A number of noninvasive technics have been advocated as reflecting left ventricular performance. These methods include systolic time intervals, echocardiography and imaging of the left ventricular chamber with radionuclides during systole and diastole. Radionuclide evaluation of left ventricular function by means of the gamma camera and gating currently appears to be the most reliable noninvasive method for approximating angiographic evaluation of left ventricular performance. Utilizing the radionuclide angiography, we measured the left ventricular function in 19 normal healthy control, 60 patients with coronary artery diseases 7 patients with dilated cardiomyopathy, 5 patients with hypertension. 1) Left ventricular ejection fraction decreased in 12 patients with anterior myocardial infarction (39.9+/-11.6%), 17 patients with inferior myocardial infarction (49.9+/-8.4%) and 7 patients with dilated cardiomyopathy (19.0+/-5.8%), and there was a statistically significant difference compared with 19 normal control group (63.5+/-8.2%)(p<0.005). However there were no statistically significant difference between normal control group, patients with hypertension (58.8+/-7.6%) and patients with angina pectoris (60.1+/-6.5%). 2) Left ventricular ejection fraction decreased in both anterior and inferior myocardial infarction, and there was a statisically significant difference between both groups (p<0.01). All 13 patients with acute myocardial infarction had abnormal LVEF (40.5+/-9.1%) whcih was significantly lower than that of 16 patients with old myolardial infarction (50.1+/-10.5%)(p<0.01).
Angina Pectoris ; Cardiomyopathy, Dilated ; Coronary Artery Disease* ; Coronary Vessels* ; Diastole ; Echocardiography ; Gamma Cameras ; Humans ; Hypertension ; Infarction ; Inferior Wall Myocardial Infarction ; Myocardial Infarction ; Radioisotopes ; Radionuclide Angiography* ; Stroke Volume ; Systole ; Ventricular Function, Left*

BACKGROUNDS/AIMS: Liver hemangioma, the most common benign liver tumor, can be safely managed by clinical observation. However, surgical treatment should be considered in a subset of patients with giant hemangioma with abdominal symptoms. We reviewed the feasibility of total laparoscopic liver resection for giant hemangioma of >6 cm in diameter. METHODS: Nine consecutive patients who underwent total laparoscopic liver resection for giant hemangioma between August 2008 to December 2012 were included in this study. Medical records were retrospectively reviewed for demographic data, laboratory findings, and perioperative results. RESULTS: The median age of patients was 36 yrs (range, 31-63). Eight females and 1 male were included in the study. The median size of hemangioma was 11 cm in diameter (range, 6-18) and 5 patients had a hemangioma >10 cm. Indications for surgical treatments were abdominal symptoms in 4 patients, increased size in 5 patients, and uncertain diagnosis in 1 patient. The median operation time was 522 minutes for right hepatectomy, 220 minutes for left lateral sectionectomy, and 90 minutes for wedge resection. The median estimated blood loss was 400 ml (range, 50-900). There was no postoperative morbidity, including Clanvien-Dindo grade I. CONCLUSIONS: The resection of giant hemangioma demands meticulous surgical technique due to high vascularity and the concomitant risk of intraoperative hemorrhage. Laparoscopic liver resection is feasible with minimal operative complication. Therefore, laparoscopic liver resection can be considered as an option for surgical treatment for giant hemangioma.
Diagnosis ; Female ; Hemangioma* ; Hemorrhage ; Hepatectomy ; Humans ; Liver* ; Male ; Medical Records ; Retrospective Studies

No abstract available.
Blood Platelets* ; Hypertension, Pulmonary* ; Lung Diseases, Obstructive* ; Platelet Activation*

