Experimental findings have suggested that the metabolic activities of articular cartilage can be influenced by mechanical stimuli. Our recent mathematical analysis predicted that cyclic compressive loading may create periods of intermittent negative hydrostatic pressure within the cartilage extracellular matrix. Therefore, we hypothesize that intermittent negative hydrostatic pressure, created in the cartilage extracellular matrix during dynamic compression, has a stimulative effect on the biosynthesis of chondrocytes. In order to test this hypothesis, the present study developed a custom designed negative pressure generator to subject a monolayer culture of chondrocytes to an intermittent negative pressure. It was found that the intermittent negative pressure produced a 40% increase in proteoglycan and a l7% increase in non-collagenous protein synthesis during the pressurization period(p (0.05). The collagenous protein synthesis was not affected by the intermittent negative pressure regimen used in this study. After the intermittent negative pressurization, the metabolic activities of the chondrocytes returned to normal(control level). The intermittent negative pressure also produced an increase in the mRNA signals for aggrecan. Therefore, we conclude that intermittent negative pressure may be one of the major mechanical stimulators of chondrocytes in articular cartilage during dynamic compression.
Aggrecans ; Cartilage ; Cartilage, Articular ; Chondrocytes* ; Collagen ; Extracellular Matrix ; Hydrostatic Pressure* ; Metabolism* ; Proteoglycans ; RNA, Messenger

No abstract available.
Candidiasis* ; Fluconazole*

The coronary artery fistula from right coronary artery to left ventricle is a rare disease among coronary artery anomaly. We experienced three cases of rare coronary fistula and report with literature review. Although symptoms of coronary artery fistula are associated with arteriovenous shunt and coronary steal phenomenon, many cases are asymptomatic. In this report, all patients had no symptom. but incidental murmur was noted (two are continuous, one is diastolic rumbling). The diagnosis was made by transthoracic or transesophageal echocardiogram and selective coronary angiography. Because patients were relatively young and the diameter of dilated coronary artery were huge, we perfomed operation on three patients.
Coronary Angiography ; Coronary Vessels* ; Diagnosis ; Fistula* ; Heart Ventricles* ; Humans ; Rare Diseases

Endotracheal intubation has been a routine practice in general anesthesia and is accepted by anesthetiste and surgeons as an integral part of airway management during anesthesia and operation. Paradoxically however, there have been several cases of obstruction of the airway which occurred due to endotracheal intubation. The authors experienced two cases of airway obstruction due tendotracheal and endobronchial techniques, using tubes with malfunctioning cuffs. The lumen of an endotracheal tube was collapsed by intracuff pressure, shortly after inflation of the cuff and resulted in extremely high airway resistance. In the other case, gradual leakage of air from the distal cuff of a Carlens tube led to collapse of the distal cuff. This promoted the movement of blood, secretions, and pus from the diseased right lung to the normal healthy left lung in association with the left lateral recumbent position, which in turn resulted in total airway obstruction.
Airway Management ; Airway Obstruction ; Airway Resistance ; Anesthesia ; Anesthesia, General ; Inflation, Economic ; Intubation, Intratracheal* ; Lung ; Suppuration ; Surgeons

A patient with Behcet's syndrome in whom multiple pulmonary artery aneurysms were completely resolved after a combined treatment with corticosteroid and chlorambucil is reported.
Aneurysm/*drug therapy ; Behcet Syndrome/*drug therapy ; Case Report ; Chlorambucil/*therapeutic use ; Drug Therapy, Combination ; Human ; Male ; Prednisone/*therapeutic use ; *Pulmonary Artery

No abstract available.
Empty Sella Syndrome ; Hypoglycemia ; Insulin ; Receptor, Insulin

BACKGROUND: Severe mitral regurgitation is a common clinical entity that can lead to progressive, irreversible left ventricular dysfunction, and thus should be corrected in proper stage of life. Authors have conducted this investigation to assess left ventricular function after mitral valve operation and to determine the predicting factors. METHODS AND RESULTS: The echocardiographic parameters, specifically left ventricular ejection fraction, shortening fraction, end-systolic dimension and volume, and end-diastolic dimension and volume were measured in preoperative and postoperative period of congenital mitral regurgitation patients (n=60), between March 1992 and March 1998. After correction of severe mitral regurgitaion, left ventricular ejection fraction and shortening fraction decreased significantly (p<0.001 and p<0.05 respectively). Furtheremore, after reoperation of recurred mitral regurgitation, left ventricular ejection fraction and shortening fraction decreased significantly (p<0.05). Left ventricular ejection fraction and shortening fraction in mitral valve reoperation group (n=23) is significantly lower than those in non-reoperation group (n=37) in both preoperative and postoperative period (p<0.05). Left ventricular ejection fraction and shortening fraction is also significantly lower in mitral valve replacement group (n=20) than in mitral valvuloplasty group (n=40)(p<0.05). Severe postoperative left ventricular dysfunction led to dilated cardiomyopathy in 5 patients. Postoperative left ventricular end systolic dimension increased significantly in reoperation group and DCMP group respectively (p<0.05). CONCLUSION: After surgical correction of mitral regurgitation, left ventricular dysfunction is frequent and carries a poor prognosis. Postoperative left ventricular dysfunction can be predicted by preoperative ejection fraction, shortening fraction and systolic diameter. Therefore surgical therapy before the onset of left ventricular dysfunction is recommended.
Cardiomyopathy, Dilated ; Deoxycytidine Monophosphate ; Echocardiography ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Postoperative Period ; Prognosis ; Reoperation ; Stroke Volume ; Ventricular Dysfunction, Left ; Ventricular Function, Left*

