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Purpose@#The effects of dexmedetomidine on locomotor function and thermal hyperalgesia in sciatic nerve crush injury (SNCI) were investigated using rats. @*Methods@#After exposing the right sciatic nerve, the sciatic nerve was crushed for 1 minute by a surgical clip. One day after nerve injury, dexmedetomidine (5, 25, and 50 µg/kg) was directly applied to the injured sciatic nerve once a day for 14 days. Walking track analysis was used to assess locomotor function and plantar test was conducted to assess thermal pain sensitivity. Immunohistochemistry was performed to determine the expression of c-Fos in the ventrolateral periaqueductal gray (vlPAG) and paraventricular nucleus (PVN). Western blot was used to evaluate the expression level of nerve growth factor (NGF) and myelin basic protein (MBP) in the sciatic nerve. @*Results@#SNCI resulted in deterioration of locomotor function and increased thermal pain sensitivity. The level of c-Fos expression in the PVN and vlPAG was increased and the level of NGF and MBP expression in the sciatic nerve was enhanced by SNCI. Dexmedetomidine treatment improved locomotor function and upregulated expression of NGF and MBP in the sciatic nerve of SNCI. Dexmedetomidine treatment alleviated thermal hyperalgesia and downregulated expression of c-Fos in the vlPAG and PVN after SNCI. @*Conclusions@#Dexmedetomidine may be used as a potential new treatment drug for recovery of locomotion and control of pain in peripheral nerve injury.
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PURPOSE@#Postoperative cognitive dysfunction (POCD) is a complication of surgery characterized by acute cognitive dysfunction, memory impairment, and loss of attention. The effect of polydeoxyribonucleotide (PDRN) on the POCD environment induced by lipopolysaccharide (LPS) and sevoflurane exposure were investigated in human neuronal SH-SY5Y cells.@*METHODS@#The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and WST-8 assays were performed to determine cell viability. Cyclic adenosine-3,5′-monophosphate (cAMP), tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 concentrations were measured using enzyme-linked immunoassay (ELISA). Immunocytochemistry was performed for vascular endothelial growth factor (VEGF) and brain-derived neurotrophic factor (BDNF), and western blotting for TNF-α, IL-1β, IL-6, and cAMP response element-binding protein (CREB).@*RESULTS@#Induction of the POCD environment reduced cell viability in the MTT and WST-8 assays. PDRN treatment reduced TNF-α, IL-1β, and IL-6 expression in POCD conditions, and significantly increased cAMP concentrations and the p-CREB/CREB ratio. PDRN treatment activated adenosine A2A receptors and then increased the expression of VEGF and BDNF, which had been reduced by LPS and sevoflurane exposure.@*CONCLUSIONS@#PDRN treatment showed a therapeutic effect on the LPS and sevoflurane-induced POCD environment. PDRN was shown to have an excellent therapeutic effect on POCD, not only by promoting rapid anti-inflammatory effects in damaged cells, but also by enhancing the expression of BDNF and VEGF.
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PURPOSE: Sleep deprivation induces depressive symptoms. Dexmedetomidine is a α2-adrenoreceptor agonist and this drug possesses sedative, anxiolytic, analgesic, and anesthetic-sparing effect. In this study, the action of dexmedetomidine on sleep deprivation-induced depressive behaviors was investigated using mice. METHODS: For the inducing of sleep deprivation, the mice were placed inside a water cage containing 15 platforms and filled with water up to 1 cm below the platform surface for 7 days. One day after sleep deprivation, dexmedetomidine at the respective dosage (0.5, 1, and 2 μg/kg) was intraperitoneally treated into the mice, one time per a day during 6 days. Then, forced swimming test and tail suspension test were conducted. Immunohistochemistry for tyrosine hydroxylase (TH), 5-hydroxytryptamine (5-HT; serotonin), tryptophan hydroxylase (TPH) and western blot for D1 dopamine receptor were also performed. RESULTS: Sleep deprivation increased the immobility latency in the forced swimming test and tail suspension test. The expressions of TPH, 5-HT, and D1 dopamine receptor were decreased, whereas, TH expression was increased by sleep deprivation. Dexmedetomidine decreased the immobility latency and increased the expressions of TPH, 5-HT, and D1 dopamine receptor, whereas, HT expression was decreased by dexmedetomidine treatment. CONCLUSIONS: In our results, dexmedetomidine alleviated sleep deprivation-induced depressive behaviors by increasing 5-HT synthesis and by decreasing dopamine production with up-regulation of D1 dopamine receptor.
