Pacemaker malfunctions are secondary to alterations of the preset pacing rate, irregular pacing failure of sensing, failure of cardiac capture or depolarization, and various combinations of these events. A 76 years old male patients was admitted due to pacemaker malfunction. 2 years ago, he was diagnosed as complete atrioventricular block. And then bipolar permanent pacemaker was implanted. Since then syncopal attack developed repetitivly. 12 lead ECG and 24 hour holter moniter monitoring, revealed pacing and sensing failure, thus we converted bipolar system into unipolar system. since then syncopal attack did not developed again.
Atrioventricular Block* ; Electrocardiography ; Humans ; Male

PURPOSE: Routine pancreatico-splenectomy with total gastrectomy should no longer be considered as the standard surgical procedure for gastric cancer because of the lack of proven surgical benefit for survival. The aim of this study is to evaluate the clinicopathologic factors and the survival of patients with locally advanced gastric cancer and they had undergone combined pancreatico-splenectomy with a curative intent. Material and Methods: We retrospectively reviewed a total of 118 patients who had undergone total gastrectomy with distal pancreatico-splenectomy from 1990 to 2001. The patients were divided into 2 groups: 90 patients who were free from cancer invasion (group I), and 28 patients with histologically proven cancer invasion into the pancreas (group II). The various clinicopathologic factors that were presumed to influence survival and the survival rates were analyzed. RESULTS: The rate of pathological pancreatic invasion was 23.7%. The tumor stage, depth of invasion, pancreas invasion, lymph node metastasis, lymph node ratio, curability and the hepatic and peritoneal metastasis were statistically significance on univariate analysis. Among these factors, the tumor stage, lymph node ratio and curability were found to be independent prognostic factor on multivariate analysis. The 5-years survival rates were 36.2% for group I and 13.9% for group II. The morbidity rate was 22.1%, and this included pancreatic fistula (5.1%), intra-abdominal abscess (4.2%) and bleeding (4.2%). The overall mortality rate was 6.8%. CONCLUSION: Combined distal pancreatico-splenectomy with total gastrectomy with a curative intent was selectively indicated for those patients with visible tumor invasion to the pancreas, a difficult complete lymph node dissection around the distal pancreas and spleen, and no evidence of liver metastasis or peritoneal dissemination.
Abdominal Abscess ; Gastrectomy* ; Hemorrhage ; Humans ; Liver ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreas ; Pancreatic Fistula ; Retrospective Studies ; Spleen ; Stomach Neoplasms* ; Survival Rate

A free-floating ball thrombus in the left atrium is a rare complication of the mitral valvular disease. A 53-year-old man was admitted for pain and paresthesia on both legs. On admission he had auscultatory sign of mitral stenosis and mitral regurgitation, and the roentgenogram of his chest revealed a slight pulmonary ve..ous congestion, enlargement of the pulmonary conus and cardiomegaly. Laboratory findings including complete blood counts, coagulation studies and blood chemistry were normal. An echocardiographic examination revealed a mitral stenosis and a free-floating ball thrombus in the left atrium. We performed the emergent open heart surgery for removal of the ball thrombus and mitral replacement successfuly with Duromedics 29 mm valve. The size of thrombus was 39 X 32 X 30 mm.
Blood Cell Count ; Cardiomegaly ; Chemistry ; Conus Snail ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart Atria ; Humans ; Leg ; Middle Aged ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Paresthesia ; Thoracic Surgery ; Thorax ; Thrombosis*

In Order to evaluate determinants of successful percutaneous transluminal coronary angioplasty (PTCA), PTCA was performed for 172 coronary arterial lesions in 120 patients(89 male, 31 female) at Yeungnam university hospital from Sep. 1992 to Aug 1993. The corinary artery luminal diameter at the site of the original stenosis was eveluated from end-diastolic frames of identical projections of the preangioplasty and immediate post angioplasty. The coronary luminal and balloon diameters were measured with using of computer measuring system. Overall success rate of 172 attempted lesions was 87.2%. Success rate of female patients was 93.5% and higher than those of male patients. According to the clinical diagnosis, success rate in stable angina was 93.7% and higher than those of post myocardial infarction angina, unstable angina and acute myocardial infarcrion. Success rate of American Heart Association type C lesion was 65.5% and lower those of type A(95.7%), type B (89.%). There was significantly difference in preangioplasty luminal stenosis, elastic recoil and length of lesion between successful PTCA group and failed PTCA group. Success rate of lesion location at a bed >45° and presence of intracoronary thrombus were lower than than those of other angiographic findings. In coclusion, primary angioplasty success was affected by specific angiographic factors, Stenosis severity, thrombus, lesion location at a bend >45°, elastic recoil, and length of lesion were the principle of determinants of coronary angioplasty success rate.
American Heart Association ; Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary* ; Arteries ; Constriction, Pathologic ; Diagnosis ; Female ; Humans ; Male ; Myocardial Infarction ; Phenobarbital ; Thrombosis

