Diabetes is accompanied by delayed wound healing and insufficient granulation tissue formation, possibly because of a defect in fibroblast function. Maintaining glucose level at acceptable low level is considered to be an important part of the clinical treatment of diabetes, but the exact mechanism by which diabetes delays wound repair is not yet known. This study was designed to evaluate the effects of glucose on proliferation([3H]-thymidine uptake) and collagen synthesis([3H]-proline uptake) in dermal fibroblasts from non-lesional skins and chronic wounds. The subjects were divided into 3 groups: non-diabetic control(n = 5), glucose controlled(glycated Hb < 7%) diabetics(n = 5), and glucose uncontrolled(glycosylated Hb > 8%) diabetics(n = 5). The fibroblasts were cultured in two conditions, low glucose(5 mM) and high glucose(20 mM) medium. The data were compared using Mann-Whitney test. The results are as follows: 1. There were no significant differences in the proliferation and collagen synthesis of non-lesional skin fibroblasts in all groups. 2. In high glucose medium culture, the proliferation of the fibroblasts from the wound of the glucose uncontrolled diabetic group was significantly lower than those of the other 2 groups(p< 0.05), and the collagen synthesis of the wound fibroblasts of the control group was significantly higher than those of 2 diabetic groups(p< 0.05). 3. The proliferation and collagen synthesis of the wound fibroblasts in all groups were significantly lower than those of the non-lesional skin fibroblasts(p< 0.05). 4. In the control group and the glucose controlled diabetic group, the proliferation of the wound fibroblasts in the high glucose culture media were lower than those in the low glucose culture media(p< 0.05). Also, in the glucose controlled diabetic group, the collagen synthesis of the wound fibroblasts in the high glucose culture medium was lower than that in the low glucose culture medium(p< 0.05). These results demonstrate that the glucose level may affect the proliferation and collagen synthesis of fibroblasts, and the strict blood glucose control is beneficial to the prevention and treatment of diabetic chronic wounds.
Blood Glucose ; Collagen* ; Culture Media ; DNA* ; Fibroblasts* ; Glucose* ; Granulation Tissue ; Skin ; Wound Healing ; Wounds and Injuries*

STUDY DESIGN: Case report OBJECTIVES: We report a case of a female patient who had only upper back pain without neurological symptoms and was later diagnosed with spine tuberculosis in combination with a compression fracture. SUMMARY OF LITERATURE REVIEW: Spine tuberculosis is the most common type of musculoskeletal tuberculosis. However, the indolent nature of tuberculous bone and joint disease often leads to delayed diagnosis and severe neurologic complications. MATERIAL AND METHODS: A 37-year-old female with only upper back pain for five months was admitted. She had no signs, symptoms or past histories related to tuberculosis. She had taken conservative management, but symptoms persisted. RESULTS: By doing motor and sensory evoked potential studies, we questioned spinal cord jury. Then, we confirmed spine tuberculosis T5 with T4 compression fracture by thoracic magnetic resonance imaging and pathologic findings. CONCLUSIONS: When a patient presents constant back pain without neurological symptoms, image study and electromyography should be evaluated.
Adult ; Back Pain ; Delayed Diagnosis ; Electromyography ; Evoked Potentials ; Female ; Fractures, Compression ; Humans ; Joint Diseases ; Magnetic Resonance Imaging ; Spinal Cord ; Spine ; Spondylitis ; Tuberculosis ; Tuberculosis, Spinal

Sciatic nerve injury after stretching exercise is uncommon. We report a case of an 18-year-old female trained dancer who developed sciatic neuropathy primarily involving the tibial division after routine stretching exercise. The patient presented with dysesthesia and weakness of the right foot during dorsiflexion and plantarflexion. The mechanism of sciatic nerve injury could be thought as hyperstretching alone, not caused by both hyperstretching and compression. Electrodiagnostic tests and magnetic resonance imaging revealed evidence of the right sciatic neuropathy from the gluteal fold to the distal tibial area, and partial tear of the left hamstring origin and fluid collection between the left hamstring and ischium without left sciatic nerve injury. Recovery of motor weakness was obtained by continuous rehabilitation therapy and some evidence of axonal regeneration was obtained by follow-up electrodiagnostic testing performed at 3, 5, and 12 months after injury.
Adolescent ; Axons ; Female ; Follow-Up Studies ; Foot ; Humans ; Ischium ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Stretching Exercises ; Paresthesia ; Regeneration ; Rehabilitation ; Sciatic Nerve* ; Sciatic Neuropathy

