OBJECTIVE: In order to confirm the local production of total and specific IgE antibodies in the nasal polyp tissues. MATERIAL AND METHOD: We measured total IgE and house dust mite(Dermatophagoides pteronpssinus .' DP)-specific IgE antibody using enzyme-linked immunosorbent assay(ELISA) in the supernatant of nasal polyp homogenates from 72 subjects undergoing nasal polypectomy. The subjects were divided into three groups according to skin reactivity to DP: 20 strongly atopic subjects to group I(mean wheal diameter) 3mm), 19 weakly atopic subjects to group II (mean wheal diameter 1-3mm) and 33 negative skin responders to group III. RESULT: Group I showed significantly higher levels of total and DP-specific IgE levels in the nasa
Antibodies ; Dust* ; Immunoglobulin E* ; Nasal Polyps* ; Pyroglyphidae* ; Skin ; United States National Aeronautics and Space Administration

BACKGROUND: Intrathecal morphine provides good pain relief after anorectal surgery, but often associated with unpleasant side effects. Ondansetron, a selective 5-hydroxytryptamine3 (5-HT3) receptor antagonist, have been introduced for the prevention and treatment of emesis after chemotherapy in cancer patients and after general anesthesia. METHODS: Thus we studied the effect of ondansetron on the postoperative analgesic and side effects of spinal morphine in 60 patiens. The patients were given subarachnoid injection of 0.5% tetracaine 5 mg mixed with morphine 0.3 mg and positioned to jack-knife after fixation of anesthetic level. Either simple 5% dextrose solution 1000 ml or dextrose solution 1000 ml mixed with ondansetron 8 mg was injected intravenously in a rate of 100 ml/hr. The visual analog scale (VAS) of pain and incidence and severity of postoperative nausea, vomiting, pruritus and urinary retention were evaluated at 12 hour, 24 hour and 48 hour after injection of spinal morphine. RESULTS: The number of patients who became nauseated or vomited did not differ significantly between groups. Also, the VAS and the incidence and severity of other side effects such as pruritus and urinary retention did not differ significantly between groups. CONCLUSION: Ondansetron administered intravenously, did not prevent side effects of intrathecal morphine.
Analgesics ; Anesthesia, General ; Drug Therapy ; Glucose ; Humans ; Incidence ; Morphine* ; Ondansetron* ; Postoperative Nausea and Vomiting ; Pruritus ; Serotonin ; Tetracaine ; Urinary Retention ; Visual Analog Scale ; Vomiting

Aprotinin is a serine protease inhibitor that improves the hemostatic function and modulates the anti-inflammatory responses. Recently, aprotinin has been widely used in various surgical procedures including open heart surgery. One of the complications of aprotinin is anaphylactic reaction and the incidence increases with re-exposure. We experienced a case of anaphylactic reaction in a 5-year-old female during open heart surgery. After cardiopulmonary bypass weaning, during aprotinin i.v. infusion for reducing blood loss, sudden hypotension and bradycardia occurred. After re-institution of CPB, the patient recovered. In the post-operative review of the chart and patient, we found that this patient had been exposed to aprotinin 20 days ago. In conclusion, we recommend some preventable methods for anaphylaxis of aprotinin; aprotinin should be used after a skin test or i.v. infusion test and used by mixing with CPB priming solution.
Anaphylaxis ; Aprotinin* ; Bradycardia ; Cardiopulmonary Bypass ; Child, Preschool ; Female ; Heart* ; Humans ; Hypotension ; Incidence ; Serine Proteases ; Skin Tests ; Thoracic Surgery* ; Weaning

No abstract available.
Blood Pressure*

There have been numerous reports of complications associated with central venous catheterization. These are pneumothorax, hemothorax, nerve injury, and so on. These complications can occur more frequently with the subclavian approach than with the internal jugular approach in inexperienced hands. We report a rare complication, cardiac tamponade, which occurred during subclavian venous catheterization. A 44 year-old woman was scheduled for left pneumonectomy due to a tuberculosis destroyed lung. The first trial of subclavian venous catheterization was failed because of the arterial puncture. The internal jugular vein was cannulated successfully. Just after catheterization, sudden hypotension and tachycardia developed and persisted with vasopressors. An emergent left thoracotomy and pericardiostomy to evacuate massive hematoma confirmed the diagnosis, cardiac tamponade. This case suggests that central catheterization should be done carefully and it is better to avoid using the subclavian vein when there is radiological evidence of abnormal cardiac anatomy or great vessels due to a destroyed lung.
Adult ; Cardiac Tamponade* ; Catheterization* ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Diagnosis ; Female ; Hand ; Hematoma ; Hemothorax ; Humans ; Hypotension ; Jugular Veins ; Lung ; Pericardial Window Techniques ; Pneumonectomy ; Pneumothorax ; Punctures ; Subclavian Vein ; Tachycardia ; Thoracotomy ; Tuberculosis

Pulmonary hypertension is a serious complication of a number of lung and heart diseases that is characterized by peripheral vascular structural remodeling and loss of vascular tone. Nitric oxide can modulate vascular injury and interrupt elevation of pulmonary vascular resistance selectively; however, it can also produce cytotoxic oxygen radicals and exert cytotoxic and antiplatelet effects. The balance between the protective and adverse effects of nitric oxide is determined by the relative amount of nitric oxide and reactive radicals. Nitric oxide has been shown to be clinically effective in the treatment of congenital heart disease, mitrial valvular disease combined with pulmonary hypertension and in orthotropic cardiac transplantation patients. Additionally, new therapeutic modalities for the treatment of pulmonary hypertension, phosphodiesterase inhibitors, natriuretic peptides and aqueous nitric oxide are also effective for treatment of elevated pulmonary vascular resistance.
Heart Diseases ; Heart Transplantation ; Humans ; Hypertension, Pulmonary ; Lung ; Natriuretic Peptides ; Nitric Oxide ; Phosphodiesterase Inhibitors ; Reactive Oxygen Species ; Vascular Resistance ; Vascular System Injuries

No abstract available.

