BACKGROUND: Ketamine and dexmedetomidine are commonly used for sedation and analgesia in patients. We tried to compare the effects of intravenous ketamine and dexmedetomidine infusion on spinal block with bupivacaine. METHODS: Ninety American Society of Anesthesiologists physical status class I or II patients, who were scheduled to spinal anesthesia were randomly assigned to one of three groups (n = 30). Normal saline 10 ml, 5 ml/hr (loading dose for 10 minutes, infusion) (Group NS), dexmedetomidine 1 microg/kg, 0.5 microg/kg/hr (Group DEX), or ketamine 0.2 mg/kg, 0.5 mg/kg/hr (Group KET) was infused intravenously before spinal anesthesia. We recorded the time to highest sensory block level, sensory and motor regression, and hemodynamic changes. RESULTS: Patients in Groups KET had a significantly faster onset time of sensory block than patients in Group NS. The highest sensory block levels were not significantly different between groups. Average time of sensory regression and knee flexion, was significantly longer in the Group KET and Group DEX than the Group NS. CONCLUSIONS: Intravenous dexmedetomidine and ketamine were found to have a similar synergistic effect with intrathecal bupivacaine. Hemodynamic stability showed better results in Group KET.
Analgesia ; Anesthesia, Spinal ; Bupivacaine* ; Dexmedetomidine* ; Hemodynamics ; Humans ; Ketamine* ; Knee

Yerba Mate, derived from the leaves of the tree, Ilex paraguariensis, is widely-used as a tea or as an ingredient in formulated foods. The aim of the present study was to evaluate the effects of Yerba Mate extract on weight loss, obesity-related biochemical parameters, and diabetes in high-fat diet-fed mice. To this end, by using in vivo animal models of dietary-induced obesity, we have made the interesting observations that Yerba Mate has the ability to decrease the differentiation of pre-adipocytes and to reduce the accumulation of lipids in adipocytes, both of which contribute to a lower growth rate of adipose tissue, lower body weight gain, and obesity. Our data from in vivo studies revealed that Yerba Mate treatment affects food intake, resulting in higher energy expenditure, likely as a result of higher basal metabolism in Yerba Mate-treated mice. Furthermore, in vivo effects of Yerba Mate on lipid metabolism included reductions in serum cholesterol, serum triglycerides, and glucose concentrations in mice that were fed a high fat diet. In conclusion, Yerba Mate can potentially be used to treat obesity and diabetes.
Adipocytes ; Adipose Tissue ; Animals ; Basal Metabolism ; Body Weight ; Cholesterol ; Diet, High-Fat ; Eating ; Energy Metabolism ; Food, Formulated ; Glucose ; Ilex paraguariensis ; Lipid Metabolism ; Mice ; Models, Animal ; Obesity ; Tea ; Trees ; Triglycerides ; Weight Loss

Erectile dysfunction (ED) is a highly prevalent disorder that affects millions of men worldwide. ED is now considered an early manifestation of atherosclerosis, and consequently, a precursor of systemic vascular disease. This study was designed to investigate the effects of male silkworm pupa powder (SWP) on the levels of nitric oxide synthase (NOS) expression, nitrite, and glutathione (GSH); lipid peroxidation; libido; and erectile response of the corpus cavernosum of the rat penis. We induced ED in the study animals by oral administration of 20% ethanol over 8 weeks. The SWP-treated male rats were divided into 3 groups that were orally administered 200, 400, and 800 mg/kg. The libido of the SWP-administered male rats was higher than that of the ethanol control group. In addition, the erectile response of the corpus cavernosum was restored in males on SWP administration, to a level similar to that of the normal group without ED. The testosterone concentration did not increase significantly. The lipid peroxidation in the corpus cavernosum of the male rats administered SWP decreased significantly. In contrast, compared to the ethanol group, SWP-administered male rats showed increased GSH levels in the corpus cavernosum. The level of nitrite and NOS expression in the corpus cavernosum of SWP-administered male rats increased significantly. These results indicated that SWP effectively restored ethanol-induced ED in male rats.
Administration, Oral ; Animals ; Atherosclerosis ; Bombyx ; Erectile Dysfunction ; Ethanol ; Glutathione ; Humans ; Libido ; Lipid Peroxidation ; Male ; Nitric Oxide Synthase ; Penis ; Pupa ; Rats ; Testosterone ; Vascular Diseases

