Effects of Insulin-like Growth Factor-I and 1,25-(OH)2 Vitamin D3 Concentration on Intrauterine Growth of Newborns from Mothers with Preeclampsia / 소아과

PURPOSE: This study was undertaken to observe the blood levels of IGF-I and 1,25-(OH)2 Vit. D3 in maternal and neonatal compartments and the effects of IGF-I concentration on intrauterine fetal growth and 1,25-(OH)2 Vit. D3 metabolism in the presence of preeclampsia. METHODS: Thirty-four full-term pregnant women with preeclampsia and their newborns(preeclampsia group) and 10 normotensive full-term pregnant women and their newborns(normotensive group) were observed. IGF-I and 1,25-(OH)2 Vit. D3 concentrations in maternal and umbilical cord blood were analysed. RESULTS: Maternal and umbilical cord blood levels of IGF-I and 1,25-(OH)2 Vit. D3 were significantly lower in the preeclampsia group than in the normotensive group. In the preeclampsia group, maternal and cord blood levels of IGF-I of small-for-gestational age newborns were significantly lower than those of appropriate-for-gestational age newborns. The birth weight and length of newborns correlated with IGF-I concentrations of maternal and umbilical cord blood in small-for-gestational age newborns of preeclampsia group. The correlation between IGF-I and 1,25-(OH)2 Vit. D3 was significant in the umbilical cord blood of preeclampsia group, but only in appropriate-for-gestational age newborns. CONCLUSION: It is suggested that the lower level of IGF-I is the primary factor of intrauterine growth retardation in preeclampsia, and the effect of IGF-I on the metabolism of 1,25-(OH)2 Vit. D3 is different according to the presence of preeclampsia and intrauterine fetal growth retardation.

Characterization of the Pulmonary Circulation According to Hemodynamic Changes by Computed Tomography

Increased or decreased pulmonary blood flow (PBF) and an increased pulmonary vascular resistance (PVR), represent common and important change in pulmonary hemodynamics. In this study, we constructed 3 hemodynamic models in 5 dogs, that is, an increased and a decreased PBF model, and an increased PVR model. A CT perfusion scan was performed in each hemodynamic model. Perfusion parameters including blood flow (BF), blood volume (BV), mean transit time (MTT), and maximal slope (MS) were calculated automatically by specialized software and analyzed for changes according to hemodynamic status. In terms of the normal state, blood flow was affected by gravity and dependent area showed higher BF and BV and lower MS and MTT than the non-dependent area. The decreased PBF model showed a significant increase in BF and MS (p=0.046, 0.005) but no significant change in BV (p > 0.05), and a slight elongation of MTT (p > 0.05) versus the normal state. The increased PBF model showed a slightly increased BV and a slightly decreased MTT (p > 0.05). The increased PVR model showed significant reduction in BF, BV, and MS (p 0.05). However, it was noticeable that the distribution of MTT with respect to gravity in the normal lung was completely reversed in the increased PVR model. In conclusion, based on our understanding of perfusion characteristic in normal state, abnormal regional hemodynamic changes in the lung can be detected and evaluated. Predicting changes in pulmonary vascular resistance should be possible by a thorough analysis of CT perfusion parameters.

Experimental Congenital Diaphragmatic Hernia in a Fetal Lamb Model (I)

PURPOSE: The purpose of this study was to construct a fetal animal model of congenital diaphragmatic hernia in a lamb under domestic environments. METHODS: Left-sided diaphragmatic hernias were created in seven fetal lambs at about 85 days' gestation (experimental group). Three other fetal lambs did not receive any surgical procedure and served as control group. Four of these lambs (3 in the experimental group and 1 in the control group) were delivered after a sufficient intrauterine period. The morphological changes of lung development were compared between the two groups. RESULTS: Creation of diaphragmatic hernia resulted in marked hypoplasia in fetal lung development. In this experiment, the maternal mortality was 33.3%, and the fetal mortality was 60% which are relatively high as compared with previous reports. CONCLUSION: From this data, the authors concluded that experimental fetal diaphragmatic hernia can be established although the technique for the measurement of gestational age, anesthesia and postoperative care should be improved to overcome domestic inexperience in using the lamb as an experimental animal.

A Case of Transfusion Complication under General Anesthesis / 대한마취과학회지

Transfusion complications include ABO/Rh incompatibility, sepsis, febrile reaction, immunosuppression, and viral transmission. We experienced a case of anaphylactic reaction in a 40-year-old male scheduled for laminectomy. Anesthesia was induced by intravenous (I.V.) thiopental sodium and maintained with enflurane / N2O / oxygen. Vital signs were stable until 2 hours into surgery, when patient developed sudden profound hypotension (systolic pressure 60 mmHg) with tachycardia, skin flushing and bronchial wheezing shortly after infusion of only a few milliliters of 4th unit of whole blood. Blood transfusion was immediately stopped, anesthetic agents were discontinued, and 100% oxygen was administered. Rapid administration of I.V. fluids was begun and I.V. hydrocortisone along with pheniramine were administered. Patient was successfully treated and eventually discharged from the hospital. In conclusion, besides hemolytic transfusion reaction, anaphylactic transfusion reaction may cause severe hypotension. One should be aware of the potential for adverse effects including anaphylaxis, should recognize them immediately and treat them appropriately.

The Effects of Lidocaine and Propranolol on the Heart Rate and Blood Pressure during Halothane-N2O Anesthesia / 대한마취과학회지

It is well known that lidocaine and propranolol possess antiarrhythmic properties. In addition, the former has direct myocardial depressant effects with indirect stimulant effects mediated by the autonomic nervous system and the latter has negative chronotropic, inotropic and dromotropic effects through beta-adrenergic blockade. The heart rate is one of the principle determinants of myocardial oxygen demand, so prevention and treatment of tachycardia are very important during anesthesia. Therfore, the present study was undertaken to evaluate the effects of lidocaine(1mg/kg) and propranolol (0.02mg/kg) on the heart rates and blood pressures in patients with tachycardia(100~120 beats per minute) under halothane-nitrons oxide anesthesia. The results were as follows: 1) In the lidocaine receiving group, the heart rate and blood pressure decreased slightly, but these changes were not statistically significant. 2) in the propranolol receiving group, the heart rate decreased significantly and reached steady value(13bpm, p<0.01) at 7 min and blood pressure decreased slightly, but these changes were not statistically significant. 3) In propranolol-lidocaine mixture receiving group, heart rate decreased significantly and reached to steady value(13bpm, p<0.01) at 5 min and systolic blood pressure decreased about 5 torr(p<0.05), but the diastolic blood pressure remained unchanges. From the above results, it is suggested that the lidocaine and propranolol mixture rather than individual is more valuable in restoring the heart rate and blood pressure to normal value.

The Study of the Effect on s-GOT, s-GPT after the Enflurane Auesthesia / 대한마취과학회지

In order to observe the effect on liver function after exposure to enlurane which has relatively minimal hepatotoxic effect, we evaluated the changes of the s-GOT & s-GPT levels caused by general anesthesia with enflurane. This study was undertaken to evaluate the effect of enflurane on liver function by comparing the preoperative and postoperative(1st day, 3rd day, 5th day, and 7th day) liver function(s-GOT & s-GPT) tests is il cases of the first general anesthesia with enflurane and 15 cases of a second general anesthesia with enflurane. The results were as folllows: 1) The 1st operative group. a. There are 5 cases (45%) of significant changes of s-GOT levels and no case of significant change in sGPT levels. b. In most of cases, the level of s-GOT & s-GPT have returned to normal values on the 7th postoperative day. 2) The 2nd operative group. a. The increase in the levels of s-GOT was found in 10 cases, and the s-GPT in 6 cases. b. Postoperatively, the simultaneous increase in the levels of s-GOT & s-GPT were found in 4 cases. c. On the 7th postoperative day, the levels of s-GOT & s-GPT was not normal in 3 cases, and not normal for s-GPT in 2 cases. The above results show that the higher of levels of s-GOT & s-GPT after the second general anesthesia with enflurane apparent compared to the levels after the first general anesthesia with enflurane. And it can be assumed that the extreme precaution is necessary in conduction the second general anesthesia with enflurane.