BACKGROUND: It is a well known phenomenon that alveolar and peritoneal macrophages exposed to bacterial lipopolysaccharide (LPS) induce a large output of nitric oxide (NO) and an inducible nitric oxide synthase (iNOS) m-RNA expression. The author elucidate the effects on NO production and iNOS m-RNA expression of various anesthetics, inhalational (halothane, enflurane, sevoflurane) and intravenous (ketamine, propofol), on endotoxemic rats. METHODS: To examine the production of NO in peritoneal macrophages, NO concentrations were measured from the rats following 2 hours exposure to LPS and 2 hours administration of various anesthetics, respectively. Culture supernatants were collected 24 hours after exposure to LPS and anesthetics and assayed by ELISA (Enzyme Linked Immunosorbent Assay) for production of NO. iNOS m-RNA expression was measured using PCR (Polymerase Chain Reaction) techniques and autoradiography. RESULTS: In the control group, the NO concentration was measured at 120 minutes after infusion of LPS to rats, and showed 12+/-4 micrometer. After insufullation of anesthetics to experimental animals, NO concentration increased in the halothane, enflurane, sevoflurane, propofol, and ketamine groups, 132+/-27 (P< 0.05), 49+/-19 (P< 0.05), 23+/-14 (P< 0.05), 37+/-11 (P< 0.05), and 17+/-2 micrometer respectively. The size and brightness of the iNOS m-RNA bands were large in halothane, enflurane, sevoflurane, propofol and ketamine, in order. CONCLUSIONS: Intravenous anesthetics showed more stability than inhalation anesthetics with regand to production of NO and iNOS m-RNA expression in sepsis on rats. The mechanism is not clear, but it is related to the strong stimulating effect to the airway tract in from inhalational anesthetics.
Anesthetics* ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Animals ; Autoradiography ; Enflurane ; Enzyme-Linked Immunosorbent Assay ; Halothane ; Ketamine ; Macrophages, Peritoneal* ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Polymerase Chain Reaction ; Propofol ; Rats* ; Sepsis

No abstract available.
Paraplegia* ; Spondylitis, Ankylosing*

No abstract available.
Animals ; Rats* ; Somatotrophs*

No abstract available.
Animals ; Brain* ; Mice*

No abstract available.
Humans

PURPOSE: The purpose of this study was to observe and compare the changes in the patterns of hemodynamic and blood profiles on the circuit of Extra-corporeal life support system (ECLS) by using a dual pulsatile pump (T-PLS). METHODS: An acute heart failure model using partial pulmonary artery banding was constructed in 12 piglets (20 -25kg). The animals were divided into centrifugal (n=6) and dual pulsatile pump (n=6) group. Each animal was placed on an ECLS system with a membrane oxygenator bypassing the right atrium and the aorta for 2 hours under general anesthesia. The parameters mainly observed were intra-circuit pressure changes, arterial pulsatility (pulse pressure), plasma free hemoglobin, hemodynamic changes, and other blood profiles. The parameters obtained just prior to the bypass were compared with the corresponding parameters obtained two hours after the bypass. RESULTS: Before bypass, the parameters were statistically the same between the groups. Two hours after the bypass, no significant differences were observed between the groups in ABGA, VBGA, AST/ALT, BUN/Cr, and electrolytes; the plasma free hemoglobin was 14.8+/-4.7 g/dl in the dual pulsatile group and 19.1+/-9.1 g/dl in the centrifugal group (p=NS). The pulse pressure was higher in the dual pulsatile pump than in the centrifugal pump group (35+/-8 vs. 11+/-7 mmHg, p=0.0253 mmHg). The highest circuit pressure was generated at the inlet of the membrane oxygenator and was higher in the dual pulsatile group than in the centrifugal group (173+/-12 mmHg vs. 222+/-8 mmHg, p=0.0000). CONCLUSION: The results demonstrate that a dual pulsating mechanism lessens blood cell trauma while providing physiologic pulsatile blood flow. The ECLS system using a dual pulsatile pump (T-PLS) can be useed as an effective and safe driving motor for an ECLS.
Anesthesia, General ; Animals ; Aorta ; Bays ; Blood Cells ; Blood Pressure ; Cardiopulmonary Resuscitation ; Electrolytes ; Heart Atria ; Heart Failure ; Hemodynamics ; Life Support Systems* ; Oxygenators, Membrane ; Plasma ; Pulmonary Artery

No abstract available.
Animals ; Rats* ; Suprachiasmatic Nucleus* ; Vasoactive Intestinal Peptide*

