Postoperative Thrombotic Microangiopathy with the Combined Administration of Tranexamic Acid and Batroxobin: Two Case Reports

Thrombotic microangiopathy (TMA) is a clinical syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ damage. When TMA is suspected, accurate diagnosis is required; however, differential diagnosis is often difficult because each patient has various clinical features, and the causes of triggers may overlap. We report two cases of TMA that developed after surgeries in patients, with the combined administration of tranexamic acid and batroxobin intraoperatively. We need to consider the risk of adverse effects of the concomitant use of tranexamic acid and batroxobin for anesthetic management.

Epidural analgesia versus intravenous analgesia after minimally invasive repair of pectus excavatum in pediatric patients: a systematic review and meta-analysis / 대한마취과학회지

Background@#Postoperative pain control after the minimally invasive repair of pectus excavatum (MIRPE) is essential, but there is a controversy about a better analgesic method between epidural and intravenous (IV) analgesia. This systematic review and meta-analysis aimed to compare the effect of epidural versus IV analgesia following MIRPE. @*Methods@#We searched PubMed, MEDLINE, EMBASE, Cochrane Central Register, and ClinicalTrials.gov for randomized controlled trials (RCTs) dated up to 31st May 2021. The primary outcome was the area under the curve (AUC) of the weighted mean visual analog scale (VAS) after MIRPE. The secondary outcomes were postoperative nausea, operation time, total operating room time, and postoperative length of hospital stay. @*Results@#Four RCTs involving 243 patients were finally included in this meta-analysis. The AUC of the weighted mean VAS was 343.62 in the epidural group and 375.24 in the IV group. The epidural group showed lower VAS than the IV group at 12 to 48 h after the surgery. Postoperative nausea, operation time and length of hospital stay was not different between two groups. The epidural group had a significantly longer total operating room time due to epidural catheter insertion time. @*Conclusions@#Epidural analgesia after the MIRPE had a better analgesic effect than IV analgesia. However, IV analgesia may also be a viable option, and physicians should wisely choose analgesic modalities after MIRPE.

Postoperative Thrombotic Microangiopathy with the Combined Administration of Tranexamic Acid and Batroxobin: Two Case Reports

Thrombotic microangiopathy (TMA) is a clinical syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ damage. When TMA is suspected, accurate diagnosis is required; however, differential diagnosis is often difficult because each patient has various clinical features, and the causes of triggers may overlap. We report two cases of TMA that developed after surgeries in patients, with the combined administration of tranexamic acid and batroxobin intraoperatively. We need to consider the risk of adverse effects of the concomitant use of tranexamic acid and batroxobin for anesthetic management.

Epidural analgesia versus intravenous analgesia after minimally invasive repair of pectus excavatum in pediatric patients: a systematic review and meta-analysis / 대한마취과학회지

Background@#Postoperative pain control after the minimally invasive repair of pectus excavatum (MIRPE) is essential, but there is a controversy about a better analgesic method between epidural and intravenous (IV) analgesia. This systematic review and meta-analysis aimed to compare the effect of epidural versus IV analgesia following MIRPE. @*Methods@#We searched PubMed, MEDLINE, EMBASE, Cochrane Central Register, and ClinicalTrials.gov for randomized controlled trials (RCTs) dated up to 31st May 2021. The primary outcome was the area under the curve (AUC) of the weighted mean visual analog scale (VAS) after MIRPE. The secondary outcomes were postoperative nausea, operation time, total operating room time, and postoperative length of hospital stay. @*Results@#Four RCTs involving 243 patients were finally included in this meta-analysis. The AUC of the weighted mean VAS was 343.62 in the epidural group and 375.24 in the IV group. The epidural group showed lower VAS than the IV group at 12 to 48 h after the surgery. Postoperative nausea, operation time and length of hospital stay was not different between two groups. The epidural group had a significantly longer total operating room time due to epidural catheter insertion time. @*Conclusions@#Epidural analgesia after the MIRPE had a better analgesic effect than IV analgesia. However, IV analgesia may also be a viable option, and physicians should wisely choose analgesic modalities after MIRPE.

