Biotransformation of (-)-alpha-Pinene by Whole Cells of White Rot Fungi, Ceriporia sp. ZLY-2010 and Stereum hirsutum

Two white rot fungi, Ceriporia sp. ZLY-2010 (CER) and Stereum hirsutum (STH) were used as biocatalysts for the biotransformation of (-)-alpha-pinene. After 96 hr, CER converted the bicyclic monoterpene hydrocarbon (-)-alpha-pinene into alpha-terpineol (yield, 0.05 g/L), a monocyclic monoterpene alcohol, in addition to, other minor products. Using STH, verbenone was identified as the major biotransformed product, and minor products were myrtenol, camphor, and isopinocarveol. We did not observe any inhibitory effects of substrate or transformed products on mycelial growth of the fungi. The activities of fungal manganese-dependent peroxidase and laccase were monitored for 15 days to determine the enzymatic pathways related to the biotransformation of (-)-alpha-pinene. We concluded that a complex of enzymes, including intra- and extracellular enzymes, were involved in terpenoid biotransformation by white rot fungi.

Remifentanil-induced pronociceptive effect and its prevention with pregabalin / 대한마취과학회지

BACKGROUND: Experimental and clinical studies have suggested that remifentanil probably causes acute tolerance or postinfusion hyperalgesia. This study was designed to confirm whether remifentanil given during propofol anesthesia induced postoperative pain sensitization, and we wanted to investigate whether pregabalin could prevent this pronociceptive effect. METHODS: Sixty patients who were scheduled for total abdominal hysterectomy were randomly allocated to receive (1) a placebo as premedication and an intraoperative saline infusion (control group), (2) a placebo as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (remifentanil group), or (3) pregabalin 150 mg as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (pregabalin-remifentanil group). Postoperative pain was controlled by titration of fentanyl in the postanesthetic care unit (PACU), followed by patient-controlled analgesia (PCA) with fentanyl. The patients were evaluated using the visual analogue scale (VAS) for pain scores at rest and after cough, consumption of fentanyl, sedation score and any side effects that were noted over the 48 h postoperative period. RESULTS: The fentanyl titration dose given in the PACU was significantly larger in the remifentanil group as compared with those of the other two groups. At rest, the VAS pain score in the remifentanil group at 2 h after arrival in the PACU was significantly higher than those in the other two groups. CONCLUSIONS: The results of this study show that remifentanil added to propofol anesthesia causes pain sensitization in the immediate postoperative period. Pretreatment with pregabalin prevents this pronociceptive effect and so this may be useful for the management of acute postoperative pain when remifentanil and propofol are used as anesthetics.

The Effects of Postoperative Brachial Plexus Block Using MgSO4 on the Postoperative Pain after Upper Extremity Surgery

BACKGROUND: Although a brachial plexus block can be used to provide anesthesia and analgesia for upper extremity surgery, its effects using MgSO4 on postoperative pain management have not been reported. The aim of this study was to evaluate brachial plexus block using MgSO4 on postoperative analgesia. METHODS: Thirty-eight patients who were scheduled to undergo upper extremity surgery were randomly allocated into two groups: patients receiving axillary brachial plexus block with 0.2% ropivacaine 20 ml and normal saline 2 ml (group S) or 0.2% ropivacaine 20 ml and MgSO4 200 mg (group M). Before extubation, the blocks were done and patient controlled analgesia was started, and then, the patients were transported to a postanesthetic care unit. The postoperative visual analogue scale (VAS), opioid consumption, and side effects were recorded. RESULTS: The two groups were similar regarding the demographic variables and the duration of the surgery. No differences in VAS scores were observed between the two groups. There was no statistically significant difference in opioid consumption between the two groups. Nausea was observed in three patients for each group. CONCLUSIONS: Axillary brachial plexus block using MgSO4 did not reduce the level of postoperative pain and opioid consumption.

