Bone Forming Gene Therapy (Immune Animal Model in Ex Vivo Gene Therapy for Spinal Fusion with Type 5 Adenoviral Delivery of the LIM Mineralization Protein-1 cDNA) / 대한척추외과학회지

STUDY DESIGN: In vivo study to determine the immune effects to adenoviral vector encoding LMP-1 cDNA in rabbit. OBJECTIVE: To quantify the immune effect of Ad5-LMP-1 in the rabbit during the therapeutic gene transfer. SUMMARY OF LITERATURE REVIEW: One of the major limitations in the use of adenoviral vector for gene therapy is the immune response and it made the poor transduction efficiency when re-administrated. Adenoviral antigen plus those derived from transgene expression in transduced cell contribute to cellular, humoral and non-specific immune response constitutes barriers to successful gene therapy. Therefore, the animal immune model will be mandatory to study the immune impact. MATERIALS AND METHOD: We i.v. injected Ad5-betaGal to total 24adult NZW rabbits; 1x108, 1x109, 1x1010, 1x1011v.p. to each 6 rabbits allowed them to develop immune response. Six non-immunized animals were used as control. Adenovirus antibodies were measured at 0, 4, 8, 16, 20 weeks. Group I. 6 control rabbit underwent spinal arthrodesis at 4 weeks (n=3) and 16 weeks (n=3) with 4 million cells and MOI of 4. Group II. 6 rabbit underwent spinal arthrodesis at 4 weeks after injection of 108 p.f.u virus (n=3) and 16 weeks (n=3). Group III. six 109 immunized rabbits, Group IV. six 1010 immunized rabbits, Group V. six 1011 immunized rabbits, underwent spinal arthrodesis at 4 and 16 weeks after injection. Total anti-Ad Ig and neutralizing antibody titer was measured on the 0. 4. 8, 16, 20 weeks after injection. RESULTS: Group I. All 6 non-immunized rabbits had solid spine fusions at 4 and 16 weeks. Group II. All 3immunized rabbits had not spine fusions at 4 weeks and all three had solid spine fusion at 16 weeks. Group III. None of them (n=6) immunized rabbits had spine fusion at 4 and 16weeks, but some bone formation was observed at 16 weeks. Group IV, V. None of them immunized rabbits had bone formation. The anti-Ad5 Ig and neutralizing Ab were detected and peaked at the 4weeks and significantly dropped off 16 weeks after injection. CONCLUSION: This experiment revealed that a small dose of adenovirus elicited an enough immune response that inhibited the bone formation. Because majority of human posses the Ab against adenovirus, it will be mandatory to overcome immune response in adenoviral vector gene therapy.

Estimation of the Size of the Severe and Persistent Mentally Ill in Korea: Through Two Community Surveys / 신경정신의학

OBJECTIVES: The purpose of this study was to estimate the number of serious and persistent mentally ill patients in Korea. METHODS: Study populations were recruited from medical insurance data of two district areas one rural and the other urban areas. Subjects were all mentally ill who had ever visited any hospital in 1993 and were diagnosed as having psychosis, personality disorder and drug abuse. We conducted a home visiting survey applying semi-structured diagnostic interview, assessing the level of social adjustment with Strauss-Carpenter Scale, and past psychiatric history by the trained researchers, in October and November, 1994. RESULTS: According to diagnostic assessment, schizophrenic patients constituted the major portion(61.1%) of study subjects. The distribution of occupational functions and social contacts was variable according to diagnosis. Most schizophrenic patients were unemployed or worked less than 6 months in the previous year(67.2%), and showed poor social contact(72.3%). But affective disorder patients were relatively independent in job maintenance and social relationship. Alcoholic patients lay between those of schizophrenic and affective disorder groups. It was estimated that about 87,000 adult Koreans were suffering from chronic mental disorders which seriously interfere with their daily life. CONCLUSIONS: Serious and persistent mentally ill patients were common in Korea. Community support program should be provided for them.

Effects of thoracic epidural anesthesia on coronary blood flow and cardiovascular system in dogs / 대한마취과학회지

We have been using general anesthesia with thoracic epidural anesthesia to manage intrao-perative and postoperative pain for thoracic and cardiac surgery patients. Hemodynamic changes due to sympathetic block with epidural anesthesia is dependent on the level of sympathetic block. Thoracic epidural anesthesia block the cardiac sympathetic innervation, so there may be changes of cardiac function and pressure dependent coronary blood flow especially in coronary artery diseases. To investigate the effects of thoracic epidural anesthesia on coronary blood flow and hemodynamic changes, we performed thoracic epidural anesthesia by injection of 0.5% bupivacaine via a surgieally introduced catheter in dogs. The results were as follows ; 1) Coronary blood flow, systolic, mean and diastolic blood pressure, heart rate and cardiac output were decreased at 5 min, 10 min, 15 min, 20 min, 30 min, 45 min, 60 min, 90 min, 120 min after epidural injection of 0.5% bupivaeaine compared to control value (p<0.05). 2) Systemie vascular resistance, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, stroke volume and pulmonary vascular resistance were not changed after epidural injection of 0.5% bupivacaine.

