BACKGROUND: Endotoxins play important roles in the pathophysiologic alterations associated with sepsis so the authors examined the effects of hydroxocobalamin, NW-nitro-L-arginine-metyl ester (L-NAME) and aminoguanidine on thiopental-induced contractile responses of lipopolysaccharide (LPS)-treated and control rat aortic rings. METHODS: Aortic ring preparation was obtained from LPS-treated (1.5mg/kg, i.p. for 18h) rats. Cumulative doses of thiopental (10-4~3x10- 3M) were added to construct contraction response curves. Hydroxocobalamin (10-5M), L-NAME (10-6M) or aminoguanidine (10-6M) were added as NO scavenger or as NOS inhibitors. Contraction curves by cumulative doses of thiopental (10-4~3x10-3M) were remeasured after treatment of NO scavenger or NOS inhibitors. Statistical significances (p<00.05) were analyzed according to data characteristics by Student's t-test, paired t-test or ANOVA. RESULTS: The vascular responses of cumulative thiopental (10-4~3x10 3M) administration were dose- dependent contraction and LPS-treated rat was less contracted (p<00.05). There was significant increment on vascular contraction induced by thiopental after hydroxocobalamin pretreatment in LPS-treated rat (p<0.05), in spite of L-NAME, aminoguanidine pretreatment was failed to increase contractile forces in control and LPS-treated rats. CONCLUSIONS: From these results, viewed from maintenance of vasomotor tone in septic state, it is suggested that hydroxocobalamin may be candidate for vasopressor during usual induction of general anesthesia.
Anesthesia, General ; Animals ; Aorta, Thoracic* ; Endotoxins ; Hydroxocobalamin* ; NG-Nitroarginine Methyl Ester ; Rats* ; Sepsis ; Thiopental

No abstract available.
Humans ; Stomach Neoplasms* ; Young Adult*

A nineteen year-old boy with progressive enlargement of the joints and distal extremities, clubbing, coarse facial features and hyperhidrosis was investigated. In physical examination, thickening of the scalp with furrowing (cutis verticis gyrata) and greasy thickening of skin (pachyderma) was prominent. His endocrine profile was normal. Radiological studies demonstrated bilateral symmetrical periosteal new bone formation with acroosteolysis and incidental microadenoma of pituitay gland. After extensive investigation to exclude systemic and endocrine causes, the patient was diagnosed as pachydermoperiostosis (PDP). PDP is a rare syndrome manifested clinically by finger clubbing, extremity enlargement, hypertrophic skin changes, and periosteal bone formation. The pathogenesis of the disorder has not been clarified though few endocrine abnormalities were seen. To aware of these clinical phenotype would help to differentiate PDP from acromegaly.
Acro-Osteolysis ; Acromegaly ; Extremities ; Fingers ; Humans ; Hyperhidrosis ; Joints ; Male* ; Osteoarthropathy, Primary Hypertrophic* ; Osteogenesis ; Phenotype ; Physical Examination ; Scalp ; Skin ; Young Adult*

No abstract available.
Orientia tsutsugamushi* ; Rickettsia* ; Ulsan*

BACKGROUND: Recent studies revealed that inhalational anesthetics (IA) attenuate NO production. But the hemodynamic changes produced by IA in septic syndrome patient are still sufficient to threaten patient, surgeon and anesthesiologist. So we examined which IA is proper to maintain vascular contractile force and evaluated the effects of NOS inhibitors on contractile force of septic rat aorta under IA. METHODS: Aortic ring preparation was obtained from LPS-treated (1.5 mg/kg, i.p. for 18h) rats. The development of sepsis was confirmed by iNOS activity and iNOS expression using RT-PCR. Contractile responses of aorta to phenylephrine admministation in the presence or absence of halothane, enflurane and isoflurane were evaluated. We also evaluated the effects of NOS inhibitors, one is NG-nitro-L-arginine methyl ester (L-NAME) and the other is aminoguanidine. Statistical significances (p<0.05) were analyzed according to data characteristics by unpaired t-test and paired t-test. RESULTS: The contractile responses to phenylephrine admministration were attenuated in LPS-treated rings. Isoflurane, even at the dose of 2 MAC, didn't affect the contractile response while both halothane and enflurane decreased the contractile response even at the dose of 1 MAC. The potentiation of contractile responses by NOS inhibitors were not affected during administeration of IA. CONCLUSIONS: From these results, it is suggested that isoflurane is the safest inhalational anesthetic and NOS inhibitors, especially L-NAME, may be very useful in the therapy of septic shock patients during general anesthesia.
Anesthesia, General ; Anesthetics* ; Animals ; Aorta ; Enflurane ; Halothane ; Hemodynamics ; Humans ; Isoflurane ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase* ; Nitric Oxide* ; Phenylephrine ; Rats* ; Sepsis ; Shock, Septic

