Spontaneous rupture with internal bleeding of solid tumors has rarely been described at the time of diagnosis or during chemotherapy. This rare event must be regarded as a life threatening condition. In these emergency situations, control of hemorrhage, which is life-saving, can be achieved by transcatheter arterial embolization (TAE) and/or surgical resection. This report describes two infants presenting with acute hemorrhagic shock due to spontaneous tumor rupture of hepatoblastoma and neuroblastoma during chemotherapy. TAE successfully arrested the tumor bleeding and a visibly reduced the tumor size in both children. Spontaneous rupture of solid tumors occur infrequently in children, but is a life threatening situation. Careful monitoring for the occurrence of this rare event especially in very young children presenting with a large tumor mass.
Child ; Diagnosis ; Drug Therapy ; Emergencies ; Hemorrhage ; Hepatoblastoma ; Humans ; Infant ; Neuroblastoma ; Rupture ; Rupture, Spontaneous ; Shock, Hemorrhagic

BACKGROUND: Caspase-3 is a cysteine protease that plays a major role in the process of apoptotic cell death. The dysregulated expression of c-myc contributes to the tumorigenesis in a variety of human cancers. The aim of this study was to investigate the expressions of caspase-3 and c-myc and their significances as prognosis markers in patients with completely resected non-small cell lung cancer (NSCLC). MATERIAL AND METHOD: A total 130 consecutive patients who had undergone complete resection without pre-operative radio-therapy or chemotherapy between May 1996 and December 2003 for NSCLC were retrospectively reviewed. The median follow-up period of the patients was 50 months (range: 3~128 months). The expressions of caspase-3 and c-myc were immunohistochemically examined, and these were correlated with the clinico-pathologic data. RESULT: The prevalence of caspase-3 and c-myc expressions in the patients was 68% (88/130) and 59% (77/130), respectively. Significant association was found between the frequency of the expressions of caspase-3 and c-myc (p=0.025). The caspase-3 and c-myc expressions were not significantly associated with the prognosis in all the patients. However, according to stages, a positive caspase-3 expression was significantly correlated with a favorable prognosis for patients with stage IIIa disease (median survival period: 35 months vs. 10 months, p=0.021). Multivariate analysis showed the pathologic stage to be significantly correlated with a good prognosis in all the patients (p=0.024), and with a positive caspase-3 expression, well differentiated tumor and negative neuronal invasion in the patients with stage IIIa disease (p=0.005, p=0.003, p=0.004, respectively). CONCLUSION: Caspase-3 and c-myc were frequently expressed in NSCLC, suggesting its possible involvement in tumor development. The caspase-3 expression, as determined with performing immunohistochemical staining, may be a favorable prognostic indicator in patients with completely resected NSCLC of an advanced stage (IIIa).
Carcinoma, Non-Small-Cell Lung ; Caspase 3 ; Cell Death ; Cell Transformation, Neoplastic ; Cysteine Proteases ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Neurons ; Prevalence ; Prognosis ; Retrospective Studies

No abstract available.
Larynx* ; Pharmacology ; Succinylcholine* ; Vecuronium Bromide*

BACKGROUND: A question was whether it was preferable to give the reversal agent when profound block was present or wait for some spontaneous recovery before antagonizing the block. This study has been conducted to evaluate the reversal effects of neostigmine with divided doses in the rabbits after pancuronium when profound relaxation(PTC=O) or the first twitch of TOF stimulation was appeared (TOF,T1) was confirmed. METHODS: Rabbits(n=60) were randomly allocated to 5 groups. After pancuronium 0.2 mg/kg intravenously, spontaneous recovery was evaluated in group 1. When the profound relaxation(PTC=O) was confirmed at 5 min. after pancuronium, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 2. At that time, neostigmine 10 ug/kg with atropine 4 ug/kg were injected and after 3 min. neostigmine 40 ug/kg with atropine 16 ug/kg were injected in group 3. When TOF, Tl was confirmed, neostigmine 50 ug/kg with atropine 20 ug/kg were injected in group 4. At that time, neostigmine and atropine were injected in group 5 as the same way of group 3. RESULTS: The mean time from injection of pancuronium to 95% recovery was 98.9 min. in group 1, 60.3 min. in group 2, 50.9 min. in group 3, 71.0 min. in group 4 and 67.1 min. in group 5. The recovery index was significantly reduced when neostigmine was injected at TOF,T1(p<0.05). The recovery time after neostigmine with divided doses was reduced, but there was no significant difference. CONCLUSIONS: The results of present study suggested that total recovery time was reduced when neostigmine was injected earlier with divided doses than single dose unrelated to profound relaxation.
Atropine ; Muscle Relaxation* ; Neostigmine* ; Pancuronium ; Rabbits* ; Relaxation

