The myocardial protective effects of endothelin antagonist in ischemic cardiomyopathy (ICMP), doxorubicin-induced cardiomyopathy (DOX) and pressure-overload hypertrophy by transverse aortic constriction (TAC) models have been predicted to be different. The objective of this experiment, therefore, is to evaluate the myocardial protective effect of tezosentan, an endothelin receptor antagonist, in various experimental heart failure models. Sprague-Dawley rats (6-8 weeks old, 200-300 g) were randomized to three experimental groups (n=30 each): ICMP; DOX; and TAC group. Each of these groups was randomly assigned further to the following subgroups (n=10 each): sham-operated ischemia-reperfusion subgroup (SHAM); tezosentan treated ischemia-reperfusion subgroup (Tezo); and tezosentan non-treated ischemia-reperfusion subgroup (N-Tezo). Total circulatory arrest was induced for 1 hr, followed by 2 hr of reperfusion. The left ventricular developed pressure, peak positive and negative first derivatives, and coronary blood flow were significantly different (P<0.05) among the SHAM, Tezo, and N-Tezo subgroups of the ICMP group at 30 min of reperfusion, but there were no statistically significant differences among the subgroups of the DOX and TAC groups. In conclusion, tezosentan, an endothelin receptor antagonist, showed myocardial protection effects only on the ischemic cardiomyopathy rat model, but not in the non-ischemic heart failure rat models.
Animals ; Cardiomyopathies/chemically induced/drug therapy/physiopathology ; Coronary Vessels/physiology ; Disease Models, Animal ; Doxorubicin/toxicity ; Heart Failure/*drug therapy/physiopathology ; Hypertrophy/drug therapy/physiopathology ; Male ; Pressure ; Pyridines/*therapeutic use ; Rats ; Rats, Sprague-Dawley ; Receptors, Endothelin/*antagonists & inhibitors/metabolism ; Reperfusion Injury/*drug therapy/physiopathology/surgery ; Tetrazoles/*therapeutic use ; Vasodilator Agents/*therapeutic use ; Ventricular Function, Left/physiology

The purpose of this study was to estimate the possibilities of an acellular matrix using a modified acellularization protocol, which circumvents immunological, microbiological, and physiological barriers. We treated porcine subclavian arteries with various reagents to construct acellular grafts. Afterwards, these grafts were interposed in a mongrel dogs' abdominal aorta. Six dogs underwent interposition with fresh porcine grafts (control group), and seven had interposed acellular grafts (acellular group). The control and acellular group dogs were sacrificed at 1, 3, 5 (n=2 in each group) and 12 months (n=1 in acellular group) after the operation. Histopathological examinations were then performed, to assess the degree to which re-endothelialization, inflammation, thrombus formation, and calcification occurred. The entire acellular group, but none of the control group, exhibited re-endothelialization. The degrees to which inflammation, thrombosis, and calcification occurred were found to be lower in the acellular group. We also discovered many smooth muscle cells in the medial layer of the xenograft that had been implanted in the dog sacrificed 12 months after the operation. These results suggest that the construction of xenografts using our modified acellularization protocol may offer acceptable outcomes as a vascular xenograft.
Transplantation, Heterologous/*methods ; Tissue Engineering/*methods ; Swine ; Subclavian Artery/*cytology/*transplantation ; Graft Survival/*physiology ; Dogs ; Cell-Free System/*transplantation ; Animals

We evaluated the safety and stability of the less-invasive submuscular bar fixation method in the Nuss procedure. One hundred and thirteen patients undergoing the Nuss procedure were divided into three groups according to the bar fixation technique employed. Group 1 consisted of 25 patients who had undergone bilateral pericostal bar fixation, group 2 consisted of 39 patients with unilateral pericostal one, and group 3 included 49 patients with bilateral submuscular one. The patients' age ranged from 2 to 25 yr, with an average of 7.2+/-5.67 yr. Bar dislocation occurred in 1 patient (4%) in Group 1, 2 patients (5.1%) in Group 2, and 1 patient (2.0%) in Group 3 (p=0.46). Hemothorax was noted in 2 patients (8%) in Group 1, 2 (5.1%) in Group 2, and none (0%) in Group 3 (Group 1 vs. Group 3, p=0.028). The mean operation time was shorter in Group 3 than Group 1 (50.1+/-21.00 in Group 3 vs. 67.2+/-33.07 min in Group 1, p=0.041). The submuscular bar fixation results in a decrease in technique-related complications and operation time and is associated with favorable results with regard to the prevention of bar dislodgement.
Treatment Outcome ; Thoracic Surgical Procedures/*instrumentation/*methods ; Surgical Procedures, Minimally Invasive/instrumentation/methods ; Ribs/surgery ; Reconstructive Surgical Procedures/*instrumentation/*methods ; *Prostheses and Implants ; Male ; Humans ; Funnel Chest/*surgery ; Female ; Child, Preschool ; Child ; Adult ; Adolescent ; Abdominal Muscles/surgery

