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Biomedical subjects

D C Kim

Publications and source records attributed to D C Kim.

At least 37 records · Page 2Linked to original sources
PubMed1998

Epidural verapamil reduces analgesic consumption after lower abdominal surgery.

UNLABELLED: In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to investigate the possible role of the calcium channel blocker, verapamil, in postoperative pain. One hundred patients (ASA physical class I or II) scheduled for lower abdominal surgery were randomly assigned to one of four groups. Group 1 received 10 mL of 0.5% epidural bupivacaine injected 15 min before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 2 received 10 mL of epidural normal saline injected before incision, followed by 10 mL of 0.5% epidural bupivacaine 30 min after incision. Group 3 received 10 mL of 0.5% epidural bupivacaine plus 5 mg of verapamil injected before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 4 received the same drugs as Group 3, in the reverse order. Pain and mood numeric rating scores, sedation scores, Prince Henry scores, patient-controlled cumulative postoperative analgesic consumption, and the incidence of side effects were assessed 2, 6, 12, 24, and 48 h after the operation in each group. Cumulative postoperative analgesic consumption in Groups 3 and 4 was significantly lower (P < 0.05) than that in Groups 1 and 2 24 and 48 h after surgery. There were no differences in the pain, mood, and sedation scores and the incidence of side effects among the four groups. We conclude that epidural verapamil decreases postoperative pain, possibly by interfering with normal sensory processing and by preventing the establishment of central sensitization. IMPLICATIONS: Calcium plays an important role in pain physiology at the spinal cord level. We examined the effect of bupivacaine plus verapamil (calcium channel blocker) and of bupivacaine alone. We demonstrated that the combination, administered epidurally, resulted in less postoperative analgesic consumption than bupivacaine alone.

Abdomen↗
PubMed1998

Malignant mixed Müllerian tumor (homologous type) of the adnexa with neuroendocrine differentiation: a case report.

Malignant mixed müllerian tumors (MMMT) are unusual neoplasms occurring mostly in the uterus. In the ovary, they are very rare and represent fewer than 1% of all ovarian malignancies; in the salpinx, they are even rarer than those of the ovary. We report a carcinosarcoma of the left adnexa having features of neuroendocrine differentiation in a 69-year-old female. The tumor contained both adenocarcinoma and squamous cell carcinoma having dear cell change admixed with an undifferentiated malignant mesenchymal component. The sarcoma components consisted of spindle cells, small-round cells and bizarre giant cells mimicking rhabdomyoblast. Almost all of the carcinomatous glandular components and some foci of the squamous cell and undifferentiated carcinomatous components were focal positive for S-100 protein, chromogranin, neuron specific enolase, synaptophysin and Leu-7. Electron microscopy revealed membrane-bound neurosecretory granules in the cytoplasm of some glandular epithelial cells. Histologically, the tumor involved the left adnexa, abdominal peritoneum, surface of the bladder dome, omentum and left external iliac lymph node (stage IIIc).

Adnexa Uteri↗
PubMed1998

The indications for and techniques and outcomes of ablative procedures of the distal ulna. The Darrach resection, hemiresection, matched resection, and Sauvé-Kapandji procedure.

Several ablative procedures exist for the treatment of distal radio-ulnar joint arthritis. This article describes the indications, techniques, pitfalls, and outcomes for the four most popular procedures: Darrach, hemiresection-interposition, Sauvé-Kapandji, and matched ulnar resection. The authors explain their personal algorithm for treatment selection, emphasizing patient requirements versus the physiologic characteristics of each procedure.

Arthritis↗
PubMed1997

A cyclic hexapeptide is a potent antagonist of alpha 4 integrins.

