Anesthetic experience of pheochromocytoma resection with catecholamine-induced cardiomyopathy and congestive heart failure : A case report

Catecholamine-induced cardiomyopathy associated with pheochromocytoma is a relatively well-recognized but rare entity. We report a case of 15-year old man with a pheochromocytoma and severe heart failure caused by a catecholamine-induced cardiomyopathy. He had symptoms such as fatigue, cold sweating, and dyspnea for 7 months. The chest x-ray showed an enlarged cardiac shadow and pulmonary edema. Echocardiography showed severe decreased left ventricular contractility with multiple thrombi and right ventricular hypokinesia with mild pulmonary hypertension. This report describes our experience of the anesthetic management for the removal of pheochromocytoma with catecholamine-induced cardiomyopathy, which barely responded to high vasopressin and epinephrine.ope

Effect of scalp nerve blocks on post-craniotomy pain in the patients undergoing craniotomy

BACKGROUND: Sympathetic stimulation associated with post-craniotomy pain might subsequently increase blood pressure resulting in postoperative complications. We studied whether scalp nerve blocks would reduce the severity of postoperative pain. METHODS: Thirty-two patients undergoing craniotomy were randomly allocated to either the ropivacaine group (n = 16) or the saline group (n = 16). After the skin closure, we carried out scalp nerve blocks with ropivacaine (0.75%) or saline (0.9%). Visual analog scale scores (VAS), mean arterial pressure, and heart rate were measured at 0.5, 1, 2, 4, 6, 12, 24, and 48 h after extubation. Tramadol 50 mg iv was used as rescue analgesic. The delay before administration of the first analgesic and cumulative dose of rescue analgesic for the first 48 h postoperatively were measured. RESULTS: The ropivacaine group had lower analgesic requirements than the saline group (P = 0.008). The delay before administration of the first analgesic was not different significantly between two groups. VAS was similar between the two groups at each time interval. Postoperative MAP and HR were not significantly different between two groups. VAS did not correlate with these hemodynamic variables. CONCLUSIONS: Although scalp nerve blocks with ropivacaine reduced the analgesic requirement, they did not provide the sufficient pain reliefope

MicroRNAs as novel regulators of stem cell fate

Mounting evidence in stem cell biology has shown that microRNAs (miRNAs) play a crucial role in cell fate specification, including stem cell self-renewal, lineage-specific differentiation, and somatic cell reprogramming. These functions are tightly regulated by specific gene expression patterns that involve miRNAs and transcription factors. To maintain stem cell pluripotency, specific miRNAs suppress transcription factors that promote differentiation, whereas to initiate differentiation, lineage-specific miRNAs are upregulated via the inhibition of transcription factors that promote self-renewal. Small molecules can be used in a similar manner as natural miRNAs, and a number of natural and synthetic small molecules have been isolated and developed to regulate stem cell fate. Using miRNAs as novel regulators of stem cell fate will provide insight into stem cell biology and aid in understanding the molecular mechanisms and crosstalk between miRNAs and stem cells. Ultimately, advances in the regulation of stem cell fate will contribute to the development of effective medical therapies for tissue repair and regeneration. This review summarizes the current insights into stem cell fate determination by miRNAs with a focus on stem cell self-renewal, differentiation, and reprogramming. Small molecules that control stem cell fate are also highlighted.ope

Persistent train-of-four fade in myasthenia gravis patients after sevoflurane anaesthesia

ope

A retrospective analysis of prolonged propofol-remifentanil anesthesia in the neurosurgical patients

BACKGROUND: A rare, but fatal, propofol infusion syndrome has been reported in critically ill patients after prolonged use of propofol (more than 24-48 hours). But there are few reports on the clinical characteristics of prolonged anesthesia (more than 10 hours) using propofol, especially in the neurosurgical patients. METHODS: A retrospective study was conducted to find intra-and post-anesthetic characteristics (up to 7 postoperative days) and long-term outcomes (more than 1 and half years) in the neurosurgical patients who needed prolonged propofol-remifentanil anesthesia. Data were collected via medical records and descriptive analysis was conducted. RESULTS: Thirty one neurosurgical patients underwent 34 operations using propofol-remifentanil anesthesia for more than 10 hours from November 2005 to January 2007. Mean duration of anesthesia and surgery was 936 +/- 279 and 805 +/- 283 min, respectively. Propofol and remifentanil were administered with a mean infusion rate of 7.2 +/- 1.8 mg/kg/h and 8.6 +/- 2.4microg/kg/h, respectively. Vasopressors were used in six cases during anesthetic management. Intraoperative hypotension occurred in two patients. Even though hepatic, cardiac, and renal enzymes elevated transiently in some patients during postanesthetic course, any significant lactic acidosis did not occur in them. Two patients died of sepsis and GI bleeding thereafter. Median days of hospital admission and stay at neurosurgical care unit were 36.5 days and 8 days. CONCLUSIONS: A retrospective analysis of the prolonged propofol and remifentanil anesthesia for 34 neurosurgical cases did not show any morbidities and mortalities related to intravenous anesthetics.ope

