• Journal of Chest Surgery
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• v.43 no.3
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• pp.235-245
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• 2010

Background: Our goal was to evaluate anti-calcification effects of decellularization and diverse fixing methods including preincubation of the bovine pericardium with ethanol. We also assessed changes in mechanical properties. Material and Method: Harvested bovine pericardium was decellularized with 0.25% sodim dodecysulfate and then treated with 5 methods of fixation: (1) 0.5% glutaraldehyde (GA) for 14 days, (2) 0.5% GA for 5 days, 2% GA for 2 days and 0.25% GA for 7 days, (3) 0.5% GA for 5 days, 2% GA for 2 days, 0.25% GA for 7 days, and then 70% ethanol for 2 days, (4) 0.5% GA for 5 days, a mixture of 2% GA and 70% ethanol for 2 days, and 0.25% GA for 7 days, (5) 0.5% GA for 5 days, a mixture of 2% GA, 65% ethanol, and 5% octanediol for 2 days and then 0.25% GA for 7 days. All treated bovine pericardia were tested for histological variables, lipid content, and mechanical properties including tensile strength and thermal stability. A total 10 kinds of differently treated bovine pericardia were implanted into rat subdermis and harvested 8 weeks later. Harvested pericardia were evaluated for calcium content. Result: No protein denaturation was observed microscopically after decellularization. There was a 32% mean decrease in tensile strength index after decellularization in the bovine pericardium group fixed. Octanediol preincubation attenuated the decrease in tensile strength and maintained thermal stability. TG and cholesterol were not affected by decellularization but were decreased by organic solvent. Calcium content was decreased after decellularization, and organic solvent preincubation decreased calcification in the non-decellularized bovine pericardium group. Conclusion: Decellularization and organic solvent preincubation have anti-calcification effects but decellularization may cause mechanical instability. A method of decellularization and fixation that does not cause damage to matrices will be needed for evaluation of the next step in using tissue-engineering for replacement of cardiac valves.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.28-33
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• 2009

Background: Functional tricuspid regurgitation (TR) greater than or equal to a mild grade requires tricuspid valvuloplasty, and tricuspid valvuloplasty with ring annuloplasty has shown good outcomes. We report here on our early experience with the Edwards $MC^3$ annuloplasty system (Edwards LifeSciences, Irvine, CA). Material and Method: From November 2004 to July 2006, 72 patients with tricuspid annular dilatation and TR underwent tricuspid valvuloplasty with using the Edwards $MC^3$ annuloplasty ring. Sixty-eight patients were operated on via median sternotomy and four patients were operated on using robotic assisted minimal invasive thoracotomy. The patient population included 21 males and 51 females and their mean age was $53.9{\pm}12.3$. The mean grade of TR, as assessed by the preoperative echocardiography, was $2.2{\pm}1.0$. The mean NYHA functional class was $3.1{\pm}0.8$. The mean left ventricular ejection fraction was $57.0{\pm}9.9$%. Result: The TR and NYHA functional class, as assessed by postoperative echocardiography, was significantly reduced (mean=$0.4{\pm}0.6$ and $2.0{\pm}0.7$, respectively p<0.001). There was one case of hospital mortality. One patient required permanent pacemaker insertion for third degree atrioventricular block. Conclusion: Our study shows that the Edwards $MC^3$ remodeling ring is easy to implant and it effectively corrects functional TR with excellent clinical and echocardiographic outcomes. Further follow-up and a larger clinical series are required to establish the long-term stability of this repair technique.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.233-237
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• 2009

Background: Bupivacaine with fentanyl might be suitable as the spinal anesthesia for performing ambulatory surgery to treat varicose vein. Material and Method: Thirty patients who underwent spinal anesthesia for a varicose vein operation were enrolled in this study. They were classified into 2 groups of either fentanyl 25ug mixed with bupivacaine 4mg (group FB4) or bupivacaine 8mg (group B8). We compared the groups for the success of the analgesia, the recovery time from sensory and motor block, the side effects and the postoperative complications. Result: The groups did not differ significantly regarding the success of analgesia (13 of 15 [group FB4], 15 of 15 [group B8]). None of the patients were converted to general anesthesia due to surgical pain. None of the patients required medication for hypotension and/or bradycardia. The operative and nonoperative side effects of motor block (tested for by using a modified Bromage scale) was significantly lower in group FB4 than that in group B8, as checked at 2 hours after spinal anesthesia (p<0.05). Recovery from spinal block was significantly quicker in group FB4 than that in group B8 (p<0.05). The first voluntary micturition time did not differ significantly (6.5 hours v 4.5 hours [p=0.143]) between the groups, but a nelatone catheter was inserted into 2 of the group B8 patients due to dysuria. Conclusion: Adequate intraoperative analgesia and hemodynamic stability and faster mobilization were achieved using bupivacaine 4mg with fentanyl 25ug. Low dose spinal anesthesia with fentanyl is suitable for performing ambulatory surgery to treat varicose vein.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.373-378
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• 1999

Background: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. Material and Method: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. Result: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. Conclusion: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.

