BACKGROUND: New stent implantation during intracoronary brachytherapy is discouraged due to the high risk of late thrombosis. However, new stent implantation is inevitable in some cases due to the inadequate ballooning or major dissections. Long-term follow-up results of newly implanted stents during brachytherapy are not well-known. We performed this study to evaluate the long-term clinical outcomes of newly implanted stents during intracoronary brachytherapy. METHODS: In the Seoul national university Post-Angioplasty RhEnium irradiation (SPARE) trial, patients were treated with conventional catheter-based technique and then randomized to either beta- radiation (RG) or control group (CG). Radiation was performed with 188 -rhenium-filled conventional balloon catheter system. From 1999 to 2001, new stent implantation was performed in 58 and 56 patients in RG and CG, respectively. Clinical and angiographic follow up data were analyzed. RESULTS: In RG, short-term angiographic restenosis rate was lower than CG (28.6% vs 53%, p=0.03). In RG, late thrombosis was found in 3 patients. However, there was no late thrombosis in CG. Two year major cardiac event rates were not different between the 2 groups (RG: 25.9% vs CG: 28.3%). Independent predictors for major cardiac event in RG were major dissections (>or=type C) after stent implantation (beta=70, p=0.01) and longer administration of dual antiplatelets (aspirin+clopidogrel/ ticlopidine, >6 months, beta=0.07, p=0.04). CONCLUSION: Stenting during intracoronary brachytherapy seems to be ineffective in reducing long-term event rates. When new stent implantation is inevitable during brachytherapy, extreme attention is required not to make a dissection and long-term dual antiplatelet treatment should be followed after stent implantation.
Angioplasty ; Brachytherapy ; Catheters ; Follow-Up Studies ; Humans ; Rhenium ; Seoul ; Stents* ; Thrombosis ; Ticlopidine

OBJECTIVES: The poor survival rates among patients receiving surgery alone for stages II and III non-small cell lung cancer prompted several trials of adjuvant therapy after resection. We performed a prospective phase II study in patients with stage II-IIIA non-small cell lung cancer after resection to evaluate the feasibility, activity and toxicity of the postoperative sequential MVP chemotherapy and radiotherapy. METHODS: Between February 1991 and May 1995, 60 patients with resected stage II, IIIA non-small cell lung cancer received 2 cycles of MVP combination chemotherapy (Mitomycin-C 6 mg/m2, Vinblastine 6 mg/m2, Cisplatin 60 mg/m2) within 3 weeks after surgery, followed by thoracic irradiation (5,040 cGy after complete resection and 900 cGy booster to microscopically positive resection margin at 1.8 Gy per fraction) within 3-4 weeks after chemotherapy. RESULTS: Forty nine men and 11 women with a median age of 60.5 years (range 33-81 years) were included. During the median follow-up period of 828 days (61-2,015 days), 25 patients had developed recurrence. Among the 25 failures, 3 were local relapse only and 20 were distant metastasis only and 2 had both local and distant sites of recurrence. Three-year overall survival and event-free survival were 43% and 37%, respectively. Neutropenia of grade I-II was observed only in 13 patients. Eleven patient showed grade I-II radiation pneumonitis and 32 had grade I-II radiation esophagitis. CONCLUSION: Postoperative sequential MVP chemotherapy and radiotherapy in resected stage II-IIIA non-small cell lung cancer is well-tolerated and shows interesting activity.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Disease-Free Survival ; Drug Therapy* ; Drug Therapy, Combination ; Esophagitis ; Female ; Follow-Up Studies ; Humans ; Male ; Mitomycin* ; Neoplasm Metastasis ; Neutropenia ; Prospective Studies ; Radiation Pneumonitis ; Radiotherapy* ; Recurrence ; Survival Rate ; Vinblastine*

