Local anesthesia for arthroscopic procedure of the knee is an increasinglv popular technique that avoids the use of general anesthesia and the associated risks of respiratory depression, aspiration, and postoperative sedation. Many authors, for example McGinty etc., Martin, Yoshiya etc., advocated local anesthesia as safe and efficient method for arthroscopic procedures of the knee. We performed arthoroscopy of the knee under local anesthesia on 150 patients for diagnostic and operative purposes between January l993 and December l996. The technique of local anesthesia that we used was that 20cc of 0.5%; bupivacaine with I:200,000 epinephrine was injected into superolateral portal of the knee joint and additional 10-20cc ot 1% lidocaine into the arthroscopic portals. Pnevmatic tourniquet wa, not applied in all cases. We analysed the 150 cases and the results were as follows; The diagnostic arthroscopy was performed in 50 cases and the operative arthroscopy was in 100 cases. The duration ot local anethesia was from 4 hours to 12 hours, with an average of 6 hours. In 35 cases arthroscopy was performed as outpatient procedure and average hospital stay excluding other problem was 5 days. No complication related to systemic toxicity by local anesthetics was observed. Conclusively arthroscopy of the knee under local anesthesia is safe and effective procedure to avoid the risks of general anesthesia but patients selection is very important.
Anesthesia, General ; Anesthesia, Local* ; Anesthetics, Local ; Arthroscopy* ; Bupivacaine ; Epinephrine ; Humans ; Knee Joint ; Knee* ; Length of Stay ; Lidocaine ; Outpatients ; Respiratory Insufficiency ; Tourniquets

Bipotent progenitors for T and natural killer (NK) lymphocytes are thought to exist among early precursor thymocytes or liver lymphocytes. The identification of such a progenitor population or mature NK cells in such organs remains undefined. Here we report the identification of a novel receptor of NK cells, p58 (HLA class I-specific inhibitory receptors), in fetal thymocytes and fetal liver lymphocytes. Our finding suggests the NK cells mature in the developmental stage during feta1 ontogeny. Flow cytometric analysis revealed p58 positive cells in thymocytes or in fetal liver lymphocytes and reverse transcription PCR also showed amplification of p58 RNA. The result of single stranded conformational polymorphism (SSCP) showed it discriminates one or two base pair differences of the p58 gene. Although the question still remains as to whether the expression of p58 is due to the NK cells or natural T cells, it is clear the p58 is expressed in fetal thymocytes or liver lymphocytes. And SSCP analysis using appropriate sets of primers used in this study, is helpful to study the diversity of p58.
Base Pairing ; Killer Cells, Natural ; Liver* ; Lymphocytes* ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational ; Reverse Transcription ; RNA ; T-Lymphocytes ; Thymocytes*

The authors have experience of three cases of laryngeal edema after tracheal intubation for general anesthesia. Two cases have been treated by oxygen therapy, epinephrine spray on the larynx and dexamethasone injection. A case has been treated after tracheostomy. We find the etiology of laryrigeal edema as follows; trauma, infection and allergic response to the lubricant, rubber, plastic and to topical anesthetics. We should like to prevent and remedy complications of tracheal intubation.
Anesthesia, General* ; Anesthetics ; Dexamethasone ; Edema ; Epinephrine ; Intubation* ; Laryngeal Edema* ; Larynx ; Oxygen ; Plastics ; Rubber ; Tracheostomy

Fetal thymus may be the organ for NK cell maturation, but the in vivo evidences are few, Here, by analyzing NK cell receptor, we present that NK cells develop in fetal thymus and fetal liver and that NK cell receptor appears earlier than the expression CD16 or CD56. Moreover, the finding that the repertoire of NK cell receptor is different between fetal thymus and fetal liver lymphocytes suggests that the environmental factors may influence the NK cell receptor repertoire during NK cell maturation.
Killer Cells, Natural* ; Liver* ; Lymphocytes* ; Thymocytes* ; Thymus Gland

