Breast Tissue Reconstruction Using Polycaprolactone Ball Scaffolds in a Partial Mastectomy Pig Model

BACKGROUND@#Breast cancer patients suffer from lowered quality of life (QoL) after surgery. Breast conservancy surgery (BCS) such as partial mastectomy is being practiced and studied as an alternative to solve this problem. This study confirmed breast tissue reconstruction in a pig model by fabricating a 3-dimensional (3D) printed Polycaprolactone spherical scaffold (PCL ball) to fit the tissue resected after partial mastectomy. @*METHODS@#A 3D printed Polycaprolactone spherical scaffold with a structure that can help adipose tissue regeneration was produced using computer-aided design (CAD). A physical property test was conducted for optimization. In order to enhance biocompatibility, collagen coating was applied and a comparative study was conducted for 3 months in a partial mastectomy pig model. @*RESULTS@#In order to identify adipose tissue and fibroglandular tissue, which mainly constitute breast tissue, the degree of adipose tissue and collagen regeneration was confirmed in a pig model after 3 months. As a result, it was confirmed that a lot of adipose tissue was regenerated in the PCL ball, whereas more collagen was regenerated in the collagen-coated Polycaprolactone spherical scaffold (PCL–COL ball). In addition, as a result of confirming the expression levels of TNF-a and IL-6, it was confirmed that PCL ball showed higher levels than PCL–COL ball. @*CONCLUSION@#Through this study, we were able to confirm the regeneration of adipose tissue through a 3-dimensional structure in a pig model. Studies were conducted on medium and large-sized animal models for the final purpose of clinical use and reconstruction of human breast tissue, and the possibility was confirmed.

Complete Recovery after Prolonged Resuscitation Using Extracorporeal Membrane Oxygenation for In-hospital Arrest Due to Refractory Ventricular Fibrillation

Extracorporeal life support (ECLS) has been used as an adjunctive therapy to conventional cardiopulmonary resuscitation (CPR) in patients with in-hospital cardiac arrest. However, whether to apply ECLS after prolonged CPR (>30 minutes) is a difficult decision. We present the case of a 49-year-old woman with in-hospital cardiac arrest caused by refractory ventricular fibrillation and rescued by extracorporeal membrane oxygenation (ECMO) during prolonged CPR. The ECMO was implemented 90 minutes after the initiation of CPR and the total duration of CPR was about 5 hours. The patient fully recovered and was discharged without neurological complications.

Clinical Impact of Time Delay on 1-Year Mortality in Patients with ST-Segment Elevation Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: The delay between the onset of myocardial infarction symptoms and primary percutaneous coronary intervention (PCI) is an important prognostic factor in patients with ST-segment elevation acute myocardial infarction (STEMI). We reviewed this delay in patients with STEMI and analyzed clinical outcomes. METHODS: The study enrolled 3,399 patients (age, 61.4 +/- 12.8 years; 25.6% women) with STEMI who underwent primary PCI within 12 hours of symptom onset between October 2005 and February 2008 from the Korea Acute Myocardial Infarction Registry. The patients were divided into two groups according to the symptom-to-balloon time: group I ( 3 hours, n = 2444). The in-hospital mortality rates and 1-year mortality and major adverse cardiac event (MACE) rates were compared between the two groups. RESULTS: The mean time interval from the onset of symptoms to arrival at the emergency room (ER) was 188.0 +/- 133.6 minutes (median, 152 minutes). The mean time interval from the ER to reperfusion (door-to-balloon time) was 97.8 +/- 67.9 minutes (median, 80 minutes). The mean time interval from the onset of symptoms to reperfusion (symptom-to-balloon time) was 285.8 +/- 146.2 minutes (median 250 minutes). The in-hospital mortality rate was significantly lower in group I as compared with group II (3.6% versus 5.2%, p = 0.044). The 1-year mortality rate was also significantly lower in group I (4.7% versus 7.2%, p = 0.012), while the 1-year MACE rate was not significantly different between groups (17.9% versus 20.4%, p = 0.179). CONCLUSIONS: This study demonstrates that there is a significant pre-hospital time delay in patients with STEMI in Korea and this time delay is associated with increased 1-year mortality.

