The Heart Rate and ECG Changes after Endoscopic Thoracic Sympathectomy in Patients with Primary Hyperhidrosis / 대한흉부외과학회지

BACKGROUND: Primary focal hyperhidrosis is characterized by overactivity of the sympathetic nervous function, and this has been effectively treated with endoscopic thoracic sympathetic denervation (ESD). The imbalance of sympathetic and parasympathetic nervous system that's created by ESD may affect the heart, lung and other thoracic organs. We analyzed the heart rate and ECG changes after performing ESD at our hospital, and this is the first such study that has been conducted on this. MATERIAL AND METHOD: Of the 263 patients who underwent ESD between October 1996 and October 2006, 130 had ECG before and after ESD, and they were classified into 3 groups according to the level of ESD: Group I (n=40) patients underwent ESD at the 2nd rib (T2ESD), Group II (n=80) at the 3rd rib (T3ESD) and Group III (n=10) at the 4th rib (T4ESD). RESULT: There was no mortality or major morbidity. Heart rate (HR) was significantly decreased from 71.6+/-10.6/min to 66.8+/-10.2/min after ESD (p<0.01); however, the PR (from 148.6+/-21.2 msec to 152.8+/-20.5 msec) and QTc (from 399.2+/-15.4 msec to 404.0+/-15.1 msec) intervals were significantly increased after ESD in the patients who suffered with primary hyperhidrosis (p<0.01). According to the level of ESD, there were significant changes in the HR and QTc interval in group I (T2ESD), the HR and PR interval in group II and the QTc interval in Group III. CONCLUSION: There were significant changes in the heart rate and ECG findings after ESD. The thoracic sympathetic denervation of T2, T3 and T4 affected the electrical activity of the heart at the resting state.

BSE situation and establishment of Food Safety Commission in Japan

Eight major policies were implemented by Japanese Government since Oct. 2001, to deal with bovine spongiform encephalopathy (BSE). These are; 1) Surveillance in farm by veterinarian, 2) Prion test at healthy 1.3mi cows/yr, by veterinarian, 3) Elimination of specified risk material (SRM), 4) Ban of MBM for production, sale use, 5) Prion test for fallen stocks, 6) Transparent information and traceability, 7) New Measures such as Food Safety Basic Law, and 8) Establish of Food Safety Commission in the Cabinet Office. At this moment, the extent of SRM risk has only been indicated by several reports employing tests with a limited sensitivity. There is still a possibility that the items in the SRM list will increase in the future, and this indiscriminately applies to Japanese cattle as well. Although current practices of SRM elimination partially guarantee total food safety, additional latent problems and imminent issues remain as potential headaches to be addressed. If the index of SRM elimination cannot guarantee reliable food safety, we have but to resort to total elimination of tissues from high risk-bearing and BSE-infected animals. However, current BSE tests have their limitations and can not yet completely detect highrisk and/or infected animals. Under such circumstances, tissues/wastes and remains of diseased, affected fallen stocks and cohort animals have to be eliminated to prevent BSE invading the human food chain systems. The failure to detect any cohort should never be allowed to occur, and with regular and persistent updating of available stringent records, we are at least adopting the correct and useful approach as a reawakening strategy to securing food safety. In this perspective, traceability based on a National Identification System is required.

The Effects of Leukocyte Depleted Priming Solution on the Gastric Mucosal CO2 Partial Pressure and Serum IL-8 Level during Cardiopulmonary Bypass in Korean Mongrel Dogs / 대한흉부외과학회지

