BACKGROUND: Reperfusion after brief periods within 20 minutes of myocardial ischemia can result in prolonged depression of contractile function without causing myocardial necrosis-myocardial stunning. It has been also demonstrated that low reflow phenomenon and the impairment of coronary flow reserve(CFR) can occur as the consequences of brief ischemia-reperfusion on the coronary vasculature. Although these vascular functional derangements may occur after various periods of ischemia, a 15-min episode of ischemia is known to be long enough to induce microvascular dysfunction and a briefer 10-min occlusion is not. Whether reperfusion after ischemia for 15-min or 20-min results in structural damage to the large and microvessels, as well as vascular function, and their relationship with contractile dysfunction, remains uncertain. PURPOSE: This study was performed to determine whether 1) c5-min and 20-min coronary occlusion followed by 60 minutes of reperfusion in vivo would result in injury of coronary vasculature, evident as functional and ultrastructural derangements, 2) there are any differences in the severity of vascular alterations by the duration of ischemic period, and 3) these vascular alterations relate to the regional myocardial dysfunction. METHODS: Open chest dogs underwent a 15-min(n=8) and 20-min(n=10) left circumflex coronary artery occlusion followed by reperfusion for 60 minutes. Coronary blood flow(CBF) was measured with electromagnetic flow probes. At 30 minutes and 60 minutes of reperfusion, CFR was determined after intracoronary acetylcholine(ACH, 0.01microg/kg), adenosine(ADE, 1.5microg/kg) and reactive hyperemia(RH) after 20 seconds coronary occlusion. Segmental LV function was assessed with % myocardial thickening and % endocardial wall motion by 2D echocardiography. The ultrastructure of epicardial artery and the microvessels in the endocardium was examined. RESULTS: Following reperfusion, increase in CBF and decrease in coronary vascular resistance in reponse to ACH, endothelium dependent vasodilator, was significantly impaired in both 15-min and 20-min occlusion groups. The CBF response to ADE, endothelium independent vasodilator, was intract in 15-min occlusion group, whereas significantly impaired in 20-min occlusion group. The CBF response to RH was significantly depressed in both groups. On ultrastructural examination, there was no evidence of injury in the microvessels of the subendocardium in all subjects. In the large epicardial arteries, the endothelium was damaged in all subjects and its severity was milder in 15-min occlusion group than those with 20-min occlusion. Furthermore, in 50% cases of 20-min occlusion group, the injury of superficial layer of medial smooth muscle was accompanied. There was no difference in the severity of segmental LV dysfunction between two groups, and there was no appreciable correlation between myocardial dysfunction and the depressed CBF responses to ACH, ADE and RH. CONCLUSION: 1) Reperfusion after occulsion for 15 minutes produced selective dysfunction and damage to the endothelium of epicardial artery, whereas those after 20 minutes significantly decreased coronary flow reserve and induced more pronounced damage to the epicardial artery, indicated that the severity of vascular alterations is determined by the duration of ischemic period even within 20 minutes. 2) These vascular derangements are not related to the severity of contractile dysfunction, suggesting that brief ischemia-reperfusion precipitates vascular stunning as an independent phenomenon of myocardial stunning.
Animals ; Arteries ; Coronary Occlusion ; Coronary Vessels ; Depression ; Dogs ; Echocardiography ; Endocardium ; Endothelium ; Ischemia ; Magnets ; Microvessels ; Muscle, Smooth ; Myocardial Ischemia* ; Myocardial Stunning ; Reperfusion* ; Thorax ; Vascular Resistance

Considerable controversy exists as to whether rhythm or rate control is the more appropriate management for the patients with persistent atrial fibrillation (AF). Until recently, it was our belief that the initial approach to rhythm management should give primary consideration to the restoration and maintenance of the sinus rhythm (SR), which provides the potential benefits of reducing the risk of thromboembolism and the need for anticoagulants, and improved the hemodynamics and quality of life. However, there are negative aspects of rhythm control, including the poor efficacy of the antiarrhythmic drugs and the potential of adverse effects. Five recent clinical trials; AFFIRM (The Atrial Fibrillation Follow-Up Investigation of Rhythm Management), RACE (Rate Control versus Electrical Cardioversion), PIAF (Pharmacological Intervention in Atrial Fibrillation), HOT CAFE (How to Treat patients with Chronic Atrial Fibrillation) and STAF (The Strategies of Treatment of Atrial Fibrillation), have looked specifically at the issue of the balance between the benefits and risks of restoration and maintenance of the SR, primarily with drug therapy. The conclusions of these trials were consistent, although the study subjects were heterogeneous;1) Rhythm control, with anti-arrhythmics, does not lead to an improvement in the symptom control, quality of life or a reduction in the short to median term clinical events, in fact, in the longer term the mortality may increase. 2) Maintenance of the SR remains poor, even with an aggressive strategy. Hence, long term anticoagulation is needed for most patients treated with rhythm control, even if the SR is restored in the short term. A number of non-pharmacological therapies have emerged, such as catheter ablation and pacing, for patients remaining highly symptomatic, despite the use of several anti-arrhythmics and serial electrical cardioversion. In conclusions, rate control should be considered as the initial strategy in the majority of the patients with persistent AF. For the minority that remain highly symptomatic, aggressive rhythm control, with invasive treatments, such as pulmonary vein isolation or rate control, with atrioventricular nodal ablation and ventricular pacing, should be considered.
Anti-Arrhythmia Agents ; Anticoagulants ; Atrial Fibrillation* ; Catheter Ablation ; Continental Population Groups ; Drug Therapy ; Electric Countershock ; Follow-Up Studies ; Hemodynamics ; Humans ; Mortality ; Pulmonary Veins ; Quality Control ; Quality of Life ; Risk Assessment ; Thromboembolism

