Cystic Primary Hepatic Neuroendocrine Tumor / 대한소화기학회지

Neuroendocrine tumors (NETs) can arise throughout the body. Most NETs in the liver are metastatic tumors; primary hepatic NET (PHNET) is extremely rare. A diagnosis of PHNET is very difficult. No single modality can diagnose PHNET by itself, and it often resembles other hypervascular masses of the liver. This paper reports the case of a 51-year old female with a large hepatic mass. Unlike most of PHNETs reported previously, it was composed of a solid mass with mainly multiple cystic lesions, which led to an erroneous diagnosis of hepatic mucinous cystadenoma or cystadenocarcinoma. PHNET with cystic lesions is extremely rare, and the features are not well studied. This case may help physicians suspect PHNET in a differential diagnosis of an atypical hepatic mass.

A symptomatic lumbosacral perineural cyst: A case report / 대한마취과학회지

Lumbosacral perineural cysts are formed by the arachnoid membrane of the nerve root at the lumbosacral level. Most of these cysts are asymptomatic and are found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) for other causes of chronic lower back pain. This type of cyst requires a differential diagnosis to distinguish it from other causes of radiating pain and neurological symptoms. In the present case, a symptomatic lumbosacral perineural cyst was found, and pain relief was achieved by non-surgical treatment. A lumbosacral perineural cyst was identified from a differential diagnosis of a lumbar disc disorder that presented as radiating pain and neurological symptoms.

Anaphylaxis induced by hydroxyethyl starch during general anesthesia: A case report / 대한마취과학회지

Hydroxyethyl starch (HES) solutions are synthetic non-protein colloid solutions used to treat hypovolemia. However, their use is not free from the risk of allergic reactions. A 42-year-old male was scheduled to undergo aortic-iliac-femoral bypass surgery for the treatment of arteriosclerosis obliterans. He had no history of allergy. Two hours after the start of surgery, and within minutes after HES administration, facial erythema, hypotension and bronchospasm developed. HES infusion was discontinued under the estimation of anaphylaxis. The patient received phenylephrine, ephedrine, diphenhydramine and hydrocortisone with hydration. After restoration of vital signs, surgery was performed without complications.

Reduction of propofol injection pain by utilizing the gate control theory / 대한마취과학회지

BACKGROUND: Propofol is the most commonly using intravenous hypnotic for the induction and maintenance of general anesthesia. However, pain on propofol injection is a well known adverse event. Currently, acute and chronic pain can be controlled by utilizing the "gate control" theory. METHODS: Patients were randomized to receive lidocaine (0.5 mg/kg; Group L), touch on IV injection site (Group T), combination lidocaine (0.5 mg/kg) and touch on IV injection site (Group B), or normal saline (Group S) with venous occlusion for 1 minute, followed by administration of propofol (0.5 mg/kg) into the largest dorsal vein of the hand. Immediately after administering propofol, an investigator blinded to the group assignments asked the patient about pain at the injection site and assessed pain intensity using a 4-point verbal rating scale (0 = none, 1 = mild, 2 = moderate, 3 = severe). RESULTS: A significant decrease in the incidence of pain on propofol injection was achieved in group L (37%) and group B (23%) compared to either group T (80%) and group S (83%) (P < 0.001). But, the incidence of moderate and severe pain was significantly lower in group L (7%), group T (20%) and group B (0%) when compared to group S (53%) (P < 0.05). CONCLUSIONS: Light touch and rubbing reduced pain, although while, they did not reduce the incidence of pain, they reduced the intensity of pain. This method might be considered as an alternative to other treatments but may be contraindicated for use with other drugs.

Morphine and remifentanil-induced cardioprotection: its experimental and clinical outcomes / 대한마취과학회지

During the past few decades, a large number of animal studies demonstrated that commonly used opioids could provide cardioprotection against ischemia-reperfusion (I/R) injury. Opioid-induced preconditioning or postconditioning mimics ischemic preconditioning (I-Pre) or ischemic postconditioning (I-Post). Both delta- and kappa-opioid receptors (OPRs) play a crucial role in opioid-induced cardioprotection (OIC). Down stream signaling effectors of OIC include ATP-sensitive potassium (KATP) channels, protein kinase C (PKC), tyrosine kinase, phosphatidylinositol-3-kinase (PI3-kinase), extracellular signal regulated kinase1/2 (ERK1/2), glycogen synthase kinase-3beta (GSK-3beta), and mitochondrial permeability transition pore (MPTP), among others. Recently, various reports also suggest that opioids could provide cardioprotection in humans. This review will discuss OIC using mostly morphine and remifentanil which are widely used during cardiac anesthesia in addition to the clinical implications of OIC.

