著者

古川 朋靖 渡辺 道隆 山川 卓也 正木 義男 加納 昭彦 市川 銀一郎

出版者

Japan Society for Equilibrium Research

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.57, no.5, pp.480-486, 1998 (Released:2009-10-13)

参考文献数

15

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IntroductionFor transcranial magnetic stimulation of the facial nerve, a magnetic coil is fixed to the temporal region over the nerve. It has been reported that the facial nerve can be stimulated at the distal part of the auditory canal, and it is expected that the peripheral vestibular organs are included in the time-varying magnetic field. We examined the influence of magnetic stimulation on the peripheral vestibular organs using a stabilometer.MethodsExperiments were carried out on 10 healthy adults. Magnetic stimulation was administered to the temporal region including the peripheral vestibular organs and stabilometry was performed before and after stimulation. We used a G5500 system stabilometer (Anima Co.) with a sampling time of 20 msec. and recorded body sway for 60 sec. A Mag lite (Dantec Co.) was used for magnetic stimulation and a Synax ER 1100 (NEC-Sanei Co.) was used as the trigger. The stimulus was set at 4 Hz and stimulation was done 60 times. The output was set at about 40% of 1.9 Tesla (maximum output).ResultsWe analyzed the body sway length, 8-directional body sway velocities, and the power spectrum of the lateral body sway velocity. The total length of body sway and the velocity of lateral sway increased significantly after magnetic stimulation.

著者

正木 義男 古川 朋靖 渡辺 道隆 市川 銀一郎

出版者

The Oto-Rhino-Laryngological Society of Japan, Inc.

雑誌

日本耳鼻咽喉科学会会報 (ISSN:00306622)

巻号頁・発行日

vol.102, no.7, pp.891-897, 1999-07-20 (Released:2010-10-22)

参考文献数

16

被引用文献数

1 1

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はじめに: 鼻副鼻腔手術後のガーゼ抜去時に患者が失神様の発作を起こすことがある. この状態は神経原性失神の1つである三叉・迷走神経反射が原因と言われている. 三叉神経が刺激されることにより, 迷走神経が反応して心拍数, 血圧が急激に低下する現象であるが, 我々は疼痛や緊張で上昇するアドレナリン (Adrenaline, 以下Adr. と略す) に着目し, ネコ10匹を使用して迷走神経反射におけるAdr. の効果を調べた.目的: 迷走神経刺激時にAdr. が脳血流に及ぼす影響を調べる.対象と方法: 実験には成猫10匹を用いた. 頸部で迷走神経を露出し, 末梢側に白金電極を装着した. さらに頭部を30度挙上した. コントロール群 (迷走神経を1分間電気刺激). Adr. +神経刺激群 (Adr. を30秒間静注した後, 迷走神経を1分間電気刺激) の2群に分け, 刺激前後の前庭神経核, 下オリーブ核, 小脳室頂核の脳血流量, 及び心拍数, 動脈圧を比較した. 脳血流の測定には水素クリアランス法を使用した.結果: コントロール群, Adr. +神経刺激群ともに刺激前と比較し, 刺激後は有意に脳血流量が低下した. さらに, 両群の脳血流量の変化を比較したところ, いずれの部位においてもAdr. +神経刺激群の方が, コントロール群と比較し有意に脳血流量が低下していた. 心拍数, 動脈圧についてはコントロール群は刺激後有意に低下したが, Adr. +神経刺激群では, より大きな脳血流量低下があったにもかかわらず有意な変化はなかった.考察: Adr. +神経刺激群ではAdr. のβ2作用で末梢欠陥抵抗が低下し, 迷走神経を電気刺激した際に, より大きな脳血流量低下が起きたのではないかと考えられた. この結果より疼痛や緊張で上昇したAdr.が, 三叉・迷走神経反射による脳血流量低下を増強しているのではないかと考えられた.

