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Coronary Artery Bypass Graft Surgery in Patients 70 Years of Age and Older (70세 이상 고령 환자에서의 관상동맥우회술)

  • Park Jong Un;Lee Weon Yong;Kim Kun Il;Hong Ki Woo;Chee Hyun Keun;Shin Yoon Cheol;Lee Jae Woong;Kim Eung Jung
    • Journal of Chest Surgery
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    • v.39 no.1 s.258
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    • pp.28-34
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    • 2006
  • Background: There has been an increase in the number of elderly patients considered for coronary artery bypass grafting (CABG). Recently, there were many satisfactory reports of coronary artery bypass grafting (CABG) in old age due to the development in operative technique and postoperative management. We evaluated operative and follow-up results of patients 70 years of age and older compared to 60 years old. Material and Method: We retrospectively studied the cases of 74 consecutive patients 70 years or older (group A) who underwent a elective CABG from January 2000 to December 2003 and compared that of relatively young age group (group B, 60-69 years old). We compared preoperative characteristics, operation technique, postoperative results that effect outcome, also we investigated late mortality and cardiac events at follow-up periods. Result: Preoperative demographic and clinical characteristics of two groups were not different, except preoperative renal dysfunction(serum creatinine: $\geq$1.4 mg/dl) (group A 17, 23$\%$ vs group B 14, 9$\%$) (p=0.024). There was no difference of the mean number of distal anastomosis and the left ventricular ejection fraction in group A decreased significantly from 53.7$\pm$13$\%$ preoperatively to 49.9$\pm$ 12$\%$ postoperatively (p=0.02), but not changed in group B. There was no difference at operative mortality rate and postoperative major morbidity rate, but wound problem of saphenous vein harvest site was significantly higher in group A than group B (6.8$\%$ vs 0.7$\%$, p=0.02). The mean follow up duration was 24.3$\pm$13 months and the cumulative survival were 95.4$\%$ at 2 year and 79.9$\%$ at 4 year in group A and 95.4$\%$ at 2 year and 90.1$\%$ at 4 year in group B (p=ns). Conclusion: We conclude that age is not a factor of determination when we decide about operation because coronary artery bypass grafting in elderly more than 70 years old can be performed with a low mortality rate and acceptable morbidity rate.

Combined Transcatheter Arterial Chemoembolization and Local Radiotherapy for Unresectable Hepatocellular Carcinoma (절제불가능 원발성 간암에서 경간동맥 항암 색전술과 국소 방사선의 병용요법)

  • Seong Jinsil;Keum Ki Chang;Han Kwang Hyub;Lee Do Yun;Lee Jong Tae;Chon Chae Yoon;Moon Young Myoung;Kim Gwi Eon;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.16 no.2
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    • pp.159-165
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    • 1998
  • Purpose : The best prognosis for hepatocellular carcinoma can be achieved with surgical resection. However, the number of resected cases is limited due to the advanced lesion or associated liver disease. A trial of combined transcatheter arterial chemoembolization(TACE) and local radiotherapy(RT) for unresectable hepatocellular carcinoma(HCC) was prospectively conducted and its efficacy and toxicity were investigated. Materials and Methods : From 1992 to 1994, 30 Patients with unresectable HCC due either to advanced lesion or to associated cirrhosis were entered in the study Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child's class C, tumors occupying more than two-thirds of the whole liver, and an ECOG scale of more than 3. Patient cHaracteristics were : mean tumor size $8.95\pm3.4cm$, serum AFP+ in all patients, portal vein thrombosis in all patients, liver cirrhosis in 22 patients, and UICC stage III and IVA in 10 and 20 patients, respectively. TACE was performed with the mixture of Lipiodol(5ml) and Adriamycin(50mg) and Gelfoam embolizatin. RT(mean dose $44.0\pm9.3Gy$) 10 days with conventional fractionation. Results : An objective response was observed in 19 patients($63.3\%$). Survival rates at 1 2, and 3 years were $67\%,\;33.3\%$ and $22.2\%$, respectively. Median survival was 17 months. There were 6 patients surviving more than 3 years. Distant metastasis occurred in 10 patients, with 8 in the lung only and 2 in both lung and bone, Toxicity included transient elevation of liver function test in all patients, fever in 20, thrombocytopenia in 4, and nausea and vomiting in 1. There was no treatment-related death. Conclusion : Combined TACE and RT appear to produce a favorable response and survival results with minimal toxicity.

