No abstract available.
Leiomyosarcoma* ; Uterine Inversion*

BACKGROUND: Laryngoscopy and tracheal intubation for general anesthesia are potent stimuli to the cardiovascular system due to sympathetic stimulation. The aim of this study was to compare the hemodynamic responses with different administration routes of lidocaine on blood pressure and heart rate changes associated with tracheal intubation. METHODS: Sixty patients were randomly assigned to spray group (Group 1, n=20) received 10% lidocaine 1.5 mg/kg spray to intratracheally immediately before tracheal intubation, IV group (Group 2, n=20) received 2% lidocaine 1.5 mg/kg intravenously before 90 sec tracheal intubation and control group (Group 3, n=20). Anesthesia was induced with thiopental 5 mg/kg IV, vecuronium 0.1 mg/kg and 50% N2O-O2- 2vol % enflurane. After 5 minutes, tracheal intubation was performed. Mean arterial pressure and heart rate were measured at preintubation and immediately postintubation, 1, 3, 5 mins after tracheal intubation. RESULTS:The differences of mean arterial pressure which were measured at preintubation and immediately postintubation and 1 minute after intubation in group 1 were significantly lower than those in other group (p<0.05). The differences of heart rate which measured at preintubation and 1 minute after intubation were lower than those in group 3 (p<0.05). CONCLUSIONS: For the suppression of sympathetic stimulation following tracheal intubation, 10% lidocaine spray to the laryngotrachea is an effective method to suppress cardiovascular response.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Enflurane ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation* ; Laryngoscopy ; Lidocaine* ; Thiopental ; Vecuronium Bromide

Although basic mechanisms of atopic dermatitis remain largely speculative, many studies on pathogenesis suggest the importance of food and inhalent allergens. To evaluate the frequency of food and house dust mite hypersensitivity and differences in this frequency according to ages, we measured the levels of specific IgE antibodies to egg white, egg yolk, milk, soy, and house dust mites in 119 children with atopic dermatitis. The results showed that 53% of patients had positive RAST to any one kind of allergens. The frequency of food and house dust mite hypersensitivity were 34.5%, 30.3 %, respectively. Among allergens, house dust mites and egg white are the most prevalent allergens in all atopic dermatitis patients. The Prevalence of egg white is most common under the age of 2 years, but those of house dust mites are the dust mites are the highest in the ages of 5-12 years. In conclusion, we recommend an egg restriction diet in atopic dermatitis patients who are less than 2 years old when their symptoms do not improve with general skin care.
Allergens ; Antibodies ; Antigens, Dermatophagoides ; Child* ; Child, Preschool ; Dermatitis, Atopic* ; Diet ; Dust* ; Egg White ; Egg Yolk ; Humans ; Hypersensitivity ; Immunoglobulin E ; Mites ; Ovum ; Prevalence ; Pyroglyphidae* ; Skin Care ; Soy Milk

