Hyperpolarized 1- 13Cpyruvate Magnetic Resonance Spectroscopy Shows That Agmatine Increased Lactate Production in the Brain of Type 2 Diabetic Mice

Purpose@#Type 2 diabetes mellitus (T2DM) is associated with a 2-fold increased risk of developing Alzheimer’s disease. In earlier research, agmatine has been demonstrated to alleviate diabetes symptoms and increase cognitive performance. However, it is unclear whether the improvement of cognitive function is attributable to the reduction of diabetic symptoms or its direct influence on brain metabolism. Using hyperpolarized (HP) [1- 13C]pyruvate magnetic resonance spectroscopy (MRS), this study intends to evaluate the influence of agmatine on brain metabolism. @*Materials and Methods@#ICR mice were fed a high-fat diet and injected with streptozotocin to develop a T2DM animal model. During a 2-week period, T2DM mice were treated with normal saline or 100 mg/kg of agmatine, and brain HP [1- 13C]pyruvate MRS was performed. The effect of agmatine on lactate generation and NADH/NAD+ redox state was investigated using C6 and neuro-2a (N2a) cells. @*Results@#As a perfusion marker, the total 13C signals in the brain of T2DM mice (p=0.07) and agmatine-treated mice (p<0.05) were reduced. The conversion constant (Kpl) from [1- 13C]pyruvate to [1- 13C]lactate was not distinguishable in the brains of T2DM mice but was significantly increased in the brains of agmatine-treated T2DM mice. Treating C6 and N2a cells with agmatine increased NADH/NAD+ ratio and lactate generation. @*Conclusion@#Agmatine influences the NADH/NAD+ redox state in the brains of T2DM mice, which may be connected with enhanced cognitive performance and increased conversion of HP [1- 13C]pyruvate to HP [1- 13C]lactate.

Validation of the Osteomyelitis Induced by Methicillin-Resistant Staphylococcus aureus (MRSA) on Rat Model with Calvaria Defect

Background@#Osteomyelitis resulting from bacterial strains, such as methicillin-resistant Staphylococcus aureus (MRSA) that are resistant to multiple drugs, brings further clinical challenges. There is currently no model of osteomyelitis induced by MRSA using rats with calvaria defects. So, We induced osteomyelitis in rat models with the calvaria bone defect. @*Methods@#The rats were randomly divided into six groups according to inoculation dose levels, which ranged from 6 × 100 to 6 × 105 CFU/5 µl. Bone tissues were retrieved from all rats used in the study and assessed using histology, microbiology, and radiobiology 4 weeks after surgery to evaluate the relationship between inoculation dose and infectivity. @*Results@#In Histological results, high levels of inflammatory responses, bone necrosis, and bacteria were observed in treatment groups G3 to G5. In IHC staining, high levels of cox-2 expression were observed in treatment groups G3. Microbiological observations also indicated that significantly higher numbers of CFUs were found in G3 to G5. In radiography results, the bone mineral density in G3 to G5 was significantly higher than in the control group, G1, and G2. Our results indicate that an inoculating dose of 6 × 103 CFU/5 μl is sufficient to induce the development of osteomyelitis in rat models. @*Conclusion@#This study suggests that the minimum dose (6 × 103CFU/5 µl) can induce osteomyelitis in calvaria rat model. This can offer information and ability of more accurately modeling osteomyelitis and simulating the challenge of osteomyelitis treat.

Danshen Extracts Prevents Obesity and Activates Mitochondrial Function in Brown Adipose Tissue

