Sixty parturients scheduled for elective cesarean section at term under epidural anesthesia were randomly divided into one of two groups. Group 1 patients were given a prepared 2% lidocaine solution with 1:200,000 epinephrine plus 1ml of normal saline per 10ml of lidocaine; the solution pH was 2.45. Group 2 patients were given a prepared 2% lidocaine solution with 1:200,000 epinephrine plus 1ml(lmEq) NaHCO3 per 10ml of lidocaine; the solution pH was 7.20. Just before injection, either 2ml normal saline(group 1)or 2ml(2mEq) 8.4 % NaHCO3 solution(group 2) was added to 20ml 2% lidocaine hydrochloride with 1:200, 000 epinephrine. The time to onset of the T5 sensory block (time between completion of injection and loss of cold sensation at T5 dermatome) was significantly more rapid in the group 2 that received the pH adjusted solution. The mean onset time was 4.9+/-1.3 min in the group 2 and 6.4+/-2.0 min in the group 1. The time to peak level was also significantly more rapid in the group 2 at 10.5+/-2.7 min and group 1 at 13.3+/-4.0 min. But the peak level was not statistically signifieant between the two groups. The spread of sensory blockade was significantly more rapid in the pH-adjusted group at 5, 10 and 15 min after epi- dural injection. Incidence of maternal hypotension during the operation did not differ signifi- cantly between the two groups. The time from end of injection to Bromage scale 0 did not differ significantly between the two groups.
Anesthesia, Epidural ; Cesarean Section* ; Epinephrine ; Female ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Incidence ; Lidocaine* ; Pregnancy ; Sensation ; Sodium Bicarbonate

Most obstetric anesthesiologist now consider epidural anesthesia to be the preferred anesthetic technique for patients with preeclampsia. In the severe preeclampsia effective ciirculatory volume is usually low, so appropriate preanesthetic hydration is essential feature of safe management. We performed CVP monitoring before epidural anesthesia in nine severe preeclamptic patients undergoing cesarean section. Mean CVP of them was 2+/-1 mm Hg which was not significantly different from normal term parturient. In four patients whose CVP was less than 2 mmHg, preanesthetic hydration with Hartman's solution 500~700 rrd was performed under the monitoring of CVP until it became to rise 2~3 mmHg. Five patients out of nine whose systolic blood pressure dropped below 100 mmHg during anesthesia were IV injected ephedrine 4 mg immmediately and three of them needed repeat injection of ephedrine 4 mg. With the monitoring of CVP, the operations of all the nine severe preeclamptic patients were completed successfully without any problem during and after anesthesia. lt is important to reaUze the limitation of central venous pressure monitoring : but if used with caution in proper circumstance it can provide clinically useful information with minimal risk to the patient.
Anesthesia ; Anesthesia, Epidural* ; Blood Pressure ; Central Venous Pressure* ; Cesarean Section ; Ephedrine ; Female ; Humans ; Pre-Eclampsia* ; Pregnancy

BACKGROUND: Coal workers' pneumoconiosis is a fibrotic lung disease resulting from chronic inhalation of coal dust. The precise mechanism of lung fibrosis in coal workers' pneumoconiosis is uncertain. However, a relationship between the stimulation of fibroblast proliferation and collagen production by mediators released from inflammatory and resident lung cells is thought to be a major factor. The transforming growth factor-β(TGF-β), a multifunctional cytokine and growth factor, plays a key role in the scarring and fibrotic processes due to its ability to induce extracellular matrix proteins and modulate the growth and immune function of many cell types. To determine the involvement of TGF-βin the development of lung fibrosis in coal workers' pneumoconiosis, the TGF-β1 level in plasma was measured in patients with coal workers' pneumoconiosis. METHODS: Plasma was collected from 40 patients with coal workers' pneumoconiosis (20 with simple coal workers' pneumoconiosis and 20 with complicated coal workers' pneumoconiosis) and from 10 normal controls. The ELISA method was used to measure the plasma TGF-β1 concentration. RESULTS: Compared to the control group (0.63±0.18 ng/mL), there was no significant difference in the plasma TGF-β1 level in patients with simple coal workers' pneumoconiosis (0.64±0.17 ng/mL) (p>.05). However, in patients with complicated coal workers' pneumoconiosis the plasma TGF-β1 level (0.79±0.18 ng/mL) was significantly higher than in patients with simple coal workers' pneumoconiosis and control group (p<0.05). CONCLUSION: The data suggests that TGF-β1 has some influence in the development of lung fibrosis in coal workers' pneumoconiosis.
Cicatrix ; Coal* ; Collagen ; Dust ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix Proteins ; Fibroblasts ; Fibrosis ; Humans ; Inhalation ; Lung ; Lung Diseases ; Plasma* ; Pneumoconiosis* ; Pulmonary Fibrosis