STUDY DESIGN: This is a retrospective, case-controlled study. OBJECTIVE: We wanted to evaluate the efficacy of lower-pressure percutaneous vertebroplasty (LP-PVP) using larger-diameter cement fillers for treating osteoporotic vertebral compression fracture (VCF). SUMMARY OF THE LITERATURE REVIEW: Despite the popularity of conventional PVP(C-PVP), critical complications associated with cement leakage have been widely reported due to the inadequate viscosity of flabby cement. MATERIALS AND METHODS: With excluding Kummell's disease, 23 VCF's were treated with LP-PVP using 2.8mm-diameter cement fillers, 51 VCF's were treated with kyphoplasty(KP) using the same size of cement fillers and 19 VCF's were treated with C-PVP using 1.4mm-diameter biopsy needles. The clinical and radiographic results along with the complications were investigated for more than one year. RESULTS: The visual analogue scale (VAS) was improved in all the groups. The infused cement volume was 5.9+/-1.6ml for the LP-PVP, 5.9+/-1.9ml for the KP and 3.5+/-1.0ml for the C-PVP (p=0.000). The collapsed vertebral height was restored by 10.8+/-10.3%, 13.0+/-12.7% and 4.7+/-7.6%, respectively, in each group (p=0.000) with a reduction loss of 2.1+/-1.8%, 1.1+/-1.4% and 5.9+/-4.2%. respectively, in each group (p=0.000) at follow-up. These was a reduction of the vertebral kyphotic angle by 3.0+/-4.0degrees, 3.7+/-4.4degrees and 4.2+/-4.4degrees, respectively, in each group (p=0.528) with reduction loss of 1.0+/-0.9degrees, 0.1+/-1.7degrees and 3.5+/-2.8degrees, respectively, in each group (p=0.000). There was a reduction of the regional Cobb's angle by 4.3+/-2.6degrees, 3.1+/-4.7degrees and 2.9+/-3.8degrees, respectively, in each group (p=0.184) with a reduction loss of 3.6+/-4.5degrees, 0.1+/-1.5degrees and 1.0+/-4.1degrees, respectively, in each group (p=0.000). Extravasation of cement was noticed in 6 cases (26.1%) of LP-PVP, in 14 cases (27.5%) of KP and 4 cases (26.1%) of C-PVP (p=0.689). No cases of additional VCF happened for the LP-PVP, eight cases of additional VCF happened (15.7%) for the KP and one case of additional VCF happened (5.3%) for the C-PVP (p=0.030). CONCLUSION: The LP-PVP showed clinically and radiologically results that were similar to those of KP with a higher amount of infused cement volume compared to that of C-PVP. LP-PVP is thought to be effective for the clinical and radiolographic aspects and to have fewer complications for the treatment of osteoporotic VCF.
Biopsy ; Case-Control Studies ; Follow-Up Studies ; Fractures, Compression ; Needles ; Retrospective Studies ; Vertebroplasty ; Viscosity

No abstract available.

STUDY DESIGN: This is a retrospective preparative study and prospective study OBJECTIVE: We instituted and verified the precautions against postoperative spinal infection. SUMMARY OF THE LITERATURE REVIEW: Postoperative infection comes from contamination during the operation and various strategies have been recommended to prevent it. MATERIALS AND METHODS: 583 cases that underwent instrumented posterior spinal fusion during two years (group I), were reviewed to discover the risk factors, and intraoperative cultures were done to detect the contamination routes and the causative microorganisms for the next 4 months. Six precautions, based on the results, were instituted. We analyzed 354 cases that underwent operation in the following year (group II) using the precautions. RESULTS: Twenty cases (3.4%) were infected in group I and the types of infection were superficial wound infection (4 cases), deep wound infection (4 cases), osteomyelitis around the interbody space (7 cases), osteomyelitis around the pedicle screws (4 cases) and a combination of wound infection and osteomyelitis around the pedicle screws (1 case). Infections happened more frequently in the cases of interbody fusion (p=0.034), revision (p=0.087) and those done in the summer season (p=0.025). S. epidermidis, as the causative bacteria, was cultured from both the operation environments and wounds. Six precautions based on the preliminary results were instituted as follows; irrigation method reformation, delayed opening of instruments, turning-off local air conditioners, changing of gowns before instrumentation, local bone irrigation and limited indications for interbody fusion. After implementation, two cases (0.6%) of infection developed in group II (p=0.002, odds ratio=0.160; 95% confidence interval = 0.037 to 0.688). CONCLUSION: Wounds, grafted bones or instruments can be contaminated under longer-time exposure to operating room air and so produce interbody or pedicle osteomyelitis without wound infection. The precautions were effective to decrease the postoperative infection rates following posterior spinal fusion.
Bacteria ; Operating Rooms ; Osteomyelitis ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Seasons ; Spinal Fusion ; Transplants ; Wound Infection

