P2X and P2Y Receptors Mediate Contraction Induced by Electrical Field Stimulation in Feline Esophageal Smooth Muscle

It is well-known that electrical field stimulation (EFS)-induced contraction is mediated by a cholinergic mechanism and other neurotransmitters. NO, ATP, calcitonin gene-related peptide (CGRP), and substance P are released by EFS. To investigate the purinergic mechanism involved in the EFS-induced contraction, purinegic receptors antagonists were used. Suramine, a non-selective P2 receptor antagonist, reduced the contraction induced by EFS. NF023 (10(-7)~10(-4) M), a selective P2X antagonist, inhibited the contraction evoked by EFS. Reactive blue (10(-6)~10(-4) M), selective P2Y antagonist, also blocked the contraction in a dose-dependent manner. In addition, P2X agonist alpha,beta-methylene 5'-adenosine triphosphate (alphabetaMeATP, 10(-7)~10(-5) M) potentiated EFS-induced contraction in a dose-dependent manner. P2Y agonist adenosine 5'-[beta-thio]diphosphate trilithium salt (ADPbetaS, 10(-7)~10(-5) M) also potentiated EFS-induced contractions in a dose-dependent manner. Ecto-ATPase activator apyrase (5 and 10 U/ml) reduced EFS-induced contractions. Inversely, 6-N,N-diethyl-D-beta,gamma-dibromomethylene 5'-triphosphate triammonium (ARL 67156, 10(-4) M) increased EFS-induced contraction. These data suggest that endogenous ATP plays a role in EFS-induced contractions which are mediated through both P2X-receptors and P2Y-receptors stimulation in cat esophageal smooth muscle.

Event-Related Functional Magnetic Resonance Imaging in Post-Traumatic Stress Disorder / 신경정신의학

OBJECTIVE: Symptom provocation paradigms using event-related functional magnetic resonance imaging(fMRI) can be an important tool to visualize neuroanatomic correlates of PTSD symptoms. The purpose of this study is to measure regional changes of brain upon exposure to fear stimulus and elucidate the probable relation between signal changes and fear response in PTSD. METHOD: Event-related fMRI was performed during a task where traffic accident-related photos and checkerboards were presented in 9 women with PTSD and 9 woman normal controls in unpredictable order. MRI data were acquired on a 1.5 T GE vision system with a head volume coil. Stimuli were presented on a mirror mounted on the head coil. A total of 200 functional images were taken during a 10-minute scanning session. TR was 3 seconds and inter-stimulus time was varing 4.5 to 11.5 seconds. Data was analyzed using SPM99. RESULTS: In PTSD group, the fear conditions versus the neutral conditions showed activations in both occipital cortex, both fusiform gyrus, left parietal lobule, both insula, right cerebellar tonsil, right putamen, right claustrum, but deactivations in both prefrontal gyrus(p<0.001). In normal control group, activation were found for the fear conditions as compared with the neutral conditions in left fusiform gyrus, both occipital cortex, left parietal lobule, right frontal lobule(p<0.001). CONCLUSIONS: Emotion provocation paradigm using event-related functional magnetic resonance imaging can be applied to illustrate fear response mechanism in PTSD. The result suggests that insula, limbic lobe, cerebellum may play a role in mediating fear response in PTSD.

A Case of Progressive Supranuclear Palsy with Schizophrenic Symptoms / 신경정신의학

We have experienced a rare case of progressive supranuclear palsy with hallucination and delusion. The common manifestations of progressive supranuclear palsy are gait disturbance, mental change and sign of vertical ophthamoplegia but no efficacious therapy has been known. Neuropsychiatric symptom clusters include cognitive impairment, affective and behavioral changes, sleep disturbance, and psychotic symptoms. Though schizophrenia-like psychosis has been reported but this is certainly rare. Addressing a case of progressive supranuclear palsy, in whom parkisonian symptoms appeared with concurrent psychotic symptoms, we emphasize accurate diagnosis.

Alteration in Collagen Concentration and Subtypes of Corpus Cavernosum of Rats with Veno-occlusive Priapism / 대한남성과학회지

PURPOSE: This study was undertaken to investigate the serial alteration of collagen after resolution of the priapism in mechanically induced veno-occlusive priapism of rat model. METHODS: Sprague-Dawley male rats were used and divided into control and experimental groups (3, 6, 12, 24 and 48 hours according to the duration of ischemic time). The corpora were dissected out at 4 weeks after the relief of veno-occlusive condition, and then the collagen concentration was quantified. Type I, III and IV collagen were determined by immunohistochemical staining. RESULTS: The corporal collagen concentration showed significant increase in the groups of 12, 24, 48 hours of ischemic time. Types III collagen did not increased in intensity, but type I & IV collagen showed gradual increase in intensity according to the time interval of ischemic period. CONCLUSIONS: The irreversible collagen alteration in corpus cavernosum with veno-occlusive priapism occurred in case of 12 or more hours of ischemic time before resolution. Earlier non-surgical management is necessary for the patients to be safe from further cumulative damages either by recurrent episode or other kinds of disease.

