No abstract available.
Fibrin Tissue Adhesive* ; Fistula*

BACKGROUND: After an esophageal resection for an esophageal disease, the stomach becomes the most common organ for a substitute. The stomach has the advantages of being simple with fewer complications when used properly. The complications of an esophageal reconstruction using the stomach as the substitute are assessed and discussed. MATERIAL AND METHOD: Between 1990 and 1998, 44 patients who underwent esophagogastric anastomosis were treated in the department of Thoracic and Cardiovascular Surgery of Yongdong Severance Hospital, Seoul, Korea. RESULT: The rate of postoperative complications and mortality in these 44 patients were 70.5% and 13.6%, respectively. The major complications in our series involved the stricture of anastomosis(13.6%), pneumonia(11.4%), and wound infection(9.1%). The most frequent causes of postoperative deaths were pulmonary complications and sepsis(6.8%). CONCLUSION: Anastomotic leakage is no longer a major complication of an esophagogastrostomy. Most postoperative stricture can be overcome with frequent esophageal dilations. Postoperative pulmonary infection, nutrition, and physiotherapy are very important in reducing the rate of pulmonary morbidity and mortality.
Anastomotic Leak ; Constriction, Pathologic ; Esophageal Diseases ; Humans ; Korea ; Mortality* ; Postoperative Complications ; Seoul ; Stomach ; Wounds and Injuries

BACKGROUND: There has been controversy about predicting difficult LMA insertion and suboptimal position. Our aim was to evaluate bedside predictors for difficult LMA ProSeal(TM) (PLMA) insertion and suboptimal position. METHODS: As the potential predictive factors for difficult PLMA insertion and suboptimal position, we considered male gender, increased body mass index (BMI), seven individual items suggesting difficult airway [modified Mallampati classification > or = III, inter-incisor distance < or = 5 cm, thyromental distance < or = 6.5 cm, head/neck movement < or = 90degrees, history of difficult intubation, buck of teeth > or = moderate, upper lip bite test (ULBT) > or = II] and > or = 3 of total airway score which is the sum of scores assessed by a score of 0, 1, 2 in seven individual items. The PLMA position was assessed by fiberoptic bronchoscopy to determine whether these predictors predict suboptimal position of PLMA (fiberoptic score < 3, as graded on a standard fiberopitc scale). We also investigated the effect of predictive factors on the failure of the first insertion of PLMA and time required for successful Proseal LMA insertion on the first attempt. RESULTS: 154 patients were enrolled in the study. The total airway score did have a significant relationship with the fiberoptic findings. The male gender and ULBT I of investigated predictors did significantly correlate with failure on the first insertion of PLMA. We did not find any significant relationship between the predictive factors and PLMA insertion time on the first attempt. CONCLUSIONS: The male gender and ULBT I indicate difficult PLMA insertion, and the total airway score > or = 3 indicates suboptimal position of PLMA.
Body Mass Index ; Bronchoscopy ; Classification ; Humans ; Intubation ; Laryngeal Masks* ; Lip ; Male ; Tooth

BACKGROUND: Since 1992, we developed the technique for video endoscopic sympathectomy to treat palmar hyperhidrosis. It was soon proven to be a simple and effective therapy for essential hyperhidrosis. Compensatory hyperhidrosis, however, is the main cause of patient dissatisfaction after video-assisted thoracoscopic sympathectomy. According to many authors, initial satisfaction rate was high(94-98%), but it was declined with time (66%) due to mainly to embarrassing side effects. MATERIAL AND METHOD: From January 1992 to February 1998, the thoracoscopic T2 sympathicotomy, T2 sympathectomy and T2-4 sympathectomy were performed in 315 patients suffering from Essential hyperhidrosis in the Department of Thoracic and Cardiovascular Surgery in the Respiratory Center of Yongdong Severance Hospital Seoul, Korea. Eighty-nine patients underwent T2 sympathicotomy, and Eighty-eight patients underwent division T2 sympathectomy. RESULT: All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis. The global rate of compensatory sweating were ; 64.0% in T2 sympathicotomy, 73.8% in T2 sympathectomy and 87.8% in T2-4 sympathectomy. The rate of embarrassing or disabling compensatory sweating was significantly higher in T2 sympathicotomy 15.7%(14/89) and in T2 sympathectomy 32.8%(28/88) than in T2-4 sympathectomy 58.0%(80/138) with significancy in statistic analysis(p<0.05). Video- assisted thoracoscopic sympathectomy is an effective minimally invasive and effective procedure. CONCLUSION: We suggest that the incidence and degree of compensatory hyperhidrosis was closely related to the extent of thoracic sympathectomy.
Humans ; Hyperhidrosis* ; Incidence ; Korea ; Respiratory Center ; Seoul ; Sweat ; Sweating ; Sympathectomy*

