Spinal anesthesia is a type of regional anesthesia obtained by blocking the spinal nerves with the introduction of local anesthetic solutions into the subarachnoid space. Historically, in 1885 Corning accidentally introduced spinal anesthesia and in 1898 August Bier produced true spinal anesthesia in animal and man for the first time. Even though spinal anesthesia is widely used because of many advantages, headache, the most common untoward complication, has been said to be the greatest single deterrent to the patient who is considering this anesthetic technique. The obstetric patient is more likely to suffer from headache than the surgical patient after spinal anesthesia. Authors observed the incidence of post-spinal headache in 288 patients who received spinal anesthesia for cesarean section at department of anesthesiology in Ewha Womans University Hospital from March 1979 to February 1980. The patients were divided into 2 groups according to the needle size, used to perform spinal tap i.e. 22 and 25 gauge (G). The results obtained were as follows; 1) Among 288 cases, 63 cases underwent spinal anesthesia with 22 G and 225 cases with 25 G. 2) The indications for cesarean section were previous cesarean section(36. 8%), cephalopelvic disproportion(20.5%), malpresentation(10. 7%) and placenta previa(4. 2%) in order of frequency. 3) In the age distribution, the majority(72.6%) was in 20~29 years age group. 4) The incidence of headache was higher in the group of 22 G(17.8%) than in 25 G group (9. 8%), but there was no statistical significance. 5) The onset of headache was within 2 or 3 days after spinal anesthesia in both groups. 6) In the severity of headache, the group of larger size needle showed headache worse than that of small size needle. 7) In the location of headache, generalized headache developed in 54. 5% of cases in the group of 22 G needle and frontal headache developed in 40. 9% in the group of 25 G needle. 8) Ocular complication associated with headache noted in 2 cases of the group of 25 G needle. There was no auditory complication.
Age Distribution ; Anesthesia, Conduction ; Anesthesia, Spinal ; Anesthesiology ; Animals ; Cesarean Section* ; Clinical Study* ; Female ; Headache* ; Humans ; Incidence ; Needles ; Placenta ; Pregnancy ; Spinal Nerves ; Spinal Puncture ; Subarachnoid Space ; Zea mays

Direct laryngoscopy and endotracheal intubation cause increased arterial blood pressure and heart rates. These cirulatory effects are due to mechanical stimulation of the laryngopharynx and traches via efferent cervical sympathestic fibers. And various cardiac arrhythmias, even-cardiac arrest may occur by stimulation of the vague nerve during intubation. The present study observed the ECG and circulatory changes following i.v. injection of meperidine, 50 mg, and diazepam, 10mg, as primary i.v. anesthetic agents, for the purpose of the prevention of circulatory stimulation before laryngoscopy and tracheal intubation. This study was undertaken on eight-eight, ASA class l-ll patients of either sex undergoing elective surgical procedures in the Department of Anesthesiology at Ewha Womans University hospital. The results were as follows: 1) The increases of systolic blood pressure following intubation were markedly reduced in the pre-treated groups for both normotensive and hypertensive individuals. 2) Heart rates following intubation were markedly increased in all groups. 3) Transient abnormal findings in the ECG appeared in sixty-nine cases(78.4%) following intubation and the majority showed sinus tachycardia. 4) pH, PaCO2, and PaO2 values were within normal range following intubation in all groups.
Anesthesiology ; Anesthetics ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Pressure ; Diazepam* ; Electrocardiography ; Female ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy* ; Meperidine* ; Reference Values ; Surgical Procedures, Elective ; Tachycardia, Sinus

This study aimed to investigate the existence of GABA receptor and the mechanisms of action of GABA and diazepam of the trachealis muscle isolated from dog. Horizontal muscle strips of 2mm×15mm were prepared from canine trachea, and isometric myography in isolated muscle chamber bubbled with 95/5%-O₂/CO₂ at 36℃, at the pH of 7.4 was performed. Muscle strips contracted responding to the electrical field stimulation (ESP) by 2~20 Hz, 20 msec, monophasic square wave of 60 VDC. GABA and diazepam suppressed the EFS-induced contractions to the similar extent, significantly. (p<0.05). Bicuculline, a GABA(A) receptor antagonist blocked both GABA- and diazepam-inhibitions; but DAVA, a GABA(B) receptor antagoinst did not affect either of them. These results suggest than in the canine trachealis muscle, there may be only GABA(A) receptor, and GABA and diazepam inhibit the contractility via GABA(A) receptor.
Animals ; Bicuculline ; Diazepam ; Dogs ; gamma-Aminobutyric Acid* ; Hydrogen-Ion Concentration ; Myography ; Receptors, GABA ; Receptors, GABA-A ; Trachea

