Dexmedetomidine (DEX), a highly selective alpha2-adrenergic receptor agonist, is the newest agent introduced for sedation in intensive care unit (ICU). The sedation strategy for critically ill patients has stressed light sedation with daily awakening and assessment for neurologic, cognitive, and respiratory functions, since Society of Critical Care Medicine (SCCM) guidelines were presented in 2002. The traditional GABAergic agents, including benzodiazepines and propofol, have some limitations for safe sedatives in this setting, due to an unfavorable pharmacokinetic profile and to detrimental adverse effects (such as lorazepam associated propylene glycol intoxication and propofol infusion syndrome). DEX produces it's sedative, analgesic and cardiovascular effects through alpha2 receptors on the locus ceruleus (LC). Activities of LC, the tuberomammillary nucleus (TMN) are depressed and activity of the ventrolateral preoptic nucleus (VLPO) is increased during DEX sedation, which is similar in features to normal non-REM (NREM) sleep. At the same time, perifornical orexinergic activity is maintained, which might be associated with attention. This mechanism of action produces a normal sleep-like, cooperative sedation. The characteristic feature of sedation, together with a concomitant opioid sparing effect, may decrease the length of time spent on a ventilator, length of stay in ICU, and prevalence and duration of delirium, as the evidence shown from several comparative studies. In addition, DEX has an excellent safety profile. In conclusion, DEX is considered as a promising agent optimized for sedation in ICU.
Alkenes ; Benzodiazepines ; Critical Care ; Critical Illness ; Delirium ; Dexmedetomidine ; GABA Agents ; Humans ; Hypnotics and Sedatives ; Hypothalamic Area, Lateral ; Intensive Care Units ; Length of Stay ; Light ; Locus Coeruleus ; Lorazepam ; Prevalence ; Propofol ; Propylene Glycol ; Ventilators, Mechanical

The occurrence of the colonic obstruction secondary to colorectal carcinoma (CRC) has been reported in 7~30% of the CRC patients. It is generally believed that obstructive CRC is associated with a poor prognosis with respect to operative mortality and five-year survival. A series of 1064 cases of the CRC treated surgically at Asan Medical Center from June 1989 to December 1996 has been analyzed to compare clinicopathological findings between obstructive and non-obstructive CRC and to evaluate surgical treatment options in obstructive CRC. Complete obstruction was present in 49 cases (4.6%). There were no differences between obstructive and non-obstructive CRC in tumor location, size, Dukes' stage, and differentiation. In forty-nine obstructive CRC cases, primary resections were performed in 29 cases after peri-operative bowel decompression. In this group, right colon cancer was more prevalent than staged operation group (45% vs. 5%, P<0.05) and hospital stay was significantly short (16 days vs. 38 days, P<0.05). Postoperative complication rate was higher in staged operation group (65% vs. 28%, P=0.01). It may be due to stoma related wound complication. In obstructive left colon cancer, there was a significant difference in complication rate between primary resection and staged operation (P<0.05). Overall 5-year survival rate were 66% and 53% in non-obstructive and obstructive group, respectively. Survival rate according to the Dukes' B and C stages did not show statistical differences, either. Conclusively, primary resection is preferred to the obstructive CRC when supportive care, preoperative bowel decompression, and intraoperative colonic irrigation were performed adequately.
Chungcheongnam-do ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Decompression ; Humans ; Length of Stay ; Mortality ; Postoperative Complications ; Preoperative Care ; Prognosis ; Survival Rate ; Wounds and Injuries

BACKGROUND: Several studies have indicated that a nerve injury enhances the expression of the voltage-gated calcium channel alpha2delta1 subunit (Cavalpha2delta1) in sensory neurons and the dorsal spinal cord. This study examined whether NMDA receptor activation is essential for Cavalpha2delta1-mediated tactile allodynia in Cavalpha2delta1 overexpressing transgenic mice and L5/6 spinal nerve ligated rats (SNL). These two models show similar Cavalpha2delta1 upregulation and behavioral hypersensitivity, without and with the presence of other injury factors, respectively. METHODS: The transgenic (TG) mice were generated as described elsewhere (Feng et al., 2000). The left L5/6 spinal nerves in the Harlan Sprague Dawley rats were ligated tightly (SNL) to induce neuropathic pain, as described by Kim et al. (1992). Memantine 2 mg/kg (10 ul) was injected directly into the L5/6 spinal region followed by 10microl saline. Tactile allodynia was tested for any mechanical hypersensitivity. RESULTS: The tactile allodynia in the SNL rats could be reversed by an intrathecal injection of memantine 2 mg/kg at 1.5 hours. The tactile allodynia in the Cavalpha2delta1 over-expressing TG mice could be reversed by an intrathecal injection of memantine 2 mg/kg at 1.5, 2.0 and 2.5 hours. CONCLUSIONS: The behavioral hypersensitivity was similar in the TG mice and nerve injury pain model, supporting the hypothesis that elevated Cavalpha2delta1 mediates similar pathways that underlie the pain states in both models. The selective activation of spinal NMDA receptors plays a key role in mediating the pain states in both the nerve-injury rats and TG mice.
Animals ; Calcium ; Calcium Channels ; Hyperalgesia ; Hypersensitivity ; Injections, Spinal ; Memantine ; Mice ; Mice, Transgenic ; N-Methylaspartate ; Negotiating ; Neuralgia ; Rats ; Rats, Sprague-Dawley ; Receptors, N-Methyl-D-Aspartate ; Sensory Receptor Cells ; Spinal Cord ; Spinal Nerves ; Up-Regulation

