Ischemic brain hippocampal formation has been developed to understand the relationship between delayed neuronal damage and the expression of NMDA receptor subunits[NR2A, NR2B], MAP2, and NF200 in ttle conditions of hypoxia. Changes of NR subunits[NR2A, 2B], MAP2 6nd NF200 in rat brain postsynaptic density[PSD] after hypoxic injury were investigated through immunoblot analyses. To understand the effect of Ca2+ influx through NMDA receptors on neuronal damage which is manifested by morphological change, cytoskeletal disruption was examined through H & E, toluidine blue and immunohistochemical studies. The expression of NR2B was increased than normal at 30 hours after hypoxia. At this time, the expression of MAP2 and NF200 was markedly decreased and their morphology was more eosinophilic than normal and then became darker with expanded perineuronal space. Irreversible neuronal cell damage in hypoxic hippocampal formation is most prominent in CA3 region of hippocampus and the process is triggered by Ca2+ influx through NR1/MR2B receptor channel at 30 hour after initial hypoxic insult. Ca2+ influx through NR1/MR2B receptor channel may activate intracellular proteases which would degrade cytoskeleton. Proteolysis of cytoskeleton leads to its reorganization and eventually damages normal function of cell membrane which causes neuronal cell death. And, morphological changes of neuronal cells in hypoxic conditions were manifested as red neurons in the stage of reactive change, and as dark neuron in the stage of late hypoxic cell damage.
Animals ; Anoxia* ; Brain ; Cell Death ; Cell Membrane ; Cytoskeleton ; Eosinophils ; Hippocampus* ; N-Methylaspartate ; Neurons ; Peptide Hydrolases ; Proteolysis ; Rats* ; Receptors, N-Methyl-D-Aspartate ; Tolonium Chloride

Pulmonary blastoma is a rare lung tumor resembling fetal lung tissue. Pathologically the tumor can be classified to 2 groups, well-differentiated fetal adenocarcinoma(WDFA) and biphasic blastoma. WDFA has more favorable prognosis with fewer metastasis at initial presentation and fewer recurrence after treatment. We experienced a case of pulmonary blastoma in 32-year-old female patient. The patient was referred to our hospital because of abnormal mass shadow in right middle lobe. The diagnosis of pulmonary blastoma(WDFA type, Stage I T2NOMO) was confirmed after right middle lobectomy. We followed up 22 months without an evidence of recurrence.
Adult ; Diagnosis ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Prognosis ; Pulmonary Blastoma* ; Recurrence

BACKGROUND: Activated coagulation time (ACT) is commonly used to guide heparin and protamine dosing during cardiovascular surgery. There are many factors that influence the ACT such as time of test, hemodilution, temperature, aprotinin and etc. We considered the other factor that influence the ACT, the route of blood sample. METHODS: This study included 40 patients who were scheduled for cardiac surgery. Whole blood was sampled through arterial and central venous line at 10 minutes after surgical incision and heparin administration. The ACT was measured with Hemochron 801 blood coagulation timer with 12 mg of celite surface activator. RESULTS: At 10 minutes after surgical incision and heparin administration, arterial blood and venous blood ACTs were 127 20, 537 214 seconds and 118 18, 496 145 seconds respectively (p<0.05). CONCLUSIONS: We conclude that the venous blood ACT is more less than arterial blood ACT during cardiovascular surgery.
Aprotinin ; Blood Coagulation ; Diatomaceous Earth ; Heart* ; Hemodilution ; Heparin ; Humans ; Thoracic Surgery*

BACKGROUND: Incorrect infusion of dopamine can be potentially life threatening. If the actual volume of a 100 ml intravenous bag or bottle used to mix dopamine solutions is greater than the labeled volume, overdilution of dopamine can occur, resulting in ineffective hemodynamic response. To determine the significance of dopamine overdilution induced by the excessive volume, dopamine concentration and hemodynamic effect were compared in the manually mixed dopamine and the manufactured premixed dopamine. METHODS: For 5% dextrose water (D5W) 100 ml intravenous bottle mixed with 160 mg (4 ml) of dopamine (group 1), D5W 96 ml mixed with 160 mg of dopamine (group 2), premixed dopamine with 1.6 mg/ml of concentration manufactured 2 months ago (group 3), premixed dopamine with 1.6 mg/ml of concentration manufactured 6 months ago (group 4), and D5W 100 ml intravenous bottle mixed with 160 mg (4 ml) of dopamine after removal of 4 ml dextrose water (group 5), dopamine concentration was measured by High performance liquid chromatography (HPLC). Hemodynamic data was obtained from 10 mongrel dogs for each group at baseline (T1), 15 minutes after dopamine infusion at a rate of 3 microgram/kg/min (T2), 8 microgram/kg/min (T3), and 15 microgram/kg/min (T4). RESULTS: Dopamine concentrations of group 1, 2, 3, 4, and 5 were 1.51+/- 0.09, 1.60 +/- 0.10, 1.63 +/- 0.06, 1.57+/- 0.08 and 1.57+/- 0.07 mg/ml, respectively. Group 1 showed a significantly low concentration (p< 0.05). There was no significant differences in all hemodynamic data between group 1, 2, 3, and 4. In group 1, however, there was no significant increase in both mean blood pressure at T4 and mixed venous oxygen saturation at T3 compared with T1. CONCLUSIONS: The actual volume of D5W in 100 ml intravenous bottle is greater than the labeled, and therefore can cause significant overdilution of dopamine. Premixed dopamine, however, has the same concentration and hemodynamic effects as the dopamine mixed manually but precisely.
Animals ; Blood Pressure ; Chromatography, Liquid ; Dogs ; Dopamine* ; Glucose ; Hemodynamics* ; Oxygen ; Water

