Isolated pulmonary stenosis, a relatively common congenital anomaly that accounts for about 10 percent of all congenital heart disease, is characterized by stenosis of pulmonary valve itself, infundibulum or both of them. Since cardiac catherterization was applied to man by Cournand and Ranges, pulmonary stenosis had been easily diagnosed and many clinical studies had been investigated. It has a wide clinical spectrum depending on the degree of stenosis. The electrocardiogram, phonocardiogram and chest X-ray have proved useful in estimating the severity of hemodynamic facotrs in individual cases. This series comprises 47 cases in whom the clinical diagnosis of isolated pulmonary stenosis was confirmed by right heart catheterization with cardiac cineangiography at Severance Hospital, Yonsei University. An attempt was made to correlate the electrocardiographic, phonocardiographic, chest X-ray findings, and types of stenosis with the hemodynamic data in these cases. 1. Of 47 patients, 33 were male and 14 female. Their ages ranged from 2 to 42 years: the mean age was 19.1 years. 2. The incidence was 5.9 percent of all 797 catheterized congenital heart disease cases. The pulmonary valvular stenosis was 30 (68.3%), infundibular 7 (14.6%) and combined 10 (21.6%) cases. 3. The correlation between electrocardiogram and hemodynamic data were as follows. i) The regression equation between right ventricular sysytolic pressure (RVSP) and height of R wave in V1 lead (RV1) was RVSP=3.32 RV1+48.2: its correlation coefficient was 0.818 and it was very significant (p=0.000). ii) The higher the RVSP, the more the frontal axis of QRS complex shifted to the right side (r=0.55. p=0.001). iii) The RVSP of the groups with positive ECG findings such as p-pulmonale, right ventricular hypertrophy or right ventricular strain were much higher than the RVSP of the groups without such findings (p=0.032.0.000, 0.000). iv) The group with RV1 higher than 20 mm showed much more elevated mean of RVSP than the group with lower RV1 (p=0.000). v) The groups with the above mentioned positive ECG findings showed good correlation with the severity of RVSP which was arbitrarily classified as 49 or less, 50~100, and 100 mmHg or more (chi-square=8.96, 26.69, 19.06; p=0.011, 0.000, 0.000). 4. The group with late occurrence of the maximum intensity of the ejection systolic murmur showed higher mean of RVSP than the group with early peak of the murmur (p=0.014). 5. The means of RVSP of the groups with chest X-ray findings such as decreased pulmonary vascularity, were much higher than the means of RVSP of the groups without such findings (p=0.000, 0.005, 0.015). The groups with above mentioned positive chest X-ray findings showed good corelations with the severity of RVSP which was classified as above limits (chi-square=7.55, 10.94, 13.36; p=0.022, 0.004, 0.001). 6. Combined pulmonary valvular and infundibular stenosis showed more severe systolic pressure gradient and higher mean of RVSP than the isolated types (p=0.000).
Axis, Cervical Vertebra ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Catheters ; Cineangiography ; Constriction, Pathologic ; Diagnosis ; Electrocardiography ; Female ; Heart Defects, Congenital ; Hemodynamics* ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Pulmonary Valve ; Pulmonary Valve Stenosis* ; Systolic Murmurs ; Thorax

