河西 稔

The maintenance of normoglycemia has been reported to reduce painful sensations in diabetic subjects. This suggests that lowering the tissue glucose concentration might inhibit the increased cutaneous nociceptor activities seen in a diabetic conditin. To test this hypothesis, we studied the effect of changing the glucose concentration in the superfusate of in vitro preparations (high, HG: 20 mM or normal glucose, NG: 6.7 mM) on the mechanical response of C-fiber polymodal receptors (C-polymodal receptors). Single fiber activities of C-polymodal receptors were recorded from skin-nerve in vitro preparations of streptozotocin-induced diabetic and age-matched control rats. Pressure stimulation was applied to the receptive field by a servo-controlled mechanical stimulator. C-polymodal receptors from diabetic preparations superfused with HG-solution showed increased spontaneous activity, lowered response threshold, increased response magnitude and a less adaptive response pattern to mechanical stimulation compared with those from control preparations superfused with NG-solution. C-polymodal receptors from diabetic preparations superfused with NG-solution showed no such changes. The responsiveness of C-polymodal receptors from control preparations was not different in NG- or HG-conditions. These data demonstrated that normalization of the glucose concentration normalized the responsiveness of C-polymodal receptors in diabetic animals. This response may be associated with the fact that normoglycemia reduces painful sensations in diabetic subjects. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

The maintenance of normoglycemia has been reported to reduce painful sensations in diabetic subjects. This suggests that lowering the tissue glucose concentration might inhibit the increased cutaneous nociceptor activities seen in a diabetic conditin. To test this hypothesis, we studied the effect of changing the glucose concentration in the superfusate of in vitro preparations (high, HG: 20 mM or normal glucose, NG: 6.7 mM) on the mechanical response of C-fiber polymodal receptors (C-polymodal receptors). Single fiber activities of C-polymodal receptors were recorded from skin-nerve in vitro preparations of streptozotocin-induced diabetic and age-matched control rats. Pressure stimulation was applied to the receptive field by a servo-controlled mechanical stimulator. C-polymodal receptors from diabetic preparations superfused with HG-solution showed increased spontaneous activity, lowered response threshold, increased response magnitude and a less adaptive response pattern to mechanical stimulation compared with those from control preparations superfused with NG-solution. C-polymodal receptors from diabetic preparations superfused with NG-solution showed no such changes. The responsiveness of C-polymodal receptors from control preparations was not different in NG- or HG-conditions. These data demonstrated that normalization of the glucose concentration normalized the responsiveness of C-polymodal receptors in diabetic animals. This response may be associated with the fact that normoglycemia reduces painful sensations in diabetic subjects. © 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

気管内挿管時には,歯牙の状態によって喉頭鏡の操作により歯牙や補綴物(継続歯,架工義歯)が脱臼,破損,脱離する可能性がある.これを防止するために,現在,われわれはモデリングコンパウンドを使用しているが,今回,このモデリングコンパウンドと既製のマウスプロテクター,マウスコレクター(成人の平均値的模型上で成型試作したもの),および,プレス式カスタムマウスガード(各症例ごとに歯型をとり,模型上にプレスをして作製)を比較した.モデリングコンパウンドは,気管内挿管操作直前に作製し,各症例の歯牙に合った成型ができたことより,その効果も満足すべきものであった.しかし,装着する際に,ある程度手技の熟練さが必要であり,モデリングコンパウンドの厚さが喉頭鏡による喉頭展開操作に制限を感じさせることがあった.これに反し既製のマウスプロテクター,マウスコレクターは,装着に熟練度は必要でなかったが,すべての症例に適合させることは困難で,歯牙損傷の目的を完全に達成できるとは考えられなかった.<br>プレス式カスタムマウスガードは,作製時間と,実費で600円程度の費用を要するが,各歯牙に確実に適合し,モデリングコンパウンド以上に健全隣在歯との連結による固定効果があるため,特に動揺歯のある場合に安心して挿管できるものと考えられた.