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Animais , Camundongos , Western Blotting , Depressão , Dexmedetomidina , Dopamina , Elevação dos Membros Posteriores , Imuno-Histoquímica , Esforço Físico , Receptores Dopaminérgicos , Serotonina , Privação do Sono , Triptofano Hidroxilase , Tirosina 3-Mono-Oxigenase , Regulação para Cima , ÁguaRESUMO
Undifferentiated pleomorphic sarcoma (UPS) is a rare soft tissue sarcoma of the sinonasal area. Here, we present two primary cases of UPS and three post-irradiation sinonasal UPS cases. Imaging findings were misinterpreted by radiologists as representing other malignant tumors or recurrence of the primary tumor. Our cases indicate that post-irradiation UPS can originate within any part of the radiation field. Treatment outcomes of primary sinonasal UPS seem to be favorable if the tumor is treated aggressively, but the outcomes of post-irradiation sinonasal UPS may be poor if appropriate surgical margins cannot be obtained.
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Humanos , Cavidade Nasal , Recidiva , SarcomaRESUMO
IgG4-related sclerosing disease (IgG4-RSD) is characterized by extensive IgG4-positive plasma cell and T-lymphocyte infiltration of various organs. However, the nasal cavity is an extremely rare site of involvement. The authors experienced three cases of igG4-RSD in the nasal cavity. A 54-year-old woman presented with a nasal cavity mass on endoscopic exam and computed tomography (CT) revealed not only a hypoenhancing mass in the right nasal cavity but also a pituitary gland macroadenoma. Endoscopic removal and endoscopic TSA were performed. A 20-year-old man diagnosed with chronic sinusitis, underwent endoscopic sinus surgery. A 26-year-old woman showed thickening of the nasal septum and cribriform plate, and an infiltrating soft tissue lesion in right the alveolar process on CT and an endoscopic biopsy was performed. Pathologic specimens of all cases showed IgG4-positive plasma cell infiltration, consistent with IgG4-RSD. Serum IgG4 levels were checked in two of the cases, and the results were within normal range. All cases were further treated with methylprednisolone and all showed clinical improvement.
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Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Processo Alveolar , Biópsia , Osso Etmoide , Imunoglobulina G , Metilprednisolona , Cavidade Nasal , Septo Nasal , Hipófise , Plasmócitos , Valores de Referência , Sinusite , Linfócitos TRESUMO
BACKGROUND AND OBJECTIVES: Epistaxis is the most common symptom in patients with hereditary hemorrhagic telangiectasia (HHT). The aim of this study is to report treatment of severe epistaxis related to HHT with the septodermoplasty and to assess patient outcomes. SUBJECTS AND METHOD: Six patients with HHT who underwent septodermoplasty from 2009 to 2013 were reviewed retrospectively. We analyzed the clinical characteristics, surgical management and treatment outcomes. RESULTS: Three patients had been diagnosed with definite HHT and three patients with possible HHT. Three patients had combined abnormal vascular structures in visceral organs. The mean preoperative and postoperative hemoglobin were 7.2 g/dL and 12.8 g/dL, respectively, and visual analogue scale score for frequency and intensity of nasal bleeding remarkably decreased after septodermoplasty in all patients. CONCLUSION: Septodermoplasty was a safe and efficacious procedure for reducing the frequency and severity of bleeding in most patients with intractable epistaxis and HHT.
