BACKGROUND: To test whether propofol with fentanyl pretreatment produces better sedative efficacy than that of propofol alone in patients under spinal anesthesia. METHODS: Fifty-four patients undergoing lower leg orthopedic surgery were sedated randomly with propofol-normal saline (PN, n = 27) or propofol-fentanyl (PF, n = 27). In both groups, sedation was maintained with an initial loading dose of propofol 0.4 mg/kg, and subsequent infusion at a rate of 50 microg/kg/min. Prior to propofol administration, normal saline 0.02 ml/kg or fentanyl 1 microg/kg was given intravenously to Group PN and Group PF, respectively. We measured bispectral index (BIS) and the Observer's Assessment of Alertness/ Sedation (OAA/S) scale scores to investigate sedative efficacy, prior to and at 5 minute intervals for 1 hour after propofol infusion. RESULTS: BIS and OAA/S scores were decreased in both groups over time after starting propofol infusion (P < 0.0001). Comparison between the PF group and the PN group at each time point did not demonstrate statistically significant differences, and group effect was also not found to be statistically significant for BIS and OAA/S [BIS, P = 0.4644 (group effect), P = 0.7817 (time*group interaction)], [OAA/S scale, P = 0.4373 (group effect), P = 0.125 (time*group interaction)]. CONCLUSIONS: Judging from the BIS and OAA/S scores, propofol with fentanyl pretreatment did not produce an additional sedative effect compared to propofol alone in spinal anesthesia.
Anesthesia, Spinal* ; Fentanyl* ; Humans ; Hypnotics and Sedatives ; Leg ; Orthopedics ; Propofol*

BACKGROUND: To test whether propofol with fentanyl pretreatment produces better sedative efficacy than that of propofol alone in patients under spinal anesthesia. METHODS: Fifty-four patients undergoing lower leg orthopedic surgery were sedated randomly with propofol-normal saline (PN, n = 27) or propofol-fentanyl (PF, n = 27). In both groups, sedation was maintained with an initial loading dose of propofol 0.4 mg/kg, and subsequent infusion at a rate of 50 microg/kg/min. Prior to propofol administration, normal saline 0.02 ml/kg or fentanyl 1 microg/kg was given intravenously to Group PN and Group PF, respectively. We measured bispectral index (BIS) and the Observer's Assessment of Alertness/ Sedation (OAA/S) scale scores to investigate sedative efficacy, prior to and at 5 minute intervals for 1 hour after propofol infusion. RESULTS: BIS and OAA/S scores were decreased in both groups over time after starting propofol infusion (P < 0.0001). Comparison between the PF group and the PN group at each time point did not demonstrate statistically significant differences, and group effect was also not found to be statistically significant for BIS and OAA/S [BIS, P = 0.4644 (group effect), P = 0.7817 (time*group interaction)], [OAA/S scale, P = 0.4373 (group effect), P = 0.125 (time*group interaction)]. CONCLUSIONS: Judging from the BIS and OAA/S scores, propofol with fentanyl pretreatment did not produce an additional sedative effect compared to propofol alone in spinal anesthesia.
Anesthesia, Spinal* ; Fentanyl* ; Humans ; Hypnotics and Sedatives ; Leg ; Orthopedics ; Propofol*

Interrupted aortic arch (IAA) is an interruption in the continuity of the aortic arch, often with a fibrous cord between the two segments. It accounts for about 1% of congenital cardiovascular defects and is differentiated from severe coarctation and aortic atresia by the absence of any structural connection (1). Survival may be prolonged because effective arterial collaterals to the descending aorta develop during fetal and postnatal life (2). Although only two cases reported a combination between IAA and an aneurysm of the circle of Willis, there is none of report in coil embolization of the same case. We describe a 31-year-old patient, in whom IAA and unruptured aneurysm were discovered during angiography. Coil embolization was performed via direct puncture of the common carotid artery, which was required due to arterial tortousity and interruption.
Adult ; Aneurysm* ; Angiography ; Aorta, Thoracic* ; Carotid Artery, Common ; Circle of Willis ; Embolization, Therapeutic ; Humans ; Punctures

