BACKGROUND: Free radical-mediated oxidative damage has been implicated in ischemic brain injury. There are also increasing evidences that nitric oxide is involved in the mechanisms of cerebral ischemia. To elucidate the effect of nitric oxide synthesis inhibition on the hydroxyl radical formation, we used a method based on the chemical trapping of hydroxyl radical in the form of the stable adducts 2,3-DHBA following salicylate adminstration. METHODS: Sprague-Dawley rats were subjected to 15 min of global cerebral ischemia by both carotid artery occlusion plus systemic hemorrhagic hypotension (35 mmHg). Artificial CSF including salicylate (5 mM) was continuously infused through a microdiaysis probe implanted in the left hippocampus CA1. Hippocampal extracellular fluid was sampled at regular intervals before, during, and after ischemia. The levels of 2,3-DHBA were assayed by HPLC with electrochemical detection during 15 minutes of ischemia and reperfusion period. RESULTS: Cerebral blood flow was reduced to 5% level of control in ischemic period, but increased 3 or 4 times in early phase of reperfusion period, and returned to normal 50 to 60 minutes after the cessation of ischemia. Inhibition of NOS by L-NAME did not prevent ischemia-induced 2,3-DHBA elevation, but increased its level during reperfusion. This increase in 2,3-DHBA could be reversed by L-arginine. The elevated 2,3-DHBA after IR in L-NAME treated rats was not due to either changes in CBF or local blood brain barrier permeability. CONCLUSIONS: The above results indicate NO protects brain from damages by hydroxyl radical, at least less than one hour after initiation of reperfusion.
Animals ; Arginine ; Blood-Brain Barrier ; Brain ; Brain Injuries ; Brain Ischemia ; Carotid Arteries ; Chromatography, High Pressure Liquid ; Extracellular Fluid ; Hippocampus ; Hydroxyl Radical* ; Hypotension ; Ischemia ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase* ; Nitric Oxide* ; Permeability ; Rats* ; Rats, Sprague-Dawley ; Reperfusion

Chronic discogenic low back pain remains a difficult treatment challenge. Also, Internal disc derangement in the lumbar spine is a common yet difficult clinical condition to treat. The reported prevalence of chronic low back pain due to intrinsic disc mediated pain is at least 40%. Internal disc derangement has characteristics such as degeneration of the collagen of the disc annulus, fissures, global disc degeneration, and herniation with or without root compression. The common treatment for chronic discogenic low back pain has been conservative, including physical therapy and pharmacological management but the effectiveness remians controversial. Surgical fusion offers modest results at best, but often fails, and is associated with complications and postoperative continued pain. The intradiscal electrothermal annuloplasty has become known as a safe and effective treatment for patients suffering from discogenic pain and offers the advantage of potentially repairing the damaged disc while maintaining normal disc function. We applied a navigable catheter with a temperature controlled thermal resistive coil, deployed intradiscally through a percutaneous extrapedicular approach under two plane fluoroscopic guidance in chronic low back patients. The authors experienced two cases of chronic discogenic pain that had failed to respond to any kind of conservative treatment but which was successfully relieved by the intradiscal electrothermal annuloplasty.
Catheters ; Collagen ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain* ; Prevalence ; Spine

BACKGROUND: Tracheal tubes are different on the flexibility, material and bevel angle according to the manufacturers. These may affect the success rate of blind tracheal intubation through laryngeal mask airway (LMA). In addition, using straight-tip exchanger or curved-tip introducer, we tried to compare the success rate of tracheal tube insertion through LMA. METHODS: After receiving informed consents, 30 patients were enrolled. Blind tracheal intubation was tried with reinforced tracheal tube (M group), or one of two kinds of conventional tracheal tube (P group and B group). Tracheal tube was selected in random order and advanced into the trachea through LMA one by one. If all the three attempts was unsuccessful, we considered the blind tracheal intubation through LMA a failure. We also compared the success rate of blind tracheal insertion through LMA using straight-tip exchanger or curved-tip introducer. The first trial was performed on the neutral head position. The exchanger or introducer was rotated during the second trial. If the second attempt was unsuccessful, the exchanger- or intubator-guided intubation was performed on the sniffing position and, as a last and fourth trial, while mandible was being elevated with hands. RESULTS: Success rate of blind tracheal intubation through LMA was 50% (15/50) in group P and 36.7% (11/30) in group M, 33.3% (10/30) in group B (P=0.05). By using curved-tip introducer, intubation through LMA was successful in 80% (16/20), while it was successful only in 35% (7/20) via straight-tip exchanger. CONCLUSION: Blind tracheal intubation through LMA was dependent on the types of tracheal tube. Also, curved tip introducer may be a more valuable aid in performing blind tracheal intubation through LMA. Its use seems to be better technique than directly inserting tracheal tube through LMA.
Hand ; Head ; Humans ; Intubation* ; Laryngeal Masks* ; Mandible ; Pliability ; Trachea

