No abstract available.
Bone Marrow* ; HL-60 Cells* ; Humans ; Interferon-gamma*

We describe here a case of difficult intubation due to pseudoankylosis of the temporo-mandibular joint after a pterional craniotomy. A 50-year-old female was admitted to our hospital presenting with severe headache. According to her angiogram, a ruptured aneurysm in left posterior communicating artery (PCoA) and an unruptured right PCoA aneurysm were detected. We the operation in two-steps; the first operation for the left PCoA proceeded without any problem, and the tracheal intubation also was not difficult. Four weeks later, while inducing the general anesthesia for her second operation, severe trismus was detected after the infusion of propofol 120 mg. While ventilating the patient with a well-fitted mask, we performed several attempts of conventional tracheal intubation, and the patient was finally managed using a ProSealTM laryngeal mask airway with controlled ventilation. According to patient's history, trismus has also occurred after her first operation. We think that the reason for her trismus was a result of contracture of the temporalis muscle after her first pterional craniotomy.
Anesthesia, General ; Aneurysm ; Aneurysm, Ruptured ; Arteries ; Contracture ; Craniotomy* ; Female ; Headache ; Humans ; Intubation* ; Joints* ; Laryngeal Masks ; Masks ; Middle Aged ; Propofol ; Trismus ; Ventilation

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway(LMA), but the results of those studies were much different much different from one another. The aim of this study was to compare the incidence of gastroesophageal reflux and regurgitation of gastric contents between the LMA and the endotracheal tube(ETT). METHOD: Ninety patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA(n-49) or a ETT(n=41) for airway management. The esophageal manometry was carried out for the exclusion of esophageal motility disorders and the 24-hour ambulatory pH metry was done from one day before the operation. A methylene blue(50mg) capsule was swallowed just before the induction and the simultaneous recordings of pH were maintained during anesthesia. At the end of anesthesia, the episodes of regurgitation of gastric contents above hypopharynx were analyzed by the pharyngeal blue staining and the pH metric data were analyzed for the detection of gastroesophageal relux episodes during anesthesia. RESULTS: There was no significant difference in the incidence of gastroesophageal relux(pH< or =4) between two groups; only two patients in LMA and three patients in ETT had reflux episodes during the removal or arousal phase. There was no episode of the pharyngeal blue staining in both group. All of the gastroesophageal reflux patients in both group developed a cough or straining during those phases. There was no clinical evidence of aspiration of gastric contents in both group. CONCLUSION: In comparison with ETT, use of LMA does not appear to increase the incidence of gastroesophageal reflux and regurgitation above hypophryngeal level in positive pressure ventilating patients during long surgical procedures. Therefore, the risk of aspiration in LMA will not be much more than ETT.
Airway Management ; Anesthesia ; Arousal ; Cough ; Esophageal Motility Disorders ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Incidence ; Laryngeal Masks* ; Manometry ; Masks* ; Orthopedics

BACKGROUND: Antihypertensive agents such as verapamil and esmolol are well known for their effects of hemodynamic stabilization on tracheal intubation. But hemodynamic discrepancies in these agents may result from different techniques of anesthetic induction. The aim of the present study was to compare and evaluate their efficacy in controlling hemodynamic responses to tracheal intubation under the different anesthetic induction agents. METHODS: Seventy-two patients, ASA physical status I or II, were randomly assigned to one of six groups (n = 12 each): a Thiopental-Saline (T-S) group and a Propofol-Saline (P-S) group in saline 10 ml; a Thiopental-Verapamil (T-V) group and a Propofol-Verapamil (P-V) group in verapamil 0.1 mg/kg; a Thiopental-Esmolol (T-E) group and a Propofol-Esmolol (P-E) group in esmolol 1 mg/kg according to the induction agents, thiopental or propofol. Anesthesia was induced with thiopental 5 mg/kg or propofol 2 mg/kg intravenous, respectively. Next, saline, verapamil and esmolol were administered as a bolus, and were immediately followed by succinylcholine 1.5 mg/kg. Tracheal intubation was carried out 60 s and 90 s after the intravenous injections of verapamil and esmolol, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. RESULTS: There was a significant attenuation in systolic and diastolic arterial pressure after tracheal intubation in the verapamil groups compared to the esmolol groups. Heart rates were significantly lower in the esmolol groups than in the verapamil groups after tracheal intubation. CONCLUSIONS: Verapamil 0.1 mg/kg and esmolol 1 mg/kg attenuated increases in blood pressure and heart rate after tracheal intubation. The different anesthetic induction agents did not influence the hemodynamic effects of verapamil and esmolol on tracheal intubation.
Anesthesia ; Antihypertensive Agents ; Arterial Pressure ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation* ; Propofol ; Succinylcholine ; Thiopental ; Verapamil*

