Prevention of thromboembolism with ticlopidine and aspirin after cardiac valve replacement (심장변막치환후 Ticlopidine과 Aspirin의 혈전방지 효과)
-
- Journal of Chest Surgery
- /
- v.19 no.1
- /
- pp.35-42
- /
- 1986
Prevention of thrombombolism after rosthetic cardiac valve replacement is essential for the patients. About 90% of patients are free of major and minor thromboembolic complications 5 year after replacement of cardiac valves with prosthetic devices when they are under control of anticoagulant therapy. Ticlopidine is a drug that alter platelet function to have an antithrombotic effect. It is an antiaggregating agent which inhibits primary platelet function to have an antithrombotic effect. It is an antiaggregating agent which inhibits primary platelet aggregation induced by ADP and increases the production of prostaglandin $D_{2}$. Aspirin in small doses inhibits platelet synthesis of prostaglandins by irreversibly blocking the enzyme cyclo-oxygenase. Platelet secretion and aggregation are impaired with Ticlopidine and Aspirin. the thromboembolic event sof 54 patient s who were treated with Ticlopidine and Aspirin after cardiac valve replacement were evaluated and compared with that of 79 patients who were treated with Wafarin and Aspirin after the same type of operation. The follow-up period ranged from 4 to 110 months (mean of 48 months). there were 11 major thromboembolic episodes including three deaths in the warfarin goup during mean follow-up period of 56 months. two cases of CVA and one hemoarthrosis were noted due to overdose of Warfarin. Inticlopidine group, there was only one fatal thromboembolic epdisode three month after mitral valve replacement during mean follow-up period of 18 months. Two episodes of hypermenorrhea resulting anemia ere noted in the ticlopidine group. We measured the parameters of platelet function in aggreagation curve of platelet with platelet aggregometer (chrono-log Aggregometer, Model No. 430) Aggregation test was performed with three final concentrations of epinephrine in 10 uM/L, ADP in 5uM/L. 28 patients with prosthetic cardiac valves and 35 healthy volunteers were subgrouped as follows to analyze the effect of antithrombotic drugs used. Group I ; 11 patients treated with 250-500 mg of ticlopidine and 0.5gm of Aspirin as a daily single dose after cardiac valve replacement (14 St. Jude Medical and 1 Carpentier-Edwards, 9 patients with atrial fibrillation among them) Group II ; 10 patients treated with 3-5 mg of Warfarin and 0.75 gm of Aspirin daily to prolong prothrombin time around 20 seconds for more than 6 months and single Aspirin dose was maintained afterward as a life-long regimes(3 St. Jude Medical, 1 Hall-Kaster and 7 Carpentier-Edwards valve, 9 patients in atrial fibrilation). Group III ; 7 patients who quit anticoagulant treatment (Warfarin + Aspirin) 6-12 months after the regime as group II (3 St. Jude Medical. 1 bjork-Shiley, 1 Hall-Kaster, 3 Carpentier-Edwards valve, 2 of them are with atrial fibrillation). Group IV ; 35 healthy vounteers (28 males and 7 females). The following results were obtained. 1. The mean maximal platelet aggregability in Group I induced by 10uM/L epinephrine was 15.6%, and 17.5 and 18.7% in BM in proportion to the induction by 5 and 10 uM/L ADP. 2. The mean maximal platelet aggregability in Group II induced by 10uM/L epinephrine was 16.5%, and 27.4 and 44.7% in BM in proportion to the induction by 5 and 10uM/L ADP. 3. The mean maximal platelet aggregability in group III induced by 10uM/L epinephrine was 65%, and 56.5 and 51.8% in BM in proportion to the induction by 5 and 10 uM/L ADP. 4. The mean maximal platelet aggregability in the normal subjects induced by 10 uM/L epinephrine was 64%, and 65 and 69% in Bm inproportion to the induction by 5 and 10 uM/L ADP. 5. Reversible change of platelet aggregation curve induced by 5 and 10uM/L was noted all of the patients in Group I. conclusion : Ticlopidine is an antiaggregating agent which inhibits primary platelet aggregation induced by ADP, and increases the production of prostaglandin $D_{2}$. Ticlopidine and Aspirin produced a significant inhibition of platelet in the presence of ADP and epinephrine in our study. Acccording to our brief experience, 250 mg of ticlopidine and low dose of Aspirin resulted synergistic superior effect to each drug alone in prevention of thromboembolism after prosthetic cardiac valve replacement.