The effect of milrinone infusion on right ventricular function during coronary anastomosis and early outcomes in patients undergoing off-pump coronary artery bypass surgery / 대한마취과학회지

BACKGROUND: During coronary anastomosis in off-pump coronary artery bypass surgery (OPCAB), hemodynamic alternations can be induced by impaired diastolic function of the right ventricle. This study was designed to examine the effect of milrinone on right ventricular function and early outcomes in patients undergoing OPCAB. METHODS: Forty patients undergoing OPCAB were randomly assigned in a double-blind manner to receive either milrinone (milrinone group, n = 20) or normal saline (control group, n = 20). Hemodynamic variables were measured after pericardiotomy (T1), 5 min after stabilizer application for anastomosis of the left anterior descending coronary artery (LAD, T2), the obtuse marginalis branch (OM, T3), the right coronary artery (RCA, T4), 5 min after sternal closure (T5), and after ICU arrival. The right ventricular ejection fraction (RVEF) and right ventricular volumetric parameters were also measured using the thermodilution technique. For evaluation of early outcomes, the 30-day operative mortality and morbidity risk models were used. RESULTS: There was no significant difference in hemodynamic variables, including mean arterial pressure, between the 2 groups, except for the cardiac index and RVEF. The cardiac index and RVEF were significantly greater at T3 in the milrinone group than in the control group. CONCLUSIONS: Continuous infusion of milrinone demonstrated a beneficial effect on cardiac output and right ventricular function in patients undergoing OPCAB, especially during anastomosis of the graft to the OM artery, and it had no adverse effect on early outcomes.

The effects of lidocaine and fentanyl on airway irritability during inhalation induction with desflurane / 대한마취과학회지

BACKGROUND: Inhalation induction with desflurane can cause airway irritability and sympathetic stimulation. The aim of this study was to investigate whether lidocaine and fentanyl could reduce these unwanted reactions. METHODS: Seventy-five patients who had premedication with midazolam were randomly allocated to one of three groups to receive intravenous saline (S group), lidocaine 1.5 mg/kg (L group), fentanyl 1 microgram/kg (F group), respectively, before tidal volume induction with desflurane in oxygen and nitrous oxide. We recorded airway irritability such as cough, apnea, laryngospasm and excitatory movement and hemodynamic changes. RESULTS: Airway irritability was not significantly different between the groups. In F group, mean blood pressure at LOC ver and LOC BIS and heart rate at LOC ver, LOC BIS and just before intubation were lower than those of S group (P < 0.05). Other results were not significantly different. CONCLUSIONS: The results of the study showed that intravenous fentanyl and lidocaine had no beneficial effects to reduce airway irritability, but intravenous fentanyl could significantly reduce hemodynamic stimulation during inhalation induction with desflurane in the patients who were premedicated with midazolam.

Hypertension Following Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

Hypertension has been reported as a possible sequela of extracorporeal shock wave lithotripsy. The detailed pre & post-ESWL blood pressure measurements were made for 1-21 months in 1159 patients who were treated with ESWL monotherapy using the EDAP-LT01 piezoelectric lithotriptor between February, 1987 and June, 1989. The following results were obtained : 1. Among 1053 pre-ESWL normotensive patients, normal blood pressure was remained in 1012 (96.1%) and new onset hypertension was noted in 41(3.9%). Moreover, in 106 patients having pre-ESWL hypertension, 78(73.6%) patients were sustained hypertension, mild decrement in 10(9.6%) and increment in 6(5.7%). 2. Of the new onset hypertensive 41 patients, the male to female sex ratio was about 4:1 and their ages ranged from 14 to 68 years with an average of 47.9 years, but most of them were above 40 years. 3. Concerning these 41 patients, they had renal(32 cases) or ureteral(9 cases) stones of which sizes ranged from 0.7 to 3.8cm(mean 1.7cm) and number of treatments were ranged from 1 to 21 with an average of 5 sessions. 4. Of the post-ESWL hypertensive 32 patients who had renal stones, the mean diastolic blood pressure increased from 10 to 50mmHg with an average of 28.1mmHg. Seven of these 32 patients required drug therapy and an additional 25 patients had an increase in diastolic blood pressure not requiring therapy. The rate of hypertension was not increased in accordance with the storage of shock waves. Only 41(3.9%) patients who were normotensive prior to treatment become hypertensive after ESWL. If we assume that the age-dependent increase of hypertension is 0.9% per year, there is not too much evidence at the moment that hypertension is caused by ESWL treatment and requires further study.

