If cardiac sympathetic activity increases after myocardial injury, a ventricular electrical storm (VES) may occur. The stellate ganglion block is a minimally invasive technique performed to control VES through temporary sympathetic cessation. This case was treated after 3 stellate ganglion blocks in VES developed after non-ST elevation myocardial infarction. This patient underwent prophylactic stellate ganglion block prior to radical nephrectomy for a renal mass found during hospitalization, and the operation was safely completed. Stellate ganglion block is expected to be a safe treatment option for patients with unstable VES.

Background: Abdominal compartment syndrome (ACS) occurs due to increased abdominal cavity pressure, causes multiple organ damage, and leads to fatal consequences. Increased intraperitoneal pressure due to different reasons generally does not result in serious damage, due to the compliance of the abdominal wall. However, when the pressure exceeds the limit, ACS develops, thereby causing fatal damage to the organs. Case: A patient presented with rapid stomach swelling due to excessive food intake and was known to have bulimia nervosa, which had now resulted in ACS. Mental changes, abdominal distension, color change in the legs, acute kidney injury, and acidosis were seen. The patient expired due to ischemia-reperfusion injury and disseminated intravascular coagulation, which occurred after surgical decompression. Conclusions Under suspected ACS conditions, we should be aware of various symptoms that can occur. Early attempts for decompression are helpful, and it is important to be prepared for reperfusion injury prior to surgical decompression attempts.

One-third of all hospital-regulated medical waste (RMW) comes from the operating room (OR), and it considerably consists of disposable packaging and wrapping materials for the sterilization of surgical instruments. This study sought to identify the amount and type of waste produced by ORs in order to reduce the RMW so as to achieve environmentally-friendly waste management in the OR. We performed an initial waste segregation of 4 total knee replacement arthroplasties (TKRAs) and 1 total hip replacement arthroplasty, and later of 1 extra TKRA, 1 laparoscopic anterior resection of the colon, and 1 pelviscopy (with radical vaginal hysterectomy), performed at our OR. The total mass of non-regulated medical waste (non-RMW) and blue wrap amounted to 30.5 kg (24.9%), and that of RMW to 92.1 kg (75.1%). In the course of the study, we noted that the non-RMW included recyclables, such as papers, plastics, cardboards, and various wrapping materials. The study showed that a reduction in RMW generation can be achieved through the systematic segregation of OR waste.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Colon ; Medical Waste* ; Operating Rooms* ; Plastics ; Product Packaging ; Recycling ; Sterilization ; Surgical Instruments ; Waste Management

PURPOSE: Previously, we reported the presence of virus-encoded microRNAs (miRNAs) in the urine of prostate cancer (CaP) patients. In this study, we investigated the expression of two herpes virus-encoded miRNAs in prostate tissue. METHODS: A total of 175 tissue samples from noncancerous benign prostatic hyperplasia (BPH), 248 tissue samples from patients with CaP and BPH, and 50 samples from noncancerous surrounding tissues from these same patients were analyzed for the expression of two herpes virus-encoded miRNAs by real-time polymerase chain reaction (PCR) and immunocytochemistry using nanoparticles as molecular beacons. RESULTS: Real-time reverse transcription-PCR results revealed significantly higher expression of hsv1-miR-H18 and hsv2-miRH9- 5p in surrounding noncancerous and CaP tissues than that in BPH tissue (each comparison, P<0.001). Of note, these miRNA were expressed equivalently in the CaP tissues and surrounding noncancerous tissues. Moreover, immunocytochemistry clearly demonstrated a significant enrichment of both hsv1-miR-H18 and hsv2-miR-H9 beacon-labeled cells in CaP and surrounding noncancerous tissue compared to that in BPH tissue (each comparison, P<0.05 for hsv1-miR-H18 and hsv2- miR-H9). CONCLUSIONS: These results suggest that increased expression of hsv1-miR-H18 and hsv2-miR-H95p might be associated with tumorigenesis in the prostate. Further studies will be required to elucidate the role of these miRNAs with respect to CaP and herpes viral infections.
Carcinogenesis ; Herpesviridae ; Humans ; Hyperplasia* ; Immunohistochemistry ; MicroRNAs ; Nanoparticles ; Prostate* ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Real-Time Polymerase Chain Reaction

PURPOSE: To evaluate the effect of anti-interleukin-33 (anti-IL-33) on a mouse model of ovalbumin (OVA)-induced acute kidney injury (AKI). METHODS: Twenty-four female BALB/c mice were assigned to 4 groups: group A (control, n=6) was administered sterile saline intraperitoneally (i.p.) and intranasally (i.n.); group B (allergic, n=6) was administered i.p./i.n. OVA challenge; group C (null treatment, n=6) was administered control IgG i.p. before OVA challenge; and group D (anti-IL-33, n=6) was pretreated with 3.6 µg of anti-IL-33 i.p. before every OVA challenge. The following were evaluated after sacrifice: serum blood urea nitrogen and creatinine levels, Kidney injury molecule-1 gene (Kim-1) and protein (KIM-1) expression in renal parenchyma, and expression of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), phosphorylated endothelial NOS (p-eNOS), and phosphorylated AMP kinase (p-AMPK) proteins in renal parenchyma. RESULTS: After OVA injection and intranasal challenge, mice in groups B and C showed significant increases in the expression of Kim-1 at both the mRNA and protein levels. After anti-IL-33 treatment, mice in group D showed significant Kim-1 down-regulation at the mRNA and protein levels. Group D also showed significantly lower COX-2 protein expression, marginally lesser iNOS expression than groups B and C, and p-eNOS and p-AMPK expression at baseline levels. CONCLUSIONS: Kim-1 could be a useful marker for detecting early-stage renal injury in mouse models of OVA-induced AKI. Further, anti-IL-33 might have beneficial effects on these mouse models.
Acute Kidney Injury ; Adenylate Kinase ; Animals ; Blood Urea Nitrogen ; Creatinine ; Cyclooxygenase 2 ; Down-Regulation ; Female ; Humans ; Immunoglobulin G ; Interleukin-33 ; Kidney* ; Mice ; Nitric Oxide Synthase Type II ; Ovalbumin ; Ovum ; RNA, Messenger

