Pulmonic autograft replacement of the aortic valve (Ross procedure) has been to have potential for growth in children, no complication of antiocagulation, and enhanced durability. Therefore, Ross operation is indicated in the young, in patients with an active life style, and when anticoagulation is contraindicated. However, late autograft valve has occurrd more frequently in patients with significant size discrepancy between the pulmonay valve annulus and the aortic valve annulus. In order to resolve this problem, we performed aortic annuloplasty with Duran ring for more accurate and strong reinforcement. We report a case using the Duran ring as a method of aortic annuloplasty during Ross procedure.
Aortic Valve ; Autografts ; Child ; Humans ; Life Style

BACKGROUND: The purpose of this study is to define the risk factors of S. epidermidis acquisition and the epidemiology of strain variation in acute leukemia patients. METHODS: The participants were 155 patients of acute leukemia admitted in a University hospital for 11 months. 83 patients are the isolated group who had isolated S. epidermidis from body sites (blood, oral cavity, nares, rectum) and 72 patients are the not isolated group who had not isolated S. epidermidis. Isolates were analysed by CHEF and cluster analysis with dendrogram. Differences In proportions were tested with the Chi-square and Fisher's exact test. RESULTS: Ninety-one S. epidermidis were obtained from blood, oral cavity, nares, and rectum. The major proportion of positive culture was 81.3% from nares. Eight-nine S. epidermidis were isolated from healthcare workers. There were significant development of bacteremia in patients with S. epidermidis from nares. Resistance rate of S. epidermidis was 75.8% to methicillin, 86.3% to erythromycin, 81.l% to gentamicin, 68.9% to ciprofloxacin, 0% on vancomycin. There was significant difference on resistance rate between patients and healthcare workers' group. There was no relation between the strain of patients and those of healthcare workers. Sex age, diagnosis, length of stay, type of chemotherapy, duration of chemotherapy, Type of central venous catheter. duration of central venous catheter, prior antibiotic therapy, number of antibiotics, site of nosocomial infection, neutropenic period were not significantly different between S. epidermidis isolated group and not isolated group. Significant risk factors included duration of central venous catheter. hyper-alimentation, and folliculitis. CONCLUSION: Our result suggests that S. epidermidis in nares can be a risk factor of bacteremia. This research would be helpful for decreasing the S. epidermidis of immunocompromised patients.
Anti-Bacterial Agents ; Bacteremia ; Central Venous Catheters ; Ciprofloxacin ; Cross Infection ; Delivery of Health Care ; Diagnosis ; Drug Therapy ; Epidemiology ; Erythromycin ; Folliculitis ; Gentamicins ; Humans ; Immunocompromised Host ; Length of Stay ; Leukemia* ; Methicillin ; Molecular Epidemiology* ; Mouth ; Rectum ; Risk Factors* ; Staphylococcus epidermidis* ; Staphylococcus* ; Vancomycin

PURPOSE: A laparoscopy-assisted gastrectomy with lymph node dissection for gastric cancer is considered technically more complicated than the open method. To evaluate the short-term surgical validity, the surgical outcome of the laparoscopy-assisted distal gastrectomy (LADG) with extraperigastric lymph node dissection was compared with that of the conventional open distal gastrectomy (CODG) in patients with early gastric cancer. METHODS: One hundred and forty-seven patients with early gastric cancer received a radical distal gastrectomy during 2002 and 2003, where a LADG was performed on 71 patients. The clinicopathological characteristics, postoperative outcomes and courses, and the postoperative morbidities and mortalities were compared between the two groups. Data were retrieved from the stomach cancer database at Dong-A University Medical center. RESULTS: Baseline characteristics, including gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, tumor size, T stage, and lymph node metastasis, were similar between the two groups. No significant differences were found between these groups in terms of the number of retrieved lymph nodes with respect to D1+(D1+no. 7) and D1+beta (D1+no. 7, 8a, and 9) lymphadenectomies. In the LADG group, the wound size was smaller (P <0.0001), but the operation time was longer (P=0.0001) than in the CODG group. The perioperative recovery was faster in the LADG than in the CODG group, as reflected by the shorter hospital stay (P=0.0176) and less additional analgesics (P=0.0370). The serum albumin level in the LADG was higher (P=0.0002) on day 7 than that in the CODG group, and the leukocyte count in the LADG lower (P=0.0445) on day 1 than that in the CODG gruop. There were no significant differences in the postoperative morbidities and mortalities between the two groups. CONCLUSIONS: Our data confirmed that a LADG with an extraperigastric (no. 7, 8, and 9) lymph node dissection was a feasible and acceptable surgical technique for early gastric cancer. From a surgical point of view, a LADG with an extraperigastric lymph node dissection is suggested to be a preferred surgical option for patients with early gastric cancer. Its oncological validity awaits larger and prospective multicenterd trials.
Academic Medical Centers ; Analgesics ; Anesthesiology ; Body Mass Index ; Gastrectomy* ; Humans ; Length of Stay ; Leukocyte Count ; Lymph Node Excision* ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis ; Serum Albumin ; Stomach Neoplasms* ; Wounds and Injuries

