BACKGROUND: Aprotinin, which is a nonspecific serine protease inhibitor, has an antiinflammatory and thrombogenic effect. However, it has an antithrombogenic effect during the cardiopulmonary bypass. This study was performed to evaluated the effects of aprotinin on the activated clotting time(ACT) and the total amount of the heparin used during the cardiopulmonary bypass. MATERIAL AND METHOD: From December 1998 to November 1999, 82 consecutive patients electively underwent open heart surgery at Gachon medical school. The patients were older than 18 years. Eighty two patients were classified into a control group(group C, n=36) and a aprotinin-treated group(group A, n=46). Body weight, height, body surface area(BSA), pump time(PT), aortic cross clamping time(ACCT), and body temperature(BT) were determined. Total amount of heparin and protamine during the CPB were also measured. ACT was determined before heparin administration, at 20, 40 and 60 minutes after heparin administration, and after protamine administration. RESULT: No significant differences were noted in either group in body weight, height, BSA, BT, and the total amoun of heparin and protamine. Group A demonstrated a significant(p<0.05) increase in age, PT, ACCT, and ACT at 20, 40, and 60 minutes after heparin administration. CONCLUSION: In summary, the use of aprotinin prime resulted in an increase in ACT. The total amount of heparin in aproinin-treated patient was similar to that of the control group in spite of having the prolonged pump time. Therefore aprotinin may reduce the requirement of heparin.
Aprotinin* ; Body Height ; Body Weight ; Cardiopulmonary Bypass ; Constriction ; Heart* ; Heparin* ; Humans ; Schools, Medical ; Serine Proteases ; Thoracic Surgery*

The patient with unilateral or bilateral inverted nipple has both functional and cosmetic impairments. The structural and histopathologic features of inverted nipple are that inverted nipple has less fibromuscular tissue than normal nipple and has short lactiferous duct and dense fibrous tissue. For these reasons, surgical correction of inverted nipple requires release of the short lactiferous ducts and providing the bulkiness under the nipple. We combined the concept of both adding the bulkiness under the nipple and creating a tight neck at its base without sacrificing the duct system. We rotated the bilateral diamond shaped deepithelized dermal flaps around the nipple areolar complex for providing the nipple bulkiness without division of lactiferous duct and reinforced it with the purse-string suture around the dermal flap for providing the stability. This two rotational dermal flap method was applied 12 inverted nipple in 6 patients and followed up for 2 months to 24 months. We have got the satisfactory results in cosmetic and functional aspect without any complication such as sensory change, relapse, and nipple necrosis.
Diamond ; Humans ; Neck ; Necrosis ; Nipples* ; Recurrence ; Sutures

Early treatment to facilitate the muscular blood flow can avert myonephropathic metabolic syndrome (MNMS) and major amputation for patients suffering with acute limb ischemia. Delayed reperfusion or microemboli in the small vessels can aggreviate: ischemic changes and lead to irreversible muscle necrosis. Amnion is an excellent biological dressing, and we tried using it to treat anterior compartment muscle necrosis (ACMN). The amnions were aseptically collected from caesarean sections. Additional betadine (1 : 3 solution) and vaseline-soaked gauzes were applied over the amnion as a daily biologic wet dressing. The amnion was replaced every three days. Finally, split skin grafting was performed on the healthy granulation tissue. We treated two patients who happened to have shin muscle necrosis. A 65-year-old man with a femoro-femoral arterial bypass showed graft thrombosis. Thirteen days after performing balloon angioplasty with stent insertion in the right femoral artery, new emboli were found in the stent and in the left popliteal artery. There was an attack of myocardial infarction the next day after embolectomy. The severe MNMS and ACMN at the right shin occurred after cardiopulmonary resuscitation. The dry gangrene was excised 3 months later, and this was followed by a skin graft 4 months later. An 81-year-old woman with atrial fibrillation showed left common femoral arterial obstruction and ACMN on the left shin during the management of congestive heart failure. The dry gangrene was excised 2 months later, and this was followed by a skin graft 3 months later. The amnion dressing shows promises for providing healthy granulation tissue for split skin grafts when treating muscle necrosis of the leg. Biologic dressing with using amnion is an option for limb salvage in the case of muscle necrosis that is caused by acute limb ischemia, although the treatment takes a long time.
Aged ; Aged, 80 and over ; Amnion* ; Amputation ; Angioplasty, Balloon ; Atrial Fibrillation ; Bandages* ; Biological Dressings ; Cardiopulmonary Resuscitation ; Cesarean Section ; Embolectomy ; Extremities* ; Female ; Femoral Artery ; Gangrene ; Granulation Tissue ; Heart Failure ; Humans ; Ischemia* ; Leg ; Limb Salvage ; Lower Extremity* ; Myocardial Infarction ; Necrosis* ; Popliteal Artery ; Povidone-Iodine ; Pregnancy ; Reperfusion ; Skin ; Skin Transplantation ; Stents ; Thrombosis ; Transplants

