BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.
Anesthesia* ; Animals ; Arrhythmias, Cardiac ; Dogs* ; Epinephrine* ; Halothane* ; Hemostasis ; Myocardium ; Ventricular Premature Complexes

In patients with chronic renal failure, spontaneous tendon rupture may occur due to degenerative changes in the tendon. Transosseous suture and suture anchor are commonly used for repair of quadriceps tendon rupture. But in chronic renal failure patients, the fixation of the repaired tendon is weak due to degenerative changes in the tendon, and decreased bone mineral density results in a relatively high rerupture rate. In this case, spontaneous quadriceps tendon rupture in a patient who has chronic renal failure with dialysis over 10 years was repaired with a newly designed transosseous suture method in order to increase contact of patella base and to reduce the rate of rerupture. Divide ruptured tendon arbitrarily into four layers using the anatomical structure of quadriceps tendon, then pull them out through the three vertical transosseous tunnels and tied them each. This procedure may be considered as another option in the case with high rerupture risk.

Osteoporotic vertebral compression fractures (OVCFs) are the most common osteoporotic fractures in postmenopausal women. One the other hand, they may be misdiagnosed if the deformity is not severe at the time of occurrence. In general, it is treated through absolute bed rest and braces. Vertebroplasty or kyphoplasty is sometimes performed when there is a severe decrease in the height of the vertebral body. In addition, transpedi cular fixation can be performed when there is an accompanying injury to the posterior complex or neurologic symptoms. In this case, the authors performed minimally invasive transpedicular fixation after achieving vertebral body height recovery through postural reduction in OVCF patient who were neglected for one month after the injury. After securing initial stability through screw fixation, complete bony union was achieved more quickly and stably through weekly teriparatide administration. The authors report this case with a review of the relevant literature.

In anesthesia for Caesarean section, some induction agents have been used. Thiopental so- dium is regarded as the standard induction agent. Propofol and ketamine have properties which suggest that it might be useful alternstives to thiopental. The purpose of our study was to evaluate the maternal and neonatal effect of propofol and ketamine used as induction agent for general anesthesia for elective Caeearean section. Sixty mothers undergoing elective Caesarean section under general anesthesia were allocated randomly to receive thiopental 4 mg/kg or ketamine 1 mg/kg or propofol 2 mg/ kg for induction of anesthesia. The results were as follows; 1) There were significant increase in systolic pressure, diastolic pressure and heart rate at postintubation within three groups(p<0.05). But there were no significant differences in cardiovascular responses between three groups during the induction. 2) The Apgar scores and blood gas analyses of neonates did not differ between three groups significsntly and the results were within normal range in all groups. As a result, propofol and ketamine are acceptable alternatives to thiopental for the induction of general anesthesia in Caesarean section. But in view of maternal cardiovascular changes and fetal well being, propofol and ketamine offer no significant advantage over thiopental.
Anesthesia ; Anesthesia, General ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Female ; Fetal Blood* ; Heart Rate ; Humans ; Infant, Newborn* ; Ketamine ; Mothers ; Pregnancy ; Propofol ; Reference Values ; Thiopental ; Umbilical Cord*