BACKGROUND: Tracheal intubation can cause sympathetic stimulation such as hypertension and tachycardia. Many drug are used for reducing the incidence of hypertension and tachycardia induced by intubation. Among these drugs, fentanyl can be used with good result. The purpose of this study was to find the appropriate fentanyl injection time before intubation when a small dose (3 microgram/kg) was used. METHODS: We studied 82 ASA class 1 2 patients, scheduled for gynecological elective surgery, randomized into 5 groups. Group 1 received no fentanyl before intubation, and groups 2, 3, 4 and 5 received 3 microgram/kg fentanyl at 7 min, 5 min, 3 min and 1 min before intubation, respectively. The blood pressure and heart rate were checked at preinduction and post-intubation periods for 5 minutes. RESULTS: The increase of the heart rate was significantly lower in groups 2 and 3 than in group 5 just after intubation. Furthermore the increase of the mean blood pressure was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. The incidence of tachycardia and hypertension was significantly lower in groups 2, 3 and 4 than in group 5 just after intubation. CONCLUSIONS: When a small dose of fentanyl was used to blunt the intubation induced sympathetic stimulation, the appropriate time was prior to 3 minutes before intubation.
Blood Pressure ; Fentanyl* ; Heart Rate ; Humans ; Hypertension* ; Incidence* ; Intubation* ; Tachycardia*

PURPOSE: Sometimes chronic subdural hematoma can be developed following posttraumatic subdural hygroma. The purpose of this study is to investigate its incidence, the duration required for their conversion, and characteristic CT and MR findings of subdural hygroma and chronic subdural hamatoma. MATERIALS AND METHODS: We studied 8 patients with persistent posttraumatic subdural hygroma which consquently developed chronic subdural hamatoma. The patients were examined with CT initially and foilowed-up with CT in 3 and MR in 5. We analyzed the location of the lesion, the change of the density or signal intensity, the change of the size, and the degree of enhancement and mass effect. RESULTS: The duration required for the formation of hematoma was 48-166 days (mean, 76 days). The characteristic CT findings of subdural hygroma were a crescentric lesion with CSF density along the inner table without contrast enhancement. The mass effect was minimal. The CT findings of chronic subdural hematoma were higher density than that of hygroma in all cases, increase in thickness and size in 3 cases, and contrast enhancement along the inner membrane of the hematoma in 5 cases. The signal intensities of the subdural hygroma were identical to those of CSF on both T1 and T2 weighted images, whereas, those of chronic subdural hematoma were higher. CONCLUSION: The increased signal intensity on T1 weighted MR images and increased attenuation or contrast enhancement of the lesion on CT may suggest the conversion of subdural hygroma into chronic subdural hematoma.
Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Lymphangioma, Cystic ; Membranes ; Subdural Effusion*

BACKGROUND: Obtaining and utilizing the feed-backs from residents who have finished four year of anesthesia residency could well contribute to improvement in training program. Therefore authors have designed a self questionnaire to analyze the degrees or measures of satisfaction from such training program and data were evaluated to provide,in future,the guideline which would improve the quality of the training program. METHODS: The self-questionnaires were sent to residents(n=148),who have been through the entire four year of residency training courses under anesthesia department. The assessment was conducted to measure the degree of satisfaction based on several variables such as motivation, selection of anesthesiology as a first choice, type of training hospital, and sex. To evaluate the current problems of anesthesia residency program, we made 30 open-ended and close-ended questions. Data analysis was made using Fishers exaet test. RESULTS: There were no statistically significant difference between the degree of satisfaction and their motivation for choosing anesthesia, anesthesia as a major, selection of anesthesiology as a first choice, and types of hospitals. As for the difference in satisfaction of training, male residents showed significantly higher satisfaction rate( n=92, 36.2%) than female residents(n=47, 17%). CONCLUSIONS: These results suggest that degrees of satisfaction was more likely related to the program of each training hospital and sex compared to other variables studied.
Anesthesia Department, Hospital ; Anesthesia* ; Anesthesiology ; Education ; Female ; Humans ; Internship and Residency* ; Male ; Motivation ; Surveys and Questionnaires ; Statistics as Topic

