No abstract available.
Carbon*

BACKGROUND: It has been known that alveolar macrophage exposed to bacterial lipopolysaccharide (LPS) induces a lots of nitric oxide (NO) and inducible nitric oxide synthase (iNOS) mRNA expression. The Authors elucidated the effects of iNOS mRNA expression by inhalational anesthetics (isoflurane) on endotoxemic rats and positive pressure ventilation with and without LPS. METHODS: Fifty Sprague-Dawley rats (250 - 270 g) were anesthesized with urethane injected in the peritoneal cavity. Then the expression of iNOS mRNA in the alveolar macrophages of the rats were measured after injection of LPS, 2 hours of isoflurane (0.5 - 2.5%) anesthesia, and 2 hours of positive pressure ventilation. The activities of iNOS in macrophages were measured by analysing iNOS mRNA expression by Northern blot analysis with autoradiography using the polymerase chain reaction (PCR) method. RESULTS: The size and patterns of the iNOS mRNA band in the 0.5 - 2% isoflurane group were almost same as with the control group. The size of the iNOS mRNA band in the 2.5% isoflurane group increased more than in the control group. In the continous positive-pressure ventilation with LPS group, the iNOS mRNA band was slightly increased compared to the normal lung and the continous positive-pressure ventilation without LPS group. CONCLUSIONS: Higher concentrations of isoflurane anesthesia may evoke the expression of iNOS mRNA in a septic model. Positive pressure ventilation in sepsis may induce iNOS mRNA production.
Anesthesia ; Anesthetics ; Animals ; Autoradiography ; Blotting, Northern ; Isoflurane* ; Lung ; Macrophages ; Macrophages, Alveolar ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Peritoneal Cavity ; Polymerase Chain Reaction ; Positive-Pressure Respiration ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger* ; Sepsis ; Urethane

Hypoxemia is a common and potentially serious postoperative complication. Hypoxic encephalopahty may occur in prolonged hypoxemia. This condition needs brain protection. There are many brain protective methods. The primary cental nervous system protective mechanism of the barbiturates is attributed to their ability to decrease the cerebral metabolic rate, thus improving the ratio of oxygen (O2) supply to O2 demand. The electroencephalogram-derived bispectral index system (BIS) is a promising new method to predict probability of recovery of consciousness. We experienced two cases of hypoxic brain damage in recovery room. The patients were treated with thiopental and monitored with BIS. The use of thiopental as brain protection during complete global ischemia after cardiac arrest was not effective.
Anesthetics ; Anoxia ; Barbiturates ; Brain ; Consciousness ; Heart Arrest ; Humans ; Hypoxia, Brain* ; Ischemia ; Nervous System ; Oxygen ; Postoperative Complications ; Recovery Room ; Thiopental*

Ehlers-Danlos syndrome (EDS) is an inherited disorder of collagen biosynthesis and structure, characterized by skin hyperextensibility, joint hypermobility, aberrant scars, and tissue friability. Besides the skin, skeleton (joint) and vessels, other organs such as the eyes and the intestine can be affected in this syndrome. Accordingly, interdisciplinary cooperation is necessary for a successful treatment. Three basic surgical problems are arising due to an EDS: decreased the strength of the tissue causes making the wound dehiscence, increased bleeding tendency due to the blood vessel fragility, and delayed wound healing period. Surgery patients with an EDS require an experienced surgeon in treating EDS patients; the treatment process requires careful tissue handling and a long postoperative care. A surgeon should also recognize whether the patient shows a resistance to local anesthetics and a high risk of hematoma formation. This report describes a patient with a wide open wound on the foot dorsum and delayed wound healing after the primary approximation of the wound margins.
Anesthetics, Local ; Blood Vessels ; Cicatrix ; Collagen ; Connective Tissue Diseases ; Ehlers-Danlos Syndrome ; Foot ; Hematoma ; Hemorrhage ; Humans ; Intestines ; Joint Instability ; Postoperative Care ; Skeleton ; Skin ; Wound Healing ; Wounds and Injuries

According to the three step-ladder analgesics in patients with cancer pain, adjuvant drugs are required for pain relief according to the pain character and also to reduce side effects of opioids. Pain clinicians sometimes want to decide to jump directly from naive and mild opioid to transdermal therapeutic system (TTS) fentanyl with less side effects. We investigated the safety, efficacy, and satisfaction of the patients of TTS fentanyl converting from opioid-naive and mild-opioid with adjuvant drug medications in related to dose cascade of TTS fentanyl. Both opioid-naive (n=3) and opioid-using (n=34) patients started with TTS fentanyl in the lowest available delivery rate (25 microgram/hr) with rescue medication. A numeric rating scale (NRS, from 0=no pain to 10=worst pain imaginable), satisfaction of the patients with the transdermal therapy and side effects were recorded everyday during 29 days. Average reductions of NRS scores were 1.79 and 2.77, and the mean doses were 35.14 and 44.12 microgram/hr on the 15th and 29th day, respectively. Reported level of satisfaction with the transdermal patch and generalized pain management were 'completely satisfied' and 'satisfied'. Frequent side effects were nausea, vomiting, and constipation. In conclusion, initial application of TTS fentanyl with proper adjuvant medications is effective, safe, and well tolerated.
*Administration, Cutaneous ; Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid/*therapeutic use ; Dose-Response Relationship, Drug ; Female ; Fentanyl/*therapeutic use ; Human ; Logistic Models ; Male ; Middle Aged ; Neoplasms/*drug therapy ; Pain/*drug therapy ; *Pain Measurement ; Time Factors

