MAGE (melanoma antigen gene) is a tumor specific shared antigen, presented by HLA class I molecules, which is recognized by cytotoxic T lymphocytes. MAGE proteins are expressed in malignant tumor cells, in contrast to no expression in normal or benign tissues except for testis and placenta. MAGE might be a potential target for immunotherapy of malignant tumors. However, its biological aspects associated with cell cycle are not yet described. The flow cytometry is a useful tool for objective and quantitative analyses of heterogenous tumor cell population. To understand the status of MAGE related to cell cycle and its relationship with p53 as the G1 checkpoint regulator, p21, and PCNA as a proliferative index, we investigated expression of MAGE-3 protein, mutant p53, p21, and PCNA by flow cytometry and immunohistochemical stain. In addition, double stains for MAGE-3/p53, p53/PCNA, and p53/p21 were analysed with bivariate flow cytometry. DNA histograms using MAGE-3/PI (DNA) and p53/PI (DNA) were also analysed. The cell line (PNUH- 12) used for this study originated from a hypopharyngeal squamous cell carcinoma, which has point mutation (exon 7, C-->G) of p53. The expression rate of MAGE-3 was 83%, PCNA 85%, and p53 81%. No expression for p21 was identified. MAGE-3 was expressed in cytoplasm, while both PCNA and p53 were expressed in nuclei of tumor cells. With bivariate analyses, coexpression rates of MAGE-3/p53 and p53/PCNA were 0.96 and 0.97, respectively. Both MAGE-3 and p53 showed constantly high level throughout the cell cycle. These results suggest that expression of MAGE-3 and mutant p53 is not dependent on the cell cycle. p21 seems to be inactivated.
Carcinoma, Squamous Cell* ; Cell Cycle ; Cell Line* ; Coloring Agents ; Cytoplasm ; DNA ; Flow Cytometry* ; Immunotherapy ; Mutant Proteins ; Placenta ; Point Mutation ; Proliferating Cell Nuclear Antigen* ; T-Lymphocytes, Cytotoxic ; Testis

PURPOSE: MAGE (melanoma antigen gene) is a tumor associated antigen, presented by HLA class I molecules, which is recognized by cytotoxic T lymphocytes. The expression of MAGE proteins are confined to malignant tumor tissues, except for the normal testis and placental tissues. Therefore, MAGE may be a potential target for immunotherapy of malignant tumors. However, biological aspects associated with the cell cycle are not yet described. MATERIALS AND METHODS: The material used for this study was a novel human squamous cell carcinoma cell line (PNUH-12) from the hypopharynx, which had one point mutation of 78th base, C to G, in exon 7 of p53 gene. To understand the role of MAGE in relation to cell cycle and its relationship with p53 as the Gl checkpoint regulator, the expressions of MAGE-3 protein and mvtant p53 (Mtp53) were accessed by flow cytometry and immunohistochemistry. Double stains for MAGE-3/Mtp53 was analyzed with bivariate flow cytometry. DNA histograms using MAGE-3/PI (DNA) and Mtp53/PI (DNA) were also analyzed. RESULTS: The expression rate of MAGE-3 and Mtp53 were 83% and 85%, respectively. MAGE-3 was expressed in cytoplasm, while M:p53 were expressed in the nuclei of the tumor cells on the immunohistochemical sections. With bivariate analyses, coexpression rate of MAGE-3/Mtp53 was 0.96, and MAGE-3 and Mtp53 constantly showed high levels throughout the cell cycle except Go. CONCLUSIONS: These results mean that (I) MAGE-3 might have yet unknown relationship with mutant p53, (2) expressions of MAGE-3 and Mtp53 are not dependent on the cell cycle in PNUH-12 hypopharyngeal squamous carcinoma cell line, and suggest that MAGE-3 might have a role as important as p53 during the development of malignant tumors.
Carcinoma, Squamous Cell ; Cell Cycle* ; Cell Line ; Coloring Agents ; Cytoplasm ; DNA ; Exons ; Flow Cytometry* ; Genes, p53 ; Humans ; Hypopharynx ; Immunohistochemistry ; Immunotherapy ; Point Mutation ; T-Lymphocytes, Cytotoxic ; Testis