PURPOSE: Kawasaki disease(KD) is a multisystemic inflammatory vasculitis of unknown etiology, but immunological abnormalities have been documented and implicated in the pathogenesis of KD. Matrix metalloproteinases(MMPs) have proteolytic activity against connective tissue proteins, and increased activity of MMPs and a quantitative imbalance between MMP and tissue inhibitor of MMP (TIMP) can result in several pathologic conditions. MMP and TIMP may also be involved in the formation of coronary arterial lesions in KD. METHODS: Serum levels of MMP1, MMP2, MMP9, TIMP1, TIMP2, interleukin(IL)-6 and tumor necrosis factor(TNF)-alpha were measured in 27 KD patients(group I, 10 patients with normal coronary artery; group II, 17 patients with coronary arterial lesions) and 15 healthy children(group III). Blood samples from each study group were drawn before and after intravenous immunoglobulin(IVIG) therapy and in the convalescent stage. RESULTS: The MMP9 levels and MMP9/TIMP2 ratios before and after IVIG therapy were significantly higher in group II. The MMP9 levels were significantly higher before IVIG therapy, and decreased through the convalescent stage. The IL-6 and TNF-alpha levels were also significantly higher in group II than in the other groups. The serum MMP9 levels showed significantly positive correlation with the circulating leukocyte counts and IL-6 levels. CONCLUSION: The increased levels of MMP and the imbalance between MMP and TIMP increase the susceptibility to the coronary arterial lesions in KD. The cytokines including IL-6 and TNF-alpha are also important in the activation of MMP and formation of coronary arterial lesions in KD.
Connective Tissue ; Coronary Vessels ; Cytokines* ; Humans ; Immunoglobulins, Intravenous ; Interleukin-6 ; Leukocyte Count ; Matrix Metalloproteinases* ; Mucocutaneous Lymph Node Syndrome* ; Necrosis ; Tumor Necrosis Factor-alpha ; Vasculitis

BACKGROUND: Coronary artery bypass graft with cardiopulmonary bypass is the standard surgical coronary revascularization procedure; however, there are many adverse effects such as air embolism, and high rate of neurologic and coagulation complications. In this article, we describe hemodynamic alterations during coronary bypass grafting (CABG) without cardiopulmonary bypass but using a medical tissue stabilizer. METHODS: Thirty patients were included in our study who underwent an off-pump CABG (OPCAB) between 1/1999 and 12/1999. RESULTS: We created 73 anastomoses. Movement of the heart to reach the target site of anastomosis caused hemodynamic alterations. These could be corrected by anesthetic interventions such as fluid load and low dose inotropics. Complications included postoperative panperitonitis (one patient), and delirium tremens (one patient). On the other hand, major complications, such as intraoperative myocardial infarction and stroke did not occur. The median postoperative length of hospital stay was 14 days. Overall operative mortality was 3.3% (one patient). CONCLUSIONS: On the basis of the present data, off-pump coronary artery bypass grafting appeared to be a safe and effective technique in selected patients with appropriate coronary lesions. Off-pump CABG surgery requires anesthetic interventions because hemodynamic alterations are caused by the presentation of the heart to the surgeon.
Alcohol Withdrawal Delirium ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Embolism, Air ; Hand ; Heart ; Hemodynamics ; Humans ; Length of Stay ; Mortality ; Myocardial Infarction ; Stroke ; Transplants*

