In the normal disc tissue, the blood vessles have not been observed. It has been suggested that the vascular ingrowth promotes the granulation tissue formation in the herniated disc tissue. The origin of capillaries observed in the herniated disc tissue has remained unclear, but basic fibroblast growth factor(bFGF) may be the important inducer of capillary ingrowth. The purpose of this study is to evaluate the neovascularization in the intervertebral disc without rupture of annulus fibrosus, not being exposed to epidural fat. The disc tissues including nucleus pulposus and annulus fibrosus were obtained at anterior interbody fusion from 30 patients with back pain. All specimens were immediately frozen and stored at -70degrees C. Hematoxylin-eosin stain, polyclonal von Willebrand factor(FVIII) antibody, smooth muscle actin antibody and anti-human endothelial cell antibody(CD31) were used to confirm the blood vessel. Polyclonal bFGF antibody expression was evaluated in the disc tiussues. All of the blood vesseles were observed in the inner portion of annulus fibrosus and the transitional zone. The blood vesseles were observed in 96.7% with hematoxylin-eosin stain, 83.3% with smooth muscle actin antiboy stain, 90% with FVIII, 86.7% with CD31 and the immunopositive blood vesseles were observed in 83.3% with bFGF immunostain. The neovascularization of disc was frequently found in the annulus fibrosus and the transitional zone. The neovasuarlization of intervertebral disc was present in the intervertebral disc without rupture of annulus fibrosus.
Actins ; Back Pain* ; Blood Vessels ; Capillaries ; Endothelial Cells ; Fibroblast Growth Factor 2* ; Fibroblasts ; Granulation Tissue ; Humans ; Intervertebral Disc Displacement ; Intervertebral Disc* ; Muscle, Smooth ; Rupture

We performed real-time 3D echocardiography in sixteen sheep to compare acute geometric changes in the mitral annulus after left anterior descending coronary artery (LAD, n=8) ligation and those after left circumflex coronary artery (LCX, n=8) ligation. The mitral regurgitation (MR) was quantified by regurgitant volume (RV) using the proximal isovelocity surface area method. The mitral annulus was reconstructed through the hinge points of the annulus traced on 9 rotational apical planes (angle increment=20 degrees). Mitral annular area (MAA) and the ratio of antero-posterior (AP) to commissure-commissure (CC) dimension of the annulus were calculated. Non-planar angle (NPA) representing non-planarity of the annulus was measured. After LCX occlusion, there were significant increases of the MAA during both early and late systole (p<0.01) with significant MR (RV: 30+/-14 mL), while there was neither a significant increase of MAA, nor a significant MR (RV: 4+/-5 mL) after LAD occlusion. AP/CC ratio (p<0.01) and NPA (p<0.01) also significantly increased after LCX occlusion during both early and late systole. The mitral annulus was significantly enlarged in the antero-posterior direction with significant decrease of non-planarity compared to LAD occlusion immediately after LCX occlusion.
Sheep ; Mitral Valve/*pathology/*ultrasonography ; Ligation ; Image Processing, Computer-Assisted ; Echocardiography, Three-Dimensional ; Coronary Vessels/*pathology/*ultrasonography ; Coronary Arteriosclerosis/pathology/ultrasonography ; Animals

The incidence of airway difficulty in the general surgical population varies greatly depending on the degree of airway difficulty. Much of the anesthesia related morbidity attributable to managing a difficult airway comes from an interurruption of gas exchange (hypoxia and hypercarbia) which may cause cardiovascular instability and brain damage. Most airway catastrophes ocurrs when possible difficulty with the airway was not recognized. Although fiberoptic intubation is reliable method in patients with difficult airways, there are many cases of difficulty in visualizing the structure of the larynx with conventional fiberoptic technique due to copious secretion, swelling and hemorrhage in the pharyngeal cavity. Recently, we experienced a success in difficult tracheal intubation with LMA in the 27 year old male patient diagnosed ankylosing spondylitis. We hope that using a #4 LMA as a conduit for 6.0 mm cuffed endotracheal tube with the aid of fiberscope attached to the video camera system would be an alternative method for difficult intubation.
Adult ; Anesthesia ; Anesthesia, General* ; Blood Pressure* ; Brain ; Clonidine* ; Epinephrine ; Heart Rate* ; Heart* ; Hemodynamics ; Hemorrhage ; Hope ; Humans ; Incidence ; Intubation* ; Larynx ; Male ; Norepinephrine ; Plasma* ; Skin ; Spondylitis, Ankylosing ; Succinylcholine ; Thiopental

