BACKGROUND: Desflurane is a new inhaled anesthetic with the lowest blood/gas partition coefficient and enflurane is one of the major anesthetics in these days. But the effect of volatile anesthetics and the site of action on the blood vessel are still controversial. Since Furchgott (1980) discovered endothelium derived relaxing factor (EDRF) from endothelium, many investigators have studied about the relationship between the EDRF and the effect of the volatile anesthetics on blood vessels. In this study, we evaluated that the effect and the action site of enflurane and desflurane on isolated aortic rings of the rabbit. METHODS: Each of obtained thoracic aorta from rabbits (1.5~2.5 kg) was divided into 4~6 mm rings, and a half of that were denuded. All of the aortic rings were preconstricted with phenylephrine 1.5 10-7 Mole in warm organ bath filled with modified Krebs' solution, and then LNAME (inhibitor of nitric oxide synthase, 3 10-4Mole) was administered to one group of aortic rings. MB (inhibitor of soluble guanylyl cyclase, 2 10-5Mole) was administered to another one group and neither of LNAME nor MB was administered to the other group. And then enflurane (1%, 2%, 3%, 4%) or desflurane (6%, 9%, 12%) was administered to all of aortic rings. The polygraph recorded the changes of tension of aortic ring which was transmitted through the force transducer. RESULTS: It was proved that basal EDRF was released from endothelium by the fact that intact aortic rings were more constricted after LNAME or MB administration. The intact aortic rings were constricted in all concentration of enflurane and both intact and denuded rings were maintained from control tension in all concentrations of desflurane. CONCLUSION: It is concluded that enflurane in all concentrations has an endothelium-mediated vasoconstriction effect and desflurane in all concentrations has no effect on isolated aortic rings of rabbit.
Anesthetics ; Aorta, Thoracic ; Arginine* ; Baths ; Blood Vessels ; Endothelium ; Endothelium-Dependent Relaxing Factors ; Enflurane* ; Guanylate Cyclase ; Humans ; Nitric Oxide Synthase ; Phenylephrine ; Rabbits ; Research Personnel ; Transducers ; Vasoconstriction

Background: The integrase strand transfer inhibitor dolutegravir has been indicated in Korea since 2014 for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in combination with other antiretroviral agents. This regulatory post-marketing surveillance (PMS) study evaluated the real-life safety and effectiveness of dolutegravir in patients with HIV-1 in clinical practice in Korea. Materials and Methods: This open-label PMS study examined data from consecutive patients (aged ≥12 years) with HIV-1 infection receiving dolutegravir according to locally approved prescribing information; treatment-naïve and treatment-experienced patients were permitted. Data regarding patient demographics, medical history, clinical characteristics, medications (HIV-related and concomitant), and comorbidities were extracted from patient records over a 1-year treatment period. Outcomes included the safety of dolutegravir (primary endpoint) and real-life effectiveness according to the Physician Global Assessment (PGA) and the proportion of patients with plasma HIV-1 RNA count <50 copies/mL at 48 weeks. Results: Of 147 patients treated with dolutegravir at 18 centers in Korea (August 2014 – August 2020), 139 were eligible for the safety analyses and 75 for effectiveness analyses.Patients (mean age 47 years) were mostly male (92.8%) and received dolutegravir in combination with nucleoside reverse transcriptase inhibitor (70.5%) or protease inhibitors (21.6%). Adverse events (AEs) (n = 179 in total) were mostly mild in severity, with the most common being nasopharyngitis (5.0%), dyspepsia (5.0%), pruritus (4.3%), and rash (4.3%).Of 16 adverse drug reactions (ADRs), the most frequent were rash, diarrhea, headache, insomnia, and somnolence (1.4% each). Of 2 serious ADRs, only 1 (gastroenteritis) was unexpected, and both resolved. The risk of experiencing an AE while receiving dolutegravir appeared to be especially increased in patients receiving concomitant medications for other conditions. Dolutegravir effectively suppressed HIV-1 (93.3% of patients had plasma HIV-1 RNA <50 copies/mL), and 100% of patients showed symptom improvement based on physician global assessment. Conclusion Results of this PMS study showed that dolutegravir administered as highly active antiretroviral therapy was well tolerated and effective in patients with HIV-1 infection.