OBJECTIVE: This study is designed to compare the therapeutic effect of continuous epidural injection with catheter and intermittent epidural injection without catheter in the patients with low back pain. METHOD: One hundred and nine patients with low back pain were randomly divided into two groups. First group (49 patients) were treated with two or three times of intermittent epidural injections with steroid mixed with local anesthetics. Second group (60 patients) were treated with continuous steroid mixed with local anesthetics injection through epidural catheter. The effect of the epidural injections was assessed by visual analog scale (VAS) at pre-injection and post- injection. RESULTS: Pre- and post-injection VAS scores of the first group were 6.5+/-1.2 and 3.5+/-1.5, respectively. Pre- and post-injection VAS scores of the second group were 6.2+/-1.6 and 2.3+/-1.1, respectively. VAS score changes between pre-and post-injection were significant (p<0.01) in both groups. VAS score changes between two groups were greater (p<0.01) in the second group. The more severe the disc herniation (protrusion and extrusion) in MRI finding, the more marked VAS score changes in the second group. When morbidity period was less than 1 year, the VAS score changes in the second group were greater (p<0.05). CONCLUSION: The therapeutic effect of catheter inserted continuous epidural injection is better than that of intermittent epidural injection in patients with low back pain.
Anesthetics, Local ; Catheters* ; Humans ; Injections, Epidural* ; Low Back Pain* ; Magnetic Resonance Imaging ; Visual Analog Scale

The purpose of this study is to characterize the recurrence and to investigate the risk factors for the recurrence in the 989 patients who had hypertensive intracerebral hemorrhage between 1989-1995. Fifty-three patients(5.4%) had two episodes of hemorrhage with median interval of 22.3+16.3 months(range, 1.7-71.9 months). The probable risk of recurrent hemorrhage was the highest within two years of the first hemorrhage, being 3.6 % in the first year and 3.5 % in the second year. The sites of the recurrent hemorrhage were different from the initial site in all patients. The common patterns of recurrence were "ganglionic(putamen/caudate nucleus)-thalamic" in 26.8% and "ganglionic-ganglionic in 21.4%. The "lobar-lobar" pattern was noted in only 2 patients, The overall mortality was 28.3%. In patients who had ganglionic-ganglionic pattern, the mortality was significantly inc reased (p<0.005). No recurrent hemorrhage occurred during the regular treatment for hypertension. The only significant tactor for recurrent hemorrhage was the antihypertensive therapy of less than 3 months after the initial attack(p<0.005). Considering lifelong treatment for hypertension, long-term regular control for hypertension will be required to prevent the recurrent hemorrhage.
Hemorrhage ; Humans ; Hypertension ; Intracranial Hemorrhage, Hypertensive ; Mortality ; Recurrence ; Risk Factors

Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignant neoplasm. Cutaneous SCC shows a broad spectrum, ranging from easily managed superficial tumors to highly infiltrative, metastasizing ones that can cause death. We have experienced two patients with SCC with intracranial extension. One case was an 88-year-old man with a tumor on the forehead treated with Mohs micrographic surgery who presented with local recurrence at the perilesional region of the primary site after 3 years. Wide excision was performed, and histologic findings showed a SCC that extended to the dura mater. The other case was a 69-year-old woman who presented with an erythematous 2x4 cm-sized plaque on the right temple, and a biopsy examination revealed SCC. The patient refused surgery and 7 months later, presented with a 5x10 cm-sized oozing plaque with multiple ulcers. Radiologic evaluation demonstrated intracranial invasion and right retropharyngeal metastatic lymph nodes. She was treated with radiotherapy for 4 months.
Aged ; Aged, 80 and over ; Biopsy ; Carcinoma, Squamous Cell* ; Dura Mater ; Female ; Forehead ; Humans ; Lymph Nodes ; Mohs Surgery ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Skin ; Ulcer

