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

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: 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

BACKGROUND: Recently many investigators have reported the studies of radiation therapy to prevent proliferation of vascular smooth muscle cells (VSMCs) which is the main cause of restenosis. This work is designed to investigate the effects of gamma-radiation on the proliferation and cell cycle of VSMCs. METHOD: Rat aortic smooth muscle cells were isolated, and the cells were used between 5th and 7th passage. The cultured cells were irradiated using Cesium-137 (137Cs) with the dose of 2, 8, or 16 Gray (Gy), and harvested at 12, 24, or 48 hours after irradiation. Proliferation of cells was subsequently assessed. And the changes of DNA synthesis and cell cycle were analyzed by flow cytometry. RESULTS: 1) The number of inoculated cells was 0.4 x 105 cells/cm2. After irradiation with the dose of 0, 2, 8, or 16 Gy, cell counts at 24 hour were 3.3+/-0.9, 2.3+/-0.3, 1.9+/-0.6, 1.3+/-0.2 x 105 cells/cm2, and those at 48 hour were 5.1+/-2.1, 2.0+/-0.8, 1.8+/-0.6, 1.2+/-0.5 x 105 cells/cm2, respectively. The cells of control group grew by 56% at 48 hour compared with those at 24 hour, however the cell growth of irradiated groups was inhibited in a dose-dependent manner. 2) The inhibitory effect of irradiation was consistently observed when the culture condition was changed to high (450 mg/dl) or low glucose concentration (100 mg/dl) and with or without estrogen (180 nM of 17 beta-estradiol). 3) DNA synthesis was analysed by [3H] thymidine incorporation. Radioactivity of cells decreased significantly after irradiation (8 Gy), and this phenomenon was not influenced by various culture conditions; high aminoacid medium (with F12, high glucose concentration, or with or without estrogen). 4) The cell cycle was analyzed after irradiation. The proportions of G0/G1-S-G2/M phase in control and irradiated group were 68-14-18 vs 64-3-33% at 24 hour, 87-2-11 vs 77-2-21% at 48 hour and 86-2-12% vs 71-2-27% at 72 hour after irradiation. G1 and G2 arrest occurred at 24 hour and partial release of G2 arrest were observed at 48 hour after irradiation. CONCLUSION: The results of this study indicate that gamma-irradiation potentially inhibits the VSMCs proliferation in a dose-dependent manner by the mechanism of cell cycle arrest.
Animals ; Cell Count ; Cell Cycle ; Cell Cycle Checkpoints ; Cells, Cultured ; DNA ; Estrogens ; Flow Cytometry ; Glucose ; Humans ; Muscle, Smooth, Vascular* ; Myocytes, Smooth Muscle ; Radiation, Ionizing* ; Radioactivity ; Rats* ; Research Personnel ; Thymidine

BACKGROUND: When aortic stenosis is associated with atrial fibrillation, estimation of the aortic valve area(AVA) by continuity equation refuires averaging of 8-12 beats of LVOT-TVI and AV-TVI to calculate mean LVOT-TVI and mean AV-TVI. Since this method labour intensive, we therefore propose a new simplified method. METHODS: We studied 9 patients of aortic stenosis with atrial fibrillation. We recorded LVOT velocity and aortic valve velocity in 4-chamber view and measure the LVOT area in the parasternal long axis view. We measured RR interval(RR) and diastolic filling time(DFT) of preceding beat in ECG recorded simultaneously. AVA(mean)was defined as the aortic valve area calculated from the mean LVOT-TVI and mean AV_TVI of 10 veats by using continuity equation. AVA)RR), AVA(DFT), AVA(rTT) and AVA-rDDFT) were defined as the aortic valve area calculated from the 1 beat of LVOT-TVI and AV_TVI normalized by RR, DDFT, rRR and rDFT respectively. 20 sets of AVA(mean), AVA(RR), AVA(DFT),AVA(rTT) and AVA(DFT) were calculated in each patient and their means and standard deviations are compared. RESULTS: 1) R values of the correlation of RR, DFT, rTT, rDFT is 0.87, 0.87, 0.89 with LVOT-TVI and 0.91, 0.93, 0.94 with AV-TVI. 2) Averages of AVAs are AVA(mean) 0.76+/-0.35cm2, AVA(rRR) 0.75+/-0.04cm2, AVA(RR) 0.76+/-0.11cm2, AVA(DFT) 0.82+/-0.35cm2, AVA(rRR) 0.75+/-0.15cm2, AVA(rDFP) 0.76+/-0.10cm2. 3) Averages of AVAs showed no significant difference. Standard deviation of AVA(mean) was significantly smaller than other new AVAs(p<0.01). THe standard deviation of AVA(rDFT) was significantly smaller than that of AVA(RR), AVA(DFT) and AVA(RR)(p=0.35, p=0.05,p=0.008). CONCLUSION: When aortic stenosis is associated with atrial fibrillation, newly derived AVA(rDFT) could be more easily calculated compared to conventional AVA(mean) and was also a reproducibe and precise estmate of aortic valve area.
Aortic Valve Stenosis* ; Aortic Valve* ; Atrial Fibrillation* ; Axis, Cervical Vertebra ; Electrocardiography ; Humans