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Effect of the Supply of Natural Water from Deep Sea Rock on the Immune Response and Antioxidant Activity in Rats (천연 암반 심해수 공급이 흰쥐의 면역반응 및 항산화 활성에 미치는 영향)

  • 정수진;주은정;유지영;김윤경;조용진;윤병선;조진국;남기택;황성구
    • Journal of Animal Science and Technology
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    • v.48 no.2
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    • pp.211-218
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    • 2006
  • This experiment was conducted to study the effects of the natural deep sea water, which contained approximately 2.3% salt, and various minerals of K, Mg, Ca, Na, Fe, Mn, Zn, Cu etc, on the immune response and antioxidant activity in rats. 24 Sprague Dawley rats were randomly allotted to a control group and 3 treatment groups. Control rats were supplied with filtered tap water, and each treatment group rats were supplied with 0.5% deep sea water, 1% deep sea water and Jijangsoo, respectively, which is upper clear water separated from sediment by the clay. Feed and water were provided ad libitum throughout the experiment that lasted for 4 weeks. The results showed that 1% deep sea water group showed the highest values in weight gain, feed intake, and feed efficiency than those of other groups. The levels of water intake of 1%- and 0.5%-deep sea water, and Jijangsoo group were 49.1%, 22.8%, and 40.5% higher than that of control group, respectively. The Jijangsoo group rats showed that perirenal and epididymal adipose tissue weights were decreased by 32% and 25%(p<0.05), respectively, when compared to control group rats. There were no remarkable differences of serum glucose concentration among all experimental groups. However, insulin concentration of experimental groups were remarkably increased in order of Jijangsoo (4.54), 1% deep sea water (3.70), 0.5% deep sea water (3.25)(p<0.05). B cell and T cell stimulation were increased about 44.7% and 207%, respectively, by 0.5% deep sea water in comparison with control (p<0.05). TBARS values of 0.5 % deep sea water group were significantly lower than that of control(p<0.05). Catalase and SOD activities of 0.5 % deep sea water group were 200% and 47% higher than that of control, respectively. From the results, it can be concluded that the supply of natural deep sea water can slightly improve the physiological activity which modulates immune response and antioxidant activity in rats.

Effect of Treadmill Exercise Training on the Expression of PGC-1α, GLUT-1, Tfam Proteins and Antioxydent Ezymes in Brain of STZ-Induced Diabetic Rats (트레드밀 지구성 운동이 streptozotocin으로 유발된 당뇨 흰쥐의 뇌에서 PGC-1α, GLUT-1, Tfam 단백질 및 항산화 효소(Cu, Zn-SOD, Mn-SOD)의 발현량에 미치는 영향)

  • Park, Noh-Hwan;Lee, Jin;Jung, Kook-Hyun;Choi, Bong-Am;Jang, Hyung-Chae;Lee, Suk-In;Lee, Dong-Soo;Cho, Joon-Yong
    • Journal of Life Science
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    • v.21 no.3
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    • pp.435-443
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    • 2011
  • The purpose of this study is to identify the effects of exercise training [ET, 10~18 m/min (speed), 20~30 min (exercise duration)/a day for 5 day/wk, 6 wk) on PGC-$1{\alpha}$, GLUT-1, Tfam, Cu,Zn-SOD and Mn-SOD proteins in brain of STZ-induced diabetic rats. The male Sprague-Dawley (SD) rats were single-injected intraperitoneally with 50mg/kg of streptozotocin (STZ) to produce STZ-induced diabetic rats. Rats were divided into 3 experimental groups with 8 rats in each group, as follows: (1) non-STZ group (n=8), (2) STZ-CON group (n=8), (3) STZ-EXE group (n=8). The results of this study suggest that i) serum glucose level was significantly reduced in STZ-EXE group compared with STZ-CON group (p<0.05), ii) PGC-$1{\alpha}$ (p<0.001), mtPGC-$1{\alpha}$ (p<0.001), GLUT-1 (p<0.001), and mtTfam (p<0.001) proteins in brain of STZ-induced diabetic rats were significantly increased in STZ-EXE group compared with STZ-CON group, iii) Cu,Zn-SOD (p<0.001) and Mn-SOD (p<0.01) proteins in the STZ-induced diabetic rats were significantly increased in STZ-EXE group compared with STZ-CON group. In conclusion, the findings of the present study reveal that treadmill exercise training increases brain GLUT-1 protein level possibly through up-regulation of PGC-$1{\alpha}$ and Tfam proteins which represent key regulatory components of stimulation of brain mitochondrial biogenesis. In addition, treadmill exercise training may prevent oxidative stress by up-regulation of Cu,Zn-SOD and Mn-SOD proteins in the STZ-induced diabetic rats.