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Humanos , Epistaxe , Hemorragia , Estudos Retrospectivos , Telangiectasia Hemorrágica HereditáriaRESUMO
PURPOSE: Asthma exacerbation from human rhinovirus (HRV) infection is associated with deficient antiviral interferon (IFN) secretion. Although chronic rhinosinusitis (CRS), an inflammatory upper airway disease, is closely linked to asthma, IFN-beta responses to HRV infections in human nasal epithelial cells (HNECs) from CRS patients remain to be studied. We evaluated inflammatory and antiviral responses to HRV infection in HNECs from CRS patients. METHODS: HNECs, isolated from turbinate tissue of 13 patients with CRS and 14 non-CRS controls, were infected with HRV16 for 4 hours. The HRV titer, LDH activity, production of proinflammatory cytokines and IFN-beta proteins, and expression levels of RIG-I and MDA5 mRNA were assessed at 8, 24, and 48 hours after HRV16 infection. RESULTS: The reduction in viral titer was slightly delayed in the CRS group compared to the non-CRS control group. IL-6 and IL-8 were significantly increased to a similar extent in both groups after HRV infection. In the control group, IFN-beta production and MDA5 mRNA expression were significantly increased at 8 and 24 hours after HRV16 infection, respectively. By contrast, in the CRS group, IFN-beta was not induced by HRV infection; however, HRV-induced MDA5 mRNA expression was increased, but the increase was slightly delayed compared to the non-CRS control group. The RIG-I mRNA level was not significantly increased by HRV16 infection in either group. CONCLUSIONS: HRV-induced secretion of proinflammatory cytokines in CRS patients was not different from that in the non-CRS controls. However, reductions in viral titer, IFN-beta secretion, and MDA5 mRNA expression in response to HRV infection in CRS patients were slightly impaired compared to those in the controls, suggesting that HRV clearance in CRS patients might be slightly deficient.
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Humanos , Asma , Citocinas , Células Epiteliais , Interferon beta , Interferons , Interleucina-6 , Interleucina-8 , Rhinovirus , RNA Helicases , RNA Mensageiro , Conchas NasaisRESUMO
BACKGROUND AND OBJECTIVES: Mucosal melanoma comprises 1.3% of all malignant melanomas and mainly occurs at the oropharynx and the sinonasal cavity in the head and neck area. Five year survival rate is about 10-46%. We aimed to investigate the clinical features and treatment outcomes of 38 patients with sinonasal malignant melanoma (SNMM). SUBJECTS AND METHOD: A retrospective review of medical records was carried out on 38 patients who were diagnosed as SNMM between August 1995 and December 2012. Clinical features were evaluated and tumors were staged according to the TNM staging system. The Kaplan-Meier method was used to assess survival in the cohort. RESULTS: The 38 patients consisted of 18 males and 20 females, ranging in age from 36 to 91 years, with a median age of 59 years at diagnosis. Common symptoms were nasal obstruction and epistaxis, and mean symptom duration to diagnosis was 2.0 months. The main treatment modalities were surgery only (n=18) or surgery plus adjuvant radiotherapy (n=9). Distant metastases were detected in 15 patients (39.5%) at 8 months after initial therapy. Overall 5-year survival rate was 45.6%. There was no significant difference in survival rate between patients who underwent surgery only and those who had surgery with postoperative radiation (p=0.359). CONCLUSION: Sinonasal mucosal melanoma is a highly recurrent tumor (80% recurrence rate) with poor prognosis (5-year survival rate; 46%). As radiation treatment and/or chemotherapy are not so effective for the recurrent tumor, early detection and surgical resection are mandatory at present. New treatment modality should be developed to improve the survival rate.
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Feminino , Humanos , Masculino , Estudos de Coortes , Diagnóstico , Tratamento Farmacológico , Epistaxe , Cabeça , Prontuários Médicos , Melanoma , Obstrução Nasal , Pescoço , Metástase Neoplásica , Estadiamento de Neoplasias , Orofaringe , Prognóstico , Radioterapia Adjuvante , Recidiva , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Huntington's chorea is a rare hereditary disorder of the nervous system. It is inherited as an autosomal dominant disorder and is characterized by progressive chorea, dementia and psychiatric disturbances. The best anesthetic technique is yet to be established for these patients with increased risk of aspiration due to involvement of pharyngeal muscles and an exaggerated response to sodium thiopental and succinylcholine. The primary goal in general anesthesia for these patients is to provide airway protection and a rapid and safe recovery. We report the anesthetic management of a 51-year-old patient with Huntington's chorea admitted for an emergency operation.
