BACKGROUND: An increase of the extracellular K+concentrations up to about 8 mM in the isolated vessels causes relaxation in pre-contracted state. In order to elucidate the mechanisms of K+induced relaxation and compare with that of 2-kidney, 1 clip (2K1C) renal hypertensive rats, we recorded aortic vascular tension using an organ bath study. METHOD: 2K1C hypertension was made by clipping the left renal artery and age-matched control rats received a sham treatment. Thoracic aortic rings were mounted in tissue baths for measurement of isometric contractile force. RESULTS: Exposure to K+(from 2 to 8 mM) relaxed a phenylephrine (2 x 10-6 M)-induced contraction in K+free Krebs-Ringer solution, dose-dependently. Ouabain (10-5 M) enhanced the K+induced relaxation in above 2 mM K+ The K+induced relaxation was still induced in endothelium-denuded condition. Incubation with the K+channel blockers such as tetraethylammonium (TEA, 1 mM), glibenclamide (10-5 M), 4-aminopyridine (3 mM), barium (5 mM) and cesium (2 mM) did not affect on the K+induced relaxation. In renal hypertensive rats, the K+induced relaxation was markedly suppressed and ouabain enhanced it. CONCLUSIONS: These results suggest that the K+induced relaxation in aorta be mediated by Na-pump independent mechanisms, and the decrease of the K+induced relaxation in the renal hypertensive rats may be a possible mechanism of hypertension.
4-Aminopyridine ; Animals ; Aorta ; Barium ; Baths ; Cesium ; Glyburide ; Hypertension ; Muscle, Smooth* ; Ouabain ; Phenylephrine ; Placebos ; Rats* ; Relaxation ; Renal Artery ; Tetraethylammonium ; Vasodilation*

BACKGROUND: An increase of the extracellular K+concentrations up to about 8 mM in the isolated vessels causes relaxation in pre-contracted state. In order to elucidate the mechanisms of K+induced relaxation and compare with that of 2-kidney, 1 clip (2K1C) renal hypertensive rats, we recorded aortic vascular tension using an organ bath study. METHOD: 2K1C hypertension was made by clipping the left renal artery and age-matched control rats received a sham treatment. Thoracic aortic rings were mounted in tissue baths for measurement of isometric contractile force. RESULTS: Exposure to K+(from 2 to 8 mM) relaxed a phenylephrine (2 x 10-6 M)-induced contraction in K+free Krebs-Ringer solution, dose-dependently. Ouabain (10-5 M) enhanced the K+induced relaxation in above 2 mM K+ The K+induced relaxation was still induced in endothelium-denuded condition. Incubation with the K+channel blockers such as tetraethylammonium (TEA, 1 mM), glibenclamide (10-5 M), 4-aminopyridine (3 mM), barium (5 mM) and cesium (2 mM) did not affect on the K+induced relaxation. In renal hypertensive rats, the K+induced relaxation was markedly suppressed and ouabain enhanced it. CONCLUSIONS: These results suggest that the K+induced relaxation in aorta be mediated by Na-pump independent mechanisms, and the decrease of the K+induced relaxation in the renal hypertensive rats may be a possible mechanism of hypertension.
4-Aminopyridine ; Animals ; Aorta ; Barium ; Baths ; Cesium ; Glyburide ; Hypertension ; Muscle, Smooth* ; Ouabain ; Phenylephrine ; Placebos ; Rats* ; Relaxation ; Renal Artery ; Tetraethylammonium ; Vasodilation*

A rare case of intraventricular central neurocytoma in 17-year-old male is reported. The patient had diffuse headache and diplopia. Radiologic findings displayed obstructive hydrocephalus and a large, well-demarcated intraventricular mass lesion obstructing the foramen of Monroe. The tumor arouse from the splenium of corpus callosum. It was removed successfully using two different approaches after extraventricular drainage of the cerebrospinal fluid(CSF). Histologically, the tumor showed pathological features as that of oligodengroglioma on the light microscope. In immunohistochemical examination, glial fibrillary acidic protein(GFAP) was negative and synaptophysin, positive. Numerous neurosecretory granules were found and no typical synapsis was noticed on the electron microscope. No shunt operation was needed. Postoperative radiotherapy or chemotherapy was not performed and no tumor recurrence was detected during the one year follow-up period. We present the case together with a review of the literatures.