BACKGROUND: The immediate result of coronary balloon angioplasty was influenced by plastic and elastic changes of the vessel wall. After successful coronary angioplasty, the minimal luminal diameter of the dilated coronary artery segment was generally smaller than the diameter of the largest balloon catheter at the maximal inflation pressure. Several mechanisms could explain this phenomenon, including vasoconstriction, subintimal or intraplaque bleeding or edema and platelet or thrombus deposition. In addition, whenever balloon inflation results in overdistension of elastic components of the arterial wall, some degree of elastic recoil may occur. METHODS: To evaluate magnitude of elastic recoil after percutaneous transluminal coronary angioplasty in relation to lesion morphology and other procedure-related variables, 141 coronary lesions were selected from patients with acute myocardial infarction, stable angina, unstable angina and post myocardial infarction angina undergoing successful coronary angioplasty. Coronary angiograms were recorded before and after angioplasty, and during dilatation of balloon. The computer measuring program was used for the assessment of balloon diameters and coronary luminal diameters. RESULTS: 1) Of all 141 coronary lesions, percent diameter stenosis before angioplasty averaged 74.2% and after angioplasty averaged 22.5%. 2) Residual diameter stenosis was directly related to the degree of elastic recoil, the greater the elastic recoil the more severe the residual lesion immediately after angioplasty. The increase in elastic recoil corresponded to a increase in the balloon/artery ratio(p<0.05). 3) The residual diameter stenosis tended to decrease in segments dilated with an oversized balloon than with an undersized balloon(p<0.05). 4) The elastic recoil increased significantly in the subgroups of coronary segments dilated with an oversized balloon, of eccentric lesion, and type C lesion(p<0.05). 5) Percent residual stenosis was more sever in eccentric stenosis dilated with undersized balloon than in concentric stenosis. 6) Elastic recoil was greater in type C coronary segment dilated with an oversized balloon than with an undersized balloon(<0.05). 7) The lesion dilated with oversize non-compliant balloon showed more elastic recoil than with oversize compliant balloon(p<0.05). CONCLUSION: Factors such as oversized balloon, eccentric lesion, type C lesion, and non-compliant balloon significantly affected increase of the elastic recoil.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary* ; Blood Platelets ; Catheters ; Constriction, Pathologic ; Coronary Stenosis* ; Coronary Vessels ; Dilatation ; Edema ; Hemorrhage ; Humans ; Inflation, Economic ; Myocardial Infarction ; Phenobarbital ; Plastics ; Thrombosis ; Vasoconstriction

We studied the incidence and results of treatment of secondary hypertension in Yeungnam University Hospital. Nineteen hundred fifty patients with hypertension were included from march 1990 to march 1994. We analysed the prevalence of secondary hypertension and results of treatment. The incidence of secondary hypertension in Yeungnam University Hospital was six percent. The most common underlying causes of secondary hypertension was renal parenchymal disease. Patients with three forms of potentially reversible secondary hypertension, namely, renovascular hypertension, endocrine disease, exogenous hormone, were assed to determine whether surgery or withdrawal of the exogenous hormane had led to an improvement in blood pressure control. The incidence of secondary hypertension in Yeungnam University Hospital was low(6%), but some of these are curable. Thus it is very inportant that evaluate the secondary hypertension.
Blood Pressure ; Endocrine System Diseases ; Equidae ; Humans ; Hypertension* ; Hypertension, Renovascular ; Incidence ; Prevalence

In generalized amyloidosis, involvement of heart is not rare, but development fo severe conduction distubance in cardiac amyloidosis is a rare presentation in a clinical situation. We report the first case in Korea of cardiac amyloidosis with complete atrioventricular block, which was confirmed by endomyocardial biopsy. A 59-year-old woman was admitted due to drowsy mentality. We observed a severe atrioventricular conduction disturbance on the electrocardiogram and a marked hypertrophied ventricular wall and a granular sparkling appearance within the wall, a characteristic feature in cardiac infiltration of amyloidosis, on the echocardiography. Endomyocardial biopsy was performed and revealed extensive deposition of amorphous eosinophilic materials within the cardiac muscle cells. Polarizing illumination after Congo-red staining showed typical green birefrigence. We performed a insertion of permanent pacemaker(VVI type) for the treatment of complete atrioventricular block.
Amyloidosis* ; Atrioventricular Block* ; Biopsy ; Echocardiography ; Electrocardiography ; Eosinophils ; Female ; Heart ; Humans ; Korea ; Lighting ; Middle Aged ; Myocytes, Cardiac