To delineate the coronary anatomy and the left ventricular function during early myocardial infarction, coronary arteriography and left ventriculography were performed prospectively in 28(34%) of 83 patients who were admitted to the coronary care unit at Severance Hospital from November 1983 to August 1984 within 30 days(median : 14 days;range : 4 hours to 30 days) after the onset of symptoms. The frequency of total occlusion of the infarct related artery was evaluated in the time course of infarction. To prove spontaneous recanalization, 3 patients who had total coronary occlusion underwent serial study within 11-20 days after the first study. We categorized the patients into two comparable groups according to the infarction site, coronary angiographic findings, and age. Comparison of clinical and angiographic findings between each group was made. The following results were obained. 1) There were 23 patients with transmural myocardial infarction(82.1%) and 5 with nontransmural infarction(17.9%). Among 23 patients with transmural infarction, 14 had anterior infarction(60.9%) and 9(39.1%) inferior infarction. 2) The mean age was 51.3 years(range : 31-79 years). The ratio of male to female was 3.7:1. 3) Fifteen patients(53.6%) had one-vessel disease, 10(35.7%) two-vessel disease and 2(7.1%) three-vessel disease, One patient(3.6%) had insignificant disease(less than 50% reduction in luminal diameter). Nontransmural infarction had a tendency to be associated with higher prevalence of multivessel disease than transmural infarction(80% vs 34.8%). 4) In 23 patients with transmural infarction, 12(52.2%) had complete occlusion and 11(47.8%) incomplete occlusion of the infarct related artery. Three patients(13.0%) had subtotal occlusion(90-99%) and 4(17.4%) had lesions of 70-89% luminal diameter narrowing. Three patients(13.0%) had 50-69% lesions and the remaining 1(4.4%) had insignificant obstructive lesions. 5) Of the 23 patients with transmural infarction, 12 were studied within 14 days and 11 in 15-30 days after the onset of symptoms. The frequency of total coronary occlusion was significantly higher in the patients studied within 14 days of symptom onset vs those studied in the 15-30 days period(83.3% vs 18.2%;p<0.001). Serial studies of 3 patients with total coronary occlusion at the initial study demonstrated occurrance of spontaneous recanalization in 2 patients. 6) The left ventricular-ejection fraction was higher in the patients with nontransmural infarction, inferior infarction, and incomplete coronary occlusion(65+/-14%, 58+/-16% and 57+/-17%) than that of the patients with transmural infarction, anterior infarction, and complete coronary occlusion(51+/-15%, 47+/-14% and 46+/-13, p<0.05). But there was no significant difference in left ventricular ejection fraction between the young(<45 year) and the old(> or =45 year) age groups. And also 0-1 vessel disease and 2-3 vessel disease groups did not show significant difference in ejection fraction. The degree of congestive heart failure was more severe in the patients with anterior infarction than in those with inferior infaction. multi-vessel disease group was significantly older than 0-1 vessel disease group(55+/-8 yrs vs 46+/-12 yrs, p<0.05), and the young age group had a tendency to be associated with higher prevalence of single vessel disease. 7) As for the complications of angiocardiography in this study, there was ventricular finbrillation in 2 patients(7.1%) without mortality. It is concluded that coronary arteriography can be safely performed within one month after acute myocardial infarction;high prevalence of one-vessel disease in acute myocardial infarction in the Korean adult patients admitted to a general hospital;lower incidence of total coronary occlusion in the late time course of infarction due to spontaneous recanalization;better left ventricular function in the patient groups with nontransmural infarction, inferior infarction and incomplete coronary occlusion.
Adult* ; Angiocardiography ; Angiography ; Arteries ; Coronary Care Units ; Coronary Occlusion ; Female ; Heart Failure ; Humans ; Incidence ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Phenobarbital ; Prevalence ; Prospective Studies ; Stroke Volume ; Ventricular Function, Left

No abstract available.
Chylothorax*

Wound healing of the skin and soft tissue defect is accomplished by generation of granulation tissue, collagen synthesis, contraction and re-epithelization. In the full-thickness skin wound, contraction plays an important role and fundamental principles in the treatment of infected wounds include the elimination of infection, the evacuation of pus, and the debridement of all necrotic material. The natural healing process of infected wounds can be expedited by the application of agents which will effectively eliminate infection with facilitating the healing process. Yunkyo is one of the most commonly used oriental herb medicine which is known to be effective in wound healing. In order to evaluate the effects of Yunkyo over wound healing and inhibition of bacterial growth, the author counted the bacterial colony in vitro and made skin defect on the back of rats for the comparison of reduced wound size and changes of tissue bacterial colony count after treatmnet with Solcoseryl, TCDO (Tetra-chloro-deca-oxide) and povidone. The results were obtained as follows: Calculating colony count in vitro, Yunkyo treated group was the most effective(p<0.001). There were significant differences between Yunkyo treated and control group in wound healing(p<0.001): Yunkyo healed the wound more rapidly. Calculating tissue bacterial colony count in open infected wound, Yunkyo treated group was showed the lowest colony count. In microscopic findings, the author observed marked growth of the granulation tissue, infiltration of the inflammatory cells, development of capillaries and even arrangement of collagen in Yunkyo treated groups than in the control group. In electron microscopy, abundant protein synthesis and myofilament in the myofibroblast were observed, and the authors found active wound contraction and the growth of granulation tissue. In conclusion, the Yunkyo has remarkable antibiotic effect and promotes wound contraction and the growth of granulation tissue in the process of wound healing.
Actihaemyl ; Animals ; Capillaries ; Collagen ; Debridement ; Granulation Tissue ; Microscopy, Electron ; Myofibrils ; Myofibroblasts ; Povidone ; Rats* ; Skin ; Suppuration ; Wound Healing* ; Wounds and Injuries*

