Many patients,especially in certain high risk groups, undergo operative procedures under regional anesthesia in belief that this approach is safer than general anesthesia. During the regional anesthesia, sedation is often provided with intravenous agents, such as diazepam even if diazepam has some dipressant effects on respiration and hemodynamics. To evaluate the effects of diazepam on spinal anesthesia, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), arterial oxygen saturation (SaO2) and mean arterial pressure (MAP) were measured at 1,3,5.10,15,20and 30min. following diazepam iv (0.2 mg/kg) under spinal anesthesia (group 2), and were compared with the changes in the control group (group 1), who received spinal anesthesia without diazepam administration. The results were as follows: 1) MAP revealed no significant decrease in the control group, and decreased significantly in the group 2 from 3 to 30 min. after diazepam iv under spinal anesthesia. 2) PaO2 did not change significantly in the control group, but PaO2 in group 2 decreased significantly at 1 and 10 min. after intravenous administration of diazepam. And the changes from 3 to 20 min. after intravenous administration of diazepom were significantly different from changes in the group 3) PaO2 increased significantly in grorp 2 from 3 min. after diazepam iv which were significantly different from the changes in the control group. 4) SaO2 decreased significantly in group 2 from 1 to 30 min. after diazepam iv which were significantly different from the changes in the control group. From the above results, diazepam administration under spinal anesthesia affects the respiratory function and hemodynamics, so oxygen inhalation technique may be needed in most cases of sedatives administration after spinal anesthesia.
Administration, Intravenous ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Arterial Pressure* ; Carbon Dioxide ; Diazepam* ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Inhalation ; Oxygen ; Respiration ; Surgical Procedures, Operative

Controlled hypotension induced with sodium nitroprusside (SNP) has been most widely used to facilitate the surgical procedure and to reduce blood loss. However, major problem with its clinical use is cyanide toxicity, which is dose related. And resitance and tachyphylaxis, probably being mediated by sympathoadrenal response to lowered blood pressure, is known to increase dose requirements. Accordingly, several attempts have been made to attenuate sympathetic activity and therefore to reduce dose requirement of SNP. Verapamil, a representative calcium channel blocker, exerts inotropic and chronotropic effect, as well as vasodilation. And it is, also, known to impair pulmonary gas exchange. The purpose of these experiments was to evaluate hemodynamic and gas exchange effects of verapamil, and also its efficacy for reducing the amount of SNP during induced hypotension in patients anesthetized with isoflurane and N2O. Twenty five patients, scheduled to undergo general anesthesia with hypotension, were randomly assigned to two groups. Twelve patients were pretreated with verapamil (160mg, SOD: verapamil group) and the other thirteen were not (control group). The results were as follows: 1) Cardiac index remained unchanged in both groups and did not differ significantly between groups at all times. 2) Heart rate was significatly lower in verapamil group than in control group in the hypotensive period. (113+/- 3.3 vs 103+/- 2.7, p < 0.05) 3) Hypotension induced by SNP resulted from a marked decrease in systemic vascular resistance in both groups. 4) MPAP, PCWP, CVP, SVR and PVR significantly decreased after SNP infusion in both groups, but they did not differ significantly between the groups at all times. 5) SNP dose requirements to attain the same MAP reduction did not differ significantly between groups. (5.5+/-0.8vs 4.1+/-0.8mcg/kg/min, NS) 6) Verapamil pretreatment produced no significant change in intrapulmonary shunt fraction at all times. 7) SNP caused a signficant decrease in arterial oxygen tension in both group, but there were no significant difference between groups at all times. From the above results, it might be concluded 1) that verapamil, in clinical doses, does not blunt a reflex increase in sympathetic activity in response to SNP induced vasodilation, since it produced only a minor influence on SNP induced hemodynamics and the SNP dose requirements, and that verapamil does not inhibit hypoxic pulmonary vasoconstriction during isoflurane-N2O anesthesia. Thus, verapamil could not be a valuable adjunct of SNP in enhancing the hypotensive effect in spite of preserved arterial oxygenation.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Calcium Channels ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension* ; Hypotension, Controlled ; Isoflurane ; Nitroprusside* ; Oxygen ; Pulmonary Gas Exchange* ; Reflex ; Sodium* ; Tachyphylaxis ; Vascular Resistance ; Vasoconstriction ; Vasodilation ; Verapamil*

BACKGROUND: To investigate the upper airway changes in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients, we measured cross-sectional areas of the upper airway [retropalatine (RP) and restoglossal (RG) regions] and volumes of upper airway structures on upper airway MRI in OSAHS patients and normal controls. METHODS: The Apnea/Hypopnea index (AHI) of OSAHS patients was calculated by overnight polysomnography whereas apnea-hypopnea screening for normal controls was performed by a portable screening device. Upper airway MR images were obtained in normal subjects and OSAHS patients using a 1.5-T MRI scanner. The following parameters were measured on MRI using Analyze 6.0 software: (1) mean area, minimal area, vertical and horizontal lengths of the minimal area in RP and RG region; (2) volumes of RP and RG airway, soft palate, lateral pharyngeal wall, lateral pharyngeal fat pad and tongue. RESULTS: Nineteen OSAHS patients and 14 normal controls were included. Body mass index (BMI) and AHI were significantly higher in OSAS (BMI 27.7+/-2.5, AHI 56.8+/-22.3) than normal controls (BMI 23.0+/-1.9, AHI 3.5+/-2.1). OSAHS group had significantly smaller mean RP and RG area, smallest area in RP and RG regions and horizontal length of smallest area in RP and RG regions. The volumes of soft palate and lateral pharyngeal wall were larger in the OSAHS group. CONCLUSIONS: Korean OSAHS patients had smaller mean RP and RG area, minimal RP and RG area and horizontal length in minimal RP and RG region and larger volume of soft palate and lateral pharyngeal wall than normal controls.
Adipose Tissue ; Body Mass Index ; Humans ; Magnetic Resonance Imaging* ; Mass Screening ; Palate, Soft ; Polysomnography ; Sleep Apnea, Obstructive ; Tongue

