The Pulmonary Arterial Reactivity to Nitric Oxide after Cardiopulmonary Bypass and Reperfusion in Pigs / 대한마취과학회지

BACKGROUND: We hypothesized that the decreased nitric oxide after cardiopulmonary bypass and reperfusion would play an important role in temporary pulmonary hypertension. METHODS: We used the pulmonary arteries of three pigs weighing 40-50 kg after cardiopulmonary bypass and reperfusion in experimental group. We also used the pulmonary arteries of five pigs before cardiopulmonary bypass under sham operation in control group. All cumulative concentration-effect curves were performed on vessel rings beginning at their optimum resting zone. EC50 and maximal response (Emax) were calculated by using nonlineal logistic regression analysis with the software PRISM (Graphpad, Mountain View, CA). RESULTS: CPB inhibited endothelium-dependent relaxation to acetylcholine in pulmonary arterial rings, but did not affect SNP induced relaxation in ones. CONCLUSIONS: The Ability of pulmonary arterial relaxation after CPB and reperfusion in pigs was decreased without attenuated pulmonary arterial sensitivity to NO.

Delayed Severe Bradycardia during Epidural Anesthesia: A case report / 대한마취과학회지

Severe bradycardia and asystole are uncommon complications during epidural anesthesia but can be life threatening if not properly managed. There are several risk factors including baseline bradycardia, first degree AV block, preoperative beta-blocker, male gender, high sensory block level, and American Society of Anesthesiologists (ASA) physical status class 1. A 48-year-old, ASA class 1, male patient was admitted for the repair of a ventral hernia under epidural anesthesia. Approximately 60 minutes after the epidural anesthesia, heart rate decreased markedly to 10/min without loss of consciousness and a decrease in saturation. The heart rate returned to 90/min after administering atropine. We concluded that severe bradycardia was induced by vagal activation as a result of the low venous return and high sympathetic blockade (T4 sympathetic level).

The Effect of Pretreatment with Thiopental on Reducing Pain Induced by Rocuronium Injection

We examined whether pretreatment with a small dose of thiopental was effective in reducing pain induced by the intravenous injection of rocuronium. Withdrawal movement was used to assess pain reduction. Ninety patients were randomly assigned to one of two groups: patients in the control group were pretreated with 2 mL saline, and those in the thiopental group were pretreated with 2 mL (50 mg) thiopental. Thiopental 5 mg/kg was injected intravenously. After a loss of consciousness, the upper arm was compressed with a rubber tourniquet, and the pretreatment drugs were administered. Thirty seconds later the tourniquet was removed and 0.6 mg/kg rocuronium was administered. Withdrawal movement was assessed using a four-grade scale: no movement, movement limited to the wrist, to the elbow or to the shoulder. The frequency of withdrawal movement in the group pretreated with thiopental was lower than in the control group (34 vs. 13, p 0.05). We concluded that pretreatment with 2 mL (50 mg) thiopental is effective in reducing pain caused by the intravenous injection of rocuronium.

Effects of Deletions in the Regulatory Domain on the Stability and Enzymatic Characteristics of Tyrosine Hydroxylase

BACKGROUND: Various vectors have been developed and tried for the delivery of tyrosine hydroxylase (TH) in order to supplement dopamine, which is severely deficient in Parkinson's disease, however, none of the protocols tried have yielded fruitful results that can be applied directly to humans. One of the problems revealed from previous trials was a short duration of expression of the delivered gene, that is, tyrosine hydroxylase. METHODS: To extend the stability and to improve the enzymatic characteristics of the protein, part of the regulatory domain was deleted via PCR technique. The cDNA for regulatory domain-deleted THs (dTH) were sub-cloned into a retroviral vector and the resulting recom-binant retrovirus was used to infect NIH-3T3. After selection, expression levels of TH were determined by Western blot analysis and the enzymatic characteristics were examined. RESULTS: The deletion increased steady state expression level of TH protein by 7-fold for d19TH (TH with amino acids #2-19 are deleted) and 3-fold for d31TH (TH with amino acids #2-31 are deleted. The elevated expression level of d19TH is likely due to the enhanced stability of the protein as determined by a treatment of cycloheximide. The activity of d19TH was also increased approximately by 3-fold but no increase of the L-dopa production was observed. However, the production of L-dopa was dramatically increased when GTP cyclohydrolase I (GTPCH I) was co-transfected suggesting that the activity of d19TH is dependent on the presence of cofactor. d19TH seem to be free of feedback inhibition at low concentration of dopamine (10 nM~1 nM) but more sensitive to the inhibition at high concentration of dopamine (10 mM). CONCLUSIONS: The deletion of 18 amino acids on the regulatory domain increases the stability of the protein, reduces the activity, and frees it from the feedback inhibi-tion by the end product.

