Young Woo Cho

Tristetraprolin down-regulates IL-17 through mRNA destabilization.

An excess of interleukin 17 (IL‐17) may contribute to chronic inflammatory disorders, but mechanisms that regulate IL‐17 in immune cells are unclear. Here we report that tristetraprolin (TTP) inhibits IL‐17 production in human T cell lines. Overexpression of TTP decreased the expression of IL‐17. Conversely, TTP inhibition by siRNA increased IL‐17 production. IL‐17 mRNA contains eight AREs within its 3′UTR. TTP bound directly to the IL‐17 mRNA 3′UTR at a location between the fourth and seventh AREs and enhanced decay of IL‐17 transcripts. These results suggest that TTP could control IL‐17‐mediated inflammation.

Cerebral oxygenation monitoring of patients during arthroscopic shoulder surgery in the sitting position

Background Cerebral hypotension and desaturation can occur during shoulder surgery in the seated position. We evaluated the correlation of cerebral oxygen saturation (rSO2) using near infra-red spectroscopy (NIRS) and mean arterial pressures (MAP) (at the levels of the brain and heart). Methods Fifty patients, scheduled for the arthroscopic shoulder surgery in the seated position, were enrolled to monitor the rSO2, bispectral Index (BIS), and MAPs at the levels of the brain and heart. The values of each parameter were collected at 5 min after intubation, immediately after placing the patient in the sitting position, 5 min after the patient was seated, immediately after the surgical incision, and every 30 min after incision. Results A correlation between the cerebral rSO2 and the MAP at the level of brain were statistically significant. Cerebral rSO2 and MAP after a change of posture from supine to sitting position were significantly decreased, compared to the baseline value. Conclusions Monitoring cerebral rSO2 and MAP at the level of brain can be helpful to detect the possibility of cerebral deoxygenation earlier.

Experience without using venoveno bypass in adult orthotopic liver transplantation

Background Venoveno bypass (VVB) has been used to achieve hemodynamic stability and decrease the incidence of renal dysfunction. However, VVB has many complications. The purpose of this study is to verify the safety of total clamping of the suprahepatic inferior vena cava (IVC) without VVB during orthotropic liver transplantation (OLT) in terms of anesthetic management. Methods Twenty-five patients without preoperative renal dysfunction who underwent primary OLT were enrolled in this study. Hemodynamic data and blood gas measurements were collected 1 hour after incision, 30 minutes after IVC total clamping and 30 minutes after reperfusion. Postoperative laboratory data, including blood urea nitrogen (BUN), creatinine (Cr) and glomerular filtration rate (GFR), were assessed at postoperative day (POD) 0-7, 30, 90, 180 and 1 year. Results Mean blood pressure was well maintained during IVC total clamping with infusion of inotropics. There was no case of severe acidosis (pH < 7.2) during the anhepatic period. The immediate postoperative Cr and GFR were not significantly different from those of the preoperative values. BUN increased from POD 1 and decreased after POD 6, while Cr increased at POD 90 only. Conclusions In patients without preoperative renal dysfunction, when IVC was totally clamped, VVB does not need to be routinely performed to maintain hemodynamics during the anhepatic phase and renal function after OLT.

Inhaled nitric oxide for the brain dead donor with neurogenic pulmonary edema during anesthesia for organ donation: a case report

Neurogenic pulmonary edema (NPE) in brain dead organ donors occurring after an acute central nervous system insult threatens organ preservation of potential organ donors and the outcome of organ donation. Hence the active and immediate management of NPE is critical. In this case, a 50-year-old male was admitted to the intensive care unit (ICU) for organ donation. He was hypoxic due to NPE induced by spontaneous intracerebral hemorrhage and intraventricular hemorrhage. Protective ventilatory management, intermittent recruitment maneuvers, and supportive treatment were maintained in the ICU and the operating room (OR). Despite this management, the hypoxemia worsened after the OR admission. So inhaled nitric oxide (NO) therapy was performed during the operation, and the hypoxic phenomena showed remarkable improvement. The organ retrieval was successfully completed. Therefore, NO inhalation can be helpful in the improvement of hypoxemia caused by NPE in brain dead organ donors during anesthesia for the organ donation.

Needles as Urethral Foreign Body in a Child: Successful Removal Using a New Method With a Laparoscopic Needle Holder

Self-inserted foreign bodies in the lower urinary tract are rare among children. The treatment of foreign bodies in the urethra is determined by their type, size, location, shape, and mobility. We describe here a 13-year-old boy who had self-inserted a needle into his urethra out of curiosity. Initial attempts to remove the needle from the urethra by inserting a cystoscope failed due to the weak biting force of the forceps and because the needle was trapped in the urethral mucosa. We successfully used a laparoscopic needle holder to remove the needle through the perineum.

