BACKGROUND: Many investigations were done about pulmonary protection in lung transplantation which is the most effective treatment of end-stage pulmonary disease. The objective of this study is to verify the effect of prostacyclin on the ischemia-reperfusion injury in terms of the change of arterial blood gas (ABGA), pulmonary vascular resistance (PVR) and pulmonary water content. METHODS: In twelve mongrel dogs weighing approximately 20 kg, double-lumen endotracheal tube was intubated and Swan-Ganz catheter was inserted. To obtain control data for water content of left lung right postcaval lobe was resected. Left hilum was snared with umbilical tape after collapse of left lung and tightened to clamp. It was maintained for 90 min. Thereafter, ventilation and perfusion of left lung were restored. To control group (n=6), prostacyclin was not given. To prostacyclin group (n=6), prostacyclin was intravenously administered at 250 ng/kg/min for 20 min, just before ischemia and just after reperfusion. We measured hemodynamic variables and analyzed arterial blood gas before and after ischemia and then at every 1 hour interval. At 4 hours after reperfusion, left lung was resected, and water content was measured with wet-dry method. RESULTS: There was no significant difference between control group and prostacyclin group in ABGA, PVR and water content of lung. However, three subjects of prostacyclin group showed higher PaO2 after reperfusion than that of others. CONCLUSION: This study shows that protective effect of prostacyclin is not uniform in severely injured canine ischemia-reperfusion model. We conclude that prostacyclin does not have pulmonary protective effect in severe ischemia-reperfusion injury.
Animals ; Catheters ; Dogs ; Epoprostenol* ; Hemodynamics ; Ischemia ; Lung ; Lung Diseases ; Lung Transplantation ; Perfusion ; Reperfusion ; Reperfusion Injury* ; SNARE Proteins ; Vascular Resistance* ; Ventilation

BACKGROUND: PUVA has been used effectively in the treat,ment of vitiligo, but the mechanism by which PUVA stimulat.es melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and t,he incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes* ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo*

BACKGROUND: PUVA has been used effectively in the treat,ment of vitiligo, but the mechanism by which PUVA stimulat.es melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and t,he incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes* ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo*

BACKGROUND: Prostacyclin (PGI2) is a commonly used protective agent against pulmonary ischemia-reperfusion injury. In this study, it was postulated that the protective effect of PGI2 on pulmonary ischemia-reperfusion injury would differ according to the state of pulmonary expansion during ischemic injury. METHODS: Under general anesthesia, left pulmonary ischemia was induced by occluding the left hilum in 40 New Zealand white rabbits. They were allocated to four groups (n = 10 in each group). In groups I and II, ischemia was started with lungs inflated, and in groups III and IV, ischemia was started with lungs collapsed. PGI2 was infused only in groups II and IV at 250 ng/kg/min for 20 minutes just before and after the ischemic period. After 60 minutes of ischemia, reperfusion was maintained for 2 hours, and then the left lung was resected. ABGA and lung water fraction were measured to assess the severity of the ischemia-reperfusion injury. RESULTS: Compared to groups I and II, PaO2 decreased markedly in group III and moderately in group IV (P < 0.05). The PaCO2 of groups III and IV significantly differed from those of groups I and II (P< 0.05). The percent changes in lung water fraction were significantly higher in group III than in the other groups (P < 0.05). CONCLUSIONS: PGI2 infused before and after pulmonary ischemia produced a significant protective effect on ischemia- reperfusion injury in the collapsed lung group. In the expanded lung group, however, the effect of PGI2 was masked by lung expansion, which itself led to excellent pulmonary preservation against ischemia-reperfusion injury.
Anesthesia, General ; Epoprostenol* ; Inflation, Economic* ; Ischemia ; Lung Transplantation ; Lung* ; Masks ; Prostaglandins ; Rabbits ; Reperfusion ; Reperfusion Injury*

