The purpose of this study is to investigate the effects of doxapram on the rates of spontaneous and neostigmine-induced recovery from neuromuscular block with vecuronium and atracurium. Following intravenous injection of either vecuronium (40 patients) or atracurium (40 patients), recovery index (RI) was measured without administering either doxapram or neostigmine (Group 1), or after administration of a combination of neostigmine 40 ug/kg and doxapram 1 mg/kg (Group 2), neostigmine 40 ug/kg (Group 3) or doxapram 1 mg/kg (Group 4) when twitch tension returned to 25% block of train of four response, each of the four group had 10 patients. The results were such that RI was significantly prolonged after vecuronium in the presence of doxapram compared with Group 1 (13.5 min vs 8.2 min). There was no significant difference in the RI after atracurium in the presence of doxapram compared with Group 1 (7.0 min vs 7.1 min). There was rapid recovery which was significant when neostigmine was administered with or without doxapram (2.4 min vs 2.3 min respectively after vecuronium; 2.3 min vs 2.4 min respectively after atracurium). The authors conclude that administration of doxapram in situation where neuromuscular block with vecuronium is not adequately antagonized does not contribute to rapid recovery from neuromuscular block.
Atracurium* ; Doxapram* ; Humans ; Injections, Intravenous ; Neostigmine ; Neuromuscular Blockade ; Vecuronium Bromide*

OBJECTIVES: This study is aimed to quantify the complex dynamics of beat-to-beat fetal heart rate(FHR) fluctuations by using approximate entropy(ApEn) which is a recently developed mathematical formula quantifying regularity and also to determine the differences between normal fetuses and growth retarded fetuses. BACKGROUND: Recently, some measures of heart rate variability and nonlinear "complexity" of heart rate dynamics have been used as indicators fetal well-being. Approximate entropy is a new mathematical approach and formula to quantify regularity in data. It has been shown to provide new information in fetal heart rate analysis. Because growth retarded fetus accounts for a significant increase in perinatal morbidity and mortality, than normal fetus, we postulated that there existed important differences between normal fetuses and growth retarded fetuses. METHODS: We analyzed FHR tracings for 40 minutes, and approximately 5,000 points in normal fetuses(n=315) and growth retarded fetuses(n=76). The overall "complexity" of each FHR time series was quantified by its approximate entropy, measure of regularity derived from nonlinear dynamics, "chaos theory". RESULTS: Mean baseline FHR increased in growth retarded fetuses than normal fetuses. And the FHR ApEn significantly decreased in growth retarded fetuses(ApEn=0.623) compared to that of the normal fetuses(ApEn=0.868) throughout all gestational ages(p < 0.001). CONCLUSIONS: The ApEn of FHR decreased in growth retarded fetuses throughout all gestational ages. These findings indicated that decreased ApEn values of FHR are associated with sickness and the greater perinatal morbidity risks. Therefore ApEn quantifies subtle changes in FHR regularity and promises for new information in FHR analysis.
Entropy* ; Female ; Fetal Heart* ; Fetus* ; Gestational Age ; Heart Rate ; Heart Rate, Fetal* ; Mortality ; Nonlinear Dynamics ; Pregnancy

Wolf-Hirschhorn syndrome (WHS) is a malformation associated with a hemizygous deletion of the distal short arm of chromosome 4. Herein we report a fetal autopsy case of WHS. A male fetus was therapeutically aborted at 17(+0) weeks gestational age, due to complex anomaly and intrauterine growth retardation, which were found in prenatal ultrasonography. His birth weight was 65 g. Mild craniofacial dysmorphism, club feet, bilateral renal hypoplasia, edematous neck, and left diaphragmatic hernia of Bochdalek were found on gross examination. On GTG-banding, the fetus revealed 46,XY,add(4p) karyotype and the mother revealed 46,XX,t(4;18)(p16;q21.1), with normal karyotype of the father. Array comparative genomic hybridization performed on the autopsied lung tissue revealed loss of 4p16.2-->4pter and gain of 18q21.1-->18qter, suggesting 46,XY,der(4)t(4;18)(p16.2;q21.1)mat of fetal karyotype. This suggested deletion of 4p, compatible with WHS inherited from the mal-segregation of a maternal translocation t(4;18)(p16.2;21.1). Therefore, our fetus was both genotypically and phenotypically compatible with WHS.
Arm ; Autopsy ; Birth Weight ; Chromosomes, Human, Pair 4 ; Comparative Genomic Hybridization ; Fathers ; Fetal Growth Retardation ; Fetus ; Foot ; Gestational Age ; Hernia, Diaphragmatic ; Humans ; Karyotype ; Karyotyping ; Lung ; Male ; Mothers ; Neck ; Ultrasonography, Prenatal ; Wolf-Hirschhorn Syndrome