BACKGROUND: Antihypertensive agents such as verapamil and esmolol are well known for their effects of hemodynamic stabilization on tracheal intubation. But hemodynamic discrepancies in these agents may result from different techniques of anesthetic induction. The aim of the present study was to compare and evaluate their efficacy in controlling hemodynamic responses to tracheal intubation under the different anesthetic induction agents. METHODS: Seventy-two patients, ASA physical status I or II, were randomly assigned to one of six groups (n = 12 each): a Thiopental-Saline (T-S) group and a Propofol-Saline (P-S) group in saline 10 ml; a Thiopental-Verapamil (T-V) group and a Propofol-Verapamil (P-V) group in verapamil 0.1 mg/kg; a Thiopental-Esmolol (T-E) group and a Propofol-Esmolol (P-E) group in esmolol 1 mg/kg according to the induction agents, thiopental or propofol. Anesthesia was induced with thiopental 5 mg/kg or propofol 2 mg/kg intravenous, respectively. Next, saline, verapamil and esmolol were administered as a bolus, and were immediately followed by succinylcholine 1.5 mg/kg. Tracheal intubation was carried out 60 s and 90 s after the intravenous injections of verapamil and esmolol, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. RESULTS: There was a significant attenuation in systolic and diastolic arterial pressure after tracheal intubation in the verapamil groups compared to the esmolol groups. Heart rates were significantly lower in the esmolol groups than in the verapamil groups after tracheal intubation. CONCLUSIONS: Verapamil 0.1 mg/kg and esmolol 1 mg/kg attenuated increases in blood pressure and heart rate after tracheal intubation. The different anesthetic induction agents did not influence the hemodynamic effects of verapamil and esmolol on tracheal intubation.
Anesthesia ; Antihypertensive Agents ; Arterial Pressure ; Blood Pressure* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Injections, Intravenous ; Intubation* ; Propofol ; Succinylcholine ; Thiopental ; Verapamil*

BACKGROUND: Reactive oxygen species (ROS) induce lipid peroxidation and tissue damage in endothelium. We studied the influences of ketorolac and diclofenac on ROS effects using the endothelium of rabbit abdominal aorta. METHODS: Isolated rabbit aortic rings were suspended in an organ bath filled with Krebs-Henseleit (K-H) solution bubbled with 5% CO2 and 95% O2 at 37.5degrees C. After being stimulated to contract with phenylephrine (PE, 10(-6) M), changes in arterial tension were recorded following the cumulative administration of acetylcholine (ACh, 3 x 10(-8) to 10(-6) M). The percentages of ACh-induced relaxation of aortic rings before and after exposure to ROS, generated by electrolysis of K-H solution, were used as the control and experimental values, respectively. The aortic rings were pretreated with ketorolac or diclofenac at the same concentrations (10(-5) M to 3 x 10(-4) M), and the effects of these agents were compared with the effects of ROS scavengers: catalase, mannitol, sodium salicylate and deferoxamine and the catalase inhibitor, 3-amino-1,2,4-triazole (3AT). RESULTS: Both ketorolac and diclofenac maintained endothlium-dependent relaxation induced by ACh in a dose-related manner inspite of ROS attack (P < 0.05 vs. control value). The 3AT pretreated ketorolac (3 x 10(-3) M) group was decreased more significantly than un-pretreated ketorolac (P < 0.05). CONCLUSIONS: These findings suggest that ketorlac and diclofenac preserve the endothelium-dependent vasorelaxation against the attack of ROS, in a concentration-related manner. One of the endothelial protection mechanisms of ketorolac may be hydrogen peroxide scavenging.
Acetylcholine ; Amitrole ; Aorta, Abdominal ; Arterial Pressure ; Baths ; Catalase ; Contracts ; Deferoxamine ; Diclofenac ; Electrolysis ; Endothelium ; Hydrogen Peroxide ; Ketorolac ; Lipid Peroxidation ; Mannitol ; Phenylephrine ; Reactive Oxygen Species ; Relaxation ; Sodium Salicylate ; Vasodilation

