A 49 year-old male was scheduled for a cholecystectomy, thereafter a 37 year-old female scheduled for removal of a epidural hematoma in the same operating room. Both of them had no specific medical problems and past medical histories for anesthesia. For those reasons, anesthesia was induced with thiopental sodium and succinylcholine with endotracheal intubation. After induction, vital signs including body temperatures were stable. But moisture dew in the unidirectional valves and corrugated tubes, and color changes of soda lime were discovered. At that time, severe hypercarbia was recognized by arterial blood gas analysis in both cases. In both cases, there were no malfunctions in unidirectional valves, expiratory valves, corrugation tubes, soda lime, ventilators and there connection parts in the anesthetic machines. Also there were no abnormalities of blood pressures, electrocardiograms, pulse oxymeters, temperatures and the pulse in the patient monitoring systems except capnography. At first, we thought that medical signs revealed malignant hyperthermias. But vital signs, air way pressures and functions of all kinds of anesthetic machine components including ventilators were normal. After discontinuing N2O gas deliveries in the operation room, hypercarbias disappeared. Thus, anesthetic gas delivery systems via central piping systems were checked and it was discovered that CO2 gas was in the N2O gas tank instead of N2O.
Adult ; Anesthesia ; Blood Gas Analysis ; Body Temperature ; Capnography ; Carbon Dioxide* ; Carbon* ; Cholecystectomy ; Electrocardiography ; Female ; Hematoma ; Humans ; Intubation, Intratracheal ; Male ; Malignant Hyperthermia ; Middle Aged ; Monitoring, Physiologic ; Nitrous Oxide* ; Operating Rooms ; Succinylcholine ; Thiopental ; Ventilators, Mechanical ; Vital Signs

PURPOSE: To evaluate a recently developed technique to place a medium-duration(weeks to months) central venous access. MATERIALS AND METHODS: Within three-year period, 635 patients were referred to interventional radiology suite for placement of peripherally inserted central catheter(PlCC). Contrast medium was injected into the peripheral intravenous line and a puncture was made into the opacified vein near the junction of the middle and upper thirds of the upper arm, either the brachial or basilic vein under fluoroscopic guidance. A 5.5-French peel-away sheath was inserted into the vein and a 5- French silicone catheter was introduced with its distal tip to the junction of the right atrium and superior vena cava. RESULTS: Catheter placement was successful in all patients unless there was a central venous obstruction. Catheters were maintained from 2 days to 5 months with a mean of 3 weeks. Complications included infection requiring removal of the PICC in 16 patients(2.5%), acute thrombosis of the subclavian vein in 3(0.5%). Occluded catheters in 4 patients were easily cleared with urokinase in place. CONCLUSION: The PICC system is an excellent option for medium-duration cen- tral venous access. Patients were able to carry on normal activities with the catheters in place.
Arm* ; Catheters* ; Heart Atria ; Humans ; Ocimum basilicum ; Punctures ; Radiology, Interventional ; Silicones ; Subclavian Vein ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins ; Vena Cava, Superior

PURPOSE: To evaluate a recently developed technique to place a medium-duration(weeks to months) central venous access. MATERIALS AND METHODS: Within three-year period, 635 patients were referred to interventional radiology suite for placement of peripherally inserted central catheter(PlCC). Contrast medium was injected into the peripheral intravenous line and a puncture was made into the opacified vein near the junction of the middle and upper thirds of the upper arm, either the brachial or basilic vein under fluoroscopic guidance. A 5.5-French peel-away sheath was inserted into the vein and a 5- French silicone catheter was introduced with its distal tip to the junction of the right atrium and superior vena cava. RESULTS: Catheter placement was successful in all patients unless there was a central venous obstruction. Catheters were maintained from 2 days to 5 months with a mean of 3 weeks. Complications included infection requiring removal of the PICC in 16 patients(2.5%), acute thrombosis of the subclavian vein in 3(0.5%). Occluded catheters in 4 patients were easily cleared with urokinase in place. CONCLUSION: The PICC system is an excellent option for medium-duration cen- tral venous access. Patients were able to carry on normal activities with the catheters in place.
Arm* ; Catheters* ; Heart Atria ; Humans ; Ocimum basilicum ; Punctures ; Radiology, Interventional ; Silicones ; Subclavian Vein ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins ; Vena Cava, Superior

