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: 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

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: Loss of myocardium due to acute myocardial infarction may cause acute heart failure and future left ventricular dysfunction. During heart failure, homeostatic mechanism will be activated and the renin-angiotensin system may play a role in congestive heart failure. Its primary components are angiotensinogen, renin, angiotensin converting enzyme, and angiotensin. According to the recent improvement of molecular biologic technique, it is possible to know the angiotensinogen nucleotidde sequence, amino acid sequence, and tertiary structure and to detect very small amount of material from tissue. The aim of the present study was to examine the change of expression of the liver angiotensinogen mRNA, a component of the circulation renin-angiotensin system in rats after myocardial infarction. METHODS: Female Sprague-Dawley rats(body weight 200-250g) were anesthetized and subjected either to left coronary artery occlusion or to sham operation. And the rats were sacrificed at 1 hours, 4 hours, 18 hours, 24 hours, 3 days, 7 days, 1 week, 2 weeks and 3 weeks. Northern blot analysis was performed. RESULTS: The liver angiotensinogen amRNA levels were elevated at 4 hours, 18 hours, 24 hours after myocardial infarction and reduced to control values at 3 days(max 5-fold). The liver angiotensinogen mRNA levels were lesser elevated at 4 hours, 18 hours, 24 hours after sham operation(max 1.8-fold). CONCLUSION: The renin-angiotensin system is one of the major regulators of blood pressure and fiuid and electrolyte homeostasis. It appears that the circulating renin-angiotensin system is activated acutely after myocardial infarction and is then turned off at cardiovascular compensation.
Amino Acid Sequence ; Angiotensinogen* ; Angiotensins ; Animals ; Blood Pressure ; Blotting, Northern ; Compensation and Redress ; Coronary Vessels ; Female ; Heart Failure ; Homeostasis ; Humans ; Liver* ; Myocardial Infarction* ; Myocardium ; Peptidyl-Dipeptidase A ; Rats* ; Rats, Sprague-Dawley ; Renin ; Renin-Angiotensin System ; RNA, Messenger* ; Ventricular Dysfunction, Left

BACKGROUND: This study was designed to evaluate the clinical efficasy of lovastatin, HMG-CoA reductase inhibitor, in patients with hypercholesterolemia. METHODS AND RESULTS: Lovastatin 20 to 80 mg were administered once daily for 12 weeks in twenty five patients(11 male, 14 famale ; nine patients with familial hypercholesterolemia) with hypercholesterolemia(>240mg/dl). Compared with pretreatment levels, lovastatin significantly decreased levels of total cholesterol(309+/-46mg/dl versus 201+/-37mg/dl) by 35%, LDL-cholesterol(230+/-48mg/dl versus 125+/-40mg/dl) by 46% and triglyceride(170+/-76 versus 142+/-66mg/dl) by 11% (p<0.05) with significantly decreased levels of total-cholesterol/HDL-cholesterol ratio(7.4+/-2.1 versue 4.6+/-1.5) and LDL-cholesterol/HDL-cholesterol ratio(5.6+/-1.9 versue 2.9+/-1.4) (p<0.005 except triglyceride, respectively). The level of Apo B(183+/-32mg/dl versus 114+/-26mg/dl) was decreased significantly by 37%(p<0.005) with significantly decreased level of Apo A-1(115+/-22 to 122+/-26mg/dl) was increased significantly by 6%(p<0.05). No serious side effects were found. CONCLUSIONS: Results from the present study show that lovastatin is an effective and well-tolerated cholesterol-lowering agent.
Humans ; Hypercholesterolemia* ; Lovastatin* ; Male ; Oxidoreductases ; Triglycerides

BACKGROUND: Left ventricular remodeling after myocardial infarction is closely related to the prognosis of the patients with infarction and can be modified by angiotensin converting enzyme inhibitor. In experimental transmural infarction rat model, captopril decreases the ventricular compliance and simultaneously decrease the ventricular volume, but its effects on the nontransmurally infarcted heart are not elucidated. METHODS: Female Sprague-Dawley rats underwent 45-minute left coronary artery occlusion followed by reperfusion to produce nontransmural myocardial infarction. At 5 days after infarction, rats were randomized into two groups : untreated(n=8) and captopril-treated(captopril 2g/liter drinking water)(n=8). After 21 days of treatment, the hearts were arrested at diastole and excised. Passive pressure-volume curve of the left ventricle was plotted, and the stiffness modulus and mean compliance were calculated in the range of 5 to 30mmHg of pressure. Infarct size was also measured to confirm each group has similar size of lesion. The extent of fibrosis(relative area of fibrosis to randomly-selected peri-infarcted zone) was quantified on Masson's trichrome-stained ventricular slices by automatic image analysis software. RESULTS: Compared with untreated group, captopril-treated rats showed significantly decreased ventricular weight-to-body weight ratio(2.60+/-0.18mg/g vs. 2.84+/-0.20, p<0.05), decreased ventricular stiffness modulus(7.24+/-0.61 vs. 8.28+/-0.57, p<0.005), increased mean compliance(9.71+/-0.75 1/mmHg vs. 7.55+/-0.67, p<0.0001), and decreased fibrosis extent(0.82+/-1.49% vs. 5.53+/-5.33, p<0.01). CONCLUSION: These findings suggest that captopril increases the compliance of nontransmurally-infarcted left ventricle at least partly by the suppression of fibrosis, in contrast with previous findings that captopril decresed the passive compliance of transmurally-infarcted ventricle.
Animals ; Captopril ; Compliance ; Coronary Vessels ; Diastole ; Drinking ; Female ; Fibrosis ; Heart ; Heart Ventricles ; Humans ; Infarction ; Models, Animal ; Myocardial Infarction* ; Peptidyl-Dipeptidase A ; Prognosis ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Ventricular Remodeling*