This study attempted to assess the risk factors for mortality of very-low-birth-weight (VLBW) infants in the neonatal intensive care unit (NICU, n=2,386). Using data from the Korean Neonatal Network, we investigated infants with birth weights <1,500 g and gestational ages (GAs) of 22-31 weeks born between January 2013 and June 2014. Cases were defined as death at NICU discharge. Controls were randomly selected from live VLBW infants and frequency matched to case subjects by GA. Relevant variables were compared between the cases (n=236) and controls (n=236) by Cox proportional hazards regression to determine their associations with cause-specific mortality (cardiorespiratory, neurologic, infection, gastrointestinal, and others). In a Cox regression analysis, cardiorespiratory death were associated with a foreign mother (hazard ratio, HR, 4.33; 95% confidence interval, CI, 2.08-9.02), multiple gestation (HR, 1.65; 95% CI, 1.07-2.54), small for gestational age (HR, 2.06; 95% CI, 1.25-3.41), male gender (HR, 1.69; 95% CI, 1.10-2.60), Apgar score < or =3 at 5 min (HR, 1.97; 95% CI, 1.18-3.31), and delivery room resuscitation (HR, 2.60; 95% CI, 1.53-4.40). An Apgar score < or =3 at 5 min was also associated with neurological death (HR, 2.95; 95% CI, 1.29-6.73). Death due to neonatal infection was associated with outborn delivery (HR, 5.09; 95% CI, 1.46-17.74). Antenatal steroid and preterm premature rupture of membranes reduced risk of cardiorespiratory death (HR, 0.43; 95% CI, 0.27-0.67) and gastrointestinal death (HR, 0.30; 95% CI, 0.13-0.70), respectively. In conclusion, foreign mother, multiple gestation, small gestation age, male gender, Apgar score < or =3 at 5 min, and resuscitation in the delivery room are associated with cardiorespiratory mortality of VLBW infants in NICU. An Apgar score < or =3 at 5 min and outborn status are associated with neurological and infection mortality, respectively.
Apgar Score ; Cohort Studies ; Databases, Factual ; Female ; Gestational Age ; Humans ; Infant ; *Infant Death ; *Infant Mortality/trends ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Kaplan-Meier Estimate ; Male ; Pregnancy ; Pregnancy, Multiple ; Proportional Hazards Models ; Republic of Korea ; Resuscitation ; Risk Factors ; Sex Factors

OBJECTIVES: Septic shock is characterized by the circulatory failure including vasodilation, hyporeactivity to vasoconstrictor agents and organ ischemia in association with multiple organ failure and increased platelet aggregation and blood coagulation. In the present study, we investigated the preventive effects of N-nitro-L-arginine methyl ester (L-NAME, 30mg/kg, i.p.), a non-selective nitric oxide synthase (NOS) inhibitor, S-methylisothiourea sulfate (SMT, 5mg/kg, i.p.) and pentoxifylline (PTX,10mg/kg, i.p.) on the multiple organ dysfunction in a rat model of circulatory shock induced by bacterial endotoxin (E. coli lipopolysaccharide: LPS) and discussed the mechanism underlying the development of multiple organ failure. METHODS: The effect of each other N-nitro-L-arginine methyl ester(L-NAME, 30 mg/kg, i.p.), a non-selective nitric oxide synthase(NOS) inhibitor, S-methyli-sothiourea sulfate(SMT, 5mg/kg, i.p.) and pentoxifylline (PTX, 10mg/kg, i.p.) were comparatively evaluated following inducing circulatory shock by means of infusion of bacterial endotoxin to the rat model. RESULTS: 1) The systemic mean arterial blood pressure decreased by 48.7mmHg and vascular hyporeactivity to noradrenaline injection(1 g/kg, i.v.) upon intravenous administration of LPS. 2) Endotoxemia for 6hours resulted in little change in the numbers of white blood cells and neutrophils but a significant reduction in the numbers of platelets. The variables were not affected by the inhibitors. 3) Endotoxemia for 6hours caused a significant increase in serum nitric oxide level (P<0.01) which was inhibited by SMT, but not by L-NAME and PTX. 4) Upon injection of LPS, serum creatinine(0.65+/-0.08mg/dl) and urea(28.7+/-5.9mg/dl) were significantly elevated to 0.92+/-0.12 (P<0.05) and 54.3+/-2.1mg/dl (P< 0.01). These elevated levels were significantly attenuated by PTX but not by L-NAME and SMT. 5) Endotoxemia for 6 hours resulted in a significant increases in serum ALT(988.8+/-28.2 IU/L, P<0.01) and AST levels(1470.5+/-396.5 IU/L, P<0.01) from basal levels of ALT(67.8+/- 11.7IU/L) and AST(170.3+/-14.8IU/L). These increased activities were significantly attenuated by PTX, but not by L-NAME and SMT. The level of LDH(1279.8+/-156.2IU/L) was significantly increased by LPS treatment to 2932.0+/-519.9IU/L (P<0.05), which was inhibited by PTX. 6) Upon LPS treatment, the myeloperoxidase activity in the lung homogenate was significantly increased by LPS treatment (P<0.05), whereas that in the liver showed less change. The increased activity was reduced by PTX (P<0.05), but not by L-NAME and SMT. 7) The level of serum malondialdehyde, an index of lipid peroxidation by oxygen free radicals, was little influenced by LPS. CONCLUSION: Based on these results, it is summarized that PTX characteristically inhibited the development of multiple ogran dysfunction in a murine model of endotoxemia. Thus, it is concluded that the formation of TNF and increased activity of neutrophils may importantly contribute to the development of LPS-induced endotoxemia.
Administration, Intravenous ; Animals ; Arterial Pressure ; Blood Coagulation ; Endotoxemia ; Free Radicals ; Ischemia ; Leukocytes ; Lipid Peroxidation ; Liver ; Lung ; Malondialdehyde ; Models, Animal ; Multiple Organ Failure ; Neutrophils ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Norepinephrine ; Oxygen ; Pentoxifylline* ; Peroxidase ; Platelet Aggregation ; Rats* ; Shock ; Shock, Septic ; Vasoconstrictor Agents ; Vasodilation

