BACKGROUND: Patient-controlled sedation (PCS) involves the patient self administering the sedative agent to the point at which the patient is satisfied with the level of sedation with the advantage to overcome the phamacodynamic differences between individual patients. We performed the PCS with two different dosages of propofol and compared the efficacy and side effects for local anesthesia patients in plastic surgery. METHODS: Thirty patients underwent propofol PCS with Perfusor fm (B. Braun, Germany) PCA pump during nasal inhalation of O2 3 L/min with continuous monitoring of SpO2. PCS settings were 10 mg of bolus dose, 30 mg of initial loading dose, 1 min of lockout interval, 100 mg/hr of continuous infusion in group 1 and 20 mg of bolus dose, 60 mg of initial loading dose, 1 min of lockout interval, 100 mg/hr of continuous infusion in group 2. All the patients received local anesthesia with 1% lidocaine before operation. Observer's assessment of alertness/sedation (OAA/S) scale, SpO2, mean infusion rate of propofol, duration of induction and recovery, recall of operative procedure, and patient's and surgeon's satisfaction were checked. RESULTS: The mean infusion rate (group 1; 32.2 +/- 19.4, group 2; 38.3 +/- 20.5 ug/kg/min), duration of induction (group 1; 4.9 +/- 1.9, group 2; 3.1 +/- 1.4 min), duration of recovery (group 1; 1.7 +/- 1.2, group 2; 2.5 +/- 1.3 min), and mean OAA/S scale (group 1; 3.8 +/- 1.6, group 2; 3.1 +/- 1.5) were not significantly different between the groups (mean +/- SD). Inadequate sedation occurred more frequently in group 1 (13%) than group 2 (0%), and incidences of respiratory depression (SpO2 < 95%) were more higher in group 2 (20%) than group 1 (0%). Numbers of satisfaction of patient and surgeon were 100% and 87% in group 1, and 87% and 93% in group 2. CONCLUSIONS: 10 mg or 20 mg as a bolus dose and 30 mg or 60 mg as a initial loading dose of propofol for PCS provided effective sedation and patient's and surgeon's satisfaction without significant side effect for local anesthesia patients in plastic surgery. (Korean J Anesthesiol 2004; 46: 583~588)
Anesthesia, Local* ; Humans ; Incidence ; Inhalation ; Lidocaine ; Passive Cutaneous Anaphylaxis ; Propofol ; Respiratory Insufficiency ; Surgery, Plastic* ; Surgical Procedures, Operative

BACKGROUND: Breast cancer is the one of the commonly diagnosed female cancer in Korea. Numerous factors have been noted to be associated with risk of breast cancer: body mass index, menarche, menopause, family history, pregnancy and delivery, breastfeeding, alcohol use, smoking habits, diet, education and use of oral contraceptives. Little is known about hair minerals in breast cancer patient and about correlation between hair minerals and body mass index. METHODS: We compared hair mineral analysis data of 37 breast cancer subject with age and body mass index-matched normal control data (N = 144) by cross-sectional analysis. All breast cancer patients were newly diagnosed at one Breast Cancer Center in Ajou University and had their hair cut before anti-cancer chemotherapy, and the normal controls (without breast cancer) also had their hair cut for various reasons in out-patient clinics of the Department of Family Practice and Community Health. RESULTS: Breast cancer patients had low calcium, magnesium, and zinc, whereas they had high arsenic, sodium, and potassium compared with the normal controls. Only hair zinc level had significant negative correlation with body mass index (r = -0.705, P < 0.001) in breast cancer patients, not in normal controls. CONCLUSION: We observed the difference of hair mineral patterns in newly diagnosed breast cancer patients compared to normal controls and the correlation between these minerals and body mass index in breast cancer patient. Especially hair zinc concentration was significantly reduced and had significant negative correlation with body mass index in breast cancer patients.
Arsenic ; Body Mass Index ; Breast ; Breast Feeding ; Breast Neoplasms ; Calcium ; Contraceptives, Oral ; Cross-Sectional Studies ; Family Practice ; Female ; Food Habits ; Hair ; Humans ; Korea ; Magnesium ; Menarche ; Menopause ; Minerals ; Outpatients ; Potassium ; Reproductive History ; Smoke ; Smoking ; Sodium ; Zinc

Systemic sclerosis is a multisystemic disorder of unknown etiology characterized by fibrosis of skin, blood vessel, and visceral organ. A 38-week pregnant, 29 year-old woman with systemic sclerosis and migraine was scheduled for cesarean section under lumbar epidural anesthesia because of dyspnea, decreased diffusion lung capacity and Raynaud's phenomenon. She suffered from sudden onset of severe headache, repetitive nausea, vomiting, and hypertension during cesarean section under the epidural anesthesia. The above symptoms did not respond to beta-blocker, vasodilator during the operation period. In the recovery room, the headache and vomiting were relieved by intravenous injection of ketorolac and metoclopramide. She experienced single tonic-clonic generalized seizure and intermittent migraine after operation in the ward, and discharged 7 days after operation.
Adult ; Anesthesia, Epidural ; Blood Vessels ; Cesarean Section* ; Diffusion ; Dyspnea ; Female ; Fibrosis ; Headache ; Humans ; Hypertension ; Injections, Intravenous ; Ketorolac ; Lung Volume Measurements ; Metoclopramide ; Migraine Disorders ; Nausea ; Pregnancy ; Recovery Room ; Scleroderma, Systemic* ; Seizures ; Skin ; Vomiting