Endothelial Dysfunction in the Smokers Can Be Improved with Oral Cilostazol Treatment

BACKGROUND: Smoking is one of well known environmental factors causing endothelial dysfunction and plays important role in the atherosclerosis. We investigated the effect of cilostazol could improve the endothelial dysfunction in smokers with the measurement of flow-mediated dilatation (FMD). METHODS: We enrolled 10 normal healthy male persons and 20 male smokers without any known cardiovascular diseases. After measurement of baseline FMD, the participants were medicated with oral cilostazol 100 mg bid for two weeks. We checked the follow up FMD after two weeks and compared these values between two groups. RESULTS: There was no statistical difference of baseline characteristics including age, body mass index, serum cholesterol profiles, serum glucose and high sensitive C-reactive protein between two groups. However, the control group showed significantly higher baseline endothelium-dependent dilatation (EDD) after reactive hyperemia (12.0 +/- 4.5% in the control group vs. 8.0 +/- 2.1% in the smoker group, p = 0.001). However, endothelium-independent dilatation (EID) after sublingual administration of nitroglycerin was similar between the two groups (13.6 +/- 4.5% in the control group vs. 11.9 +/- 4.9% in the smoker group, p = 0.681). Two of the smoker group were dropped out due to severe headache. After two weeks of cilostazol therapy, follow-up EDD were significantly increased in two groups (12.0 +/- 4.5% to 16.1 +/- 3.7%, p = 0.034 in the control group and 8.0 +/- 2.1% to 12.2 +/- 5.1%, p = 0.003 in the smoker group, respectively). However, follow up EID value was not significantly increased compared with baseline value in both groups (13.6 +/- 4.5% to 16.1 +/- 3.7%, p = 0.182 in the control group and 11.9 +/- 4.9% to 13.7 +/- 4.3%, p = 0.430 in the smoker group, respectively). CONCLUSION: Oral cilostazol treatment significantly increased the vasodilatory response to reactive hyperemia in two groups. It can be used to improve endothelial function in the patients with endothelial dysfunction caused by cigarette smoking.

Iatrogenic Left Internal Mammary Artery to Great Cardiac Vein Anastomosis Treated With Coil Embolization

Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.

Iatrogenic Left Internal Mammary Artery to Great Cardiac Vein Anastomosis Treated With Coil Embolization

Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.

Transient Use of Oral Bosentan Can Be an Additional Option to Reduce Pulmonary Arterial Hypertension in a Patient with Severe Pulmonary Arterial Hypertension Associated with Atrial Septal Defect

Atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) is thought to preclude shunt closure. However, there are several reports that vasodilator treatment is associated with good clinical outcome in these patients, recently. We report a case of good clinical outcome in a patient with ASD and severe PAH successfully treated with operative closure of ASD and subsequent use of oral bosentan medication. This case supports that the corrective repair of ASD and an oral bosentan treatment can be one of the treatment options in the selected patients with severe PAH associated with ASD.

Growth Differentiation Factor 5 (GDF5) Core Promoter Polymorphism Is Not Associated with Susceptibility to Osteoarthritis of the Knee in the Korean Population

