No abstract available.
Thymoma*

No abstract available.
Contraceptives, Oral* ; Female ; Humans

PURPOSE: In order to provide a systematic and standardized treatment course for MVD patients, a critical pathway (CP) program was developed and the results of its long term application were analyzed. METHODS: This was a methodological study. The CP was established and applied to 75 (step I) and 1,216 (step II). Another group of 56 with similar features was used as a control group. RESULTS: The application of CP turned out to be useful in many regards: the rate of hearing loss was reduced from 1.8% to 0% (step I) and 0.5% (step II), and low cranial nerve palsy was reduced from 1.8% to 1.3% and 0.7%, respectively. The length of hospitalization decreased by 2.56 days (25.2%) for step I and 3.05 days (30.0%) for step II. Days of ICU stay were reduced by 7.9% and 1.8%. The total cost per patient was reduced by 14.8% (step I). The cost per day was increased by 13.7% and 52.4%. An increase in the patient satisfaction index was noted, as shown in the ICU information guide (p=.002). CONCLUSION: The development and application of CP was found to improve the quality of medical treatment and the efficacy of hospital management in MVD patients. Well organized and efficient system and multidisciplinary teamwork are the key component of the successful application of CP.
Cranial Nerve Diseases ; Critical Pathways* ; Hearing Loss ; Hospitalization ; Humans ; Methods ; Microvascular Decompression Surgery* ; Patient Satisfaction ; Quality Control

No abstract available.
Anterior Cruciate Ligament*

No abstract available.

Infective endocarditis is a disease that is characterized by the vegetations. Although cardiac complications remain the leading cause of death, endocarditis is complex, systemic illness with involvement of virtually all the organs. The spectrum and incidence of cardiovasular, neurologic, renal complications also are presented by direct embolism and immune- mediated phenomena. Systemic embolism is the common and serious complications associated with infective endocarditis. Mycotic aneurysm by septic embolization is known complication of bacterial endocarditis, but mycotic aneurysm of superior mesenteric artery is very rare complication and approximately 10 cases has been reported in the literature. Acute hemorrhagic pericarditis is unusual clinical manifestation of bacterial endocarditis and subject to catastrophic hemodynamic compromise secondary to cardiac tamponade. We report a case of bacterial endocarditis in 23 years old male who developed acute hemorrhagic pericarditis and hemoperitoneum due to rupture of mycotic aneurysm in superior mesenteric artery with brief review of lieratures.
Aneurysm, Infected* ; Cardiac Tamponade ; Cause of Death ; Embolism ; Endocarditis ; Endocarditis, Bacterial* ; Hemodynamics ; Hemoperitoneum* ; Humans ; Incidence ; Male ; Mesenteric Artery, Superior* ; Pericarditis* ; Rupture* ; Young Adult

