BACKGROUND: One of the most common side effects of antidepressant medication is orthostatic hypotension, which can be caused by impaired vasoconstriction. This study was designed to compare the inhibitory effects of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), on the contractile responses to alpha1-adrenergic receptor activation and depolarization in isolated rat aorta. METHODS: Vascular rings were suspended for the measurement of isometric tension in a water-jacketed bath filled with Tyrode solution. After pretreatment with antidepressant for 20 min, vasoconstriction induced by norepinephrine (NE) or 35 mM K+ was measured and compared to the control response. RESULTS: Whereas trazodone and tricyclic antidepressants (TCAs) selectively inhibited NE-induced vasoconstriction, SSRIs inhibited depolarization-induced vasoconstriction more potently. The IC50 value of fluoxetine on depolarization- induced vasoconstriction was 3.29 microM, which is consistent with the previous results on L-type Ca2+ currents of cardiac myocyte. Moclobemide, a monoamine oxidase inhibitor, had no effect on vasoconstriction induced by either alpha- adrenergic receptor activation, or depolarization. CONCLUSION: These results suggest that SSRIs, different from TCAs and trazodone, have potent inhibitory actions to depolarization-induced contraction that may be due to blocking Ca2+ entry through L-type Ca2+ channel.
Animals ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Aorta* ; Baths ; Fluoxetine ; Hypotension, Orthostatic ; Inhibitory Concentration 50 ; Moclobemide ; Monoamine Oxidase Inhibitors ; Myocytes, Cardiac ; Norepinephrine ; Rats* ; Receptors, Adrenergic ; Serotonin Uptake Inhibitors* ; Trazodone ; Vasoconstriction*

Thyroid nodules are the most common endocrine disease requiring surgical management. Various techniques for evaluating thyroid nodules have been developed and are being utilized, but it is difficult to differentiate the few malignant lesions from the numerous benign nodules. We reviewed 187 patients with thyroid nodules who were admitted to and operated on at the Department of General Surgery, Buchon Sejong General Hospital, from January 1990 to December 1996. The results are summarized as follows: 1) The incidence of benign nodules was 83.9%, and that of malignant nodules was 16.0% among the 187 cases of thyroid nodules. 2) The sexual distribution revealed female preponderance of 6.5:1 for benign nodules and 14:1 for malignant nodules. 3) The peak-incidence was in the 4th decade to both patients with benign nodules and patients with malignant nodules. 4) As to the duration of illness, 39.6% of cases were resolved within 3 months, 77.5% of cases within 1 year. 5) The most common subjective symptoms were a palpable mass (100%), fatigue, palpitation, and headache, in order of frequency. 6) Eight four percent (84%) of the nocules were unilateral, 46.5% were on the right, 37.4% were on the left, and 12.8% were bilateral. 7) The most common (36.9%) nodule size was 2~3 cm. 8) There was a single nodule in 142 (75.9%) cases and multiple nodules in 45 (24.1%) cases. There was no difference in the incidence of cancer between single and multiple nodules. Also, 35.7% of the benign tumors and 80.0% of the malignant ones were solid. 9) On thyroid scanning, 86.0% of the benign nodules and 93.3% of the malignant nodules were cold nodules. 10) The histopathologic classifications of the benign nodules in decreasing order of frequency were adenomatous goiter, 121 cases (77.1%); follicular adenoma, 20 cases (12.7%); Graves' disease, 6 cases (3.8%); Hashimoto's thyroiditis, 6 cases (3.8%), cyst, 3 cases (1.9%); and subacute thyroiditis, 1 case (0.6%). The malignant diseases were papillary carcinoma, 26 cases (86.7%); follicular carcinoma, 3 cases (10.0%); and medullary carcinoma, 1 case (3.3%). 11) Benign nodules were treated with a lobectomy (69.4%), a lobectomy with isthmectomy (17.8%), a near total thyroidectomy (11.5%) or a total thyroidectomy (1.3%). Malignant nodules were treated with a lobectomy (23.3%), a lobectomy with isthmectomy (20.0%), a total thyroidectomy (20%), a total thyroidectomy with radical neck dissection (20%) a near total thyroidectomy (13.3%), or a near total thyroidectomy with radical neck disection(RND) or modified RND (3.3%). 12) The postoperative complications were transient hypocalcemia (6.4%), permanent hypocalcemia (2.1%), transient hoarseness (1.6%), permanent hoarseness (0.5%), and hematoma (0.5%).
Adenoma ; Carcinoma, Medullary ; Carcinoma, Papillary ; Classification ; Endocrine System Diseases ; Fatigue ; Female ; Goiter ; Graves Disease ; Headache ; Hematoma ; Hoarseness ; Hospitals, General ; Humans ; Hypocalcemia ; Incidence ; Neck ; Neck Dissection ; Postoperative Complications ; Thyroid Gland* ; Thyroid Nodule* ; Thyroidectomy ; Thyroiditis ; Thyroiditis, Subacute

