PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.
Aneurysm* ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common* ; Fibrosis ; Hemorrhage ; Incidence ; Inflammation ; Microsurgery ; Necrosis ; Nylons ; Polypropylenes ; Rats* ; Rats, Sprague-Dawley ; Sutures

PURPOSE: An ideal suturing material should be strong, easy to handle, should produce minimal tissue reaction and finally should disappear without a trace. Various micro-vascular suture materials have been produced in the past several decades in order to meet these demands. We have used nylon suturing material in experimental microsurgery because it is less expensive than polypropylene. After carotid artery end-to-end anstomosis, we found fusiform aneurysm incidentally. In this study 9-0 nylon (group I) and 9-0 polypropylene (group II) were compared to 10-0 nylon (group III), and 10-0 polypropylene (group IV) in order to survey the incidence of aneurysmal development in each material for use in microvascular surgery. METHOD: Forty Sprague-Dawley rats, 230 g to 350 g body weight, were used for this study. The carotid arteries were anastomosed end-to-end with 9-0 nylon, and 10-0 nylon, in addition to 9-0 polypropylene, and 10-0 polypropylene. The suture number of all arteries was 10 points except for two cases were 11 points due to uncontrolled bleeding. Specimens were harvested 1 week, 3 weeks, 6weeks and 10 weeks postoperatively. RESULT: The number of animals studied during the first week totaled 20 carotid arteries and they showed no interval change. After 3 weeks, we identified aneurysms in following cases: group I 3 cases, group II 2 cases, group III 1 case and group IV 1 case per five cases in each group. After 6 weeks, gross aneurysmal changes seen: group I, all (5) cases; Group II, 2 cases; group III, all (5) cases; Group IV, 3 cases. After 10 weeks, many aneurysms were observed: group I, all (5) cases; group II, all (5) cases; group III, 0 case; group IV, 2 cases. The aneurysms were measured and ranged in size from 1.3 mm to 8.1 mm. Histological analysis for inflammation, fibrosis and medial necrosis at the anastomosis site revealed no significant difference between same sized suture materials. If the experimental aneurysms were more than 5 times the diameter of the carotid artery, the aneurysms were considered to be experimental giant aneurysms. Seventy of our 34 experimental aneurysms were considered to be giant aneurysms. CONCLUSION: Our findings demonstrate that the development of aneurysms was related to size of the suture material and not the type of suturing material used. An ideal suture material for anastomosisof the carotid artery in the rat wasd a 10-0 monofilament suture material with suture numbers was above 10 points. We also made good aneurysm model. When we used 9-0 suture material and suture numbers were below 10 points multiple aneurysms developed. This model demonstrated the development mechanism of giant fusiform aneurysms.
Aneurysm* ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common* ; Fibrosis ; Hemorrhage ; Incidence ; Inflammation ; Microsurgery ; Necrosis ; Nylons ; Polypropylenes ; Rats* ; Rats, Sprague-Dawley ; Sutures

A delayed hemolytic transfusion reaction (DHTR) is the result of delayed anamnestic alloantibody response four to fourteen days after transfusion of apparently compatible blood. Most DHTRs are very mild and may not be recognized clinically. Some are manifested only by anemia. Only a few cases are severe enough to induce a massive hemolytic reaction followed by frank renal failure. Recently, we experienced a case of DHTR with acute renal failure (ARF) due to anti-E. A 21-year-old woman received compatible four units of packed red cells after right artificial total hip replacement arthroplasty due to juvenile rheumatoid arthritis. She had a history of transfusion 4 years ago. Fourteen days after the transfusion, she showed a fall in hematocrit, hemoglobinuria and a positive indirect antiglobulin test, and accompanied by ARF. Anti-E was identified in the patient's serum by antibody screening and identification test at that time. She recovered from ARF after hemodialysis with conservative management. However, eventually, she died due to disseminated intravascular coagulopathy.
Acute Kidney Injury* ; Anemia ; Arthritis, Juvenile ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Blood Group Incompatibility* ; Coombs Test ; Female ; Hematocrit ; Hemoglobinuria ; Humans ; Mass Screening ; Renal Dialysis ; Renal Insufficiency ; Young Adult