Background@#Danshen has been widely used in oriental medicine to improve body function. The purpose of this study is to investigate the effect of water-soluble Danshen extract (DE) on weight loss and on activation proteins involved in mitochondrial biogenesis in brown adipose tissue (BAT) in obese mice. @*Methods@#BAT was isolated from 7-week-old male Sprague-Dawley rats, and expression of proteins related to mitochondrial biogenesis was confirmed in both brown preadipocytes and mature brown adipocytes treated with DE. For the in vivo study, low-density lipoprotein receptor knock out mice were divided into three groups and treated for 17 weeks with: standard diet; high fat diet (HFD); HFD+DE. Body weight was measured every week, and oral glucose tolerance test was performed after DE treatment in streptozotocin-induced diabetic mice. To observe the changes in markers related to thermogenesis and adipogenesis in the BAT, white adipose tissue (WAT) and liver of experimental animals, tissues were removed and immediately frozen in liquid nitrogen. @*Results@#DE increased the expression of uncoupling protein 1 and peroxisome proliferator-activated receptor gamma coactivator 1-alpha in brown preadipocytes, and also promoted the brown adipocyte differentiation and mitochondrial function in the mature brown adipocytes. Reactive oxygen species production in brown preadipocytes was increased depending on the concentration of DE. DE activates thermogenesis in BAT and normalizes increased body weight and adipogenesis in the liver due to HFD. Browning of WAT was increased in WAT of DE treatment group. @*Conclusion@#DE protects against obesity and activates mitochondrial function in BAT.

Validation of the Osteomyelitis Induced by Methicillin-Resistant Staphylococcus aureus (MRSA) on Rat Model with Calvaria Defect

Background@#Osteomyelitis resulting from bacterial strains, such as methicillin-resistant Staphylococcus aureus (MRSA) that are resistant to multiple drugs, brings further clinical challenges. There is currently no model of osteomyelitis induced by MRSA using rats with calvaria defects. So, We induced osteomyelitis in rat models with the calvaria bone defect. @*Methods@#The rats were randomly divided into six groups according to inoculation dose levels, which ranged from 6 × 100 to 6 × 105 CFU/5 µl. Bone tissues were retrieved from all rats used in the study and assessed using histology, microbiology, and radiobiology 4 weeks after surgery to evaluate the relationship between inoculation dose and infectivity. @*Results@#In Histological results, high levels of inflammatory responses, bone necrosis, and bacteria were observed in treatment groups G3 to G5. In IHC staining, high levels of cox-2 expression were observed in treatment groups G3. Microbiological observations also indicated that significantly higher numbers of CFUs were found in G3 to G5. In radiography results, the bone mineral density in G3 to G5 was significantly higher than in the control group, G1, and G2. Our results indicate that an inoculating dose of 6 × 103 CFU/5 μl is sufficient to induce the development of osteomyelitis in rat models. @*Conclusion@#This study suggests that the minimum dose (6 × 103CFU/5 µl) can induce osteomyelitis in calvaria rat model. This can offer information and ability of more accurately modeling osteomyelitis and simulating the challenge of osteomyelitis treat.

Dual Component Analysis for In Vivo T₂* Decay of Hyperpolarized ¹³C Metabolites

PURPOSE: To investigate the exchange and redistribution of hyperpolarized ¹³C metabolites between different pools by temporally analyzing the relative fraction of dual T₂* components of hyperpolarized ¹³C metabolites. MATERIALS AND METHODS: A dual exponential decay analysis of T₂* is performed for [1-¹³C] pyruvate and [1-¹³C] lactate using nonspatially resolved dynamic ¹³C MR spectroscopy from mice brains with tumors (n = 3) and without (n = 4) tumors. The values of shorter and longer T₂* components are explored when fitted from averaged spectrum and temporal variations of their fractions. RESULTS: The T₂* values were not significantly different between the tumor and control groups, but the fraction of longer T₂* [1-¹³C] lactate components was more than 10% in the tumor group over that of the controls (P < 0.1). The fraction of shorter T₂* components of [1-¹³C] pyruvate showed an increasing tendency while that of the [1-¹³C] lactate was decreasing over time. The slopes of the changing fraction were steeper for the tumor group than the controls, especially for lactate (P < 0.01). In both pyruvate and lactate, the fraction of the shorter T₂* component was always greater than the longer T₂* component over time. CONCLUSIONS: The exchange and redistribution of pyruvate and lactate between different pools was investigated by dual component analysis of the free induction decay signal from hyperpolarized ¹³C experiments. Tumor and control groups showed differences in their fractions rather than the values of longer and shorter T₂* components. Fraction changing dynamics may provide an aspect for extravasation and membrane transport of pyruvate and lactate, and will be useful to determine the appropriate time window for acquisition of hyperpolarized ¹³C images.