The alpha 4 integrins mediate leukocyte adhesion to specific counter-receptors, including vascular cell adhesion molecule-1 (VCAM-1), the fibronectin splice variant containing connecting segment 1 (CS1), and mucosal addressin cell adhesion molecule-1. A series of cyclized peptides based on the LDV sequence of CS1 were synthesized and assayed for inhibition of alpha 4 integrin binding. The most potent peptide, C*WLDVC* (where * indicates disulfide-linked residues), inhibited alpha 4 beta 1-dependent binding of lymphocytes to VCAM-1 and CS1 with half-maximal inhibition achieved at 1 to 3 microM of peptide. The peptide proved more potent when the lymphocytes were activated with 1 mM MnCl2; half-maximal inhibition was reached at 0.4 and 0.05 microM for VCAM-1 and CS1, respectively. This represents a 100- to 800-fold increase in potency over a linear CS1 peptide in these same assays. C*WLDVC* also inhibited alpha 4 beta 7-dependent lymphocyte binding to the ligands mucosal addressin cell adhesion molecule-1, VCAM-1 and CS1. Immunoprecipitation of radiolabeled integrin indicated that the peptide could bind alpha 4 beta 1 and alpha 4 beta 7 directly and elute alpha 4 beta 1 from a CS1-conjugated agarose resin. The peptide showed selectivity for alpha 4 integrins in that it effectively inhibited alpha 4 beta 1-dependent, but not alpha 5 beta 1-dependent, binding of cells to intact fibronectin. Due to its small size and potency, C*WLDVC* may serve as a useful tool for the study of alpha 4 integrin biology and the development of small molecule therapeutics.

Amino Acid Sequence↗
PubMed1997

Perceptions and misconceptions of the plastic and reconstructive surgeon.

Little is known about professional perceptions of plastic and reconstructive surgery. In an era of managed health care and social reform, public perception, or misconception, may ultimately have a significant impact on this specialty. A survey was conducted to provide some initial evidence for the scope and scale of the misconceptions. Three populations were surveyed for this study: consecutive patients visiting a primary-care facility, medical students, and primary-care physicians. The survey addressed various aspects of plastic surgery-reconstruction, hand, craniofacial, and aesthetic surgery. One thousand one hundred twenty-one individuals of various ages, education levels, and ethnic backgrounds participated in this study. Our data demonstrate that public perception of the plastic and reconstructive surgeon is limited and grossly underestimates this specialty. Although the plastic surgeon is associated with reconstructive surgery, they are not necessarily identified as primary surgeons for procedures fundamental to this specialty. Furthermore, a significant number of respondents would prefer a cosmetic surgeon for aesthetic procedures. We believe that it is crucial that the public, physicians, and medical establishments (e.g., insurance companies, hospital administrations) be educated on the essence of plastic and reconstructive surgery.

Adult↗
PubMed1996

Porcine gastroepiploic artery as an in vitro experimental model to study vasodilators in microsurgery.

Arterial vasospasm is a common problem in microsurgery. This pharmacological study compares seven vasodilators-lidocaine, papaverine, nicardipine, verapamil, diltiazem, sodium nitroprusside, and hydralazine-for their efficacy and potency in an experimental model of vasospasm. Porcine gastroepiploic arteries were cut into rings to measure isometric tension development in vitro. The arteries were preconstricted with endothelin-1, a stable thromboxane A2 analogue, norepinephrine, or potassium, and then exposed to increasing concentrations of each vasodilator. Every vasodilator except hydralazine and sodium nitroprusside was efficacious in producing near-maximal relaxation of arteries preconstricted with any vasospastic substance. The five efficacious vasodilators differed markedly in potency, as reflected in the concentrations producing half-maximal relaxation. The order of potency was nicardipine < or = verapamil or diltiazem < papaverine < lidocaine. This study suggests that nicardipine would be the most potent vasodilator for systemic or direct intra-arterial administration. Papaverine and lidocaine, in concentrations employed clinically, were both efficacious as topical vasodilators.

Animals↗
PubMed1996

Endothelin-1-induced modulation of contractile responses elicited by an alpha 1-adrenergic agonist on human corpus cavernosum smooth muscle.