We experienced a case of cerebral hypoperfusion due to cyclosporine neurotoxocity confirmed only by Tc-99m ECD brain SPECT. A 53-year-old female had received allogenic peripheral blood stem cell transplantation due to refractory plasmacytoid lymphoma. Cyclosporine and steroid had been administrated to prevent graft versus host disease. Twenty days after transplantation, she became delirious and suffered from generalized tonic-clonic seizure. Immediately, brain MRI and MR angiography were performed and these studies did not show any abnormal findings. However, Tc-99m ECD brain SPECT showed diffuse hypoperfusion in the left cerebral hemisphere and blood cyclosporine level was 962.6 ng/ml. Cyclosporine administration was stopped and discontinuation of cyclosporine resulted in disappearance of all neurological symptoms. The same neurological symptoms recurred with cyclosporine re-administration for management of exacerbated graft versus host disease. In this case, Tc-99m ECD brain SPECT proved very helpful in the diagnosis of cycloporine neurotoxicity.
Angiography ; Brain ; Cerebrum ; Cyclosporine* ; Diagnosis ; Female ; Graft vs Host Disease ; Humans ; Lymphoma ; Magnetic Resonance Imaging ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; Seizures ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Thallium behaves similarly to potassium in vivo. Potassium channel opener (K-opener) opens ATP-sensitive K+/-channel located at cell membrane, resulting in potassium efflux from cytosol. We have previously reported that K-opener can alter biokinetics of Tl-201 in cultured cells and in vivo. Malignant tumor cells have high Na-K ATPase activity due to increased metabolic activities and dedifferentiation, and differential delineation of malignant tumor can be possible with Tl-201 imaging. K-opener may affect tumoral uptake of Tl-201 in vivo. To investigate the effects of pinacidil (one of the potent K-openers) on the localization of the tumor with Tl-201 chloride, we evaluated the changes in biodistribution of Tl-201 with pinacidil treatment in tumor-bearing mice. MATERAL AND METHODS: Balb/c mice received subcutaneous implantation of murine breast cancer cells in the thigh and were used for biodistribution study 3 weeks later. 100 microgram of pinacidil dissolved in 200 microliter DMSO/PBS solution was injected intravenously via tail vein at 10 min after 185 KBq (5 microcurie) Tl-201 injection. Percentage organ uptake and whole body retention ratio of Tl-201 were measured at various periods after injection, and values were compared between control and pinacidil-treated mice. RESULTS: Pinacidil treatment resulted in mild decrease in blood levels of Tl-201, but renal uptakes were markedly decreased at 30-min, 1- and 2-hour, compared to control group. Hepatic, intestinal and muscular uptake were not different. Absolute percentage uptake and tumor to blood ratios of Tl-201 were lower in pinacidil treated mice than in the control group at all time points measured. Whole body retention ratio of Tl-201 was lower in pinacidil treated mice (58+/-4%), than in the control group (67+/-3%) at 24 hours after with injection of 100 microgram pinacidil. CONCLUSION: K-opener did not enhance, but rather decreased absolute tumoral uptake and tumor-to-blood ratios of Tl-201. Decreased whole body retention ratio and renal uptake were observed with pinacidil treatment in tumor-bearing mice.
Adenosine Triphosphatases ; Animals ; Breast Neoplasms ; Cell Membrane ; Cells, Cultured ; Cytosol ; Mice* ; Pinacidil* ; Potassium ; Potassium Channels ; Thallium ; Thigh ; Veins

BACKGROUND: Protease-activated receptor 2 (PAR2) belongs to a family of G protein- coupled receptors activated by proteolytic cleavage. Trypsin-like serine proteases interact with PAR2 expressed by a variety of tissues and immune cells. The aim of our study was to investigate whether PAR2 stimulation can lead to the activation of human macrophages. METHODS: PAR2-mediated proliferation of human macrophage cell line THP-1 was measured with MTT assay. We also examined the extracellular regulated kinase (ERK) phosphorylation and cytokine production induced by trypsin and PAR2-agonist using western blot and enzyme-linked immunosorbent assay (ELISA), respectively. RESULTS: Treatment of trypsin or PAR2-activating peptide increased cell proliferation in a dose-dependent manner, and induced the activation of ERK1/2 in THP-1 cells. In addition, trypsin-induced cell proliferation was inhibited by pretreatment of an ERK inhibitor (PD98059) or trypsin inhibitor (SBTI). Moreover, PAR2 activation by trypsin increased the secretion of TNF-alpha in THP-1 cells. CONCLUSION: There results suggest that PAR2 activation by trypsin-like serine proteases can induce cell proliferation through the activation of ERK in human macrophage and that PAR2 may play a crucial role in the cell proliferation and cytokine secretion induced by trypsin-like serine proteases.
Blotting, Western ; Cell Line* ; Cell Proliferation ; Enzyme-Linked Immunosorbent Assay ; Humans* ; Macrophages* ; Phosphorylation ; Phosphotransferases ; Receptor, PAR-2* ; Serine Proteases ; Trypsin ; Tumor Necrosis Factor-alpha

Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder.
Bile Ducts, Extrahepatic* ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Common Bile Duct ; Cystic Duct ; Diagnosis ; Gallbladder ; Ligation ; Ultrasonography

Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder.
Bile Ducts, Extrahepatic* ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Common Bile Duct ; Cystic Duct ; Diagnosis ; Gallbladder ; Ligation ; Ultrasonography

No abstract available.
Kidney Failure, Chronic*