PURPOSE: The aim of this study was to compare the short-term surgical and long-term functional outcomes of Billroth I, Billroth II, and Roux-en-Y reconstruction after laparoscopic distal gastrectomy. MATERIALS AND METHODS: We retrospectively collected data from 697 patients who underwent laparoscopic distal gastrectomy for operable gastric cancer between January 2009 and December 2012. The patients were classified into three groups according to the reconstruction methods: Billroth I, Billroth II, and Roux-en-Y. The parameters evaluated included patient and tumor characteristics, operative details, and postoperative complications classified according to the Clavien-Dindo classification. Endoscopic findings of the remnant stomach were evaluated according to the residue, gastritis, bile (RGB) classification and the Los Angeles classification 1 year postoperatively. RESULTS: Billroth I, Billroth II, and Roux-en-Y were performed in 165 (23.7%), 371 (53.2%), and 161 patients (23.1%), respectively. Operation time was significantly shorter (173.4+/-44.7 minute, P<0.001) as was time to first flatus (2.8+/-0.8 days, P=0.009), time to first soft diet was significantly faster (4.3+/-1.0 days, P<0.001), and postoperative hospital stay was significantly shorter (7.7+/-4.0 days, P=0.004) in Billroth I in comparison to the other methods. Postoperative complications higher than Clavien-Dindo grade III occurred in 61 patients (8.8%) with no statistically significant differences between groups (P=0.797). Endoscopic findings confirmed that gastric residue, gastritis, bile reflux, and reflux esophagitis were significantly lower in Roux-en-Y (P<0.001) patients. CONCLUSIONS: Roux-en-Y reconstruction after laparoscopic distal gastrectomy for middle-third gastric cancer is beneficial in terms of long-term functional outcome, whereas Billroth I reconstruction for distal-third gastric cancer has a superior short-term surgical outcome and postoperative weight change.
Anastomosis, Surgical ; Bile ; Bile Reflux ; Classification ; Diet ; Esophagitis, Peptic ; Flatulence ; Gastrectomy* ; Gastric Stump ; Gastritis ; Gastroenterostomy ; Humans ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms

Background: There are no clear guidelines to determine whether to perform D1 or D1+ lymph node dissection in early gastric cancer (EGC). This study aimed to develop a nomogram for estimating the risk of extraperigastric lymph node metastasis (LNM). Materials and Methods: Between 2009 and 2019, a total of 4,482 patients with pathologically confirmed T1 disease at 6 affiliated hospitals were included in this study. The basic clinicopathological characteristics of the positive and negative extraperigastric LNM groups were compared. The possible risk factors were evaluated using univariate and multivariate analyses. Based on these results, a risk prediction model was developed. A nomogram predicting extraperigastric LNM was used for internal validation. Results: Multivariate analyses showed that tumor size (cut-off value 3.0 cm, odds ratio [OR]=1.886, P=0.030), tumor depth (OR=1.853 for tumors with sm2 and sm3 invasion, P=0.010), cross-sectional location (OR=0.490 for tumors located on the greater curvature, P=0.0303), differentiation (OR=0.584 for differentiated tumors, P=0.0070), and lymphovascular invasion (OR=11.125, P<0.001) are possible risk factors for extraperigastric LNM. An equation for estimating the risk of extraperigastric LNM was derived from these risk factors. The equation was internally validated by comparing the actual metastatic rate with the predicted rate, which showed good agreement. Conclusions A nomogram for estimating the risk of extraperigastric LNM in EGC was successfully developed. Although there are some limitations to applying this model because it was developed based on pathological data, it can be optimally adapted for patients who require curative gastrectomy after endoscopic submucosal dissection.

PURPOSE: Combined resection of invaded organ in advanced gastric cancer has been performed for complete removal of tumor and clearance of regional lymph node. However, higher morbidity and mortality associated with this procedure have been reported in recent large series and the efficacy of the procedure in survival remains controversial. In this study, we analyzed the efficacy of gastrectomy combined with invaded organ resection. METHODS: The medical records of 153 patients with T4 gastric carcinoma who underwent operation at Department of Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea from 1990 to 1998 were evaluated retrospectively. The patients were divided into three groups. Thirty five patients with combined resection were included in group I, and 72 patients with gastrectomy alone were in group II and 46 patients with no resection were included in group III. RESULTS: Pancreas was the most frequently invaded organ (100 patients: 65.4%), followed by colon (57 patients: 37.3%). The patients of group III were older than that of group I, and the tumor size was bigger in group I than group II. Incidence of the lower one third of the gastric cancer was higher in group II and III than that of group I. Histologically, undifferentiated carcinomas were more frequent in all groups. Postoperative complications in group I occurred in 11 patients (31.5%): intraabdominal abscess (4 patients: 11.4%), duodenal stump leakage (2 patients: 5.7%), renal failure (2 patients: 5.7%), and followed by bleeding, pulmonary complication, pancreatitis. Operative mortality of group I was 2.9%. The 5-year survival rate of group I and II was 15.6% and 3.1%, respectively and 0% in group III. In patients without peritoneal or liver metastasis, the 5-year survival rate of group I and II was 27.0% and 5.5%, respectively. But in patients with incurable factors, there was no difference in survival between the two groups. Median survival of group I with incurable factors was only 7 months. CONCLUSION: Combined resection of invaded organ in patients with T4 gastric carcinoma is a relatively safe procedure. Combined resection should be considered in patients without incurable factors such as peritoneal or liver metastasis.
Abscess ; Carcinoma ; Colon ; Gastrectomy ; Hemorrhage ; Humans ; Incidence ; Korea ; Liver ; Lymph Nodes ; Medical Records ; Mortality ; Neoplasm Metastasis ; Pancreas ; Pancreatitis ; Postoperative Complications ; Renal Insufficiency ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate