BACKGROUND: Retrograde cerebral perfusion(RCP) is currently used for brain protection during aorta surgery, however, for the safety of it, various data published so far are insufficient. We performed RCP using pig and investiaged various parameters of cerebral metabolism and brain injury after RCP under deep hypothermia. MATERIAL AND METHOD: We used two experimental groups: in group I(7 pigs, 20 kg), we performed RCP for 120 minutes and in group II (5 pigs, 20 kg), we did it for 90 minutes. Nasopharyngeal temperature, jugular venous oxygen saturation, electroencephalogram were continuously monitored, and we checked the parameters of cerebral metabolism, histological changes and serum levels of neuron-specific enolose(NSE) and l actic dehydrogenase(LDH). Central venous pressure during RCP was mainained in the range of 25 to 30 mmHg. RESULT: Perfusion flow rates(ml/min) during RCP were 130+/-57.7(30 minutes), 108.6+/-55.2(60 minutes), 107.1+/-58.8(90 minutes), 98.6+/-58.7(120 minutes) in group I and 72+/-11.0(30 minutes), 72+/-11.0(60 minutes), 74+/-11.4(90 minutes) in group II. The ratios of drain flow to perfusion flow were 0.18(30 minutes), 0.19(60 minutes), 0.17(90 minutes), 0.16(120 minutes) in group I and 0.21, 0.20, 0.17 in group II. Oxygen consumptions(ml/min) during RCP were 1.80+/-1.37(30 minutes), 1.72+/-1.23(60 minutes), 1.38+/-0.82(90 minutes), 1.18+/-0.67(120 minutes) in group I and 1.56+/-0.28(30 minutes), 1.25+/-0.28(60 minutes), 1.13+/-0.26(90 minutes). We could observe an decreasing tendency of oxygen consumption after 90 minutes of RCP in group I. Cerebrovascular resistance(dynes sec cm-5) during RCP in group I incrased from 71370.9+/-369145.5 to 83920.9+/-49949.0 after the time frame of 90 minutes(p<0.05). Lactate(mg/min) appeared after 30 minutes of RCP and the levels were 0.15+/-0.07(30 minutes), 0.18+/-0.10(60 minutes), 0.19+/-0.19(90 minutes), 0.18+/-0.10(120 minutes) in group I and 0.13+/-0.09(30 minutes), 0.19+/-0.03(60 minutes), 0.29+/-0.11(90 minutes) in group II. Glucose utilization, exudation of carbon dioxide, differences of cerebral tissue acidosis between perfusion blood and drain blood were maintained constantly during RCP. Oxygen saturation levels(%) in drain blood during RCP were 22.9+/-4.4(30 minutes), 19.2+/-4.5(60 minutes), 17.7+/-2.8(90 minutes), 14.9+/-2.8(120 minutes) in group I and 21.3+/-8.6(30 minutes), 20.8+/-17.6(60 minutes), 21.1+/-12.1(90 minutes) in group II. There were no significant changes in cerebral metabolic parameters between two groups. Differences in serum levels of NSE and LDH between perfusion blood and drain blood during RCP showed no statistical significance. Serum levels of NSE and LDH after resuming of cardipulmonary bypass decreased to the level before RCP. Brain water contents were 0.73+/-0.03 in group I and 0.69+/-0.06 in group II and were higher than those of the controls(p<0.05). The light microscopic findings of cerebral neocortex, basal ganglia, hippocampus(CA1 region) and cerebellum showed no evidence of cerebral injury in two groups and there were no different electron microscopy in both groups(neocortex, basal ganglia and hippocampus), but they were thought to be reversible findings. CONCLUSIONS: Although we did not proceed this study after survival of pigs, we could perform the RCP successfully for 120 minutes with minimal cerebral metabolism and no evidence of irreversible brain damage. The results of NSE and LDH during and after RCP should be reevaluated with survival data.
Acidosis ; Aorta ; Basal Ganglia ; Brain Injuries ; Brain* ; Carbon Dioxide ; Central Venous Pressure ; Cerebellum ; Electroencephalography ; Glucose ; Hemodynamics* ; Hypothermia ; Metabolism ; Microscopy, Electron ; Neocortex ; Oxygen ; Oxygen Consumption ; Perfusion* ; Phosphopyruvate Hydratase* ; Swine*