BACKGROUND: This study was designed to evaluate the effect of propofol and oral clonidine on bleeding and their efficacy in blunting the hemodynamic effects of epinephrine during endoscopic sinus surgery. METHODS: Informed consent was obtained from eighty patients scheduled for endoscopic sinus surgery under general anesthesia. All patients received atropine 0.5 mg IM for premedication. Group I (n = 20) received thiopental sodium 5 mg/kg and vecuronium 0.1 mg/kg followed by an isoflurane 1 - 1.5 vol% in O2/N2O 50/50. Group P (n = 20) received propofol 2 mg/kg and vecuronium 0.1 mg/kg followed by an infusion of 6 - 10 mg/kg/hour in O2/N2O 40/60. Group P + 75 (n = 20) received oral clonidine 75ng and Group P + 150 (n = 20) received oral clonidine 150ng 60 min before induction of anesthesia. In anesthetic induction and maintenance, Group P + 75 and Group P + 150 were identical to Group P. Blood pressure, heart rate, EKG and SpO2 were continuously monitored. Blood losses were collected and measured at the end of each procedure. Pre- and postoperative hematocrit were checked. The duration of heart rate to peaked level and side effects were observed in all patients after the intranasal injection of epinephrine. RESULTS: The average estimated blood losses in Group P, P + 75 and P + 150 were significantly less than that of Group I (P < 0.05). In Group P + 150, the duration of heart rate increase was significantly shorter than that of Group I (P < 0.05). In Group P + 150, mean arterial pressure and the difference between preoperative and postoperative hematocrit were significantly less than that of Group I (P < 0.05). CONCLUSIONS: General anesthesia based on propofol infusion may have the advantage of decreased bleeding compared with conventional inhalation agents during endoscopic sinus surgery. Tachycardia inresponse to intranasal epinephrine injection was attenuated by oral clonidine.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Atropine ; Blood Pressure ; Clonidine* ; Electrocardiography ; Epinephrine ; Heart Rate ; Hematocrit ; Hemodynamics* ; Hemorrhage ; Humans ; Informed Consent ; Inhalation ; Isoflurane ; Premedication ; Propofol* ; Tachycardia ; Thiopental ; Vecuronium Bromide

No abstract available.
Aneurysm* ; Renal Artery*

BACKGROUND: In recent years, the incidence of extended-spectrum beta-lactamase (ESBL) producing Klebsiella has been steadily increased, and the newer species K. planticola and K terrigena, formerly regarded as nonpathogen, have been reported with astonishing frequency from human infectious processes by some investigators. The aim of this study is to elucidate the isolation rate and antimicrobial susceptibility of recent clinical Klebsiella isolates. METHOD: For the clinical Klebsiella isolates during the period of June 1999 to May 2000, isolation frequency of Klebsiella species by specimen, departments, age, and sex were analyzed. And antimicrobial susceptibilities were also analyzed. RESULT: Isolation rate of Klebsiella in order of decreasing frequency were K. pneumoniae (74:7%), K. oxytoca (12.1%), K. ozaenae(1.7%), K. planticola(1.0%), K. terngena(0.9%), and K, ornithinolytica (0.7%), respectively. K. rhinoscleromatis was not isolated. Compared with outpatients, increase of resistance rates of inpatients's Klebsiella isolates were 10% in ciprofloxacin, 15% in cefoperazone/sulbactam, and the others were ranged from 24% to 31%. Isolation rate of ESBL producing K. pneumoniae by double disk (DD) synergy test was 41%, and detection rates by antimicrobial agents were as follows: cefotaxime (95%), aztreonam (58%), and ceftriaxone (37%). Antimicrobial susceptibility rate with the exception of ampicillin and imipenem decreased from the range of 81%-96% on admission day to 29-62% after one week on admission. CONCLUSION: The isolation rates of K. planticola and K. terrigena were less than 1%. The proportion of ESBL producing K. pneumoniae was 41 %. And the vast majority of multidrug resistant Klebsiella including ESBL producing strains are acquired by hospitalization.
Ampicillin ; Anti-Infective Agents ; Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftriaxone ; Ciprofloxacin ; Epidemiology* ; Hospitalization ; Humans ; Imipenem ; Incidence ; Klebsiella pneumoniae ; Klebsiella* ; Outpatients ; Pneumonia ; Research Personnel

BACKGROUND: In recent years, the incidence of extended-spectrum beta-lactamase (ESBL) producing Klebsiella has been steadily increased, and the newer species K. planticola and K terrigena, formerly regarded as nonpathogen, have been reported with astonishing frequency from human infectious processes by some investigators. The aim of this study is to elucidate the isolation rate and antimicrobial susceptibility of recent clinical Klebsiella isolates. METHOD: For the clinical Klebsiella isolates during the period of June 1999 to May 2000, isolation frequency of Klebsiella species by specimen, departments, age, and sex were analyzed. And antimicrobial susceptibilities were also analyzed. RESULT: Isolation rate of Klebsiella in order of decreasing frequency were K. pneumoniae (74:7%), K. oxytoca (12.1%), K. ozaenae(1.7%), K. planticola(1.0%), K. terngena(0.9%), and K, ornithinolytica (0.7%), respectively. K. rhinoscleromatis was not isolated. Compared with outpatients, increase of resistance rates of inpatients's Klebsiella isolates were 10% in ciprofloxacin, 15% in cefoperazone/sulbactam, and the others were ranged from 24% to 31%. Isolation rate of ESBL producing K. pneumoniae by double disk (DD) synergy test was 41%, and detection rates by antimicrobial agents were as follows: cefotaxime (95%), aztreonam (58%), and ceftriaxone (37%). Antimicrobial susceptibility rate with the exception of ampicillin and imipenem decreased from the range of 81%-96% on admission day to 29-62% after one week on admission. CONCLUSION: The isolation rates of K. planticola and K. terrigena were less than 1%. The proportion of ESBL producing K. pneumoniae was 41 %. And the vast majority of multidrug resistant Klebsiella including ESBL producing strains are acquired by hospitalization.
Ampicillin ; Anti-Infective Agents ; Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftriaxone ; Ciprofloxacin ; Epidemiology* ; Hospitalization ; Humans ; Imipenem ; Incidence ; Klebsiella pneumoniae ; Klebsiella* ; Outpatients ; Pneumonia ; Research Personnel