BACKGROUND: The purpose of this study is to investigate the frequency of and errors in citation of references in articles from the Korean Journal of Anesthesiology (KJA) from the first application of the present contribution rules (1996) to 1998 and to suggest a clue to improve the quality of our journal. METHODS: All references cited from KJA were reviewed using a computerized searching system. If any differences are found during the review, we compare it with the original article. Errors on the contribution rules were examined according to the instructions for the authors revised in 1995. RESULTS: Overall 74% of the articles had more than one reference cited from KJA. The average number of the references cited from KJA per article was 1.73. In such references, citation errors were found in 48% of articles published in 1996, 44% in 1997, and 43% in 1998. The percentages of general errors and errors involving the contribution rules were 62% and 38%, respectively. Common general errors were found in titles (164 cases), pages (102 cases), and name (60 cases). Those involving the contribution rules found in the notation of name (120 cases), pages (54 cases), and inadequate notation of the number of issue (49 cases). CONCLUSIONS: Despite numerous efforts, the incidence of citation errors was still high when the articles of KJA were cited as references. Improvement in the quality of our journal will be possible only by rigid adherence to contribution rules, thorough review of the articles, and a lucid explanation of contribution rules.
Anesthesiology* ; Incidence

PURPOSE: To report the patient characteristics and treatment outcomes in 12 cases of orbital lymphangioma. METHODS: In this study, orbital lymphangioma was diagnosed based on clinical, radiologic (computed tomography, magnetic resonance imaging), and histologic findings when possible. Patients whose vision was not compromised by orbital lymphangioma, or that did not have increased intraocular pressure (IOP), received oral corticosteroids. Orbital lymphangioma that affected vision or increased IOP was treated by surgery, which included aspiration of blood or partial resection with or without injection of a sclerosant. RESULTS: Four patients without compromised vision responded well to oral corticosteroids. Eight patients with compromised vision underwent some form of surgery. Bleeding recurred in three patients after aspiration of blood and in two after partial resection and intralesional injection of a sclerosant. Overall, five patients were treated successfully by aspiration of blood, intralesional injection of a sclerosant, and application of continuous negative pressure by appropriate drainage. Partial resection was successful in two patients with organized hematoma. CONCLUSIONS: Orbital lymphangioma that does not compromise vision can be treated medically using oral corticosteroids. Patients with threatened vision or elevated IOP due to acute hemorrhage should be treated by aspiration of blood, intralesional injection of a sclerosant, and application of continuous negative pressure. Partial resection may be effective only in patients with organized hematoma.
Adrenal Cortex Hormones ; Drainage ; Hematoma ; Hemorrhage ; Humans ; Injections, Intralesional ; Intraocular Pressure ; Lymphangioma* ; Orbit* ; Sclerotherapy ; Treatment Outcome