STUDY DESIGN: This is a mechanical study of polymethylmetacrylate(PMMA) mixed with blood as a filler. OBJECTIVE: We tried to change the properties of PMMA so that it is more suitable to use for percutaneous vertebroplasty (PVP). SUMMARY OF THE LITERATURE REVIEW: The mechanical changes by adding a filler into PMMA were expected to decrease the Young's modulus, the polymerization temperature and the setting time. These changes of PMMA were considered to be more suitable and adaptable conditions for PVP for treating osteoporotic vertebral compression fracture. MATERIALS AND METHODS: Porous PMMA was produced by mixing 2 ml (B2), 4 ml (B4) and 6 ml (B6)-blood as a filler, and the mechanical properties were investigated in comparison with regular PMMA(R) in view of Young's modulus, the polymerization temperature, the setting time and the optimal passing-time within the injectable viscosity (20~50N-needed) through a 2.8mm-diameter cement-filler tube. Porosity was inspected by performing microcomputated tomography (micro-CT). RESULTS: Young's modulus was decreased from 919.5 MPa (R) to 701 MPa (B2), 693.5 MPa (B4) and 545.6 MPa (B6) in each group. The polymerization temperature decreased from 74.2degrees C (R) to 59.8degrees C (B2), 54.2degrees C (B4) and 47.5degrees C(B6), respectively. The setting time decreased from 1065sec (R) to 624sec (B2), 678sec(B4) and 606sec (B6), respectively, and the optimal passing-time decreased from 75.6sec (R) to 46.6sec (B2), 65.0sec (B4) and 79.0sec(B6), respectively. The porosity increased from 4.2%(R) to 27.6%(B2), 27.5%(B4) and 29.5%(B6), respectively. A homogenous microstructure with very fine pores was seen on inspection of all the blood-mixed PMMAs. CONCLUSION: Blood mixed with PMMA was considered as an excellent filler that was easy to make and had good biocompatibility. The 6ml blood-mixed PMMA (B6) showed more suitable mechanical properties, including a decreased elastic modulus due to more porosity, less heating and a retarded optimal passing-time by the serum barrier, which diminished the friction between the PMMA and a cement-filler tube.
Elastic Modulus ; Fractures, Compression ; Friction ; Heating ; Hot Temperature ; Polymerization ; Polymers ; Polymethyl Methacrylate ; Porosity ; Vertebroplasty ; Viscosity

STUDY DESIGN: Mechanical study of polymethylmetacrylate (PMMA) mixed with blood as a filler. PURPOSE: An attempt was made to modify the properties of PMMA to make it more suitable for percutaneous vertebroplasty (PVP). OVERVIEW OF LITERATURE: The expected mechanical changes by adding a filler into PMMA included decreasing the Young's modulus, polymerization temperature and setting time. These changes in PMMA were considered to be more suitable and adaptable conditions in PVP for an osteoporotic vertebral compression fracture. METHODS: Porous PMMA were produced by mixing 2 ml (B2), 4 ml (B4) and 6 ml (B6) of blood as a filler with 20 g of regular PMMA. The mechanical properties were examined and compared with regular PMMA(R) in view of the Young's modulus, polymerization temperature, setting time and optimal passing-time within an injectable viscosity (20-50 N-needed) through a 2.8 mm-diameter cement-filler tube. The porosity was examined using microcomputed tomography. RESULTS: The Young's modulus decreased from 919.5 MPa (R) to 701.0 MPa (B2), 693.5 Mpa (B4), and 545.6 MPa (B6). The polymerization temperature decreased from 74.2degrees C (R) to 59.8degrees C (B2), 54.2degrees C (B4) and 47.5degrees C (B6). The setting time decreased from 1,065 seconds (R) to 624 seconds (B2), 678 seconds (B4), and 606 seconds (B6), and the optimal passing-time decreased from 75.6 seconds (R) to 46.6 seconds (B2), 65.0 seconds (B4), and 79.0 seconds (B6). The porosity increased from 4.2% (R) to 27.6% (B2), 27.5% (B4) and 29.5% (B6). A homogenous microstructure with very fine pores was observed in all blood-mixed PMMAs. CONCLUSIONS: Blood is an excellent filler for PMMA. Group B6 showed more suitable mechanical properties, including a lower elastic modulus due to the higher porosity, less heating and retarded optimal passing-time by the serum barrier, which reduced the level of friction between PMMA and a cement-filler tube.
Elastic Modulus ; Fractures, Compression ; Friction ; Heating ; Hot Temperature ; Polymerization ; Polymers ; Polymethyl Methacrylate ; Porosity ; Vertebroplasty ; Viscosity ; X-Ray Microtomography