No Abstract Available.
Astrocytes* ; Humans*

Tumor necrosis factor-n (TNF - alpha) involved in the pathogenesis of multiple sclerosis and contribute to the degeneration of oligodendrocytes as well as neurons. TNF - alpha is produced by miocroglia and astrocytes, which also produce hormones and cytokines that influence its biological activity. Astrocytes, the major glial cells in the CNS, are capable of producing TNF - alpha at both the mRNA and protein levels in response to interleukine-1 (IL-1) or TNF - alpha. Two immunosuppressive cytokines, transforming growth factor - beta (TGF - beta) and IL-10, have been shown to influence glial cell function. TGF - beta can modulate the activity of glial cells by inhibiting interferon-gamma (IFN - gamma) induced expression of class II major histocompatibility complex (MHC) molecules on astrocytes and microglia. To explore the role of astrocytes in the production of TNF - alpha, astrocytes were pretreated with IL-10 or TGF - beta and then stimulated with IL-1p to determine their effects on TNF - alpha production. The secretion of TNF - alpha by human fetal astrocytes was markedly inhibited by TGF - beta at a low concentration. In contrast IL-10 had no effect on TNF - alpha mRNA level. These results show that TGF - beta may regulate the expression of TNF - alpha in activated human fetal astrocytes.
Astrocytes* ; Cytokines ; Gene Expression* ; Humans* ; Interferon-gamma ; Interleukin-10 ; Major Histocompatibility Complex ; Microglia ; Multiple Sclerosis ; Necrosis ; Neuroglia ; Neurons ; Oligodendroglia ; RNA, Messenger ; Transforming Growth Factors

No abstract available.
Astrocytes* ; Humans*

No abstract available.
Astrocytes* ; Gene Expression* ; Humans* ; Polymerase Chain Reaction*

Thyroid hemiagenesis is a development failure of one of the thyroid lobes, predominantly in females with a left lobe. The associated disease in the remaining thyroid lobe include benign adenoma, multinodular goiter, hyperthyroidism, chronic thyroiditis, and carcinoma etc. We report a very rare case of thyroid hemiagesesis with hyperthyroidism, thyroid cancer, and ectopic thymus. A 43-year-old female presented with hyperthyoidism and thyroid nodule. Thyroid scan with 99mTcO4 revealed cold nodule in left lobe with absent right lobe. The patient underwent thyroid exploration. Because nodule in the remaining thyroid lobe proved to be a thyroid cancer on frozen biopsy, total thyroidectomy was performed. There was a thyroid-like tissue at the right side (scan 'absent' side) and removed. Pathology confirmed that the removed tissue from right side was thymus. There has been no report in world literatures of such case; in one patient, thyroid hemiagenesis, hyperthyroidism, thyroid carcinoma, and ectopic thymus coexists. We report the case and review the literature on thyroid hemiagenesis and ectopic thymus.
Adenoma ; Adult ; Biopsy ; Female ; Goiter ; Humans ; Hyperthyroidism* ; Pathology ; Sodium Pertechnetate Tc 99m ; Thymus Gland* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis

