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.

No abstract available.
Veins*

30 patients were randomly divided into three groups : halothane in oxygen(N=10) ; enflurane in oxygen(N= 10) ; Thalamonal plus nitrous oxide in oxygen(N= 10). Standardized bleeding time was measured using Ivy method before and at leaat 40 min after the induction of anesthesia. Arterial pressure was maintained at+/- 200 of control values and tem-perature was kept at 35~37 degrees C. The bleeding time was prolonged by 58% in the halothane group (P<0.001). There was essentially no change in bleeding time in the groups receiving enflurane and nitrous oxide-Thalamonal group, although there was considerable variability within each group, which did not seem to be related to differences in sex, age, type of surgery, concentration of agent used or surgical procedure. In conclusion, our resultg suggest that halothane may be contraindicated in situations where optimal hemostasis is critical.
Anesthesia ; Arterial Pressure ; Bleeding Time* ; Enflurane* ; Halothane* ; Hemorrhage* ; Hemostasis ; Humans ; Nitrous Oxide

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: 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

Many fungi including Penicillium, Aspergillus, Gliocladium, and Thermoascus produce an epipolythiodioxopiperazine class of fungal metabolite, gliotoxin, which contirbutes the pathogenesis of fungal infection as an immunomodulator and cytotoxic agent. This study is designed to define the mechanism by which gliotoxin exerts the cytotoxic effect of gliotoxin on human promyelocytic leukemic cells, HL-60. Gliotoxin induces the apoptosis of HL-60 cells which is characterized by the ladder pattern fragmentation of DNA. Gliotoxin induces the activation of DEVD-specific cysteine protease in a time- and dose-dependent rnanner. It also increases the phosphotransferase activities of c-Jun N-terminal kinase1 (JNK1) and p38 in gliotoxin-treated HL-60 cells. Furthermore, gliotoxin decreases the activation of transcriptional activator, actiating protein (AP-1) and NF-kB. These results suggest that gliotoxin induces the apoptotic death of HL-60 cells via activation of DEVD- specific caspase as well as mitogen activated protein kinases (MAP kinases) including JNK1 and p38, and inhibition of transcriptional activators, AP-1 and NF-kB.
Apoptosis* ; Aspergillus ; Caspase 3 ; Cysteine Proteases ; DNA ; Fungi ; Gliocladium ; Gliotoxin* ; HL-60 Cells* ; Humans ; Mitogen-Activated Protein Kinases ; NF-kappa B ; Penicillium ; Thermoascus ; Transcription Factor AP-1 ; Transcription Factors

No abstract available.
Hemorrhage* ; Kidney Transplantation*

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

STUDY DESIGN: A retrospective study. OBJECTIVES: The aim of this study was to examine the usefulness of axial and sagittal-reconstructed CT images in the evaluation of spinal canal encroachment by thoracolumbar burst fractures. SUMMARY OF LITERATURE REVIEW: The dimensions of spinal canal encroachment by burst fractures have been described using axial CT images in the thoracolumbar region and sagittal-reconstructed images in the lower cervical region. However, the validity and reliability, depending on the measuring method, have not been fully evaluated. MATERIALS AND METHODS: A hundred and ninety-nine patients, who had diagnosed as a thoracolumbar burst fracture, were included in this study. Three orthopedic surgeons independently measured the canal encroachment of the burst fragment in the axial CT images and the sagittal-reconstructed images using the ratio of spinal length (method 1) and the ratio of area (method 2). The validity for the evaluation of the deformity and fracture stability was evaluated. In addition, the reliability of each method was assessed. RESULTS: Sixty-seven stable burst fractures and 132 unstable burst fractures were assessed. The mean kyphotic angle of stable and unstable burst fracture were 11.89 +/- 8.49degreesand 15.90 +/- 9.63degrees(P=0.005). The mean canal encroachment ratios of stable fracture were 17.21 +/- 15.82 % (axial-method 1), 16.71 +/-16.49 % (axial-method 2), 19.54 +/- 17.03 % (sagittal reconstructed-method 1), and 11.75 +/- 12.33 % (sagittal reconstructed-method 2). The mean canal encroachment ratios of unstable fracture were 31.54 +/- 17.10 % (axial-method 1), 29.67 +/- 18.47 % (axial-method 2), 28.53 +/- 18.60 % (sagittal reconstructed-method 1), and 21.20 +/- 15.11 % (sagittal reconstructed-method 2). There was no relationship between the fracture deformity and the canal encroachment ratio in all 4 methods. All ratios in the 4 method showed significant differences in the evaluation of fracture stability. All methods except method 1 in the sagittal-reconstructed images showed significant differences in the assessment of neurologic compromise. CONCLUSIONS: The measurement of a canal encroachment area using axial and sagittal-reconstructed images was valid in the description of fracture stability.
Congenital Abnormalities ; Humans ; Orthopedics ; Reproducibility of Results ; Retrospective Studies ; Spinal Canal