BACKGROUND: Thoracic epidural analgesia is the mainstay of postoperative pain control after thoracotomy. Usually the epidural catheter is blindly inserted and secured without confirming the tip position. The purpose of this study was to determine the influence of epidural approach angle on the position of the thoracic epidural catheter tip. METHODS: 129 patients scheduled for thoracotomy were enrolled. Patients were randomized into two groups: narrow angle group and wide angle group. The epidural needle was inserted at the skin of T8-9 level in both groups. In the narrow angle group the epidural space was approached at T7-8, whereas in the wide angle group the epidural space was approached at T6-7. After epidural space confirmation, a B-D nylon multi-hole epidural catheter was threaded 8cm into the epidural space. The epidural catheter tip position was assessed using a small amount of radiocontrast dye under fluoroscopy. RESULTS: The mean (95% confidence interval) position of the catheter tip was the mid-body of T5 (T5-6 - T5 upper body) in the narrow angle group and T3-4 (mid-body of T4-T3 lower body) in the wide angle group (P = 0.037). CONCLUSIONS: When approaching the thoracic epidural space by a wide angle, we can place the epidural catheters at a higher level because of a straighter threading.
Analgesia ; Analgesia, Epidural ; Catheterization* ; Catheters* ; Epidural Space ; Fluoroscopy ; Humans ; Needles ; Nylons ; Pain, Postoperative ; Skin ; Thoracic Surgery ; Thoracotomy

This study was to determine which of two routes of administration of 5-fluorouracil (5-FU) is more effective, by measuring the radioactvity in the body tissues of gastric cancer patients after the administration of 5-FU-l4C via the systemic intravenous and the regional intra-arterial routes. After the drug was administered intravenously in one group of patients, and intra-arterially in another; samples of portal venous blood, the liver, the lymph nodes, and the normal and the cancerous tissues of the stomach were obtained. The radioactivities of the samples were measured, and it was found that those of the regional lymph nodes, the liver, and the normal and the cancerous tissues of the stomach were much higher in the latter group. The regional intra-arterial routes is the more effective way to administer 5-FU in patients with stomach cancer.
Carbon Radioisotopes/diagnostic use ; Comparative Study ; Fluorouracil/administration & dosage ; Fluorouracil/metabolism* ; Human ; Injections, Intra-Arterial ; Injections, Intravenous ; Stomach Neoplasms/drug therapy* ; Stomach Neoplasms/metabolism

Takayasu's arteritis is generally recognized as a chronic, idiopathic, inflammatory disease, which affects the aorta and the proximal portions of its major branches. We experienced a patient with Takayasu's arteritis who was presented with main pulmonary artery stenosis and right coronary ostial occlusion without involvement of aorta nor its major branches. She was managed with pulmonary arterioplasty and coronary artery bypass graft. This case emphasize that the disease cannot affect the aorta.
Aorta ; Constriction, Pathologic* ; Coronary Artery Bypass ; Coronary Vessels* ; Humans ; Pulmonary Artery* ; Takayasu Arteritis* ; Transplants

Struma ovarii is a rare tumor of the ovary pathologically resembling teratomas with thyroid components. The presenting clinical, radiological, and pathological features of patie-nts with consequent struma ovarii is diverse and does not give substantial information with regard to the nature of the ovarian tumor. Ten cases collected over a period of eight years from two institutes are presented which showed a wide diversity of clinical features, and in which the diagnosis was only made later by strict pathological criteria. The treatment for struma ovarii, and in even rarer cases, malignant struma ovarii, remains highly controvers-ial, but it is suggested that conservative treatment by tumor excision only may be sufficie-nt. Surgical treatment also greatly ameliorates any accompanying hydrothorax and ascites.
Academies and Institutes ; Ascites ; Diagnosis ; Female ; Hydrothorax ; Ovary ; Struma Ovarii* ; Teratoma ; Thyroid Gland

