Morphology and Synaptic Pattern of Calretinin-immunoreactive Neurons in the Superficial Dorsal Horn of the Rat Spinal Cord / 대한해부학회지

The distribution and the synaptic relationships of calretinin-immunoreactive neurons were studied in the superficial dorsal horn of the rat spinal cord. Calretinin-immunoreactive neurons and fibers were found in all laminae of spinal cord. The densest staining of both cell bodies and fibers occurred in the superficial laminae. In lamina I, marginal cells and other neurons with small round cell bodies showed calretinin-like immunoreactivity. A calretinin-immunoreactive plexus of nerve fibers was also found in this lamina. Lamina II was densely packed with calretinin-immunoreactive neuronal elements. The outer layer of lamina II was primarily composed of calretinin-immunoreactive neurons with a round or oval shape, whereas in the inner layer dorsoventrally orientated labeled neurons with spindle-shaped cell bodies were observed. Densely labeled neuropils with punctate profiles were also seen. By electron microscopy most of the labeled punctate profiles appeared to be dendrites, but axonal profiles were also found in smaller numbers. Labeled dendritic profiles established symmetric or asymmetric synapses with unlabeled axons and labeled axons established primarily symmetric synaptic contacts with unlabeled dendrites. Synaptic contacts between two calretinin-immunoreactive processes were observed infrequently.

The Preliminary Study of Reliability and Validity on the Korean Version of Personality Disorder Questionnaire-4+ (PDQ-4+) / 신경정신의학

OBJECTIVES: The purpose of this study was to examine the reliability and the validity of the Korean version of Personality Disorder Questionnaire-4+ (PDQ-4+). METHODS: PDQ-4+ was administered to 540 subjects of general population group and 37 subjects of personality disorder group. For measuring concurrent reliability, we tested internal consistency, split-half reliability, test-retest reliability and correlation of item score of subscale and mean of subscale. And also, we performed factor analysis for the evaluation of validity, and t-test to group difference of the total scores between general population group and personality disorder group. RESULTS: In general population group and personality disorder group, internal consistency was above .500 (range of Cronbach alpha: .4007 to .6693) in most of the Personality disorder categories. Split-half reliability was .839 between even and odd items. Test-retest reliability done 2 weeks interval was .868. Item scores of subscales and mean of subscales showed high correlation coefficient. Group difference of the total scores between general population and personality disorder group showed very significant difference (t=9.146, df=76, p=.000). CONCLUSION: The PDQ-4+ shows a reasonable degree of reliability and validity and could be a valuable tool in screening for overall personality disturbances.

Effects of Postoperative Patient-Controlled Ketorolac Analgesia on Recovery of Gastro-intestinal Motility after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: Postoperative ileus remains a common condition that prolongs hospitalization and increases the cost of surgical therapy. Ketorolac, a potent nonsteriodal antiinflammatory drug, has been known to prevent small bowel ileus in a rodent model. Therefore, we compared the effect of intravenous patient-controlled analgesia (iv PCA) with or without ketorolac. METHODS: Fifty-four patients undergoing gynecologic surgery were assigned in a double-blind manner into one of three groups (n = 18). Pain control was achieved using meperidine 600 mg only (group M), meperidine 300 mg-ketorolac 150 mg (group MK) or butorphanol 10 mg-ketorolac 150 mg (group BK) during the 48 hours following surgery. It was designed as loading (30 mg), continuous infusion (9.6 mg/hr), PCA dose (9.6 mg) and lockout interval (15 min) for group M and as loading (30 mg of ketorolac), continuous infusion (2 ml/hr), PCA dose (2 ml), and lockout interval (15 min) for groups MK and BK. We measured the interval to the first flatus during the 72 hours following surgery and recorded the numerical rating score (NRS) of pain with side effects at 1, 6, 12, 24 and 48 hrs postoperatively. RESULTS: Ketorolac expedited the return of bowel function significantly (P < 0.05). Analgesic efficacy and side effect were not significantly different in all three groups. CONCLUSIONS: IV PCA with meperidine-ketorolac and butorphanol-ketorolac afforded equal analgesia compared to the meperidine only. It also allowed earlier recovery of bowel function in patients undergoing gynecologic surgery.