We report a case of an incarcerated internal hernia which was diagnosed preoperatively by using an abdominal CT scan. An-84-year-old female patient suddenly developed cramping upper abdominal pain after a meal, followed by nausea and vomiting associated with slight abdominal distension. This patient's initial abdominal plain X-ray was interpreted as indicating abdominal free gas. A dilated small bowel loop was revealed based on a late abdominal CT scan, and an internal hernia was suspected. On operation, herniation through defects in the gastrocolic omentum and gastrohepatic ligament was found and was successfully reduced. A jejunal loop internal herniation of this nature is extremely rare, and closed-loop obstructions result to incarceration or strangulation. When abnormal gas is detected at the right upper or the epigastric area in a simple abdominal X-ray. An unusual internal hernia must be a concern, and an abdominal CT scan can be useful for preoperative diagnosis.
Abdominal Pain ; Diagnosis ; Female ; Hernia* ; Humans ; Intestinal Obstruction* ; Ligaments ; Meals ; Muscle Cramp ; Nausea ; Omentum ; Tomography, X-Ray Computed ; Vomiting

PURPOSE: Spontaneous tendon rupture of finger is defined the rupture of tendon without any intrinsic or extrinsic pathological processes in finger. Spontaneous flexor tendon ruptures are rare. Burn affects not only skin but also muscle and tendon according to the depth. Particularly, burn in hand badly affects movement of finger. Thus, We report the case of spontaneous flexor tendon rupture of finger that happened after burn. METHODS: We studied a 42 year old male presented with third degree electrical burn at the palm of the right hand. And then, Terudermis(R) was applied on 23rd day after burn and split thickness skin graft was applied on 37th day after burn. After operation, there were no special symptoms for some period. But, on 74th day after burn, while providing physical therapy to finger, he could not flex his thumb of the hand with popping sound and edema. So we performed US and MRI scan, finally diagnosed complete tear on FPL tendon of the right hand which was in flexor tendon injury zone IV. We harvested donor from Palmaris longus and tendon graft was applied. RESULTS: After operation, graft was well taken without other problem. And after applying splint, 4th day after tendon graft, active finger extension was done with passive flexion achieved using a rubber band attached to the finger tip. 4 weeks after the operation, splint was removed and the patient gently started active exercise. CONCLUSION: Spontaneous rupture of flexor tendon is rare and moreover, there was no case report of rupture after burns so far. We are now reporting that we early diagnosed the spontaneous flexor tendon rupture of the burned hand and functionally corrected by tendon graft.
Burns ; Edema ; Fingers ; Hand ; Humans ; Magnetic Resonance Imaging ; Male ; Muscles ; Pathologic Processes ; Rubber ; Rupture ; Rupture, Spontaneous ; Skin ; Splints ; Tendon Injuries ; Tendons ; Thumb ; Tissue Donors ; Transplants

PURPOSE: Talipes equinus deformity is defined as impossibility of heel weight-bearing and lacking of improvement of toe-tip gait despite sufficient duration of conservative treatment. The incidence of equinus deformity induces post-traumatic extensive soft tissue defect and subsequently increases it. Severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using achilles Z-lengthening and free-tissue transfer. METHODS: Free radial forearm flap was done in nine cases of eight patients from January 2000 to November 2006. Causes of deformity were post-traumatic contracture (one patient) and post-burn scar contracture (seven patients). Seven patients were male, one patient was female. Mean age was 32.1 (range, 10-57). Flap donors were covered with artificial dermis (Terudermis(R)) and split thickness skin graft (five cases), and medium thickness skin graft only (four cases). RESULTS: The size of flaps varied from 6x12 to 15 x12cm (average, 12x7.8cm). Achilles tendon was lengthened 4.2cm on average. Free radial forearm flap was satisfactory in all cases. All patients could ambulate normally after the surgery. Cases having donor coverage with Terudermis(R) were aesthetically better than those having skin grafts only. CONCLUSION: This study suggested that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively free radial forearm flap and Achilles tendon lengthening.
Achilles Tendon* ; Ankle ; Cicatrix ; Clubfoot* ; Congenital Abnormalities* ; Contracture ; Dermis ; Equinus Deformity* ; Female ; Foot ; Forearm* ; Gait ; Heel ; Humans ; Incidence ; Leg ; Male ; Skin ; Tissue Donors ; Transplants ; Weight-Bearing

