PURPOSE: Flow interruptor high frequency ventilator(HFV) on neonatal respiratory failure caused by various disorders has been applied in order to assess its therapeutic effect and safety. METHODS: Premature babies below 1.8kg with respiratory failure from 1991 to 1997 in the Fatima neonatal intensive care unit(NICU) for 6 year and 4 months are included. Flow interruptor HFV with low intermittent mandatory ventilation(IMV) has been applied in 74 cases. If clinical symptom and arterial blood gas analysis(ABGA) became stable for 6-12 hrs, we started weaning aggressively. RESULTS: Mean duration of HFV with low IMV was 5.4 4 days. Initial success rate of weaning was 63 cases(85.1%). Weaning failure rate was 11 cases(14.9%). Six cases was due to underlying sepsis. Four cases was caused by pneumothorax and one case resulted from patent ductus arteriosus(PDA) with congestive heart failure(CHF). Complication of HFV with combined low IMV was 5 cases of pneumothorax, 4 cases of grade III intraventricular hemorrhage and one case of bronchopulmonary dysplasia(BPD). Eleven cases of stage III or more retinopathy of prematurity(ROP) and 5 cases of periventricular leukomalasia(PVL) were confirmed. CONCLUSION: Flow interruptor HFV with low IMV can be used safely as conventional mechanical ventilators in the case of respiratory failure caused by various disorders. If MAP has been adjusted appropriately, incidence of pneumothorax and BPD are expected to diminish by aggressive weaning as clinical symptom become stable.
Estrogens, Conjugated (USP) ; Heart ; Hemorrhage ; High-Frequency Ventilation* ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Pneumothorax ; Respiratory Insufficiency* ; Sepsis ; Ventilators, Mechanical ; Weaning

The treatment of a brachymetacarpia using a distraction osteogenesis was mostly single, unilateral pattern. In case of multiple brachymetacarpia, single-stage lengthening or rapid distraction lengthening with a bone graft were usually used. Multiple brachymetacarpia treated by distraction osteogenesis is rarely reported. We report a case of a 15-year-old female presented with bilateral multiple brachymetacarpia treated by distraction osteogenesis simultaneously without complications. Also, we have evaluated the clinical results and factors which influence the clinical results.
Adolescent ; Brachydactyly ; Female ; Hand Deformities ; Humans ; Osteogenesis, Distraction* ; Transplants

No Abstract available.
Tracheal Stenosis*

Bilateral sagittal split ramus osteotomy (BSSRO) is generally indicated for mandibular setback, to improve occlusion, masticatory function, and aesthetics by altering the mandibular position. However, BSSRO narrows the pharyngeal airway and increases airway resistance, resulting in postoperative respiratory disturbances during emergence from anesthesia. Oxygen delivery system via high-flow nasal cannula (HFNC) has been known to improve airway patency and oxygenation via low-level positive pressure as well as reduce the respiratory load. We report a case of postoperative respiratory disturbance, following a large mandibular setback, despite nasotracheal extubation in the fully awake patient. Respiratory disturbance was successfully controlled after oxygen delivery via HFNC until self-respiration was completely restored. Therefore, the use of HFNC may facilitate the control of postoperative respiratory disturbances induced by anatomical changes in upper airway after BSSRO surgery.
Airway Resistance ; Anesthesia ; Catheters* ; Dyspnea ; Esthetics ; Humans ; Orthognathic Surgical Procedures ; Osteotomy, Sagittal Split Ramus* ; Oxygen ; Oxygen Inhalation Therapy ; Respiratory Distress Syndrome, Adult

BACKGROUND AND OBJECTIVES: In patients with fibromyalgia (FM) syndrome, stress and pain may chronically enhance sympathetic activity, altering cardiovascular responses and inducing the arterial wall-stiffening process. We investigated arterial stiffness in FM patients using pulse wave velocity (PWV) and analyzed whether arterial stiffness was affected by the clinical parameters of FM. SUBJECTS AND METHODS: This study included 108 female FM patients (51.5+/-8.9 years) without any known cardiovascular diseases and 76 healthy female controls (50.1+/-8.9 years). FM patients underwent a manual tender point survey for tender point counts, and completed the visual analogue scale (VAS) of pain and fibromyalgia impact questionnaire (FIQ), which were composed of a physical and feel score. Brachial-ankle pulse-wave velocity (baPWV) was measured with an automated device. The study participants were subdivided into 2 groups based on the sum of the FIQ score (group A: FIQ > or =50, group B: <50). RESULTS: Patients with FM had significantly higher baPWV than the controls, and significant increase were noted in baPWV values of group A compared with those of group B. BaPWV showed a significant positive correlation (correlation coefficient=6.83, p=0.022) with severity of disease assessed by FIQ. CONCLUSION: The patients with FM showed significantly increased arterial stiffness, suggesting a pathophysiologic link between FM and endothelial dysfunction. This study provides a basis for clarifying the mechanism by which chronic pain syndrome is associated with an increased risk of vascular stiffness.
Aluminum Hydroxide ; Carbonates ; Cardiovascular Diseases ; Chronic Pain ; Compliance ; Female ; Fibromyalgia ; Humans ; Pulse Wave Analysis ; Vascular Stiffness ; Surveys and Questionnaires

