BACKGROUND: This study was aimed to elucidate the effect of propofol anesthesia on circulatory response to hemorrhage in rats by power spectral analysis of heart rate and blood pressure variability. METHODS: Nineteen male Sprague-Dawley rats weighing 350-580 g were divided into propofol (2 mg/kg, iv)-anesthetized (P, n=10) and saline control (C, n=9) groups. Blood pressure signal was digitized at 500 Hz for 5 min at basal, during hemorrhage and after hemorrhage. The signal was analyzed with fast Fourier transform algorithm to yield power spectra of systolic (SPV) and diastolic (DPV) blood pressure and cycle length variability (HRV). Very low frequency (VLF, 0.02-0.26 Hz), low frequency (LF, 0.26-0.75 Hz), high frequency (HF, 0.75-5.00 Hz) powers, LF/HF ratio and total power were obtained. Powers of each band were expressed as percent of total power. RESULTS: Blood pressure was decreased during hemorrhage in C and with a greater magnitude in P. Heart rate tended to increase during hemorrhage in C, but was not changed in P. LF powers of SPV in P was decreased after propofol injection. Hemorrhage decreased LF and increased HF. LF powers of DPV in P was decreased after propofol injection. Hemorrhage caused a further decrease in LF. LF powers of HRV in P was decreased after propofol injection. Hemorrhage caused a further decrease in LF. Powers of SPV, DPV and HRV in C were not changed by hemorrhage. LF/HF of SPV, DPV and HRV were decreased during hemorrhage in P, but not in C. CONCLUSIONS: These results suggest that propofol depressed sympathetic activity to diminish peripheral vascular tone and hemorrhage under propofol anesthesia resulted in a greater blood pressure fall due to impaired sympathetic compensation including attenuated baroreflex mechanism.
Anesthesia ; Animals ; Baroreflex ; Blood Pressure* ; Compensation and Redress ; Fourier Analysis ; Heart Rate* ; Heart* ; Hemorrhage* ; Humans ; Male ; Propofol ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Recent studies demonstrated that volatile anesthetics suppress the NO-cGMP system in the vascular system. It has been known that the hemodynamic changes produced by volatile anesthetics in septic patients are mediated by upregulation of iNOS leading to excessive release of NO. The mechanisms underlying suppression of the NO-cGMP system by anesthetics are still controversial. It has been elucidated that nitric oxide synthase (NOS) plays a major role in the regulatory function in the L-arginine-NO system. So we examined the effects of NOS inhibitor (L-NAME, aminoguanidine) and NO scavenger (hydroxocobalamin) on vascular smooth muscle contractile function in lipopolysaccharide (LPS)-treated rat aorta during halothane administration. METHODS: Aortic ring preparations were obtained from LPS-treated (1.5 mg/kg, ip, for 18 h) rats. We evaluated the effects of hydroxocobalamin, L-NAME and aminoguanidine on contractile responses to phenylephrine during halothane (1 & 2 MAC) administration respectively. Statistical significances (P<0.05) were analyzed according to data characterictics by repeated measures ANOVA test and student's t-test. RESULTS: The contractile responses to phenylephrine in LPS-treated rats aorta were significantly (P<0.05) increased in the presence of hydroxocobalamin and L-NAME. During the halothane (1 and 2 MAC) administration, the contractile responses to phenylephrine in LPS-treated rats aorta were increased significantly (P<0.05) in the presence of hydroxocobalamin and L-NAME. CONCLUSIONS: From these results, it is suggested that hydroxocobalamin and L-NAME may be useful in the therapy of septic shock.
Anesthetics ; Animals ; Aorta ; Halothane* ; Hemodynamics ; Humans ; Hydroxocobalamin* ; Muscle, Smooth, Vascular ; NG-Nitroarginine Methyl Ester* ; Nitric Oxide Synthase ; Phenylephrine ; Rats* ; Shock, Septic ; Up-Regulation