OBJECTIVE: To understand the clinical manifestations and disease course of adult onset Still' s disease (AOSD). METHODS: 15 patients of AOSD diagnosed at Severance hospital, Yonsei University College of Medicine were retrospectively analysed in the period of September 1988 to September 1995. RESULTS: There were 3 men and 12 women (male to female ratio of 1:4). Age of disease onset ranged from 17-55 years, and over 86% of the patients were younger than age 40 at disease onset. The prevalence of clinical features were as follows fever (100%), arthritis (93%), skin rash (93%), sore throat (60%), abnormal liver function (73%), lymphadenopathy (47%), splenomegaly (47%), hepatomegaly (20%), serositis (13%). Fever was the most common initial symptom. Common labaratory features were leukocytosis with neutrophilia (87%), anemia' Hgb <10 g/dL (67%), increased serum ferritin (83%), ESR (87%) and CRP (93%). Serum ferritin was markedly raised at disease onset and correlated with disease activity. In 2 patients, the disease was controlled with NSAID alone, but most of the patients required steroid to control the disease activity. In 6 patients, MTX was added for steroid sparing effect and for steroid resistant arthritis. Most of AOSD patients had intermittent and chronic disease course. Root joint arthritis and polyarthritis were factors associated with chronicity. CONCLUSION: The clinical features of AOSD in our study generally resemble previous reports. Serum ferritin was a useful marker of disease activity. Most patients of AOSD had intermittent and chronic disease course. Root joint athritis and polyarticular pattern at disease onset were factors associated with chronicity.
Adult* ; Arthritis ; Chronic Disease ; Exanthema ; Female ; Ferritins ; Fever ; Hepatomegaly ; Humans ; Joints ; Leukocytosis ; Liver ; Lymphatic Diseases ; Male ; Pharyngitis ; Prevalence ; Retrospective Studies ; Serositis ; Splenomegaly ; Still's Disease, Adult-Onset*

BACKGROUND: The changes of the composition in the T-lymphocyte are important as an immunological abnormality in the pathogenesis of tuberculosis. Previously, the second type of TCR dimer(gamma delta T lymphocyte) that did not express CD4 or CD8 molecules was found. In other reports the presence of this type of lymphocytes was increased in the initial stage of tuberculous infections. METHOD: To determine whether there are some differences in the T-lymphocyte subsets in the peripheral blood or pleural effusion among the forty-nine patients were examined T-lymphocyte subset analysis(CD4+T-cell,CD8+ T-cell,gamma delta T-lymphocytes) with anti-Leu4, anti-Leu3a, anti-Leu2a, anti HLA-DR and anti-TCR-gammadelta-1(Becton & Dickinson Co.). RESULTS: The average age of the patients was 50 years old(17-81year). There were 33 males and 16 female patients. patiensts with tuberculosis are 30cases(tuberculous pleurisy 15), lung cancer 12cases(malignant effusion 9) and pneumonia 7cases(parapneumonic effusion 6cases) In T lymphocyte subsets of pleural effusion, helper T lymphocyte(54.6 + 13.8 %) of tuberculous pleurisy was higher than that(36.2 + 25.3 %) of non-tuberculous pleurisy(p= 0.04). The peripheral blood gammadelta T-lymphocytes in tuberculousis was insignificantly higher than non-tuberculous patients(p= 0.24). The peripheral blood gammadelta T-lymphocytes and pleural gammadelta T-lymphocytes in tuberculous pleurisy was insignificantly higher than in non-tuberculous pleurisy(p= 0.16, p= 0.12). CONCLUSION: The percentage of gammadelta T lymphocytes among the total T-lymphocytes is not significantly increased in the peripheral blood or pleural effusion of the pleural tuberculosis. gammadelta T lymphocytes is less useful as a diagnostic method of pleural tuberculosis.
Female ; HLA-DR Antigens ; Humans ; Lung Neoplasms ; Lymphocytes ; Male ; Pleural Effusion ; Pleurisy ; Pneumonia ; T-Lymphocyte Subsets ; T-Lymphocytes* ; Tuberculosis ; Tuberculosis, Pleural*

