We recently had a patient(51 year-old man) who was to undergo resection of pheochromocytoma under general ansthesia. The patient was treated with phenoxybenzamine for 10 days preoperatively. Following induction of anesthesia with intravenous thiopental sodium, endotracheal intubation was performed with vecuronium and anesthesia was maintained with isoflurane. Following intubation, tachycardia controlled by intravenous injection of small dose of propranolol. The course of anesthesia was rather stormy reflected by hypertension, arrhythmia and hypotension. But the patient tolerated long anesthesia and operation relatively well with appropriate use of nitroglycerine, lidocaine, etc. Importance of preoperative preparation, sufficient sedation, smooth induction, complete analgesia, and good muscular relaxation, adequate alveolar ventilation and stable cardiovascular control has been discussed. Blood pressure during manipulation of tumor was 150/100 mmHg without arrhythmia, but gradually was controlled to the range of 120/80 mmHg after intravenous infusion of nitroglycerine at the rate of 0.5-5 pg/kg/min. To our surprise, the blood pressure and pulse and pulse rate was controlled very well with nitroglycerine and isoflurane. After removal of tumor, the blood pressure dropped 100/70 mmHg, so, blood pressure was controlled by LV fluid(Hartmans dextrose, normal saline, plasmanate, low molecular weight dextran), packed red blood cell, whole blood, fresh frozen plasma, vasopressor of small amount was used. There was no marked hypertension, hypotension, tachycardia, arrhythmia during anesthesia. Thus, we anticipate that nitroglyecerine with beta-blocker may be good intraoperative antihypertensive regimen for pheochromocytoma.
Analgesia ; Anesthesia ; Arrhythmias, Cardiac ; Blood Pressure ; Erythrocytes ; Glucose ; Heart Rate ; Humans ; Hypertension ; Hypotension ; Infusions, Intravenous ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Isoflurane ; Lidocaine ; Molecular Weight ; Nitroglycerin* ; Phenoxybenzamine ; Pheochromocytoma* ; Plasma ; Propranolol ; Relaxation ; Tachycardia ; Thiopental ; Vecuronium Bromide ; Ventilation

Background: Coffee is one of the most commonly consumed beverages in the world. There is evidence that the consumption of coffee has a strong influence on health outcomes. However, the relationship between coffee consumption and serum uric acid in the Korean population is unclear. In this study, we investigated the relationship between coffee consumption and serum uric acid levels in Korean adults. Methods: This study included 2,966 adults aged ≥19 years who participated in the Korea National Health and Nutrition Examination Survey 2016. The participants were divided into four groups according to the amount of coffee consumed and serum uric acid level. Linear regression analysis was used to analyze the relationship between coffee consumption and serum uric acid level. Results: Serum uric acid level increased with increasing coffee consumption (P<0.001). After adjusting for all confounding factors, serum uric acid level was higher in the groups that consumed coffee daily, at more than four teaspoons, than in the groups that did not consume coffee (P<0.001). Conclusion The findings of this study suggest that coffee consumption has a positive relationship with serum uric acid level.

BACKGROUND: This study aimed to investigate the relationship between leisure time physical activities (LTPA) and metabolic syndrome (MS). METHODS: Five thousand seven hundred and thirty two adults 40 years old or older were enrolled in the study from April 2009 to December 2010. National Cholesterol Education Program's Adult Treatment Panel III was used for the criteria of MS, and Minnesota Leisure Time Physical Activity Questionnaire was used to measure LTPA. After adjusted covariates (age, hypertension, smoking, drinking, education level, household income level, work time physical activities, and menopause for females), the relationship between LTPA and MS was analyzed using logistic regression analysis. RESULTS: The prevalence of MS was 22.8% in men, and 14.1% in women. Average LTPA was 1,498 kcal/wk in men, and 1,308 kcal/wk in women. After adjustment for covariates, the odds ratios of middle and low LTPA compared with high LTPA were 1.06 (0.87-1.34), 1.54 (1.08-1.75), for women, this same association was not seen in men. The prevalence of MS was 22.8% in men and 14.1% in women, and their LTPA burned 1,498 and 1,308 kcal/wk, respectively. When the odds ratio of MS for the high LTPA group was set at 1.0, the odds ratio of MS was 1.06 (0.87-1.34) in the middle LTPA group and 1.54 (1.08-1.75) in the low LTPA group in women, which showed that the MS risk increased when the LTPA was lower. This same association was not seen in men. CONCLUSION: LTPA was independently associated with metabolic syndrome, but only for women.
Adult ; Burns ; Cholesterol ; Drinking ; Education ; Family Characteristics ; Female ; Health Behavior ; Humans ; Hypertension ; Leisure Activities* ; Logistic Models ; Male ; Menopause ; Minnesota ; Motor Activity* ; Odds Ratio ; Prevalence ; Surveys and Questionnaires ; Smoke ; Smoking

