No abstract available.
Fibrin Tissue Adhesive* ; Fistula*

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: 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

Percutaneous transluminal coronary angioplasty (PTCA) is a relatively safe and effective procedure in the treatment of coronary artery disease, but complications related to dilating catheters and guide wires such as coronary artery dissection, spasm, rupture, and perforation can be. Pericardial tamponade is a rare complication of cardiac catheterization, and prompt diagnosis and proper management are important in lifesaving. We report 4 patients who developed pericardial tamponade following PTCA, presumably from coronary artery or right ventricular perforation. All 4 patients received heparin during PTCA and temporary pacemaker was placed in the right ventricle. Pericardial tamponade was recognized in the catheterization laboratory in 1 patient, within 3 hours after leaving the laboratory in 3 patients. Emergent pericardiocentesis was performed in all patients. Three patients recovered and one patient died.
Angioplasty, Balloon, Coronary* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Tamponade* ; Catheterization ; Catheters ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Heart Ventricles ; Heparin ; Humans ; Pericardiocentesis ; Rupture ; Spasm

BACKGROUND AND OBJECTIVES: Identification of coronary sites susceptible to progression or nonprogression might provide additional information to select medical or surgical treatment and furthermore for appropriate timing for percutaneous transluminal coronary angioplasty or coronary artery bypass graft. METHODS: We reviewed serial coronary arteriograms of 50 patients with coronary artery disease retrospectively. Patients were managed with standard treatment including anti-hypertensives, antiplatelets, lipid-lowering agents and other risk factor management by attending physician's decision. Patients who received percutaneous transluminal angioplasty, coronary artery bypass graft or thrombolysis were excluded. Cononary arteriographies were undertaken with average 33 months interval. Criteria for the progression and regression were the changes of the luminal diameter narrowing of the arterial segment by 20% or more reduction or increase, respectively. Results: Patients show progressive change, regressive change or no significant interval change in 50%, 12% and 30% of total 50 patients, respectively. Male gender, angiographic interval were the significant predictor of progressive change. In terms of coronary segment, stable segments are most frequent 52.2% (72/138) and progression in 40.2% (74/184), regression in 27.5% (38/138). Initial coronary lesions with low grade stenosis (less than 50%) have a tendency to progress than that of high grade stenosis (70% or more) Percentage diameter stenosis of new lesion are not related linearly with the interval between two sequential angiographies. CONCLUSION: Number of patients with progressive coronary arteriogram are more frequent than the patients with regressive change or no interval change. Progression and regression are frequent finding of serial coronary arteriography in usual clinical practice. Progression and regression are found frequently in the same patient at different coronary branches (16 patients). It suggested that the local factors may play an important role in the pathogenesis of coronary artery disease as well as systemic risk factors.
Angiography* ; Angioplasty ; Angioplasty, Balloon, Coronary ; Antihypertensive Agents ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Humans ; Male ; Phenobarbital ; Retrospective Studies ; Risk Factors ; Transplants

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*

Infective endocarditis is still one of the important fatal diseases, especially with systemic embolic manifestations. Infective endocarditis is often misdiagnosed because of variability of systemic embolic manifestations. We have experienced 3 cases of infective endocarditis with systemic embolic manifestations who were initially misdiagnosed as other infectious diseases. Case 1 is a 66 year-old man, who was admitted to our hospital with dyspnea , fever and petechia. His chest X-ray showed rapid decrease of cardiomegaly and pulmonary congestion in two days. At 1 week after discharge he was readmitted for recurrent fever. On the follow-up echocardiography, mitral regurgitation was newly detected. Case 2 is a 75 year-old man, who was admitted to neurology department with sudden left hemiplegia and headache, in whom it was initially difficult to differentiate from ischemic brain infarction. Case 3 is a 29 year-old man, who was admitted to neurosurgery department with fever and back pain, in whom it was initially difficult to diffrentiate from tuberculous spondylitis in early radiologic study. All 3 cases were treated effectively with appropriate antibiotic therapy and discharged with improvement of symptoms. We report 3 cases of systemic embolic manifestations complicated by infective endocarditis with a brief review of literatures.
Adult ; Aged ; Back Pain ; Brain Infarction ; Cardiomegaly ; Communicable Diseases ; Dyspnea ; Echocardiography ; Embolism ; Endocarditis* ; Estrogens, Conjugated (USP) ; Fever ; Follow-Up Studies ; Headache ; Hemiplegia ; Humans ; Mitral Valve Insufficiency ; Neurology ; Neurosurgery ; Spondylitis ; Thorax

BACKGROUND AND OBJECTIVES: The purpose of this study is to examine clinical characteristics and outcome in patients with cardiogenic shock or ongoing cardiogenic shock by acute coronary syndrome who underwent intraaortic balloon pump(IABP) support, and to identify factors predictive of in-hospital mortality. MATERIALS AND METHODS: Thirty-two consecutive patients with IABP support from 1994 to 1997 were analyzed retrospectively. RESULTS: The causes for insertion of IABP are cardiogenic shock(31%), unstable hemodynamics during angiography or angioplasty(31%), ventricular tachycardia(15%), mechanical complications(15%), and ongoing chest pain(6%). The overall survival rate was 47%. Revascularization procedures were done in 23 cases(72%) in whom inhospital survival rate was 52%. The mortality rate was significantly higher in patients with cardiogenic shock(80%) and mechanical complications(100%) including ventricular septal defect and acute mitral regurgitation, but lower with intractable ventricular tachycardia. Differences between survivors and nonsurvivors were not significant in regard to clinical characteristics, extent of coronary artery disease, time to IABP, time to coronary artery bypass graft, and clamping time, but only duration of IABP is longer in nonsurvivors. CONCLUSIONS: Emergent uses of IABP in patients with intractable ventricular tachycardia may be effective in maintaining hemodynamics before revascularization procedures, but patients with pump failure by cardiogenic shock or mechanical complications have higher mortality rates.
Acute Coronary Syndrome ; Angiography ; Constriction ; Coronary Artery Bypass ; Coronary Artery Disease ; Heart Septal Defects, Ventricular ; Heart* ; Hemodynamics ; Hospital Mortality ; Humans ; Mitral Valve Insufficiency ; Mortality ; Retrospective Studies ; Shock, Cardiogenic ; Survival Rate ; Survivors ; Tachycardia, Ventricular ; Thorax ; Transplants

No abstract available.
Female* ; Hand* ; Humans ; Thromboangiitis Obliterans*