The goal of these studies was to examine endothelin-1 (ET-1)-induced modulation of contractile responses elicited by the selective alpha 1-adrenergic agonist, phenylephrine (PE), on isolated human corporal tissue strips. Pharmacological studies were conducted on human corporal tissue strips obtained from 22 patients undergoing implantation of penile prostheses for erectile dysfunction. For the purposes of statistical analysis, the patients were stratified into two age groups: A, age < or = 59 y (n = 10) and B, age > or = 60 y (n = 12). The patients were further sub-divided into two diagnostic categories, diabetics (DM, n = 9) and nondiabetics (ND, n = 13). Cumulative concentration-response curves (CRCs) were constructed to the alpha 1-adrenergic agonist, PE, prior to constructing a CRC to a single mixture of PE and ET-1 on the same tissue. A previously described fixed molar ratio (FMR) protocol was used to generate CRCs to mixtures of PE and ET-1. In all cases, for the PE:ET-1 FMRs of 90:10, 80:20 and 70:30, the partial substitution of PE with ET-1 resulted in an approx 3-fold leftward shift in the EC50 of the PE alone CRC with an approx 4% concomitant increase in Emax and a decrease in the slope factor value. There were no significant age- or disease-related differences in any of the logistic parameter estimates that describe the FMR CRC, indicating that there are no detectable age- or disease-related alterations in ET-1-induced amplification of alpha 1-adrenergic-mediated contractions in these studies. In addition, the location of the FMR CRC was precisely predicted by the theoretical CRC for simple additivity of agonist effects. In conclusion, since relatively small increases in ET-1 concentrations were associated with significant increases in alpha 1-adrenergic-mediated contractile responses, these data provide further testimony to the importance of ET-1 in modulating corporal smooth muscle tone, and moreover, establish a conceptual framework for understanding the mechanism of its action(s).

Adrenergic alpha-1 Receptor Agonists↗
PubMed1995

Kidney as a major clearance organ for recombinant human interleukin-1 receptor antagonist.

This study was designed to provide information on the tissue distribution and elimination of recombinant human interleukin-1 receptor antagonist (rhIL-1ra) in rats. Following intravenous (iv) bolus administration of metabolically labeled [35S]rhIL-1ra alone or together with unlabeled rhIL-1ra, biodistribution of [35S]rhIL-1ra in the early phase as well as at steady state was investigated. The renal elimination of rhIL-1ra at steady state was also studied. In the early phase biodistribution study, 11, 9, 6, and 2% of the dose was distributed to the kidney, liver, gut, and lung, respectively. Additional rhIL-1ra was found in muscle (43%) and plasma (26%). The time profiles of [35S]rhIL-1ra in the kidney and liver were analyzed by integration plots to determine the early-phase distribution clearance of [35S]rhIL-1ra. The distribution clearance of [35]rhIL-1ra per gram of kidney was five times greater than that of the liver. When expressed as clearance per organ, total liver clearance and total renal clearance were comparable, together accounting for approximately 20% of plasma clearance in the early phase. The distribution clearances of [35S]rhIL-1ra in these tissues (liver and kidney) were not affected by coadministration of excess unlabeled rhIL-1ra (5 mg/rat), indicating that clearance occurs via a mechanism having a high capacity for rhIL-1ra. The steady-state biodistribution of rhIL-1ra was also studied to examine the accumulation of rhIL-1ra in the tissues. The tissue-to-plasma concentration ratios at steady state were similar to the corresponding extracellular spaces in the tissues investigated except the kidney, where the ratio was 4.10.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Ca2+-dependent and -independent mechanisms of ischaemia-evoked release of [3H]-dopamine from rat striatal slices.