BACKGROUND: Cardiopulmonary bypass is an essential process to maintain circulation for saving life during the cardiac surgery. But it is a process in which systemic inflammation was evoked inevitably because of the exposure of blood to foreign surface. The injuries to distal organs during the cardiopulmonary bypass were resulted from systemic inflammation and the disturbances of micro-circulations in the organs. We designed this study to research the effects of leukocyte depletion from pump-oxygenator priming solution on the systemic inflammation, and the micro-circulation of gastric mucosa that is suggested by the gastric mucosal CO2 partial pressure and acidity. MATERIAL AND METHOD: The dogs were divided into three groups according to the different pump-oxygenator priming solutions; non-hemic crystalloid solution; leukocyte-depleted homologous blood; and non leukocyte-depleted homologous blood. Each priming solution group contained five dogs. In all three groups, 2 hours of cardiopulmonary bypass, and 4 consecutive hours of general anesthesia was maintained on the mechanical ventilation. Each dog was evaluated for the gastric mucosal pH, CO2 partial pressure, arterial pH, CO2 partial pressure, the exhaled air CO2 partial pressure and the level of IL-8 on before the cardiopulmonary bypass, 1 hour after the cardiopulmonary bypass, 2 hours after the cardiopulmonary bypass, 2 hours after the restoration of normal circulation, and 4 hours after the restoration of normal circulation after the cardiopulmonary bypass. The levels of IL-8 were measured with ELISA (enzyme linked immunosorbent assay) technique. RESULT: 1. There were significant differences of gastric mucosal CO2 partial pressure between the leukocyte-depleted homologous blood group and other two groups(vs non leukocyte-depleted homologous blood group; p=0.02, vs non-hemic crystalloid solution group; p=0.01). 2. The gastric mucosal pH of leukocyte-depleted homologous blood group was significantly different from non leukocyte-depleted homologous blood group (p=0.01). 3. The levels of IL-8, which examine the systemic inflammation, showed significantly better results in leukocyte-depleted homologous blood group and non-hemic crystalloid solution group than non leukocyte-depleted homologous blood group (p=0.01, 0.01). CONCLUSION: Based upon these results, we concluded that the leukocyte depletion from the pump-oxygenator priming solution has a beneficial effects in reducing systemic inflammation and the preserving of gastric mucosal micro-circulation.

Modified Thoracoscopic Bullectomy / 대한흉부외과학회지

BACKGROUND: Morbidity, the use of analgesics, the amount of postoperative drainage and the postoperative hospital stay were reduced in VATS for pneumothorax. However, some authors preferred minithoracotomy to VATS because the rate of recurrence after VATS were between 5% and 10%. Therefore, we present a modified thoracoscopic bullectomy (MTB) which we believe has the advantages of conventional VATS and minithoracotomy. MATERIAL AND METHOD: Sixty-six patients who received the operation from January 2002 to December 2002 were divided into 3 groups. Twenty-six patients were treated by axillary minithoracotomy and thirteen by conventional VATS and 18 by modified thoracoscopic bullectomy. The mean age was 21.9 years (range, 16~35 years) for minithoracotomy group, 20.6 years (range, 17~28 years) for conventional VATS group and 22.6 years (range, 16~39 years) for MTB group. The mean follow-ups were 11.4months for minithoracotomy group, 9.5 months for conventional VATS group and 4.7 months for MTB group. RESULT: The mean duration of operation was 55.79+/-23.35 minutes in MTB and 44.23+/-19.24 minutes in conventional VATS (p=0.333). The number of staplers being used was 1.63+/-0.76 in MTB, 1.41+/-0.64 in minithoracotomy (p=0.663), and 2.92+/-1.19 in conventional VATS (p<0.001). The duration of indwelling chest tube was 1.63+/-0.76 day in MTB, 4.07+/-1.41 day in minithoracotomy (p<0.001) and 4.46+/-2.33 day in conventional VATS (p<0.001). Hospital length of stay was 3.26+/-0.81 day in MTB, 6.04+/-2.21 day in minithoracotomy (p<0.001) and 6.69+/-3.33 day in conventional VATS (p<0.001). The number of postoperative complication and recurrence were 2 in minithoracotomy (7.4%), 5 in conventional VATS (38.5%) and 1 in MTB (5.6%). CONCLUSION: Modified thoracoscopic bullectomy is an effective procedure in the treatment of spontaneous pneumothorax.

Study on mechanism of multistep hepatotumorigenesis in rat: development of hepatotumorigenesis

With the aim of establishing bio-indices for the development of multistep hepatotumorigenesis, rats were fed water containing 0.01% diethylnitrosamine (DEN) ad libitum for 13 weeks. This treatment with DEN only made it possible to induce hepatic tumors in 100%. After the DEN administration, several clinical symptoms were observed including minor behavioral changes, brittleness of hair and a decrease in water and food intake. The concentration of total serum protein and albumin in all treated groups was significantly lower than in non-treated controls (p<0.05). Increase of specific enzyme (AST, ALT and GGT) activity (p<0.05), variable tumor size and hepatomegaly of the liver was observed in all rats treated with DEN for 10 weeks. Both hepatocellular carcinoma and cholangiocarcinoma were found in the same livers at the same time, and were prominently developed after 12 weeks. In case of carcinoma, some of the livers showed more or less advanced states over the 12-15 weeks period. In the present study, hepatocellular carcinoma was developed by treating DEN in only the drinking water, without any other carcinogens or without partial hepatectomy. These results indicate that DEN is a new carcinogen that acts directly on it the liver, moreover, it might be very useful for investigating hepatotumorigenesis.