Determination of Optimal Scan Time for the Measurement of Downstream Metabolites in Hyperpolarized 13C MRSI

PURPOSE: For a single time-point hyperpolarized 13C magnetic resonance spectroscopy imaging (MRSI) of animal models, scan-time window after injecting substrates is critical in terms of signal-to-noise ratio (SNR) of downstream metabolites. Prescans of time-resolved magnetic resonance spectroscopy (MRS) can be performed to determine the scan-time window. In this study, based on two-site exchange model, protocol-specific simulation approaches were developed for 13C MRSI and the optimal scan-time window was determined to maximize the SNR of downstream metabolites. MATERIALS AND METHODS: The arterial input function and conversion rate constant from injected substrates (pyruvate) to downstream metabolite (lactate) were precalibrated, based on pre-scans of time-resolved MRS. MRSI was simulated using twosite exchange model with considerations of scan parameters of MRSI. Optimal scantime window for mapping lactate was chosen from simulated lactate intensity maps. The performance was validated by multiple in vivo experiments of BALB/C nude mice with MDA-MB-231 breast tumor cells. As a comparison, MRSI were performed with other scan-time windows simply chosen from the lactate signal intensities of prescan time-resolved MRS. RESULTS: The optimal scan timing for our animal models was determined by simulation, and was found to be 15 s after injection of the pyruvate. Compared to the simple approach, we observed that the lactate peak signal to noise ratio (PSNR) was increased by 230%. CONCLUSIONS: Optimal scan timing to measure downstream metabolites using hyperpolarized 13C MRSI can be determined by the proposed protocol-specific simulation approaches.

The Role of Foxo3 in Leydig Cells

PURPOSE: Foxo3 in female reproduction has been reported to regulate proliferation of granulose cells that form follicles. There are no reports so far that discuss on the role of Foxo3 in males. This study was designed to outline the role of Foxo3 in the testes. MATERIALS AND METHODS: Testes from mice at birth to postpartum week (PPW) 5 were isolated and examined for the expression of Foxo3 using immunostaining. To elucidate role of Foxo3 in Leydig cells, R2C cells were treated with luteinizing hormone (LH) and the phosphorylation of Foxo3. Testosterone and steroidogenic acute regulatory (StAR) protein levels were measured after constitutive active [triple mutant (TM)] human FOXO3 adenovirus was transduced and StAR promoter assay was performed. RESULTS: Foxo3 expression in the testicles started from birth and lasted until PPW 3. After PPW 3, most Foxo3 expression occurred in the nuclei of Leydig cells; however, at PPW 5, Foxo3 was expressed in both the nucleus and cytoplasm. When R2C cells were treated with luteinizing hormone, Foxo3 phosphorylation levels by AKT increased. After blocking the PI3K pathway, LH-induced phosphorylated Foxo3 levels decreased, indicating that LH signaling regulates Foxo3 localization. When active FOXO3-TM adenovirus was introduced into a Leydig tumor cell line, the concentrations of testosterone and StAR protein decreased. When FOXO3 and a StAR promoter vector were co-transfected into HEK293 cells for a reporter assay, FOXO3 inhibited the StAR promoter. CONCLUSION: FOXO3 affects testosterone synthesis by inhibiting the formation of StAR protein. LH hormone, meanwhile, influences Foxo3 localization, mediating its function.

Quality of Life and Demands for the Welfare of the Parents with Children in Special School in Goyang City

OBJECTIVE: To investigate the level of quality of life, life satisfaction, depression and demands of parents with children in special school. METHOD: Data were collected through a questionnaire answered by 152 parents whose children were enrolled in four special schools in Goyang City. The quality of life (QOL), life domain satisfaction measure (LDSM), Beck depression inventory (BDI) and the demand for rehabilitation and welfare service were obtained. RESULTS: The average score of QOL was less than 50 and the mental health component in particular was the lowest of all. The average score of LDSM was 3.9+/-0.9, and most notably the score regarding economic status resulted to be the lowest. The average score of BDI was 13.4. The general health screening and medical service related needs of the parents with disabled children were most significant, including the need for the expansion of welfare facilities for disabled people. CONCLUSION: In order to provide better rehabilitation service to disabled children, a policy which could decrease the physical and mental burden of parents with disabled children should be considered.