The duty shifts of hospital nurses not only affect nurses' physical and mental health but also present various personnel management problems which often result in high turnover rates. In this context a study was carried out from October to November 1995 for a period of two months to find out the status of hospital nurses' duty shift patterns, and preferred duty hours and fixed duty shifts. The study population was 867 RNs working in five general hospitals located in Seoul and its vicinity. The questionnaire developed by the writer was used for data collection. The response rate was 85.9 percent or 745 returns. The SAS program was used for data analysis with the computation of frequencies, percentages and Chi square test. The findings of the study are as follows: 1. General characteristics of the study population: 56 percent of respondents was (25 years group and 76.5 percent were "single": the predominant proportion of respondents was junior nursing college graduates(92.2%) and have less than 5 years nursing experience in hospitals(65.5%). For their future working plan in nursing profession, nearly 50% responded as uncertain The reasons given for their career plan was predominantly 'personal growth and development' rather than financial reasons. 2. The interval for rotations of duty stations was found to be mostly irregular(56.4%) while others reported as weekly(16.1%), monthly(12.9%), and fixed terms(4.6%). 3. The main problems related to duty shifts particularly the evening and night duty nurses reported were "not enough time for the family, " "afraid of security problems after the work when returning home late at night." and "lack of leisure time". "problems in physical and physiological adjustment." "problems in family life." "lack of time for interactions with fellow nurses" etc. 4. The forty percent of respondents reported to have '1-2 times' of duty shift rotations while all others reported that '0 time'. '2-3 times'. 'more than 3 times' etc. which suggest the irregularity in duty shift rotations. 5. The majority(62.8%) of study population found to favor the rotating system of duty stations. The reasons for favoring the rotation system were: the opportunity for "learning new things and personal development." "better human relations are possible. "better understanding in various duty stations." "changes in monotonous routine job" etc. The proportion of those disfavor the rotating 'system was 34.7 percent. giving the reasons of"it impedes development of specialization." "poor job performances." "stress factors" etc. Furthermore. respondents made the following comments in relation to the rotation of duty stations: the nurses should be given the opportunity to participate in the. decision making process: personal interest and aptitudes should be considered: regular intervals for the rotations or it should be planned in advance. etc. 6. For the future career plan. the older. married group with longer nursing experiences appeared to think the nursing as their lifetime career more likely than the younger. single group with shorter nursing experiences (
Purpose: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). Materials and Methods: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+
The research conducted here focuses on the effect of factors that affect the behavior of UCC (User Created Content) website users, other than user's rational recognition of how useful a UCC website can be. Most discussions in the existing literature on information systems have focused on users' evaluation how a UCC website can help to attain the users' own goals. However, there are other factors and this research pays attention to an individual's 'personality,' which is stable and biological in nature. Specifically, I have noted here that 'extroversion' and 'neuroticism,' the two common personality factors presented in Eysenck's most representative 'EPQ Model' and 'Big Five Model,' are the two personality factors that affect a site's 'usefulness,' by this I mean how useful does the user consider the website and its content. How useful a site is considered by the user is the other factor that has been regarded as the antecedent factor that influences the adoption of information systems in the existing MIS (Management Information System) research. Secondly, as using or creating a UCC website does not guarantee the user's or the creator's extrinsic motivation, unlike when using the information system within an organization, there is a greater likelihood that the increase in user's activities in relation to a UCC website is motivated by emotional factors rather than rational factors. Thus, I have decided to include the relationship between an individual's personality and what they find pleasurable in the research model. Thirdly, when based on the S-O-R Paradigm of Mehrabian and Russell, the two cognitive factors and emotional factors are finally affected by stimulus, and thus these factors ultimately have an effect on an individual's respondent behavior. Therefore, this research has presented an assumption that the recognition of how useful the site and content is and what emotional pleasure it provides will finally affect the behavior of the UCC website users. Finally, the relationship between the recognition of how useful a site is and how pleasurable it is to useand UCC usage may differ depending on certain