Kappa-opioid receptor activation during reperfusion limits myocardial infarction via ERK1/2 activation in isolated rat hearts / 대한마취과학회지

BACKGROUND: We investigated whether p42/p44 extracellular signal-regulated kinases (ERK1/2) and/or phosphatidylinositol-3-OH kinase (PI3K)-Akt play a crucial role in cardioprotection by kappa-opioid receptor (KOP) activation. METHODS: Langendorff perfused rat hearts were subjected to 30 min of regional ischemia and 2 h of reperfusion. Antagonists of ERK1/2 and PI3K were perfused in hearts treated with the KOP agonist U50488H (U50). Infarct size was measured after 2 h of reperfusion. The phosphorylation states of ERK1/2 and Akt by Western immunoblots were determined. Drugs were perfused for a period of 5 min before and 30 min after reperfusion. RESULTS: Inhibition of ERK1/2 (26.8 +/- 2.9%, P 0.05 vs. U50) completely abrogated the anti-infarct effect of U50488H. Western blot analysis revealed a significant increase in ERK1/2 but not Akt phsophorylation in U50488H-treated hearts as compared to control hearts when measured immediately after reperfusion. CONCLUSIONS: KOP activation effectively reduces myocardial infarction. The anti-infarct effect of U50488H is mediated by the ERK1/2, but not the PI3K-Akt pathway.

The Shoulder Pain due to Metastatic Breast Cancer: A Case Report

A rotator cuff tear causes shoulder pain and limits movement of the shoulder joint. A chronic degenerative change or impingement is the reason for a rotator cuff tear. Diagnosis is made based on medical history and, physical and radiological examinations. Other causes of shoulder pain include calcific tendinitis, degenerative arthropathy, joint dislocation, fracture, and primary or metastatic neoplasm. However, metastatic cancer in the shoulder joint is difficult to diagnosis. We experienced a case in which a 46-year-old female patient complained of left shoulder pain and limited joint mobility, and these symptoms were due to metastatic breast cancer in the shoulder.

Central Venous Catheter-related Infection in Major Burn Patients: Comparison of Subclavian Vein and Femoral Vein / 대한구급학회지

BACKGROUND: A central venous catheter (CVC) is usually inserted in patients with severe burns and the selection of the CVC is often difficult due to widespread burned skin. We investigated the incidences of colonization and catheter-related blood stream infection (CRBSI) according to the insertion site of the CVC in major burn patients METHODS: In 63 adult massive burn patients in the intensive care unit, 93 CVCs (47 polyurethane standard CVCs and 46 Oligon anti-mocrobial CVCs) were randomly inserted via the subclavian vein (SCV group, n = 66) or femoral vein (FEV group, n = 27). All catheter tips removed were routinely cultured. Bacterial findings from the burn wound and peripheral blood were also monitored in all patients RESULTS: There was no significant difference in the average insertion length of the CVC (14.3 +/- 6.8 days in SCV and 13.6 +/- 3.8 days in FEV) between the two groups. There were no significant differences in CVC colonization (48.5% in SCV and 63.0% in FEV) and CRBSI (7.6% in SCV and 11.1% in FEV) between the two groups. Logistic analysis found that the use of polyurethane standard CVC is significantly associated with increased risk of CVC colonization (odds ratio = 2.68) CONCLUSIONS: The placement of the CVC via the femoral vein does not increase the incidence of CVC colonization in massive burn patients. The use of Oligon anti-microbial CVC may be helpful to reduce CVC colonization in major burn patients.

