Kawasaki disease (KD) is an immune-mediated disease which is a leading cause of acquired cardiovascular disease in developed country. Recently, tumor necrosis factor-alpha (TNF-alpha) blocker, infliximab has been considered a promising option for patients with refractory KD. Although chronic use of a TNF-alpha blocker could increase risk of opportunistic infections, a few studies have documented that use of infliximab was safe without serious adverse effects in patients with KD. We observed serious bacterial infection after infliximab treatment in an infant with refractory KD. Our patient was a 5-month-old male infant diagnosed with KD who did not respond to repeated doses of intravenous immunoglobulin. We effectively treated him with a single infusion of infliximab (5 mg/kg), but gram-negative (Acinetobacter lwoffii) septicemia developed after infliximab infusion. Therefore, we report a case of serious septicemia after treatment with infliximab, and suggest considering the risk of severe infection when deciding whether to prescribe infliximab to an infant with refractory KD.
Bacterial Infections ; Cardiovascular Diseases ; Developed Countries ; Humans ; Immunoglobulins ; Infant* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Opportunistic Infections ; Sepsis* ; Tumor Necrosis Factor-alpha ; Infliximab

From January 1993 to December 1995, 47 patients with rectal carcinomas underwent a rectal anastomosis using the double stapling technique at the Surgical Department of Kwang-ju Christian Hospital. The major advantages of the double stapling technique for lower rectal cancer over the single stapling technique or a hand-sewn operation are as follows:1) Insertion of a purse-string suture is eliminated, and application of a linear stapler to close the distal rectum may be performed with greater ease. 2) In addition, fecal contamination and spillage of tumor cells from the rectal segment are minimized. 3) Differences in the sizes of the colons and rectums are not a concern in constructing the anastomosis. 4) The operating time is shorter. The following results were obtained by a comparison with 24 patients with rectal carcinoma who had undergone a rectal anastomosis using the double stapling technique from January 1989 to December 1992 which was reported in a previous study:1) Anastomotic stenosis was decreased from 8.3% to 4.2% because of reduced ischemia due to the double row of staples and the reduced injury due to compression of tissue between the anvil and the cartridge with experience. In addition, it resulted from reduced tension of the anastomosis due to sufficients mobilization of the proximal colon and from selection of large cartridge (33 mm). 2) Anastomotic leakage, even though the same location as the tumor and in the advanced age group, was decreased from 4.2% to 0% because the blood circulation was maintained and unnecessary tension was reduced with experience. In addition, it resulted from reinforced suture of the anastomotic site which was performed after anastomosis. 3) Systemic recurrence was the same result as that of the previous study(4.2/4.3%). 4) Local recurrence, even though at the same distal distance from the margin of the cancer, was increased from 0% to 2.1% because of advancing the pathologic stage (B2, C1>B1, B2) and increasing the poorly differentiated pathologic type.
Anastomotic Leak ; Blood Circulation ; Colon ; Constriction, Pathologic ; Gwangju ; Humans ; Ischemia ; Postoperative Complications ; Rectal Neoplasms* ; Rectum ; Recurrence ; Sutures

From January 1993 to December 1995, 47 patients with rectal carcinomas underwent a rectal anastomosis using the double stapling technique at the Surgical Department of Kwang-ju Christian Hospital. The major advantages of the double stapling technique for lower rectal cancer over the single stapling technique or a hand-sewn operation are as follows:1) Insertion of a purse-string suture is eliminated, and application of a linear stapler to close the distal rectum may be performed with greater ease. 2) In addition, fecal contamination and spillage of tumor cells from the rectal segment are minimized. 3) Differences in the sizes of the colons and rectums are not a concern in constructing the anastomosis. 4) The operating time is shorter. The following results were obtained by a comparison with 24 patients with rectal carcinoma who had undergone a rectal anastomosis using the double stapling technique from January 1989 to December 1992 which was reported in a previous study:1) Anastomotic stenosis was decreased from 8.3% to 4.2% because of reduced ischemia due to the double row of staples and the reduced injury due to compression of tissue between the anvil and the cartridge with experience. In addition, it resulted from reduced tension of the anastomosis due to sufficients mobilization of the proximal colon and from selection of large cartridge (33 mm). 2) Anastomotic leakage, even though the same location as the tumor and in the advanced age group, was decreased from 4.2% to 0% because the blood circulation was maintained and unnecessary tension was reduced with experience. In addition, it resulted from reinforced suture of the anastomotic site which was performed after anastomosis. 3) Systemic recurrence was the same result as that of the previous study(4.2/4.3%). 4) Local recurrence, even though at the same distal distance from the margin of the cancer, was increased from 0% to 2.1% because of advancing the pathologic stage (B2, C1>B1, B2) and increasing the poorly differentiated pathologic type.
Anastomotic Leak ; Blood Circulation ; Colon ; Constriction, Pathologic ; Gwangju ; Humans ; Ischemia ; Postoperative Complications ; Rectal Neoplasms* ; Rectum ; Recurrence ; Sutures