Usefulness of Strut in Ossiculoplasty during Canal Wall Down Tympanomastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing improvement after CWD tympanomastoidectomy is another major goal of surgery after eradication of disease, especially in cases with intact stapes. The objective of this study is to compare the postoperative results of hearing gain and middle ear condition according to the types of ossiculoplasty described above. SUBJECTS AND METHOD: Of patients who received CWD tympanomatoidectomy, 90 who had been followed up for more than 1 year after surgery were selected. We found 30 cases of classical tympanoplasty type III, 38 SC tympanoplasty cases, and 22 PORP tympanoplasty cases. Age and sex distribution, success rate of hearing improvement, mean of postoperative air-bone gap (ABG), rate of middle ear adhesion were analysed according to the type of surgery. RESULTS: At 3 months after surgery, success rates of hearing improvement were 37.0%, 51.4%, 57.1% for classical tympanoplasty type III, SC tympanoplasty, PORP tympanoplasty, respectively. Means of postoperative ABG in the above listed order were 25.1 dB, 19.4dB, 17.2 dB, respectively. Hearing results were statistically better in PORP tympanoplasty when compared with other groups (ANOVA with Duncan's multiple range test). At 1 year after surgery, success rates of hearing improvement were 21.1%, 35.5%, 64.7% in classical tympanoplasty type III, SC tympanoplasty, PORP tympanoplasty, respectively. Means of postoperative ABG in the above listed order were 29.1 dB, 20.3 dB, 16.7 dB, respectively. Hearing results were statistically better in PORP tympanoplasty compared with other groups (ANOVA with Duncan's multiple range test.). Rates of middle ear adhesion were 23.1%, 54.5% in classical tympanoplasty type III, tympanoplasty using strut, respectively. CONCLUSION: In cases with intact stapes in CWD tympanoplasty, we conclude that tympanoplasty using strut is more useful for hearing improvement and prevention of middle ear adhesion than classical tympanoplasty type III; for the strut material, we found PORP more effective than autologous materials.

The Relationship between Quality of Life and Psycho-Socio-Spiritual Characteristics in Male Patients with Alcohol Dependence / 신경정신의학

OBJECTIVES: This study was designed to evaluate the relationship between quality of life (QOL) and psycho-socio-spiritual characteristics in male patients with alcohol dependence. METHODS: The sample consisted of 109 men with alcohol dependence defined by DSM-IV criteria. We assessed QOL by the WHO QOL assessment instrument-BREF (WHOQOL) and SmithKline Beecham QOL (SBQOL). Sociodemographic and alcohol related data were collected, and 7 questionnaires were administered: MAST, BDI, STAI, Drinker Inventory of Consequences (DrInC), Scale of Social Support (SSS), Religious Beliefs and Behaviors (RBB) and Spiritual Well-being Scale (SWBS). The correlations between each QOL score and other variables were examined, and stepwise multiple regression analysis was performed. RESULTS: The WHOQOL score positively correlated with education level, SSS (support) and RBB and negatively correlated with MAST, DrInC, BDI, STAI (trait) and SSS (conflict) scores. In stepwise regression analysis, the scores on the STAI and BDI contributed to the score on the WHOQOL. The SBQOL score correlated with the income level, and negatively correlated with BDI and STAI score. STAI score was a weak predictor of SBQOL score. CONCLUSION: The significant predictors of QOL in patients with alcohol dependence were psychological factors such as anxiety and depression.

The Effects of Music on Maternal Anxiety and the Evaluation of Explicit and Implicit Memory during Cesarean Section / 대한마취과학회지