Polyphenol (-)-epigallocatechin gallate targeting myocardial reperfusion limits infarct size and improves cardiac function / 대한마취과학회지

BACKGROUND: This experiment was performed to determine the effect of polyphenolic (-)-epigallocatechin (EGCG), the most abundant catechin of green tea, given at reperfusion period. METHODS: Isolated rat hearts were subjected to 30 min of regional ischemia and 2 h of reperfusion. Green tea extract (GT) was perfused with the following concentrations; 0, 0.5, and 1 micrometer (GT-O, GT-0.5, and GT-1, respectively). In a next experiment, hearts were assigned randomly to one of the following groups; Control, EGCG-1 (1 micrometer of EGCG), and EGCG-10 (10 micrometer of EGCG). GT and EGCG were perfused for a period of 5 min before and 30 min after reperfusion. For comparison of cardioprotection among groups, morphometric measurement was performed by 2,3,5-triphenyltetrazolium chloride staning. RESULTS: GT 1 micrometer (10.3 +/- 2.1%, P < 0.05) significantly reduced infarct volume as a percentage of ischemic volume compared to untreated hearts (27.4 +/- 1.1%). EGCG 10 micrometer (13.2 +/- 4.0%) significantly reduced myocardial infarction compared to control hearts (27.2 +/- 1.4%, P = 0.002). After 2 h of reperfusion, cardiodynamic variables, including left ventricular developed pressure, rate-pressure produce, +dP/dt(max), and -dP/dt(min) were significantly improved by 10 micrometer of EGCG compared to control hearts (P = 0.01, 0.016, 0.009, and 0.019, respectively). CONCLUSIONS: EGCG treatment at an early reperfusion period reduces myocardial infarction and improves cardiodynamics in isolated rat hearts.

Polyphenol (-)-epigallocatechin gallate targeting myocardial reperfusion limits infarct size and improves cardiac function / 대한마취과학회지

BACKGROUND: This experiment was performed to determine the effect of polyphenolic (-)-epigallocatechin (EGCG), the most abundant catechin of green tea, given at reperfusion period. METHODS: Isolated rat hearts were subjected to 30 min of regional ischemia and 2 h of reperfusion. Green tea extract (GT) was perfused with the following concentrations; 0, 0.5, and 1 micrometer (GT-O, GT-0.5, and GT-1, respectively). In a next experiment, hearts were assigned randomly to one of the following groups; Control, EGCG-1 (1 micrometer of EGCG), and EGCG-10 (10 micrometer of EGCG). GT and EGCG were perfused for a period of 5 min before and 30 min after reperfusion. For comparison of cardioprotection among groups, morphometric measurement was performed by 2,3,5-triphenyltetrazolium chloride staning. RESULTS: GT 1 micrometer (10.3 +/- 2.1%, P < 0.05) significantly reduced infarct volume as a percentage of ischemic volume compared to untreated hearts (27.4 +/- 1.1%). EGCG 10 micrometer (13.2 +/- 4.0%) significantly reduced myocardial infarction compared to control hearts (27.2 +/- 1.4%, P = 0.002). After 2 h of reperfusion, cardiodynamic variables, including left ventricular developed pressure, rate-pressure produce, +dP/dt(max), and -dP/dt(min) were significantly improved by 10 micrometer of EGCG compared to control hearts (P = 0.01, 0.016, 0.009, and 0.019, respectively). CONCLUSIONS: EGCG treatment at an early reperfusion period reduces myocardial infarction and improves cardiodynamics in isolated rat hearts.

Cardiomyopathy after local infiltration or application of epinephrine for plastic surgery under general anesthesia : Two cases report / 대한마취과학회지

Catecholamine-induced cardiomyopathy rarely occurs after local epinephrine infiltration. We experienced two patients with catecholamine induced cardiomyopathies. An 8-yr-old girl was scheduled for closed reduction of a nasal bone fracture. Propofol and rocuronium bromide were used for induction of anesthesia. After induction, lidocaine mixed with epinephrine was infiltrated to the block of supratrochlear and infraorbital nerves. About 10 sec later ventricular tachycardia, hypotension, hypoxemia, and pulmonary edema developed. The other case was a 23-yr-old woman with a nasal bone fracture. Propofol, rocuronium bromide, and fentanyl were used for the induction of anesthesia. After induction, epinephrine-containing wet gauze was packed in the nasal cavity for mucosal shrinkage. About 1 minute later, hypertension, tachycardia, and hypoxemia developed. After each operation, a transthorcic echo-cardiogram revealed hypokynesia of the myocardium.

