Development of Korean Version of Heparin-Coated Shunt / 대한흉부외과학회지

BACKGROUND: This study was designed to develop a Korean version of the heparin-coated vascular bypass shunt by using a physical dispersing technique. The safety and effectiveness of the thrombo-resistant shunt were tested in experimental animals. MATERIAL AND METHOD: A bypass shunt model was constructed on the descending thoracic aorta of 21 adult mongrel dogs(17.5-25 kg). The animals were divided into groups of no-treatment(CONTROL group; n=3), no-treatment with systemic heparinization(HEPARIN group; n=6), Gott heparin shunt (GOTT group; n=6), or Korean heparin shunt(KIST group; n=6). Parameters observed were complete blood cell counts, coagulation profiles, kidney and liver function(BUN/Cr and AST/ ALT), and surface scanning electron microscope(SSEM) findings. Blood was sampled from the aortic blood distal to the shunt and was compared before the bypass and at 2 hours after the bypass. RESULT: There were no differences between the groups before the bypass. At bypass 2 hours, platelet level increased in the HEPARIN and GOTT groups(p<0.05), but there were no differences between the groups. Changes in other blood cell counts were insignificant between the groups. Activated clotting time, activated partial thromboplastin time, and thrombin time were prolonged in the HEPARIN group(p<0.05) and differences between the groups were significant(p<0.005). Prothrombin time increased in the GOTT group(p<0.05) without having any differences between the groups. Changes in fibrinogen level were insignificant between the groups. Antithrombin III levels were increased in the HEPARIN and KIST groups(p<0.05), and the inter-group differences were also significant(p<0.05). Protein C level decreased in the HEPARIN group(p<0.05) without having any differences between the groups. BUN levels increased in all groups, especially in the HEPARIN and KIST groups(p<0.05), but there were no differences between the groups. Changes of Cr, AST, and ALT levels were insignificant between the groups. SSEM findings revealed severe aggregation of platelets and other cellular elements in the CONTROL group, and the HEPARIN group showed more adherence of the cellular elements than the GOTT or KIST group. CONCLUSION: Above results show that the heparin-coated bypass shunts(either GOTT or KIST) can suppress thrombus formation on the surface without inducing bleeding tendencies, while systemic heparinization(HEPARIN) may not be able to block activation of the coagulation system on the surface in contact with foreign materials but increases the bleeding tendencies. We also conclude that the thrombo-resistant effects of the Korean version of heparin shunt(KIST) are similar to those of the commercialized heparin shunt(GOTT).

Calcification-resistant Effect of Surface-modified Biologic Arteries by Sulfonated Polyethyleneoxide / 대한흉부외과학회지

BACKGROUND: Calcific degeneration is the major cause of clinical failure of glutaraldehyde (GA) crosslinked bioprosthetic tissues implanted in the body and necessitates the reoperation or causes death. Surface modification of biologic tissues using sulfonated polyethyleneoixde (PEO-SO3) has been suggested to significantly enhance blood compatibility, biostability and calcification-resistance by means of the synergistic effect of highly mobile and hydrophilic PEO chains and electrical repulsion of negatively charged sulfonate groups. This study was designed to evaluate the anticalcification effect of surface-modification of biologic arteries by direct coupling of PEO-SO3 after GA fixation and changes of calcification according to the implantation period through the quantitative investigation of the deposited calcium and phosphorous contents of the biologic arterial tissues in the canine circulatory implantation model. MATERIAL AND METHOD: Total of 16 fresh canine carotid arteries were harvested from eight adult dogs and divided in to GA group(n =8) and PEO-SO3 group(n=8). Sulfonation of diamino-terminated PEO was performed using propane sultone. Canine carotid arteries were only crosslinked with 0.65% GA solution in GA group and modified by direct coupling 5% PEO-SO3 solution after GA crosslinkage for 2 days and stabilized by NaBH4 solution for 16 hours in PEO-SO3 group. In both groups the resected segment of bilateral carotid arteries were reconstructed. Reconstructed segments of the two groups were analysed the quantities of calcium and phosphorous contents after 3(n=4) and 6(n=4) weeks in vivo. RESULT: After implantation of 3 seeks, PEO-SO3 group showed significantly less depositions.

Comparison of the Reconstruction Routes after Esophagectomy for Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: Selection of reconstruction route in esophageal cancer surgery is based on the patient's status, characteristics of tumor, surgeon's preference and experience. Of the various routes, it has been documented that subcutaneous or substernal route may prolong operation time and may be vulnerable to postoperative respiratory complications. This study was designed to evaluate whether the selection of reconstruction route affects the surgical outcomes. MATERIAL AND METHOD: Of 131 patients who have undergone resection and reconstruction for esophageal cancer, posterior mediastinal route(Group I, n=34), substernal route (Group II, n=31), and subcutaneous route(Group III, n=21) were retrospectively reviewed in 86 patients. Results of early operations and morbidities were compared between the groups. RESULT: There was a male prevalence(79 of males vs. 7 of females). There were 81 squamous cell cancers and 5 adenocarcinomas. There were no differences between groups in weight, height, age, cancer staging and location, and in the preoperative anesthetic risk evaluation and pulmonary function test(p=NS). Postoperative mechanical ventilation time was longer in Group I(20.6 hours) than in Group II(7.8 hours) or III(3.4 hours)(p=0.005). Duration of stay in the intensive care unit was prolonged in Group III(6.4 days) compared to Group I (3.9 days) or II(3.1 days)(p=0.043). No differences were noted in the duration of hospital stay between the groups(p=NS). Blood transfusion was needed in 30 out of 34 patients in Group I compared to 14/31 in Group II or 15/21 in Group III(p=0.001). The mean amount of transfusion for each patient was also higher in Group I(3,833 mL) than in Group II(1535 mL) or Group III(1419 mL)(p=0.04), but there was no difference in the inreoperation due to bleeding. Ea ly mortality rate was substantially higher in Group I(17.6%) but the differences between the groups were insignificant(p=NS). Although sepsis was a more prevalent cause of death in Group I, it was not related to anastomotic leak. Other morbidities did not differ between the groups(p=NS). CONCLUSION: In above results show that the reconstruction route does not affect the outcome of esophageal cancer surgery. We believe that the selection of reconstruction route can be based on the surgeon's preference and experience.

Cervical Esophago-Enteric Anastomosis with Straight Endostapler / 대한흉부외과학회지

BACKGROUND: The use of the stapler n esophageal reconstruction after esophageal resection for benign or malignant esophageal diseases has become popular because it has less leakage at the anastomotic site and shorter operation time than manual sutures. However, the use of classic circular stapler has some complications such as stenosis and dysphagia that requires additional treatment. Such complications are closely related to the inner diameter of the anastomotic sites. In this study, the diameter of anastomotic site was compared after the use of circular stapler(EEA) and straight endoscopic stapler(endo GIA). MATERIAL AND METHOD: The patients who received esophageal reconstruction by stapler from August 1995 to September 1997 were reviewed. The patients were divided into 2 groups. One group need the circular stapler, and the other group the straight endo GIA(14 cases with endo GIA 30mm, 24 with endo GIA 45mm). After a cervical esophago-enteric anastomosis, the stricture of anastomotic site and the incidence of dysphagia were compared between the 2 groups using an esophagography and the patient's symptoms. The follow-up period was 12months in average. RESULT: In the former group in which the circular stapler was used, 2 cases of anastomotic stenosis were reported. In comparison, none were reported in the latter group. Dysphagia were reported in 8 cases of the former group, and in 3 cases of the latter group(1 case in endo GIA 30 mm, 2 cases in endo GIA 45 mm). CONCLUSION: The use of endo GIA in esophago-enteric anastomosis resulted in a wider diameter of the anastomotic site, lesser stricture, and lesser incidence of dysphagia compared to the use of former circular stapler. Therefore, it is thought to be a better method in esophageal reconstructions.

Thoracoscopic resection of mediastinal tumor: two cases report / 대한흉부외과학회지

No abstract available.