BACKGROUND AND OBJECTIVES: Cardiovascular morbidities and mortalities due to persistent hypertension, left ventricular (LV) dysfunction and increased LV mass have been reported in adolescents and adults with successful coarctoplasty. We evaluated progressive properties by measuring resting blood pressures (BP), LV functions and the masses in young children with successful coarctoplasty in infancy. SUBJECTS AND METHODS: BP in the right arm and the left ankle, LV function and mass, by the use of M-mode and pulsed wave Doppler ultrasound, were measured in 25 patients, with a mean age of 6.4+/-3 years; and a mean age at the time of repair of 0.22+/-0.24 years, and in 22 control subjects, with a mean age of 5.8+/-2.4 years. All subjects were divided into two groups based on age (more than 5 years of age and less than 5 years of age) and were analyzed independently. RESULTS: BP in the right arm and left ankle, LV function and mass showed no consistent differences between the two groups. However, as age increased, there was a tendency of wide pulse pressure (PP) in the right arm of patients contrary to that in the control subjects. The relative increase in the PP was mainly due to a relative decrease in the diastolic BP. There was a significant increase in the LV mass index of patients with increasing age (p<0.01). The LV mass index showed significant positive correlations with the systolic BP (p<0.05) and the pulse pressure (p<0.05) of the right arm of the patients. CONCLUSION: We recommend careful long-term follow-up through out adulthood to reduce morbidity and mortality, even for children who received successful coarctoplasty in early infancy.
Adolescent ; Adult ; Ankle ; Aortic Coarctation ; Arm ; Blood Pressure ; Child* ; Follow-Up Studies ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Mortality ; Ultrasonography ; Ventricular Function ; Ventricular Function, Left*

BACKGROUND AND OBJECTIVES: The purpose of this study was to share our clinical experience on the use of bioresorbable poly L-/DL-lactide 70/30 implant to repair blow out fracture. SUBJECTS AND METHOD: The medical records of 130 patients with orbital fractures that were treated surgically from June 2006 to February 2011 were reviewed retrospectively. Patients who had diplopia or limited extraocular motion, significant Enophthalmos (>2 mm), or a large orbital wall fracture on a computed tomographic scan were enrolled for the study. We investigated diplopia, limited extraoacular motion, enophthalmos before and after surgery. RESULTS: The mean postoperative follow-up was 28 months. There was no evidence of sinus infection related to the implant. However, six patients showed dislocation of orbital implant in the nasal cavity. After six postoperative months, diplopia was seen in 1 (2%) patient, and significant enophthalmos was seen 2 (2%) patients. We carried out re-operation on six cases and the main cause was incomplete reduction or over reduction. CONCLUSION: Bioresorbable poly L-/DL-lactide 70/30 implants are safe and reliable for the reduction for blowout fracture.
Diplopia ; Dislocations ; Enophthalmos ; Follow-Up Studies ; Humans ; Medical Records ; Nasal Cavity ; Orbit* ; Orbital Fractures ; Orbital Implants ; Retrospective Studies

PURPOSE: The prognosis of patients with corrected transposition of the great arteries(C-TGA) is variably affected by associated intracardiac defects, systemic right ventricular function, tricuspid valve competence, and conduction disturbances. This study aims to evaluate the importance of those factors at mid-term follow-up. METHODS: Medical records of 94 patients(males 58, females 36; mean age at last follow-up, 12+/-9 years; mean follow-up duration, 9+/-6.4 years) diagnosed between January 1980 and May 2002 at Seoul National University Children's Hospital were studied retrospectively. RESULTS: Among 94 patients, operations were performed in 72 patients(classic operations in 55; double switch operations in 17). Among prognostic factors including associated intracardiac anomalies(at least moderately severe tricuspid insufficiency(TI), ventricular septal defect, pulmonary stenosis and pulmonary atresia), intracardiac operation and complete atrioventricular block, TI was the only significant factor for death(P=0.001), and in turn, Ebstein anomaly and high grade atrioventricular block predicted TI. 20-year survival without TI was 77%, but only 35% with TI(P=0.0002); excluding perioperative death, the 20-year survival rates with and without TI were 48% and 87% respectively(P= 0.008). There was no statistical difference in 20-year survival rate or association with TI between classic and double switch operation. CONCLUSION: TI was the major prognostic factor for C-TGA and was associated with Ebstein anomaly and high grade atrioventricular block at mid-term follow-up. Long-term follow-up is required to evaluate other factors, including double switch operations and associated intracardiac defects more exactly.
Arteries* ; Atrioventricular Block ; Ebstein Anomaly ; Female ; Follow-Up Studies* ; Heart Septal Defects, Ventricular ; Humans ; Medical Records ; Mental Competency ; Prognosis ; Pulmonary Valve Stenosis ; Retrospective Studies ; Seoul ; Survival Rate ; Tricuspid Valve ; Tricuspid Valve Insufficiency ; Ventricular Function, Right