Eosinophilic cellulitis (EC) is a rare idiopathic disorder, first described as a "recurrent granulomatous dermatitis with eosinophilia", that mimics cellulitis of infectious origin. We describe here a previously healthy 11-year-old girl who experienced fever and tender erythematous patch lesions after trauma to her knees. Because of the relapsing cellulitis-like skin lesions, skin biopsies were taken, resulting in a diagnosis of EC. The patient responded well to oral prednisolone but experienced side effects and relapse during dose tapering. She was switched from prednisolone to cyclosporine. Her EC remained under control, and she showed no evidence of relapse after discontinuation of cyclosporine.
Biopsy ; Cellulitis ; Cyclosporine ; Dermatitis ; Eosinophilia ; Eosinophils ; Fever ; Humans ; Knee ; Prednisolone ; Recurrence ; Skin

OBJECTIVES: Heart rate variability (HRV) has gained recognition as a noninvasive marker of autonomic activity. HRV is considered a promising tool in various clinical scenarios. The optimal electrocardiogram (ECG) sampling frequency required to ensure sufficient precision of R–R intervals for HRV analysis has not yet been determined. Here, we aimed to determine the acceptable ECG sampling frequency range by analyzing ECG signals from patients who visited an emergency department with the chief complaint of acute intoxication or overdose. METHODS: The study included 83 adult patients who visited an emergency department with the chief complaint of acute poisoning. The original 1,000-Hz ECG signals were down-sampled to 500-, 250-, 100-, and 50-Hz sampling frequencies with linear interpolation. R–R interval data were analyzed for time-domain, frequency-domain, and nonlinear HRV parameters. Parameters derived from the data on down-sampled frequencies were compared with those derived from the data on 1,000-Hz signals, and Lin's concordance correlation coefficients were calculated. RESULTS: Down-sampling to 500 or 250 Hz resulted in excellent concordance. Signals down-sampled to 100 Hz produced acceptable results for time-domain analysis and Poincaré plots, but not for frequency-domain analysis. Down-sampling to 50 Hz proved to be unacceptable for both time- and frequency-domain analyses. At 50 Hz, the root-mean-squared successive differences and the power of high frequency tended to have high values and random errors. CONCLUSIONS: A 250-Hz sampling frequency would be acceptable for HRV analysis. When frequency-domain analysis is not required, a 100-Hz sampling frequency would also be acceptable.
Adult ; Electrocardiography* ; Emergencies ; Emergency Service, Hospital ; Heart Rate* ; Heart* ; Humans ; Poisoning ; Signal Processing, Computer-Assisted

The clinical and pathological features were analyzed for 11 cases with intracranial ependymoma treated surgically at the Keimyung University Dongsan Medical Center during the years 1987 to 1992. Tumor histology was reviewed individually and grouped into three categories(Categories I to III) according to the pathologic grade used by Nazar, et al. There were 2 cases(18%) with category I histology, 5(45%) with category II histology, and 4(36%) with category III histology. The high recurrent rate, short recurrent interval, high rate of cerebrospinal fluid seeding and poor outcome were noted in patients with category III histology. The authors also investigated the recurrent interval according to the degree of tumor resection. The mean recurrent interval after surgery was 12 months in cases of subtotal resection and 33 months in a case of total resection. Tumors resected subtotally showed response to radiation and chemotherapy. In conclusion, the pathologic grade and the degree of tumor resection were regarded as important prognostic factors after surgery. Aggressive surgery with chemotherapy or radiotherapy were required in the management of intracranial ependymoma.
Cerebrospinal Fluid ; Drug Therapy ; Ependymoma* ; Humans ; Prognosis ; Radiotherapy