Adolescent ; Cerebral Ventricles ; Chromosome Pairing ; Corpus Callosum ; Diplopia ; Drainage ; Drug Therapy ; Follow-Up Studies ; Headache ; Humans ; Hydrocephalus ; Male ; Neurocytoma* ; Radiotherapy ; Recurrence ; Synaptophysin

BACKGROUND: Pressure support(PS) is becomimg a widely accepted method of mechanical ventilation either for total unloading or for partial unloading of respiratory muscle. The aim of the study was to find out if PS exert different effects on respiratory mechanics in synchronized intermittent mandatory ventilation(SIMV) and continuous positive airway pressure (CPAP) modes. METHODS: 5, 10 and 15 cm H2O of PS were sequentially applied in 14 patients(69+/-12 yrs, M:F=9:5) and respiratory rate (RR), tidal volume(VT), work of breathing(WOB), pressure time product(PTP), P(0.1), and T(1)/T(TOT) were measured using the CP-100 pulmonary monitor(Bicore, USA) in SIMV and CPAP modes respectively. RESULTS: 1) Common effects of PS on respiratory mechanics in both CPAP and SIMV modes As the level of PS was increased(0, 5, 10, 15 cm H2O), VT was increased in CPAP mode(0.28+/-0.09, 0.29+/-0.09, 0.31+/-0.11, 0.34+/-0.12 L, respectively, p=0.001), and also in SIMV mode(0.31+/-0.15, 0.32+/-0.09, 0.34+/-0.16, 0.36+/-0.15 L, respectively, p=0.0215). WOB was decreased in CPAP mode(1.40+/-1.02, 1.01+/-0.80, 0.80+/-0.85, 0.68+/-0.76 joule/L, respectively, p=0.0001), and in SIMV mode(0.97+/-0.77, 0.76+/-0.64, 0.57+/-0.55, 0.49+/-0.49 joule/L, respectively, p=0.0001). PTP was also decreased in CPAP mode(300+/-216, 217+/-165, 179+/-187, 122+/-114cm H2O * sec/min, respectively, p=0.0001), and in SIMV mode(218+/-181, 178+/-157, 130+/-147, 108+/-129cm H2O.sec/min, respectively, p=0.0017). 2) Different effects of PS on respiratory mechanics in CPAP and SIMV modes By application of PS (0, 5, 10, 15 cm H2O), RR was not changed in CPAP mode(27.9+/-6.7, 30.0+/-6.6, 26.1+/-9.1, 27.5+/-5.7/min, respectively, p=0.505), but it was decreased in SIMV mode (27.4+/-5.1, 27.8+/-6.5, 27.6+/-6.2, 25.1+/-5.4/min, respectively, p=0.0001). P(0.1) was reduced in CPAP mode(6.2+/-3.5, 4.8+/-2.8, 4.8+/-3.8, 3.9+/-2.5 cm H2O, respectively, p=0.0061), but not in SIMV mode(4.3+/-2.1, 4.0+/-1.8, 3.5+/-1.6, 3.5+/-1.9 cm H2O, respectively, p=0.054). T(1)/T(TOT) was decreased in CPAP mode(0.40+/-0.05, 0.39+/-0.04, 0.37+/-0.04, 0.35+/-0.04, respectively, p=0.0004), but not in SIMV mode(0.40+/-0.08, 0.35+/-0.07, 0.38+/-0.10, 0.37+/-0.10, respectively, p=0.287). 3) Comparison of respiratory mechanics between CPAP+PS and SIMV alone at same tidal volume. The tidal volume in CPAP+PS 10 cm H2O was comparable to that of SIMV alone. Under this condition, the RR(26.1+/-9.1, 27.4+/-5.1/min, respectively, p=0.516), WOB(0.80+/-0.85, 0.97+0.77 joule/L, respectively, p=0.485), P0.1(3.9+/-2.5, 4.3+/-2.1 cm H2O, respectively, p=0.481) were not different between the two methods, but PTP(179+/-187, 218+/-181 cmH2O.sec/min, respectively, p=0.042) and T(1)/T(TOT)(0.37+/-0.04, 0.40+/-0.08, respectively, p=0.026) were significantly lower in CPAP+PS than in SIMV alone. CONCLUSION: PS up to 15 cm H2O increased tidal volume, decreased work of breathing and pressure time product in both SIMV and CPAP modes. PS decreased respiration rate in SIMV mode but not in CPAP mode, while it reduced central respiratory drive(P(0.1)) and shortened duty cycle (T(1)/T(TOT)) in CPAP mode but not in SIMV mode. By 10 cm H2O of PS in CPAP mode, same tidal volume was obtained as in SIMV mode, and both methods were comparable in respect to RR, WOB, P(0.1), but CPAP+PS was superior in respect to the efficiency of the respiratory muscle work (PTP) and duty cycle(T(1)/T(TOT)).
