BACKGROUND: Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. METHOD: We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group (clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine (10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram (lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. RESULTS: Clonidine group showed significant decrease of heart rate after pretreatment (p<0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group (p<0.05). The time required for resuscitation was shorter in clonidine group than control group (p<0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group (p<0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. CONCLUSIONS: Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation.
Analgesia ; Animals ; Arterial Pressure ; Bupivacaine ; Clonidine* ; Dogs* ; Electrocardiography ; Epinephrine ; Heart Arrest ; Heart Massage ; Heart Rate ; Injections, Intravenous ; Resuscitation* ; Seizures ; Thoracotomy ; Vecuronium Bromide ; Vital Signs

The diagnosis of a Battered Child Syndrome is made by the pediatrician, surgeon and the radiologist because almost parents deny the diagnosis or refuse to answer the doctor's questions. The imaging modalities play a key role in the investigation and documentation of the battered child syndrome, because of the high frequency of the typical skeletal lesion. Although physical abuse is denied by parents, the recognition of this entity is possible by the primary diagnostic imaging study in the suspected child abuse. The imaging studies are either a bone scan and x-ray series or a complete radiolographic skeletal survey by X-ray series. In an expected intracranial injury, a CT scan of the head is mandatory We experienced a case of Battered Child Syndrome in a 6 month-old male infant who had subdural hemorrhage and fractures of skull and ribs in different stages of healing and repair. The brief review of the literature was made.
Battered Child Syndrome* ; Child ; Child Abuse ; Diagnosis ; Diagnostic Imaging ; Head ; Hematoma, Subdural* ; Humans ; Infant ; Male ; Parents ; Ribs ; Skull ; Tomography, X-Ray Computed

BACKGROUND: Impairment of relaxing response and augmentation of contractile response to vasoactive substances have been reported in atherosclerotic arteries. These alterations in vascular reactivity are considered as an underlying mechanism for the development of acute vasospasm in atherosclerotic coronary artery. Recently, it has been reported that lysophophatidylcholine (LPC), an oxidative metabolite of low density lipoprotein causes this functional abnormality. However, the precise mechanism of LPC induced change of vascular reactivity is still uncertain. METHOD: In this study, to elucidate the underlying mechanisms of abnormal vascular reactivity in atherosclerotic coronary artery, we examined the effect of LPC on whole cell K+current using patch clamping technique in rabbit coronary smooth muscle cells. RESULTS: Application of LPC(1microM) showed dual effect on whole cell outward current which depends on the magnitude of test potentials. At relatively high depolarizing test potentials (> 10 mV), LPC increased amplitude of outward current which was blocked by Gd3+ not by iberiotoxin (100 nM) and TEA (1 mM). Reversal potential of this Gd3+sensitive, LPC-induced current was -9.7 +/- 0.6 mV. At less depolarizing test potentials (< 10 mV), LPC decreased whole cell K+currents in a dose dependent manner (from 0.01 to 10 microM) in the range of -30 mV to +0 mV. Half maximal inhibition of K+current was 1.509 microM at 0 mV test potential (n =5). Depolarizing holding potential (0 mV) prevented this LPC-induced inhibition of K+current. Steady state activation and inactivation parameters of K+current were significantly shifted to the positive direction by application of LPC (p < 0.01, n =8). Pretreatment of staurosporine (100 nM), a blocker of protein kinase C partially blocked LPC-induced decrease of K+currents. CONCLUSION: LPC-induced inhibition of voltage dependent K+current may explain abnormal vascular reactivity in atherosclerotic coronary artery.
Arteries ; Constriction ; Coronary Vessels ; Lipoproteins ; Lysophosphatidylcholines* ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Protein Kinase C ; Staurosporine ; Tea

Bradycardia is recognized as an acute complication of cervical cord injury. The etiology of such a phenomenon is believed to be due to an imbalance in the autonomic nervous system imposed on the heart by a cervical cord injury. The majority of the episodes of bradycardia degrees Ccurred either with tracheal suctioning or with changes in position. We experienced a case of severe bradycardia and hypotension when turning the patient with acute cervical spinal cord injury to the prone position, which was reversed by administration of intravenous atropine and ephedrine.
Anesthesia, General* ; Atropine ; Autonomic Nervous System ; Bradycardia* ; Ephedrine ; Heart ; Humans ; Hypotension* ; Prone Position ; Spinal Cord Injuries* ; Spinal Cord* ; Suction

BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation. METHODS: Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order. RESULTS: IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed. CONCLUSIONS: The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.
Arterial Pressure ; Blood Gas Analysis ; Central Venous Pressure ; Critical Illness* ; Glaucoma ; Humans ; Intraocular Pressure* ; Positive-Pressure Respiration* ; Tonometry, Ocular ; Veins