PURPOSE: Early pubertal timing in girls is associated with psychological and behavioral problems. This study aimed to evaluate the psychological features of girls who perceived breast development beginning by analyzing their depression levels and self-concept. METHODS: From March 2007 to December 2012, 93 girls were enrolled and assigned to a pre-8 (younger than 8 years, n=43) or post-8 (8 years and older, n=50) group according to the age at onset of perceived breast development, and their height, body weight, body mass index, bone age (BA), Tanner stage, and luteinizing hormone and follicle-stimulating hormone levels were examined. We investigated their psychological state with the Korean Children's Depression Inventory (CDI) and Piers-Harris Children's Self-Concept Scale (PHCSC) to evaluate depression levels and self-concept, respectively. RESULTS: The pre-8 group had a significantly greater height standard deviation score, (0.5+/-1.01 vs. 0.11+/-0.86, P = 0.048) and more advanced BA (2.07+/-1.02 years vs. 1.40+/-0.98 years, P = 0.004) compared to the post-8 group. There were no statistically significant intergroup differences for the CDI and PHCSC scores; however, the pre-8 group scored higher than the post-8 group in the physical appearance and attributes domain of the PHCSC (9.93+/-2.57 vs. 8.52+/-3.03, P = 0.017). CONCLUSION: The timing of perceived breast development among girls who thought puberty to begin did not affect depression levels and self-concept. There was no correlation between Tanner stage and depression levels and self-concept despite the perception of pubertal onset. The pre-8 group had a more positive view of their physical appearance than the post-8 group.
Adolescent ; Body Height ; Body Weight ; Breast ; Depression* ; Human ; Female ; Follicle Stimulating Hormone ; Luteinizing Hormone ; Puberty ; Self Concept ; Sexual Development

BACKGROUND: Etomidate produces minimal cardiovascular effects in clinical uses but their effects on the porcine coronary arteries are not well known yet. We studied the direct effects of etomidate on porcine coronary arterial tone and the underlying mechanism of its vascular relaxation. METHODS: Porcine coronary arterial ring segments (3-4 mm) with or without endothelium were suspended in modified Krebs solution (37oC) and preconstricted with K+ 40 mM. Changes in tension were measured following cumulative administrations of etomidate (10(-5), 5 x 10(-5) and 10(-4) M). Relaxation caused by etomidate (10(-4)M) were measured in the presence of either NG-nitro-L-arginine methyl ether (L-NAME 10(-5)M, n = 13), indomethacin (2.8 x 10(-5)M, n = 12), methylene blue (2 x 10(-5)M, n = 12), tetraethylammonium (TEA, KCa2+ blocker, 20 mM, n = 11), glibenclamide (n = 13) 2.5 x 10(-5)M or 4-aminopyridine (4-AP, K+ DR blocker, 10 4 M, n = 12). Effects of etomidate on Ca2+ influx through the voltage operated channel (VOC) of the vascular cells were also evaluated. RESULTS: Arterial reings were relaxed by etomidate in a concentration-dependent manner and these effects were not affected by endothelium. In the etomidate pretreated group, arterial ring in a calcium-free solution showed no contraction with KCl 40 mM, but the contraction after the administration of calcium 2.5 mM less than without etomidate group (47.2 +/- 8.7% vs 97.7 +/- 10.6%). The other group, not pretreated with etomidate, showed the same vascular tone of the control group in a slow upstroke manner with calcium administration. Pretreatment with either L-NAME, indomethacin and methylene blue did not affect etomidate-induced vasorelaxation. The TEA, glibenclamide and 4-AP pretreated groups also did not affect the vascular relaxation. CONCLUSIONS: Etomidate relaxes the porcine coronary artery in a concentration-dependent manner withor without endothelium, via inhibition of Ca2+ influx through the voltage-operated Ca2+ channel.
4-Aminopyridine ; Calcium ; Coronary Vessels* ; Endothelium ; Ether ; Etomidate* ; Glyburide ; Indomethacin ; Methylene Blue ; NG-Nitroarginine Methyl Ester ; Nitroarginine ; Relaxation ; Tea ; Tetraethylammonium ; Vasodilation