Herpes Simplex virus thymidine kinase gene therapy delivered by retroviral or adenoviral vector in mouse model of lewis lung carcinoma / 결핵

BACKGROUND: The antitumor effects of herpes simplex virus thymidine kinase(HSV-tk) and ganciclovir(GCV) strategies for cancer gene therapy have a the following advantages:1) a direct cytotoxicity to HSV-tk modified cancer cells by GCV 2) a cell death by the local transfer of toxic metabolites from the HSV-tk modified cells to nearby unmodified tumor cells(bystander effect), and 3) in vivo bystander effect such as antitumor-immunity. Retroviral and adenoviral sequences can silence transgene expression in cells and mice. In this study, we investigated the above described advantages of HXV-tk/GCV strategy in Lewis lung cell and mouse lung cancer model using retroviral vector and adenoviral vector. Also, we observed whether the expression of a silenced gene can be reactivated by treating cell with butyrate. METHODS: Retrovirus-HSV-tk and adenovirus-HSV-tk vectors were used for the transduction of Lewis lung carcinoma(LLC) cells. The change of HSV-tk expression by butyrate was measured by Western blot.The antitumor activities containing bystander effect were observed in vivo(by MTT assay) and in vivo tumor models of various combinations of LLC and LLC-tk. RESULTS: 1. Butyrate induced the enhancement of HSV-tk expression from adenovirally transduced cells but not from retrovirally transduced cells. 2. Both retrovirus-HSV-tk and adenovirus-HSV-tk vectors with GCV treatment were effective for killing of tumor cell in vitro and suppression of LLC tumorigenicity. Bystander effect was responsible for killing of mixture of LLC-tk and LLC in vitro and in vivo-tumorigenicity model. CONCLUSION: Butyrate could augment adenoviral vector seems to be an effective approach for lung cancer therapy.

Comparison of MR Myelography with Conventional Myelography in Lumbar Disc Diseases

PURPOSE: To compare MR myelography(MRM) using heavily T2 weighted fast spin echo(FSE) with conventional myelography in the evaluation of lumbar degenerative disc diseases. MATERIALS AND METHODS: A total of 50 patientswith lumbar degenerative disc diseases underwent both MRM and conventional myelography. A 1.5 T Signa MR systemwas used. For MRM, heavily T2 weighted FSE pulse sequences were performed in sagittal, coronal and both obliqueplanes. The images of MRM and conventional myelography were analyzed retrospectively and compared, focusing on the pattern of compression of the thecal sac and nerve roots. RESULTS: MRM yielded comparable images to conventional myelography in 68% (34/50). MRM was superior to conventional myelography in 11 cases (22%), and the opposite resulted in 5 cases(10%). MRM could visualize the spinal canal below the level of complete block in 6 patients,provided better contrast in the cases of dural ectasia in 3 cases and better delineation of individual nerve roots with source images in 1 case. Additional informations such as incidental retroperitoneal vascular malformation and extravasation of the CSF could be obtained by MRM in 1 case each. Disadvantages of MRM were poor contrast in thecases of multiple spinal stenosis, obscuration of the nerve roots by engorged paraspinal vessels, and occassional difficulty in defining the levels due to vanishment of the bony background image. CONCLUSION: MRM is a safe, noninvasive, nonionizing modality which in very effective in evaluating the lumbosacral disc disease. Use ofFSE-MRM in addition to the routine MR imaging could be very helpful not only for better evaluation of nerve roots but also for the additional informations.