BACKGROUND: Osteoarthritis (OA) is a common disease characterized by degenerating joint cartilage in the knee, hip, and hand. A functional single nucleotide polymorphism (SNP) +104T/C; rs143383 in the 5' untranslated region of the growth differentiation factor 5 (GDF5) gene was recently associated with susceptibility to OA in the Japanese and Chinese populations. METHODS: To investigate whether this association is present in the Korean population, the frequency of the polymorphism was investigated in 276 patients with knee OA and 298 healthy subjects as controls. Polymorphism analysis was performed by amplifying the core promoter region of the GDF5 gene and digesting it with the BsiEI restriction enzyme. RESULTS: The frequency of the TT, CT, and CC genotypes was 54.3% (150/276), 41.7% (115/276), and 4.0% (11/276), respectively, in patients with OA, and 53.4% (159/298), 37.9% (113/298), and 8.7% (26/298), respectively, in healthy controls. No significant differences in genotypic or allelic frequencies of the +104T/C SNP of the GDF5 gene were observed between patients with OA and controls. Also, no significant differences in allelic and genotypic frequencies were found when the individuals were stratified by age and gender. CONCLUSIONS: The results suggest that the +104T/C; rs143383 GDF5 core promoter polymorphism is not a risk factor for OA in the Korean population.

A Case with Upper Extremity Deep Vein Thrombosis after in vitro Fertilization

Deep vein thrombosis (DVT) is a predisposing condition of pulmonary embolism which can be fatal. Usually, DVT is found in the lower extremities. However, DVT can be occurred in the upper extremities. The usual predisposing conditions of the upper extremity DVT include insertion of central venous catheters and pacemaker wires. Here, we report a case of upper extremity DVT after in vitro fertilization and embryo transfer. The patient was successfully controlled with subcutaneous administration of low molecular weight heparin.

A Case of Acute ST-Segment Elevation Myocardial Infarction Mimicking Stress Induced Cardiomyopathy; Demonstration of Typical Echocardiographic Finding Correlated with Unusual Distribution of Left Anterior Descending Coronary Artery

Stress-induced cardiomyopathy (SCMP) is diagnosed in 1-2% of patients presenting with symptoms suggestive of acute coronary syndrome. Because of sharing many common clinical features with SCMP, acute ST-segment elevation myocardial infarction (STEMI) can be misdiagnosed as SCMP. However, it can be associated with fatal outcome of the patient. Also, diagnosis of SCMP seems to be always challenging to clinicians, especially in the decision of taking coronary angiography which is still invasive and even risky. Here, we present a case with acute STEMI mimicking SCMP as a result of anatomical variation of coronary circulation. In this patient, prompt and early coronary angiography and stent implantation was very helpful.

The Clinical Feasibility of Transradial Primary Percutaneous Coronary Intervention with an ST Elevation Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: With the lower incidence of bleeding complications and earlier ambulation, transradial coronary intervention (TRI) is related with improved patient satisfaction compared with that of conventional transfemoral intervention (TFI). However, there is insufficient data about the efficacy of TRI in patients with an acute ST segment elevation myocardial infarction (STEMI). The aim of this study was to evaluate the safety and efficacy of TRI in selected patients with an acute STEMI. SUBJECTS AND METHODS: Between March 2003 to August 2006, 386 acute STEMI patients were treated using primary percutaneous coronary intervention (PCI), of which 335 had undergone TRI and were included in the study. This study was performed retrospectively on 335 consecutive patients, including 246 males, with a mean age of 62+/-11 years. RESULTS: Hemodynamically stable patients (n=335) underwent primary PCI via TRI. Fourteen of the TRI cases were changed to the TFI group during the procedure. The procedural success rate was 96%. The mean time interval from arterial access to balloon dilatation and total procedure time were 13.4+/-7.1 and 37+/-18 min, respectively. A 6 French sized guiding catheter was used in 235 cases (70%). There were no major bleeding complications, and the mean duration of hospital stay was 4.7+/-4.9 days. CONCLUSION: In the setting of primary PCI, TRI can be a feasible and safe approach in selected hemodynamically stability patients.

Genetic and expression analysis of the KCNRG gene in hepatocellular carcinomas

The potassium channels are ubiquitous multisubunit membrane proteins, and potassium-dependent alterations in the membrane potential play an important role in the proliferation of many types of cells. This study analyzed the mutation, allelic loss and expression patterns of the KCNRG gene in 77 HCCs in order to determine if the KCNRG gene, which encodes the potassium channel regulating protein, is involved in the tumorigenesis of hepatocellular carcinoma (HCC). One KCNRG missense mutation, CGT->CAT (Arg->His) was found at codon 92 within the T1 domain. Hep3B hepatoma cells were transfected with the wild- or mutant-KCNRG to determine the effect of this mutation in KCNRG. Interestingly, the suppressive cell growth activity of the mutant-type KCNRG was significantly lower than that of the wild-type KCNRG. In addition, allelic loss was detected in 17 out of 64 (26.5%) informative HCC cases, and all were hepatitis B virus (HBV)-positive. Moreover, the allelic loss was closely related to an intrahepatic metastasis (P=0.0247), higher grade (P=0.0078) and clinical stage (P=0.0071). Expression analysis revealed 22 tumor tissues to have a loss of expression of the KCNRG transcript. These results suggest that genetic alterations and the expression of KCNRG might play an important role in the development and/or progression of a subset of HCCs.

The Clinical Feasibility of Transradial Coronary Intervention in Selective Patients Undergoing Left Main Coronary Intervention

BACKGROUND AND OBJECTIVES : The transradial approach has been increasingly used as an alternative to conventional transfemoral intervention. However, there is little data on the efficacy of transradial coronary intervention (TRI) in left main coronary arterial (LMCA) disease. The purpose of this study was to evaluate the feasibility of TRI in selective patients undergoing percutaneous coronary intervention (PCI) for LMCA disease. SUBJECTS AND METHODS : Between Jan 2003 and May 2005, 83 patients with LMCA stenosis were treated with PCI. Of these, 40 selected patients having undergone TRI were included in this study. RESULTS : The patients included 30 males and 10 females, with a mean age of 61+/-12 years. There were 28 cases (70%) involving coronary arteries other than the LMCA and 24 cases (60%) with bifurcation lesion involvement. In 28 cases (70%), a 6 Fr sized guiding catheter was used. No case required crossover from TRI to TFI due to procedural failure. During hospitalization, 2 patients who underwent primary PCI in the setting of STEMI died, but there were no other clinical events. CONCLUSION : In selected patients with LMCA disease, TRI can be a feasible and safe approach for PCI.

A Single Nucleotide Polymorphism in the E-cadherin Gene Promoter-160 is Not Associated with Risk of Korean Gastric Cancer

Recently, the -160 C/A polymorphism, located within the regulatory region of E-cadherin promoter, has been shown to influence E-cadherin transcription by altering transcription factor binding. We examined the effect of this polymorphism on risk of gastric cancer and on histological classification of intestinal- and diffuse-type gastric cancer in 146 normal healthy individuals and 292 Korean gastric cancer patients. Genomic DNA samples were examined by polymerase chain reaction (PCR)-single strand conformational polymorphism (SSCP)-sequencing and confirmed by restriction fragment length polymorphism (RFLP). Unexpectedly, there was no significant difference in the genotype frequencies of the polymorphism between normal control and gastric cancer patients (x(2) test, p=0.433). The estimated odd ratio of C/C to A/A genotype in gastric cancer cases was 1.07 (95% confidence interval, 0.396-2.870). We also found no evidence for differences in risk for the intestinal- and diffuse-type gastric cancer. These results suggest that the -160 C/A polymorphism of the E-cadherin has no direct effect on the risk of Korean gastric cancer development and on its histological classification.

A Comparison of NSAID and Intramuscular Stimulation Therapy Effectiveness in the Female Patient with Chronic Shoulder Pain