Idiopathic hypertrophic cranial pachymeningitis: Report of 2 cases & Review of literatures

Idiopathic hypertrophic cranial pachymeningitis(IHCP) is a rare chronic pro gressive fibrosing inflammation of pachymeninges of unknown origin. Since the spreading of CT and MRI, there has been a few cases of IHCP have been reported. We describe two patients of IHCP with brain parenchymal involvement presented as epilepsia partialis continua which has not been described as a symptom of IHCP and review the previous reported literatures. IHCP commonly presents headache, multiple cranial nerve palsy, ataxia, and sometimes seizure. In many cases, the CSF finding is noninfectious inflammation, and the erythrocyte sedimentation rate is elevated. The brain MRI is the best noninvasive tool for diagnosis of IHCP and shows diffuse thickening and enhancing dura, especially posterior fossa. IHCP responds steroid initially but recurs frequently and progresses chronically.

The clinical study of benign paroxysmal positional vertigo of horizontal semicircular canal origin

BACKGROUND & OBJECTIVES: It was well known that benign paroxysmal positional vertigo(BPPV) was caused by the involvement of the posterior semicircular canal, but there were a few reports about horizontal canal variant of BPPV. We studied the clinical features electronystagmographic (ENG) findings and the possible mechanism of BPPV of the horizontal canal(HBPPV). METHODS: We examined 10 cases of HBPPV with episodic vertigo and intense horizontal geotropic nystagmus provoked by rotation of the head in a supine position. Six patients underwent ENG and we recorded four patients' nystagmus, provoked by rotating head from extreme lateral, mid and nose-up position to extreme contralateral direction in supine position. RESULTS: All observed horizontal nystagmus beated towards the ground on both sides and were more pronounced when head was rotated to pathological side. In rotating to pathological side, nystagmus had mean latency of 2.6+/-1.8 seconds, peak velocity of slow phase of 66,8+/-19.7 degree/second and mean duration of 24.7+/-3.4 seconds. In rotating to healthy side the nystagmus had 3. 7+/- 2.9, 38.0+/-11.5 and 22.5+/-4. Secondary phase nystagmus occurred in 2 patients and fatigue was observed in 4 patients. The slow phase velocity of nystagmus was relative to the distance of head rotation. The duration of attack is 3 to 17 days(6.9+/-5.2days). Liberatory manuever had relatively a good effect. CONCLUSION: HBPPV represents the origin of horizontal semicircular canal and has a good prognosis Above findings support that mechanism of horizontal BPPV is canalolithiasis.

Clinical Study of Benign Childhood Epilepsy with Occipital Paroxysms(BCEOP)

BACKGROUND & OBJECTIVES: Although benign childhood epilepsy with controtemporal spikes (BCECT) has been well characterized and extensively studied, the clinical findings and prognosis of benign childhood epilepsy with occipital paroxysms (BCEOP) have been less well understood. The purpose of this study was to evaluate clinical manifestations, responses to antiepileptic drugs, and longterm. Prognosis of BCEOP. METHODS AND SUBJECTS: We studied 10 BCEOP patients seen between 1985 and 1995 and followed up from 2 to 14 years(7.2+/-2.9). RESULTS: In 10 patients, there were 7 females and 3 males. The age of onset ranges from 4 to 9 year-old(6.4+/-1.5). In the cases whose age of onset was below 6 year-old, the main clinical manifestations were tonic deviation of eye bal1, ictal vomiting and frequent development of status epilepticus in the sleep. In the cases whose age of onset was above 7 year-old, the main clinical manifestations were visual symptoms (blurring or blindness) associated with ictal vomiting/headache and complex visual hallucination evolved to automatism. The typical EEG findings were occipital paroxysms, characterized by repetitive high amplitude spike or sharp and slow wave complexes in the occipital area, mainly when the eyes were closed. Except one patient, the seizures responded well to anticonvulsant therapy and did not occur after the age of 11. CONCLUSION: Although the number of cases was small and the follow-up period was not long enough, our data indicated that BCEOP had a good prognosis and showed diverse clinical manifestations, which might be dependent on the age of onset.

