No abstract available.
Hypertrophy*

BACKGROUND: This prospective, randomized controlled study was undertaken to compare stress hormone response to open thoracotomy for lung resection at different anesthetic depths, as determined by bispectral index (BIS) monitoring, in patients under propofol-remifentanil anesthesia. METHODS: Forty-eight adult patients scheduled for lung resection surgery using one-lung ventilation were randomly assigned to either a deep anesthesia group (BIS score of 40 +/- 5, n = 24) or a light anesthesia group (BIS score of 60 +/- 5, n = 24) by adjusting propofol infusion rates. Blood norepinephrine, epinephrine, adrenocorticotropic hormone, and cortisol levels were measured before the induction of anesthesia, at the end of surgery, and at 2 hours postoperatively. Blood glucose, hemodynamic, and oxygenation-ventilation variables, and postoperative outcomes were also measured. RESULTS: Norepinephrine and epinephrine levels remained unchanged over time in the deep group, but norepinephrine levels significantly increased in the light group at 2 h after surgery than at baseline (P = 0.007 and 0.004, respectively). Temporal changes in norepinephrine, but not in epinephrine, were significantly different between the two groups (P = 0.036). Plasma glucose levels in the light group increased with time and were significantly higher than in the deep group at the end of surgery (P = 0.002). CONCLUSIONS: A deep level of anesthesia achieved using high propofol infusion rates during lung surgery provided lower perioperative norepinephrine and glucose responses than light level of anesthesia during the early postoperative period but failed to affect immediate postoperative outcomes.
Adrenocorticotropic Hormone ; Adult ; Anesthesia* ; Blood Glucose ; Catecholamines ; Consciousness Monitors ; Epinephrine ; Glucose ; Hemodynamics ; Humans ; Hydrocortisone ; Lung* ; Norepinephrine ; One-Lung Ventilation ; Postoperative Period ; Propofol* ; Prospective Studies ; Pulmonary Surgical Procedures ; Thoracotomy

No abstract available.
Doxorubicin* ; Drug Therapy* ; Small Cell Lung Carcinoma*

Total intravenous anesthesia(TIVA) with ketamine and fentanyl has many advantages such as no air pollution, no hepatic or renal toxicity and good postoperative pain relief compared with inhalational anesthesia, but this anesthetic method also has several disadvantages such as hypertension, delayed recovery and emergence delirium. For improvement of this problems, the authors tried new TIVA method with propofol and fentanyl to the 20 patients in ASA class I or II and compared this method with 20 patients in ASA class I or II who had been anesthetized with enflurane-N2O from March to May 1992. The results were as follows; 1) Systolic blood pressure decreased after induction from 127+/-12mmHg to 105+/-17mmHg in propofol-fentanyl group(p<0.05) and mean arterial pressure decreased after induction from 93 9 mmHg to 799 mmHg in propofol-fentanyl group and from 98+/-10 mmHg to 83+/-11 mmHg in enflurane-N2O group(p<0.05), but they became preoperative values during operation in both groups. RPP(rate-pressure product) and heart rate decreased about 28-39% after induction and during operation in propofol-fentanyl group(p<0.05) but there was no change in enflurane- N2 group. 2) The data of arterial blood gas had no clinically significant changes in both groups. 3) The blood sugar level increased during operation(p<0.05) but it became preoperative value from postoperative 30 min in both groups. 4) There were no clinically significant changes in hepatic or renal function test of postoperative 3rd day compared with preoperative one. 5) There were no postoperative complications except 2 cases of nausea in propofol-fentanyl group. 6) Emergence time and recovery time had no difference in both groups but the duration from arrival on recovery room to postanesthetic recovery score of 10 was shorter in propofol- fentanyl group(7.5+/-7.3 min) than in enflurane-N2O group(16.7+/-l0.3 min)(p<0.05). Therefore TIVA with propofol and fentanyl is considered to have good controllability nearly equal to enflurane-N2O anesthesia and it can be applied as one of general anesthetic methods in the case of contraindication to N2O and volatile anesthetics, but futher study will be required to quantify the appropriate dosage of propofol or fentanyl to minimize perioperative hemodynamic changes and respiratory depression.
Air Pollution ; Anesthesia ; Anesthesia, Intravenous* ; Anesthetics ; Arterial Pressure ; Blood Glucose ; Blood Pressure ; Delirium ; Enflurane ; Fentanyl* ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Ketamine ; Nausea ; Pain, Postoperative ; Postoperative Complications ; Propofol* ; Recovery Room ; Respiratory Insufficiency