BACKGROUND: This study was proposed to examine the effects of butorphanol on propofol dose requirements and hemodynamic responses during propofol-N2O-O2 anesthesia. In addition, the effects of butorphanol on the recovery time, sedation score and postoperative first analgesic request time were assessed. METHODS: Forty patients were allocated to 2 groups. Twenty patients received butorphanol (20 microgram/kg, group (B) and the others received an equal volume of placebo (group P) 3 minutes before induction with propofol. After induction, anesthesia was maintained with propofol (6 - 10 mg/kg, iv)-N2O (70%)-O2 (30%). Propofol doses for induction and maintenance and hemodynamic responses (blood pressure, heart rate) were checked. After surgery, sedation score, recovery profiles, and postoperative first analgesic request time were assessed. RESULTS: The induction doses of propofol were lower in group B than in group P. Diastolic pressure and heart rate decreased in group B compared to group P after endotracheal intubation and before skin incision. After skin incision, decreased diastolic pressure and heart rate returned to preanesthetic levels in group P, but the decreased level was sustained in group B. There were group differences in sedation score at 5 and 10 minutes after extubation. In group B, recovery was delayed and more time elapsed before the first analgesic request. CONCLUSIONS: Butorphanol co-administered with propofol reduces the induction dose of propofol and delays the first analgesic request time, but there are significant fluctuations in blood pressure and heart rate during endotracheal intubation and skin incision.
Anesthesia* ; Blood Pressure ; Butorphanol* ; Heart ; Heart Rate ; Hemodynamics* ; Humans ; Intubation, Intratracheal ; Propofol* ; Skin

Gangliosides have been suggested to play important roles in various functions such as adhesion, cell differentiation, growth control, and signaling. Mouse follicular development, ovulation, and luteinization during the estrous cycle are regulated by several hormones and cell-cell interactions. In addition, spermatogenesis in seminiferous tubules of adult testes is also regulated by several hormones, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and cell-cell interactions. The regulation of these processes by hormones and cell-cell interactions provides evidence for the importance of surface membrane components, including gangliosides. During preimplantation embryo development, a mammalian embryo undergoes a series of cleavage divisions whereby a zygote is converted into a blastocyst that is sufficiently competent to be implanted in the maternal uterus and continue its development. Mouse embryonic stem (mES) cells are pluripotent cells derived from mouse embryo, specifically, from the inner cell mass of blastocysts. Differentiated neuronal cells are derived from mES cells through the formation of embryonic bodies (EBs). EBs recapitulate many aspects of lineage-specific differentiation and temporal and spatial gene expression patterns during early embryogenesis. Previous studies on ganglioside expression during mouse embryonic development (including during in vitro fertilization, ovulation, spermatogenesis, and embryogenesis) reported that gangliosides were expressed in both undifferentiated and differentiated (or differentiating) mES cells. In this review, we summarize some of the advances in our understanding of the functional roles of gangliosides during the stages of mouse embryonic development, including ovulation, spermatogenesis, and embryogenesis, focusing on undifferentiated and differentiated mES cells (neuronal cells).
Animals ; *Cell Differentiation ; *Embryonic Development ; Embryonic Stem Cells/*cytology/metabolism ; Gametogenesis ; Gangliosides/*metabolism ; Mice ; Urogenital System/cytology/embryology/metabolism

