PURPOSE: Postoperative wound infection accounts for approximately 15% of all hospital infections. Methicillin-resistant Staphylococcus aureus (MRSA) infections are 14% of the domestic hospital infections and this is increasing in incidence over time. The aim of this study was to retrospectively evaluate the relationship between wound dehescence after urologic surgery and MRSA infection. MATERIALS AND METHODS: Thirty patients (25 males and 5 females) who experienced wound dehescence after urologic surgery were subdivided into two separate groups; the MRSA group and non-MRSA group, and they were retrospectively analyzed via a chart review according to the age of the patients, the associated disease, the hepatic or renal functional status, the admission duration, the use of preoperative antibiotics and the number and duration of inserted catheters. RESULTS: The mean age of the MRSA group and the non-MRSA group was 62.6+/-12.4 years and 59.3+/-19.9 years, respectively (p=0.235). The elapsed operative time in the MRSA group and non-MRSA group was 355.8+/-99.5 minutes and 305.8+/-90.2 minutes, respectively (p=0.021). Contrary to 35.2+/-23.6 days of catheter duration in the MRSA group, that of the non-MRSA group was 14.6+/-8.5 days (p=0.007). The tendency for MRSA infection was observed for an increased duration of drain placement, a decreased hepatic or renal function and the preoperative antibiotic use. The extent of admission was obviously longer for the MRSA group (39.6+/-23.5 days) than for the non-MRSA group (28.9+/-9.9 days) (p=0.013). CONCLUSIONS: Wound dehescence assocated with MRSA infection is intimately related to the elapsed operative time and the period of catheter-insertion, which in turn increases the number of admission days.
Anti-Bacterial Agents ; Catheters ; Cross Infection ; Humans ; Incidence ; Male ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus* ; Operative Time ; Retrospective Studies ; Staphylococcus aureus ; Surgical Wound Infection ; Wound Infection ; Wounds and Injuries*

Background:Ghrelin is a new endogenous ligand for the growth hormone secretagogue receptor. It activates the release of growth hormone from the pituitary and it also participates in the regualtion of energy homeostasis. The aims of the study were to characterize the changes in plasma ghrelin levels in obese subjects compared with lean control or overweight subjects, and their relationship to various parameters in obese subjects. METHODS:In this study, 121 elementary school children were divided into 3 groups according to their body mass index (BMI). The lean control subjects consisted of 28 children who had less than 85 percentile of BMI. The overweight subjects consisted of 22 children who had 85-95 percentile of BMI. The obese subjects consisted of 71 children who had over 95 percentile of BMI. All subjects in 3 groups were evaluated according to their age, height, weight, obesity index, plasma ghrelin, serum lipid, glucose and insulin levels. Leu72Met mutation of prepro-ghrelin gene was directly detected by digesting the PCR fragments with Bsrl. RESULTS:Among antropometric data, body weight, BMI and obesity index were higher in obesity and overweight subjects than those of lean control subjects (P<0.05). The plasma ghrelin levels were significantly lower in overweight and obese subjects (P<0.05). In addition, serum triglyceride and LDL cholesterol levels were significantly higher in these groups compared to the control subjects (P<0.05). The concentrations of plasma ghrelin were significantly negatively correlated with BMI, obesity index, serum triglyceride, LDL cholesterol and insulin in all the children. However, there was no significant relationship between plasma ghrelin levels and any various parameters in obese subjects. Leu72Met mutation was detected in about 30% of obese children. However, we could not find any differences between lean control and obese children. CONCLUSION: We proved a significantly lower plasma ghrelin levels in overweight and obese subjects. Further studies are now needed to establish the role of ghrelin in the pathogenesis of human obesity.
Body Mass Index ; Body Weight ; Child* ; Cholesterol, LDL ; Ghrelin* ; Glucose ; Growth Hormone ; Homeostasis ; Humans ; Insulin ; Obesity* ; Overweight ; Plasma* ; Polymerase Chain Reaction ; Receptors, Ghrelin ; Triglycerides

PURPOSE: The purpose of this study was to evaluate the radiologic features of juxtafacet cyst and determine the correlation between these features and clinical outcome. MATERIALS AND METHODS: We analyzed a total of 23 patients. The degree of facet joint degeneration was classified using the Fujiwara method. The facet joint angles were measured with an magnetic resonance imaging to determine whether there was a difference between the cystic lesion that was occupied and the cystic lesion that was not occupied. Disc degeneration was measured by the Pfirrmann classification method. The clinical result was evaluated using the Oswestry disability index score and visual analogue scale. RESULTS: The L4–5 level of juxtafacet cyst was mostly affected, as found in previous studies. Facet joint arthritis was more severe within the side with the cystic lesion. Significant correlation was found between disc degeneration and juxtafacet joint cyst. All patients underwent wide decompression and fusion. Clinical result was excellent. No patients had signs of recurrence during the follow-up periods. CONCLUSION: Juxtafacet cyst has a significant correlation with facet joint degeneration. Therefore, aggressive surgical treatment—not just simple cyst excision—should be considered as the treatment option for juxtafacet cyst associated with degenerative lumbar disease.
Arthritis ; Classification ; Decompression ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration ; Joints ; Magnetic Resonance Imaging ; Methods ; Recurrence ; Zygapophyseal Joint

