To evaluate the diagnostic accuracy of two-dimensional echocardiogrphy(2-D echo) in ventricular septal defect, location and size of the defects, estimated right ventricular systolic pressure and associated cardiac anomaly were compared to the operative findings in 139 children operated for correction of ventricular septal defect at Severance Hospital from Jan. 1983 to June 1987. In addition, postoperative complications and mortality cases were anlysed. The following results were obtained; 1) Perimembranous defects were 82 cases(66.1%), subarterial infundibular defects 33 cases(26.6%), and muscular defect was found in only 1 case(0.8%). The accuracy of 2-D echo in localizing the defects was 84.2%. 2) In 79.2% of the patients, the defects were moderate to large in size, and actual size measured at operation was larger than that obtained by echocardography in general. 3) The estimated right ventricular systolic pressure was correlated(r=0.650) with that measured at the operating field. 4) Combined cardiac anomalies were patent ductus arteriosus(22 cases), atrial septal defect(3 cases), valvular pulmonic stenosis(2 cases) and interventricular septal aneurysm(2 cases). The sensitivity of 2-D echo in detecting these anomalies was 65.5% and the specificity was 96.4%. 5) Among 32 patients who had postoperative complications, in two thirds, there were pulmonary complication including lung atelectasis(16 cases), pleural effusion(5 cases)and pneumonia(5 cases). 6) Operative mortality was 2.9%(4 cases). The causes of death were low cardiac output state due to left ventricular myocardial failure in 3 patients and respiratory failure from asphyxia in one case. In conclusion, with close cooperation with cardiac surgeons, there will be few problems in diagnosing and operating patients with ventricular septal defect on the basis of two-dimensional echocardiographic findings without invasive procedures, such as cardiac catheterization, even with pulmonary hypertension, unless Eisenmenger syndrome is complicated.
Asphyxia ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output, Low ; Catheterization* ; Catheters* ; Cause of Death ; Child* ; Echocardiography* ; Eisenmenger Complex ; Heart Failure ; Heart Septal Defects, Ventricular* ; Humans ; Hypertension, Pulmonary ; Lung ; Mortality ; Postoperative Complications ; Respiratory Insufficiency ; Sensitivity and Specificity

We present herein two cases of acquired periungual fibrokeratoma occuring beneath the proximal nail folds. A firm duplicated and mitten-shaped protruding mass was found on the left middle finger nail of 38-year-old woman and a firm triplicated and finger-shaped protruding mass was found of the left great toe nail of 46-year-old man. The epidermis of the tumors showed compact hyperkeratosis, focal hypergranulosis, and irregular acanthosis. Thick collagen bundles and dilated capillaries were predominantly oriented in the direction of the longitudinal axis of the lesions. There were no adnexal elements and inflammatory cells in the dermis.
Adult ; Axis, Cervical Vertebra ; Capillaries ; Collagen ; Dermis ; Epidermis ; Female ; Fingers ; Humans ; Middle Aged ; Toes

We present herein a case of 20 nail onychogryphosis with localized plantar hyper keratosis and cutaneous horns occuring in a 21 year-old schizophrenic female patient. The finger nails were brownish in color and the surface of nail plates has the coarse transverse striations. The nail plates beyond the free edge were thickened and curved inward markedly. The toe nails were dirty grayish in color and the nail plates were thickened markedly and curved like the horn of ram. All the nail plates were seperated and removed from the nail beds without any difficulty and the nail matrices were destroyed by electrodesiccation. Lacalized plantar hyperkeratosis and cutaneous horns were also removed successfully by occlusive dressing with 40% salicylic acid ointment and by surgical excision. Psychogenic disorder and prolonged hygienic indifference could be the most. probable cause in this patient.
Animals ; Female ; Fingers ; Horns* ; Humans ; Keratosis ; Occlusive Dressings ; Salicylic Acid ; Schizophrenia ; Toes ; Young Adult