BACKGROUND: Chronic shoulder pain draws the attention of doctors since it is a very common and serious disease at primary care level. The patients with this pain usually have a tendency to see many doctors, to take an abundance of medication, and sometimes to even suffer from depression. The pain and the symp- toms thereof often disable the patients in their every day lives. This study aims to seek the most efficient way of treatment between two therapies, namely, the existing drug therapy based on NSAID and the intramuscular stimulation(herein after IMS) therapy, which has re- cently been introduced, by comparing them in accordance with the following method. METHODS: The two therapies were applied for 3 weeks to female patients aged between 50 and 70 who had visited a hospital over a period of more than 3 months due to this type of pain. The patients were randomly given each therapy although the treatment and monitoring was done by the same physiotherapist. The monitoring was performed four times, the day before the start of treatment, 1 week, 2 weeks and 3 weeks after respectively. It measured the following elements: (1) pain scale by VAS(Visual Analogue Scale), (2) Sleep hygiene scale by VAS, (3) ROM(Range of Motion), Repeated measure ANOVA was used for analysis. RESULTS: While both therapies reduced the pain significantly during the 3 weeks, the study showed that IMS was more effective than the drug therapy in every element monitored(p<0.05). IMS turned out to be more effective the 1st week in every measured element, however, the drug therapy was more effective the 3rd week if compared to the 2nd week in terms of Sleep VAS score. CONCLUSION: IMS is more effective in easing chro nic shoulder pain since it has better results than NSAID in pain VAS score, sleep VAS score and ROM.

Association of the Interleukin-1beta and Interleukin-1 Receptor Antagonist Genetic Polymorphism and Korean Gastric Cancer

PURPOSE: Interleukin 1beta (IL-1beta) polymorphisms are associated with hypochlorhydria, atrophic gastritis, and increased risk of gastric cancer in Caucasians. We tried to determine whether the IL-1beta and IL-1 receptor antagonist (IL-1 RN) genetic polymorphisms contribute to the development of gastric cancer and the specific type of gastritis in Korean. MATENRIALS AND METHODS: The study population was comprised of 128 gastric cancer patients with histologically proven carcinoma and 63 normal healthy individuals. Sixty-eight carcinomas were of intestinal-type and sixty tumors were of diffuse-type. No patient had a familial gastric cancer history. The 511 bp and 31 bp polymorphisms in the IL-1beta were genotyped by polymerase chain reaction (PCR)-restriction fragment length polymorphism. The polymorphism of the IL-1 RN was analyzed with variable number tandem repeat after PCR. RESULTS: The genotype of 511C/-31T of IL-1beta and allele 1 of IL-1 RN was dominant in the present subjects. The allelic frequencies of the C allele IL-1beta, which is a high risk genotype for gastric cancer, were 0.551 and 0.429 in gastric cancer and normal controls, respectively. Statistically, significant difference in allelic frequencies of three polymorphic sites between gastric cancer patients and normal controls, and between intestinal-type and diffuse-type was not observed. CONCLUSION: These results suggest that the polymorphisms of IL-1beta and IL-1 RN may not contribute to the development of Korean gastric caner and that other endogenous or exogenous factors will be important for gastric carcinogenesis.

The Hepatitis B Carrier Rate in Siblings of Patients with HBV-associated Chronic Liver Disease / 대한간학회지

Backgrounds/Aims: This study aimed to estimate the seroepidemiology of hepatitis B virus (HBV) infection with emphasis on the transmission of HBV infection between mothers and their children. METHODS: For 452 patients with HBV associated chronic liver disease, and 1,098 of their offspring, who visited Korea University Kuro Hospital from February, 2000 to February, 2001, HBsAg was tested by radioimmunoassay. RESULTS: Among siblings whose mothers were HBsAg-positive, the overall prevalence rate of HBV infection was 44.9% (140/312) and decreased with decreasing age (54.7% in > or =20 years old age group, 33.3% in 10-19 years old age group, 7.6% in <10 years old age group). The estimated proportion of perinatal infection out of modes of HBV transmissions in the general population was 38% in <10 years and 63.4% in 10-19 years. CONCLUSION: The present hepatitis B vaccination strategies -especially against perinatal infection- of Korea have performed to their utmost. More effective methods for the prevention of HBV transmission are now needed.