Intravenous Magnetic Resonance Arthrography of the Knee

PURPOSE: Knee IVIR images were repeatedly obtained after intravenous administration of gadopentetate dimeglumine to evaluate the arthrographic effect and to determine the optimal scan timing and technique. MATERIALS AND METHODS: Sagittal Tl-weighted (650/15) sequences were repeated before and after intravenous gadolinium enhancement in 26 patients who were divided into exercise (14/26) and nonexercise (12/26) groups. Fourteen patients in exercise group were allowed to move the affected knee joint actively for 10 minutes immediately after the first post-enhancement scan and before repeating scans. The signal intensities in central and peripheral portions of the joint were measured and compared between these two groups. RESULTS: In all cases, enhancement of joint fluid began at peripheral portion and progressed toward central portion. The diffusion rate in exercise group was far faster than that in nonexercise group and homogeneous arthrographic image was revealed within 10 minutes after completion of joint movement. The arthrographic effect continued and the rate of signal decrease was quite slow. CONCLUSION: MR arthrographic image of knee joint can be obtained within 10 minutes after completion of a few minute exercise following intravenous injection of gadopentetate dimeglumine. Intravenous MR arthrography is expected to become an useful method as a convenient alternative to direct MR arthrography.

CT Evaluation of Maxillary Sinus Aspergillosis: Morphological Patterns on CT

PURPOSE: In order to classify the involving patterns of maxillary sinus aspergillosis on CT that will be an important guidance for functional endoscopic sinus surgery(FESS) and to evaluate CT findings of each pattern. MATERIALS AND METHODS: We reviewed CT findings of 37 cases of maxillary sinus aspergillosis which were confirmed pathologically. These were classified into three patterns according to the location:the maxillary pattern(I), the infundibular pattern(11), and combined pattern(Ill). All cases were correlated with FESS findings. We also evaluated CT density, presence of contrast enahncement and calcifications, and surrounding bony changes of each pattern. RESULT: The combined pattern was most commonly seen in 24 of 37 cases(64.9%). The maxillary pattern was identified in 8(21.6%), with 5(13.5%)cases demonstrating the infundibular patttern. These patterns were consistent with FESS findings. Calcifications were seen in 28 cases(75.7%). 31 cases(83.8%) revealed hypodensity and 16cases among them showed peripheral enhancement. Central high density with peripheral low density rim was shown in 25%(2/8) of the maxillary pattern and 12.5%(3/24) of combined patttern. Surrounding bony changes were noted mainly in infundibular pattern and combined pattern. Erosion of uncinate process showed all cases of both patterns. Erosion or elevation of ethmomaxillary plate was seen in 3 of 5 cases of infundibular pattern and all cases of the combined pattern. CONCLUSION: CT fidnings of maxillary sinus aspergillosis can be classified into 3 patterns according to their distribution. These classification could be helpful for planning FESS approach. Calcifications are the most characteristic findings of maxillary sinus aspergllosis whereas CT density or enhancement pattern do not contribute to diagnosis.

CT Evaluation of Nasal Cavity Masses: Differential Diagnosis between Nasal Polyps and Their Mimics

PURPOSE: The purposes of this article are to identify CT findings distinguishing nasal polyps, that are the most common cause of the nasal polypiod lesions, from other nasal cavity masses and to identify differential points between benign and malignant masses of nasal cavity. MATERIALS AND METHODS: We classified 567 cases of pathologically proved nasal cavity masses into 4 different groups on CT according to the sites of origin and surrounding bone changes. RESULT: The nasal polyps were the most common cause of nasal cavity masses(515/567). Group I had a high diagnostic specificity for the nasal polyps (513/515, 99.6%) although inverted papilloma (8/522) and malignant melanoma(1/522) showed similar CT appearances. The representitive nasal mass of Group Ila was the inverted papilloma (15/24, 66.5% of the inverted papilloma). Group III pattern was seen in 3 cases of benign minor salivary gland tumor and 2 cases of pyogenic granuloma. Group IV suggested malignancy and thus was mostly observed in malignant tumors except I case of inverted papilloma and 1 case of granulomatous necrosis. CONCLUSION: The differential diagnosis between nasal polyps and the other nasal cavity masses is possible by characteristic bone changes and their sites of origin revealed on CT. In addition, it is possible to differentiate malignant masses from benign in most cases.