Successful repair of lacerated tendons must restore continuity of the tendon and should yield a strong tenorrhaphy. Mechanical strength of repair should be adequate to early postoperative motion and mobility, The optimal repair technique must be able to withstand the rigors of early motion and also must not interfere with tendon healing. The relative strength of three suture methods of lacerated tendon were measured by mechanical disruption in effort to determine the strength of suture technique. Fifty-four Calcaneal tendons of 27 the New Zealand white rabbit were transected at mid portion and repaired with the three suture technique: group 1, Kessler suture, group 2, Pennington’s modified-Kessler suture and group 3, augmented- Becker suture technique. Each group was composed of 18 calcaneal tendons. Nine rabbits were sacrified immediately after suture, nine in postoperative 2 weeks and nine in postoperative 4 weeks Six calcaneal tendons in each three experimental group were obtained immediately after suture, at postoperative 2 and 4 weeks respectively. Tensile strength, maximum strength and modulus of elasticity of all experimental specimens were measured with Instron-UTM-4-100(Toyo-Baldiwin, Japan). The results were evaluated statistically to compare the strength of the three suture technique at three different periods. The tensile strength was predominantly strongest in augmented-Becker method among three suture technique at immediate suture, postoperative 2 weeks and 4 weeks respectively. The augmented Becker repair was strongest in maximum stress among Kessler and modified Kessler repair at immediate operation, postoperative 2 weeks and 4 weeks respectively. The augmented Becker repair was highest in modulus of elasticity than Kessler method and modified-Kessler method at immediate operation, postoperative 2 weeks and postoperative 4 weeks respectively. Tensile strength, maximum stress and modulus of elasticity were gradually increased from immediate operation to postoperative 4 weeks, but there were not statistically significance between experimental three suture methods at postoperative 4 weeks.
Elastic Modulus ; Methods ; New Zealand ; Rabbits ; Suture Techniques ; Sutures ; Tendons ; Tensile Strength

BACKGROUND: The aim of this study was to compare the cost-effectiveness of proton pump inhibitors (PPI) and ranitidine in gastroesophageal reflux disease (GERD) in Korea. METHODS: We assessed the cost-effectiveness two ways. First, mean costs for the complete healing of one patient with GERD within one year were calculated. Second, Markov (state-transition) models were used to simulate a cohort of patients with GERD, taking one of following strategies for 5 years : 1) PPI (rabeprazole 10 mg, omeprazole 20 mg, or lansoprazole 30 mg), 2) ranitidine 300 mg per day. Data on healing rate, relapse rate, surgical complication rate, success rate of surgery were taken from the literature. Direct medical costs of each strategy and surgical complications were calculated. Health effects were expressed as quality-adjusted life years (QALYs). Sensitivity analyses using various ranges of probability of healing rates and costs were performed. Costs and health outcomes were discounted at a rate of 3 % per year. RESULTS: The mean costs for complete healing of one case within one year was 475,836 in PPI and 1,064,704 in ranitidine, respectively. In the base case analysis using Markov model, the treatment costs of PPI were 155,238 and 214,781 in ranitidine and the effects were 4.81 QALYs and 4.26 QALYs, respectively; PPI strategy was more effective and less costly than ranitidine strategy. The sensitivity analyses using varying ranges of probability, cost, discount rate and utility were robust. CONCLUSION: PPI was superior to ranitidine in terms of cost-effectiveness in the treatment of GERD.
Cohort Studies ; Cost-Benefit Analysis ; Esophagitis ; Gastroesophageal Reflux* ; Health Care Costs ; Humans ; Korea ; Lansoprazole ; Omeprazole ; Proton Pump Inhibitors* ; Proton Pumps* ; Protons* ; Quality-Adjusted Life Years ; Ranitidine* ; Recurrence