BACKGROUND: Gastric carcinomas (GCs) have recently been reclassified according to the mucin phenotypes. We aimed to characterize the relationship between the mucin phenotypes and the genetic alterations or the clinicopathologic parameters of GCs. METHODS: Immunohistochemistry was performed for MUC1, MUC5AC, MUC6, MUC2, CD10, p53, hMLH1, CerbB2 and E-cadherin in 150 GCs. The mucin phenotypes of the GCs were classified as 4 phenotypes: gastric, intestinal, mixed and unclassified. RESULTS: MUC1, MUC5AC, MUC6, MUC2 and CD10 were expressed in 63.3%, 42.7%, 14.0%, 24.7% and 14.0% of the GCs, respectively. The mucin phenotypes of the GCs corresponded to the gastric type in 31.3%, the intestinal type in 20.0%, the mixed type in 15.3% and the unclassified type in 33.3%. The incidence of a p53 overexpression was higher in the gastric or mixed phenotype than in the intestinal or unclassified phenotype. MUC5AC expression, p53 overexpression and the gastric or mixed phenotype were associated with poor patient survival by multivariate analysis. CONCLUSION: This study suggests the gastric or mixed mucin phenotype may more likely go through the p53 pathway in carcinogenesis and the mucin phenotype may be considered as a prognostic indicator.
Cadherins ; Carcinogenesis ; Humans ; Immunohistochemistry ; Incidence ; Mucins* ; Multivariate Analysis ; Phenotype* ; Stomach ; Tumor Suppressor Protein p53

Previously, we have reported that p-chlorophenylalanine (PCPA), a serotonin depletor, profoundly increased pancreatic fluid and bicarbonate secretion but remarkably inhibited pancreatic amylase secretion in anesthetized rats. The present study was performed to verify the detailed effects of PCPA on pancreatic amylase synthesis that is directly related to amylase exocrine secretion. PCPA significantly decreased pancreatic RNA and protein contents as well as the amylase activity. However, pancreatic DNA content, trypsin and chymotrypsin activities were not influenced by the treatment of PCPA. The rate of pancreatic amylase synthesis, which was assessed by the amount of incorporated (35S)-methionine into amylase for 1 h, was also significantly decreased by 44% in PCPA-treated rats. In order to determine whether the PCPA-induced decrease of amylase synthesis resulted from change in the level of amylase mRNA, Northern blot analysis was performed. The mRNA expression level of amylase was also decreased by 48% in the PCPA-treated rats, indicating that the inhibitory effect of PCPA on the synthesis of pancreatic amylase was mainly regulated at a step prior to translation. It was also revealed in SDS-polyacrylamide gel electrophoresis that the qualitative change of amylase was induced by PCPA. The 54 KDa amylase band seems to be degraded into small molecular weight protein bands in PCPA-treated rats, suggesting that the PCPA-induced decrease of amylase may be partly attributed to the degradation of synthesized amylase.
Amylases* ; Animals ; Blotting, Northern ; Chymotrypsin ; DNA ; Electrophoresis ; Fenclonine* ; Molecular Weight ; Pancreas ; Rats* ; RNA ; RNA, Messenger ; Serotonin ; Trypsin

Left ventricular pseudoaneurysm, in which a ventricular free wall rupture is locally contained by adherent pericardium, is a rare complication of myocardial infarction. Compared w'th a true left ventricular aneunsm, a pseudoaneurysm has a greater propensity to sudden rupture, with catastrophic sequelae. Pseudoaneurysm may be surgically curable, a prompt and accurate diagnosis is thus essential. Transthoracic echocardiography has been the procedure of choice in the diagnosis of pseu- doaneurysm. Transesophageal echocardiography can provide more accurate information than transthoracic echocardiography for the evaluation of ventricular pseudoaneurysm located in posterior and inferior wall. We experienced a case of pseudoaneurysm of left ventricle in a 75-year-old female who presented with dyspnea. A large pseudoaneurysm of left ventricle vith narrow neck was de- tected by transesophageal echocardiography.
Aged ; Aneurysm, False* ; Diagnosis ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart Rupture ; Heart Ventricles ; Humans ; Myocardial Infarction ; Neck ; Pericardium ; Rupture

On page 173, the incorrect image which was not submitted by the author was mistakenly printed for Fig. 5 by a system error of the editing company.