Autograft is frequently used to restore anatomic morphology and functional properties in bone defects. Disadvantages of the autograft are related to donor site morbidity and include the risk of wound infection, increased blood loss, and additional postoperative discomfort. Allograft and xenograft, which are currently employed as the most common alternative to autografts, encounter the complications. such as fracture, resorption, and nonunion secondary to immunologic rejection. Hydroxyapatite(HAp), a calcium phosphate ceramic, is a well known biocompatible artificial bone substitute without induction of systemic toxic and foreign body reactions. Bone conduction is usually occurred by the implanted HAp. Biodegradation of HAp is poor and the bone formation around HAp is slow and about more than 70% of the natural apatite in bone is composed of carbonate apatite that has carbonic radical(CO3) instead of hydroxyl radical(OH-) or Phosphate radical(PO4 ) of HAp. Carbonate apatite ahs been known as that the physicochemical properties are similar of the natural bony apatite. In vivo experiment, carbonate apatite demonstrates non-toxic reactions. In this study, the compostite consisted of carbonate apatite and type I collagen, which is the bony structural protein, was implanted in rabbit tibiae to evaluate possibility as an artificial bone substitute. Biodegradation rate of the composite, the rate and qiantity of the regenerative cortical and cancellous bone formation were investigated radiologically and histopathologically. HAp and the carbonate apatite coilagen composite(Ap-C) were applied in the dissected rabbit tibiae(7-8mm), and fixed by external fixators. Postoperative roentgenograms were taken 2, 4, 6, and 8 weeks after implantations. For histological ohservations, the rabbits were sacrificed and the specimens were obtained 2, 4, 6, and 8 weeks after operation. Radiological Lane scores of Ap-C were 1.16±0.92, 2.16±0.98, 3.33± 0.82, and 3.67±0.51 in 2. 4, 6 and weeks after operation, while the Lane score of HAp were 0.53±0.84, 0.83±0.75, 1.67±0.81, and 2.83±0.98 respectively. Ap-C demonstrated the faster degradation and more bone formation then HAp. Though physicochemical properties of carbonate apatite is similar to those of HAp, the carbonate apatite and type I collagen composite(Ap-C) revealed rather faster degradation and bone formation than HAp in both radiological and histological investigations.
Allografts ; Autografts ; Bone Conduction ; Bone Substitutes ; Calcium ; Carbon ; Ceramics ; Collagen Type I ; Collagen ; Durapatite ; External Fixators ; Foreign Bodies ; Heterografts ; Humans ; Osteogenesis ; Rabbits ; Tibia ; Tissue Donors ; Wound Infection

Calcium channel blockers (CCBs) have a relaxatory effect on cardiovascular smooth muscles and newly developed Felodipine has more vascular selectivity than myocardiac effects. This study was undertaken to evaluate the effect of CCBs, including felodipine. on in-vivo penile erection and whether these drugs can be clinically applied to diagnosis and treatment of impotence in the future. We observed intracavernosal and systemic blood pressure changes to cavernous nerve stimulation (1Hz., 2-4V), intracavernosal injection of CCBs (felodipine, diltiazem, verapamil), calcium ionophore (A23187) and calcium channel promotor (Bay-K 8644) in Sprague-Dawley rats(weight: 250-350 gm) using polygraph with the biopac data analyzing system. The results were as follows. 1) Injections administered in dose dependent manner of felodipine (10(-10) - 10(-6)M, n=8). diltiazem (10(-10) - 10(-6)M. n=8) and verapamil (10(-10) - 10(-6)M, n=8) caused increases in intracavernosal pressuret(CP) (p<0.05) with no significant difference observed among the three drugs. In most effective dose, a transient drop of systemic blood pressure was observed by a degree of 30% to 33% of preinjection values, although systemic blood pressure was spontaneously recovered in one minute. However, a longer plateau phase of maximal pressure and a longer duration of detumescence were observed with injection of felodipine (18 min., 20 min.) than with diltiazem (5min., 4min.) or verapamil (5min., 3min, p<0.05). In comparison with ECh of the three drugs, felodipine also showed the effects of 3.4 to 4.4 times larger than diltiazem or verapamil. 2) Intracavemous injections of Bay-K 8644 (10(-6) - 10(-4)M, n=18) or A23187 (10(-6) - 10(-4)M, n=18) in dose dependent manner were found to suppress the most effective dose of felodipine, diltiazem or verapamil-induced erection. These results suggest that penile erection is related to the movement of calcium through its channel and CCBs, especially felodipine, may be useful for the diagnosis and treatment of impotence in the future, although the clinical effect remains to be investigated.
Animals ; Blood Pressure ; Calcimycin ; Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Diagnosis ; Diltiazem ; Erectile Dysfunction ; Felodipine ; Male ; Muscle, Smooth ; Penile Erection ; Rats* ; Rats, Sprague-Dawley ; Verapamil