OBJECTIVE: The purpose of this investigation was to establish the prenatal diagnosis for identifying the risk for epidermolytic palmoplantar keratoderma(EPPK) of a fetus by sequence analysis of fetal genomic DNA from chorionic villi. METHODS: Chorionic villus sampling under transvaginal sonography at 12 weeks of gestation from a woman at risk for a child in a EPPK-affected family was perfomed. Polymerase chain reaction amplification of specific allele (PASA) assay was carried out for the detection of mutation(R162W in keratin 9 [K9] gene) previously identified in this family. Direct DNA sequencing analysis of K9 gene was accomplished to confirm the mutation. RESULTS: We had found the point mutation, R162W of K9 gene, in affected family members and confirmed by PASA assay. Affected family members were shown to have PCR products reactive with both the mutant and wildtype specific primers. Because we could not find any expected products after PASA assay with the primers la(+)/KSmt(-) of the fetal DNA, we predicted that the fetus did not inherited the mutant allele and that the fetus could be unaffected. After PASA assay, we analyzed DNA sequences of two family members to confirm the mutation. A C-to-T substitution at bp 545 was detected in the father, instead the fetus did not have any mutant band at that base pair. CONCLUSION: The PASA assay and direct DNA sequencing analysis of K9 gene through chorionic villi sampling and extraction of genomic DNA had validity to early prenatal diagnosis whether fetus was affected in EPPK or not.
Alleles ; Base Pairing ; Base Sequence ; Child ; Chorionic Villi ; Chorionic Villi Sampling ; DNA* ; Fathers ; Female ; Fetus ; Humans ; Keratin-9 ; Keratoderma, Palmoplantar, Epidermolytic* ; Point Mutation ; Polymerase Chain Reaction ; Pregnancy ; Prenatal Diagnosis* ; Sequence Analysis ; Sequence Analysis, DNA

Eosinophilic gastritis is a rare disease that is characterized by eosinophilic infiltration of the bowl wall tissue, and the presentation of symptoms varies depending on the affected site. It is likely that eosinophil-active cytokines play important roles in this disease. A 22-year old man presented with abdominal pain and vomiting. Endoscopic gastric biopsy revealed eosinophilic infiltration, and the serum level of Interleukin (IL)-5 was increased. Gastric emptying was moderately delayed in this patient. The patient was treated with steroid and he showed dramatic clinical improvement with disappearance of the eosinophilic infiltration of the gastric mucosa, normalization of the serum level of IL-5 and improvement of the gastric emptying time. There has been few case reports of eosinophilic gastritis that have described the change of the serum level of cytokines and the gastric emptying. We report here on a case of eosinophilic gastritis and the patient showed elevated serum level of cytokines and delayed gastric emptying. The patient improved after being treated with steroid.
Abdominal Pain ; Biopsy ; Cytokines ; Enteritis ; Eosinophilia ; Eosinophils ; Gastric Emptying ; Gastric Mucosa ; Gastritis ; Humans ; Interleukin-5 ; Interleukins ; Rare Diseases ; Vomiting