PURPOSE: Renal scar or reflux nephropathy, known as a major cause of end-stage renal failure and hypertension in children and young adults, is frequently detected in pediatric urinary tract infection(UTI) patients at their first infections. So early and accurate diagnosis, and follow up of renal scar are very important. We performed this study to recognize the importance of radiologic examinations for detection of renal scar and vesicoureteral reflux(VUR) in pediatric UTI patients at their first attacks, and to compare the accuracy and usefulness of DMSA renal scan with renal ultrasonography and IVP in early detection and follow up of renal scar. We also wanted to find the association of renal scar with VUR detected by VCUG, and increased C-reactive protein(CRP) level. METHODS: We studied on 41 pediatric UTI patients without past medical history of UTI, who were admitted to the Department of Pediatics, Kangbuk Samsung Hospital from May 1993 to August 1995. On admission a blood sample was taken for the determination of CRP. Renal ultrasonography and DMSA renal scan were performed within five days after admission. Eight weeks later, with repeated studies of renal ultrasonography and DMSA renal scan, IVP and VCUG were also performed for all patients. RESULTS: 1) The incidence of UTI was most prevalent in infancy grou(56%). The ratio of male to female patients was 4.8:1 under the age of one year, and 1:2 over the age of one year. 2) At admission, 21 of 41 patients(51%) showed renal scars in the DMSA renal scans. At follow up of DMSA renal scans, 8 weaks later, 7 of 21 initially abnormal cases(33%) became normal while 14 cases(67%) continued to show renal scars. Twenty initially normal cases continued to show normal DMSA renal scans at follow up. 3) Renal ultrasonography showed 10 abnormal cases among 41 cases(24%) at admission, and 7 abnormal cases(17%) at follow up. IVP showed 13 abnormal cases among 41 cases(32%). 4) For detection of renal scar, sensitivity and specificity of DMSA renal scan were 95% and 100%, sensitivity and specificity of renal ultrasonography were 45% and 90%, and sensitivity and specificity of IVP were 59% and 100% retrospectively. 5) VCUG showed reflux in 13 patients among 41 patients(32%). Among 20 patients with normal DMSA renal scan, only two patients(10%) showed VUR in VCUG, and they were classified as grade I and II VUR by International Reflux Study Committee classifications. Among 21 patients with abnormal by DMSA renal scan, 11 patients(52%) showed VUR in VCUG, of whom 9 patients were classified as severe reflux above grade III. 6) The mean CRP level in the patients with normal DMSA renal scan was 9.6mg/L, significantly lower than mean CRP level of patients with abnormal DMSA renal scan which was 60.57mg/L(p<0.01). CONCLUSIONS: For early detection of renal scars and reflux nephropathy, appropriate radiologic investigations including DMSA renal scan and VCUG should be done to all pediatric UTI patients at their first attacks. DMSA renal scan seemed to be better radiologic method than renal ultrasonography and IVP in early detection of renal scar and have association with VUR. We also found that blood CRP level is easy and useful test for early suspection of upper UTI.
C-Reactive Protein* ; Child ; Cicatrix ; Classification ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic ; Male ; Retrospective Studies ; Sensitivity and Specificity ; Succimer* ; Ultrasonography ; Urinary Tract Infections* ; Urinary Tract* ; Young Adult

No abstract available.
Animals ; Embryonic Structures* ; Mice*

BACKGROUND: Although considerable efforts have been made to improve the graft patency in coronary artery bypass surgery, the role of biomechanical factors remains underrecognized. The aim of this study is to investigate the influences of geometric configurations of the bypass graft on hemodynamic characteristics in relation to anastomosis. MATERIALS AND METHODS: The Numerical analysis focuses on understanding the flow patterns for different values of inlet and distal diameters and graft angles. The Blood flow field is treated as a two-dimensional incompressible laminar flow. A finite volume method is adopted for discretization of the governing equations. The Carreau model is employed as a constitutive equation for blood. In an attempt to obtain the optimal aorto-coronary bypass conditions, the blood flow characteristics are analyzed using in vitro models of the end-to-side anastomotic angles of 45degrees, 60degrees and 90degrees. To find the optimal graft configurations, the mass flow rates at the outlets of the four models are compared quantitatively. RESULTS: This study finds that Model 3, whose bypass diameter is the same as the inlet diameter of the stenosed coronary artery, delivers the largest amount of blood and the least pressure drop along the arteries. CONCLUSION: Biomechanical factors are speculated to contribute to the graft patency in coronary artery bypass grafting.
Bays ; Computer Simulation ; Coronary Artery Bypass ; Coronary Vessels ; Hemodynamics ; Transplants

PURPOSE: Monoclonal antibodies (mAb) specific for CD45RB as a potent tolerogenic target can prolong allograft survival in several animal models. The mechanisms of CD45RB mAb-mediated tolerance are largely unknown. Therefore, the present studies were performed to determine the immunomodulatory effects of CD45RB mAb on T cells in early or late time after allogenic skin transplantation. METHODS: Skin grafts and bone marrows from BALB/c donor mice were transplanted on C57BL/6 recipient mice and Busulfan was administerd. Group 1 was composed of anti-CD154 mAb administerd mice, group 2 was composed of anti-CD154 and anti-CD45RBB mAb administerd mice, and group 3 consisted of anti-CD154 mAb and CTLA4-Ig administerd mice. The proportion of splenic CD4+ and CD8+ T cell and range of CD45RB was observed by flow cytometry. Cytokines secreted by CD4+ T cell were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: CD45RB mAb in combination with CD154 mAb enhanced graft survival in allogenic skin transplantation model where CD45RB mAb specific for CD45RB, which was proven mainly expressed by CD8+ T cells, had inhibitory effects on the proportion of splenocyte-derived CD8+ and CD4+CD45RB(high) T cells in early or late time posttransplant. CONCLUSION: The combined therapy showed decreases in the proliferation of CD8+ T cells in vivo and allospecific responses of IFN-gamma-producing cells. Such immunomodulatory effects may be associated with the tolerogenic ability of CD45RB mAb in allogenic skin transplantation.
Abatacept ; Allografts ; Animals ; Antibodies, Monoclonal ; Bone Marrow ; Busulfan ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Graft Survival ; Humans ; Immune Tolerance* ; Lymphocytes* ; Mice* ; Models, Animal ; Skin ; Skin Transplantation ; T-Lymphocytes ; Tissue Donors ; Transplants

