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

PURPOSE: To evaluate the clinical utility of performing fluorescence in situ hybridization(FISH) in voided urine specimens for the diagnosis and surveillance of bladder cancer, we compared the results of FISH with the results of urine cytology. MATERIALS AND METHODS: Voided urine samples from 196 patients were obtained for performing FISH and urine cytology. The bladder cancer group consisted of 76 patients who had biopsy-proven bladder cancer, and the control group was 120 patients without bladder cancer. FISH was performed using the UroVysion kit. The sensitivity and specificity of FISH were determined and compared with that of urine cytology. RESULTS: The overall sensitivity for FISH was significantly higher than the corresponding value for urine cytology(50% vs. 23.7%, respectively, p= 0.001). The specificities for FISH and cytology were 97.5% and 99.2%, respectively. When analyzing the results concerning the T-category, the sensitivity of FISH and cytology was 22.9% and 8.6% for pTa, 79.2% and 45.8% for pT1, and 54.5% and 9.1% for pT2-4 tumors, respectively. Concerning the tumor grade, the sensitivity was 22.2% and 5.6% for G1, 48.5% and 24.2% for G2, 70.8% and 33.3% for G3 for FISH and cytology, respectively. CONCLUSIONS: These findings show that the sensitivity of FISH for voided urine samples is higher than that of cytology, but the specificity was not significantly different. We recommend FISH as a useful diagnostic tool for patients who are suspected of having new bladder cancer and recurrent cancer, in combination with performing urine cytology.
Carcinoma, Transitional Cell ; Fluorescence ; Humans ; In Situ Hybridization ; Sensitivity and Specificity ; Urinary Bladder ; Urinary Bladder 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

Tolosa-Hunt syndrome (THS) is a clinical syndrome of painful ophthalmoplegia associated with an idiopathic inflammation in the superior orbital fissure or cavernous sinus. We report a 61-year-old woman with recurrent THS. She had been treated with steroids for the painful ophthalmoplegia. After a symptom-free period, she developed similar symptoms. The postcontrast brain MRI showed increased signal in the cavernous sinus, which was also seen in the previous MRI.
Brain ; Cavernous Sinus ; Female ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Middle Aged ; Ophthalmoplegia ; Orbit ; Steroids ; Tolosa-Hunt Syndrome*

The use of controlled hyperventilation during neurosurgical procedures prevents the deleterious effects of hypercarbia on the cerebral blood flow and intracranial pressure. hyperventilation with hypocarbia produces cerebral vasoconstriction, reduced cerebral blood flow and a reduction in brain size in the majority of patients with increased intracranial pressure. But since excessive cerebral vasoconstriction might induce cerebral ischemia, there has been much discussion concerning the optimal level of hypocarbia. Several studies have shown biochemical evidence of a change in cerebral glucose utilization to anaerobic metabolism during hypocarbia. In our investigation, the effect of hyperventilation on 10 neurosurgical patients was evaluated by blood gas analysis and the estimation of lackate and pyruvate in arterial blood and the cerebrospinal fluid. The results were as follows: 1) PaCO2 decreased from a prearesthetic value of 38+/-2.2 mmHg to 22+/-2.1mmHg 1 hour postinduction and 24+/-2.2mmHg at 2 hours due to hyperventilation. pH was 7.58+/-0.047 1 hour postinduction and 7.56+/-0.018 at 2 hours. PaO2 was 251+/-33.0mmHg 1 hour postinduction 1 hour and 215+/-20.9mmHg at 2 hours under a 50% inspired oxygen concentration(FiO2=0.5). 2) The arterial blood lactate value increased statistically significantly from a preanesthetic value of 9.3+/-1.5mg% to 11.8+/-1.47mg% 1 hour postinduction(p<0.01) to 12.5+/-1.53mg% at 2 hours(p<0.005). However all values were within the normal range(4.7+/-15.1mg%), and the lacte/pyruvate ratio did not change. 3) In the cerebrospinal fluid, pH was 7.45+/-0.057, PCO2 was 34+/-3.5mmHg and PO2 was 91+/-6.7mmHg following hyperventilation for 1 hour. The lactate value of the cerebrospinal fluid was 19.2+/-3.14mg%(normal range: 11.0~27.0mg%) and the lactate/pyruvate ration was 14.5+/-2.39. 4) No evidence of an excessive increase in CSF lactate was seen in any case. The above findings suggest that maintenance of an adequate oxygen concentration and a carbon dioxide value over 20mmHg would prevent cerebral ischemia following hypocarbia due to hyperventilation.
Anesthesia* ; Blood Gas Analysis ; Brain ; Brain Ischemia ; Carbon Dioxide ; Cerebrospinal Fluid* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation* ; Intracranial Pressure ; Lactic Acid ; Metabolism ; Neurosurgical Procedures ; Oxygen ; Pyruvic Acid ; Vasoconstriction

BACKGROUND: During total hip arthroplasty, replacement of a substantial amount of blood loss is necessary. The adverse effects of homologous blood transfusion have been documented consequently and the intraaperative autotransfusion has attracted considerable interest. The authors have attempted to reduce the amount of the homologous blood transfusion by inducing hypotension and autotransfusion. METHODS: Twenty patients who underwent revision total hip arthroplasty were divided into two groups. Group1 received homologous blood perioperatively. Group2 was transfused with predonated autologous blood and intraoperative salvage technique with Cell Saver apparatus, were used along with sodium nitroprusside for hypotensive anesthesia to decrease intraoperative bleeding. We observed the amount of blood loss and transfused blood, and hematologic laboratory data, and complications. RESULTS: The mean requirement for transfusion was 3080 ml in group1 and 1289 ml in group2. In the level of the hematocrit, there was a significant smaller hematocrit drop (8%) over the first two postoperative days in group2I. There were no complications such as disseminated intravascular coagulopathy, severe thrombocytopenia, microemboli, and nephrotoxicity. CONCLUSIONS: The autologous transfusion and induced hypotension in the total hip arthroplasty is thought to be an effective method to reduce the amount of homologous blood transfusion.
Anesthesia ; Arthroplasty, Replacement, Hip ; Blood Pressure ; Blood Transfusion ; Blood Transfusion, Autologous* ; Hematocrit ; Hemorrhage ; Hip* ; Humans ; Hypotension* ; Nitroprusside ; Orthopedics ; Thrombocytopenia