BACKGROUND: To reduce surgical stress, fentanyl is frequently used for neurosurgical procedure where focal and/or global ischemia may occur. However, the effect of fentanyl on the cytokine level during ischemia/reperfusion is still uncertain. The goal of this study was to evaluate the effect of fentanyl infusion on the proinflammatory cytokine, TNF-alpha and IL-1beta, levels during global cerebral ischemia/reperfusion (I/R) in rats using the intracerebral microdialysis technique. METHODS: Forty male S-D rats weighing 280 320 g were randomly assigned to four groups. Group 1: no fentanyl infusion and only I/R, Group 2: 1.5 ng/ml of fentanyl infusion during I/R, Group 3: 3.0 ng/ml of fentanyl infusion during I/R (n = 10 in each group). Rats were anesthetized with a intraperitoneal injection of pentobarbital (50 mg/kg), intubated and ventilated with room air using an animal ventilator. Two femoral arteries and one femoral vein were cannulated with PE-50 tubing for hemorrhagic hypotension, drug infusion and hydration. Both carotid arteries were dissected and a sling was placed for brain ischemia. The head was fixed on a stereotaxic device and a small burrhole was made for probe insertion. A CMA-12 probe was inserted into the left hippocampal CA-1 region according to the guidelines. Artificial CSF was run from the inserted microdialysis probe and infused with or without fentanyl at 3 microliter/min using a microinjection syringe pump during I/R. Ischemia was induced by clamping the carotid arteries while hemorrhagic hypotension for 17 min via the femoral artery and reperfusion were accomplished by the unclamping of the sling and reinfusing the blood via the femoral artery. Nasopharyngeal and rectal temperatures were maintained within the normal range during the whole procedure. After 2 hours of stabilization, the microdialysate was collected every 17 min just before (control) and during I/R and stored at 80oC until analysis using HPLC. RESULTS: During global I/R, TNF-alpha and IL-1 beta significantly increased at reperfusion (R5) compared to the control value (P < 0.05). However, in both cases of fentanyl infusion, TNF-alpha and IL-1 beta did not increase compared to the control value. CONCLUSIONS: Fentanyl inhibited the increase of proinflammatory cytokine TNF-alpha and IL-1 beta levels during global cerebral ischemia/reperfusion in rats.
Animals ; Brain Ischemia ; Carotid Arteries ; Chromatography, High Pressure Liquid ; Constriction ; Femoral Artery ; Femoral Vein ; Fentanyl* ; Head ; Humans ; Hypotension ; Injections, Intraperitoneal ; Interleukin-1beta ; Ischemia ; Male ; Microdialysis ; Microinjections ; Neurosurgical Procedures ; Pentobarbital ; Rats* ; Reference Values ; Reperfusion ; Syringes ; Tumor Necrosis Factor-alpha* ; Ventilators, Mechanical

To demonstrate the effect of diaschisis in acute unilateral cerebral infarction, the changes of regional cerebral and cerebellar blood flow(rCBF) following experimental occlusion of one middle cerebral artery(MCA) were studied in 15 mongrel cats, following occlusion of left MCA by coagulation using transorbital approach, rCBF's of both MCA trerritories and both cerebellum were measured simultaneously by the hydrogen clearance technique. Sham operation group consisted of 5 cats, in which transorbital exposure of left MCA was performed and the rCBF's were measured in the same manner as the experimental group without cauagulation of left MCA. After measurement of rCBF for 8 hours at fixed intervals, the animals were sacrificed and immediately thereafter 25 ml of 2% triphenyl tetrazolium chloride(TTC) solution was injected through each common carotid artery. The brain was removed and immersed in 10% buffered fomalin solution for two weeks, then the coronal plane through optic chiasm was examined for the cerebral infarction. As results, contralateral MCA territory and both cerebellum showed diaschisis after occlusion of left MCA, and contralteral cerebellar rCBF decreased more, showing characteristics of crossed cerebellar as well as interhemispheric diaschisis. Sham operation group showed no infarction, and in experimental group 40.2+/-1.3% of the coronal plane through the optic chiasm was infracted, showing high percentage of infarction with small standard deviation.
Animals ; Brain ; Carotid Artery, Common ; Cats ; Cerebellum ; Cerebral Infarction* ; Hydrogen ; Infarction ; Middle Cerebral Artery ; Optic Chiasm