Hypokalemia causes metabolic alkalosis and morphological changes of the kidney. K⁺ balance is regulated not only by ion channels or pump gene, but also by various genes including NF-E2-related factor 2 (Nrf2). Previous study suggested the possibility that Akt and ERK kinase may be involved in Nrf2 transcriptional gene activation. In present study, we investigate the alterations of Akt, p-Akt, ERK, p-ERK protein in both normal kidney and K⁺-deficient diet kidney using Western blot analysis, and immunohistochemisrty. Our western blot data showed that the expression of Akt and p-Akt was increased gradually in K⁺-depleted diet (from 1W-3W) compared to normal group. The expression of ERK and p-ERK was markedly increased in K⁺-depleted diet 2W in comparison with normal group. Based on our immunostaining results, Akt protein immunoreactivity was prominently increased in outer medullary collecting duct, especially in K⁺-depleted diet 2 weeks. The localization of p-Akt proteins in K⁺-depleted groups was not different from normal group, but the immunoreactivity was significantly increased in distal convoluted tubule, macula densa and outer medullary thick ascending limb in K⁺-depleted diet 1 and 2 weeks groups. ERK protein immunoreactivity was prominently increased in outer medullary collecting duct, especially in K⁺-depleted diet 2 and 3 weeks. The localization of p-ERK proteins in K⁺-depleted groups was not different from normal group, but the immunoreactivity was prominently increased in the nucleus of outer medullary collecting duct especially in K⁺-depleted diet 2 weeks. Taken together, we suggest that the expression of p-Akt was gradually increased in K⁺-depleted groups of kidney, but the expression of p-ERK was markedly increased in K⁺-depleted diet 2 week group. Hence, the promotion of AKT and ERK phosphorylation in hypokalemic condition may be involved in the regulation of ion channels, ion transporters and subsequent intracellular signal transduction.
Alkalosis ; Animals ; Blotting, Western ; Diet ; Extremities ; Hypokalemia ; Ion Channels ; Ion Transport ; Kidney* ; NF-E2-Related Factor 2 ; Phosphorylation ; Phosphotransferases ; Rats* ; Signal Transduction ; Transcriptional Activation

Nine surgically proven congenital absence of gallbladder (CAGB) cases were reviewed. All of them had one or more kinds of biliary symptom. Tests such as abdominal ultrasonography, intravenous or oral cholecystography and even endoscopic retrograde cholangiography not only failed to predict CAGB but misleadingly indicated other similar conditions. Only the abdominal computed tomography (CT), performed on one patient, enabled the accurate diagnosis of CAGB. All the patients underwent abdominal exploration, and CAGB was confirmed by the meticulous dissection of the entire extrahepatic biliary tree and the operative cholangiography. Five patients had concomitant biliary pathologies responsible for their symptoms, but four patients had isolated CAGB. CAGB is a rarely encountered condition for a clinician, but extensive diagnostic work-ups including abdominal CT should be performed in all situations where CAGB is suspected. Thus unnecessary exploration can be avoided in the isolated CAGB case.
Bile Duct Diseases/etiology/surgery ; Diagnostic Techniques, Surgical ; Gallbladder/*abnormalities ; Human ; Radiography, Abdominal ; Tomography, X-Ray Computed

Endotracheal intubation is the most useful and safe method to keep airway in general anesthesia. But there are many problems such as severe cardiovascular changes, difficult intubation, larygospasm and tracheal stenosis in using laryngoscope and tracheal intubation. Laryngeal mask airway(LMA) is new method to keep airway and has many advantages such as easy insertion, decreasing cardiovascular changes, insertion without muscle relaxant, decreasing damage of pharynx and laynx and useful in difficult intubation. Cinical study of LMA No. 2 was done in 30 children weighted between 8.9-26 kg, about cardiovascular changes, volume and pressure changes of inflaton cuff, problems and complications during insertion and maintaining of LMA. The result, were follows I) The average time taken to insert the LMA was 7.4+/-3.3 second and 12 case were correct placement at the second attempt to use laryngoscope. 2) The volume of inflation cuff without air leak during positive pressure ventilation with 15cmH2O of peak airway pressure was 7.9+/-0.5ml and inflation cuff pressure at insertion was 40.1+/-15.9 mmHg and increased(p<0.05) continously. 3) Mean arterial pressure was increased(p<0.05) compared with preinduction value and normalize within a minute. Heart rate was incresed(p<0.05) compared with preinduction value and increase was sustained. 4) There were no complications except 1 case of gastric disteesion.
Anesthesia, General ; Arterial Pressure ; Child* ; Heart Rate ; Humans ; Inflation, Economic ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopes ; Pharynx ; Positive-Pressure Respiration ; Tracheal Stenosis

The fibroepithelial polyp of the ureter is a rare, benign tumor. Its pathogenesis is unclear, but most investigators agree that it arises from elements of mesodermal origin within the ureteral wall. Symptoms include hematuria and intermittent flank pain secondary to partial ureteral obstruction. Correct radiologic assessment is crucial to direct surgical management. We report a case of a fibroepithelial polyp of the ureter in a child in whom correct preoperative diagnosis was made by correlating the results of excretory urography, sonography, CT and urine cytology.
Child* ; Diagnosis ; Flank Pain ; Hematuria ; Humans ; Mesoderm ; Polyps* ; Research Personnel ; Ureter* ; Ureteral Obstruction ; Urography