PURPOSE: Kawasaki disease is a multisystemic inflammatory vasculitis and associated with neurologic features such as aseptic meningitis. High-dose intravenous immunoglobulin(IVIG) is used to treat Kawasaki disease and generally considered to be safe, but rare cases of aseptic meningitis with unknown etiology have been reported. The aseptic meningitis associated with Kawasaki disease was compared with meningitis as the adverse reaction of high-dose IVIG. METHODS: Sixteen Kawasaki disease patients with typical meningeal irritation symptoms were reviewed from January 1997 to July 2002. Group I(n=11) had meningitis associated with Kawasaki disease and Group II(n=5) had meningitis as the adverse reaction of high-dose IVIG therapy. The clinical features and hematologic and cerebrospinal fluid(CSF) findings were compared between the two groups. RESULTS: The duration of fever was significantly longer in group I than group II. Meningeal irritation symptoms were milder in group II than group I. Hemoglobin levels were lower in group II than group I. Monocyte counts were higher in group I than group II. In the CSF analysis, neutrophil counts were significantly higher in group II than group I. Otherwise, there were no significant differences in CSF protein and sugar levels between the two groups. CONCLUSION: Aseptic meningitis occurred in patients with Kawasaki disease after administration of high-dose IVIG. High-dose IVIG was considered to be safe in general. However, clinicians should be aware of the potential for neurologic complications such as acute aseptic meningitis in patients receiving high-dose IVIG for Kawasaki disease.
Fever ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Meningitis ; Meningitis, Aseptic* ; Monocytes ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Vasculitis

BACKGROUND: The incidence of renal insufficiency is reported about 18-27% during the thoracoabdominal aneurysm surgery. The possible mechanisms are reduction and maldistribution of renal blood flow, activation of renin angiotensin system, release of various mediators. In this study, we observed the effect of nicardipine, one of the calcium channel blockers that commonly used, on the systemic hemodynamics and the renal fuctions. METHODS: A total of 13 mongrel dogs were divided into two groups: control group (C, n = 7), nicardipine administration group (N, n = 6). After brachial arterial and Swan-Ganz catheterization, midline abdominal incision was made. For the aortic cross clamping the supraceilac aorta was exposed and the doppler flowmeter probe was placed on the left renal artery. The thermal diffusion microprobe was inserted in the renal parenchyme to measure local renal perfusion. At sixty minutes after aortic cross clamping, systemic hemodynamic data, renal blood flow and local renal perfusion were measured and at 1, 2, 3, 4, 5 and 6 hours after unclamping the same parameters were measured. RESULTS: There were no differences on renal blood flow, renal perfusion and oxygen extraction ratio between two groups. The renal blood flow and renal perfusion did not recover to the baseline level after unclamping in both groups. The plasma renin activity, serum creatinine concentration and cystatin-c did not show any difference between groups respectively. CONCLUSIONS: We concluded that the administration of nicardipine after supraceliac aortic unclamping to improve the renal function was not effective in experimental dogs.
Aneurysm ; Animals ; Aorta ; Calcium Channel Blockers ; Catheterization, Swan-Ganz ; Constriction* ; Creatinine ; Dogs* ; Flowmeters ; Hemodynamics* ; Incidence ; Nicardipine* ; Oxygen ; Perfusion ; Plasma ; Renal Artery ; Renal Circulation ; Renal Insufficiency ; Renin ; Renin-Angiotensin System ; Thermal Diffusion

We have already reported good effect of meperidin and pentazocin as the sole agent for spinal anesthesia. The present study was undertaken to examine toxic effects of pentazocin and meperidine on peripheral nerve tissue. 11 rats were divided into three groups i.e. pentazocine, meperidine and control group. The sciatic nerves of adult rats were exposed and injected with pentazocin 0.5ml(15mg) or meperidine 0.5ml (25mg). Two specimens of normal nerve and another two specimens injected with normal saline 0.5 ml were used as the controIs. The nerve was examined under electron microcopy at 24 hours, 48 hours, 1 week and 4 weeks after the injection of each of the drugs. A total of twenty injections were carried out in 11 rats. The results were as follows: The pentazocien group revealed hydropic changes in the mitochondria and ER of axon and Schwann cell but the degree of injury was not significant and was reversible. The meperidine group showed hydropic changes that were not significant but the specimen taken at one week revealed severe axonal and myeline changes, admixed with fat globules and Schwann cell with severe fatty changes in the cytoplasm. Although most of the above mentioned changes may reverse, it is not certain yet that pentazocin and meperidine are free of toxicity on nerve cells until further study is done to find the causes of the severe histolgical changes which were shown in the one week specimen with demerol.
Adult ; Anesthesia, Spinal ; Animals ; Axons ; Cytoplasm ; Humans ; Meperidine ; Mitochondria ; Myelin Sheath ; Narcotics* ; Neurons ; Pentazocine ; Peripheral Nerves* ; Rats* ; Sciatic Nerve