We have experienced one case of anesthesia for living related liver transplantation with propofol. The recipient was 18-month-old girl and 10.5 kg. She was suffered from congenital liver disease (biliary atresia). We decided propofol as an anesthetic agent of the recipient with permission of the recipient's parents. Total anesthetic time was about 13 hours and anhepatic phase was 110 min. Careful attention was paid to prevent infection, hypothermia, hepatic artery thrombosis and to keep proper lung function. Hemodynamic changes were relatively stable throughout the operation and postoperative mechanical ventilatory support was required for about 2 days.
Anesthesia ; Female ; Hemodynamics ; Hepatic Artery ; Humans ; Hypothermia ; Infant ; Liver Diseases ; Liver Transplantation* ; Liver* ; Lung ; Parents ; Propofol* ; Thrombosis

We have experienced one case of anesthesia for living related liver transplantation with propofol. The recipient was 18-month-old girl and 10.5 kg. She was suffered from congenital liver disease (biliary atresia). We decided propofol as an anesthetic agent of the recipient with permission of the recipient's parents. Total anesthetic time was about 13 hours and anhepatic phase was 110 min. Careful attention was paid to prevent infection, hypothermia, hepatic artery thrombosis and to keep proper lung function. Hemodynamic changes were relatively stable throughout the operation and postoperative mechanical ventilatory support was required for about 2 days.
Anesthesia ; Female ; Hemodynamics ; Hepatic Artery ; Humans ; Hypothermia ; Infant ; Liver Diseases ; Liver Transplantation* ; Liver* ; Lung ; Parents ; Propofol* ; Thrombosis

No abstract available.
Finasteride* ; Risk Factors ; Venous Thrombosis*

Internal abdominal hernias are an unusual cause of intestinal occlusion. They are responsible for 2% of all the intestinal obstructions. Various types of hernia have been described. Paraduodenal hernias are relatively rare congenital malformations and result from incomplete rotation of the midgut with entrapment of the small intestine beneath the developing colon. We report a case of paraduodenal hernia of the small intestine in a 32-year-old man with presentation of intestinal obstruction. The patient suffered from nausea, vomiting and acute abdominal pain for 9 hours. Abdominal CT showed sac-like mass of clustered, dilatated small bowel in the right upper quadrant. At operation, herniation of small intestine into a retroperitoneal space through a defect on right mesocolon was noted. A right paraduodenal (mesocolic) hernia was diagnosed. The patient made an uneventful recovery except some diarrhea after extensive segmental resectio of strangulated small bowel. Paraduodenal hernia is important as it usually presents as intestinal obstruction, and is often misdiagnosed before laparotomy. Mortality is increased significantly with delays in surgical treatment. Though rare, paraduodenal hernia should be taken into account in a differential diagnosis of intestinal obstruction. Early surgical intervention allows uneventful recovery and also prevents the possible complication of gangrenous bowels.
Abdomen, Acute ; Abdominal Pain ; Adult ; Colon ; Diagnosis, Differential ; Diarrhea ; Hernia* ; Hernia, Abdominal ; Humans ; Intestinal Obstruction ; Intestine, Small ; Laparotomy ; Mesocolon ; Mortality ; Nausea ; Retroperitoneal Space ; Tomography, X-Ray Computed ; Vomiting

Cryptococcosis is a relatively common mycosis of human caused by a worldwide Cryptococcus neoformans. Cryptococcosis occurs more frequently in immuno-compromised hosts such as patients with lymphoma, AIDS, leukemia and other debilitating diseases which manifest a condition of altered cell mediated immunity. Also cancer patients with anticancer chemotherapy are at high risk. Cryptococcosis is primarily a pulmonary disease that remains asymptomatic and unrecognised in most cases. Meningitic and meningoencephalitc forms are more frequently diagnosed because of their striking clinical symptoms.Meningoencephalitis is an uncommon form of cryptoccocosis that often leads to coma and death within a short time, if it is not quickly diagnosed and treated properly. The treatment of choice for the cryptococcosis consists of intravenous amphotericin B and 5-fluorocytocine. We report a case of cryptococcal meningitis in 47-year-old female breast cancer patient with liver metastasis after systemic chemotherapy. She complained headach, fever and diagnosed as cryptococcal meningitis after the India ink smear and culture of CSF. After treated with amphotericin B, her conditions were improved.
Amphotericin B ; Breast Neoplasms ; Coma ; Cryptococcosis ; Cryptococcus neoformans ; Drug Therapy ; Female ; Fever ; Herpes Zoster* ; Humans ; Immunity, Cellular ; India ; Ink ; Leukemia ; Liver* ; Lung Diseases ; Lymphoma ; Meningitis, Cryptococcal* ; Middle Aged ; Neoplasm Metastasis* ; Strikes, Employee