BACKGROUND: Recent investiogations have shown that aortic valve area derived by continuity equation as well as Gorlin formula varied with transvalvular volume flow rate. This study was designed to investigate the effect of heart rate on aortic valve area calculated by continuity equation. METHODS: We studied 10 patients of with cath-proven aortic stenosis. Patients underwent echocardiography recording during right atrial pacing with 80, 100 and 120 beats/min. Flow rate and continuity equation valve area were obtained at each heart rate by doppler echocardiography. RESULTS: Transvalvular flow rates were 194+/-30 ml/sec, 208+/-38 ml/sec and 200+/-39 ml/sec with pacing at 80, 100 and 120 beats/min respectively, and there was no significant change in flow rate with heart rate. Aortic valve areas derived by continuity equation were 0.77+/-0.14cm2, 0.81+/-0.14cm2and 0.86+/-0.15cm2with pacing at 80, 100 and 120 beats/min. There was signifcant increase in aortic valve area between heart rate 120 and 100 beat/min(p=0.02), and between heart rate 120 and 80 beas/min([=0.003). there was no significant change in aortic valve area between heart rate 100 and 80 beat/min. CONCLUSION: Although there was no significant change in transvalvular flow rate with heart rate increase, aortic valve area derived by continuity equation significantly increased with increased heart rate. This relation should be considered when interpretion continuity equation valve area in aortic stenosis.
Aortic Valve Stenosis ; Aortic Valve* ; Echocardiography ; Echocardiography, Doppler ; Heart Rate* ; Heart* ; Humans

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

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*

BACKGROUND: Familial hypercholesterolemia(FH) is an autosomal dominant inharited disorder. Total cholesterl level of FH heterozygotes is two to fourfold higher than that of normal population. Substained hypercholesterolemia results in cholesterol deposition on various organs or tissues and Achilles tendon xanthoma due to cholesterol deposition is one of the specific clinical findings of FH. One of the lipid lowering drugs, 3-hydroxy-3-methylglutaryl coenzyme A(HMG Co-A) reductase inhibitor effectively lowers the blood cholesterol level in patients with FH, but whether the cholesterol deposition can be regressed by the lipid lowering drugs is rarely reported. This study attemted to determine whether the tendon xanthoma can be regressed by lipid lowering drugs commonly used in patients with FH. METHODS: We analyzed procepectively the serum lipid levels of patients with heterozygous FH before and after lipid lowering therapy with HMG Co-A reductase inhibitor alone(Lovastatin or Pravastatin) or in combination with bile acid sequestrating resin(Cholestyramine). The Achilles tendon thickness was measured radiographically by using soft tissue technique. RESULT: Total 18 patients with heterozygotes FH(M : F=8 :10, mean age; 51.7+/-9.0 years) were treated with the HMG Co-A reductase inhibitor alone or combined with bile acid sequestrating resin and followed for mean 31.9+/-11.9 months. During that period, serum total cholesterol and low density lipoprotein cholesterol significantly fell from 329+/-42 mg/dl to 230+/-29 mg/dl and from 246+/-56 mg/dl to 151+/-28 mg/dl, respectively(p<0.001). Serum high density lipoprotein level increased and maintained 15.3% higher than basal level(p<0.01). Achilles tendon thickness decreased significantly from 13.3+/-3.1 mm to 11.9+/-3.2 mm(p<0.001) with percent reduction of 9.8+/-10.5%(range; 3.1-36.4%). The amount of change of tendon thickness was significantly correlated only with percent reductionof LDL(p=0.029) and female sex(p0.020) on univariate analysis, but it was found to be significantly correlated only with percent reduction of LDL on multivariate analysis(r=0.514,p=0.029). CONCLUSION: Achilles tendon xanthoma can be regressed by effective lipid lowering therapy with HMG Co-A reductase inhibitor alone or with bile acid sequestrating resin in patients with heterozygous FH. the regression of tendon xanthoma is likely to be related to reduction of serum LDL.
Achilles Tendon* ; Bile* ; Cholesterol ; Cholesterol, LDL ; Female ; Heterozygote ; Humans ; Hypercholesterolemia ; Hyperlipoproteinemia Type II* ; Lipoproteins ; Oxidoreductases* ; Tendons ; Xanthomatosis*