BACKGROUND: Distribution of local anesthetics injected into subarachnoid space is determined by many intrinsic & extrinsic factors. The purpose of this study was to compare the spread of spinal anesthetic agent according to the direction of bevel and addition of epinephrine. METHOD: Eighty nine consenting patients, undergoing orthopedic surgery of lower extremities were divided into eight groups to direction of bevel and addition of epinephrine in each direction. In lateral decubitus position, 25-gauge spinal needle was introduced into the subarachnoid space and 1% tetracaine with the same volume of 10% dextrose was injected through the spinal needle. Patients were turned to the supine position and checked sensory block level by pin-prick test at anterior axillary line every 5 minutes. Degree of motor block was measured by Bromage scale and two-segment regression time was measured by pin-prick test every 15 minutes interval after maximal sensory block level was reached. RESULTS: No significant difference in maximum level of sensory block was found among groups. But two segment regression time was significantly prolonged in epinephrine added cephalad and down groups. CONCLUSION: Direction of bevel did not affect maximum level of sensory block and duration of spinal anesthesia but, epinephrine prolonged the duration of local anesthetics in special directions.
Anesthesia, Spinal* ; Anesthetics ; Anesthetics, Local ; Epinephrine* ; Glucose ; Humans ; Lower Extremity ; Needles* ; Orthopedics ; Subarachnoid Space ; Supine Position ; Sympathetic Nervous System ; Tetracaine

BACKGROUND: Central nervous system dysfunction continues to be a major cause of morbidity after aorta and cardiac surgery under cardiopulmonary bypass (CPB). Pupillary reflexes are important component of the neurologic examination. The purpose of this study was to evaluate how the pupil reacts during hypothermic CPB under fentanyl anesthesia and its relation with postoperative neurologic deficits. METHODS: Fourteen patients undergoing ascending aortic dissection or aneurysm repair surgery under profound hypothermic CPB and circulatory arrest were enrolled. Pupil size and light reflex were evaluated at varying stages of CPB and temperatures. Temperatures were measured at different sites of perfusate, nasopharynx and rectum. Postoperatively neurologic assessments were performed to compare with the pupillary signs. RESULTS: Anesthetic induction with fentanyl decreased pupil size to pinpoint. Pupil dilated progressively under hypothermic CPB reaching fully dilated size at profound hypothermia. Rewarming returned the pupil to original size. Nasopharyngeal temperature correlated well with pupil size during cooling and rewarming. Light reflex was absent at any stage or temperature after anesthetic induction. Seven patients showed insignificant anisocoria and two died of other causes than neurologic deficit. One patient who was not in the anisocoria group exhibited delirium. CONCLUSIONS: Profound hypothermic CPB under fentanyl anesthesia dilates the pupil to a maximum size without light reflex overwhelming narcotic effect. Fully dilated pupil does not denote neurologic damage.
Anesthesia* ; Aneurysm ; Anisocoria ; Aorta ; Cardiopulmonary Bypass* ; Central Nervous System ; Delirium ; Fentanyl* ; Humans ; Hypothermia ; Narcotics ; Nasopharynx ; Neurologic Examination ; Neurologic Manifestations ; Pupil* ; Rectum ; Reflex ; Reflex, Pupillary ; Rewarming ; Thoracic Surgery

BACKGROUND: Nitrous oxide concentration is easily controlled by respiratory ventilation. It suppresses bone marrow via the inhibition of thymidylate synthesis. The aim of this work was to determine the optimal pressure and exposure duration of nitrous oxide, as well as methotrexate concentration that maximizes the suppression of 4 cancer cells: CCRF-CEM, K562, A549 and MDA-MB-231. METHODS: Each cancer cell was cultured in a hyperbaric chamber at 1, 2 and 3 atmosphere of 74% nitrous oxide for 24, 48, and 72 hours at 0, 0.3, 0.7, 1, 2, 5 and 10 microM methotrexate (MTX), respectively. The results were expressed in the ratio of the number of cancer cells cultured under specific conditions (S cells) to that under normal conditions (N cells). RESULTS: The S/N ratio of CCRF-CEM cells was 87.4% in 24-hour culture, 95.0% in 48-hour culture and 115.9% in 72-hour culture (P < 0.05). The S/N ratio of K562 cells was 103.6% at 1 atm, 102.4% at 2 atm and 115.6% at 3 atm (P < 0.05). The S/N ratio of A549 cells was 94.3% at 1 atm, 94.1% at 2 atm, 99.3% at 3 atm, 96.2% in 24-hour culture, 99.2% in 48-hour culture and 99.3% in 72-hour culture (P > 0.05). However, the S/N ratio of MDA-MB 231 cells was 66.9% in 24-hour culture, 83.1% in 48 hour culture and 87.8% in 72-hour culture (P < 0.05). CONCLUSIONS: Only the growth of the MDA-MB-231 cells was significantly reduced after a longer exposure time to nitrous oxide, but those of the other cells were not.
Atmosphere ; Bone Marrow ; K562 Cells ; Methotrexate ; Nitrous Oxide ; Ventilation