No abstract available.

No abstract available.
Epilepsy*

No abstract available.
Epilepsy*

No abstract available.
Atrial Fibrillation*

No abstract available.
Beauty ; Burns ; Cicatrix

No abstract available.
Colostrum* ; Humans ; Lymphocyte Subsets* ; Lymphocytes* ; Milk* ; Mothers*

PURPOSE: Laparoscopic cholecystectomy has become the standard modality of acute and chronic gallbladder disease. This study was performed to evaluate a change in the indication for laparoscopic cholecystectomy according to period by analyzing our experiences. METHODS: We retrospectively analyzed 2,096 cases of laparoscopic cholecystectomy that were treated at the Department of Surgery, Dong-A University. They were divided into 3 groups from October 1992 to December 1996 (Group 1), from January 1997 to December 2001 (Group 2) and from January 2002 to March 2007 (Group 3). RESULTS: The mean age was 50.14+/-13.89 years and the male-to-female ratio was 1 : 1.23. Previous abdominal surgery was noted in 12.24% from Group 1, 14.96% from Group 2 and 21.48% from Group 3. Chronic cholecystitis was the most common pathologic diagnosis in all cases. However, while the incidence of acute cholecystitis and gallbladder empyema in Group 1 was 3.36% and 0%, that of Group 2 was 12.52% and 3.88% and that of Group 3 was 31.79% and 7.59%, which was increased. The mean operation time of each group was 101.00+/-51.00, 69.86+/-40.55, 78.01+/-45.55 minutes (P<0.05). The conversion rate of each group was nine cases (6.04%), 21 cases (3.02%), and 51 cases (4.07%). The surgical complication rate was 7.38%, 3.88% and 4.71%, respectively. The length of hospital stay was 6.08+/-3.65, 3.16+/-2.99 and 2.91+/-3.34 days, which was significantly decreased (P<0.05). CONCLUSION: As surgical experience increased and laparoscopic surgical skills developed, the indication for laparoscopic cholecystectomy changed. The results of this study showed that laparoscopic cholecystectomy was feasible for the treatment of complicated gallbladder lesion.
Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Gallbladder ; Gallbladder Diseases ; Incidence ; Length of Stay ; Retrospective Studies

BACKGROUND: Propafenone is effective in the treatment of ventricular arrhythmias and paroxysmal supraventricular tachycardia. Propafenone has been shown to be also useful in preventing the recurrence of atrial fibrillation. But to date, date concerning the efficacy of propafenone for patients experiencing paroxysmal and chronic atrial fibrillation have not been examined in Korea. METHODS: In patients with paroxysmal atrial fibrillation propafenone was given at a dose of 450mg daily without dose titration and symptomatic recurrences were evaluated by patient interview during follow-up. In patients with chronic atrial fibrillation, who had no previously attempted cardioversion, propafenone was given at a dose of 450~675mg daily without dose titration, and after a minimum of 3 days pharmacological cardioversion was assessed. Those patients in whom sinus rhythm had been restored pharmacologically or by combined direct current cardioversion were followed with maintaining propafenone therapy also at a dose of 450~675mg daily. RESULTS: Of 7 patients with paroxysmal atrial fibrillation, 4 (57%) patients had marked symptomatic improvement and they were followed for 197 to 460 (mean 286) days Of 13 patients with chronic atrial fibrillation, 7 patients incuding 4 pharmacologically converted patients were initially controlled to sinus rhythm. In 5 (38%) patients maintenance of sinus rhythm was followed for 90 to 415 (mean 224) days. CONCLUSION: Although these observations were made in small number of patients and are so limited, the results are comparable to the previous studies which showed the potential role of propafenone in the management of atrial fibrillation.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Electric Countershock ; Follow-Up Studies ; Humans ; Korea ; Propafenone* ; Recurrence ; Tachycardia, Supraventricular