BACKGROUND: Propofol(2,6 diisopropylphenol) is a potent hypnotic currently formulated as an oil-in-water emulsion. Although previous studies reported decreases in arterial pressures and heart rate, no detailed studies of hemodynamic effects of propofol administration alone are available in Korea. This study is to determine the hemodynamic changes induced by doses of propofol. METHODS: Sixty patients(ASA physical status 1 or 2) were divided randomly into three groups as follows: group I, pmpofol 1.5 mg/kg; group 2, propofol 2.0 mg/kg; group 3, propofol 2.5 mg/kg. Heart rate and mean arterial pressure were measured by Datascope 2200I, and cardiac index(CI) and systemic vascular resistance index(SVRI) were obtained by doppler cardiac output monitor(Datascope Accucom 2) at the suprasternal notch before and after induction of propofol. RESULTS: Statistically significant decreases in mean arterial pressure were observed since 2 min after induction. CI was decreased from 2.94+/-0.51 to 2.35+/-0.57 L/min/m(2) at 6 min after induction of propofol 2.5 mg/kg, and no differences among groups. CI was also decreased in group 1 and 2 but without any significance. SVRI was decreased in all groups but there were no significance, and no differences among groups. CONCLUSIONS: The data suggest that the usual doses of propofol do not significantly cause hemodynamic changes, and a decrease in mean arterial pressure is a result of decreased CI and reduced SVRI.
Anesthetics ; Arterial Pressure ; Cardiac Output ; Heart Rate ; Hemodynamics* ; Korea ; Propofol* ; Vascular Resistance

Anesthetic drugs by themselves were without effect on neummuscular function, but when the margin of safety in transmission was reduced, because of the admimstration of a musde relaxant, then a synergistic effect on relaxation might be observed. The purpose of this study was to examine whether the twitch recovery after vecuronium bromide (vecuronium) was influenced by thiopental sodium (thiopental), ketamine and lidocaine. Eighty healthy adult patients were randomly allocated to four groups according to the drugs, control group, normal saline 5 ml, study group ; 2.5% thiopental 5 mg/kg, ketamine 2 mg/kg and 1% lidocaine 1 mg/kg. Neuromuscular bloek was induced by intravenous vecuronium 0.1 mg/kg and applied ulnar nerve stimuli of every 10 seconds single twitch using Myotest Mk II(R). The adduction force of the resultant thumb twitch was measured by the acceleration of a small piezo-electric ceramic wafer with electrodes of Mini-accelograph(8) and recorded by Datascope 2200I(8). When the twitch height was near 15 mm, the drug was injected and recorded the twitch height for 10 min. and checked mean arterial pressure and heart rate after injection. The results were as follows ; 1) There were no significant changes of mean arterial pressure after drug injection. 2) Heart rate was significantly increased in thiopental group (77.7+/-8.3 beats/min. 93.7+/-9.1 beats/min.) and lidocaine group (85.6+/-15.9 beats/min. - 88.4+/-16.4 beats/min.), but no change in control and ketamine group. 3) In the linear regression analysis between the twitch length and the time, control group was Y=16.0+/-1.0X, r2=0.33, thiopental group was Y=14.9+/-1.1X, r2%.39, ketamine gmup was Y=14.8+0.9X, r2=0.24 and lidocaine group was Y=15.1+0.8X, r2=0.30. Lidocaine group was only significantly decreased than control group. With the above results the authors concluded that the twitch recovery after vecuronium was significantly deaeased by lidocaine, but no cbanges by thiopental and ketamine. We should more find the drug interaction with vecuronium in the man.
Acceleration ; Adult ; Anesthetics ; Arterial Pressure ; Ceramics ; Drug Interactions ; Electrodes ; Heart Rate ; Humans ; Ketamine ; Lidocaine* ; Linear Models ; Relaxation ; Thiopental* ; Thumb ; Ulnar Nerve ; Vecuronium Bromide*