BACKGORUND: Echocardiography is usually performed for preoperative cardiac evaluation before coronary bypass graft surgery. if the variables detected by this noninvasive method could predict the outcome of the off-pump coronary bypass surgery (OPCAB), it would be very helpful. The purpose of this study is the evaluation of preoperative transthoracic echocardiographic findings as the predictor of OPCAB outcome. METHODS: We evaluated the relationships between preoperative variables identified by the transthoracic echocardiography and postoperative outcomes. RESULTS: Among the doppler findings trans-mitral flow shows no relationship with the postoperative outcome. But, left ventricular mass had the predictability of postoperative time of extubation, iCU stay, and hospital stay. CONCLUSiONS: Left ventricular mass can be used to predict the outcome after OPCAB and There are the need of further study to find out the reason the left ventricular mass show relationship with the postoperative outcome.
Atrial Fibrillation ; Coronary Artery Bypass, Off-Pump* ; Echocardiography* ; Length of Stay ; Prognosis* ; Transplants*

Histopathology of pulmonary lymphangioleiomyomatosis(LAM) is studied using four new cases and six previously reported cases, which include two cases without definite evidence of LAM. The important diagnostic features of this lesion were nodular proliferation of immature smooth muscle and cleft or cyst formation within the nodules of smooth muscle cells. The nuclei of the smooth muscle cells were bigger than those of blood vessels or fibrotic lung, and the direction of nuclei was irregular. The lung parenchyma showed little inflammatory change but there were multiple air cysts with smooth muscle nodules at their margin. There were two cases with exuberant proliferation of smooth muscle nodules and two cases with papilliferous projections of the cells into lymphatic lumen. Whereas, three cases had only a few small slender nodules of smooth muscle cells at the margin of air cyst. The lymphatic lumen with smooth muscle nodules is dilated in four cases but other four cases show collapsed lumen. Pulmonary hemorrhage and hemosiderosis were prominent in three cases. There were variety of histology in terms of the cellularity of smooth muscle nodules, the size of the lymphatic lumen and the degree of pulmonary destruction, which may have significance on the clinical presentation and prognostication.
Cysts

For many years it has been known that the dosage of thiopental required to induce anesthesia depends on the age of the patient, but this information ha resulted from clinical experience with the drugs rather than from planned study. In our study, to elucidate the influence of age on the size of the sleeping dosage of thiopental, 144 patients who underwent minor orthopedic and gynecological operations were studied. This patients had no evidence of a disease other than that scheduled for operation and were within normal values in hematologic examination, liver function and kidney function. Using a simple "yes" or "no" verbal command response, as sleeping response, to a single bolus of thiopental in mg/kg body weight, we have attemted to minimize uncontroliable factors such as cerebral perfusion, circulation time and plasma protein binding which would alter response to thiopental infusions continued to the end points. The results were as follows: 1) There was no statistical difference in verbal command response to thiopental according to age in age groups below 59 years. 2) Compared with age groups below 59 years, 60~79yrs, group failed to respond to the verbal command in 33% by 2.2mg/kg and 100% by above 2.6mg/kg.(p<0.05) 3) The mean time for loss of verbal command response after thiopental injection was 27.4+/-10.3 seconds and 80.4% of theses patients lost lid reflex with a mean time of 41.7+/-9.1 seconds after thiopental injection. 4) All groups showed statistically non-significant alterations of systolic blood pressure and heart rate after injection of thiopental.
Anesthesia ; Blood Pressure ; Body Weight ; Heart Rate ; Humans ; Kidney ; Liver ; Orthopedics ; Perfusion ; Plasma ; Protein Binding ; Reference Values ; Reflex ; Thiopental*

