Temporary and short-term cardiac assists have been used for management of cardiac failure in a wide variety of application. Among these, extra-corporeal membrane oxygenation (ECMO) can be used if conventional therapies have been unsuccessful. Although ECMO has been utilized often in infants, the indications for ECMO in the adult population are not well delineated and the results have been less encouraging. This is a case of a 32 year-old female who has had underlying mitral stenosis. When admitted, she was in shock and presented with severe post-partum pulmonary edema unresponsive to inotropics, pulmonary vasodilator , and diuretics. She was put on ECMO for 14 hours by right femoral venoarterial cannulation and improved immediately after the application of ECMO. Afterwards, double valve replacement was done, and ECMO was continued post-operatively. The total application of ECMO was 62 hours including valve operation, and the weaning of ECMO was accomplished successfully under stable hemodynamics, improved pulmonary edema, and correction of underlying pathophysiology. She was discharged on post-operative day 30 without specific complications.
Adult ; Catheterization ; Diuretics ; Extracorporeal Membrane Oxygenation* ; Female ; Heart Failure ; Hemodynamics ; Humans ; Infant ; Membranes ; Mitral Valve Stenosis ; Oxygen ; Postpartum Period* ; Pulmonary Edema ; Shock* ; Weaning

Surgical interruption through a left posterolateral thoracotomy and percutaneous transcatheter closure of ductus arteriosus were popular procedures of treatment. However, concerns over postthoracotomy syndrome and postoperative pain and complications such as persistent shun-ting, hemolysis, possible migration, and problem of prophylaxis against bacterial endocarditis in residual shunt were reported. Therefore, we present our procedure using video-assisted thoracoscopy for PDA clipping. 6 patients underwent video assisted-thoracoscopic clipping of PDA, but one case was converted into minithoracotomy. Postoperative examination showed the absence of murmur and decreased pulmonary vascularities progressively in all patients. In our series, we had no cases of ductal rupture during operation, incomplete ductal closure, pneumothorax, or hoarseness. Mean hospital stay was 3.4days. Postoperative echocardiography revealed no cases of ductal patency or residual shunt. We concluded that the technique described here is an effective procedure in view of the prevention of postthoracotomy syndrome, successful closure of ductus, cosmetic effect, and a short hospital stay.
Ductus Arteriosus ; Ductus Arteriosus, Patent* ; Echocardiography ; Endocarditis, Bacterial ; Hemolysis ; Hoarseness ; Humans ; Length of Stay ; Pain, Postoperative ; Pneumothorax ; Rupture ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy

BACKGROUND: Maze procedure, as an antiarrhythmic surgery, results in a favorable sinus conversion rate, however , the complexity and relatively longer operative time made its application difficult for all patients having atrial fibrillation. Therefore, pulmonary vein isolation(PVI) can be done for selected patients. We performed the risk factor analysis associated with sinus conversion for patients who underwent PVI procedure. MATERIAL AND METHOD: Retrospective study was done for 96 patients who received concomitant PVI procedure from October 1995 to February 1999. There were 37 males(38.5%) and 59 females(61.5%), with mean age of 46.9+/-11.6 years. Underlying valvular heart diseases were as cases of mitral stenosis(52.1%), 24 cases of mitral regurgitation(25%), and 22 cases of mitral stenoinsufficiency(22.9%). Left atrial auricle was resected and pulmonary venous encircling incision was performed after valvular procedure. Electrocardiogram and echocardiogram was performed between 6 months and 1 year after the operation. Mean follow up duration was 25.9+/-11.5 months. Analysis was done between sinus conversion group and non-conversion group. RESULT: There were 3 early deaths and 2 follow-up losses within postoperative 6 months. Early postoperative complications include 4 cases of reoperation for bleeding, 1 required ventricular assistant device, 1 stroke, 1 perioperative MI and so on. Late complications include 1 case of permanent pacemaker implantation due to sick sinus syndrome, and 1 case of transient ischemic attack. There was no valve-related complication. 75 patients(82%) converted to sinus rhythm after operation. Risk factors associated with difficulty for sinus conversion were age over 50 years(p=0.03), left atrial size more than 65 mm(p=0.03), and accompanying right heart procedure(p=0.02). CONCLUSION: PVI can be done for selected patients with acceptable sinus conversion rate.
Atrial Fibrillation* ; Electrocardiography ; Follow-Up Studies ; Heart ; Heart Valve Diseases* ; Hemorrhage ; Humans ; Ischemic Attack, Transient ; Operative Time ; Postoperative Complications ; Pulmonary Veins ; Reoperation ; Retrospective Studies ; Risk Factors ; Sick Sinus Syndrome ; Stroke

There are so many differences between the elderly patients and the younger patients in the aspects of a causes and the clinical course of spontaneous intracerebral hemorrage (ICH). As the mean life-time of a general population goes longer, the incidence of spontaneous ICH increases but the aggressive support in ICH is withdrawn more commonly and a prognosis of ICH becomes poor. Therefore, a prevention of ICH and a strict control of hypertension is very very important.
Aged ; Cerebral Hemorrhage* ; Humans ; Hypertension ; Incidence ; Mortality ; Prognosis

