No abstract available.
Cyclophosphamide* ; Hypersensitivity*

Percutaneous transcatheter closure of atrial septal defects as a therapeutic alternative in appropriate patients provides superior cosmetic results, is less invasive, and allows for shorter hospital stays. Unfortunately, however, such percutaneous procedures can be associated with catastrophic procedure complications that may require immediate surgical intervention. We report a case of aorta-to-right atrial fistula two months after transcatheter occlusion of an atrial septal defect by an Amplatzer septal occluder. Revealed by dyspnea, palpitation and hemolysis, this complication needed an emergency surgical operation. The fistula between the noncoronary Valsalva sinus of the aorta and the right atrium was repaired. The atrial septal defect was closed by patch. The cause of this serious complication appears to be erosion into the aorta by the right atrial disk.
Aorta* ; Dyspnea ; Emergencies ; Fistula* ; Heart Atria* ; Heart Septal Defects, Atrial* ; Hemolysis ; Humans ; Length of Stay ; Prostheses and Implants ; Septal Occluder Device ; Sinus of Valsalva

Tularemia is a major laboratory acquired zoonoses caused by Francisella tularensis that have high virulence, and usually transmitted to humans from direct contact with infected wild animals like rabbits or insect vectors like ticks. Clinical tularemia can be divided with 6 major syndromes that are delineated by the mode of organism aquisition, in which ulceroglandular type is the most common. F. tularensis have 3 different biogroups which have homogeneous antigenecity, type A (biogroup tularensis), type B (biogroup palearctica) and biogroup novicida, and can be confirmed by serology most frequently. In the domestic area, there was no reports of tularemia in humans or presence of bacteria in the reservoirs. Authers experienced a case of tularemia which is suspected as F. tularensis type B, ulceroglandular type. A healthy 40-year-old man admitted the hospital for lymph node swelling in both axillary and upper arm area and for furuncles in both forearm and palm. He contacted with dead rabbit and eated it after cooking before 20 days from admission day. In laboratory cultures, F. tularensis did not grow in any of the routine or anaerobic culture media except for one blood agar plate at 5 days. After subculturing that to cystine containing chocolate agar plate at 37C degree, 5% CO2 incubator, we could see the accelerating growth of colony. In microbiological test, it was oxidase and urease negative. In acid production in cystine trypticase agar base, it was glucose positive and sucrose, maltose, glycerol negative. In agglutinating test, F. tularensis antiserum titer (Difco, USA) with isolates was 1:160 or over and antibody titer to F. tularensis antigen (Difco, USA) was 1:320 or over. Anti-F. tularensis-IF assay and Anti-F. tularensis-indirect-EIA with isolates were positive.
Adult ; Agar ; Animals ; Animals, Wild ; Arm ; Bacteria ; Cacao ; Cooking ; Culture Media ; Cystine ; Forearm ; Francisella tularensis* ; Francisella* ; Furunculosis ; Glucose ; Glycerol ; Humans ; Incubators ; Insect Vectors ; Lymph Nodes ; Maltose ; Oxidoreductases ; Rabbits ; Sucrose ; Ticks ; Tularemia* ; Urease ; Virulence ; Zoonoses

PURPOSE: Effectiveness of the performance of bystander cardiopulmonary resuscitation (CPR) has a decisive impact on the outcomes for out-of-hospital cardiac arrest patients who receive it. After initial CPR education, CPR performance for those trained declines over time. Public education in CPR is commonly recommended to be repeated every 2 years. In this study, we evaluated the willingness of those who have been CPR trained to perform CPR as impacted by their training experience. METHODS: The staff of a small firm received 2 hours of primary CPR education. Two years later, their CPR training was repeated in an identical manner. Participants answered a questionnaire regarding their willingness to perform bystander CPR. Those who answered that they wouldn't perform bystander CPR were asked to select their reason. We also inquired about what they viewed as the most difficult phase of CPR performance, and collected their opinions about the overall necessity and appropriate time period for re-education. RESULTS: Those who answered 'definitely yes' to 'willingness to perform to CPR' increased from 36.6% before primary CPR education to 74.2% afterward. But 2 years later and before re-education, only 30.1% answered 'definitely yes' to 'willingness to perform CPR'. Meanwhile, 41.2% and 29.4% answered that 'fear of legal liability' and 'fear of poor knowledge/performance' were the reasons why they would not perform bystander CPR. Ventilation was the most difficult stage in CPR identified by 34% of the participants, and 18.4% answered that chest compression was the most difficult stage in CPR. 93.6% answered that they should receive CPR re-education. CONCLUSION: The willingness to perform bystander CPR declined significantly after 2 years. Therefore routine public re-education for bystander CPR is necessary.
Cardiopulmonary Resuscitation ; Humans ; Out-of-Hospital Cardiac Arrest ; Surveys and Questionnaires ; Thorax ; Ventilation