Assessment of the right internal jugular vein cross-sectional area with different levels of positive end-expiratory pressure in patients with controlled ventilation during anesthesia

For drug administration, IV fluid administration, and if securing a peripheral vein is difficult, the internal jugular vein is used for the central venous catheter to secure an IV route and for central venous pressure monitoring. Theoretically, the bigger the cross-sectional area (CSA) of the internal jugular vein, the higher the success rate when cannulation is carried out, and the smaller the area, the higher the possibility of failure, increasing the risk of complications such as hemothorax, pneumothorax, and arterial puncture [1]. Most existing cannulation methods are attempted in the trendelenburg position with leg elevation, but positive end expiratory pressure (PEEP) is being introduced as an useful method for patients under control of this study is to find an effective PEEP level for the internal jugular vein cannulation for patients under controlled ventilation and who have difficulties with the trendelenburg position. This study includes 20 American Society of Anesthesiology (ASA) Physical Status I or II patients between 24-83 year of age undergoing elective surgery that required central venous access. All patients received standardized induction of general anesthesia with penthotal sodium 5 mg/kg IV, lidocaine 60 mg IV, rocuronium 0.8-1 mg/kg IV. The patients were tracheally intubated and their lungs mechanically ventilated using volume-control mode with tidal volume 6-8 ml/kg, respiratory rate 10 breaths/min, inspiratory to expiratory ratio 1 : 2, PEEP 0 cmH2O, and were maintained with O2-Air-Desflurane. After anesthetic induction, the bed was placed in a level position and the patient was laid in the supine position, A 13 MHz linear transducer of Ultrasound (Esoate Ⓡ , Wing international, Italy) was placed vertically on the skin at the angular point where the medial sternocleidomastoid muscle and lateral sternocleidomastoid muscle meet, and the images of right internal jugular vein were acquired applying as little pressure as possible. (P0) The size of right internal jugular vein differs with each breath, and the largest size was recorded. Following the above method, PEEP 5 (P5), 10 (P10), 15 (P15) cmH2O and 10 o

Relation between preoperative autonomic function and blood pressure change after tourniquet deflation during total knee replacement arthroplasty

Background Tourniquets are used to provide a bloodless surgical field for extremities. Hypotension due to vasodilation and bleeding after tourniquet deflation is a common event. Hemodynamic stability is modulated by the autonomic nervous system (ANS). Heart rate variability (HRV) is a sensitive method for detecting individuals who may be at risk of hemodynamic instability during general anesthesia. The purpose of this study was to investigate ANS function to predict hypotension after tourniquet deflation. Methods Eighty-six patients who underwent total knee replacement arthroplasty (TKRA) were studied. HRV, systolic blood pressure variability (SBPV) and baroreflex sensitivity (BRS) were analyzed. We assigned two groups depending on the lowest systolic blood pressure (SBP) or mean BP (MBP) after tourniquet release (Group H; SBP < 80 mmHg or MBP < 60 mmHg, Group S; SBP > 80 mmHg and MBP > 60 mmHg). Results Fifteen patients developed severe hypotension and ten patients were treated with ephedrine. Of the parameters of HRV, SBPV, and BRS, only BRSSEQ was significant being low in Group H. BRS and high-frequency SBPV were correlated with the degree of MBP change after tourniquet deflation. Conclusions Preoperative low BRS is associated with hypotension after tourniquet deflation, suggesting the importance of baroreflex regulation for intraoperative hemodynamic stability.

Use of stellate ganglion block for treatment of recurrent syncope followed by chest pain

Syncope is defined as a transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery. Stellate ganglion block (SGB) is a nerve block method that is used for treatment of neuropathic pain in the head, neck and upper extremities, especially trigeminal neuralgia, postherpetic neuralgia and complex regional pain syndrome. SGB can modulate and stabilize the sympathetic nervous system, which prevents it from overexcitation and improves symptoms of syncope. The authors report a patient who was treated for pain and edema of both upper extremities with SGB, then showed improvement in recurrent syncope followed by chest pain and overall quality of life.

Severe hypotension following urethral catheterization during general anesthesia in a patient with bladder cancer -A case report-

The process of micturition is related to activation of the cardiovascular autonomic nervous system. Hypotension with bradycardia often occurs during or immediately after micturition. We experienced a case of sudden severe hypotension and bradycardia following urethral catheterization in a patient who underwent an urethral dilatation and transurethral resection of bladder tumor while under general anesthesia. The patient was treated with inotropics and intravenous fluids, and he recovered without any complications. The characteristics of this case are similar to the physiologic changes that occur in micturition syncope. Therefore, it is presumed that the autonomic reflex that was triggered by the urethral catheterization caused the hypotension and bradycardia.