PURPOSE: Since the laparoscopic cholecystectomy became an usual procedure, operative indications of the gallbladder polyps have had the tendency to enlarge. There are no precise management plan about the gallbladder polyps which is not included in the accepted operative indications. Therefore a management plan may be required for the patients who has gallbladder polyps which is not accepted operative indications. METHODS: We retrospectively analysed 106 patients with gallbladder polyps who were diagnosed preoperatively by ultrasound and CT from January 1991 to January 2005. Our operation indications are polyp above 10 mm, symptomatic polyp, sessile polyp, coincidence of stone, focal thickening of gallbladder wall, diffuse wall thickening and detection during other operations. The gallbladder polyps which were suspected to the gallbladder cancer strongly on radiologic studies and polyps above 20 mm size were excluded in this studies. RESULTS: Among the 106 patients, 87 patients underwent operation, and polypoid lesions disappeared during the follow-up period in 3 patients, and 16 patients are on regular follow up. Fifty-six cases received operation with accepted operative indications, and the thirty-one cases underwent operation by the patient's demand. Two groups showed significant difference in true polyp on pathological diagnosis (P < 0.001). There was 16.07% true polyp in opertive indication based 56 patients and no true polyp in patient's demanded 31 cases. The pathologic diagnoses were cholesterol polyp in 27 patients (87.15%), no polyp in 2 patients, adenomatous hyperplasia in 2 patients. The correlation of the polyp size and pathologic diagnosis was an inverse relation to the polyp size and incidence of pseudopolyp (P=0.014). CONCLUSION: We propose that the 6-month-interval follow-up observation is fully safe for polyps sized below 10 mm and not included in accepted operative indications.
Cholecystectomy, Laparoscopic ; Cholesterol ; Diagnosis ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Hyperplasia ; Incidence ; Polyps ; Retrospective Studies ; Surgical Procedures, Operative ; Ultrasonography

In order to find out the accuracy of the quantification of the infarction area by using triphenyltetrazolium chloride(TTC) staining and to evaluate the change of the infarction size according to the duration after the ischemic insult, in a series of 33 adult rats, a surgical occlusion of the middle cerebral artery(MCA) was carried out through a small subtemporal craniotomy. 11 animals at 6 hour, 12 animals at 24 hour and 10 animals at 48 hour following the surgical occlusion of the MCA, rats were sacrificed and brain slices were obtained and stained with TTC, and hematoxyline and eosin(H & E). The size of the infraction area stained by each method was quantified by a computer image analysis system. The average percent of the infarction size(+/-standard error) was larger in the 24 and 48 hour groups than that of the 6 hour group(determined by TTC:9.94+/-0.97 vs. 9.98+/-1.08 vs. 6.83+/-0.82%, respectively:6 hour vs. 24 & 48 hour groups;one-way ANOVA test p<0.05 determined by H & E:10.02+/-0.94 vs. 10.02+/-1.06 vs. 7.73+/-0.85%, respectively). However, there was no significant difference in the size of the infarction between the 24 and 48 hour groups. The size of the infarction area determined by either method was not significantly different in any group(TTC vs. H & E:paired t-test p>0.05), and linear regression analysis showed a significant correlation existed between the two methods in all groups. However, the degree of correlation was more prominent in the 24 and the 48 hour groups than 6 hour group(6 hour group:r=0.76, slope=0.78, y intercept=0.55;24 hour group:r=0.97, slope=1.03, y intercept=-0.78;48 hour group:r=0.98, slope=0.94, y intercept=0.42). From this study it is concluded that: 1) the evolution of the infarction size continues up to 24 hours following the arterial occlusion, and thereafter, the change of the infarction size is minimal in the rat. This data suggests that it is sufficient to evaluate the change of the infarction size up to 24 hours following the ischemic insult in the experimental study of ischemia in the rat. 2) the detection and the quantification of the cerebral infarction by using TTC staining is a reliable method after 24 hours following the ischemic insult. However, in the earlier period than 24 hours following the ischemic insult, staining with TTC coupled with histopathological H & E staining will add to the accuracy in the obtainin the quantity of the cerebral infarction in the rat.
Adult ; Animals ; Brain ; Cerebral Infarction* ; Craniotomy ; Hematoxylin ; Humans ; Infarction ; Infarction, Middle Cerebral Artery* ; Ischemia ; Linear Models ; Middle Cerebral Artery* ; Rats

