Many researchers and clinicians have been concerned about the potential impact of anesthetic agents on human immune system. There have been expanding evidences associating an- esthesia and surgery with down-regulation of immune functions. Immune alterations associated with anesthesia and surgery are manifested by lymphapenia and granulocytosis, decreased T cell and B cell counts, decreased delayed hypersensitivity responses, increased metastatic rates of tumors, depressed basal natural killer cell activity and enhanced antibody responses. All of the above effects have been described as short lived, returning to normal levels within 3 -7 days following surgery. But the clinical significance of suppressed immunity in the perioperative period is important, it has been suggested that such suppression contributes to postoperative dissemination of carcinoma and to postoperative infections. The present study was designed to examine the effects of general and epidural anesthesia on the lymphocyte subpopulations in patients undergoing hysterectomy. Halothane was used as a main anesthetic agent in general anesthesia group(10 patients) while bupivacaine was used in epidural anesthesia group(10 patients). Lymphocyte, granulocytes and T-lymphocyte subpopulations were counted before, during and after anesthesia. A significant reduction in peripheral total T-lymphocyte to total lymphocyte ratio(CD3+ percentage), Helper/Inducer T-lymphocyte to total T-lymphocyte ratio(CD4+ percentage), Suppressor/Cytotoxic T-lymphocyte to total T- lymphocyte ratio(CD8+ percentage) and Suppressor/Inducer T-1ymphocyte to total T-lympho- cyte ratio(CD4+ and CD45R+ percentage) was seen in patients under general anesthesia but minimal changes were found in the patients who had an epidural anesthesia. The results suggest that the immunosuppressive alterations in lymphocyte subsets induced by surgery and general anesthesia can be prevented to certain degree by epidural anesthesia.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Anesthetics ; Antibody Formation ; Bupivacaine ; Cell Count ; Down-Regulation ; Granulocytes ; Halothane ; Humans ; Hypersensitivity, Delayed ; Hysterectomy ; Immune System ; Killer Cells, Natural ; Lymphocyte Subsets* ; Lymphocytes* ; Perioperative Period ; T-Lymphocytes

OBJECTIVE: As for growth hormone(GH) secreting pituitary adenoma, it's remission should be declared on the basis of satisfactory controlling of the tumor, normalization of hormonal level, and symptomatic improvement of the patient. Several modalities of treatment have been applied and administered, and yet, this disease still remains as inveterate one to be fully treated. The purpose of this study is to evaluate the outcome of gamma knife radiosurgery(GKRS) for GH secreting pituitary adenoma, and to identify various factors affecting the outcome of the treatment. METHOD: A group of 24 out of 35 patients, treated by Leksell gamma knife unit during the period of March of 1992 through October of 1997, had been observed for more than two years. The mean target volume of microadenoma was 449.3mm3(range 216-880mm3), and that of macroadenoma was 3183.1mm3(range 1456-13125mm3). The tumor margin was covered with 50% isodose profile, and mean marginal dose was 25.2Gy(range 15-32.4Gy). The mean number of isocenter was 4.3(range 1-6). The exposed dose to the optic apparatus was less than 8Gy. The mean follow-up period was 37.8months(range 24-102months). RESULT: No patients showed any increase in the tumor volume during the follow-up period. And definite shrinkage of tumor volume(tumor volume reduction rate, TVRR: more than 50%) was obtained in 10 patients(41.7%). Twenty one patients(87.5%) had reduced hormonal level compared than pre-treatment level. Among them, normalization of the hormonal level was achieved in 12 patients(50%). Clinicoendocrinological remission was seen in 3 patients (12.5%). According to the results of statistical analysis, tumor volume(p=0.016),duration of symptoms(p=0.046), initial GH level(p=0.017), and the invasion of cavernous sinus(p=0.036) were significantly favorable to post-radiosurgical outcome. The TVRR was significantly related to post-radiosurgical reduction of serum GH level. Permanent complication was not seen. CONCLUSION: The authors concluded that GKRS is a safe and effective treatment modality for acromegaly. To otain the better outcome of GKRS in GH secreting pituitary adenoma, more careful and sophisticated treatment-planning is recommended.
Acromegaly ; Follow-Up Studies ; Growth Hormone ; Growth Hormone-Secreting Pituitary Adenoma ; Humans ; Pituitary Neoplasms* ; Radiosurgery* ; Treatment Outcome* ; Tumor Burden

