Anesthesia and operation may impair the immune system so that bacterial growth and tumor cells spread can occur more rapidly and host response to transplanted tissue may be altered. In order to evaluate the influence of inhalation anesthetics on immune function, mitogen induced lymphocyte transformation and colony formation of T lymphoctye of peripheral blood in rats were studied. The experimental animals were divided into 4 groups according to inhaled anesthetics such as control, 0.8% halothane, 1.65% enflurane and 1.05% isoflurane 6 hours inhaled group. One day after inhalation of anesthetics, 5 ml of blood was sampled from inferior vena cava and the lymphocytes were isolated and cultured. Spontaneous and phytohemagglutinin (PHA) or pokeweed mitogen (PWM) induced lymphocte transformation were measured by the titration of H-thymidine uptake and the number of colony forming unit-T lymphocyte (CFU-TL) were counted. The results were as follows: Spontaneous lymphocyte transformation was increased by halothane and decreased by enflurane significantly but not differed by isoflurane compared with the control group. Lymphocyte transformation were decreased significantly before and after PHA stimulation in all of the anesthetic groups respectively compared with the control group. 3) Lymphocyte transformation by PWM stimulation also decreased in all of the anesthetic groups. 4) The numbers of CFU-TL cluster and colony decreased in all of the anesthetic groups compared with the control group. In conclusion, inhalation anesthetics such as halothane, enflurane and isoflurane decreased immune competence and that halothane was the most, isoflurane was the least immunosuppressive among these three inhalation anesthetics.
Anesthesia ; Anesthetics ; Anesthetics, Inhalation* ; Animals ; Enflurane ; Halothane ; Immune System ; Inhalation* ; Isoflurane ; Lymphocyte Activation* ; Lymphocytes* ; Mental Competency ; Phytolacca americana ; Rats ; Vena Cava, Inferior

To determine how closely end- tidal PCO2 measured by capnometer(Datex, Finland), a kind of infrared gas analyzer, reflects arterial PCO2(measured by Corning 175: U.S.A.) during general anesthegia, peak- tidal PCO2 and arterial were measured simultaneously. Thirty patients ranging between the age of 18 and 49, having no apparent abnomalities and having physical status class I by American Society of Anesthesiologist's classification-were seleted for the study. The anesthesia was induced with 2.5% pentothal sodium 4~5 mg/kg, succinylcholine 1mg/kg and incubated. The anesthesia was maintained with each 2 L/min gas flow of nitrous oxide, oxygenand 1 halothne. The patients were ventilated br anesthetic ventilator with tidal volume 8~10 ml/kg and ramie of 15 Per minute. The measurement of CO2 gas tension was performed 20 minutes after the induction when the patient's anesthetic conditions were stabilized. The CO2 gas ganlples were taken from mouth piece inserted between endotracheal adapter and circle breathing circuit, The arterial blood tramples were taken from the radial artery. There was a significant correlation between the end-tidol PCO2 and the arterial PCO2 in this series. The mean arterial PCO2 was 37.57+/-4.59 mmHg and the mean end tidal PCO2 was 23.73+/-5.78 mmHg. The mean difference between the arterial and the end tidal PCO2 was 6.53+/-2.23 mmHg. The correlation index between the two measurement was 0.8. In conclusion, the measurement of the end-tidal PCO2 by Datex Capnometer reflected the blood PCO2 and is convenient method of clinical use for its non invasiveness and continuous measurement of ventilatory status of patients under general anesthesia.
Anesthesia ; Anesthesia, General* ; Boehmeria ; Carbon Dioxide* ; Carbon* ; Humans ; Mouth ; Nitrous Oxide ; Radial Artery ; Respiration ; Sodium ; Succinylcholine ; Thiopental ; Tidal Volume ; Ventilators, Mechanical ; Zea mays