Mutation in the p53 suppressor gene is the most common genetic alteration found in human cancers including primary brain tumors. Ki-67 labeling index(LI) is known to be a marker of proliferating activity. The purpose of this study was to verify whether an immunohistochemical expression of p53 antibody and Ki-67 LI could be related to different clinicopathologic parameters including histologic grade, size, invasiveness and recurrence of the brain tumors. Materials were based on the 147 surgically resected brain tumors during the last two years. Of the 147 brain tumors, there were 35 astrocytic tumors, 35 meningiomas, 10 oligodendrogliomas, 7 craniopharyngiomas, 5 dysembryoplastic neuroepithelial tumors, 4 medulloblastomas, 5 ependymomas, 23 pituitary adenomas, 9 schwannomas, and 14 other brain tumors. The p53 expression and Ki-67 LI were higher in malignant brain tumors including astrocytic tumors, medulloblastoma, PNET and gliosarcoma. The p53 positivity was correlated with histologic grades and tumor recurrence. The brain tumors with a high Ki-67 LI(>6%) also showed a close relationship to a higher histologic grading, radiological invasiveness and recurrence. There was no evident correlation with the age and tumor size with p53 expression and Ki-67 LI. These results suggest that p53 overexpression and high proliferation potential of the tumor cells are associated with the higher histologic grade and aggressive clinical course in the central nervous system tumors.
Brain Neoplasms* ; Brain* ; Central Nervous System Neoplasms ; Craniopharyngioma ; Ependymoma ; Genes, Suppressor ; Gliosarcoma ; Humans ; Medulloblastoma ; Meningioma ; Neoplasms, Neuroepithelial ; Neurilemmoma ; Neuroectodermal Tumors, Primitive ; Oligodendroglioma ; Pituitary Neoplasms ; Recurrence

Zonular traction tufts, which exist in 15% of normal population, do not cause retinal detachment by themselves but they can cause traction retinal detaehment when there is traction force added. It is thought that the possibility of development of retinal detaehment increases especially when zonular traetion tufts originate posterior to the vitreous base No case of traction retinal detachment caused by zonular traction tufts has been reported. Here, we report one suspected case of traction retinal detachment induced by zonular traction tufts and lens subluxation.
Lens Subluxation ; Retinal Detachment* ; Retinaldehyde* ; Traction*

Severe neurologic complication after epidural anesthesia is very rare. We experinced a case of cauda equina syndrome following epidural anesthesia with 2% lidocaine 20 ml, alkalinized with sodium bicarbonate and 1: 200,000 epinephrine added in female patient underwent abdominal hysterectomy. She complained hypoesthesia of buttock, perineum, left leg and weakness of left leg. She also suffered from urinary retension and defecation difficulty and abdominal discomfort 2 days after epidural block. In MRI taken 4 days after block, spinal stenosis (L4-5) and mild disc bulging (L3-4) were noted. She was treated with medication, bladder training and physical therapy and recovered slowly but gradually, finally discharged 2 months after block with mild weakeness of left leg. We suggest the causative factors are the temporary neural compression due to spinal stenosis and the spinal cord ischemia due to vascular spasm because of added epinephrine.
Anesthesia, Epidural* ; Buttocks ; Cauda Equina* ; Defecation ; Epinephrine ; Female ; Humans ; Hypesthesia ; Hysterectomy ; Leg ; Lidocaine ; Magnetic Resonance Imaging ; Perineum ; Polyradiculopathy* ; Sodium Bicarbonate ; Spasm ; Spinal Cord Ischemia ; Spinal Stenosis ; Urinary Bladder

