of pterygoid venous plexus in patulous eustachian tube symptoms.

CONCLUSIONS: The pterygoid venous plexus (PVP) is an important factor in the mechanism of eustachian tube (ET) closure under conditions that can cause increased venous pressure in the head, such as during neck compression and postural change from the sitting/standing to the recumbent position. OBJECTIVES: The symptoms of patulous ET are usually improved by neck compression or postural change (from sitting/standing to recumbent position). Venous congestion around the ET and/or gravitational change may be involved in the changing degree of symptoms, but its mechanism is not understood. This study investigated whether the PVP is involved. MATERIALS AND METHODS: The dimensions of soft tissues surrounding ET were measured on magnetic resonance images before and after neck compression. RESULTS: The lateral pterygoid muscle became enlarged after neck compression. Simultaneously, the volume of venous plexus observed between the medial pterygoid muscle and tensor veli palatini muscle was increased. Such enlargement was probably due to blood pooling in the PVP, resulting in protrusion of the ET anterior wall to the luminal side, and decreased ET patency.

Audiometry with nasally presented masking noise: novel diagnostic method for patulous eustachian tube.

OBJECTIVE: Nasal-noise masking audiometry was developed to assess the acoustic transfer function from the nasopharyngeal cavity to the middle ear via patulous eustachian tube (ET). STUDY DESIGN: Prospective. SETTING: Tertiary referral center. PATIENTS: Twenty-seven ears of 18 patients with patulous ET and 20 ears of 10 healthy subjects with no history of ear disease or complaints of aural symptoms. MAIN OUTCOME MEASURES: Audiometric measurement was conducted with and without masking noise presented in the nasal cavity. RESULTS: The masking effect of nasally presented noise caused elevation of the threshold for the tone presented in the external auditory canal. This threshold elevation was significantly greater, particularly in the lower-frequency region, in ears with patulous ET and was decreased to the normal range after obstructive treatment of the patulous ET. CONCLUSION: Nasal-noise masking audiometry is a simple and effective way to identify patulous ET.

Effects of hearing level on habitual sniffing in patients with cholesteatoma.

CONCLUSIONS: Quality of hearing is one of the key conditions promoting habitual sniffing associated with closing failure of the Eustachian tube and sniffing may stop with deterioration of hearing due to progression of the disease. OBJECTIVE: To examine habitual sniffing associated with closing failure of the Eustachian tube and hearing level in patients with cholesteatoma. PATIENTS AND METHODS: A total of 171 patients with middle ear cholesteatoma treated in Tohoku University Hospital (106 sides in 101 patients, 63 males and 38 females, mean age 43.3 years), and Sendai Ear Surgi Center (70 sides in 70 patients, 37 males and 33 females, mean age 42.7 years) were included. The patients were divided into two groups based on the presence or absence of habitual sniffing, and pre- and postoperative hearing was compared between the two groups. RESULTS: Habitual sniffing was not found in patients with air conduction hearing level worse than 60 dB or air-bone gap larger than 40 dB. Habitual sniffing disappeared in all patients with expanded air-bone gaps in lower frequency regions after surgery.

Surgery cancellations after entering the operating room.

BACKGROUND: Surgery cancellation results in unavailability of the operating room and loss time. We identified the frequency of and reasons for operation cancellations after patients entered the operating room and assessed the preventability of such cancellations. FINDINGS: A retrospective chart review of all scheduled surgical procedures proposed under general anesthesia in a period spanning 2008 to 2016 was performed, and the reasons for cancellation were assessed.A total of 30 surgery procedures were cancelled after the patient had entered the operation room and preparation for general anesthesia had been completed. Ten of 18 cases (55.6%) that were cancelled before general anesthesia induction could have been prevented, accounting for 36.7% of the overall cancellations. The majority of the cancellations after anesthesia were due to the patients' health status. CONCLUSIONS: Improving the systems for checking patients' medical problems and performing preoperative evaluations can reduce the number of cancellations after the patient has entered the operating room.

Anesthetic management of a patient with esophageal penetration of a tracheal stent: a case report.

BACKGROUND: Tracheal stent is a good way to maintain a patent airway in case of stenosis. Although anesthesia techniques for the placement of a stent in the trachea of patients with tracheal stenosis have been reported, the management of general anesthesia in patients with a tracheal stent is not well established. CASE PRESENTATION: We report the anesthetic management in the patient with a partly fractured tracheal stent. A 65-year-old man with colon cancer was scheduled for colectomy under general anesthesia. Eight years ago, a tracheal stent was placed because of lung cancer. Preoperative evaluation revealed that a part of the tracheal stent had penetrated the esophagus. We induced general-epidural anesthesia via spontaneous breathing through a laryngeal mask airway to avoid mediastinal emphysema caused by positive pressure ventilation. The patient has been followed up for 2 years without any respiratory complications. CONCLUSION: General anesthesia can be safely induced under spontaneous ventilation through a laryngeal mask airway in a patient with a fractured tracheal stent.

A case of unexpectedly difficult intubation caused by a large asymptomatic choanal polyp.

We report a case of unexpectedly difficult intubation in a patient with a huge but asymptomatic choanal polyp. A 77-year-old man with invasive bladder cancer was scheduled for total cystectomy under general anesthesia. However, tracheal intubation with a Macintosh laryngoscope proved impossible due to obstruction by a large oropharyngeal tumor. Using a video laryngoscope, intubation was successfully achieved. Choanal polyps are not uncommon, but large choanal polyps reaching the oropharynx appear relatively rare. Anesthesia and airway management for large oropharyngeal tumor has not been sufficiently discussed.

Effect of electroconvulsive stimulation on messenger RNA expression in the prefrontal cortex in a rat pain model.

Previous reports have shown that electroconvulsive therapy (ECT) is efficacious in the treatment of neuropathic pain; however, its mechanism of action remains unclear. The present study aimed to understand these mechanisms by investigating the alterations in the expression of neuropeptide Y (NPY) and interleukin-1ß (IL-1ß) in the prefrontal cortex. A rat model of neuropathic pain produced by chronic constrictive injury of the sciatic nerve was used, and mechanical and thermal hyperalgesia were evaluated starting 2 days after the injury. Using a pulse generator, ECT was administered to the rodents for 6 days from days 7-12 after the injury. Thermal and mechanical stimulation were administered to assess pain thresholds. Quantitative polymerase chain reaction, used to measure gene expression levels in the prefrontal cortex, showed that NPY and IL-1ß gene expression levels in the prefrontal cortex increased following the injury. The present results indicate that these gene expression level variations may be associated with the mechanisms underlying the effect of ECT in treating neuropathic pain.