This study was aimed at finding out whether weight reduction alone can improve liver function in obese patients with fatty liver. We did a longitudinal, clinical intervention study on weight reduction by behavior modification, diet and exercise. The study subjects were 25 patients referred to an obesity clinic in whom obesity is the sole factor causing abnormal liver function and fatty liver. Patients were weighed about one year later. We compared the degree of improvement in hepatic function between Group I that showed weight reduction and Group II that showed no-weight reduction. Group I (13) showed dramatic improvement in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, nearly all down to within normal levels. AST showed statistically significant improvement from 74 +/- 36 IU/l to 25 +/- 7 IU/l. ALT also showed statistically significant improvement from 109 +/- 67 IU/l to 30 +/- 14 IU/l. Group II (12) showed higher AST and ALT levels on follow-up visit than initial visit. AST showed statistically significant elevation from 43 +/- 11 IU/l to 59 +/- 23 IU/l. ALT also showed statistically significant elevation from 64 +/- 21 IU/l to 97 +/- 33 IU/l. If we can rule the other causes of hepatic abnormalities in obese patients with fatty liver, we suggest these patients would benefit by weight reduction.
Adolescent ; Adult ; Alanine Transaminase/metabolism ; Aspartate Aminotransferases/metabolism ; Body Weight/physiology ; Comparative Study ; *Diet, Reducing ; Fatty Liver/complications/*diet therapy/physiopathology ; Female ; Human ; Liver/enzymology/*physiopathology ; Longitudinal Studies ; Male ; Middle Age ; Obesity/complications/*diet therapy/physiopathology

Background : The approximate entropy of heart rate variability has recently been used as a tool in evaluating cardiovascular health and physiology and in diagnosing pertubated physiologic status, by quantifying the irregularity and the pattern of the heart rate variability. Therefore approximate entropy of the fetal heart rate variability will be used as an important tool in studying the fetal cardiovascular health and disease, but unfortunately there have been no previous systematic studies of the approximate entropy in normal fetuses. This study's aim has been to present the normal approximate entropy values of the fetal heart rate variability according to the gestational age, to demonstrate the developmental maturation of physiology of the control systems of the heart rate, and to quantify the evolution of the pattern of fetal heart rate variability. METHODS: Three hundred and thirty seven mothers with normal singleton pregnancies, who were 20 weeks or more of gestational age, were randomly chosen. For more than 40 minutes fetal heart rates and fetal movements were recorded and were downloaded to a computer. From each heart rate data, 5000 points ('total') of heart rate during which fetal movements occured and 1200 points ('rest') during which no fetal movement occured were selected and the approximate entropy was calculated, and then 2 weeks' average of the approximated entropy of the heart rate were calculated and compared to find the maturational differences of them. RESULTS: The approximate entropy of the rest period showed a tendency to increase with advancing gestation (p=0.0001). It was significantly higher between the 41st-42nd week (0.987 +/-0.017) than the period before the 24 th week (0.864+/-0.032) and between the 25th-26th week (0.868+/-0.022). (p<0.05). The approximate entropy of the total period showed another tendency (p<0.05): from a low level before the 24 th week (0.788+/-0.067) it increased to reach its peak at the 29th-30 th week (0.963+/-0.041) then it gradually decreased again to significantly (p<0.05) lower levels at the 37th-38th week (0.776+/-0.046) and the 39th-40th week (0.786+/-0.047). CONCLUSIONS: Normal value of approximate entropy, which is bound to be used as an index in evaluating the fetal well-being, has been presented from 20th to 42th week of gestation with an interval of two weeks. The systems that control the heart rate seem to mature consistently as gestation advances, but before the 26th week it is significantly more immature than at term. Fetal heart rate variability evolves from an immature oscillating pattern into a transitional patternless pattern during the second trimester and finally consolidates into a mature accelerational pattern during the third trimester.
Entropy* ; Female ; Fetal Heart* ; Fetal Movement ; Fetus ; Gestational Age ; Heart Rate ; Heart Rate, Fetal* ; Humans ; Mothers ; Physiology ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnancy* ; Reference Values