Cushing disease in children and adolescents, especially with multiple pituitary adenomas (MPAs), is very rare. We report 17-year-old boy with MPAs. He presented with a vertebral compression fracture, weight gain, short stature, headache, and hypertension. On magnetic resonance imaging (MRI), only a left pituitary microadenoma was found. After surgery, transient clinical improvement was observed but headache and hypertension were observed again after 3 months later. Follow-up MRI showed a newly developed right pituitary microadenoma 6 months after the surgery. The need for careful clinical and radiographic follow-up should be emphasized in the search for potential MPAs in patients with persistent Cushing disease.
Adolescent* ; Child ; Follow-Up Studies ; Fractures, Compression* ; Headache ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Pituitary ACTH Hypersecretion* ; Pituitary Neoplasms* ; Weight Gain

Laser enucleation and morcellation of the prostate is an increasingly used surgical management of benign prostatic hyperplasia. However, it can cause several complications including capsular perforation, ureteral orifice injury, and bladder mucosal morcellation injury. Herein, we report a case of severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser surgery of the prostate. The patient experienced massive abdominal distension and severe respiratory difficulty after the procedure. Although immediate postoperative cystogram showed no leakage of contrast dye, the computed tomography scan of the abdomen and pelvis showed massive fluid collection in the abdominal pelvic cavity suggesting bladder wall injury. After percutaneous drainage of intraperitoneal fluid, abdominal distention and dyspnea were relieved.
Abdomen ; Drainage ; Dyspnea* ; Humans ; Laser Therapy ; Pelvis ; Prostate* ; Prostatic Hyperplasia ; Ureter ; Urinary Bladder

BACKGROUND: Core body temperature (TC) can decrease during general anesthesia. Particularly in elderly patients, more aggressive strategies to prevent intraoperative hypothermia may be required. Here, we investigated the effect of a heated humidifier on intraoperative TC decrease in the elderly. METHODS: Twenty-four elderly patients were randomly assigned into two groups: those who used a heated humidifier (group H) and those who used a conventional ventilator circuit with a heat moisture exchanger (group C). TC was measured continuously at the esophagus at several time-points during surgery. RESULTS: In group C, TC significantly decreased 90 minutes after skin incision (P < 0.001), while significant differences were not noted in group H during surgery. Comparing the two groups, TC decreased more in group C than in group H at 60, 90, 120, and 150 minutes after skin incision (group C vs. group H: -0.6℃ vs. -0.3℃, P = 0.025; -0.7℃ vs. -0.4℃, P = 0.012; -0.9℃ vs. -0.4℃, P = 0.006; and -1.0℃ vs. -0.5℃, P = 0.013, respectively). There were no significant differences between the two groups for any other parameters. CONCLUSIONS: A heated humidifier is more effective in preventing intraoperative TC decrease in elderly patients than a heat moisture exchanger. However, further studies with a larger population are required to substantiate its clinical use.
Aged* ; Anesthesia, Closed-Circuit ; Anesthesia, General ; Body Temperature* ; Esophagus ; Heating ; Hot Temperature* ; Humans ; Humidity ; Hypothermia ; Observational Study* ; Prospective Studies* ; Skin ; Ventilators, Mechanical

Cerebral air embolism is a rare but potentially life-threatening complication. We experienced a living-donor liver transplant recipient who presented with unexpected cerebral air embolism and transient neurologic abnormalities that subsequently developed just after the removal of the pulmonary artery catheter from the central venous access device. One day after the initial event, the patient's neurologic status gradually improved. The patient was discharged 30 days after liver transplantation without neurologic sequelae.
Catheters* ; Central Venous Catheters ; Embolism, Air* ; Humans ; Liver Transplantation ; Liver* ; Pulmonary Artery* ; Transplantation*