1. Ischaemia was induced by 5 min of deprivation of glucose and an additional 5 min of deprivation of glucose and oxygen from Mg(2+)-free artificial cerebrospinal fluid in vitro. 2. During the ischaemic period, 11 +/- 1.5% of the total [3H]-dopamine ([3H]-DA) was released into the incubation medium. 3. Ischaemia-evoked release of [3H]-DA from striatal slices was attenuated by tetrodotoxin (TTX), MgSO4, dizocilpine, ketamine, 6,7-dinitroquinoxaline-2,3-dione (DNQX) or carbetapentane. 4. Release of [3H]-DA was attenuated by verapamil, omega-conotoxin GVIA and dantrolene. 5. Nomifensin inhibited the ischaemia-induced release of [3H]-DA. 6. Omission of Ca(2+) from incubation media potentiated ischaemia-evoked [3H]-DA release. The inhibitory effect of nomifensin was potentiated in Ca(2+)-free incubation media. 7. These results suggest that ischaemia induces release of [3H]-DA by dual mechanisms; one is Ca(2+)-dependent exocytosis and the other is reversal of transporter.

Animals↗
PubMed1995

Characterization of nitroglycerine-induced relaxation in human corpus cavernosum smooth muscle: implications to erectile physiology and dysfunction.

The importance of the nitric oxide--guanylate cyclase--cGMP system in modulating corporal smooth muscle tone and penile erection has been amply demonstrated. The goal of these studies was to evaluate the possibility that age- or disease-related alterations in human corporal smooth muscle responsivity to activation of this pathway might play a role in the etiology of erectile dysfunction. Thus, we utilized a previously described heuristic model to assess the kinetic and steady-state characteristics of relaxation of precontracted isolated corporal tissue strips elicited by nitroglycerine (NTG). Studies were conducted on corporal tissue strips excised from 26 patients with organic erectile dysfunction, and 7 patients with documented erections. For the purposes of statistical analysis the impotent patient population was stratified into two age groups (A, < or = 59 years; B, > or = 60 years) and further subdivided into two diagnostic categories, diabetic and nondiabetic patients, respectively. In approximately 75% of precontracted corporal tissue strips derived from impotent patients (contracted to approximately 75% of maximum with phenylephrine), the NTG-induced response was biphasic, consisting of a rapid relaxation response that reached steady state before onset of a more slowly developing regaining of tension, termed the desensitization response. In contrast, a biphasic response was observed much less frequently (approximately 30%) in corporal tissue strips derived from a potent patient population (p < 0.0001). Statistical analysis revealed significant heterogeneity among corporal tissue strips derived from patients with organic erectile dysfunction, with respect to both the kinetic and steady-state characteristics of the NTG-induced relaxation and desensitization responses. In particular, the maximal rate constant for both NTG-induced relaxation (krelmax; p < 0.01) and desensitization (kdes; p < 0.03) responses was significantly greater in corporal tissue strips excised from diabetic than nondiabetic patients. Furthermore, the EC50 for NTG-induced relaxation of precontracted corporal smooth muscle strips from potent patients (approximately 25 nM) was 0.90 log unit less than that for equivalently contracted corporal smooth muscle strips derived from impotent patients (approximately 180 nM; p < 0.03). Such observations suggest that alterations in corporal smooth muscle responsivity to activation of the guanylate cyclase--cGMP pathway, per se, may be a characteristic of organic erectile dysfunction. In the absence of compensatory changes in other vasodilatory mechanisms, this may contribute to incomplete corporal smooth muscle relaxation and the etiology of erectile dysfunction in some patients.

Adult↗
PubMed1995

Two cases of Gymnophalloides seoi infection accompanied by diabetes mellitus.

Gymnophalloides seoi, a new intestinal trematode of humans transmitted by oysters on a southwestern island of Korea, drew medical attentions because of its possible relationship with evoking pancreatitis or other pancreatic diseases. We experienced two interesting cases of G. seoi infection who were accompanied with diabetes mellitus. In routine stool examination, eggs of a gymnophallid were detected from two patients, and after treatment with praziquantel and purgation, 772 and 10 adult flukes were recovered respectively. They were identified as G. seoi. The first patient was a 62-year old man who lived in Mokpo, nearby the known endemic area, and the second patient, a 54-year old woman who lived in Inchon. They used to eat raw oysters. It should be ruled out that G. seoi infection has some relationship with pancreatic diseases.

Animals↗
PubMed1995

Endothelin-1 as a putative modulator of erectile dysfunction: I. Characteristics of contraction of isolated corporal tissue strips.

