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Thoracic Epidural Anesthesia for Upper Abdominal Surgery and Postoperative Pain Control (상복부 수술을 위한 흉추 경막외 마취와 술후 통증관리)

  • Choi, Kyu-Taek;Cheun, Jae-Kyu
    • The Korean Journal of Pain
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    • v.2 no.1
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    • pp.66-71
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    • 1989
  • It has been standard practice in many institutions to use a combination of a light general anesthesia and an epidural block for lower abdominal and pelvic surgery. This combination of a balanced anesthesia can provide various benefits to the patient such as less bleeding in the surgical field, the use of a lower concentration of general anesthetics, less muscle relaxant, and post operative pain management. However, there are several problems associated with hemodynamics such as bradycardia and hypotension etc. In order to block the pain of the high surgical area with a lumbar epidural puncture postoperatively, a large volume of local anesthetic is required and consequently an extensive blockade of sympathetic, sensory and motor functions can occur causing motor weakness, numbness and postural hypotension. Therefore, the patient is unable to have early ambulation postoperatively. In this study, thoracic epidural catheterization was undertaken to locate the tip of the catheter exactly at the surgical level for upper abdominal surgery, and was followed by general anesthesia. Twenty-one patients scheduled for upper abdominal surgery were selected. Fifteen of them had hepatobiliary operations and the remaining 6 had gastrectomies. Thoracic epidural punctures were performed mostly at T9-T10 (57.1%) and T8-T9. Neuromuscular blocking agents were not used in half of the cases and the, mean doses of relaxant were $3.5{\pm}1.0mg$ in gastrectomies, and $2.7{\pm}0.9mg$ in cases of hepatobiliary operation. Epidural morphine was injected 1 hour before the end of the operation for postoperative pain control. Eight patients did not require additional analgesics and the mean dose of epidural morphine was $2.2{\pm}0.9mg$, and 13 cases were given 0.125% epidural bupivacaine when patients complained of pain. Their initial doses of epidural morphine were $1.9{\pm}0.4mg$ and the mean duration of bupivacaine was 6 hours 20 minutes${\pm}40$ minutes. In conclusion. thoracic epidural analgesia is valuable to reduce postoperative pain in patients with upper abdominal surgery, However, it is not easy to maintain this balanced anesthesia with high epidural analgesia-and light general anesthesia for upper abdominal surgery because of marked hemodynamic changes. Therefore, further practice will be required.

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Bioequivalence Evaluation of Two Brands of Zolpidem Tartrate 10 mg Tablets(Zanilo and Stilnox) in Healthy Male Volunteers

  • Ryu, Ju-Hee;Lee, Heon-Woo;Lee, Hyun-Su;Kang, Il-Mo;Seo, Ji-Hyung;Kang, Jin-Yang;Lee, Kyung-Tae
    • Journal of Pharmaceutical Investigation
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    • v.36 no.5
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    • pp.343-348
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    • 2006
  • The purpose of the present study was to evaluate the bioequivalence of two zolpidem tartrate tablets, Stilnox tablet(Sanofi-aventis Korea, reference product) and Zanilo tablet(ChoDang Pharm Co., Ltd., Korea, test product), according to the guidelines of Korea Food and Drug Administration(KFDA). After adding an internal standard(cimetropium), 250 ${\mu}L$ plasma samples were extracted using 1.3 mL of ethyl acetate. Extracted compounds were analyzed by HPLC with triple-quadrupole mass spectrometry. This method for determination of zolpidem is proved accurate and reproducible with the limit of quantitation of 1 ng/mL in human plasma. Twenty-four healthy male Korean volunteers received each medicine at the zolpidem tartrate dose of 10 mg in a $2{\times}2$ crossover study. There was one-week washout period between the doses. Plasma concentrations of zolpidem were monitored for over a period of 8 hr after the administration. $AUC_{0-t}$(the area under the plasma concentration-time curve) was calculated by the linear trapezoidal rule. $C_{max}$(maximum plasma drug concentration) and $T_{max}$(time to reach $C_{max}$) were compiled from the plasma concentration-time data. Analysis of variance was carried out using logarithmically transformed $AUC_{0-t}$ and $C_{max}$. No significant sequence effect was found for all of the bio-availability parameters indicating that the crossover design was properly performed. The 90% confidence intervals for the log transformed data were acceptable range of log 0.8 to log 1.25(e.g., log 0.92-log 1.06 for $AUC_{0-t}$, log 0.96-log 1.13 for $C_{max}$). The major parameters, $AUC_{0-t}$ and $C_{max}$ met the criteria of KFDA for bioequivalence indicating that Zanilo tablet is bioequivalent to Stilnox tablet.

