BACKGROUND: Recent evidences suggest that anesthetic action within the spinal cord is important in suppressing somatic responses to painful stimuli. Intrathecal endothelin-1 (ET-1) is known to have antinociceptive effect. The purpose of this experiment was to determine whether intrathecal ET-1 may influence the minimum alveolar concentration (MAC) of isoflurane in rats and access the role of the spinal cord as the sites of anesthetic action in blocking somatic responsiveness. METHODS: In Sprague-Dawley rats fitted with an indwelling intrathecal catheter, we determined the MAC of isoflurane using a tail-clamp technique as a painful stimulus, combined with end-tidal anesthetic sampling. In experiment 1, the control MAC was determined and changes of control MAC were observed after intrathecal ET-1 (4x10-2 nmol, 4x10-3 nmol) administration. In experiment 2, we observed the effects of L or N type Ca++ channel blocker such as verapamil (50 g) or W-conotoxin (0.5 g) on the MAC after measurement of the control MAC. In experiment 3, after measurement of the control MAC, ET-1 (10-2 nmol) was administered intrathecally and the MAC was determined again. Next, intrathecal verapamil (50 g) or W-conotoxin (0.5 g) was injected. After that, the MAC was determined again. RESULTS: In experiment 1, ET-1 decreased the MAC of isoflurane and its effect was sustained over 2 hours. In experiment 2, the MAC, determined following administration of verapamil or W-conotoxin, was not different from that of the control. In experiment 3, the MAC was decreased after ET-1 administration and then increased following injection of verapamil or W-conotoxin. CONCLUSIONS: These results suggested that ET-1, in relation to calcium, might play an important role in determining the MAC of isoflurane in the spinal cord.
Animals ; Calcium ; Catheters ; Endothelin-1* ; Isoflurane* ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Verapamil

No abstract available.
Anemia, Hypoplastic, Congenital*

Background: This study was designed to determine whether presynaptic receptor blockade could be differentiated from postsynaptic receptor blockade by examining the effect of increasing frequencies of indirect stimulation on partial twitch depression in vitro rat phrenic nerve hemidiaphragm preparations. Methods: After isolating rat phrenic nerve hemidiaphragm preparation, T200/T1 ratio (twitch height of the 200th stimuli divided by that of the 1st stimuli) at frequencies of 0.2, 0.5, 1.0, and 2.0 Hz using a drug concentration which provided approximately 20% twitch depression at 0.1 Hz was calculated. To compare T200/T1 ratios with TOF ratios, 2.0 Hz TOF response was measured immediately after 200th stimuli at either frequency of stimulation. Results: Hexamethonium caused a marked decrease in T200/T1 ratio at 0.5~2.0 Hz of stimulation, whereas alpha-bungarotoxin caused no change in T200/T1 ratios at up to 2.0 Hz of stimulation. The T200/T1 ratios produced by d-tubocurarine, vecuronium, mivacurium, and rocuronium located intermediate between alpha-bungarotoxin and hexamethonium, however significant differences among four drugs were found at 2.0 Hz. The propensity for decrease in T200/T1 ratios at 2.0 Hz might differ from this study: hexamethonium >d-tubocurarine >rocuronium >mivacurium = vecuronium >alpha-bungarotoxin. T200/T1 ratios at 2.0 Hz were not different from TOF ratios. Conclusions: When the observed effects in this study were provided with result of alpha-bungarotoxin acting predominantly at postsynaptic receptors and hexamethonium acting predominantly at presynaptic receptors, the effects of nondepolarizing muscle relaxants at each binding site could be differentiated by examining the T200/T1 ratios at 2.0 Hz.
Animals ; Binding Sites ; Bungarotoxins ; Depression* ; Hexamethonium ; Phrenic Nerve* ; Rats* ; Receptors, Presynaptic ; Tubocurarine ; Vecuronium Bromide