No abstract available.
Pulmonary Artery*

BACKGROUND: Intimal tear or dissection is a serious complication after coronary angioplasty,sometimes which may develop an acute ischemic event. We evaluate the factor that may predict the development of dissection after angioplasty. METHODS: To identify the factors that development of dissection after angioplasty, the data of 52 patients identified as having dissection with or without immediate vessel closure were examined. Follow-up coronary angiogram was obtained in 22 out of 58 lesions at mean 5.6 month after angioplasty. RESULTS: Intimal dissection developed 58 lesion(31%) out of 177 lesions in 122 patients after PTCA. Ischemic complications, defined as ischemic chest pain, myocardial infarction, the need for coronary bypass surgery occured in 5 patients(9.6%) out of 52 patients with dissections. Significant correlates of a development of dissection were the lesion morphology of type C(P<0.01), more tight diameter stenosis before PTCA(P<0.01), and right coronary artery(P<0.02), especially in the proximal portion (P<0.05). There were no significant correlations of clinical pictures, whether complex or simple angioplasty and PTCA in single vessel disease or in multivessel disease. Morphologic feature of dissection was type A(radiolucency) in 22(38%), B(filling defect)in 14(24%), C(extra-luminal "cap")in 8(14%), D(spiral dissection)in 5(9%), E(filling defect with delayded antegrade flow)in 7(12%) and F(total occlusion) in 2(3%). Twenty-two(38%) dissection out of 58 were obtained follow-up angiogram at mean 5.6 month. Angiographic restenosis occured in 9(41%) lesions, which included more type A dissections (7/9,78%) compared to lesions with dissection healing (3/13, 23%)(P<0.001) at follow-up. Thirteen lesions with dissection healing at follow-up included more B and C dissection(B;54%,C;15%)and E dissection in 1. Furthermoremore restenosis occurred more prevalent in the infarct-related artery(P<0.001) and left anterior decending coronary artery lesion(P<0.01). There was somewhat higher diameter residual stenosis after angioplasty (32+/-11% vs 26+/-10%) in the lesions with restenosis, but there was no statistical significance. CONCLUSION: Intimal dissection after angioplasty occurred in 58(31%) leisions out of 122(177leisions) consecutive patients underwent PTCA developments if intimal dissection after PTCA significantly correlated with the lesions if type C, more tight diameter stenois before PTCA and right coronary artery. At mean 5.6months follow-up,angiographic restenosis occured in 41% of dissections, which had more included type A(radiolucency)dissections, infarct-related artery and left anterior descending coronary artery leision.
Angioplasty* ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Follow-Up Studies* ; Humans ; Myocardial Infarction

BACKGROUND: Large series of patients with symptomatic mitral stenosis have undergone percutaneous mitral balloon valvuloplasty(PMV) with use of the Inoue or double balloon technique. But to date the result of the two procedure have not been compared with a single series prospectively. METHODS: In order to assess the immediate hemodynamic results and the longterm efficacy of two different PMV technique, a prospective, randomized trial of PMV was performed using the Inoue balloon(Toray, I group) in 59 patients and the double balloons(a pair of Mansfield balloon. D group) in 61 patients with moderate to severe mitral stenosis. Before valvuloplasty, the patients series were comparable with regard to average age. gender, most clinical and echocardiographic variables. All the patients(120 patients, M/F 38/82, mean age 41+/-11 year) were preselected with good echoscore> or =9. RESULTS: The success rate was 83% in the I group and 89% in the D group when the success defined as mitral valve area(MVA)> or =1.5cm2 with 25% gain in MVA and mitral regurgitation> or =2+ at the end of procedure. The magnitude of increase of mitral valve area and decrease of mitral gradient, left atrial pressure and pulmonary arterial pressure were not significantly different in the Inoue and double balloon series(1.0+/-0.4 and 1.1+/-0.4cm2 for mitral vale area, 10.2+/-6.6 and 11.7+/-6.4mmHg for mitral gradient, 10.5+/-6,4 and 12.9 +/-7,3mmHg for left atrial pressure, and 8.7+/-7.3 and 10.1+/-9.4 mmHg for pulmonary artrial pressure respectively). Immediatly after dilation, the long diameter changes of the mitral orifice was more prominent in the D group(from 1.0+/-0.2 to 2.6+/-0.4cm p<0.01) than those in I series(from 1.1+/-0.4 to 2.3+/-0.3cm) Moreover, the magnitude of increase in the EF slop was significantly larger in the D group(31.9+/-17.0 vs 21.8+/-14.2mm/sec, p<0.001). The duration of total procedure(56+/-20 vs 84+/-24 min, p<0.002) and the fluoroscopic time (15+/-6 vs 25+/-11min, p<0.002) was significantly shorter in group I. The incidence of left to right shunt at the atrial level(Qp/Qs>1.5) was 3.4% in group I and 4.9% in group D. Severe mitral regurgitation> or =3+ occurred in 2 patients in each I(3.4%) and D(3.3%) group respectively. At follow-up, the mitral valve area was significantly decreased(1.6 in group I vs 1.8cm2 in group D, P<0.001 vs immediate after MVA) at 6 months and well maintained at 1 year follow-up in both groups. Until 6 months after valvuloplasty, the long diameter of orifice was greater in group D, however the difference was not apparent at 1 year follow-up. CONCLUSION: The Inoue and double balloon techniques obtained equivalent results of the success rate and the frequently of complications. However, the Inoue balloon technique reduced significantly fluoroscope time and total procedure duration. Double balloon technique afforded a longer longitudinal splitting of the commissure immediatly and 6 months after valvuloplasty. However the differences was not apparent at 1 year follow-up. Increased MVA was well maintained at 1 year in both groups. The severity of the newly developed mitral regurgitation immediately after valvuloplasty reduced significantly in 53% of the Inoue and 43% in the double balloon group at 6 months follow-up. In the view point of similiar immediate and late results of the two methods, the stepwise dilation with Doppler echocardiographic monitoring during the Inoue procedure appeared to be cumbersome.
Arterial Pressure ; Atrial Pressure ; Balloon Valvuloplasty* ; Echocardiography ; Follow-Up Studies* ; Hemodynamics ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Prospective Studies

