BACKGROUND: This bispectral index, which is used for intravenous anesthetics and inhalation anesthesia, is a scale of sedation and hypnotic effect, which is widely used in clinics. Atypical changes in BIS are expected due to increased cardiac output, decreased blood albumin concentrations and renal function in severe burn patients undergoing early escharectomy. The aim of this study was to compare BIS according to effected site concentrations of propofol during anesthetic induction using propofol TCI in severe burn and nonburn patients. METHODS: Forty patients were classified as twenty nonburn elective surgical patients (group 1) and twenty burn patients scheduled for escharectomy (group 2). For induction, a propofol TCI device incorporating a prefilled syringe was adjusted to a target concentration of 6mug/ml in flash mode. The bispectral index was checked before induction and at each effect site concentration of propofol (0.5mug/ml interval) until an effect site concentration of 4.5mug/ml. Other suspected contributory factors such as cardiac index, creatinine clearance and albumin were checked simultaneously. The unpaired t-test and repeated measures ANOVA were performed for the statistical analysis. RESULTS: Below an effect site concentration of propofol of 3mug/ml, no BIS difference was evident between group 1 and group 2. However, at 3.5mug/ml, group 1 was 41.1+/-13.5 and group 2 was 54.7+/-16.6 and at 4mug/ml, group 1 was 40.1+/-2.6 and group 2 was 50.1+/-13.1. Among the suspected contributing factors, cardiac index and albumin showed significant differences between groups 1 and 2 (cardiac index: 3.4+/-0.5 L/min/m2 vs 2.7+/-0.3 L/min/m2, albumin: 4.1+/-0.3 g/dl vs 2.6+/-0.3 g/dl, P<0.05). Creatinine clearance showed no significant difference between the groups. CONCLUSIONS: Severe burn patients who are expecting early escharectomy had higher BIS values than nonburn patients from an effect site concentration of propofol of 3.5mug/ml. This study suggest that cardiac index should be considered as a factor that influences propofol.
Anesthesia, Inhalation ; Anesthetics, Intravenous ; Burns* ; Cardiac Output ; Creatinine ; Humans ; Hypnotics and Sedatives ; Propofol* ; Syringes

A 49-year-old man with a left upper lobe mass lesion was admitted for evaluation. An open thoracotomy biopsy confirmed tuberculosis. A left upper lobectomy was then performed under general anesthesia. The operative procedure was remarkable for a 15-second acute episode of cardiac asystole during the aortopulmonary window lymph node dissection. After injection of epinephrine and open cardiac massage, sinus rhythm was restored. The rest of the patient's hospital course was uneventful. A vasovagal reflex due to the operative procedure, anesthetic medications, and undiagnosed underlying heart disease could be considered for the possible etiology.
Anesthesia, General ; Biopsy ; Epinephrine ; Fentanyl ; Heart Arrest* ; Heart Diseases ; Heart Massage ; Humans ; Lymph Node Excision ; Middle Aged ; Propofol ; Reflex ; Surgical Procedures, Operative ; Thoracotomy ; Tuberculosis ; Vecuronium Bromide

Pulmonary hypertension (PH) is a rare manifestation in patients with primary Sjogren's syndrome (pSS) and it can occur with or without interstitial lung disease (ILD). Patients with PH and ILD who show signs of exacerbation of dyspnea are commonly assessed for pure PH aggravation, ILD progression or pulmonary infection. However, the presence of congenital cardiac anomalies, such as partial anomalous pulmonary vein return (PAPVR), can also be a cause of dyspnea exacerbation. PAPVR is a rare congenital anomaly that involves drainage of 1 to 3 pulmonary veins into the right-sided heart circulation, resulting in a partial left-to-right shunt. Here we present a case of PAPVR as the cause of PH aggravation in a patient with pSS with accompanying PH.
Dyspnea ; Heart ; Humans ; Hypertension, Pulmonary ; Lung Diseases, Interstitial ; Pulmonary Veins ; Sjogren's Syndrome

