PURPOSE: Excessive amounts of glutamate are released into the extracelluar space during hypoxia/ischemia and contribute to neuronal injury through overactivation of the NMDA receptors. It will be expected that the changes of the NMDA receptors to decrease the injury are developed as a kind of defense mechanism. The NMDA receptors are composed of NR1 and NR2, and there are four NR2 subunits; NR2A, NR2B, NR2C, and NR2D. The NR1 is essential for the function of the NMDA receptors and multiple NR2 subunits potentiate and differentiate the function of the NMDA receptors. The NR2 subunits alone show no ability to respond to several agonists, however when coexpressed with the NR1, the NR2 subunits markedly potentiated the NR1 activity and produced functional variability of the NMDA receptors. Compared with the NR2C and the NR2D, the NR2A and the NR2B show prominent expression in the hippocampus. In an in vitro model of rat hippocampal slices after hypoxia, we investigated the changes of the NR2A and the NR2B amounts through immunoblot with anti-NR2A and anti-NR2B antisera. METHODS: Hippocampi from adult rats(Sprague Dawley) were isolated and sliced into a 500 m section in a glucose containing artificial CSF medium on ice. In order to induce a hypoxia, sample slices were treated with 95% N2/5% CO2 for 10 min, 20 min, 30 min, and 60 min, respectively and control slices were treated with 95% O2/5% CO2 to supply sufficient oxygen as the same way. And then the control and the sample slices were homogenated and 40 g of each homogenates were electrophoresed in a 6% SDS-gel, transfered to nitrocellulose, and immunostained with anti-NR2A and anti-NR2B antisera. RESULTS: 1) Anti-NR2A antisera were produced by recombinant DNA technology. 2) The NR2A and the NR2B were enriched in the order of PSD, synaptosome and brain homogenate. 3) There was no difference of the NR2A and the NR2B expression in both control and experimental group. CONCLUSIONS: At least up to one hour after hypoxic damage, it is likely that there is no prominent changes of the NR2A and the NR2B amounts. Considering that the changes could occur locally or microscopically in this experimental protocol, the relative amounts of the NR2A and the NR2B in the hippocampal homogenates are too small to be detected by immunoblot analyses. And we can not exclude the possibility of no changes in one hour after hypoxia, if these changes evolve with a extremely slow progression.
Adult ; Animals ; Anoxia ; Brain ; Collodion ; DNA, Recombinant ; Glucose ; Glutamic Acid ; Hippocampus ; Humans ; Ice ; Immune Sera ; Infant, Newborn ; N-Methylaspartate* ; Neurons ; Oxygen ; Rats* ; Receptors, N-Methyl-D-Aspartate ; Synaptosomes

PURPOSE: Excessive amounts of glutamate are released into the extracelluar space during hypoxia/ischemia and contribute to neuronal injury through overactivation of the NMDA receptors. It will be expected that the changes of the NMDA receptors to decrease the injury are developed as a kind of defense mechanism. The NMDA receptors are composed of NR1 and NR2, and there are four NR2 subunits; NR2A, NR2B, NR2C, and NR2D. The NR1 is essential for the function of the NMDA receptors and multiple NR2 subunits potentiate and differentiate the function of the NMDA receptors. The NR2 subunits alone show no ability to respond to several agonists, however when coexpressed with the NR1, the NR2 subunits markedly potentiated the NR1 activity and produced functional variability of the NMDA receptors. Compared with the NR2C and the NR2D, the NR2A and the NR2B show prominent expression in the hippocampus. In an in vitro model of rat hippocampal slices after hypoxia, we investigated the changes of the NR2A and the NR2B amounts through immunoblot with anti-NR2A and anti-NR2B antisera. METHODS: Hippocampi from adult rats(Sprague Dawley) were isolated and sliced into a 500 m section in a glucose containing artificial CSF medium on ice. In order to induce a hypoxia, sample slices were treated with 95% N2/5% CO2 for 10 min, 20 min, 30 min, and 60 min, respectively and control slices were treated with 95% O2/5% CO2 to supply sufficient oxygen as the same way. And then the control and the sample slices were homogenated and 40 g of each homogenates were electrophoresed in a 6% SDS-gel, transfered to nitrocellulose, and immunostained with anti-NR2A and anti-NR2B antisera. RESULTS: 1) Anti-NR2A antisera were produced by recombinant DNA technology. 2) The NR2A and the NR2B were enriched in the order of PSD, synaptosome and brain homogenate. 3) There was no difference of the NR2A and the NR2B expression in both control and experimental group. CONCLUSIONS: At least up to one hour after hypoxic damage, it is likely that there is no prominent changes of the NR2A and the NR2B amounts. Considering that the changes could occur locally or microscopically in this experimental protocol, the relative amounts of the NR2A and the NR2B in the hippocampal homogenates are too small to be detected by immunoblot analyses. And we can not exclude the possibility of no changes in one hour after hypoxia, if these changes evolve with a extremely slow progression.
Adult ; Animals ; Anoxia ; Brain ; Collodion ; DNA, Recombinant ; Glucose ; Glutamic Acid ; Hippocampus ; Humans ; Ice ; Immune Sera ; Infant, Newborn ; N-Methylaspartate* ; Neurons ; Oxygen ; Rats* ; Receptors, N-Methyl-D-Aspartate ; Synaptosomes