BACKGROUND: Music is widely used to help a patient relax, and divert their attention from unpleasant and stressful situations. In addition, it eliminates the noise in the operating room. A light level of general anesthesia for a cesarean section is usually applied to the mother to improve the fetal safety. Therefore, there is an increased incidence of maternal explicit and implicit memory with the bispectral index (BIS) monitoring. METHODS: Fifty patients undergoing a cesarean section under general anesthesia were allocated randomly to either a control group (group 1) or a music group (group 2). Patients in group 2 listened to music with a headphone during the procedure. The blood pressure, heart rate, intraoperative awareness, postoperative explicit and implicit memory and the plasma cortisol level were assessed. RESULTS: The systolic blood pressure and heart rate were significantly lower in group 2 than group 1 at 1 minute before intubation and 5 minutes after extubation (P <0.05). The BIS value were significantly lower in group 2 than group 1 at 1 minute after intubation and 10 minutes after delivery (P <0.05). The hit ratios of the implicit of memorial test were significantly higher in the group 2 (2.4 +/- 0.7) than in group 1 (1.6 +/- 0.4) (P <0.05). The hits of the implicit memorial test had no corresponding BIS value (P <0.05). The plasma cortisol level was significantly higher group 1 than in group 2 at 30 minutes after intubation and 10 minutes after arriving at the recovery room (P <0.05). CONCLUSIONS: It was found that the music played to the mother during a cesarean section under general anesthesia decreased the anxiety and stress response, and this technique may help protect patients from unwanted explicit and implicit memory.

EDTA-dependent Pseudothrombocytopenia Confirmed by Supplementation of Kanamycin: A Case Report

EDTA-dependent pseudothrombocytopenia (PTCP) is the phenomenon of a spurious low platelet count due to EDTA-induced aggregation of platelets. Since the failure to recognize EDTA-dependent PTCP may result in incorrect diagnosis and inappropriate treatment, the recognition of this phenomenon is very important. We report an insidious case of EDTA-dependent PTCP confirmed by supplementation of kanamycin to anticoagulant in a 53-year-old women. Although sodium citrate and heparin usually prevented the aggregation of platelets in EDTA-dependent PTCP patients, these anticoagulants failed in preventing PTCP in our case. EDTA-dependent PTCP was confirmed by the findings that the clumping of platelets on microscopic evaluation was found in EDTA-anticoagulated blood samples, whereas thrombocytopenia and platelet aggregation were not revealed in the sample supplemented with kanamycin.

Multiple dose methotrexate chemotherapy in suspected medical treament failure of ectopic pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine the efficacy of multiple dose methotrexate (MTX) chemotherapy approved as a primary treatment of ectopic pregnancy in suspected medical treatment failure of ectopic pregnancy. METHODS: This study included 77 hemodynamically stable high risk ectopic pregnants diagnosed from January 1995 to June 2000 at department of Obstetrics & Gynecology, Sanggye Paik hospital, Inje university. High risk criteria of our study were adnexal ectopic mass 3.5 cm or serum-hCG 4,000 mIU/ml or presence of fetal heart beat(FHB) or presence of peritoneal fluid and fresh blood on culdocentesis. Statistics were analyzed with 2-test, Student t-test and odds ratio of each risk factors. RESULTS: The response rate of multiple dose MTX chemotherapy was 85.7%(66/70). There was no statistically difference of risk factors between success and failure group except fetal heart beat. Among 11 failure patients, there were 3 patients with adnexal ectopic mass 3.5 cm (odds ratio=1.4, 0.3~5.7), 3 patients with presence of FHB, 7 patients with presence of peritoneal fluid(odds ratio=1.0, 0.3~3.8), 8 patients with serum-hCG 4,000 mIU/ml (odds ratio=2.8, 0.7~11.6). CONCLUSION: There results suggest that multiple dose MTX chemotherapy can be treated regardless of ectopic mass size, presence of pretoneal fluid, serum beta-hCG level. But we must pay attention to treat ectopic pregnancy with presence of fetal heart beat.

A Case of Primary Tubal Choriocarcinoma / 대한산부인과학회잡지

Primary trbal choriocarcinoma is extremely rare. We have experienced a case of primary tubal choriocarcinoma and report with a brief review of its related literatures.