Background: and PurposeResponses to oral appliances (OAs) in obstructive sleep apnea (OSA) vary, and have not been fully evaluated in Korean patients. In this study we aimed to determine the efficacy of OAs for the first-line treatment of Korean patients with moderate or severe OSA. Methods: This multicenter prospective observational study included 45 patients with moderate or severe OSA that had been newly diagnosed between March 2017 and May 2018 and who underwent OA treatment for 1 month. Questionnaires were completed and polysomnography (PSG) was performed before and after OA treatment. The primary outcome measures were improvement in the absolute apnea-hypopnea index (AHI) and the percentage reduction in the AHI. The secondary outcomes were improvements in the questionnaire scores related to sleep-associated symptoms and PSG parameters. Results: The patients were aged 47.4±12.1 years (mean±SD), only two of them were female, and their AHI at baseline was 29.7±10.9/h. After OA treatment the AHI had reduced by 63.9±25.8%, with the reduction was similar between the patients with moderate OSA and those with severe OSA. Overall 31.1% of the patients achieved a normal AHI (<5/h), and 64.4% had an AHI of ≤10/h after the treatment. The body mass index (BMI) was the most reliable factor for predicting the percentage reduction in the AHI. The OAs also improved the sleep architecture and subjective sleep-related symptoms. Conclusions The OAs were effective in patients with moderate or severe OSA. The OAs reduced the mean AHI to 63.9% of the baseline value, and this reduction was influenced by the BMI.

BACKGROUND: Intravenous tissue-type plasminogen activator (tPA) is recognized as the standard treatment for ischemic stroke. However, its narrow therapeutic window and association with an increased risk of intracranial hemorrhage have required caution when used. In this context, several approaches are required to deal with the shortcomings of such a double-edged drug. Anesthetics are known to protect against ischemic reperfusion injury, and their protective role in ischemic post-conditioning is crucial for reducing ischemia-related injury. The aim of this study was to assess the effect of isoflurane post-treatment on intracranial hemorrhage and cerebral infarction after tPA treatment for transient cerebral ischemia. METHODS: Cerebral ischemia was modeled in male Sprague-Dawley rats (n = 32) by occluding the right middle cerebral artery for 1 h, followed by intravenous tPA administration. Rats were randomly divided into control and isoflurane post-treatment group, and isoflurane post-treatment group was post-treated by administering 1.5% isoflurane for 1 h from the start of reperfusion. Twenty-four h after reperfusion, neurobehavioral changes were assessed. The extent of cerebral infarction and intracranial hemorrhage were also assessed by quantification of infarction volume and cerebral hemoglobin concentration from brain tissue, respectively. RESULTS: Neurobehavioral testing showed better functional outcomes in the isoflurane post-treatment group than the control group. The extent of cerebral infarction and intracranial hemorrhage were both reduced in isoflurane post-treatment group compared to control group. CONCLUSIONS: Isoflurane post-treatment may mitigate infarction volume and intracranial hemorrhage in tPA-exaggerated brain injury. Our findings provide an encouraging novel approach for enhancing clinical outcomes in tPA-exaggerated brain injury.
Anesthetics ; Animals ; Brain ; Brain Injuries* ; Brain Ischemia ; Cerebral Infarction ; Humans ; Infarction ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Ischemic Postconditioning ; Isoflurane* ; Male ; Middle Cerebral Artery ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Stroke* ; Tissue Plasminogen Activator

BACKGROUND: Deregulated bcl-2 appears to prolong cell survival and to cooperative with c-myc in promoting cell proliferation. We investigated whether there is any clinicopathologic correlation between the survival and the frequency of bcl-2/JH rearrangement and bcl-2, c-myc protein expression in non-Hodgkin's lymphoma. METHODS: We conducted a study for bcl-2 mbr/JH rearrangement with polymerase chain reaction and for bcl-2, c-myc expression with immunohistochemical staining in 46 formalin-fixed, paraffin-embedded non-Hodgkin's lymphoma tissues of patients treated with CHOP chemotherapy including 37 specimens of diffuse large cell type. RESULTS: The bcl-2 mbr/JH rearrangement was positive in 13% (6/46) of non-Hodgkin's lymphoma specimens. For bcl-2, strong positive reaction (3+) and 2+ positive reaction were seen in 16 (35%) and 16 cases (35%), respectively; while 3+ and 2+ reactions were found in 20 (44%) and 16 cases (35%), respectively, for c-myc by immunohistochemistry. Eighty one percent of positive cases for bcl-2 were also positive for c-myc simultaneously. The 6 cases with bcl-2 mbr/JH rearrangement were weakly positive at 3 cases and strong positive at 3 cases for bcl-2 by staining. In cases of diffuse large cell lymphoma, high expression (3+) of bcl-2 & c-myc protein tended to have a shorter 2 year survival, though it was statistically not significant. CONCLUSION: High expression of bcl-2 and c-myc protein suggest that bcl-2 cooperate with c-myc in tumorigenesis of aggressive non-Hodgkin's lymphoma. The prognostic implication of bcl-2 and c-myc expression in diffuse large cell lymphoma patients needs to be evaluated in a larger, prospective cohort to draw a definitive conclusion.
Carcinogenesis ; Cell Proliferation ; Cell Survival ; Cohort Studies ; Drug Therapy ; Humans ; Immunohistochemistry ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin* ; Polymerase Chain Reaction

PURPOSE: To investigate the effect of intraperitoneal injection of IGF-I after hypoxic ischemic brain injury on neuronal cell necrosis, apoptosis and expression of proapoptotic and antiapoptotic proteins bax and bcl-2, respectively. METHODS: The right carotid artery was cut between the double ligation. Then allowed to recover for 30 minutes followed by exposure to 8% oxygen at 37degree C for 2 hours. Devided 2 groups, control group(N=30) and IGF-I treated group(N=30). IGF-I treated group received IGF-I 20 microg 2 hours after hypoxic ischemic injury intraperitoneally. Rates were decapitated at 24 hours and 72 hours following hypoxic ischemic brain injury. After then, right hippocampal CA1 and CA3 neuronsof rat brains were examined. RESULTS: The apoptosis and necrosis was significantly less in IGF-I treated group than control group and necrosis was more prominent in CA1 neurons than CA3 neurons. Necrosis was slightly decreased at 72 hours in both groups(P<0.05). The apoptosis was more prominent at 24 hours than 72 hours after hypoxic ischemic injury(P<0.05). Bax protein expression was prominent in control group, especially at 72 hours(P<0.05) and less in the IGF-I treated group than control group. Bcl-2 protein expression was not detected in both group. CONCLUSION: The results from this study suggest that exogenous systemic IGF-I had a neuroprotective effect by inhibition of up-regulation of bax protein expression after hypoxic ischemic brain injury.
Animals ; Apoptosis ; bcl-2-Associated X Protein ; Brain Injuries* ; Brain* ; Carotid Arteries ; Control Groups ; Injections, Intraperitoneal ; Insulin-Like Growth Factor I* ; Ligation ; Necrosis ; Neurons ; Neuroprotective Agents ; Oxygen ; Rats* ; Up-Regulation

Although various combinations of chemotherapy regimens have been tried for patients with esophageal cancer, their duration of survival is extremely poor. In this study, we investigated the safety and clinical efficacy of paclitaxel and cisplatin chemotherapy in metastatic or recurrent esophageal cancer. 32 patients enrolled in this study and the median age was 60 yr. Of all the 32, 28 patients (88%) had been treated previously, 22 of them with chemotherapy or radiation therapy. All patients in the study received biweekly paclitaxel (90 mg/m2) followed by cisplatin (50 mg/m2). One patient (3%) responded completely, and 12 patients (38%) showed a partial response; in 9 patients (28%) the disease remained stable, and in 10 patients (31%) it progressed. The objective response rate was 41%. The median duration of response was 4.8 months, and the median overall survival in all patients was 7 months. The 1-yr and 2-yr survival rates were 28.1% and 7.1%, respectively. Grade 3 or 4 of neutropenia and anemia were observed in 6 (19%) and 5 (16%) patients, respectively. The major non-hematologic toxicity was fatigue, but most of them could manageable. In conclusion, biweekly paclitaxel and cisplatin is effective in patients with metastatic or recurrent esophageal cancer.
Aged ; Anemia/chemically induced ; Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use ; Bone Neoplasms/drug therapy/secondary ; Cisplatin/administration & dosage/adverse effects ; Diarrhea/chemically induced ; Esophageal Neoplasms/*drug therapy/pathology ; Fatigue/chemically induced ; Humans ; Liver Neoplasms/drug therapy/secondary ; Lung Neoplasms/drug therapy/secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Nausea/chemically induced ; Neoplasm Recurrence, Local ; Paclitaxel/administration & dosage/adverse effects ; Survival Analysis ; Thrombocytopenia/chemically induced ; Time Factors ; Treatment Outcome ; Vomiting/chemically induced

