Anti-thrombin III deficiency is known as a disease of autosomal dominant trait and relatively common, but in Korea, exact incidence and mortality is not known, In general, Anti-thrombin III deficiency is expressed to venous thromboembolism like deep vein thrombosis or pulmonary embolism. But, arterial embolism is very rare. We experienced a case of Antithrombin III deficiency expressed as myocardial infarction of inferior wall by huge thrombosis in the mid and distal right coronary artery.
Antithrombin III Deficiency ; Coronary Vessels ; Embolism ; Incidence ; Korea ; Mortality ; Myocardial Infarction* ; Pulmonary Embolism ; Thrombosis ; Venous Thromboembolism ; Venous Thrombosis

A pseudo-Cushing's state can be defined as some or all of the clinical features of Cushing's syndrome together with some evidence for hypercortisolism. It may be related to depression, alcohol abuse and obesity. Its manifestation may be transient and resolved with abstinence from causing factors. We report a case of a 70-year-old woman with unilateral nonfunctioning adrenal adenoma and geriatric depressive disorder, which diagnosed by Geriatric Depression Scale (GDS). She showed clinical and/or biochemical features of Cushing's syndrome. Low dose and high dose dexamethasone suppression tests were not identical to those in ACTH independent Cushing's syndrome. Few cases of pseudo-Cushing's syndrome were reported previously in Korea but there was no report about pseudo-Cushing's syndrome combined with nonfunctional adrenal adenoma.
Adenoma* ; Adrenal Glands ; Adrenocorticotropic Hormone ; Aged ; Alcoholism ; Cushing Syndrome ; Depression ; Depressive Disorder ; Dexamethasone ; Female ; Humans ; Korea ; Obesity

No abstract available.
Humans ; Survival Rate*

A 52 day-old male infant who had Taussig-Bing anomaly with coarctation of the aorta underwent initial palliative Damus-Kaye-Stansel (DKS) procedure including arch reconstruction because of suspected intramural coronary artery, size discrepancy of great arteries, potential subaortic stenosis, refractory pneumonia, and severe congestive heart failure. Total repair was done 44 months later, which was composed of VSD patch closure, DKS take-down, and arterial switch procedure. We report a successful case of DKS take-down and arterial switch operation for the reuse of native aortic and pulmonary valves rather than Rastelli-type procedure in a patient with Taussig-Bing anomaly having palliative DKS procedure.
Aortic Coarctation ; Arteries ; Constriction, Pathologic ; Coronary Vessels ; Double Outlet Right Ventricle* ; Heart Defects, Congenital ; Heart Failure ; Humans ; Infant ; Male ; Pneumonia ; Pulmonary Valve

