Extreme thrombocytosis in a traumatic patient / 대한마취과학회지

No abstract available.

Intrathecal Gabapentin Increases Interleukin-10 Expression and Inhibits Pro-Inflammatory Cytokine in a Rat Model of Neuropathic Pain

We examined the possible anti-inflammatory mechanisms of gabapentin in the attenuation of neuropathic pain and the interaction between the anti-allodynic effects of gabapentin and interleukin-10 (IL-10) expression in a rat model of neuropathic pain. The anti-allodynic effect of intrathecal gabapentin was examined over a 7-day period. The anti-allodynic effects of IL-10 was measured, and the effects of anti-IL-10 antibody on the gabapentin were assessed. On day 7, the concentrations of pro-inflammatory cytokines and IL-10 were measured. Gabapentin produced an anti-allodynic effect over the 7-day period, reducing the expression of pro-inflammatory cytokines but increasing the expression of IL-10 (TNF-alpha, 316.0 +/- 69.7 pg/mL vs 88.8 +/- 24.4 pg/mL; IL-1beta, 1,212.9 +/- 104.5 vs 577.4 +/- 97.1 pg/mL; IL-6, 254.0 +/- 64.8 pg/mL vs 125.5 +/- 44.1 pg/mL; IL-10, 532.1 +/- 78.7 pg/mL vs 918.9 +/- 63.1 pg/mL). The suppressive effect of gabapentin on pro-inflammatory cytokine expression was partially blocked by the anti-IL-10 antibody. Expression of pro-inflammatory cytokines was significantly attenuated by daily injections of IL-10. The anti-allodynic effects of gabapentin may be caused by upregulation of IL-10 expression in the spinal cord, which leads to inhibition of the expression of pro-inflammatory cytokines in the spinal cords.

Interaction of Morphine and Selective Serotonin Receptor Inhibitors in Rats Experiencing Inflammatory Pain

Citalopram and paroxetine are selective serotonin reuptake inhibitors and also have antinociceptive effects. We investigated the antiallodynic and antihyperalgesic effects of intrathecally administered morphine, citalopram, paroxetine, and combinations thereof, in a rat model in which peripheral inflammation was induced by complete Freund's adjuvant (CFA). Drugs were intrathecally administered via direct lumbar puncture. Mechanical allodynia was measured using a Dynamic Plantar Aesthesiometer. Thermal hyperalgesia and cold allodynia were determined by measuring latency of paw withdrawal in response to radiant heat and cold water. Behavioral tests were run before and 15, 30, 45, and 60 min after intrathecal injection. Intraplantar injection of CFA produced mechanical allodynia, thermal hyperalgesia, and cold allodynia. Intrathecally administered morphine (0.3 or 1 microg) had antiallodynic or antihyperalgesic effects (24.0%-71.9% elevation). The effects of morphine were significantly increased when a combination of citalopram (100 microg) and paroxetine (100 microg) was added (35.2%-95.1% elevation). This rise was reversed by naloxone and methysergide. The effects of citalopram and paroxetine were also reversed by naloxone and methysergide. We suggest that the mu opioid receptor and serotonin receptors play major roles in production of the antiallodynic and antihyperalgesic effects of morphine, citalopram, paroxetine, and combinations thereof, in animals experiencing inflammatory pain.

Effect of preoperative warming during cesarean section under spinal anesthesia / 대한마취과학회지

BACKGROUND: Postoperative hypothermia and shivering is a frequent event in patients during cesarean section under spinal anesthesia. We assessed the effect of preoperative warming during cesarean delivery under spinal anesthesia for prevention of hypothermia and shivering. METHODS: Forty five patients undergoing elective cesarean section were randomly assigned to three groups. Group F received warmed intravenous fluid (40degrees C). Group A patients were actively warmed by forced air-warming. Group C was the control group. Forced air-warming and warmed fluid was maintained for the 15 min preceding spinal anesthesia. Core temperature (tympanic membrane) and the skin temperature of arm and thigh were measured and shivering was graded simultaneously. RESULTS: The core temperature at 45 min decreased less in Groups F and A than Group C (-0.5degrees C +/- 0.3degrees C vs -0.6degrees C +/- 0.4degrees C vs -0.9degrees C +/- 0.4degrees C, respectively; P = 0.004). The arm temperature at 15 min and 30 min exhibited a greater increase in Group A than Group F and Group C (P = 0.001 and P = 0.012, respectively). Leg temperature increased similarly among the three groups. The incidence of shivering was significantly less in Group A and Group F than Group C (20%, 13.3%, and 53.3%, respectively; P = 0.035). CONCLUSIONS: Preoperative forced air-warming and warmed fluid prevents hypothermia and shivering in patients undergoing elective cesarean delivery with spinal anesthesia.