An obturator hernia is a rare but important cause of small bowel obstruction, due to the difficulty of its diagnosis and the high mortality rate. Elderly, multiparous and debilitated women with comorbid illnesses are most often affected, and this hernia, coupled with a delay in the diagnosis and operative intervention, results in the high mortality rate, which represents both diagnostic and therapeutic challenges to the surgeon. Recently, we experienced two unusual obturator hernia cases, where incarceration had lead to a small bowel obstruction. One patient was an 82-year-old woman with a compression fracture of the lumbar spine, which presented with left inguinal pain and abdominal distension. The abdominal plain X-ray showed evidence of a small bowel obstruction. The hernia was diagnosed by a computed tomography (CT) scan and repaired using the lower midline transperitoneal approach. To prevent a recurrence, the hernial defect was enforced with a polypropylene plug and mesh. The other patient was a 92-year old woman with fracture of the neck of the left femur, which presented with defecation difficulty and abdominal distension. The abdominal plain X-ray showed multiple distended small bowel loops consistent with small bowel obstruction. A contrast-enhanced CT scan of the abdomen and pelvis showed a right obturator hernia with strangulation. We recommended an emergency operation, but the patient refused the operative procedure. With on going conservative management, the symptom was fortunately resolved. Herein, we report these findings with a brief review of the literature.
Abdomen ; Aged ; Aged, 80 and over ; Defecation ; Diagnosis ; Emergencies ; Female ; Femur ; Fractures, Compression ; Hernia ; Hernia, Obturator* ; Humans ; Mortality ; Neck ; Pelvis ; Polypropylenes ; Recurrence ; Spine ; Surgical Procedures, Operative ; Tomography, X-Ray Computed

The aim of the present study was to examine the effect of leptin on CA release from the isolated perfused model of the rat adrenal gland, and to establish its mechanism of action. Leptin (1~100 ng/ml), when perfused into an adrenal vein of the rat adrenal gland for 60 min, enhanced a dose-dependently the secretory responses of CA evoked by ACh (5.32x10 (-3)M), DMPP (10 (-4)M) and McN-A-343 (10 (-4)M), although it alone has weak effect on CA secretion. However, it did not affect the CA secretion evoked by excess K+ (5.6x10 (-2)M). Leptin alone produced a weak secretory response of the CA. Moreover, leptin (10 ng/ml) in to an adrenal vein for 60 min also augmented the CA release evoked by BAY-K-8644, an activator of the dihydropyridine L-type Ca2+ channels, and cyclopiazonic acid, an inhibitor of cytoplasmic Ca2+ ATPase. However, in the presence of U0126 (1micrometer), an inhibitor of mitogen-activated protein kinase (MAPK), leptin no longer enhanced the CA secretion evoked by ACh and DMPP. Furthermore, in the presence of anti-leptin (10 ng/ml), an antagonist of Ob receptor, leptin (10 ng/ml) also no longer potentiated the CA secretory responses evoked by DMPP and Bay-K-8644. Collectively, these experimental results suggest that leptin enhances the CA secretion from the rat adrenal medulla evoked by cholinergic stimulation (both nicotininc and muscarinic receptors), but does not that by membrane depolarization. It seems that this enhanced effect of leptin may be mediated by activation of U0126-sensitive MAPK through the leptin receptors, which is probably relevant to the activation of the dihydropyridine L-type Ca2+ channels located on the rat adrenomedullary chromaffin cells.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; 3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Adrenal Glands ; Adrenal Medulla* ; Animals ; Calcium-Transporting ATPases ; Chromaffin Cells ; Cytoplasm ; Dimethylphenylpiperazinium Iodide ; Leptin ; Membranes ; Protein Kinases ; Rats* ; Receptors, Leptin ; Veins

