Influence of omega-Conotoxin GVIA, Nifedipine and Cilnidipine on Catecholamine Release in the Rat Adrenal Medulla

The present study was designed to establish comparatively the inhibitory effects of cilnidipine (CNP), nifedipine (NIF), and omega-conotoxin GVIA (CTX) on the release of CA evoked by cholinergic stimulation and membrane depolarization from the isolated perfused model of the rat adrenal medulla. CNP (3 micrometer), NIF (3 micrometer), and CTX (3 micrometer) perfused into an adrenal vein for 60 min produced greatly inhibition in CA secretory responses evoked by ACh (5.32 x 10(-3) M), DMPP (10(-4) M for 2 min), McN-A-343 (10(-4) M for 2 min), high K+ (5.6 x 10(-2) M), Bay-K-8644 (10(-5) M), and cyclopiazonic acid (10(-5) M), respectively. For the CA release evoked by ACh and Bay-K-8644, the following rank order of potency was obtained: CNP > NIF > CTX. The rank order for the CA release evoked by McN-A-343 and cyclopiazonic acid was CNP > NIF > CTX. Also, the rank orders for high K+ and for DMPP were NIF > CTX > CNP and NIF > CNP > CTX, respectively. Taken together, these results demonstrate that all voltage-dependent Ca2+ channels (VDCCs) blockers of cilnidipine, nifedipine, and omega-conotoxin GVIA inhibit greatly the CA release evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors and the membrane depolarization without affecting the basal release from the isolated perfused rat adrenal gland. It seems likely that the inhibitory effects of cilnidipine, nifedipine, and omega-conotoxin GVIA are mediated by the blockade of both L- and N-type, L-type only, and N-type only VDCCs located on the rat adrenomedullary chromaffin cells, respectively, which are relevant to Ca2+ mobilization. It is also suggested that N-type VDCCs play an important role in the rat adrenomedullary CA secretion, in addition to L-type VDCCs.

Assessment of the Specificity of A Hybridization of Surfactant Protein A by Addition of Non-specific Rat Spleen RNA / 결핵

BACKGROUND: Nucleic acid hybridization has become an essential technique in the development of our understanding of gene structure and function. The quantitative analysis of hybridization has been used in the measurement of genome complexity and gene copy number. The filter hybridization assay is rapid, sensitive and can be used to measure RNAs complementary to any cloned DNA sequence. METHODS: The authors assessed the accuracy, linearity, correlation coefficient and specificity of the hybridization depending on the added dose(0, 1, 5, and 10 microgram) of non-specific rat spleen RNA to hybridization of surfactant protein A mRNA. Filter hybridization assays were used to obtain the equation of standard curve and thereby to quantitate the mRNA quantitation. METHODS: 1. Standard curve equation of filter hybridization assay between counts per minute (X) and spleen RNA input (Y) was Y=0.13X-19.35. Correlation coefficient was 0.98. 2. Standard curve equation of filter hybridization assay between counts per minute (X) and surfactant protein A mRNA transcript input (Y) was Y=0.00066X-0.046. Correlation coefficient was 0.99. 3. Standard curve equation of filter hybridization assay between counts per minute (X) and surfactant protein A mRNA transcript input (Y) after the addition of 1 microgram spleen RNA was Y=0.00056X-0.051. Correlation coefficient was 0.99. 4. Standard curve equation of filter hybridization assay between counts per minute (X) and surfactant protein A mRNA transcript input (Y) after the addition of 5 microgram spleen RNA was Y=0.00065X-0.088. Correlation coefficient was 0.99. 5. Standard curve equation of filter hybridization assay between counts per minute (X) and surfactant protein A mRNA transcript input (Y) after the addition of 10 microgram spleen RNA was Y=0.00051X-0.10. Correlation coefficient was 0.99. CONCLUSIONS: Comparison of cpm/filter in a linear range allowed accurate and reproducible estimation of surfactant protein A mRNA copy number irrespective of the addition dosage of non-specific rat spleen RNA over the range 0-10 microgram.