BACKGROUND: Vasodilatory shock after cardiac surgery may result from the vasopressin deficiency following cardiopulmonary bypass and sepsis, which did not respond to usual intravenous inotropes. In contrast to the adult patients, the effectiveness of vasopressin for vasodilatory shock in children has not been known well and so we reviewed our experience of vasopressin therapy in the small babies with a cardiac disease. MATERIAL AND METHOD: Between February and August 2003, intravenous vasopressin was administrated in 6 patients for vasodilatory shock despite being supported on intravenous inotropes after cardiac surgery. Median age at operation was 25 days old (ranges; 2~41 days) and median body weight was 2,870 grams (ranges; 900~3,530 grams). Preoperative diagnoses were complete transposition of the great arteries in 2 patients, hypoplastic left heart syndrome in 1, Fallot type double-outlet right ventricle in 1, aortic coarctation with severe atrioventricular valve regurgitation in 1, and total anomalous pulmonary venous return in 1. Total repair and palliative repair were undertaken in each 3 patient. RESULT: Most patients showed vasodilatory shock not responding to the inotropes and required the vasopressin therapy within 24 hours after cardiac surgery and its readministration for septic shock. The dosing range for vasopressin was 0.0002~0.008 unit/kg/minute with a median total time of its administration of 59 hours (ranges; 26~140 hours). Systolic blood pressure before, 1 hour, and 6 hours after its administration were 42.7+/-7.4 mmHg, 53.7+/-11.4 mmHg, and 56.3+/-13.4 mmHg, respectively, which shows a significant increase in systolic blood pressure (systolic pressure 1hour and 6 hours after the administration compared to before the administration; p=0.042 in all). Inotropic indexes before, 6 hour, and 12 hours after its administration were 32.3+/-7.2, 21.0+/-8.4, and 21.2+/-8.9, respectively, which reveals a significant decrease in inotropic index (inotropic indexes 6 hour and 12 hours after the administration compared to before the administration; p=0.027 in all). Significant metabolic acidosis and decreased urine output related to systemic hypoperfusion were not found after vasopressin administration. CONCLUSION: In young children suffering from vasodilatory shock not responding to common inotropes despite normal ventricular contractility, intravenous vasopressin reveals to be an effective vasoconstrictor to increase systolic blood pressure and to mitigate the complications related to higher doses of inotropes.
Acidosis ; Adult ; Aortic Coarctation ; Arteries ; Blood Pressure ; Body Weight ; Cardiopulmonary Bypass ; Child ; Diabetes Insipidus, Neurogenic ; Diagnosis ; Double Outlet Right Ventricle ; Heart Defects, Congenital* ; Heart Diseases ; Humans ; Hypoplastic Left Heart Syndrome ; Postoperative Care ; Scimitar Syndrome ; Sepsis ; Shock* ; Shock, Septic ; Thoracic Surgery ; Vasodilation ; Vasopressins*

PURPOSE: To determine the effect of bFGF complexed collagen gel, which allows constant release of bFGF along with biodegradation of the collagen gel. The specific study purpose was to determine whether it can accelerate the fibrovascular ingrowth into wrapped HA-coated porous alumina and to verify the safety of new wrapping materials. Synthetic polyester-urethane (Neuropatch(R)) and lyophilized bovine pericardium (Lyoplant(R)) were compared to donor sclera for the fibrovascular ingrowth into HA-coated porous alumina. METHODS: The experimental and control groups, each consisting of 9 rabbits were wrapped with each wrapping materials (3 rabbits per wrapping material). The experimental group underwent pretreatment of bFGF-collagen gel while the control group did not. The fibrovascular ingrowth was compared at 2 and 4 weeks after implantation. Western blot analysis was conducted at 4 weeks using antibodies against CD141 and laminin. The rate of fibrovascular ingrowth was fastest in orbital implant wrapped with Lyoplant(R). RESULTS: Histopathologic examinations at 2 weeks showed no differences in distance and percentage area of fibrovascular ingrowth. Histopathologic examinations at 4 weeks showed that pretreatment of bFGF-collagen gel increased the fibrovascular ingrowth in the experimental group. Western blot analysis on experimental group also showed that the expressions of CD141 and laminin were increased by bFGF-collagen gel, thereby indicating that the fibrovascular proliferations were accelerated by bFGF released from the complex. CONCLUSIONS: bFGF-collagen gel increased the rate and degree of fibrovascular growth into hydroxyapatite-coated porous alumina by releasing bFGF as the collagen gel biodegraded. Both Lyoplant(R) and Neuropatch(R) were evaluated as safe for substitution of the donor sclera.
Aluminum Oxide ; Antibodies ; Blotting, Western ; Collagen* ; Humans ; Laminin ; Orbit* ; Orbital Implants* ; Pericardium ; Rabbits ; Sclera ; Tissue Donors

Report of right atrial thrombus complicating pulmonary embolism after cardiac surgery is rare. A 54-year-old woman operated on the atrial septal defect 10 months ago was admitted for left pleuritic pain and dyspnea. Multiple segmental perfusion defects were detected in lung perfusion scan. Transesophageal echocardiography showed a large mobile right atrial mass attached to the free wall of the right atrium with a stalk. Despite the intravenous heparinization for 13 days, follow-up echocardiography revealed the right atrial mass had not diminished in size. The mass which was confirmed as an organizing thrombus was excised under cardiopulmonary bypass. The patient recovered uneventfully and was discharged on warfarin therapy.
Cardiopulmonary Bypass ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Follow-Up Studies ; Heart Atria ; Heart Septal Defects, Atrial* ; Heparin ; Humans ; Lung ; Middle Aged ; Perfusion ; Pulmonary Embolism* ; Sutures* ; Thoracic Surgery ; Thrombosis* ; Warfarin