The aim of the present study was to investigate the effects of 6-chloro-7,8-dihydroxy-1-phenyl-2,3, 4,5-tetrahydro-1H-3-benzazepine (SKF81297), a selective agonist of dopaminergic D1 receptor, on the secretion of catecholamines (CA) evoked by cholinergic stimulation and membrane-depolarization in the isolated perfused rat adrenal gland, and also to elucidate the mechanism involved. SKF81297 (10~100microM) perfused into an adrenal vein for 60 min produced dose- and time-dependent inhibition of CA secretory responses evoked by ACh (5.32 mM), high K+ (56 mM), DMPP (100microM) and McN-A-343 (100microM). Also, in adrenal glands loaded with SKF81297 (30microM), the CA secretory responses evoked by Bay-K-8644 (10microM), an activator of L-type Ca2+ channels and cyclopiazonic acid (10microM), an inhibitor of cytoplasmic Ca2+-ATPase were also inhibited. However, in the presence of the dopamine D1 receptor antagonist, (R)-(+)-8-chloro-2,3,4,5-tetrahydro-3-methyl-5-phenyl-1H-benzazepine-7-ol (SCH23390, 3microM), which is a selective antagonist of dopaminergic D1 receptor, the inhibitory responses of SKF81297 (30microM) on the CA secretion evoked by ACh, high K+, DMPP, McN-A-343, Bay-K-8644, and cyclopiazonic acid were significantly reduced. Collectively, these experimental results suggest that SKF81297 inhibits the CA secretion from the rat adrenal medulla evoked by cholinergic stimulation (both nicotininc and muscarinic receptors) and membrane depolarization. This inhibitory of SKF81297 seems to be mediated by stimulation of dopaminergic D1 receptors located on the rat adrenomedullary chromaffin cells, which are relevant to extra- and intracellular calcium mobilization. Therefore, it is thought that the presence of the dopaminergic D1 receptors may be involved in regulation of CA release in the rat adrenal medulla.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; 3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Adrenal Glands ; Adrenal Medulla* ; Animals ; Calcium ; Catecholamines ; Chromaffin Cells ; Cytoplasm ; Dimethylphenylpiperazinium Iodide ; Membranes ; Rats* ; Receptors, Dopamine D1 ; Veins

BACKGROUND: It is well known that intravenous patient controlled analgesia (IV-PCA) is an effective method to reduce the magnitude of postoperative pain. However, we do not know the appropriate time to start the IV-PCA. To determine the appropriate time to minimalize the sympathetic stimulation and shorten the awakening time after general anesthesia, experiments to indicate whether starting an infusion of the IV-PCA before the end of an operation has a minimal hemodynamic change and similar recovery index compared with the control group were done. METHODS: Seventy-eight patients scheduled for a total abdominal hysterectomy were randomly allocated to two groups. In the IV-PCA group (n = 37), we started the infusion of the IV-PCA before the end of the operation and in the control group (n = 41) which received no IV-PCA, we did not use the IV-PCA as a postoperative pain control method. We measured heart rate, blood pressure, postanesthesia recovery score every 10 minutes for 60 minutes and awakening time at the post-anesthesia care unit. RESULTS: The postanesthesia recovery scores on arrival, 10, 20, 30, 40 and 50 minute after arrival at the post-anesthesia care unit were lower in the IV-PCA group than in the control group. In addition the awakening time after vaporizer-off and at the post-anesthesia care unit was longer in the IV-PCA group than in the control group. CONCLUSIONS: We conclude that starting the infusion of the IV-PCA before the end of the operation is not effective in early recovery and awakening.
Analgesia, Patient-Controlled ; Anesthesia, General ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Hysterectomy ; Pain, Postoperative