Dynamic cardiomyoplasty is a recently introduced surgical method to improve myocardial performance. It consists of a placement of a skeletal muscle flap around the heart and stimulation of the flap in synchrony with ventricular contraction. We experienced a case of cardiomyoplasty in a 25 year old male patient with congestive heart failure. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. The operation was performed for 8hrs without cardiopulmonary bypass and the patient was transferred to the intensive care unit. He was mechanically ventilated electively overnight and extubation was done 18hrs postoperatively. The patient was discharged home on the 40days after operation and improved in exercise tolerance. We report the anesthetic management and hemodynamic changes in a patient who underwent dynamic cardiomyoplasty.
Adult ; Anesthesia ; Cardiomyoplasty* ; Cardiopulmonary Bypass ; Exercise Tolerance ; Fentanyl ; Heart ; Heart Failure ; Hemodynamics ; Humans ; Intensive Care Units ; Isoflurane ; Male ; Midazolam ; Muscle, Skeletal

PURPOSE: This study was aimed to evaluate the recurrence rate of a giant cell tumor (GCT) of the bone. MATERIALS AND METHODS: The medical records of fifty four patients who were diagnosed with a giant cell tumor of the bone between March 1980 and December 2008 were analysed retrospectively. Among 54 patients, 27 were men, remaining 27 were women with the mean age of 33.1 years (range, 13-67 years). The mean duration of follow-up was 67.1 months. RESULTS: Twenty-one patients (38.9%) had a local recurrence. The mean time to recurrence was 21.5 months (range, 2-59 months). The local recurrence rate of the upper extremities was higher than that of lower extremities. According to Campanacci classification, patients with a grade I diseae had lower recurrence rate than those with grade II or III disease. There was no significant differences in the recurrence rates based on cryotherapy, the filling of bone cement or bone grafts and surgical margin. CONCLUSION: To prevent local recurrence of GCT of bone, curettage of the tumor and elimination of the remaining cells are more important than adjuvant therapy.
Cryotherapy ; Curettage ; Female ; Follow-Up Studies ; Giant Cell Tumors ; Giant Cells ; Humans ; Lower Extremity ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Transplants ; Upper Extremity

Jehovah,s Witnesses who require operation represent a challenge to the physician because of the patient,s refusal to accept blood transfusion. An orthotopic heart transplantation was succesfully performed in a 40-year old Jehovah,s Witness without use of any blood product. During the operation, cell saver was used for shed blood and aprotinin was administered intravenously. The use of blood conserving methods, meticulous operative technique and brisk postoperative diuresis has added to the efficacy of heart transplantation in this patient. Total postoperative drainage was 860 ml and the lowest hemoglobin level was 11.8 g%. The patient recovered uneventfully and discharged on the 60th postoperative day.
Adult ; Anesthesia* ; Aprotinin ; Blood Transfusion ; Disulfiram ; Diuresis ; Drainage ; Heart Transplantation* ; Heart* ; Humans ; Transplantation

No abstract available.
Animals ; Antibody Formation* ; Cattle ; Enzootic Bovine Leukosis* ; Giant Cells* ; Goats* ; Leukemia Virus, Bovine*

No abstract available.
Ultrasonography, Prenatal*

Ultrastructural changes of the retinal capillary basement membrane in the streptozotocin-induced diabetic rats Cho, Hokyun, M.D., Lee, Dohyung, M.D. We studied the changes of the retinal capillary in diabetic retinopathy. We measured the thickness of the basement membrane of the retinal capillary endothelial cells and the capillary pericytes using streptozotocin-induced diabetic rats and the results were compared with that of normal control rats. And also an morphological lterations of the retinal capillary were examed on the prediabetes and 3, 7 month-aged diabetic rats. The basement membrane thickness was measeured with 0.1mm calibrated ruler overlaying the electron micrograph with a transparent plastic sheet on which were etched 20 radiating lines exactly 18degree apart. The SPSS and Instat program were used for statistical evaluation of the data. An age related increase of the basement membrane of the capillary pericyte and endothelial cell was evident in both diabetic and control group. It was more prominent in the pericyte basement membrane of diabetic rats (diabetic rats 112.5%, control 62.5%). Comparing the age related thickening of the pericyte basement membrane and endothelial basement membrane, the increase of the thickness of the pericyte basement membrane at 7 month-aged diabetic rats was statistically significant(p<.0005). Some degenerative changes of the basement membrane itself and cytoplasmic degeneration of the endothelial cell and pericyte were visible, and those were more prominent in diabetic rats. Some capillary endothelial cell shows thinning in 7 month-aged diabetic rats.
Animals ; Basement Membrane* ; Capillaries* ; Cytoplasm ; Diabetic Retinopathy ; Endothelial Cells ; Pericytes ; Plastics ; Prediabetic State ; Rats* ; Retinaldehyde*

Superior vena cava syndrome (SVCS) is usually caused by extrinsic compression or invasion of the superior vena cava (SVC) by malignant tumors involving mediastinal structures. Although thymomas are well-known causes of SVCS, cases of SVCS caused by malignant thymomas protruding into adjacent vessels draining the SVC with thrombosis have been very rarely reported worldwide. We experienced a 39-year-old female patient with SVCS that developed after the direct invasion of the left brachiocephalic vein (LBCV) and SVC by an anterior mediastinal mass with a high maximum standardized uptake value on the chest computed tomography (CT) and positron emission tomography-CT. Based on these results, she underwent en bloc resection of the tumor, including removal of the involved vessels, and was eventually diagnosed as having a type B2 thymoma permeating into the LBCV and SVC. We present this case as a very rare form of SVCS caused by an invasive thymoma.
Adult ; Brachiocephalic Veins ; Electrons ; Female ; Humans ; Positron-Emission Tomography ; Superior Vena Cava Syndrome* ; Thorax ; Thrombosis ; Thymoma* ; Vena Cava, Superior*

No abstract available.
Animals ; Cattle* ; Lymphocytes*

No abstract available.
Antibodies, Antineutrophil Cytoplasmic* ; Wegener Granulomatosis*

PURPOSE: The treatment of the osteonecrosis in the acetabulum and femoral head after irradiation has not been well estabilished. The early failure of acetabular component after total hip arthroplasty (THA) is the main concern in osteonecrosis after irradiation. MATERIALS AND METHODS: Our study included 18 patients with post-radiation osteonecrosis of 26 hips who had a THA, mean age 54.2 years. Average irradiation dosage was 4611 cGy and interval between irradiation and primary total hip replacement was 64.3 months. The cementless acetabular components were used in 16 hips (group one) and acetabular reinforcement rings were used in 10 hips (group two: Muller cup 6 cases, Ganz cup 4 cases). RESULTS: Acetabular loosenings were occurred at 8 of 16 hips (Group 1: 50%) during the mean follow-up 46 months. The cases of Muller cup (Group 2: 33%) was failed in 2 of 6 hips at postoperative 12 months and 22 months. CONCLUSION: Although follow up duration is short and cases are small, the use of cemented cup with acetabular reinforcement ring was better than non-cemented cup for THA in irradiated hip in terms of preventive of early failure of acetabular component.
Acetabulum* ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies ; Head ; Hip* ; Humans ; Osteonecrosis