Aristolochia manshuriensis Kom (AMK) is an herb used as a traditional medicine; however, it causes side effects such as nephrotoxicity and carcinogenicity. Nevertheless, AMK can be applied in specific ways medicinally, including via ingestion of low doses for short periods of time. Non-alcoholic steatohepatitis (NASH) induced the hepatocyte injury and inflammation. The protective effects of AMK against NASH are unclear; therefore, in this study, the protective effects of AMK ethyl acetate extract were investigated in a high-fat diet (HFD)-induced NASH model. We found decreased hepatic steatosis and inflammation, as well as increased levels of lipoproteins during AMK extract treatment. We also observed decreased hepatic lipid peroxidation and triglycerides, as well as suppressed hepatic expression of lipogenic genes in extract-treated livers. Treatment with extract decreased the activation of c-jun N-terminal kinase 1/2 (JNK1/2) and increased the phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2). These results demonstrate that the protective effect of the extract against HFD-induced NASH occurred via reductions in reactive oxygen species production, inflammation suppression, and apoptosis related to the suppression of JNK1/2 activation and increased ERK1/2 phosphorylation. Taken together, these results indicate that that ethyl acetate extract of AMK has potential therapeutic effects in the HFD-induced NASH mouse model.
Animals ; Apoptosis ; Aristolochia* ; Diet, High-Fat ; Eating ; Fatty Liver* ; Hepatocytes ; Inflammation ; JNK Mitogen-Activated Protein Kinases ; Lipid Peroxidation ; Lipoproteins ; Liver ; Medicine, Traditional ; Mice* ; Non-alcoholic Fatty Liver Disease ; Phosphorylation* ; Phosphotransferases* ; Reactive Oxygen Species ; Therapeutic Uses ; Triglycerides

BACKGROUND: Caudal administration of local anesthetics, opioids, and the alpha2 adrenergic agonists is effective for postoperative pain. Intrathecal and epidural opioids may commonly result in urinary retention. The purpose of this study was to evaluate the effects of fentanyl or clonidine on postoperative analgesia and urinary retention. METHODS: Forty patients undergoing a hemorrhoidectomy were randomly assigned to receive 20ml of 2% lidocaine and 1 : 200,000 epinephrine plus clonidine 100 microgram (group C100, n = 10), clonidine 150 microgram (group C150, n = 10), fentanyl 50 microgram (group F50, n = 10), or fentanyl 100 microgram (group F100, n = 10) for caudal anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were measured before anesthesia and immediately postanesthesia, and every 5 min after caudal administration for 30 min. The following variables were recorded: onset time, analgesic time, voiding time, and urinary retention. RESULTS: The MAP at 20, 25, and 30 min in group C150 (91 +/- 7, 91 +/- 6, and 90 +/- 7 mmHg, respectively) was less than in group F50 (99 +/- 4, 101 +/- 6, and 101 +/- 5 mmHg, respectively) (P < 0.05). There was no difference in HR and onset time of anesthesia among the groups. Analgesic times in groups C150, F50, and F100 (270 +/- 22, 265 +/- 23, and 323 +/- 82 min, respectively) were longer than in group C100 (207 +/- 59 min), (P < 0.05). The number of patients using a urinary catheter to void was much higher in group F100 (7 patients) than in the groups C100, C150, or F50 (4, 5, and 3 patients, respectively) (P < 0.05). The voiding time was longer in group C150 than in group C100 (369 +/- 122 min vs 266 +/- 83 min, P < 0.05). No side effects were reported. CONCLUSIONS: We conclude that clonidine 150 microgram is adequate to provide effective analgesia and a low incidence of urinary retention during caudal anesthesia.
Adrenergic Agonists ; Analgesia* ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Caudal* ; Anesthetics, Local ; Arterial Pressure ; Clonidine* ; Epinephrine ; Fentanyl* ; Heart Rate ; Hemorrhoidectomy ; Humans ; Incidence ; Lidocaine ; Pain, Postoperative ; Urinary Catheters ; Urinary Retention*

