PURPOSE: Hemoaccess using a polytetraflouroethylene (PTFE) graft is widely performed when primary arteriovenous access is unavailable. An infection of a PTFE graft is a common complication and a major cause of hemoaccess failure. This study reviewed the infected case of PTFE grafts in our hospital, and evaluated the incidence, surgical treatment, progress and outcome. METHODS: From March 2000 to February 2005, among 1,067 patients who received PTFE graft surgery in Soonchunhyang University Hospital, 58 patients were treated graft infection. These patients were managed by a total graft excision (TGE), a subtotal graft excision (SEG), and a partial graft excision (PEG) with a bypass graft. Usually, SGE is defined as the removal of all of the graft except for 2~3 mm from the arterial anastomosis. However, in our cases, SGE was performed with 1~1.5 cm of the arterial remnants, according to the operative risk, and either the surgical technique or the patient's medical condition. All the records were reviewed retrospectively. RESULTS: The mean age of the patients was 55 years, and 36 patients had a history of diabetes. The PTFE graft placed in the brachiobrachial position of the upper arm was encountered most frequently (72%). 23 graft infections located within the body of the graft, 20 of these were documented to be at a recent puncture site for hemodialysis access. The most common presentation (29%) was purulent discharge. Among the 58 patients treated for a graft infection, 40 patients received SGE, PGE was replaced by a new graft in 15 patients, TGE was performed in 2 patients, and incision and drainage was performed in 1 patient. After surgery, all the patients were treated with antibiotics. The bacterial cultures were positive in 38 cases. Of the 38 culture positive wounds, the most common organism was Staphylococcus aureus (33 cases). 15 cases developed infectious complications: pneumonia, systemic sepsis, duodenal ulcer with or without bleeding, and septic arthritis. The overall mortality was 8% (5 patients). Among the SGE patients, 11 patients evolved an infection of the remnant prosthesis, and a surgical procedure was required. CONCLUSION: Infections are one of a serious complications of PTFE graft that can progress more graft failure or death. There are many treatment options. These include 1) Incision and drainage, 2) TGE, 3) SGE and 4) PGE. TGE should be performed if the graft is not well incorporated or the entire graft was infected. In our experience with infected peripheral bypass grafts, a subtotal graft excision was used if the arterial anastomosis was intact and encased in scar tissue. A risky dissection of an artery encased in scar tissue was avoided by oversewing 1~1.5 cm rather than a 2~3 mm cuff of the remainder of the graft.
Anti-Bacterial Agents ; Arm ; Arteries ; Arthritis, Infectious ; Cicatrix ; Dialysis* ; Drainage ; Duodenal Ulcer ; Hemorrhage ; Humans ; Incidence ; Mortality ; Pneumonia ; Polytetrafluoroethylene ; Prostaglandins E ; Prostheses and Implants ; Punctures ; Renal Dialysis ; Retrospective Studies ; Sepsis ; Staphylococcus aureus ; Transplants* ; Wounds and Injuries

PURPOSE: To evaluate the efficacy and safety of placement of a central venous catheter with infusion portinto the superior vena cava MATERIALS & METHODS: Central venous catheters with a infusion port were implanted in21 patients (M:F=4:17, age range:15-63, mean age:41) diagnosed as suffering from breast cancer(n=9),lymphoma(n=7), thymoma(n=2) rhabdomyosarcoma(n=2) and rectal cancer(n=1). The peripheral portion of the subclaveanvein was punctured under fluoroscopic guidance during injection of contrast media at the site of the ipsilateralperipheral vein (20 cases) and under ultrasonographic guidance (1 case). 9.6F central venous catheters placed inthe superior vena cava via the subclavian vein and the connected infusion ports were implanted in the subcutaneouspocket near the puncture site of the right anterosuperior chest wall. RESULTS: Catheter insertion in the superiorvena cava and port implantation in the subcutaneous pocket were successful in all patients. Mean procedure timewas 23 minutes and there were no early complications. Because the incision site had not healed, one patientunderwent resuturing 3 weeks after the procedure. In one case, thrombotic occlusion of the catheter occurred, butsuccessful recanalization, involving urokinase infusion, was performed. At the end of the chemotherapy schedule,at 180, 157 and 139 days after the procedure, three central venous catheters with a infusion port were removed inthe radiologic suite. Catheter days are 5 days-180 days(mean, 119) from now (1997. 7. 1). CONCLUSIONS: Radiologicplacement under fluoroscopic guidance of a central venous catheter with a infusion port is easy, safe and usefulfor patients requring long-term venous access.
Breast ; Catheters ; Central Venous Catheters ; Contrast Media ; Drug Therapy ; Fluoroscopy ; Humans ; Punctures ; Subclavian Vein ; Thoracic Wall ; Urokinase-Type Plasminogen Activator ; Veins ; Vena Cava, Superior