BACKGROUND: The bispectral index (BIS) has been designed to objectively measure the degree of sedation and hypnosis for anesthesia. Although it has been well-known that BIS correlates highly with the concentration of inhalation anesthetics, it is not clear whether analgesic potency expressed as MAC is comparable to hypnotic potency described as BIS50 in inhaled anesthetics. This study was conducted to examine the degree of correspondence by correlating the changes of BIS according to the different MAC of commonly used inhalation anesthetics. METHODS: One hundred ASA class 1 or 2 patients, scheduled for laparoscopic knee surgery were included. Patients were equally divided into 4 groups (n = 25 each) according to the inhalational agent enflurane, isoflurane, desflurane, or sevoflurane. Anesthetic depth for each individual agent was controlled to 2.0, 1.75, 1.5, 1.25, 1.0, 0.75 and 0.5 MAC, respectively. After equilibration for each concentration, BIS values were measured three times at 30 second intervals and an average was obtained. In addition, MAC values for each agent were measured when the bispectral index showed 50. RESULTS: The concentrations of inhaled agents vs. BIS showed high negative correlations (enflurane; -0.91, isoflurane; -0.94, desflurane; -0.84, and sevoflurane; -0.86). BIS50 for each agent was enflurane, 0.93 (1.6 vol%); isoflurane, 0.71 (0.9 vol%); desflurane, 0.95 (5.7 vol%); and sevoflurane, 0.84 MAC (1.7 vol%). Isoflurane-BIS50 showed a significant difference to the others (P<0.05). CONCLUSIONS: We concluded that the MAC of inhalation anesthetics showed poor correlation with BIS, suggesting a difference between the hypnotic and analgesic potency of individual inhaled anesthetic agents.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation* ; Enflurane ; Humans ; Hypnosis ; Inhalation* ; Isoflurane ; Knee

BACKGROUND: In major burn patients, many invasive monitors including a pulmonary artery catheter (PAC) are often required to assess hemodynamic status. An esophageal Doppler monitor (EDM), as a noninvasive method of measuring hemodynamic parameters, may be a substitute for a PAC in this clinical circumstance. This study was conducted to evaluate the validity of Doppler derived hemodynamic indices in comparison to that of a PAC. METHODS: A total of 20 critically ill, severe burn patients, scheduled for an elective escharectomy and application of artificial dermis, were enrolled for the placement of a PAC and EDM. Simultaneous data was collected in regular intervals and the various parameters were compared between the two methods. RESULTS: A total of 158 pairs of data in 20 patients were gathered. Among all the parameters, cardiac output (CO) and stroke volume (SV) showed consistently 20% less in EDM. Correlation coefficients of heart rate (HR), CO, SV and systemic vascular resistance (SVR) were 0.97, 0.54, 0.62, and 0.68 respectively. Corrected flow time (FTc) had poor correlations with central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). In the mean time, significant, but very weak correlations with FTc vs. CO and SV were demonstrated. CONCLUSIONS: EDM may be a substitute for a thermodilution (TD) PAC technique, it can be used with usefulness for hemodynamic and preload assessment in major burn patients.
Burns* ; Cardiac Output ; Catheters* ; Central Venous Pressure ; Critical Illness ; Dermis ; Heart Rate ; Hemodynamics* ; Humans ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Stroke Volume ; Thermodilution ; Vascular Resistance

Rheumatoid arthritis(RA)is occasionally associated with variable extra-articular involvement and the chronic inflammatory process can affect the gastrointestinal system.The gastrointestinal involvement in RA may present in many causes:drug induced colitis,vasculitis and amyloidosis involved in the gut,association with certain bowel diseases such as collagenous colitis or infectious colitis. Ulcerative colitis(UC)is a chronic inflammatory bowel disease and is commonly associated with peripheral joint disease which correlates with the disease activity and extent of the bowel inflammation.The arthritis is usually presented in pauciarticular,generally asymmetric,transient,and nondestructive pattern.However,the chronic and destructive peripheral arthritis has been reported in a few cases and RA has not been observed in association with UC. We experienced a case of RA patient with recurrent abdominal pain,hematochezia,and tenesmus who was diagnosed as UC by endoscopic and histologic finding.We herein report the case with literature.
Amyloidosis ; Arthritis ; Arthritis, Rheumatoid* ; Colitis ; Colitis, Collagenous ; Colitis, Ulcerative* ; Humans ; Inflammatory Bowel Diseases ; Joint Diseases ; Ulcer*

