The Use of Saline Bag for Cardiac Displacement Facilitates the Transgastric Transesophageal Echocardiographic View during Off-pump Coronary Artery Bypass Graft Surgery : A case report / 대한마취과학회지

During off-pump coronary artery bypass graft surgery (OPCAB), vigorous displacement and compression of the heart producing significant hemodynamic change are essential for optimal exposure of graft anastomoses. Intraoperative transesophageal echocardiography (TEE) is useful in determining hemodynamic compromise and prompting medical and mechanical support. However, in addition to the loss of contact between the heart and diaphragm during the displacement, swabs or snears underneath the heart interrupt the TEE signal transmission, resulting in a compromised transgastric (TG) TEE view. Therefore, TEE monitoring during OPCAB is usually limited to the mid-esophageal view. The authors placed a saline bag (a surgical glove filled with saline) underneath the heart to facilitate this anterior displacement of the heart, as well as avoid the signal interruption of the TG echocardiographic window. As a result, the optimal heart position with the minimal changes in LV regional wall motion, LV function and mitral regurgitation were found using the TG and other TEE views. The series of velocity-time integral of aortic valvular flow (VTI-Ao) in TG long axis view, in addition to SvO2, were then monitored as a surrogate marker of the cardiac output during a graft construction of the left circumflex artery. It was concluded that the use of a saline bag may be useful in avoiding compromise of the TG TEE view and determine the hemodynamic change using VTI-Ao during cardiac displacement for OPCAB.

Continuous Cardiac Output by using Arterial Pressure Waveform Analysis and Central Venous Oxygen Saturation during Cardiac Surgery: A case report / 대한마취과학회지

The determination of arterial pressure wave-derived cardiac output (APCO) and central venous O2 saturation (ScvO2) has been introduced as a less invasive procedure for monitoring cardiac function and oxygen delivery. We have used an APCO sensor (FloTracTM) and a monitor for ScvO2 (Vigileo(TM)) in two cases of cardiac valve surgery, where placement of pulmonary artery catheter (PAC) was not applicable due to unfavorable cardiac structure (case 1) and was contraindicated due to an unstable cardiac conduction disorder and arrhythmia (case 2). In case 1, monitoring of APCO was started from the beginning of anesthesia induction and a ScvO2 monitoring central venous catheter was inserted just after anesthesia induction. APCO, ScvO2 and other hemodyanamic information such as arterial BP, CVP, and data obtained from transesophageal echocardiography (TEE) during the pre- cardiopulmonary bypass (CPB) period were measured. APCO and ScvO2 during the post-CPB period showed a reliable correspondence with continuous cardiac output (CCO) and mixed venous O2 saturation (SvO2) as measured by PAC at the end of CPB. In case 2, APCO and ScvO2 were monitored instead of CCO and SvO2. The values of APCO showed a good correlation to intraoperative COs indirectly calculated by the velocity-time integral of the aortic outflow determined in the TEE examination. We experienced that monitoring APCO and ScvO2 is useful for anesthesia management in cardiac valve surgery and can be an alternative to CCO and SvO2 if the placement of PAC and the thermodilution method are not applicable.

Intraoperative Thermoregulation in Laparoscopic Gynecologic Surgery with Conventional and Low Insufflation: A Comparison with Open Surgery / 대한마취과학회지

BACKGROUND: It has been suspected that laparoscopic surgery exacerbates hypothermia to a greater extent than open surgery. Thus, this study was designed to compare the intraoperative thermoregulatory profiles of three different operative techniques: open surgery, low pressure (LP: 8 mmHg) or conventional pressure (CP: 13 mmHg) laparoscopic surgery. METHODS: Forty five patients who were scheduled for radical hysterectomy were allocated to three groups, 15 in each group: group O (open surgery), group LP and group CP. Anesthesia was maintained with 2.5% sevoflurane. Intraoperative core temperature and forearm minus fingertip skin temperature gradients were measured at 15-min intervals during the first three hours. Vasoconstriction threshold was defined by the esophageal temperature at which the skin temperature gradient equalled 0 degree C. RESULTS: All groups were comparable in terms of the characteristics of patients and preoperative body temperatures. Core temperatures and forearm minus fingertip skin temperature gradients were not significantly different among the three groups at all measurements. Thermoregulatory vasoconstrictions were observed in 6 of group O and 6 of laparoscopic surgical patients (4 patients from group LP and 2 patients from group CP). These 12 patients were divided into open (n = 6) and laparoscopic (n = 6) surgery group. There were no significant difference between the groups with regard to the vasoconstriction threshold and threshold time. CONCLUSIONS: Laparoscopic procedures with conventional insufflation pressure have similar profiles in terms of intraoperative thermoregulation, when compared to open surgery. Lowering insufflation pressure to 8 mmHg can not reduce the risk of intraoperative hypothermia.