Monitoring temporal trends of antimicrobial resistance can provide useful information for the empirical selection of antimicrobial agents to treat infected patients and for the control of nosocomial infections. In this study, we analyzed antimicrobial resistance of clinically relevant bacteria in 2003 at Korean hospitals and at a commercial laboratory. The following organism-antimicrobial agent resistance combinations were very prevalent: oxacillin-resistant Staphylococcus aureus (68%), expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae (25%), and fluoroquinolone-resistant Escherichia coli (33%), Acinetobacter spp. (58%), and Pseudomonas aeruginosa (40%). Moreover, gradual increases in vancomycin-resistant Enterococcus faecium (20%), cefoxitin-resistant E. coli (10%) and K. pneumoniae (23%), and imipenem-resistant P. aeruginosa (20%) and Acinetobacter spp. (13%) were also observed. The resistance rates of Acinetobacter spp. to most antimicrobial agents at hospitals and at the commercial laboratory were similar. Among the Acinetobacter spp. isolated at a tertiary-care hospital, 46.2% were multidrug-resistant to 9-12 of 13 antimicrobial agents, and 18.3% were panresistant. The exclusion of duplicate isolates at a tertiary-care hospital significantly lowered the proportion of oxacillin-resistant S. aureus, vancomycin-resistant E. faecium, and fluoroquinolone-resistant E. coli.
Vancomycin Resistance ; Vancomycin/pharmacology ; Population Surveillance ; Microbial Sensitivity Tests ; Korea/epidemiology ; Klebsiella pneumoniae/drug effects/isolation & purification ; Klebsiella Infections/drug therapy/epidemiology/microbiology ; Imipenem/pharmacology ; Humans ; Gram-Positive Bacterial Infections/drug therapy/epidemiology/*microbiology ; Gram-Negative Bacterial Infections/drug therapy/epidemiology/*microbiology ; Gammaproteobacteria/*drug effects/isolation & purification ; Fluoroquinolones/pharmacology ; Enterococcus faecium/*drug effects/isolation & purification ; *Drug Resistance, Bacterial ; Anti-Bacterial Agents/*pharmacology ; Amikacin/pharmacology ; Acinetobacter Infections/drug therapy/epidemiology/microbiology ; Acinetobacter/drug effects/isolation & purification

The surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis remains a challenge. The Rastelli operation or Lecompte operation is the preferred surgical procedure, but its long-term results are not optimal because of a warped left ventricular outflow tract through a space-occupied intraventricular tunnel and a contrived right ventricular outflow tract. We performed a half-turned truncal switch operation as an alternative surgical procedure in a 3-year-old boy (weighing 9.6 kg) with this anomaly. Postoperative echocardiography showed laminar flow through straight and nonobstructive aortic and pulmonary ventricular outflow tracts.
Arteries ; Child, Preschool ; Echocardiography ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Humans ; Male ; Pulmonary Valve Stenosis* ; Transposition of Great Vessels*

Microinvasive carcinoma of the uterine cervix(FIGO stage IA) has been reported as highly curable disease even with conservative surgery such as conization and simple hysterectomy. Nevertheless, the surgical management for microinvasive carcinomas has been proposed varying from conservative surgery to radical hysterectomy with pelvic nodes dissection according to different diagnostic criterias for microinvasive carcinoma. We reviewed 512 patients who had been diagnosed as microinvasive carcinoma of the uterine cervix at the Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center from Jan. 1988 to Dec. 1995. Among them, 376 patients were included in this study satisfying guided criterias such as proper management and follow up more than at least one year, and they were analyzed retrospectively based on the clinicopathologic characteristics, pattern of surgical management and postoperative status. (continue)
Cervix Uteri* ; Conization ; Delivery of Health Care ; Diagnosis* ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Obstetrics ; Retrospective Studies