Primary mediastinal nonseminomatous germ cell tumor is extremely rare. Apart from rarity and large size, mediastinal germ cell tumors show striking similarity to testicular tumors in age, incidence, and tumor type. The symptoms associated with these tumors are related mainly to size, invasion of neighboring structures, and distant metastases. Tissue diagnosis is obtained by biopsy of the primary lesion or by biopsy of metastatic sites. Tumors often present with advanced bulky disease, which are unresectable. So these tumors require an aggressive multidisciplinary approach to management. Optimal management includes aggressive surgical debulking and early use of cisplatin-bleomycin-based combination chemotherapy. Serial biomarker measurements permit early recognition of recurrence and improved timing of surgical intervention. The prognosis for mediastinal germ cell tumors is poor, not only because they are far advanced at the time of diagnosis but also because some of the tumors-such as embryonal carcinomas, choriocarcinomas, and endodermal sinus tumors-are very aggressive. In these cases, we present three young male patients with large mass on anterior mediastinum. Tissue diagnosis was obtained by primary lesion biopsy. All patients received surgical debulking and combination chemotherapy and experienced a brief response and eventually had relapses. We report these cases with a review of literatures.
Biopsy ; Carcinoma, Embryonal ; Choriocarcinoma ; Diagnosis ; Drug Therapy, Combination ; Endoderm ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Humans ; Incidence ; Male ; Mediastinum ; Neoplasm Metastasis ; Neoplasms, Germ Cell and Embryonal* ; Pregnancy ; Prognosis ; Recurrence ; Strikes, Employee ; Testicular Neoplasms

It is well known that the pulmonary capillary endothelium is rich in angiotensin converting enzyme(ACE), which is released in the event of smoking, acute lung injury, or some lung diseases such as Gauchers disease and hypertension. Serum ACE levels may be clinically useful because they are reflections of pulmonary circulation. In order to evaluate the effect of extracorporeal circulation and pulmonary perfusion on serum ACE levels, we measured serum ACE level during prebypass, total bypass(5', 30', 60') and pulmonary perfusion (30', 60', 24 hrs.) in 10 open-heart patients. The results were as follows: 1) The SACE level before the begining of extracorporeal circulation was 10.03+/-1.66u/ml and decreased significantly to 2.79+/-0.63u/ml(p<0.005) 5min. after extracorporeal circulation was initiated. 2) The decreased SACE level seen during extracorporeal circulation returned to a nearly normal (9.33+/-1.8u/ml) 24hrs. after pulmonary perfusion. 3) There were no significant correlations between the SACE level and the variation of age during extracorporeal circulation and pulmonary perfusion. The above results suggest that SACE levels are proportional to the amount of pulmonary blood flow.
Acute Lung Injury ; Angiotensins* ; Cardiopulmonary Bypass ; Endothelium, Vascular ; Extracorporeal Circulation* ; Gaucher Disease ; Humans ; Hypertension ; Lung Diseases ; Peptidyl-Dipeptidase A* ; Perfusion ; Pulmonary Circulation ; Smoke ; Smoking

The use of controlled hyperventilation during neurosurgical procedures prevents the deleterious effects of hypercarbia on the cerebral blood flow and intracranial pressure. hyperventilation with hypocarbia produces cerebral vasoconstriction, reduced cerebral blood flow and a reduction in brain size in the majority of patients with increased intracranial pressure. But since excessive cerebral vasoconstriction might induce cerebral ischemia, there has been much discussion concerning the optimal level of hypocarbia. Several studies have shown biochemical evidence of a change in cerebral glucose utilization to anaerobic metabolism during hypocarbia. In our investigation, the effect of hyperventilation on 10 neurosurgical patients was evaluated by blood gas analysis and the estimation of lackate and pyruvate in arterial blood and the cerebrospinal fluid. The results were as follows: 1) PaCO2 decreased from a prearesthetic value of 38+/-2.2 mmHg to 22+/-2.1mmHg 1 hour postinduction and 24+/-2.2mmHg at 2 hours due to hyperventilation. pH was 7.58+/-0.047 1 hour postinduction and 7.56+/-0.018 at 2 hours. PaO2 was 251+/-33.0mmHg 1 hour postinduction 1 hour and 215+/-20.9mmHg at 2 hours under a 50% inspired oxygen concentration(FiO2=0.5). 2) The arterial blood lactate value increased statistically significantly from a preanesthetic value of 9.3+/-1.5mg% to 11.8+/-1.47mg% 1 hour postinduction(p<0.01) to 12.5+/-1.53mg% at 2 hours(p<0.005). However all values were within the normal range(4.7+/-15.1mg%), and the lacte/pyruvate ratio did not change. 3) In the cerebrospinal fluid, pH was 7.45+/-0.057, PCO2 was 34+/-3.5mmHg and PO2 was 91+/-6.7mmHg following hyperventilation for 1 hour. The lactate value of the cerebrospinal fluid was 19.2+/-3.14mg%(normal range: 11.0~27.0mg%) and the lactate/pyruvate ration was 14.5+/-2.39. 4) No evidence of an excessive increase in CSF lactate was seen in any case. The above findings suggest that maintenance of an adequate oxygen concentration and a carbon dioxide value over 20mmHg would prevent cerebral ischemia following hypocarbia due to hyperventilation.
Anesthesia* ; Blood Gas Analysis ; Brain ; Brain Ischemia ; Carbon Dioxide ; Cerebrospinal Fluid* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation* ; Intracranial Pressure ; Lactic Acid ; Metabolism ; Neurosurgical Procedures ; Oxygen ; Pyruvic Acid ; Vasoconstriction

