BACKGROUND: The aim of this study was to compare dexmedetomidine (DEX), which is a selective, short-acting, central alpha2-adrenergic agonist, with fentanyl in terms of the hemodynamic stability, achieving hypnosis and sedation, and the postoperative pain control at the PACU (postanesthetic care unit). METHODS: In this double-blind study, 50 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive either dexmedetomidine 1 microg/kg over 10 min followed by a 0.5 microg/kg/hr infusion (the DK group) or fentanyl 0.8-1.2 microg/kg over 1 min followed by a 0.2-0.6 microg/kg/hr infusion (the FK group) from the time of ending the operation after total hysterectomy to the time in the PACU. We evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs, the respiratory variables (SpO2, RR and EtCO2) and the perioperative side effects to compare the efficacy of dexmedetomidine and fentanyl. RESULTS: Compared with the fentanyl-ketorolac (FK) group, the modified OAA/S scores were significantly lower in the dexmedetomine-ketorolac (DK) group at 0, 5 and 10 min after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different between the two groups. The blood pressure and heart rate in the DK group was significantly lower than that of the FK group at the PACU (P < 0.05). CONCLUSIONS: The DK group, at the doses used in this study, has a significant advantage over the FK group in terms of the postoperative hemodynamic stability at the PACU. There was no significant difference between the two groups for the postoperative pain control.
Blood Pressure ; Dexmedetomidine ; Double-Blind Method ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Hypnosis ; Hysterectomy ; Imidazoles ; Nitro Compounds ; Pain, Postoperative ; Vital Signs

BACKGROUND: The aim of this study was to compare dexmedetomidine (DEX), which is a selective, short-acting, central alpha2-adrenergic agonist, with fentanyl in terms of the hemodynamic stability, achieving hypnosis and sedation, and the postoperative pain control at the PACU (postanesthetic care unit). METHODS: In this double-blind study, 50 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive either dexmedetomidine 1 microg/kg over 10 min followed by a 0.5 microg/kg/hr infusion (the DK group) or fentanyl 0.8-1.2 microg/kg over 1 min followed by a 0.2-0.6 microg/kg/hr infusion (the FK group) from the time of ending the operation after total hysterectomy to the time in the PACU. We evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs, the respiratory variables (SpO2, RR and EtCO2) and the perioperative side effects to compare the efficacy of dexmedetomidine and fentanyl. RESULTS: Compared with the fentanyl-ketorolac (FK) group, the modified OAA/S scores were significantly lower in the dexmedetomine-ketorolac (DK) group at 0, 5 and 10 min after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different between the two groups. The blood pressure and heart rate in the DK group was significantly lower than that of the FK group at the PACU (P < 0.05). CONCLUSIONS: The DK group, at the doses used in this study, has a significant advantage over the FK group in terms of the postoperative hemodynamic stability at the PACU. There was no significant difference between the two groups for the postoperative pain control.
Blood Pressure ; Dexmedetomidine ; Double-Blind Method ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Hypnosis ; Hysterectomy ; Imidazoles ; Nitro Compounds ; Pain, Postoperative ; Vital Signs

This study was conducted to explore the geometrical changes of the mitral annulus during systole. The 3D shape of the mitral annulus was reconstructed in 13 normal subjects who had normal structure of the mitral apparatus using real-time 3D echocardiography (RT3DE) and 3D computer software. The two orthogonal (antero-posterior and commissure-commissure) dimensions, the areas (2D projected and 3D surface) and the non-planarity of the mitral annulus were estimated during early, mid and late systole. We demonstrated that the MA had a "saddle shape" appearance and it consistently enlarged mainly in the antero-posterior direction from early to late systole with lessening of its non-planarity, as was determined by 3D reconstruction using RT3DE and 3D computer software.
*Echocardiography, Three-Dimensional ; Humans ; Image Processing, Computer-Assisted ; Mitral Valve/cytology/*ultrasonography ; Software ; Systole/*physiology