Normal erectile physiology is heavily dependent on a delicate balance between the effects of endogenous vasoconstricting and vasorelaxing hormones on the tone of the corporal smooth muscle. Recent studies indicate that endothelin-1 (ET-1) is present and physiologically active in the human corpora. The primary goal of the present investigation was to further define the role of ET-1 in corporal physiology and to ascertain whether it might play a role in augmenting corporal tone in vivo, as reported in other vascular tissues. Thus, we conducted pharmacological studies of ET-1-induced steady-state contractions in isolated human corporal smooth muscle strips to determine if there were any detectable age- or diabetes-related alterations in ET-1-induced contractions. For statistical analysis, the patient population was divided into 2 age groups, A (< or = 59 years of age; = 11 patients) and B (> or = 60 years of age; n = 7 patients), and further subdivided into 2 diagnostic categories, diabetic (n = 7 patients) and nondiabetic (n = 11 patients). Construction of cumulative concentration response curves (CRCs) for ET-1-induced contractions revealed characteristically slow onset and long-lasting responses. Endothelin-1 CRC data were computer fit to the logistic equation to derive Emax (calculated maximal response), pEC50 (negative logarithm of the concentration that elicits one-half of the calculated maximal response) and slope factor (n) values. Two-factor analysis of variance revealed no detectable age- or diabetes-related alterations, nor any age-diabetes interaction in any of the logistic parameters. Furthermore, logistic analysis of ET-1 CRC data on 14 isolated corporal tissue strips derived from 3 potent patients with documented spontaneous erections revealed no differences in ET-1 contractility from that observed for patients with organic erectile dysfunction. Importantly, despite an apparent absence of age- or diabetes-related alterations in ET-1-induced steady-state contractions, preliminary studies demonstrated that coadministration of the alpha 1-adrenergic agonist phenylephrine and ET-1 produce much greater contractile responses than those observed in the presence of phenylephrine (PE) alone. Moreover, the magnitude of the augmentation was precisely that predicted by a model for simple additivity of agonist effects. Such observations suggest that the physiological relevance of ET-1 to corporal physiology may be related to its ability to augment the contractile responses of other vasomodulators present in the human corpora, in particular, perhaps modulating the contractile responses to sympathetic activity.

Diabetes Mellitus↗
PubMed1994

Training model for microvessel anastomosis.

In the early stages of microsurgical training a model is required which is accessible, inexpensive, and approximates human tissue. In this research centre initial training exercises utilize cold stored vessels harvested from sacrificed animals used in other experiments. This model serves as an initial training tool prior to the progression to live animal research which maximizes use of animal specimens and approximates the in vivo qualities of blood vessels. The costs involved are minimal and a large number of vessels can be efficiently harvested and stored using basic equipment. As a training model, cold stored vessels have balanced cost with practicality, given an excellent approximation to living tissue and have markedly reduced our usage of live animals for teaching. This latter effect is significant at a time of increased scrutiny of the ethical use of laboratory animals.

Anastomosis, Surgical↗
PubMed1993

Eosinophilic granulopoiesis in human fetal liver.

Eosinophilic granulopoiesis was investigated in human fetal liver during intrauterine life from 5 to 34 weeks of gestation. Eosinophilic granulocytes were observable for the first time at 5 weeks in the hepatic laminae and were frequently found in the late embryonic period around the large vessels and in the mesenchyme adjacent to the liver. Eosinophilic granulopoiesis increased gradually in the hepatic laminae (P < 0.01) after 20 weeks of gestation and in the portal areas (P < 0.05) after 16 weeks of gestation. The proportions of each cellular differentiation stage were relatively constant during fetal life, but a greater number of mature eosinophils were observed in the portal areas. Eosinophilic granulopoiesis was evident in all the hepatic tissue components, but developed more actively in portal areas than in hepatic laminae during intrauterine life. Eosinophilic granulopoiesis preceded both erythropoiesis and megakaryopoiesis in the human embryonic liver. Although the latter two occurred mainly in the hepatic laminae, eosinophilic granulopoiesis developed more actively in the portal areas, where it exhibited increasing activity along with the development of the component cells.