Thyroid nodules are the most common endocrine disease requiring surgical management. Various techniques for evaluating thyroid nodules have been developed and are being utilized, but it is difficult to differentiate the few malignant lesions from the numerous benign nodules. We reviewed 187 patients with thyroid nodules who were admitted to and operated on at the Department of General Surgery, Buchon Sejong General Hospital, from January 1990 to December 1996. The results are summarized as follows: 1) The incidence of benign nodules was 83.9%, and that of malignant nodules was 16.0% among the 187 cases of thyroid nodules. 2) The sexual distribution revealed female preponderance of 6.5:1 for benign nodules and 14:1 for malignant nodules. 3) The peak-incidence was in the 4th decade to both patients with benign nodules and patients with malignant nodules. 4) As to the duration of illness, 39.6% of cases were resolved within 3 months, 77.5% of cases within 1 year. 5) The most common subjective symptoms were a palpable mass (100%), fatigue, palpitation, and headache, in order of frequency. 6) Eight four percent (84%) of the nocules were unilateral, 46.5% were on the right, 37.4% were on the left, and 12.8% were bilateral. 7) The most common (36.9%) nodule size was 2~3 cm. 8) There was a single nodule in 142 (75.9%) cases and multiple nodules in 45 (24.1%) cases. There was no difference in the incidence of cancer between single and multiple nodules. Also, 35.7% of the benign tumors and 80.0% of the malignant ones were solid. 9) On thyroid scanning, 86.0% of the benign nodules and 93.3% of the malignant nodules were cold nodules. 10) The histopathologic classifications of the benign nodules in decreasing order of frequency were adenomatous goiter, 121 cases (77.1%); follicular adenoma, 20 cases (12.7%); Graves' disease, 6 cases (3.8%); Hashimoto's thyroiditis, 6 cases (3.8%), cyst, 3 cases (1.9%); and subacute thyroiditis, 1 case (0.6%). The malignant diseases were papillary carcinoma, 26 cases (86.7%); follicular carcinoma, 3 cases (10.0%); and medullary carcinoma, 1 case (3.3%). 11) Benign nodules were treated with a lobectomy (69.4%), a lobectomy with isthmectomy (17.8%), a near total thyroidectomy (11.5%) or a total thyroidectomy (1.3%). Malignant nodules were treated with a lobectomy (23.3%), a lobectomy with isthmectomy (20.0%), a total thyroidectomy (20%), a total thyroidectomy with radical neck dissection (20%) a near total thyroidectomy (13.3%), or a near total thyroidectomy with radical neck disection(RND) or modified RND (3.3%). 12) The postoperative complications were transient hypocalcemia (6.4%), permanent hypocalcemia (2.1%), transient hoarseness (1.6%), permanent hoarseness (0.5%), and hematoma (0.5%).
Adenoma ; Carcinoma, Medullary ; Carcinoma, Papillary ; Classification ; Endocrine System Diseases ; Fatigue ; Female ; Goiter ; Graves Disease ; Headache ; Hematoma ; Hoarseness ; Hospitals, General ; Humans ; Hypocalcemia ; Incidence ; Neck ; Neck Dissection ; Postoperative Complications ; Thyroid Gland* ; Thyroid Nodule* ; Thyroidectomy ; Thyroiditis ; Thyroiditis, Subacute