PURPOSE: We tried to compare normal term infants with low-birth-weight infants discharged from NICU by evaluating morbidity. So we studied rates of rehospitalization, reasons for rehospitalization and neonatal risk factors that affect rehospitalization of normal term infants and low-birth-weight infants discharged from NICU. METHODS: This study was performed on 217 low-birth-weight infants discharged from NICU and 126 normal term infants born in Presbyterian Medical Center from January 1992 to December 1994. RESULTS: Low-birth-weight infants discharged from NICU had higher rates of rehospitalization than normal term infants. Twenty-nine percent of low-birth-weight infants discharged from NICU were rehospitalized, compared with 12.7% of normal term infants(P<0.001). Rates of rehospitalization by birth weight was 45.5% in infants of 1500g or less and 31.2% in infants of 1500-1999g of birth weight. The rates of rehospitalization increased as birth weight decreased (P<0.001), but there was no significant difference between 16.4% in infants of 2000-2500g of birth weight and 12.7% of normal term infants(P=0.442). Reasons for rehospitalization of low bith weight infants were respiratory problem(63.1%), congenital/developmental problem(10.8%), surgical problem(9.2%), G-I problem(7.7%), ophthalmic problem(3.1%), and cardiac problem(1.5%). Neonatal risk factors related to rehospitalization of low birth weight infants were mechanical ventilation, duration of mechanical ventilation, bronchopulmonary dysplasia and duration of hospitalization(P<0.01). CONCLUSION: Rates of rehospitalization increased accordingly to decreasing birth weight. The most common cause of rehospitalization was respirartory problem. Neonatal risk factors related to rehospitalization were mechanical ventilation, bronchopulmonary dysplasia and duration of hospitalization. The data suggest that high risk infants of rehospitalization require close follow up.
Birth Weight ; Bronchopulmonary Dysplasia ; Hospitalization ; Humans ; Infant ; Infant, Low Birth Weight* ; Infant, Newborn ; Protestantism ; Respiration, Artificial ; Risk Factors

Tono-pne and Perkins tonometer have been widely accepted to measure the intraocular pressure(IOP) of children under the general anesthesia because of their portability. We evaluated the difference of IOP between two devices and the IOP variability in 39 children(77 eyes) under age 13 who had undergone surgery for strabismus or entropin under the general anesthesia. One observer measured the IOP three times alternately, and the order of measurement was randomized. Only 5% of Tono-pens coefficient of variance was considered valuable. The range of Tono-pen IOPs was 9~22mmHg, and the average was 15.41+/-3.23mmHg. The range of Perkins IOPs was 4~20 mmHg, with the average of 12.47+/-3.31mmHg. The difference between two methods on average was 2.94mmHg. Tono-pen IOPs were significantly greater than those recorded by Perkins tonometer, but both were within normal range. The IOP variability was not significantly different between two devices. Therefore both methods can be applied effectively in a clinical setting after sedation or general anesthesia of uncooperative children.
Anesthesia, General* ; Child* ; Humans ; Intraocular Pressure* ; Reference Values ; Strabismus

PURPOSE: Perigraft seromas are a collection of clear and sterile ultrafiltered serum, encased by a fibrous pseudocapsule or within a well-circumscribed gray sponge-like soft tissue mass (gelatinoma) that develops around a patent prosthetic vascular graft. Seromas are unusual complications of hemodialysis grafting with a high rate of recurrence and graft loss. There is no effective therapy for patients and multiple operations and graft replacements often are followed by unsatisfactory results. We successfully replaced the transducing prosthesis segment with the great saphenous vein. The purpose of this study was to review the treatment of perigraft seromas complicating hemodialysis grafts using great saphenous vein interposition. METHOD: We reviewed the records of eight patients who had treatment of a perigraft seroma complicating hemodialysis with the great saphenous vein from January 2005 to December 2006. RESULT: The mean age of the patients was 51 years and three patients had a history of diabetes mellitus. The PTFE graft was placed at the brachiobrachial (loop) position of the forearm in six patients. The affected site was the arterial anastomosis in all cases. In all cases, the transuding segment of the prosthesis was successfully replaced with the greater saphenous vein and excision of the pseudo-capsule. There was no recurrence. CONCLUSION: If rerouting of prosthetic material through a new anatomic route is difficult, treatment of perigraft seroma can be successfully achieved by the removal of the original graft and as much of the seroma as possible, including the pseudocapsule. The transducing proximal segment of the prosthesis at the arterial anastomosis was successfully replaced with a reversed greater saphenous vein, placed along the same route. This procedure resulted in resolution of the seroma with preservation of the original graft. This procedure was safe and effective for the treatment of perigraft seromas.
Diabetes Mellitus ; Forearm ; Humans ; Polytetrafluoroethylene ; Prostheses and Implants ; Recurrence ; Renal Dialysis* ; Saphenous Vein* ; Seroma* ; Transplants*