In this article, a part of fund and grant supports was omitted unintentionally.

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.
Adult ; Arteries ; Cardiopulmonary Bypass ; Catheterization ; Causality ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Emergencies ; Extracorporeal Membrane Oxygenation ; Heart Failure ; Hemodynamics ; Humans ; Lower Extremity ; Male ; Oxygenators, Membrane ; Spasm* ; Stents ; Transplants*

PURPOSE: The frequency of thoracic endovascular aortic repair (TEVAR) is increasing due to lower morbidity and mortality than that of open repair. The aim is to evaluate the results of TEVAR in patients with thoracic aortic disease. METHODS: Twenty seven patients have undergone TEVAR from October, 2003 to November, 2012. Aortic diagnoses were 7 descending thoracic aortic aneurysms, 6 acute descending aortic dissections, 6 traumatic aortic transactions, 4 aortic arch aneurysms, 2 chronic descending aortic dissections, and 2 penetrating aortic ulcers (PAU). Multi detector computerized tomography (MDCT) aortography was done at one week, one month, six months, and one year interval. RESULTS: Indications for TEVAR were aortic diameter of more than 5.5 cm in 9 patients, traumatic aortic transaction in 6, persistent chest pain in 4, increasing aortic diameter during follow-up period in 3, aneurysm rupture in 3, and PAU more than 2 cm in 2. Hybrid TEVAR was done in 7 patients. Primary technical success, showing complete aneurysmal exclusion, was done except in one patient (96%). There was one operation death (4%). Two patients developed perioperative stroke, but recovered without sequelae. MDCT was done during the mean of 18 months (range, 1 to 98 months) follow-up period. Small type I endoleak was found in two patients (7%), and type III endoleak was found in a patient (4%). Stent graft migration was in one patient. There was no aorta related deaths during the follow-up period. CONCLUSION: Intermediate term result of TEVAR in patients with thoracic aortic aneurysmal disease was encouraging. It may be used as a treatment option for thoracic aortic disease.
Aneurysm ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Aortic Diseases ; Aortography ; Chest Pain ; Chimera ; Endoleak ; Follow-Up Studies ; Humans ; Rupture ; Stents ; Stroke ; Transplants ; Ulcer

BACKGROUND: Dexmedemomidine, a highly selective alpha-2 adrenoreceptor agonist has an analgesic and sedative effect without causing respiratory depression. In this study, we compared the duration of brachial plexus block (BPB), the time at which the patient first feels pain after performing BPB, the need for use of analgesics, and the occurrence rate of complications while continuous infusion with dexmedetomidine was used for sedation in patients undergoing BPB, to a control group, who were only infused with normal saline. METHODS: BPB was performed in 48 patients scheduled for upper limb surgery. Infraclavicular approach was provided with 40 ml of 1.5% mepivacaine and 200 microg of epinephrine using nerve stimulator. After verification of successful block, dexmedetomidine group received dexmedetomidine (loading dose 0.1 microg/kg/min for the first 10 minutes followed by a maintenance dose of 0.005 microg/kg/min as required to maintain bispectral index 60-80). In the control group, normal saline was infused at a rate of 10 ml/hr. The duration of BPB, the time at which the patient first feels pain after performing BPB, frequency of complication, and the use of analgesics of the both groups were checked. RESULTS: The motor and sensory block duration, and the time at which the patient first feels pain after BPB were longer in the dexmedetomidine group compared to the control group. And the need for analgesics were less in the dexmedetomidine group. CONCLUSIONS: Intravenous administration of dexmedetomidine prolongs the duration of BPB.
Administration, Intravenous ; Analgesics ; Brachial Plexus ; Dexmedetomidine ; Epinephrine ; Humans ; Hypnotics and Sedatives ; Mepivacaine ; Respiratory Insufficiency ; Upper Extremity

Although paraganglioma (PGL), an extra-adrenal retroperitoneal pheochromocytoma (PHEO), is a rare catecholamine-secreting neuroendocrine tumor, it can cause severe hypertensive crisis during anesthesia or surgery if undiagnosed preoperatively. Extraluminal perigastric masses may be presumed to be gastrointestinal stromal tumors (GISTs) or soft tissue sarcomas even when histologic confirmation is not possible. Therefore, without a histologic diagnosis or symptoms of excessive catecholamine secretion, PGL may be mistaken for GIST. We report a case of preoperatively undiagnosed PGL which caused hypertensive crisis during anesthesia for retroperitoneal mass excision.
Anesthesia ; Gastrointestinal Stromal Tumors ; Neuroendocrine Tumors ; Paraganglioma ; Pheochromocytoma ; Sarcoma ; Stromal Cells