BACKGROUND: Inhaled nitric oxide (NO) therapy causes selective pulmonary vasodilation in patients with pulmonary hypertension. However, attempts to discontinue inhaled NO may be complicated by abrupt life-threatening rebound pulmonary hypertension (RPH). The purpose of this study was to determine the risk factors to develop RPH and to present the adequate weaning methods. METHODS: We studied 19 consecutive children who were treated with inhaled NO because of pulmonary hypertension after surgery for congenital heart disease. We compared the dose of NO at the time of start and withdrawal, the duration of weaning and treatment, hemodynamic data, and blood gas analysis before inhaled nitric oxide withdrawal, between patients without (group I, n = 13) and with RPH (group II, n = 6). RESULTS: Compared with group I, group II patients were older in age (1204 1688 versus 546 1654 days, P < 0.05), had a lower NO concentration just before withdrawal (3 +/- 1.6 versus 5 +/- 2.6 ppm, P <0.05), a shorter duration of NO weaning period (4 +/- 3.3 versus 15 +/- 13.4 hours, P < 0.05) and received NO therapy for a shorter duration (26 +/- 11.6 versus 57 +/- 46.0 hours, P < 0.05). CONCLUSIONS: We recommend a progressive withdrawal of inhaled nitric oxide to avoid life-threatening RPH observed in the sudden discontinuation.
Blood Gas Analysis ; Child ; Heart Defects, Congenital* ; Hemodynamics ; Humans ; Hypertension, Pulmonary* ; Nitric Oxide* ; Risk Factors ; Vasodilation ; Weaning

OBJECTIVES: Patients who develop rheumatoid arthritis over 60 years old(elderly-onset rheumatoid arthritis, EORA) are different from those of younger-onset disease(YORA). Several aspects are emphasized; more equal sex distribution, more often systemic complaints, more larger joints involvement, high ESR rates, and less rheumatoid factor positivity. We compared the clinical characteristics of EORA with those of YORA. METHODS: Five hundred and fifty-six patients who had met the ACR criteria for rheumatoid arthritis were studied. We compared the difference with clinical manifestation, disease activity markers, serologic markers including rheumatoid factor and anti-perinuclear factor, and radiologic changes between EORA and YORA. RESULTS: EORA : YORA ratio is 49 : 507, no difference between male and female ratio. The age at onset of EORA is 67.3 +/- .89 years old, YORA is 4.9 +/-10.5 years old, disease duration is not different in both groups. The ESR of EORA (47.65 +/-13.8) is higher than that of YORA ( 39.49+/-.1 ), the positivity of antiperinuclear factor is significantly increased in the EORA group as compared with YORA group. The comparisons of disease activity including Ritchie index; early RA in both groups showed significant difference only in rheumatoid factor titer. CONCLUSION: The EORA is similar to YORA except high ESR, high rheumatoid factor titer, and high positivity of antiperinuclear factor. However, we failed to demonstrate that the EORA runs different course with heterogeneous pathogenesis to the YORA.
Aged* ; Aged, 80 and over ; Arthritis, Rheumatoid* ; Female ; Fibrinogen ; Humans ; Joints ; Male ; Rheumatoid Factor ; Sex Distribution

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) is a useful method in both the accurate diagnosis and treatment of gastric mucosal lesions. A gastric adenoma is a neoplastic lesion which has malignant potential, and therefore it is advisable to have it removed completely when discovered. We evaluated the role of EMR in the treatment of gastric adenomas by analyzing the follow-up endoscopic results of patients treated with EMR for such lesions. METHODS: We analyzed the initial endoscopic findings, EMR results, and follow-up endoscopic outcomes of 35 patients with 41 gastric adenomas, from June 1994 to January 1997 in Seoul National University Hospital.
Adenoma* ; Diagnosis ; Follow-Up Studies ; Humans ; Recurrence ; Seoul