Reversible thermal injury to the esophagus as the result of drinking hot liquids has been reported to generate alternating white and red linear mucosal bands, somewhat reminiscent of a candy cane. This phenomenon is associated with chest pain, dysphagia, odynophagia, and epigastric pain. Here, we report a case of thermal injury to the esophageal and oral cavity due to the drinking of hot tea, including odynophagia and dysphagia. A 69-year-old man was referred due to a difficulty in swallowing which had begun a week prior to referral. The patient, at the time of admission, was unable to swallow even liquids. He had recently suffered from hiccups, and had consumed five cups of hot adlay tea one week prior to admission, as a folk remedy for the hiccups. Upon physical examination, the patient's oral cavity evidenced mucosal erosion, hyperemia, and mucosa covered by a whitish pseudomembrane. Nonspecific findings were detected on the laboratory and radiological exams. Upper endoscopy revealed diffuse hyperemia, and erosions with thick and whitish pseudomembraneous mucosa on the entire esophagus. The stomach and duodenum appeared normal. We diagnosed the patient with thermal esophageal injury inflicted by the hot tea. He was treated with pantoprazole, 40 mg/day, for 14 days, and evidenced significant clinical and endoscopic improvement.
Tea/*adverse effects ; Mouth Mucosa/injuries ; Male ; Humans ; Heat/adverse effects ; Esophagus/*injuries ; Deglutition Disorders/*etiology ; Chest Pain ; Burns/drug therapy/*etiology/physiopathology ; Anti-Ulcer Agents/therapeutic use ; Aged ; 2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use

Most malignant tumors originating from the biliary tract are adenocarcinomas, and adenosqamous carcinoma of Klatskin's tumor is a very rare finding. An 83-yr-old man was admitted to our hospital because of jaundice. The abdominal computed tomography and magnetic resonance cholangiopancreatography revealed wall thickening and luminal stenosis of both the intrahepatic duct confluent portion and the common hepatic duct. These findings were compatible with Klatskin's tumor, Bismuth type III. Considering the patient's old age, palliative combined modality therapy was performed. After percutaneous transhepatic biliary drainage, biopsy was performed via percutaneous transhepatic cholangioscopy. The histopathologic findings showed adenosquamous carcinoma. External radiotherapy and intraluminal brachytherapy through the endobiliary Y-type stent were then done. Nine months after the radiotherapy, the laboratory findings and the abdominal computed tomography revealed biliary obstruction and progressive hepatic metastasis. The combined modality therapy of external radiotherapy, intraluminal brachytherapy and stenting assisted him to live a normal life until he finally experienced biliary obstruction.
Aged, 80 and over ; Bile Duct Neoplasms/*diagnosis/therapy ; *Bile Ducts, Extrahepatic ; Carcinoma, Adenosquamous/*diagnosis/therapy ; Cholangiography ; Combined Modality Therapy ; Humans ; Jaundice/etiology ; Male ; *Palliative Care ; Stents ; Tomography, X-Ray Computed

