The influence of Propofol on regional cerebral function and CBF were studied using 24 male Spragus-Dawley rat by quantitative autoradiographic technique for glucose ( (14C)deoxyglucose) and (14C) Iodoantipyrine. Rats had both femoral artery and vein cannulated and were placed on lead weight. Propofol was infused intravenously at a rate of 0.35 mg/kg/min. for induction and 0.3 mg/kg/min for maintenance untill loss of corneal reflex with stable vital signs. Local cerebral glucose utilization and CBF were checked from conscious control rats and propofol anesthetized rats. The results were as follows; 1) There was no physiologically significant effect of propofol on body temperature, MAP, PaCO, and pH. 2) Regional cerebral glucose utilization was markedly decreased in many, but not all, cerebral structures. 3) The order of decreased glucose utilization was Diencephalone>Telencephalone>Mesence-phalone>Mylencephalone. which means the forebrain was more affected than hindbrain. 4) The most affected area of glucose utilization were cerebral association area, visual system and sensory motor cortex, but the auditory system was not so much affected. 5) During combined use of N,O and propofol, there was no significant stimulation effect of N,O to propofol in glucose utilization. 6) Regional CBF were markedly decreased in many brain regions which means low local cerebral glucose utilization with low CBF. 7) Propofol has specific effect of lowering cerebral metabolic rate, CBF, and intracranial pressure but no signigicant effect on cardiovascular system, pulmonary system, or temperature.
Anesthesia* ; Animals ; Body Temperature ; Brain ; Cardiovascular System ; Femoral Artery ; Glucose* ; Humans ; Hydrogen-Ion Concentration ; Intracranial Pressure ; Male ; Motor Cortex ; Propofol* ; Prosencephalon ; Rats* ; Reflex ; Rhombencephalon ; Veins ; Vital Signs

A case of Juvenile Granulosa Cell Tumor (JGCT) of the ovary with unusual pleomorphic histologic and malignant biologic behaviour is described. The tumor occurred in a 10-year-old girl and was associated with clinical features of isosexual pseudoprecosity and a marked elevation of serum estradiol. The mass manifested initially in the right ovary and subsequently involved the contralateral ovary. A multi-organ metastasis developed during a 6-month-interval despite chemotherapy. She received two operations at 6-month interval, and tissues were obtained from the tumor mass. A marked histologic difference was observed between these two samples. The second biopsy showed profound cellular pleomorphism with numerous multinucleated tumor giant cell formation and hyaline bodies. The differential diagnosis from germ cell tumor and the possible factors for the pleomorphism are discussed.
Diagnosis, Differential ; Biopsy ; Neoplasm Metastasis

An autopsy case of holoacardius hemisomus acephalus is reported. She weighed 2,190 gm and the height was 38 cm. The head and upper extremities were absent, while the vertebrae and lower extremities were relatively well developed, but severely edematous. The heart, lungs, stomach, liver, spleen, and pancreas were missing, but the lower abdominal organs including kidneys, adrenal, urinary bladder, and genital organs were present. The intestine was blind-ended at jejunal level but opened into a normal anus. The umbilical cord had two arteries and one vein.

PURPOSE: The purpose of this study was to assess the psychosocial status of candidates for deceased donor kidney transplantation (DDKT) in South Korea and identify factors associated with high-risk psychosocial status.METHODS: The descriptive cross-sectional design included application of a standardized transplantation-specific assessment tool, the Psychosocial Assessment Candidacy Transplantation (PACT) instrument, and review of candidates' medical records. A total of 157 patients awaiting DDKT were recruited from a Korean organ transplantation center. The collected data were analyzed using descriptive statistics and binary logistic regression. Candidates were divided into high- and low-psychosocial risk groups using 3 as the cutoff point of PACT.RESULTS: The mean score for the PACT final rating was 2.10, and the lowest average subscale score was 2.30 for understanding the processes of transplantation and follow up. Poor physical candidacy, especially due to comorbidities, and older age were associated with high psychosocial risk.CONCLUSION: The results of this study showed that the psychosocial status of Korean DDKT candidates was problematic. Development of systematic management programs for effective clinical strategies in the care of candidates is crucial to maintain their desirable psychosocial status in case of an emergency DDKT operation and improve post-transplantation outcomes. Continuous education is absolutely necessary to enhance understanding of the transplantation process for high-risk psychosocial candidates. Additionally, nurses and transplantation professionals should screen candidates with high-risk psychosocial status early in the process using transplantation-specific assessment tools and provide intensive interventions, particularly for poor physical candidacy patients and older candidates.
Comorbidity ; Education ; Emergencies ; Follow-Up Studies ; Humans ; Kidney Transplantation ; Kidney ; Korea ; Logistic Models ; Medical Records ; Nursing Assessment ; Organ Transplantation ; Psychology ; Tissue Donors ; Transplants ; Waiting Lists

