No abstract available.
Arthritis* ; Osteoarthritis* ; Transforming Growth Factor beta* ; Transforming Growth Factors*

The pectus excavatum is the most common deformity of chest wall. The most common cause of surgical correction is cosmetic problem. From January 1981 to July 1996, 24 patients had undergone surgery for pectus excavatum and they were corrected by Ravitch operation (n=4) or modified Wada operation (n=20) respectively. We analyzed each surgical cases according to age, sex, chief complaint, degree of deformity, EKG findings, complications and satisfaction degree of patient. In some cases, we measured Welch index preoperatively and postoperatively. The postoperative complications were wound infection in two, pneumothorax in two and reccurrence in one. The average value of Welch index was significantly improved from 5.86+/-0.51 preoperatively to 4.10+/-0.51 postoperatively (p<0.05). The results by Humphreys' criteria were satisfiable in 88% (excellent 71%, good 17%). The findings of this study suggest that surgical correction of pectus excavatum with modified Wada rocedure and submammary s in incision is effective method in physical and psychiatric aspect.
Congenital Abnormalities ; Electrocardiography ; Funnel Chest* ; Humans ; Pneumothorax ; Postoperative Complications ; Thoracic Wall ; Wound Infection

BACKGROUND: All currently available mechanical and bioprosthetic valves are associated with various types of deterioration leading to dysfunction and/or valvular complications. Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. This review was conducted to determine the factors affecting the risk of reoperation for prosthetic valve replacement. MATERIAL AND METHOD: From January 1985 to July 1996, 124 patients underwent reoperation on prosthetic heart valves, and 3 patients had a second valve reoperation. The causes of reoperation were prosthetic valve failure (96 cases, 77.4%), prosthetic valve thrombosis (16 cases, 12.9%), prosthetic valve endocarditis (7 cases, 5.6%) and paravalvular leak (5 cases, 4.1%). This article is based on the analysis of the experience with particular emphasis on the preoperative risks affecting the outcome of the reoperation. RESULT: Overall hospital mortality rate was 8.9% (11/124). Low cardiac output was the most common cause of death (70.6%). Left ventricular systolic dimension (p=0.001), New York Heart Association functional class IV (p=0.003) and serum creatinine level (p=0.007) were the independent risk factors, but age, sex and cardiothoracic ratio did not have any influence on the operative mortality. Follow-up period was ranged from 3 to 141 months (mean, 50.6 months). A late mortality rate was 1.8%. CONCLUSION: The surgical risk of reoperation on heart valve prostheses in the advanced NYHA class patients is higher, therefore reoperation is recommended before the hemodynamic impairment become severe.
Cardiac Output, Low ; Cause of Death ; Creatinine ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis* ; Heart Valves* ; Heart* ; Hemodynamics ; Hospital Mortality ; Humans ; Mortality ; Reoperation ; Risk Factors ; Thrombosis

BACKGROUND: Thirty children ranging from 3 to 15 years of age underwent cardiac valve replacement at Dongsan Medical Center from 1982 to 1997. MATERIAL AND METHOD: There were 16 boys and 14 girls. The mean age was 12.1. The underlying pathological cause for valve replacement was congenital heart disease in 17 children and acquired heart disease in 13. The valve replaced was mitral in 15 children, aortic in 11, tricuspid in 3, and combined aortic and mitral in 1. Twenty-one mechanical and 10 tissue valves were placed: primary mechanical valve have been utilized since 1985. Eight of ten patients with tissue valves have had successful second valve replacements 4 to 11 years after the initial operation. RESULT: The operative mortality was 6.7%, but mortality was higher among patients less than 5 years of age and patients who had previous cardiac operations. Of the 28 operative survivors, 4 patients were lost to follow-up: the remaining patients were observed for a total of 2091 patient/months(mean 74.7 months, maximum 187 months). There was one late death from dilated cardiomyopathy after mitral valve replacement in 7 year-old patient with atrioventricular septal defect. After the operation, all patients with mechanical valves were placed on a strict anticoagulant regimen with Coumadin. The actuarial survival rate was 96% at the end of the follow-up. No instance of thromboembolism or major bleeding were observed in the survivors. CONCLUSION: These results indicate that valve replacement can be performed with low mortality in children, and with satisfactory long-term survival.
Cardiomyopathy, Dilated ; Child* ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Diseases ; Heart Valves ; Hemorrhage ; Humans ; Lost to Follow-Up ; Mitral Valve ; Mortality ; Survival Rate ; Survivors ; Thromboembolism ; Warfarin