BACKGROUND: Psychogenic and physical aspects of health is interesting issue in the field of family medicine. We intended to study the relationship between physical illness and symptoms with self esteem, and hoped to understand disease in general behavioral context. METHODS: We selected 124 persons who visited family medicine OPD in Paik Hospital from August 3 to August 20, 1995, and answered questionnaire frankly. The qestionnaire consisted of Rosenberg self esteem scale as paremeter of self esteem and Hopkins symptom check list as parameter of physical health. The third author analyzed the medical record and rated the severity of disease as grade I-VII, for another parameter of physical health. The other factors-age, sex, marriage, education level, family, income-were analyzed by self esteem. RESULTS: We divided the study population into two groups, low self esteem group and high self esteem group. In low self esteem group, the persons complain more symptoms in Hopkins symptom check list significantly(P=0.009). Those who were highly educated had significantly higher self esteem(P=0.047). The severity of disease, sex, age, marriage, type of family, income showed no significant relationship with self esteem. CONCLUSIONS: The education level was the factor that influence self esteem. The person of low self esteem complains more symptoms. So we should consider self esteem in medical practice.
Education ; Hope ; Humans ; Marriage ; Medical Records ; Self Concept* ; Surveys and Questionnaires

BACKGROUND: Psychogenic and physical aspects of health is interesting issue in the field of family medicine. We intended to study the relationship between physical illness and symptoms with self esteem, and hoped to understand disease in general behavioral context. METHODS: We selected 124 persons who visited family medicine OPD in Paik Hospital from August 3 to August 20, 1995, and answered questionnaire frankly. The qestionnaire consisted of Rosenberg self esteem scale as paremeter of self esteem and Hopkins symptom check list as parameter of physical health. The third author analyzed the medical record and rated the severity of disease as grade I-VII, for another parameter of physical health. The other factors-age, sex, marriage, education level, family, income-were analyzed by self esteem. RESULTS: We divided the study population into two groups, low self esteem group and high self esteem group. In low self esteem group, the persons complain more symptoms in Hopkins symptom check list significantly(P=0.009). Those who were highly educated had significantly higher self esteem(P=0.047). The severity of disease, sex, age, marriage, type of family, income showed no significant relationship with self esteem. CONCLUSIONS: The education level was the factor that influence self esteem. The person of low self esteem complains more symptoms. So we should consider self esteem in medical practice.
Education ; Hope ; Humans ; Marriage ; Medical Records ; Self Concept* ; Surveys and Questionnaires

Collagen, which is newly synthesized by the cellular component, is the major component of extracellular matrix in PVR membranes. The effects of transforming growth factor (TGF)-beta in the synthesis of collagen were evaluated. Tissue culture of PVR membrane was incubated for 19 hours with or without TGF-beta in the absence of serum. Newly synthesized collagen in the membrane were measured by a collagenase-digestion assay. The biosynthetically labeled collagens were analyzed on SDS-polyacrylamide gel electrophoresis. Collagen synthesis was dose-dependently stimulated by TGFbeta. At a concentration of 1ng/ml of TGFbeta1or TGFbeta2,at a concentration of 10ng/ml, induced a 90125% increase in collagen synthesis over that of controls. PVR membranes in culture synthesized predominantly type I, III and V collagen. In conclusion TGFbeta are potent stimulants of collagen.
Collagen* ; Electrophoresis ; Extracellular Matrix ; Membranes ; Retinal Pigment Epithelium ; Transforming Growth Factor beta ; Transforming Growth Factors ; Vitreoretinopathy, Proliferative*

