An oral glucose tolerance test (O-GTT) was conducted in 96 non-obese healthy children (7∼11 years old) and adolescents (12∼16 years old) to obtain the index of insulin resistance from the insulin (IRI) and C-peptide (CPR) values of fasting, 2-hour postload conditions and the Σ values, and the homeostasis model assessment ratio (HOMA-R) by assuming the value of the mean+2SD to be the upper limit of the normal value for each clinical variable. The results show that the adolescents, whose insulin resistance is thought to increase, showed higher IRI and CPR values of the 2-hour postload condition and Σ values compared to those of the children, but there were no differences between the 2 age groups in the values of the fasting condition, as well as in the HOMA-R values which were calculated from the fasting values. These findings indicate that there is a limitation in using fasting values to judge insulin resistance. Instead, using the 2-hour postload values and/or the Σ values is more appropriate.

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An oral glucose tolerance test (O-GTT) was conducted in 22 patients with type 2 diabetes mellitus whose ages at onset were less than 18 years old. They were classified into 2 groups, obese and non-obese at onset, and insulin secretory function was compared with that of a non-obese healthy group. The results show that, in the group of obese subjects with type 2 diabetes mellitus, both values of fasting IRI and ΣIRI were significantly higher than those in the healthy group. In the non-obese adolescent group with type 2 diabetes mellitus, both values of fasting IRI and ΣIRI were also significantly higher than those in the healthy group, although the difference was not as prominent as in the obese subjects with type 2 diabetes mellitus. It was revealed that insulin resistance is present not only in obese adolescents with type 2 diabetes mellitus, but also in non-obese adolescents with type 2 diabetes mellitus.

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Mild hypothermia is a common complication during spinal anesthesia and may induce a serious adverse outcome. We investigated the effect of low-dose ketamine infusion on the core temperature during spinal anesthesia sedated by propofol infusion. Twenty patients who were scheduled to undergo spinal anesthesia were assigned to one of two groups: after intrathecal injection of bupivacaine, patients who received infusion of ketamine (0.3 mg/kg/hr) and propofol (initial rate of 10 mg/kg/hr)(KP group), and patients who received infusion of placebo (saline) and propofol (initial rate of 10 mg/kg/hr)(P group). The rate of propofol administration was reduced as much as possible while maintaining sedation with an OAA/S score of 3 or below. The core temperature, forearm temperature, and fingertip temperature were recorded before spinal anesthesia, and just before (baseline) and 15, 30, 45, and 60 minutes after the start of propofol administration. The core temperature, reduction in core temperature from baseline (delta CT), and forearm-fingertip temperature gradient were compared between the two groups. In the P group, the core temperature linearly decreased over time. The core temperature at 30, 45, and 60 minutes was significantly higher in the KP group than in the P group (36.3±0.2 and 35.9±0.3, at 60 minutes, mean±SD, p<0.05). The delta CT at 15, 30, 45, and 60 minutes was significantly smaller in the KP group than in the P group. There were no significant differences in the forearm-fingertip temperature gradient between the two groups over the study period. In conclusion, low-dose ketamine administration may confer thermoprotection during spinal anesthesia sedated by propofol.

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Allelic deletion at chromosome 8p21-25 is an early and frequent event in the carcinogenesis and development of various cancers. To facilitate investigation of alterations of the macrophage scavenger receptor 1 (MSR1), which is located on 8p22, and to determine the role of this gene in human carcinogenesis and tumor progression, we determined intronic primers designed to amplify the coding region. Since frequent deletion of 8p21-23 has been previously reported in lung cancer, we searched for mutations throughout the coding sequence of the MSR1 gene within a panel of genomic DNA samples obtained from 30 primary lung cancers. Our approach, which involved polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis and direct DNA sequencing, revealed nucleotide variants of the MSR1 gene in only one of the 30 cases examined, with this sample displaying both a 6 bp deletion and a thymine-to-cytosine substitution, the latter occurring within intron 7. The 6 bp deletion was located at a DNA microsatellite region and the thymine-to-cytosine substitution seemed to be a polymorphism. These results suggest that the MSR1 gene is not commonly mutated in lung cancer and not important in susceptibility to lung cancer. Further studies may focus on alternative mechanisms through which the MSR1 gene might be inactivated, such as aberrant DNA methylation, and/or pursue analyses of other genes on 8p21-23 for mutational events. Nevertheless, the panel of intronic PCR primer pair sequences presented here will facilitate future studies to determine the full spectrum and frequency of genetic events that may affect expression/activity of the MSR1 gene in human tumors.