BACKGROUND: Arterial grafts have been used to achieve better long-term results for coronary revascularization. Bilateral internal thoracic artery (ITA) grafts have a better results, but it may be not used in some situations such as diabetes and chronic obstructive pulmonary disease (COPD). We evaluated the clinical and angiographic results of composite left internal thoracic artery-radial artery (LITA-RA) Y graft. MATERIAL AND METHOD: Between April 2002 and September 2004, 119 patients were enrolled in composite Y graft for coronary bypass surgery. The mean age was 62.6+/-8.8 years old and female was 34.5%. Preoperative cardiac risk factors were as follows: hypertension 43.7%, diabetes 33.6%, smoker 41.2%, and hyperlipidemia 22.7%. There were emergency operation (14), cardiogenic shock (6), left ventricle ejection fraction (LVEF) less than 40% (17), and 17 cases of left main disease. Coronary angiography was done in 35 patients before the hospital discharge. RESULT: The number of distal anastomoses was 3.1+/-0.91 and three patients (2.52%) died during hospital stay. The off-pump coronary artery bypass (OPCAB) was applied to 79 patients (66.4%). The LITA was anastomosed to left anterior descending system except three cases which was to lateral wall. The radial Y grafts were anastomosed to diagonal branches (4), ramus intermedius (21), obtuse marginal branches (109), posterolateral branches (12), and posterior descending coronary artery (8). Postoperative coronary angiography in 35 patients showed excellent patency rates (LITA 100%,and RA 88.5%; 3 RA grafts which anastomosed to coronary arteries <70% stenosed showed string sign with competitive flow). CONCLUSION: The LITA-RA Y composite graft provided good early clinical and angiographic results in multivessel coronary revascularization. But it should be cautiously used in selected patients.
Arteries ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Emergencies ; Female ; Heart Ventricles ; Humans ; Hyperlipidemias ; Hypertension ; Length of Stay ; Mammary Arteries ; Pulmonary Disease, Chronic Obstructive ; Radial Artery ; Risk Factors ; Shock, Cardiogenic ; Transplants*

Osteogenesis imperfecta is one of the groups of hereditary disorders of connective tissue which includes the Ehlers-Danlos syndrome, the Marfan syndrome, pseudoxanthoma elasticum, and Hurler syndrome. While cardiovascular involvement is associated with each of these disorders, it is least common in osteogenesis imperfecta and is overshadowed by the bony, ocular, otologic, cutaneous, and dental manifestations that are characteristic of the disorder. In evaluating patients with osteogenesis imperfecta, careful attention should be paid to cardiovascular findings and if valvular lesions are noted, patients should be instructed regarding the need for antibiotic prophylaxis for dental and surgical procedures. We report a case of osteogenesis imperfecta associated with aortic regurgitation.
Antibiotic Prophylaxis ; Aortic Valve Insufficiency* ; Connective Tissue ; Ehlers-Danlos Syndrome ; Humans ; Marfan Syndrome ; Mucopolysaccharidosis I ; Osteogenesis Imperfecta* ; Osteogenesis* ; Pseudoxanthoma Elasticum

PURPOSE: To evaluate the possibility of using porous beta-calcium pyrophosphate (beta-CPP) as a bone graft substitute by comparing its osteoconduction and degradation with porous hydroxyapatite (HA). MATERIALS AND METHODS: Porous HA and porous beta-CPP were implanted in the proximal tibia of 7 dogs. Two animals were sacrificed at 8weeks and 5 animals were sacrificed at 20 weeks after surgery. Radiographs and histologic sections were evaluated. RESULTS: The mean period required for the radiolucent zone to disappear was 7.1+/-1.1 weeks in HA and 6.4+/-1.1 weeks in beta-CPP. By serial radiography, resorption was more prominent in porous beta-CPP than in porous HA at 8 weeks (p=0.04) and at 20 weeks. The proportion of bony tissue in the pore was 16.8% in HA and 29.7% in -CPP. The proportion of pores with bony tissue was 70.2% in HA and 62.5% in beta-CPP at 8 weeks. CONCLUSION: In beta-CPP, the new bone growth was as vigorous as in HA, but the degradation was more rapid than in HA. These results suggest that beta-CPP is a more ideal new bone graft substitute.
Animals ; Bone Development ; Bone Regeneration ; Dogs ; Durapatite ; Radiography ; Tibia ; Transplants*

BACKGROUND: Bioactive glass-ceramics have the ability to directly bind to bones and have been widely used as bone graft substitutes due to their high osteoconductivity and biocompatibility. CaO-SiO2-P2O5-B2O3 glass-ceramics are known to have good osteoconductivity and are used as bone graft extenders. METHODS: This study aimed to evaluate the effects of the resorbing properties of glass-ceramics in bone fusion after producing and analyzing three types of CaO-SiO2-P2O5-B2O3 glass-ceramics with high osteoconductivity that had enhanced resorption by having an increased B2O3 content. The three types of CaO-SiO2-P2O5-B2O3 glass-ceramics with B2O3 contents of 8.0, 9.0, and 9.5 weight % were designated and grouped as P20B80, P10B90, and P5B95, respectively. Glass-ceramic types were tested for fusion rates and bone formation by employing the lumbar 5-6 intertransverse process fusion model in 51 New Zealand male rabbits. Bioactivity was assessed by soaking in simulated body fluid (SBF). RESULTS: In vitro study results showed sufficient hydroxycarbonate apatite layer formation occurred for P20B80 in1 day, for P10B90 in 3 days, and for P5B95 in 5 days after soaking in SBF. For the rabbit lumbar spine posterolateral fusion model, the autograft group recorded a 100% fusion rate with levels significantly higher than those of P20B80 (29.4%), P10B90 (0%), and P5B95 (14.3%), with high resorbing properties. Resorbing property differences among the three glass-ceramic groups were not significant. Histological results showed new bone formation confirming osteoconductivity in all three types of glass-ceramics. Radiomorphometric results also confirmed the resorbing properties of the three glass-ceramic types. CONCLUSIONS: The high resorbing properties and osteoconductivity of porous glass-ceramics can be advantageous as no glass-ceramics remain in the body. However, their relatively fast rate of resorption in the body negatively affects their role as an osteoconductive scaffold as glass-ceramics are resorbed before bony fusion.
Animals ; Bone Resorption ; Bone Substitutes/adverse effects/*therapeutic use ; Ceramics/adverse effects/*therapeutic use ; Electric Conductivity ; Lumbosacral Region/*surgery ; Male ; Rabbits ; Spinal Fusion/*methods