BACKGROUND:In this study, a distribute characteristics on the bispectral coupling of EEG were examined according to the depth of anesthesia by using bispectum analysis a type of nonlinear signal processing. METHODS: 25 patients during the general anesthesia were studied. In the preprocess, base line correction and linear detrend was used. During the awakening state, preoperatively and postoperatively, appearance rate of bispectral coupling was observed that a strong appearance rate was represented in major frequency zone such as (15, 15) Hz but weak appearance rate investigated in the other minor frequency zone. Whilst anesthetized, a strong appearance rate revealed the low frequency range below (10, 10) Hz and a weak appearance rate viewed in the other frequency range. As such was compared with the delta ratio and spectrum edge frequency (SEF). RESULTS: The delta ratio showed significantly lower values at induction (3.60 +/- 0.98) and during the maintenance (5.0+/-1.74) of anaesthesia than preoperatively (10.30 +/- 2.44) and postoperatively (13.03 +/- 2.29)(P < 0.05). These results were consistent with the trend of delta ratio, namely that the index of evaluation for the depth of anesthesia, known as the reflex of the conscious level of patient's during anesthesia. While these results were not consistent with SEF analysis results that the index of evaluation for suppression level of patient's during recovery stage of anesthesia. SEF shows lower values at maintenance (17.00 +/- 1.22) and postoperatively (12.20 +/- 1.53) than preoperatively (22.50 +/- 1.75) and at the induction (22.40 +/- 1.18) of anesthesia(P < 0.05). CONCLUSIONS: The bispectrum analysis method provided useful information about the index of evaluation according to the level of unconsciousness and suppression among other evaluation factor on depth of anesthesia.
Anesthesia* ; Anesthesia, General ; Electroencephalography* ; Humans ; Reflex ; Unconsciousness

Primary tumors of the heart are rare and the most are benign. Malignant tumors constitute less than 25% of primary cardiac tumors and angiosarcomas are the most commonly reported histologic type. At least 160 cases have been reported in the world, but no previous report in Korea. We reported a case of primary cardiac angiosarcoma located in right atrium.
Heart ; Heart Atria ; Heart Neoplasms ; Hemangiosarcoma* ; Korea

Subclavian artery(SCA) injuries are rare, accounting for only 1 to 2% of all acute vascular injuries. The majority of SCA injuries are occured by motor vehicle accident and by penetrating trauma, only 1 to 5% of all subclavian artery injuries occurred by blunt mechanisms. The incidence of brachial plexus injury is also rare and 60% of brachial plexus injuries induced by blunt injury is occurred by motor vehicle accident. Aggressive diagnostic work-up is recommended for the patients with high suspicious index and repair is essential for the successful management of these rare vascular injuries. We report the experience of one case of combined subclavian artery and brachial plexus injuries due to blunt trauma.
Brachial Plexus* ; Humans ; Incidence ; Motor Vehicles ; Subclavian Artery* ; Vascular System Injuries ; Wounds, Nonpenetrating

No abstract available.
Aortic Stenosis, Supravalvular*

In order to elucidate the existence and locality of DARP in the human brain, immunohistochemical identification was done in the brain tissues. This glycoprotein was distributed in paraventricular nucleus and thalamic reticular nucleus of diencephalon, substantia nigra and inferior colliculus of mesencephalon, medial vestibular nucleus, medial longitudinal nucleus, lateral reticular nucleus of medulla oblongata. And they follows a close distribution to that of catecholamine (CA) rich in either CA fiber or CA neuronal cell groups as previously reported by others using tyrosine hydroxylase (TH) as a marker. This striking similarities in the topographic arrangement of the DARP-positive reaction product and the TH-positive reaction product is another argument favoring the view that DARP is involved in the regulation of catecholaminergic neurons.
Brain* ; Diencephalon ; Dopamine* ; Glycoproteins ; Humans* ; Inferior Colliculi ; Medulla Oblongata ; Mesencephalon ; Neurons ; Paraventricular Hypothalamic Nucleus ; Strikes, Employee ; Substantia Nigra ; Tyrosine 3-Monooxygenase ; Vestibular Nuclei