Inadvertent application of ionizing radiation, a valuable tool in diagnostic radiology and radiotherapy, results in injury and death of adjacent normal cells, inducing gene mutations or even producing latent cancers. Captopril, an angiotensin I converting enzyme (ACE) inhibitor, has been reported to prevent the structural and functional changes in variable organs, such as lung and kidney, from radiation injury in different experimental animal models. An experiment was carried out to elucidate the radiation-induced histomorphologic changes of small intestine, especially jejunum, and to determine whether captopril can reduce or prevent the radiation-induced injuries in jejunum. Twenty-six healthy Sprague-Dawley rats were used. Experimental group (n=24) was divided into two large groups: the first one (n=16) was treated with two different single dose (9 Gy, 17 Gy) irradiation only and was sacrificed at 12 hours and at 8 weeks following irradiation; the second one (n=8) received captopril 500 mg/l per oral continuously after same doses of irradiation and was sacrificed at 8 weeks. The control group (n=2) was maintained on a stock diet in a same period of experimental group and sacrificed coincidentally. On light and electron microscopy, the 9 Gy and 17 Gy 12 hours groups revealed frequent apoptosis and necrosis but extremely decreased mitotic figures of the crypt cells. However, the 9 Gy and 17 Gy 8 weeks groups and the combined irradiation with captopril groups showed extremely reduced apoptosis and necrosis with increased mitotic figures. There was good correlation between experimental groups in apoptotic count and mitotic count (p<0.05). In the 9 Gy and 17 Gy 12 hours groups, the mucosal surface was focally or diffusely fragmented and the villi were slightly to moderately distorted. Collagen deposition was very mild and confined to the lower portion of the lamina propria. The 9 Gy and 17 Gy 8 weeks groups showed more severe mucosal surface fragmentation even with foci of erosion, short and distorted villi, and more intense collagen deposition. In contrast, the combined irradiation with captopril groups revealed complete regeneration of the mucosal surface epithelium and absent collagen deposition. These findings suggest that the acute radiation injuries to small intestine occur principally in the mucosal crypt cells. Captopril, the ACE inhibitor, might provide a useful intervention in the radiation injuries of intestinal mucosa.
Animals ; Apoptosis ; Captopril ; Collagen ; Diet ; Epithelium ; Intestinal Mucosa* ; Intestine, Small ; Jejunum ; Kidney ; Lung ; Microscopy, Electron ; Models, Animal ; Mucous Membrane ; Necrosis ; Peptidyl-Dipeptidase A ; Radiation Injuries ; Radiation, Ionizing ; Radiotherapy ; Rats* ; Rats, Sprague-Dawley ; Regeneration

Tissue engineering can serve as an alternative treatment for a malfunctioning or lost organ. Isolated and expanded cells adhere to a temporary scaffold, proliferate, and secrete their own extracellular matrices (ECM) replacing the biodegrading scaffold. The genitourinary system, composed of the kidney, ureter, bladder, urethra, and genital organs, is exposed to a variety of possible injury sites from the time of fetal development. All the urinary organs are mainly composed of smooth muscle and uroepithelial cells and which may be approached by tissue engineering techniques. A large number of materials, including naturally-derived and synthetic polymers have been utilized to fabricate prostheses for the genitourinary system. Usually, whenever there is a lack of native urologic tissue, reconstruction is considered with native non-urologic tissue, such as, gastrointestinal segments, or skin or mucosa from multiple body sites. Engineering tissues using selective cell transplantation may provide a means to create functional new genitourinary tissues. This review concerns urinary tissues reconstructed with bladder uroepithelial cells and smooth muscle cells (SMCs) implanted on biodegradable polymer matrices.
Animal ; Biomedical Engineering*/methods ; Bioreactors ; Cytological Techniques/trends ; Human ; Stem Cells/physiology ; Urinary Tract*

Seven fibrovascular diabetic preretinal membranes were examined with lightmicroscophic immunohistochemical stain and electron-microscopy to evaluate the possibility of pericytes to be involved in membrane contraction. Pericytes were positively stained with anti-actin antibody together with some stromal cells thought to be myofibroblasts presumedly. On transmission electron microscopic study, pericytes were highly active with numerous cytoplasmic processes and contained abundant microfilaments considered as actin in their cytoplasm. Pericyte/endothelial cell ratio of vascular channels were increased in some actively proliferative portion of the membranes. Myofibroblasts that contain abundant cytoplasmic microfilaments were also demonstrated in the extravascular stroma of the membranes and were very similar to the pericytes morphologically. Although the evidence that the pericytes are related to the origin of the myofibroblasts could not be demonstrated, this study suggested that the pericytes may play important roles in development and contraction mechanism of fibrovascular diabetic preretinal membranes.
Actin Cytoskeleton ; Actins ; Cytoplasm ; Membranes* ; Myofibroblasts ; Pericytes* ; Stromal Cells