Cardiomyocytes from phorbol myristate acetate-activated mesenchymal stem cells restore electromechanical function in infarcted rat hearts

Despite the safety and feasibility of mesenchymal stem cell (MSC) therapy, an optimal cell type has not yet emerged in terms of electromechanical integration in infarcted myocardium. We found that poor to moderate survival benefits of MSC-implanted rats were caused by incomplete electromechanical integration induced by tissue heterogeneity between myocytes and engrafted MSCs in the infarcted myocardium. Here, we report the development of cardiogenic cells from rat MSCs activated by phorbol myristate acetate, a PKC activator, that exhibited high expressions of cardiac-specific markers and Ca(2+) homeostasis-related proteins and showed adrenergic receptor signaling by norepinephrine. Histological analysis showed high connexin 43 coupling, few inflammatory cells, and low fibrotic markers in myocardium implanted with these phorbol myristate acetate-activated MSCs. Infarct hearts implanted with these cells exhibited restoration of conduction velocity through decreased tissue heterogeneity and improved myocardial contractility. These findings have major implications for the development of better cell types for electromechanical integration of cell-based treatment for infarcted myocardium.ope

경관영양 환자의 설사 발생 양상 조사 연구

간호학교육전공/석사[영문] [한글] 경관영양은 경관을 통해 위장관계로 유동식이를 제공하는 방법으로 위장관계의 기능은 정상이나 입으로 적절한 영양소를 섭취할 수 없는 환자에게 적합한 방법으로, 위장관계 구조와 기능적 통합성을 유지하고, 영양소 이용을 증진시키며 안전하고 비용이 적게 드는 장점이 있으나, 경관영양과 관련되어 오심, 구토, 설사, 위내 배출 지연, 관폐색, 홉인 성 폐렴 등의 여러문제가 발생하는데, 그중 설사 발생이 가장 높게 나타나는데 그 발생률 은 2.3-63%로 다양하게 보고되고 있다 이러한 설사 발생에 영향을 미치는 요인은 경관영 양 투여 방법, 항생제, H^^2 수용체 길항제, 혈청 알부민 수준 등으로 다양하게 나타나고 , 여러가지의 다양한 간호중재에도 불구하고 경관영양을 하는 환자의 설사 발생이 계속적 으로 나타나고 있다. 따라서 본연구의 목적은 경관영양시 나타나는 설사 발생 현황에 대 해 조사하여 경관영양을 하는 환자의 간호에 도움을 주고자 한다 연구 방법은 서을 시내에 위치한 Y대학 병원에 6월 20일부터 11월 30일까지 입원 기간 중인 환자중에서 경관 시작일로 부터 7일이상 30일까지 중단없이 경관영양을 한 39명을 대상으로 하여 의무기록을 통해 자료수집을 하였다. 본 연구의 연구 결과는 다음과 같다. 1. 경관영양과 관련된 대상자의 특성은 경관영양 기간이 9일 이하가 5명, 10-19일 17명 , 20-29일 6명, 그리고 30일 이상 11명으로 이루어져 있고, 경관영양 방법은 지속적 주입 법 66.7%(26명)으로 많았고, 혈청 알부민 수준은 3.4gm/dl 이상 69.2%(27명), 항셍제를 사용한 군이 92.3%(36명), H^^2 수용체 길항제를 사용한 군이 64.1%(25명)으로 많았다. 또한 경관영양을 지속하는 11명이외에 경관영양 중단이유는 금식 10명, 구강 식이 전환 1 3명, 퇴원 3명, 사망 2명 등이었다. 2. 본 연구의 대상자중 경관영양 기간에 설사를 경험한 대상자는 66.7%(26명)이었고, 조사기간내 대상자의 평균 영양 기간은 18.7일이었으며, 경관영양일에 따른 설사 발생 분 포를 보면 비교적 고른 분포를 보여 특정한양상이 나타나지 않았고, 경관영양 기간 동안 의 설사 경험 횟수는 2회 이상을 반복적으로 경험한 대상자가 65.4%(17명으로 나타났다. 3. 설사 발생 유무에 따라 대상자를 비교해 보면 설사를 경험한 군 66.7%(26명), 경험 하지 않은 군 33.3%(13명)으로 나타났고, 경관영양 기간에 따라 비교해 보면 설사를 경험 한 군은 30일 이상 지속한 군이 10명(39.3%)로 가장 많았고, 경험하지 않은 군에서는 10- 19일 동안 경관영양을 한 군이 9명(69.2%)로 가장 많았다. 