Serious complications involving the alimentary tract are commonly reported following cardiac transplantation and may be associated with significant morbidity and mortality. Between April 1994 and April 1996, 17 patients underwent orthotopic cardiac transplantation at the Buchon Sejong General Hospital. Recipients comprised 15 males and 2 females with a mean age of 33-years old. Basic immunosuppressive therapy was accomplished with immuran and cyclosporine and prednisolone. Gastrointestinal complications developed in 10 patients(58.8%), including gastritis[n=4(23.5%)], nonspecific enteritis[n=3(17.6%)], cholecystitis[n=1(5.8%)], perianal abscess[n=1(5.8%)] and panperitonitis due to mesenteric infarction[n=1(5.8%)]. Among them three patients required surgical procedures and one is dead due to sepsis and multiple organic failure(surgical mortality:33.3%). Gastrointestinal complications in cardiac transplantation are frequent cause of postoperative morbidity and mostly step benign courses, they should be detected as soon as possible and be managed with aggressive intervention. Early, aggressive surgical intervention may reduce subsequent mortality.
Adult ; Azathioprine ; Cyclosporine ; Female ; Heart Transplantation* ; Hospitals, General ; Humans ; Male ; Mortality ; Prednisolone ; Sepsis

No abstract available.
Cell Line* ; Humans* ; Interferon-gamma* ; Matrix Metalloproteinases* ; Tumor Necrosis Factor-alpha* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

No abstract available.
Cell Line* ; Humans* ; Interferon-gamma* ; Matrix Metalloproteinases* ; Tumor Necrosis Factor-alpha* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Five medical students in the fourth-year took anatomy as their elective courses for 1 month. They dissected one cadaver, and investigated Digital Report, under the course subjects as follows; (1) the shape of thyroid gland and the location of its isthmus, (2) the branches of left and right coronary arteries, (3) the number of blood vessels and bronchi on the hilum of lung, (4) topographical relationship of the renal vessels and ureter, and the shape of the renal pelvis, (5) the location and attachment of the appendix, (6) the penetration of median nerve through the pronator teres, (7) the sensory nerves and the extensor tendons on the dorsum of hand, (8) the branches of deep femoral artery. The pancreatic and live samples were processed and stained with H&E, for LM observation, since the individual had suffered from pancreatic cancer and got a Pylorus preserving pancreatico-duodenectomy (PPPD). At the last step of the elective course, students wrote small articles following the conventional method for writing manuscript. From the viewpoint of professor, the anatomy course for the fourth-year students were definitely different from that for first-year students, and had many positive effects in terms of anatomy education.
Appendix ; Blood Vessels ; Bronchi ; Cadaver ; Coronary Vessels ; Education ; Femoral Artery ; Hand ; Humans ; Kidney Pelvis ; Lung ; Median Nerve ; Pancreatic Neoplasms ; Pylorus ; Students, Medical* ; Tendons ; Thyroid Gland ; Ureter ; Writing

The most common cardiovascular side effects of antidepressants are cardiac arrhythmias and orthostatic hypotension. Little is known, however, about the mechanisms by which these adverse reactions may occur, especially with regard to newer drugs such as fluoxetine. We hypothesized that these side effects may have an electrophysiological basis at the level of the cardiac myocyte. Thus, we investigated the effects of fluoxetine and other antidepressants on action potentials and ionic currents of rat ventricular myocytes using the amphotericin B perforated patch clamp technique. Fluoxetine (10 microM) prolonged the action potential duration (APD50) to 146.7 +/- 12.9% of control value without altering resting membrane potential. Fluoxetine and sertraline potently inhibited the L-type Ca2+ current (IC50 = 2.82 and 2.31 microM, respectively), but did not significantly modify the steady-state inactivation. Amitriptyline and imipramine had similar, but slightly weaker, effects (IC50 = 3.75 and 4.05 microM, respectively). Fluoxetine attenuated the peak transient outward K+ current and also altered current kinetics, as shown by accelerated decay. Fluoxetine did not change the voltage-dependence of the steady-state inactivation. Sertraline, amitriptyline and imipramine inhibited the transient outward K+ current with potencies very similar to fluoxetine. In contrast to the other antidepressants tested, trazodone weakly inhibited the Ca2+ and K+ currents and moclobemide had no detectable effect. Our comparative pharmacology data suggest that selective serotonin reuptake inhibitors, such as fluoxetine, are as potent as tricyclic antidepressants in inhibiting L-type Ca2+ and transient outward K+ currents. These inhibitory effects may contribute to cardiovascular complications such as arrhythmias and orthostatic hypotension.
Animal ; Antidepressive Agents, Second-Generation/pharmacology* ; Calcium Channels/drug effects* ; Calcium Channels, L-Type ; Electric Conductivity ; Fluoxetine/pharmacology* ; Male ; Myocardium/metabolism* ; Myocardium/cytology ; Potassium/physiology* ; Rats ; Rats, Sprague-Dawley ; Ventricular Function/physiology*