Inhibitory Effect of the Hexane Extract of Saussurea lappa on the Growth of LNCaP Human Prostate Cancer Cells (목향 헥산추출물의 LNCaP 전립선암세포 증식 억제 효과)

  • Park, So-Young;Kim, Eun-Ji;Lim, Do-Young;Kim, Jong-Sang;Lim, Soon-Sung;Shin, Hyun-Kyung;Yoon Park, Jung-Han
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.37 no.1
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    • pp.8-15
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    • 2008
  • Saussurea lappa (SL) has been used to reduce abdominal pain and tenesmus in traditional oriental medicine. SL and major compounds of SL, sesquiterpene lactones, have been suggested to possess various biological effects, including anti-tumor, anti-ulcer, anti-inflammatory, anti-viral and cardiotonic activities. Recently, it has been reported that ethanol extracts from roots of SL have antiproliferative effects on gastric cancer cells. To explore the possibility that SL has chemopreventive effects on prostate cancer, we examined whether the hexane extract of SL (HESL) inhibits the growth of LNCaP human prostate cancer cells. Cells were incubated with various concentrations ($0{\sim}4$ mg/L) of HESL in DMEM/F12 containing 5% charcoal stripped fetal bovine serum. HESL substantially decreased viable cell numbers and induced apoptosis of LNCaP cells in dose-dependent manners. HESL increased the levels of cleaved caspase-8, -9, -7 and -3, and poly (ADP-ribose) polymerase. HESL increased the levels of the pro-apoptotic Bak and truncated-Bid proteins whereas it had no effect on the anti-apoptotic Bcl-2, Bcl-xL, or Mcl-1. The present results indicate that HESL inhibits the growth of human prostate cancer cells by inducing apoptosis, which involves the activation of the caspase cascades.

Improvement Effect of Cordycepin-Enriched Cordyceps militaris JLM 0636 Powder against Orotic Acid-Induced Fatty Liver in Rats (Cordycepin 고함유 동충하초(Cordyceps militaris JLM 0636)의 orotic acid 유발 흰쥐의 지방간 개선효과)

  • Cha, Jae-Young;Ahn, Hee-Young;Heo, Su-Jin;Park, Sang-Hyun;Jeong, Yong-Kee;Cho, Young-Su
    • Journal of Life Science
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    • v.21 no.9
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    • pp.1274-1280
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    • 2011
  • The concentration of cordycepin produced by crossbred Cordyceps militaris JLM 0636 (CM${\alpha}$) was 7.42 mg/g dry weight, which was 7-fold higher than that of C. militaris (CM). However, cordycepin was not detected in Paecilomyces japonica (PJ). The improvement effects of CM${\alpha}$, CM and PJ on orotic acid (OA)-induced fatty liver in male Sprague-Dawley rats was investigated. Rats were randomly divided into five groups (n=6) based on five dietary categories: normal (N), OA control (C), OA plus 3% (w/w) PJ (PJ), OA plus 3% CM (CM), and OA plus 3% CM${\alpha}$ (CM${\alpha}$). OA treatment induced the retardation of body weight gain and enlargement of the liver. The concentration of hepatic triglyceride was markedly increased by OA-feeding, whereas this rise was significantly reduced by simultaneous feeding of OA, PJ, CM, and CM${\alpha}$, and this phenomenon was more pronounced by cordycepin-enriched CM${\alpha}$. The contents of total lipid, triglyceride, and free fatty acid in the serum were significantly or slightly lower in the OA control group than those of the N group, but there were no significant differences among the OA treatment groups. The hepatocytes in the OA-induced fatty liver contained numerous large lipid droplets, but PJ, CM, and CM${\alpha}$ feeding prevented the OA-induced lipid droplet accumulation in the hepatocytes. This effect was more pronounced in cordycepin-enriched CM${\alpha}$ than in PJ or CM in OA treatment rats. Accordingly, cordycepin-enriched CM${\alpha}$ could be an ideal candidate material as a dietary supplement in healthy functional foods to improve the effects of fatty liver.