Reassessment of the Diagnostic Value of Penile-Brachial Index / 대한비뇨기과학회지

Penile-brachial Index(P. B. I) was measured before and after injection of papaverine in 79 psychogenic impotences, 31 arteriogenic impotences and 11 neurogenic impotences. Its diagnostic usefulness was compared with qualities of papaverine induced artificial erection and pudendal angiographic findings. The results were as follows , 1. Among 31 patients with arteriogenic impotence, 17(54.8%) patients were above 0.8 in P. B. I before injection of papaverine. Thus, the arteriogenic impotence could not be excluded in patients of P. B. I. above 0.8. 2. Among the psychogenic impotences, there was no case of P. B. I. below 0.8 after injection of papaverine. So arteriogenic impotence could be like in the case of P. B. I. below 0.8. However, the arteriogenic impotence could not be excluded in the case of P. B. I. above 0.8 because 25(86.6%) patients of arteriogenic impotence were above 0.8. 3. The specificity. sensitivity and efficiency of the P. B. I. concerning prediction of response to papaverine injection were 88.2, 41.2, 80.4% in P. B. I. of 0.8. 4. The specificity, sensitivity and efficiency of the P. B. I. concerning prediction of findings of pudendal angiogram were 71.4, 90.3, 86.8% in P. B. I. of 0.9. In conclusion, it was difficult to establish the base line of normal value of P. B. I. and there was limitation of diagnostic value of the P.B.I.

Complications of Penile Prosthetic Surgery / 대한비뇨기과학회지

We have followed up 85 patients who have underwent penile prosthetic surgeries(Jonas ; 12. AMS 600 ; 33. AMS 700 ; 11, AMS 700 CX ; 5, Mentor ; 1, Hydroflex ; 23) for erectile dysfunction with a mean follow-up period of 28.7 months. Nineteen cases of complications in 15 patients(17.6%) developed of which 17 cases of medico-surgical in 14 patients and 2 cases of mechanical in one patient. As the medico-surgical complications, occurred a crural corporeal perforation, a protrusion of AMS 600 against glans, an acute angled protrusion of Hydroflex on penile base in flaccid state, 2 cases of exposure of Scott's inflatable prostheses through scrotal erosion (a case of tubing exposure and a case of pump exposure), two cases of urethral erosion and urine leak with infected prostheses, a skin necrosis of glans, 2 infected prostheses, 4 cases of urinary retention, and a dehiscence of perineal surgical wound. As the mechanical complications, crevice of the Hydroflex of both sides with fluid leak happened with 9 months interval in one patient.

A Case of Matrix Stone / 대한비뇨기과학회지

Matrix stones are a rare form of urinary stones and composed primarily of matrix material, approximately 65% by weight. The characteristic X-ray feature is a radiolucent filling defect within the urinary system. The matrix stones are yellowish-white to light tan in color and have a consistency which ranges from that of gelatin to that of putty. We recently experienced a case of left renal matrix stone in 37-year-old woman who had another radiolucent stones in right ureter. So we report the case with a brief review of the literatures.

Application of Goretex to Reconstruct Protrusion of the Prosthesis against Thin Tunicae Albuginea after Hydroflex Penile Prosthesis / 대한비뇨기과학회지

We recently experienced a case of protrusion of the penile prosthesis against thin tunicae albuginea after Hydroflex penile prosthesis in a 30-year-old man having neurogenic and vasculogenic impotence associated with urethral injury. The thin tunicae albuginea were reconstructed by application of Goretex.