Iatrogenic cerebrospinal fluid(CSF) rhinorrhea, rarely occuring, is one of the major complications, and should be managed immediately if it occurs during operation. CSF leakage can be repaired intracranially or extracranially. Extracranial approaches are subdivided into extranasal and intranasal. Recent advance in nasal endoscopy and its advantage of low morbidity allow more surgeons to perform the intranasal approach using endoscope. As graft materials, free or rotational flaps of temporalis muscle fascia, muscle, fat, and mucosa or mucoperiosteum in the nasal septum or turbinates have widely been used. Sometimes composite graft such as osteomucoperiosteal(OMP) free flap was also used. By intranal endoscopic approach using OMP free flap obtained from the middle Turbinate(MT), we successfully repaired CSF leakage from a defect, 5~7mm in size, which had occured in the right ethmoid roof near the lamina cribrosa during endoscopic sinus surgery on a patient with chronic paranasal sinusitis. Repair of CSF rhinorrhea using MT OMP free flap may be an useful technique for immediate intraoperative management of the defect, if it is not so large, because of availability and easy handling of this flap in the same surgical field.
Cerebrospinal Fluid Rhinorrhea* ; Cerebrospinal Fluid* ; Endoscopes ; Endoscopy ; Fascia ; Free Tissue Flaps* ; Humans ; Mucous Membrane ; Nasal Septum ; Sinusitis ; Transplants ; Turbinates*

As an effort to develop a rapid and sensitive diagnostic test, we produced previously a monoclonal antibody (MAb) specific to the lipoarabinomannan (LAM) antigen and used in a sandwich ELISA for detection of mycobacterial antigens in sputum. In this study, we attempted to improve the antigen detection assay by combination of af5nity-purified antibodies against Mycobacterium tuberculosis soluble antigen and anti-LAM MAb. With the new assay, the LAM antigen was detectable as low as 2 ng/ml, and none of 10 gram-negative and gram-positive organisms gave significant absorbance, thus indicating the specific detection of mycobacterial antigens. Sputum samples from 62 patients who were suspected having tuberculosis and from 37 healthy controls were examined. The sensitivity of the antigen detection assay ranged from 0% in the 1+ culture group to 78.8% in the 3+ culture group. When the results were combined, 15 of 24 culture-positive samples were antigen-positive, thus giving an overall sensitivity of 62.5%. The overall specificity was 96.0%, when all the culture-negative samples were combined. The results thus demonstrate that the antigen detection assay can provide a rapid supplemental information for the diagnosis of pulmonary diagnosis.
Antibodies ; Diagnosis* ; Diagnostic Tests, Routine ; Enzyme-Linked Immunosorbent Assay ; Humans ; Mycobacterium tuberculosis* ; Mycobacterium* ; Sensitivity and Specificity ; Sputum* ; Tuberculosis ; Tuberculosis, Pulmonary*

Achondrogenesis is a lethal form of congenital chondrodystrophy characterized by extreme micromelia. We describe a case of achondrogenesis type II (Langer-Saldino achondrogenesis) detected by prenatal ultrasonography at 20-week gestation. A dwarfed fetus with large head, short neck and chest, prominent abdomen and short limbs was terminated transvaginally. Radiologic and histopathologic examination revealed features of mild form of achondrogenesis type II. Although the case had no known risk factor and the phenotypic abnormality was mild, modern development in prenatal screening made the early detection possible.
Abortion, Induced ; Achondroplasia/ultrasonography ; Achondroplasia/pathology* ; Bone and Bones/pathology ; Case Report ; Female ; Fetal Diseases/ultrasonography ; Fetal Diseases/pathology* ; Human ; Pregnancy ; Ultrasonography, Prenatal