Bioequivalence of RoxithrinTM Tablet to RulidTM Tablet (Roxithromycin 150 mg) (루리드 정(록시스로마이신 150 mg)에 대한 록시스린 정의 생물학적동등성)

  • Joung, Sun-Koung;Lee, Yun-Young;Cho, Tae-Seob;Kim, Ho-Hyun;Lee, Ye-Rie;Lee, Kyung-Ryul;Lee, Hee-Joo
    • Journal of Pharmaceutical Investigation
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    • v.34 no.3
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    • pp.209-214
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    • 2004
  • A bioequivalence study of $Roxithrin^{TM}$ tablet (Kukje Pharma. Ind. Co., Ltd.) to $Rulid^{TM}$ tablet (Han Dok Pharma. Ind. Co., Ltd.) was conducted according to the guidelines of Korea Food and Drug Administration (KFDA). Twenty four healthy male Korean volunteers received each medicine at the roxithromycin dose of 300 mg in a $2{\times}2$ crossover study. There was a one-week wash-out period between the doses. Plasma concentrations of roxithromycin were monitored by a high-performance liquid chromatography for over a period of 36 hours after drug administration. $AUC_t$ (the area under the plasma concentration-time curve from time zero to 36 hr) was calculated by the linear trapezoidal rule method. $C_{max}$ (maximum plasma drug concentration) and $T_{max}$ (time to reach $C_{max}$) were compiled from the plasma concentration-time data. Analysis of variance was carried out using logarithmically transformed $AUC_t$ and $C_{max}$. No significant sequence effect was found for all of the bioavailability parameters indicating that the cross-over design was properly performed. The 90% confidence intervals of the $AUC_t$ ratio and the $C_{max}$ ratio for $Roxithrin^{TM}/Rulid^{TM}$ were 1.00 - 1.13 and 0.98 - 1.10, respectively. These values were within the acceptable bioequivalence intervals of 0.80 - 1.25. Thus, our study demonstrated the bioequivalence of $Roxithrin^{TM}$ and $Rulid^{TM}$ with respect to the rate and extent of absorption.

Effect of African Mango (Irvingia gabonesis, IGOB 131TM) Extract on Glucose Regulation in STZ-Induced Diabetes (Streptozotocin으로 유발한 당뇨동물 모델에서 아프리칸 망고 추출물의 혈당 조절 효과)

  • Ha, Yejin;Lee, Minhee;Kwon, Han Ol;Lee, Yoo-Hyun
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.44 no.11
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    • pp.1607-1611
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    • 2015
  • This study investigated the regulatory effects of African mango (Irvingia gabonesis, IGOB $131^{TM}$) extract on blood glucose level in streptozotocin (STZ)-induced diabetic rats. Experimental groups were treated with two different doses of IGOB $131^{TM}$ (1% and 2% in each AIN93G supplement) for 5 weeks [4 weeks pre-treatment and 1 week post-STZ treatment (60 mg/kg body weight)]. STZ-induced diabetic rats showed significantly reduced body weight gain compared to normal control (NC). Oral glucose tolerance test (OGTT) was measured using glucose oxidase-peroxidase reactive strips. The area of under the curve for the glucose response from OGTT in STZ-induced diabetic rats was higher than that of NC rats, and there was a significant difference between the DM and the IGOB $131^{TM}$-treated groups. Serum glucose levels after sacrifice were significantly lower in the IGOB $131^{TM}$ group than the DM group. However, there was no statistical difference between low- and high-dose treatments. Serum insulin levels increased by 234.4% and 175.9%, respectively, upon treatment with IGOB $131^{TM}$. Serum lipid profiles were not significantly different among the experimental groups. The tested samples had no effects on serum levels of lipid profiles (triglyceride, total cholesterol, low density lipoprotein/very low density lipoprotein-cholesterol, high density lipoprotein-cholesterol). These results suggest that IGOB $131^{TM}$ is able to ameliorate diabetes by reducing serum glucose levels that may result from increased insulin levels.