The authors have experienced 9 cases of postgastrectomy efferent loop obstruction during the past 16 months' period and analyzed the clinical features, radiological findings, causes, and types of obstruction. The incidence of efferent loop obstruction was 1.3%(9/673). Among the 9 cases, eight patients were male and one patient was female. Median age was 60 years and more than half(5 out of 9 cases) of the patients were obese(defined by more than 110% of ideal body weight). None of the cases showed signs of strangulation, including persistent pain, fever, focal abdominal tenderness, and/or leukocytosis. Gastrointestinal anastomoses were done using a GIA stapler in 6 cases, and manually in 3 cases. The diagnoses were made on the basis of clinical symptoms and signs, further supported by radiologic contrast studies. All the patients were initially treated with conservative measures, including nasogastric drainage and fluid therapy for about 2 weeks in average. 7 cases underwent re-laparotomy using separate left subcostal incisions as conservative management had failed. Among the relaparotomy cases, adhesiolysis and side to side jejunojejunostomy were performed in 5 patients, Roux-en-Y gastrojejunostomy in 1 patient, and gastrojejunostomy revision in 1 patient. Causes of the obstruction in the seven re-opened cases were confirmed as postoperative adhesion. The authors have analyzed the pattern of obstruction and classified the patterns into 4 types. One of the remaining two patients underwent balloon dilatation successfully and the other was managed with prolonged nasogastric decompression. The average hospital stay was 32 days. Adequate omentectomy, gentle tissue handling during dissection, avoidance of ischemia along the suture line of anastomosis, and the use of biologically inert suture material would prevent this kind of postoperative adhesive obstruction.
Adhesives ; Decompression ; Diagnosis ; Dilatation ; Drainage ; Female ; Fever ; Fluid Therapy ; Gastric Bypass ; Humans ; Incidence ; Ischemia ; Length of Stay ; Leukocytosis ; Male ; Stomach Neoplasms ; Sutures

We have reported that serum amylase and lipase level elevate immediately after total gastrectomy independent to whether the pancreas is manipulated or not. Although we found high levels of amylase and lipase from the draining fluid via intraabdominal drain, none of them became pancreatic fistula. To check the amylase and lipase level after distal gastrectomy and to check whether the protease inhibitor (gabexate mesilate) reduce the elevated amylase and lipase, we made a prospective study. A Jackson-Pratt drain was inserted intraperitoneally during the operation to check amylase and lipase levels postoperatively. We present the postoperative changing patterns of amylase and lipase levels in the draining fluid. Serum amylase and lipase levels were also monitored. We found elevation of amylase and lipase concentrations in the draining fluid for a few days after distal gastrectomy. However, none of the patients developed pancreatic fistula, although all of the surgical methods showed hyperamylasemia and hyperlipasemia. Postoperative treatment with protease inhibitor was not effective against the elevated amylase and lipase levels in serum or draining fluid.
Amylases ; Gabexate ; Gastrectomy* ; Humans ; Hyperamylasemia ; Lipase ; Pancreas ; Pancreatic Fistula ; Prospective Studies ; Protease Inhibitors*