STUDY DESIGN: This is a retrospective study. OBJECTIVES: To verify the efficacy of the separate curve derotation technique by segmental pedicle screw fixation in King type V adolescent idiopathic scoliosis(AIS). SUMMARY OF BACKGROUND DATA: King type V AIS is commonly treated by fusion of both the upper and the lower thoracic curve. However, both curves fusion often leads to undesirable shoulder asymmetry by relative overcorrection of the more flexible lower thoracic curve. METHODS: Fourteen patients subjected to both curve fusion with segmental pedicle screw fixation by separate curve derotation were analyzed after a minimum follow-up of 2 years. The group comprised 11 females and 3 males with a mean age of 15.9 years. All patients had upper left thoracic and lower right thoracic curve pattern. The upper thoracic curve was 46.2+/-10.3degrees with a flexibility of 39.6%. The lower thoracic curve was 54.3+/-14.5degrees with a flexibility of 59.1%. Preoperatively, shoulder was level in 4, left elevated in 8 and right elevated in 2 patients. RESULTS: At the final follow up, the upper thoracic curve was corrected to 21.5+/-8.7degrees showing a correction of 52.8%. The lower thoracic curve was corrected to 20.0+/-10.6degrees showing a correction of 63.5%. All the patients had improvement of shoulder height difference and trunk balance clinically and radiologically. CONCLUSIONS: Segmental pedicle screw fixation and separate derogation is an effective method of restoring shoulder symmetry and maintainig trunk balance in King type V AIS.
Adolescent* ; Female ; Follow-Up Studies ; Humans ; Male ; Pliability ; Retrospective Studies ; Shoulder

The degree of hematopoietic depression and spontaneous recovery of depressed cells with 50% nitrous oxide inhalation for 6 or 12 hours were studied in 120 Sprague-Dawley rats. Immediately after, 1 day, 3 days and 1 week after nitrous oxide inhalation, precursor cells of granulocyte-monocyte and T lymphocyte in bone marrow and blood were sampled and cultured. After one week of culture period, the numbers of colony forming unit-granulocyte monocyte (CFU-GM) and colony forming unit-T lymphocyte (CFU-TL) were counted. There was no change in the number of colony immediately after inhalation of nitrous oxide, but was significant decrease in number of colony 1 day and 3 days after inhalation of nitrous oxide (p<0.001). One week after cessation of nitrous oxide inhalation, spontaneous recovery of number of colony developed without any treatment. To evaluate the protective effect of folinic acid (Rescuvolin) against hematopoietic depression, Rescuvolin 0.1 mg/0.3 ml were injected intraperitoneally at 12 hours and 1 hour before, 1 hour before and immediately after nitrous oxide inhalation, respectively. The data of each group were compared with that of the animals which have inhaled nitrous oxide for 6 hours without folinic acid. Folinic acid injected groups showed significant increase in numbers of colony (p<0.001) especially in 12 and 1 hour before nitrous oxide inhalation. In conclusion, the longer the duration of nitrous oxide inhalation, the faster and severer hematopoietic depression developed. The pretreatment of folinic acid may prevent the bone marrow depression by a long-term and repeated use of nitrous oxide. In clinical anesthesia, it is recommended to avoid to use nitrous oxide for the patients with bone marrow depressed disease such as leukemia and aplastic anemia.
Anemia, Aplastic ; Anesthesia ; Animals ; Bone Marrow ; Depression* ; Humans ; Inhalation ; Leucovorin* ; Leukemia ; Lymphocytes ; Monocytes ; Nitrous Oxide* ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations. METHODS: From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion. RESULTS: VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions. CONCLUSIONS: In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.
Adolescent ; Adult ; Arthroscopy/*methods ; Humans ; Magnetic Resonance Imaging ; Male ; Orthopedic Procedures/*methods ; Pain Measurement ; Postoperative Care ; Range of Motion, Articular ; Shoulder Dislocation/diagnosis/etiology/physiopathology/*surgery ; Tendon Injuries/complications/diagnosis/physiopathology/*surgery ; Treatment Outcome ; Young Adult

Thirty-six adult patients who received caudal anesthesia for perianal surgery were rando-mly agsigned to two grgups. Of these, 15 patients ingroup 1 were given 1.5 and 2% plain lidocaine in 18 and 7 ml doses, repectively. Twenty-one patients in group 2 were given lidooaine carbonated with 5% NaHCO3 0.1 ml per 1 ml-lidocaine in the same volume and concentration as in group 1. The time of onset of analgesia for the pin prick and scratch tests was significantly more rapid in group 2(2.04+/-0.63 and 4,69+/-1.12 min for the pin prick and scratch tests, respecti-vely-) than those in group 1(5.00+/-1.70 and 9.48+/-5.40 min for the pin prick and scratch test, respectively). However, the duration of anesthesia in both groups was not significantly different (111.80 +/-40.24 and 105.95+/-45.04 min in group 1 and 2, respectively). The mean pH of the 1.5 and 2% agents used in group 1 was 5.289+/-0.206 and 5.257+/-0.193, respectively, while the mean PH of the 1.5 and 2% carbonated lidocaine used in group 2 was 7.004+/-0.079 and 7.023+/-0.288, reapectively. The results iridicate that pH-adjusted lidocaine for caudal anesthesia has a more rapid onset than plain lidocaine hut that there is no difference in the length of duration of its effect.
Adult ; Analgesia ; Anesthesia ; Anesthesia, Caudal ; Bone Marrow* ; Carbon ; Humans ; Hydrogen-Ion Concentration ; Lidocaine ; Tissue Donors*

