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*

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

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

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

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

BACKGROUND: This study was conducted to determine the effects of dexamethasone and MK-801 on the formation of brain edema resulting from a focal ischemic injury by middle cerebral artery occlusion in rats. METHODS: Fifteen Sprague-Dawley rats (220 280 g) were freely allowed to drink and eat until just before surgery. Anesthesia was induced with 4% isoflurane in oxygen and then maintained with 2% isoflurane in oxygen. Ischemic injury was induced by an intraluminal suture with a blunted tip inserted into the internal carotid artery and occlusion of the middle cerebral artery. All rats were divided randomly into three groups. In group I (n = 5), normal saline 1 ml was injected intravenously 10 minutes before MCA occlusion. In group II (n = 5), dexamethasone 3 mg/kg was administered 10 minutes before injury. In group III (n = 5), a N-methyl-D-aspartate receptor antagonist, MK-801 1 mg/kg was injected 30 minutes before injury. Rectal temperatures were monitored during the experiment. After 60 minutes of MCA occlusion, the intraluminal sutures were removed and all the rats were returned to their cages. Their brain were quickly removed and the cerebral hemispheres were sepaerated into ischemic cores and penumbra zones after 1 hour of reperfusion. The separated cerebral hemispheres were dried 7 days at 60oC dry oven. The cerebral water content was assessed by the dry-weight method. RESULTS: In the dexamethasone group, there were no significant changes in cerebral edema formation in both ischemic core and the penumbra. In the MK-801 group, there were significant reductions in the brain edema formation in the penumbra (P< 0.05), but not in the core. CONCLUSIONS: Dexamethasone has no effect on ischemic brain edema; however, MK-801 is effective in the ischemic penumbra zone by reducing of edema formation.
Anesthesia ; Animals ; Brain ; Brain Edema ; Carotid Artery, Internal ; Cerebrum ; Dexamethasone* ; Dizocilpine Maleate* ; Edema* ; Infarction, Middle Cerebral Artery* ; Isoflurane ; Middle Cerebral Artery* ; N-Methylaspartate ; Oxygen ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Sutures

BACKGROUND: Subcutaneous injection of 5% formalin in the hind paw of the rat produces a biphasic nociceptive response. The second phase depends on changes in dorsal horn cell function that occur shortly after the initial C-fiber discharge, spinal sensitization, or windup phenomenon. Several studies about the effect of analgesic or anesthetic drugs on spinal sensitization has been done and we studied the effects of common intravenous anesthetic agents, thiopental, propofol and ketamine on spinal sensitization. METHODS: Sprague-Dawley rats weighing 200 to 250 gm were used for this study. Under halothane anesthesia PE-10 catheter was introduced into the right internal jugular vein, and tunnelled subcutaneously to the back of the rat. Before formalin test, animals were given saline 0.2 ml, propofol 10 mg/kg, propofol 6 mg/kg, thiopental 15 mg/kg, or ketamine 15 mg/kg. After formalin injection flinching was counted for 90 minutes. RESULTS: Propofol caused a significant decrease in phase 2 activity while thiopental showed no difference compared to control. Ketamine also caused a significant decrease in phase 2 activity. CONCLUSIONS: Propofol and ketamine not thiopental alter the spinal sensitization in rats. So we consider that these agents may have beneficial effect on attenuation of postoperative pain.
Anesthesia ; Anesthetics ; Anesthetics, Intravenous* ; Animals ; Catheters ; Formaldehyde* ; Halothane ; Injections, Subcutaneous ; Jugular Veins ; Ketamine ; Pain Measurement* ; Pain, Postoperative ; Posterior Horn Cells ; Propofol ; Rats* ; Rats, Sprague-Dawley ; Thiopental

PURPOSE: Renal graft mass has been known as a determinant of the outcome after kidney transplantation. We evaluated the correlation between the donated kidney weight and the recipient's creatinine clearance (Ccr), the donated kidney weight and serum creatinine (Scr) as well as the correlation between the donor traits and graft function after living-donor transplantation in adults. METHODS: The weight of a donated kidney was measured just after flushing during the operative procedures, and the recipient's Scr was measured on a daily basis postoperatively. When the Scr of the recipient reached the baseline level, we collected the recipient's 24-hour urine for the Ccr calculation. Based on the measured body weight and height, body surface area (BSA) and lean body weight (LBW) were calculated. Pearson correlation analysis was carried out using the SPSS. RESULTS: The weight of donated kidney was significantly correlated with the post-transplant recipient's Ccr (P=0.022). Scr was significantly correlated with the variable of graft weight/ recipient body weight ratio (P=0.047, Pearson correlation=-0.539), graft weight/recipient BSA ratio (P=0.028, Pearson correlation=-0.438), graft weight./recipient LBW ratio (P=0.001, Pearson correlation=-0.603), donor body weight/recipient body weight ratio (P<0.001, Pearson correlation= 0.667), donorBSA/recipient BSA ratio (P<0.001, Pearson correlation=0.743), donor LBW/recipient LBW ratio (p<0.001 Pearson correlation=0.759). CONCLUSIONS: It may be appropriate to select potential living donors based on the predicted size of the kidney, especially for the recipient who will likely to have higher metabolic demands.
Adult ; Body Height ; Body Weight ; Creatinine ; Flushing ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors* ; Surgical Procedures, Operative ; Tissue Donors ; Transplants*

BACKGROUND: Preemptive analgesia may improve postoperative antinociceptive treatment that prevents the development of central sensitization which contributes to post-injury pain hypersensitivity. However, beneficial effects of preemptive analgesia appear controversial. The purpose of this study was to examine the effect of pre- and post-incisional local infiltration of lidocaine and gabapentin on incisional pain in rats. METHODS: Thirty five male rats were divided into 7 groups; control group (n = 5), pre-lidocaine infiltration group (n = 5), post-lidocaine infiltration group (n = 5), pre-gabapentin 10 mg infiltration group (n = 5), post-gabapentin 10 mg infiltration group (n = 5), pre-gabapentin 30 mg infiltration group (n = 5), and post-gabapentin 30 mg infiltration group (n = 5). To evaluate postoperative mechanical hyperalgesia in injured feet, withdrawal thresholds were measured by calibrated von Frey filaments at 2 hrs, 1, 2, 3, 4, and 5 days after an incision. RESULTS: The pre-lidocaine infiltration group shows better analgesic effects than post-lidocaine infiltration group until postoperative day 1 (P < 0.05). The gabapentin infiltration groups were effective in postoperative pain management but there were no significant differences between pre- and post- incisional treatment. CONCLUSIONS: A preemptive lidocaine injection has a good analgesic effect on incisional pain. Gabapentin also has a good analgesic effect on incisional pain.
Analgesia ; Animals ; Central Nervous System Sensitization ; Foot ; Humans ; Hyperalgesia ; Hypersensitivity ; Lidocaine* ; Male ; Pain, Postoperative* ; Rats*