BACKGROUND: In Korea, a platelet transfusion dose (TD) of 8 units of platelet concentrates (PC) is usually used. To minimize the shortage of blood products and transfusion-related adverse reactions, the TD has been changed from 8 to 6 units in 2006 in our hospital. Here, we analyzed the dose reduction effect on patients' platelet counts and transfusion frequency. METHODS: We compared the amount of issued PC, platelet counts before and after transfusion, post-transfusion platelet increments, and transfusion frequencies in patients who were transfused with 8 PC in 2006 and 6 PC in 2008. RESULTS: Despite an increase in the number of admitted patients by 20% in 2008 with a disease distribution similar to that in 2006, the number of issued PC in 2008 was decreased by 26.6% compared to that in 2006. In 2008, post-transfusion platelet counts, pre-transfusion platelet counts in patients transfused with 320 mL whole blood-derived PC, and platelet increments in patients transfused with 400 mL whole blood-derived PC were significantly decreased. However, the mean transfusion frequency per one month was not significantly different, 4.3 times in 2006 and 4.7 in 2008. CONCLUSIONS: By implementing a policy of platelet TD restriction, the amount of total issued PC was markedly decreased. Although post-transfusion platelet counts were decreased, the transfusion frequency in a month was not significantly increased. The restriction of platelet TD was helpful for increasing physicians' recognition of blood shortage while achieving similar transfusion effects. We conclude that 6 units of PC would be a better guideline for the platelet TD.
Evaluation Studies as Topic ; Humans ; Organizational Policy ; Platelet Count ; *Platelet Transfusion

17 cases of acute myocardial infarction with no or insignificant narrowing of major coronary arteries on angiogram and without any-other types of heart disease were found in a series of 133 consecutively studied patients with acute myocardial infarction(12,7%). There were no differences in risk factors between groups. Although the infarction site were similar in both groups, the patients with normal coronary arteries had fewer complications during hospitalization(p<0.05) and lesser ST segment change during the exercise test before discharge(p<0.05). In the hemodynamic fingings, cardiac index, left ventricualr and diastolic pressure and resional wall motion were similar in both groups of the patients, but ejection fraction was higher(p<0.05) in the patients with the normal coronary arteries. In conclusion, it could be predicted that the acute myocardial infarction with the normal coronary arteries would have the better prognosis. And a transient coronary occlusion, as the most likely pathogenic mechanism of the acute mtocardial infarction with normal coronary arteries, might be studied in the aspect of the thrombosis following lysis, the coronary artery spasm and the platelet aggregation.
Angiography* ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels ; Exercise Test ; Heart Diseases ; Hemodynamics ; Humans ; Infarction ; Myocardial Infarction* ; Platelet Aggregation ; Prognosis ; Risk Factors ; Spasm ; Thrombosis

No abstract available.
Heart-Lung Transplantation ; Humans ; Pulmonary Artery ; Sarcoma

The peri-stent vascular changes after 2nd generation drug-eluting stent (2G DES) implantation have not been fully investigated compare to 1st generation DES (1G DES). From March 2003 to October 2010, patients receiving percutaneous coronary intervention (PCI) with either 1G or 2G DES were retrospectively included. All patients underwent intravascular ultrasound (IVUS) at post-procedure and 8-12 months after PCI. A total of 281 patients (1G DES: 201 patients with 217 lesions and 2G DES: 80 patients with 88 lesions) were enrolled. The incidence of positive peri-stent vascular remodeling (PPVR) and late-acquired incomplete stent apposition (LAISA) were investigated by IVUS images. Major adverse cardiac events (MACE) up to 3 years were also evaluated. The lesion and the stent length were shorter, and the stent size was larger in the 2G DES group. The incidences of PPVR and LAISA were lower in the 2G DES group before and after propensity score matching. However, the incidence of 3-year MACE were not different between the two groups. Independent predictors for PPVR or LAISA were stent length and 1G DES implantation. These results suggested that biocompatible stent system in 2G DES might have reduced peri-stent vascular changes.
Drug-Eluting Stents* ; Humans ; Incidence ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Propensity Score ; Retrospective Studies ; Stents* ; Ultrasonography*