STUDY DESIGN: Clinical and radiographic results of spine fracutre treated with pedicle screws and hooks were reviewed. OBJECTIVES: Evaluate the efficacy of tile pedicle screw and hook for thoracolumar bursting fracture. SUMMARY OF LITERATURE REVIEW: Despite of the mechanical advantage of the pedicle screw, the metal failure in short segment fusion has been reported. A biomechanical study showed additional laminar hook increased rotational strength. MATERIALS AND METHODS: Between 1994 and 1996, seventeen patients who had a Denis type B bursting fracture of the thoracolumbar spine were treated by posterior instrumentation with pedicle screws and laminar hooks and auterior interbody fusion after partial corpectomy. They have been followed for an average of 13.4 months. RESULTS: At last follow-up, radiographs showed successful fusion of the injured spinal segment in all patient. The subsidence of grafts which were used In anterior interbody fusion was an average of 0.76mm. There was a loss of 2.6 degrees on average in the correction of the kyphosis. No patients had screw breakage or loosening. CONCLUSIONS: We concluded that posterior fixation with screws and hooks, anterior decompression by partial corpectomy, and strut-grafting in patient who had a Denis type B bursting frafture of the thoracolumbar spine yielded good radiographic and functional results.
Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Spine* ; Transplants

Cluster headache is a severe pain syndrome with a piercing, tearing sensation, nicknamed the suicide headache. It is associated with an autonomic symptom. No effective therapy is available in approximately 4-15% of patients with cluster headache. One of the treatment methods is occipital nerve block. It is conventionally performed with local anaesthetics, and in this case we used the botulinum toxin type A. Botulinum toxin is an effective therapeutic agent for various disorders, and has recently been discovered to be an effective treatment for chronic migraine. The efficacy of Botulinum toxin in headache invokes possible neurogenic effects that may reduce or even prevent sensitization of both the peripheral and central nervous system. Therefore, we describe a case of a 45-year-old male with a cluster headache that could not be controlled with conventional therapy. We performed botulium toxin type A therapy. Cluster headache VAS showed improvement after occipital nerve block using the botulinum toxin A.
Botulinum Toxins ; Botulinum Toxins, Type A ; Central Nervous System ; Cluster Headache ; Headache ; Humans ; Male ; Middle Aged ; Migraine Disorders ; Nerve Block ; Sensation ; Suicide

BACKGROUND: Electroconvulsive(ECT) or electroshock therapy(EST) remains controversial and its indications are still the subject of discussion. Despite both medical and legal opposition, it is still widely practiced. The aim of ECT is to produce a grand mal seizure rather than the electrical stimulus which is responsible for the therapeutic effect. This causes widespread physiological changes, particularly affecting the cardiovascular and nervous system. The anesthetic agents for ECT should provide a smoooth rapid induction, a rapid recovery and attenuation of the physiologic effect of ECT. METHODS: Propofol(1 mg/kg) and thiopental sodium(2 mg/kg) were compared as anesthetic agents for ECT in 20 patients on four occasions in a repeated measure crossover study. In each patients receiving propofol or thiopental sodium on different occasions, arterial pressure, heart rate, seizure duration and recovery time were recorded. RESULTS: The incidence of discomfort on injection was significantly higher with propofol (47.5%) compared to thiopental sodium (2.5%). The duration of seizure with propofol was 37+/-11.3 sec and thiopental sodium was 41.2+/-11.6 sec but it was not significant(P=0.11). The increase in systolic and diastolic arterial pressure and heart rate were higher with thiopental sodium. Recovery time was significantly shorter with thiopental sodium (476.5+/-47.7 sec) compares to propofol (506.6+/-62.2 sec) (P<0.05). CONCLUSIONS: Propofol is more effective than thiopental sodium at obtunding the hypertensive to ECT without causing significant hypotention.
Anesthetics ; Arterial Pressure ; Cross-Over Studies ; Electroconvulsive Therapy* ; Electroshock ; Heart Rate ; Humans ; Incidence ; Nervous System ; Propofol* ; Seizures ; Thiopental*

In obsterics and gynecology laparoscopic surgery is increasing in numbers and gaining wide popularity replacing classical laparotomy and is becoming new trend in surgical fields. Laparoscopic surgery is favoured over the classical laparotomy because of numerous advantages but it can cause complications by insuffulatory CO2 to induce artificial pneumoperitoneum. Therefore, wide knowledges and thorough understandings of anesthesiologist on the prevention of complications and their treatments are essential. Authors present one case that the patient developed subcutaneous emphysema and ateleciasis on right upper lobe, pulmonary edema in left side lung resulting from inadvertent one lung ventilation during laparoscopic hysterectomy under general anesthesia and on trendelenberg position.
Anesthesia, General* ; Gynecology ; Humans ; Hysterectomy* ; Laparoscopy ; Laparotomy ; Lung ; One-Lung Ventilation* ; Pneumoperitoneum, Artificial ; Pulmonary Edema ; Subcutaneous Emphysema*