PURPOSE: We describe our experience with the Permacol graft in anophthalmic socket reconstruction, and compare it to the autologous buccal mucosal graft, emphasizing the postoperative vascularization and contraction of each graft. METHODS: This was a retrospective comparative study. We measured the time necessary for the graft surface to be completely vascularized, as well as the fornix depth of the conjunctival sac in anophthalmic patients. RESULTS: Ten patients underwent Permacol graft reconstruction, with 44 undergoing buccal mucosal graft reconstruction. Seven eyelids (70%) in the Permacol group had a good outcome, with improvement in lower eyelid position and prosthesis retention. Nine out of 10 eyelids (90%) in this group showed complete vascularization of the graft at 2.6 ± 1.9 months postoperatively, while the grafted buccal mucosa was fully vascularized at 1.1 ± 0.3 months postoperatively (p < 0.01). Postoperative fornix depth in the Permacol group was 9.1 ± 2.2 mm, compared to 14.9 ± 4.5 mm in the buccal mucosal graft group (p < 0.01). Mean increases in fornix depth were 33.1% and 67.9% of the mean vertical length of the implanted graft. CONCLUSIONS: The Permacol graft can be useful as spacer graft material in anophthalmic socket patients. It takes longer to vascularize, and undergoes greater graft shrinkage with time, compared to the buccal mucosal graft.
Acellular Dermis* ; Anophthalmos ; Eyelids ; Humans ; Lacrimal Apparatus ; Mouth Mucosa* ; Prosthesis Retention ; Retrospective Studies ; Transplants*

There is a wide variety of genital abnormalities observed in patients with Denys-Drash syndrome (DDS). WT1 is thought to influence the genes related to genital development and mutations in this gene have been associated with DDS. DDS should be considered in the differential diagnosis of newborns with genital anomalies. In contrast to other conditions with 46,XY disorders of sex development, individuals with DDS often have duplicated genital organs (a double vagina, cervix or uterus). A double uterus has not yet been reported with 1390G>A (Arg464 Asn) mutation. However, duplicated genitals have been reported with other genetic mutations in patients with DDS. The duplicated genitals in DDS may be associated with low anti-Mullerian hormone (AMH) secretion. Measurement of the AMH levels may add to our understanding of variations in genital development and their abnormalities in disorders such as DDS. In conclusion, this is first case of low level of AMH and double uterus in 1390G>A (Arg464 Asn) mutations of DDS male.
46, XY Disorders of Sex Development ; Anti-Mullerian Hormone* ; Cervix Uteri ; Denys-Drash Syndrome* ; Diagnosis, Differential ; Female ; Genitalia ; Humans ; Infant, Newborn* ; Male ; Uterus ; Vagina*

BACKGROUND: A previous history of transfusion has been known to be associated with production of anti-HLA class I antibodies. However, platelet glycoproteins are the main target of idiopathic thrombocytopenic purpura (ITP). The mechanism of antibody production is known to differ significantly between glycoproteins and anti-HLA class I. The aim of this study was to evaluate the clinical significance of anti-HLA class I antibodies in childhood ITP. METHODS: Enrollment for the normal control group targeted 48 people who visited Gyeongsang National University Hospital from 1990 to 2010, and 48 young children with ITP. Anti-glycoproteins and anti-HLA class I antibodies were tested using the Modified Antigen Capture Enzyme-linked immunosorbent assay (MACE) kit. RESULTS: The positive rate of anti-HLA antibodies was significantly different [36/39 (92.3%) vs 29/46 (63%)] [ITP group vs normal control group] (P=0.002). The mean positive S/C ratio of anti-HLA antibodies was also significantly different (3.55 vs 1.51) [ITP group vs normal control group] (P=0.0000). The positive rate of anti-HLA did not differ significantly between the transfused group and the non-transfused group [12/12 (100%) vs 24/27 (88%)] [transfused ITP vs non-transfused ITP]. The mean positive S/C ratio of anti-HLA antibodies did not differ significantly between the transfused ITP group and the non-transfused ITP group (4.30 vs 3.25) [transfused ITP vs non-transfused ITP]. Consecutive testing showed that positive rate and positive S/C ratio of anti-HLA antibodies did not change significantly between sampling times in both groups [transfused ITP vs non-transfused ITP] (P=1.00 and P=0.15). CONCLUSION: Anti-HLA class I antibodies may be involved in childhood ITP. Transfusion did not affect the course of childhood ITP.
Antibodies* ; Antibody Formation ; Blood Platelets* ; Child* ; Enzyme-Linked Immunosorbent Assay ; Glycoproteins ; Humans ; Platelet Membrane Glycoproteins ; Purpura, Thrombocytopenic, Idiopathic*