The incidence of spinal meningioma is very rare in children. A 14-year-old girl presented with right arm weakness, gait disturbance, and urinary incontinence. Cervical magnetic resonance imaging revealed an intradural extramedullary tumor dorsal to the spinal cord in the level of C1. The tumor was totally removed despite the severe cord compression. Meningotheliomatous meningioma was diagnosed after histological examination.
Arm ; Child ; Gait ; Humans ; Incidence ; Magnetic Resonance Imaging ; Meningioma ; Spinal Cord ; Urinary Incontinence

Microparticle induced inflammatory reaction has been extensively studied as a potential cause of implant loosening. However, there has been little in vivo study on the effect of the particles on the preserved cartilage in partial joint replacements. The purpose of this study was to determine in vivo effects of microparticles on the articular cartilage. Ninety rabbit knee joints were challenged repeatedly with 1-3 micron commercial pure titanium (Ti) and 1-45 micron ultra high molecular weight polyethylene (PE). After 12 weeks, patella and distal femur were harvested for determination of degenerative change by light and scanning electron microscope. The results are as follows: 1, In the joints without exposure of the subchondral bone, neither Ti nor PE elicited significant change. However, simultaneous introduction of both particles resulted in significant degeneration of the articular cartilage. 2. With the subchondral bones exposed, Ti and PE both induced significant cartilage degeneration. In this condition the PE particles were more detrimental than the Ti particles in causing degeneration of the articular cartilage. Although there exists a species difference, these results imply that the longevity of partial joint replacements may be shortened not only by mechanical problems, but also by the microparticles causing secondary degenerative change.
Cartilage ; Cartilage, Articular* ; Femur ; Joints ; Knee Joint* ; Knee* ; Longevity ; Molecular Weight ; Patella ; Polyethylene ; Titanium

BACKGROUND AND OBJECTIVES: Neurohormonal compensation plays an important role on the pathophysiologic aspects of congestive heart failure (CHF). There is recent clinical evidence that beta blocker is beneficial in selected patients. However, there is little information regarding the effect of beta blocker on elderly patients. MATERIALS AND METHODS: 26 patients of CHF under stable condition by conventional management were selected and were divided into two age subgroup. Group 1 were more than 65 years (n=12) and group 2 were less than 65 years (n=14). From 12.5 to 25 mg/day of carvedilol was given according to the clinical condition. The left ventricular end diastolic dimension (LVEDD), left ventricular end systolic dimension (LVESD), left ventricular volume index (LVVI), ejection fraction (LVEF), E/A ratio and E wave deceleration time (EwDT) of mitral inflow doppler velocity were measured by echocardiographic examination before and 3 months after carvedilol trial. Six-minute walk distance were also measured. RESULTS: Between before and after carvedilol treatment, there were significant decrease of LVVI and sign-ificant increase of EF in group I and group II. The EwDT and 6 minute walk distance of both group were also increased significantly after carvedilol trial. The delta EF of group I is smaller than group II (4.1+/-5.7 vs 9.7+/-10.0, p<0.05). CONCLUSION: When compared to younger patients with CHF, the efficacy of carvedilol on LV function in aged patients was evident. Improved clinical conditions would be expected by using carvedilol in elderly patients with CHF.
Aged* ; Compensation and Redress ; Deceleration ; Echocardiography ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Ventricular Function, Left*

Argyria is a rare cutaneous discoloration caused by the intake of silver or various compounds containing silver. We report a case of argyria in a 73-year-old male following ingestion of colloidal silver as an alternative medicine over 5 years. He had a diffuse, slate gray discoloration of his face and hands. A biopsy specimen from the face revealed brown-black extracellular granules in the upper dermis and between collagen bundles. We also found silver particles in the mucous of the colon. The ingestion of colloidal silver appears to be increasing among patients using alternative health practices. We report this case to bring people's attention to the problems associated with the ingestion of colloidal silver.
Aged ; Argyria ; Biopsy ; Collagen ; Colloids ; Colon ; Complementary Therapies ; Dermis ; Eating ; Hand ; Humans ; Male ; Silver