As the number of elderly people increases, the incidence of stroke, especially the hemorrhagic stroke, is increasing. A large-scale survey of the entire country pertaining to the incidence and demographic characteristics of hemorrhagic stroke in elderly is necessary. Through information garnered from a basic survey and clinical study, we must design a treatment program to reduce the mortality of elderly people through elucidating the specific properties of stroke pathophysiology.
Aged* ; Humans ; Incidence* ; Mortality ; Stroke*

Hypertension is a very common disorder in the aged persons. There exist several hemodynamic characteristics associated with hypertension in the geriatric population, - decreased elasticity of arterioles due to fibrosis, decreased renin activity, and decreased cardiac output and renal blood flow. Clinically, isolated systolic hypertension, blood pressure variation within a day, and white coat hypertension, are more common in the aged population. Furthermore, aged persons have more chances to suffer other diseases, diabetes, COPD, and renal dysfunction, for example. These characteristics need tailored approaches in diagnosing and managing hypertension in the aged. In the current literature, detailed characteristics of 'geriatric hypertension', are described, including definition, grade of hypertension, importance of treatment of hypertension, complications of hypertension, drug or non-drug treatment, and principles of drug treatment especially in the specific age group.
Arterioles ; Blood Pressure ; Cardiac Output ; Elasticity ; Fibrosis ; Geriatrics* ; Hemodynamics ; Humans ; Hypertension* ; Pulmonary Disease, Chronic Obstructive ; Renal Circulation ; Renin ; White Coat Hypertension

The stereotactic radiosurgery for arteriovenous malformation (AVM) began in the early 1970s. Nowadays, by 2000 world-wide, more than 27,500 patients have undergone Gamma Knife radiosurgery for cerebrovascular disease (CVD). New concepts, consisting of obliteration rate, postradiosurgical hemorrhagic risk, dose selection for treatment, and radiosurgery for pediatric AVM, medium-to-large sized AVM, cavernous malformation, venous angioma, so on, have been established. Gamma Knife radiosurgery has been considered as an effective management stratege with relatively few side effects for AVM. However, recently delayed radiation-induced complications were reported in 3.2 to 12.5% in range. Therefore, the long-term follow-up is thought to be mandatory even after treatment goal, complete obliteration, is confirmed.
Arteriovenous Malformations ; Follow-Up Studies ; Hemangioma ; Humans ; Patient Selection ; Radiosurgery*

These days, a less invasive surgery is stressed. One current thought is that the endovascular surgery itself is the less invasive and safer surgery for a cerebral aneurysm, and not the microsurgery. Is this true? We have evaluated the merits and demerits of each method. Our conclusion is as follows. Endovascular Surgery should be considered as an alternative, only for the specific patients. Microsurgery itself retains its position of the first treatment of choice for a cerebral aneurysm. "Less invasive" cannot be equated with "less dangerous". We will show the above reasons using slides and videotapes of several patients.
Humans ; Intracranial Aneurysm ; Microsurgery ; Videotape Recording

Although Leuconostoc species with intrinsic high-level vancomycin resistance have rarely been isolated from clinical specimens, this organism may cause serious invasive infections such as bacteremia and meningitis in immunocompromised hosts or patients with a wide spectrum of underlying diseases including alcoholic liver diseases and gastrointestinal diseases. Predisposing factors of Leuconostoc bacteremia include intravenous or enteral feeding catheters, other invasive access devices such as tracheostomy, gastrostomy or endotracheal tubes, and previous antimicrobial treatment. This low prevalence may be due, in part, to the inability of automated systems to recognize this organism. It is important that all Leuconostoc isolates obtained from clinical specimens that are related to serious infections should be identified to species level for appropriate antibiotic therapy. We report two cases of Leuconostoc bacteremia occurring in a 65-year-old male with variceal bleeding, and in a 5 month child with ileostomy receiving total parenteral nutrition therapy.
Aged ; Bacteremia* ; Catheters ; Causality ; Child ; Enteral Nutrition ; Esophageal and Gastric Varices ; Gastrointestinal Diseases ; Gastrostomy ; Humans ; Ileostomy ; Immunocompromised Host ; Leuconostoc* ; Liver Diseases, Alcoholic ; Male ; Meningitis ; Parenteral Nutrition, Total ; Prevalence ; Tracheostomy ; Vancomycin Resistance

Streptococcus pneumoniae is the most common cause of community-acquired pneumonia in adults and an important agent in other infections, including meningitis, otitis media, and conjunctivitis, etc. The optochin susceptibility test is the most widely used method to discriminate S. pneumoniae from other streptococci. However, 0.8-1.5% of S. pneumoniae contain optochin resistant population. Recently, we experienced three cases of variants of S. pneumoniae with decreased susceptibility to optochin. Equivocal optochin disk test should be confirmed by bile solubility, agglutination test, or DNA probe test.
Adult ; Agglutination Tests ; Bile ; Conjunctivitis ; DNA ; Humans ; Meningitis ; Otitis Media ; Pneumonia ; Solubility ; Streptococcus pneumoniae* ; Streptococcus*