Continuous Positive Airway Pressure ; Respiration, Artificial ; Respiratory Mechanics* ; Respiratory Muscles ; Respiratory Rate ; Tidal Volume ; Work of Breathing

A 17 year-old high school girl was admitted for anterior chest pain. Pulmonary edema and circulatory collapse progressed in spite of the medical treatment and intra-aortic balloon pump. Left ventricular assist device(LVAD, Bio-Pump, Medtronic Bio-Med, USA) was instituted under the impression of acute fulminant myocarditis. The inlet cannula was inserted in the left atrium(LA) via left submammary anterior thoracotomy. Biopsy was taken from left atrial appendage. The outlet cannula inserted to the left femoral artery using PTFE cuff. After 158 hours of extracorporeal circulation, LVAD was able to be weaned successfully with nearly normalized LV motion on echocardiogram. Coxsakievirus was identified with immunochemistry and serum neutralization test. She was discharged without any heart failure symptoms after 23 days of hopitalization.
Adolescent ; Atrial Appendage ; Bays ; Biopsy ; Catheters ; Chest Pain ; Extracorporeal Circulation ; Female ; Femoral Artery ; Heart Failure ; Heart-Assist Devices* ; Humans ; Immunochemistry ; Myocarditis* ; Neutralization Tests ; Polytetrafluoroethylene ; Pulmonary Edema ; Shock ; Thoracotomy

BACKGROUND: Auto-PEEP which develops when expiratory lung emptying is not finished until the beginning of next inspiration is frequently found in patients on mechanical ventilation. Its presence imposes increased risk of barotrauma and hypotension, as well as increased work of breathing (WOB) by adding inspiratory threshold load and/or adversely affecting to inspiratory trigger sensitivity. The aim of this study is to evaluate the relationship of auto-PEEP with WOB and to evaluate the effect of PEEP applied by ventilator (external PEEP) on WOB in patients with auto-PEEP. METHOD: 15 patients, who required mechanical ventilation for management of acute respiratory failure, were studied. First, the differences in WOB and other indices of respiratory mechanics were examined between 7 patients with auto-PEEP and 8 patients without auto-PEEP. Then, we applied the 3 cm H2O of external PEEP to patients with auto-PEEP and evaluated its effects on lung mechanics as well as WOB. Indices of respiratory mechanics including tidal volume (V(T)), repiratory rate, minute ventilation (V(E)), peak inspiratory flow rate (PIFR), peak expiratory flow rate (PEFR), peak inspiratory pressure (PIP), T(I)/T(TOT), auto-PEEP, dynamic compliance of lung (Cdyn), expiratory airway resistance (RAWe), mean airway resistance (RAWm), P(0.1), work of breathing performed by patient (WOB), and pressure-time product (PTP) were obtained by CP-100 Pulmonary Monitor (Bicore,USA). The values were expressed as meanSEM (standard error of mean). RESULTS: 1) Comparison of WOB and other indices of respiratory mechanics in patients with and without auto-PEEP: There was significant increase in WOB (1.71 +/-0.24 vs 0.500.19 J/L, p=0.007), PTP (317+/-70 vs 98+/-36 cm H2O * sec/min, p=0.023), RAWe (35.6+/-5.7 vs 18.2+/-2.3 cm H20/L/sec, p=0.023), RAWm (28.8+/-2.5 vs 11.9+/-2.0 cm H2O/L/sec, p=0.001) and P0.1 (6.21.0 vs 2.9+0.6 cm H2O, p=0.021) in patients with auto-PEEP compared to patients without auto-PEEP. The differences of other indices including V(T), PEFR, V(E) and T(I)/T(TOT) showed no significance. 