그리고 경관영양 방법과 항생 제 사용 유무, H^^2수용체 길항제는 설사를 경험한 군과 설사를 경험하지 않은 군에서 x* *2검정에서 통계적으로 유의한 차이가 없었고, 형청 알부민 수준도 3.4gm/dl 이상인 군과 3.3gm/dl인 군간에 유사한 분포를 보였다. 경관영양을 중단한 이유는 설사를 경험한 군 에서는 금식이 10명(38.5%)으로 가장 많았고, 설사를 경험하지 않은 군에서는 구강식이 전환이 8명(61.5%)으로 가장 많았다. Study on the Diarrhea Pattern in Enteral Nutrition Patients Choi, Eun Mee Dept. of Nursing Education Graduation School of Education Yonsei University The Purpose of this study was to describe the diarrhea pattern in enteral nutrition patients. The subjects for this study were 39 enteral nutrition patients who were hospitalized in a selected university affiliated Hospital from June 27, 1997 to November 30, 1997 and receiving continuous enteral feeding for at least seven days. The data were collected from charts that were filed in the chart record department during period from October 15, 1997 to November 30, 1997. Data analysis was done using the SPSS program. The results were as follows : 1. The perods of enteral feeding were as follows : less than 9 days-5 patients : from 10 to 19 days-17 patients ; from 20 to 29 days-6 patients, and over 30 days-11 patients. Of the 39 patients, a continuous infusion was 26 patients received and a bolus infusion 13 patients received. The albumin level differated above 3.4 gm/dl in 27 patients and showed below 3.3 gm/dl in 12 patients. The medications receiver were as follow : the 36 patients received antibiotics and the 25 patients used H^^2 receptor blocker. The reason for discontinuance of enteral feedings were fasting, dietary change to the oral feeding, discharge and death. 2. OF this group 26 patients(66.7%) experienced diarrhea during enteral feeding period and most of them had more than one diarrhea, but there was no diarrhea pattern according to the period of enteral feeding. 3. Among the patients experiencing diarrhea, 10 patients received enteral feedings for more than 30 days, but among the group that didn't experience diarrhea, 9 patients had enteral feeding from 10 to 19 days. In terms of the diarrhea related factors, there was no difference between the diarrhea group and non-diarrhea group as to the type of enteral feeding, antibiotics received, albumin level, and use of H^^2 receptor blocker. The most common reason for discontinuance of the enteral feeding in the diarrhea group was diarrhea.restrictio

이붕소 마그네슘 박막에서의 자기 소용돌이 사태에 관한 연구

Docto

Characteristics of Total Gaseous Mercury (TGM) Concentration in Seoul, Korea - Focusing on Contribution from Long-range transport

학위논문(석사) --서울대학교 보건대학원 :환경보건학과(대기환경전공),2010.2.Maste

Physical properties and fluoride release of dental pit and fissure sealants including sodium fluoride and stannous f