BACKGROUND AND OBJECT: Cheiro-oral syndrome (COS) is characterized by a sensory disturbance in the unilateral hand and ipsilateral mouth corner. It is usually due to a lesion in the parietal cortex, thatamocortical projections, thalamus, or rarely brain stem. However, the syndrome is relatively unknown and rarely mentioned in most neurological textbooks. We presented ten cases of COS with a review of the clinical symptoms and signs and the neuroradiological methods used to demonstrate the responsible site. METHODS AND RESULTS: We studied 10 patients with stroke who showed restricted sensory disturbance on the one hand and ispilateral mouth. The study forms consisted of clinical manifestaion, neurological examination, electrophysiological, and neuroradiologic studies. Computed tomography and/or magnetic resonance imaging identified lesion in the thalamus in 5, brain stem in 3, and corona radiata in 1 patient. But, the anatomical responsible site for one case was not founded. Infarction had occurred in nine cases and hemorrhage in one. Seven of the 10 patients showed sensory disturbances restricted to the perioral area, hands, fingers when they were first examined; the remaining patients complained more diffuse sensory disturbances at first, but it had become restricted to perioral and fingers, usually within 2-3 weeks. The durations of symptom varied from 5 days to more than 15 months and these symptoms were improved within 2-3 weeks to 4 months in treated patients. CONCLUSION: When the symptoms and signs of the COS were presented, especially if a history of migraine is lacking, neuroradiological methods such as CT or MRI should be undertaken to localize and diffentiate the nature of lesion.
Brain Stem ; Fingers ; Hand ; Hemorrhage ; Humans ; Infarction ; Magnetic Resonance Imaging ; Migraine Disorders ; Mouth ; Neurologic Examination ; Rabeprazole ; Stroke ; Thalamus

PURPOSE: A retrospective analysis was performed to evaluate the incidence of radiation induced lung damage after the radiation therapy for the patients with carcinoma of the lung. MATHOD AND MATERIALS: Sixty-six patients with lung cancer (squamous cell carcinoma 27, adenocarcinDma 14, large cell carcinoma 2, small cell carcinoma 13, unknown 10) were treated with definitive, postoperative or palliative radiation therapy with or without chemotherapy between July 1987 and December 1991. There were 50 males and 16 females with median age of 63 years(range: 33~80 years). Total lung doses ranged from 500 to 6,660 cGy (median 3960 cGy) given in 2 to 38 fractions (median 20) over a range of 2 to 150 days (median 40 days) using 6 MV or 15 MV linear accelerator. To represent different fractionation schedules of equivalent biological effect, the estimated single dose(ED) model, ED=D.N-0.377.T-0.058 was used in which D was the lung dose in cGy, N was the number of fractions, and T was the overall treatment time in days. The range of ED was 370 to 1357. The endpoint was a visible increase in lung density within the irradiated volume on chest X-ray as observed independently by three diagnostic radiologists. Patients were grouped according to ED, treatment duration, treatment modality and age, and the percent incidence of pulmonary damage for each group was determined. RESULT: In 40 of 66 patients, radiation induced change was seen on chest radiographs between 11 days and 314 days after initiation of radiation therapy. The incidence of radiation pneumonitis was increased according to increased ED, which was statistically significant (p=0.001). Roentgenographic charges consistent with radiation pneumonitis were seen in 100% of patients receiving radiotherapy after lobectomy or pneumonectomy, which was not statistically significant. In 32 patients who also received chemotherapy, there was no difference in the incidence of radiation induced charge between the group with radiation alone and the group with radiation and chemotherapy, among the sequence of chemotherapy. No correlation was seen between incidence of radiation pneumonitis and age or sex. CONCOUSIONS: The occurrence cf radiation pneumonitis varies. The incidence of radiation pneumonitis depends on radiation total dose, nature of fractionation, duration of therapy, and modifying factors such as lobectomy or pneumonectomy.
Appointments and Schedules ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Drug Therapy ; Female ; Humans ; Incidence ; Lung Neoplasms* ; Lung* ; Male ; Particle Accelerators ; Pneumonectomy ; Radiation Pneumonitis ; Radiography, Thoracic ; Radiotherapy ; Retrospective Studies ; Thorax