PURPOSE: Febrile seizure is the most common type of seizure affecting 3-4% of children. The recurrence rate of febrile seizure is approximately 33%. About 16% of children with a febrile seizure during the febrile illness have a recurrent seizure attack within 24 hours. This study aimed to investigate the optimum dose of diazepam to reduce the recurrence of febrile seizures in children who have had a febrile seizure attack. METHODS: The children with febrile seizure who were admitted to the Maryknoll hospital for in vestigation and treatment were retrospectively reviewed. The study group compromised 306 children. The febrile seizure was defined as seizure attack with fever(above 38degreeC) without evidence of intracranial infection or defined cause in children aged 6 months to 5 years. The children were divided into four groups according to dose of diazepam. Group I, 72 patients, received no diazepam therapy. Group II, 78 patients, received oral diazepam in a dose of 0.1 mg/kg every eight hours during the febrile illness, Group III, 87 patients, 0.2 mg/kg, and Group IV, 69 patients, 0.3 mg/kg, respectively. RESULTS: The seizure attack rate and the duration of admission were reduced in both Group III and Group IV. However, there was no difference in the side effects of the diazepam between group III and IV. CONCLUSION: Oral diazepam in a dose of 0.2 mg/kg effectively decreases both the seizure attack rate and the duration of admission.
Child ; Diazepam* ; Humans ; Recurrence ; Retrospective Studies ; Seizures* ; Seizures, Febrile*

Intravenous lidocaine has been used for attenuating cardiovascular responses to endotracheal intubation. To determine the optimal time of administration of lidocaine for attenuating hemodynamic changes induced by intubation, 100 patients were allocated randomly to a control group (without lidocaine) or four treated groups (with lidocaine). Lidocaine 1.5 mg/kg was administered intravenously at 60 (Group 2), 90 (Group 3), 120 (Group 4) and 180 seconds (Group 5) before intubation. Arterial pressure (systolic, mean and diastolic), heart rate and rate-pressure product (RPP) were measured before induction, after lidocaine injection, immediatly before intubation, immediately and 5 minutes after intubation. After intubation, arterial pressure, heart rate and RPP increased significantly in every study groups. In group 2 and 3, however, such changes were attenuated significantly, Postintubation elevation of systolic blood pressure, mean arterial pressure and RPP were effectively prevented in group 2 and 3. Lidocaine effect on diastolic pressure was observed only in group 3. Changes of heart rate were not affected with lidocaine adminiistration. In Group 4 and Group 5, this effect was not observed. In diastolic pressure, suppressive effect of lidocaine in increasing of blood pressure and RPP was observed in Group 3 significantly, but not in Group 2, Group 3 and Group 5. Changes of heart rate show that in all groups injected lidocaine (Group 2,3,4,5) significantly suppressive effect was not observed as compared with control group. These results suggest that intravenous lidocaine (1.5 mg/kg), 60-90 second prior to intubation attenuate hemodynamic responses induced by intubation.
Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal* ; Lidocaine*

The aim of this study was to analyze long-term survivals in patients with stage IB to IIA cervical cancer treated by neoadjuvant chemotherapy setting. Between February 1989 and January 1998, 94 women with previously untreated stage IB to IIA carcinoma of the uterine cervix who received cisplatin based neoadjuvant chemotherapy were enrolled in this study. All of patients with chemoresponse (complete response, n=15; partial response, n=47) and 16 patients with chemoresistance received radical surgery (RS group). The other 16 patients with chemoresistance received radiotherapy for definite treatment (RT group). In the RS group, the 10 yr survival estimation in patients with bulky tumors (diameter > or =4 cm, n=26) was similar to that with non-bulky tumors (83.3% vs. 89.3%, p=NS). In selected patients with chemoresistance, those treated by radiotherapy (n=16) showed significantly poorer survivals than those treated by radical surgery (n=16) [10 yr survival rates of RT (25%) vs. RS (76.4%), p=0.0111]. Our results support that a possible therapeutic benefit of neoadjuvant chemotherapy plus radical surgery is only in patients with bulky stage IB to IIA cervical cancer. In cases of chemoresistance, radical surgery might be a better definite treatment option.
Uterine Cervical Neoplasms/drug therapy/*radiotherapy/*surgery ; Treatment Outcome ; Survival Analysis ; Retrospective Studies ; Prognosis ; Neoplasm Staging ; Multivariate Analysis ; Middle Aged ; Humans ; Follow-Up Studies ; Fluorouracil/administration & dosage ; Female ; Drug Resistance, Neoplasm ; Combined Modality Therapy ; Cisplatin/administration & dosage ; Chemotherapy, Adjuvant ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Adult