Supravalvular aortic stenosis is an uncommon congenital narrowing of the ascending aorta that may be localized or diffuse, originating at the superior margin of the sinuses of Valsalva just above the level of the coronary arteries. The most common complication of supravalvular aortic stenosis is early onset of intimal hyperplasia and atherosclerosis of the coronary arteries. The coronary arterial lesions of supravalvular aortic stenosis are dilatation or coronary artery ostial obstruction. We experienced a case of supravalvular aortic stenosis combined with right coronary artery ostial obstruction. A 21 year-old female patient was admitted because of exertional dyspnea and chest pain for 2 months. Cardiac catheterization showed a narrowing of ascending aorta with prominent calcification in the lesion and moderate aortic valve insufficiency. The peak to peak left ventricular-supravalvular aortic pressure gradient was 54 mmHg. Selective coronary angiography revealed as a complete obstruction of the ostium of the right coronary artery. Surgical correction was performed successfully. Postoperative left ventricular-supravalvular aortic pressure gradient was decreased to 22 mmHg. Postoperative clinical course was favorable and she was discharged with good condition. We present a case of supravalvular aortic stenosis combined with right coronary artery ostial obstruction with a review of literatures.
Aorta ; Aortic Stenosis, Supravalvular* ; Aortic Valve Insufficiency ; Arterial Pressure ; Atherosclerosis ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Angiography ; Coronary Vessels* ; Dilatation ; Dyspnea ; Female ; Humans ; Hyperplasia ; Young Adult

BACKGROUND: Atrial fibrillation (Af) after open heart surgery may result in hypotension, heart failure, embolic complication and prolongation in length of hospital stay. Several studies have investigated the efficacy of pharmacological prophylaxis in reducing the incidence of Af after cardiac surgery. The pericardial sac represents a natural physical barrier and provides a drug receptacle to restrict drug delivery to the heart. The overall objective of this study was to determine whether the pericardial sac could function as a delivery chamber for antiarrhythmic drugs. We investigated whether quinidine delivered into the pericardial sac exerted an effect on atrial and ventricular refractoriness, impulse generation, and conduction. METHODS: All animals were anesthetized with alpha-chloralose. After a sternotomy, the pericardium was opened and cradled to produce a "container" of approximately 30 ml. Experimental animals received quinidine, 3.33 mg/ml, dissolved in Krebs-Henseleit solution instilled into their pericardial sacs for 30 minutes. Baseline and 5, 10 and 30 minutes postinstillation electrophysiologic studies were performed. Plasma quinidine levels were measured at each of the time intervals in three different sites i.e., right ventricle (RV), aortic root and femoral vein (FV). RESULTS: Baseline systolic (SAP) and diastolic aortic pressure (DAP) were 148+/-16.8 mmHg, and 111+/-23.9 mmHg, respectively. Both SAP and DAP were significantly decreased at 5, 10 and 30 minutes after instillation of quinidine solution into pericardial sac. In electrocardiographic parameters, the increase in sinus cycle length and corrected QT interval were significantly greater compared with baseline at each of the time intervals after instillation of quinidine solution into pericardial sac. All electrophysiologic parameters including 1:? AV conduction, effective refractory period (ERP) of RA and RV were significantly increased compared with baseline at three time points. Quinidine concentrations in RV and aorta were significantly higher than in FV at three time points. In RV and aorta, quinidine concentrations at 30 min were significantly lower than those at 5 and 10 min postinstillation periods. There were significant correlations between plasma quinidine levels and corrected QT interval or RAERP. CONCLUSION: Above results showed that quinidine instilled into the pericardial sac migrates transmurally and produces significant prolongation of effective refractory period and may appear to prevent various arrhythmias including atrial fibrillation after cardiac surgery.
Animals ; Anti-Arrhythmia Agents ; Aorta ; Arrhythmias, Cardiac ; Arterial Pressure ; Atrial Fibrillation ; Chloralose ; Electrocardiography ; Electrophysiology ; Femoral Vein ; Heart ; Heart Failure ; Heart Ventricles ; Hypotension ; Incidence ; Length of Stay ; Pericardium ; Plasma ; Quinidine* ; Sternotomy ; Thoracic Surgery