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Humanos , Anestesia Geral , Broncoscópios , Coreia , Demência , Emergências , Doença de Huntington , Intubação , Sistema Nervoso , Músculos Faríngeos , Sódio , Succinilcolina , TiopentalRESUMO
BACKGROUND: The use of neuraxial anesthesia for Cesarean section has dramatically increased. There was little information about the relationship of cerebrospinal fluid (CSF) pressure according to the position and spinal block level in pregnant women. The aims of this study are to investigate the cerebrospinal fluid pressure according to the degree of flexion in the lateral position and block height after spinal anesthesia in pregnant women undergoing Cesarean section. METHODS: We enrolled 40 patients, American Society of Anesthesiologists physical status I-II, aged 22-40 years, undergoing Caesarean section under spinal anesthesia. Patients were randomly divided into two groups. In group I, patients were placed in a full flexed position, and 10 mg of 0.5% hyperbaric bupivacaine was injected. In group II, the same dose of bupivacaine was injected when the hip and neck was straightened slowly. Following injection, the patients were immediately placed in supine position. The level of spinal anesthesia was checked by pinprick at 5, 10, 15, and 30 min after the subarachnoid injection. RESULTS: There was significant difference in the cerebrospinal fluid pressure between full-flexed position and non-full-flexed position. The spinal block height level was T3-T5 in both groups, and there was no significant difference in the spinal block height level in both groups. CONCLUSIONS: CSF pressures according to the degree of flexion in the lateral position during the subarachnoid injection have no significant correlation with the block level in spinal anesthesia for Cesarean section.
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Idoso , Feminino , Humanos , Gravidez , Anestesia , Raquianestesia , Bupivacaína , Pressão do Líquido Cefalorraquidiano , Cesárea , Quadril , Pescoço , Gestantes , Decúbito DorsalRESUMO
Burkitt's lymphoma is a highly aggressive small B-cell lymphoma. The treatment of choice is complex chemotherapy. As a rare tumor in the head and neck area, Burkitt's lymphoma usually involves cervical lymph nodes, and only fewer than 25% of cases involves extranodal regions. Involvement of the paranasal sinuses has been reported in only 14 cases in the past century. We describe here two patients with rare, sporadic, American type Burkitt's lymphoma involving the nasal cavity and paranasal sinuses manifesting nasal obstruction. We also review clinical and histological features of Burkitt's lymphoma.
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Humanos , Linfoma de Burkitt , Cabeça , Linfonodos , Linfoma , Linfoma de Células B , Cavidade Nasal , Obstrução Nasal , Pescoço , Seios ParanasaisRESUMO
Penetrating neck injuries can be a fatal event and they are difficult to manage for both surgeons and anesthesiologists. So, adequate preoperative evaluation is important to improve the patients' outcomes, but this can not be done for hemodynamically unstable or uncooperative patient. Here we present our clinical experience with a patient with a penetrating neck injury and who was hemodynamically stable, but she was uncooperative and the knife was still embedded in her neck. The surgical exploration and bronchoscopic examination were successfully done under monitored anesthesia care.
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Humanos , Anestesia , Pescoço , Lesões do PescoçoRESUMO
BACKGROUND AND OBJECTIVES: Nasolabial cysts are relatively rare and are sometimes confused with tumors due to progressive enlargement. Treatment of a nasolabial cyst consists of sublabial excision or endonasal endoscopic marsupialization (EEM). The purpose of this study was to investigate the clinical features of nasolabial cysts in order to provide a basis for correct diagnosis and treatment. MATERIALS AND METHODS: Sixty-four patients with a nasolabial cyst were surgically treated between December, 1989 and January, 2010 at the Department of Otolaryngology, Asan Medical Center. Their clinical features, radiologic and histopathologic findings, and treatment and outcomes were retrospectively analyzed. RESULTS: The patients comprised 51 (80%) women and 13 men (20%), with ages ranging from 16 to 69 years with a mean of 43 years. Swelling of the nasolabial fold was the most frequently experienced symptom. There was no right or left side preponderance. Sublabial excision was applied in 57 cases (89%), while seven cases (11%) were treated via the endonasal approach. There was no case of recurrence. CONCLUSION: Nasolabial cysts should be suspected in patients with swelling of the nasolabial area and nasal obstruction. Enhanced CT may be needed to differentiate from tumors, odontogenic cysts, or other inflammatory lesions. Nasolabial cysts can be successfully treated via sublabial or endonasal approaches. Postoperative complications or recurrence is very rare.