The interruption of hepatic blood flow has been adopted as a method of bleeding control in hepatectomy and liver transplantation. But this occlusion of hepatic inflow may result in significant hepatic injury by various kinds of oxygen radicals produced as a result of hepatic ischemia and following reperfusion. Arterial ketone body ratio(AKBR) is adequatc and convenient parameter by which both acute and prolonged changes of the hepatic function can be estimated. Pharmacological modulation of hepatic injury during warm ischemia and early reperfusion has shown some benefical effects. The authors conducted an experiment to evaluate the inhibitory effect of glutathione and prostaglandin E on hepatic injury due to acute hepatic ischemia and reperfusion. Thirty rabbits were divided into three groups, such as control(n=10), GSH(n=10) and PGE(n=10) groups. Acute hepatic ischemia was induced through the application of portal triad cross-clamping for 30 minutes, and thereafter hepatic reperfusion was induced with the removal of cross-clamping. A single bolus of 200 mg glutathione was injected 10 min before clamp in GSH group, and 200 ng/kg/min of PGE continuously from 10 min before clamp to 30 min after declamp in PGE group. AKBR and hepatic histological findings hefore clamp, 30 min after clamp, 5 min and 30 min after declamp, respectively were compared among 3 groups AKBR was markedly decreased during the clamping period in all groups (P<0.05). In control and PGE groups AKRR was significantly increased after reperfusion than before clamp (P<0.05), but was significantly lower than before clamp. Thirty minutes after reperfusion in GSH group AKBR returned to normal level and was significantly higher than in control group (P<0.05). On light tnicroscopic examination of liver biopsy, mild swollen hepatocytes in the centrilobular zone were seen at ischemia and reperfusion in control and GSH groups, but nearly normal hepatic architectures in PGE group. These results suggest that glutathione has some benefical effect on protection of hepatic dysfunction, and PGE1 on protection of hepatocellular injury during hepatic ischemia and reperfusion.
Alprostadil* ; Biopsy ; Constriction ; Glutathione* ; Hemorrhage ; Hepatectomy ; Hepatocytes ; Ischemia* ; Liver ; Liver Transplantation ; Prostaglandins E ; Rabbits* ; Reactive Oxygen Species ; Reperfusion Injury ; Reperfusion* ; Warm Ischemia

PURPOSE: To demonstrate the anatomy of the female pelvic floor and to determine the anatomic differences between normal controls and women with stress urinary incontinence, using MRI. MATERIALS AND METHODS: Five healthy, young, nulliparous women and 12 with stress urinary incontinence un-derwent MR imaging. We obtained FSE T2-weighted axial images, 3mm thick, of the region extending from the urethrovesical junction to the perineal membrane. The following parameters were determined : angle, asymmetry and signal intensity of the levator ani muscles, the distance between the urethra and symphysis, and the presence, shape and angulation of urethropelvic ligament. RESULTS: In contrast to normal controls, frequent findings in women with stress incontinence were as follows : increased angle(43%), asymmetry(43 %) and higher signal intensity(67%) of the levator ani muscles; increased distance between the urethra and symphysis; loss(43 %), discontinuity (60 %) and dorsal angulation(43%) of the urethropelvic ligament. CONCLUSION: In women with stress urinary incontinence, MRI clearly demonstrates the anatomy of the female pelvic floor, changes in the levator ani muscles, the distance between the urethra and symphysis, and the ure-thropelvic ligament. The modality can therefore be used to evaluate the anatomical changes occurring in cases of stress urinary incontinence.
Female ; Humans ; Ligaments ; Magnetic Resonance Imaging* ; Membranes ; Muscles ; Pelvic Floor* ; Urethra ; Urinary Incontinence*

No abstract available.
Hemorrhage* ; Kidney Transplantation*

No abstract available.
Cause of Death* ; Kidney Transplantation* ; Kidney*

PURPOSE: This study is to examine the painful dysesthesia of lip & gingiva followed after implant surgeries and to evaluate the prognosis of microsurgical epineurotomy & tubulization with e-PTFE tubes. METHOD: Three patients who had been suffered from painful anesthesia and dysesthesia following dental implant surgeries were examined periodically and followed for over 1 year after epineurotomy and e-PTFE tubulization. Neurosensory dysfunctions were examined by Static Light Touch Threshold, Moving Direction Discrimination. Two Point Discrimination, Pin-Prick Nociception. Visual Analog Scales and Tinel sign. The subjective symptoms were confirmed by SSEP and DITI prior to surgical exploration. RESULT: Two patients complained of continuous tearing and lancinating pain disclosed complete avulsion of IAN and degenerative changes with neuroma. One patient complained of mild painful dysesthesia revealed partial adhesion & fibrous epineural changes. Two patients whose IAN were explored after over 1 year resulted in only mild improvement in sensory recovery and moderate reduction of pain score. While the patient to whom decompression & epineural repair were given in 3 months after nerve injuries resulted in satisfactory improvement in sensory function and pain reduction. CONCLUSION: Painful dysesthesias occurred after implant placement were resulted from neurotmesis and disclosed degenerative neuropathy. Therefore, the micro-surgical explorations and repairs (epineurotomy, decompression neurolysis, and neurorrhaphy) can be recommended for known injuries as early as possible. For the delayed painful dysesthesia lasted over year, however, epineurotomy & tubulization could be an option to improve the painful discomfort but not satisfactory.
Anesthesia ; Decompression ; Dental Implants ; Discrimination (Psychology) ; Gingiva ; Humans ; Lip ; Mandible* ; Neuroma ; Nociception ; Paresthesia* ; Prognosis* ; Sensation ; Visual Analog Scale