BACKGROUND: The median effective concentration, EC(50), for the supraglottic airway (predicted plasma concentration equilibrated with the effect site at which supraglottic airway insertion is successful in 50% of patients) of propofol in children was not known. The aim of this study was to determine the EC(50) with a target-controlled infusion of propofol to insert a classic laryngeal mask airway (LMA) and laryngeal tube (LT) in pediatric patients. METHODS: Pediatric patients scheduled for urologic, orthopedic, or plastic surgery lasting less than 2 hr under general anesthesia were enrolled in this study. The patients were divided into two groups in a randomized, double blind manner. After applying a standard cardiorespiratory monitor, anesthesia was carried out with a target-controlled infusion (TCI) using the stelpump program. The initial target concentration of propofol was 5microgram/ml, and in accordance with Dixon's up-and-down, the propofol concentration for consecutive patients in each group was varied with increments or decrements of 0.2microgram/ml based on the previous patient insertion result. RESULTS: The EC(50) of propofol required to insert a LMA and LT was 5.5+/-0.2microgram/ml and 5.6+/-0.2microgram/ml, respectively. CONCLUSIONS: The EC50 of propofol is similar for LMA and LT.
Anesthesia ; Anesthesia, General ; Child* ; Humans ; Laryngeal Masks* ; Orthopedics ; Plasma ; Propofol* ; Surgery, Plastic

BACKGROUND: There have been some investigations regarding expression of c-fos, as a marker of altered neuronal expression in the spinal cord of neuropathic rats. However, the expression of c-fos in the brain of a neuropathic pain model has not yet been investigated. The purpose of this study was to evaluate the time course of c-fos expression in the brain of neuropathic pain rats. METHODS: The experimental rats were divided into two group; neuropathic pain (n = 16) and control (n = 16) groups. The left L5 L6 spinal nerves of the neuropathic pain group were ligated but those of the control group not ligated (sham operation). Two hours, 1st day, 3rd day and 7th day after the operation, we examined the expression of Fos in the cerebral cortex, the amygdala, the thalamus and the hypothalamus of the coronary sectioned brains of the rats. RESULTS: C-fos expressions in the cerebral cortex and the amygdala of the neuropathic pain group were greater at 2 hours, the 3rd and the 7th day than the control group, but those of the thalamus and hypothalamus of the neuropathic pain group were greater on the 3rd and 7th day than the control group (P< 0.05). In the neuropathic pain group, c-fos expressions of four brain regions were greater on the 3rd and 7th day than those at 2 hours and day 1, but there was no difference between the 3rd and 7th day's (P< 0.05). CONCLUSIONS: There were significant expressions of Fos protein in the brain of the neuropathic pain group at 2 hours, the 3rd day and 7th day of the operation, but the meaning of each expression was different. The expression of Fos at postoperative 2 hours resulted from acute pain but that at the 3rd and 7th day of the operation resulted from neuropathic pain.
Acute Pain ; Amygdala ; Animals ; Brain* ; Cerebral Cortex ; Hypothalamus ; Neuralgia* ; Neurons ; Rats* ; Spinal Cord ; Spinal Nerves ; Thalamus

Peritoneal tuberculosis is a rare presentation of tuberculosis. The presenting signs and symptoms, imaging examinations and CA-125 status in peritoneal tuberculosis sometimes resemble that of ovarian cancer. Thus, the possibility of peritoneal tuberculosis should be considered in the differential diagnosis of ovarian carcinoma. We report two cases of peritoneal tuberculosis initially suspected as ovarian carcinoma but diagnosed as peritoneal tuberculosis with laparoscopy. Using diagnostic laparoscopy unnecessary laparotomy was avoided. We suggest that diagnostic laparoscopy can be helpful in differential diagnosis between peritoneal tuberculosis and ovarian carcinoma.
Diagnosis, Differential ; Laparoscopy* ; Laparotomy ; Ovarian Neoplasms ; Peritonitis, Tuberculous* ; Tuberculosis