BACKGROUND: Remifentanil is useful during general anesthesia because of its rapid onset and short acting time. However, some studies report that due to opioid-induced hyperalgesia (OIH) and tolerance, remifentanil also increases early postoperative pain. The occurrence of OIH and opioid-induced tolerance is mainly thought to be due to central sensitization by the activation of NMDA receptors. Therefore, we investigated the effects of continuous infusion of ketamine, an NMDA receptor antagonist, on postoperative pain and the quantity of opioids used. METHODS: 40 patients scheduled to undergo laparoscopic gynecologic surgery were randomly allocated into two groups. Anesthesia was equally maintained with sevoflurane and 4 ng/ml of remifentanil in all patients. Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 microl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline. We compared postoperative VAS up to 7 hours and morphine demand through PCA. RESULTS: Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively. CONCLUSIONS: When general anesthesia is maintained with sevoflurane and remifentanil in patients undergoing laparoscopic gynecologic surgery, continuous infusion of low dose ketamine decreased early postoperative pain and the quantity of opioids used.
Analgesics, Opioid ; Anesthesia ; Anesthesia, General ; Central Nervous System Sensitization ; Female ; Gynecologic Surgical Procedures ; Humans ; Hyperalgesia ; Ketamine ; Methyl Ethers ; Morphine ; N-Methylaspartate ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Piperidines ; Receptors, N-Methyl-D-Aspartate

No abstract available.
Primary Health Care*

The occurrence of seizure increases 15-30% in women who become pregnant while being treated for epilepsy, due to pharmacological changes in the antiepileptic drugs and, changes in the emotional status and hormones. It is reported that 1-2% of pregnant women experience status epilepticus. When refractory status epilepticus occurs in a pregnant woman, parturition may be an important method of treatment. We report here on a case of a 28 weeks pregnant woman who had epilepsy for 21 years and she had status epilepticus in a refractory status and so she underwent general anesthesia for cesarean section.
Anesthesia, General ; Anticonvulsants ; Cesarean Section ; Epilepsy ; Female ; Humans ; Parturition ; Pregnancy ; Pregnant Women ; Seizures ; Status Epilepticus

BACKGROUND: Bioelectrical impedance analysis (BIA) can be used to estimate body composition. To achieve the best results, the manufacturer's guidelines advise that individuals should restrict intake of food or caffeine, avoid vigorous exercise for 4 hours, and drink 2–4 glasses of water 2 hours before testing. We evaluated the appropriacy of drinking 2–4 glasses of water 2 hours before the BIA, as the validity of this indication has not been specifically demonstrated, by comparing intracellular water (ICW), extracellular water (ECW), total body water (TBW) in the fasting state, and after 1 and 2 hours of ingesting 500 mL of water.METHODS: Twenty-nine healthy adult men (n=10) and women (n=19) were recruited for the study. In the fasting state, the InBody 720 analyzer was used as multi-frequency (MF)-BIA and the output was recorded to determine the exact weight. Subsequently, Medinex BIA 450 analyzer was used as single-frequency (SF)-BIA, and the output was recorded. After drinking 500 mL of water 1 or 2 hours before assessment, the BIA tests were repeated as indicated above, and the ICW, ECW, TBW were compared by repeated measures ANOVA.RESULTS: SF-BIA measurements showed that compared to fasting state, the ICW decreased by approximately 0.56 L after 1 hour of drinking (P=0.001). The ECW was increased by about 0.62 L, 1 hour after drinking water compared to the fasting state (P=0.002). There were no significant differences between the results of BIA testing at 1 and 2 hours of fluid intake. The MF-BIA measurements indicated that testing after fasting, or 1 or 2 hours after fluid intake, did not result in significantly different ICW and ECW values. TBW showed no significant differences in the fasting state, or after 1 or 2 hours of fluid intake for both SF and MF.CONCLUSION: Several studies have shown that bioelectrical impedance should be measured in the fasting state. But not the food intake, drinking 500 mL of water may be permitted when measuring MF-BIA. However, for SF-BIA measurements, fluid intake resulted in an increase in the ECW level and a decrease in ICW.
Adult ; Body Composition ; Body Water ; Caffeine ; Drinking ; Drinking Water ; Eating ; Electric Impedance ; Eyeglasses ; Fasting ; Female ; Glass ; Humans ; Male ; Water