BACKGROUND: Lung pericytes are important constituent cells of blood-air barrier in pulmonary microvasculature. These cells take part in the control of vascular contractility and permeability. In this study, it was hypothesized that change of lung pericytes might be attributable to pathologic change in microvasculature in acute lung injury. The purpose of this study was how hypoxia change proliferation and genetic expression in lung pericytes. METHODS: From the lungs of several Sprague-Dawley rats, performed the primary culture of lung pericytes and subculture. Characteristics of lung pericytes were confirmed with stellate shape in light microscopy and immunocytochemistry. 2% concentration of oxygen and 200muM CoCl2 were treated to cells. Tryphan blue method and reverse transcription-polymerase chain reaction were done. RESULTS: 1. We established methodology for primary culture of lung pericytes. 2. Hypoxia inhibited cellular proliferation in pericytes. 3. Hypoxia could markedly induce vascular endothelial growth factor(VEGF) and smad-2. 4. Hypoxia-inducible factor-1alpha (HIF-1alpha)was also induced by 2% oxygen. CONCLUSION: Viability of lung pericytes are inhibited by hypoxia. Hypoxia can stimulate expression of hypoxia-responsive genes. Pericytic change may be contributed to dysfunction of alveolar-capillary barrier in various pulmonary disorders.
Acute Lung Injury ; Anoxia ; Blood-Air Barrier ; Cell Proliferation ; Immunohistochemistry ; Lung* ; Microscopy ; Microvessels ; Oxygen ; Pericytes* ; Permeability ; Rats, Sprague-Dawley ; Vascular Endothelial Growth Factor A

A rapid response to corticosteroid treatment and a generally favourable outcome are characteristic features of BOOP (Bronchiolitis obliterans organizing pneumonia). However, with increasing experience of the clinical spectrum of this disease, it is now recognized that some patients are refractory to steroid, which is associated with a poor prognosis. Here, two cases of BOOP initially treated with predinisone and antibiotics without effects, but subsequently responded to secondary cyclosporine treatment, are reported.
Anti-Bacterial Agents ; Bronchiolitis Obliterans* ; Bronchiolitis* ; Cryptogenic Organizing Pneumonia* ; Cyclosporine* ; Humans ; Prognosis

BACKGROUND AND OBJECTIVES: The ventricular pacing electrodes are customarily placed into the right ventricular muscle because there is easily accessible. However detailed physiologic studies have shown that the single stimulation of right ventricular sites causes dysynchronous ventricular contraction due to early depolarization of the right ventricle and delayed depolarization of the left ventricle. In contrast, normal human ventricular activation, which is conducted by the Purkinje system, spreads transmurally from the endocardium to multiple paraseptal epicardial regions and results in more synchronous contraction of the ventricle. Therefore, the hypothesis that producing biventricular activation by simultaneously pacing ventricles across the septum might confer hemodynamic benefits over those of conventional right ventricular pacing. The purpose of this study was to evaluate the acute hemodynamic changes of different pacing modes (right ventricular : RV, biventricular : BV, atrio-right ventricular : A-RV, and atrio-biventricular : A-BV pacing). MATERIALS AND METHOD: In 9 open chest dogs anesthetized with alpha-chloralose, sinus node crushing was done, and then hemodynamic data (QRS width, femoral arterial pressure : FAP, pulmonary arterial pressure : PAP, and Cardiac output : CO) were acquired after 5 minutes of pacing at a fixed rate during each pacing mode. RESULTS: Results were as follow : 1. BV pacing significantly increased cardiac output compared with RV pacing (P<0.01). BV pacing significantly shortened QRS width compared with RV pacing (P<0.01). 2. A-BV pacing significantly increased cardiac output compared with A-RV pacing (P<0.01). A-BV pacing significantly shortened QRS width compared with A-RV pacing (P<0.01). 3. A-RV pacing significantly increased systolic pulmonary arterial pressure and cardiac output compared with BV pacing (P<0.01). CONCULSION: These results support the use of atrio-biventricular pacing to improve acute hemodynamic performance.
Animals ; Arterial Pressure ; Cardiac Output ; Cardiac Resynchronization Therapy* ; Chloralose ; Dogs* ; Electrodes ; Endocardium ; Heart Ventricles ; Hemodynamics* ; Humans ; Sinoatrial Node ; Thorax*

