Evaluation of Near-infrared Fluorescence-conjugated Peptides for Visualization of Human Epidermal Receptor 2-overexpressed Gastric Cancer

Purpose@#A near-infrared (NIR) fluorescence imaging is a promising tool for cancer-specific image guided surgery. Human epidermal receptor 2 (HER2) is one of the candidate markers for gastric cancer. In this study, we aimed to synthesize HER2-specific NIR fluorescence probes and evaluate their applicability in cancer-specific image-guided surgeries using an animal model. @*Materials and Methods@#An NIR dye emitting light at 800 nm (IRDye800CW; Li-COR) was conjugated to trastuzumab and an HER2-specific affibody using a click mechanism. HER2 affinity was assessed using surface plasmon resonance. Gastric cancer cell lines (NCI-N87 and SNU-601) were subcutaneously implanted into female BALB/c nu (6–8 weeks old) mice.After intravenous injection of the probes, biodistribution and fluorescence signal intensity were measured using Lumina II (Perkin Elmer) and a laparoscopic NIR camera (InTheSmart). @*Results@#Trastuzumab-IRDye800CW exhibited high affinity for HER2 (KD =2.093(3) pM).Fluorescence signals in the liver and spleen were the highest at 24 hours post injection, while the signal in HER2-positive tumor cells increased until 72 hours, as assessed using the Lumina II system. The signal corresponding to the tumor was visually identified and clearly differentiated from the liver after 72 hours using a laparoscopic NIR camera. AffibodyIRDye800CW also exhibited high affinity for HER2 (KD =4.71 nM); however, the signal was not identified in the tumor, probably owing to rapid renal clearance. @*Conclusions@#Trastuzumab-IRDye800CW may be used as a potential NIR probe that can be injected 2–3 days before surgery to obtain high HER2-specific signal and contrast. Affibodybased NIR probes may require modifications to enhance mobilization to the tumor site.

The MRI Findings of Flexor Digitorum Accessorius Longus Muscle: a Case Report

The flexor digitorum accessorius longus (FDAL) is the most common accessory muscle found in the posterior compartment of the ankle area. The accessory muscle in this area such as the FDAL may be incidentally identified on magnetic resonance images (MRI). There are some case reports about the FDAL in cadaver researches. However, the MRI findings about the FDAL have been reported in a few cases. In this paper, we report a case of the FDAL incidentally identified on MRI with review of the literature about the FDAL.

The Relationships between Administration Time of Pyridostigmine and the Recovery of Vecuronium-induced Neuromuscular Blockade / 대한마취과학회지

BACKGROUND: The timing of administration may be an important factor in order to obtain maximal antagonizing effect of anticholinesterase on neuromuscular blockade. The objective of this study is to seek for the optimal administration time of pyridostigmine for reducing the recovery time of vecuronium. METHODS:Thirty patients were devided into three groups,who were receiving intravenously pyridostigmine (0.2 mg/kg) at 10% (group 1), 20% (group 2) and 25% (group 3) recovery of T1. The recovery indices (RI: time taken for T1 to recover from 25 to 75% of control) and recovery time (time taken for T1 to recover from 5% to 20, 25, 50 & 75%) in vecuronium (0.1 mg/kg) neuromuscular blockade were checked and compared between 3 groups using train of four stimulation with Relaxograph(Datex co., Finland). RESULTS: The recovery time (T5-20, T5-25, T5-50, T5-75) was significantly faster in the group 1 than the group 3. But there were no significant differences in recovery indices (RI) between 3 groups. CONCLUSIONS: Provided there is a slightest evidence of spontaneous recovery, early administration of anticholinesterse will reduce the recovery time of nondepolarizing neuromuscular block. But it can not affect the dissociation rate of vecuronium (KD) and there were no significant differences in recovery indices.

The Rebleeding of Ruptured Intracranial Aneurysm during Induction of Anesthesia / 대한마취과학회지

The intraoperative rupture of an intracranial aneurysm can dramatically interrupt the fine operative procedure and jeopardize the patient's chance for meaningful survival. A sudden increase of the arterial pressure and intracranial pressure during laryngoscopy and intubation is potentially dangerous and may lead to fresh bleeding from an aneurysm in patient with recent subarachnoidal hemorrhage due to aneurysmal rupture. But aneurysmal rupture during induction occurs rarely. Recently we experienced rebleeding due to sudden increased arterial blood pressure during laryngoscopy and intubation in 39 years old female patient who was scheduled for clipping of ruptured intracranial aneurysm on 11th day after ictus. And she died of cerebral death on 6th postoperative day. Here we discuss the incidence, prognosis, diagnosis, management and prophylaxis of the aneurysmal rupture during induction with a brief review of the literature.