Idiopathic venous thromboembolism (VTE) and pulmonary embolism (PE) are relatively infrequent in the pediatric population but are almost always associated with an underlying disease or risk factors, such as congenital or acquired coagulation abnormalities, autoimmune disorders, or malignancies. In the pediatric emergency department, VTE, and particularly, PE, are often less considered in differential diagnoses because of their low incidence. On the other hand, a delayed diagnosis can result in serious morbidity and mortality. Therefore, even if there are no well-known risk factors, it is important to consider the possibility of PE, whenever there are suspicious symptoms and signs. The transposition of the inferior vena cava (IVC) is one of the major anatomical variants among the spectrum of IVC malformations. Although most IVC malformations are clinically silent and are discovered incidentally on radiographs, they are associated with PE in rare cases. In the pediatric population, no cases of transposition of the IVC that was discovered by acute PE have been reported. We report a case of acute PE associated with a transposition of the IVC in a 14-year-old boy without intra-cardiac anomalies or coagulation abnormalities.
Adolescent* ; Delayed Diagnosis ; Diagnosis, Differential ; Emergency Service, Hospital ; Hand ; Humans ; Incidence ; Male* ; Mortality ; Pulmonary Embolism* ; Risk Factors ; Vascular Malformations ; Vena Cava, Inferior* ; Venous Thromboembolism

BACKGROUND: Appendicitis is one of the most common causes of abdominal emergency with a life time risk of 6-8%. Children are unable to give an accurate history, and since acute nonspecific abdominal pain is more common than appendicitis at this age, diagnosis and management of appendicitis are often delayed. This results in more frequent complications and difficult management. In order to evaluate whether pediatric appendicitis should be thought as more urgent and serious because of the delay in its diagnosis, we compared the clinical characteristics and outcomes of appendicitis in children with those of adults. METHODS: We retrospectively reviewed 106 adults and 43 children who were pathologically verified with appendicitis after an appendectomy. RESULTS: There was no difference in the duration of symptoms. Advanced appendicitis was more frequent in children (60.5% vs. 53.7%). In children, the symptom durations of advanced appendicitis were similar to those that of early appendicitis, but were significantly longer in adults. Children showed no increase in cumulative rate of advanced appendicitis in relation with prolonged symptom duration whereas adults showed a steady increase after 72 hours of onset. The complication rate was higher in advanced cases in both, but children had a lower complication rate than adults. The postoperative hospital stay was significantly longer in advanced cases in both, but children had a relatively shorter hospital stay. CONCLUSIONS: Pediatric appendicitis was more prone to early perforation with a relatively higher perforation rate. However, children had a lower morbidity rate and a shorter admission stay. Therefore, appendicitis in children is not necessarily more serious and urgent than in adults.
Abdominal Pain ; Adult* ; Appendectomy ; Appendicitis* ; Child* ; Diagnosis ; Emergencies ; Humans ; Length of Stay ; Retrospective Studies

OBJECTIVE: The present study was performed to investigate the efficiency of partial laser assisted hatching (p-LAH; lased 1/2 ZP width from ZP edge) on hatching of mouse blastocysts. METHODS: We used non-contact 1.48 micrometer diode laser (MTM, Switzland) to create a precise hole on zona pellucida. 2-cell embryos were collected from the mouse (ICR) oviduct at 48 hours after hCG administration. Collected 2-cell embryos were cultured in the P-1 medium supplemented with 0.4% BSA. For experiments, embryos at 8-cell stage were used after 20~22 hours in culture. After conventional (c-LAH) or partial laser assisted hatching, the embryos were further cultured in P-1 medium supplemented with 0.4% BSA for 3 days. To compare efficiency of complete and partial laser assisted hatching, hatching rate, hatching time and blastocyst diameter and zona pellucida thickness at hatching time were investigated. Embryos were examined every 12 hours. Blastocyst diameter and zona pellucida thickness at hatching time were measured with an ocular micrometer. RESULTS: Hatching rates of p-LAH group (84.2%) was significantly higher than that of control group (39.3%), but there was no difference between the p-LAH (84.2%) and c-LAH (91.2%). p-LAH group was hatched 12 hours earlier than control group, but hatched 12 hours later than c-LAH group. The diameter of blastocyst at hatching time of p-LAH group (113.1+/-6.4 micrometer) was smaller than that of control group (122.2+/-5.0 micrometer), but larger than that of c-LAH group (102.2+/-2.7 micrometer). Zona pellucida thickness at hatching time of p-LAH group (6.4+/-0.9 micrometer) was thicker than that of control group (4.5+/-1.5 micrometer), but thinner than that of c-LAH group (10.0+/-0.8 micrometer). CONCLUSION: These results suggest that p-LAH may maintains the cell arrangement of early embryos to ensure successful development and prevent precocious hatching of blastocyst when compare to c-LAH and conventional (acidic tyrode) AH. Thus, p-LAH may provide a valuable and effective AH technique for human ART program.
Animals ; Blastocyst ; Embryonic Structures* ; Humans ; Lasers, Semiconductor ; Mice* ; Oviducts ; Zona Pellucida