The nuclear medical study on the effect of Hap-Kok(LI4) Acupuncture on cerebral blood flow (합곡(合谷) 침자(鍼刺)가 뇌혈류에 미치는 영향에 대한 핵의학적 고찰)

  • Yang Yoo-Sun;Kim Sung-Jin;Hwang Yoo-Jin;Lyu Dong-Soo;Kim Min-Ja;Cho Eun-Hee;Kim Hyun-Jung;Yang Myeong-Bok;Lee Beung-Cheul;Lee In;Lee Geon-Mok
    • Journal of Acupuncture Research
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    • v.18 no.6
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    • pp.93-104
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    • 2001
  • Objective : To localize and compare the cerebral regions- activated by the the stimulation of traditional and burning acupunctures in right Hap-Kok (LI4) acupoints. Methods : Thirty-four healthy normal volunteers (19 males, 15 females, age 31${\pm}$11 years) were studies by rest/acupuncture Tc-99m HMPAO SPECT using same-dose sequential injection method using right Hap-Kok(LI4), traditional and burning acupunctures. All images were spatially normalized and the differences between rest and acupuncture activation state were statistically analyzed using SPM 96. Results : Statistical analysis of the effect by the stimulation using traditional acupuncture in right L14 showed regional cerebral perfusion increase in right inferior frontal lobe, right straight gyrus, left anterolateral frontal lobe, left anteroinferior temporal lobe, left posterior temporal lobe, and left cerebellum. In the stimulation using burning acupuncture in right LI4, regional cerebral perfusion increased in right posterior prefrontal lobe, right precental gyrus, right postcentral gyrus, right poteroinferior temporal lobe, left precentral gyrus, left Broca's area, left anterior parietal lobe, left posterior prefrontal lobe, and left cerebellum. In right LA, diffuse perfusion increase were noted in the both inferior frontal lobe by traditional acupuncture compared to burning acupuncture. Conclusion : The results localized the cerebral areas showed the effect of the acupuncture on cerebral blood flow. The effects of traditional and burning acupunctures on cerebral blood flow were similar in right Hap-Kok (LI4) acupoints. But the effects of traditional acupunctures on cerebral blood flow are stronger than those of burning acupunctures on cerebral blood flow.

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UNLEADED GASOLINE AND LEAD LEVEL IN HUMAN BLOOD

  • Kim, Dae-Seon;Cha, Joung-Hoon
    • Proceedings of the Korean Environmental Health Society Conference
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    • 2001.11a
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    • pp.30-41
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    • 2001
  • Rapid economic development and industrialization has been accompanied by an increase of energy demand and environmental pollution. The consumption of gasoline has increased totally, but decreased in use of leaded gasoline after 1988 in Korea. On the other hand, risk assessment of environmental pollutants requires reliable dose estimates. Source oriented monitoring is not providing adequate information to estimate human exposure. The Health Surveillance Project has been launched in Korea from 1980, which questioned their symptoms based on questionnaires and medical examinations for inhabitants in the vicinity of 13 industrial areas and 2 non-industrial areas. 10, 598 inhabitants living in these 15 areas had medical checkups and donated their blood f3r heavy metal analysis from 1980 to 2000 through this project. Especially lead levels in inhabitants' blood of these areas were determined and monitored. Totally 4, 967 samples in target areas were used to review the trend of blood lead level in this paper. Average lead concentrations by areas were from 15.2 to 21.0 ug/dl in 1981 and 22.3 to 34.3 ug/dl in 1988, but were 8.8 to 11.1 ug/dl in 1992 and 4.4 to 4.8 ug/dl in 1995. On the other hand, the consumption of leaded gasoline was at a peak in 1958. Blood lead level showed a very close relationship with the consumption of leaded gasoline in the change pattern(p<0.01) and showed a rapid declining trend since the use of unleaded gasoline, especially from 1988 when Seoul held the olympic games. For example, the blood lead levels were 15.2 ug/dl in 1981, 20.2 ug/dl in 1955. 24.3 ug/dl in 1988 and 3.9 ug/dl in 1993 in Yochon area. China also had monitored blood lead levels of general population. 7, 015 inhabitants living in 28 areas donated their blood far heavy metal analysis from 1981 to 1988. Average lead concentrations by areas were from 5.1 to 5.6 ug/dl before. 1984 but were form 2.8 to 11.2 ug/dl after 1984. Average lead concentration in blood showed increasing trends clearly in most of the areas. The recent policy of unleaded gasoline use for automobile will be a very beneficial policy for the management of atmospheric lead pollution & health risk assessment for the general population in China. It is recommended that it should be propelled more widely and rapidly to the entire country.