Cytochrome P450 3A4 (CYP3A4), is the dominant human liver hemoprotein enzyme localized in the endoplasmic reticulum (ER), and is responsible for the metabolism of more than 50% of clinically relevant drugs. While we were studying CYP3A4 expression and activity in human liver, we found that anti-CYP3A4 antibody cross-reacted with a lower band in liver cytoplasmic fraction. We assessed the activities of CYP3A4 and its truncated form in the microsomal and cytoplasmic fraction, respectively. In the cytoplasmic fraction, truncated CYP3A4 showed catalytic activity when reconstituted with NADPH-cytochrome P-450 reductase and cytochrome b5. In order to determine which site was deleted in the truncated form in vitro, we transfected cells with N-terminal tagged or C-terminal tagged human CYP3A4 cDNA. The truncated CYP3A4 is the N-terminal deleted form and was present in the soluble cytoplasmic fraction. Our result shows, for the first time, that N-terminal truncated, catalytically active CYP3A4 is present principally in the cytoplasm of human liver cells.
Blotting, Western ; Catalysis ; Cell Line ; Cytochrome P-450 CYP3A/chemistry/*metabolism ; Cytoplasm/*enzymology ; Humans ; Microsomes, Liver/*enzymology

Breast metastasis from nonmammary malignant neoplasms is uncommon, and it accounts for approximately 2% of all breast tumors. Distant metastasis of thymoma is very rare, and especially to extrathorcic areas. We report a female who had a metastatic thymoma in her breast 20 years after undergoing resection for a non-invasive thymoma. She presented with a palpable mass in her left breast. Mammography and ultrasonogram showed a lobular mass at the anterior glandular portion. Histological examination after surgical excision revealed a metastatic thymoma.
Breast Neoplasms/diagnosis/*secondary/surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Thymoma/diagnosis/*secondary/surgery ; Thymus Neoplasms/diagnosis/*pathology/surgery ; Tomography, X-Ray Computed ; Ultrasonography, Mammary

PURPOSE: The aim of this study is to analyze the clinical results of thermo-irradiation treatment for surgically unresectable advanced hepatoma with or without hepatic arterial chemo-embolization (HACE), chemotherapy (CT) and interferon (IFN) therapy. MATERIALS AND METHODS: Between February 1990 and December 1992, 45 patients with surgically unresectable advanced hepatomas were treated by thermo-irradiation with or without hepatic arterial chemo-embolization and other treatment modalities. Among them, We analyzed retrospectively 25 patients who received more than three times of hyperthermias. Mean age was 50 years (range: 18-71 years) and male to female ratio was 20:5. In the study, treatment was administered as follows: 3 patients received radiation therapy (RT) and hyperthermia (HT). 3 received RT+HT+CT. 3 received RT+HT+HACE. 1 received RT+HT+CT+HACE. 2 received RT+HT+CT+IFN. 10 received RT+HT+HACE+IFN. 3 received RT+HT+CT+HACE+IFN. Radiation therapy was done by a 6 MV linear accelerator. Patients were treated with daily fractions of 180 cGy to doses of 11 Gy-50Gy (median 30Gy). Local hyperthermia was done by HEH-500C(Omron Com Japan), 30-45 min/session, 2 session/wk and the number of HT sessions ranged from 3 to 17 (median 7 times). 15 patients of 25 were followed by abdominal CT scan or abdominal ultra-sonogram. The following factor were analyzed : Age, histologic grade, sex, number of hyperthermia, total RT does, hepatic arterial chemo-embolization. RESULTS: Of 25 patients. There were observed tumor regression (partial response and minimal response) in 6 (24%), no response in 8 (32%), progression in 1 (4%) and not evaluable ones in 10 (40%) radiographically. The over all 1-year survival was 25% with a mean survival of 33 weeks. The treatment modes of partial and minimal responsive patients (PR+MR) were as follows: Two were treated with RT+HT+HACE, 2 were done with RT+HT+HACE+IFN Remaining 2 were treated with RT+HT+CT+HACE+IFN. The significant factor affecting the survival rate were RT dose (more than 25Gy), HACE, number of HT (above 6 times), responsiveness after treatment (PR+MR). Age, sex, histologic differentiation, chemotherapy, interferon therapy were not statistically significant factors affecting the survival rate. Conclusion : Although follow-up duration was short, the thermo-irradiation with/without hepatic arterial chemo-embolization was well tolerated and there were no serious complications. In future, it is considered the longer follow up and prospective, well controlled trails should be followed to evaluate the efficacies of survival advantage.
Carcinoma, Hepatocellular* ; Drug Therapy ; Female ; Fever ; Follow-Up Studies ; Humans ; Hyperthermia, Induced ; Interferons ; Male ; Particle Accelerators ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed

BACKGROUND: The beach chair position (BCP) can cause significant hypotension. Epinephrine is used to prolong the duration of local anesthetics; it is also absorbed into blood and can exert systemic effects. This study determined the effects of epinephrine mixed with ropivacaine for an interscalene block (ISB) on hemodynamic changes related to BCP. METHODS: Patient data collected from March 2013 to August 2014 were used retrospectively. We divided the patients into three groups: 1) ISB only, 2) I+G (general anesthesia after ISB without epinephrine), and 3) I+E+G (general anesthesia after ISB with epinephrine). Mean blood pressure (MBP) and heart rate (HR) were measured for 30 minutes at 5-minute intervals. RESULTS: The study analyzed data from 431 patients. MBP tended to decrease gradually in the groups I+G and I+E+G. There were significant differences in MBP between the groups I+G and I, and between the groups I+G and I+E+G. Group I+E+G showed a significant increase in HR compared with the other two groups. CONCLUSIONS: ISB with an epinephrine mixture did not prevent hypotension caused by the BCP after general anesthesia. HR increased only in response to the epinephrine mixture. A well-planned prospective study is required to compare hemodynamic changes in that context.
Anesthesia ; Anesthesia, General* ; Anesthetics, Local ; Blood Pressure ; Epinephrine* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Postural Balance ; Prospective Studies ; Retrospective Studies*

PURPOSE: We wanted to investigate the accuracy of axillary ultrasonography for detecting axillary nodal metastasis in patients with T1-2 breast cancer and we also wanted to determine the factors affecting the sensitivity. MATERIALS AND METHODS: Two radiologists performed axillary ultrasonography in 119 consecutive patients with T1-2 breast cancer and clinically uninvolved axillae. We analyzed the accuracy of ultrasonography for detecting axillary nodal metastasis with the histologic results being used as a reference standard. We evaluated the number of involved lymph nodes, T staging and the histologic grade of the tumors. RESULTS: Axillary nodes were involved in 39% of total patients (46/119); 30% of the patients with T1 cancer and 55% of the patients with T2 cancer. The sensitivity, specificity, positive predictive value and negative predictive value were for 52%, 92%, 80% and 75%, respectively. The sensitivity was significantly lower for the cases with one to two lymph nodes metastasis and T1 cancer than in those cases with 3 or more lymph nodes metastasis and T2 cancer (35% and 75% in the cases with 1-2 cancer and the cases with > 3 lymph nodes metastasis, respectively, p = 0.009; 38% and 68% in the cases with T1 and the cases with T2 cancer, respectively, p = 0.045). CONCLUSIONS: The ultrasonographic sensitivity for detecting axillary lymph node metastasis is low, especially in the cases with one to two lymph nodes metastasis and the cases with T1 cancer. Detailed analysis and adoption of cytologic examination of the axillary lymph nodes are necessary to improue the accuracy of ultrasonography.
Adoption ; Axilla ; Breast ; Breast Neoplasms ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common clinical entities encountered in a dizziness clinic. Treatment of this disease, canalith repositioning procedures, have been reported to be successful in 44-90%. Treatment requires only one treatment visit in most patients. However, there are significant numbers of patients who require multiple treatment visits for relief. The goal of this study is to identify variables that may be associated with these difficult to treat cases. METHODS: Retrospective review was performed for the patients diagnosed as BPPV at Samsung medical center. Variables for statistical analysis included age, sex, involved canal, presence of bilateral disease, involvement of unilateral multiple canals, presence of recent head trauma, presence of chronic otitis media, history of middle ear surgery, history of otologic surgery, unilateral vestibular loss, accompanying sudden SNHL, underlying disease such as hypertension or diabetes, change of involved canal during treatment course and number of treatment visits. Statistical analysis using Pearson chi-square test was performed. RESULTS: Three hundred thirty-one patients with BPPV who received treatment were identified from 2001 to 2005. 85.2% required one treatment visit, 12.4% required a second treatment visit, and 98.2% were successfully treated after three treatment visits. Variables such as bilateral disease, anterior canal BPPV, post-traumatic BPPV, duration of symptom before treatment and change of involved canal during treatment were significantly related with number of treatments. CONCLUSION: Patients with anterior semicircular canal BPPV or bilateral BPPV or with recent head trauma or longer duration of symptom are more likely to require multiple visits for canalith repositioning.
Craniocerebral Trauma ; Dizziness ; Ear, Middle ; Humans ; Hypertension ; Otitis Media ; Retrospective Studies ; Semicircular Canals ; Vertigo*