No abstract available.
Diverticulum, Esophageal*

To analyze the developmental changes in soma diameters of digastric motoneurons, wheat-germ agglutinin conjugated horseradish peroxidase (WGA-HRP) was injected into the digastric muscle and visualized the retrogradely HRP-labeled motoneurons through tungstate/tetramethylbenzidine (TMB) and following diaminobenzidine (DAB) reactions. The results obtained from Sprague-Dawley rats at postnatal days 1 (P1), 10 (P10) and 30 (P30) indicated as follows: firstly, soma diameters of digastric motoneurons showed unimodal distribution in all postnatal days examined; secondly, the period of P1 to P10 (period 1) showed about 2 times faster growth rate than that of P10 to P30 (period 2); thirdly, the smallest soma examined in each postnatal day exhibited slower growth rate with that of the largest one (increase ratio in soma diameters from P1 to P30, smallest vs. largest =1.62 : 1.93); Finally, relative growth rates a day showed again that period 1 had faster growth rate than that of period 2. Consequently, developmental changes in soma diameters of digastric motoneurons resulted in very different growth rates between both periods. This implies that the growth of the soma is almost completing within P10 and thereafter growing slowly. The period 1 and 2 are corresponding to sucking and sucking/masticatory period, respectively. Therefore present study providing morphological changes in soma diameters of digastric motoneurons suggests that both periods and their different growth rates of the motoneurons in each period may closely be related with each other.
Animals ; Carisoprodol* ; Horseradish Peroxidase ; Rats* ; Rats, Sprague-Dawley

We had a 16-month-old male presented for a surgery for degloving injury of left lower extremity. He had no considerable past or family history. High fever and increased end-tidal CO2 with tachycardia was revealed after induction of general anesthesia with thiopental sodium, vecuronium, isoflurane-N2O and O2. Arterial blood gas analysis showed a severe mixed acidosis. Under the suspicion of malignant hyperthermia, all anesthetics were discontinued. Anesthesia was maintained with fentanyl and midazolam. The patient was managed with surface cooling, gastric lavage with cold saline, sodium bicarbonate and diuretics. Dantrolene sodium 50 mg was administered. The patient survived without any sequelae and discharged after 9 days. The etiologic factors, incidence, clinical features, prevention and treatments of malignant hyperthermia are discussed.
Acidosis ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Blood Gas Analysis ; Child* ; Dantrolene ; Diuretics ; Fentanyl ; Fever ; Gastric Lavage ; Humans ; Incidence ; Infant ; Lower Extremity ; Male ; Malignant Hyperthermia* ; Midazolam ; Sodium Bicarbonate ; Tachycardia ; Thiopental ; Vecuronium Bromide

We experienced a case of lumbar epidural lipomatosis patient who had been treated with several epidural steroid injection for the management of lower back pain. This 67-years-old man, complained of lower back pain and radiating paresthetic pain to the dorsum of left foot. Epidural lipomatosis is a rare condition of focal or multiple deposition of excessive adipose tissue in epidural space. Since excessive deposited adipose tissue compresses the spinal cord or spinal root, patients complaint the atypical low back pain and low extremity radiculopathy which mimics the symptoms of spinal stenosis or herniated nucleus pulposus. In managing of lower back pain patient, especially who had been treated with steroid previously, we should consider that epidural lipomatois would be one of the cause.
Adipose Tissue ; Epidural Space ; Extremities ; Foot ; Humans ; Lipomatosis* ; Low Back Pain* ; Radiculopathy ; Spinal Cord ; Spinal Nerve Roots ; Spinal Stenosis

BACKGROUND: Somato-sensory evoked potential (SSEP) monitoring has been used to help minimize neurologic morbidity during spinal surgery. However, SSEP is affected by anesthetics, technical errors and physiologic aspects. We reviewed 50 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. METHODS: Fifty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl (Group I, P-F) or ketamine (Group II, P-K), and monitored by SSEP. We checked the changes of blood pressure and heart rates during the operation, recorded latency and amplitude of SSEP in the pre-induction, post-induction, during screw insertion and post-distraction periods. Also, we checked the number transfers to the ICU and application of a ventilator. RESULTS: Systolic and diastolic blood pressure were increased significantly in the propofol-ketamine group (P < 0.05), but there was no difference in heart rate between both groups. In addition there were no statistical differences in latencies and amplitudes of SSEP. The number of patients transferred to the ICU and placed on a ventilator showed no statistical difference. CONCLUSIONS: We think that the combination of propofol and fentanyl or ketamine used for total intravenous anesthesia is a very useful method in spinal surgery under SSEP monitoring.
Anesthesia* ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Blood Pressure ; Evoked Potentials* ; Fentanyl ; Heart Rate ; Humans ; Ketamine ; Propofol ; Spine* ; Ventilators, Mechanical

The thyroglossal duct cyst, mainly appearing as a midline neck swelling in adolescence and young adults, is the most common cervical mass among the congenital anomalies in the neck. The cysts are usually asymptomatic and movable when swallowing or protruding the tongue. Carcinoma arising in thyroglossal duct cyst is found in approximately 1% of these lesions, therefore the presentation of the patient with carcinoma is indistinguishable from the common cyst. A 50-year-old man was examined preoperatively by ultrasonography of the neck, assay of thyroid hormones and neck CT with enhancement, which yielded a diagnosis of a thyroglossal duct cyst. The patient underwent Sistrunk procedure for excision of a thyroglossal duct cyst. No thyroid abnormality and no palpable lymph node were noted. The histopathological examination revealed papillary carcinoma. So we performed bilateral neck dissection 17 days after the Sistrunk procedure. There were no problems in the postoperative course and no signs of local recurrence or metastases through one year after surgery. We present this case of papillary carcinoma arising in the thyroglossal duct cyst, with the review of literature.
Adolescent ; Carcinoma, Papillary* ; Deglutition ; Diagnosis ; Humans ; Lymph Nodes ; Middle Aged ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Recurrence ; Thyroglossal Cyst* ; Thyroid Gland ; Thyroid Hormones ; Tongue ; Ultrasonography ; Young Adult

BACKGROUND AND OBJECTIVES: Recent studies have demonstrated overexpression of cyclooxygenase-2 (COX-2) in various cancers including head and neck cancers. COX-2, an inducible enzyme which catalyzes the formation of prostaglandins from arachidonic acid, is expressed in some cancers. We investigated the anti-tumor effect of selective COX-2 inhibitor, Meloxicam, on the human oral cavity squamous cell carcinoma xenografted in nude mice. MATERIALS AND METHOD: We inoculated the oral cavity cancer cell (KB cell) line subcutaneously into 30 athymic mice which were divided into 3 groups 1 week after inoculation. One group received no treatment whereas two other groups received selective COX-2 inhibitor, Meloxicam, 10mg/kg and 40mg/kg three times weekly for 3 weeks. We studied mean tumor volume, apoptotic index (TUNEL) and proliferative index (Ki 67) in the control and treated groups. RESULTS: Meloxicam induced apoptosis, suppressed cell proliferation with significant difference (p<0.01), and suppressed the xenografted tumor growth with significant difference (p<0.05) in the Meloxicam treated group. All tumor expressed COX-2. CONCLUSION: This result suggested that the selective COX-2 inhibitors suppressed the growth of human oral cavity squamous carcinoma and a further study will be needed for determination of the pharmacologic pathway and efficacy of selective COX-2 inhibitor for head and neck cancers.
Humans ; Mice ; Animals

