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

This prospective intervention study was undertaken to estimate the prevalence and treatment rate of osteoporosis following osteoporosis screening tests in the same cohort. From November 1, 2014 to August 31, 2015, participants received screening tests for osteoporosis using ultrasound bone densitometry and education concerning osteoporosis and related conditions. The participants were interviewed using a questionnaire on the diagnosis and initiation of osteoporosis treatment during the follow-up period. Of 960 potential participants, 595 people (68.8%; 150 men and 445 women) were given bone densitometry measurements and completed the questionnaire. The mean age of the participants was 74.0 years. Of the 595 participants, 393 people (66.1%; 67 men and 326 woman) were diagnosed with osteoporosis (T score <−2.5). The prevalence of osteoporosis showed an increasing trend, from 48.1% in 2004 to 66.1% in 2015. Of the 393 participants diagnosed with osteoporosis, 65 participants received additional bone densitometry measurements while hospitalized and osteoporosis management was re-initiated in 44 patients. The osteoporosis management rate in the study cohort increased from 21.6% to 32.8%, with osteoporosis diagnosed in 66.2% of participants at the latest follow-up. This prospective intervention study demonstrated that a screening test and an educational brochure increased the treatment rate from 21.6% to 32.8%.
Cohort Studies ; Densitometry* ; Diagnosis ; Education* ; Follow-Up Studies ; Humans ; Male ; Mass Screening* ; Osteoporosis* ; Pamphlets ; Prevalence* ; Prospective Studies ; Ultrasonography*

Shikonin, a major ingredient in the traditional Chinese herb Lithospermumerythrorhizon, exhibits multiple biological functions including antimicrobial, anti-inflammatory, and antitumor effects. It has recently been reported that shikonin displays antitumor properties in many cancers. This study was aimed to investigate whether shikonin could inhibit oral squamous carcinoma cell (OSCC) growth via mechanisms of apoptosis and cell cycle arrest. The effects of shikonin on the viability and growth of OSCC cell line, SCC25 cells were assessed by MTT assay and clonogenic assays, respectively. Hoechst staining and DNA electrophoresis indicated that the shikonin-treated SCC25 cells were undergoing apoptosis. Western blotting, immunocytochemistry, confocal microscopy, flow cytometry, MMP activity, and proteasome activity also supported the finding that shikonin induces apoptosis. Shikonin treatment of SCC25 cells resulted in a time- and dose-dependent decrease in cell viability, inhibition of cell growth, and increase in apoptotic cell death. The treated SCC25 cells showed several lines of apoptotic manifestation as follows: nuclear condensation; DNA fragmentation; reduced MMP and proteasome activity; decrease in DNA contents; release of cytochrome c into cytosol; translocation of AIF and DFF40 (CAD) onto the nuclei; a significant shift in Bax/Bcl-2 ratio; and activation of caspase-9, -7, -6, and -3, as well as PARP, lamin A/C, and DFF45 (ICAD). Shikonin treatment also resulted in down-regulation of the G1 cell cycle-related proteins and up-regulation of p27(KIP1). Taken together, our present findings demonstrate that shikonin strongly inhibits cell proliferation by modulating the expression of the G1 cell cycle-related proteins, and that it induces apoptosis via the proteasome, mitochondria, and caspase cascades in SCC25 cells.
Apoptosis* ; Asian Continental Ancestry Group ; Blotting, Western ; Carcinoma, Squamous Cell* ; Caspase 9 ; Cell Cycle Checkpoints* ; Cell Death ; Cell Line* ; Cell Proliferation ; Cell Survival ; Cytochromes c ; Cytosol ; DNA ; DNA Fragmentation ; Down-Regulation ; Electrophoresis ; Flow Cytometry ; Humans ; Immunohistochemistry ; Microscopy, Confocal ; Mitochondria ; Proteasome Endopeptidase Complex ; Tongue* ; Up-Regulation