A Comparison Study on the Effects of the Variable Combination of Drugs Through Thoracic Epidural Catheter with General Anesthesia / 대한마취과학회지

Comparing with the simple general anesthesia, the combined thoracic epidural and general anesthesia generally provide with more improved regional endocardial perfusion, reduced myocardial oxygen consumption, eventually reduced postoperative morbidity and mortality. Patients undergoing thoracotomy have severe pain and related cardio-respiratory impairment postoperatively, so large amount of the analgesics are usually administered systemically. Recently, the method using epidural injection of the local anesthetics and/or analgesics is prefered during and after the operation because of its excellent analgesic action and advantage of lowering the need for anesthetics and systemic analgesics but has remaining problems such as eardiopulmonary and CNS depression and reduced motor function and so on. So, in an attempt to reduce the untoward effects of epidural injection, we planned to evaluate the validity of the mixing local anesthetic, bupivacaine, and narcotic analgesic, fentanyl, in a given concentration and infusion rate and randomized 70 patients undergoing thoracotomy into 4 groups. Group A(n=20): Intermittent intramuscular injection of nalbuphine hydrochloride in a dose of 0.2 mg/kg Group B(n=15): Continuous epidural infusion of fentanyl citrate, 2-5 ml/hr of 5 mcg/ml solution Group C(n=15): Continuous epidural infusion of bupivacaine hydrochloride, 2-5 ml/hr of 0.15% solution Group D(n=20): Continuous epidural infusion of mixtures of fentanyl and bupivacaine, 2-5 ml/hr of same concentrations We observed the visual analogue pain scale perioperatively and measured the hemodynamic parameters such as cardiac output, cardiac index, systemic vascular resistance, stroke volume, mean arterial pressure and heart rate. The results were as follows: I) The postoperative analgesic outcome was best in group D as compared with other groups. 2) The cardiac output decreased postoperatively in group A, B and C while group D showed an increase but there was no statistical significance. 3) The cardiac index decreased significantly in group B and sbowed a trend of decreasing in group C, increasing in group D, and no change in group A. 4) The stroke volume decreased postoperatively in group A and B but the significance was only in group A. 5) The systemic vascular resistance showed significant postoperative increase in group B. 6) The mean arterial pressure decreased in group D and increased in other groups. 7) The heart rate increased during and immediate after the operation in group B.

A report of hypercarbia during general anesthesia / 대한구급학회지

No abstract available.

A Report of Three Cases of Hypercarbia During General Anesthesia / 대한마취과학회지

It is common to use semiclosed circle system for general anesthesia because of economy, easy controllability of humidity and temperature, less contamination of operating room with anesthetic gas etc, but in case of malfunction of unidirectional valve, inappropriate absorption of carbon dioxide,leakage or obstruction of circle system the patient may become fatal. During general anesthesia with newly purchased anesthesia machine(Ohmeda Modulus II plus) we experienced three cases of hypercarbia because of malfunction of expiratory valve which could not be easily found due to overlying PEEP valve.

Hemodynamic and Arterial Blood Gas Changes during Thoracoscopic Surgery with CO2 Insufflation Under GEneral Anesthesia / 대한마취과학회지

The development of endoscopic video systems and instrumentation has allowed therapeutic thoracoscopy for peripheral lung resection, pleural biopsy, open lung biopsy, closure of leaking blebs, parietal pleurodesis, and perieardiectomy and biopsy. The purpose of this study is to investigate the cardiovascular effects and blood gas changes during thoracoscopic surgery with one-lung ventilation and intrathoracic CO2 insufflation to collapse the affected site of the lung and so to get optimal surgical field under lateral position. Measurements of cardiac index, systemic vascular resistance, central venous pressure, heart rate, mean arterial blood pressure, and end-tidal PCO2 were done in twenty three patients who underwent bleb resection via thoracoscopy with intrathoracic CO2 insufflation. Each measurement was done 10 minutes after tracheal intubation(control), 10 minutes after position change, l0 minutes after one-lung ventilation, 30 minutes after CO2 insufflation, 1 hour ater CO2 deflation, and 6 hours after CO2 deflation. Also the measurement of arterial blood gas was done before anesthesia and used as a control. The results were as follows; 1) End-tidal PCO2 was increased after CO2 insufflation. 2) Arterial PCO2 was increased after CO2 insufflation and until 1 hour after CO2 deflation, and the value measured 6 hours afer deflation was recovered to the preanesthetic value. 3) Arterial PO2 was decrease after one-lung ventilation, but there was no change after CO2 insufflation. 4) Mean arterial blood pressure was increased after one-lung ventilation, after CO2 insufflation, 1 hour after CO 2 deflation and 6 hours after CO2 deflation from the control values respectively. 5) Heart rate was decreased after position change, and until one-lung ventilation, but it was increased after CO2 insufflation. 6) Central venous pressure was increased after position change, after one-lung ventilation and after CO insufflation. 7) Cardiac index waa increaeed after CO2 insufflation compared to the immediately preceding values. 8) Systemic vascular resistance was not changed throughout the procedure.