BACKGROUND: Tracheal intubation and skin incision are potent stimuli that can induce increased sympathetic activity, tachycardia and hypertension. The purpose of this study is to evaluate whether the epidural clonidine pretreatment reduce the sympathetic activity and cardiovascular response. We compared the hemodynamic changes and catecholamine concentration before, during and after general anesthesia with epidural clonidine pretreatment. METHODS: Forty patients undergoing lower abdominal surgery were randomly allocated into the two groups. In Group 1, 10 ml of 0.9% normal saline was administered epidurally 15 minutes before induction of anesthesia as control. In Group 2, 3 microgram/kg clonidine diluted in 10 ml normal saline was administered epidurally 15 minutes before induction of anesthesia. We measured the blood pressure, heart rate and plasma catecholamine concentration at preinduction, 1 minute after intubation (T1), 1 (T2) and 30 minutes after skin incision (T3), 1 (T4) and 2 (T5) hours after arrival at recovery room and the results were compared between group 1 and group 2. RESULTS: There was statistically significant difference in systolic pressure at T1 and T2 between the two groups. Heart rate was statistically significant difference at T1 and T4 between the two groups. There was statistically significant difference in epinephrine and norepinephrine concentration at T1 and T2 between the two groups. CONCLUSION: The elevation of blood pressure, heart rate and plasma catecholamine concentration accompanying tracheal intubation and skin incision may be reduced by administration of epidural clonidine.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Clonidine* ; Epinephrine ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Norepinephrine ; Plasma* ; Recovery Room ; Skin ; Tachycardia

OBJECTIVE: The rat middle cerebral artery thread-occlusion model has been widely used to investigate the pathophysiological mechanisms of stroke and to develop therapeutic treatment. This study was conducted to analyze energy metabolism, apoptotic signal pathways, and genetic changes in the hippocampus of the ischemic rat brain. METHODS: Focal transient cerebral ischemia was induced by obstructing the middle cerebral artery for two hours. After 24 hours, the induction of ischemia was confirmed by the measurement of infarct size using 2,3,5-triphenyltetrazolium chloride staining. A cDNA microarray assay was performed after isolating the hippocampus, and was used to examine changes in genetic expression patterns. RESULTS: According to the cDNA microarray analysis, a total of 1,882 and 2,237 genes showed more than a 2-fold increase and more than a 2-fold decrease, respectively. When the genes were classified according to signal pathways, genes related with oxidative phosphorylation were found most frequently. There are several apoptotic genes that are known to be expressed during ischemic brain damage, including Akt2 and Tnfrsf1a. In this study, the expression of these genes was observed to increase by more than 2-fold. As energy metabolism related genes grew, ischemic brain damage was affected, and the expression of important genes related to apoptosis was increased/decreased. CONCLUSION: Our analysis revealed a significant change in the expression of energy metabolism related genes (Atp6v0d1, Atp5g2, etc.) in the hippocampus of the ischemic rat brain. Based on this data, we feel these genes have the potential to be target genes used for the development of therapeutic agents for ischemic stroke.
Animals ; Apoptosis ; Brain ; Brain Ischemia* ; Energy Metabolism ; Gene Expression* ; Hippocampus* ; Ischemia ; Ischemic Attack, Transient ; Middle Cerebral Artery ; Oligonucleotide Array Sequence Analysis ; Oxidative Phosphorylation ; Rats* ; Signal Transduction ; Stroke