Combined hepatocellular-cholangiocarcinoma (HCC-CC) with sarcomatoid features is an extremely rare primary liver cancer, of which only four cases have been reported. We report a case of sarcomatoid combined HCC-CC in a 60-year-old woman who complained of right upper quadrant pain and presented with a 7 cm mass in the S4 region of the liver in abdominal CT. Ultrasonography-guided needle biopsy diagnosed it as HCC, and left lobectomy of the liver followed. Microscopically, the tumor consisted of two portions: HCC portion showing trabecular pattern, which had partially sarcomatous area with spindle-shaped tumor cells, and CC portion with glandular pattern. Immunohistochemically, HCC portion reacted positively with alpha-fetoprotein while CC portion demonstrated positive reactivity with carcinoembryonic antigen and mucicarmine. Sarcomatoid cells reacted positively for cytokeratin. She died of tumor recurrence and hepatic failure 12 months after the operation. Combined HCC-CC has poor prognosis, and sarcomatoid HCC has high metastatic potential and poor prognosis compared with ordinary HCC.
Bile Duct Neoplasms/*pathology ; *Bile Ducts, Extrahepatic ; Carcinoma, Hepatocellular/*pathology ; Cholangiocarcinoma/*pathology ; English Abstract ; Female ; Humans ; Liver Neoplasms/*pathology ; Middle Aged ; Sarcoma/*pathology

In this study, the synergistic effect of 6-[4-(1-cyclohexyl-1H-tetrazol-5-yl) butoxy]-3,4-dihydro-2(1H)-quinolinone (cilostazol) and Ginkgo biloba extract (GbE) was examined in apolipoprotein E (ApoE) null mice. Co-treatment with GbE and cilostazol synergistically decreased reactive oxygen species (ROS) production in ApoE null mice fed a high-fat diet. Co-treatment resulted in a significantly decreased atherosclerotic lesion area compared to untreated ApoE mice. The inflammatory cytokines and adhesion molecules such as monocyte chemoattractant-1 (MCP-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and VCAM-1 which can initiate atherosclerosis were significantly reduced by the co-treatment of cilostazol with GbE. Further, the infiltration of macrophages into the intima was decreased by co-treatment. These results suggest that co-treatment of GbE with cilostazol has a more potent anti-atherosclerotic effect than treatment with cilostazol alone in hyperlipidemic ApoE null mice and could be a valuable therapeutic strategy for the treatment of atherosclerosis.
Animals ; Apolipoproteins E/genetics/physiology ; Atherosclerosis/*drug therapy ; Cytokines/metabolism ; Disease Models, Animal ; Drug Synergism ; Ginkgo biloba/*chemistry ; Humans ; Macrophages/cytology/drug effects ; Male ; Mice ; Mice, Nude ; Plant Extracts/*administration & dosage/chemistry ; Reactive Oxygen Species/*metabolism ; Tetrazoles/*administration & dosage

Gastritis cystica profunda (GCP) is a rare disease in which cystically dilated gastric foveolae or glands extend into the muscularis mucosae or below. The pathogenesis of GCP has been described as an interruption of the muscularis mucosae and migration of epithelial elements to submucosa caused by presence of suture materials after surgery or erosion of the gastric mucosa in chronic gastritis and ischemia. Macroscopically, GCP may present not only as a giant gastric mucosal folds but also as a submucosal tumor or as solitary or diffuse polyps. An endoscopic ultrasonographic (EUS) findings clearly differ from findings in the other disordes. The combination of EUS and mucosectomy appears to be very useful for the diagnosis of GCP. Therefore, all unnecessary surgical procedures should be avoided in cases of GCP. We report a case of GCP associated with gastric perforation which presented as diffuse giant gastric folds and clinically advanced gastric cancer was suspected.
Diagnosis ; Endosonography ; Gastric Mucosa ; Gastritis* ; Ischemia ; Mucous Membrane ; Polyps ; Rare Diseases ; Stomach Neoplasms ; Sutures