The osteoplasties of maxilla and mandible as the craniomaxillofacial surgery is popular and markedly developed in technically. In traditional osteoplasty, we have been use the mechanical saw, burr, cutting bar which is big sized instrument to transmit the energies to the saw or burr tips. So it is technically difficult to use such big instrument in narrow operative field Recently, the development of laser technology makes wider influence in the medical field. So, the laser is applying to high energy-using osteotomy in addition to hemangioma, tatoo, laserbrasion, hypertrophic scar and endoscopic surgery. The objective of the present study is to evaluate the extent of damage of bone and subsequent healing between the conventional mechnical saw osteotomies and the ND-YAG laser used osteotomies on the rabbit mandible angles by the histologic examination. Fifteen New Zealand white rabbits were used for the study. After exposure of rabbit's mandibular angle, one side of mandible angles were osteomized used by Nd-YAG laser and the other by the saw randomly. We compared the extent of damage and healing of laser and saw osteotomies at immediate, 2 week, 4 week, 3 months, 6 months postoperatively. The result revealed that, in two weeks after operation, the one of damaged bone was looks wider in laser osteotomies sites than by conventional mechanical saw osteotomies sites, but there is not remarkable differences between the laser and saw used group after 4 weeks, and we believe that it is possibility to use alser in craniomaxillofacial field saftly in near future.
Cicatrix, Hypertrophic ; Hemangioma ; Lasers, Solid-State* ; Mandible ; Maxilla ; Osteotomy ; Rabbits

We experience coronary artery aneurysm and coronary artery stenosis in an adult as complications of Kawasaki disease. The patient suffered from ischemic heart disease due to coronary artery aneurysm and stenosis, We carried out PTCA and stenting at stenotic coronary artery successfully. A brief review of related literature was made.
Adult* ; Aneurysm ; Angioplasty, Balloon, Coronary* ; Constriction, Pathologic ; Coronary Aneurysm* ; Coronary Stenosis* ; Coronary Vessels* ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Ischemia ; Stents

BACKGROUND: QT dispersion(QTD : QTmax-QTmin) or JT dispersion(JTD:JTmax-JT-min)in 12 leads ECG has been known to reflect regional variations in ventricular repolarization and has been reported to bel one of the marker of regional myocardial ischemia. To evaluate the significance of QTD or JTD of exercise ECG in diagnosis of coronary artery disease, we studied 106 patients(mean age, 56.9 years old, male 63) who were referred for the evaluation of chest pain on exertion. METHOD: Treadmill exercise stress test with modified Bruce protocol and coronary angiography were performed in 106 patients with chest pain on exertion. ST-segment depression by >1.0 mm 0.08 second after J-point during or after exercise in exercise test and >50% stanosis of epicardial artery in coronary angiogram were defined as positive. Of 106 patients, 41 had positive exercise ECG and positive coronary angiogram(true positive, TP), 20 had positive exercise ECG and negative coronary angiogram(false positive, FT), 20 had negative exercise ECG and positive coronary angiogram(faalse negative, FN), and 23 had negative exercise ECG and negative coronary angiogram(true negative, Tn). QT and JT interval in 12 leads were measured at baseline and peakexercise and were corrected for heart rate using Bazett's formula. QTD and JTD were measured by calculation the difference between the maximum QT and mininum QT and that between maximum JT and minumum JT. RESULTS: QTD at baseline for TP(72.8ms)was prolonged compared to Tn(52.2ms,P<0.01), but was not different from that for FT(70.2 ms). At peak exercise, QTD for TP(81.3 msec) was significantly prolonged(p<0.01), while QTD for FP(71.2 msec) was not different from that for TN(56.8 msec). JTD at baseline(78.4 msec) and at peak exercise(88.2 msec) for TP were significantly prolonged compared to those for TN(55.2msec and 55.1msec p<0.01,p<0.01, respectively), but those for FP were not porlonged(77.0msec and 79.0msec, respectively). QTD and JTD at peak exercise were more markedly prolonged in patients with sever stenosis of coronary artery(p=0.053 and p<0.05, repectively) and multivessels diseases(p<0.01, 0<0.05) than those with less severe disease and single vessel disease. Patients with left anterior descending artery lesion had greater QTD and JTD at peak exercise than those with other vessels lesion(p<0.01). In addition to standard criteria with ST segment displacement in exercise EGC, inclusion of exercise induced QTD of more than 60msec increased the sensitivity of exercise ECG from 66.7% to 83.3%, and JTD of more than 70msec increased the specificity from 52% to 76.0%. CONCLUSION: Measurement of QT dispersion and JT dispersion of exercise ECG may be useful method to identify the severity of coronary artery disease and to improve diagnostic accuracy of exercise ECG in coronary artery disease.
Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Depression ; Diagnosis ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Male ; Myocardial Ischemia ; Sensitivity and Specificity