This research was carried out in order to study the effects of Rapid Maxillary Expansion on maxilla and it's surrounding skeletal structures. The sample for this study consists of 14 patients who were in retention period after rapid maxillary expansion. Following results were obtained after performing comparative analysis of cephalograms taken before and after rapid maxillary expansion. 1. In almost every cases, inferior displacement of palatal planes with concurrent changes in their inclination were observed. 2. Changes in the inclination of palatal plane can be categorized into inferiorly inclined group, superiorly inclined group and constant group in relation to the states before rapid masillary expansion. 3. Decrease in < Se-FMN/PMV and increase in < Se-FMN-A were evident in the superiorly inclined group and vice versa for the inferiorly inclined group.
Humans ; Maxilla ; Palatal Expansion Technique* ; Recurrence*

Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. The most common cause of maternal death in Korea is complications related to the postpartum period (obstetric embolism), accounting for 37.5%, while complications of labor and delivery (uterine atony, PPH, etc.) were the second most common cause, accouning for 21.9%. The effective treatment of PPH often requires multidisciplinary intervention. When managing PPH, multiple interventions (medical, mechanical, invasive, and nonsurgical and surgical procedures), which require different levels of skill and technical expertise, may be used to control bleeding. The healthcare provider needs to begin resuscitative efforts quickly, establish the cause of the hemorrhage, and possibly enroll the assistance of other care providers, such as an obstetrician, anesthetist or radiologist. Avoiding delays in diagnosis and treatment will have a significantly impact on sequelae and chances of survival. This review discusses the causes, identification, management, prevention and prediction of PPH.

BACKGROUND: Fever in patients can provide an important clue to the etiology of a patient's symptoms. Non-invasive temperature sites (oral, axillary, temporal) may be insensitive due to a variety of factors. This has not been well studied in adult emergency department patients. To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature. METHODS: A retrospective chart review was made of 27130 adult patients in a high volume, urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature. RESULTS: The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F (P<0.001), with 25.9% of the patients having higher rectal temperatures ≥2 °F, and 5.0% having higher rectal temperatures ≥4 °F. The mean difference among the patients who received oral, axillary, and temporal temperatures was 1.2 °F (P<0.001), 1.8 °F (P<0.001), and 1.2 °F (P<0.001) respectively. About 18.1% of the patients were initially afebrile and found to be febrile by rectal temperature, with an average difference of 2.5 °F (P<0.001). These patients had a higher rate of admission (61.4%, P<0.005), and were more likely to be admitted to the hospital for a higher level of care, such as an intensive care unit, when compared with the full cohort (12.5% vs. 5.8%, P<0.005). CONCLUSIONS: There are significant differences between rectal temperatures and non-invasive triage temperatures in this emergency department cohort. In almost one in five patients, fever was missed by triage temperature.

Recently the esthetic demands of clinicians and patients made the surgeon try to regenerate bone defects and gingival tissue after extraction. For that, many surgical methods were used and socket preservation have been evaluated simple, effective and good prognosis in the implant placement. Bone grafting was one of the methods for socket preservation. This study was to evaluate the histologic view of the effects on healing of the extraction sockets when deproteinized bovine bone mineral and tetracycline coated deproteinized bovine bone mineral was implanted 1. In control group, at 4 weeks after implantation, the extraction sockets were filled with connective tissue. And after 8 weeks, osteoblasts were observed in newly formed trabecular among the fibrous connective tissue in the extraction sockets. 2. In experimental 1 group, there was connective tissue and new bone trabecular around newly formed woven bone at 4 weeks. And many osteoblasts were observed in various direction at 8 weeks. 3. In experimental 2 group, there was a lot of new bone made around the bone powder after 4 weeks, and the thicker bone trabecular, lamellar bone and irregular osteoblasts arrangement were observed at 8 weeks. From the results of this study, tetracycline coated BBP would be better than the other groups in the lamellar bone formation and be faster in the bone formation rate.
Animals ; Bone Transplantation ; Connective Tissue ; Dogs* ; Humans ; Osteoblasts ; Osteogenesis ; Prognosis ; Tetracycline

No abstract available.
Hepatolenticular Degeneration*