Comparison of Vasodilator Effects of Platycodin D and D3 in Rats

The aim of the present study was to examine the effects of platycodin D and D3, which are active components derived from the roots of Platycodon grandiflorum A. DC., on the contractile force of the i3olated rat aorta and blood pressure of the anesthetized rat, and also to elucidate its mechanism of action. Both phenylephrine (an adrenergic alpha1-receptor agonist) and high potassium (a membrane- depolarizing agent) caused great contractile responses in the isolated aortic strips. Platycodin D at high concentration (24microgram/ml) inhibited contractile responses induced by phenylephrine (10 (-5) M) and high potassium (5.6x10 (-2) M), while low concentrations of platycodin D (4~8microgram/ml) did not affect those responses. However, platycodin D3 (8~32microgram/ml) did not alter the contractile responses evoked by phenylephrine and high K+. Interestingly, the infusion of platycodin D3 (1.0 mg/kg/30 min) significantly reduced the pressor responses induced by intravenous norepinephrine. However, platycodin D3 (1.0 mg/kg/30 min) did not affect them. Taken together, these results show that intravenously administered platycodin D depresses norepinephrine-induced pressor responses in the anesthetized rat, at least partly through the blockade of adrenergic alpha1-receptors. Platycodin D also caused vascular relaxation in the isolated aortic strips of the rat via the blockade of adrenergic alpha1-receptors, in addition to an unknown direct mechanism. However, platycodin D3 did not affect both norepinephrine-induced pressor responses and the isolated rat aortic contractile responses evoked by phenylephrine and high potassium. Based on these results, there seems to be much difference in the mode of action between platycodin D and platycodin D3.

An Analysis of Triage and Transportation on Multiple-Casualty Incidents in Rural Area

BACKGROUND: Triage and transportations are important and life-saving medical task performed at the site of mutiple-casualty incidents(MCIs). We pursued three road traffic accidents victims to find out any problem in triaging and transporting them, and to provide an information for equipping an local disaster planning. METHODS: The medical records of 70 consecutive patients who were transported to five emergency facilities in Kangnung, on three MCIs from 1998 to 2000, were analysed, retrospectively. The intervals and types of transport vehicles were analysed. We compared the prehospital time between severity-based groups, which were graded into 3 groups according to the Triage score(0, 1~8, 9). RESULTS: Among the 70 patients, 33 patients(47.1%), 21 patients(30%), and 16 patients(22.9%) were transported to Level I, Level II, and Level III trauma centers, respectively. The time elapsed from scenes to the Level I trauma center was significantly shorter(p=0.003) than to others, but no differences in the mean Triage score between trauma centers were seen(p>0.05). The 119 rescue services transported 58.6%(41 patients) of victims to emergency facilities, and 58.5%(24 patients) of them was concentrated to Level I. There were no significant differences in the prehospital time between three Triage score groups(p>0.05). CONCLUSION: There was no medical control such as triage and transportation in the cases of three MCIs. In the construction of emergency medical service system(EMSS) preparing MCIs or disasters, we suggest the integration and unification of 119 rescue services and emergency medical information centers for effective medical control. We propose to making a new and simple triage guideline. The prehospital personnel should be educated and disaster drills should be performed under the guideline.

Problems of Emergency Medical Information Exchange

BACKGROUND: To manage the EMS(emergency medical services) system effectively, departments, such as fire stations, emergency information centers, hospitals, and The Ministry of Health and Welfare, should exchange information that they own and/or gather during patient care and/or transportation. Medical records and information are very important for continuing the patient's care and for deciding on a treatment plan, but medical information is not exchanged fully in spite of its importance. METHOD: We analyzed the transfer medical reports that were written by medical doctors who transferred emergency patients to our hospital. The contents and the accuracy of the transfer medical records were analyzed and graded into 4 groups. Group A was fully described and was equipped with diagnosis, laboratory data, X-ray films; group B had a diagnosis and full laboratory data; group C had a diagnosis, but only partial laboratory data; and group D had only a diagnosis. RESULTS: Among 38,214 patients who visited our hospital from Jan. 2001 to Jun. 2001, 7,031 cases were transferred from other hospitals with transfer medical records. According to the accuracy and important contents of the transfer records, Group A occupied 1.9%, group B 5.2%, group C 32.5%, and group D, with only a diagnosis, 60.4%. In the case of our hospital, we delivered all emergency medical information by written paper(transfer note), E-mail, and web-based information system(cyber-AMC) to the doctors concerned with managing the patient. However, 93% of the medical records of patients transferred from other hospital contained insufficient information to adequately care for the emergency patients. In addition, most of the transferred patients had been transorted without prior information about transportation. CONCLUSION: Within the near future, a medical information center equipped with a computerized system should be operated to exchange medical data. As most general hospitals are operating the OCS(order communication system), EMR(electronic medical record), telemedicine, and PACS(picture-archiving communication system), medical information can be exchanged freely in real time if a code standard and HL7(Health Level 7) can be established.

