Expression of Cell Cycle Regulators During Smooth Muscle Cell Proliferation After Balloon Catheter Injury of Rat Artery

Intimal hyperplasia is defined as the abnormal migration and proliferation of vascular smooth muscle cells (VSMCs) with deposition of extracellular matrix. However, the cell cycle regulatory mechanisms of injury-induced VSMC proliferation are largely unknown. To examine the expression kinetics of cell cycle regulatory factors which is known to be worked positively or negatively, we used rat balloon injury model. Marked induction of proliferating cell nuclear antigen (PCNA), G1/S cyclin-dependent kinase (cdk2), and its regulatory subunit (cyclin E) occurred between 1 and 3 days after balloon arterial injury, and this was sustained for up to 7 days and then declined. However, the induction of the negative regulators, p21 and p27, occurred between 3 and 5 days of injury, peaked after 7 and 14 days and was then sustained. VSMC proliferation after balloon catheter injury of the rat iliac artery is associated with coordinated expression of positive (cdk2, cyclin E and PCNA) and negative (p21, p27) regulators. Cell cycle regulators such as cdk2, cyclin E, p21, p27 may be suitable targets for the control of intimal hyperplasia.

A Clinical Analysis on the Restoration of Sinus Rhythm Following Mitral Valve Surgery / 대한흉부외과학회지

BACKGROUND: The atrial fibrillation in patients with mitral valvular heart disease is frequently converted to sinus rhythm after the mitral valve surgery. This sinus restoration implies an important meaning in that it not only helps postoperative convalescence in patients with unstable hemodynamics but also reduces the rate of postoperative thromboembolism. MATERIAL AND METHOD: We retrospectively analyzed 184 patients who received mitral valve surgery from June 1986 to December 1996 to investigate the trend of rhythm change following mitral valve surgery and thus to clarify the predisposing factors of postoperative sinus rhythm conversion and its maintenance. RESULT: The sinus rhythm was restored after the operation in 54 out of 139 patients with atrial fibrillation preoperatively(38.8%). However, the atrial fibrillation recurred in 41 patients at the time of discharge showing a recurrence rate of 75.9 percent. The mean duration of sinus rhythm in patients with eventual atrial fibrillation recurrence was 8.2+/-5.9 days. Only 15 patients were in sinus rhythm at the time of late follow-up with the mean follow-up period of 84.4+/-34.7 months. While the age, duration of symptoms, duration of atrial fibrillation, left atral size, and pulmonary artery pressure were thought to be the predisposing factors for sinus conversion after the operation, only the duration of atrial fibrillation and ejection fraction were considered risk factors for the recurrence of the atrial fibrillation following sinus conversion. CONCLUSION: This study suggests that the early operation is mandatory for the satisfactory result regarding postoperative rhythm. Moreover, additional operative measure in adjunct to the intervention of mitral valve should be considered for the maintenance of restored sinus rhythm as reflected by high postoperative recurrence rate of atrial fibrillation.

Double Valve Replacement via Ministernotomy: A Case Report / 대한흉부외과학회지

Recently, several versatile approaches via limited incision have been developed for minimally invasive cardiac surgery. As the incision is limited, it is often dfficult to get a satisfactory operative field, especially for the manipulation of two separate lesions such as simultaneous mitral and aortic valve disease with a single limited incision. Here, we describe a case of successful double valve replacement via ministernotomy, which was followed by two cases of minimally invasive aortic valve replacement via transsternal approach. The operative field was unexceptionally satisfactory and the postoperative patient's acceptance was high. The methodology is described with a review of the relevant literatures.

Monitoring of Activated Coagulation Time with Kaolin vs. Celite Activator in Cardiac Surgical Patients with Aprotinin / 대한흉부외과학회지

BACKGROUND: High-dose aprotinin has been reported to enhance the anticoagulant effects of heparin during cardiopulmonary bypass ; hence, som authors have advocated reducing the dose of heparin in patients treated with aprotinin. MATERIAL AND METHOD: The ACT was measured before, during and after cardiopulmonary bypass, with Hemochron 801 system using two activators of celite (C-ACT) and kaolin (K-ACT) as surface activator. From June, 1996 to February, 1997, 22 adult patients who were scheduled for elective operation were enrolled in this study. RESULT: The ACT without heparin did not differ between C-ACT and K-ACT. At 30 minutes after anticoagulation with heparin and cardiopulmonary bypass, the average C-ACT was 928+/-400 s; K-ACT was 572+/-159s (p<0.05). After administration of protamine, C-ACT was 137+/-26 s; K-ACT was 139+/-28s, which were not statistically significant. CONCLUSION: Our results showed that the significant increase in the ACT during heparin-induced anticoagulation in the presence of aprotinin was due to the use of celite as surface activator, rather than due to enhanced anticoagulation of heparin by aprotinin. We conclude that the ACT measured with kaolin provides better monitoring of cardiac surgical patients treated with high dose aprotinin than does the ACT measured with celite. The patients treated with aprotinin should receive the usual doses of heparin.

Adult Tracheoesophageal Fistula Incidentally Found on General Endotracheal Anesthesia: A Case Report / 대한흉부외과학회지

We describe a case of adult tracheoesophageal fisula incidentally found during laparotomy. A 41 year old male came to the emergency room due to multiple injuries from a car accident. An emergent laparotomy was given to the patient to rule out hemoperitoneum, and progressive distension of the stomach was noted with each positive pressure ventilation. The diagnosis of tracheoesophageal fistula was made via an intraoperative esophagogram. Detailed inquiry of the patient's history from his mother together with extensive destructive changes over the right upper lung field on the patient's chest X ray suggested that the fistula was longstanding and not of traumatic origin, obviating the need of urgent operation. The fistula was divided via the right thoracotomy 24 days later. Postoperative course was uneventful.