A dissociative anesthetic agent, ketamine has bronchodilating property and its bronchodilating effects in asthmatic patients have been apparent since earlier clinical studies. In this study, after anesthetizing patients who did not have any respiratory disease, we administered ketamine to the patients intravenously, and then monitored airway pressure to see the changes in respiratory mechanics indirectly. ASA physical status class 1 and 2 surgical patients who didn't have any respiratory disease were studied. Without premedication, fentanyl 3 mcg/kg, midazolam 0.1 mg/kg, thiopental 3 mg/kg and vecuronium 0.15 mg/kg were injected intravenously consecutively. Ventilation was controlled by face mask with O2-N2O(50%)-isoflurane(<0.5 vo1.%) for 5 minutes with closed circuit anesthetic machine(Physio-Flex). After intubation, anesthesia was maintained with O2-N2O(50%)-isoflurane(<0.5 vol.%) and controlled ventilation was done with tidal volume 9 ml/kg, respiratory rate 11/min and inspiratory flow was constant for each subject. When airway pressure was stabilized, ketamine 4 mg/kg was administered intravenously, Thereafter, for 20 minutes P(peak), P(plateau), P(mean), mean arterial pressure and heart rate were monitored every minute interval. Dynamic compliance, static compliance and resistance of the total respiratory system were calculated by inspiratory pressure method. The result is that ketamine does not produce significant changes in airway pressure, resistance and compliance of total respiratory system. In conclusion, ketamine does not have bronchodilating effect in normal pntients anesthetized with isoflurane of low concentration.
Administration, Intravenous* ; Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Compliance* ; Fentanyl ; Heart Rate ; Humans ; Intubation ; Isoflurane ; Ketamine* ; Masks ; Midazolam ; Premedication ; Respiratory Mechanics ; Respiratory Rate ; Respiratory System ; Thiopental ; Tidal Volume ; Vecuronium Bromide ; Ventilation

We report a case in which WPW (Wolff-Parkinson-White)-type preexcitation syndrome arose unexpectedly immediately after induction of general anesthesia on a 25-yr-old man who had another rare cardiac arrhythmia, parasystole. His preoperative ECG showed ventricular bigeminy and a delta wave was observed after induction of anesthesia with fentanyl, midazolam and propofol. Anesthesia was maintained with propofol, fentanyl and nitrous oxide. The intraoperative ECG showed varying and temporary responsiveness to drugs such as atropine, lidocaine and ephedrine. After we started to infuse the dobutamine, the delta wave, ventricular bigeminy disappeared on the intraoperative ECG. We should consider the influence of anesthesia-related agents on arrhythmia, and aim to prevent and manage tachyarrhythmias caused by this syndrome.
Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac ; Atropine ; Dobutamine ; Electrocardiography ; Ephedrine ; Fentanyl ; Humans ; Lidocaine ; Midazolam ; Nitrous Oxide ; Parasystole* ; Pre-Excitation Syndromes* ; Propofol ; Tachycardia ; Wolff-Parkinson-White Syndrome

No abstract available.
Pregnancy*

Ehlers-Danlos syndrome (EDS) is a rare inherited disorder of the connective tissue that is characterized by hyperextensible skin, hypermobile joints and abnormalities of the cardiovascular system. A 15-year-old girl with Ehlers-Danlos syndrome underwent thoracolumbar surgery for deformity correction. After surgery, an abdominal aortic rupture occurred, and she complained of abdominal distension had an abdominal circumference of 80 cm. Abdominal computed tomography revealed a pseudoaneurysm and a large hematoma at the retroperitoneum. She died of a massive hemorrhage during subsequent abdominal aortic surgery.
Adolescent ; Aneurysm, False ; Aortic Aneurysm, Abdominal ; Aortic Rupture ; Cardiovascular System ; Congenital Abnormalities ; Connective Tissue ; Ehlers-Danlos Syndrome ; Hematoma ; Hemorrhage ; Humans ; Joints ; Rupture ; Skin ; Spine