situational conditions. In other words, the relationship between the three factors may vary according to how much users are involved in the creation of the website content. Creation thus emerges as the keyword of UCC. I analyzed the above relationships through the moderating variable of the user's involvement in the creation of the site. The research result shows the following: When it comes to the relationship between an individual's personality and what they find pleasurable it is extroverted users who have a greater likelihood to feel pleasure when using a UCC website, as was expected in this research. This in turn leads to a more active usage of the UCC web site because a person who is an extrovert likes to spend time on activities with other people, is sensitive to new experiences and stimuli and thus actively responds to these. An extroverted person accepts new UCC activities as part of his/her social life, rather than getting away from this new UCC environment. This is represented by the term 'Foxonomy' where the users meet a variety of users from all over the world and contact new types of content created by these users. However, neuroticism creates the opposite situation to that created by extroversion. The representative symptoms of neuroticism are instability, stress, and tension. These dispositions are more closely related to stress caused by a new environment rather than this creatingcuriosity or pleasure. Thus, neurotic persons have an uneasy feeling and will eventually avoid the situation where their own or others' daily lives are frequently exposed to the open web environment, this eventually makes them have a negative attitude towards the web environment. When it comes to an individual's personality and how useful site is, the two personality factors of extroversion and neuroticism both have a positive relationship with the recognition of how useful the site and its content is. The positive, curious, and social dispositions of extroverted persons tend to make them consider the future usefulness and possibilities of a new type of information system, or website, based on their positive attitude, which has a significant influence on the recognition of how useful these UCC sites are. Neuroticism also favorably affects how useful a UCC website can be through a different mechanism from that of extroversion. As the neurotic persons tend to feel uneasy and have much doubt about a new type of information system, they actively explore its usefulness in order to relieve their uncomfortable feelings. In other words, neurotic persons seek out how useful a site can be in order to secure their own stable feelings. Meanwhile, extroverted persons explore how useful a site can be because of their positive attitude and curiosity. As a lot of MIS research has revealed that the recognition of how useful a site can be and how pleasurable it can be to use have been proven to have a significant effect on UCC activity. However, the relationship between these factors reveals different aspects based on the user's involvement in creation. This factor of creationgauges the interest of users in the creation of UCC contents. Involvement is a variable that shows the level of an individual's mental effort in creating UCC contents. When a user is highly involved in the creation process and makes an enormous effort to create UCC content (classed a part of a high-involvement group), their own pleasure and recognition of how useful the site is have a significantly higher effect on the future usage of the UCC contents, more significantly than the users who sit back and just retrieve the UCC content created by others. The cognitive and emotional response of those in the low-involvement group is unlikely to last long,even if they recognize the contents of a UCC website is pleasurable and useful to them. However, the high-involvement group tends to participate in the creation and the usage of UCC more favorably, connecting the experience with their own goals. In this respect, this research presents an answer to the question; why so many people are participating in the usage of UCC, the representative form of the Web 2.0 that has drastically involved more and more people in the creation of UCC, even if they cannot gain any monetary or social compensation. Neither information system nor a website can succeed unless it secures a certain level of user base. Moreover, it cannot be further developed when the reasons, or problems, for people's participation are not suitably explored, even if it has a certain user base. Thus, what is significant in this research is that it has studied users' respondent behavior based on an individual's innate personality, emotion, and cognitive interaction, unlike the existing research that has focused on 'compensation' to explain users' participation with the UCC website. There are also limitations in this research. Firstly, I divided an individual's personality into extroversion and neuroticism; however, there are many other personal factors such as neuro-psychiatricism, which also needs to be analyzed for its influence on UCC activities. Secondly, as a UCC website comes in many types such as multimedia, Wikis, and podcasting, these types need to be included as a sub-category of the UCC websites and their relationship with personality, emotion, cognition, and behavior also needs to be analyzed.