Cell Count↗
PubMed1993

A correlation between the permeability characteristics of a series of peptides using an in vitro cell culture model (Caco-2) and those using an in situ perfused rat ileum model of the intestinal mucosa.

In an attempt to establish an in vitro/in situ correlation of intestinal permeability data, the permeability coefficients (Papp) for a series of model peptides, which were determined using an in situ perfused rat ileum model, were compared to the permeability coefficients (Pmono) determined using an in vitro cell culture model (Caco-2). The model peptides, which were all blocked on the N-terminal (acetyl, Ac) and the C-terminal (amide, NH2) ends, consisted of D-phenylalanine (F) residues (e.g., AcFNH2, AcFFNH2, AcFFFNH2). To alter the degree of hydrogen bonding potential, the nitrogens of the amide bonds were sequentially methylated [e.g., AcFF(Me)FNH2, AcF(Me)F(Me)FNH2, Ac(Me)F(Me)FNH2, Ac(Me)F(Me)F(Me)]. These peptides were shown not to be metabolized in the in situ perfused rat ileum system. The results of the transport experiments showed that there were poor correlations between the apparent permeability coefficients (Papp) determined in an in situ perfused rat ileum model and the octanol-water partition coefficients (r = 0.60) or the hydrogen bonding numbers (r = 0.63) of these peptides. However, good correlations were observed between the in situ Papp values for these peptides and their partition coefficients in heptane-ethylene glycol (r = 0.96) and the differences in their partition coefficients between octanol-water and isooctane-water (r = 0.86). These results suggest that lipophilicity may not be the major factor in determining the intestinal permeability of these peptides and that hydrogen bonding potential may be a major contributing factor. These results suggest that lipophilicity may not be the major factor in determining the intestinal permeability of these peptides and that hydrogen bonding potential may be a major contributing factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1993

Evaluation of the bile acid transporter in enhancing intestinal permeability to renin-inhibitory peptides.

To evaluate the bile acid transporter as a means of enhancing the ability of renin-inhibitory peptides (RIPs) to penetrate the intestinal mucosa, two RIP-cholic acid conjugates and an RIP-taurocholic acid conjugate were synthesized. Conjugation was through the N-terminus of an RIP and the 3-position of the bile acid, via a six-carbon spacer. An RIP derivative containing the spacer without the bile acid moiety was also synthesized. The bile acid-RIP conjugates and the RIP derivative were shown to be potent inhibitors of human renin in vivo and to have in vivo hypotensive activity equivalent to that of the parent RIP (ditekiren) in a human renin-infused rat model. The ability of these RIP derivatives to bind to the bile acid transporter and be transported across an epithelial cell monolayer was evaluated in an in vitro model of the intestinal mucosa consisting of Caco-2 cell monolayers grown on microporous membranes. One of the RIP-cholic acid conjugate (KI = 60 +/- 10 microM) and the RIP-taurocholic acid conjugate (KI = 19 +/- 5 microM), but not the RIP derivative, were shown to be potent inhibitors of the apical (AP) to basolateral (BL) transport of [14C]-taurocholic acid ([14C]-TA). At concentrations up to 250 microM these RIP-bile acid conjugates had no effect on the diffusion of [3H]-PEG (800-1000), which is a marker of the paracellular pathway. The permeability coefficients of the RIP-bile acid conjugates, determined using Caco-2 cell monolayers, were shown to be six times less than that of [3H]-PEG (800-1000). In addition, the transport of one of the RIP-cholic acid conjugates was investigated in perfused rat ileum in which the mesenteric vein was cannulated. The conjugate was not detected in blood samples taken from the mesenteric vein, while its concentration in intestinal perfusate remained almost constant during the perfusion experiment. These results suggest that while the peptide-bile acid conjugates retain binding affinity for the intestinal bile acid transporter, the molecules are not themselves transported.

Animals↗