Influence of strychnine on catecholamine release evoked by activation of cholinergic receptors from the perfused rat adrenal gland

The present study was attempted to investigate the effect of strychnine on catecholamine (CA) secretion evoked by ACh, high K+, DMPP and McN-A-343 from the isolated perfused rat adrenal gland. The perfusion of strychnine (10-4 M) into an adrenal vein for 20 min produced great inhibition in CA secretory responses evoked by ACh (5.32X10-3 M), DMPP (10-4 M for 2 min) and McN-A-343 (10-4 M for 2 min), but did not alter CA secretion by high K+ (5.6X10-2 M). Strychnine itself did also fail to affect basal catecholamine output. Furthermore, in adrenal glands preloaded simultaneously with strychnine (10-4 M) and glycine (an agonist of glycinergic receptor, 10-4 M), CA secretory responses evoked by ACh, DMPP and McN-A-343 were considerably recovered to some extent when compared with those evoked by treatment with strychnine only. However, CA secretion by high K+ (5.6X10-2 M) was not affected. Taken together, these results demonstrate that strychnine inhibits greatly the CA secretory responses evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors, but does not affect that by membrane depolarization. It is suggested that strychnine-sensitive glycinergic receptors are localized in rat adrenal medullary chromaffin cells.

Endotracheal Intubation in the Emergency Department of an Tertiary Care Center

BACKGROUND: The purpose of this study was to analyze the endotracheal intubation cases performed in the emergency department. METHODS: We investigated retrospectively 326 cases of endotracheal intubation performed in the emergency department of a tertiary care center from April 1, 1998 to March 31, 1999. We focused on operators, medications used, its success rate and immediate complications, and the relationship between its success rate and medications. RESULTS: Of 326 consecutive intubations, 193 patients(59.2%) were done by emergency medicine residents or attending physician. While 320 patients(98.2%) were successfully intubated, 6 patients could not be intubated and 2 patients underwent tracheostomy. Of 50 cases of intubations(15.3%) attempted with paralyzing agents, 48 cases were done with succinylcholine and 46 cases underwent by emergency physicians. Intubations with neuromuscular paralysis resulted in high success rates at the first attempt. Of 55 immediate adverse events were encountered in 47 patients(desaturation=17, bronchial intubation=15, hypotension=8, bradycardia=4, cardiac arrest=2, others=5). CONCLUSION: At this institution, paralyzing agents were used infrequently, but almost all of them were used by emergency physicians.

Rapid Sequence Intubation in the Korean Emergency Department

BACKGROUND: Assessing and securing airway is the beginning of the treatment for emergency patients. Rapid Sequence Intubation is a technique that uses sedatives and neuromuscular blockers to perform endotracheal intubation. This is a basic technique that all emergency physicians must master. Therefore, we investigated the recent circumstance of Rapid Sequence Intubation in patients at the emergency department. METHODS: Ten-item surveys were mailed to the board certified emergency physicians in the emergency department of 45 hospitals. Among the 45 surveys, 37 surveys were returned. The rate of reply was 82.2%. RESULTS: Throughout the hospital, 35/37 of the endotracheal intubation was performed in the emergency department. Anesthesiologists were not called for endotracheal intubation in 34/37 emergency department, and anesthesiologists were not called for the use of neuromuscular blockers in 36/37 emergency departments. 35 emergency departments used sedatives. The sedatives used were as follows : midazolam(48.6%), diazepam(25.7%), thiopental sodium(22.9%), and ketamine(2.9%). 30 emergency departments used neuromuscular blockers. The neuromuscular blockers used were as fallows : succinylcholine(46.7%), vecuronium(43.3%), and pancuronium(10.0%). The rate of Rapid Sequence Intubation was 33.8%. Various monitoring devices were used during Rapid Sequence Intubation ; cardiac monitors 90.5%, pulse oximeters 80.4%, noninvasive blood pressure monitors 64.9% and ETCO2/ 12.8%. Only 6 of 37 hospitals had the assessment program far endotracheal intubations and 60% was the assessment rate in these hospitals, however, there was no proctocol for the quality assurance assessment. CONCLUSION: Emergency endotracheal intubation was performed independently by the physician of the emergency department. The Rapid Sequence Intubation was effective and had low adverse effect. We recommended that Rapid Sequence Intubation should be used more aggressively in patients. Also, applying these assessment proctocol in patients, we could improve the quality of assurance assessment.