BACKGROUND: The hemodynamic effects of an episode of ventricular tachycardia (VT) may vary from mild decrease in blood pressure to sustained hypotension, collapse, and death. Little is known about the factors responsible for these diverse effects. Ventricular function, vasomotor tone, and tachycardia cycle length could be major determinants of variable hemodynamic responses to VT. The site of origin was found to be a factor affecting pulse pressure even in an isolated ventricular premature contraction. However, the role of origin site in hemodynamics of VT is not yet elucidated. The purposes of this study were to evaluate the effects of VT origin site and VT cycle length to their hemodynamic changes. And we also have assessed the role of cardiac autonomic receptor activation in hemodynamic recovery during and immediate after VT. METHODS: In 18 open chest dogs anesthetized with chloralose, bipolar ventricular pacing (VP) was performed using sutured epicardial electrodes at 3 different sites ; left ventricular apex (LVA), right ventricular outflow tract (RVOT), and right ventricular apex (RVA). At each site, VP was repeated for 60 seconds at 3 different rates; 1.75X, 2X, and 2.25X of baseline heart rate (BHR). Mean arterial pressure (MAP), mean left atrial pressure (MLAP) and mean pulmonary artery pressure (MPAP) were monitored during VP. deltaMAP was defined as the difference between the baseline MAP and lowest MAP during VP. deltaMLAP was defined as the difference between highest MLAP during VP and baseline MLAP. Cardiac vagal and beta-adrenoreceptor blockades were achieved by intravenous bolus administration of propranolol (1 mg/kg and then 1 mg/kg/hr) and atropine (0.5 mg/kg and then 0.5 mg/kg/hr). After cardiac autonomic blockade, VP was repeated at 2X of baseline heart rate for 60 seconds at each site. RESULTS: Baseline MAP, MLAP, and MPAP were 101+/-8.1 mmHg, 0.3+/-0.41 mmHg, and 10+/-2.4 mmHg, respectively. At the same pacing site of VP, MAP was decreased significantly with VP and deltaMAP was increased significantly as VP cycle length shortened (all P<0.001). At the same pacing cycle length of VP, deltaMAP was significantly greater at RVA or RVOT than LVA: LVA vs RVOT ; all P<0.001 at 3 different rates, LVA vs RVA ; P<0.05 (1.75X & 2X of BHR), P<0.001 (2.25X of BHR). But there was no significant difference in deltaMAP between RVA and RVOT. At the same pacing site of VP, MLAP and deltaMLAP were increased significantly as VP cycle length shortened (all P<0.01), but at the same cycle length of VP, there was no significant differences in deltaMLAP at 3 different VP sites. Ventricular pacing after autonomic blockade induced a greater increase in deltaMAP and deltaMLAP compared to controls (all P<0.01 at 3 pacing sites). And cardiac autonomic blockade also resulted in significant blunting of recovery of MAP during VP compared to controls. CONCLUSION: Above results showed that pacing cycle length plays a major role in determining the hemodynamic outcomes during ventricular pacing, and that the site of origin could be an independent factor of ventricular tachycardia hemodynamics. And also modulation of tone of the adrenergic nervous system is essentially required for the hemodynamic recovery during ventricular tachycardia.
Animals ; Arterial Pressure ; Atrial Pressure ; Atropine ; Blood Pressure ; Chloralose ; Dogs* ; Electrodes ; Heart Rate ; Hemodynamics* ; Hypotension ; Nervous System ; Propranolol ; Pulmonary Artery ; Tachycardia ; Tachycardia, Ventricular ; Thorax ; Ventricular Function

OBJECTIVE: The aim of this retrospective study is to evaluate the efficacy of adjuvant chemotherapy following radical hysterectomy for intermediate risk stage IB cervical cancer. METHODS: From January 1993 to December 2007, a total of 100 patients of stage IB were enrolled in this study who had at least two of the following three intermediate risk factors (deep stromal invasion, lymphovascular space involvement, and large tumor size) after radical hysterectomy and all patients had no high risk factors and no radiotherapy. Of these patients, 22 patients had surgery only and 78 patients had cisplatin-based combination chemotherapy as adjuvant therapy postoperatively to improve survival. Kaplan-Meier survival curves and Cox's proportional-hazards regression model and log-rank test were used for survival analysis and to estimate the impact of prognostic factors on survival. RESULTS: The mean age was 52 years (range, 28 to 76 years). The overall survival rate of all intermediate tumors are 92% (92/100). Surgery only group is 81.8% (18/22) and adjuvant chemotherapy group is 94.9% (74/78). Comparison of survival between two groups revealed significant statistical difference in both univariant and multivariant survival analysis (P<0.05). The main toxicities of adjuvant chemotherapy were bone marrow suppression (18%), nausea and vomiting (5.2%) and alopecia in etoposide-cisplatin chemotherapy group (100%) but most side effects of postoperative adjuvant chemotherapy were transient, reversible and within acceptable limits to all patients. CONCLUSION: Cisplatin based combined adjuvant chemotherapy for intermediate risk tumors after radical hysterectomy is promising with significant improvement of overall survival and with acceptable toxicity profile.
Alopecia ; Bone Marrow ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy, Combination ; Humans ; Hysterectomy ; Kaplan-Meier Estimate ; Nausea ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Survival Rate ; Uterine Cervical Neoplasms ; Vomiting