Fatal pulmonary embolism and coincidental cerebral infarction after spinal anesthesia: A case report / 대한마취과학회지

A pulmonary embolism and cerebral infarction are the second and third most common acute cardiovascular diseases after a myocardial infarction. Early diagnosis and appropriate management are important clinical challenges. In this case, a fatal pulmonary embolism and extensive cerebral infarction caused cardiac arrest during spinal anesthesia for total hip replacement surgery. Transesophageal echocardiography indicated a pulmonary embolism and brain CT showed large area of acute infarction at right middle cerebral artery territory. Pulmonary CT angiogram revealed massive pulmonary embolism findings. This paper reviews this case and suggests other preventive modalities.

Effect of lumbar epidural and caudal analgesia on the second stage of labor

BACKGROUND: Epidural analgesia is the most effective way of providing pain relief during labor.However, its effect on the second stage of labor is controversial.This study examined the effect of epidural analgesia combined with caudal analgesia on the second stage of labor. METHODS: Forty three multiparous women were divided into three groups, non-epidural group, epidural group and epidural with caudal group.Epidural analgesia was maintained with patient-controlled epidural analgesia (0.09375% ropivacaine with 0.0002% fentanyl) in both the epidural and epidural with caudal groups.The epidural with caudal group was injected with 0.09375% ropivacaine into the caudal epidural space after inserting the lumbar epidural catheter.The assessments made throughout labor included the visual analogue score (VAS), patient's satisfaction, motor block and duration of the second stage. RESULTS: There were no significant differences in the patient's satisfaction, VAS and motor block between the epidural group and epidural with caudal group.There were no significant differences in the duration of the second stage between the non-epidural, epidural and epidural with caudal groups. No cesarean or instrumental deliveries were performed. CONCLUSIONS: Epidural with caudal analgesia offers no additional benefit during the second stage of labor.However, it carries no added risk on the maternal outcome.

Determination of Blood Propofol Concentration and Performance Error Using Knibbe's Method / 대한마취과학회지

BACKGROUND: Determination of blood concentration is essential for the pharmacokinetic/pharmacodynamic (PK/PD) study of intravenous anesthetic agents. Knibbe's method is a rapid, simple, and reliable method to quantify propofol in low-volume samples. The aim of this study was to qualify Knibbe's method by calculating the performance error in propofol target-controlled infusion (TCI). METHODS: With ethics commitee approval and informed consent, thirty ASA 1 or 2 adult patients undergoing orthopedic surgery participated in this study. All patients were premedicated with atropine 0.5 mg IM and received general anesthesia with propofol TCI (Master TCI) supplemented by 67% N2O and 33% O2. Anesthesia was induced by propofol TCI with a target concentration of 6 microgram/ml and maintained around 3-5 microgram/ml according to bispectral index (40-50). In the middle of surgery, the target concentration was increased to 6 microgram/ml and maintained until the effect concentration matched the target concentration. Three min after equilibration, 3 ml of blood was taken from the radial artery to analyse blood concentration using HPLC with the fluorescence detection method described by Knibbe et al. Using this method, the performance error for the 1 6 microgram/ml of predicted propofol concentration in whole blood was calculated according to the following formula: measured concentration-predicted concentration/predicted concentration x 100. RESULTS: The performance errors at each concentration were -12.86, -13.61, -2.95,7.94,9.22, and 13.85% for 1-6 microgram/ml of predicted propofol concentration, respectively. CONCLUSIONS: Knibbe's method for determination of plasma propofol concentration showed itself to be accurate accuracy in that there was a relatively low performance error in the concentration range of 1 6 microgram/ml, which is considered the usual concentration range for clinical practice.