Effect of General Anesthesia with Isoflurane and Epidural Anesthesia Bupivacaine and Surgery on Interleukin-2 Receptor Levels / 대한마취과학회지

Inability to synthetize adequate amounts of IL-2 has been suggested to be the basis of defective T-cell function following anesthesia with the operation. The present study was designed to examine the effect of anesthesia and operation on host defence mechenism. serum soluble IL-2R(sIL-2R) levels and hemo-dynamic parameters were measured in 30 patients. Patients were divided into two groups (G: general anesthesia with isoflurane, E:epidural anesthesia with bupivacaine) according to the method of anesthesia. Venous blood samples were taken before anesthesia(T1), 10 mins after induction of anesthesia(T2), 10 mins after injection of bupivacaine in epidural anesthesia(T2), 1 hour after skin incision(T3), 30 mins after completion of operation(T4), and 24 hours after completion of operation(T5). Simultaneously arterial blood pressure and heart rate were measured. Six mililiter of perip-heral blood was obtained for sIL-2R studies in plain tubes. Serum concentration of sIL-2R was measured by human IL-2 receptor ELISA kit(Boehringer Mannheim Biochemica, Mannheim, Germany). Any significant change in IL-2R level was not seen in patients under general anesthesia with isoflurane and operation. Also any significant change in IL-2R level was not seen in patients who had an epidural anesthesia with bupivacaine and operation. The results suggest that suppression of T-lymphocyte function and decrease in lymphocyte counts induced by anesthesia and operation is not due to alteration of intracellular metabolism, but due to extracellular immune depressor. And general anesthesia operation with isoflurane as well as epidural anesthesia with bupivgcaine is safe and can be selected for immunosuppressive patients.

Effect of Anesthesia and Surgery on Serum Interleukin-6 Levels / 대한마취과학회지

Increasing evidence suggests that many of the systemic responses that occur after injury and infection are related to elabolation of cytokines by the host. Cytokines are a diverse poup of polypeptides released from activated reticuloendothelial cells, which have multiple biological activities. But there is a paucity of information on the effect of anesthesia on plasma cytokine levels and little information on cytokine release following surgery. We studied plasma cytokine levels and hemodynamic parameters during anesthesia, surgery, and post operation 1 day. Sixty patients were studied. Patients were divided into two groups (G: general anesthesia with isofiurane, E:epidural anesthesia with 0.5% bupivacaine) according to the method of anesthesia. Venous samples were collected at the following time: a baseline sample 30 minutes before induction of anesthesia, at 10 minutes after induction of anesthesia, at 30 minutes after the induction of surgery, at 30 minutes after the end of anesthesia, and at 24 hours after the end of anesthesia. Arterial blood pressure and heart rate were measured at all time. Eight mililiter of peripheral blood was obtained for interleukin-6 studies in plain tubes. Plasma concentration of IL-6 was measured by IL-6 ELISA kit(Amershem Life Science, England). The results were as follows: 1) IL-6 did not change during general anesthesia but increased 30~40 fold at 30 minutes after the end of anesthesia and at 24 hours after the end of anesthesia. 2) IL-6 did not change during epidural anesthesia but increased 10~40 fold at 30 minutes after the end of operation and at 24 hours after the end of operation. 3) Arterial blood pressure and heart rate were unchanged during this experiment and there were no relationships between the change of interleukin-6 level and the arterial blood pressure and heart rate. The results suggest that the increment of IL-6 levels may be induced by the tissue damage or reaction of stress in operation with anesthesia. Isoflurane, NO2O and bupivacaine, however, may not increase the IL-6 level. Further researches will be needed that the effects of other anesthetics selection except isoflurane and bupivacane to IL-6 level and immunological mechanism.

A case of blood aspiration due to epistaxis during nasotracheal intubation / 대한마취과학회지

Nasotracheal intubation is usually recommended when surgery in the oral cavity or on the mandible is facillitated by an unobstructed view. If the mouth is to be wired or banded shut after surgery, a nasal tube must be used. Contraindication to nasal intubation include coagulopathy, severe intranasal pathology, basal skull fracture, and presence of a cerebrospinal fluid leak. We experienced a case of blood aspiration during nasotracheal intubation. The patient was admitted for open reduction and internal fixation due to mandible fracture. On preoperative evaluation, specific problem was not noted. During nasotracheal intubation, epistaxis was developed and the aspiration of blood into the lung was occurred, accidentally. Operation was postponed and the patient was transferred to recovery room. In recovery room, a chest x-ray of left lung revealed deerease of volume, increase of interstitial marking, and more opaque finding than right lung. Arterial blood gas revealed pH 7.43, PCO2 44mmHg, PO2 61mmHg. With frequent suction, encouraging expectoration, antibiotic therapy and 0, supplementation by nasal prong, patient was nearly normalized following 5 hours after the episode of aspiration. Carefully, retrial of nasotracheal intubation was done one week later under the preparation of bosmin (Jeil pharmacy) nasal packing and lubricated endotracheal tube. Intubation and the operation was finished uneventfully.

