Clonidine, an a2-adrenergic agonist, has sedative and analgesic properties and reduces the inhalation anesthetic requirement and modifies the hemodynamic responses to surgery. But occasionally, severe bradycardia and hypotensian during inhalation anesthesia develops following oral clonidine premedication. To predict intraoperative hemodynamic changes during enflurane anesthesia, author evaluated noninvasive autonomic tests consisted of respiratory sinus arrhythmia (RSA), Valsalva's maneuver (VSV), R-R interval difference in head up tilt (HTR) and diastolic blood pressure difference in head up tilt (HTP) in fifty-one patients (ASA physical status I~II ) scheduled for elective surgery. Patients were received 5 ug/kg of oral clonidine at 90 min before operation. Anesthesia was maintained with enflurane, oxygen (2 liter/min) and nitrous oxide (2 liter /min). The enflurane concentration was controlled to maintain blood pressure within +/-20% of preinduction value. After anesthesia, patients were allocated to two groups according to above and below 0.5 MAC (0.84 vo1%) enflurane concentration. Each preoperative autonomic test results revealed significant correlation with heart rate (HR), mean arterial pressure (MAP), and enflurane concentration (EC), respectively (p<0.05). Values of RSA, HTR, HTP, MAP and HH wm 81+/-14.4 ms, 76+/-43.5 ms, -6+/-5.2 mmHg, 76+6.4 mmHg and 63+/-5.5 beats/min, respectively in below 0.5 MAC enflurane concentration group and were significantly different from values of RSA; 16933.7 ms, HTR; 175+/-41.7 ms, HTP; 6+/-3.1 mmHg, MAP; 90+/-11.0 mmHg and HR; 76+/-7.6 beats/min in above 0.5 MAC enflurane concen- tration group (p<0.05). In conclusion, the simple noninvasive autonomic tests are recommended in prediction of intra-operative hemodynamic changes during enflurane anesthesia when oral clonidine premedication is indicated.
Anesthesia* ; Anesthesia, Inhalation ; Arrhythmia, Sinus ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Clonidine* ; Enflurane* ; Head ; Heart Rate ; Hemodynamics* ; Humans ; Inhalation ; Nitrous Oxide ; Oxygen ; Premedication ; Valsalva Maneuver

Clonidine, an a2-adrenergic agonist, has sedative and analgesic properties and reduces the inhalation anesthetic requirement and modifies the hemodynamic responses to surgery. But occasionally, severe bradycardia and hypotensian during inhalation anesthesia develops following oral clonidine premedication. To predict intraoperative hemodynamic changes during enflurane anesthesia, author evaluated noninvasive autonomic tests consisted of respiratory sinus arrhythmia (RSA), Valsalva's maneuver (VSV), R-R interval difference in head up tilt (HTR) and diastolic blood pressure difference in head up tilt (HTP) in fifty-one patients (ASA physical status I~II ) scheduled for elective surgery. Patients were received 5 ug/kg of oral clonidine at 90 min before operation. Anesthesia was maintained with enflurane, oxygen (2 liter/min) and nitrous oxide (2 liter /min). The enflurane concentration was controlled to maintain blood pressure within +/-20% of preinduction value. After anesthesia, patients were allocated to two groups according to above and below 0.5 MAC (0.84 vo1%) enflurane concentration. Each preoperative autonomic test results revealed significant correlation with heart rate (HR), mean arterial pressure (MAP), and enflurane concentration (EC), respectively (p<0.05). Values of RSA, HTR, HTP, MAP and HH wm 81+/-14.4 ms, 76+/-43.5 ms, -6+/-5.2 mmHg, 76+6.4 mmHg and 63+/-5.5 beats/min, respectively in below 0.5 MAC enflurane concentration group and were significantly different from values of RSA; 16933.7 ms, HTR; 175+/-41.7 ms, HTP; 6+/-3.1 mmHg, MAP; 90+/-11.0 mmHg and HR; 76+/-7.6 beats/min in above 0.5 MAC enflurane concen- tration group (p<0.05). In conclusion, the simple noninvasive autonomic tests are recommended in prediction of intra-operative hemodynamic changes during enflurane anesthesia when oral clonidine premedication is indicated.
Anesthesia* ; Anesthesia, Inhalation ; Arrhythmia, Sinus ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Clonidine* ; Enflurane* ; Head ; Heart Rate ; Hemodynamics* ; Humans ; Inhalation ; Nitrous Oxide ; Oxygen ; Premedication ; Valsalva Maneuver