Subdural hematoma is a serious but rare complication of spinal anesthesia. A 70-year-old woman patient underwent elective total knee replacement under spinal anesthesia. At 4 days postoperatively, the patient complained of headache and vomiting. Brain computed tomography revealed an acute-on-chronic subdural hematoma with midline shift. The patient recovered completely after surgical decompression. We report a patient with an undiagnosed chronic subdural hematoma, who developed acute-on-chronic subdural hematoma after spinal anesthesia.
Aged ; Anesthesia, Spinal ; Arthroplasty, Replacement, Knee ; Brain ; Decompression, Surgical ; Female ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Chronic ; Humans ; Vomiting

PURPOSE: To compare functional MR imaging of the motor cortex during active and passive movement. MATERIALS AND METHODS: Seven healthy, right-handed volunteers (M:F=6:1; age:25-30 years) were included in this study. A 1.5-T whole body scanner and the multislice EPI BOLD method were used. The motor paradigm was flexion-extension of a thumb against rest. In the active motion task, the thumb was flexed voluntarily once a second, while in the passive task, it was tied with a thread and pulled to flex and extend passively at the same interval and with the same intensity as in the active task. For image postprocessing, an SPM 96 program was used. The sites, numbers, and signal intensity of the activated pixels were determined, and the threshold for significance was set at p<0.001 to p<0.01. RESULTS: In the active motion task, strong activation at the contralateral side of the primary sensorimotor cortex and supplementary motor cortex occurred in all 14 examples in all seven volunteers. Additionally, the ipsilateral primary sensorimotor cortex and supplementary motor area were activated in 12/14 and 11/14 such tasks, respectively. During passive motion tasks, on the other hand, weak activation occurred at the contralateral side of the primary sensorimotor cortex in all cases, but in the contralateral supplementary motor cortex in only three. In the ipsilateral primary sensorimotor cortex and supplementary motor area, there was no activation. CONCLUSION: Compared with the active motion task, activation occurring in the contralateral primary sensorimotor cortex and supplementary cortex was weaker and less frequent during the passive task, and during this latter, the ipsilateral motor cortex remained inactive. These results may be useful for the clinical application of functional MR imaging in unconscious patients or in animal studies.
Animals ; Hand ; Humans ; Magnetic Resonance Imaging* ; Motor Cortex* ; Thumb ; Volunteers

BACKGROUND: BK virus is a polyomavirus associated with a range of clinical presentations from asymptomatic viruria with pyuria to ureteral ulceration with ureteral stenosis in renal transplant patients. BK viral Infection of renal allografts has been associated with diminished graft function in some individuals. We tried to detect BK virus in urine and plasma from Korean renal transplant recipients, renal transplant candidates, and healthy donors. METHODS: To detect BK virus in urine and plasma, we used PCR-RFLP (polymerase chain reaction and restriction fragments length polymorphism) with BamHI. The study was performed from 118 renal transplant recipients, 18 renal transplant candidates, and 25 healthy donors. RESULTS: BK virus DNAs were detected in 21.2% of urine and 0.9% of plasma from renal transplant recipients. BK virus DNA was detected in neither urine nor plasma from healthy donors and renal transplants candidates. Among a total of eight patients who were clinically suspected of having BK nephropathy, three were PCR positive for BK virus and two were decoy-cell cytology positive. Six patients were diagnosed as BK nephropathy by tissue pathology. Among them, BK virus was detected by PCR in urine from five patients, and decoy cells were shed from five patients, respectively. CONCLUSIONS: BK virus detection by polymerase chain reaction in urine may be a non-invasive and sensitive tool for diagnosing and monitoring BK nephropathy.
Allografts ; BK Virus* ; Constriction, Pathologic ; DNA ; Humans ; Kidney Transplantation ; Pathology ; Plasma ; Polymerase Chain Reaction* ; Polyomavirus ; Pyuria ; Tissue Donors* ; Transplantation* ; Transplants ; Ulcer ; Ureter