BACKGROUND: Endothelin, a very potent vasoconstricting substance released from the endothelium, has been known to be elevated in various cardiovascular disorders, however, the sites of endothelin porduction as well as the influence of acute hemodynamic changes upon plasma endothelin-1 concentration remains elucidated. METHODS: In order to evaluate the probable site of endothelin production and relationship between levels of plasma endothelin and hemodynamic variables, six patients with moderate to severe mitral stenosis underwent percutaneous mitral commissurotomy(PMC) were included. Measurement of mean pulmonary arterial pressure, cardiac output as well as plasma endothelin-1 concentration of renal vein, main pulmonary artery, and ascending aorta were performed before and 20 minutes after PMC. RESULTS: After PMC, cardiac output increased significantly, whereas mean pulmonary artery pressure and transvalvular pressure gradient were reduced significantly(both p<0.05). Before PMC, plasma endothelin-1 concentration tended to be higher in renal vein(6.12+/-3.7pg/ml) and pulmonary artery(5.07+/-1.7) than that in aorta(3.05+/-1.2pg/ml). After hemodynamic improvement with PMC, plasma endothelin-1 concentration decreased at all the site, however the change at pulmonary artery was statistically significant. CONCLUSION: These results suggest that endothelin-1 may be produced mainly somewhere in systemic venous circulation such as kidney rather than pulmonary circulation, and plasma endothelin-1 concentration tends to decrease in response to the acute hemodydnamic im provement.
Aorta ; Arterial Pressure ; Cardiac Output ; Endothelin-1* ; Endothelins ; Endothelium ; Hemodynamics ; Humans ; Kidney ; Mitral Valve Stenosis ; Plasma* ; Pulmonary Artery ; Pulmonary Circulation ; Renal Veins

BACKGROUND: It was reported that patients who have left ventricular hypertrophy have higher D allele frequency of angiotensin I-converting enzyme gene polymorphism, especially in Caucasian normotensive men. We studied to know whether genetic polymorphism of angiotensin I-converting enzyme gene is associated with the development of left ventricular hypertrophy in Korean people whose genotype frequency is quite different from that of Caucasians. METHODS: Total 156 patients were included in this study. Presence of hypertension was checked with the criteria that hypertensives are one whose blood pressures were all above 140/90 at least 3 times spanning 2 months or one who had been diagnosed as hypertension and on his medication. Left ventricular mass index(LVMI) was calculated using electrocardiogram by Rautaharju equation, and left ventricular hypertrophy(LVH) was defined as LVMI was above 131g/m2 in male or above 110g/m2 in female. Genomic DNA was extracted from the mononuclear cell of each subjects and PCR was performed using new primers for the region of intron 16 and exon 17. RESULTS: Genotype frequencies of D/D genotype and D allele were 0.200 and 0.413 respectively in group with LVH(n=40), 0.103 and 0.392 respectively in group without LVH(n=116). There was no significant difference with each other group. However, when only the normotensives were included in this analysis, frequency of D/D genotype is significantly higher in group with LVH(0.231, n=26) than in group without LVH(0.076, n=79)(Fisher's exact test,p<0.05). There was no significant difference in genotype frequency between the normotensives(n=105) and the hypertensives(n=51). CONCLUSIONS: In Korean people, D allele of polymorphism of angiotensin I-converting enzyme gene is also associated with development of left ventricular hypertrophy in the normotensives and is not associated with essential hypertension.
Alleles ; Angiotensins* ; DNA ; Electrocardiography ; Exons ; Female ; Gene Frequency ; Genotype ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Introns ; Male ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Polymorphism, Genetic