Bonding orthodontic adhesive resins to glazed porcelain surface is not attainable. The aim of this investigation was to examine, in vitro, the effect of three methods of porcelain surface pretreatment on the shear bond strength of orthodontic adhesives, and to compare the shear strength of orthodontic bracket bonding to porcelain surface by the best results that to human enamel. Porcelain disks (Ceramco((TM)) and Vita((TM))) baked in the laboratory were roughened by sandpapers, #320, #600, #800, #1000 and #1200, and were pretreated with silane and dried at the various temperatures, room temperature, 50degreesC, 70degreesC and 90degreesC, and were etched by 3% hydrofluoric acid solution for 1, 3, 5, 7, and 9 minutes, orthodontic adhesives (System 1 +((TM)) and Unite((TM))) were applied on them, and shear bond strengths were measured by Instron. The best results of pretreatment of each method were determined by the shear bond strengths. Again, porcelain disks were pretreated by the determined best results and human enamel were etched by 37% hydrofluoric acid solution, orthodontic brackets were bonded on them by the orthodontic adhesives, and the shear bond strengths were measured and compared between them. 1. Roughening porcelain surfaces with coarse sandpaper (#300) showed higher shear bond strength than that with finer sandpapers, but it (22.44 Kgf/cm2) was distinguishably low compared to that from etched human enamel (144.11 Kgf/cm2). 2. There were disparities in shear bond strengths upon the orthodontic resins, which was presumably related to the contents of fillers in orthodontic adhesive resins. Also there were disparities in shear bond strength upon the porcelains which had different composition. 3. Silane enhanced the shear bond strength of orthodontic resins to porcelain surfaces (25.20 Kgf/cm2 at 50degreesC), which was markedly low compared to that from etched human enamel. 4. Etched porcelain surface with 3% hydrofluoric acid solution for 1 to 9 minutes showed no difference in shear bonding strength of orthodontic adhesive resins. Shear bond strength from etched porcelain (97.43-120.72 Kgf/cm2) were as high as clinically available, but low compared to that from etched human enamel. 5. Roughening with #300 sandpaper and etching by 3% hydrofluoric acid followed silane application on porcelain surface showed lower shear bond strength than etched human enamel, but were as high as clinically useful. 6. The results suggest that etching porcelain surface by 3% hydrofluoric acid solution might provide comparatively high shear bond strength as much as clinically favorable.
Dental Cements ; Dental Enamel ; Dental Porcelain* ; Humans ; Hydrofluoric Acid ; Orthodontic Brackets ; Shear Strength

Tissue expansion in breast reconstruction is a invaluable alternative surgical procedure. the advent of permanent expander prosthesis eliminated a second operative procedure for removal of the expander and replacement with another permanent implant. When we consider the choice of method for breast reconstruction, we have to take account of the extent of mastectomy, past-medical history of the patient, timing of operation, and patient's motivation. It is still accepted that autogenous Breast reconstruction is the best choice of the mothed. As autogenous breast reconstruction increase in popularity, however, it requires longer operation time, more complicated technique, and careful attention to donor site. Autogenous breast reconstruction is also not good candidate for the patients who have diabetes, vascular disease, smoking, obesity, previous history of cesarean section, or further pregnancy planning. We have performed 10 immediate breast reconstructions after modified radical mastectomy using the permanent expander prosthesis, manufactured by Mentor corporation. Among these cases, 8 patients underwent cesarean section and 2 patients pregnancy. Although this method has advantages of simple technique, minimal morbidity, and low cost, it has some limitations for orientals. First, it is inevitable in superior fullness of the reconstructed breast because of round shape of the expander. Second, it is difficult to get ptotic breast because of thick and inelastic characteristics of oriental skin. Third, the ratio of expander base to projection is not appropriate for orientals because of their smaller chest size. We experienced 2 cases of spontaneous deflation for its manufactural defect itself. In our experience, we would like to suggest that new type of permanent expander prosthesis should be innovated.
Breast* ; Cesarean Section ; Female ; Humans ; Mammaplasty* ; Mastectomy ; Mastectomy, Modified Radical ; Mentors ; Moths ; Motivation ; Obesity ; Pregnancy ; Prostheses and Implants* ; Skin ; Smoke ; Smoking ; Surgical Procedures, Operative ; Thorax ; Tissue Donors ; Tissue Expansion ; Vascular Diseases

