BACKGROUND: Spontaneous pneumothorax patients with blebs or bullae are considered to be good candidates for operation, and various objective diagnostic modalities have been performed for detection of blebs and bullae. This study was performed to compare the efficacy of thoracoscopic examination with using a minimally invasive 2 mm thoracoscope with high-resolution computed tomography (HRCT) for treating primary spontaneous pneumothorax. MATERIAL AND METHOD: From June 2001 to March 2002, 34 patients with spontaneous pneumothorax underwent study with 2 mm video-thoracoscopic examination and HRCT. We regarded a bleb larger than 5 mm in diameter as significant. Standard thoracoscopic wedge resection was performed in 18 patients with significant bleb via a 2 mm video-thoracoscopic examination. 1 patient incurred bleeding, and the remaining 15 patients were treated with pleural drainage. RESULT: Multiple or single bleb lesions were detected by 2 mm video-thoracoscope in 52.9% (18/34) of the patients with primary pneumothorax. For a total of 19 patients who were operated on, the diagnostic accuracy of the 2 mm video-thoracoscopic examination for bullae and bleb was 94.7% (18/19), which was superior to that of HRCT (73.7%, 14/19). At a mean follow-up of 30+/-3 months, no recurrence occurred in both the operative group and the non-operative group. CONCLUSION: 2 mm video-thoracoscopic examination under local anesthesia has higher diagnostic accuracy than HRCT, and it is a useful alternative for determining the operative indications for spontaneous pneumothorax.
Anesthesia, Local ; Blister ; Drainage ; Follow-Up Studies ; Hemorrhage ; Humans ; Pneumothorax ; Recurrence ; Thoracoscopes ; Thoracoscopy

BACKGROUND: It is said that tuberculous pleuritis responds well to anti-tuberculous drug in general, so no further aggressive therapeutic management is unnecesarry except in case of diagnostic thoracentesis. But in clinical practice, we often see some patients who need later decortication due to dyspnea caused by pleural loculation or thickening despite several months of anti-tuberculous drug therapy. Therefore, we want to know the clinical difference between a group who received decortication due to complication of tuberculous pleuritis despite of anti-tuberculous drug and a group who improved after 9 months of anti-tuberculous drug only. METHODS: We reviewed 20 tuberculous pleuritis patients(group 1) who underwent decortication due to dyspnea caused by pleural loculation or severe pleural thickening despite of anti-tuberculous drug therapy for 9 or more months, and 20 other tuberculous pleuritis patients(group 2) who improved by anti-tuberculous drug only and had similar degrees of initial pleural effusion and similar age,sex distribution. Then we compared between the two groups the duration of symptoms before anti-tuberculous drug treatment and pleural fluid biochemistry like glucose, LDH, protein and pleural fluid cell count and WBC differential count, and we also wanted to know whether there was any difference in preoperative PFT value and postoperative PFT value in the patients who underwent decortication, and obtained following results. RESULTS: 1) Group 1 patients had lower glucose level{63.3+/-30.8(mg/dl)} than that of the group 2{98.5+/-34.2(mg/dl), p<0.05}, and higher LDH level{776.3+/-266.0(IU/L)} than the group 2 patients{376.3 +/-123.1(IU/L), p<0.05), and also longer duration of symptom before treatment{2.0+/-1.7(month)} than the group 2{ 1.1 +/-1.2(month), p<0.05)}, respectively. 2) In group 1, FVC changed from preoperative 2.55+/-0.80(L) to postoperative 2.99+/-0.78(L)(p<0.05), and FEV1 changed from preoperative 2.19 +/- 0.70(L/sec) to postoperative 2.50+/-0.69(L/sec) (p<0.05). 3) There was no difference in pleural fluid protein level(5.05+/-1.01(gm/dL) and 5.15+/-0.77 (gm/dl), p>0.05) and WBC differential count between group 1 and group 2. CONCLUSION: It is probable that in tuberculous pleuritis there is a risk of complication in the case of showing relatively low pleural fluid glucose or high LDH level, or in the case of having long duraton of symptom before treatment. We thought prospective study should be performed to confirm this.
Biochemistry ; Cell Count ; Drug Therapy ; Dyspnea ; Glucose ; Humans ; Pleural Effusion* ; Pleurisy ; Prospective Studies ; Tuberculosis, Pleural*

Acute respiratory distress syndrome (ARDS) is difficult to treat and it is often fatal. If the medical treatment for ARDS is not effective, then extracorporeal membrane oxygenation (ECMO) can be applied to the patient. A 22-year-old female who suffered multiple traumatic injuries due to a car accident presented with acute respiratory distress syndrome. Veinarterial extracorporeal membrane oxygenation (VA ECMO) was started to treat her respiratory failure. With the VA ECMO, the systemic oxygen saturation remained at only 84%, and so the ECMO system was switched to V-VA ECMO via an additional venous outflow through the right jugular vein to increase both the systemic and pulmonary oxygen saturation. After conversion to the V-VA type ECMO, the systemic oxygen saturation increased to 94% and the partial pressure of oxygen (PaO2) increased to 65 mmHg. We report here on a successful case of ECMO conversion from the VA type to the V-VA type in a patient with severely hypoxic respiratory failure.
Extracorporeal Membrane Oxygenation ; Female ; Humans ; Jugular Veins ; Multiple Trauma ; Oxygen ; Partial Pressure ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Young Adult