BACKGROUND: Many disinfectants have been used clinically in both single and combination applications, but there have been few studies on disinfective power according to sterilization sequence when using a combination of disinfectants. The purpose of this study was to evaluate the disinfective power of a combination of 70% isopropyl alcohol and 10% povidone-iodine (PVP-I) according to sterilization sequence. METHODS: Two hundred healthy volunteers were recruited. Subjects were disinfected with a combination of 70% isopropyl alcohol and 10% PVP-I on both forearms, in varying sequence. The AP group included disinfections on the left forearm with isopropyl alcohol first followed by 10% PVP-I, while the PA group included disinfections on the right forearm with same disinfectants in reverse order. Skin cultures were obtained using cotton swabs 3 min after application of each disinfectant, and then were inoculated on blood agar plates for bacterial culture. Cultures were incubated at 37degrees C under aerobic conditions for 48 hours. RESULTS: There was no significant difference in the number of positive cultures after the 1st disinfection (AP, 45; PA, 36, P = 0.262) or the 2nd disinfection (AP, 6; PA, 13, P = 0.157), suggesting that there is no relationship between disinfective power and the sequence of the disinfectants used. The number of positive cultures significantly decreased after the 2nd disinfection (P < 0.01), however. CONCLUSIONS: There was no significant difference in disinfective power according to sterilization sequence with 70% isopropyl alcohol and 10% PVP-I in healthy volunteers. The combination of 70% isopropyl alcohol and 10% PVP-I was more effective than disinfection with a single agent regardless of sterilization sequence.
2-Propanol* ; Agar ; Disinfectants ; Disinfection ; Forearm ; Healthy Volunteers ; Povidone-Iodine* ; Skin ; Sterilization

Quercetin is a natural flavonoid phytochemical that is extracted from various plants. Having an advantages due to its varied biological properties, such as anti-inflammatory, anti-viral, anti-oxidant, and anti-cancer effects, quercetin is used to treat many diseases. Recently, it has been reported that autophagy inhibition may play a key role in anti-cancer therapy. Therefore, in this study, we investigated the molecular mechanisms and anti-cancer effects of quercetin in human osteosarcoma cells via autophagy inhibition. We ascertained that quercetin inhibited cell proliferation and induced cell death, these process is demonstrated that apoptosis via the mitochondrial pathway and the caspase cascade. Quercetin also induced autophagy which was inhibited by 3-MA, autophagy inhibitor and the blockade of autophagy promoted the quercetin-induced apoptosis, confirming that autophagy is a pro-survival process. Thus, these findings demonstrate that quercetin is an effective anti-cancer agent, and the combination of quercetin and an autophagy inhibitor should enhance the effect of anti-cancer therapy.
Apoptosis* ; Autophagy* ; Cell Death ; Cell Proliferation ; Humans ; Osteosarcoma* ; Quercetin*

BACKGROUND: Postoperative nausea and vomiting (PONV) after thyroidectomy in women is especially frequent. Ramosetron and dexamethasone prevent cancer chemotherapy-related nausea and vomiting- and PONV. METHODS: Ninety three women undergoing thyroidectomy under general anesthesia with sevoflurane and remifentanil were allocated to one of three groups: Control (n = 30), ramosetron (Group R, n = 30), ramosetron with dexamethasone (Group RD, n = 33). Doses of ramosetron (0.1 mg) oral tablet by oral route and intravenous dexamethasone (5 mg) were used. The incidence and severity of PONV, and postoperative blood glucose level in each group were studied. RESULTS: The incidence of PONV in the control and R and RD groups were 43%, 20%, and 18% respectively. The incidence and severity of PONV were similar in the R and the RD groups. Blood glucose levels postoperatively were higher in RD group compared with control and R groups. CONCLUSIONS: Oral ramosetron reduced the incidence of postoperative nausea. The combination of ramosetron and dexamethasone increased postoperative blood glucose levels significantly without additional effect on PONV.
Anesthesia, General ; Antiemetics ; Benzimidazoles ; Blood Glucose ; Dexamethasone ; Female ; Glucose ; Humans ; Incidence ; Methyl Ethers ; Nausea ; Piperidines ; Postoperative Nausea and Vomiting ; Thyroidectomy

Although anal canal is the most common site for the development of malignant melanoma in the alimentary tract, it is extremely rare and melanoma can occur primarily at lower rectum. Anorectal melanoma constitutes 0.4% to 0.8% of colorectal malignancies and less than 2% of melanomas. The prognosis may depend on the extent of disease and depth of invasion. It generally seems to be very poor in spite of aggressive treatment. We have treated four patients of rectal melanomas out of 1,477 cases of all colorectal cancer between September, 1989 and January, 1997 ; a 39-year-old female with the intermittent blood-tinged stool, a 51-year-old male with hematochezia, a 59-year-old male with anal bleeding and a 65-year-old female with anal bleeding. They were treated by abdominoperineal resection with pelvic lymph node dissection and were confirmed histologically rectal melanomas.
Adult ; Aged ; Anal Canal ; Colorectal Neoplasms ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Lymph Node Excision ; Male ; Melanoma* ; Middle Aged ; Prognosis ; Rectum