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Effect of protein transduction domain fused-bone morphogenetic protein-2 on bone regeneration in rat calvarial defects (단백질 전달 영역 융합-Bone Morphogenetic Protein-2가 백서 두개골 결손부에서 골 조직 재생에 미치는 효과)

  • Um, Yoo-Jung;Cho, Kyoo-Sung;Kim, Chong-Kwan;Choi, Seong-Ho;Chai, Jung-Kiu;Kim, Chang-Sung
    • Journal of Periodontal and Implant Science
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    • v.38 no.2
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    • pp.153-162
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    • 2008
  • Purpose: Recombining bone morphogenetic protein (BMP) is usually acquiredfrom high level animals. Though this method is effective, its high cost limits its use. The purpose of this study was to evaluate the effect of bone morphogenetic protein-2 with protein transduction domain (BMP-2/PTD;TATBMP-2) on bone regeneration. Rat calvarial defect model and osteoblastic differentiation model using MC3T3 cell were used for the purpose of the study. Materials and Methods: MC3T3 cells were cultured until they reached a confluence stage. The cells were treated with 0, 0.1, 1, 10, 100, 500 ng/ml of BMP-2/PTD for 21 days and at the end of the treatment, osteoblastic differentiation was evaluated usingvon Kossa staining. An 8mm, calvarial, critical-size osteotomy defect was created in each of 48 male Spraque-Dawley rats (weight $250{\sim}300\;g$). Three groups of 16 animals each received either BMP-2/PTD (0.05mg/ml) in a collagen carrier, collagen only, or negative surgical control. And each group was divided into 2 and 8 weeks healing intervals. The groups were evaluated by histologic analysis(8 animals/group/healing intervals) Result: In osteoblastic differentiation evaluation test, a stimulatory effect of BMP-2/PTD was observed in 10ng/ml of BMP-2/PTD with no observation of dose-dependent manner. The BMP-2/PTD group showed enhanced local bone formation in the rat calvarial defect at 2 weeks. New bone was observed at the defect margin and central area of the defect. However, new bone formation was observed only in 50% of animals used for 2weeks. In addition, there was no new bone formation observed at 8 weeks. Conclusion: The results of the present study indicated that BMP-2/PTD(TATBMP-2) have an positive effect on the bone formation in vitro and in vivo. However, further study should be conducted for the reproducibility of the outcomes.

Detection Characteristics of TL, ESR and DNA Comet for Irradiated Peanuts by Origins (TL, ESR및 DNA Comet분석에 의한 원산지별 땅콩의 방사선 조사 검지 특성)

  • 이은영;정재영;조덕조;권중호
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.30 no.6
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    • pp.1076-1081
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    • 2001
  • Gamma-irradiated peanuts, Korean and Chinese origins, were investigated on detection properties by thermoluminescence (TL), electron spin resonance (ESR), and DNA comet assay (single cell gel electrophoresis). TL measurement showed that the non-irradiated sample revealed a glow curve with low intensity at about 25$0^{\circ}C$, while the irradiated samples showed higher intensity around at 18$0^{\circ}C$. TL ratio (TL$_1$/TL$_2$) of area for TL$_1$ glow curve to TL$_2$ was below 0.05 for the non-irradiated sample and 0.2 or more for the irradiated ones, thus identifying each other. ESR spectroscopy for the irradiated peanuts using outer skin showed negligible signals induced by irradiation, indicating ESR is little applicable to the detection of irradiated peanuts. In DNA comet assay, the non-sample had no or very short tails, whereas the irradiated samples revealed the cells with long tails. Significance in the increase of their lengths depending on irradiation dose (r=0.761/Korean, r=0.768/Chinese) was also found. There was no remarkable difference in detection properties by origins of samples in all determinations, It is concluded that TL analysis or DNA comet assay is suitable for detection of irradiated peanuts and a combined method is recommendable for enhancing the reliability of detection results.