We present a patient with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), which was diagnosed and corrected in her 60 s. The patient is the oldest documented survivor of ALCAPA who underwent a surgical repair. ALCAPA should be corrected surgically to restore the dual coronary system at any age and this case shows that the surgical procedure may be performed safely even in an elderly patient.
Aged ; Coronary Vessels ; Female ; Humans ; Pulmonary Artery ; Survivors

PURPOSE: Urinary tract infections (UTIs) are the most common source of bacterial infections in infants and young children. Accurate diagnosis and treatment is important because of their association with renal scarring, which can lead to complications. Urine endothelin-1 (ET-1) is the major renal isoform produced and released by renal mesangial cells in response to glomerular injury. This study aimed to investigate whether urinary levels of ET-1 can be used as a biomarker for UTI diagnosis. METHODS: We conducted a prospective study using medical records of 70 patients below the age of 18 years, who visited Chung-Ang University Hospital from July 2012 to July 2013. We classified the patients into the UTI and control groups based on urine culture studies. The UTI group was further divided into upper and lower UTI groups using 99m-Technetium dimercaptosuccinic acid scintigraphy. Urine ET-1 was measured using enzyme linked immunosorbent assay with 0.3 mL urine. RESULTS: The UTI and control groups were comprised of 45 and 25 patients, respectively. Mean urine ET-1 levels were significantly higher in the UTI group than in the control group (1.41+/-0.35 pg/mL vs. 0.33+/-0.07 pg/mL, P=0.04). There was no significance difference in the quantitative value between the upper and lower UTI groups (P=0.552). There was no correlation between urine ET-1 and serum C-reactive protein (Pearson correlation [R]=0.24), urine ET-1 and serum white blood cell count (R=0.19). CONCLUSION: Our study suggests that urine ET-1 can be used for early diagnosis of UTI in children.
Bacterial Infections ; Biomarkers ; C-Reactive Protein ; Child* ; Cicatrix ; Diagnosis ; Early Diagnosis ; Endothelin-1* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant ; Leukocyte Count ; Medical Records ; Mesangial Cells ; Pediatrics ; Prospective Studies ; Radionuclide Imaging ; Succimer ; Urinary Tract Infections*

A 66 year old male with a suprarenal pheochromocytoma on the left side was treated preoperatively with oral phenoxybenzamine 20 mg, b. i. d. for 2 weeks. The night before surgery, phenobarbital 100 mg & diazepam 5 mg were given orally. One hour before induction, diazepam 10 mg i. m. was given. Preinduction BP was 210/140 and HR was 130/min. After diazepam 20 mg i. v, BP lowered to 200/130 and HR lowered to 126/min. With commencement of sodium nitroprusside i. v. dripping, a BP of 160/100 and HR of 118 were maintained. Following Thiopental sodium 250 mg i. v., mask induction was started with N2O-O2-Enflurane and pancuronium 4 mg i. v., after 5 minutes, a #8.5 tube was intubated and pindolol 0.16 mg was injected to prevent tachycardia. We maintained a tolerable BP and pulse by repeatedly adding a bolus i. v. injection of phenoxybenzamine 1 to 2 mg during tumor manipulation and removal. No arrhythmia was noted throughout the procedure, except tachycardia. After removal of the tumor, with rapid blood transfusion and fluid infusion plus dopamine i. v. dripping, a tolerable BP and pulse was maintained.
Aged ; Anesthesia* ; Arrhythmias, Cardiac ; Blood Transfusion ; Diazepam ; Dopamine ; Enflurane* ; Humans ; Male ; Masks ; Nitroprusside ; Pancuronium ; Phenobarbital ; Phenoxybenzamine ; Pheochromocytoma* ; Pindolol ; Tachycardia ; Thiopental