PURPOSE: To report a patient with multiple subretinal and intraretinal hemorrhages in the absence of retinal/choroidal lesions, diagnosed with infective endocarditis (IE). CASE SUMMARY: We describe the case of a 44-year-old male with an acute decrease of vision in his right eye. Ophthalmic evaluation revealed multiple subretinal and intraretinal hemorrhages, but no choroidal or other retinal lesions. A systemic examination revealed a pansystolic murmur and blood cultures with echocardiography were suggestive of IE. CONCLUSIONS: Thorough systemic evaluations are important when patients present with subretinal and intraretinal hemorrhages in the absence of other retinal/choroidal lesions.
Adult ; Choroid ; Echocardiography ; Endocarditis* ; Hemorrhage* ; Humans ; Male ; Retinal Hemorrhage ; Retinaldehyde

BACKGROUND: In a study, iris color was positively associated with skin melanin content. So it could be assumed that iris color has a close relationship with skin color. But until recently, classification system of iris color has been subjective and not suitable especially for Asian population for their relative homogeneity of iris color. OBJECTIVE: The purpose of this study was to devise an objective and quantitative method to measure iris and skin color quantitatively and to assess the relationship and its significance. METHODS: We devised photographic system composed of digital camera and tungsten lamp with color temperature conversion filter to acquire adequate iris images for colorimetric investigations. The reference CIELAB coordinates of color chart recorded with reflectance spectrophotometer were compared statistically with computed CIELAB coordinates from digital images in order to find equations for calibrating CIELAB values. To find the dermatological significance, we took pictures of 47 Korean patients with various conditions. They were evaluated with regard to iris color, color of sun-exposed and sun-protected skin. RESULTS: The images obtained with this system were enough to be used for the assessment of iris and skin color. And, it was possible to quantify the iris color, skin color and its difference in colorimetric ways using the methods in this study. Lightness (L*) of sun-exposed skin is decreased to the age. L* of iris has a positive correlation with L* of sun-exposed skin. L* of iris was positively correlated with a* and b* of iris respectively. The relations were very similar with those between L* of iris and each of a* and b* of sun-protected skin. CONCLUSION: Iris color could be assessed by using their images colorimetrically obtained by our method. As L* of iris color has the similar relations with a* and b* in both iris and sun-protected skin, the iris color would be a clue to look for and define the constitutional skin color.
Asian Continental Ancestry Group ; Colorimetry ; Humans ; Iris ; Light ; Melanins ; Skin ; Tungsten

No abstract available.
Anemia* ; Hypothyroidism*

BACKGROUND: Inhaled nitric oxide therapy causes selective pulmonary vasodilation in congenital heart diseases with pulmonary hypertension. However discontinuation of inhaled nitric oxide therapy may be complicated by abrupt life-threatening rebound pulmonary hypertension(RPH) The purpose of this study was to prevent by comparing group I(without RPH n=13) and group II(with RPH n=6) to determine the risk factors involved inthe development of the RPH. MATERIAL AND METHOD: Between Januarty 6, 1998 and April 14, 1999. we studied 19 consecutive children who were treated with inhaled nitric oxide for clinically significant pulmonary hypertension after an open heart surgery for congenital heart disease. the ratio of males and females was 12:7 ranging in age from 10 days to 6040 days(16 years) To identify the effects of nitric oxide between two groups we measured heart rate mean and systolic pulmonary arterial pressure mean and systolic systemic arterial pressure central venous pressure pH paO2/FiO2 and O2 saturation before and after the initiation and just before the withdrawal of the inhaled nitric oxide. RESULT: In 6 of 19 patients(32%) withdrawal of inhaled nitric oxide caused RPH. In the two groups inhaled nitrix oxide decreased in pulmonary arterial pressure(PAP) without decreasing the systemic arterial pressure(SAP) and increased PaO2/FiO2 Compared with patients who had no RPH(group I) patients who had RPH(group II) were older in age (1204+/-1688 versus 546+/-1654 days p<0.05) received less nitric oxide therapy(34+/-18 versus 67+/-46 hours p<0.05) has shorter weaning process(5+/-3 versus 15-13 hours p<0.05) and received lowerconcentration of initial nitric oxide supply(11+/-8 versus 17+/-8 ppm p>0.05) and lower concentration just before the withdrawal nitric oxide(4.2+/-2.6 versus 5.6+/-2.6 ppm, p>0.05) CONCLUSION: We speculate that older age shorter of nitric oxide therapy shorter weaning process are the risk factors of RPH.
Arterial Pressure ; Central Venous Pressure ; Child ; Female ; Heart Defects, Congenital ; Heart Diseases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary* ; Male ; Nitric Oxide* ; Risk Factors ; Thoracic Surgery ; Vasodilation ; Weaning