Conversion phenomenon during the induction period of general anesthesia: A case report / 대한마취과학회지

Conversion disorder is characterized as psychological symptoms such as somatization and emotional distress, but there is no abnormal electrical signal in the brain. We report a patient who appeared conversion disorder during the induction period of general anesthesia. A 45-year-old woman was planned for arthroscopic knee meniscectomy. In the operating room, she appeared stable, but she said extremely nervous in this situation. Before propofol injection for induction of anesthesia, we injected 1% lidocaine 50 mg iv for pain relief. Immediately after injection, she showed general seizure-like activity and then tonic-rigid muscle tone, dyspnea with periodic breathing without cyanosis, and clouding of consciousness. The operation was delayed, and she was examined by neurosurgeon and psychiatrist. She was diagnosed as suffering with conversion disorder and she was without brain abnormalities on the magnetic resonance imaging. Her condition improved after anti-depressant medication and supportive psychotherapy. She underwent uneventful knee surgery 40 days later.

Extracellular HIV-1 Tat enhances monocyte adhesion by up-regulation of ICAM-1 and VCAM-1 gene expression via ROS-dependent NF-kappaB activation in astrocytes

One of characteristic features of AIDS-related encephalitis and dementia is the infiltration of monocytes into the CNS. HIV-1 Tat was demonstrated to facilitate monocyte entry into the CNS. In this study, we examined the effect of HIV-1 Tat on the expression of adhesion molecules, generation of reactive oxygen species (ROS) and NF-kappaB activation in CRT-MG human astroglioma cells. Treatment of CRT-MG cells with HIV-1 Tat protein significantly increased protein and mRNA levels of ICAM-1 and VCAM-1, as measured by Western blot analysis and RT-PCR, indicating that Tat increases these protein levels at an mRNA level. In addition, Tat induced the activation of NF-kappaB in astrocytes. Treatment of CRT-MG with NF-kappaB inhibitors led to decrease in Tat-induced protein and mRNA expression of ICAM-1 and VCAM-1. Furthermore, HIV-1 Tat protein increased ROS generation. Inhibition of Tat-induced ROS generation by N-acetyl cysteine, vitamin C and diphenyl iodonium suppressed Tat-induced NF-kappaB activation, ICAM-1 and VCAM-1 expression, and monocyte adhesion in CRT-MG. These data indicate that HIV-1 Tat can modulate monocyte adhesiveness by increasing expression of adhesion molecules such as ICAM-1 and VCAM-1 via ROS- and NF-kappaB-dependent mechanisms in astrocytes.