OBJECTIVES: This study examines the problem of the preplacement health examination in terms of hearing loss case, where workers have been experiencing job instability in the labor market. METHODS: In order to measure the 2-year job retention rate of employees in 79 shipbuilding subcontracted companies in Kyongnam province, we utilized the same methods as those used by Neumark et al(1999), and Bernhardt et al(1999). We surveyed 79 heath and safety personnel from the companies with a questionnaire to evaluate the present status of the preplacement health examination. We reviewed the preplacement health certificates(result of audiometric hearing thresholds) of 1,818 recruits issued by Daewoo hospital from January 1 to June 30, 2001. RESULTS: The job retention rate was 40.3 %(male 38.53 %, female 52.01 %). Of the 79 health and safety personnel of companies, 44(55.7 %) perceived the preplacement health examination as a tool for the selection of recruits, 3(3.8 %) as a procedure for job fitting and 31(39.2 %) as both. Most of them were against the acceptance of recruits with hearing loss, spinal disease and hepatitis. Among the 1,818 workers who underwent the preplacement health examination, 530(29.1 %) were examined after employment, but 1,096(60.3 %) were examined before employment. The number with previous job experience was 1,591(87.5 %). In the audiometric hearing threshold results, the prevalence of hearing loss was positively correlated with age. There was a significant difference in the prevalence of hearing loss depending on previous job and number of quitting at 4,000 Hz. CONCLUSIONS: The comparison of 2-year job retention rates before and after the Korean economic crisis of 1997 suggests that job stability has been aggravated especially for cohorts of long tenure, irregular job, and old age. This evidence shows that previous job and age play a role in determining worker employment based on perceived results from the preplacement health examination. This result suggests that a pre-employment health examination be substituted for the preplacement health examination based on the essential job functions and reasonable accommodation. Because it has little relevance in a wide range of employment and minor health problems, the results of this examination should not debar applicants from employment.
Cohort Studies ; Employment ; Female ; Gyeongsangnam-do ; Hearing Loss* ; Hearing* ; Hepatitis ; Humans ; Prevalence ; Questionnaires ; Spinal Diseases

BACKGROUND: Deep burns of the elbow lead to soft tissue necrosis and infection, with exposure of deep structures. Adequate wound coverage of this area requires thin, pliable, and durable tissue, while optimal functional recovery requires early coverage and functional rehabilitation. We have found 3 types of island flaps that provide reliable coverage for the elbow. METHODS: A retrospective study was performed on all patients who underwent flap coverage of an elbow defect at our hospital. The patients' data including age, sex, cause of injury, wound dimensions, timing of flap coverage, postoperative elbow motion, and complications were investigated. RESULTS: Between 2001 and 2012, 16 patients were treated at our hospital. The mean age was 53.3 years. Three kinds of flaps were performed: 9 latissimus dorsi flaps, 4 lateral arm flaps, and 4 radial forearm flaps. The average defect size was 183.5 cm2 (range, 28 to 670 cm2). Wound coverage was performed at mean duration of 45.9 days (range, 14 to 91 days). The mean postoperative active elbow flexion was 98degrees (range, 85degrees to 115degrees). Partial flap failure occurred in 1 latissimus dorsi flap. Minor complications included partial flap loss (11.8%), hematoma (23.5%), seroma (35.3%), and wound infection (5.9%). CONCLUSIONS: Flap selection for elbow reconstruction is determined by the defect size and the extent of the adjacent tissue injury. Elbow reconstruction using an island flap is a single-staged, reliable, and relatively simple procedure that permits initiation of early rehabilitation, thereby improving a patient's functional outcome.
Arm ; Burns ; Elbow ; Forearm ; Hematoma ; Humans ; Necrosis ; Retrospective Studies ; Seroma ; Surgical Flaps ; Wound Infection

BACKGROUND: This paper discusses the treatment protocol for patients with frostbite. METHODS: We performed a retrospective analysis of a series of 17 patients with second- and higher-degree frostbite who had been treated at our medical institution between 2010 and 2012. RESULTS: Our clinical series of patients (n=17) included 13 men and four women, whose mean age was 42.4+/-11.6 years (range, 22-67 years). The sites of injury include the foot in six patients (35.3%), the hand in six patients (35.3%) and the facial region in five patients (29.4%). Seven patients with second-degree frostbite were completely cured with only conservative treatment during a mean period of 12.7+/-3.3 days (range, 8-16 days). Of the five patients with third-degree frostbite, two underwent skin grafting following debridement, and the remaining three achieved a complete cure with conservative treatment during a mean period of 35+/-4.3 days (range, 29-39 days). Five patients with fourth-degree frostbite were treated with surgical procedures including amputation. CONCLUSIONS: With the appropriate conservative management in the early stage of onset, surgeons should decide on surgery after waiting for a sufficient period of time until the demarcation of the wound. Continuous management of patients is also needed to achieve functional recovery after a complete cure has been achieved. This should also be accompanied by patient education for the avoidance of re-exposure to cold environments.
Clinical Protocols ; Cold Temperature ; Debridement ; Female ; Foot ; Frostbite ; Hand ; Humans ; Male ; Patient Education as Topic ; Retrospective Studies ; Skin Transplantation ; Surgical Procedures, Operative