BACKGROUND: Ventilator-induced lung injury (VILI) sustained during mechanical ventilator support is still a cause of a high rate of morbidity and mortality in intensive care units and in operating rooms. VILI is characterized by pulmonary inflammation that appears to be mediated by proinflammatory cytokines. This study investigates whether the volatile anesthetic sevoflurane has an anti-inflammatory effect that attenuates VILI. METHODS: Twenty one male rabbits were anesthetized and were mechanically ventilated with 50% oxygen at a peak inspiratory pressure (PIP) of 10 cmH2O, I : E ratio of 1 : 4, and positive end expiratory pressure of 5 cmH2O. All animals were randomly assigned to one of three groups that were ventilated for 5 h with 10 cmH2O of PIP (Sham group, n = 7); 30 cmH2O of PIP (Control group, n = 7); or 30 cmH2O of PIP and 0.8 vol% sevoflurane (Sevoflurane group, n = 7). The wet/dry weight (W/D) ratio and histopathology of the lung; concentration of interleukin-8 (IL-8) in the bronchoalveolar lavage fluid; and activation of extracellular signal-regulated kinases (ERK) 1/2, p38 mitogen-activated protein kinase, and Akt were measured in the lung tissue after completing the protocol. RESULTS: Histopathology indicated that the sevoflurane group showed fewer inflammatory cells and architectural changes than the control group did. The W/D ratio [(5.36 +/- 0.13) versus (6.61 +/- 0.20)], expression of IL-8 [(144.08 +/- 14.61) versus (228.56 +/- 15.13) pg/ml] and phosphorylation of ERK1/2 and Akt decreased significantly in the sevoflurane group relative to the control group. CONCLUSIONS: Sevoflurane attenuates VILI in rabbits mainly by inhibiting expression of IL-8, and Sevoflurane-induced inhibition of phosphorylated ERK1/2 and Akt might be a possible pathway for protection.
Animals ; Bronchoalveolar Lavage Fluid ; Cytokines ; Extracellular Signal-Regulated MAP Kinases ; Humans ; Intensive Care Units ; Interleukin-8 ; Lung ; Male ; Mortality ; Operating Rooms ; Oxygen ; Phosphorylation ; Pneumonia ; Positive-Pressure Respiration ; Protein Kinases ; Rabbits ; Signal Transduction* ; Ventilator-Induced Lung Injury* ; Ventilators, Mechanical

BACKGROUND: High dose of aprotinin has been known to reduce the requirement for homologous transfusion and the loss of blood during cardiac operation. The aim of this study was to investigate an effective minimal dose of aprotinin. METHODS: With IRB approval 61 patients undergoing cardiac operation were divided into four groups. Group I was control (n=15). Group II(high dose aprotinin, n=16) received an infusion of 24,000 KIU/kg of aprotinin followed by continous infusion of 6,000 KIU/kg per hour until the end of operation. A bolus of 24,000 KIU/kg was added to pump prime solution. Group III(low dose aprotinin, n=16) received a bolus of 24,000 KIU/kg to prime solution. Group IV(minimal dose aprotinin, n=14) received a bolus of 12,000 KIU/kg to prime solution. Coagulation profiles were analysed and blood loss through chest tubes & amount of homologous transfusion was measured. Statistical analysis was performed using one-way variance analysis. RESULTS: Group II demonstrated less amount of blood loss than group I with statistical significance. Blood loss in group III was reduced about 20% but the reduction was not statistically significant. Group IV could not reduce the blood loss. CONCLUSION: This study shows the efficacy of high and low dose(not statistically significant) aprotinin infusion during cardiac surgery in postoperative blood loss. Use of aprotinin less than low dose regimen may not be effective in reducing the blood loss and amount of homologous transfusion in cardiac operation.
Aprotinin* ; Chest Tubes ; Ethics Committees, Research ; Heart* ; Humans ; Postoperative Hemorrhage ; Thoracic Surgery*

Coronary artery dissection after blunt chest trauma is very rare conditon, and this can result in a serious acute myocardial infarction. We report a case of a 54-year old male who was presented with an anterior myocardial infarction after traffic accident, with steering wheel injury. His coronary angiography revealed a discrete eccentric 85% stenosis of proximal left anterior descending coronary artery with dissection and intravascular ultrasound showed a dissecting flap from the distal left main coronary artery to proximal left anterior descending coronary artery. He was successfully treated by percutaneous transluminal coronary angioplasty with stent.
Accidents, Traffic ; Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels* ; Humans ; Male ; Middle Aged ; Myocardial Infarction* ; Stents ; Thorax* ; Ultrasonography

PURPOSE: This study was performed to investigate whether the E2F1 protein expression can be used as a prognostic factor in clinical breast cancer. METHODS: The expressions of E2F1 and retinoblastoma protein (pRB) were analyzed in 165 lymph node positive breast cancers. All patients underwent adjuvant chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide (FAC) after curative surgery. RESULTS: E2F1 was expressed in 43.6% and pRB was expressed in 46.1%. E2F1 expression was significantly increased in pRB-expressing tumors and was associated with S-phase fraction. By univariate survival analyses, E2F1 expression and ER were the significant prognostic factors for the disease recurrence and patient survival. E2F1 was the only significant prognostic factor for the patient outcome after FAC chemotherapy by multivariate analysis. CONCLUSION: Conclusion The results of the current study indicate that abnormal expression of E2F1 and pRB is prevalent and are intimately associated with each other in clinical breast cancer. A significant association between E2F1 expression and patient survival after FAC chemotherapy mondates a further validation study.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Fluorouracil ; Humans ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Recurrence ; Retinoblastoma Protein