To investigate the role of internal elastic lamina in the formation of an aneurysm and the pathological progression of the aneurysmal wall and neck area, in a series of 32 adult rats, a small discrete mechanical lesion was made following an arteriotomy on the common carotid artery. Through the arteriotomy site, the lesion was made in the intima of the opposite side of the arterial wall by microsurgical technique at the proximal site to the bifurcation of the common carotid artery. Surgical sites of vessels were inspected grossly and light microscopically at intervals of 1, 4, 8 and 12 weeks(each group : 8 animals). Among the 32 animals, well defined aneurysms were seen in 15. In histological examination of the aneurysms, the internal elastic lamina almost disappeared or fragmented at the level of the aneurysmal neck. The aneurysmal wall was composed of only collagen fibers without evidence of elastic fibers. The aneurysmal wall and neck thickened progressively with collagen deposits. These aneurysms were similar to the human aneurysm histologically. This technique provides an experimental surgical formation of aneurysm and lends support to the important role of internal elastic lamina in the formation of an aneurysm. This experiment also showed progressiv thickening of the aneurysmal wall with collagen deposits.
Adult ; Aneurysm* ; Animals ; Carotid Arteries* ; Carotid Artery, Common ; Collagen ; Elastic Tissue ; Humans ; Neck ; Rats*

Background: and Purpose Fatigue is common in demyelinating disorders of the central nervous system (CNS), including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).We aimed to validate the usefulness of the Functional Assessment of Chronic Illness Therapy– Fatigue (FACIT-F) and the Fatigue Severity Scale (FSS) relative to the Korean version of the Modified Fatigue Impact Scale (MFIS-K) in Korean patients with MS, NMOSD, and MOGAD. Methods: There were 294 patients with MS (n=120), NMOSD (n=103), or MOGAD (n=71) enrolled in a prospective demyelinating CNS registry. Fatigue was measured using the FACIT-F, MFIS-K, and FSS. Sleep quality, quality of life, depression, and pain were evaluated using the Pittsburgh Sleep Quality Index (PSQI), 36-item Short-Form Survey (SF-36), and Beck Depression Inventory-II (BDI-II). Results: The MFIS-K, FACIT-F, and FSS scores showed high internal consistencies and strong correlations with each other in the MS, NMOSD, and MOGAD groups. The scores on all three fatigue scales were correlated with PSQI, SF-36, and BDI-II results in the three groups. The areas under the receiver operating characteristic curves for the FSS and FACIT-F were 0.834 and 0.835, respectively, for MS, 0.877 and 0.833 for NMOSD, and 0.925 and 0.883 for MOGAD. Conclusions These results suggest that the MFIS-K, FSS, and FACIT-F are useful and valuable assessment instruments for evaluating fatigue in Korean patients with MS, NMOSD, and MOGAD.

Kv3family K + channels, by ensuring speedy repolarization of action potential, enable rapid and high frequency neuronal firing and high precision temporal coding of auditory information in various auditory synapses in the brain. Expression of different Kv3 subtypes within the auditory end organ has been reported. Yet, their precise role at the hair cell synaptic transmission has not been fully elucidated. Using immunolabeling and confocal microscopy we examined the expression pattern of different Kv3 family K + channel subunits in the nerve fibers innervating the cochlear hair cells.Kv3.1b was found in NKA-positive type 1 afferent fibers, exhibiting high signal intensity at the cell body, the unmyelinated dendritic segment, first heminode and nodes of Ranvier.Kv3.3 signal was detected in the cell body and the unmyelinated dendritic segment of NKA-positive type 1 afferent fibers but not in peripherin-positive type 2 afferent. Kv3.4 was found in ChAT-positive LOC and MOC efferent fibers as well as peripherin-positive type 2 afferent fibers. Such segregated expression pattern implies that each Kv3 subunits participate in different auditory tasks, for example, Kv3.1b and Kv3.3 in ascending signaling while Kv3.4 in feedback upon loud noise exposure.