Administration of large fluid volumes decreases the incidence of postoperative nausea and vomiting as effectively as ondansetron / 대한마취과학회지

BACKGROUND: The possibility that large fluid volumes reduce postoperative nausea and vomiting (PONV) remains unclear due to conflicting data. We examined if administering large fluid volumes to high risk patients would decrease the incidence of PONV and compared the results with ondansetron administration. METHODS: Ninety ASA I, II patients who presented for laparoscopic cholecystectomy were randomized to 1 of 3 groups. They received either (group I) 5 ml/kg/hr of Hartmann's solution, (group II) 30 ml/kg/hr of Hartmann's solution or (group III) 4 mg of ondansetron and 5 ml/kg/hr of Hartmann's solution. The incidence of PONV and severity of pain were assessed at 1, 12 and 24 hours postoperatively. RESULTS: The number of PONV episodes was significantly reduced in group II and III compared to group I during the 1-12 hr postoperative period and for total incidence. However, there was no significant difference between group II and III. There were no differences among groups regarding the severity of pain. CONCLUSIONS: Intraoperative correction of intravascular volume deficits with 30 ml/kg/hr of Hartmann's solution decreases the incidence of PONV as effectively as administration of ondansetron.

The Effects of Lumbar Sympathetic Ganglion Block in the Patients with Spinal Stenosis and the Skin Temperature Changes according to the Contrast Spread Patterns

BACKGROUND: We hypothesized that if a fluoroscopic image of the lumbar sympathetic ganglion block (LSGB) showed the spread patterns of contrast at both the L2/3 and L4/5 disc areas, then this would demonstrate a more profound blockade effect because the spread patterns are close to sympathetic ganglia. In addition, we compared the effects of LSGB and transforaminal epidural steroid injection (TFESI) for the patients suffering with spinal stenosis. METHODS: Eighty patients were divided into two groups (Group S: the patients treated with TFESI, Group L: the patients treated with LSGB). The patients of group L were classified into three groups (groups A, B and, C) according to their contrast spread pattern. The preblock and postblock temperature difference between the ipsilateral and contralateral great toe (DT(pre), DT(post), degrees C), and the DTnet were calculated as follows. DT(net) = DT(post) - DT(pre). RESULTS: Both group showed a significant reduction of the visual analogue score (VAS) and the Oswestry disability index (ODI) score. Only the patients of group L showed a significant increase of their walking distance (WD). Group A showed the most significant changes in the DT(post) (6.1 +/- 1.2degrees C, P = 0.021), and the DTnet (6.0 +/- 1.0degrees C, p = 0.023), as compared to group C. CONCLUSIONS: LSGB showed a similar effect on the VAS, and ODI, and a significant effect, on WD, compared with TFESI. Group A showed a significant sympatholytic effect, as compared to group C.

Pharmacotherapy of the Failing Heart and Shock / 대한구급학회지

No abstract available.

Analysis of Factors Associated with the Therapeutic Duration of Transforaminal Epidural Steroid Injection in Lumbar Spinal Stenosis Patients / 대한통증학회지

BACKGROUND: A transforaminal epidural steroid injection (TFESI) is one of the methods for the conservative treatment of the lumbar spinal stenosis. As efforts to prolong the therapeutic duration and to predict the outcome of TFESI are very important, we analyzed factors considered to be associated with the therapeutic duration of a TFESI. METHODS: Between August 2006 and March 2007, 69 patients (Group A: patients with no pain relief, Group B: patients with pain relief of less than 6 months, Group C: patients with pain relief of more than 6 months) who failed to the medical treatment were included to undertake a fluoroscopic-guided TFESI. Prior to treatment, the VAS (visual analogue scale), ODI (Oswestry disability index), BDI (Beck depression inventory), and BAI (Beck anxiety inventory) scores were determined to evaluate the degree of pain, disability, and psychological status. The VAS and ODI scores were used to assess the degree of pain relief. To identify the total duration of pain relief, regular outpatient visits for six months were conducted, and for the patients who were not able to visit the outpatient clinic regularly, outcome was assessed by telephone interviews after six months. RESULTS: The dural sac cross-sectional area (DSCSA), ODI, pain duration, BDI, BAI, and age showed similar distribution for patients in the A, B, and C groups. CONCLUSIONS: The DSCSA, ODI, pain duration, BDI, BAI, and age were not associated with the therapeutic duration of TFESI in lumbar spinal stenosis patients.