The cardiovascular manifestations in hyperthyroidism are sinus tachycardia, paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation, atrioventricular block, bundle branch block(especially right bundle branch block), angina pectoris, heart failure and cardiomyopathy. Of these, angina pectoris is commonly seen in hyperthyroidism with coronary artery disease and the potential mechanisms have been attributed to the increased metabolic demand and consequently increased cardiac work which result in the more demand of coronary blood flow than that can be delivered via a fixed atherosclerotic coronary artery stenosis. Hyperthyroidism associated anginas without underlying coronary artery stenosis have also been reported where the mechanism of these was suspected to be the coronary vasospasm. Ventricular fibrillation may occur in the thyrotoxic patients due to myocardial ischemia such as variant angina, but it is very rare in the condition without previous heart disease. A 30-year-old male was admitted to the hospital because of palpitation, weight loss and proptosis for the previous 3 months. There was no history of effort related chest pain, syncope, drug abuse or medical illnesses such as diabetes mellitus, hypertension. The laboratory results were, TSH: 0.38uU/mL(0.4~5,0 uU/mL), free T4: 8.9ng/dL(0.8~1.9ng/dL), TSH receptor antibody: 43.6%(-15~15%), antiTPO antibody: 5000 IU/mL(0~100 IU/mL). The initial EKG showed normal sinus rhythm. He was diagnosed as Graves disease with ophthalmopathy, class 3a and was put on propylthiouracil 200 mg po tid, propanolol 40 mg po tid and started solumedrol pulse therapy for the exophthalmos on the first day of admission. He was found to have generalized tonic seizure with apnea attack on second hospital day and twice thereafter. Ventricular fibrillation was documented at that time. DC cardioversion was performed with successful response. After the attack, he was treated as accelerated hyperthyroidism namely with increased dosage of propylthiouracil, dexamethasone and Lugols solution, The echocardiogram, treadmill test, ergonovine echocardiography, coronary angiography and electrophysiologic study disclosed no abnormalities. Further episodes of ventricular fibrillation didnt occur after being euthyroid state. In conclusion, we report a case of ventricular fibrillation associated with hyperthyroidism itself without underlying coronary artery disease with brief review of literatures.
Adult ; Angina Pectoris ; Apnea ; Atrial Fibrillation ; Atrial Flutter ; Atrioventricular Block ; Cardiomyopathies ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vasospasm ; Dexamethasone ; Diabetes Mellitus ; Echocardiography ; Electric Countershock ; Electrocardiography ; Ergonovine ; Exercise Test ; Exophthalmos ; Graves Disease ; Heart Diseases ; Heart Failure ; Humans ; Hypertension ; Hyperthyroidism ; Male ; Methylprednisolone Hemisuccinate ; Myocardial Ischemia ; Propranolol ; Propylthiouracil ; Receptors, Thyrotropin ; Seizures ; Substance-Related Disorders ; Syncope ; Tachycardia, Sinus ; Tachycardia, Supraventricular ; Ventricular Fibrillation* ; Weight Loss

It has been reported that keratocytes endocytose foreign particles both in vitro and in vivo, suggesting the active participation of keratocytes in corneal wound healing and host defense mechanism. This study was conducted to investigate the phagocytosis of keratocytes against Candida albicans[C.albicans]and the intracellular response after phagocytosis. C.albicans were fixed with glutaraldehyde and then coated with fibronectin. After exposing these C.albicans to the cultured rabbit keratocytes, the phagocytosis of keratocytes against C.albicans was evaluated by light microscope[LM]and transmission electron microscope[TEM], while the intracellular response was evaluated by changes of acid phosphatase activity. Also the study about latex beads was performed at the same time to know even if keratocytes can phagocytose foreign particles, regardless of wheather or not the particles are biodegradable. After Wright staining, phagocytosed latex beads and C.albicans were observed on LM and these were recognized to be surrounded by limiting membranes inside the cytoplasm of keratocytes on TEM. The phagocytic rates of fibronectin-coated were increased to 1.5 times , as compared with that of non-coated group. Acid phosphatase activities were higher in C.albicans-exposed groups than in control[keratocytes cultured without C.albicans or latex beads]during the culture period of 24 hours and they also increased according to culture duration and reached to the plateau after 12 hours. In comparison with non-coated group, fibronectin-coated groups showed a increasing tendency of acid phosphatase activity. These results suggest that keratocytes can phagocytose not only foreign particles but also C.albicans and that fibronectin may act as effective opsonin on phagocytosis, and that keratocytes phagocytosing C.albicans increase acid phosphatase activity to digest engulfed C.albicans when corneal stroma was wounded or inflammed.
Acid Phosphatase* ; Candida albicans* ; Candida* ; Corneal Stroma ; Cytoplasm ; Fibronectins ; Glutaral ; Latex ; Membranes ; Microspheres ; Phagocytosis* ; Wound Healing ; Wounds and Injuries