Two Cases of adverse reactions of vancomycin administration in the perioperative period / 대한마취과학회지

Antibiotics are frequently administered for prophylaxis during anesthesia . Vaneomycin has increasingly become the antibiotic of choice due to the rising incidenee of resistant staphylococcal infections. Patients allergic to penicillin are candidates for vancomycin. Commonly reported adverse reactions of vancomycin include ; fever,chills, nausea, pain at the injection site, phlebitis, nephrotoxicity, ototoxicity, hypotension, cardiac arrest, broncho- spasm, noncardiogenic pulmonary edema and the so-called Red-Man's syndrome or Red Neck syndrome, Recently, we encountered two patients who had adverse reactions of vancomycin perioperatively. Vancomycin induced hypotension usually results from a negstive inotropic and vasodilator effect produced by a histamine-release phenomenon, which occurs most commonly with rapid intravenous infusion of the drug. Such a release of histarnine may also produce an acute urticarial flushing of the upper torso ("Red Neek syndrome"), pain and muscle spasm in the chest or parasternal muscles, which may mimic myocardial infarction. These effects usually abate promptly when the infusion of vancomycin is discontinued, and their resolution may be expedited by sdministration of an inotropic agent.

The Effect of MgSO4 on the Duration of Epinephrine - induced Arrhythmia Compared to the Effect of Lidocaine in Halothane Anesthetized Rabbits / 대한마취과학회지

The effect of mgSO4 on epinephrine-induced arrhythmia were evaluated in twenty male rabbits anesthetized with halothane. Epinephrine was given intravenously at a rate of 5 mcg/Kg/min by a constant volume infusion pump until two or more premature ventricular contractions occured. The arrhythmogenic dose of epinephrine was determined to be the dose at which the onset of arrhythmia occured. Thirty seconds after the onset of arrhythmia, either mgSO4 8mg/kg(group 1, n=10) or lidocaine 1.5mg/kg(group 2, n=10) was injected and repeated at 30 second intervals up to 4 times until normal sinus rhythm returned. Intravenous injection of mgSO4 decreased the duration of arrhythmia. The arrhythmia duration of group 1(78.5+/-23.9 sec) was shorter than group 2(92.5+/-46.1 sec) but which was statistically insignificant. Two cases of group 1 and four cases of group 2 did not treated by antiarrhythmic agents, but there were not statistically significant. The results of this study show that compared to lidocaine, mgSO4, had a shorter duration of epinephrine-induced cardiac tachyarrhythmia although it was not statistically significant. However malignant ventricular tachyarrhythmia not controllable with lidocaine and other conventional drugs, mgSO4 infusion is recommended.

A Comparative Study of the Prolongation of Epidural Anesthesia with 0.5 % Bupivacaine by Epinephrine and Clonidine / 대한마취과학회지

Epidural clonidine is reported to produce analgesia in humans. To investigate the analgesic effect and prolongation of epidural and spinal anesthesia, we mixed 0.2mg epinephrine, 150 mcg clonidine, or 1 cc normal saline with 0.5% bupivacaine and compared the hemodynamie and analgesic effects of each drug. Heart rate and blood pressure were checked before, during and after anesthesia. Sensory level was checked by pin-prick method. The results were as follows; 1) The analgesia onset time and the time to highest level of sensory loss was most rapid in the epinephrine group. 2) The two segment regression time was significantly prolonged in the epinephrine group. 3) The analgesia duration was significantly prolonged in the clonidine and epinephrine group. 4) Although the heart rate gradually decreased over 60 min. After injection of each drug, there was no significant change between the groups. 5) Blood pressure decreased over 20-30 min. After injection of each drug, but there was no significant change between the groups.