BACKGROUND/AIMS: This study investigated the clinical and pathological features of immunoglobulin G4 (IgG4)-related ophthalmic disease. To clarify the features, we compared IgG4-related ophthalmic disease and orbital inflammatory pseudotumor. METHODS: We retrospectively reviewed the medical records of 103 patients who were initially diagnosed with orbital inflammatory pseudotumor, and identified 16 cases in which the diagnosis was based on surgical biopsy and for which data in medical records were sufficient for analysis. Immunohistochemical staining of pathological specimens for IgG and IgG4 was performed. Finally, six of IgG4-related ophthalmic disease patient and 10 of orbital inf lammatory pseudotumor patient were analyzed. RESULTS: The IgG4-related ophthalmic disease group had more IgG4-positive plasma cells and a higher IgG4/IgG plasma cell ratio than the orbital inflammatory pseudotumor group. Collagenous fibrosis and lacrimal gland involvement were significantly more frequent in the IgG4-related ophthalmic disease group. Dense lymphocyte infiltration, obliterative phlebitis, and bilateral lesions were more frequent in IgG4-related ophthalmic disease, but the differences were not significant. The recurrence-free period was shorter in the IgG4-related ophthalmic disease group (p = 0.035). CONCLUSIONS: The location of the lesion (lacrimal gland), count and ratio of IgG4-positive plasma cells, and collagenous fibrosis aid the diagnosis of IgG4-related ophthalmic disease in patients with idiopathic orbital mass-like lesions. In addition, maintenance therapy should be considered in patients with IgG4-related ophthalmic disease to prevent recurrence.
Biopsy ; Collagen ; Diagnosis ; Fibrosis ; Humans ; Immunoglobulin G ; Immunoglobulins* ; Lacrimal Apparatus ; Lymphocytes ; Medical Records ; Orbit* ; Orbital Pseudotumor* ; Phlebitis ; Plasma Cells ; Recurrence ; Retrospective Studies

BACKGROUNDThe neurogenesis in retina of adult mammals is generally abolished, and this renders the retina lack of regenerative capacity. Despite this, there is a small population of nestin-positive cells in the ciliary epithelium which retains neurogenic potential. The present study aimed at investigating the effect of two drugs, corticosterone and paroxetine, on the cell proliferation of the ciliary body.

METHODSAdult Sprague-Dawley rats were given vehicle, corticosterone, paroxetine, or both corticosterone and paroxetine treatment for 14 days. Cell proliferation in the ciliary body was quantified using 5-bromo-2-deoxyuridine (BrdU) immunohistochemistry. Co-labelling of BrdU and stem cell marker was used to phenotype the BrdU immunoreactive cells.

RESULTSCorticosterone treatment suppressed while paroxetine treatment increased the cell proliferation of the ciliary body. Co-labelling with cell markers revealed that the BrdU positive cells also showed nestin expression but not glial fibrillary acidic protein (GFAP).

CONCLUSIONSThe results illustrate that proliferation of retinal progenitor cells situated in ciliary body are subjected to regulation by selective serotonin reuptake inhibitors (SSRI) and corticosteroid, which is similar to our previous findings in neurogenic regions in central nervous system (CNS). Paroxetine treatment could reverse the suppressive effect of corticosterone on ciliary body cell proliferation. This provides information for future investigation of retinal stem cell biology and potential treatment of retinal degenerative diseases.

Adrenal Glands ; drug effects ; pathology ; Animals ; Body Weight ; drug effects ; Cell Proliferation ; drug effects ; Ciliary Body ; cytology ; drug effects ; Corticosterone ; pharmacology ; Immunohistochemistry ; In Vitro Techniques ; Male ; Organ Size ; drug effects ; Paroxetine ; pharmacology ; Rats ; Rats, Sprague-Dawley

Duodenal varices are a rare site of hemorrhage in patients with intrahepatic and extrahepatic portal hypertension, but their bleeding is life-threatening complication. Diagnosis of duodenal varices may be difficult, requiring careful inspection of the duodenal bulb during endoscopy. Diagnosis of duodenal varices may also be revealed using angiography and transhepatic portography. Treatment of duodenal varices include endoscopic injection sclerotherapy (EIS), endoscopic variceal ligation (EVL), surgical procedures, and interventional radiology. A 50-year-old woman with liver cirrhosis was admitted with melena and hematochezia. An endoscopy on admission showed esophageal and fundal varices without any bleeding stigma. Colonoscopy showed moderate amount of fresh blood in the terminal ileum. 99mTc-labelled RBC scan showed a suspicion of a distal jejunal bleeding. She had explo-laparotomy of small bowel segmental resection based on 99mTc-labelled RBC but rebleeding occured. Selective mesenteric angiography failed to reveal the source of bleeding. Repeat endoscopy revealed undetected duodenal varix which was covered with fresh blood clots. Endoscopic injection sclerotherapy with n-butyl-2-cyano acrylate (Histoacryl) was performed and achieved succesful hemostasis.
Angiography ; Colonoscopy ; Diagnosis ; Enbucrilate* ; Endoscopy ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Hemostasis ; Humans ; Hypertension, Portal ; Ileum ; Ligation ; Liver Cirrhosis ; Melena ; Middle Aged ; Portography ; Radiology, Interventional ; Sclerotherapy* ; Varicose Veins*