The goal of this study was to compare the effects of different reperfusion methods on N-terminal B-type natriuretic peptide (NT-proBNP) in percutaneous transluminal coronary angioplasty (PTCA) or off-pump coronary artery bypass (OPCAB) patients. Fifty subjects were enrolled in the study, 32 patients received PTCA and 18 OPCAB. An NT-proBNP measurement was performed before intervention and at 1, 3, and 7 days after the procedures. NT-proBNP levels were not significantly different before intervention (PTCA group 297+/-147.3 vs. OPCAB group 235+/-167.8 pg/mL, p>0.05). However, 1 day after the procedures, NT-proBNP levels were higher in the OPCAB group (PTCA 375+/-256.4 vs. OPCAB 1,415+/-737.6 pg/mL, p<0.05), after 3 days NT-proBNP reached peak levels (PTCA 480+/-363.0 vs. OPCAB 2,119+/-818.4 pg/mL, p<0.05), and levels were reduced after 7 days (PTCA 292+/-243.7 vs. OPCAB 522+/-334.0 pg/mL, p>0.05). PTCA induced a mild and transient increase in NT-proBNP concentration, but OPCAB caused sustained high NT-proBNP levels during the 7 day postoperatively. However, differences between NT-proBNP levels associated with these two modalities showed a tendency to decrease rapidly postoperatively.
Peptide Fragments/*blood ; Natriuretic Peptide, Brain/*blood ; Middle Aged ; Male ; Humans ; Female ; *Coronary Artery Bypass, Off-Pump ; *Angioplasty, Transluminal, Percutaneous Coronary ; Aged, 80 and over ; Aged

BACKGROUND: Mortality and morbidity of anastomotic complications after esophagectomy have gradually decreased in recent years. However, swallowing difficulties and reflux symptoms after esophagogastrostomy continue to be a burden jeopardizing the quality of life. In the present study, we evaluated the quality of esophagogastrostomy by analyzing anastomotic stenosis and reflux esophagitis. MATERIAL AND METHOD: A retrospective analysis was made in 74 patients who underwent esophagogastrostomy after esophagectomy by one surgeon between January 1995 and December 2004. 53 patients of them received endoscopic examination during follow-up (29+/-23.6 months, range 5~111 months). Reflux esophagitis and stenosis at anastomostic site were analyzed according to the techniques and locations of esophagogastrostomy. RESULT: The median age at the time of repair was 60.3+/-8.87 years (range 39~81 years). 23 patients received a hand-sewn esophagogastric anastomosis and 30 patients a circular stapled one. There was no significant statistical difference in terms of anastomotic stenosis (p=0.64) and reflux esophagitis (p=0.41) between the two groups. Cervical anastomosis was performed in 26 patients and intrathoracic anastomosis in 27 patients. No significant statistical difference in anastomotic stenosis between the two groups was found (p=0.44), but reflux esophagitis was noted in 3 patients in the cervical anastomosis group and 14 patients in the intrathoracic anastomosis group (p=0.003). CONCLUSION: Cervical anastomosis was supposed to have a better quality of esophagogastrostomy by lowering the risk of reflux esophagitis. In the future, the comprehensive study including a patient's subjective symptom and Barrett's metaplasia should be performed in larger cases.
Anastomosis, Surgical ; Constriction, Pathologic ; Deglutition ; Endoscopy ; Esophageal Neoplasms ; Esophagectomy ; Esophagitis, Peptic ; Follow-Up Studies ; Humans ; Metaplasia ; Mortality ; Quality of Life ; Retrospective Studies

Bronchogenic cysts are anomalous cystic lesions of foregut and usually located in the lung or mediastinum. Generally intramuscular cysts of the esophagus are considered as enterogenous foregut malformations. We report a young adult with an intramural bronchogenic cyst causing dysphagia and heartburn. It was located in the muscular layer of the esophagus and was removed without any damage to the mucosa. Histopathologic findings revealed that it was a bronchogenic cyst.
Bronchogenic Cyst* ; Deglutition Disorders ; Esophageal Diseases ; Esophagus* ; Heartburn ; Humans ; Lung ; Mediastinum ; Mucous Membrane ; Young Adult

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

Infradiaphragmatic extralobar pulmonary sequestration is an extremely rare congenital malformation. It is more frequently diagnosed in the antenatal period due to routine ultrasonic examination of the fetus or in the first 6 months of life, though on rare occasions it is discovered incidentally in adults. A 32-yr-old man presenting with epigastric discomfort and fever was referred. Computed tomographic scanning showed that a 16-cm, multiseptated, dumbbell-shaped, huge cystic tumor was located beneath the diaphragm. On the next day, 850 mL of thick yellowish pus was drained by sonography-guided fine needle aspiration for the purpose of infection control and diagnosis, but no microscopic organisms were found in repeated culture studies. Surgical removal of the cyst was performed through thoracoabdominal incision and most of these pathologic lesions were removed but we could not find the feeding arteries or any fistulous tract to surrounding structures. Histopathologic study revealed that it was extralobar pulmonary sequestration and culture study showed that many WBC and necrotic materials were found but there were no microorganisms in the cystic contents. We report the first case of an infected infradiaphragmatic retroperitoneal extralobar sequestration which was administered a staged management and achieved an excellent clinical course.
Adult ; Bronchopulmonary Sequestration/complications/*pathology/surgery ; Diaphragm/abnormalities ; Humans ; Infection/complications/pathology ; Male ; Retroperitoneal Space/abnormalities

The major etiology of superior vena cava (SVC) syndrome is malignancy. Radiologic endovascular intervention is the treatment of choice for patients with SVC syndrome due to malignant disease, which is unresponsive to radiation therapy and chemotherapy. However, it is not clear whether endovascular intervention can replace open surgery as the primary method of management of benign SVC syndrome. We report two cases of benign SVC syndrome resulting from dialysis catheters placed in the central veins. One patient underwent bypass surgery between innominate vein and right atrium by expanded polytetrafluoroethylene. Another patient had large thrombi in SVC and other central veins. We removed them under cardiopulmonary bypass to prevent pulmonary embolism, and SVC was repaired and augmented by autologous pericardium. Prompt symptomatic relief and angiographic improvements of collateral flow were achieved in both patients.
Brachiocephalic Veins ; Cardiopulmonary Bypass ; Catheters* ; Dialysis ; Drug Therapy ; Heart Atria ; Humans ; Pericardium ; Polytetrafluoroethylene ; Pulmonary Embolism ; Renal Dialysis* ; Superior Vena Cava Syndrome* ; Veins ; Vena Cava, Superior*

BACKGROUND: Clinical outcomes of esophageal cancer have not been satisfactory in spite of the development of surgical skills and protocols of adjuvant therapy. We analyzed the results of corrective surgical patients for esophageal cancer from January 1992 to July 2002. MATERIAL AND METHOD: Among 129 patients with esophageal cancer, ths study was performed in 68 patients who received corrective surgery. The ratio of sex was 59 : 9 (male : female) and mean age was 61.07+/-7.36 years old. Chief complaints of this patients were dysphagia, epigastric pain and weight loss, etc. The locations of esophageal cancer were 4 in upper esophagus, 36 in middle, 20 in lower, 8 in esophagogastric junction. 60 patients had squamous cell cancer and 7 had adenocarcinoma, and 1 had malignant melanoma. Five patients had neoadjuvant chemotherapy. RESULT: The postoperative stage I, IIA, IIB, III, IV patients were 7, 25, 12, 17 and 7, respectively. The conduit for replacement of esophagus were stomach (62 patients) and colon (6 patients). The neck anastomosis was performed in 28 patients and intrathoracic anastomosis in 40 patients. The technique of anastomosis were hand sewing method (44 patients) and stapling method (24 patients). One of the early complications was anastomosis leakage (3 patients) which had only radiologic leakage that recovered spontaneously. The anastomosis technique had no correlation with postoperative leakage, which stapling method (2 patients) and hand sewing method (1 patient). There were 3 respiratory failures, 6 pneumonia, 1 fulminant hepatitis, 1 bleeding and 1 sepsis. The 2 early postoperative deaths were fulminant hepatitis and sepsis. Among 68 patients, 23 patients had postoperative adjuvant therapy and 55 paitents were followed up. The follow up period was 23.73+/-22.18 months (1~76 month). There were 5 patients in stage I, 21 in stage 2A, 9 in stage IIB, 15 in stage III and 5 in stage IV. The 1, 3, 5 year survival rates of the patients who could be followed up completely was 58.43+/-6.5%, 35.48+/-7.5% and 18.81+/-7.7%, respectively. Statistical analysis showed that long-term survival difference was associated with a stage, T stage, and N stage (p <0.05) but not associated with histology, sex, anastomosis location, tumor location, and pre and postoperative adjuvant therapy. CONCLUSION: The early diagnosis, aggressive operative resection, and adequate postoperative treatment may have contributed to the observed increase in survival for esophageal cancer patients.
Adenocarcinoma ; Colon ; Deglutition Disorders ; Drug Therapy ; Early Diagnosis ; Esophageal Neoplasms* ; Esophagogastric Junction ; Esophagus ; Follow-Up Studies ; Hand ; Hemorrhage ; Hepatitis ; Humans ; Melanoma ; Neck ; Neoplasms, Squamous Cell ; Pneumonia ; Sepsis ; Stomach ; Survival Rate ; Weight Loss