No abstract available.
Anesthesia, Epidural*

BACKGROUND: Reconstruction surgery of mitral valve regurgitation is now considered as an effective operative technique and has shown good long-term results. Although reconstructive surgery of mitral valve has been performed since 1970s, we have started only in early 1990s in full scale because of small number of the mitral regurgitation compared to mitral stenosis and lack of knowledge from the viewpoint of patients and physicians. MATERIAL AND METHOD: From January 1992 to December 1996, 100 patients underwent repair of the mitral valve for mitral regurgitation with or without mitral stenosis in Seoul National University Hospital. 45(45%) of the patients were men and 55(55%) were women. The mean age was 39.9+/-14.4 years. The causes of the mitral regurgitation were rheumatic in 61, degenerative in 28 and others in 11. According to the Carpentier's pathological classification of mitral regurgitation 5 patients were type I. 55 patients were type II and 40 patients were type III. 7 patients underwent concomitant aortic valvuloplasty and 8 patients underwent aortic valve replacement. 7 patients underwent Maze operation or pulmonary vein isolation. RESULT: There were no operative death but 3 major operative complications: 2patients were postoperative low cardiac output syndrome(needed intra-aortic ballon pump support) and 1 patient was postoperative bleeding. There was one late death(1.0%) The cause of death was sepsis secondary to acute bacterial endocarditis. 3 patients required reoperation for recurred mitral regurgitation. There were no statistically significant risk factors for reoperation. The other 96 patients showed no or mild degree of mitral regurgitation 99 survivors were in NYHA functional class I or II. There were two throumboembolisms but no anticoagulation-related complications. CONCLUSIONS: We concluded that mitral valve repair could be performed successfully in most cases of mitral regurgitation even in the rheumatic and combined lesions with very low operative mortality and morbidity. The early results are very promising.
Aortic Valve ; Cardiac Output, Low ; Cause of Death ; Classification ; Endocarditis, Bacterial ; Female ; Hemorrhage ; Humans ; Male ; Mitral Valve Insufficiency* ; Mitral Valve Stenosis ; Mitral Valve* ; Mortality ; Pulmonary Veins ; Reoperation ; Risk Factors ; Seoul ; Sepsis ; Survivors

Atrial fibrillation is the most common of all cardiac arrhythmias. It is associated with significant morbidity and mortality and is frequently resistant to medical therapy. On the experimental and clinical study, the presence of macroreentrant circuits and the absence of either microreentrant circuits or evidence of atrial automaticity suggests that atrial fibrillation should be amenable to surgical ablation. The results of the maze III procedure are associated with a higher incidence of postoperative sinus rhythm, improved long-term sinus node function, fewer pacemaker requirements, less arrhythmia recurrence, and improved long-term atrial transport function. We had experienced 4 patients with chronic atrial fibrillation. For the first time, Hioki procedure had been performed in the first patient with ASD and atrial fibrillation, regular sinus rhythm showed on postoperative EKG, but junctional rhythm and bradycardia developed postoperative 3 years. The maze III procedure for the rest with mitral valvular disease and atrial fibrillation had been done, followed by regular sinus rhythm for 2 patients and atrial fibrillation for 1 patient, managed with amiodarone, on immediate postoperative state. Echocardiogram documented good contraction of right atrium and hardly contraction of left atrium for 2 patients with regular sinus rhythm postoperative 3 months.
Amiodarone ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Bradycardia ; Electrocardiography ; Heart Atria ; Humans ; Incidence ; Mortality ; Recurrence ; Sinoatrial Node

Bartha strain of pseudorabies virus[PRV-Ba] was utilized as a tracer to identify the neuronal axis of rat tongue muscles ; intrinsic muscles and extrinsic muscles, styloglossus, genioglossus, and hyoglossus muscle. After injection of 10 microliter of PRV-Ba into tongue muscles and 48-96 hours survivals, rats were perfused with 4% paraformaldehyde lysine periodate and brains were removed. PRV-Ba were localized in neural circuits by immunohistochemistry employing rabbit anti PRV-Ba as a primary antibody and ABC method. Injection of PRV-Ba into the tongue muscles resulted in uptake and retrograde transport of PRV-Ba in the rat brain. The result showed a circuit specific connection of many nerve cell groups along the time sequence : PRV-Ba immunoreactive cells appeared in hypoglossal nucleus and motor trigeminal nucleus ipsilaterally as seen with conventional tracers. Raphe nucleus, prepositus hypoglossal nucleus, spinal trigeminal nucleus, Al, A5 and facial nucleus of rhombencephalon showed immunoreactivity bilaterally. There were positive neurons in parabrachial nucleus, locus ceruleus, mesencephalic trigeminal nucleus, periaqueductal gray and A7 of mesencephalon and paraventricular nucleus, suprachiasmatic nucleus, organum vasculosum of lamina terminalis of diencephalon. Also positive reactions were showed in amygdala, insular cortex, frontal cortex and subfornical organ in telencephalon. Early immunoreactivity was appeared in hypoglossal nucleus and motor trigeminal nucleus, and there were positive neurons in the nuclei of the medulla oblongate, midbrain, pons, hypothalamus, cerebellum and medial preoptic area at middle stage. Subsequently the viral antigens were found in forebrain cell groups, paraventricular nuclei, suprachiasmatic nucleus, lateral hypothalamic area and primary motor cortex in frontal lobe bilaterally at 80-90hrs postinjection. These data demonstrate that the PRV-Ba can across synapses in the central nervous system with projection specific pattern, and this virus defines many elements of the neural network governing tongue. Therefore PRV-Ba are proved as a excellent neurotracer in the tract-tracing researches.
Amygdala ; Animals ; Antigens, Viral ; Axis, Cervical Vertebra ; Brain ; Central Nervous System ; Cerebellum ; Diencephalon ; Frontal Lobe ; Hypothalamic Area, Lateral ; Hypothalamus ; Immunohistochemistry ; Locus Coeruleus ; Lysine ; Mesencephalon ; Motor Cortex ; Muscles ; Neural Pathways* ; Neurons ; Paraventricular Hypothalamic Nucleus ; Periaqueductal Gray ; Pons ; Preoptic Area ; Prosencephalon ; Pseudorabies ; Raphe Nuclei ; Rats* ; Rhombencephalon ; Subfornical Organ ; Suprachiasmatic Nucleus ; Synapses ; Telencephalon ; Tongue* ; Trigeminal Nuclei ; Trigeminal Nucleus, Spinal