The Role of Clinical and Biololgical Parameters to Predict Malignant Gestational Trophoblastic Tumor in Patients with Hydatidiform Mole / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The purpose of this study is to reevaluate the prognostic factors by investigating the clinical and biological parameters concerned malignant gestational trophoblastic tumor in patients with hydatidiform mole. METHODS: From March 1995 to February 2000, 41 patients admitted to department of the Obstetrics and Gynecology, Yonsei University College of Medicine who were diagnosed with pathologically-proven gestational trophoblastic disease were selected. Parameters such as age, gravida, parity, presence of theca lutein cyst, ratio of uterine size to gestational age, hCG level, DNA ploidy, S-phase fraction were compared between malignant gestational trophoblastic tumor group and spontaneous remission group. RESULTS: Considering the clinical prognostic factors, the patients were divided into two age groups; the first group consisted of those older than 40 years of age and the second control group consisted of those under 40. The number of patients older than 40 in the spontaneous remission group and malignant gestational trophoblastic tumor group were 4(15.4%) and 7(46.7%), respectively, showing a significantly higher number in the group over 40years. Other parameters such as gravida, parity, presence of theca lutein cyst, ratio of uterine size to gestational age, hCG level, DNA ploidy, S-phase fraction showed no statistically significant difference between the two groups. CONCLUSION: The progression rate from hydatidiform mole to malignant gestational trophoblastic tumor was significantly higher in patients over 40 years of age. Therefore, more aggressive therapeutic approach should be considered in such patients.

A Model of Cerebral Arterial Vasospasm in Rabbits

OBJECTIVES: The present study aimed at confirming whether the previously reported rabbit vasospasm models are suitable to investigate the mechanisms of vasospasm after subarachnoid hemorrhage(SAH) in human. MATERIALS AND METHODS: Twenty rabbits were divided into 3 groups. The first one was the control group receiving no operation, and the second was the sham operation group, which received injection of 0.5ml/kg normal saline into cisterna magna, and the third was the SAH group, which received injection of 0.5ml/kg autologous arterial blood into the cisterna magna. Vertebrobasilar angiographies were followed up in the 12 rabbits that survived on the 2nd, 9th, and 16th days following the operation(9 rabbits in the SAH group, and 3 rabbits in the sham operation group). Baseline angiograms were obtained two days before the operation. The diameters of basilar artery on each days following the operation were measured and expressed as the percentage reduction compared with the initial basilar artery diameter. In 3 rabbits of the control group, vertebrobasilar angiographies were followed up on the same days as in the operation groups. RESULTS: There was a statistically significant differences in the size of the basilar artery among groups at sixteen days after cisternal injection(p=0.0450). On the second and ninth day after the operations, there was only the trend of the vasospasm of basilar artery(p=0.0687 and p=0.0812). The patterns of vasospasms were quite variable among rabbits. CONCLUSIONS: This study showed that vasospasm developed with the injection of 0.5ml/kg autologous blood injection into the cisterna magna but the pattern of vasospasm did not follow those demonstrated in the previous reports of vasospasm in rabbit models. The mortality rate was lower than previously reported results of other experimental SAH models. These results suggested that studies of the rabbit model should be conducted individually. In order to improve the model for the application to human, the functional study of the spasmodic basilar artery after the injection of autologous blood into the cisterna magna seems mandatory in the rabbits.

Case of Tuberculosis of the Skull, Presenting as Osteolytic Lesion: Case Report

Tuberculosis of the skull bone tuberculosis is a very rare disease. We report a case occurring in a 52 year-old male was referred to us because of headache and painful swelling in the right frontal area. Plain chest x-ray revealed fibrous, streaky, nodular, patchy opacities in the LUL together with pleural effusion. Plain skull x-ray and CT scan demonstrated osteolytic lesion in the right frontal bone; scanning showed hot uptake by the right frontal area, and this corresponding to skll findings revealed by plain film. After frontal craniotomy the involved bone flap and epidural abscess were removed. Pafthologically, typical granulomatous inflammation was seens; this was composed of caseation necrosis, epithelioid cells and surrounding lymphocytes and plasma cells.