No abstract available.
Aneurysm, False* ; Carotid Artery, Internal* ; Epistaxis*

Capasicin, a neurotoxin extracted from red peppers, has selective effects on peptide-containing C-fiber and induces the release of neuropeptides from sensory nerve endings. Mast cells and neuropeptide-containing nerve fibers occur in close proximity throughout in the airway mucosa, around blood vessls in the smooth muscle, and beneath the epithelium. Capsaicin stimuli trigger these sensory nerve fibers to release neuropeptides, which may then initiate the process of neurogenic inflammation. Neurogenic inflammation denotes the vasodilatation and vascular permeability changes that follow neuropeptide-induced mast cell antivation. The purpose of this study was to determine whether capsaincin could induce mast cell activation in vivo. For this, effects of capsaincin on the ear swelling of mouse, degranulation of skin and mesenteric mast cells, and vascular permeability of rat in vivo were measured. We found that in vivo capsaicin induced the ear swelling of mouse, degranulation of skin and mesenteric mast cells in a dose-dependent fashion. Additionally capsaicin caused to increase of vascular permeability. These results suggest that capsaicin induces inflammation through activations of mast cell.
Animals ; Capillary Permeability ; Capsaicin ; Capsicum ; Ear ; Epithelium ; Inflammation ; Mast Cells* ; Mice ; Mucous Membrane ; Muscle, Smooth ; Nerve Fibers ; Neurogenic Inflammation ; Neuropeptides ; Rats ; Sensory Receptor Cells ; Skin ; Vasodilation

Stent dislodgement is a rare complication of complex percutaneous coronary artery intervention and is often associated with significant morbidity. We report a case of stent dislodgement complicated by coronary artery dissection and acute total occlusion of left circumflex coronary artery. Direct expansion of the dislodged stent was performed using parallel wire technique and small balloon. An overlapping stent was implanted for remained coronary artery dissection. Coronary artery flow was restored and ST segment elevation was normalized after successful intervention.
Coronary Vessels ; Stents

Atrial natriuretic peptide (ANP), a 28 amino acid basic polypeptide, is known to induce histamine release from human and rat mast cells in vitro and cause a wheel formation in rat skin. However, cellular events associated with histamine release are not clearly understood. In this study, we have examined the calcium flux and cGMP formation associated with histamine release in the ANP-treated mast cells. ANP, in vitro, induced mast cell degranulation and histamine release in a dose-dependent manner. ANP also induced an enhanced calcium uptake into cells and increased the cellular level of cGMP in mast cells. A high level of calcium in the media caused an inhibition of ANP-dependent histamine release but enhanced the level of intracellular cGMP of mast cells. ANP inducing a dose-dependent increase in vascular permeability of rat skin was confirmed by the extravasation of the circulating Evans blue. The results indicate ANP induced the histamine release and an increase in vascular permeability through mast cell degranulation in cGMP-independent and calcium uptake-dependent manner.
Animal ; Atrial Natriuretic Factor/*pharmacology ; Biological Transport ; Calcium/*metabolism ; Capillary Permeability ; Cell Degranulation ; Cyclic GMP/*metabolism ; Dose-Response Relationship, Drug ; *Histamine Release ; Mast Cells/*drug effects ; Peritoneal Cavity/cytology ; Rats