BACKGROUND: The pattern of left ventricular filling as depicted by Doppler echocardiographic transmitrial flow velocities has been used to left ventricular diastolic properties. Especially, altered transmitral flow by abnormal myocardial wall motion and left ventricular function in ischemic heart disease, was predicted during exercise test. METHODS: To determine the effects of exercise on Doppler echocardiographic measures of left ventricular diastolic filling, we studied 15 angina pectoris patients and 20 normal control subjects. Transmitral flow measurements comprised peak and integrated early passive(E) and late atrial(A) filling velocities and diastolic filling period. RESULTS: Heart rate in negative exercise treadmill test group was 70/min at rest, 111/min just after exercise, and 86/min at 5 minutes after exercise. Positive exercise treadmill test group was 69/min, 109/min and 82/min, respectively. DFP and E duration were also significantly decreased after exercise in group with negative treadmill exercise test. In positive treadmill exercise group, peak A was significantly increased from 0.57+/-0.15m/sec to 0.75+/-0.20m/sec at just after exercise(p<0.01), 0.67+/-0.12m/sec at 5 minuties after exercise. DFP and E duration were also significantly decreased after exercise. CONCLUSION: Doppler echocardiographic transmitral flow was altered by abnormal regional wall motion and left ventricular dysfunction in ischemic heart disease during exercise test. The use of Doppler echocardiography for this purpose is limited, however, because a number of variables may influence transmitral flow patterns, including age, preload, afterload and systolic function.
Angina Pectoris ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis* ; Echocardiography ; Echocardiography, Doppler* ; Exercise Test ; Heart Rate ; Humans ; Isoflurophate ; Myocardial Ischemia ; Ventricular Dysfunction, Left ; Ventricular Function, Left

It is well known that hypertension is associated with left ventricular diastolic dysfunction which frequently precede systolic dysfunction. To determine whether nifedipine could improve left ventricular diastolic function in hypertensive patients, we studied 15 hypertensive patients and 15 normotensive subjects matched for sex, age with Doppler echocardiography. After oral administration of 10mg of nifedipine, there were no significant changes in Doppler-derived transmitral diastolic filling indexes of normotensive subjects. On the other hand, although peak flow velocity in atrial systole(PFVA), time velocity integral in atrial systole(TVIA) did not change significantly after nifedipine, nifedipine significantly increased peak flow velocity in early diastole(PFVE) from 40.2+/-6.4cm/sec to 46.5+/-10.9cm/sec(p<0.005), time velocity integral in early diastole(TVIE) from 5.24+/-1.2cm to 5.97+/-1.43cm(p<0.001), the ratio of PFVE/PFVA from 0.69+/-0.11 to 0.76+/-0.12(p<0.05), the ratio of TVIE/TVIA from 1.18+/-0.21 to 1.29+/-0.24(p<0.05), deceleration slope(DS) from 244.9+/-51.9cm/sec2 to 289.9+/-49.1cm/sec2 (p<0.001) and decreased isovolumic relaxation time(IVRT) from 132.3+/-10.3msec to 117.2+/-13.5msec(p<0.001), deceleration time(DT) from 168.8+/-30.3msec to 154.9+/-29.8msec(p<0.05) in hypertensive patients. These fimdings indicated that nifedipine improves Doppler-derived early diastolic filling indexes in hypertensive patients and may be related to improvement of active relaxation of left ventricle in early diastole.
Administration, Oral ; Deceleration ; Diastole ; Echocardiography, Doppler* ; Hand ; Heart Ventricles ; Humans ; Hypertension ; Nifedipine* ; Relaxation

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder that affects synovium, tendon sheath and bursa. Although the condition can present in any joint, knee joint is the most commonly affected site and only 2.5% of cases occur in foot and ankle joint. PVNS occurs in two types: localized and diffuse. Localized type is characterized by focal involvement of the synovium with either nodular or pedunculated masses, Diffuse type affects virtually the entire synovium. Diffuse type has reported more recurrence rate. We have experienced a patient who has diffuse type PVNS of ankle joint and report an optimal method of surgical treatment.
Animals ; Ankle ; Ankle Joint ; Foot ; Humans ; Joints ; Knee Joint ; Recurrence ; Synovial Membrane ; Synovitis, Pigmented Villonodular ; Tendons

BACKGROUND: The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to M3 muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal M2 muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these M2 muscarinic receptors act as autoreceptors. Loss of function of these M2 receptors, as it occres in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of M2 muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. METHODS: We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test(PC 20<16mg/ml). Methacholine provocation tests performed twice on separate days allowing for an interval of one week. In the second test, pre-treatment with the M2 muscarinic receptor agonist pilocarpine(180µg) through inhalation was performed before the routine procedures. RESULTS: Eleven subjects with mild asthma and eight aubjects with moderate asthma showed significant increase of PC20 from 5.30±5.23mg/ml(mean±SD) to 20.82±22.56mg/ml(p=0.004) and from 2.79±1.5mg/ml to 4.67±3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of PC20 from 1.76±1.50mg/ml to 3.18±4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. CONCLUSION: In subjects with mild and moderate asthma, function of M2 muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. These results suggest that function of M2 muscarinic receptors is different according to severity of asthma.
Acetylcholine ; Asthma ; Autoreceptors ; Humans ; Inhalation ; Korea ; Methacholine Chloride ; Models, Animal ; Muscle, Smooth ; Neurons* ; Pilocarpine ; Pulmonary Medicine ; Receptors, Muscarinic* ; Respiratory Tract Infections ; Vagus Nerve