PURPOSE: Selective cyclooxygenase (COX)-2 inhibitors have been reported to inhibit cancer cell proliferation. We investigated the effects of NS-398, a selective COX-2 inhibitor, on cell proliferation in human pancreatic cancer cell lines. METHODS: Human pancreatic cancer cell lines, Aspc-1, Capan-1, and Capan-2 were used. We used western blot and/or RT-PCR to evaluate COX-2 and vascular endothelial growth factor expression. Antiproliferative effects were measured by MTT assay, apoptosis assay and cell cycle analysis. Epidermal growth factor (EGF) and troglitazone were used for combined treatment. RESULTS: COX-2 was relatively overexpressed in Capan-1 and Capan- 2, but minimal in Aspc-1 cell line. COX-2 mRNA expression was upregulated by 50 microM of NS-398 in Aspc-1 cell line but was downregulated at 100 microM in all cell lines. Treatment with NS-398 increased cell population of G0/G1 phase and also induced early apoptotic changes in a dose-dependent manner in all three cell lines. Combined treatment with EGF or troglitazone did not seem to affect antiproliferative effects of NS-398. All three cell lines expressed vascular endothelial growth factor constitutively and its expression was downregulated by treatment with NS-398. Pretreatment with NS-398 prior to radiation exposure increased radiosensitivity in Capan-2 cells. CONCLUSION: COX-2 expression was variable in pancreatic cancer cell lines. NS-398 inhibited pancreatic cancer cell proliferation by inducing apoptosis and cell cycle arrest in a dose-dependent manner. Treatment with NS-398 also inhibited expression of VEGF and enhanced radiosensitivity in pancreatic cancer cell lines. COX-2 inhibitors might be promising potential therapeutic agents for patients with pancreatic cancer.
Apoptosis ; Blotting, Western ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Line* ; Cell Proliferation ; Cyclooxygenase 2 Inhibitors ; Cyclooxygenase 2* ; Epidermal Growth Factor ; Humans ; Pancreatic Neoplasms* ; Prostaglandin-Endoperoxide Synthases ; Radiation Tolerance ; RNA, Messenger ; Vascular Endothelial Growth Factor A

PURPOSE: Phenylbutyrate is an effective redifferentiating agent in several human cancers. Recently phenylbutyrate has been reported to inhibit histone deacetylase activity. We investigated the effects of sodium 4-henylbutyrate (Na-4-PB) on cell proliferation in a human pancreatic cancer cell line. METHODS: A human pancreatic cancer cell line, Aspc-1 was purchased from Korean Cell Line Bank. Antiproliferative effects of sodium 4-phenylbutyrate were measured by MTT assay and their mechanisms were evaluated by apoptosis assay and cell cycle analysis. RESULTS: After 3 days of treatment with Na-4-PB at the concentration of 2.5, 5, 7.5, and 10 mM, relative growth inhibition compared to control was 21.3+/-8.3% (mean+/-SD), 37.8+/-2.3%, 46.7+/-0.5%, and 56.7+/-1.7% respectively (p < 0.05). Antiproliferative effect of Na-4-PB was also time-dependent. Combination treatment with Na-4-PB and troglitazone, a PPARg agonist, increased antiproliferative effects but was not synergistic. After 48 hour treatment with Na-4-PB, early apoptotic cell population in control, 2.5, and 5 mM of Na-4-PB was 29.6%, 44.2%, and 65.9%, respectively. After 24 hour treatment with Na-4- PB, G0/G1 phase population in control, 2.5, and 5 mM of Na-4-PB was 55.0%, 67.4%, and 65.8%, respectively. CONCLUSION: Na-4-PB inhibited pancreatic cancer cell proliferation by inducing apoptosis and cell cycle arrest at G0/G1 phase in time- and dose-dependent manner. Combination treatment with Na-4-PB and other chemotherapeutic agents such as troglitazone, a PPARg agonist, can enhance antiproliferative effects. Na-4-PB might be a promising potential therapeutic agent for patients with pancreatic cancer.
Apoptosis ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Line* ; Cell Proliferation ; Histone Deacetylases ; Humans ; Pancreatic Neoplasms* ; Sodium