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Neuroprotecticve Effect of Sophora Subprostrata on Transient Global Ischemia in Gerbil (광두근(廣豆根)의 Gerbil 전뇌(全腦)허혈에 대한 신경손상방어효능 연구)

  • Min, Hong-Kyu;Kang, Ho-Chang;Lee, Hyun-Sam;Kim, Sun-Yeou;Sohn, Young-Joo;Jung, Hyuk-Sang;Sohn, Nak-Won;Kim, Yoon-Bum
    • The Korea Journal of Herbology
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    • v.23 no.3
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    • pp.1-9
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    • 2008
  • Objectives : This research was performed to investigate protective effect of Sophora Subprostrata against transient global ischemic damage after 5-min two vessel occlusion. Methods : Gerbils were divided into three groups: Normal group, 5-min two vessel occlusion (2VO) group, Sophora Subprostrata administrated group after 2VO. The CCAs were occluded by microclip for 5min. Sophora Subprostrata was administrated orally(12mg/ml) for 7 days after 2VO. The histological and immunohistochemistrical analysis was performed at 72 hours and 7 days after the surgery each. For histological analysis, the brain tissue was stained with 1% cresyl violet solution and Immunohistochemistry for BAX and Bcl-2 was carried out to examine effect of Sophora Subprostrata on ischemic brain tissue. Results : The results showed that (1) Sophora Subprostrata has the protective effect against ischemia in CA1 area of the gerbil hippocampus 7 days after 5-minute occlusion, (2) the treatment of Sophora Subprostrata inhibits the expression of Bax relatively after 2VO-induced ischemia. That protective effect of the Sophora Subprostrata seems to be performed by regulating the proportion of Bax and Bcl-2 protein, (3) in hypoxia/reperfusion model using PC12 cell, the Sophora Subprostrata extract has the protective effect against ischemia in the dose of $2{\mu}/m{\ell}$ and $20{\mu}/m{\ell}$.This study suggests that Sophora Subprostrata has neuroprotective effect against neuronal damage following cerebral ischemia in vivo with a widely used experimental model of cerebral ischemia in Mongolian gerbils and that Sophora Subprostrata regulates the proportion of Bax and Bcl-2 protein following ischemia. And, Sophora Subprostrata extract has protective effects also on a hypoxia/reperfusion cell culture model using PC12 cell. Conclusions : Sophora Subprostrata has protective effects against ischemic brain damage at the early stage of ischemia.

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Regenerative effect of recombinant human bone morphogenetic protein-2/absorbable collagen sponge (rhBMP-2/ACS) after sequestrectomy of medication-related osteonecrosis of the jaw (MRONJ)

  • Min, Song-Hee;Kang, No-Eul;Song, Seung-Il;Lee, Jeong-Keun
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.46 no.3
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    • pp.191-196
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    • 2020
  • Objectives: Beyond the original application approved by the U.S. Food and Drug Administration, recombinant human bone morphogenetic protein-2 (rhBMP-2) is used for medication-related osteonecrosis of the jaw (MRONJ) treatment because of its bone remodeling enhancement properties. The purpose of the study was to investigate the bone formation effect of rhBMP-2/absorbable collagen sponge (ACS) in patients with MRONJ. Materials and Methods: In this retrospective cohort study, 26 female patients diagnosed with MRONJ and who underwent mandibular sequestrectomy at Ajou University Dental Hospital from 2010 to 2018 were included. The experimental group was composed of 18 patients who received rhBMP-2/ACS after sequestrectomy, while the control group was composed of 8 patients who did not receive rhBMP-2/ACS after sequestrectomy. A total dose of 0.5 mg of rhBMP-2 was used in the experimental group at a concentration of 0.5 mg/mL. Follow-up panoramic X-rays were taken immediately after the surgery and more than 6 months after the surgery. Using those X-rays, a radiographic index of bone defect area was calculated using the modified Ihan Hren method, which measures radiographic density of the normal bone and the defect site. Results: This study suggests that rhBMP-2 contributes to new bone formation. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the experimental group was 68.4% and 79.8%, respectively. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the control group was 73.4% and 76.7%, respectively (Wilcoxon signed rank test, P>0.05). The mean radiographic index increased 11.4% in the experimental group and 3.27% in the control group (Mann-Whitney U-test, P<0.05). Conclusion: Based on the results, use of rhBMP-2/ACS on bone defect sites after sequestrectomy could be a successful strategy for treatment of MRONJ patients.