473 patients who underwent orthopedic surgery of the upper extremities from July 1978 to August 1983 were studied and the results are as follows. 1) Among 473 patients 294 patients given general anesthesis. Axillary brachial piexus block(141 cases), intraveonus regional anesthesia(10 cases), interscalene block(2 cases) and continuous brachial plexus block were given to the rest of the patients. 2) 267 patients were male and 106 patients were female. Age distribution was from 2 to 74 years. 3) Physical status of the patients was A.S.A. (American Society of Anesthesiologists) class 2(52.5%), class 1(43.4%), class 3(4.4%) in the order. 47.2% of the patients underwent emergency operation. 4) There was a tendency that regional anesthesis has been increasing year by year. 5) The type of operations were open reduction(160cases), tendon repair(112cases), and surgery for neuropathy(65 cases). 6) The operations for upper arm, elbow, and forearm were performed mostly under general anesthesia, while regional anesthesia prevailled for hand, wrist, and digits operations. 7) Brachial plexus block was considered as a method of choice for upper extremity surgery, especially for emergency surgical procedures in patients with significant medical problems. 8) A new method was tried in which a flexible disaposable intravenous catheter was introduced into the neurovascular sheath in the axilla and used for injection of local anesthetic solutions to block the axillary brachial plexus. The catheter method constitutes an interesting alternative to the conventional needle techniques and offers a continuous axillary block and a method for postoperative pain relief.
Age Distribution ; Anesthesia, Conduction ; Anesthesia, General ; Arm ; Axilla ; Brachial Plexus ; Catheters ; Elbow ; Emergencies ; Female ; Forearm ; Hand ; Humans ; Male ; Needles ; Orthopedics ; Pain, Postoperative ; Tendons ; Upper Extremity* ; Wrist

Ventilation impairment sometimes developes in patients with a double-lumen tube (DLT) during thoracic anesthesia. A 27-year old man who suffered from a left pneumothorax showed ventilation impairment with right lung obstruction after the induction of anesthesia. We checked breathing sounds before and after clamping each lumen. Correct positioning was confirmed by direct visualization using a flexible fiberoptic bronchoscope and by chest X-ray. The DLT was removed and replaced by a single lumen endotracheal tube because of severe ventilation impairment. On careful examination of the DLT, manufacturing defects in a bifurcated connector were noted, and its openings were occluded with a thin plastic membrane. After replacing the DLT, the ventilation impairment was improved. It is important to test DLT prior to use, and to maintain an awareness that airway obstruction can occur due to structural defects.
Adult ; Airway Obstruction ; Anesthesia ; Bronchoscopes ; Constriction ; Humans ; Lung ; Membranes ; Plastics ; Pneumothorax ; Respiratory Sounds ; Thorax ; Ventilation*

This case involved a pulmonary thromboembolism, which originated from the lower extremity. A 68-year-old female, with a femur neck fracture, underwent spinal anesthesia with 0.5% heavy bupivacaine 11 mg for total hip arthroplasty. Ten minutes after the induction of spinal anesthesia, dyspnea, tachycardia and hypotension appeared. Under the impression of a pulmonary embolism, intubation was done and dopamine and epinephrine were infused. The operation stopped and she was sent to the intensive care unit. On the spiral CT chest angiogram, a pulmonary embolism was found. Deep venous thrombosis was detected in the left lower extremity on the venogram. Heparin therapy was started at a rate of 800 U/hour with a bolus of 5000 U. A consultative operation for the removal of deep vein thrombosis was performed by a chest surgeon, and total hip arthroplasty was performed successfully under spinal anesthesia.
Aged ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Bupivacaine ; Dopamine ; Dyspnea ; Epinephrine ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Heparin ; Humans ; Hypotension ; Intensive Care Units ; Intubation ; Lower Extremity ; Pulmonary Embolism* ; Tachycardia ; Thorax ; Tomography, Spiral Computed ; Venous Thrombosis