Pericarotid syndrome is the combination of a postganglionic Horner's syndrome and ipsilateral head and facial pain, which is caused by diverse pathologic processes in and around the internal carotid artery. We report a case of peri-carotid syndrome which presented Horner's syndrome and ipsilateral periodic severe hemicrania associated with malig-nant lymphma lapping internal carotid artery. After surgical removal of the mass and chemotherapy, miosis, ptosis, and ipsilateral hemicrania improved.
Carotid Artery, Internal ; Drug Therapy ; Facial Pain ; Head ; Headache ; Horner Syndrome ; Lymphoma* ; Miosis ; Pathologic Processes

Choriocarcinoma is a malignant tumor arising from chorionic villi following normal or abnormal gestation. It rarely originates in the extragonadal region such as retroperitoneum and mediastinum. In these extragonadal choriocarcinomas, primary gastric choriocarcinoma is extremely rare. A 37-year old woman with primary choriocarcinoma of the stomach presented with amenorrhea and anemia. Serum level of beta-hCG was moderately elevated. There was gastric choriocarcinoma with histologic pattern of adenocarcinoma. We wish to report the extremely rare finding of a choriocarcinoma occurring as a primary gastric neoplasm with gynecologic symptom.
Adenocarcinoma ; Adult ; Amenorrhea ; Anemia ; Choriocarcinoma* ; Chorionic Villi ; Female ; Humans ; Mediastinum ; Pregnancy ; Stomach ; Stomach Neoplasms

PURPOSE: We evaluated the predictors of biochemical recurrence (BCR) and clinical progression in order to stratify the risk of developing biologically significant disease following radical perineal prostatectomy (RPP). MATERIALS AND METHODS: Retrospective data was collected on 198 patients who underwent RPP for the treatment of clinically localized prostate cancer between June 1995 and October 2003. With multivariate analysis using a Cox regression test, several clinical and pathological variables were evaluated for the prediction of BCR following RPP. The probability of BCR-free survival was determined using the Kaplan-Meier method. Using PSA kinetics, the log slope prostate-specific antigen (PSA) was measured in each one of the 168 patients who had either >or= 2 PSA determinations at least 12 months apart following prostatectomy or a great increase of PSA in a brief period after surgery. Log slope PSA, time to BCR and pathologic features were evaluated for the prediction of metastatic progression of prostate cancer after BCR. RESULTS: Fifty patients (25%) had BCR during a mean follow-up of 30 months (range, 6-102 months). The rates of BCR-free survival at 3 and 5 years were 72% and 66% for the total population, and 91% and 84% for those with pathologically organ confined cancers, respectively. Among several variables, clinical stage, pathology Gleason score, and extraprostatic extension were the significant independent predictors of BCR. In six out of the 50 patients with BCR, distant metastatic progression was noticed. Log slope PSA and time to BCR were the predictors of metastatic progression. CONCLUSIONS: Pathology Gleason score, clinical stage, and extraprostatic extension were the independent predictor for BCR following RPP. Patients with a high log slope and short time to BCR may be identified early and placed on systemic therapy.
Follow-Up Studies ; Humans ; Kinetics ; Multivariate Analysis ; Neoplasm Grading ; Neoplasm Metastasis* ; Pathology ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy* ; Prostatic Neoplasms* ; Recurrence* ; Retrospective Studies

Primary Pulmonary leiomyosarcomas are rare tumors. These tumors may arise at any level of the lung in which smooth muscle fibers are found. The highest incidence of sarcoma is during the fourth decade whereas for bronchogenic carcinoma the maximum incidence is during the sixth and seventh decades. Leiomyosarcomas are aggressive and progressive. Treatment is mainly surgical. The chemotherapy is ineffective and the effectiveness of radiotherapy depends on the total dose of irradiation. Prognosis and significant survival rate are related to the size of the lesion. We report one patient with primary pulmonary leiomyosarcoma involving the right lower lung.
Carcinoma, Bronchogenic ; Drug Therapy ; Humans ; Incidence ; Leiomyosarcoma* ; Lung ; Muscle, Smooth ; Prognosis ; Radiotherapy ; Sarcoma ; Survival Rate