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Feminino , Humanos , Masculino , Cavidade Nasal , Obstrução Nasal , Sulco Nasogeniano , Nariz , Tumores Odontogênicos , Otolaringologia , Complicações Pós-Operatórias , Recidiva , Estudos RetrospectivosRESUMO
BACKGROUND: During neurosurgical procedures, patients are often exposed to hypoxic and ischemic brain damage. Cerebral ischemia leads to neuronal cell death and eventually causes neurological impairments. Remifentanil is a new ultra-short acting phenylpiperidine opioid analgesic. In this study, we evaluated remifentanil to determine if it exerts an anti-apoptotic effect in the hippocampal dentate gyrus following transient global ischemia in gerbils. METHODS: Step-down avoidance task, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay, and immunohistochemical staining for caspase-3 were performed. RESULTS: The numbers of TUNEL-positive cells and caspase-3-positive cells in the dentate gyrus were increased by ransient global ischemia. Latency in the step-down avoidance task was increased by transient global ischemia. Results revealed that apoptotic cell death in the dentate gyrus was increased significantly following transient global ischemia, resulting in memory impairment. However, treatment with remifentanil suppressed ischemia-induced apoptosis in the dentate gyrus, thereby alleviating the memory impairment that was induced by ischemic cerebral injury. CONCLUSIONS: These results indicate that remifentanil may exert a neuroprotective effect on ischemic brain damage during surgery.
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Humanos , Apoptose , Encéfalo , Isquemia Encefálica , Caspase 3 , Morte Celular , Giro Denteado , Gerbillinae , Isquemia , Ataque Isquêmico Transitório , Memória , Transtornos da Memória , Neurônios , Fármacos Neuroprotetores , Procedimentos Neurocirúrgicos , PiperidinasRESUMO
Rett syndrome is a neurological disease that occurs only in females and it manifests with mental retardation, seizures, movement disorders, autistic behavior and abnormal breathing. A 19-year-old female with Rett syndrome underwent ophthalmologic surgery under general anesthesia at our institution. Airway control was difficult due to her limited mouth opening. We recommend that anesthesiologists should have proper knowledge about this disease and the patients to avoid the complications and problems that can be encountered during the perioperative period.
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Adulto , Feminino , Humanos , Adulto Jovem , Manuseio das Vias Aéreas , Anestesia Geral , Deficiência Intelectual , Boca , Transtornos dos Movimentos , Período Perioperatório , Respiração , Síndrome de Rett , ConvulsõesRESUMO
Paget's disease is a well-known disorder of unclear etiology that results in deformity and enlargement of single or multiple bones due to abnormal osteoclastic-osteoblastic remodeling of bone. Osteoclastoma, also known as giant cell tumor, is a rare complication of Paget's disease that usually occurs in the skull or facial bones. This is a report of a 35-year-old woman with recurrent osteoclastoma of the sino-nasal tract, a complication of Paget's disease, for which she underwent 4 operations. Clinicopathological features of this rare disease are described here.
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Adulto , Feminino , Humanos , Anormalidades Congênitas , Ossos Faciais , Tumores de Células Gigantes , Seios Paranasais , Doenças Raras , CrânioRESUMO
Acupuncture appears to be a clinically effective treatment for acute and chronic pain. A considerable amount of research has been conducted to evaluate the role that acupuncture plays in pain suppression; however, few studies have been conducted to evaluate the side effects of the acupuncture procedure. This case report describes a suspected postdural puncture headache following acupuncture for lower back pain. Considering the high opening pressure, cerebrospinal fluid leakage, and the patient's history of acupuncture in the lower back area, our diagnosis was iatrogenic postdural puncture headache. Full relief of the headache was achieved after administration of an epidural blood patch.