A Case of Non-paralytic Pontine Exotropia in Brain Stem Infarction

Paralytic pontine extropia(PPE) is a exotropia in contralateral eye of lesion side, associated with one-and- a-half syndrome in acute phase of brainstem infarction and after then, often followed by non-paralytic pontine extropia(NPPE) and medial longitudinal fasciculus (MLF) syndrome in each clinical improvement. NPPE is pontine exotropia without lateral gaze palsy to ipsilateral side and is considered to be due to partial impairment of the unilateral paramedian pontine reticular formation(PPRF). We reported a case, 75 yearold man, of brainstem infarction who initially presented NPPE in acute phase, followed by ipsialteral MLF syndrome after 5th days.

Clinical Study of Benign Childhood Epilepsy with Centro-Temporal Spikes

This study was retrospectively undertaken to evaluate clinical manifestations, electroencephalographic findings, response to antiepileptic drugs and prognosis of 80 benign childhood epilepsy with centrotemporal spikes (BCECT) patients seen between 1967 and 1993 and followed up for more than 2 years. The age of onset ranges from 3 to 15 years. In 93 percent of patients, seizures appeared between 4 to 12 year-old, with peak of 5 year-old. The main manifestations of partial seizure were hemifacial spasm (53%) and oropharygeal signs (52%) with hypersalivation, abnormal sensation of mouth, gutteral sounds, swallowing difficulty and feeling of suffocation. The types of seizure consist of partial seizure(66%) and partial seizure with secondary generalization (34%). Distributions of seizure attack were nocturnal sleep (83%), diurnal sleep state(4%) and waking state (13%). The typical EEG findings were slow diaphasic high voltage centrotemporal spikes with unilateral (94%) and bilateral foci(6%) with normal background. In addition to typical EEG findings, there were associated with multifocal independent sharp-waves (8.9%) and generalized sharp-wave discharges (7.8%). BCECT patients were well controlled by antiepileptic drugs and had good prognosis. During the follow-up period (2-17years), we observed that all patient were well adapted to school and society. Seizures did not occur after adolescent period.

Vibration Perception Threshold in Diabetic Peripheral Polyneuropathy

This study was performed to assess the relation of vibration perception threshol (VPT) and sensory nerve conduction velocity(SNCV) in diabetics and control, respecti vely. The subjects were 39 diabetics (22 men, 17 women) who consisted of 20 patients with neuropathy symptomS(complaining group) and 19 patients without neuropathy symptoms (noncomplaining group). The followings were obtained. 1. The duration of diabetes mellitus in complaining group was significantly longer than that of noncomplaining group(p<0.05). 2. VPT of thumb. Lateral malleolus and great toe in diabetics were significantly increased and SNCV of median. Ulnar and sural nerve were significantly delayed than those of control(p<0.01). 3. VPT of thumb and lateral malleolus in noncomplaining group were significantly increased and SNCV of median, radial and sural nerve were significantly delayed than of control (p<0 05) VPT of thumb, lateral malleolus and great toe in complaining group were significantly increased and SNCV of median, ulnar and sural nerve were significantly delayed than those of control(p<0.05). VPT of great toe in complaining group was significantly increased than that of noncomplaining group(P<0.05). 4. VPT test of thumb anf great toe were more sensitive and specific than ulnar SNCV test. The results suggest that measurement of VPT is a useful method in early diagnosis and follow-up of diabetic peripheral polyneuropathy.

Dermatomal Somatosensory Evoked Potentials in Lumbosacral Radiculopathy

This study was conducted to get normal data of derrnatomal somatosensory evoked potentials (DSEP) from the lumbosacral dermatome and to evaluate the efficacy of DSEP in the diagnosis of lumbosacral radiculopathy. We examined scalp-recorded DSEP from stimulation of L4. L5 and Sl derrnatomes. DSEP was tested on 26 healthy adult volunteers (11 men and 15 women), age ranging from 22 to 66 years and 12 patients (7 men and 5 women) with lumbosacral radiculopathies. Norrnal values of P latenc! Of DSEP from stimulation of L4. L5 and S1 derrnatomes were 41.3+24.9 msec. 46.4+3.30 msec and 46.8+3.04 msec and the interside differences of the P, latency uere 1.57+1.06 msec, 1.06+0.93 msec and 1.38+0.89 msec, respectively. The latencies of DSEP were significantly influenced by age and height. But the amplitudes were not. In the seven of the twelve patients with lumbosacral radiculopathies the DSEP findings concurred with clinical, CT and/or MRI findings. In 5 cases DSEP gave different information, indicating no abnormality in three patients, more extended radiculopathy in one, and more reduced radiculopathy in one, compared with clinical and radiological findings. Above observations suggest that DSEP test is a simple. Noninvasive. Economic and useful alternative test for the diagnosis of lumboscral radiculopathy.