BACKGROUND: We evaluated the optimal concentrations of eye opening and orientation after propofol- fentanyl TCI by CSDT of the pharmacokinetic model using DiprifusorTM in adults retrospectively. Furthermore, we tried to compare those data with the cases of using propofol TCI alone that had been reported. METHODS: After obtaining informed consent and IRB approval, 124 patients of ASA class I or II scheduled for elective surgery were allocated into 3 groups according to age. Three groups were group 1 (n = 40): 18 - 29 years, group 2 (n = 42): 30 - 39 years, group 3 (n = 42): 40 - 54 years. Propofol infusion was started at a propofol target concentration (CT) of 6 microgram/ml by using DiprifusorTM. Anesthesia was mostly maintained with propofol CT 3.5 microgram/ml and fentanyl CT 1.5 ng/ml using a Stelpump and 67% nitrous oxide in oxygen. We estimated the average concentrations of propofol at eye opening and orientation in each group with DiprifusorTM, and we also evaluated the correlation coefficient. RESULTS: Total requirements of propofol in cases of propofol-fentanyl TCI were decreased by 18-26% than in propofol TCI alone. The average concentrations of propofol at eye opening and orientation after surgery were 1.2 - 1.4 microgram/ml. The times to show eye opening and orientation after surgery from stopping of nitrous oxide and infusion were 10.4 - 14.5 min in the propofol-fentanyl group compared with 7.5 - 11 min using propofol TCI alone. CONCLUSIONS: We concluded that the optimal concentrations of propofol at eye opening and orientation after surgery in cases of combination with fentanyl were 1.2 - 1.4 microgram/ml instead of 1.4 - 1.6 microgram/ml with using propofol alone.
Adult ; Anesthesia ; Ethics Committees, Research ; Fentanyl ; Humans ; Informed Consent ; Nitrous Oxide ; Oxygen ; Propofol* ; Retrospective Studies

Metastatic disease is a main cause of mortality in prostate cancer and remains to be uncurable despite emerging new treatment agents. Development of novel treatment agents are confined within the boundaries of our knowledge of bone metastatic prostate cancer. Exploration into the underlying mechanism of metastatic tumorigenesis and treatment resistance will further expose novel targets for novel treatment agents. Up to date, many of these researches have been conducted with animal models which have served as classical tools that play a pivotal role in understanding the fundamental nature of cancer. The ability to reproduce the natural course of prostate cancer would be of profound value. However, currently available models cannot reproduce the entire process of tumorigenesis to bone metastasis and are limited to reproducing small portions of the entire process. Therefore, knowledge of available models and understanding the strengths and weaknesses for each model is key to achieve research objectives. In this article, we take an overview of cell line injection animal models and patient-derived xenograft models that have been applied to the research of human prostate cancer bone metastasis.

Bladder cancer is one of most common malignant urinary tract tumor types, and transurethral resection of nonmuscle invasive bladder cancer followed by intravesical instillation of immunochemotherapy is the standard treatment approach to minimize recurrence and delay progression of bladder cancer. In general, conventional intravesical immunochemotherapy lacks selectivity for tumor tissues and the effect of drug is reduced with the excretion of urine leading to frequent administration and bladder irritation symptoms. Recently, nanomedicines which adhere to the bladder tumors for a long time, and continuously and efficiently release drug to bladder cancers may overcome all the above problems. Moreover, the advances in nanomedicine based targeted therapy have led to significant improvements in drug efficacy and precision of targeted drug delivery. This review shows the available nano-systems of targeted drug delivery to bladder cancer tissues.

Purpose: To evaluate the long-term radiologic and clinical outcomes of stent-graft placement for the treatment of post-pancreaticoduodenectomy arterial hemorrhage (PPAH) based on the imaging findings of stent-graft patency and results of liver function tests. Materials and Methods: We retrospectively reviewed the medical records of nine consecutive patients who underwent stent-graft placement for PPAH between June 2012 and May 2017. We analyzed the immediate technical and clinical outcomes and liver function test results. Stentgraft patency was evaluated using serial CT angiography images. Results: All stent-grafts were deployed in the intended position for the immediate cessation of arterial hemorrhage and preservation of hepatic arterial blood flow. Technical success was achieved in all nine patients. Eight patients survived after discharge, and one patient died on postoperative day 28. The median follow-up duration was 781 days (range: 28–1766 days). Follow-up CT angiography revealed stent-graft occlusion in all patients. However, serum aspartate aminotransferase or alanine aminotransferase levels in all patients were well below those observed in hepatic infarction cases. Conclusion Stent-graft placement is a safe and effective treatment method for acute life-threatening PPAH. Liver function and distal hepatic arterial blood flow were maintained postoperatively despite the high incidence of stent-graft occlusion observed on follow-up CT.