What is the Minimum Effective Dose of Propofol in Relieving Epidural Morphine Induced Pruritus? / 대한마취과학회지

BACKGROUND: Mu-receptor antagonists are considered effective for the treatment of epidural morphine induced pruritus (EMIP). However, they have been associated in certain cases with a concomitant reduction in analgesia. It is noteworthy that propofol has been shown to produce marked spinal depression, in particular of the dorsal and ventral horn. Recently it was reported that subhypnotic doses of propofol were efficient in relieving EMIP. This study was designed to investigate an effective minimum dose of propofol. METHODS: After obtaining informed consent from patients and with IRB approval, 155 patients having cesarean section received an epidural morphine 3 mg bolus, and 4 mg/day with continuous infusion for 2 days via a Baxter infusor(R). Patients who had pruritus with scratching were allocated randomly to one of the three groups. Patients received 10 mg propofol intravenously in group I (n = 25), 20 mg in group II (n = 25) and 30 mg in group III (n = 25). Pruritus and the level of sedation were assessed 5 minutes later using 5 points pruritus rating scale (PRS) and 4 points sedation rating scale (SRS). Statistical analysis was performed using chi-square test, one-way ANOVA and paired t-test. P or = 3). The success rate was significantly greater in the group II (76%) and group III (80%) than in the group I (48%) (P < 0.05). Seven patients had an increase in sedation in the group III versus none in the group I and group II (P < 0.05). The beneficial effect of treatment was longer than 60 minutes in 100% of patients in group I, II and III. CONCLUSION: These results suggest that 20 mg propofol and 30 mg propofol intravenously are equally effective in treating EMIP than 10 mg propofol. However the level of sedation is significantly less in 20 mg propofol group than 30 mg propofol group.

Two-dimensional gel electrophoresis of Helicobacter pylori for proteomic analysis

Two-dimensional gel electrophoresis (2-DE) is an essential tool of proteomics to analyse the entire set of proteins of an organism and its variation between organisms. Helicobacter pylori was tried to identify differences between strains. As the first step, whole H. pylori was lysed using high concentration urea contained lysis buffer (9.5 M Urea, 4% CHAPS, 35 mM Tris, 65 mM DTT, 0.01% SDS and 0.5% Ampholite (Bio-Rad, pH 3-10)). The extract (10 mug) was rehydrated to commercially available immobilised pH gradient (IPG) strips, then the proteins were separated according to their charges as the first dimensional separation. The IPG strips were placed on Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE) to separate according to molecular mass of the proteins as the second dimension. The separated protein spots were visualised by silver staining in order to compare different expression of proteins between strains. Approximately 120 spots were identified in each mini-protein electrophoresised gel, furthermore about 65 to 75 spots were regarded as identical proteins in terms of pI value and molecular weight between strains used. In addition, distinct differences were found between strains, such as 219-1, Y7 and Y14, CH150. Two representative strains were examined using strips which had pH range from 4 to 7. This strips showed a number of isoforms which were considered large spots on pH range 3-10. Furthermore, the rest of spots on pH 4-7 IPG strips appeared very distinctive compared to broad range IPG strips. 2-DE seems to be an excellent tool for analysing and identifying variations between H. pylori strains.