The fractures of tibial shaft are common and open injury are also frequenly accompanied. Since the AO unreamed interlocking nail is solid type compared to present tubular type nail, it has no dead space, and without reaming the intramedullary blood supply can be preserved and the soft tissue trauma can be minimized. Therefore it can be used with minor risk of infection in the treatment of open tibial shaft fractures without secondary operation such as in the cases using external fixaters. Especially in Orientals, whose tibial medullary canal is narrower than Smm, it can be used ideally. From October 1991, we have experienced 14 cases of tibial shaft fractures treated with AO unreamed interlocking nail. Among 14 cases, the open fractures were 8, 4 cases were type 1 and 4 cases were type 2 by Gustilo classification. Among 6 cases of closed fractures, 4 cases had risk of post operative infection due to accompanying soft tissue injuries, such as abrasion or bulla and 2 cases had narrow intramedullary canal less than 8mm. There was no postoperative infection in all cases including open fractures, and the soft tissue defect could be reconstruted by muscle transfer, etc. The AO unreamed interlocking nail is thought to be recommendable in the treatment of open tibial shaft fracture, closed fracture with risk of postoperative infection, and also the fracture with narrow canal diameter less than 8mm.
Classification ; Fractures, Closed ; Fractures, Open ; Soft Tissue Injuries ; Tibia

To evaluate the results of anterior decompression and fusion with autogenous bone graft for cervical disc disease, the authors reviewed 18 cases of cervical disc herniation which were treated surgically at Inje Univ. Paik Hosp. from 1990 to 1994 with special interest in the thickness of the bone graft. All cases have been followed for more than 12 months. We try to know the clinical results of anterior decompression and fusion with autogenous bone graft. At this treatment, controversial point is a ideal thickness of graft and the width of distraction. Therefore, we follow up the correlation between thickness of graft on roentgenogram and clinical results. The clinical results were satisfactory as excellent in 11 cases, good in 5 cases according to criteria of Robinson et al. Successful fusion occured in 16 cases within 3 months after their initial procedure, and fusion failure resulted in 2 cases. 3mm distraction from baseline disc height was considered ideal thickness of graft after anterior decompression and all cases healed successfully. We concluded that 3mm distraction from baseline disc height is necessary for successful decompression & fusion.
Decompression ; Follow-Up Studies ; Transplants

Background: Esmolol as a drug for induced hypotension can, not only avoid many drawbacks of nitroprusside, but reduce the amount of intraoperative bleeding and make better operative field. This study was performed to evalute cardiovascular changes during esmolol-induced controlled hypotension. Methods: Induced hypotension using esmolol was applied to 18 adult patients receiving spinal surgery under the diagnosis of spinal stenosis or scoliosis. After prehydraion of 2,000 ml of crystalloid solution, 0.5 mg/kg esmolol was used as loading dose once, twice or three times until mean blood pressure (MBP) fell below 70 mmHg, followed by continuous infusion (50~300 microg/kg/min) of esmolol. MBP and heart rate (HR) were measured before, 5, 10, 15, 30, 60 and 90 min after esmolol administration, and 5, 10 and 15 minutes after discontinuation of esmolol. In 8 patients, cardiac output (CO) and mixed venous oxygen tension and saturation were measured before, during and after esmolol use. Results: MBP was decreased from 91+/-12 mmHg to 67+/-7 mmHg after 15 min (P<0.05). HR(BPM) was decreased from 76+/-17 to about 60 after 15 min (P<0.05). CO was decreased about 30% during induced hypotension but recoverd to initial level 15 min after esmolol discontinuation. While oxygen transport was reduced significantly during induced hypotension (P<0.05), oxygen consumption was maintained all the time. Conclusion: With the use of esmolol, stable hypotension could be achieved. Although oxygen transport decreased possibly due to reduction of CO, but oxygen consumption was maintained.
Adult ; Blood Pressure ; Cardiac Output ; Diagnosis ; Heart Rate ; Hemorrhage ; Humans ; Hypotension* ; Hypotension, Controlled ; Nitroprusside ; Oxygen ; Oxygen Consumption ; Scoliosis ; Spinal Stenosis

No abstract available.
Fertilization in Vitro* ; Humans* ; Micromanipulation* ; Pregnancy Rate* ; Pregnancy*

We observed sisters who showed the classical symptoms and signs of the pulseless disease, which were the absence of the radial pulsation, arteriovenous anastomoses around the optic disc and intermittent dizziness. The main changes in the fundus of them were as follows. 1) wreath-like anastomoses of the central retinal artery and vein around the disc. 2) almost complete disappearance of the visible vessels beyond five disc diameters from the optic disc. 3) multiple microaneurysms and hemorrhages.
Arteriovenous Anastomosis ; Dizziness ; Hemorrhage ; Humans ; Retinal Artery ; Siblings* ; Takayasu Arteritis* ; Veins