HLA antigen expression can show close relationship with some kinds of tumor cell immunologically. We investigated the relationship between the grade of bladder transitional cell carcinoma and HLA-DR expression to demonstrate the prognostic significance. Paraffin-embedded samples from 25 human transitional cell carcinoma cases were examined for the expression of MHC class R antigen with monoclonal antibody directed against HLA-DR using immunohistochemical methods. The tumors were classified according to the Ash grading system and the degree of the peritumoral mononuclear infiltrates. Both diffuse cytoplasmic and membrane HLA-DR staining were observed in 6 or 17 low grade (Grade I, II) tumors. All 8 high grade (Grade II IV)transitional cell carcinoma exhibited negative staining for HLA-DR antigen. Apart from the relatively high incidence of the positive expression of HLA-DR in low grade tumors, no clear statistical relationship was found between the expression or HLA antigens and the tumor grade. From these results, it may be suggested that the low grade transitional cell carcinoma shows a high incidence of HLA-DR expression and prognostic significance induced by immune response; T cell-mediated immune response against TCC proliferation is evoked. But the significance of these findings remains speculative at present. Therefore, further study should be performed to demonstrate the prognostic importance of HLA-DR expression in transitional cell carcinoma of the bladder.
Carcinoma, Transitional Cell* ; Cytoplasm ; HLA Antigens ; HLA-DR Antigens* ; Humans* ; Incidence ; Membranes ; Negative Staining ; Urinary Bladder

BACKGROUND: Pulmonary vasoconstriction greatly contributes to the elevated pulmonary vascular resistance in patients with pulmonary hypertension. A rise in cytosolic Ca2+ concentration ([Ca2+]cyt) in pulmonary arterial smooth muscle cells (PASMCs) is a major trigger for pulmonary vasoconstriction. Presently, little is known about the nature of the store-operated channels (SOCs) in PASMCs, even though store depletion-mediated capacitative Ca2+ entry (CCE) is a critical mechanism for refilling the empty sarcoplasmic reticulum (SR) with Ca2+, and for maintaining a sustained increase in [Ca2+]cyt. The goal of this in vitro study was to investigate the effects of nickel and manganese on store-operated channels in canine PASMCs. METHODS: Isolated PASMCs were obtained from an enzymatically treated canine pulmonary artery. Currents were recorded at room temperature using the dialyzed whole cell recording technique. The protocol used to deplete the intracellular Ca2+ stores and to monitor the development of the store-operated Ca2+ currents, involved voltage-clamping cells at 0 mV to inactivate any voltage-dependent calcium currents. Crrents were recorded in response to a 200 ms voltage step from 120 to 40 mV in 20 mV increments every 15 seconds. RESULTS: Simultaneous depletion of intracellular Ca2+ leads to a voltage-independent and linear store-operated Ca2+ current (ISOC) reversal near 0 mV. Nickel and manganese inhibit ISOC. CONCLUSIONS: In canine PASMCs, the depletion of intracellular Ca2+ stores leads to the activation of ISOC, which is inhibited by nickel and manganese. These metals are non-specific inhibitors of non-selective cation channels. Our results indicate that Ni2+- and Mn2+-sensitive pathways may mediate Ca2+ entry, or that a class of non-selective cation channels may contribute to CCE in canine PASMCs.
Calcium ; Cytosol ; Humans ; Hypertension, Pulmonary ; Manganese* ; Metals ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Nickel* ; Patch-Clamp Techniques ; Pulmonary Artery ; Sarcoplasmic Reticulum ; Vascular Resistance ; Vasoconstriction

BACKGROUND: Laryngoscopy and tracheal intubation are associated with hemodynamic pressor responses, which can have adverse effects. During anesthesia induction with propofol target-controlled infusion (TCI), we aimed to determine the most appropriate dosage of alfentanil required for intubation, using a steady effect-site concentration of propofol and with the use of vecuronium. METHODS: Eighty ASA class 1 or 2 patients presenting for elective surgery were allocated at random to one of four groups. Anesthesia was induced in all patients with TCI of propofol target concentration 8 microgram /ml, followed by vecuronium (0.12 mg/kg). This was reduced to 5microgram/ml when the effect-site concentration had been 4microgram/ml. After the effect-site concentrations had reached to 5microgram/ml, control group received normal saline, group 1 received alfentanil 10microgram/kg, group 2 received alfentanil 20microgram/kg, and group 3 received alfentanil 30microgram/kg. Laryngoscopy and intubation were performed 90 s later. Heart rate was monitored continuously. Systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured at pre-induction, post-induction (pre-intubation) and post-intubation, respectively. Complications such as hypotention and bradycardia were recorded until 5 minutes had elapsed after tracheal intubation. RESULTS: Control group showed significant increases associated with tracheal intubation in all hemodynamic variables (P < 0.05). Post-intubation values decreased significantly from pre-induction values in groups 1, 2 and 3 (P < 0.05). In groups 2 and 3, hypotension and bradycardia occurred (zero in group 1) but there were no significant differences in their incidences between the three groups. CONCLUSIONS: We suggest that alfentanil 10microgram/kg constitutes the optimal dosage to obtund the hemodynamic responses to tracheal intubation, using propofol TCI (5microgram/ml) and vecuronium for induction of anesthesia.
Alfentanil* ; Anesthesia* ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Incidence ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Propofol* ; Vecuronium Bromide