The fibrovascular tissues surrounding a glaucoma implant have been found to play a major role for the orbital absorption of aqueous humor following a glaucoma implant surgery. An ultrasonographic study was performed to investigate the ultrasonographic, characteristics of the tissues and its relationship with the postoperative intraocular pressure(IOP) control. Twenty-three eyes of 23 patients had undergone the e-PTFE membrane-silicone tube implantation and had been followed up for at least 6-month(mean +/- SD, 17 +/- 8.8 months). An ultrasonographic study for these eyes included such paramneters as presence of an aqueous reservoir surrounding the implant, size(height) of the aqueous reservoir and echoreHectivity from the reservoir wall tissues. The aqueous reservoir was identified in 22(96%) of 23 eyes and had a height varying from 1.0 mm to 5.5 mm. In eyes with an aqueons reservoir. 3 mm high or more, the IOPs were all 21 mmHg or less without further glaucoma medications(p=0.040, chi-square). In one eye with an obliterated reservoir on ultrasonography, the opening of the silicone tube was found to be occluded toward the extrascleral portion of the implant when reoperation was performed. The echo reflections from reservoir wall tissues were denser and higher comparing with those from the sclera of the respective eye in 7 eyes with a complete failure of postoperative lOP control(>or=30 mmHg on maximum medical theraph). These eyes also had and irregular echoreflections within the aqueous reservoir, which reflect an invasion of proliferating tissues into the reservoir.
Absorption ; Aqueous Humor ; Glaucoma* ; Humans ; Orbit ; Reoperation ; Sclera ; Silicones ; Ultrasonography

PURPOSE: To investigate the outflow characteristics of silicone tubes with intraluminal stents used in membrane-tube (MT) type glaucoma shunt devices. METHODS: The silicone tubes used in MicroMT (internal diameter of 100 µm with a 7-0 nylon intraluminal stent) and Finetube MT (internal diameter of 200 µm with a 5-0 nylon intraluminal stent) were connected to a syringe-pump that delivered a continuous flow of distilled water at flow rates of 2, 5, 10, and 25 µL/min. The pressures and resistances of tubes were measured at a steady flow rate with full-length, half-length, and absence of intraluminal stents. RESULTS: The mean outflow resistance of the two types of tubes ranged from 3.0 ± 1.9 to 3.8 ± 1.7 mmHg/µL/min with a full-length intraluminal stent, 1.8 ± 1.1 to 2.2 ± 1.1 mmHg/µL/min with a half-length intraluminal stent, and 0.1 ± 0.0 to 0.2 ± 0.0 mmHg/µL/min without an intraluminal stent. Theoretically, for a physiologic state with a flow rate of 2 µL/min and episcleral venous pressure of 6 mmHg, the mean pressures of tubes were expected to be 13.2 ± 3.0, 10.5 ± 2.4, and 6.4 ± 0.2 mmHg in MicroMT with full-length, half-length, and absence of intraluminal stents, respectively, and 12.5 ± 3.9, 9.6 ± 2.4, and 6.2 ± 0.2 mmHg in Finetube MT with full-length, half-length, and absence of intraluminal stents, respectively. The pressure variance also decreased with intraluminal stent retraction (p < 0.01). CONCLUSIONS: The small diameter tubes of 100 and 200 µm internal diameters, with 7-0 and 5-0 nylon intraluminal stents, respectively, used in the MT-type glaucoma shunt device showed safe and effective outflow characteristics.
Glaucoma ; Hydrodynamics ; Intraocular Pressure ; Nylons ; Silicon ; Silicones ; Stents ; Venous Pressure ; Water

Purpose: Raised cerebral titers of acetylcholine have notable links with storage symptomatology related to lower urinary tract symptoms. The hippocampus contributes to the normal control of continence in the majority of instances (circuit 3). Owing to synaptic connections with other nerve cells, acetylcholine affects the micturition pathway via the liberation of additional cerebral neurotransmitters. Despite the fact that cerebral serotonin is a key inhibitor of reflex bladder muscle contractions, the influence of acetylcholine on its liberation is poorly delineated. The current research was conducted in order to explore the role of acetylcholine in serotonin liberation from sections of rat hippocampus in order to improve the comprehension of the relationship between cholinergic and serotonergic neurons. Methods: Hippocampal sections from 6 mature male Sprague-Dawley rats were equilibrated over a 30-minute period in standard incubation medium so as to facilitate [3H]5-hydroxytryptamine (5-HT) uptake. The cerebral neurotransmitter, acetylcholine, was applied to the sections. Aliquots of drained medium solution were utilized in order to quantify the radioactivity associated with [3H]5-HT liberation; any alterations in this parameter were noted. Results: When judged against the controls, [3H]5-HT liberation from the hippocampal sections remained unaltered following the administration of acetylcholine, implying that this agent has no inhibitory action on this process. Conclusions Serotonin liberation from murine hippocampal sections is unaffected by acetylcholine. It is postulated that the bladder micturition reflex responds to acetylcholine through its immediate cholinergic activity rather than by its influence on serotonin release. These pathways are a promising target for the design of de novo therapeutic agents.