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

Air embolism can occur during central venous catheter removal. We encountered a patient diagnosed with cerebral air embolism associated with the removal of an internal jugular venous catheter. The patient was 65 years old and was admitted to the intensive care unit due to pneumonia. He had a catheter placed in the right internal jugular vein. Five days thereafter, the catheter was removed in semi-Fowler's position using the Valsalva maneuver. Immediately after the catheter removal, the patient became pale, felt dyspneic, lost consciousness and exhibited seizure activity. A neurological examination, revealed left upper arm (grade I) and lower leg paralysis (grade II) as well as left facial palsy. A brain computed tomogram showed that, air was trapped in the cavernous sinus. In diffusion weighted magnetic resonance imaging, signal changes were reported in the right frontal cortex, indicating acute cerebral infarction. Hyperbaric oxygen therapy and ventilatory support with synchronized intermittent mandatory ventilation mode was applied. Twenty days thereafter, consciousness and motor functions were recovered completely except for mild weakness of the upper arm (grade IV).
Arm ; Brain ; Catheters ; Cavernous Sinus ; Central Venous Catheters ; Cerebral Infarction ; Consciousness ; Diffusion ; Embolism, Air ; Facial Paralysis ; Humans ; Hyperbaric Oxygenation ; Intensive Care Units ; Intracranial Embolism ; Jugular Veins ; Leg ; Magnetic Resonance Imaging ; Neurologic Examination ; Paralysis ; Pneumonia ; Seizures ; Valsalva Maneuver ; Ventilation

BACKGROUND: Different types of injury to the sciatic nerve branches produces different levels of each kind of nociception. In this study, we undertook to identify the nature of the partial sciatic nerve injury that affects nociceptive reaction to subcutaneous formalin injection, and to determine the branch of the sciatic nerve involved. METHODS: Sprague-Dawley rats were randomly divided into 4 groups, control group (n = 9) in which a sham operation was performed, a sural nerve transection group (n = 5), a tibial nerve transection group (n = 5), and a common peroneal nerve transection group (n = 5). Under enflurane anesthesia, sural, tibial, or common peroneal nerves were injured and responses to formalin test were compared for the four groups 24 hours after surgery. RESULTS: Pain behavior in the tibial and common peroneal nerve transected groups reduced in phase 2, but not in phase 1, while sural nerve transected group showed no change in response in either phase. CONCLUSIONS: Tibial and common peroneal nerves mainly affect phase 2 reaction in the formalin test in this partial sciatic nerve injury model.
Anesthesia ; Animals ; Control Groups ; Enflurane ; Formaldehyde* ; Models, Animal ; Nociception ; Pain Measurement* ; Peroneal Nerve ; Rats* ; Rats, Sprague-Dawley ; Sciatic Nerve* ; Sciatic Neuropathy ; Sural Nerve ; Tibial Nerve

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

BACKGROUND: Inhalation anesthetics are an important factor for postoperative hepatic and renal dysfunction. In this regard, TIVA can reduce the risk of hepatic and renal dysfunction inherited to inhalation anesthetics. The present study was conducted to determine whether hepatic and renal functions differ after anesthesia with sevoflurane and propofol. METHODS: Two hundred patients, ASA physical status class I, II, scheduled for an elective thyroidectomy were randomly divided into two groups. Anesthesia was maintained with sevoflurane 1-2% and remifentanil in the sevoflurane group (Group S) and propofol 2-5 ug/ml and remifentanil 2-5 ng/ml at the effect site, using a target controlled infusion (TCI) pump in the TIVA group (Group T) to maintain BIS of 40-60. To evaluate the hepatic and renal function, aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were tested at preoperation (baseline), postoperative 1 day and 3 days. RESULTS: AST was increased at postoperative 1 day and 3 days, compared with that of the preoperation in Group S, and postoperative 1 day in Group T, but the values were within its normal limit. ALT was not changed after anesthesia in both groups. BUN was increased at postoperative 1 day, compared with that of the preoperation in Group S, but the value was within its normal limit. Creatinine was not changed after anesthesia in both groups. CONCLUSIONS: The changes of hepatic and renal function after inhalation anesthesia with sevoflurane and TIVA with propofol and remifentanil for thyroidectomy were clinically insignificant, and there was no difference between the two methods.
Alanine Transaminase ; Anesthesia ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Anesthetics, Inhalation ; Aspartate Aminotransferases ; Blood Urea Nitrogen ; Creatinine ; Humans ; Inhalation ; Methyl Ethers ; Piperidines ; Propofol ; Thyroidectomy