Genotyping and Molecular Epidemiology of Helicobacter pylori Strains Isolated from Korea

This study aims to know cagA and vacA genotypes and the molecular epidemiology of H. pylori strains isolated from patients with gastroduodenal disorders and normal healthy persons of Korea using PCR genotyping, RAPD fingerprinting, and PCR-RFLP. PCR genotyping for cagA genotyping showed that 143 H. pylori isolates tested in this study were cagA positive strains. All the isolates were confirmed as type sla genotype and 13 isolates (9%) among of 143 strains were confirmed as containing the RS2 element. All 143 isolates showed individually unique RAPD profiles. PCR-based RFLP was done to assess the sequence diversity of H. pylori flagella genes. From all H. pylori isolates, 30 distinct patterns were found with HhaI digestion of 1.5 kb flaA segment and 12 distinct patterns were produced with MboI digestion. Among 30 persons, from whom multiple isolates could be obtained, 27 (90%) were confirmed to be colonized with an identical H. pylori strain and 3 (10%) were shown to be infected with the different strains. Among 5 persons attended in follow-up study, 4 were infected with identical strain for 1 year, 1 carried different strains after 1 year. Genotypes of isolates recovered from children were shown to be identical to those of their parents, suggesting that children acquire H. pylori infection from their parents.

Genomic Diversity of Helicobacter pylori

Helicobacter pylori is a causative agent of type B gastritis and plays a central role in the pathogenesis of gastroduodenal ulcer and gastric cancer. To elucidate the host-parasite relationship of the H. pylori infection on the basis of molecular biology, we tried to evaluate the genomic diversity of H. pylori. An ordered overlapping bacterial artificial chromosome (BAC) library of a Korean isolate, H, pylori 51 was constructed to set up a genomic map. A circular physical map was constructed by aligning ApaI, Notl and SfiI-digested chromosomal DNA. When the physical map of H. pylori 51 was compared to that of unrelated strain, H. pylori 26695, completely different restriction patterns were shown. Fifteen known genes were mapped on the chromosome of H. pylori 51 and the genetic map was compared with those of strain 26695 and J99, of which the entire genomic sequences were reported. There were some variability in the gene location as well as gene order among three strains. For further analysis on the genomic diversity of H. pylori, when comparing the genomic structure of 150 H. pylori Korean isolates with one another, genomic macrodiversity of H. pylori was characterized by several features: whether or not susceptible to restriction digestion of the chromsome, variation in chromosomal restriction fingerprint and/or high frequency of gene rearrangement. We also examined the extent of allelic variation in nucleotide or deduced amino acid sequences at the individual gene level. fucT, cagA and vacA were confirmed to carry regions of high variation in nucleotide sequence among strains. The plasticity zone and strain-specific genes of H. pylori 51 were analyzed and compared with the former two genomic sequences. It should be noted that the H. pylori 51-specific sequences were dispersed on the chromosome, not congregated in the plasticity zone unlike J99- or 26695-specific genes, suggesting the high frequency of gene rearrangement in H. pylori genome. The genomc of H. pylori 51 shows differences in the overall genomic organization, gene order, and even in the nucleotide sequences among the H. pylori strains, which are far greater than the differences reported on the genomic. diversity of H. pylori.

Activation of Urease Apoprotein of Helicobacter pylori

H. pylori produces urease abundantly amounting to 6% of total protein of bacterial mass. Urease genes are composed of a cluster of 9 genes of ureC, ureD, ureA, ureB, ureI, ureE, ureF, ureG, ureH. Production of H. pylori urease in E. coli was studied with genetic cotransformation. Structural genes ureA and ureB produce urease apoprotein in E, coli but the apoprotein has no enzymatic activity. ureC and ureD do not affect urease production nor enzyme activity ureF, ureG, and ureH are essential to produce the catalytically active H. pylori urease of structural genes (ureA and ureB) in E.coli. The kinetics of activation of H. pylori urease apoprotein were examined to understand the production of active H. pylori urease. Activation of H. pylori urease apoprotein, pH dependency, reversibility of CO2 binding, irreversibility of CO2 and Ni2+ incorporation, and CO2 dependency of initial rate of urease activity have been observed in vitro. The intrinsic reactivity (ko) for carbamylation of urease apoprotein coexpressed with accessory genes was 17-fold greater than that of urease apoprotein expressed without accessory genes. It is concluded that accessory genes function in maximizing the carbamylating deprotonated E-amino group of Lys 219 of urease B subunit and metallocenter of urease apoprotein is supposed to be assembled by reaction of a deprotonated protein side chain with an activating CO2 molecule to generate ligands that facilitate productive nickel binding.