Narcotic analgesics may be added to spinal anesthetics solution to improve the quality of sensorimotor blockade and to produce postoperative pain relief. The opioid-related side effects of respiratory depression, pruritus, nausea, and urinary retension also occur with intrathecal administration and the effects are dose-related. It is difficult to select morphine with spinal anesthetic solution due to fatal side-effect, respiratory depression. Intrathecal morphine dose used for our study was less than 1mg, thereby the risk of respiratory depression was decreased. There was no report that the addition of morphine affected the motor block produced by the local anesthetics in spinal anesthesia. But in our study, we found that 0.9 mg of intrathecal morphine produced prolongation of optimal condition for operation(more than 3 hours duration), and sufficient postoperative pain relief(for about 20 hours) without respiratory depression in 28 out of 30 spinal anesthesia cases. On the other hand, 0.5 mg or 0.7 mg of intrathecal morphine produced sufficient postoperative pain relief without respiratory depression(for about 20 hours), but insufficient prolongation of optimal condition for operation in each 30 cases of spinal anesthesia.
Anesthesia, Spinal* ; Anesthetics ; Anesthetics, Local ; Hand ; Morphine* ; Narcotics ; Nausea ; Pain, Postoperative ; Pruritus ; Respiratory Insufficiency ; Tetracaine*

Bleomycin is well recognized as an antineoplastic agent. Pulmonary toxicity is the most significant complication of bleomycin administration. The purpose of this study was to determine whether Captopril(an angiotensin converting enzyme inhibitor) can ameliorate pulmonary toxicity induced by bleomycin. Eighty mice were divided into two groups. The control group(n=40) received only bleomycin, and the other experimental group(n=40) received bleomycin in combination with captopril. Bleomycin was administered intraperitoneally to the mice, 8 mg/kg twice a week for 5 weeks. Captopril was administered in the feed at a regimen of 50 mg/kg everyday for 5 weeks. The animals were sacrified at 6 weeks later. Morphometric analysis with light microscopy was performed to the following parameters: the number of total pulmonary: cell count, percentage of consolidation of lung parenchyma and degree of fibrosis of lung parenchyma. The results were as follows; 1) In the control group, the number of total pulmonary cell count were 23.30+/-4.35/10(-8) m2 and the percentage of consolidation was 13.9+/-7.l%(P<0.01). 2) In the experimental group, the number of total pulmonary cell count were 18.39+/-3.48/10(-5) m2 and the percentage of consolidation was 9.8+/-4.8%(P<0.01). 3) There were no typical findings of pulmonary fibrosis in Massons trichrome stain, but early fibrotic change in the portion of severe consolidation and alveolar septal thickening in some control group. In conclusion, this study demonstrated that captopril ameliorates the pulmonary toxicity by bleomycin in the mice.
Animals ; Bleomycin* ; Captopril* ; Cell Count ; Fibrosis ; Lung ; Mice* ; Microscopy ; Peptidyl-Dipeptidase A ; Pulmonary Fibrosis

Intra-carotid urokinase (UK) infusion in 20 patients with acute internal carotid artery (ICA) territorial ischemic stroke achieved immediate recanalization in 45% and the clinical outcome in patients with recanalization was superior to that of patients without recanalization. The procedure was most effective in patients with smaller arterial occlusions: 7 of 10 patients with MCA branch occlusions (M2 to M4) achieved recanalization compared to only 2 of 10 with distal ICA or M1 occlusions, which should be an important issue for the critical evaluation of the efficacy of thrombolytic therapy (TT). Hemorrhagic transformation was observed in 9 patients on CT scan; petechial hemorrhage in 5 and intraparenchymal hematoma formation in 4. Among 4 patients with hematoma formation, clinical deterioration was seen in 3 cases and the angiography at the immediate end of the UK infusion showed recanalization in only one patient. The average dose of UK in patients with parenchymal hematoma formation was higher than that of patients without hemorrhagic transformation (123.3 x 10(4) units vs 101 x 10(4) units). The administration of a large dose of UK, probably more than 100 x 10(4) units, and the absence of immediate recanalization seemed to increase the risk of parenchymal hematoma formation. Despite the effort of investigators, the in-hospital time delay for the TT was significant which was mainly related to the time consuming preparation for angiography especially during night. A more effective system for the earlier intervention of acute ischemic stroke needs to be developed.
Adult ; Aged ; Angiography ; Brain Ischemia/*drug therapy/radiography ; Carotid Artery Thrombosis/*drug therapy/radiography ; Female ; Human ; Male ; Middle Age ; Support, Non-U.S. Gov't ; Thrombolytic Therapy/*methods ; Tomography, X-Ray Computed ; Urinary Plasminogen Activator/*administration & dosage