Homologous blood transfusion entails substantial risks, including allergic reactions, transmission diseases such as hepatitis, acquired immunodeficiency syndrome. Autotransfusion system is a common method of reducing the need for homologous blood transfusion during cardiac operation. Between July 1993 and July 1995, a series of 40 patients undergoing open heart surgery was selected to an autotransfusion group (n=20) or a control group (n=20). The cell saver system (AT1000, Electromedics, Englewood, CO, USA) was employed for autotransfusion. With this system, shed blood in operative field during cardiopulmonary bypass (CPB) and remained blood in cardiotomy reservior after CPB was aspirated by means of a locally heparinized collecting system. After centrifuge salvaged blood, the resulting red cell concentrate reinfused subsequently. The amounts of blood loss were 766.5+/-121.3 ml in cell saver group, 770.1+/-113.6 ml in control group, and there were no significant differences between two groups (P=NS). The amounts of blood transfused were 2.91+/-1.72 units in cell saver group, 4.82+/-1.72 units in control group. Composition of processed blood by cell saver was hemoglobin 17.4 gm%, hematocrit 56.4%, RBC 5,780,000/ul, WBC 9,900/ul, and platelet 33,000/ul. There was no complication related to cell saver. Conclusively, cell saver autotransfusion system is safe, effective method for reducing the homologous blood trasfusion in cardiac surgery.
Acquired Immunodeficiency Syndrome ; Blood Platelets ; Blood Transfusion ; Blood Transfusion, Autologous* ; Cardiopulmonary Bypass ; Heart* ; Hematocrit ; Heparin ; Hepatitis ; Humans ; Hypersensitivity ; Thoracic Surgery*

Total body water is increased after cardiopulmonary bypass resulting in tissue edema and organ dysfunction. Ultrafiltration has been used to reduce this accumulation of water. We have carried out a prospective randomized study in 17 children undergoing open heart surgery, comparing modified ultrafiltration (MUF) with nonfiltered controls. MUF was carried out for about 10 minutes after completion of cardiopulmonary bypass to a hematocrit 36~42%. Blood loss, blood transfused, hemodynamics, and laboratory data were recorded for 24 hours postoperatively. The results were analyzed using Mann-Whitney U test, comparing controls (n=7) to ultrafiltered (n=10). There was no death in each group. The mean filtrate volume (ml/kg) was 42 (30~68). Blood loss (ml/kg/24hr) was 14.5 mean (4.0~26.6) in controls versus 12.1 mean (6.0~21.5) in MUF (p>0.05) ; blood transfused (ml/kg/24hr) was 9.4 mean (6.0~36.3) in controls versus 3.4 mean (0~11.4) in MUF (p<0.05). There was rise in arterial blood pressure during MUF. Percent rise of systolic blood pressure was 4.2 (0~11.7) in controls versus 19.8 (7.0~36.9) in MUF (P=0.001). Percent rise of diastolic blood pressure was 10.0 (1.6~20.8) in controls versus 30.6 (5.8~73.3) in MUF (p<0.05). Platelet count, fibrinogen, and oncotic pressure rose after MUF. No complications directly attributable to the ultrafiltration were observed. Conclusively, MUF is safe, effective means of removing body water and beneficial to hemodynamics.
Arterial Pressure ; Blood Pressure ; Body Water ; Cardiopulmonary Bypass ; Child ; Edema ; Fibrinogen ; Heart* ; Hematocrit ; Hemodynamics ; Humans ; Platelet Count ; Prospective Studies ; Thoracic Surgery* ; Ultrafiltration*

Systolic coronary arterial narrowing, secondary to myocardial bridging which is capable of producing chest pain, myocardial infarction and ventricular fibrillation is a known but an uncommon entity. A supra-arterial myotomy in a case of myocardial bridge causing medication-refractory angina is described. Under the partial sternotomy incision, we performed a supra-arterial myotomy in the left anterior descending coronary artery without cardiopulmonary bypass. The postoperative course was uneventful.
Cardiopulmonary Bypass* ; Chest Pain ; Coronary Vessels ; Myocardial Bridging* ; Myocardial Infarction ; Sternotomy ; Ventricular Fibrillation