False aneurysms (Pseudoaneurysms) and arteriovenous fistulas have only rarely been reported in the facial region. In this region the false aneurysm arises most frequently in the superficial temporal and facial artery, but other branches of the external carotid are sometimes involved, including the maxillary and lingual artery. False aneurysms can be occurred by blunt trauma that either laceration or rupture the full thickness of the arterial wall. The diagnosis of a false arterial aneurysm can be often made solely on the basis of physical examination. Angiography is helpful for conformation, for delineating the lesion and its vascular supply, and for ruling out the presence of associated vascular lesions such as arteriovenous fistulas. Ultrasonography may also be useful in delineating lesions that are not easily accessible for physical examination. Treatment of false aneurysms is excision, ligation, and arterial embolization. This is a case of false aneurysm of the lingual artery after facial trauma caused by traffic accident. The lesion was successfully treated by embolization and ligation of the lingual and facial branches of the external carotid artery.
Accidents, Traffic ; Aneurysm ; Aneurysm, False* ; Angiography ; Arteries* ; Arteriovenous Fistula ; Carotid Artery, External ; Diagnosis ; Lacerations ; Ligation ; Physical Examination ; Rupture ; Ultrasonography

PURPOSE: Vasectomy has become a popular method for male sterilization in Korea and this, in turn, has been followed by an increase in the number of patient requiring vasectomy reversal. Recently, many authors have reported high success rates of vasovasostomy using microsurgical techniques. The purpose of this study was to compare patency and pregnancy rates and operation time of a new method for vasovasostomy developed at the Department of Urology, Dong-A University Hospital with those of other methods, and to find out other factors influencing patency and pregnancy rates. MATERIALS AND METHODS: Microscopic vasovasostomy was performed in 149 patients from June 1990 to September 1997 at our department. Among 89 patients who could be followed up post-operatively, standard two layer vasovasostomy was performed in 22 patients, modified one layer vasovasostomy with 4 full thickness sutures in 32 patients and modified one layer vasovasostomy with 5 full thickness sutures developed at our department in 35 patients. We compared mean operation times and patency and pregnancy rates between the techniques and examined patency and pregnancy rates according to age, vasal obstruction interval, presence of sperm in vas fluid and sperm granuloma. RESULTS: Success rates were 95.5% for patency and 68.2% for pregnancy in standard two layer vasovasostomy, 87.5% for patency and 59.42% for pregnancy in modified one layer vasovasostomy with 4 full thickness sutures and 97.1% for patency and 65.7% for pregnancy in modified one layer vasovasostomy with 5 full thickness sutures and there was statistical significance in the patency rates between each method (p<0.05). Mean operation times were 136.6+/-19.2 minutes in standard two layer vasovasostomy, 86.6+/-16.8 minutes in modified one layer vasovasostomy with 4 full thickness sutures and 96.7+/-18.4 minutes in modified one layer vasovasostomy with 5 full thickness sutures (p<0.001). With regard to factors influencing operation, the pregnancy rates were slightly higher in cases of younger patients, presence of sperm in vas fluid and presence of sperm granuloma (p>0.05) and significantly lower in case of longer vasal obstruction interval (p<0.0005). CONCLUSIONS: We found little difference in success rates between standard double layer vasovasostomy and modified one layer vasovasostomy with 5 full thikness sutures and the latter was easier and more time saving technique.
Granuloma ; Humans ; Korea ; Pregnancy ; Pregnancy Rate ; Spermatozoa ; Sterilization, Reproductive ; Sutures ; Urology ; Vasectomy ; Vasovasostomy*