BACKGROUND: When we use a volatile anesthetic that increases cerebral blood flow (CBF) and propofol which decreases CBF in appropriate doses, respectively, an increase in ICP and cerebral ischemia can be prevented. The purpose of this study was to look for the proper method for balanced anesthesia using a jugular bulb oxygen saturation (SjO2) that depends on the concentration of propofol used in combination with isoflurane-N2O anesthesia. METHODS: Randomly we divided these patients into group 1 (12 patients), group 2 (12 patients), and group 3 (15 patients). Using a Master TCI and injecting a volatile anesthetic continuously, we injected 2ng/ml of blood concentration to group 1, 3ng/ml to group 2 and 4ng/ml to group 3 and maintained a partial pressure of CO2 in the vein around 30 mmHg during the operation. After induction of anesthesia, injection of propofol, and the dura mater was opened, we measured mean arterial blood pressure, heart rate, respectively, measured partial pressure of CO2, hematocrit, oxygen saturation sampling the arterial blood, measured oxygen saturation sampling jugular bulb. RESULTS: There were no differences of mean arterial blood pressure, heart rate, hematocrit, arterial blood partial pressure of CO2, oxygen saturation, or jugular bulb oxygen saturation among the groups. In addition, there were no statistical differences of variables measured before and after injecting propofol and the dura was opened. For 1 in group 1, 2 in group 2, and 3 in group 3, jugular oxygen saturation dropped below 50% after injecting propofol, but was not verified statistically. CONCLUSIONS: There were no significant hemodynamic effects when we used propofol with the volatile anesthetic in neuroanesthetic management.
Anesthesia ; Arterial Pressure ; Balanced Anesthesia ; Brain Ischemia ; Dura Mater ; Heart Rate ; Hematocrit ; Hemodynamics ; Humans ; Inhalation* ; Isoflurane ; Oxygen* ; Partial Pressure ; Propofol* ; Veins

BACKGROUND: Endoscopic surgical procedure has recently been applied to not only intraabdominal or intrathoracic surgery but also saphenous vein harvesting, because it is less invasive and more cosmetically advantageous. Carbon dioxide insufflation during an endoscopic saphenous vein harvesting may cause an adverse effects on arterial blood gas and hemodynamic variables. This study was conducted to evaluate the safety of carbon dioxide insufflation during endoscopic saphenous vein harvesting. METHODS: Patients in ASA physical status III or IV, scheduled for an endoscopic saphenous vein harvesting (n=30) were gathered for the evaluation. Until the end of the procedure, controlled mechanical ventilation (tidal volume: 10 ml/kg, respiratory rate: 10 rates/min) and ventilator mode was fixed in this tidal volume and respiratory rate. Arterial blood gas analysis, end-tidal carbon dioxide, blood pressure and heart rate were measured before and at 10, 20, 30, 40 minutes after carbon dioxide insufflation. RESULTS: Preinsufflation values of PaCO2 (partial pressure of arterial carbon dioxide) and PETCO2 (partial pressure of end-tidal carbon dioxide) were 33.4 +/- 3.6 mmHg and 24.1 +/- 4.1 mmHg, respectively. PaCO2 was significantly increased at 30 and 40 minutes after carbon dioxide insufflation (40.1 +/- 7.4 mmHg and 41.4 +/- 8.6 mmHg). PETCO2 was significantly increased at 20, 30 and 40 minutes after carbon dioxide insufflation(27.6 +/- 5.5 mmHg, 28.9 +/- 7.0 mmHg and 29.6 +/- 7.8 mmHg). But, the magnitude of difference between PaCO2 and PETCO2 was not significantly different. CONCLUSIONS: During endoscopic saphenous vein harvesting, PaCO2 was significantly increased compared with preinsufflation values. Careful monitoring of PaCO2 is mandatory during the procedure.
Blood Gas Analysis ; Blood Pressure ; Carbon ; Carbon Dioxide ; Coronary Artery Bypass* ; Coronary Vessels* ; Endoscopy ; Heart Rate ; Hemodynamics ; Humans ; Insufflation ; Respiration, Artificial ; Respiratory Rate ; Saphenous Vein* ; Tidal Volume ; Ventilators, Mechanical

Propofol is used for the treatment of refractory status epilepticus. When given as a long-term infusion, in combination with catecholamines and/or steroids, propofol rarely causes the fatal complication, known a propofol infusion syndrome. Herein, the case of a previously healthy 8-years-old boy with status epilepticus is reported. He was treated with propofol, in doses ranging from 8.6 to 10.9 mg/kg/h, for 43 hours. The propofol resulted in multiple organ failure, with rhabdomyolysis, which caused the death of the patient. This case fulfills all the criteria of propofol infusion syndrome.
Catecholamines ; Humans ; Male ; Multiple Organ Failure ; Propofol* ; Rhabdomyolysis ; Status Epilepticus* ; Steroids