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Purpose: Tizanidine is a clonidine derivative and has the same effects, such as sedation, anxiolysis and analgesic response. We evaluated the effect of tizanidine on infiltration pain during epidural catheterization. Methods: Forty patients scheduled to undergo epidural anesthesia in elective surgery were randomly allocated into two groups. The control group received placebo 60 minutes before arrival in the operating room, and the tizanidine group received 3 mg of oral tizanidine as premedication 60 minutes before arrival in the operating room. Every patient was measured heart rate and blood pressure before receiving placebo or premedication and after arrival in the operating room. After an epidural catheter was indwelled, the patients were questioned about the infiltrating pain of local anesthetic, and the degree was assessed by means of visual analog scale score (VAS score, 0∼100 mm). Results: Blood pressure in the operating room was significantly attenuated in the tizanidine group compared to the control group (148±21 mmHg vs 130±15 mmHg). Heart rate was not significantly different between the two groups. Rate-pressure product was significantly lower in the tizanidine group (11282±2960 vs 9592±2632). VAS score in the tizanidine group was significantly lower than that in the control group (P<0.001). Conclusion: It was possible to reduce the infiltration pain of local anesthetic during epidural catheterization by oral administration of 3 mg of tizanidine as premedication. Blood pressure and rate-pressure product in the operating room were also attenuated by receiving tizanidine. Therefore, we recommend premedication with tizanidine for patients undergoing epidural catheterization.

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We experienced a case of a subcutaneous emphysema after tonsillectomy. The patient, a 24-year-old man, complained of a recurrent sore throat and was diagnosed as having chronic tonsillitis. Pre-operative general examinations revealed no abnormalities. The operation was carried out under general anesthesia. The adhesions between the tonsils and the surrounding tissues were moderate. The bi-lateral tonsils were easily removed. The recovery period was uneventful. On the next morning, marked swelling of the left cheek and submandibular area was noted. On palpation, there was a characteristic crepitation and softness in these areas. The X-ray examination revealed subcutaneous emphysema. There was no finding of airway obstruction. We diagnosed him as having a subcutaneous emphysema and administered antibiotics for 5 days. From clinical findings, the subcutaneous emphysema was thought to be caused by surgical rather than anesthetic factors. The subcutaneous emphysema gradually disappeared. One year after the tonsillectomy, the patient is under observation as an outpatient and is free from any abnormal symptoms. To avoid this kind of complication, we should pay attention to carefully separate the tonsil from its fossa and to make appropriate selection of surgical equipments.

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Gastrointestinal stromal tumor is a mesenchymal tumor of the digestive tract. Although there used to be no effective therapy for the tumor, there have been many recent reports on the efficacy of imatinib. We report on a 53-year-old female patient with a primary tumor of the jejunum who underwent 3 operations. As the tumor could not be removed at the 3rd operation, she was given imatinib orally. Results showed significant reduction ratios of the tumor area (83.0%) and volume (92.2%) at 18 months after starting imatinib administration. Also, the mean reduction ratios of the tumor area and volume per month (%/M) after starting imatinib treatment showed remarkable results, especially during the initial 3 weeks: 53.9%/M and 49.5%/M, respectively. Whether imatinib is the first choice of treatment for GIST or not, and what is the appropriate dose and period should be resolved.

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Objective: To determine whether or not there is any interaction between iopamidol and gadopentetate dimeglumine (Gd-DTPA) in test tubes using the direct mixing manner. Materials and Methods: The test solution was prepared by mixing iopamidol (Iopamiron 300) and Gd-DTPA (Magnevist) at a ratio of 1:1. The color, viscosity, and pH of the mixed solutions were assessed immediately after mixing and 1, 3, 6, and 24 hours after mixing. The concentration of aromatic primary amines, content of iopamidol, concentration of free iodine ion, and content of Gd-DTPA in the mixed solution were determined, and the presence or absence of spots, other than those resulting from iopamidol and Gd-DTPA, was determined using thin layer chromatography. These tests were carried out immediately, and 24 hours after mixing. Using iopamidol alone and Gd-DTPA alone as controls, the same items were examined. Results: There was no significant change in the appearance or pH of the mixed iopamidol and Gd-DTPA solution immediately and 1, 3, 6, and 24 hours after direct mixing. The study of iopamidol alone or Gd-DTPA alone showed no apparently abnormal values or findings. Conclusion: The direct mixing of iopamidol and Gd-DTPA in a test tube results in no significant interaction.

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