Factors Predicting the Development of Radiation Pneumonitis in the Patients Receiving Radiation Therapy for Lung Cancer (방사선 치료를 시행 받은 폐암 환자에서 방사선 폐렴의 발생에 관한 예측 인자)

  • An, Jin Yong;Lee, Yun Sun;Kwon, Sun Jung;Park, Hee Sun;Jung, Sung Soo;Kim, Jin whan;Kim, Ju Ock;Jo, Moon Jun;Kim, Sun Young
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.1
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    • pp.40-50
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    • 2004
  • Background : Radiation pneumonitis(RP) is the major serious complication of thoracic irradiation treatment. In this study, we attempted to retrospectively evaluate the long-term prognosis of patients who experienced acute RP and to identify factor that might allow prediction of RP. Methods : Of the 114 lung cancer patients who underwent thoracic radiotherapy between December 2000 and December 2002, We performed analysis using a database of 90 patients who were capable of being evaluated. Results : Of the 44 patients(48.9%) who experienced clinical RP in this study, the RP was mild in 33(36.6%) and severe in 11(12.3%). All of severe RP were treated with corticosteroids. The median starting corticosteroids dose was 34 mg(30~40) and median treatment duration was 68 days(8~97). The median survival time of the 11 patients who experienced severe RP was significantly poorer than the mild RP group. (p=0.046) The higher total radiation dose(${\geq}60Gy$) was significantly associated with developing in RP.(p=0.001) The incidence of RP did not correlate with any of the ECOG performance, pulmonary function test, age, cell type, history of smoking, radiotherapy combined with chemotherapy, once-daily radiotherapy dose fraction. Also, serum albumin level, uric acid level at onset of RP did not influence the risk of severe RP in our study. Conclusion : Only the higher total radiation dose(${\geq}60Gy$) was a significant risk factor predictive of RP. Also severe RP was an adverse prognostic factor.

Detection of TNF-alpha in Serum as the Effect of Corticosteroid to the Myocardial Protection in Cardiopulmonary Bypass (체외순환시 스테로이드의 심근보호효과에 관한 혈청내 TNF-alpha 측정의 의의)

  • 최영호;김욱진;김태식;조원민;김학제
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.502-508
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    • 1998
  • Proinflammatory cytokines such as tumor necrosis factor-$\alpha$(TNF-$\alpha$) have been implicated in myocardial and organ dysfunction associated with postperfusion syndrome. We tested the hypothesis that cytokine productions are depressed by preoperative cortiosteroid injection for cardiopulmonary bypass(CPB) and the postoperative courses will be better than without steriod pretreated cases. Cardiac surgery was performed in randomized blind fashion for 20 patients from June 1996 to September 1996. In the steroid group(n=10), corticosteroid(dexamethasone 1 mg/kg) was injected 1 hour before anesthetic induction, but in the control group(n=10), nothing was injected. Each of groups were sampled 11 times as scheduled for TNF-$\alpha$ bioassays. We have checked EKG, cardiac enzymes(CPK, LDH with isoenzyme), WBC count preoperative day, one day and three days after operation. Viatal signs were continuously monitored for three postoperaive days. In the postoperative period three patients in the control group had elevated body temperature and four patients had hypotension that required considerable intravenous fluid administration. But steroid injected patients showed normal body temperture and acceptable blood pressures without supportive treatment. CPK enzymes rose in control group higher than steroid group at postoperative 1st and 3rd day(CPK; 1122$\pm$465 vs 567$\pm$271, 864$\pm$42 vs 325$\pm$87), and CPK-MB enzymes rose in control group higher than steroid group at postoperative 1st day(106.4$\pm$115.1 vs 29.5$\pm$22.4)(P=0.02). Arterial tumor necrosis factor-$\alpha$ rose during cardiopulmonary bypass, peaking at 5 minutes before the end of aortic cross clamping(ACC-5min) in steroid group(11.9$\pm$4.7 pg/ml), and 5 minutes before the end of cardiopulmonary bypass(CPB-5min) in control group(22.3$\pm$6.8 pg/ml). The steroid pretreated patients had a shorter period of time in respirator suport time, ICU stay day, hospital admission day. We conclude that corticosteroid suppress cytokine production during and after cardiopulmonary bypass, and may improve the postoperative course through inhibition of reperfusion injury such as myocardial stunning and hemodynamic instability.