Post-ESWL(Extracorporeal Shock Wave Lithotripsy) Renal Hematoma: CT Evaluation / 대한비뇨기과학회지

Morphological changes of the kidney after ESWL in 130 patients are analyzed with CT at Dept. of Urology, Chung-Ang University Hospital from March 1987 to May 1987. Of 130 patients, 9 patients(6.9%) showed renal hematoma. Among 9 patients, 5 patients (3.8%) had subcapsular hematoma and 4 patients(3.1%) had parenchymal hematoma. We analyzed these 9 patients radiologically and clinically. These hematoma were clinically insignificant and self-limited in all cases. So ESWL can be regarded as a safe modality for treatment of the renal and ureteral calculi.

A Case of Hypervascularization of the Glans after Epigastrico-dorsal Vein Anastomosis / 대한비뇨기과학회지

We recently experienced a case of hypervascularization of the glans after arterialization of the deep dorsal vein(Furlow`s method) in a 25-year-old man having vasculogenic impotence due to arterial insufficiency of the penis. The Hypervascularization of the glans was corrected by ligating the branches of the deep dorsal Vein at the corona of the penis.

Experience with Extracorporeal Shock Wave Lithotripsy(ESWL): A Report of 400 Cases / 대한비뇨기과학회지

A total 400 patients underwent 676 treatments with E.D.A.P.-LTOI extracorporeal shock wave lithotripsy for urinary tract stones between February 25 and August 18, 1987. The results were obtained as follows; 1. sex ratio was about 3: 1, 292(73.0 %) in male and 108(27.0 %) in female patients. The average patient age was 43.9 years, with a range of 2 to 85 years. The fifth decade(30.5 %) was most followed by the forth decade (26.0 %) and sixth decade (20.7 %). 2. Treated stone locations were kidney in 286 (71.5 %);calyx in 187 (46.8%) and renal pelvis in 98 (24.5 %) and ureter in 144 (28.5 %); upper ureter in 71 (17.8%) and lower ureter 43(10.7 %). There were multiple renal stone in 83 (20.7 %), bilateral renal stone in 22(5.5 %), bilateral renal stone in 22 (5.5 %), bilateral ureteral stone in 3 (0.7 %) and unilateral renal and ureteral stones in 23 (5.8 %). The average stone size was 1.6 cm, with a range of 0.6 to 4.8 cm. 3. The average numbers of treatment were 1.4 sessions and the average treatment time was 13.7 minutes, with a range of 12 to 78 minutes. Of the patients, 81 (20.2 %) were complained severe pain but treatment interruption or anesthesia were not required. 4. The success rate of treatment-ended patients were 97.8 % in 0.6~1.0cm(137 cases), 89.2% in 1.0~2.0 cm (93 cases) and 89.2 % in 2.0~3.0 cm (37 cases). Therefore, the total average success rate was 93.6 %. 5. The method of pre-ESWL additional manipulation was used a ureteral stone `push up` in 12 (3.0 %). The post-ESWL additional measures were made in 10 (2.5%); ureteral manipulation in 8 cases and lithotomy in 2 cases. The causes of failed ESWL (21 cases) were stone components in 8, impacted stone in 8, incomplete stone localization in 4 and infundibular stricture in 1. 6. ESWL-complications were required admission and medical management in 18(4.5 %); colic in 12 (3.0 %), acute urinary retention in 2 (0.5 %) and subscapular hematoma in 1(0.3% ), Therefore, we confirmed that E.D.A.P.-LTOI ESWL is a safe and effective method for the treatment of urinary tract stones.

Experimental Study on Alloplastic Spermatocele / 대한비뇨기과학회지

The "bridge" alloplastic spermatocele, which connected the tails of the both epididymis and collected sperms from both testes, were constructed in 30 male Wistar rats, using Goretex cylinder. The artificial cylinder were aspirated postoperatively every week for 8 weeks, and the animals were then sacrificed and the epididymis connected with spermatoceles were examined histologically. The valid experimental results were not obtained because of the inflammation. However, the surgical procedure was relatively easy and a greater quantity of aspirate was obtained with easy execution of the single puncture. The number of sperms was markedly decreased from the 3rd weeks, and no sperms were survived at the first week in all the experimental rats. Therefore, it is recommended that the basic aspect of the spermatocele should be worked out experimentally before applying it to human patients.