2) Effect of 3 cm H2O external PEEP on respiratory mechanics in patients with auto-PEEP: When 3 cm H2O of external PEEP was applied, there were significant decrease in WOB (1.71+/-0.24 vs 1.20+/-0.21 J/L, p=0.021) and PTP (317+/-70 vs 231+/-55 cm H2O * sec/min, p=0.038). RAWm showed a tendency to decrease (28.8+/-2.5 vs 23.9+/-2.1 cm H2O, p=0.051). But PIP was increased with application of 3 cm H2O of external PEEP (16+/-2 vs 22+/-3 cm H2O, p=0.008). V(T), V(E), PEFR, T(I)/T(TOT) and Cdyn did not change significantly. CONCLUSION: The presence of auto-PEEP in mechanically ventilated patients was accompanied with increased WOB performed by patient, and this WOB was decreased by 3 cm H2O of externally applied PEEP. But, with 3 cm H2O of external PEEP, increased PIP was noted, implying the importance of close monitoring of the airway pressure during application of external PEEP.
Airway Resistance ; Barotrauma ; Compliance ; Humans ; Hypotension ; Lung ; Mechanics ; Peak Expiratory Flow Rate ; Positive-Pressure Respiration ; Positive-Pressure Respiration, Intrinsic* ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Mechanics ; Tidal Volume ; Ventilation ; Ventilators, Mechanical ; Work of Breathing*

ATP-sensitive K+ channels (KATP) were not identified in gastric smooth muscle cells. However, in tension recording of intact gastric circular muscle, lemakalim of KATP channels opener in other tissues suppressed mechanical contractions and this effect was blocked by glibenclamide, a specific inhibitor of KATP channels. The aims of this study were to investigate whether KATP channels exist in gastric smooth muscle of guinea-pig and to know its physiological role. Whole cell K+ currents activated by lemakalim were recorded from freshly isolated cells with a 0.1 mM ATP, 140 mM KCl pipette solutions. Lemakalim (10 muM) increased inward currents of -224 +/- 34 pA (n = 13) at -80 mV of holding potential in bath solution contained 90 mM K+. Bath-applied glibenclamide (10 muM) inhibited the lemakalim-activated inward currents by 91 +/- 6% (n = 5). These lemakalim-activated inward currents were reduced by increased intracellular ATP from 0.1 to 3 mM (-41 +/- 12 pA) (n = 5). The reversal potential of the glibenclamide-sensitive inward currents was -5.2 +/- 2.4 mV (n = 3) in external 90 mM K+ and shifted to -14.8 +/- 3.6 mV (n = 3) in external 60 mM K+, which close to equilibrium potential of K+ (EK). External barium and cesium inhibited the lemakalim-activated inward currents dose-dependently. The half-inhibitory dose (IC50) of barium and cesium were 2.3 muM (n = 5) and 0.38 mM (n = 4), respectively. 10 mM tetraethylammonium (TEA) also inhibited the lemakalim-activated inward currents by 66 +/- 15% (n = 5). Both substance P (SP) (5 muM) and acetylcholine (ACh) (5 muM) inhibited lemakalim-activated inward currents. These results suggest that KATP channels exist in the gastric smooth muscle and its modulation by neurotransmitters may play an important role in regulating gastric motility.