PURPOSE: To evaluate the extent of pain response and objective response to palliative radiotherapy (RT) for bone metastases from hepatocellular carcinoma according to RT dose. MATERIALS AND METHODS: From January 2007 to June 2010, palliative RT was conducted for 103 patients (223 sites) with bone metastases from hepatocellular carcinoma. Treatment sites were divided into the high RT dose and low RT dose groups by biologically effective dose (BED) of 39 Gy10. Pain responses were evaluated using the numeric rating scale. Pain scores before and after RT were compared and categorized into 'Decreased', 'No change' and 'Increased'. Radiological objective responses were categorized into complete response, partial response, stable disease and progression using modified RECIST (Response Evaluation Criteria In Solid Tumors) criteria; the factors predicting patients' survival were analyzed. RESULTS: The median follow-up period was 6 months (range, 0 to 46 months), and the radiologic responses existed in 67 RT sites (66.3%) and 44 sites (89.8%) in the high and low RT dose group, respectively. A dose-response relationship was found in relation to RT dose (p=0.02). Pain responses were 75% and 65% in the high and low RT dose groups, respectively. However, no statistical difference in pain response was found between the two groups (p=0.24). There were no differences in the toxicity profiles between the high and low RT dose groups. Median survival from the time of bone metastases diagnosis was 11 months (range, 0 to 46 months). The Child-Pugh classification at the time of palliative RT was the only significant predictive factor for patient survival after RT. Median survival time was 14 months under Child-Pugh A and 2 months under Child-Pugh B and C. CONCLUSION: The rate of radiologic objective response was higher in the high RT dose group. Palliative RT with a high dose would provide an improvement in patient quality of life through enhanced tumor response, especially in patients with proper liver function.
Carcinoma, Hepatocellular ; Follow-Up Studies ; Humans ; Liver ; Neoplasm Metastasis ; Quality of Life

Idiopathic hypereosinophilic syndrome is a state of marked eosinophilia of unknown cause accompanied by multiple organ involvement. Any organ may be involved including bone marrow, heart, lung, gastrointestinal tract, liver, kidney and the nervous system. The common cardiac manifestations of hypereosinophlic syndrome are myocarditis, endocardial fibrosis, formation of mural thrombi, valvular hearat disease, restrictive cardiomyopathy and congestive heart failure. We report a case of a 61-year-old man with idiopathic hypereosinophilic syndrome manifested by myocarditis and severe pericardial effusion on transthoracicechocardiography that was successfully treated by pericardiocentesis and on-going steroid therapy.
Bone Marrow ; Cardiomyopathy, Restrictive ; Eosinophilia ; Fibrosis ; Gastrointestinal Tract ; Heart ; Heart Failure ; Humans ; Hypereosinophilic Syndrome* ; Kidney ; Liver ; Lung ; Middle Aged ; Myocarditis ; Nervous System ; Pericardial Effusion* ; Pericardiocentesis

The National Evidence-based Collaborating Agency (NECA) holds the NECA Round-table Conference that not only disseminates objective and systematic information on topics of social concern in public health care but also organizes discussions on core issues under dispute in the literature through panels composed of multidisciplinary experts. Accordingly, the Round-table Conference was composed of multidisciplinary experts including medical specialists in the areas of psychiatry and preventive medicine, psychiatric and mental health nursing, psychologists, social welfare experts, consultation experts, religious leaders, and government officials from the Ministry of Education, Science and Technology, and Ministry of Health and Welfare. The Round-table Conference, tasked with analysis of the actual status and causes of, and search for solutions for suicide in adolescents, has reached consensus on the current status, trend, risk factors and prevention factors, problems and issues in prevention and coping strategies, effective prevention and coping strategies and areas of research needed for the future. The Round-table Conference commented on the actual status and gravity of suicides in adolescents, and came to the agreement that mental health issues including stress from interpersonal relationships and depression are the key risk factors of suicide. It was further agreed that problems in the measures being implemented for each of the areas include lack of manpower and funding, and inadequate organic association and cooperation among relevant institutions. They also agreed that development of a government-initiated suicide prevention program for adolescents, association among relevant experts, and development, and management of practical guidelines that are of broad and practical use are important. Furthermore, the panels were in agreement that the mass media must comply with the recommended level of coverage in reporting of suicide as adolescents are greatly influenced by provocative mass media reports due to their strong impulsive dispositions.
Adenosine-5'-(N-ethylcarboxamide) ; Adolescent ; Cause of Death ; Consensus ; Depression ; Dissent and Disputes ; Financial Management ; Gravitation ; Humans ; Mass Media ; Mental Health ; Occupational Groups ; Porphyrins ; Preventive Medicine ; Public Health ; Risk Factors ; Social Welfare ; Specialization ; Suicide