Lymphangioma usually occurs in children and usually involves neck and axillary region. Renal or perirenal cystic lymphangioma, hepatic lymphangiomatosis and splenic lymphangiomatosis are very rare disorders. Perirenal cystic lymphangioma combined with multiple hepatic cysts or multiple splenic cysts suspected to be lymphangiomatosis has not been reported in adults in this country until now. The patient was a 43-year-old woman who had been diagnosed with multiple splenic cysts about ten years ago. She presented with a perirenal cystic lesion discovered incidentally and we detected small multiple hepatic cysts additionally with abdominal CT. We removed perirenal cyst surgically and a perirenal lymphangioma was confirmed.
Adult ; Child ; Female ; Humans ; Kidney ; Liver ; Lymphangioma ; Lymphangioma, Cystic ; Neck ; Spleen

STUDY DESIGN: This is a retrospective study. OBJECTIVE: We wanted to evaluate the efficacy of kyphoplasty for treating osteoporotic VCF and we wanted to determine the risk factors for additional VCF. SUMMARY OF THE LITERATURE REVIEW: Successful pain relief with performing kyphoplasty for VCF has been well documented. However, unsatisfactory reduction and additional VCF are remained problems for kyphoplasty. MATERIALS AND METHODS: Sixty-three patients who underwent kyphoplasty were followed up for more than 1 year. The degree of reduction of the collapsed vertebral height, the vertebral kyphotic angle, the regional Cobb's angle and the overall sagittal alignment, the visual analogue scale (VAS), the fracture configuration, the bone mineral density (BMD), the presence of intradiscal cement leakage and additional VCF were investigated. The risk factors for additional VCF were analyzed. RESULTS: In terms of deformity correction, the collapsed vertebral height were restored (67.3+/-15.6% to 82.5+/-11.8%), the vertebral kyphotic angle was improved (12.1+/-6.9degrees to 8.1+/-5.3degrees ), the degree of the regional Cobb's angle was reduced (3.1+/-4.5degrees ) and the overall sagittal balance was improved (1.7+/-5.3 cm to 0.5+/-3.9 cm) with clinical satisfaction (VAS: 6.9+/-1.3 points to 2.3+/-0.9 points). But less than 40% of the patients reached the expected reduction criteria (the vertebral height > 90%, the vertebral kyphotic angle and regional Cobb's angle reduction > 5degrees ). Additional VCF occurred in 10 patients (15.9%). The average BMD in the additional VCF group was T-score of -3.8 and that for the no-additional VCF group was T-score of -3.0 (p=0.025). The degree of reduction under general anesthesia was twice more than that under local anesthesia. Eleven cases (17.5%) of intradiscal cement leakages were noticed, but this showed no relevance to the fracture configurations and additional VCF. The overall sagittal alignment and cement volume showed no relevance to additional VCF. CONCLUSION: Kyphoplasty was excellent for pain reduction, but it was unsatisfactory for correcting deformity. Vertebral height correction was more effectively performed under general anesthesia. Additional VCF was caused by severe osteoporosis.
Anesthesia, General ; Anesthesia, Local ; Bone Density ; Congenital Abnormalities ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteoporosis ; Retrospective Studies ; Risk Factors