BACKGROUND: Currently, combined spinal-epidural anesthesia (CSE) is frequently administered, especially in obstetrics and orthopedic surgery. The aim of this study is to determine the appropriate concentration of bupivacaine to use with epidural volume extension that is suitable for total knee replacement during CSE. METHODS: Eighty patients (ASA physical status I and II) scheduled for totalknee replacement were randomly allocated to four groups of 20 patients each: All patients intrathecally received 2 ml of 0.5% hyperbaric bupivacaine. After fixation of spinal anesthesia, the groups received the following treatments. Group S patients received a 10 ml administration of normal saline for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B1 patients received a 10 ml administration of 0.125% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B2 patients received a 10 ml administration of 0.25% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. Group B3 patients received a 10 ml administration of 0.5% bupivacaine for 15 min followed by a continuous 10 ml/hr epidural infusion. RESULTS: The incidence of intraoperative movement in group S and group B1 patients were significantly greater than the incidence for group B2 and B3 patients. The incidence of intraoperative pain in group S patients was significantly greater than for patients in any of the other groups. CONCLUSIONS: We conclude that it is necessary to administer more than a 0.25% concentration of epidural bupivacaine load and provide continuous administration after a spinal block during total knee replacement.
Anesthesia* ; Anesthesia, Spinal ; Arthroplasty, Replacement, Knee* ; Bupivacaine* ; Humans ; Incidence ; Obstetrics ; Orthopedics

Fulminant gas gangrene is a rare condition, usually associated with contaminated traumatic injuries. It carries a high rate of mortality and morbidity. Also, a number of studies have implicated non-traumatic gas gangrene, associated mostly with underlying diseases that cause immunodeficiency. We report a non-traumatic fatal case of Klebsiella pneumoniae gas gangrene with small air bubbles in the left external and common iliac vein, and inferior vena cava in a previously healthy male. We would like to recommend you do not use nitrous oxide in case of gas gangrene, because it can aggravate pulmonary air embolism.
Embolism, Air ; Gas Gangrene ; Humans ; Iliac Vein ; Klebsiella ; Klebsiella pneumoniae ; Male ; Nitrous Oxide ; Vena Cava, Inferior

Intimal hyperplasia is the universal response to endothelial denudation and occur after a variety of vascular procedures. In a proportion of cases the smooth muscle cell proliferation may lead to stenosis of the blood vessels. The precise pathophysiologic pathways leading to the development of intimal hyperplasia have not been characterized. This study was undertaken to examine the effect of drugs on the development of proliferative intimal lesion after experimental arterial injury in a rat model. Aortic denudation was performed by balloon catheter in 20 rats. The rats were divided into three group: 1) control group, normal feeding, 2) heparin group, heparin 1200 U/kg/day subcutaneously, 3) ACE inhibitor group, ramipril 10 mg/kg/day subcutaneously. The rat were sacrificed and aortas were perfused and fixed at 21 days after denudation. Microscopic findings were observed and cross sectional intima-to-media ratio were calculated. To evaluate the effects of various drugs on gene expression of aortic smooth muscle cell, semiquantitative reverse transcription polymerase chain reaction(RT-PCR) was done. After reverse transcription, PCR was done to evaluate the change of gene expression in platelet-derived growth factor(PDGF-B), transforming growth factor-beta(TGF-beta). The results were as follows: 1) Normal aorta with intima to media ratio was 0.38+/-0.06. 2) Marked intimal thickening with a mean I-M ratio of 1.35+/-0.45 in the control group. 3) In contrast, the I-M ratio in the heparin group was 0.54+/-0.23, ramipril group was 0.71+/-0.27(P<0.05). 4) mRNA expression of PDGF-B did show significantly increased in control group compared to normal group(0.97+/-0.34 vs 1.60+/-0.21), treatment with heparin and ACE inhibitor shows a tendency to downregulation of mRNA expression to control group(1.04+/-0.31 in heparin group, 1.23+/-0.41 in ACE inhibitor treated group). 5) mRNA expression of TGF-beta was decreased in control group compared to normal group(2.80+/-0.74 vs 1.97+/ 0.24), treatment with heparin and ACE inhibitor shows a tendency to downregulation of mRNA expression to control group(1.36+/-0.40 in heparin group, 1.65+/- 0.45 in ACE inhibitor treated group). In summary, this study shows that repair in even the simplest model of vascular injury is an exceedingly complex, including upregulation of PDGF gene expression. Treatment with heparin and ACE inhibitor revealed a downregulation of each mRAN expression to control group. There results suggest that dysregulation of there gene expression may be involved in the pathogenesis of intimal hyperplasia after endothelial injury.
Animals ; Aorta ; Blood Vessels ; Catheters ; Constriction, Pathologic ; Down-Regulation ; Gene Expression ; Heparin ; Hyperplasia ; Models, Animal ; Myocytes, Smooth Muscle ; Polymerase Chain Reaction ; Ramipril ; Rats ; Reverse Transcription ; RNA, Messenger ; Transforming Growth Factor beta ; Up-Regulation ; Vascular System Injuries

African tick-bite fever (ATBF), caused by Rickettsia africae, is the second most frequent cause of fever after malaria in travelers returning from Southern Africa. As the Korean outbound travelers are increasing every year, tick-borne rickettsial diseases as a cause of febrile illness are likely to increase. We describe a febrile Korean returning traveler who showed two eschars after visiting the rural field in Manzini, Swaziland. We performed nested polymerase chain reaction using the eschar and diagnosed the patient with ATBF. He was treated with oral doxycycline for 7 days, and recovered without any complications. We believe that the present case is the first ATBF case diagnosed in a Korean traveler.