Kawasaki disease is characterized by a variety of symptoms and signs resulted from systemic vasculitis. Although the etiology of the disease remains uncertain, its serious coronary sequelae have been proved to cause ischemic heart disease in children. Coronary artery aneurysms or ectasia develop in approximately 20% of untreated children with the disease and may lead to coronary ischemia. Although the incidence of severe coronary arterial stenosis is low (2-3%), but once myocardial infarction occurs in children, the mortality is quite high (22% at the first infarction). Children with coronary aneurysms should be assessed carefully with periodic stress testing for reversible ischemia. Coronary artery bypass surgery is indicated when there is an evidence of myocardial ischemia even in small children. However, one should keep in mind that the ability to recanalize or develop collateral vessels in children is very high and recanalization is frequently noted in the right coronary artery. Internal thoracic arteries are the graft of choice. We performed coronary bypass grafting in 5 patients with Kawasaki disease since 2001. The mean age of the patients was 18.8+/-11.2 (range, 2-30) year. The mean number of anastomosis was 1.8+/-1.1. All patients survived and have revealed no evidence of myocardial ischemia during follow-up.
Aneurysm ; Child ; Constriction, Pathologic ; Coronary Aneurysm ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Dilatation, Pathologic ; Exercise Test ; Follow-Up Studies ; Humans ; Incidence ; Ischemia ; Mammary Arteries ; Mortality ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction ; Myocardial Ischemia ; Systemic Vasculitis ; Transplants

Mediastinitis and sternal wound infection frequently occurred after corrective surgery for complex heart anomalies. Most of the patients are neonate or infant and they have showed low oxygen tension. For that poor condition, application of invasive treatment of mediastinitis is not appropriate and recovery takes a long time. We successfully treated a mediastinitis after Norwood operation using vacuum assisted closure. So we introduce the technique and the modification of neonatal vacuum assisted closure.
Heart ; Humans ; Infant ; Infant, Newborn ; Mediastinitis* ; Negative-Pressure Wound Therapy* ; Norwood Procedures* ; Oxygen ; Vacuum* ; Wound Infection

We experienced tracheobronchial stenosis caused by malrotation of the heart in a 3-year-old girl. Malrotation of the heart is induced by the decreased right lung volume, which was the result of right lung hypoplasia and herniation of the left thoracic cavity. We corrected the right lung volume and location of the heart to treat tracheobronchial stenosis.
Child, Preschool ; Constriction, Pathologic* ; Female ; Heart* ; Humans ; Lung ; Thoracic Cavity ; Tracheal Stenosis

This study reports our early experience with thoracoscopic division of vascular rings. Three patients were reviewed; their ages at surgery were 25 months, 4 years, and 57 years. All patients were suffering from complete vascular rings involving combinations of the right aortic arch, left ligamentum arteriosum, Kommerell's diverticulum, and retroesophageal left subclavian artery. The median surgical time was 180.5 minutes, and the patients showed immediate recovery. Three complications, namely chylothorax, transient supraventricular tachycardia, and left vocal cord palsy, were observed. Our early experience indicates that thoracoscopic division of a vascular ring may provide early recovery and could be a promising operative choice.
Aorta, Thoracic ; Chylothorax ; Diverticulum ; Humans ; Operative Time ; Subclavian Artery ; Tachycardia, Supraventricular ; Thoracic Surgery, Video-Assisted ; Vocal Cord Paralysis

Ossification of the posterior longitudinal ligament (OPLL) is an uncommon disorder that may be associated with slowly progressing neurological symptoms. We encountered a case of acute cervical myelopathy due to a ruptured disc in an asymptomatic patient with OPLL, who was surgically managed by the anterior approach and fusion. We report the case with a review of the relevant literature.
Humans ; Longitudinal Ligaments ; Spinal Cord Diseases*