BACKGROUND: CD34+ cells are capable of engraftment and hematopoietic reconstitution. However, expression patterns of other surface antigens such as CD13, CD33, CD38 and HLA-DR on CD34+ cells in mobilized peripheral blood have remained unclear. This study analyzed the expansion kinetics of the CD34+ cells and subsets in the peripheral blood of healthy donors treated with recombinant human Granulocyte Colony-Stimulating Factor (rhG-CSF), the relative composition of CD34+ subsets in mobilized peripheral blood and apheresis product, the yield of apheresis product. METHODS: The 6 peripheral blood stem cell donors received a daily dose of 500 microgram (8.1~10 microgram/kg) of rhG-CSF subcutaneously for 6 or 7 days. The hematologic parameters and the number of CD34+ cells and subsets in peripheral blood were recorded at baseline and daily for a total 6 to 7 days. With monoclonal antibodies which were designed for two color direct immnunofluorescence (IF) analysis with combination of fluorescence isothiocyanate (FITC) and phycoerythrin (PE) conjugated, CD34CD38, CD34HLA-DR, CD34CD13, and CD34CD33 surface antigens were analyzed by flow cytometry. RESULTS: The number of CD34+ cells mobilized to peripheral blood peaked at day 4 or 5 with rhG-CSF treatment. Circulating CD34+ cell expanded by 11.5-fold from 4.5 +/- 1.8x106/L before rhG-CSF treatment to maximal increment 51.9 +/- 13.4x106/L after mobilization. Subsets of CD34+CD38-, CD34+HLA-DR-, CD34+ CD13-, and CD34+CD33- (in % ofthe CD34+ cell) were all decreased and subsets of CD34+CD38+, CD34+HLA-DR+, CD34+CD13+, and CD34+CD33+ were all increased after mobilization, so that the numbers of early committed and myeloid committed progenitors were higher than the those of multipotent stem cells in mobilized peripheral blood and leukapheresed products. Each apheresis product yielded a mean of 451.6x106 (7.7x106/kg of RBW) CD34+ cell and 172.3x105 (2.9x105/kg of RBW) CFU-GM. CONCLUSION: Sufficient amount of CD34+ cells capable of engraftment and hematopoietic reconstitution can be mobilized by administration of rhG-CSF to healthy adult donor. Subsets of mobilized CD34+ cells were mainly composed of early committed and myeloid committed progenitors, although absolute numbers of all progenitor cells including multipotent stem cells were significantly increased.
Adult* ; Antibodies, Monoclonal ; Antigens, Surface ; Blood Component Removal ; Flow Cytometry ; Fluorescence ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Progenitor Cells ; HLA-DR Antigens ; Humans* ; Kinetics ; Multipotent Stem Cells ; Phycoerythrin ; Stem Cells ; Tissue Donors*

BACKGROUND: All-trans-retinoic acid (ATRA) induces complete remission (CR) in the great majority of patients with PML/RAR -positive acute promyelocytic leukemia (APL). However, it is associated with a rapid rise in leukocytes in one third to half the patients, with potentially fatal "ATRA syndrome". Furthermore, most of the patients relapse with maintenance therapy using ATRA alone or low-dose chemotherapy. In this study, we have analyzed the outcome for APL patients who were treated with ATRA alone or combined with low-dose chemotherapy followed by postremission chemotherapy in Chonnam University Hospital from April 1993 to December 1997. METHODS: Sixteen patients with newly diagnosed APL were eligible to analysis. Patients received 45mg/m2 ATRA until CR occurred. If initial WBC were above 5,000/microliter, low-dose chemotherapy was concomitantly given, and if during the ATRA therapy WBC were above 5,000/microliter by day 5 or 10,000/microliter by day 10, or 15,000/microliter by day 15, low-dose chemotherapy was added. Four polychemotherapy cycles or allogeneic bone marrow transplantation were given as postremission therapy. RESULTS: Median age was 34 years (range, 17 to 67). Of 16 APL patients, 15 (93.8%) achieved CR and 1 (6.2%) died of intracerebral hemorrhage. After a median follow-up of 11.5 months (range, 0 to 47), the Kaplan-Meier estimated overall survival (OS) rate was 87.1 +/- 8.6% at 3 year, the event-free survival (EFS) rate was 87.1 +/- 8.6%, 58.0 +/- 24.4% and 29.0 +/- 23.9% at 1 year, 2 year and 3 year, and the disease-free survival (DFS) rate was 92.9 +/- 6.9%, 69.6 +/- 20.7% and 46.4 +/- 23.5% at 1 year, 2 year and 3 year, respectively. CONCLUSION: The present study suggests that ATRA with or without low-dose chemotherapy followed by postremission chemotherapy is a well-tolerated and effective regimen that is shown to improve the CR rate, reduce a early mortality rate and considerably prolong the overall survival in patients with newly diagnosed APL.
Bone Marrow Transplantation ; Cerebral Hemorrhage ; Disease-Free Survival ; Drug Therapy* ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Jeollanam-do ; Leukemia, Promyelocytic, Acute* ; Leukocytes ; Mortality ; Recurrence ; Tretinoin*