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In-Hospital Outcomes of Acute Renal Failure Requiring Continuous Renal Replacement Therapy in Patients with On-pump CABG (심폐기 가동하 관상동맥우회술 후 발생한 급성신부전 환자들에 있어 지속적 신대체요법의 병원 내 결과)

  • Kim, Young-Du;Park, Kuhn;Kang, Chul-Ung;Yoon, Jeong-Seob;Moon, Seok-Whan;Wang, Young-Pil;Jo, Kuhn-Hyun
    • Journal of Chest Surgery
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    • v.40 no.1 s.270
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    • pp.32-36
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    • 2007
  • Background: Although acute renal failure (ARF) after coronary artery bypass graft (CABG) is relatively rare, but devastating complication with high mortality. Our study aims to evaluate the effectiveness of early application of CRRT in patients with ARF which developed after on-pump CABG. Material and Method: Two hundred and eighty seven patients underwent isolated on-pump CABG between May 2002 and Feb. 2006 at our institution, of whom 15 (5.2%) needed CRRT (11 patients for postoperatively developed ARF and the remaining 4 patients with preexisting dialysis-dependent chronic renal failure (CRF) for postoperative hemodynamic and metabolic control). Criteria for early application of CRRT were as follows; decreased urine output less than 0.5cc/h/kg for 2 consecutive hours and elevated serum creatinine level greater than 2.0 mg/dL. Result: The incidence of ARF requiring CRRT after on-pump CABG was 3.9% (11/283) and the overall hospital mortality of patient with CRRT was 33.3% (5/15). Of 5 deaths, 4 were patients with postoperatively developed ARF, and 1 was a patient with pre-existing dialysis-dependent CRF patient. The mean time between the operation and the initiation of CRRT was $25.8{\pm}5.8$ hours and the mean duration of CRRT was $62.1{\pm}41.2$ hours. Of the 7 survivors who were not on dialysis-dependent preoperatively, 6 patients fully recovered renal function during hospital stay and 1 patient required permanent renal supportive treatment after discharge from hospital. Conclusion: Early application of CRRT could maintain stable postoperative hemodynamic status and make outcomes better than those of previous reports in patients with ARF which developed after on-pump CABG.

Correlations of Leptin, Adiponectin and Leptin/Adiponectin Ratio with Metabolic Disorders in the Childhood Obesity (소아 비만에서 Leptin, Adiponectin 및 Leptin/Adiponectin Ratio와 대사 장애의 연관성에 관한 연구)

  • Cho, Sung Jong;Kim, Eun Young;Moon, Kyung Rye
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.9 no.1
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    • pp.48-57
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    • 2006
  • Purpose: To investigate the correlation of the serum leptin, adiponectin, and leptin/adiponectin ratio with metabolic disorders in the childhood obesity. Methods: Fifty children (25 obese and 25 non-obese) were recruited in the pediatric outpatient clinic of Chosun University Hospital from January 1st to June 30th 2005. Adiponectin, leptin, anthropometric parameters, glucose, LDL-cholesterol, HDL-cholesterol, total cholesterol, triglyceride, and insulin levels were measured. The correlations of leptin and adiponectin levels with anthropometric parameters, glucose, insulin and lipids were analyzed by Pearson's correlation coefficients. Results: Insulin and leptin levels of the obese group were significantly higher than those of the non-obese group (p<0.05, p<0.001 respectively). HDL-cholesterol and adiponectin levels of the obese group were significantly lower than those of the non-obese group (p<0.005, p<0.05 respectively). In the obese group, leptin level was positively correlated with BMI and the percentage of body fat, but negatively correlated with adiponectin level. Moreover, adiponectin level of the obese group was negatively correlated with BMI and the percentage of body fat, but positively correlated with leptin level. In the non-obese group, only insulin level was positively correlated with adiponectin. In the obese group, leptin/adiponectin ratio was positively correlated with the percentage of body fat and leptin level. Also, leptin/adiponectin ratio was positively correlated with BMI and the percentage of body fat in the non-obese group. Conclusion: Leptin, adiponectin, and leptin/adiponectin ratio did not appear to have a major role linking various metabolic disorders in the childhood obesity, even though they were strongly associated with obesity indices. Also, leptin/adiponectin ratio was associated with obesity indices even in non-obese children.

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