PURPOSE: Various vasopressor agents are used to raise systemic vascular resistance (SVR) during liver transplantation. After grafted liver was reperfused, postreperfusion syndrome could be treated with various vasopressors. However, epinephrine can decrease the splanchnic perfusion and oxygen saturation and then hepatic blood flow would be jeopardized. Decreased hepatic blood flow might result in centrilobular necrosis which contributes to disruption of liver functions. We tried to know the effect of epinephrine on tissue perfusion of the liver. METHODS: In this study, measurement of hepatic microcirculation (HMC) and hemodynamic changes was performed in eight dogs to investigate the effect of vasopressors on hepatic microcirculation. Animals were divided into four groups in which low-dose epinephrine (0.05mug/Kg/min) and high-dose epinephrine (0.5mug/Kg/min) were randomly infused into the systemic vein and portal vein (1/6 of systemic dose) for ten minutes. Hepatic microcirculation was measured by Thermal Diffusion Probe. RESULTS: At low-dose systemic infusion of epinephrine, mean arterial bloodpressure (MABP), cardiac output (CO), and hepatic microcirculation (HMC) were significantly increased but systemic vascular resistance (SVR) was decreased. On high-dose epinephrine, MABP, CO (P=0.01), and SVR were significantly increased without changes of HMC. Intraportal infusion of low- and high-dose epinephrine increased hepatic vein pressure and SVR, respectively. CONCLUSION: These results would provide clues that systemic low-dose epinephrine infusion is enough to raise HMC and high-dose infusion of epinephrine to raise SVR could be used without jeopardizing HMC.
Animals ; Cardiac Output ; Dogs ; Epinephrine ; Hemodynamics ; Hepatic Veins ; Liver ; Liver Transplantation ; Microcirculation* ; Necrosis ; Oxygen ; Perfusion ; Portal Vein ; Thermal Diffusion* ; Transplants ; Vascular Resistance ; Vasoconstrictor Agents ; Veins

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation

The authors report two cases of successful reconstruction in infected nonunion of the femur involving marked shortening by compression and gradual distraction at the nonunion site using Ilizarov external fixator. At first, infection was controlled by radical excision & the administration of systemic antibiotics for four weeks and we also started compression at the nonunion site 3 days after operation. Autogenous iliac bone graft was added to strengthen the site of new bone formation lastly. In this report, the role of the compression seems to provide a good environment for distraction osteogenesis by focal necrosis and triggering inflammation. Compression and gradual distraction may be one of the treatment mordalities for nonunion of a long bone with massive bone loss or shortening, even infected.
Anti-Bacterial Agents ; External Fixators ; Femur* ; Inflammation ; Necrosis ; Osteogenesis ; Osteogenesis, Distraction ; Transplants

The aim of this study was to investigate the role of the 5-HT receptors in acetylcholine (ACh) release from the striatum. Slices from the rat striatum and synaptosomes were incubated with [3H]-choline and the release of the labelled products was evoked by electrical (3 Hz, 2 ms, 5 V/cm, rectangular pulses, 2 min) and potassium-stimulation (25 mM), respectively, and the influence of various serotonergic drugs on the evoked tritium outflows was investigated. Serotonin decreased the electrically-evoked ACh release in striatum in a concentration-dependent manner without the change of basal release. In hippocampal and entorhinal cortical slices, serotonin did not affect the evoked and basal release of ACh, but, at large dose (30 microM) decreased the evoked ACh release in hippocampus. 2,5-Dimethoxy-4-iodoamphetamine (DOI), a specific 5-HT 2A/2C agonist, decreased evoked ACh release in the striatum. CGS-12066A (5-HT 1B agonist), m-chlorophenyl-biguanide (5-HT 3 agonist) and 5-[(dimethyl -amino)methyl]-3-(1-methyl-1H-indol-3-yl)-1,2,4-oxadiazole (5-HT 3 antagonist) did not affect the evoked and basal ACh release in all tissues. Ritanserin, a specific 5-HT 2A/2C antagonist, blocked the inhibitory effects of serotonin and DOI, whereas, ketanserin, an another type of specific 5-HT 2A/2C antagonist did not affect the inhibitory effects of serotonin and DOI. In striatal synaptosomal preparation, serotonin and DOI did not affect the K +-evoked ACh release. These findings suggest that ritanserin-sensitive 5-HT 2A/2C receptors located in the soma and/or axons of the striatal cholinergic neurons play a important role in ACh release.
Acetylcholine* ; Animals ; Axons ; Carisoprodol ; Cholinergic Neurons ; Hippocampus ; Ketanserin ; Rats* ; Receptors, Serotonin* ; Ritanserin ; Serotonin Agents ; Serotonin* ; Synaptosomes ; Tritium

