We sought to document the clinical performance of the 1st American Academy of Orthopaedic Surgeons (AAOS) guideline on the prevention of symptomatic pulmonary embolism (PE) after total knee arthroplasty (TKA) in Korean patients, in terms of the proportions of the each risk-stratified group, efficacy and safety. Consecutive 328 patients underwent TKA were preoperatively assessed for the risks of PE and bleeding and categorized into 4 groups: 1) standard risk, 2) high risk for PE, 3) high risk for bleeding, and 4) high risks both for PE and bleeding. One of three options was administered according to the groups (aspirin in group 1 or 4; enoxaparin and following aspirin in group 2; antithrombotic stocking in group 3). Incidences of symptomatic deep vein thrombosis (DVT) and PE, and major or minor bleeding complications were evaluated. Majority of the patients (86%) were assessed to be with standard risks both for PE and bleeding. No patient experienced symptomatic DVT or PE and major bleeding. Eleven percent of the patients discontinued chemoprophylaxis because of bleeding-related wound complication. In conclusion, the 1st AAOS guideline functions successfully in Korean patients undergoing TKA in terms of prevention of symptomatic DVT and PE while avoiding major bleeding complications.
Aged ; Arthroplasty, Replacement, Knee/*adverse effects ; Aspirin/administration & dosage ; Cohort Studies ; Enoxaparin/administration & dosage ; Female ; Fibrinolytic Agents/administration & dosage ; Humans ; Male ; Middle Aged ; Orthopedics ; Postoperative Complications/etiology/*prevention & control ; Postoperative Hemorrhage/etiology/prevention & control ; *Practice Guidelines as Topic ; Pulmonary Embolism/etiology/*prevention & control ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Societies, Medical ; Stockings, Compression ; Venous Thrombosis/etiology/prevention & control

Ras-related, estrogen-regulated, and growth-inhibitory gene (RERG) is a novel gene that was first reported in breast cancer. However, the functions of RERG are largely unknown in other tumor types. In this study, RERG expression was analyzed in hepatocellular carcinomas of human patients using reverse transcriptase PCR analysis. In addition, the possible regulation of RERG expression by histone deacetyltransferases (HDACs) was studied in several cell lines. Interestingly, the expression of RERG gene was increased in hepatocellular carcinoma (HCC) of male patients (57.9%) but decreased in HCC of females (87.5%) comparison with paired peri-tumoral tissues. Moreover, RERG gene expression was increased in murine hepatoma Hepa1-6 cells, human breast tumor MDA-MB-231 cells, and mouse normal fibroblast NIH3T3 cells after treated by HDAC inhibitor, trichostatin A. Our results suggest that RERG may function in a gender-dependent manner in hepatic tumorigenesis and that the expression of this gene may be regulated by an HDAC-related signaling pathway.
Signal Transduction ; Sex Factors ; Mice, Transgenic ; Mice, Inbred C57BL ; Mice ; Male ; Liver Neoplasms/*genetics ; Humans ; Histone Deacetylases/*physiology ; Hepatocytes/metabolism ; Growth Inhibitors/*genetics ; *Genes, ras ; *Gene Expression Regulation, Neoplastic ; Female ; Estrogens/*pharmacology ; Estrogen Receptor alpha/analysis ; Cell Proliferation ; Animals

BACKGROUND: The clinical application of cryosurgery for the management of lung cancer is limited because the response of lung at low temperature is not well understood. The purpose of this study is to investigate the response of the pulmonary tissue at extreme low temperature. MATERIAL AND METHOD: After general anesthesia the lungs of twelve Mongrel dogs were exposed through the fifth intercostal space. Cryosurgical probe (Galil Medical, Israel) with diameter 2.4 mm were placed into the lung 20 mm deep and four thermosensors (T1-4) were inserted at 5 mm intervals from the cryoprobe. The animals were divided into group A (n=8) and group B (n=4). In group A the temperature of the cryoprobe was decreased to -120 degrees C and maintained for 20 minutes. After 5 minutes of thawing this freezing cycle was repeated. In group B same freezing temperature was maintained for 40 minutes continuously without thawing. The lungs were removed for microscopic examination on 1 day after the cryosurgery. In four dogs of the group A the lung was removed 7 days after the cryosurgery to examine the delayed changes of the cryoinjured tissue. RESULT: In group A the temperatures of T1 and T2 were decreased to 4.1+/-11 degrees C and 31+/-5 degrees C respectively in first freezing cycle. During the second freezing period the temperatures of the thermosensors were decreased lower than the temperature during the first freezing time: T1 -56.4+/-9.7 degrees C, T2 -18.4+/-14.2 degrees C, T3 18.5+/-9.4 degrees C and T4 35.9+/-2.9 degrees C. Comparing the temperature-distance graph of the first cycle to that of the second cycle revealed the changes of temperature-distance relationship from curve to linear. In group B the temperatures of thermosensors were decreased and maintained throughout the 40 minutes of freezing. On light microscopy, hemorrhagic infarctions of diameter 18.6+/-6.4 mm were found in group A. The infarction size was 14+/-3 mm in group B. No viable cell was found within the infarction area. CONCLUSION: The conductivity of the lung is changed during the thawing period resulting further decrease in temperature of the lung tissue during the second freezing cycle and expanding the area of cell destruction.
Anesthesia, General ; Animals ; Cryosurgery* ; Dogs ; Freezing ; Infarction ; Lung Neoplasms ; Lung* ; Microscopy ; Models, Animal