Background: The shelf life policies for central supply department (CSD) sterilized items and other devices should be determined by the healthcare facility's infection control program. We investigated effect of the sterility integrity of the CSD sterilized packs by wrapping-materials, storage period and environment to modify and extend current shelf-life. Methods: The first phase study was from May to October in 2000 and the second phase study was planned to extend further the shelf-life of the sterile packs from April 2001 to June 2002. Six hundred and fourty packs containing small gauze with four wrapping materials(100 times and 50 times washed two-ply reusable cotton, disposable craft paper, and disposable new pouch bag) and the 104 returned set after their shelf-life were stored on the top or middle of shelves or closed cabinets and storage durations from 1 to 20 weeks in the first phase study. The test packs were collected weekly and cultured in the laboratory. Five hundred seventy-six test packs were prepared with three wrapping materials (except 50 times washed cotton and returned set) and stored in the same location as the First phase study and collected and cultured monthly after three months storage (from July 2001) for one year in the second phase study. The temperature and relative humidity was monitored whenever the test pack was collected. Results: The gauze in the test packs were not contaminated until 154 days in the first study phase and until 423 days in the second phase study. The temperature and relative humidity of storage locations were 25.9degrees C and 55.2% in the first phase study and 26.0degrees C and 45.9% in the second phase study, respectively. Conclusions: There was no difference in the sterility integrity of the test packs with different wrapping materials. storage locations and environments. and storage durations. It was possible to extend shelf-life from two weeks to three and six months in the study hospital.
Delivery of Health Care ; Humidity ; Infection Control ; Infertility

PURPOSE: Earlier and accurate identification of preterm infants who are likely to develop hemodynamically significant patent ductus arteriosus (hsPDA) would allow for early prophylaxis and thus minimize the risk of neurologic and respiratory morbidity. The purpose of this study is to clarify the usefulness of plasma B-type natriuretic peptide (BNP) as an early biochemical predictive marker of subsequent symptomatic PDA (sPDA) in preterm infants. METHODS: Clinical and echocardiographic findings of PDA were evaluated at 24 and 48 hours of age in 69 infants ranging from 25 to 34 gestational weeks of age. Plasma BNP concentrations were simultaneously measured with a Triage(R) BNP test kit (Biosite Diagnositics, San Diego, California, U.S.A.). When two or more clinical symptoms of PDA and large ductal shunt from echocardiographic findings were found, sPDA was diagnosed and treated with indomethacin. RESULTS: The mean BNP level in sPDA group (N=22) was significantly higher than that of control group (N=47) at 24 and 48 hours. BNP levels were significantly correlated with the magnitudes of the ductal shunt, such as the ratio of left atrial to aortic root diameter and the diastolic flow velocity of the left pulmonary artery. At 24 hours of age, a cutoff BNP value of 468.5 pg/mL had a sensitivity of 90.9%, a specificity of 74.5% and a positive predictive value of 95.2% for prediction of sPDA (area under ROC curve: 0.908, P<0.001, 95% CI: 0.840 to 0.977). CONCLUSION: Rapid BNP assay allows early prediction of subsequent sPDA that may require treatment in preterm infants.
California ; Ductus Arteriosus, Patent* ; Echocardiography ; Humans ; Indomethacin ; Infant ; Infant, Newborn ; Infant, Premature* ; Natriuretic Peptide, Brain* ; Plasma ; Pulmonary Artery ; ROC Curve ; Sensitivity and Specificity

Necrotizing enterocolitis(NEC) is the most common life-threatening surgical emergency in neonates, and remains a major cause of morbidity and mortality. In addition to conventional laparotomy, intraperitoneal drains have been used for the treatment of perforated NEC, especially in extremely low birth weight(ELBW) infants. We report a case of perforated NEC with bacterial peritonitis in an ELBW infant managed with primary peritoneal drainage(PD) without further need for surgery. To our knowledge, this is the first documented Korean case of an ELBW infant where PD was used as primary treatment for perforated NEC. Primary PD is effective and safe in ELBW infants with perforated NEC; although it is not considered a definitive procedure, it should be considered in all cases where infants are too unstable to tolerate anesthesia and surgery.
Anesthesia ; Drainage* ; Emergencies ; Enterocolitis, Necrotizing* ; Humans ; Infant ; Infant, Extremely Low Birth Weight* ; Infant, Low Birth Weight ; Infant, Newborn ; Laparotomy ; Mortality ; Parturition ; Peritonitis*