Flow cytometric evaluation on the age-dependent changes of testicular DNA contents in rats

An age-dependent cellular change of DNA contents in the testis of Sprague-Dawley rats was investigated by flow-cytometric method. Testicular cell suspensions at the age of 4, 5, 6, 7, 8, 10, 12, 16 and 26 weeks were prepared and stained with propidium iodide. The relative proportions in the number of mature and immature haploid (1n), diploid (2n), S-phase and tetraploid (4n) cells were calculated. The proportion in the number of mature haploid cells was sharply increased to the age of 10 weeks (about 38%), thereafter increased slightly to the level of 42% at the age of 26 weeks. The proportion of immature haploid cells was dramatically increased to the age of 6 weeks, then maintained at the level of 20 to 30% thereafter. The proportion of diploid cells was 64% at the age of 4 weeks, then decreased gradually through the age of 26 weeks. The proportion of S-phase cells was increased to the age of 4 weeks, then maintained at a plateau level to the age of 26 weeks. The proportion of tetraploid cells were about 26% at the age of 4 weeks, then decreased gradually to the age of 26 weeks. These results suggest that the proportions of testicular cells may depend on the age of the rat and that the flow cytometric method may be useful in the evaluation of the spermatogenic status with regard to accuracy and sensitivity.

Effect of ethylene glycol monoethyl ether on the spermatogenesis in pubertal and adult rats

The effects of ethylene glycol monoethyl ether (EGEE) on testicular cell populations in pubertal (5 weeks old) and adult (9 weeks old) male rats were investigated by a flow cytometric method. A total of 50 rats (in number, 25 pubertal and 25 adult rats) was divided into 5 experimental groups including 0 (control), 50, 100, 200, and 400 mg EGEE/kg of body weight. The animals were administered by gavage for 4 weeks. In adult rats, the treatment of EGEE at the dose of 400 mg/kg of body weight decreased significantly the populations of haploid, while it increased those of diploid and tetraploid cells. In pubertal rats, the treatment of EGEE at the dose of 400 mg/kg of body weight caused only minimal changes in the relative percent of testicular cell types. These results suggest that the effects of EGEE on testicular function in pubertal rats appear to be less pronounced than in adult rats.

Influence of Cortex mori on the Capsaicin-induced Neurogenic Inflammation / 대한해부학회지

The root bark of mulberry (Morus alba L. Cortex Mori and other plant of the genus Morus) has been used as an antiphlogistic, diuretic, and expectorant in herbal medicine, and the crude drug is known as "Sangbaikpi" in Korea. Capsaicin, a neurotoxin extracted from a red peppers, has selective effects on peptide-containing C-fiber and induces the release of neuropeptides from sensory nerve ending. But, any reports about the influences of Cortex mori (CM) on the capsaicin-induced neurogenic inflammation were not found, and the precise mechanism of capsaicin-induced neurogenic inflammation remains incompletely understood. The purpose of this study was to determine whether CM could inhibit the capsaicin-induced cutaneous reaction, and to find out its action mechanism. For this purpose, influences of CM on the capsaicin-induced cutaneous reaction (vascular permeability) in back skin of Sprague-Dawley rat, capsaicin-induced histamine release, calcium influx and the change of intracellular cAMP level in rat peritoneal mast cell were estimated. Results obtained were as follows; 1. Pretreatment of CM inhibited remarkably the capsaicin-induced cutaneous reaction. 2. The capsaicin-induced histamine release was inhibited by pretreatment with CM. 3. Capsaicin-induced calcium influx into mast cell was also inhibited by pretreatment with CM. 4. Capsaicin-induced decrease of cAMP level in the mast cell was inhibited significantly by pretreatment with CM. These results suggest that CM contains some substances with an anti-neurogenic inflammatory activity which inhibit the capsaicin-induced cutaneous reaction through the mechanism of mast cell stabilization.