BACKGROUND: It has been known that pulsatile flow is physiologic and more favorable to tissue perfusion than nonpulsatile flow. The purpose of this study is to directly compare the effect of pulsatile versus nonpulsatile blood flow to renal tissue perfusion in extracorporeal circulation by using a tissue perfusion measurement system. MATERIAL AND METHOD: Total cardiopulmonary bypass circuit was constructed to twelve Yorkshire swines, weighing 20~30 kg. Animals were randomly assigned to group 1 (n=6, nonpulsatile centrifugal pump) or group 2 (n=6, pulsatile T-PLS pump). A probe of the tissue perfusion measurement system (QFlow(TM)-500) was inserted into the renal parenchymal tissue. Extracorporeal circulation was maintained for an hour at a pump flow of 2 L/min after aortic cross-clamping. Tissue perfusion flow of the kidney was measured at baseline (before bypass) and every 10 minutes after bypass. Serologic parameters were collected at baseline and 60 minutes after bypass. RESULT: Baseline parameters were not different between the groups. Renal tissue perfusion flow was substantially higher in the pulsatile group throughout the bypass (ranged 48.5~4 in group 1 vs. 65.8~8.3 mL/min/100 g in group 2, p=0.026~0.45). The difference was significant at 30 minutes bypass (47.5+/-18.3 in group 1 vs. 83.4+/-28.5 mL/min/100 g in group 2, p=0.026). Serologic parameters including plasma free hemoglobin, blood urea nitrogen, and creatinine showed no differences between the groups at 60 minutes after bypass (p=NS). CONCLUSION: Pulsatile flow is more beneficial to tissue perfusion of the kidney in short-term extracorporeal circulation. Further study is suggested to observe the effects to other vital organs or long-term significance.
Animals ; Blood Urea Nitrogen ; Cardiopulmonary Bypass ; Creatinine ; Extracorporeal Circulation* ; Kidney ; Perfusion* ; Plasma ; Pulsatile Flow ; Swine

Hepatitis C virus (HCV) is a major causative agent in liver disease. In order to investigate if Korean type HCV core protein and its related mutants, S99Q and S116I, are cytopathic to liver, three types of transgenic mice were established. The expression of transgenes was confirmed by HCV specific RT-PCR and Western immunoblotting. The livers of all wild type core and S116I transgenic lineages remained largely histologically normal. However, the livers of the S99Q transgenic mice showed significant high level of cell dysplasia associated with the transgene expression in hepatocytes largely located around the central veins by in situ hybridization analysis. In conclusion, the mutant HCV core protein at S99Q may contribute to the progress of HCV induced liver disease.
Amino Acid Sequence ; Animals ; Base Sequence ; Gene Expression ; Genetic Vectors/genetics ; Hepatitis C/*pathology/virology ; Hepatitis, Viral, Animal/*pathology/virology ; Hepatocytes/pathology/virology ; Liver/pathology/*virology ; Mice ; Mice, Transgenic ; Molecular Sequence Data ; Mutation/genetics ; RNA, Messenger/chemistry/metabolism ; Research Support, Non-U.S. Gov't ; Transgenes ; Viral Core Proteins/analysis/*genetics/metabolism

BACKGROUND: The significance of MIDCAB is emerging topics recently as OPCAB is going to be universalized, and long-term outcome of bypass graft surgery was proved to be more excellent than balloon dilation or stent insertion. We report our MIDCAB results in 73 patients in the last three years. MATERIAL AND METHOD: Retrospective analysis of medical records was done from November 1, 2000 through November 31, 2003. There were 47 males and 26 females ranging in age from 31 years to 79 years (average 61.3+/-9.8 years). Observation periods after operative procedures were 10 to 1238 days (average 763+/-319.8 days). Left longitudinal parasternal incision as a standard procedure was done to approach the heart after dissection of the left internal thoracic artery by partial or total resection of 3rd to 5th ribs. RESULT: Of those patients, 46 patients were transferred to ICU after extubation at operation room and 58 patients were extubated within 3 hours after operation. Average ICU staying periods was 26.8+/-11.5 hours. Follow-up angiography during admission was done in 36 patients and showed 100% patency. Only one patient died on the 10th post operative day because of sudden CVA. Complications included wound problems in 4 patients, and constructing pericardial window using thoracoscopy due to continuous pericardial effusion in 1. Permanent pacemaker was inserted in one patient owing to sick sinus syndrome. In one patient with recurrence of angina 8 months after operation, stenosis at anastomic site was found and improved with balloon dilatation. CONCLUSION: We were satisfied with our results of MIDCAB in single and multi-vessel coronary artery disease. These results have made the cardiologists tried to operate positively and we expect widening operative indications including hybrid revascularization.
Angiography ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Dilatation ; Female ; Follow-Up Studies ; Heart ; Humans ; Male ; Mammary Arteries ; Medical Records ; Pericardial Effusion ; Recurrence ; Retrospective Studies ; Ribs ; Sick Sinus Syndrome ; Stents ; Surgical Procedures, Minimally Invasive ; Surgical Procedures, Operative ; Thoracoscopy ; Transplants ; Wounds and Injuries