BACKGROUND: It was reported that patients who have left ventricular hypertrophy have higher D allele frequency of angiotensin I-converting enzyme gene polymorphism, especially in Caucasian normotensive men. We studied to know whether genetic polymorphism of angiotensin I-converting enzyme gene is associated with the development of left ventricular hypertrophy in Korean people whose genotype frequency is quite different from that of Caucasians. METHODS: Total 156 patients were included in this study. Presence of hypertension was checked with the criteria that hypertensives are one whose blood pressures were all above 140/90 at least 3 times spanning 2 months or one who had been diagnosed as hypertension and on his medication. Left ventricular mass index(LVMI) was calculated using electrocardiogram by Rautaharju equation, and left ventricular hypertrophy(LVH) was defined as LVMI was above 131g/m2 in male or above 110g/m2 in female. Genomic DNA was extracted from the mononuclear cell of each subjects and PCR was performed using new primers for the region of intron 16 and exon 17. RESULTS: Genotype frequencies of D/D genotype and D allele were 0.200 and 0.413 respectively in group with LVH(n=40), 0.103 and 0.392 respectively in group without LVH(n=116). There was no significant difference with each other group. However, when only the normotensives were included in this analysis, frequency of D/D genotype is significantly higher in group with LVH(0.231, n=26) than in group without LVH(0.076, n=79)(Fisher's exact test,p<0.05). There was no significant difference in genotype frequency between the normotensives(n=105) and the hypertensives(n=51). CONCLUSIONS: In Korean people, D allele of polymorphism of angiotensin I-converting enzyme gene is also associated with development of left ventricular hypertrophy in the normotensives and is not associated with essential hypertension.
Alleles ; Angiotensins* ; DNA ; Electrocardiography ; Exons ; Female ; Gene Frequency ; Genotype ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Introns ; Male ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Polymorphism, Genetic

BACKGROUND: Pressure-controlled intermittent coronary sinus occlusion(PICSO) as well as synchronized retrograde perfusion(SRP) have emerged as a new technique that can redirect blood through the coronary sinus to nourish ischemic myocardium beyond a coronary occlusion. Also, coronary sinus occlusion pressure(CSOP) can be measured during application of PICSO. This experimental study was to determine the characteristics of CSOP and the effects of PICSO on the reduction of infarct size in experimentally induced acute myocardial infarction. METHOD: 22 dogs were included in this study, 9 in control group and 13 in PICSO group. Thirty minutes after experimental ligation of proximal left anterior descending artery, PICSO device was applied to PICSO group for 4 hours. Systolic and end-diastolic pressure of CSOP, LVEDP(left ventricular end-diastolic pressure), LVSP and aortic pressure with heart rate were measured every 1 hour. After 4 hours, heart was excised and 1% TTC(triphenyl tetrazolium cholride) solution was perfused distal to left anterior descending(LAD) coronary artery to measure the area of viable myocardium in LAD territory. 'The area at risk(LAD territory/LV surface area)' and 'the area of necrosis(necrosis area/LAD territory)' were calculated with cut surface of LV using planimetry. RESULTS: 1) End-diastolic pressure of CSOP and left ventricular end-diastolic pressure(LVEDP) were closely equalized and significantly correlated each other(p<0.001). 2) Aortic pressure profiles, left ventricular pressure profiles and heart rate during coronary occlusion did not differ significantly from the control group. Aortic and left ventricular systolic and mean pressures declined significantly after 1 hour of coronary occlusion. Also LVEDP increased significantly after 1 hour of coronary occlusion(p<0.01). 3) The area of myocardium at risk was similar in both groups(control 12.0+/-2.1 %, PICSO 11.5+/-1.2%). But the results of the area of necrosis within the area of risk showed that PICSO significantly reduces myocardial infarct size(control 79.1+/-4%, PICSO 25.3+/-5%). CONCLUSION: PICSO can be indicated in acute coronary syndrome to reduce the myocardial necrosis especially in LAD territory. In addition, PICSO can be used to evaluated LVEDP by measuring CSOP,especially in patients with severe aortic valvular stenosis. Further study is needed upon the effectiveness of PICSO on clinical situations and precise metabolic effects of PICSO on myocardium.
Acute Coronary Syndrome ; Animals ; Arterial Pressure ; Arteries ; Constriction, Pathologic ; Coronary Occlusion ; Coronary Sinus* ; Coronary Vessels ; Dogs ; Heart ; Heart Rate ; Humans ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Ventricular Pressure