The Analgesic Effect of Intrathecal Gabapentin in a Rat Model of Incisional Pain / 대한마취과학회지

BACKGROUND: Gabapentin, an anticonvulsant structurally related to gamma-aminobutyric acid (GABA), was recently reported to be effective in pain associated with reflex sympathetic dystrophy and neuropathy. However, the effects of intrathecal (IT) gabapentin in postoperative pain are unclear. This study was designed to evaluate the analgesic action of IT gabapentin in a rat model of postoperative pain which was similar to human postoperative pain states. METHODS: Rats were prepared with chronic intrathecal catheter. Under halothane anesthesia, a 1 cm incision was made in the plantar aspect of the hind paw and closed. Rats were divided into 7 groups, a control group (saline 20 microliter intrathecally n = 6); a GP 30 group (gabapentin 30 microgram intrathecally, n = 6); a GP 100 group (gabapentin 100 microgram intrathecally, n = 6); a GP 300 group (gabapentin 300 microgram intrathecally, n = 6); a GP 1000 group (gabapentin 1,000 microgram intrathecally, n = 6); a NS-GP group (saline 10 microliter and gabapentin 300 microgram intrathecally, n = 6) and DS-GP group (D-serine 100 microgram and gabapentin 300 microgram intrathecally, n = 6). The rats were placed on an elevated plastic mesh floor, and withdrawal threshold was determined using calibrated von Frey filaments applied from beneath the test cage to an area adjacent to the wound. A cumulative pain score based on the weight bearing behavior of the rats, and motor deficit score, were also assessed. RESULTS: In all group, the median withdrawal threshold for punctate hyperalgesia decreased from 148.4 mN before surgery to 1.5 mN-14.5 mN 2 hours after surgery-inducing hyperalgesia and remained unchanged during the 2hr testing period. The IT administration of gabapentin (30 300 microgram) increased the median withdrawal threshold toward preincision values dose-dependently and the nonevoked pain scores were also decreased. But the effects of intrathecal gabapentin were reversed by IT D-serine. The Analgegic effects of gabapentin were observed at doses that had no significant effect on motor function or spontaneous activity. CONCLUSIONS: These observations suggest that intrathecal gabapentin can modulate the facilitation of spinal nociceptive processing by tissue injury and may offer a therapeutic agent for the treatment of postoperative pain.

Effects of Preemptive Intrathecal Bupivacaine on Postoperative Pain in Rats / 대한마취과학회지

BACKGROUND: Preemptive analgesia is an antinociceptive treatment that prevents the development of central sensitization which contributes to the post-injury pain hypersensitivity. But controversies exist over the effectiveness and clinical value of preemptive analgesia. The aim of this study is to evaluate the preemptive effect of intrathecal bupivacaine on incisional pain in rats. METHODS: Thirty male rats were divided into 3 groups, saline-treated control group (n=10), post-treatment group (n=10), and pre-treatment group (n=10) according to the time which intrathecal administration of bupivacaine was done. To evaluate postoperative mechanical hyperalgesia in injured feet, withdrawal frequency and withdrawal thresholds were measured by von Frey filaments at 30 min, 1 hr, 2 hrs, 3 hrs, 1 day, 3 days and 7 days after incision. RESULTS: In control group, the withdrawal frequency increased from 0+/-0% before incision to 98.0+/-1.3% after the foot incision and the responses gradually declined during the postoperative 7 days to 52.0+/-4.7%. The median withdrawal threshold decreased from 148.43 mN before incision to 0.05 mN after foot incision and gradually increased during the postoperative 7 days to 6.79 mN. The post-treatment group showed no significant differences in the withdrawal frequency and withdrawal thresholds when compared with control group at post-operative 1 hour and thereafter (P<0.05). The pre-treatment group showed significantly lower withdrawal frequency and significantly higher withdrawal threshold compared with control group at postoperative 30 min and thereafter (P<0.05), and significantly lower withdrawal frequency and higher withdrawal threshold compared with post-treatment group at postoperative 2 hours and thereafter (P<0.05). CONCLUSION: We conclude that intrathecal bupivacaine administered before incision reduces postoperative delayed hyperalgesia in incisional pain model, and it may result from preventing the development of injury- induced central sensitization.

Effects of Preemptive Intrathecal Bupivacaine on Postoperative Pain in Rats / 대한마취과학회지

BACKGROUND: Preemptive analgesia is an antinociceptive treatment that prevents the development of central sensitization which contributes to the post-injury pain hypersensitivity. But controversies exist over the effectiveness and clinical value of preemptive analgesia. The aim of this study is to evaluate the preemptive effect of intrathecal bupivacaine on incisional pain in rats. METHODS: Thirty male rats were divided into 3 groups, saline-treated control group (n=10), post-treatment group (n=10), and pre-treatment group (n=10) according to the time which intrathecal administration of bupivacaine was done. To evaluate postoperative mechanical hyperalgesia in injured feet, withdrawal frequency and withdrawal thresholds were measured by von Frey filaments at 30 min, 1 hr, 2 hrs, 3 hrs, 1 day, 3 days and 7 days after incision. RESULTS: In control group, the withdrawal frequency increased from 0+/-0% before incision to 98.0+/-1.3% after the foot incision and the responses gradually declined during the postoperative 7 days to 52.0+/-4.7%. The median withdrawal threshold decreased from 148.43 mN before incision to 0.05 mN after foot incision and gradually increased during the postoperative 7 days to 6.79 mN. The post-treatment group showed no significant differences in the withdrawal frequency and withdrawal thresholds when compared with control group at post-operative 1 hour and thereafter (P<0.05). The pre-treatment group showed significantly lower withdrawal frequency and significantly higher withdrawal threshold compared with control group at postoperative 30 min and thereafter (P<0.05), and significantly lower withdrawal frequency and higher withdrawal threshold compared with post-treatment group at postoperative 2 hours and thereafter (P<0.05). CONCLUSION: We conclude that intrathecal bupivacaine administered before incision reduces postoperative delayed hyperalgesia in incisional pain model, and it may result from preventing the development of injury- induced central sensitization.