Newly Revised Lung Cancer Staging System and Survival in Non-Small Cell Lung Cancer Patients / 결핵

BACKGROUND: Non-small cell lung carcinoma is a common tumor with a poor prognosis. Of all malignancies, it is the main cause of death for male and female patients in the Western world. Resection remains the most effective treatment when feasible. Accurate description and classification of the extent of cancer growth are important in planning treatment, estimating prognosis, evaluating end results of therapy, and exchanging information on human cancer research. Until effective systemic therapy is available for non-small cell lung cancer, development of new treatment strategies depends on knowledge of the end results achieved for carefully staged groups of patients in the lung cancer populations. For these reasons, we investigated the sruvival rate in radically resected non-small cell lung cancer patients by newly revised staging system adopted by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer. METHODS: Clinical, surgical-pathologic and follow-up informations on 84 consecutive, previously untreated, patients who received their primary treatment for non-small cell lung cancer were investigated. Staging definitions for the T(primary tumor), N(reginal lymph node), and M(distant metastasis) components were according to the International Staging System for Lung Cancer. Death from any causes was the primary target of the evaluation. RESULTS: The median survival rates were as follows; stage I;79.1 months, stage II;47.3 months, stage III a;22.7 months, stage III b;16.1 months, and stage IV;15.2 months versus newly revised stage I a;58.5 months, stage I b;76.0 months, stage II a; not available, stage II b;43.0 months, stage III a;22.5 months, stage III b;16.1 months, and stage IV;15.2 months. The survival rates were not significantly different between old and newly revised staging system. Cumulative percent survival at 36months after treatment was 100% in stage I a, 80% in stage I b, not available in stage II a,26% in stage II b, and 21% in stage III a respectively. CONCLUSIONS: Although these data were not significantly different statistically, the newly revised lung cancer staging system might be more promising for the accurate evaluation of the prognosis in the non-small cell lung cancer patients.

The Analysis of Emergency Medical Transport by EMS Helicopter

BACKGROUND: The fast EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used far transporting emergent patients. Authors, here upon, report the transporting experiences. METHODS: From Dec. 1, 1996 to Dec. 31,1997, Samsung Medical Centers EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. RESULT: A total of 65 patients were transported. Male to female ratio was 1.95 : 1. The mean transport time was 64.1min(10-160 min). Majority of the evacuated patients was surgical patients (General Surgery'16, Orthopedic surgery : 10, Neurosurgery : 6, Infernal medicine 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation amended The patients. No medical problems or deaths developed during the air evacuation period. CONCLUSION: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.

Significance of Serum Troponin-T Level in Acute Ischemic Pain Syndrome / 대한내과학회지

OBJECTIVES: In coronary arterial disease, quantitative assessment of the extent of myocardial damage is important both in management of the patient and prediction of prognosis. Measurement of serum Troponin-T is a new method for detecting myocardial cellular injury, used as more specific marker of tissue damage and reperfusion status in acute myocardial infarction, This study was performed to evaluate the significance of serum Troponin-T measurement in various acute chest pain syndrome. METHODS: 37 patients who presented anterior ischemic chest pain enrolled from April, 1994 to September, 1995, From the initial period of admission, serial measurements of serum level of cardiac enzymes (CK, CK MB, Myoglobin, Troponin-T) were made. Then release time, peak time and normalization time of each enzyme were derived and compared each other. To evaluate whether Troponin-T level can reflect the extent of ischemic injury, correlation between peak Troponin-T level and peak CK MB level was analysed by regression method. RESULTS: 1) Acute myocardial infarction was confirmed in 15 cases; Q-wave myocardial infarction was 10 cases(anterior wall-5 cases, inferior wall-4 cases, lateral wall-1 cases), and non Q-wave myocardial infarction was 5 cases. Unstable angina was 22 cases. All cases had significant stenosis in coronary angiography. 2) The appearance in the serum level of 4 cardiac enzymes was as follows. The release time(hours) of 4 cardiac enzymes(Troponin-T, CK, CK MB, Myoglobin) were 7.1(1-30), 9.3(1-30), 9.9(1-30), 6.2(1-30). The peak time(hours) of 4 cardiac enzymes were 23.0(1.5-96), 21.6(2-66), 16.9(2-42), 12.7(3-40). The normalization time(hours) of the enzymes were over 72, 53.7(11-86), 52.3(11-94), 32.3(10-82). 3) Elevation pattern of cardiac enzymes showed concordance of all 3 enzymes(Troponin-T, CK MB, Myoglobin) in 29 of 43 cases(67.4%), There was concordance of 2 enzymes in 10 cases; 5 cases of CK MB and Myoglobin, 5 cases of Troponin-T and Myoglobin. In 4 cases, only Myoglobin level was increased. 4) There was significant correlation between peak Troponin-T level and peak CK level(r=0.66, p=0.0178), significant correlation was also observed between peak Troponin-T level and peak CK MR level(r=0.90, p=0.0001). CONCLUSION: In acute myocardial infarction serum Troponin-T was detectable as early as CK MB, and lasted longer after other enzyme level was normalized. There was significant correlation between peak Troponin-T level and peak CK, CK MB level, suggesting Troponin-T as useful marker for assessing the extent of myocardial damage.