BACKGROUND/AIMS: This study was designed to determine the effect of hepatic fibrotic severity on pharmacokinetics of propranolol in CCl4-treated rats. METHODS: 1 mL/kg of 10% CCl4 in olive oil was injected intramuscularly to rats twice weekly for 4, 6, 8 and 10 weeks, respectively (n=6). Control (n=6) was a sham-injected equal dose of olive oil for 10 weeks. After intravenous bolus injection of 2 mg/kg propranolol to rats, the serum propranolol concentrations were analyzed for 4 hours at various time points by a HPLC-fluorimetric system, and pharmacokinetic parameters such as C0, MRT, AUC, Vdss, t1/2( ) and CLp were determined. Then, a small amount of hepatic tissue was obtained and subjected to determination of the hepatic 4-hydroxyproline content, which confirmed the hepatic fibrotic severity. RESULTS: The serum concentrations of propranolol at 0.5, 1, 2 and 4 hours were significantly increased in CCl4-treated rats (p<0.01). In proportion to the duration of CCl4 treatment, C0 and AUC were significantly increased, and Vdss and CLp were significantly decreased (p<0.001). But MRT and t1/2( ) were not significantly changed. The hepatic 4-hydroxyproline content was gradually increased in CCl4-treated rats (p<0.001). CONCLUSION: Gradual changes in pharmacokinetic parameters of propranolol were seen to be dependent on the hepatic fibrotic severity. We suggest that gradual dosage modification, according to their hepatic fibrotic severity, is necessary for many drugs administered to patients with chronic liver disease.
Animals ; Area Under Curve ; Humans ; Hydroxyproline ; Liver Diseases ; Olea ; Pharmacokinetics ; Propranolol* ; Rats* ; Olive Oil

BACKGROUND/AIMS: Colonoscopy is the golden standard used as a surveillance test and screen for colon cancer, and the current demand for colonoscopy exceeds its availability. This study is an assessment of the colonoscopic surveillance intervals currently practiced. METHODS: A multiple choice survey of the colonoscopic surveillance interval used in six case scenarios [hyperplastic polyp; two 0.5 cm tubular adenomas (TAs); a 1.5 cm TA; 0.8 cm triple TAs; a 1.5 cm TA with high grade dysplasia; current normal exam after polypectomy of a <1 cm sized TA 3 years ago] was sent via e-mail to members of the KASID. RESULTS: A total of 131 colonoscopists (104 men, 27 women) replied, and the mean age of the respondents was 36 years (range 28~58). All respondents were board- certified in their respective specialties (internal medicine 75, general surgery 3, and GI subspecialty 53). When compared with the AGA guidelines, 90.1~99.2% of the respondents performed the first post-polypectomy surveillance colonoscopy prematurely, and 75.6% of respondents performed the second surveillance prematurely. CONCLUSIONS: Most post-polypectomy surveillance colonoscopies were performed prematurely. It is quite possible that unnecessary surveillance may account for a significant portion of the demand for colonoscopy.
Adenoma ; Colonic Neoplasms ; Colonoscopy* ; Surveys and Questionnaires ; Electronic Mail ; Humans ; Male ; Polyps

Backgroud: The purpose of this study was to assess the effect of inflating a laryngeal mask airway ProSeal(TM) (PLMA(TM)) cuff, prior to insertion, on the degree of difficulty of inserting a PLMA(TM) by the inexperienced, and the incidence of postoperative sore throat. METHODS: Before induction, we measured the thyromental and sternomental distance. PLMA(TM) insertions were conducted by those with experience of less than 15 previous insertions. One hundred and five consecutive patients undergoing general anesthesia were randomized into 3 groups: In group 1, the PLMA(TM) was inserted with the cuff fully deflated, in group 2, the cuff was partially inflated (i.e., filled with half the recommended air), in group 3, the cuff was fully inflated. Successful insertion was judged primarily by the clinical function of the airway. The number of insertion attempts to achieve a satisfactory airway were recorded. Each patient was asked whether he had a sore throat, dysphonia, or dysphagia just before leaving the postanesthesia care unit (PACU) and again 24 hr after surgery. RESULTS: The number of insertion attempts required to achieve a satisfactory airway and the failure rate of insertion were not significantly different in the 3 groups. However, the 3 groups were significantly different in terms of the incidence of postoperative sore throat in the PACU. This was highest in group 3 (P<0.05). The incidences of other variables of laryngopharygeal morbidity in the PACU and 24 hrs after surgery were not significantly different in the 3 groups. CONCLUSIONS: Inflation of the cuff prior to insertion did not affect the success rate of inserting a PLMA(TM) by the inexperienced, and PLMA(TM) insertion after partial inflation was associated with higher incidence of postoperative sore throat in the PACU. Thus, in general anesthesia, it is desirable that the inexperienced insert the PLMA(TM) with the cuff fully deflated.
Anesthesia, General ; Deglutition Disorders ; Dysphonia ; Humans ; Incidence ; Inflation, Economic* ; Laryngeal Masks* ; Pharyngitis*