Prader-Willi Syndrome: A case report / 대한마취과학회지

In 1956, Prader and Willi first described a clinical syndrome that included severe neonatal hypotonia, hyperphagia, obesity, diabetes, hypogonadism, cryptorchidism, dental caries and mental deficiency. We have anesthetized a male patient who had Prader-Willi syndrome. He suffered for both pyoknee. General anesthesia was performed using N2O-O2-isoflurane. During induction and maintenance of anesthesia, we focused on the airway management, hypotonia, abnormal glucose metabolism, protection of aspiration and cardiovascular stabilization. Emergence of anesthesia was unremarkable. But he was expired from sepsis on the fourth postoperative day.

Malignant Hyperthermia during General Anesthesia: Two cases / 대한구급학회지

Malignant hyperthermia is a hypermetabolic disorder of skelectal muscle. It goes fatal progress in the majority of cases unless early diagnosis and treatment are performed. We experienced two cases of malignant hyperthermia during general anesthesia. First case is 7-year-old boy with congenital bilateral ptosis. Second case is 46-year-old male with lung cancer. We were faced to difficult intubation due to masseter muscle spasm. After induction, tachycardia, muscle rigidity, body temperature elevation, end tidal CO2 elevation and acidosis developed. Enflurane was discontinued, vigorous emergency treatment was attempted. Fortunately, two patients were recovered from malignant hyperthermia and then discharged without complications.

The Distribution of Brain-stem and Hypothalamus Fos like Immunoreactivity Associated with blockade of Superior Cervical Ganglion in Rats / 대한마취과학회지

BACKGROUND: Recently there have been many experiences regarding systemic effects of stellate ganglion block(SGB). During sympathetic hyperactivation, the SGB can be helpful to impaired microcirculation in brain-stem and hypothalamus. However, the exact mechanism and possible central action sites of SGB have not yet been investigated. In the present study, we traced central neural pathways following superior cervical ganglion block using the protein product(Fos) of c-fos protooncogene as a metabolic marker in a rat's brain. Method: The animals were divided into a superior cervical ganglion block group(n=5) using Marcaine 0.2 ml and a control block group(n=5) using saline 0.2ml. Medulla oblongata, pons, midbrain and hypothalamus were sectioned transversely with a sliding microtome. After imunohistochemical staining using rabbit polyclonal antibody we observed the distribution and grade of Fos expression under a light microscope. RESULTS: A blockade of superior cervical ganglion in rat led to the induction of c-fos in areas related to pain modulation sites and the autonomic nervous system; such as the parabrachial nucleus and central gray of the pons including dorsal raphe nucleus, as well as the substatia nigra of the midbrain, paraventricular hypothalamic nucleus, paraventricular thalamic nucleus posterior and habenular nucleus. CONCLUSIONS: Expressions of c-fos-like protein as a marker for neuronal activity following the blockade of the superior cervical ganglion in the rat have a part in the transcriptional control of the neurons which are related to the autonomic nervous system and endogenous pain modulation sites in the brain-stem.

Severe Clonic Movement of Extremities suspected as Conversion Reaction after Continuous Epidural and General Anesthesia / 대한마취과학회지

Spontaneous shivering-like postanesthetic tremor occurs in about 40% of patients during recovery from all types anesthesia. Although most postoperative tremor is associated with intraoperative hypothermia, some is abnormal, centrally mediated thermoregulatory shivering. Conversion reactions are well known pathologic means to reduce uncontrolled anxiety and one of conversion symptom is clonic movement. 26-year old woman was brought to the operating room for surgery of ovarian cyst torsion. We had done combined continuous epidural and general anesthesia induced by pentothal sodium, succinylcholine, followed endotracheal intubation and maintained by inhalation of N2O-O2 (4: 2) We experienced severe localized clonic movement of upper extremities of the patient during recovery from general anesthesia. Clonic movement was not easily controlled by valium and naloxon. Patient had past history of unstable emotion and experienced pain during early period of epidural anesthesia, but her vital signs including body temperature were stable. We could not find any physical causes. Result of psychological review disclosed patient's clonic movement conversion reaction. Frequency and degree of clonic movement was reduced by psychiatric manipulation and lorazepam after 3 hours of recovery from anesthesia. Several episodes of clonic movement had developed at ward but she could discharged without any other complications.