Enterotoxigenic Bacteroides fragilis (ETBF) is a human gut commensal bacteria that causes inflammatory diarrhea and colitis. ETBF also promotes colorectal tumorigenesis in the Min mouse model. The key virulence factor is a secreted metalloprotease called B. fragilis toxin (BFT). BFT induces E-cadherin cleavage, cell rounding, activation of the beta-catenin pathway and secretion of IL-8 in colonic epithelial cells. However, the precise mechanism by which these processes occur and how these processes are interrelated is still unclear. E-cadherin form homophilic interactions which tethers adjacent cells. Loss of E-cadherin results in detachment of adjacent cells. Prior studies have suggested that BFT induces IL-8 expression by inducing E-cadherin cleavage; cells that do not express E-cadherin do not secrete IL-8 in response to BFT. In the current study, we found that HT29/C1cells treated with dilute trypsin solution induced E-cadherin degradation and IL-8 secretion, consistent with the hypothesis that E-cadherin cleavage causes IL-8 secretion. However, physical damage to the cell monolayer did not induce IL-8 secretion. We also show that EDTA-mediated disruption of E-cadherin interactions without E-cadherin degradation was sufficient to induce IL-8 secretion. Finally, we determined that HT29/C1 cells treated with LiCl (beta-catenin activator) induced IL-8 secretion in a dose-dependent and time-dependent manner. Taken together, our results suggest that BFT induced IL-8 secretion may occur by the following process: E-cadherin cleavage, disruption of cellular interactions, activation of the beta-catenin pathway and IL-8 expression. However, we further propose that E-cadherin cleavage per se may not be required for BFT induced IL-8 secretion.
Animals ; Bacteria ; Bacterial Toxins ; Bacteroides fragilis* ; Bacteroides* ; beta Catenin ; Cadherins* ; Cell Transformation, Neoplastic ; Colitis ; Colon ; Diarrhea ; Edetic Acid ; Epithelial Cells ; Fibrinogen ; Humans ; Interleukin-8* ; Metalloendopeptidases ; Mice ; Trypsin

Soft-tissue reconstruction of the foot and ankle has long been a challenge for reconstructive surgeons. Limitations in the available local tissue and donor-site morbidity restrict the options. In an effort to solve these difficult problems, the authors have begun to use a subcutaneous fascial pedicled lateral supramalleolar flap. This report presents the authors' experience with five patients treated with this flap. The patients' ages ranged from 26 to 72 years; four of the patients were male and one was female. The cause of the soft-tissue defects involved acute trauma and malignant melanom. All flaps survived and provided satisfactory coverage of the defect. Compared with the classic lateral supramalleolar flap, when the perforating branch is interrupted in its course, it is possible to elevate this subcutaneous fascial pedicled flap. The distally based flap with a compound pedicle which is continuous with a vascular axis and a band of subcutaneous fascial pedicle has long pedicle. This procedure is valuable for remote defect of the foot. It is believed that this flap is versatile and effective and is a good addition to the available techniques used by reconstructive surgeons for coverage of the foot and ankle.
Ankle ; Axis, Cervical Vertebra ; Female ; Foot ; Humans ; Male ; Surgical Flaps

BACKGROUND AND OBJECTIVES: This study was done to evaluate the safety of Gore-Tex as a nasal implant. Materials and METHOD: A retrospective multicenter study was carried out on 15 surgeons from 11 general hospitals and 4 private practice clinics regarding the safety of the Gore-Tex as a nasal implant. The study involved 853 patients, of whom 656 received primary surgery and 197 revision surgery. Gore-Tex was mainly used as a dorsal implant in a form of sheet or as a reinforced nasal implant. RESULTS: The overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases ; 2.1%) followed by 2 cases of seroma and 1 case of persistent nasal swelling. In 19 out of 21 complication cases, the graft needed removal to control the infection or seroma (91% removal rate). Nine cases of infection developed in both primary cases (1.37%) and in revision cases (4.57%), which suggests a higher association rate between infection and revision cases (p=0.0062). Infection developed within 1 month in 5 cases while 9 cases developed infection after 6 months of operation. Other complications such as aesthetic problems (malpositioning of the implant or dorsal irregularities) were found in 15 cases (1.8%) and hematoma in 1 case. CONCLUSION: The infection rate of Gore-Tex used in rhinoplasty was about 2% and it rose significantly in the revision cases. If infected, almost all of the implanted Gore-Tex needs removal; therefore, we suggest judicious use of Gore-Tex in rhinoplasty.
Hematoma ; Hospitals, General ; Humans ; Polytetrafluoroethylene* ; Private Practice ; Retrospective Studies ; Rhinoplasty* ; Seroma ; Transplants

The aim of this study was to evaluate whether the clinical outcomes were associated with socioeconomic status (SES) in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). The author analyzed 2,358 patients (64.9 +/- 12.3 yr old, 71.5% male) hospitalized with AMI between November 2005 and June 2010. SES was measured by the self-reported education (years of schooling), the residential address (social deprivation index), and the national health insurance status (medical aid beneficiaries). Sequential multivariable modeling assessed the relationship of SES factors with 3-yr major adverse cardiovascular events (MACEs) and mortality after the adjustment for demographic and clinical factors. During the 3-yr follow-up, 630 (26.7%) MACEs and 322 (13.7%) all-cause deaths occurred in 2,358 patients. In multivariate Cox proportional hazards regression modeling, the only lower education of SES variables was associated with MACEs (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.04-1.91) and mortality (HR, 1.93; 95% CI, 1.16-3.20) in the patients with AMI who underwent PCI. The study results indicate that the lower education is a significant associated factor to increased poor clinical outcomes in patients with AMI who underwent PCI.
Acute Disease ; Age Factors ; Aged ; *Angioplasty, Balloon, Coronary ; Cohort Studies ; Demography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction/economics/mortality/*therapy ; *Percutaneous Coronary Intervention ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Sex Factors ; Social Class ; Socioeconomic Factors ; Treatment Outcome