BACKGROUND: The value of coronary reperfusion resulting from Thrombolysis and/or coronary angioplasty in patients with evolving myocardial infarction has been rigorously evaluated and improved left venticular function and short-term survival rates have been demonstrated consistently in controlled studies. Benefits from delayed coronary angioplasty at 7-10 days after onset of acute myocardial infarction (AMI) without thrombolysis remains unclear. In order to assess the effect of delayed reperfusion in infarct-related artery(IRA), we analyzed the restenosis rate of IRA after successful coronary angioplasty and the change of left ventricular function at late follow-up angiogram. METHOD: Coronary angioplasty in 69 lesions of 55 patients(M/F:48/7, mean age 53 years) with acute myocardial infarction(AMI) were performed at 7-10 days after onset of AMI and follow-up coronary angiogram (25 lesions of 20 pts) with left ventriculogram were obtained at means 5.1 months(range 4-6 months) after angioplasty. Restenosis rate of dilated infaret-related arteries and the changes of left ventricular function after angioplasty were evaluated. RESULTS: The overall procedural success rate of delayed elective coronary angioplasty in patients with AMI was 86% with a higher success rate in subtotally occluded vessel(98%) than in the occluded IRA(64%). Complications included acute closure after large dissection in 1(1.6%) and on -hospital mortality due to cardiogenic shock in 1(1.8%). Angiographically restenosis rate of IRA was 65% at mean 5.1 months follow-up, which was relatively higher than that after non-IRA angioplasty in AMI(25%) and in patients with angina(24%). Left ventricular ejection fraction improved significantly from 47.2+/-12.7% to 58.8+/-8.6%(P<0.05) at follow-up. Patients who had a patent IRA at follow-up had a restenotic IRA at follow-up had no statistically significant improvement in EF(table 3). Patients with a left anterior descending artery(LAD) lesion had lower mean immediate EFs than patients with right coronary artery lesion, however the degree of improvement in EF at follow-up was more significant in patients with LAD lesion. CONCLUSIONS: Delayed elective angioplasty of IRA at 7-10 days after onset of AMI was relatively safe and had comparable procedural success rate. Higher restenosis rate(65%) of IRA at follow-up appeared to be related, at least on part, to the endothelial dysfunction after ischemic-reperfusion injury and clinically unstable status. Left ventricular function improved significantly after angioplasty at follow-up. Recovery of left ventricular function might be reated to whether or not the IRA had an angiographically restenosis at follow-up.
Angioplasty* ; Arteries ; Coronary Vessels ; Follow-Up Studies* ; Humans ; Mortality ; Myocardial Infarction* ; Myocardial Reperfusion ; Reperfusion ; Shock, Cardiogenic ; Stroke Volume ; Survival Rate ; Ventricular Function, Left