This study was performed to determine if women with day 3 serum inhibin-B concentrations <45pg/ml (conversion factor to SI unit, 1.00) demonstrate a pro. response to ovulation induction and assisted reproductive technology outcome to women with inhibin-B > or = 45pg/ml, independant of day 3 FSH, E2 and patient age. From Jan 1996 to Dec 1996, 16 volunteers patients who underwent 25 IVF cycles with luteal phase GnRH agonist suppression and HMG stimulation were allocated to the study group. We evaluated day 3 serum inhibits-B, FSH, E2, peak E2, cancellation rate per initiated cycle (%) and clinical pregnancy rate per initiated cycle (%) according to the above two groups and independent of patient age, day 3 FSH, day 3 E2 and all of above combined. Women with day 3 serum inhibin-B > or =45pg/m1 demonstrated higher average day 3 inhibits-B level, clinical pregnancy rate per initiated cycle (20.3+/-2.5 pg/ml vs 80.9+/- 5.0pg/ml, p<0.05; 24.8% vs 8.5%, p<0.05) and lower day 3 FSH level, cancellation rate per initiated cycle (6.9+/-0.3 mIU/ml vs 8.5+/-0.5 mIU/ml, p<0.05; 1.5% vs 9.0%, p<0.05). Women with day 3 serum inhibin> or =45pg/ml and age<40 year demonstrated higher pregnancy rate per initiated cycle (28.2% vs 7.4%, p<0.05) and lows. day 3 FSH level, cancellation rate per initiated cycle (6.9+/-0.5 mIU/ml vs 8.2+/-0.7 mIU/ml, p<0.05; 1.0% vs 9.0%, p<0.05). Women with day 3 serum inhibin> or =45pg/ml and day 3 FSH<15mIU/inl demonstrated higher pregnancy rate per initiated cycle (33.5% vs 9.5%, p<0.05) and lower day 3 FSH level, cancellation rate per initiated cycle (7.7+/- 0.2 mIU/ml vs 8.5+/-0.5 mIU/ml, p<0.05; 1.5% vs 10.0%, p<0.05). Women with day 3 serum inhibin> or =45pg/ml and day 3 E2<50pq/ml demonstrated higher pregnancy rate per initiated cycle (30.0% vs 9.5%, p<0.05) and lower cancellation rate per initiated cycle (1.5% vs 9.5%, p<0.05). Women with day 3 serum inhibin> or =45pg/ml, age<40 year, day 3 FSH<15mIU/ml and day 3 E2<50pg/m1 demonstrated higher pregnancy rate per initiated cycle (30.0% vs 10.8%, p<0.05) and lower day 3 FSH level, cancellation rate per initiated cycle (6.8+/-0.6 mIU/ml vs 8.4+/-0.9 mIU/ml, p<0.05; 1.5% vs 7.8%, p<0.05). Therefore women with low day 3 serum inhibits-B concentrations demonstrate a poorer response to ovulation induction and are less likely to conceive a clinical pregnancy though ART relative to women with high day 3 inhibits-B and day 3 serum inhibin-B, in addition to a day 3 FSH, E2 and patient age, appears helpful in prediction in IVF-ET outcome.
Female ; Gonadotropin-Releasing Hormone ; Humans ; International System of Units ; Luteal Phase ; Ovulation Induction ; Pregnancy ; Pregnancy Rate ; Reproductive Techniques, Assisted* ; Volunteers

Purpose: This study aimed to investigate the potential role of copine-1 (CPNE1), a calcium-dependent membrane-binding protein encoded by the CPNE1 gene, in colorectal cancer (CRC). Despite previous research on the involvement of copine family members in various solid tumors, the specific role of CPNE1 in CRC remains poorly understood. Methods: We conducted clinicopathological analysis and functional studies to explore the impact of CPNE1 in human CRC.We examined the expression levels of CPNE1 in CRC patients and correlated it with invasive depth, lymph node metastasis, distant metastasis, lymphatic invasion, and TNM stage. Additionally, we performed experiments to assess the functional consequences of CPNE1 knockdown in CRC cells, including proliferation, colony formation, migration, invasion, and the expression of key regulators involved in the cell cycle and epithelial-mesenchymal transition (EMT). Furthermore, we evaluated the effects of CPNE1 knockdown on tumor growth using a xenograft mouse model. Results: High expression of CPNE1 was significantly associated with advanced tumor features in CRC patients. CPNE1 knockdown in CRC cells led to impaired abilities in proliferation, colony formation, migration, and invasion. Furthermore, CPNE1 silencing resulted in the suppression of protein expression related to the cell cycle and EMT. In the xenograft mouse model, CPNE1 knockdown inhibited tumor growth. Conclusion CPNE1 plays a crucial role in promoting tumorigenesis and metastasis in human CRC. By regulating the cell cycle and EMT, CPNE1 influences critical cellular processes at the membrane-cytoplasm interface. These results provide valuable insights into the potential development of novel therapeutic strategies for CRC targeting CPNE1.