BACKGROUND: It is generally accepted that propofol does not inhibit hypoxic pulmonary vasoconstriction (HPV). However, because the previous studies for the effects of propofol on HPV were established in vivo, the effects of physiologic variables could not be ruled out. Therefore, we investigated the effects of various concentrations of propofol on HPV at isolated rat lungs and the relationship of these effects of propofol on HPV and endothelium-derived relaxing factor (EDRF) and an ATP-dependent K+ channel which were candidates as the mechanism of HPV. METHODS: In 30 isolated rat lungs, after three hypoxic challenges for 5 minutes, we administered saline in the control group, N(G)-nitro-L-arginine methyl ester (L-NAME) in the L group and glibenclamide in the G group followed by three hypoxic challenges for 5 minutes. In addition, we studied the effects of various concentrations of propofol on HPV in the three groups. RESULTS: L-NAME and glibenclamide did not alter baseline pulmonary arterial pressure but L-NAME significantly enhanced HPV. Clinical concentrations of propofol did not affect HPV and high concentrations of propofol inhibited HPV. The pretreatment of L-NAME and glibenclamide did not alter the inhibition of HPV even at high concentrations of propofol. CONCLUSIONS: The EDRF and ATP-dependent K+ channel did not largely contribute to baseline pulmonary arterial tone but EDRF might be released and downregulate HPV. Clinical concentrations of propofol did not inhibit HPV but high concentrations of propofol inhibited HPV. In addition, the mechanism of inhibition of HPV at high concentrations of propofol did not relate to the EDRF pathway and ATP-dependent K+ channel.
Animals ; Arterial Pressure ; Endothelium-Dependent Relaxing Factors ; Glyburide* ; Lung* ; NG-Nitroarginine Methyl Ester* ; Propofol* ; Rats* ; Vasoconstriction*

Severe bronchospasm at the termination of the cardiopulmonary bypass period is an unusual but dangerous complication of open-heart surgery. We report a case of severe unilateral bronchospasm detected at the end of the bypass period on the basis of high airway pressures with remarkable difficulties to deflate the right lung and it was relieved with bronchodilator therapy by intrapulmonary percussive ventilation. Fiberoptic bronchoscopic examination revealed unobstructed, free tracheobnncheal airway and capnographic finding was obstructive pattern. As in the previously published cases, the exact cause of bronchospasm remains unknown in our patient as well, but the possible causes of the bronchospasm are described.
Bronchial Spasm* ; Cardiopulmonary Bypass* ; Humans ; Lung ; Ventilation

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.
Aged* ; Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Meperidine ; Morphine ; Passive Cutaneous Anaphylaxis

BACKGROUND: Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. METHODS: Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. RESULTS: Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analogue scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. CONCLUSION: The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function.
Aged* ; Analgesia ; Analgesia, Patient-Controlled* ; Fentanyl ; Humans ; Meperidine ; Morphine ; Passive Cutaneous Anaphylaxis

OBJECTIVE: The purposes of this study were to obtain the reference values of latency and amplitude of the medial plantar sensory nerve action potential(SNAP) in normal controls and to evaluate the diagnostic sensitivity of medial plantar sensory nerve conduction study(NCS) in diabetic neuropathy. METHOD: Thirty healthy controls(mean age, 48.7 years; range, 38~59 years) and 33 diabetic patients(mean age, 50.8 years; range, 37~64 years) were included in this study. The inclusion criteria for diabetic patients were subjects with the normal peroneal and tibial compound muscle action potentials, obtainable sural SNAPs and intact pressure-perception to Semmes-Weinstein monofilament 5.07. RESULTS: The medial plantar sensory nerve action potentials were obtainable in all control subjects and the reference values of onset latency and peak to peak amplitude were 4.29+/-0.49 msec and 3.1+/-1.34 V, respectively. All 33 diabetic patients showed the normal latency and 3 of them showed the low amplitude in sural SNAPs. The medial plantar SNAPs were obtainable in 24 diabetic patients. Among 9 patients with unobtainable medial plantar SNAPs, 6 showed the normal sural SNAPs and 3 showed the low sural SNAPs. The sensitivities of medial plantar SNAPs to sural nerve and sural SNAPs to medial plantar sensory nerve were 100%(3/3) and 27.3%(3/11) respectively. CONCLUSION: We concluded that medial plantar sensory NCS was more valuable in the early diagnosis of diabetic neuropathy than the sural NCS and Semmes-Weinstein monofilament (North Coast Medical Inc, USA).
Action Potentials ; Diabetic Neuropathies ; Early Diagnosis ; Humans ; Neural Conduction* ; Reference Values ; Sural Nerve ; Tibial Nerve