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Acupuntura , Placa de Sangue Epidural , Pressão do Líquido Cefalorraquidiano , Dor Crônica , Cefaleia , Dor Lombar , Agulhas , Cefaleia Pós-Punção DuralRESUMO
BACKGROUND AND OBJECTIVES: Antrochoanal polyp (ACP) is a benign maxillary sinus polyp that originates from the mucosa of the maxillary sinus, passes through the sinus ostium, and extends into the choana. Surgical methods employed in the treatment of antrochoanal polyp are simple avulsion, Caldwell-Luc operation, osteoplastic maxillary sinus operation, and endonasal endoscopic removal. In this study, we evaluated the clinical presentation of ACP and compared its surgical outcomes. MATERIALS AND METHODS: We retrospectively reviewed 111 patients who were treated for ACP between January 1995 and May 2008, and analyzed clinical features, radiologic findings, and surgical results. RESULTS: The study group consisted of 111 patients (65 males, 46 females) with a mean age of 20.0 years (range, 4 to 70). Sixty-one cases were accompanied by sinusitis (20 with unilateral sinusitis, 41 with bilateral sinusitis). Endoscopic sinus surgery (ESS) was used to treat 95 cases, and the external approaches of Caldwell-Luc operation or osteoplastic maxillary sinus operation were applied in 12 and four cases, respectively. Among those who received ESS, ACP recurred in 16 cases, whereas none of the patients who received the external approach showed recurrence. CONCLUSION: Endoscopic sinus surgery is a good alternative method for the treatment of ACP. If the antral part of ACP cannot be removed completely, an external approach such as Caldwell-Luc operation or osteoplastic maxillary sinus operation for pediatric patients may be considered to prevent recurrence.
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Humanos , Masculino , Carbamatos , Seio Maxilar , Mucosa , Compostos Organometálicos , Pólipos , Recidiva , Estudos Retrospectivos , SinusiteRESUMO
Herein we describe two cases of nasal glomus tumor. Histological findings were typical, save for one which was quite large (3.1 cm in its greatest dimension) with an invasive growth pattern and increased ki-67 labeling index (up to 10%). These features raised a red flag of similarity to a recently described "invasive glomus tumor of nasal cavity", suggesting a more aggressive form of glomus tumor. However, objective criteria for this possibility is lacking at present and more similar case studies are needed to establish a truly aggressive form of glomus tumor.
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Tumor Glômico , Cavidade Nasal , Seios ParanasaisRESUMO
BACKGROUND: Metastases to the sinonasal tract are rare but occur for many malignancies. The demographics of sinonasal metastases in Korea aren't well known. METHODS: Nine cases of metastases to the sinonasal tract identified at Asan Medical Center from January, 1995 to December, 2007 were reviewed. RESULTS: Metastatic carcinomas accounted for 2.4% of sinonasal malignancies and 4.7% of carcinomas. Six kinds of cancer metastasized to the sinonasal tract. They included hepatocellular carcinomas (nasal cavity and maxillary sinus), colonic adenocarcinomas (sphenoid sinus and maxillary sinus), clear cell renal cell carcinoma (nasal cavity), pulmonary small cell carcinoma (nasal cavity), follicular carcinoma of thyroid (sphenoid sinus), and breast ductal carcinoma (maxillary sinus). Primary sites had been known in 7 cases, but follicular carcinoma and one adenocarcinoma were diagnosed after sinus metastases. Histologically, they had ill-defined borders and involved both mucosae and bones. Microscopic findings were not different from those for the primary tumors. CONCLUSIONS: The pattern of sinonasal metastases in Korea are different from western data regarding incidence, site, and type, with hepatocellular carcinoma and the nasal cavity being the most common type and site, respectively. Awareness of the possibility of metastases and their pattern is encouraged when examining sinonasal tumors.