BACKGROUND: The aim of this study was to compare the accuracy of measured cardiac output using the newly developed esophageal doppler device with that of the thermodilution method using a pulmonary artery catheter. METHODS: In 15 patients undergoing off-pump coronary artery bypass surgery, cardiac outputs were measured at four episodes of surgery; (1) after induction of anesthesia, (2) during dissection of the internal mammary artery, (3) during anastomosis of the left anterior descending artery, and (4) after closure of the pericardium. RESULTS: The bias between the two methods was 0.52 +/- 1.09 L/min. Analysis of the changes in cardiac output from sample episode 1 to 2, from sample episode 2 to 3 and from sample episode 3 to 4, expressed as percent change values, shows no significant differences between the two methods (P > 0.05). CONCLUSIONS: The esophageal doppler accurately reflects changes in cardiac output with time when compared with that of the thermodilution.
Anesthesia ; Arteries ; Bias (Epidemiology) ; Cardiac Output* ; Catheters ; Coronary Artery Bypass, Off-Pump* ; Humans ; Mammary Arteries ; Pericardium ; Pulmonary Artery ; Thermodilution* ; Thoracic Surgery

BACKGROUND: The antitumor effects of herpes simplex virus thymidine kinase(HSV-tk) and ganciclovir(GCV) strategies for cancer gene therapy have a the following advantages:1) a direct cytotoxicity to HSV-tk modified cancer cells by GCV 2) a cell death by the local transfer of toxic metabolites from the HSV-tk modified cells to nearby unmodified tumor cells(bystander effect), and 3) in vivo bystander effect such as antitumor-immunity. Retroviral and adenoviral sequences can silence transgene expression in cells and mice. In this study, we investigated the above described advantages of HXV-tk/GCV strategy in Lewis lung cell and mouse lung cancer model using retroviral vector and adenoviral vector. Also, we observed whether the expression of a silenced gene can be reactivated by treating cell with butyrate. METHODS: Retrovirus-HSV-tk and adenovirus-HSV-tk vectors were used for the transduction of Lewis lung carcinoma(LLC) cells. The change of HSV-tk expression by butyrate was measured by Western blot.The antitumor activities containing bystander effect were observed in vivo(by MTT assay) and in vivo tumor models of various combinations of LLC and LLC-tk. RESULTS: 1. Butyrate induced the enhancement of HSV-tk expression from adenovirally transduced cells but not from retrovirally transduced cells. 2. Both retrovirus-HSV-tk and adenovirus-HSV-tk vectors with GCV treatment were effective for killing of tumor cell in vitro and suppression of LLC tumorigenicity. Bystander effect was responsible for killing of mixture of LLC-tk and LLC in vitro and in vivo-tumorigenicity model. CONCLUSION: Butyrate could augment adenoviral vector seems to be an effective approach for lung cancer therapy.
Adenoviridae ; Animals ; Butyrates ; Bystander Effect ; Carcinoma, Lewis Lung* ; Cell Death ; Genes, Neoplasm ; Genetic Therapy* ; Herpes Simplex* ; Homicide ; Lung ; Lung Neoplasms ; Mice* ; Phosphotransferases* ; Retroviridae ; Simplexvirus* ; Thymidine ; Transgenes ; Zidovudine*

BACKGROUND: Endoventricular circular patch plasty (EVCPP)was introduced as an effective reconstructive procedure for ventricular aneurysm and diffuse dilated cardiomyopathy after myocardial infarction.We report the 4-year results of EVCPP in Seoul National University Hospital, the experiences of anesthesia and intensive care for EVCPP in patients with ischemic cardiomyopathy. METHODS: EVCPP has been performed on 31 patients (22 men and 9 women wit h a mean age of 62 years)during 4 years from March 1998 to March 2002.Six patients (19%)were NYHA cl ass II,24 pat i ent s were cl ass III,and 1 pat i ent was cl ass I V.Preoperative and postoperative left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),ejection fraction (EF)were determined and compared.Transesoghageal echocardiograghy (TEE)was used to measure the distance between aortic annulus and ventricular aneurysm during EVCPP.Milrinone combined with beta -adrenergics was infused during separation from cardiopulmonary bypass (CPB) and in the intensive care unit. RESULTS: Three patients (10%)needed an intra-aortic balloon pump to wean from CPB and one patient (3%)died in the hospital.Out of 30 survivors,29 patients returned to NYHA class I or II and one patient to class III.Out of 30 patients who underwent echocardiographic study before and after EVCPP,EF increased from 34 +/-9%to 38 +/-10%,and LVEDV and LVESV decreased from 139 +/-43 ml to 94 +/-20 ml and from 90 +/-34 ml to 59 +/-17 ml,respectively. CONCLUSIONS: EVCPP is effective to exclude the akinetic left ventricular segment,thus improving left ventricular function and clinical status of patients with ischemic cardiomyopathy.However, studies concerning postoperative intensive care are warranted to reduce the postoperative complications and morbidity.
Anesthesia ; Aneurysm ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Cardiopulmonary Bypass ; Echocardiography ; Equidae ; Female ; Humans ; Critical Care ; Intensive Care Units ; Male ; Milrinone ; Postoperative Complications ; Seoul ; Stroke Volume ; Ventricular Function, Left