OBJECTIVE: Assisted reproductive technology has been associated with an increase in multiple pregnancies. The most effective strategy for reducing multiple pregnancies is single embryo transfer. Beginning in October 2015, the National Supporting Program for Infertility in South Korea has limited the number of embryos that can be transferred per in vitro fertilization (IVF) cycle depending on the patient's age. However, little is known regarding the effect of age and number of transferred embryos on the clinical outcomes of Korean patients. Thus, this study was performed to evaluate the effect of the number of transferred blastocysts on clinical outcomes. METHODS: This study was carried out in the Fertility Center of CHA Gangnam Medical Center from January 2013 to December 2014. The clinical outcomes of 514 women who underwent the transfer of one or two blastocysts on day 5 after IVF and of 721 women who underwent the transfer of one or two vitrified-warmed blastocysts were analyzed retrospectively. RESULTS: For both fresh and vitrified-warmed cycles, the clinical pregnancy rate and live birth or ongoing pregnancy rate were not significantly different between patients who underwent elective single blastocyst transfer (eSBT) and patients who underwent double blastocyst transfer (DBT), regardless of age. However, the multiple pregnancy rate was significantly lower in the eSBT group than in the DBT group. CONCLUSION: The clinical outcomes of eSBT and DBT were equivalent, but eSBT had a lower risk of multiple pregnancy and is, therefore, the best option.
Blastocyst* ; Embryo Transfer* ; Embryonic Structures ; Female ; Fertility ; Fertilization in Vitro ; Humans ; Infertility ; Korea ; Live Birth ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Reproductive Techniques, Assisted ; Retrospective Studies ; Single Embryo Transfer

Chlorogenic acid (CGA) possesses various biological activities such as anti-oxidant, anti-inflammatory, and anti-diabetic activities. In the present study, we examined the effect of CGA on the transduction efficiency of PEP-1-ribosomal protein S3 (PEP-1-rpS3) into cells and brain tissues, and its neuroprotective potential against ischemia/reperfusion. We found that, in the presence of CGA, the transduction efficiency of PEP-1-rpS3 into astrocytes and the CA1 region of the hippocampus was enhanced, compared to its transduction in the absence of CGA. Also, cell viability data demonstrated that the sample treated with CGA + PEP-1-rpS3 exhibited improved cell viability against hydrogen peroxide (H2O2)-induced toxicity more significantly than the sample treated with PEP-1-rpS3 alone. Also, in a gerbil ischemia model, data demonstrated that following the ischemic insult, the group treated with PEP-1-rpS3 + CGA showed markedly enhanced protection of neuron cells in CA1 region of hippocampus, compared to those treated with CGA or PEP-1-rpS3 alone. Taken together, these results suggest that CGA may improve the transduction efficiency of protein transduction domain (PTD) fusion proteins into target cells or tissues, thereby enhancing their therapeutic potential against various diseases.
Astrocytes ; Brain ; Cell Survival ; Chlorogenic Acid ; Gerbillinae ; Hippocampus ; Hydrogen Peroxide ; Ischemia ; Neurons ; Neuroprotective Agents ; Proteins

PURPOSE: Anatomy of deep pelvis, narrow distal margin and tumor invasion into neighbor organ are obstacles for curative radical resection for advanced cancer of distal rectum. Technically, laparoscopic application after downstaging the tumor with preoperative concurrent chemotherapy (CCRT) may give a solution to overcome the anatomical difficulties. We compared the results of laparoscopic surgery in the patients who received CCRT with those of patients who had conventional surgery. MATERIALS AND METHODS: A continuous infusion of 5FU plus leucovorin and radiotherapy (50.4 Gy) in 28 fractions was given each patient as CCRT. They underwent D2 radical resection with TME and ANP for the rectal cancer in 4 weeks. RESULTS: Thirty three patients had laparoscopic resection such as LAR, colo-anal anastomosis and APR. The results were compared with 12 cases of the conventional resections. As a result of preoperative CCRT, the cancer was down-staged in 71%. Two year disease free survival was 75% and 74% in the group of conventional and laparoscopic resection, respectively (p=0.427). Ileus, voiding difficulty and leakage after surgery were not different between two groups. Weakness of ejaculation was noted in 9~11% of both groups. The DFS of the preoperative CCRT followed by radical resection in the groups with a response was more favorable than that in the group with progressive or stable disease. CONCLUSION: Radical resection of advanced distal rectal cancer could be done with performing a laparoscopic assisted operation after CCRT induced down-staging. We may suggest that laparoscopic assisted resection is a good treatment option as it doesn't increase the complications and it has a compatible survival rate to conventional surgery.
Atrial Natriuretic Factor ; Chemoradiotherapy* ; Disease-Free Survival ; Drug Therapy ; Ejaculation ; Fluorouracil ; Humans ; Ileus ; Laparoscopy ; Leucovorin ; Male ; Pelvis ; Radiotherapy ; Rectal Neoplasms* ; Rectum ; Survival Rate