Absence of response to train of four(TOF) and single twitch stimulation at ulnar nerve did not guarantee ided intubation conditions after vecuronium. The double burst stimulation (DBS) introduced by Viby-Mogensen, made it easier to evaluate postoperative residual neuromuscular blockade manually than did the use of the TOF method. The purpose of this study was to examine which will be the best stimulus among DBS, TOF and single twitch stimulation(STS) for an indicator of the optimal time for tracheal intubation. One hundred and nine healthy patients were randomly allocated to three groups in which DBS(n=34), TOF(n=38) and STS(n=37) group. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained 1% enflurane until intubation. Neuromuscular block was induced by intravenous vecuronium0.1 mg/kg, and applied facial nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher and Paykel Co.) continuously. The complete relaxation time of orbicularis oculi muscle was closely observed with authors naked eyes. Tracheal intubation was performed immediately by the author after disappearance of the response to stimuli. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cords opening, coughing reflex and response to laryngoscopy attempts. The intubation time was 195.9+/-74.7(90-390) seconds in DBS group, 180.9+/-49.8(100-290) seconds in TOF group and 167.7+/-37.9(90-270) seconds in STS group and there were no statistically significant difference. There were also no significance on vocal cords opening and response to laryngoscopy attempts in three groups but DBS group was statistically less cough reflex than TOF group and STS group(p<0.05). With the above results the authors concluded that DBS on the facial nerve with the orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation and the time was about l96 seconds after vecuronium.
Anesthesia ; Cough ; Enflurane ; Facial Nerve* ; Humans ; Injections, Intravenous ; Intubation* ; Laryngoscopy ; Muscle, Skeletal ; Neuromuscular Blockade ; Reflex ; Relaxation ; Thiopental ; Ulnar Nerve ; Vecuronium Bromide* ; Vocal Cords