BACKGROUND: It has recently been shown that esmolol provided consistent and reliable protection against increase in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation. This study was therefore designed to establish whether esmolol was as effective in controlling the responses to awake fiberoptic tracheal intubation as it was in controlling the responses to traditional intubation and to assess the effect of esmolol for conditions of intubation, sedation, respiratory system during fiberoptic laryngoscopy and intubation. METHODS: Thirty patients, ASA physical status I-II, scheduled for oral and maxillofacial surgery, were randomly assigned to receive preintubation dose of either fentanyl 100 microgram(Group F) or fentanyl 50 microgram and esmolol 100 mg(Group E). And during awake fiberoptic nasotracheal intubation, heart rate, systolic and diastolic arterial pressures, minimal peripheral oxygen saturation, sedation score, intubation condition and time were recorded. RESULTS: There were no significant differences in arterial blood pressures, sedation score, intubation condition and time. But the change of heart rate in Group E was significantly less at 1 minite and 2 minites after the start of tracheal intubation and in Group F, minimal peripheral oxygen saturation was significantly reduced and two patients in Group F were hypoxemic and apneic. CONCLUSIONS: The present results show that esmolol provides attenuation of the change of heart rate by awake fiberoptic nasotracheal intubation and minimize the risk of apnea and hypoxia due to combination of fentanyl with midazolam.
Anoxia ; Apnea ; Arterial Pressure ; Blood Pressure ; Fentanyl ; Heart Rate ; Humans ; Intubation* ; Laryngoscopy ; Midazolam ; Oxygen ; Respiratory System ; Surgery, Oral

Undifferentiated pleomorphic sarcoma (UPS) is a rare soft tissue sarcoma of the sinonasal area. Here, we present two primary cases of UPS and three post-irradiation sinonasal UPS cases. Imaging findings were misinterpreted by radiologists as representing other malignant tumors or recurrence of the primary tumor. Our cases indicate that post-irradiation UPS can originate within any part of the radiation field. Treatment outcomes of primary sinonasal UPS seem to be favorable if the tumor is treated aggressively, but the outcomes of post-irradiation sinonasal UPS may be poor if appropriate surgical margins cannot be obtained.
Humans ; Nasal Cavity ; Recurrence ; Sarcoma*

Pneumolabyrinth describes a condition with entrapped air in the labyrinth and usually occurs in temporal bone fractures that involve the otic capsule. While sporadic cases of bilateral pneumolabyrinth have been reported, cases lacking head trauma are very rare. We report the case of a 43-year-old man who had sudden hearing loss bilaterally after blowing his nose at an interval of 1 year. Although conservative management for the right ear and exploratory tympanotomy with sealing of the possible site of perilymphatic leakage in the left ear were performed, hearing outcome was poor in both ears. To our knowledge, this is the first case of bilateral pneumolabyrinth occurring as a result of nose blowing.
Adult ; Craniocerebral Trauma ; Ear ; Ear, Inner ; Hearing ; Hearing Loss ; Hearing Loss, Sudden ; Humans ; Nose* ; Temporal Bone ; Valsalva Maneuver

Most genes are processed by alternative splicing for gene expression, resulting in the complexity of the transcriptome in eukaryotes. It allows a limited number of genes to encode various proteins with intricate functions. Alternative splicing is regulated by genetic mutations in cis-regulatory factors and epigenetic events. Furthermore, splicing events occur differently according to cell type, developmental stage, and various diseases, including cancer. Genome instability and flexible proteomes by alternative splicing could affect cancer cells to grow and survive, leading to metastasis. Cancer cells that are transformed by aberrant and uncontrolled mechanisms could produce alternative splicing to maintain and spread them continuously. Splicing variants in various cancers represent crucial roles for tumorigenesis. Taken together, the identification of alternative spliced variants as biomarkers to distinguish between normal and cancer cells could cast light on tumorigenesis.
Alternative Splicing ; Cell Transformation, Neoplastic ; Epigenomics ; Eukaryota ; Gene Expression ; Genomic Instability ; Light ; Neoplasm Metastasis ; Proteins ; Proteome ; Transcriptome ; Biomarkers

Most genes are processed by alternative splicing for gene expression, resulting in the complexity of the transcriptome in eukaryotes. It allows a limited number of genes to encode various proteins with intricate functions. Alternative splicing is regulated by genetic mutations in cis-regulatory factors and epigenetic events. Furthermore, splicing events occur differently according to cell type, developmental stage, and various diseases, including cancer. Genome instability and flexible proteomes by alternative splicing could affect cancer cells to grow and survive, leading to metastasis. Cancer cells that are transformed by aberrant and uncontrolled mechanisms could produce alternative splicing to maintain and spread them continuously. Splicing variants in various cancers represent crucial roles for tumorigenesis. Taken together, the identification of alternative spliced variants as biomarkers to distinguish between normal and cancer cells could cast light on tumorigenesis.
Alternative Splicing ; Cell Transformation, Neoplastic ; Epigenomics ; Eukaryota ; Gene Expression ; Genomic Instability ; Light ; Neoplasm Metastasis ; Proteins ; Proteome ; Transcriptome ; Biomarkers