Sodium nitroprusside(SNP) is used to induce hypotension for a wide variety of indica- tions. Ordinarily, blood pressure responds sensitively to infusion of SNP in low doses, but occasioally resistance is seen, and actual tachyphylaxis during SNP infusion has been reported. To investigste the continuous infusion rates of SNP, we retrospectively reviewed 144 cases of spinal fusion operations which had been performed under deliberate hypotensive anesthesia (mean arterial pressure at 50-60 mmHg). To produce deliberate hypotension, The mean dose of SNP was 17.16 mg, the mean infusion time 283.85 minutes, and the average infusion rates 1.05 ug/kg/min. Patients who received csptopril required less SNP than untreated patients(0.95 vs 1.23 ug /kg/min., p<0.05). Isovolemic hemodilution also reduced aversge infusion rates of SNP (0. 87 vs 1.22ug/kg/min., p<0.05). There were, however, no significant differences in preoperative hypertention vs normotension, mild hypothermia vs. normothermia during the operation, and male vs. female. In addition, the average infusion rates of SNP were significantly correlated with body mass index(r=0.3329, p<0.01). But those were not correlated with age, infusion time of SNP, weight, volume of transfusion, height/age, and height.
Anesthesia* ; Arterial Pressure ; Blood Pressure ; Female ; Hemodilution ; Humans ; Hypotension ; Hypothermia ; Male ; Nitroprusside ; Retrospective Studies ; Sodium* ; Spinal Fusion ; Tachyphylaxis

No abstract available.
Thyroid Gland* ; Thyroid Nodule*

Spinal anesthesia has a rapid onset and requires small doses of local anesthenc to provide reliable surgical anesthesia and good muscular reiaxation but the disadvantages are the unpredictability of upper level of block, precipitous hypotension, inability to extend the block, and the risk of postdural puncture headache. A combined spinalepidural (CSE) technique can be used to reduce or eliminate some of the disadvantages of spinal and epidural anesthesia while preserving their activity. A combined spinalepidural block may combine the reliability of spinal block and the flexibility of epidural block while minimizing their drawbacks. CSE anesthesia was performed in the 19 patients scheduled for elective total knee arthroplasty. At first 17 G Tuohy needle was inserted L2-3 interspace, the epidual space would be identified, and then a long 22 G spinal needle was introduced through the Tuohy needle until the tip of the spinal needle would penetrate the dura. The correct placement of the spinal needle was confirmed by the appearence of cerebrospinal fluid at the head of needle, then 0.5% hyperbaric tetracaine 1.6-2 ml was injected into subarachnoid space. The spinal needle was withdrawn and a 18 G epidural catheter was introduced into the epidural space. If the patients complained pain during operation, 5 ml of 2% lidocaine was injected through epidural catheter, 2.5 mg Morphine was injected into epidural space for postoperative pain control after operation. Operations were well performed under CSE anesthesia and postoperative pain controls were well managed, too. The responses of the patients who has experienced CSE anesthesia were mostly good.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Arthroplasty* ; Catheters ; Cerebrospinal Fluid ; Epidural Space ; Head ; Humans ; Hypotension ; Knee* ; Lidocaine ; Morphine ; Needles ; Pain, Postoperative ; Pliability ; Post-Dural Puncture Headache ; Subarachnoid Space ; Tetracaine

No abstract available.

Percutaenous transhepatic biliary drainage (PTBD) is widely used to control cholangitis, sepsis, or jaundice caused by biliary tree obstruction. The PTBD tract can be used in percutaneous biliary stone extraction in pre-or post-operative state when ERCP is failed or operation is contraindicated. We performed 16 cases of percutaneous transhepatic biliary stone removal. Locations of biliay stones are combined intrahepatic and extrahepatic in 8 cases (50%), only extrahepati in 7 cases (44%), and only intrahepatic in 1 case (6%). The number of stones was single in 6 cases and multiple in 10 cases. Over all success rate was 81% (13/16), 93% (14/15) in extrahepatic stones and 78% (7/9) in intrahepatic stones. In 5 of 6 cases, complete stone removal was impossible due to marked tortuosity of T-tube tract or peripherally located stones, complete removal of biliary stones was achieved via a new PTBD tract. No significant pre-or post-procedure complication was occured. Percutaneous removal of biliary stones via PTBD tract is an effective and safe alternative method in difficult cases in the menagement of biliary tract stones.
Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Drainage ; Jaundice ; Methods ; Sepsis

PURPOSE: To investigate the effect of hypoxia on the survival and nitric oxide (NO) production of cultured trabecular meshwork (TM) cells. METHODS: After inducing chemical hypoxia with sodium cyanide, the survival and nitrite production of the primarily cultured porcine TM cells were assessed with MTT and Griess assays. The effect of NOS inhibitor, N(omega)-Nitro-L-arginine methyl ester (L-NAME), was also assessed. Flow cytometry using annexin/PI was done to evaluate apoptosis. RESULTS: Chemical hypoxia decreased TM cell survival significantly (p<0.05) with increased NO production. This hypoxia-induced antiproliferative effect was abolished by L-NAME (p<0.05). Flow cytometric analysis revealed that hypoxia induced apoptosis of TM cells, which was inhibited by L-NAME. CONCLUSIONS: Hypoxia decreases the survival of TM cells and induced apoptosis, accompanied by increased NO production. The hypoxia-induced decreased survival of TM cells may be mediated by NO.
Anoxia* ; Apoptosis ; Cell Survival ; Flow Cytometry ; NG-Nitroarginine Methyl Ester ; Nitric Oxide* ; Sodium Cyanide ; Trabecular Meshwork*