Stimulation of ulnar nerve and. measurement of adductor pollicis response have been used for many years in clinical practice and research, but different muscles respond differently to relaxants, both in terms of onset and duration of blockade. The onset time of neuromuscular blockade at the vocal cords and at the orbicularis oculi muscle(OO) was similar, and was shorter than at the adductor pollicis muscle(AP). The purpose of this study was to examine which will be the best stimulus among double burst stimulation(DBS), train of four(TOF) and single twitch stimulation(STS) on OO or AP for an indicator of the optimal tiime for tracheal intubation. Two hundreds and thirty six healthy patients were randomly allocated to six groups in which DBS(n=34), TOF(n=36) and STS(n=37) group in OO group, and DBS(n=43), TOF(n=43) and STS(n=43) group in AP grouy. Anesthesia was induced with thiopental sodium 3-5 mg/kg and maintained with 1% enfluraae until intubation. Neuromuscular block was induced by intravenous vecuronium 0.1 mg/kg and applied facial nerve or ulnar nerve stimuli immediately by DBS, TOF and STS using INNERVATOR(Fisher & Paykel Co.) continuously. The complete relaxation time of OO group was closely observed with authors naked eyes, but the time of AP group were measured by tactile response of thumb. Tracheal intubation was tried immediately by the author after complete disappearance of the muscle contraction. The intubation time from intravenous injection of vecuronium was recorded, and the intubating conditions were evaluated by vocal cord opening, coughing reflex and response to laryngoscopy attempts. The results were as follows: 1) The intubation time of OO group was 195.97+/-12.82 sec. in DBS group, 182+/-8.46 sec. in TOF group and 167.73+/-6.24sec. in STS group, respectively and there were no significance among groups. 2) The intubation time of AP group was 290.56+/-12.1sec. in DBS group, 276.79+/-10.32sec. in TOF group and 230.16+/-9.88sec, in STS group, respectively and there were no significance among groups. But the intubation time of AP group was significantly prolonged more than that of OO group. as much as 95 sec. of DBS group, 94 sec. of TOF group and 63 sec. of STS group, respectively(p<0.05). 3) There were no significance of vocal cords opening and response to laryngoscopy attempts in three groups, but DBS group(6%) was statistically less cough reflex than TOF(37%) and STS group(33%) in OO group(p<0.05). There were no significance of the intubation responses among three groups in AP group. 4) Coughing reflex ratio(positive cough cases/total cases X 100) of OO group(36%) was significantly more than that of AP group(12%) in TOF group, and coughing reflex ratio of OO group (32%) was significantly more than that of AP group(12%) in STS group, but there were no significance of coughing reflex ratio between OO and AP group in DBS group. With the above results the authors concluded that DBS on facial nerve observed orbicularis oculi muscle was most reliable index to determine the optimal time for tracheal intubation, and facial nerve stimuli was more sensitive than ulnar nerve stimuli due to reduce 95 sec. of intubation time. The optimal intubation time was about 196 sec. after vecuronium(0.1 mg/kg).
Anesthesia ; Cough ; Facial Nerve* ; Humans ; Injections, Intravenous ; Intubation* ; Laryngoscopy ; Muscle Contraction ; Muscle, Skeletal ; Muscles ; Neuromuscular Blockade ; Reflex ; Relaxation ; Thiopental ; Thumb ; Ulnar Nerve* ; Vecuronium Bromide ; Vocal Cords

The Pentaspan is a high molecular weight(250,000), hyperosmolar(320 mOsm/l) colloid solution and blood volume expander in clinical practice. Many researches revealed the decreasing of systemic vascular resistance and pulmonary vascular resistance after Pentaspan administration in vivo. Some colloid solution is contraindicated in acute renal failure. We tried to confirm the direct effects of the Pentaspan and its mechanism on the abdominal aorta and renal artery in vitro. The rat abdominal aorta and renal artery were precontracted with norepinephrine(10(-7) M/1) in 50 ml Krebs solution and 5 ml Pentaspan was infused. Ten mininutes after, changes of the vascular tones were obtained. The results were as follows. 1) The vascular tones were significantly decreased in both vessels. 2) Abdominal aorta group, renal artery group and with or without endothelium group were not significant different each other. 3) The vascular tones were not affected by with or without endothelium, indomethacin and methylene blue pretreatment. Smooth muscles were induced relaxation by the Pentaspan infusion and the relaxation were not dependent to endothelium derived relaxing factor, prostanoid and cyclic guanosinemonophosphate.
Acute Kidney Injury ; Animals ; Aorta, Abdominal* ; Arteries ; Blood Volume ; Colloids ; Endothelium ; Endothelium-Dependent Relaxing Factors ; Hydroxyethyl Starch Derivatives* ; Indomethacin ; Methylene Blue ; Muscle, Smooth ; Rats* ; Relaxation ; Renal Artery* ; Vascular Resistance

The Department. of Anesthesiology of Hanyang University had a case of operation for pheo- chromocytoma. For the operation of pheochromocytoma, used to prazosin for preoperative treatment of hypertension and used to enflurane as inhalational anesthetic, treated with sodium nitroprusside for severe elevation of blood pressure during operation, used to vecuronium for neuromuscular blocker. Also we tried to get the knowledge about the variation of catecholamine concentration in blood through operation. As we used to the other drugs with adequate amount of fluid without any other complication in this operation we reported here with other references and our experience of a case of operation for remove of pheochromocytoma.
Anesthesiology ; Blood Pressure ; Enflurane* ; Hypertension ; Neuromuscular Blockade ; Nitroprusside ; Pheochromocytoma* ; Prazosin ; Vecuronium Bromide