We present herein a case of pyodcrma gangrenosum, who showed good response to clofazimine therapy. The patient, 19-year-old male, had suffered from chronic diarrhea for 10 months before the rapidly spreading pustules and ulcers with undermined purple-to-red borders devkloped on his both lower and upper extremitics. Clofazimine was given orally in a dose of 100mg three times daily for 16 days, and tapered to 100 mg two times daily for the next 11 days. Clinical improvement was noted after 7 day's treatment and the almost all of the skin lesiors were replaced by granulation tissue with epithelizatiori or crust formation after 6 days treatment.
Clofazimine* ; Diarrhea ; Granulation Tissue ; Humans ; Male ; Pyoderma Gangrenosum* ; Pyoderma* ; Skin ; Ulcer ; Young Adult

No abstract available.
Catheters* ; Heart Defects, Congenital*

We present herein a case of human infestation of canine scabies occuring in a 7l-year-old female patient. Severe pruritic, erythematous papular lesions and excoriation were found over the abdomen, submammary area, and thigh. The itching sensation was aggravated especially at night. Efforts to demonstrate mites from the lesiona of the patient were unsuccessful. Her pet, a small puppy, showed loss of hair and crusted or scaly erythematous patches on the auricles and trunk 1 month prior to her skin lesions. Sarcaptescabiei var. canis were collected from the puppy by brushing the hair snd crusted or scaly patches on its skin. The patient and puppy were treated successfully with application of 25% benzyl benzoate solution.
Abdomen ; Benzoates ; Female ; Hair ; Humans* ; Mites ; Pruritus ; Scabies* ; Sensation ; Skin ; Thigh

Double outlet right ventricle, a complex of congenital cardiac anomalies in which both great arteries arise wholly or in large part from the morphologic right ventricle presents diverse clinical manifestations according to the morphological characteristics. Eighty cases with DORV were diagnosed and operated at Yonsei Cardiovascular Center from 1988 to 1992. The analysis of the morphological characteristics of this anomaly and comparative study of operative methods and mortality according to the morphological classification led to the following results: 1) The location of VSD varied to be subaortic in 40 cases, subpulmonic in 15, doubly committed in 6 and noncommitted in 19 cases. The great arteries were interrelated in D-malposition in 43 cases and L-malposition in 18 and 26 cases among above mentioned 61 cases revealed the side-by-side relationship. Ten of the cases showed normal position and the rest 9, A-malposition. 2) Pulmonary stenosis was found in 60 cases, and when associated with subpulmonic VSD, occurring less frequently. PDA and ASD secundum were associated in successional order and only 3 cases were verified to carry aortic arch anomalies such as coarctation and interruption, all with subpulmonic VSD. 3) Intraventricular tunnel repair was possible in every case associated with subaortic VSD and the postoperative prognosis was excellent. In comparison, most of the cases associated with other types of VSD in which only palliative surgery or various types of intraventricular repair were performed, the general outcome was poor. But total cavopulmonary connection, one of the physiological corrective methods, showing a better postoperative prognosis is being carefully considered for its broad adoptation in future. In conclusion, double outlet right ventricle, a pathophysiological complex of various anomalies, should be thoroughly evaluated for the morphological characteristics to decide the most appropriate types of operation and for consequent improvement of prognosis.
Aorta, Thoracic ; Arteries ; Classification ; Double Outlet Right Ventricle* ; Heart Ventricles ; Mortality ; Palliative Care ; Prognosis ; Pulmonary Valve Stenosis

OBJECTIVE: To investigate the difference of outcome variables and demographic features between traumatic and non-traumatic spinal cord injury (SCI) patients. METHOD: Medical records of 87 spinal cord injured patients were retrospectively reviewed. The patients were divided into traumatic and non-traumatic groups. The etiology, level and completeness of SCI were investigated. The functional evaluation was performed by Frankel's classification, American spinal cord injury association (ASIA) motor and sensory scores, and modified Barthel scores at the time of admission and discharge. Bladder function and emptying method were also investigated. RESULTS: Spinal cord injury of non-traumatic etiology was more likely to result in a incomplete injury and more prevalent in females. At admission, the ASIA motor and sensory scores and modified Barthel index of non-traumatic spinal cord injury patient were higher than those of traumatic patients. At discharge, same results were observed for ASIA motor and sensory scores, but the modified Barthel scores showed no difference between the two groups. The changes of the scores between time of admission and discharge showed no significant difference in the two groups. There was no significant difference of bladder type and bladder emptying method. CONCLUSION: This study suggest that favorable outcome in non-traumatic spinal cord injury patients might be due to better functional status at the time of admission and not due to the degree of recovery.
Asia ; Classification ; Female ; Humans ; Medical Records ; Retrospective Studies ; Spinal Cord Injuries ; Spinal Cord* ; Urinary Bladder