PURPOSE: To evaluate the characteristic CT and cerebral angiographic findings in patients with acutespontaneous subdural hematomas and correlate these imaging findings with causes of bleeding and clinical outcome. MATERIALS AND METHODS: Twenty-one patients with nontraumatic acute spontaneous subdural hematoma presentingduring the last five years underwent CT scanning and cerebral angiography was performed in twelve. To determinethe cause of bleeding, CT and angiographic findings were retrospectively analysed. Clinical history, laboratoryand operative findings, and final clinical outcome were reviewed. RESULTS: The 21 cases of acute spontaneoussubdural hematomas were caused by cerebral vascular abnormalities(n=10), infantile hemorrhagic disease(n=5), orwere of unknown origin(n=6). All ten cases of cerebral vascular abnormality were confirmed angiographically; sixwere aneurysms, three were arteriovenous malformations, and one was moyamoya disease. On CT, subarachnoidhemorrhage was seen to be associated with aneurysms, intracerebral hemorrhage with arteriovenous malformations,and intraventricular hemorrhage with moyamoya disease. All five patients with hemorrhagic disease were infantsaged 1-17 months ; characteristic diffuse distribution of subdural hematoma in both temporoparietal-occipitalregions is typical. The average overall mortality rate was 52.4%(11/21). In patients with cerebral vascularabnormalities, mortality was as low as 20%(2/10), but in hemorrhagic disease was high (60%). In cases of unknownorigin it was 100%. CONCLUSION: Acute spontaneous subdural hematoma is a rare condition, and the mortality rateis high. In patients with acute spontaneous subdural hematoma, as seen on CT, associated subarachnoid orintracerebral hemorrhage is strongly indicative of intracerebral vascular abnormalities such as aneurysm andarteriovenous malformation, and cerebral angiography is necessary. To ensure proper treatment and thus morkedlyreduce mortality, the causes of bleeding should be prompty determined by means of cerebral angiography.
Aneurysm ; Arteriovenous Malformations ; Cerebral Angiography ; Cerebral Hemorrhage ; Hematoma ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Mortality ; Moyamoya Disease ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Hypoxemia is often associated with liver cirrhosis without cardiopulmonary diseases. Pulmonary vascular impairments including intrapulmonary shunt have been considered as a major mechanism of hypoxemia. The aim of this study was to determine the incidence and pathophysiologic basis of hypoxemia in cirrhotic patients without respiratory symptoms. METHODS: In fourty three cirrhotic patients without heart and lung diseases, we performed the arterial blood gas analysis and calculated alveolar arterial oxygen gradient (A-aO2). According to the A-aO2, the patients were divided into hypoxemic and normoxemic groups. In each group, a Tc-99m-macroaggregated albumin (Tc-99m-MAA) scan, a contrast-enhanced echocardiography and a pulmonary function test were performed. RESULTS: Twenty-eight of 43 patients (65%) showed hypoxemia. Hypoxemic patients showed significantly more increased shunt fraction of 3.1 1.4% than normoxemic one of 2.1 1.1% in the Tc-99m-MAA scan (p<0.05). However, only two of hypoxemic patients had shunt fraction above physiologic shunt range. By contrast-enhanced echocardiography, an intrapulmonary shunt was confirmed in one patient. There was no significant correlation between the shunt fraction and the hepatic reserve based on the Child-Pugh classification in hypoxemic patients. In the results of pulmonary function test, only DLco decreased more significantly in hypoxemic group than in normoxemic group (58.4 14.2 % vs 75.3 16.5% of predicted, p<0.05). CONCLUSIONS: Hypoxemia is not infrequently observed in cirrhosis, but incidence of significant intrapulmonary shunt is low. Therefore, other mechanism such as diffusion defect may be suggested to play a role in the development of hypoxemia in cirrhotic patients without respiratory symptoms.
Anoxia ; Blood Gas Analysis ; Classification ; Diffusion ; Echocardiography ; Fibrosis ; Heart ; Humans ; Incidence ; Liver Cirrhosis* ; Liver* ; Lung Diseases ; Oxygen ; Respiratory Function Tests ; Technetium Tc 99m Aggregated Albumin

No abstract available.
Kidney* ; Transplants* ; Tuberculosis*

A 65-year-old male patient with preoperative severe left ventricular dysfunction and mitral and tricuspid insufficiency went into low cardiac output and failure to wean, biventricular assistance was provided with centrifugal pumps. The patient survived the ordeal. This is the first reported case of a survival after biventricular assistance using the centrifugal pump.
Adult* ; Aged ; Cardiac Output, Low ; Heart Diseases* ; Heart* ; Humans ; Male ; Ventricular Dysfunction, Left