The use of a pneumatic torniquet to obtain a blood less field in the extremities is essential in the precise operations of present-day plastic and orthopedic surgery. There have been studies conducted regarding systemic and metabolic change in response to torniquet ischemia and complication, associated with torniquets have been reported such as injuries to nerves, muscles and blood vessel. The purpose of this investigation was to examine changes in the systemic circulation, blood gases serum potassium and base status on release of torniquet ischemia in adult. The results were as follows: 1) The mean blood pressure and heart rate did not change significantly after torniquet release. 2) The pH decreased significantly after the torniquet release. 3) The PaO2, and PaCO2, did not charge significantly after torniquet release. 4) The HCO3, and BE decreased significantly after torniquet release (P<0.05). 5) The serum potassium levels tended to increase after torniquet release but the changes was not significant. There-fore to minimize the predictable complications, the ventilatory control and rapid volume replacement are needed during the time immediately preceeding and following torniquet release.
Adult* ; Blood Circulation ; Blood Pressure ; Blood Vessels ; Extremities ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Ischemia ; Lower Extremity* ; Muscles ; Orthopedics ; Plastics ; Potassium

Cannulation of the arterial system is an invasive monitoring technique that readily is justified by its high information yield and minimal discomfort and risk to the patient and is commonly performed in the ICU and operating room, allowing continuous monitoring and graphic display of the systemic arterial blood pressure, and repeated analysis of arterial blood gases. The major complications subsequent to cannulation are thrombosis and occlusion pain at the puncture site, hematoms and infection. We performed a clinical study on complications following percutaneous arterial cannulation in 378 patients with radial artery cannulation and 172 patients with dorsalis pedis artery cannulation who had undergone surgery at Kyung Hee University Hospital from April to September, 1987. The patients were examined to confirm the patency of the collateral circulation of the hand and foot before cannulation and the frequency of complication was studied by physical examination and the Doppier technique on the 1st, 7th and 10th days after decannulation. The results were as follows: 1) The most common complication of radial artery cannulation was ecchymosis(41.8%) and the next common complications were abnormal blood flow(17.5%), abnormal pulse (13.2%), sensory change(1.3%) and infection(0.3%). 2) The most common complication of dorsalis pedis artery cannulation was ecchymosis(34.9%) and the next common complications were abnormal blood flow(19.8%), abnormal pulse(12.8%), sensory chang(1.7%) and infection(0.6%). 3) The crrelation of sex, duration of cannulation, number of punctures and age to the incidence of abnormal flow was studied in both arteries. Abnormal flow was only significantly related to females(p<0.05) in both arteries. 4) The correlation of both arteries to the incidence of abnormal flow under several circumstances was studied. But neither artery did not revealed a significant difference to the incidence of abnormal flow. 5) No permanent ischemic damage to the hand or foot occurred in any patient in this study. Therefore, we concluded that radial artery cannulation is a low-risk highly beneficial monitoring technique and careful dorsalis pedis artery cannulation provides a relatively safe, reliable and available to the radial artery with caution.
Arterial Pressure ; Arteries ; Catheterization ; Collateral Circulation ; Foot ; Gases ; Hand ; Humans ; Incidence ; Operating Rooms ; Physical Examination ; Punctures ; Radial Artery ; Thrombosis