치의학과/박사[한글] 대부분의 불화물은 치약이나 구강양치용액 그리고 충전용 레진에 함유되어 탈회를 억제하고 재광화를 증진시킴으로써 치아우식 예방효과를 나타낸다. 불소도포와 치면열구전색은 두 가지 다 치아 표면에 도포하는 방법으로 임상에서 가장 많이 사용하는 우식 예방법이다. 불소함유 치면열구전색재는 치면열구전색재에 불화물이 첨가되어 재료의 물성변화가 되지 않도록 적절한 물리화학적 성질과 항우식성, 생체친화성 등의 특성을 가지고 있어야 한다. 불소가 첨가된 치면열구전색재는 불소국소도포 효과와 치면열구전색 효과를 동시에 나타낼 수 있는 좋은 방법이다.따라서 본 연구에서는 Bis-GMA계 치면열구전색재에 현재 불소도포에 사용되는 불화물인 NaF, SnF2를 첨가하여 시험군 1, 시험군 2를 제조하고, NaF와 SnF2를 함께 첨가하여 시험군 3을 제조하였으며, 불화물을 첨가하지 않은 Bis-GMA계 치면열구전색재를 대조군으로 하여 재료의 미세구조를 관찰한 후 중합깊이, 경도, 미중합필름 두께, 점도, 물흡수도와 용해도, 중합도, 불소방출, 세포독성을 비교 시험하여 다음과 같은 결과를 얻었다.1. 주사전자 현미경 관찰 결과 시험 2군에서는 불화물 입자가 관찰되지 않았으나, 시험 1군과 3군 치면열구전색재에서 불화나트륨 입자가 관찰되었다.2. 중합 깊이는 2군에서 가장 높게 나타났으며(p0.05).3. 경도는 1군이 20.65 VHN, 대조군이 18.95 VHN 그리고 2군이 18.40 VHN, 3군 이 16.86 VHN으로 조사되었다. 대조군과 1군, 3군 그리고 1군과 2군, 3군에서 유의차가 나타났다(p0.05).5. 점도는 대조군이 가장 높았으며, 3군과 1군 그리고 2군 순으로 조사되었다.6. 물흡수도와 용해도는 모든 군 간에 유의차가 없었다(p>0.05).7. 중합도는 3군이 43.5 %로 가장 높게 나타났으며, 1군 38.4 %, 대조군 37.2 %, 2군 32.6 %의 순서로 조사되었다.8. 불소방출은 3군에서 1～30일 1.17 ppm, 31～60일 0.31 ppm 그리고 61～90일 0.45 ppm이 방출되었으며, 90일 이후에는 불소 방출량이 차이가 없는 것으로 조사되었다.9. 세포독성은 RPMI 실험대조군과 비교한 결과 대조군에서 cell viability가 93.7 % 로 나타났으며, 3군이 84.4 %, 1군이 83.7 %, 2군이 82.6 % 이었다. 모든 군 간에 유의차는 없었다(p>0.05).이상의 실험 결과로 Bis-GMA계 치면열구전색재에 NaF 또는 SnF2의 불화물 분말을 첨가한 치면열구전색재의 물리화학적 특성이 크게 변화되지 않는 것으로 조사되었으며, 불소는 9개월 동안 방출되어 치면열구전색재가 구강 내에서 유지되는 기간 동안에 항우식 효과를 나타낼 수 있을 것으로 예측되었다. 또한 약한 정도의 세포독성을 나타내어 시험군 모두 치면열구전색재로 임상에 적용할 수 있을 것으로 사료되었다. [영문] In order to prevent dental caries effectively, high concentration of NaF or SnF2 has been applied to Bis-GMA type sealants 2 % NaF as theexperimental group 1, 8 % SnF2 as the experimental group 2, both of 2 % NaF and 8 % SnF2 as the experimental group 3, and nothing as the control group.The microstructure, cured depth, hardness, uncured film thickness, viscosity, water absorption, solubility, conversion degree, fluoride release and cytotoxicity were used to evaluate the preventive effectiveness of added fluoride.1. The experimental group 2 was shown fluoride power was distributed evenly in contrast, the group 1 and 3 were shown sodium particles during observing the microstructure.2. In the cured depth test, the experimental group 2 was the highest (p0.05).3. The hardness of the experimental group 1 was 20.65 VHN and that of the control group was 18.95 VHN (p0.05).4. There were no significantly differences of the uncured film thickness among the experimental groups and the control group (p>0.05).5. The viscosity of the control group was the highest. Those were decreased in order of the experimental group 3, 1, and 2.6. In water absorption and solubility test, there were not significantly different among the experimental groups and the control group (p>0.05).7. The conversion degree of the experimental group 3 was shown 43.5 %, the highest. Those were decreased in order of the group 1 of 38.4 %, the control group of 37.2 %, and the group 2 of 32.6 %.8. The amounts of fluoride release were 1.17 ppm during 130 days, 0.31 ppm during 31～60 days, and 0.45 ppm during 61～90 days. As time went by, the amount was getting decreased until 270 days.9. In cytotoxicity test, the cell viability was 93.7 % in the control group, 84.4 % in the experimental group 3, 83.7 % in group 1 and 82.6 % in group 2, but there were not significantly different (p>0.05).From these experiments, there was no difference of physical and chemical characteristic when mixing of NaF or SnF2 with the Bis-GMA type dental pit and fissure sealants. There were anticaries effects for a long time by released fluoride. Thus, it is predictable that the use of fluorides, such as NaF and SnF2, are able to apply to the fit and fissure sealants.ope