BACKGROUND: Acute myocardial infarction is one of major cardiovascular disease that increases according to the changes of diet and life style. Early diagnosis and treatment of acute myocardial infarction is critical for better prognosis and for reducing mortality. But early diagnosis of acute myocardial infarction is limited by several factors. Recently it was reported that measurements of several serum cardiac enzymes were useful for early diagnosis of acute mocardial infarction. This study was performed to investigate which method of serum creatine kinase measurement is the faster and accurate and whether serum creatine kinase is an early noninvasive predictor of coronary artery patency following thrombolysis in patients with acute myocardial infarction by means of analysis of serial changes in serum creatine kinase. METHODS: This study included 32 patients who had acute myocardial infarction. Serum CK-MB was measured by electrophoretic method and enzymatic immuoasssay method. and compared with EKG and total CK activity which measured by photoabsorbance method. Also we studied whether CK time-activity could be predictor for reperfusion. RESULTS: Immunoassay method accurately measures the serum CK-MB and correlates well with that of electrophoretic method in patients with acute mocardial infarction. Immunoassay method is more sensitive than EKG and has the similar sensitivity to electrophoretic method in diagnosis of acute myoardial infarction. Reperfusion of an occluded coronary artery results in early elevation of serum creatine kinase and CK-MB reflected by earlier appearance time, peak, and onset of clearance. CONCLUSION: Because immunoassay measurement of serum creatine kinase is faster than electrophoresis and requires less technical expertise, it is possible to make diagnosis in patients with acute myocardial infarction in a more timely and cost effective manner and creatine kinase is good predictor of recanalization of an occluded coronary artery after intravenous thrombolytic therapy.
Cardiovascular Diseases ; Coronary Vessels ; Creatine Kinase* ; Creatine* ; Diagnosis ; Diet ; Early Diagnosis* ; Electrocardiography ; Electrophoresis ; Humans ; Immunoassay ; Infarction ; Life Style ; Mortality ; Myocardial Infarction* ; Professional Competence ; Prognosis ; Reperfusion* ; Thrombolytic Therapy

OBJECTIVE: The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). MATERIALS AND METHODS: We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. RESULTS: All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). CONCLUSION: Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV.
Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Aortic Valve* ; Classification ; Consensus ; Constriction, Pathologic ; Echocardiography ; Humans ; Magnetic Resonance Imaging ; Membranes ; Multidetector Computed Tomography ; Retrospective Studies

Phlebectasia of the venous system of the upper limb is very rare and it does not have a well-defined etiology. Phlebectasia means isolated fusiform or saccular dilatation of the venous system and isolated phlebectasia of the forearm may present as a painless cosmetic deformity or it may cause pain, decreased range of movement, compression on adjacent structures, bleeding, thrombosis and consumptive coagulopathy. We report here on a case of isolated phlebectasia of the forearm and we briefly review the relevant literature.
Congenital Abnormalities ; Cosmetics ; Dilatation ; Forearm ; Hemorrhage ; Thrombosis ; Upper Extremity ; Veins

Although several reports have showed the application of 3-dimensional (3D) echocardiography, it is hard to find a report regarding the intraoperative use of real time 3D transesophageal echocardiography (TEE) in mitral valve repair surgery. In the present case, real time 3D TEE the one from the one TEE probe position as well as their rotated and cropped images showed detailed spatial images enough for immediate assessment of the mitral valve deformity and the characteristics of mitral regurgitation flow. Under cardiopulmonary bypass (CPB) employing moderate hypothermia, the prolapsed mital leaflet was excised, the ruptured cord was repaired and an annuloplasty ring was inserted to reinforce the mitral valve and to close up the defect. The 2D and 3D TEE images after CPB showed effective repair providing complete closure of the mitral leaflets and absence of residual regurgitation flow. Considering that the conventional 2D TEE requires examiner's ability to gather the various 2D TEE images and experience essential for intergrating the 2D images for full understanding of spatial structure of valvular deformity and dysfunction, 3D TEE's ability for making a comprehensive spatial image from a limited number of 2D images seems to have an additional clinical efficacy in intraoperative TEE monitoring for cardiac value surgery.
Cardiopulmonary Bypass ; Congenital Abnormalities ; Echocardiography ; Echocardiography, Transesophageal ; Hypothermia ; Mitral Valve ; Mitral Valve Insufficiency

