A 28-yr-old woman, weighing 61 kg with bleeding myoma of uterus was scheduled for total abdominal hysterectomy. There was no history of cardiac arrhythmia or syncope. She was not premedicated. The heart rate was 115 beats/min and arterial pressure was 155/95 mmHg, immediately before the induction of anesthesia. Under the preoxygenation, anesthesia was induced with IV injection of thiopental sodium 250 mg followed by succinylcholine 75 mg. About 20 seconds after the succinylcholine bolus, the ECG showed an abrupt change from sinus rhythm to asystole without any stimulus including laryngoscopy. After a precordial thump and atropine 0.5 mg IV, tracheal intubation and ventilation with 100% O2 were quickly accomplished. Normal sinus rhythm with heart rate of 87 beats/min returned during laryngoscopy and intubation. The interval from the sinus arrest to the reestablishment of normal sinus rhythm was only 15 seconds. Surgery proceeded uneventfully and the patient recovered without any complication.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure ; Atropine ; Electrocardiography ; Female ; Heart Arrest* ; Heart Rate ; Hemorrhage ; Humans ; Hysterectomy ; Intubation ; Laryngoscopy ; Myoma ; Succinylcholine* ; Syncope ; Thiopental ; Uterus ; Ventilation

No abstract available.
Dysgerminoma* ; Female ; Ovary* ; Pregnancy*

Atherosclerotic vascular disease is the leading cause of morbidity and mortality in developed countries. While it is a complex condition resulting from numerous genetic and environmental factors, it is well recognized that oxidized low-density lipoprotein produces pro-atherogenic effects in endothelial cells (ECs) by inducing the expression of adhesion molecules, stimulating EC apoptosis, inducing superoxide anion formation and impairing protective endothelial nitric oxide (NO) formation. Emerging evidence suggests that the enzyme arginase reciprocally regulates NO synthase and NO production by competing for the common substrate L-arginine. As oxidized LDL (OxLDL) results in arginase activation/upregulation, it appears to be an important contributor to endothelial dysfunction by a mechanism that involves substrate limitation for endothelial NO synthase (eNOS) and NO synthesis. Additionally, arginase enhances production of reactive oxygen species by eNOS. Arginase inhibition in hypercholesterolemic (ApoE-/-) mice or arginase II deletion (ArgII-/-) mice restores endothelial vasorelaxant function, reduces vascular stiffness and markedly reduces atherosclerotic plaque burden. Furthermore, arginase activation contributes to vascular changes including polyamine-dependent vascular smooth muscle cell proliferation and collagen synthesis. Collectively, arginase may play a key role in the prevention and treatment of atherosclerotic vascular disease.
Animals ; Apoptosis ; Arginase ; Arginine ; Atherosclerosis ; Cell Proliferation ; Collagen ; Developed Countries ; Endothelial Cells ; Lipoproteins ; Lipoproteins, LDL ; Mice ; Muscle, Smooth, Vascular ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type III ; Plaque, Atherosclerotic ; Reactive Oxygen Species ; Superoxides ; Vascular Diseases ; Vascular Stiffness

PURPOSE: Stimulation of human aortic smooth muscle cells (hAoSMCs) with native low-density lipoprotein (nLDL) induced the production of interleukin-8 (IL-8) that is involved in the pathogenesis of cardiovascular diseases. However, the process of signal transduction of nLDL was currently uncharacterized. Therefore, the aim of this study was to investigate the signal transduction pathway of nLDL-dependent IL-8 production and the effect of IL-8 on hAoSMCs migration. MATERIALS AND METHODS: nLDL was prepared by ultracentrifugation with density-adjusted human serum of normocholesterolemia. In hAoSMCs, IL-8 secreted to medium was measured using ELISA assay, and Western blot analysis was performed to detect p38 MAPK activation as a key regulator of IL-8 production. nLDL-dependent H2O2 generation was determined by microscopic analysis using 2',7'-dichlorofluoroscein diacetate (DCF-DA). IL-8-induced migration of hAoSMCs was evaluated by counting the cell numbers moved to lower chamber using Transwell plates. RESULTS: nLDL-induced IL-8 production was completely blocked by preincubation of hAoSMCs with pertussis toxin (PTX), which inhibited nLDL-dependent p38 MAPK phosphorylation. PTX-sensitive G-protein coupled receptor was responsible for nLDL-dependent H2O2 generation that was abrogated with preincubation of the cells with of polyethylene glycol-conjugated catalase (PEG-Cat). Pretreatment of PEG-Cat prevented nLDL-induced p38 MAPK phosphorylation and IL-8 production, which was partly mimicked by treatment with exogenous H2O2. Finally, IL-8 increased hAoSMCs migration that was completely blocked by incubation with IL-8 neutralizing antibody. CONCLUSION: PTX-sensitive G-protein coupled receptor-dependent H2O2 generation by nLDL plays a critical role in IL-8 production in hAoSMC, and IL-8 may contribute to atherogenesis through increased migration of hAoSMCs.
Cell Movement/*physiology ; Cells, Cultured ; Humans ; Hydrogen Peroxide/*metabolism ; Interleukin-8/*biosynthesis ; Lipoproteins, LDL/*pharmacology ; Muscle, Smooth, Vascular/cytology/*metabolism ; Myocytes, Smooth Muscle/cytology/*metabolism ; Pertussis Toxin/pharmacology ; Phosphorylation/drug effects ; Reactive Oxygen Species/metabolism ; Receptors, G-Protein-Coupled/*physiology ; Signal Transduction ; p38 Mitogen-Activated Protein Kinases/metabolism