Acetylcholine ; Adenosine Triphosphate ; Barium ; Baths ; Cesium ; Cromakalim ; Glyburide ; KATP Channels ; Muscle Cells* ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Neurotransmitter Agents ; Substance P ; Tetraethylammonium

The purpose of this prospective study was to determine whether using magnetic resonance imaging (MRI) for early screening for brain metastases (BM) can improve quality of life, survival in patients with non-small cell lung cancer (NSCLC). The study group comprised 183 patients newly diagnosed with NSCLC. All patients underwent limited brain MRI and routine workups. The control group comprised 131 patients with NSCLC who underwent limited brain MRI only if they had neurologic symptoms. The incidence of BM was 20.8% (38/183) in the study group and 4.6% (6/131) in the control group. The rate of upstaging based on the MRI data was 13.5% (15/111) overall and 15.9% (11/69) in patients that had been considered initially to be resectable surgically. There was no significant difference in survival outcome between the groups. Patients who had BM alone had a greater overall survival time (49 weeks) than those who had multiple systemic metastases (27 weeks; p=0.0307). In conclusions, limited brain MRI appears to be a useful, costeffective method to screen for BM at the time of initial staging. And it may facilitate timely treatment of patients with NSCLC and improve their survival and quality of life.
Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms/*diagnosis/pathology/*secondary ; Carcinoma, Non-Small-Cell Lung/*diagnosis/*pathology ; Female ; Humans ; Lung Neoplasms/*diagnosis/pathology ; Magnetic Resonance Imaging/*economics/methods ; Male ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Time Factors

BACKGROUND/AIMS: The identification of significant coronary arterial disease (CAD) is important to reduce perioperative ischemic insult and the possibility of repeated open-chest surgery in patients scheduled to undergo valvular surgery. However, there are no published data on the incidence of significant CAD in these patients. Thus, we examined the prevalence of significant CAD in patients scheduled to undergo valvular surgery. METHODS: From January 2005 to June 2011, all consecutive adult patients diagnosed with significant valvular disease and scheduled for an elective open valvular operation were retrospectively investigated at Chungnam National University Hospital and Chonbuk National University Hospital. Patients who underwent emergent valvular operations due to acute aortic dissection or trauma and concomitant valvular operations at the time of coronary artery bypass graft (CABG) surgery were excluded. RESULTS: During the study period, a total of 431 patients (58 +/- 13 years old, 204 males) were included. The distributions of mitral (241 patients) and aortic valvular disease (230 patients) were similar. Coronary angiography was performed in 297 patients (68.9%). Of these, 36 (12.1%) showed significant CAD and 32 underwent concomitant CABG operations. Based on a multivariate analysis, the presence of CAD was significantly associated with old age (> or = 65 years old) [odds ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], more cardiovascular risk factors (> or = 3) (OR = 3.002, 95% CI = 1.386-6.503, p = 0.005), and the presence of aortic stenosis (OR = 2.763, 95% CI = 1.269-6.013, p = 0.010). CONCLUSIONS: The incidence of significant CAD was 12.1% in adult patients who underwent valvular operations in Korea. CAD was more common in patients with old age, aortic stenosis, and multiple cardiovascular risk factors.
Adult ; Aortic Valve Stenosis ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Heart Valve Diseases ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Risk Factors ; Transplants