Usnea longissima has a long history of use as a traditional medicine. Several bioactive compounds, primarily belonging to the polyketide family, have been isolated from U. longissima. However, the genes for the biosynthesis of these compounds are yet to be identified. In the present study, three different types of non-reducing polyketide synthases (UlPKS2, UlPKS4, and UlPKS6) were identified from a cultured lichen-forming fungus of U. longissima. Phylogenetic analysis of product template domains showed that UlPKS2 and UlPKS4 belong to group IV, which includes the non-reducing polyketide synthases with an methyltransferase (MeT) domain that are involved in methylorcinol-based compound synthesis; UlPKS6 was found to belong to group I, which includes the non-reducing polyketide synthases that synthesize single aromatic ring polyketides, such as orsellinic acid. Reverse transcriptase-PCR analysis demonstrated that UlPKS2 and UlPKS4 were upregulated by sucrose; UlPKS6 was downregulated by asparagine, glycine, and alanine.
Alanine ; Asparagine ; Fungi* ; Glycine ; Humans ; Medicine, Traditional ; Polyketide Synthases ; Polyketides ; Sucrose ; Usnea*

The use of antibiotics, including therapeutically in human and veterinary medicine, or as prophylaxis of growth promotion in animal husbandry, ultimately exerts selective pressure favorable for the propagation of antibiotic resistant bacteria. In this study we have determined the resistance for antibiotics of E. coli from pig farm environment, and investigate genetic relatedness by random amplification of polymorphic DNA (RAPD). Six farms were randomly selected in Gyeongsanman-do and Busan provinces for collecting samples from feces, manure and underground water. A total of 88 isolates from feces, 74 isolates from manure and 1 isolate from underground water were analyzed by antibiotic resistance and RAPD. Antibiotic resistance testing was performed by disk diffusion method using 16 antibiotics. The highest percentage of antibiotic resistance of isolates from feces and manure was found to the following antibiotics; tetracycline (100% and 100%), sulfamethoxazole/trimethoprim (60.2% and 62.2%), streptomycin (50.0% and 68.9%), chloramphenicol (56.8% and 56.8%), ampicillin (50.0% and 81.1%) and cephalothin (50.0% and 51.4%). Of isolates from feces and manure, 22.7% and 20.3% showed multiple resistance to 4 and 5 antibiotics, respectively. The isolates from GE pig farm showed six RAPD patterns. A single pattern, RAPD-C, was predominat in feces isolates (50.0%) and manual isolates (46.7%), and the rest of feces isolates showed RADP-A, B and E pattern and manure isolates showed D and E pattern. One isolate from underground water showed F pattern. The appearance of multiresistant in E. coli isolates from pig farms environment is a problem of major concern of public health and RAPD may offer an useful tool of discrimination for the epidemiological investigation.
Ampicillin ; Animal Husbandry ; Anti-Bacterial Agents ; Bacteria ; Busan ; Cephalothin ; Chloramphenicol ; Diffusion ; Discrimination (Psychology) ; DNA ; Drug Resistance, Microbial* ; Escherichia coli* ; Escherichia* ; Feces ; Groundwater ; Humans ; Manure ; Public Health ; Streptomycin ; Tetracycline ; Veterinary Medicine

Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in childhood and is primarily diagnosed in up to 4.5% of children who undergo chronic renal replacement therapy. Escherichia coli serotype O157:H7 is the predominant bacterial strain identified in patients with HUS; more than 100 types of Shiga toxin-producing enterohemorrhagic E. coli (EHEC) subtypes have also been isolated. The typical HUS manifestations are microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency. In typical HUS cases, more serious EHEC manifestations include severe hemorrhagic colitis, bowel necrosis and perforation, rectal prolapse, peritonitis, and intussusceptions. Colonic perforation, which has an incidence of 1%-2%, can be a fatal complication. In this study, we report a typical Shiga toxin-associated HUS case complicated by small intestinal perforation with refractory peritonitis that was possibly because of ischemic enteritis. Although the degree of renal damage is the main concern in HUS, extrarenal complications should also be considered in severe cases, as presented in our case.
Acute Kidney Injury ; Anemia, Hemolytic ; Child* ; Colitis ; Colon ; Enteritis ; Enterohemorrhagic Escherichia coli ; Escherichia coli ; Hemolytic-Uremic Syndrome* ; Humans ; Incidence ; Intestinal Perforation* ; Intussusception ; Necrosis ; Peritonitis ; Rectal Prolapse ; Renal Insufficiency ; Renal Replacement Therapy ; Shiga Toxin ; Thrombocytopenia

BACKGROUND: Two dimensional echocardiographic monitoring of left ventricular resional wall motion abnormalities(RWMA) with incremental injection of ergonovine up to 350microg(ErgEcho) is useful for a noninvasive diagnosis of coronary vasospasm(CVS). The prevalence that CVS may evoke unstable angina(UA). However, this theory has not been the subject of any systematic analysis to date. This prospective study was carried out on patients who had been tentatively diagnosed as having UA when they were carried out on patients who has been tentatively diagnosed as having UA when they were admitted to the coronary care unit due to chest pain. The aim was to determine the significance of CVS in the clinical spectrum of UA and the value of Erg Echo when applied to this situation. METHODS: With antianginal medications a diagnostic coronary angiography was done to rule out significant fixed athrosclerotic disease(FD), with more than 70% narrowing of luminal diameter. In patients with normal coronary angiograms of insignificant FD. Erg Echo was performed to diagnose CVS after the discontinuation of all antianginal medications. All patients with postinfarction or secondary angina were excluded in this study. RESULTS: Of 191 patients(135 males, 57+/-9 yrs) enrolled from Mar 1992 to June 1993,71%(135/191) showed significant FD in the angiography. CVS was documented in 18%(34/191) using Erg Echo with mean injected ergonovine dosage of 125+/-89microg. In patients with CVS only 24%(8/34) had mild fixed lesion in the angiography with mean luminal narrowing of 60%(+/-12%). RWMA in the territory of left anterior descending artery was the most common(70%, 24/34). Other causes of chest were esophageal spasm in 3 patient(1%, 3/191) and hypertrophic cardiomyopathy in 2 patients, and 17 patients were diagnosed as having chest pain of unkwnon etiology. One of them redeveloped chest pain 2 months later. when repeated Erg Echo revealed RWMA. Others were symptom free during the follow-up(8+/-4 months) and there were no cardiac events. CONCLUSION: Our data suggest that in patients presenting UA in Korea, CVA is the main cause of myocardial ischemia in considerable number of patient, and Erg Echo after the angiography is useful and safe for noninvasive diagnosis of CVS in this situation.
Angina, Unstable* ; Angiography ; Arteries ; Cardiomyopathy, Hypertrophic ; Chest Pain ; Coronary Angiography ; Coronary Care Units ; Coronary Vasospasm ; Diagnosis ; Echocardiography* ; Ergonovine* ; Esophageal Spasm, Diffuse ; Humans ; Korea ; Male ; Myocardial Ischemia ; Phenobarbital ; Prevalence ; Prospective Studies ; Thorax