BACKGROUND: Malpositioning of the endotracheal tube within airway after intubation may results in serious complications, such as accidental extubation and inadvertent endobronchial intubation. Therefore, early detection of malposioning of the endotracheal tube is very impotant for deciding patient's prognosis. METHODS: We assessed the distance from the tip of the endotracheal tube to the carina according to the patient's age, sex, and the time, the location, and the route of intubation. The chest x-ray was taken for 333 patients (men, 226: women, 107) who were admitted to the intensive care unit of Wonju Christian Hospital from march 1, 1995 to February 28, 1996. Chest x-ray was obtained after intubation to verify endotracheal tube position. Appropriate endotracheal tube position on chest x-ray was defined as between 2 and 6 cm above the carina. RESULTS: Of the 333 intubations, 106 (31.8%) endotracheal tubes were inappropriately placed according to the chest x-ray. The percentage of malpositioned endotracheal tubes (<2 cm) was higher in women than in men (11.2% vs. 5.3%, p<0.05), with higher in night (7 PM to 7 AM) than in day (7 AM to 7 PM) (42% vs. 24%, p<0.05). Distance from the carina to the tip of endotracheal tube is 4.34 +/- 1.77cm in women and 5.23 +/- 1.64cm in men. Thus, position of the endotracheal tube in women is deeper than men (p<0.001). CONCLUSIONS: We conclude that the chest x-ray for confirmation of endotracheal tube position after endotracheal intubation may remain the standard of practice. And endotracheal tube position should be carefully assessed immediately after tracheal intubation, particularly in women and at night.
Female ; Gangwon-do ; Humans ; Incidence* ; Intensive Care Units ; Intubation ; Intubation, Intratracheal* ; Male ; Prognosis ; Thorax*

Complications related to a broken stylet during endotracheal intubation have been infrequently reported. In most cases, broken stylets have been recognized by chest radiography. We report a case of unrecognized iatrogenic aspiration of a broken stylet. A 37-year-old man, who underwent explo-laparotomy two days previously, was reintubated with an uncoated stylet in the intensive care unit because of dyspnea and pulmonary congestion. He was on artificial ventilation for one day and was extubated one week later. We could not find the broken stylet on serial chest x-ray films until a metallic substance was expectorated while the patient was coughing 28 days after extubation. During the intervening period the patient did not complain of any chest discomfort and we did not realize that the broken stylet remained. The use of a plastic coated stylet and its careful observation after intubation are recommended to avoid this complication.
Adult ; Cough* ; Dyspnea ; Estrogens, Conjugated (USP) ; Humans ; Intensive Care Units ; Intubation ; Intubation, Intratracheal ; Plastics ; Radiography ; Thorax ; Ventilation ; X-Ray Film

Accurate placernent of double-lumen endobronchial tube is essential for successful one lung anesthesia We studied 58 adult patients (38 males and 20 females) undergoing thoracic surgery under one lung anesthesia. We used the fiberoptic bronchoscope as an "introducer" over which the double lumen tube was advanced under direct vision. Correct position of the left side double-lumen endobronchial tube at supine position was determined by direct vision of cephalad surface of the bright blue bronchial cuff immediately below the carina. Correct position of the right side double lumen endobronchial tube at supine position was determined by direct vision of the right upper lobe bronchial orifice through the right upper labe ventilation slot. After the patient was repositioned, the position of the double lumen endobronchial tube was rechecked by fiberoptic bronchoscope. The results were as follows; 1) There was a significant correlation of correct depth of left and right double lumen endobronchial tube at supine position with height for both male and female patients. 2) Left side double lumen endobronchial tube: 58% of total cases (20 Case of 38 Case) were displaced by turning of the patient from supine to the lateral decubitus position. 3) Right side double lumen endobronchial tube: 65% of total cases (13 Case of 20 Case) were displaced by turning of the patient from supine to the lateral decubitus position.
Adult ; Anesthesia ; Bronchoscopes ; Female ; Humans ; Lung ; Male ; Supine Position ; Thoracic Surgery ; Ventilation

Successful management of active hemorrhagic shock is directed toward efforts to control bleeding, replenish blood and fluid deficits, restore cardiac output, and enhance oxygen delivery. In patients with low hemoglobin concentration, the use of whole blood or packed red blood cell is indicated. Some patients may refuse blood transfusions on religious grounds, and some patients may not be given blood transfusions for uncommon blood type. We report a case of a 34 years old hemorrhagic shock patient(Hgb 3.7 g/dl) whose blood type was Rh- 0, and who underwent operation successfully with profound hemodilution.
Adult ; Blood Transfusion ; Cardiac Output ; Erythrocytes ; Hemodilution ; Hemorrhage ; Humans ; Oxygen ; Shock ; Shock, Hemorrhagic*

No abstract available.
Leiomyosarcoma* ; Uterine Inversion*

Pneumothorax and pulmomary edema can be produced as a complication during general anesthesia. The former which occurs during pressure ventilation is highly dangerous. It is characterized by a dramatic onset which is readily recongnized and demands immediate management. The latter may be developed after the upper airway obstruction has been relived due to the reduction of the intersitial hydrostatic pressure and increased capilary permeability. We experienced a case of pneumothorax and pulmonary edema that occurred after treatment for upper airway obstruction.
Airway Obstruction* ; Anesthesia, General ; Edema ; Hydrostatic Pressure ; Permeability ; Pneumothorax* ; Pulmonary Edema* ; Ventilation