BACKGROUND: Unilateral lung hyperinflation develops in lungs with asymmetric compliance, which can lead to vital instability. The aim of this study was to investigate the respiratory dynamics and the effect of airway diameter on the distribution of tidal volume during mechanical ventilation in a lung model with asymmetric compliance. METHODS: Three groups of lung models were designed to simulate lungs with a symmetric and asymmetric compliance. The lung model was composed of two test lungs, lung1 and lung2. The static compliance of lung1 in C15, C60, and C120 groups was manipulated to be 15, 60, and 120 ml/cmH₂O, respectively. Meanwhile, the static compliance of lung2 was fixed at 60 ml/cmH₂O. Respiratory variables were measured above (proximal measurement) and below (distal measurement) the model trachea. The lung model was mechanically ventilated, and the airway internal diameter (ID) was changed from 3 to 8 mm in 1-mm increments. RESULTS: The mean ± standard deviation ratio of volumes distributed to each lung (VL1/VL2) in airway ID 3, 4, 5, 6, 7, and 8 were in order, 0.10 ± 0.05, 0.11 ± 0.03, 0.12 ± 0.02, 0.12 ± 0.02, 0.12 ± 0.02, and 0.12 ± 0.02 in the C15 group; 1.05 ± 0.16, 1.01 ± 0.09, 1.00 ± 0.07, 0.97 ± 0.09, 0.96 ± 0.06, and 0.97 ± 0.08 in the C60 group; and 1.46 ± 0.18, 3.06 ± 0.41, 3.72 ± 0.37, 3.78 ± 0.47, 3.77 ± 0.45, and 3.78 ± 0.60 in the C120 group. The positive end-expiratory pressure (PEEP) of lung1 was significantly increased at airway ID 3 mm (1.65 cmH₂O) in the C15 group; at ID 3, 4, and 5 mm (2.21, 1.06, and 0.95 cmH₂O) in the C60 group; and ID 3, 4, and 5 mm (2.92, 1.84, and 1.41 cmH₂O) in the C120 group, compared to ID 8 mm (P < 0.05). CONCLUSIONS: In the C15 and C120 groups, the tidal volume was unevenly distributed to both lungs in a positive relationship with lung compliance. In the C120 group, the uneven distribution of tidal volume was improved when the airway ID was equal to or less than 4 mm, but a significant increase of PEEP was observed.
Airway Obstruction ; Compliance ; Lung Compliance* ; Lung* ; Positive-Pressure Respiration ; Positive-Pressure Respiration, Intrinsic ; Respiration, Artificial ; Tidal Volume ; Trachea ; Ventilation

In a murine model system, enhancement of the total IgA and rotavirus-specific IgA of suckling mice was measured by ELISA with the intestinal fluid following oral administration of murine rotavirus EC (EDIM-Cambridge) strain. In the EC strain-administered group, the geometric mean titers (GMT) of total IgAs were 512 and 91 at 1 and 2 week postinfection, respectively. On the other hand, the GMTs of the rotavirus-specific IgAs were 108 and 3 at the same periods, respectively. Thus increase in the total IgAs was 64 folds and that in the rotavirus-specific IgAs was 43 folds compared with the negative control group. As the maximal titers of both the total and rotavirus-specific IgAs were observed at 1 week decreasing until 2 weeks after infection, it is evident that the GMT of the total IgA implies that of rotavirus-specific IgA. In our ELISA system, whose specificity was verified by Western blot analysis, the total IgA in the administered group was determined to be 40-400 ng per 1 ml of the intestinal fluid. Therefore it is concluded that determination of the rotavirus-specific IgA in murine models can be a sensitive indication of rotavirus infection, and will be another promising tool in viral challenge experiments in vaccine development.
Administration, Oral ; Animals ; Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Hand ; Immunoglobulin A* ; Mice ; Mice, Inbred ICR* ; Rotavirus Infections ; Rotavirus* ; Sensitivity and Specificity

We report on a 28 years old female with recurred cardiac myxomas who presented with dizziness, headache, and blurred vision. She had an excision of biatrial atrial myxomas 10 years age. Varying sized multiple cerebral aneuysms and myxomas in left atrium and left ventricle were found on a cerebral angiogram and echocardiogram, respectively. After wide excision including interatrial septum and part of left ventricular septum, her symptoms were much improved.
Adult ; Dizziness ; Female ; Headache ; Heart Atria ; Heart Ventricles ; Humans ; Intracranial Aneurysm ; Myxoma* ; Ventricular Septum

No abstract available.
Gonadotropin-Releasing Hormone* ; Gonads* ; Steroids* ; Trophoblasts*