BACKGROUND: Vasovagal syncope is a common cause of syncope. In some cases, syncopal episode is recurrent, resulting in physical injury. Head-up tilt test with or without isoproterenol provocation has been a tool to diagnose vasovagal syncope. But the protocol of head-up tilt test has not been settled. In this study, we evaluate the usefulness of a head-up tilt test with isoproterenol provocation in patients with syncope or presyncope of unexplained origin. METHODS: Head-up tilt test was performed with patients in the fasting state in the morning. After supine heart rate and blood prewwure were obtained, each patient was tilted to the 70 degree upright position for 30 minutes using a motorized tilt table with a footboard. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 microg/min and then increased by 1 microg/min every three minutes to a maximum of 5 microg/min while maintaining 70 degree upright position. The end points of test were positive response, intolerance of isoproterenol, heart rate>150 beats/min, and completion of the protocol. When an end point reached, the patient was rapidly returned to the horizontal position. RESULTS: 1) Of 122 patients with syncope or presyncope, 113 patients(93%) had prodromal symptoms. 2) 23 patients(19%) had physical injury during episode. 3) 93 patients(76%) experienced episodes while they were standing or sitting. 4) A total of 83 patients(68%) had a positve response during head-up tilt test ; 7 patients(8%) of these 83 patients had a positive response during the baseline tilt. But, 76 patients(92%) required isoproternol provocation to elicit this response. 5) The pattern of positive response showed vasodepressive pattern in 55 patients(67%), mixed pattern in 26 patients(31%), and cardioinhibitory pattern in 2 patients(2%). 6) No significant side effect of isoproterenol was noted. 7) There were no significant differences between positive response group and negative response group in terms of clinical characteristics and hemodynamic findings during head-up tilt test. CONCLUSION: A head-up tilt test with isoproterenol provocation could be an useful tool for diagnosing vasovagal syncope or presyncope in adults.
Adult* ; Fasting ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Isoproterenol ; Prodromal Symptoms ; Syncope* ; Syncope, Vasovagal

BACKGROUND: Oral beta-blocker is initially used to prevent the symptons in patients with vasovagal syncope or presyncope. But, beta-blocker treatment may actually cause worsening of symptoms in some patients. The purpose of the present study was to evaluate the efficacy of oral beta-blocker in preventing symptoms during repeat head-up tilt test in patients who had a positive response in initial head-up tilt test. METHOD: Patients. Among the 150 patients with unexplained syncope or presyncope who underwent head-up tilt from October 1994 to January 1996, forty-three patients, who were taking beta-blocker and underwent repeat head-up tilted test, were included in this study. Initial head-up tilt test. Each patients was tilted to the 70 degree upright position for 30 minutes. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 (micro)g/min and then increased by 1 (micro)g/min every three minutes to al maximum of 5 (micro)g/min while maintaining 70 degree upright position. Repeat head-up tilt test. The test was repeated while each patients was taking atinolol. The repeat test was continued until reaching at the stage where each patient had a positive response in initial test. RESULTS: 1) In initial head-up tilt test, most (91%) of a positive response occured during isoproterenol provocation. 2) In repeat head-up tilt test on atenolol, thirty-four patients(79%) had a negative response. But nine patients(21%) still had a positive response. 3) Nonresponsive group showed younger age and shorter time period to a positive response in initial head-up tilt test than responsive group. CONCLUSION: It may be useful to assess the effectiveness of beta-blocker by repeat head-up tilt before deciding long term treatment, especially younger age group.
Adult* ; Atenolol ; Humans ; Isoproterenol ; Syncope* ; Syncope, Vasovagal*