Purpose: To evaluate the long-term radiologic and clinical outcomes of stent-graft placement for the treatment of post-pancreaticoduodenectomy arterial hemorrhage (PPAH) based on the imaging findings of stent-graft patency and results of liver function tests. Materials and Methods: We retrospectively reviewed the medical records of nine consecutive patients who underwent stent-graft placement for PPAH between June 2012 and May 2017. We analyzed the immediate technical and clinical outcomes and liver function test results. Stentgraft patency was evaluated using serial CT angiography images. Results: All stent-grafts were deployed in the intended position for the immediate cessation of arterial hemorrhage and preservation of hepatic arterial blood flow. Technical success was achieved in all nine patients. Eight patients survived after discharge, and one patient died on postoperative day 28. The median follow-up duration was 781 days (range: 28–1766 days). Follow-up CT angiography revealed stent-graft occlusion in all patients. However, serum aspartate aminotransferase or alanine aminotransferase levels in all patients were well below those observed in hepatic infarction cases. Conclusion Stent-graft placement is a safe and effective treatment method for acute life-threatening PPAH. Liver function and distal hepatic arterial blood flow were maintained postoperatively despite the high incidence of stent-graft occlusion observed on follow-up CT.

PURPOSE: The detection of occult micrometastasis in breast cancer patients may allow the establishment of prognosis and development of new therapeutic approaches. This study was performed in order to improve on existing methods of detection by evaluating the potential of specific mRNA markers in reverse-transcriptase polymerase chain reaction (RT-PCR) of peripheral blood and bone marrow taken from patients with breast cancer. METHODS: Peripheral blood and bone marrow samples were obtained from thirty-four breast cancer patients who undergone surgery in the Department of Surgery, Uijongbu St. Mary's Hospital between January 2000 and May 2001. In RT-PCR, we tried multiple primers on breast cancer cell lines and patient samples. Using MUC-1 and CK19 mRNA primers, we detected micrometastasis in breast cancer patients. Subsequently, we analysed the correlation with RT- PCR results and other prognostic factors. RESULTS: MUC-1 and CK19 were detected in all breast cancer cell lines. However, CEA was not detected in some cell lines. CK19 showed greater sensitivity than MUC-1 in RT-PCR. Using MUC-1 as primers, the detection rate was 47.1% and 35.3% in bone marrow and peripheral blood, respectively. Seven patients (20.5%) were positive in both sources. In the case of CK19, the detection rate was 50% and 41.2% in bone marrow and peripheral blood, respectively. Twelve patients (35.2%), were noted as being positive for both primers. The concordance rate of both primers mers was 38.2% and 23.5% in bone marrow and peripheral blood, respectively. CK19 positivity in the peripheral blood was correlated with bone marrow positivity and MUC-1 positivity in both sources and inversely correlated with ER. CK19 positivity of bone marrow was correlated with MUC-1 positivity of bone marrow. CONCLUSION: CK19 and MUC-1 may be good candidates for use in RT-PCR for the detection of micrometastasis of breast cancer. CK19 showed greater sensitivity. However, using both primers in RT-PCR, we may detect micrometastasis more sensitively and specifically and more wisely choose a treatment modality.
Bone Marrow* ; Breast Neoplasms* ; Breast* ; Cell Line ; Humans ; Keratin-19 ; Neoplasm Micrometastasis* ; Polymerase Chain Reaction ; Prognosis ; RNA, Messenger

We present a 32-year-old, extremely obese, pregnant woman who developed severe hypotension and water intoxication after an accidental injection of large bolus of oxytocin during cesarean section under general anesthesia. The patient was initially thought to have an amniotic fluid embolism because of the abrupt hemodynamic changes developed immediately after fetal delivery and lack of recognition of medication error. It is highly recommended that careful attention should be paid not only to the possibility of hemodynamic deterioration and water intoxication if oxytocin is given rapidly in excessive doses, but to the confirmation of the proper use of the drug before it is injected.
Adult ; Anesthesia, General ; Cesarean Section ; Embolism, Amniotic Fluid ; Female ; Hemodynamics ; Humans ; Hypotension ; Medication Errors ; Oxytocin ; Pregnancy ; Pregnant Women ; Water Intoxication