BACKGROUND: Atropine is an anticholinergic drug which is commonly used in clinical practice. The effect of parasympathetic block with atropine on dynamic cerebrovascular regulation remains unclear. This study was aimed to identify effects of vagolytic atropine on cerebrovascular response during acute orthostatic hypotension in humans. METHODS: Continuous middle cerebral blood flow velocity (CBFV, transcranial Doppler) and arterial blood pressure (ABP, Finometer) were measured during a sit-to-stand procedure in 10 healthy subjects with placebo and vagolytic (10 microg/kg) doses of atropine. Cerebral vascular tone was assessed by cerebrovascular resistance (CVR = ABP / CBFV). Dynamic cerebral autoregulation was also assessed by transfer function analysis of ABP and CBFV. RESULTS: During the standing session, ABP fell to a similar extent in both groups by an average of 23 to 25 mmHg (26% to 29%). CBFV also fell in all subjects but significantly more in vagolytic atropine (-15.0 +/- 7.0 cm/s) compared with placebo (-12.0 +/- 5.8 cm/s, P < 0.05). CVR was decreased significantly in the placebo group during posture change (1.56 +/- 0.44 vs. 1.38 +/- 0.38, P < 0.05), in contrast, lesser decreased in the atropine group (1.60 +/- 0.50 vs. 1.53 +/- 0.42, P = 0.193). Transfer function coherence in the very-low-frequency range was significantly increased in the atropine group during the standing session (0.55 +/- 0.14), compared with the sitting session (0.45 +/- 0.14, P = 0.006). CONCLUSIONS: These data present that vagolytic atropine attenuates cerebral vasodilation response to acute orthostatic hypotension, suggesting the use of atropine may need care in patients with cerebrovascular disease with vagal impairment.
Arterial Pressure ; Atropine* ; Blood Flow Velocity ; Homeostasis ; Humans ; Hypotension, Orthostatic* ; Posture ; Vasodilation*

Intracranial pressure (ICP) monitoring is an important issue for liver transplant recipients, since increased ICP is associated with advanced hepatic encephalopathy or graft reperfusion during liver transplantation. Invasive monitoring of ICP is known as a gold standard method, but it can provoke bleeding and infection; thus, its use is a controversial issue. Studies have shown that optic nerve sheath diameter > 5 mm by ocular ultrasonography is useful for evaluating ICP > 20 mmHg noninvasively in many clinical settings. In this case report, we present experiences of using ocular ultrasound as a diagnostic tool that could detect changes in ICP noninvasively during liver transplantation.
Hemorrhage ; Hepatic Encephalopathy ; Intracranial Pressure ; Liver ; Liver Transplantation ; Optic Nerve ; Reperfusion ; Transplants

Adrenal insufficiency, which is related to hemodynamic instability and increased mortality, has been reported in patients with advanced liver disease regardless of the presence of septic conditions. In this regard, the hepatoadrenal syndrome has been recently proposed as adrenal insufficiency in critically ill patients with liver disease. We describe here a 67-year-old female patient with hepatic failure and adrenal insufficiency. The patient showed stable vital signs and no evidence of sepsis preoperatively. Despite hydrocortisone replacement and inotropics administration, severe intraoperative hemodynamic instability was observed. Hydrocortisone administration was continued postoperatively, nevertheless inotropics could not be tapered. On postoperative day 11, the patient died due to pneumonia and septic shock. Hepatoadrenal syndrome may have played a key role in her severe hemodynamic fluctuation and poor outcome, reinforcing the importance of adrenal function in the liver transplantation surgery.
Adrenal Insufficiency ; Critical Illness ; Female ; Hemodynamics ; Humans ; Hydrocortisone ; Liver ; Liver Diseases ; Liver Failure ; Liver Transplantation ; Pneumonia ; Sepsis ; Shock, Septic ; Vital Signs

No abstract available.