Since the first report by Drury and Szent-Gyorgyi in 1929, the inhibitory influences of adenosine on the heart have repeatedly been described by many investigators. A lot of investigations on the working mechanisms of adenosine have been focused mainly on the effects on the coronary blood flow. However, the cellular mechanisms underlyiag the inhibitory action of adenosine on the SA node are not well understood yet. Furthe-rmore, the physiological role of adenosine in the regulation of the heart beat remains still to be explored. Thus, this study was undertaken to examine the behavior of the rabbit SA node ander the influence of adenosine, and the interactions between adenosine and aminophylline on the SA node, and then to compare these results with those of acetylcholine. At the same dosage range, adenosine suppressed the sinus rate and atrial contractility even in the reserpinized preparation. The spontaneous firing rate of the SA node at 35degrees C (mean+/-SEM, n=16) was 154+/-3.3 beats/min. The parameters of action potential were: maximum diastolic potential(MDP), -73+/-1,7 mV; overshoot(OS), 9+/-1.4 mV; slope of pacemaker potential(SPP), 94+/-3.0 mV/sec. Adenosine suppressed the firing rate of the SA node in a dose-dependent manner. This inhibitory effect appeared at the concentration of 10(-4)M and was potentiated in parallel with the increase in adenosine concentration. Changes in the action potential by adenosine were dose-dependent as show by the increase of MDP and the decrease of SPP until 10(-4)M. Above this concentration, however, the amplitude of the action potential decreased markedly due to the simultaneous decrease of both MDP and OS. Dipyridamole, which is known to block the adenosine transport aross the cell membrane, definately potentiated the action of adenosine. The effects of adenosine on the SA node were inhibited by aminophylline. However, the similar effects of acetylcholine to those of adenosine were not reversed by aminophylline. These results suggest that adenosine suppressed the pacemaker activity by acting dire-ctly on the membrane of the SA node, and the effects of adenosine on SA node are sele-ctively inhibited by aminophylline.
Acetylcholine ; Action Potentials ; Adenosine ; Aminophylline ; Cell Membrane ; Dipyridamole ; Fires ; Heart ; Humans ; Membranes ; Research Personnel

In order to study the effect of spinal nareotics on postoperative pulmonary function and ventilatory reserve after upper abdominal surgery, small preoperative doses of morphine were administrated into the subarachnoidal space and the changes in FVC, FEVi.e., MMEF and FEVi.e./FVC with the SC-20 spirometric computer wer evaluated. The results were as follows: 1) On the 1st day postoperatively FVC of the control group was 56% of the preperative value, 2.94+/-0.68(1/sec), and that of the morphine group was 66% of the preoperative value, 2.99+/-0.73(1/sec).(p<0.05) On the 2nd and 3rd day postoperatively the control group was 64% and 65% and that of the morphine group was 82% and 87%. (p<0.05) 2) On the 1st and 2nd postoperative day FEVi.e. of the control group was 52% and 57% of the preoperative value, 2.49+/-0.43(1/sec), and that of the morphine group was 61%, and 65% of the preoperative value, 2.42+/-0.68(1/sec). (p<0.05) On the 3rd postoperative day the FEVi.e. of the control group was 65% and that of the morphine group was 80%. (p<0.05) 3) On the 1st and 2nd postoperative day the MMEF of the control group was 56%, and 61% of the preoperative value, 2.45+/-0.77(1/sec). In the 3rd postoperative day the MMEF on the control group was 63% and that of the morphine group was 78%. (p<0.01) 4) The preoperative FEVi.e./FVC of the control group was 84.3% and that of the morphine group was 78.7%. in the postoperative period, there were no significant differences between the control and morphine group.
Morphine* ; Postoperative Period

For many years it has been known that the dosage of thiopental required to induce anesthesia depends on the age of the patient, but this information ha resulted from clinical experience with the drugs rather than from planned study. In our study, to elucidate the influence of age on the size of the sleeping dosage of thiopental, 144 patients who underwent minor orthopedic and gynecological operations were studied. This patients had no evidence of a disease other than that scheduled for operation and were within normal values in hematologic examination, liver function and kidney function. Using a simple "yes" or "no" verbal command response, as sleeping response, to a single bolus of thiopental in mg/kg body weight, we have attemted to minimize uncontroliable factors such as cerebral perfusion, circulation time and plasma protein binding which would alter response to thiopental infusions continued to the end points. The results were as follows: 1) There was no statistical difference in verbal command response to thiopental according to age in age groups below 59 years. 2) Compared with age groups below 59 years, 60~79yrs, group failed to respond to the verbal command in 33% by 2.2mg/kg and 100% by above 2.6mg/kg.(p<0.05) 3) The mean time for loss of verbal command response after thiopental injection was 27.4+/-10.3 seconds and 80.4% of theses patients lost lid reflex with a mean time of 41.7+/-9.1 seconds after thiopental injection. 4) All groups showed statistically non-significant alterations of systolic blood pressure and heart rate after injection of thiopental.
Anesthesia ; Blood Pressure ; Body Weight ; Heart Rate ; Humans ; Kidney ; Liver ; Orthopedics ; Perfusion ; Plasma ; Protein Binding ; Reference Values ; Reflex ; Thiopental*