BACKGROUND: Myocardial contrast two-dimensional echocardiography(MC-2DE) has been known to have the real time capabilities for repeat in vivo assessment of ischemic risk areas and for evaluation of the myocardial perfusion. The aims of this investigation are (1) to evaluate the feasibility of MC-2DE for the delineation and quantitation of the area at risk. (2) to determine the relationship between the extent of the echocontrast defect area(EDA) during reperfusion and the size of myocardial infarction as determined by post-mortem tissue examination, and (3) to observe serial changes in the time echo-intensity characteristics of MC-2DE during coronary occlusion and reperfusion. METHODS: Myocardial contrast echocardiographic images were made by injecting bolus 5mL of two-syringe-agitated mixture of sodium meglumine ioxaglate(Hexabrix(R)) and normal saline(2 : 3 by volume) into the aortic root before and during coronary occlusion of the left anterior descending coronary artery, distal to the first diagonal branch and during reperfusion on eight open-chest dogs. Two-dimensional echocardiographic short axis views were obtained at four anatomic levels : the apex, the low papillary muscle, the high papillary muscle and the mitral valve. The changes in EDA and echo-intensity with its wash-out half time(WHT) at the high papillary muscle level during coronary occlusion and reperfusion were measured every 15 minutes. The total EDA was measured by planimetry at 3 minutes after coronary occlusion and at 60 minutes after reperfusion. Evans blue or methylene blue were used for the measurement of the anatomic area at risk and triphenyl-tetrazolium chloride(TTC) for the measurement of the infarct area. RESULTS: The EDA measured 30 minutes after coronary occlusion(19.6%) was smaller than that at 3 minutes after coronary occlusion(24.0%, p<0.01). Then EDA at 3 minutes occlusion was strongly predictive of the anatomic extent of area at risk(EDA=0.48 Area at risk+16.95, r=0.84, p<0.05). The EDA at 60 minutes after reperfusion, which showed an irregular margin and was located within the subendocardium of the area at risk, also correlated well with the infarct area(IA)(EDA=0.78 IA+3.32, r=0.82, p=0.09). The peak echo-intensity in the ischemic area during coronary occlusion was significantly low(14.2+/-6.5 vs 73.8+/-31.7 in the non-ischemic area, p<0.01) and the WHT was delayed more in the ischemic area than in the non-ischemic area(23.2+/-2.8 sec vs 8.1+/-3.3sec, p<0.01). During the period of reperfusion, WHT in the previously ischemic area was markedly delayed compared to that in the non-ischemic area (p<0.01), although the peak echo-intensity in the ischemic area at 3 minutes after reperfusion increased modestly compared to that in the non-ischemic area(80.9+/-22.8 vs 72.7+/-8.4), suggesting the impairment in the transit of microbubbles is probably due to microvascular damage after reperfusion. There were no adverse hemodynamic or electrocardiographic effects after injection of the contrast agent. CONCLUSIONS: These findings suggest that myocardial contrast echocardiography was useful as a non-invasive technique, first, to delineate the area at risk in vivo during coronary occlusion and, after reperfusion, the infarct area, and secondly, to evaluate indirectly the state of myocardial perfusion during coronary occlusion and reperfusion.
Animals ; Axis, Cervical Vertebra ; Coronary Occlusion* ; Coronary Vessels ; Dogs ; Echocardiography* ; Electrocardiography ; Evans Blue ; Hemodynamics ; Meglumine ; Methylene Blue ; Microbubbles ; Mitral Valve ; Myocardial Infarction ; Papillary Muscles ; Perfusion* ; Reperfusion* ; Sodium

We performed radionuclide ventriculography before and within 1 week after percutaneous mirtal valvuloplasty(PMV) to evaluate left ventricular(LV) function in 20 patients(3 males and 17 females, mean age of 38±10 years) who were pure mitral stenosis before PMV and less than grade 1 mitral regurgitation developed after PMV. 9 out of 20 patients had atrial fibrillation and 3 patients developed a small left-to-right shunt(Qp/Qs<1.5)after PMV using double-balloon technique resulted in a increase in mitral valve area(0.9±0.3 to 2.1±0.8mm
Atrial Fibrillation ; Cardiac Output ; Female ; Humans ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Radionuclide Ventriculography ; Stroke Volume