Radiation therapy is one of the cardial therapeutic modality on breast cancer. Three decades ago, the heart was considered to be radioresistant, but now it is generally recognized that the heart is also radiosensitive. The most common clinical syndromes after irradiation are pericarditis in acute and chronic forms, cardiomyopathy, valvular disease and, to a lesser degree, complete atrioventricular block. However, lesions of coronary vessels had been considered exceptionally rare and even questionable. And then there have been a few case reports for acute myocardial infartion after irradiation for left sided breast cancer and it may be considered that radiation therpy can injure endothelium of coronary artery and cause ischemic coronary artery disease. We report the case of a 38 years old women who developed acute anterior wall myocardial infarction after irradiation for left sided breast cancer.
Adult ; Anterior Wall Myocardial Infarction ; Atrioventricular Block ; Breast Neoplasms* ; Breast* ; Cardiomyopathies ; Coronary Artery Disease ; Coronary Vessels ; Endothelium ; Female ; Heart ; Humans ; Myocardial Infarction* ; Pericarditis

PURPOSE: Patients with hematologic diseases such as chronic myeloid leukemia (CML) or chronic lymphoid leukemia (CLL) are known to have an increased chance of acquiring a secondary neoplasm. Stomach cancer is one of the most common malignant diseases in Korea, and we investigated whether the incidence of secondary stomach cancer in patients with a hematologic disease increases, in order to determine if a more intensive screening program for detecting secondary gastric cancer was required. We also investigated the safety of performing a gastrectomy in hematologic disease patients. MATERIALS AND METHODS: From 1992 to 2006, the medical records of 8376 patients diagnosed with one of the six common hematologic diseases were reviewed. RESULTS: Nine secondary stomach cancers were found among the 8376 patients during the 15-year observation period. No surgical-related complications occurred, and there was no recurrence of stomach cancer if detected early. CONCLUSION: It seems that a more intensive screening program for detecting secondary gastric cancer in hematologic disease patients is not required, and surgery is not risky in these patients.
Gastrectomy ; Hematologic Diseases* ; Humans ; Incidence ; Korea ; Leukemia ; Leukemia, Lymphoid ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Mass Screening ; Medical Records ; Recurrence ; Stomach Neoplasms* ; Stomach*

BACKGROUND: Hemorrhagic cystitis(HC), a common complication of bone marrow transplantation(BMT), is known to be associated with toxic metabolites of chemotherapy drugs or reactivation of primary virus infections. In this study, we evaluated the association between polyomaviruria and HC in BMT patients. METHODS: Urine specimens of 29 patients with HC after BMT were requested for the detection of polyomavirus by culture and polyomerase chain reaction(PCR). Several clinical parameters were analyzed in relations to the presence of polyomaviruria. For comparison, 19 patients without HC after BMT were involved in this study. RESULTS: Overall, 45 of 558 patients developed HC after BMT, and the incidence of HC was estimated to be 8.1%. Patients group showed significantly high prevalence of BK viruria compared with control group by PCR(72.4% vs 31.6%, P = 0.005). In patients group, BK virus was isolated in 44.8%(13/29) by culture and detected in 72.4%(21/29) by PCR. Results of both methods were agreed in 65.5%(19/29). JC virus was detected in 6.9%(2/29) by PCR. Sex, conditioning regimen, graft-versus-host disease(GVHD), onset time after BMT and duration of hematuria did not show any statistically significant differences between the two groups based on the presence of BK viruria by PCR. CONCLUSIONS: High prevalence of BK viruria in HC patients after BMT suggests the possible association between BK virus and HC. However, we could not find any significant clinical parameters in association with BK viruria.
BK Virus ; Bone Marrow Transplantation ; Bone Marrow* ; Cystitis* ; Drug Therapy ; Hematuria ; Humans ; Incidence ; JC Virus ; Polymerase Chain Reaction ; Polyomavirus ; Prevalence