A Case of Thymic Carcinoid Tumor / 결핵

Until 1972, many carcinoid tumors of the thymus were not recognized as distinct lesions and were mistakenly labeled as variants of thymomas. Thymic carcinoid tumors are unusual neoplasms that show different morphological, functional, and behavioral characteristics than those of thymomas. We report a case of a 65-year-old woman with thymic carcinoid tumor. The cinicopathological findings are discussed with a review of the literature.

Effect of bronchial artery embolization in the management of massive hemoptysis : factors influencing rebleeding / 결핵

BACKGROUND: Bronchial artery embolization has been established as an effective means to control hemoptysis, especially in patients with decreased pulmonary function and those with advanced chronic obstructive pulmonary disease. We evaluated the effect of arterial embolization in immediate control of massive hemoptysis and investigated the clinical and angiographic characteristics and the course of patients with reccurrent hemoptysis after initial succeseful embolization. Another purpose of this study was to find predictive that cause rebleeding after bronchial artery embolization. METHOD: We reviewed 47 cases that underwent bronchial artery embolization for the management of massive hemoptysis, retrospectively. We analyzed angiographic findings in all cases before bronchial artery embolization and also reviewed the angiographic findings of patients that underwent additional bronchial artery embolization for the control of reccurrent hemoptysis to find the causes of rebleeding. RESULTS: 1) Underlying causes of hemoptysis were pulmonary tuberculosis (n=35), bronchiectasis(n=5), aspergilloma(n=2), lung cancer(n=2), pulmonary A-V malformation(n=l), and unknown cases(n=2). 2) Overal immediate success rate was 94%(n=44), and recurrence rate was 40%(n=19). 3) The prognostic factors such as bilaterality, systemic-pulmonary artery shunt, multiple feeding arteries and degree of neovascularity were not statistically correlated with rebleeding tendency. (p value>0.05). 4) At additional bronchial artery embolization, Revealed recannalization of previous embolized arteries were 14/18cases(78%) and the presence of new feeding arteries was 8/18cases(44%). 5) The complications(31cases, 66%) such as fever, chest pain, cough, voiding difficulty, paralytic ileus, motor and sensory change of lower extremity, atelectasis and splenic infarction were occured. CONCLUSION: Recannalization of previous embolized arteries is the major cause of recurrence after bronchial artery embolization. Despite high recurrence rate of hemoptysis, bronchial artery embolization for management of massive hemoptysis is a effective and safe procedure in immediate bleeding control.

A Mediastinal Mass / 결핵

A 32-year-old female was admitted for evaluation of known mass on right suprahilar area. Chest PA showed 4 x 3 cm round and homogenous mass on suprahilar area. No abnormal findings were found in PFT, cytology, bacterial study, and fine needle aspiration biopsy(FNAB). On chest computed tomography, solitary mass was on right suprahilar area and no evidence of intra- pulmonary metastasis or lymphnode metastasis was seen. Right upper lobectomy of lung was performed and Castleman's disease of hyaline vascular type was diagnosed based on the histologic findings of multiple and large lymphoid follicles with prominent vascular proliferation and hyalization in the central portion.