VSD is the most common congenital carciac malformation and the natural history depends not only on the age ofpatients and the size of defect but the subtype of VSD as well, important factor in clinical management or thosepatients. In 110 patients, with surgically repaired VSD in Yonsei Medical Center in 1984, the subtype of VSDs evaluated by surgical observation were correlated with LV angiogram findings to verify the incidence of subtype inKorean and the diagnostic accuracy to predict the subtype by angiogram. 1. 110 patients included 64 boys and 46 girls, the age ranged from 3 months to 14 years(average 4.6 years old) 2. Angiographic findings were interpretedas follows; a. Perimembranous defects were profiled in LAO 60 degrees LV angiogram and located below the aorticvalve. In inlet excavation the shunted blood opacified the recess between septal leaflet of tricuspid valve and interventricular septum in early phase, in infundibular excavation opacified the recess between anterior leafletof TV and anterior free wall of RV and in travecular excavation the shunted blood traversed anterior portion of TVring, opacified trabecular portion of RV cavity. b. Subarterial type were profilled in RAO 30degrees LV angiogram,just below aortic valve as well as pulmonic valve. Total infundibular defects were profilled in RAO 30degrees andLAO 60 degrees LV angiogram subaortic in location in both views. c. In muscular VSD the profilled angle was variedaccording to the subtype but the defects were separated from the aortic valve as muscular septum interposedbetween the aortic valve and the defect. 3. The incedence of subtype of VSDs evaluated by surgical observationwere as follows. Subaterial type 32 cases(29.1%) Total infundibular defect 5 cases( 4.5%) Perimembranous type 73cases(66.3%) Infundibular excavation 32 cases(29.1%) Trabecular excavation 28 cases(25.5%) Inlet excavation 10cases(9.1%) Mixed 3 cases(2.7%) Muscular type 1 cases(0.9%) Total 63.6% of VSD, were the varieties of theinfundibular septum type. 4. The prediction of VSD subtype accoridng to the angiographic findings described above,were compared to the surgical observation. Diagnostic rate was 100% in perimembranous type, 75% in subarterialtype, 0% in total infundibular type, so 88% of cases were in accordance with the surgical findings.
Aortic Valve ; Bays ; Female ; Humans ; Incidence ; Natural History ; Tricuspid Valve

We studied the angiographic findings in 65 patients wtih congenital pulmonary atresia, ages 4 days to 14 years(mean 3.3 yrs), form 1981 to 1986 at Severance Hospital Yonsei University. 1. 6 had pulmonary atresia with anintact interventricular septum, 38 had it with cardiac anomaly Renodynamically simulating TOF, and 21 associatedwith more complicated cardiac anomalies. 2. In the group with an intact ventricular septum, 5 showed confluentintrapericardial pulmonary artery, all segmental pulmonary arteries connceted to intrapericardial pulmoanryartery. 3. In the group simulating TOF, aorta arose from RV with or without overriding in 35. In 27 patients withconfluent intrapericardial pulmonary artery, 23 had more than 10 segmental pulmoanry arteries connceted tointrapericardial artery and 5 had severely hypoplastic hilar pulmonary arteries. In 11 with nonconfluentintrapericardial pulmonary artery, 4 had more than 10 segmental pulmonary arteries connected to central pulmonaryartery and 9 had severely hypoplastic hilar pulmonary arteries. 4. In the group associated with more complicatedcardiac anomaly, included 8 patients with atrioventricular discordance, 7 with univentricular heart and 6 withtricuspid atresia. In 17 patients with confluent intrapericardial artery, 16 had more than 10 segmental pulmoanryarteries conncected to intrapeircardial artery, one showed severe hypoplasia of hilar pulmonary arteries. Inanother 4 with nonconfluence, no one showed more than 10 segmental arteries conncted to intraperdicardial or hilarpulmonary artery.
Aorta ; Arteries ; Heart ; Humans ; Pulmonary Artery ; Pulmonary Atresia ; Ventricular Septum