BACKGROUND: This retrospective review examines the preoperative condition, postoperative course, mortality and cause of death for the patients who underwent modified Blalock-Taussig shunt for complex congenital heart defects in early infancy. MATERIALS AND METHOD: Fifty eight patients underwent modified Blalock-Taussig shunts from January 2000 to November 2003. The mean age at operation was 23.1+/-16.2 days (5~81 days), and the mean body weight was 3.4+/-0.7 kg (2.1~4.3 kg). Indications for surgery were pulmonary atresia with ventricular septal defect in 12 cases, pulmonary atresia with intact ventricular septum in 17, single ventricle (SV) in 18, and hypoplastic left heart syndrome (HLHS) in 11. Total anomalous pulmonary venous return (TAPVR) was associated with SV in 4 cases. RESULT: There were 11 (19.0%) early, and 5 (10.6%) late deaths. Causes of early death included low cardiac output in 9, arrhythmia in 1, and multiorgan failure in 1. Late deaths resulted from pneumonia in 2, hypoxia in 1, and sepsis in 1. Risk factors influencing mortality were preoperative pulmonary hypertension, metabolic acidosis, use of cardiopulmonary bypass, HLHS and TAPVR. Twenty four patients (41.4%) had hemodynamic instability during the 48 postoperative-hours. Six patients underwent shunt revision for occlusion, and 1 shunt division for pulmonary overflow. CONCLUSION: Modified Blalock-Taussig shunt for complex congenital heart defects in early infancy had satisfactory results except in high risk groups. Many patients had early postoperative hemodynamic instability, which means that continuous close observation and management are mandatory in this period. Aggressive management may appear warranted based on understanding of hemodynamic changes for high risk groups.
Acidosis ; Anoxia ; Arrhythmias, Cardiac ; Blalock-Taussig Procedure* ; Body Weight ; Cardiac Output, Low ; Cardiopulmonary Bypass ; Cause of Death ; Heart Defects, Congenital* ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Hypoplastic Left Heart Syndrome ; Infant ; Mortality ; Pneumonia ; Pulmonary Atresia ; Retrospective Studies ; Risk Factors ; Scimitar Syndrome ; Sepsis ; Ventricular Septum

BACKGROUND: We evaluated the early and mid-term results for repair of Ebstein's anomaly. MATERIAL AND METHOD: Between January 1989 and June 2004, 29 patients underwent repair of Ebstein's anomaly. The median age was 11.4 years (4 days-50 years). Tricuspid insufficiency equal to or greater than grade 3 was present in 21 (72.4%) patients. Surgical techniques included tricuspid valve repair with vertical plication of the atrialized ventricle (n=14), Carpentier's technique (n=7), tricuspid valve replacement (n=4), systemic-to-pulmonary arterial shunt (n=2), tricuspid valve repair (n=1), and Fontan operation (n=1). Bi-directional cavopulmonary shunt (BCPS) was required in 5 patients. Among the 2 neonates, one patient underwent successful biventricular repair, and the other patient underwent systemic-to-pulmonary arterial shunt. Follow-up was possible in 21 patients (75%), and the average follow-up was 37.6 months (3 months~11.3 years). RESULT: There were 1(3.4%) early and 1 late deaths. Reoperation was required in 4 patients. Two patients underwent tricuspid valve re-replacement, and the other 2 tricuspid valve repair. At recent follow-up, only 2 patients showed tricuspid insufficiency equal to or greater than grade 3, and most patients showed clinical improvement. Excluding the patients who underwent tricuspid valve replacement, the actuarial rate of freedom from reoperation at 1 and 5 years were 94.7% and 79.0%, respectively. CONCLUSION: Tricuspid valve repair was possible in most patients with good mid-term outcome. Most patients showed clinical and hemodynamic improvement. Indications for the BCPS should be clarified.
Ebstein Anomaly* ; Follow-Up Studies ; Fontan Procedure ; Freedom ; Heart Bypass, Right ; Hemodynamics ; Humans ; Infant, Newborn ; Reoperation ; Tricuspid Valve

The Urachus lies between the peritoneum and transversalis fascia and extends from the anterior dome of the bladder toward the umbilicus. During the 4th and 5th months of gestation, the urachus narrows to a small-calibered epitherial tube. During fetal development, as the bladder descends into the pelvis, its apical portion narrows progressively into a fibromuscular strand of urachus. Recently, we reviewed three cases of urachal anomalies with literatures.
Fascia ; Fetal Development ; Pelvis ; Peritoneum ; Pregnancy ; Umbilicus ; Urachus ; Urinary Bladder