Bronchial foreign body is not a rare disease in children and it is urgently necessary to remove this foreign body from the airway to relive life or to prevent further damages and complications. But the innate small size of airways in infants makes it difficult to access by interventional methods such as intubation or bronchoscopy and etc. Laryngeal mask airway is a new way of method of airway management which is relatively recently introduced into medical practice. It gives way to access to airways without reducing the size of airway or incresing airway pressure during procedure through it and have many other advantages compared to the previous traditional endotracheal intubation, especially in infants. We successfully removed a case of bronchial foreign body, peanut, via laryngeal mask airway during fiberoptic bronchoscopy and by this method we can avoid the unnecessary tracheostomy in this 1 year old infant.
Airway Management ; Bronchoscopy* ; Child ; Foreign Bodies* ; Humans ; Infant ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks ; Masks* ; Rare Diseases ; Tracheostomy

BACKGROUND AND OBJECTIVES: Recently, the result of total correction in tetralogy of Fallot(TOF) is improved dramatically. But, residual anatomical changes of right ventricular outflow tract(RVOT) and pulmonary artery junctional stenosis result in bad prognosis. Therefore we sought to analyze risk factors for pulmonary artery junctional stenosis after correction of TOF. METHODS: From 1991 to 1998, 146 patients underwent the follow-up catheterizations after total correction of TOF in our institution and were analysed risk factors for pulmonary artery junctional stenosis. Of this patients group [age on operation 20.119.8 months, follow-up duration after operation 13.95.0 months, male(64%)], 20 cases(13.7%) had a PDA and 26 cases(17.8%) had a systemic-to-pulmonary shunt operation before total correction of TOF. RESULTS: 1) Residual PS is correlated significantly with post-operative RVP/LVP(r=.776, p<0.01) and post-operative RVEDP(r=.196, p<0.05). 2) Post-operative RVP/LVP and residual PS increased significantly in grade II of residual PI than grade III~IV. 3) The left pulmonary artery junctional stenosis(LPAJS) was observed in 31 cases, this group decreased significantly in pre-operative LPA diameter(p<0.01), increased in post-operative RVP/LVP(p<0.01), and increased in post-operative RPA diameter(p<0.01), decreased in post-operative LPA diameter(p<0.01) and was more severe in post-operative PI(p<0.01) than the other group respectively. 4) Of the patients group which went patch enlargement of RVOT to LPA junction, the pressure gradient on LPA junction increased significantly in PDA and false aneurysmal change. 5) Factors significantly associated with pulmonary artery junctional stenosis were patch enlargement of RVOT to LPA junction, aneurysmal change of RVOT, PDA, systemic-to-pulmonary shunt and pre-operative LPAJS. 6) LPAJS(P, mmHg) =5.43 +16.24*[false aneurysmal change of RVOT] +14.13*[RVOT patch enlargement to LPA] +16.89*PDA. CONCLUSION: Several factors significantly associated with pulmonary artery junctional stenosis influenced each other. And the LPAJS led to secondary changes (volume overload of RV, increasing diameter of RPA, et. al) therefore more active diagnosis and treatment after total correction is recommended.
Aneurysm ; Aneurysm, False ; Catheterization ; Catheters ; Constriction, Pathologic* ; Diagnosis ; Follow-Up Studies ; Humans ; Prognosis ; Pulmonary Artery* ; Risk Factors* ; Tetralogy of Fallot*

BACKGROUND/AIMS: Computed tomography during arterial portography and computed tomography during hepatic arteriography (CTAP and CTHA), one of the most sensitive method in detection of hepatocellular carcinoma (HCC) nodules , is reported to reduce unnecessary operation of HCC. However, it is not clear whet her CT AP and CT HA can reduce early post operative recurrence rate of HCC. We performed this study to find any differences in early postoperative recurrence rate of HCC according to the imaging modalities used for preoperativest aging. METHODS: Ninety-seven patients with HCC who had underg one curative hepat icres ection from Dec.1994 to Mar. 1998 were included (median age = 52 years (26-78), M:F = 85:12). They were classified into 3 groups according to the imaging methods used for preoper ative staging: CTAP & CTHA group (n=56), Lipiodol CT group (n=24), and three phase helical CT group (n=16). No significant inter-group difference was found in preoperative status of the patients or characteristics of HCC. One-year recurrence rates were compared by log-rank test. RESULTS: HCC recurred in 17 of 97 patients (18.7%) within 12 months. A significant difference in 1- year recurrence rate was observed between the groups: helical CT , may be a superior imaging modality for preoperative staging of HCC that can reduce early postoperative recurrence rate.
Aging ; Angiography ; Carcinoma, Hepatocellular* ; Ethiodized Oil* ; Humans ; Portography ; Recurrence* ; Tomography, Spiral Computed*