The protein encoded by the Bcl-2 proto-oncogene has been shown to prolong cell survival by preventing programmed cell death (apoptosis). Recent work has elucidated Bcl-2 expression in many solid tumors including bladder tumor. Because there exists some controversy as to the prognostic significance of Bcl-2 in bladder cancer, we examined the cellular expression of Bcl-2 protein using immunohistochemistry in tumor samples from 89 patients with bladder cancer and determined whether expression of Bcl-2 has prognostic significance in bladder cancer. We found Positive staining for Bcl-2 (>5% positive cells) in 41 patients (40%). Bcl-2 expression was strongly correlated with tumor stage and grade (superficial vs. invasive, p<0.025; grade II vs. grade III&IV, p<0.005). In superficial tumors, Bcl-2 expression was not correlated with disease- free survival (p>O.l) and weakly correlated with progression-free survival (p In invasive tumors, Bcl-2 expression was correlated with shortened actuarial survival (p<0.025). We assessed the effect of Bcl-2 status on the response to chemotherapy or radiotherapy in 25 patients with invasive tumor. The patients with Bcl-2 positive tumors had significantly higher response rate than with Bcl-2 negative tumors (p<0.05). These results suggest that Bcl-2 protein plays an important role in tumorigenesis of bladder cancer and that Bcl-2 expression is not superior to tumor stage and grade in assessing the prognosis of patients with superficial tumors. However, Bcl-2 expression is associated with shortened actuarial survival in the patients with invasive tumor, which may be partly due to chemosensitivity or radiosensitivity in relation to the apoptotic process.
Carcinogenesis ; Carcinoma, Transitional Cell* ; Cell Death ; Cell Survival ; Disease-Free Survival ; Drug Therapy ; Humans ; Immunohistochemistry ; Prognosis ; Proto-Oncogenes ; Radiation Tolerance ; Radiotherapy ; Urinary Bladder Neoplasms ; Urinary Bladder*

BACKGROUND: Cough and hyperdynamic reaction cause considerable discomfort, and they may lead to postoperative surgical complication. To reduce coughing and hemodynamics during emergence, the efficacy of laryngotracheal spraying with lidocaine before intubation is not clear, particularly, in children. We investigated such effect during emergence from general anesthesia, in children. METHODS: Children were studied in a double blind manner: 105 ASA physical status I-II, aged 2-16 yrs, undergoing tonsillectomy and adenoidectomy. Patients were randomly grouped into three (A, B, and C) by the lidocaine spray before endotracheal intubation: 4% lidocaine to the group A (n = 32), 10% lidocaine to the group B (n = 36), and normal saline to the group C (n = 37). The same dose (2 mg/kg) of lidocaine was applied. During emergence, patients were observed their cough and hemodynamics. RESULTS: Lidocaine spray, irrespective of concentration, did not significantly diminish the cough and the hemodynamic reaction across the groups before and after the extubation as well as in the recovery room (P value = 0.44, 0.86, 0.17). CONCLUSIONS: These findings support that the laryngotracheal spraying with lidocaine (2 mg/kg of 4% and 10%) before endotracheal intubation does not reduce the cough and hemodynamic reactions during emergence from general anesthesia in children.
Adenoidectomy ; Anesthesia, General ; Child* ; Cough* ; Hemodynamics* ; Humans ; Incidence* ; Intubation ; Intubation, Intratracheal* ; Lidocaine* ; Recovery Room ; Tonsillectomy