Analgetic effect of small amount of morphine on spinal and epidural anesthesia was investigated. Patients who received morphine showed marked analgetic effect compared to control group. It was found that the amount of morphine needed was larger for epidural anesthesia than for spinal anesthesia, the former being more than 2mg, and the latter less than 0.5mg. Spinal and epidural morhphine caused complications on several occasions: pruritis, respiratory depression with pinpoint pupil and urinary retention in spinal anesthesia, and nauses and pruritis in epidural anesthesia.
Anesthesia, Epidural ; Anesthesia, Spinal ; Humans ; Injections, Epidural* ; Morphine* ; Pruritus ; Pupil ; Respiratory Insufficiency ; Urinary Retention

Calcifying aponeurotic fibroma is a rare soft tissue tumor that mostly occurs in the distal extremities of children and adolescents. We report here on a case of calcifying aponeurotic fibroma of the right elbow in an 8-year-old boy, and the tumor was diagnosed by surgical excision. The patient complained of painless swelling and mild limitation of the range of motion of the elbow joint. Radiologically, the mass was ill-defined and showed stippled calcification with shallow bony erosion. Microscopically, the tumor was composed of spindle cells with nodular deposits of hyalination and calcification, and these deposits were surrounded by palisading polygonal plump cells. Immunohistochemically, the tumor showed a diffuse positive expression for CD99 and negativity for smooth muscle actin, S-100 protein and CD34. The patient has been well with no signs of recurrence during the 42 months after surgery.
Actins ; Adolescent ; Child ; Elbow ; Elbow Joint ; Extremities ; Fibroma ; Humans ; Hyalin ; Muscle, Smooth ; Range of Motion, Articular ; Recurrence ; S100 Proteins ; Soft Tissue Neoplasms

Exclusively dopamine producing retroperitoneal paragangliomas are extremely rare. We have experienced the first Korean case managed successfully based on the proper evaluation. A 26-year-old female patient came to our attention after the accidental detection of an adrenal mass. She had no symptoms and denied any family history. Laboratory evaluations were normal but serum dopamine (425 ng/L) and 24-hour urine dopamine levels (1,565.3 microg/day) were elevated. She underwent laparoscopic right adrenalectomy. Histopathological diagnosis was a paraganglioma. After operation, dopamine levels in serum and 24-hour urine dropped to 0.09 ng/L and 388.4 microg/day. Dopamine producing paraganglioma elicit no clinical symptoms. Only the dopamine level is elevated in serum and 24-hour urine samples. Surgical resection without using preoperative alpha blockage is the treatment of choice. The prognosis for patients with this tumor tends to be poor because the diagnosis is usually delayed due to lack of symptoms.
Adrenal Glands ; Adrenalectomy ; Adrenergic alpha-Antagonists ; Adult ; Dopamine ; Female ; Humans ; Korea ; Paraganglioma ; Pheochromocytoma ; Porphyrins ; Prognosis

The balance between tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) regulates fibrinolysis. PAI-1 expression increases in atherosclerotic arteries and vascular smooth muscle cells (VSMCs) are one of major constituents of atheroma. We investigated the impact of lysophosphatidylcholine (lysoPC), an active component of oxidized low-density lipoprotein, on the plasminogen activator system of the rat VSMCs. The lysoPC stimulated the protein and gene expressions of PAI-1 but did not affect the protein expression of t-PA. Fibrin overlay zymography revealed that lysoPC increased the activity of PAI-1 in the conditioned media, while concurrently decreasing that of free t-PA. Vitamin E inhibited the lysoPC-induced PAI-1 expression. Further, lysoPC increased the intracellular reactive oxygen species (ROS) formation. Caffeic acid phenethyl ester, an inhibitor of NF-kappaB, blocked this lysoPC effect. Indeed, lysoPC induced the NF-kappaB-mediated transcriptional activity as measured by luciferase reporter assay. In addition, genistein, an inhibitor of protein-tyrosine kinase (PTK), diminished the lysoPC effect, while 7,12-dimethylbenz[a]anthracene, a stimulator of PTK, stimulated PAI-1 production. In conclusion, lysoPC does not affect t-PA expression but induces PAI-1 expression in the VSMC by mediating NF-kappaB and the genistein-sensitive PTK signaling pathways via oxidative stress. Importantly, lysoPC stimulates the enzyme activity of PAI-1 and suppresses that of t-PA.
Animals ; Benz(a)Anthracenes/pharmacology ; Caffeic Acids/pharmacology ; Cells, Cultured ; Genistein/pharmacology ; Lipoproteins, LDL/metabolism ; Lysophosphatidylcholines/*pharmacology ; Muscle, Smooth, Vascular/cytology/*drug effects/metabolism ; NF-kappa B/antagonists & inhibitors/metabolism ; Oxidative Stress/drug effects ; Phenylethyl Alcohol/analogs & derivatives/pharmacology ; Plasminogen Activator Inhibitor 1/agonists/genetics/*metabolism ; Protein Kinase Inhibitors/pharmacology ; Protein-Tyrosine Kinases/antagonists & inhibitors/metabolism ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species/metabolism ; Signal Transduction/drug effects ; Tissue Plasminogen Activator/*metabolism ; Transcription, Genetic/drug effects ; Up-Regulation/drug effects ; Vitamin E/pharmacology