PURPOSE: We studied the relationship between anthracycline cumulative dose and anthracycline cardiotoxicity in childhood cancer and followed up 40 children with anthracycline cardiotoxicity. METHODS: A retrospective study was performed in 154 children who received anthracycline chemotherapy between January 1995 to December 2000. Cardiotoxicity was defined when the left ventricular fractional shortening(FS) was below 26%; it was divided into two groups, mild and severe cardiotoxicity, according to the FS. We followed up survivors with cardiotoxicity, and checked their present cardiac function by physical activity, echocardiography, electrocardiography(EKG) and chest X-ray. RESULTS: Of the 154 children treated with anthracyclines, forty(26.0%) were diagnosed as cardiotoxicity. The incidence of cardiotoxicity increased in exponential fashion with increases in the cumulative dose of anthracyclines. There was minimal increase of incidence until a dose of 300 mg/m2 after which the incidence increased rapidly. After mean 3.8+/-1.8 year follow-up of 23 survivors with cardiotoxicity, FS increased significantly. EKG and chest X-rays were not helpful for the diagnosis of cardiotoxicity because of their low sensitivity and specificity. CONCLUSION: Although convenient, non-invasive and inexpensive, EKG and chest X-rays were not helpful for the follow-up of anthracycline cardiotoxicity. Almost all survivors with anthracycline cardiotoxicity have improved in both physical activity and echocardiographic findings after discontinuation of anthracyclines.
Anthracyclines ; Child* ; Diagnosis ; Drug Therapy ; Echocardiography ; Electrocardiography ; Follow-Up Studies* ; Humans ; Incidence ; Motor Activity ; Retrospective Studies ; Sensitivity and Specificity ; Survivors ; Thorax

BACKGROUND: We present here the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2010 through June 2011. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 130 ICUs in 72 hospitals using KONIS. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient-days or device-days. RESULTS: A total of 3,757 NIs were found: 1,978 UTIs (1,949 cases were urinary catheter-associated), 1,092 BSIs (with 932 being central line-associated), and 687 PNEUs (410 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 3.87 cases per 1,000 device-days (95% confidence interval, 3.70-4.05), and the urinary catheter utilization ratio was 0.86 (0.859-0.861). The rate of central line-associated BSIs was 3.01 per 1,000 device-days (2.82-3.21), and the utilization ratio was 0.53 (0.529-0.531). The rate of ventilator-associated PNEUs (VAPs) was 1.75 per 1,000 device-days (1.59-1.93), and the utilization ratio was 0.40 (0.399-0.401). Although both the ventilator utilization ratiosand the urinary catheter utilization ratios were lower in hospitals with 400-699 beds than thosein hospitals with 700-899 beds ormore than 900 beds, the rates of VAPsand CAUTIs were higher in hospitals with 400-699 beds than thosein hospitals with 700-899 beds or more than 900 beds. CONCLUSION: The risk of acquiring VAP and CAUTI is higher in the ICUs of 400-699 bed hospitals than in ICUs oflarger hospitals. Therefore, ongoing targeted surveillance and implementation of proven infection control strategies are needed especially for hospitals having fewer than 700 beds.
Benzamides ; Cross Infection ; Infection Control ; Critical Care ; Intensive Care Units ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical