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*

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

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.
Animals ; Embryonic Structures* ; Mice*

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

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

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

Inverted papilloma is a rare form of a benign sinonasal tumor characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin. In contrast, involvement of sphenoid sinus is exceedingly rare. The present study describes a case of a 52-years-old patient with an inverted papilloma which originated from the sphenoid sinus. The patient complained mainly of headache, ptosis and diplopia. Radiologic study revealed that the sphenoid sinus was completely occupied by the tumor. Additionally, the ethmoid sinus, cavernous sinus and intracranial fossa have been invaded by the tumor. Endoscopic sinus surgery and postoperative radiotherapy were performed. Two months after the operation, the patient has not revealed any new symptom. However, a remnant of the inverted papilloma still remains. The clinical presentation of the inverting papillomas confined to the sphenoid sinus is often non-specific and insidious, with ptosis and diplopia being predominant. The rhinologic surgeon has to rule out this condition.
Cavernous Sinus ; Diplopia ; Ethmoid Sinus ; Headache ; Humans ; Papilloma ; Papilloma, Inverted ; Sphenoid Sinus

No abstract available.
Catheterization* ; Catheters* ; Fallopian Tube Diseases* ; Fallopian Tubes* ; Female

BACKGROUND: The nature of depressed left ventricular ejection performance in chronic pressure-overload hypertrophy due to aortic stenosis is controversial. Patients with aortic stenosis and congestive heart failure who responded well and those who responded poorly to aortic valve replacement may represent two distinct groups, rather than opposite ends of a spectrum. Whereas excess afterload accompanied by inadequate hypertrophy of functioning cardiac muscle was been suggested as the cause of impaired left ventricular shortening, intrinsic depression of contractility of the hypertrophied myocardium was also been considered, at least in part, to be the cause of altered ejection performance. METHOD: We studied 20 patient with non-rheumatic aortic stenosis using echocardiogram and cineangiocardiography. The patients were divided into two groups according to the level of LVEF and New York Heart association [NYHA] functional class. In group 1, 7 patients had an echocardiographically determined LVEF less than 40% and clinical presentation of severe congestive heart failure(NYHA functional class III or IV). In group 2, 13 patients had LVEF more than 40% and NYHA functional class I or II. Left ventricular volumes and ejection fraction were determined from the echocardiogram obtained in short axis view. As a measure of left vertricular afterload, meridional end-systolic wall stress was calculated. This method is based on the determination of end-systolic left ventricular dimension, wall thickness and peak systolic pressure. RESULTS: 1) End-systolic meridional wall stress was significantly elevated in the patient with aortic stenosis & severe congestive heart failure(group 1) compared with the patient with aortic stenosis and mild congestive heart failure(group 2)(320.09+/-72.09 vs 177.52+/-76.43 dyne x 10(3)/cm2, p<0.005). With group 1 and group 2, there was a significant inverse linear relationship between LVEF and end systolic meridional wall stress(r=-0.907, p<0.001). 2) There was significantly more decreased ratio of end-systolic meridional wall stress to end-systolic volume index(ESWS/LVESVI) of group 1 than that of group 2(5.64+/-2.65 vs 15.30+/-7.77 dyne x 10(3)cm2/ml/m2, p<0.05). And there was a significant linear relationship between LVEF and end-systolic meridional wall stress to end-systolic volume index(ESWS/LVESVI)(r=0.86, p<0.001). 3) Twenty of 20(100%) survived after surgery : 19 of these 20 showed clinical improvement. There was significant improvement of ejection performance(LVEF, % FS) in group 1 except from 1 patient(LVEF 35.43+/-6.90 VS 47.29+/-3.45%, % FS 18.76+/-4.87 vs 28.20+/-3.40, p<0.05). CONCLUSION: Thus, both altered contractility and increased afterload are operative in depressed left vertricular ejection performance in patients wth aortic stenosis ; which one predominates may have major prognostic importance. We found encouraging results for aortic valve replacement in patient with depressed preoperative left ventricular function. The majorty of patients in this series had left ventricular failure because of excessive afterload predominantly.
Aortic Valve Stenosis* ; Aortic Valve* ; Axis, Cervical Vertebra ; Blood Pressure ; Depression ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Humans ; Hypertrophy ; Myocardium ; Ventricular Function, Left