PURPOSE: In most instances, constipation is considered as idiopathic or functional. The total colonic transit time, traced by radio-opaque markers, makes possible the identification of the colon segment that has the motility alteration that causes constipation. We measured the total and segmental colonic transit time in children with chronic idiopathic constipation and compared the results with those without constipation to determine whether the classification of constipation according to colonic transit time is effective or not on management of functional constipation. METHODS: A study was performed on 15 children aged from 7 to 13, with functional chronic constipation and on 10 without constipation. In all of them the total and segmental colonic transit time were measured with radio-opaque markers. The children ingested 24 markers each on three successive days, and on the fourth day a plain abdominal radiograph was performed. RESULTS: In the nonconstipated children, the total colonic transit time(mean+/-SD) was 30.7+/-10.5 hours, in the right colon 4.7+/-3.3 hours, in the left colon 4.6+/-2.3 hours, and in the rectosigmoid 21.4+/-10.3 hours. In the constipated children, the total colonic transit time was 51.5+/-16.8 hours, in the right colon 13.1+/-6.8 hours, in the left colon 14.3+/-9.8 hours, and in the rectosigmoid 24.1+/-12.6 hours. There was a statistically significant difference(P<0.05) in the total colonic transit time and in both the right and left colon transit times between the constipation and the control group. CONCLUSION: The measurement of total and segmental colonic transit time is a simple method that allows one to distinguish constipation due to colonic dysfunction(right colon and left colon) from constipation due to distal obstruction(rectosigmoid).
Child ; Classification ; Colon* ; Constipation ; Humans

BACKGROUND: Myocardial ischemia is known to depress systolic and diastolic functions for a prolonged period of time. Dobutamine and epinephrine are frequently administered to improve myocardial function during cardiac surgery. The vascular response to vasopressors might be altered by ischemia and reperfusion, since alterations in vascular control mechanisms have been demonstrated even after a short period of ischemia. The present study was aimed to investigate the effects of dobutamine and epinephrine on regional and global myocardial functions, coronary blood flow (CBF) and myocardial oxygen consumption (MVO2) in normal and stunned myocardium in an open-chest canine model. METHODS: Forty-eight dogs were acutely instrumented under enflurane anesthesia to measure aortic and left ventricular pressures, and pulmonary (cardiac output) and left anterior descending (LAD) blood flows via a Doppler flowmeter, and a subendocardial segment length in the region supplied by the LAD. In series 1, incremental doses of dobutamine (1, 2, 5, 10microgram/kg/min, n = 9) or epinephrine (0.02, 0.04, 0.1, 0.2microgram/kg/min, n = 10) were infused intravenously (IV) for 10 min before (normal) and after 15 min of LAD occlusion and subsequent 1 hr-reperfusion (stunned). In series 2, incremental doses of dobutamine (50, 125, 250, 375 ng/mL of LAD flow, n = 14) or epinephrine (4, 10, 20, 30 ng/mL of LAD flow, n = 15) were infused directly into the LAD (IC) for 3 5 min before (normal) and after myocardial ischemia (stunned). Segment shortening (%SS), as an index of regional myocardial contractility, and the peak segment lengthening rate (dL/dt max), as an index of regional diastolic function, were evaluated. Simultaneous arterial and coronary venous contents of oxygen and lactate were measured to calculate MVO2 and oxygen (EO2) and lactate extraction (Elac) ratios during IV or IC infusions of epinephrine or dobutamine. Effectiveness of metabolic vasodilation was determined from EO2. RESULTS: IV or IC infusions of dobutamine or epinephrine before ischemia resulted in dose-dependent increases in mechanical functions (%SS and dL/dt max) and MVO2. These changes were accompanied by parallel increases in CBF resulting in unaltered EO2 with an infusion of dobutamine, while CBF increased more than MVO2 with epinephrine, resulting in decreased EO2. After the ischemia and reperfusion, %SS and dL/dt max were depressed and Elac was reduced, but similar mechanical responses (%SS and dL/dt max) to both dobutamine & epinephrine were observed. Also, in the stunned myocardium, CBF increased in parallel with mechanical function and MVO2 with either IC or IV dobutamine, resulting in an unaltered EO2. However, IC but not IV epinephrine did not affect EO2, suggesting abolishment of its direct vasodilating effect in stunned myocardium. In addition, IC epinephrine infusion further decreased Elac, while IC dobutamine did not affect it in stunned myocardium. During IV infusions, dobutamine caused a dose-dependent increase in the heart rate but epinephrine did not affect it, despite the comparable increase in cardiac index and mean aortic pressure. CONCLUSIONS: The results indicate that dobutamine and epinephrine exert similar positive inotropic and lusitropic effects in normal and stunned myocardium in dogs. However, epinephrine causes direct coronary vasodilation in normal myocardium, but it does not directly affect coronary vascular tone in stunned myocardium. In addition, epinephrine infusion dose-dependently depresses Elac in stunned myocardium. In contrast, dobutamine affects neither direct coronary vascular tone nor Elac regardless of ischemia and reperfusion injury.
Anesthesia ; Animals ; Arterial Pressure ; Dobutamine* ; Dogs* ; Enflurane ; Epinephrine* ; Flowmeters ; Heart Rate ; Ischemia ; Lactic Acid ; Myocardial Ischemia ; Myocardial Stunning* ; Myocardium ; Oxygen Consumption ; Oxygen* ; Reperfusion ; Reperfusion Injury ; Thoracic Surgery ; Vasodilation ; Ventricular Pressure