No abstract available.
Meconium* ; Peritonitis*

Alcohol withdrawal syndrome (AWS) is the most common and well-known condition occurring after intentional or unintentionalcessation or decreasing heavy drinking. Approximately 5-10% of these people are suffering from serious medical and psychiatricproblems, withdrawal seizures, perceptual disturbances, and delirium tremens. Despite acute medical conditions with the highmortality of severe AWS, proper management could decrease the severity and mortality of AWS. The Clinical Institute withdrawalassessment for alcohol-revised version is a valid, reliable, and sensitive instrument for assessing the clinical course and thetreatment monitoring of alcohol withdrawal. Benzodiazepine is the pharmacotherapy of choice for alcohol withdrawal. Diazepamor lorazepam treatment is best initiated early in the course of alcohol withdrawal to prevent progression to more severewithdrawal. There are three strategies for the pharmacotherapy of AWS. After the treatment of AWS, most patients should bemanaged or treated by the continuing care, including the psychosocial treatments, community-based management, and programsfor preventing recurrence of AWS.

Osteochondroma is a benign bone tumor that is most commonly found in the extremities and is prevalent in adolescents, with a peak incidence before the age of 20 years. Herein, we present a rare case of a 33-year-old man with an asymptomatic tumor on the right anterior rib that was pathologically confirmed to be a rib osteochondroma after surgical excision. We describe the computed tomography and magnetic resonance imaging (MRI) procedures and highlight the importance of MRI as a critical diagnostic tool for osteochondroma.

The cutaneous diseases associated with progesterone are autoimmune progesterone dermatitis, erythema multiforme- like eruption, drug-induced progesterone dermatitis and solar urticaria. Estrogen and progesterone are widely used in oral contraceptives and hormone replacement therapies, and they are rarely known to cause a photosensitive reaction. The mechanism of contraceptive-induced photosensitivity is uncertain. Estrogen, rather than progesterone, in the combined oral contraceptive pill has been most frequently implicated in the induction of photosensitivity. A 32-year-old woman presented with an erythematous patch with an itching sensation on the centrofacial area of a residual vitiligious lesion. She had a history of being previously treated with narrow band UVB for 1 year. Her skin lesions had mostly subsided, but some lesions continued. She underwent an in vitro fertilization-embryo transfer 3 months previously, and she then took synthetic progesterone for 3 weeks starting at the 4th week of pregnancy. She was in good health with neither a family history of photosensitivity nor a personal history of any other drug ingestion or topical agent such as sunscreen in association with the beginning of her lesions. Phototesting revealed her to be markedly photosensitive in the UVB and UVA ranges. The intradermal skin reactions to progesterone combined with irradiation with UVA or UVB were positive. We report here on an unusual case of photosensitivity that was localized in a vitiliginous lesion, and this was associated with the intramuscular injections of synthetic progesterone that she had received during an in vitro fertilization-embryo transfer.
Adult ; Autoimmune Diseases ; Contraceptives, Oral ; Dermatitis ; Eating ; Erythema ; Estrogens ; Female ; Hormone Replacement Therapy ; Humans ; Injections, Intramuscular ; Pregnancy ; Progesterone ; Pruritus ; Sensation ; Skin ; Urticaria

Milium-like syringoma is a rare variant of syringoma first described by Friedman and Butler in 1987. Clinically, it presents as milium, but histologically reveals syringoma with overlying keratin filled epidermoid cysts. It occurs predominantly on the periorbital area of middle-aged women. Syringomas on the genital area have rarely been reported. The lower portion of the cysts and keratin materials show positivity for CEA and negativity for CK7. The pathogenesis is not well defined, but there are some hypotheses, which include pruritus and increasing hormonal receptors (estrogen and progesterone receptors). We report a case of milium-like syringoma on the vulva.
Epidermal Cyst ; Female ; Humans ; Keratins ; Progesterone ; Pruritus ; Syringoma ; Vulva

Lichen nitidus is a rare and chronic inflammatory dermatosis first described by Pinkus in 1907. The etiology of it is still unknown and the majority of instances appear in children and young adults. The lesions are usually asymptomatic but may be mildly pruritic and the Koebner phenomenon may be observed. It is characterized by flesh-colored, minute, shiny papules occurring on the genitalia, abdomen, chest, and extremities. This disorder is most often localized, but there are rare reports of patients having a more generalized distribution of lesions. Although lichen nitidus is self-limited in most cases without any sequelae, the course of generalized lichen nitidus is unpredictable. We report a case of a 16-year-old girl diagnosed by generalized lichen nitidus refractory to general treatment and successfully treated with low dose cyclosporine (2 mg/kg/day).
Abdomen ; Adolescent ; Child ; Cyclosporine* ; Extremities ; Female ; Genitalia ; Humans ; Lichen Nitidus* ; Lichens* ; Skin Diseases ; Thorax ; Young Adult