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

BACKGROUND: The stability of A-V junctional rhythm is the most important clinical interest in the patients with the complete heart block with narrow QRS complex. The QRS morphology, the basal heart rate & the reponse of subsidiary pacemaker to drugs may be helpful to assess the stability. But it can not be assessed exactly. The recording of the His-bundle was thought to be a means of predicting the clinical course of the patients and the necessity of the artificial pacemaker insertion;also it can assess the A-V block site. But it is invasive study cannot assessed exactly the stability of subsidiary pacemaker. To investigate the characteristics of subsidiary pacemaker, we studied the responses of the artificial pacemaker to ventricular overdrive suppression and the drugs by used the artificial pacemaker in the patient with the complete heart block with the narrow QRS complex, which can be accepted as "stabli" in general. METHOD: There was total of 11 patients diagnosed with the complete AV block with the narrow QRS complex(the escape junctional rhythm was less than 0.10sec) at the Yeungnam University Hospital from May 1988 to June 1989. To investigate the ventricular overdrive suppression of subsidiary pacemaker, the response of the subsidiary pacemaker after IV administatin of drugs (atropine, isoproterenol, lidocaine) and the junctional recovery time were measured. RESULTS: Thtee patterns were obtained in the overdrive suppression test (fig.1). The recovery time of the subsidiary pacemaker was 364.5+/-212.15% of the basal R-R interval. Among seven of the eight patients who showed syncoped, the JRTmax were 3 times higher than the basal R-R interval. In one of eight, CJRT which represent the absolute time, was prolonged to 560 msec. In one case, we examined overdrive suppression test serially was which shows gradual decrement of junctional recovery time, and normal sinus rhythm was recovered at the 14th after the development of complete heart block. After VOS, the junctional recovery time of the subsidiary pacemaker was 364.5+/-212.1% of basal R-R interval in complete heart block group. After injection of atropine, the decrement of R-R interval was 5.51+/-3.88% of basal R-R interval. After injection of isoproterenol, the decrement of R-R interval was 32.76+/-8.09% of basal R-R interval. Marked increase of the basal heart rate was observed. After injection of lidocaine, the increment of R-R interval was 1.72+/-1.82% of basal R-R inteval. CONCLUSION: The results suggest that measurement of the junctional recovery time following overdrive suppression is useful for evaluation of stability of subsidiary pacemaker. And also the subsidiary pacemaker shows the better response to sympathomimetic agent than to parasympathetic blocker.
Atrioventricular Block ; Atropine ; Heart Block ; Heart Rate ; Humans ; Isoproterenol ; Lidocaine ; Pacemaker, Artificial ; United Nations

We describe the use of a new urethral stent implanted in 6 patients with prostatic outflow obstruction. All patients were in a high risk group for surgery and treated successfully, for a follow-up of 6 to 13 (mean 8.5) months. The majority of patients were satisfied with the procedure, which provided a quick, safe and effective results, compared with conventional surgical treatment. The stent, woven from nitinol in the form of a tubular mesh, was inserted into the prostatic urethra via a delivery device using endoscopic control under local anesthesia. During follow-up period, the stent remained in situ and there were no urinary incontinence or other complications. The average maximum flow rate at postoperative 6 months was 19.5 ml/sec. This stent is a useful alternative to conventional surgical treatment in the high risk and large prostate patient.
Anesthesia, Local ; Follow-Up Studies ; Humans ; Prostate ; Stents* ; Urethra ; Urinary Incontinence

Recently, laparoscopic techniques are being increasingly used for retroperitoneal surgery. These procedures are considered relatively safe and non-invasive, however, there exists a small but important risk of developing complications related to insufflation with carbon dioxide (CO2). A 51-year-old female patient was admitted for retroperitoneal laparoscopic nephrectomy under general anesthesia. About 60 minutes after carbon dioxide pneumoperitoneum, the patient's oxygen saturation decreased. A chest x-ray was taken in the operating room, which showed pneumothorax in the right lung. We concluded that anesthesiologists should be aware of the occurrence of pneumothorax during the retroperitoneal laparoscopic procedure careful monitoring and appropriate management are needed.
Anesthesia, General ; Carbon Dioxide ; Female ; Humans ; Insufflation ; Laparoscopy ; Lung ; Middle Aged ; Nephrectomy* ; Operating Rooms ; Oxygen ; Pneumoperitoneum ; Pneumothorax* ; Thorax