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*

No abstract available.
Kidney* ; Neuroectodermal Tumors, Primitive*

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

PURPOSE: To investigate the clinical results and safety of the acellular dermal allograft (SureDerm(R), Hans Biomed co., Korea) as a new spacer graft in anophthalmic socket contracture. METHODS: We grafted SureDerm(R) as the replacing spacer in 8 patients for the treatment of anophthalmic socket contracture. Under local anesthesia, SureDerm(R) was sutured at the levator aponeurosis and upper margin of the tarsus using 6-0 Vicryl in the upper lid. In the lower lid, SureDerm(R) was sutured at the tarsal conjunctiva and lower margin of the incised conjunctiva. The patients were followed-up individually for 6 to 15 months. RESULTS Surgical results in all 8 eyelids (6 lower lids, 2 upper lids) were satisfactory. The grafted SureDerm(R) survived in all patients with little contracture. There were no other complications such as infection, rejection, or exposure. CONCLUSIONS: We consider SureDerm(R) a good replacing spacer material for the treatment of anophthalmic socket contracture.
Allografts* ; Anesthesia, Local ; Ankle ; Conjunctiva ; Contracture ; Eyelids ; Humans ; Polyglactin 910 ; Transplants

We studied 28 eyes presenting with subretinal neovascular membrane by means of clinical evaluation and fluorescein angiography. Each patient was an adult under 50 years of age. None of the patients were treated with laser photocoagulation or operation. The patients included 7 males(9 eyes) and 17 females(19 eyes). Idiopathic subretinal neovascular membrane was noted in 71.4% and myopic subretinal neovascular membrane in 28.6%. Visual acuity at the first visit was from finger count to 20/25. Visual acuity of 19 eyes(67.9%) was above 20/100. In 62.5% of the cases, the size of the lesion was less than half the diameter of the disc. Subfoveal type was noted in 75.0%. Visual acuity was maintained or improved in 75.0% and decreased in 25.0%. The subretinal neovscular membranes in patients who were under 50 years of age were mostly small and idiopathic, and located at the subfovea. These patients had good visual acuity compared to patients with subretinal neovascular membrane secondary to age-related macular degeneration.
Adult* ; Fingers ; Fluorescein Angiography ; Humans ; Light Coagulation ; Macular Degeneration ; Membranes* ; Visual Acuity

We studied whether the structure and size of nasal cavity around osteotomy site had an influence on the success rate of endoscopic endonasal dacryocystorhinostomy [DCR]. Endoscopic endonasal DCR was performed on 80 eyes of 72 patients who had obstruction of nasolacrimal system.We graded nasal cavity around osteotomy site according to the diameter of drill which could pass[grade I:7 mmdrill can pass, grade II:5 mmdrill can pass, grade III:3 mmdrill can pass, grade IV:3 mmdrill cannot pass].The primary success rate is 70%[56 eyes] and final success rate is 81.3%[65 eyes]after secondary operation was perfomed on 14 eyes of 24 failed eyes in primary operation.Primary success rate was 78.8%[41/52 eyes]and 53.6%[15/28 eyes]in grade I-II and grade III-IV, respectively.Final success rate was 86.5%[45/52 eyes]and 71.4%[20/28 eyes]in grade I-II and grade III-IV, respectively.The difference of success rates according to nasal cavity size is stastically significant[P<0.05] and the relation of nasal septum deviation to small nasal cavity is stastically significant[P<0.05].We found canalicular obstruciton in 5 of 14 eyes during secondary operation which was not found in primary speration, and it was suspected to have been caused by mechanical trauma to canalicular system during operation.
Dacryocystorhinostomy* ; Humans ; Nasal Cavity* ; Nasal Septum ; Osteotomy

Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive neoplasm arising in the nasal cavity and paranasal sinuses. We report a case of SNUC in an old woman. The tumor was located at the nasal cavity and ethmoid sinus, extending to the cranial cavity. The nasopharynx was free from the tumor. Microscopically, the tumor formed nests or sheets containing medium-sized cells with small amounts of eosinophilic cytoplasm. High mitotic rates and tumor necrosis were characteristic. There was no evidence of glandular or squamous differentiation. The tumor was focally weak positive for cytokeratin, but negative for vimentin, leukocyte common antigen, S-100 protein, chromogranin, synaptophysin and neuron specific enolase. Epstein Barr Virus EBER-1 was not detected by in situ hybridization. SNUC is a highly aggressive tumor and must be distinguished from less aggressive sinonasal neoplasms.
Antigens, CD45 ; Carcinoma* ; Cytoplasm ; Eosinophils ; Ethmoid Sinus ; Female ; Herpesvirus 4, Human ; Humans ; In Situ Hybridization ; Keratins ; Nasal Cavity ; Nasopharynx ; Necrosis ; Paranasal Sinuses ; Phosphopyruvate Hydratase ; S100 Proteins ; Synaptophysin ; Vimentin

PURPOSE: This study was to observe the clinical outcome and complications of Medpor(R) orbital implant. METHODS: The clinical outcome and complications were studied retrospectively in 64 eyes with Medpor(R) implantation. Evisceration was done in 34 cases, enucleation in 19 cases, and secondary implantation in 11cases. Mean follow up period was 16 months(4~30 months) and mean age of the participants was 34.9(1~79). RESULTS: Implant infection developed in one case, implant exposure developed in four cases and superior sulcus deformity developed in two cases. Motility Coupling Post(MCP) was inserted in 26 eyes. Motility of the prosthesis was good in most cases. CONCLUSIONS: Medpor(R) orbital implant is being widely used currently. Complications or motility of the prosthesis showed no significant difference from those of Hydroxyapatite. But low cost and its handiness in operation makes it a desirable orbit implant.
Congenital Abnormalities ; Durapatite ; Follow-Up Studies ; Orbit* ; Orbital Implants* ; Prostheses and Implants ; Retrospective Studies

OBJECTIVES: To investigate whether the aspects of Pap smear affect cervical abnormality in our country. METHODS: We compared the sensitivity of Pap smear of 241 cases of pathologic proven CIN & invasive cancer, compared to that of 655 cases with normal cervical biopsy, and reviewed the history of the test of 138 cases, retrospectively. RESULTS: The sensitivity of the test was 89.6%, 92.7% in CIN & invasive cancer group, respectively, with 96.9% specificity. Among 241 cases, 138 cases were examined for the frequency of test during the 3 years with the result of 2.42, 2.17/3yr in CIN and invasive cancer. And distribution of the test was not different between the two groups. The mean intervals of last two Pap smear before diagnosing final pathology in CIN and cancer were 12.1, 13.7 months, respectively, with no statistical significance (p>0.05). CONCLUSION: We concluded that in our country the aspects of Pap smear such as frequency and interval do not influence the result of cervical abnormality, so recommend the annual Pap test as a screening.
Biopsy ; Cervical Intraepithelial Neoplasia* ; Mass Screening ; Papanicolaou Test* ; Pathology ; Retrospective Studies ; Sensitivity and Specificity

The authors report a rare case of spinal dural arteriovenous fistula (DAVF) that supplied by lateral sacral artery. A 71-year-old female initially presented with paraparesis and boring pain on lower extremities. Though magnetic resonance imaging suggested a possible spinal DAVF, routine angiographic evaluation was negative. Thereafter, the patient deteriorated progressively and became paraplegic. Definite diagnosis was made through selective pelvic angiogram. The patient was subsequently treated with embolization using mixture of glue and lipiodol. On three months after the embolization, the patient remained paraplegic, but her leg pain was improved remarkably.
Adhesives ; Aged ; Arteries* ; Central Nervous System Vascular Malformations* ; Diagnosis ; Ethiodized Oil ; Female ; Humans ; Leg ; Lower Extremity ; Magnetic Resonance Imaging ; Paraparesis