The Surgical Treatment of the Mallet Finger Deformity Due to Extensor Tendon Injury in Children / 대한정형외과학회잡지

To define the effectiveness of surgical management of the mallet finger deformity due to extensor tendon injury in children, we analyzed 9 patients who had operative treatment of mallet finger deformity in children from Jan. 1994 to Mar. 1997. The types of tendon injury in this series were as follows: 7 cases with tendon laceration, 1 case with crushing injury and 1 case with unknown injury The average period of follow up were ranged 2 years and 1 month. The clinical results were evaluated hy Kanies seale12) and Crawford scale5). An excellent result was obtained in 4 cases(44%), a good result in 5 cases(56%) according to Crawford scale and excellnt result in 9 cases(I00%) in Kanies scale, consecutively. Meticulous surgical repair of the lacerated tendon provided good result.

Anesthesia for Coronary Artery Bypass Grafting without Extracorporeal Circulation: One case report / 대한마취과학회지

Coronary artery bypass grafting (CABG) without extracorporeal circulation (ECC) is now an accepted technique of myocardial revascularization in selective cases of coronary arterial occlusive disease. We experienced a case of CABG without ECC in a 20 year old female patient with complete occlusion of the right coronary artery. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. Nitroglycerine and dopamine were given to stabilize the hemodynamics during intra- and post-operative periods. And esmolol was administered with a loading dose of 30 mg over 1 min, followed by a continuous infusion of 50~100 g/kg/min to maintain the heart rate (50~60 beats/min) and systolic blood pressure (60~80 mmHg) during distal anastomosis. The patient was recovered uneventfully and discharged on the 8th postoperative day.

Anesthetic Experience of Dynamic Cardiomyoplasty: A case report / 대한마취과학회지

Dynamic cardiomyoplasty is a recently introduced surgical method to improve myocardial performance. It consists of a placement of a skeletal muscle flap around the heart and stimulation of the flap in synchrony with ventricular contraction. We experienced a case of cardiomyoplasty in a 25 year old male patient with congestive heart failure. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. The operation was performed for 8hrs without cardiopulmonary bypass and the patient was transferred to the intensive care unit. He was mechanically ventilated electively overnight and extubation was done 18hrs postoperatively. The patient was discharged home on the 40days after operation and improved in exercise tolerance. We report the anesthetic management and hemodynamic changes in a patient who underwent dynamic cardiomyoplasty.

A Comparison of Inhalation Anesthesia with Enflurane and Intravenous Anesthesia with Ketamine Hydrochloride in Lung Surgery of Patients with Decreased Pulmonary Function / 대한마취과학회지

BACKGROUND: Serious pulmonary complications after lung surgery increase morbidity and mortality in perioperative period. Ketamine hydrochloride produces strong analgesic effect in spite of the psychomimetic effects. Intravenous anesthesia with ketamine was performed in lung surgery of patients with decreased pulmonary function and compared with inhalation anesthesia with enflurane. METHODS: Sixty patients, scheduled for elective lung surgery, were randomly assigned to two groups. Patients received either enflurane (Group 1, n=30) or ketamine (Group 2, n=30) as main anesthetic drug. Blood pressure and heart rate were compared in preinduction, postinduction, postintubation, postincision, intraoperative period (30 minutes, 60 minutes) and recovery room between groups, and in each group. Arterial blood gas analysis was compared in preoperative period, intraoperative period and recovery room between groups. Postoperative psychological complications evaluated in group 2. RESULTS: Blood pressure and heart rate were significantly different in postinduction, postintubation and recovery room between groups. PaO2 in group 2 was higher than in group 1 during intraoperative period and recovery room. Postoperative psychological complications occured in 4 patients (13%) in group 2. CONCLUSIONS: Ketamine affords advantage over enflurane anesthesia in terms of PaO2 during intraoperative period and recovery room in lung surgery of patients with decreased pulmonary function.

Anesthesia for Heart Transplantation in a Jehovah,s Witness: A case report / 대한마취과학회지

Jehovah,s Witnesses who require operation represent a challenge to the physician because of the patient,s refusal to accept blood transfusion. An orthotopic heart transplantation was succesfully performed in a 40-year old Jehovah,s Witness without use of any blood product. During the operation, cell saver was used for shed blood and aprotinin was administered intravenously. The use of blood conserving methods, meticulous operative technique and brisk postoperative diuresis has added to the efficacy of heart transplantation in this patient. Total postoperative drainage was 860 ml and the lowest hemoglobin level was 11.8 g%. The patient recovered uneventfully and discharged on the 60th postoperative day.

A Case or Ectopic Paragonimus Westermani in the Adrenal Gland / 대한비뇨기과학회지

Paragonimiasis is a chronic inflammatory process which frequently involve to the lung. The lung is the main site of infection with Paragonimus westermani, but any place of the body including brain, orbit, liver, intestinal wall, diaphragm, subcutaneous tissue, and etc. may be infected with the larva We report a case of ectopic Paragonimus westermani arising from the adrenal gland, in 70-year-old male.