No abstract available.
Family Practice* ; Humans

We have experienced 113 cases of neonatal sepsis comfirmed by clinical manifestations and blood cultures from Jan. 1988 to Dec. 1992 at the Neonatal Intensive Care Unit of Ulsan Dong-Kang Hospital and observed the incidence, predisposing perinatal factors, clinical manifestations, associated illnesses, laboratory findings, isolated microorganisms, antibiotics sensitivity test and mortality rate of neonatal sepsis according to onset of disease. The result were as follows: 1) The incidence of neonatal sepsis was 1.39% and male to female ration was 1.38:1. The incidence and sex difference between early onset and late onset disease were not significant. 2) Neonatal sepsis was more prevalent in premature infants (2.47%) than in fullterm infants (1.28%) and nore prevalent in low birth weight infants(3.01%) than in normal birth weight infants (1.25%). In premature infants, neonatal sepsis was more prevalent in early onset (63.2%) than in late onset diease (36.8%). In low birth weight infants, neonatal sepsis was more prevalent in early onset (64.8%) than in late onset dieases (35.7%P). 3) Predisposing perinatal factors, such as meconium staining, birth asphyxia, difficult delivery, premature rupture of membrane, maternal infection, toxemia and postpartum bleeding were slightly frequent in early onset disease. 4) Among the clinical manifestations, jaundice, respiratory symptoms, pallor, lethargy, poor feeding and hepatosplenonegaly were slightly frequent in early onset disease, but temperature instability and gastrointestinal symptoms were slightly frequent in late onset disease. 5) Among the associated illness, pneumonia, disseminated intravascular coagulopathy, amnionitis, hyaline membrane disease and osteomyelits were more common in early onset disease, but gastroenteritis, urinary tract infection, necrotizing enterocolitis, wound infection and meningitis were mors common in late onset disease. 6) The difference of laboratory findings between early onset and late onset disease was not significant. 7) Causative organisms were gram positive organisms in 87 cases(77.0%), gram negative organisms in 22 cases (18.6%) and mixed infections in 5 cases (4.4%). Among them, coagulase negative staphylococcus was the most common one and staphylococcus aureus was the second. The incidence of infections caused by coagulase negative staphylococcus and staphylococcus aureus, between early onset and late onset disease, was not significantly different. Streptococcal infection was more prevalent in early onset disease, especially all group B streptococcus caused early onset disease. 8) Gram positive organisms ware sensitive to Cephalothin (92.9%), Chloramphenicol (90.0%) and Ceftriaxone (88.9%). Gram negative organisms were sensitive to Amikacin (91.3%) and Colistin (82.6%). The difference of antibiotics sensitivity for organisms causing early onset and late onset diease were not significant. Gram negative organisms causing early onset disease were resistant to gentamicin and terramycin, but those organisms causing late onset disease were more sensitive to gentamicin (88.9%) and tobramycin (77.8%). 9) The mortality rate was 7.96%. It was higher in gram negative infections (23.8%) than in gram positive infections (4.6%). No significant difference of mortality rate between early onset and late onset disease was found.
Amikacin ; Amnion ; Anti-Bacterial Agents ; Asphyxia ; Birth Weight ; Ceftriaxone ; Cephalothin ; Chloramphenicol ; Chorioamnionitis ; Coagulase ; Coinfection ; Colistin ; Enterocolitis, Necrotizing ; Female ; Gastroenteritis ; Gentamicins ; Hemorrhage ; Humans ; Hyaline Membrane Disease ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Jaundice ; Lethargy ; Male ; Meconium ; Membranes ; Meningitis ; Mortality ; Oxytetracycline ; Pallor ; Parturition ; Pneumonia ; Postpartum Period ; Pregnancy ; Rupture ; Sepsis* ; Sex Characteristics ; Staphylococcus ; Staphylococcus aureus ; Streptococcal Infections ; Streptococcus ; Tobramycin ; Toxemia ; Ulsan ; Urinary Tract Infections ; Wound Infection