To evaluate the role pulmonary capillary in the metabolism of atrial natriuretic factor(ANF), we measured plasma level of immunoreative(IR) ANF in pulmonary artery, pulmonary vein, left atrium and aorta simultaneously in 7 cardiac patients with patent with foramen ovale without shunt and 8 cardiac patients with atrial septal defect(ASD) with only left to right shunt during cardiac catheterization. Plasma level of IR-ANF in pulmonary vein was significantly lower to be involved in the metabolism of ANF and that ANF secreted by left atrial myocardium is mainly drained through coronary sinus into right atrial cavity rather than directly into left atrial cavity through thebesian vein.
Aorta ; Atrial Natriuretic Factor* ; Capillaries ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Sinus ; Foramen Ovale ; Heart Atria ; Humans ; Metabolism* ; Myocardium ; Plasma ; Pulmonary Artery ; Pulmonary Circulation* ; Pulmonary Veins ; Veins

To evaluate the relationship between plasma level of immunoreactive atrial natriaretic factor(IR-ANF) and atrial functional index, we studied 28 cardiac patients undergoing cardiac catheterization.Plasma level of IR-ANF in aorta or pulmonary artery was significantly correlated with mean pulmonary capillary wedge pressure, right atrial mean pressure and pulmonary arterial mean pressure, but not with left artrial dimension. To evaluate the relationship between plasma level of IR-ANF and ventricular function index, we selected 13 patients who had normal artrial pressure and no mitral valular disease among 28 patients.Among ventricular functional indices, only left ventricualr end diastolic pressure was significantly correlated with plasma level of IR-ANF in aorta or pulmonary artery. Other indices, such as cardiac index, ejection fraction and aortic systolic blood pressure were not correlated with plasma level of IR-ANF in aorta or pulmonary artery. We concluded that increase in either left atrial pressure may trigger ANF release in man, although ventricles may not be involved in ANF release significantly.
Aorta ; Atrial Natriuretic Factor* ; Atrial Pressure ; Blood Pressure ; Hemodynamics* ; Humans ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Ventricular Function

Previous studies have shown that experimental canine coronary or rabbit cardtid qrtery stenosis that is associated with endothelial injury results in a typical pattern of blood flow characterized by gradual decreases in arterial flow followed by restorations of flow to normal values. This pattern of flow, called cyclic flow reduction(CFR), is the consequence of recurrent platelet aggregation at the site of the stenosis and endothelial injury and subsequent dislodgement of the thrombus. This study was designed to test the efficacy of verapamil in ingibiting in vivo platelet aggregation in a rabbit model of cardotid artery stenosis and ecdothelial injury. Carotid blood flow was measured continuously with a electromagnetic flowmeter probe that is positioned proximal to the constrictor. During placement of constrictor and angioplasty balloon, CFR developed in 8 of 20 rabbits with a mean frequency of 10.0+/-2.2 cycles/h. CFRs were observed for 30min, and IV verapamil was administered till declining of blood pressure(up to 100ug/kg). After intravenous verapamil, the mean frequency of CFR insignificantly decreased to 8.7+/-2.1 cycles/h(p=ns). After 20mg/kg of aspirin were given intravenously, the CFR were abolished in 5 rabbits, the mean frequency of CFR decreased in 1 rabbit, and no significant change was observed in 2 rabbits. It is concluded that verapamil is relatively ineffective in inhibiting in vivo platelet aggregation at doses that don't change hemodynamics significantly.
Angioplasty ; Arteries ; Aspirin ; Carotid Stenosis* ; Constriction, Pathologic ; Flowmeters ; Hemodynamics ; Magnets ; Platelet Aggregation ; Rabbits ; Reference Values ; Thrombosis ; Verapamil*