OBJECTIVE: To determine whether polymorphisms of the Vitamin D receptor (VDR)gene,known to be associated with osteoporosis and/or osteoarthritis (OA) in Caucasians,might also relate to the risk of OA and osteoporosis in Korean postmenopausal women METHODS: A population of 130 postmenopausal women,including 76 healthy controls and 54 knee OA patients,were studied using anteroposterior radiographs of the knee,which were graded for OA according to the Kellgren classification system.The VDR genotype was determined by using polymerase chain reaction and by digestion with the three restriction enzymes Taq I,Bsm I,and Apa I.Femoral neck bone mineral density (BMD)was assessed in all participants by dual energy X-ray absorptiometry . RESULTS: VDR genotype frequency distributions in Koreans were much different from Caucasian's both in the OA group and the control group.Especially, "t t", "B B" and "A A" genotype were very rare,prominently differentiating from Caucasians.But within Koreans,no significant differences in VDR genotype frequencies were observed between OA cases and controls.VDR genotype was not significantly associated with the radiographic grades of OA.And there were no significant relationships of VDR genotype with BMD scores in each group. CONCLUSION: In Korean postmenoposal women,the VDR gene polymorphisms do not significantly contribute to an increased prevalence of knee OA or to differences in BMD.VDR genotype analysis would not be helpful for assessing the risk of knee OA in Koreans because :(1)there is no correlation of VDR genotypes with the radiographic severity of OA ;and (2)there is a more skewed distribution of VDR genotypes in Korean population compared to the Caucasian's .
Absorptiometry, Photon ; Bone Density ; Classification ; Digestion ; Female ; Genotype ; Humans ; Knee* ; Neck ; Osteoarthritis* ; Osteoporosis ; Polymerase Chain Reaction ; Prevalence ; Receptors, Calcitriol

BACKGROUND: The purpose of this study was to determine whether the distribution of vitamin D receptor (VDR) polymorphisms in rheumatoid arthritis (RA) patients group is different from that of the control group and whether there is a relationship between VDR genotype and radiographic severity or bone mineral density (BMD) of RA patients. METHODS: The VDR genotype was determined by polymerase chain reaction and digestion with three restriction enzymes Taq I, Apa I and Bsm I in 78 healthy women and 97 female RA patients. Hand X-rays were scored by Larsen's method and bone mineral density was measured by dual energy X-ray absorptiometry (DEXA) in RA patients. RESULTS: VDR genotypic distributions in Koreans were much different from Caucasians in each control and RA patient groups. Especially, "tt" allele and "BB" allele were very rare, prominently differentiating from Caucasians. But within Koreans, no significant difference of VDR genotypic frequency was observed between control group and RA patients group. And there was no significant relationship of VDR genotype with radiographic scores, nor with BMD scores in RA patients. CONCLUSION: The distribution of VDR polymorphisms in Korean RA patients was not different from controls. The VDR polymorphisms correlate neither with the radiographic severity of RA, nor with BMD scores in Korean RA patients.
Absorptiometry, Photon ; Alleles ; Arthritis ; Arthritis, Rheumatoid* ; Bone Density ; Digestion ; Female ; Genotype ; Hand ; Humans ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Receptors, Calcitriol* ; Vitamin D* ; Vitamins*

Open bite is accompanied by decrease in tooth contact and overbite, and causes collapse of occlusal plane, mastication difficulties, speech disorders, changes in appearance, and lower occlusal force than normal. Open bite caused by temporomandibular joint disorder in adults with complete occlusion must be corrected after removal or stabilization of the causative factors. Orthodontic treatment, occlusal adjustment, prosthetic treatment, and surgical treatment can be the option of occlusal correction. This report describes about estimating the cause of occlusion change in two patients who developed an open bite due to mandibular displacement in adults with complete occlusion and different treatment approaches accordingly. In one patient, satisfactory result was obtained in functional and esthetic aspects through occlusal adjustment after stabilization of the temporomandibular joint.