OBJECTIVE: To assess the gestational age adjusted values of umbilical cord artery blood pH in term pregnancy METHODS: We retrospectively analyzed umbilical arterial blood pH values and obstetric data of 1,918 term singleton deliveries without maternal medical disease, pregnancy induced hypertension and fetal distress during labor periods at Kangnam St. Mary's Hospital, Catholic University medical college between January 2004 and December 2006. Low pH was defined as less than 7.10 as a stationary cutoff value, whereas pH less than (mean -2 standard deviations [SDs]) was used when gestational age was considered. We evaluated the risk of 5 minute Apgar score of less than 7 and meconium staining more than grade II at low pH. RESULTS: A significant negative correlation was found between gestational age and umbilical artery pH (p=0.000). We evaluated the umbilical artery pH value in different delivery mode. Vaginal delivery cases showed negative correlation (p=0.000), but elective cesarean section cases didnt. Low pH patients defined by both criteria of pH less than 7.10 and pH less than (mean -2SD) showed significantly increased risk of 5 minutes Apgar score of less than 7 (pH less than 7.10: p=0. 000, pH less than (mean -2SD): p=0.001) and meconium staining more than grade II (pH less than 7.10: p=0. 001, pH less than (mean -2SD): p=0.001). CONCLUSION: Our results suggest that umbilical cord pH has a negative relation with gestational age during term period.
Apgar Score ; Arteries ; Cesarean Section ; Female ; Fetal Distress ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pregnancy-Induced ; Meconium ; Pregnancy ; Retrospective Studies ; Umbilical Arteries ; Umbilical Cord

PURPOSE: Chronic rejection accounts for the majority of late renal graft losses and there is good evidence that both immunologic and non-immunologic factors are important in late graft loss. The hyperfiltration hypothesis postulates that kidneys with reduced renal mass will progress toward failure due to hypertrophy of the remaining nephron to meet the excess metabolic demand, eventually leading to nephron exhaustion. The impact of metabolic demand and renal mass supply on the early graft function, especially hyperfiltration phenomenon, remains uncertain. METHODS: In this study, we analyzed age, gender, body weight, height, body surface area (BSA), lean body weight (LBW), and serum creatinine (SCr) of both donors and recipients. We weighed the donated kidney and measured the recipient's SCr and LBW for six months postoperatively. Modified Cockcroft-Gault Equation standardized for BSA was used to calculate renal glomerular filtration rate (CrCl, mL/min/1.73 m2). The variables and the CrCl of the 3rd day and 6th month were analyzed with accordance to donor/recipient LBW ratio(D/R LBW) and graft weight/recipient LBW (GW/RLBW) by independent sample t-test and paired t-test using SPSS, and P<.05 was considered significant. RESULTS: The means of the 3rd day and 6th month CrCl were 76.90+/-24.35 and 73.41+/-10.80, respectively and there were no statistical differences (P=0.340). In D group (D/R LBW>1), the 3rd day and 6th month CrCl were 80.82+/-28.74 and 71.66+/-12.12, respectively. In R group (D/R LBW< or =1), the 3rd day and 6th month CrCl were 69.94+/-12.06 and 75.80+/-7.24, respectively. D group CrCl was decreased (P=0.093) and R group CrCl was increased slightly (P=0.169) during the study period, but there was no statistical significance. In H group (GW/RLBW>3), the 3rd day CrCl was 86.08+/-25.13, which was significantly decreased to 73.48+/-11.64 at the 6th month (P=0.023). In L group (GW/RLBW< or =3), the 3rd day and 6th month CrCl were 66.95+/-19.94 and 73.34+/-10.60 (P=0.158), respectively. the 3rd day CrCl of H group was higher than that of L group significantly (P=0.047), but 6th month CrCl showed no difference between the two groups (P=0.975). CONCLUSIONS: The 3rd day CrCl represents early graft function well. GW/RLBW has a strong correlation with early graft function. In L group with low early graft function, CrCl was tended to be increased to meet the metabolic demand for following the 6 months. Conversely, in H group with high early graft function, CrCl was decreased to reduce the excess graft function. So the 6th month CrCl represents adapted graft function. In this study, therefore, we postulate that the hyperfiltration or hypofiltration develops according to metabolic demand and renal mass supply.
Body Height ; Body Weight ; Creatinine ; Glomerular Filtration Rate ; Humans ; Hypertrophy ; Kidney ; Kidney Transplantation* ; Living Donors* ; Nephrons ; Tissue Donors ; Transplants*