BACKGROUND: If epileptogenic foci are close to eloquent areas of the brain, awakening is needed for functional mapping during seizure surgery. In these cases adequate analgesia and sedation are needed. However sufficient dosage of intravenous anesthetics leads to many side effects. The authors used propofol and fentanyl infusion combined with scalp nerve block to reduce the severity of side effects from overdose of anesthetics. METHODS: The subjects were adult patients who would undergo awake craniotomy. After administering fentanyl 50~100 mcg intravenously, scalp nerve block was done to supraorbital, supratrochlear, auriculotemporal and lesser and greater occipital nerves of the surgical side with 0.25% bupivacaine containing 1 : 200,000 epinephrine. The anterior temporal region was infiltrated with the same local anesthetics. Oxygen was given by nasal cannula. During operation fentanyl was infused. Propofol was infused except during the awake period. Invasive arterial blood pressure, end-tidal CO2 and respiratory rate were monitored throughout the operation and arterial blood gas analysis was done intermittently. RESULTS: During total anesthesia time (410.3 39.9 min) propofol 16.2 6.3 mg/kg and fentanyl 11.9 3.7 mcg/kg were administered. The results of scalp nerve block were satisfactory. Brain swelling and transient decrease in respiratory rate were noticed in six patients and oxygen desaturation to 94% in one patient. All the patients were cooperative and the above problems were solved by reducing drug infusion rates. CONCLUSIONS: Propofol and fentanyl infusion with scalp nerve block may be an adequate method of anesthetic management for awake craniotomy.
Adult ; Analgesia ; Anesthesia ; Anesthetics ; Anesthetics, Intravenous ; Anesthetics, Local ; Arterial Pressure ; Blood Gas Analysis ; Brain ; Brain Edema ; Bupivacaine ; Catheters ; Craniotomy* ; Epinephrine ; Fentanyl ; Humans ; Nerve Block* ; Oxygen ; Propofol ; Respiratory Rate ; Scalp* ; Seizures

PURPOSE: There is no reported evidence for an anthropometric index that might link obesity to men's sexual health. We evaluated the ability of an anthropometric index and the symptom scores of five widely used questionnaires to detect men's health problems. We determined the predictive abilities of two obesity indexes and other clinical parameters for screening for lower urinary tract symptoms and sexual dysfunction in middle-aged men. MATERIALS AND METHODS: A total of 1,910 middle-aged men were included in the study. Participants underwent a detailed clinical evaluation that included recording the symptom scores of five widely used questionnaires. The participants' body mass index and waist-to-hip ratio were determined. Serum prostate-specific antigen, urinalysis, testosterone, estimated glomerular filtration rate, evaluation of metabolic syndrome, and transrectal ultrasonography were assessed. RESULTS: By use of logistic regression analysis, age and total prostate volume were independent predictors of lower urinary tract symptoms. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis symptoms. Age and metabolic syndrome were independent predictive factors for erectile dysfunction. Waist-to-hip ratio had a statistically significant value for predicting erectile dysfunction. CONCLUSIONS: Our data showed that total prostate volume is a significant predictor of lower urinary tract symptoms, and central obesity has predictive ability for erectile dysfunction. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis-like symptoms. The management of correctable factors such as waist-to-hip ratio and metabolic syndrome may be considered preventive modalities against the development of men's health problems.
Aging ; *Body Mass Index ; Erectile Dysfunction/*diagnosis ; Humans ; Logistic Models ; Lower Urinary Tract Symptoms/diagnosis ; Male ; *Men's Health ; Metabolic Syndrome X/*physiopathology ; Middle Aged ; Obesity ; Organ Size ; Prognosis ; Prostate/*ultrasonography ; Prostate-Specific Antigen/blood ; Prostatitis/*diagnosis ; Testosterone/blood ; Ultrasound, High-Intensity Focused, Transrectal ; *Waist-Hip Ratio