Cardioprotective signaling cascade of A2 adenosine receptor agonist 5'-N-ethylcarboxaminidoadenosine against myocardial reperfusion injury / 대한마취과학회지

BACKGROUND: This experiments investigated the signaling cascade responsible for anti-infarct effect by an A2 adenosine receptor (AR) agonist 5'-N-Ethylcarboxaminidoadenosine (NECA). METHODS: Langendorff perfused isolated rat hearts were subjected to 30 minutes of regional ischemia and 120 minutes of reperfusion. Drugs were perfused for a period of 5 minutes before and 60 minutes after reperfusion. For comparison of cardioprotection among groups, area at necrosis (AN) and area at risk (AAR) were measured by triphenyltetrazolium chloride staining. RESULTS: NECA significantly attenuated AN/AAR (14.1 +/- 1.9%, P < 0.001) compared with control hearts (30.7 +/- 2.8%). Anti-infarct effect by NECA was attenuated by an A(2A)AR antagonist 8-(3-chlorostyryl)caffeine (23.7 +/- 3.4%, P < 0.05) and an A(2B)AR antagonist MRS1706 (29.9 +/- 3.3%, P < 0.001). Cardioprotection by NECA was blocked by a guanylyl cyclase inhibitor (23.1 +/- 2.9%, P < 0.05) and a protein kinase G (PKG) inhibitor KT5823 (30.3 +/- 3.2%, P < 0.001). Glycogen synthase kinase-3beta (GSK-3beta) inhibitor SB216763 attenuated the AN/AAR in both NECA with MRS (17.8 +/- 2.7%, P < 0.01 vs. control) and NECA with KT5823 treated hearts (8.2 +/- 1.8%, P < 0.001 vs. control). The mitochondrial permeability transition pore (mPTP) opener atractyloside also aborted NECA's anti-infarct effect (24.7 +/- 2.4% P < 0.05). CONCLUSIONS: The signaling pathway by NECA administered at reperfusion involves the activation of both A2AAR and A2BAR and cGMP/PKG pathway, which in turn depends on inactivation of GSK-3beta and inhibition of mPTP opening.

Ischemic Postconditioning Inhibits Mitochondrial Permeability Transition Pore via Opioid Receptor Activation in Intact Rat Heart / 대한마취과학회지

BACKGROUND: Ischemic postconditioning (Post-C), brief cycles of myocardial ischemia and reperfusion during the early phase of reperfusion, is considered as a novel adjunct strategy to protect myocardium.However, the exact mechanism remains unclear and should be determined. METHODS: The hearts of male Wistar rats were subjected to 30 min ischemia and 2 hrs reperfusion.Control rats had no intervention either before or after left coronary artery occlusion.Post-C was elicited by 6 cycles of 10s reperfusioninterspersed by 10s ischemia immediately after onset of reperfusion.Subsets of postconditioning rats were treated with drugs as followings; naloxone (non-selective opioid receptor antagonist), naltrindole (a delta-opioid receptor antagonist), SB216763 (a glycogen synthase kinase 3beta inhibitor, GSK-3beta inhibitor), or atractyloside (a mitochondrial permeability transition pore opener, mPTP opener). RESULTS: Post-C significantly reduced infarct size (15.9 +/- 2.4%, P = 0.003) compared to control (29.9 +/- 3.7%).The anti-infarct effect by Post-C was blocked by both naloxone (25.5 +/- 3.9%, P = 0.044) and naltrindole (26.9 +/- 2.3%, P = 0.022).Infarct size limiting effect by Post-C was also abolished by atractyloside (30.6 +/- 3.6%, P = 0.003).In SB216763 with naloxone treated animals, the infarct size was decreased (17.4 +/- 3.2%, P = 0.007) but not in SB216763 with atractyloside treated animals (27.4 +/- 2.6%) compared to control. CONCLUSIONS: These data suggest that Post-C may protect myocardium by inhibiting mPTP opening via delta-opioid receptor activation.GSK-3beta is a downstream mediator of opioid receptors and an upstream mediator of mPTP opening in Post-C.