OBJECTIVE: To identify the effects of isokinetic strengthening of trunk muscles on balance in hemiplegic patients after stroke. METHOD: All participants were ambulatory hemiplegic patients, injured at least 6 months prior to study. The patients (n=16) were randomly divided into two groups. The control group received neurodevelopmental treatments and gait training 3 times a week. In addition to the same treatments provided for the control group, the experimental group received trunk isokinetic strengthening exercises using isokinetic dynamometer 3 times a week. Trunk muscle peak torque and balance in the experimental group were compared with those in control group at baseline and 4 weeks after treatments. RESULTS: There were no significant differences in age, lesion of hemiplegia, time after stroke onset, trunk muscle strength and Berg balance score before treatments between two groups. In the experimental group, peak torques of trunk extensor increased significantly at 60degrees/sec and 90degrees/sec at 4 weeks (p<0.05), but there were no significant improvements in peak torques of trunk flexor at all degree and extensor peak torques at 120degrees/sec. Both the extensor and flexors showed no significant changes in the control groups. In the experimental group, a mean percent change in peak torque involving the trunk extensor was significantly increased at 60degrees/sec. In the experimental group, Berg balance scores, 10 m gait velocity, sit to stand and gait 3 m and return, and 10 seconds stair up and down were improved (p<0.05). No significant improvements were noted in the control group. CONCLUSION: Isokinetic strengthening of trunk muscles can improve balance in hemiplegic patients.
Exercise ; Gait ; Hemiplegia ; Humans ; Muscle Strength ; Muscles ; Stroke ; Torque

A casts of Barrett's esophagus complicated with stricture is reported. A 82 years old male was undergone distal esophagectomy and esophagogastrostomy on suspicion of malignancy. The microscopic examination of specimen taken from the lesion revealed the "tall columnar cells" which were indicative of Barrett's esophagus, hence the diagnosis. Barrett's esophagus is a rare disease in Korea. Because of the malignant potential of the disease, surgery involving esophagectomy is often required.
Aged, 80 and over ; Barrett Esophagus* ; Constriction, Pathologic ; Diagnosis ; Esophageal Stenosis* ; Esophagectomy ; Humans ; Korea ; Male ; Rare Diseases

BACKGROUND: Cardiac involvement of Behcets disease is very rate, however, the prognosis of Behcet disease depends on cardiovascular complications. In this article, we described surgical treatment of aortic insufficiency with Behcets disease. MATERIAL AND METHOD: From March 1986 to February 1998, we operated on 10 patients of aortic insufficiency with Behcets disease. Male to female ratio was 8 to 2, and age ranged from 21 to 40 years(mean 32.8 years). There were 8 patients with evidence of Behcets disease and another 2 patients had some suspicious findings of Behcets disease(i.e., prosthetic value dehiscence, hypertrophied aortic wall). Adequate preoperative medical treatment for Behcets disease was done in 3 patients. RESULT: We performed 24 open heart surgeries in 10 patients. Redo value replacements using prosthetic valves were done in 4 patients. Among them, 2 patients were operated on for a second redo valve replacement and one of them operated on for a 4th and 5th operation because of recurrent paravalvular leakage. These 4 patients expired. 1 patient who had undergons tissue value replacement is alive. 1 patient who underwent Cabrol operation expired dut to rupture of graft anastomosis site. We used homografts in 3 patients. In 2 of them, we performed aortic root replacement and subcoronary valve replacement in another patient. The patient who underwent subcoronary valve insertion had remnant aortic insufficiency, so we are closely observing him. We also performed Ross operation in a 24 year old female who suffered severs aortic insufficiency and endocarditis after aortic valvuloplasty. 5 patients are alive and mean follow up duration is 49.0 months. Among them, we used homografts or sutografts in 4 patients. We could observe excellent clinical results in the patients who underwent aortic root replacement using homograft and they were treated medically for Behcets disease. CONCLUSIONS: We concluded that adequate preporative diagnosis, clinical suspicion, and periopertive medical treatment for Behcets disease are very important for the result of surgical management of aortic insufficiency with Behcets disease. The use of homograft or autograft was helpful for the healing of anastomosis site and we should carefully observe the long term follow up results.
Allografts ; Autografts ; Behcet Syndrome ; Diagnosis ; Endocarditis ; Female ; Follow-Up Studies ; Heart ; Humans ; Male ; Prognosis ; Rupture ; Transplants ; Young Adult