BACKGROUND: There is a need for investigating the analgesic method as part of early recovery after surgery tailored for laparoscopic colorectal cancer (LCRC) surgery. In this randomized trial, we aimed to investigate the analgesic efficacy of an inverse ‘v’ shaped bilateral, subfascial ropivacaine continuous infusion in LCRC surgery. METHODS: Forty two patients undergoing elective LCRC surgery were randomly allocated to one of two groups to receive either 0.5% ropivacaine continuous infusion at the subfascial plane (n = 20, R group) or fentanyl intravenous patient controlled analgesia (IV PCA) (n = 22, F group) for postoperative 72 hours. The primary endpoint was the visual analogue scores (VAS) when coughing at postoperative 24 hours. Secondary end points were the VAS at 1, 6, 48, and 72 hours, time to first flatus, time to first rescue meperidine requirement, rescue meperidine consumption, length of hospital stay, postoperative nausea and vomiting, sedation, hypotension, dizziness, headache, and wound complications. RESULTS: The VAS at rest and when coughing were similar between the groups throughout the study. The time to first gas passage and time to first rescue meperidine at ward were significantly shorter in the R group compared to the F group (P = 0.010). Rescue meperidine was administered less in the R group; however, without statistical significance. Other study parameters were not different between the groups. CONCLUSIONS: Ropivacaine continuous infusion with an inverse ‘v ’ shaped bilateral, subfascial catheter placement showed significantly enhanced bowel recovery and analgesic efficacy was not different from IV PCA in LCRC surgery.
Analgesia ; Analgesia, Patient-Controlled ; Anesthetics, Local ; Catheters ; Colorectal Neoplasms* ; Colorectal Surgery ; Cough ; Dizziness ; Fentanyl ; Flatulence ; Headache ; Humans ; Hypotension ; Laparoscopy ; Length of Stay ; Meperidine ; Methods ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Wounds and Injuries

BACKGROUND/AIMS: Fitz-Hugh-Curtis syndrome is defined as perihepatitis associated with pelvic inflammatory disease (PID). We retrospectively analyzed clinical and laboratory manifestations as well as the therapeutic response in patients with clinically diagnosed Fitz-Hugh-Curtis syndrome. METHODS: A cohort of 25 patients with PID and perihepatitis (as diagnosed by dynamic abdominal computed tomography (CT)) was enrolled. The prognosis, clinical manifestations, and physical examination, laboratory, and CT findings were analyzed. RESULTS: The mean (+/-SD) age of the patients was 32(+/-8) years, and all of them were sexually active, premenopausal women, and presented with abdominal pain. Of these, 52% complained of vaginal discharge. On physical examination, right upper-quadrant tenderness was the most common finding (84%), with lower-abdominal tenderness being present in 20% of patients. On laboratory examination, erythrocyte sedimentation rate and C-reactive protein were increased in 76% and 92% of the patients, respectively. The white blood cell count was increased in 60% of them. Most patients had a normal liver function test. Using a specimen of the cervical discharge, the polymerase chain reaction to test for Chlamydia trachomatis were positive in 87% (13/15) of the patients, and Chlamydia antigen was found in 75% (9/12) of them. Dynamic abdominal CT revealed subcapsular enhancement of the liver in the arterial phase. All of the patients improved with antibiotic therapy. CONCLUSIONS: Symptoms and physical findings suggestive of PID are not present in many patients with Fitz-Hugh-Curtis syndrome. When a premenopausal woman complains of upper abdominal pain and shows CT findings compatible with perihepatitis, examination of cervical discharge would be recommended to assess the possibility of Fitz-Hugh-Curtis syndrome.
Adult ; Anti-Bacterial Agents/therapeutic use ; Chlamydia Infections/diagnosis/microbiology ; Chlamydia trachomatis/isolation & purification ; Cohort Studies ; Diagnosis, Differential ; Drug Therapy, Combination ; Female ; Gonorrhea/complications/*diagnosis/radiography ; Hepatitis/complications/*diagnosis/radiography ; Humans ; Pelvic Inflammatory Disease/complications/*diagnosis/radiography ; Retrospective Studies ; Syndrome ; Tomography, X-Ray Computed