OBJECTIVE: The primary purpose of this study was a replication of the effectiveness and tolerability of risperidone in the treatment of patients with acute mania in very larger cohort in naturalistic treatment setting to extend the data on the effect and tolerability of risperidone in the treatment of patients with acute mania to Asian population. METHODS: A total of 909 patients with DSM-IV criteria of bipolar disorder current manic and hypomanic episode, entered this large, open, multicentre study. The Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI) and Simpson-Angus Rating Scale (SARS) were measured at baseline and weeks 1, 3 and 6, for the assessment of effectiveness and extrapyramidal symptom (EPS). RESULTS: This study showed statistically significant reduction of scores on the YMRS and CGI-s (mean change=-23.5+/-11.8, p<0.0001;mean change=-2.7+/-1.5, p<0.0001, respectively) from the baseline to the endpoint (week 6). Number of patients with 50% reduction or more in the YMRS and CGI-s scores was 693 (77.8%) and 630 (70.7%) at endpoint, respectively. There were no statistically significant increments of scores on SARS. Risperidone was generally well tolerated. CONCLUSION: The present larger open study demonstrates that risperidone add-on therapy is effective and tolerable in treatment of bipolar disorder, replicating results in various controlled and uncontrolled studies from Western countries.
Asian Continental Ancestry Group ; Bipolar Disorder* ; Cohort Studies ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Risperidone*

BACKGROUND: Rib fractures are the most common injuries that are caused by blunt chest trauma. However, fractures of the costal cartilage generally go unnoticed on chest X-rays unless they involve a calcified cartilage. For this reason, the sensitivity of conventional radiography for detecting rib fractures is low, and especially those involving the cartilaginous part of the rib. Thus, we have evaluated the usefulness of ultrasonography for detecting fractures of the costal cartilage that were overlooked on the conventional radiographs of patients who suffered minor blunt chest traumas. MATERIAL AND METHOD: A total of 45 patients who suffered minor blunt chest trauma and who had no evidence of rib fractures or other major fractures on conventional radiographs were admitted for ultrasonography between April 2008 and March 2009. There were 24 women and 21 men, and the mean age of the patients was 50.4+/-15.91 years (range: 17~76 years). They were examined for the detection of fractures of the costal cartilage by performing ultrasonography with a 7.5-MHz linear transducer. RESULT: A total of 30 patients (67%) had fractures of the costal cartilage, whereas 15 patients (33%) had no evidence of chondral rib fractures. The mean number of fracture sites of the fractured costal cartilage was 1.6+/-0.81 (range: 1~4 sites) in 30 patients. Periosteal hematoma was the most common finding associated with fractures of the costal cartilage (n=7, 17%), followed by sternum fracture (n=5, 12%). However, periosteal hematoma was noticed in 1 patient (2%) who was without fracture of the costal cartilage, and sternum fracture was noticed in 1 patient (2%) who was without fractures of the costal cartilage. CONCLUSION: The results of this study suggest that ultrasonography may be a useful imaging modality for detecting fractures of the costal cartilage that are overlooked on the conventional radiographs of patients who suffer minor blunt chest trauma.
Cartilage ; Female ; Hematoma ; Humans ; Male ; Rib Fractures ; Ribs ; Sternum ; Thoracic Wall ; Thorax ; Transducers

BACKGROUND: A Comprehensive Aortic Root and Valve Reconstruction (CARVAR) procedure is comprised of aortic root wall reconstruction and corrections of the leaflets for treating various aortic valve diseases. We evaluated our recent early clinical experience with the CARVAR procedure. MATERIAL AND METHOD: From October 2007 to September 2008, 114 cases (66 males) of CARVAR procedures were performed. The mean patient age was 53 years (range: 14~84). The patients were divided into 4 groups: 1) the AAR group: aortic regurgitation with aortic root wall deformity such as annulo-aortic ectasia or ascending aortic aneurysm (n=18), 2) the IAR group: isolated AR with leaflet abnormality (n=42), 3) the IAS group: isolated aortic stenosis (n=51) and 4) the PAVR group: previous aortic valve replacement (n=3). Sinotubular junction (STJ) reduction was done in all the patients, leaflet correction was done in 10 of the AAR group patients and in all the patients of the other groups, annulus reduction was done in 14 of the AAR group patients and in 6 of the IAR group patients. Aortic dissection was excluded from this analysis. RESULT: There was no mortality or follow-up death. The diameter of the aortic sinus decreased from 54.6+/-8.4 mm to 38.3+/-3.8 mm in the AAR group, the mean AR grade decreased from 3.2 to 0.2 in the IAR group, the mean aortic valve pressure gradient decreased from 47.1+/-24.4 mmHg to 15.1+/-11.7 mmHg in the IAS group and the mean AR grade decreased to 0 in the PAVR group. Balloon type coronary perfusion cannula-related coronary ostial stenosis developed in 4 patients and this was treated with OPCAB in three patients and with PTCA in one patient. Two patients developed postoperative infectious endocarditis. All the patients were discharged and followed up in a stable condition. CONCLUSION: The CARVAR procedure showed excellent short term results, but a good further follow up result is required to apply this procedure to most kinds of aortic valve diseases.
Aortic Aneurysm ; Aortic Valve ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Congenital Abnormalities ; Constriction, Pathologic ; Dilatation, Pathologic ; Endocarditis ; Follow-Up Studies ; Humans ; Perfusion ; Sinus of Valsalva