• The Journal of the Society of Korean Medicine Diagnostics
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• v.9 no.1
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• pp.112-124
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• 2005

Background: PWV is determined by dividing the distance by the time taken for the pulses traveling between two measuring sites, used as a marker of arterial stiffness and an important indicator for cardiovascular disease. Methods: A PWV measurement system, which offers a non-invasive, simple method of measurement, and simultaneous recording of six signlas(ECG, PCG and four pulse waves from carotid, femoral, radial and dorsalis pedis arteries) was developed. Seventeen healthy subjects with a mean age of 33 years(22 to 52) without any cardiovascular disease were participated for the experiment. Two observers(A and B) performed two consecutive measurements from the same subject in a random order. For the evaluation of stability and accuracy of the PWV measurement system, reproducibility of PWV from between-observer were also evaluated. Results: PWV $values(Mean{\pm}SD)$ measured by A were $7.07{\pm}1.48m/s$, $8.43{\pm}1.14m/s$ , $8.09{\pm}0.98m/s$ for aorta, arm, and leg, respectively. The values obtained from B were $6.76{\pm}1.00m/s$, $7.97{\pm}0.80m/s$, and $7.97{\pm}0.72m/s$ for aorta, arm, and leg, respectively. Between-observer $differences(mean{\pm}SEM)$ from the aorta, arm and leg were $0.14{\pm}0.15m/s$, $0.18{\pm}0.10m/s$ and $0.07{\pm}0.10m/s$. Reproducibility coefficients(2SD) from the aorta, arm, and leg were 0.62m/s, 0.84m/s and 0.86m/s. Correlation coefficients were significantly higher in aortic PWV, 0.93, compared to the coefficients for arm and leg. Coefficient of variance which reflects the reproducibility of the system ranged from $4.4{\sim}5.8%$ in all regional PWV. , Conclusion: Reproducibility of PWV in the study shows that the developed system has reliable and reproducible characteristics. The PWV measurement system used for the study offers comfortable and simple operation and provides accurate analysis and results with high reproducibility. Results of the PWV measurement system could contribute to various clinical applications in the future.

• Journal of Chest Surgery
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• v.25 no.2
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• pp.125-130
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• 1992

To evaluate the effect of oxygenation[95% O2+5% CO2] of St. Thomas Hospital No.2 cardioplegic solution[Plegisol], 20 isolated perfused rat hearts were studied under hyp-othermic[20oC] ischemic arrest for 2 hours with infusion of cardioplegic solution every 30 minutes throughout the ischemic period. Ten isolated hearts were studied with the oxygenated cardioplegic solution and 10 another isolated hearts with the nonoxygenated one. Mean oxygen tensions of the nonoxygenated and oxygenated cardioplegic solutions were 150mmHg and 470mmHg, respectively. Two in 10 hearts infused with the nonaxygenated cardioplegic solution were not recovered from nonworking heart due to persistent ventricular fibrillation. In comparing hem-odynamic parameters between both groups, the mean postischemic recovery[expressed as a percentage of its preischemic control value] was significantly greater with the oxygenated solution[in 10 recovered hearts] than the nonoxygenated solution[in 8 recovered hearts] [95.9$\pm$1.8% compared with 88.5$\pm$2.9% in peak aortic pressure, p<0.05, 75.7$\pm$5.2% compared with 43.5$\pm$6.5% in aortic flow, p<0.01, 75.5$\pm$4.6% compared with 54.1$\pm$5.6% in cardiac output, p<0.01, 78.3$\pm$4.6% compared with 60.3$\pm$4.6% compared with 60.3$\pm$6.2% in stroke volume, p<0.05, and 80.4$\pm$5.3% compared with 58.6$\pm$7.0% in dP/dT, p<0.05]. It is concluded that oxygenation of St. Thomas Hospital No.2 cardioplegic solution improves cardiac electrical stability and postischemic hemodynamic recovery after ischemic arrest in the isolated perfused rat heart.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.11
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• pp.5333-5338
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• 2012

