PURPOSE: A Trans-Illuminated Powered Phlebectomy (TIPP) is accepted as a useful surgical procedure for varicose vein, but requires hospitalization and general or spinal anesthesia. To show the feasibility of outpatient TIPP under local anesthesia, we established an outpatient fast track protocol of TIPP, and showed the results. METHOD: We performed outpatient department-based TIPP, under local anesthesia with a 2% lidocaine subcutaneous injection and the tumescent method. Using the visual analogue pain scale and a questionnaire, the compliance of the patient were examined. RESULT: Between August 2001 and January 2005, 252 limbs of 238 patients underwent operations using our protocol. Mean age of the patients was 59 years, with a male:female of 185:53. The mean operation time and number of incisions were 30.6 minutes and 4.6, respectively. There were 7 wound problems (2.78%) and 5 redo TIPP (1.98%) due to a recurrence. 58 questionnaires were completed and collected from the patients. The mean visual analogue pain scale score was 5.7. Of the 58 patients that completed the questionnaires, 6 (10%) replied that the procedure was intolerable and that they would not have again. Whereas, the other 52 patients (90%) said the procedure was tolerable, and would have again, if necessary. CONCLUSION: Outpatient TIPP, under local anesthesia, might be a relatively safe and feasible method to establish a fast track protocol for varicose veins.
Anesthesia, Local* ; Anesthesia, Spinal ; Compliance ; Extremities ; Hospitalization ; Humans ; Injections, Subcutaneous ; Lidocaine ; Outpatients* ; Pain Measurement ; Surveys and Questionnaires ; Recurrence ; Varicose Veins* ; Wounds and Injuries

PURPOSE: This study analyzed the prognostic factors affecting admission in acute alcohol-intoxicated traumatic brain injury (TBI) patients visiting the emergency room. METHODS: A multicenter, retrospective observational study was conducted on 821 acute alcohol-intoxicated adult trauma patients, who visited 10 university hospital emergency centers from April to November 2016. The primary outcome was hospital admission. The secondary outcome was in-hospital mortality. RESULTS: One hundred sixty-eight patients diagnosed with acute alcohol-intoxicated TBI were analyzed. The increase in blood alcohol concentration was associated significantly with a mild decrease in admission (adjusted odds ratio, 0.993; 95% confidence interval, 0.989 to 0.998; p=0.01). Moderate to severe TBI patients showed a significant increase in admission compared to mild TBI patients (adjusted odds ratio, 12.449; 95% confidence interval, 3.316 to 46.743; p < 0.001). CONCLUSION: This study showed that the admission was inversely correlated with the blood alcohol concentration and is correlated directly with the increase in the severity in TBI. Therefore, emergency physicians may be required to identify the severity of TBI rapidly and accurately in acute alcohol-intoxicated trauma patients visiting the emergency room.
Adult ; Alcohol Drinking ; Blood Alcohol Content ; Brain Injuries* ; Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Observational Study ; Odds Ratio ; Patient Admission ; Prognosis ; Retrospective Studies

BACKGROUND/AIMS: The study of liver fibrogenesis by hepatitis C virus (HCV) has been limited due to the lack of an efficiency in vitro culture systems. In the present study, we investigated whether or not HCV core protein is directly related to liver fibrogenesis through stimulation of hepatic stellate cells (HSC). METHODS: Human and rat HSC were isolated and we established an in vitro co-culture system of a stable HepG2-HCV core cell line which was transfected with HCV core gene and primary HSC. We performed immunocytochemical staining and Western and Northern blot analysis in the stimulated HSC by HCV ocre protein to identify the expression of transforming growth factor beta1 (TGF-beta1), transforming growth factor beta receptor II (TGFbeta R II), alpha-smooth muscle actin (alpha-SMA) and connective tissue growth factor (CTGF). The expression of matrix metaloprotinase-2 (MMP-2) and collagen type I (Col I) in the culture media were measured by zymogram and ELISA, respectively. RESULTS: The expression of TGF-beta1 and CTGF was significantly higher in the stable HepG2-HCV core cell line than in HepG2 cells. Furthermore, the makers related to fibrosis such as alpha-SMA, TGF-beta1, Col I, TGFRII and MMP-2 were highly experssed in the co-culture of stable HepG2-HCV core with HSC. CONCLUSIONS: HCV core protein may play a direct role in the fibrogenesis of chronic liver disease with HCV infection.
Actins/metabolism ; Animals ; Cell Line, Tumor ; Coculture Techniques ; Connective Tissue Growth Factor ; Fibrosis ; Hepatitis C Antigens/*physiology ; Humans ; Immediate-Early Proteins/metabolism ; Immunoblotting ; Immunohistochemistry ; Intercellular Signaling Peptides and Proteins/metabolism ; Liver/metabolism/*pathology ; Protein-Serine-Threonine Kinases ; Rats ; Rats, Sprague-Dawley ; Receptors, Transforming Growth Factor beta/metabolism ; Transforming Growth Factor beta/metabolism ; Transforming Growth Factor beta1 ; Viral Core Proteins/*physiology