Neonatal Gaves disease is a relatively rare condition due to transplacental passage of Thyroid-stimulating antibody(TSAb) from a mother with active or inactive Graveses disease or autoimmune thyroiditis. A 11-day-old female newborn was referred to our department of pediatrics from a local clinic because of low level T4(3.55microg/dl) concurrent with high level TSH (501.74uIU/ml) on the 5th day neonatal metabolic screening. But, our repeated laboratory data showed very high serum T4(59.6microg/dl), T3(1,600ng/dl), suppressed TSH(0.43uIU/ml), and the presence of TSH receptor antibody. Her mother was treated with propylthiouracil(PTU) for Graves disease during pregnancy. Therefore, we thought it was a delayed-onset neonatal hyperthyroidism, because the fetal thyroid gland was initially suppressed by antithyroid drug taken during pregnancy. After initiating antithyroid drug therapy for the hyperthyroid nature, TSH levels became elevated again, while thyroid hormone levels decreased. Maternal and infant blood samples at the 23th day after birth were examined for serum autoantibodies directed towards the TSH receptor(Thyrotropin-binding inhibitory immunoglobulin:TBII, Thyroid-stimulating antibody:TSAb, Thyroid-stimulating blocking antibody:TSBAb) and high levels of TBII and TSAb were detected. About 2 months after birth, TBII and TSAb decreased within normal limit, and then we could stop antithyroid medication in safety. We report here a case of neonatal Graveses disease with very high level of T4 and T3, but firstly presented as hypothyroid nature on neonatal screening because of the maternally transferred antithyroid drug, PTU.
Autoantibodies ; Drug Therapy ; Female ; Graves Disease ; Humans ; Hyperthyroidism ; Infant ; Infant, Newborn ; Mass Screening ; Mothers ; Neonatal Screening ; Parturition ; Pediatrics ; Pregnancy ; Receptors, Thyrotropin ; Thyroid Gland ; Thyroiditis, Autoimmune

The infection by Helicobacter pylori(H.pylori) is known to be closely related with chronic gastritis, gastroduodenal ulcer and gastric cancer, although there is no direct evidence that shows clear "cause and effect" relationship between H.pylori and gastric cancer. The authors evaluated the infection rate by H.pylori in 45 gastric cancer patients who underwent resection for 1 month period of June 1996. Preoperatively, we checked for the presence of anti-H.pylori IgG by blood sampling of 45 patients. At operation, we excised 2 pieces of gastric mucosa from resected gastric specimen as soon as the stomach was resected, and embedded the pieces of mucosa in the commercially available CLO kit for urease test. The specimen was sent to pathologist for detection of H.pylori as well as staging of the tumor. 35 cases out of total 45 patients showed seropositivity for anti-H.pylori IgG (77.8% seroprevalence rate). But only 23 patients(51.1%) were positive by CLO test. The authors think the low detection rate by CLO test was due to 1)disappearance of H.pylori from the atrophic mucosa surrounding the cancer tissue, 2)inadequate tissue sampling from gastric specimen 3)delayed sampling after inactivation of the organisms, or 4)insufficient number of organisms in obtained tissue. The detection rate by pathologists with tissue stain was also low(12/45, 26.7%). Therefore, we conclude that the detection of H.pylori infection in gastric cancer patients can best be done by serological evlauation of anti-H.pylori antibodies.
Antibodies ; Gastric Mucosa ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Mucous Membrane ; Peptic Ulcer ; Seroepidemiologic Studies ; Stomach ; Stomach Neoplasms* ; Urease

Calbindin-D28k, a vitamin D-dependent calcium binding protein, plays a cardinal role in transport of calcium in kidney. Previous studies have demonstrated calbindin-D28k immunoreactivity in the distal nephron of mammalian kidney. However, it is well known that in most species including rat and human, there is a gradual transition from the distal convoluted tubule to the cortical collecting duct, and that the connecting segment do no tclearly demarcated, because of intermingling of distal convoluted tubule cells, connecting tubule cells, principal cells and at least two configurations of intercalated cells. In this study, to identify the cell types of calbindin-D28k-positive cells in distal nephron of rat kidney, we used double immunostaining with an antibody against calbindin-D28k and antibodies against thiazide sensitive Na+/Cl- cotransporter for distal convoluted tubule or H+-ATPase for intercalated cells. In the distal convoluted tubule, most of the distal convoluted tuble cells were calbindin-D28k-positive, whereas the intercalated cells were calbindin-D28k-negative. In the connecting tubule, 68% of the cells were calbindin-D28k-positive, and about 97% of the positive cells were connecting tubule cells and only 3% of them were intercalated cells. In the cortical collecting duct, and outer medullary collecting duct of outer stripe and inner stripe, only 8.6%, 11.8% and 4.4% of cells were weak positive for calbindin-D28k respectively. These weak positive cells in the collecting duct are mainly identified as intercalated cells. These findings indicate that calbindin-D28k is involved in not only transcellular transport of calcium but also processes regulating intracellular calcium in rat kidney.
Animals ; Antibodies ; Calbindin 1 ; Calcium* ; Carrier Proteins* ; Humans ; Immunohistochemistry ; Kidney* ; Nephrons* ; Rats* ; Transcytosis ; Vitamins