BACKGROUND AND OBJECTIVES: This study was performed to determine the predictive factors for edge dissection (ED) and clinical significance of ED after coronary stenting. MATERIALS AND METHODS: The study group comprised 215 patients (243 lesions, mean age 59 years, 157 male) in whom coronary stents were implanted between June, 1994 and June, 1998. By angiography, EDs were categorized into minor (a very focal segment <5mm from the stent margin), major (>5mm with prominent adventitial staining and >50% of lumen compromize), and acute closure. RESULTS: 1.ED occurred in 30 (12.3%, minor 15, major 12) out of 243 lesions. Twelve of 30 EDs were located at the distal margin of the stent and occurred during high pressure. 2.Development of ED after stenting significantly correlated with severity of stenosis at the stent margin (> or =30%, 19/30 vs. 33/213, p=0.0001), degree of angulation (>45 0 , 16/30 vs. 48/213, p=0.0001), and calcification in the lesion (2/30 vs. 4/213, p=0.02). 3.There was no significant difference in clinical success rate between two groups (27/30 vs. 175/185, NS). 4.CRR in major and acute closure EDs (n=12) were significantly higher in patients treated with repeated angioplasty than in patients treated with additional stents (5/6 vs. 1/8, p=0.02). CONCLUSIONS: EDs after coronary stenting are relatively common and lesion's characteristics such as severity of stenosis (> or =30%) at the stent margin, angulation (>45 0 ), and calcification of the lesion are predictive factors for EDs. EDs are not associated with early adverse clinical events. However, CRR was significantly higher in patients treated by repeated angioplasty in major and acute closure EDs.
Angiography ; Angioplasty ; Constriction, Pathologic ; Follow-Up Studies* ; Humans ; Stents*

BACKGROUNG AND OBJECTIVES: There were numerous reports for clinical characteristics and prognosis of patients with variant angina (VA) but little information is available for patients with VA who presented as acute myocardial infarction (AMI). The purpose of this study is to determine the clinical and angiographic predictors for initial development of AMI in patients with VA and prognosis of patients with VA who presented as AMI. MATERIALS AND METHODS: The study group comprised 166 patients with VA:forty one (25%) of whom presented as AMI (Group A;Male 32, mean age 50 years) and 125 presented as typical VA or unstable angina (Group B;Male 73, mean age 54 years). The diagnosis of VA was made by spontaneous spasm and ergonovine or acetylcholine (only Group B) provocation. RESULTS: 1)Male gender (78% vs. 58%, p<0.05), smoking (74% vs. 53%, p<0.05), and disease duration (18+/-5 vs. 7+/-1 month, p<0.0001), and ST-segment elevation during chest pain (71% vs. 23%, p<0.05) were significantly higher in group A than in Group B. 2)Prevalence of fixed stenosis of 50% or greater was higher in Group A than in group B (12% vs. 2%, p<0.05) and the percent stenosis after nitroglycerin injection was also greater in group A than in group B (43+/-5% vs. 28+/-2, p<0.01), but the disease activity such as frequency of resting angina, spontaneous spasm, and multivessel spasm were not different between two groups. 3)During clinical follow-up at a mean duration of 2.7 years, three patient (2%) in group B died of a cardiac cause. Non-fatal MI occurred 1 (2%) and 3 patients (2%) in group A and B, respectively. CONCLUSIONS: Our data show that male gender, smoking, duration of disease, ST-segment elevation during chest pain, and a fixed stenosis of 50% or greater are predictors for initial development of AMI in patients with VA. The prognosis in group A is excellent and this may be associated with less severe atherosclerotic disease and a high rate of medication with calcium channel blocker or nitrate compared with those in previous studies.
Acetylcholine ; Angina, Unstable ; Calcium Channels ; Chest Pain ; Constriction, Pathologic ; Diagnosis ; Ergonovine ; Follow-Up Studies* ; Humans ; Male ; Myocardial Infarction* ; Nitroglycerin ; Prognosis ; Smoke ; Smoking ; Spasm

The Eisenmenger syndrome is characterized by severe irreversible pulmonary hypertension and right-to-left shunting of blood through the pulmonary-systemic communication. The resultant right-to-left shunt leads to clinical cyanosis and secondary manifestations of chronic hypoxemia. Clinical features include dyspnea on exertion, fatigue, palpitation, hemoptysis, syncope, chest pain and predisposition to brain abscess and cerebrovascular accident. Brain abscess is a serious complication of cyanotic congenital heart disease and major cause of death. We report a patient with Eisenmenger syndrome in whom the presence of right-to-left shunt and paradoxical embolism appears to be critical for the development of brain abscess.
Anoxia ; Brain Abscess* ; Brain* ; Cause of Death ; Chest Pain ; Cyanosis ; Dyspnea ; Eisenmenger Complex* ; Embolism, Paradoxical ; Fatigue ; Heart Defects, Congenital ; Hemoptysis ; Humans ; Hypertension, Pulmonary ; Stroke ; Syncope

BACKGROUND: Recent development of endoscopic devices and surgical techniques enabled the video-assisted thoracoscopic sympathetic surgery to be reliable, safe and minimally invasive for the treatment of hyperhidrosis. People with axillary hyperhidrosis, however, were not as satisfied as those with palmar or craniofacial hyperhidrosis due to more frequent and severe compensatory sweating and lack of effect on concomitant osmidrosis. MATERIAL AND METHOD: From March 1997 through April 1999, 45 cases of axillary hyperhidrosis underwent T3,4 sympathectomy(21 patients), T2,4 sympathicotomy(20 patients) or T4 sympathectomy(4 patients). We evaluated and analyzed the early effect of symptomatic relief, compensatory hyperhidrosis and the level of long term satisfaction. The sex ratio was 28 males: 17 females with an average age of 28 years, ranging from 13 to 46 years. Two patients had concomitant osmidrosis and one patient who underwent T3,4 sympathectomy experienced profuse compensatory sweating on face and scalp for which he underwent a reoperation of T2 sympathicotomy 93 days later. All the procedures were performed under general anesthesia in semifowler's position with 30 elevation of the upper body. A 2mm needle thoracoscope was used except in 2 cases with moderate to severe pleural adhesions where a 5mm thoracoscope was used. RESULT: Average operation time was 46.2+/-11 minutes for T3,4 sympathectomy; 32.5+/-23 minutes for T2,4 sympathicotomy; and 53.8+/-18 minutes for T4 sympathectomy. Every patient who underwent T3,4 sympathectomy and T2,4 sympathicotomy showed satisfaction 17 cases(81%) and 12 cases(60%) had absolutely no sweating after T3,4 sympathectomy and T2,4 sympathicotomy, respectively and the remaining 4 cases(19%) and 8 cases(40%) experienced 'decreased amount of sweating with slightly moist armpits'. Compensatory hyperhidrosis was present in 67% and 60% of the cases after T3,4 sympathectomy and T2,4 sympathicotomy, but only 10% and 5 %, were severe enough to be embarrassing or disabling. The level of satisfaction was high in both groups, with 86% after T3,4 sympathectomy and 89% after T2,4 sympathicotomy. CONCLUSION: Both T3,4 sympathectomy and T2,4 sympathicotomy were effective means of treating axillary hyperhidrosis. T3,4 sympathectomy had superior symptomatic relief although T2,4 sympathicotomy was favored because of shorter operation time, easier surgical technique and milder compensatory sweating. Long term satisfaction level, however, was similar in both groups.
Anesthesia, General ; Female ; Humans ; Hyperhidrosis* ; Male ; Needles ; Reoperation ; Scalp ; Sex Ratio ; Sweat ; Sweating ; Sympathectomy ; Thoracoscopes

There are many various complications associated with coronary artery stenting, in cluding thrombotic and hemorrhagic complications, in-stent restenosis, side branch occlusion, stent embolization. The retention of equipment components is the uncommon, unexpected and often problematic situations that can arise requiring ingenuity, skill, and creativity. We reports on a patient in whom an sleeve marker ring of a stent balloon catheter retained within the lumen of the coronary artery following coronary stenting. The sleeve marker ring was extracted by dilatation and withdrawal of balloon catheter which readvanced over a guidewire positioned in the center of ring.
Catheters ; Coronary Vessels* ; Creativity ; Dilatation ; Humans ; Stents*

BACKGROUND: A definitive cure for an essential hyperhidrosis can be obtained by an upper thoracic sympathectomy. However, this is offset by the occurrence of a compensatory hyper hidrosis as a side effect and it is irreversible. We performed a thoracoscopic sympathetic chain block using an endoscopic clip in order to avoid the compensatory hyperhidrosis. MATERIAL AND METHOD: From Aug. 1998 to Nov. 1998, 42 cases of thoracoscopic clipping of the T2 sympathetic chain were performed. The sympathetic chain was clipped using an endoscopic clip instead of cutting. RESULT: Bilateral procedure took less than 40 minutes and occasionally necessitated one night in the hospital. There were no mortality nor life- threatening complications. Horners syndrome occurred in two cases. At the end of postoperative follow-up(median 3 months), 95.0% of the patients were satisfied with the results. Compensatory sweating occurred in 31 cases(77.5%) where nine of those cases were classified as either embarrassing(6 cases-15.0%) or disabling(3 cases-7.5%). CONCLUSION: Endoscopic thoracic T2 sympathetic chain block using endoscopic clipping is an efficient, safe and minimally invasive surgical method for the treatment of palmar and craniofacial hyperhidrosis and the results were similar to those underwent T2 sympathicotomy. We recommend that patients receive endoscopic sympathetic chain block in summer.
Horner Syndrome ; Humans ; Hyperhidrosis* ; Mortality ; Sweat ; Sweating ; Sympathectomy