著者

正木 義男 渡辺 道隆 古川 朋靖 加納 昭彦 山谷 千恵美

出版者

Japan Society for Equilibrium Research

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.57, no.3, pp.297-304, 1998 (Released:2009-10-13)

参考文献数

15

被引用文献数

2 2

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IntroductionVasovagal reflex (VVR) is a disease that has received attention in various fields.Recently, researchers have started to clarify its mechanism. Three patients with symptoms probably due to VVR were treated in this department and the Head up tilt test was used to diagnose dizziness due to VVR.PatientsThe three patients included a 21-year-old female (Case 1), a 26-year-old male (Case 2) and a 61-year-old female (Case 3). All three patients had chief complaints of spontaneous dizziness after standing or sitting for 5 to 30 minutes.ResultsThe duration of standing before the onset of positive findings was 9.5 minutes in Case 1 and 11 minutes in Case 2. In Case 3, positive findings were obtained 9.5 minutes after isoproterenol administration.DiscussionAll three patients showed spontaneous dizziness in either the standing or sitting position and the results of the Head up tilt test were positive. Therefore, dizziness seemed to be due to VVR in these patients. The instantaneous decrease in blood volume due to paradoxical activation of the vagus nerve may have induced dizziness, loss of consciousness and faintness. Because of severe patient stress during the Head up tilt test, this examination should be indicated only in those who are strongly suspected of VVR.

著者

正木 義男

出版者

Japan Society for Equilibrium Research

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.64, no.1, pp.22-28, 2005 (Released:2009-06-05)

参考文献数

32

被引用文献数

1 1

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We encountered a patient who developed dizziness due to the vasovagal reflex (VVR) during the Schellong test (ST).A 32-year-old woman had a chief complaint of dizziness. Present Illness: She had repeatedly since childhood experienced dizziness attacks associated with darkness in front of her eyes immediately after standing up. She easily developed motion sickness. Dizziness continued to occur when she was standing in a bus or train, when she was in the bath, or when she got excited. She was admitted to a hospital in the district and ECG and a blood test were conducted, but no abnormal findings were revealed. Past History: She had bronchial asthma in childhood. She had a gastric ulcer and received drug treatment in january 1997. Family history was unremarkable.She had a positive Schellong test. Immediately after standing up, her pulse rate sharply increased from 94 to 123/min., and 5 min. after standing up, the pulse rate became 127/min. She complained of dizziness immediately before the end of the testing, and the pulse rate and blood pressure measured at the time were 75/min., showing a sharp decline, and 90/55, showing a slight decrease, respectively. Thereafter, she had decreased consciousness and was immediately laid in a supine position. She soon became alert. Blood pressure recovered to 106/62 and the pulse rate to 94. Neural symptoms were absent. Treatment and Clinical Course: Although she developed WR during ST, her condition could be diagnosed as orthostatic dysregulation (OD) because it met the criteria for diagnosis of OD. However, a diagnosis of postural tachycardia syndrome (POTS) was made according to the theory that WR and OD are special types of POTS. She is under medication with an α-receptor agonist agent.Patients are always at risk, although not high, of developing VVR and falling during ST, which may be associated with injury. Therefore, after the experience of the present case in our hospital, we reevaluated the procedures of ST and decided on crite-ria for the discontinuation of the testing to prevent accidents.

著者

正木 義男

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.67, no.4, pp.269-275, 2008 (Released:2008-10-01)

参考文献数

27

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[Introduction] I encountered a patient in whom signs of the vasovagal reflex (VVR) developed when the patient underwent the Schellong test , and I also published an article describing the appropriate safety measures for performing orthostatic tests in Equilibrium Research vol. 64(1): 22-28. Specifically, we proposed that an orthostatic test should be discontinued as soon as the patient's heart rate met the relevant diagnostic criteria for the postural tachycardia syndrome (POTS). This conclusion was based on the hypothesis that VVR can be considered equivalent to POTS. I then encountered another patient who demonstrated VVR while performing the Schellong test, as described in Practica oto-rhino-laryngologica:.100(5): 341-347. Therefore, the present study was performed to examine the proportion of VVR patients fulfilling the diagnostic criteria for POTS in the course of an orthostatic test. [Subjects] Six patients who were all diagnosed to have dizziness due to VVR. [Methods] The patients were assessed as to whether or not the maximum increase in their heart rate and the absolute maximum heart rate observed during the orthostatic test fulfilled the following two diagnostic criteria for POTS: (A) a 30/min or more increase in heart rate and (B) an absolute heart rate of at least 120 beats/min. [Results] The mean±S.D of absolute heart rate was 73.0±16.6 beats/min at rest and the maximum heart rate 95.7±18.7 beats/min. The mean±S.D. of maximum increase in heart rate was 22.7±7.7 beats/min. Only 1 (16.7%) of the 6 patients tested met the diagnostic criteria for POTS. [Discussion & Conclusion] As the remaining 5 patients failed to meet the diagnostic criteria for POTS, the hypothesis that "VVR can be considered equivalent to POTS" therefore remains questionable. It is thus considered inappropriate to use only the diagnostic criteria for POTS when assessing the safety in patients undergoing an orthostatic test.