BACKGROUND: Melatonin has been shown to attenuate the reflex sympathetic increases that arise in response to orthostatic challenges. We tested the hypothesis that the attenuated sympathetic increase induced by melatonin premedication may weaken the arterial blood pressure (ABP) preserving the capability during acute hypotension, thereby altering dynamic cerebral autoregulation and causing a further decrease in cerebral blood flow (CBF). METHODS: Acute hypotension was induced in 12 healthy subjects by releasing bilateral thigh cuffs before and after an oral dose of melatonin (0.2 mg/kg). Heart rate (HR), arterial blood pressure (ABP), Modelflow estimate of cardiac output (CO), total peripheral resistance (TPR) and cerebral blood flow velocity (CBFV) by transcranial Doppler were measured. RESULTS: Steady state HR, the mean arterial pressure and CBFV were not altered 60 minutes after melatonin ingestion. Reduced systolic arterial pressure (DeltaSAP), changes in HR (DeltaHR), CO (DeltaCO), and TPR (DeltaTPR), DeltaHR/DeltaSAP and percentage restoration of SAP were not affected after a temporal decrease in ABP induced by thigh cuff release. In the cerebral circulation, melatonin did not affect changes in CBFV, cerebrovascular resistance index, the rate of regulation and percentage restoration of CBFV following a sudden decrease in ABP. CONCLUSIONS: Contrary to our hypothesis, melatonin did not affect the rapid vasodilatory and recovery responses of cardiovascular and dynamic cerebral autoregulation. These results suggest that melatonin premedication may not impair ABP and CBF preserving capability induced by sudden postural changes or hemorrhage.
Arterial Pressure ; Blood Flow Velocity ; Blood Pressure ; Cardiac Output ; Cerebrovascular Circulation ; Eating ; Heart Rate ; Hemorrhage ; Homeostasis ; Humans ; Hypotension ; Male ; Melatonin ; Premedication ; Reflex ; Thigh ; Vascular Resistance

The human colorectal carcinoma-associated GA733 antigen epithelial cell adhesion molecule (EpCAM) was initially described as a cell surface protein selectively expressed in some myeloid cancers. Gangliosides are sialic acid-containing glycosphingolipids involved in inflammation and oncogenesis. We have demonstrated that treatment with anti-EpCAM mAb and RAW264.7 cells significant inhibited the cell growth in SW620 cancer cells, but neither anti-EpCAM mAb nor RAW264.7 cells alone induced cytotoxicity. The relationship between ganglioside expression and the anti-cancer effects of anti-EpCAM mAb and RAW264.7 was investigated by high-performance thin-layer chromatography. The results demonstrated that expression of GM1 and GD1a significantly increased in the ability of anti-EpCAM to inhibit cell growth in SW620 cells. Anti-EpCAM mAb treatment increased the expression of anti-apoptotic proteins such as Bcl-2, but the expression of pro-apoptotic proteins Bax, TNF-alpha, caspase-3, cleaved caspase-3, and cleaved caspase-8 were unaltered. We observed that anti-EpCAM mAb significantly inhibited the growth of colon tumors, as determined by a decrease in tumor volume and weight. The expression of anti-apoptotic protein was inhibited by treatment with anti-EpCAM mAb, whereas the expression of pro-apoptotic proteins was increased. These results suggest that GD1a and GM1 were closely related to anticancer effects of anti-EpCAM mAb. In light of these results, further clinical investigation should be conducted on anti-EpCAM mAb to determine its possible chemopreventive and/or therapeutic efficacy against human colon cancer.
Animals ; Antibodies, Monoclonal/*immunology/*therapeutic use ; Antigens, Neoplasm/*immunology ; Apoptosis/drug effects ; Cell Adhesion Molecules/*immunology ; Cell Line ; Cell Line, Tumor ; Cell Proliferation/drug effects ; Colon/drug effects/immunology/metabolism/pathology ; Colonic Neoplasms/*drug therapy/genetics/*immunology/pathology ; Gangliosides/genetics/*immunology ; Gene Expression Regulation, Neoplastic/drug effects ; Humans ; Male ; Mice ; Mice, Inbred BALB C