Vitamin B6 functions as a coenzyme in >140 enzymatic reactions involved in the metabolism of amino acids, carbohydrates, neurotransmitters, and lipids. It comprises a group of three related 3-hydroxy-2-methyl-pyrimidine derivatives: pyridoxine (PN), pyridoxal (PL), pyridoxamine (PM) and their phosphorylated derivatives [pyridoxal 5'-phosphate (PLP) and pyridoxamine 5'-phosphate (PMP)], In the folate metabolism pathway, PLP is a cofactor for the mitochondrial and cytoplasmic isozymes of serine hydroxymethyltransferase (SHMT2 and SHMT1), the P-protein of the glycine cleavage system, cystathionine ${\beta}$-synthase (CBS) and ${\gamma}$-cystathionase, and betaine hydroxymethyltransferase (BHMT), all of which contribute to homocysteine metabolism either through folate-mediated one-carbon metabolism or the transsulfuration pathway. Folate cofactors carry and chemically activate single carbons for the synthesis of purines, thymidylate and methionine. So the evidence indicates that vitamin B6 plays an important role in maintenance of the genome, epigenetic stability and homocysteine metabolism. This article focuses on studies of strand breaks, micronuclei, or chromosomal aberrations regarding protective effects of vitamin B6, and probes whether it is folate-mediated one-carbon metabolism or the transsulfuration pathway for vitamin B6 which plays critical roles in prevention of cancer and cardiovascular disease.

• Korea-Australia Rheology Journal
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• v.18 no.2
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• pp.51-65
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• 2006

Of concern in the present theoretical investigation is the study of blood flow and convection-dominated diffusion processes in a model bifurcated artery under stenotic conditions. The geometry of the bifurcated arterial segment having constrictions in both the parent and its daughter arterial lumen frequently appearing in the diseased arteries causing malfunction of the cardiovascular system, is constructed mathematically with the introduction of suitable curvatures at the lateral junction and the flow divider. The streaming blood contained in the bifurcated artery is treated to be Newtonian. The flow dynamical analysis applies the two-dimensional unsteady incompressible nonlinear Wavier-Stokes equations for Newtonian fluid while the mass transport phenomenon is governed by the convection diffusion equation. The motion of the arterial wall and its effect on local fluid mechanics is, however, not ruled out from the present model. The main objective of this study is to demonstrate the effects of constricted flow characteristics and the wall motion on the wall shear stress, the concentration profile and on the mass transfer. The ultimate numerical solutions of the coupled flow and diffusion processes following a radial coordinate transformation are based on an appropriate finite difference technique which attain appreciable stability in both the flow phenomena and the convection-dominated diffusion processes.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.109-116
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• 1976

The effects of atelectasis on surface activity of lung extracts were examined in rabbits. Experimental atelectasis was produced in rabbits by artificial pneumothorax and surface tension properties were measured on saline extracts of lung 24 hrs, 48 hrs, one week and four weeks after the induction of pneumothorax. The results were as follows; 1) The minimum surface tension of excised lung extracts 24 hrs after pneumothorax was significantly increased to 28.3 0.41 dynes/cm, and the stability index was significantly decreased to 0.30 from normal value of 0. 87. 2) In the group which was re-expanded 24 hours, later from pneumothorax the surface activity was returned to almost normal range 24 hrs after reexpansion of collapsed lung, 3) When the atelectasis was continued by mechanical means, the extracts of atelectatic lung showed progressive decrease in surface activity, but it was found that surface activity returned to normal level after four weeks even the presence of atelectasis. 4) These observations suggest to us that atelectasis per se does not cause an increase in surface tension of lung extracts, and even in prolonged atelectasis the re-expansion of collapsed lung may be possible when the mechanical cause of atelectasis was excluded.

• Journal of Chest Surgery
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• v.18 no.1
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• pp.69-74
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• 1985

Most clinicians have taken a lot of interest in tumors arising from the bony thorax because not only of their rarity and predictable diagnosis which could be reflected as a unique radiologic shadow but also variable surgical modes for maintenance of chest wall stability encountered after en-bloc resection. By the retrospective review, we have analyzed 24 cases of primary bony thorax tumors which were experienced and surgically treated at the St. Mary`s hospital of Catholic Medical College from Jan. 1969 to Sept. 1984. The results are as follows: 1. Age incidence was evenly distributed through all decades and the male-female ratio is 15:9. 2. 16 cases out of 24 were benign tumors and the commonest one of which was fibrous dysplasia. 3. Remaining 8 cases were malignant tumors and among which osteogenic sarcoma was the commonest one. 4. The majority of tumors [22/24] were developed from the rib and the remains were from the sternum. 5. Common manifestation were palpable mass or swelling and localized tenderness. 6. Various kinds of operative procedure were underwent: single resection of rib including tumor,14 cases; multiple resection of ribs with chemotherapy or myoplasty, 2 cases; en-bloc resection of the chest wall and reconstructive procedure, 5 cases; partial resection of sternum, 1 case; bone biopsy and chemotherapy, 2 cases.