BACKGOUND: Disruption of the blood-brain barrier (BBB) can alter the internal milieu and may increase the release of excitatory amino acid neurotransmitters or catecholamines, which may affect metabolic rate or coupling. This study was performed to evaluate whether disruption of BBB by unilateral intracarotid injection of hyperosmolar mannitol would alter oxygen supply/consumption balance in the ipsilateral cortex. METHODS: Rats were anesthetized with 1.4% isoflurane using mechanical ventilation via tracheostomy. 25% mannitol was administered at a rate of 0.25 mlxkg-1s-1 for 30 s through unilateral internal carotid artery. The BBB transfer coefficient (Ki) of 14C-alpha-aminoisobutyric acid was measured in one group (N=7) after administering mannitol. Regional cerebral blood flow (rCBF), regional arterial and venous O2 saturation and O2 consumption were measured in another group using a 14C-iodoantipyrine and microspectrophotometry (N=7). RESULTS: Vital signs were similar before and after administering mannitol. Ki was significantly higher in the ipsilateral cortex (IC) than in the contralateral cortex (CC), (22.3+/-8.4 vs 4.4+/-1.1 microliterxg-1min-1). rCBF was similar between IC (105+/-21 mlxg-1min-1) and the CC (93+/-20). Venous O2 saturation was lower in the IC (43+/-7%) than in the CC (55+/-4). O2 consumption was higher in the IC (9.6+/-3.0 mlx100 g-1min-1) than in the CC (6.7+/-1.5). CONCLUSIONS: Our data suggested that increasing permeability of the BBB increased cerebral O2 consumption and deteriorated cerebral oxygen balance.
Animals ; Blood-Brain Barrier* ; Brain ; Carotid Artery, Internal ; Catecholamines ; Excitatory Amino Acids ; Isoflurane ; Mannitol ; Microspectrophotometry ; Neurotransmitter Agents ; Oxygen* ; Permeability ; Rats ; Respiration, Artificial ; Tracheostomy ; Vital Signs

BACKGROUND: Double lumen endobronchial tube and single lumen tube with bronchial blocker are most frequently used tubes for one lung anesthesia. This study compared the double lumen endobronchial tube with the single lumen tube with bronchial blocker to determine whether there were objective advantages of one over the other during one lung anesthesia. METHODS: Sixty patients were randomly assigned to one of two groups. Thirty patients were intubated with a left-sided double lumen endobronchial tube, and thirty patients were intubated with a single lumen tube with bronchial blocker. Each group was subdivided into two groups with a person intubating (i,e, certified anesthesiologist or resident) to compare the easiness of intubation according to the type of tube. Fiberoptic flexible bronchoscope was used in all patients. The following were studied 1) time required to position each tube until satisfactory placement achieved, 2) frequency of malposition after initial placement with fiberoptic bronchoscopy, 3) surgical exposure ranked by surgeons blinded to type of tube used, 4) easiness of tracheobronchial toilet (TBT). RESULTS: 1) Statistically significant differences were observed in time required to place each tube by resident(double lumen tube 5.73+/- 0.48 min. versus single lumen tube with bronchial blocker 4.18+/-0.70 min (P<0.05) and in easiness of TBT (double lumen tube 18/30 versus single lumen tube with bronchial blocker 27/30) (P<0.05). 2) No differences were observed in time required to position each tube by anesthesiologist, the frequency of malposition and surgical exposure. CONCLUSIONS: Single lumen tube with bronchial blocker is better in easiness of intubation by resident and in easiness of TBT than double lumen endobronchial tube. But the selection of two tubes depends upon type of surgery and familiarity of each tube by the anesthesiologist.
Anesthesia* ; Bronchoscopes ; Bronchoscopy ; Humans ; Intubation ; Lung* ; Recognition (Psychology)

BACKGROUND: The analytical performance of the Vitros ECi(R) Immunodiagnostic System on the thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and estradiol (E2) assays, which are based on electrochemical luminescence to replace the radioimmunoassay was evaluated. METHODS: The precision as measured by the NCCLS protocol and a comparison of the method were done for each TSH, FT3, FT4, and E2 assay. The functional sensitivity and linearity tests were performed for both TSH and E2. The free hormone validity test was performed for both the FT3 and FT4. RESULTS: All four analytes showed an acceptable precision. The functional sensitivities of TSH and E2 were 0.007 mIU/L, and 87 pmol/L, respectively. TSH and E2 showed excellent linearity up to 78 mIU/mL, and up to 7,700 pmol/L, respectively. The free hormone validity test showed acceptable results demonstrating accurate free hormone determination. The E2 showed a significant proportion-al bias requiring an adjustment of the reference range, However, the other analytes showed good agreement with a slight proportional bias. CONCLUSIONS: The TSH, FT3, FT4, and E2 assay by Vitros ECi(R) exhibited excellent performance overcoming the drawbacks of a conventional radioimmunoassay.
Bias (Epidemiology) ; Estradiol* ; Luminescence ; Radioimmunoassay ; Reference Values ; Thyrotropin ; Thyroxine* ; Triiodothyronine*