BACKGROUND: Lidocaine or verapamil are used as an antiarrhythmic agent or agent blunting the cardiovascular changes induced by intubation or extubation during anesthesia. After recovery from general anesthesia with muscle relaxants, most patients remained in a residual paralytic state, hence it might develop easily recurarization by factors that affect neuromuscular transmission. Lidocaine and verapamil are well known as agents to potentiate the neuromuscular block. We investigated the effects of lidocaine or verapamil on neuromuscular transmission in vitro. METHODS: Square wave, 0.2 ms duration at a frequency of 0.1 Hz supramaximal or train of four stimuli was applied and the twitch height response was recorded mechanomyographically on rat phrenic nerve hemidiaphragm preparations. Dose responses of rocuronium, lidocaine, verapamil, rocuronium pretreated with lidocaine or verapamil, lidocaine pretreated with rocuronium, and verapamil pretreated with rocuronium were observed by cumulative method, and effective doses (Lag dose, ED50 and ED95) between a pretreated and nonpretreated agent were compared statistically. TOF ratios were observed at 80, 70, 40 and 30% of the control twitch height value during the observation of dose responses. RESULTS: Lag dose, ED50 and ED95 of rocuronium were reduced significantly after pretreatment of lidocaine, verapamil or their mixture, and the dose response of lidocaine, verapamil or their mixture were also reduced significantly by rocuronium pretreatment. TOF ratios at the point of each twitch height decreased significantly after pretreatment. CONCLUSIONS: Lidocaine or verapamil itself did not affect the neuromuscular transmission but might have potentiated the neuromuscular blocking effect induced by rocuronium. However, in excessive doses, these agents produced neuromuscular blockade. Consequently, in the residual neuromuscular block induced by rocuronium, lidocaine or verapamil may enhance recurarization.
Anesthesia ; Anesthesia, General ; Animals ; Humans ; Intubation ; Lidocaine* ; Neuromuscular Blockade* ; Phrenic Nerve ; Rats ; Verapamil*

Diabetes is a rapidly increasing heath care problem all over the world due to increased prevalence during past decade. Diabetic nephropathy develops in 25-30% of patients with type 1 diabetes and is the leading cause of end stage renal disease. Diabetic nephropathy is characterized by persistent proteinuria, decline in renal function, hypertension and increased cardiovascular morbidity and mortality. Early detection of diabetic nephropathy risk is an important goal because early diagnosis and treatment prevent advanced renal damage and other diabetic complications. Increased urinary albumin excretion rate is widely accepted as the first clinical sign of diabetic nephropathy. However, reduced glomerular filtration or hypertension could be the first manifestation in some diabetic patients. We need improved markers and predictors of diabetic nephropathy risk. We report a case of diabetic nephropathy and decreased glomerular filtration rate (GFR) without microalbuminuria occcured in type 1 diabetic patient.
Diabetes Complications ; Diabetic Nephropathies* ; Early Diagnosis ; Filtration ; Glomerular Filtration Rate ; Humans ; Hypertension ; Kidney Failure, Chronic ; Mortality ; Prevalence ; Proteinuria