Effect of A Kappa-opioid Receptor Agonist U50488H Given at Early Reperfusion Phase in Isolated Rat Hearts / 대한마취과학회지

BACKGROUND: The experiment was performed to determine the role of kappa-opioid receptor (OR) agonist U50488H given at early reperfusion. METHODS: Isolated hearts were subjected to 30 minutes of regional ischemia and 120 minutes of reperfusion.Hearts were assigned randomly to one of the three groups:1) Control (n = 9), 2) U50-1 (n = 8); 10micrometer of U50488H, and 3) U50-10 (n = 8); 10micrometer of U50488H.U50488 was perfused for a period of 5 min before and 30 min after reperfusion. RESULTS: U50488H significantly reduced infarct size as a percentage of ischemic area (12.2 +/- 1.9% in U50-1 and 7.2 +/- 1.7% in U50-10, P < 0.001) compared to the control hearts (27.2 +/- 1.2%). After 2 hrs of reperfusion, left ventricular developed pressure was significantly recovered by U50488H (62.6 +/- 5.7% in U50-1 and 68.6 +/- 4.7% in U50-10, P = 0.018 and 0.002, respectively) compared to the control (46.3 +/- 4.4%).Rate-pressure product was improved by 100micrometer U50488H (62.3 +/- 5.5%, P = 0.007) but not by 1micrometer U50488H (50.0 +/- 4.1%) compared to the control (44.7 +/- 4.5%).U50488H significantly increased the + dP/dt(max) (77.9 +/- 5.5% in U50-1 and 78.0 +/- 4.3 in U50-10, P = 0.005 and 0.001 vs. control, respectively).The -dP/dt(min) also improved by 10micrometer U50488H (64.7 +/- 4.8%, P = 0.003) compared to control (47.0 +/- 2.7%). CONCLUSIONS: U50488H given at early reperfusion phase reduces both infarct size and myocardial stunning in isolated rat hearts.

Factors associated with the outcome of transforaminal epidural steroid injections / 대한마취과학회지

BACKGROUND: This study was undertaken to assaythe effectiveness of transforaminal epidural steroid injections (TFESIs) for sciatica and to identify potential predictors related to treatment outcome. METHODS: TFESIs were performed in 150 patients between August 2006 and March 2007. Seventy-five patients (35 women, 40 men; mean age, 59.1 years), who met the inclusion criteria, were studied. Therapeutic effects were evaluated twoweeks after injection. The following potential outcome predictors analyzed were as follows: one level vs. two level injection, Beck depression inventory score (20), Beck anxiety inventory score (16), cause of radiculopathy (spinal stenosis vs. herniated disk), gender, duration of radiculopathy (6 months), and Oswestry disability index score (60). The relationships between possible outcome predictors and therapeutic effects were evaluated. RESULTS: Forty-nine of the 75 patients (65.3%) had a satisfactory result two weeks after TFESIs. Of these, twenty-four of the 46 patients (52.2%) were treated by a one level injection and 25 (89.3%) of the 29 patients were treated by a two level injection. This outcome was statistically significant (P < 0.01). None of the other potential outcome predictors showed any statistical difference. CONCLUSIONS: TFESI is recommended as an effective method of managing radiculopathy. Two-level injectionsmay result in a better outcome than a one-level injection.

Atelectasis Induced by Thoracotomy Causes Lung Injury during Mechanical Ventilation in Endotoxemic Rats

Atelectasis can impair arterial oxygenation and decrease lung compliance. However, the effects of atelectasis on endotoxemic lungs during ventilation have not been well studied. We hypothesized that ventilation at low volumes below functional residual capacity (FRC) would accentuate lung injury in lipopolysaccharide (LPS)-pretreated rats. LPS-pretreated rats were ventilated with room air at 85 breaths/min for 2 hr at a tidal volume of 10 mL/kg with or without thoracotomy. Positive end-expiratory pressure (PEEP) was applied to restore FRC in the thoracotomy group. While LPS or thoracotomy alone did not cause significant injury, the combination of endotoxemia and thoracotomy caused significant hypoxemia and hypercapnia. The injury was observed along with a marked accumulation of inflammatory cells in the interstitium of the lungs, predominantly comprising neutrophils and mononuclear cells. Immunohistochemistry showed increased inducible nitric oxide synthase (iNOS) expression in mononuclear cells accumulated in the interstitium in the injury group. Pretreatment with PEEP or an iNOS inhibitor (1400 W) attenuated hypoxemia, hypercapnia, and the accumulation of inflammatory cells in the lung. In conclusion, the data suggest that atelectasis induced by thoracotomy causes lung injury during mechanical ventilation in endotoxemic rats through iNOS expression.