PURPOSE: The main limitation of the National Institutes of Health (NIH) consensus criteria is the biological and prognostic heterogeneity of tumors while the utility of the newly proposed UICC TNM staging system has not yet been validated. Our object is to compare the overall and disease-free survival (DFS) of patients with gastric gastrointestinal stromal tumors (GIST) using the UICC TNM staging system and the NIH consensus criteria and to determine the optimal risk stratification system for GIST.METHODS: Retrospective analysis of 164 patients who underwent operative management for primary gastric GIST between 1994 and 2004.RESULTS: The overall five-year survival rate was 89.6%. In the 149 patients who underwent an R0 resection, the five-year DFS rate was 86.3%. According to the NIH consensus criteria, the five-year survival rate after resection was 100% for patients in the very low-, low-, and intermediate-risk groups and 71.9% for patients in the high-risk group. The UICC TNM stages IA, IB, and II had the same survival rates (100%) and stage IIIA (75.0%) and stage IIIB (69.5%) showed no significant difference in survival compared to the NIH criteria, which precluded better risk stratification. The patients who were included in the high-risk group by NIH consensus criteria (>10 cm, ≤5/50 high power field) and were stage II by the UICC TNM staging system had a 100% five-year survival rate.CONCLUSION: Using the current schemes, one system does not demonstrate superior prognostic ability over the other. However, the high-risk group (T4/low mitotic rate) and stage II patients appear to be appropriately classified.
Classification ; Consensus ; Disease-Free Survival ; Gastrointestinal Stromal Tumors ; Humans ; National Institutes of Health (U.S.) ; Neoplasm Staging ; Population Characteristics ; Retrospective Studies ; Survival Rate

PURPOSE: The effect of different peritoneal dialysis (PD) modalities on the decline in residual renal function (RRF) is unclear due to inconsistencies among studies. In particular, the effect of automated peritoneal dialysis (APD) modalities [continuous cyclic peritoneal dialysis (CCPD) and nightly intermittent peritoneal dialysis (NIPD)] on RRF has not been examined in a large cohort. MATERIALS AND METHODS: We conducted a single-center retrospective study to investigate the association between PD modalities and decline in RRF in 142 incident PD patients [34 on CCPD, 36 on NIPD, and 72 on continuous ambulatory peritoneal dialysis (CAPD)]. RRF was measured within 2 months from PD start and at 1 year after PD initiation. RESULTS: The RRF at 1 year after PD initiation was 1.98+/-2.20 mL/min/1.73 m2 in CCPD patients and 3.63+/-3.67 mL/min/1.73 m2 in NIPD patients, which were moderately lower than 4.23+/-3.51 mL/min/1.73 m2 in CAPD patients (p=0.064). Moreover, there was no significant difference in the 1-year rate of decline of RRF between CCPD and NIPD patients, although APD patients had a faster 1-year RRF decline rate than CAPD patients (CCPD and NIPD vs. CAPD: -45.68 and -36.69 vs. 1.17%/year, p=0.045). APD was associated with a more rapid decline in RRF in patients with end-stage renal disease undergoing PD, although multivariate analysis attenuated the significance of this finding (beta=-31.50; 95% CI, -63.61 to 0.62; p=0.052). CONCLUSION: Our results suggest that CAPD might be more helpful than APD for preserving RRF during the first year of dialysis therapy, although there was no significant difference in the 1-year rate of decline of RRF between the two APD modalities.
Adult ; Female ; Glomerular Filtration Rate/physiology ; Humans ; Kidney/pathology/physiopathology ; Kidney Failure, Chronic/*therapy ; Male ; Middle Aged ; Peritoneal Dialysis/*adverse effects ; Retrospective Studies

A 74-year-old woman presented with edema in the lower extremities. Laboratory tests revealed anemia, thrombocytopenia, hypoalbuminemia, hypercholesterolemia, and nephrotic-range proteinuria. Myelodysplastic syndrome-refractory cytopenia with multilineage dysplasia (MDS-RCMD) was confirmed by bone marrow biopsy. Renal biopsy demonstrated membranous glomerulonephritis (MGN), stage I. Based on these clinicopathologic results, she was diagnosed as having MGN with MDS-RCMD. This is a rare case report of MGN in a parient with MDS-RCMD featuring nephrotic syndrome.
Aged ; Anemia ; Biopsy ; Bone Marrow ; Edema ; Female ; Glomerulonephritis, Membranous* ; Humans ; Hypercholesterolemia ; Hypoalbuminemia ; Lower Extremity ; Myelodysplastic Syndromes ; Nephrotic Syndrome ; Proteinuria ; Thrombocytopenia