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*

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*

Brucellosis is zoonotic disease of worldwide distribution and still remains endemic in some developing countries. The main pathogenic species worldwide are B. abortus, responsible for bovine brucellosis, B. melitensis. The B. abortus is most common in Korea. Each Brucella spp. has a preferred natural host that serves as a reservoir of infection. The incubation period varies between 5 and 60 days, and Brucella infection may be asymptomatic or symptomatic. The majority of patients complained of fever (undulating fever), sweats, malaise, anorexia, and arthralgia. The diagnosis of brucellosis requires the isolation of Brucella from blood or body tissues, or the combination of suggestive clinical presentation and positive serology. There were first patients in 2002, thereafter 16 patients in 2003, and 47 patients in 2004, the human brucellosis are increasing more gradually in Korea. Brucellosis is an occupational risk for farmers, veterinarians, and abattoir workers. The main sources of Brucella are infected animals or their products, such as milk, blood, carcasses, and abortion products. Routes of transmission of the infection to humans include direct contact with infected animals and their secretions through cuts and abrasions in the skin, by way of infected aerosols inhaled or via the ingestion of unpasteurized dairy products. A combination of doxycycline and streptomycin has been used widely in brucellosis. Prevention of brucellosis in human still depends on the eradication or control of the disease in animal hosts, the exercise of hygienic precautions to limit exposure to infection through occupational activities and the effective heating of dairy products, and other potentially contaminated foods. Also, physicians and veterinarians must be concerned about specific environments and clinical patterns of brucellosis.
Abattoirs ; Aerosols ; Animals ; Anorexia ; Arthralgia ; Brucella ; Brucellosis* ; Brucellosis, Bovine ; Cattle ; Dairy Products ; Developing Countries ; Diagnosis ; Doxycycline ; Eating ; Fever ; Heating ; Hot Temperature ; Humans ; Korea ; Milk ; Skin ; Streptomycin ; Sweat ; Veterinarians ; Zoonoses

Human anthrax has been a zoonotic disease affecting those who have close contact with animals or animal products contaminated with the spore-forming bacterium Bacillus anthracis. Now the incidence of anthrax in herbivores and human are rare, but it remains an important health problem in Korea because anthrax is seen as one of the most likely biological weapon. The B. anthracis forms a spore, which is resistant to drought, heat and numerous disinfectants, and the spore can remain viable and infective in the environment for decades. There are three major forms of human disease depending on how infection is contracted, cutaneous, inhalation and ingestion. Inhalational anthrax is the most common form, but the events in the Korea show that gastrointestinal anthrax is the most common. Several cases of anthrax have been reported in Korea. In recent years, 2 cases of bovine anthrax and 5 cases of human anthrax occurred in Changnyeong-gun, 2000, but it haven't occurred any more so far. The most useful microbiological test remains the standard blood culture. Confirmatory diagnostic tests such as polymerase chain reaction can also be used and may help in early diagnosis. Prompt clinical suspicion and rapid administration of effective antimicrobials are essential for treatment of anthrax. Ciprofloxacin or doxycycline should be used for initial intravenous therapy until antimicrobial susceptibility results are known. The best measure to eliminate human anthrax is control in domestic animals by effective surveillance and by immunization of animals in endemic areas. Also, the government must establish countplan for knowledge and rational policies in dealing with potential bioterrorism attacks.
Animals ; Animals, Domestic ; Anthrax* ; Bacillus anthracis ; Biological Warfare Agents ; Bioterrorism ; Ciprofloxacin ; Diagnostic Tests, Routine ; Disinfectants ; Doxycycline ; Droughts ; Early Diagnosis ; Eating ; Herbivory ; Hot Temperature ; Humans ; Immunization ; Incidence ; Inhalation ; Korea ; Polymerase Chain Reaction ; Spores ; Zoonoses

Renal lipomas are among the rearest of renal tumors. They probably originate from fat cells within renal capsule or parenchyma. The tumors are confined within renal capsule, in contrast to the perirenal lipomas, which are extracapsular. We recently encountered a case of renal lipoma with bladder stone and diabetes mellitus in 61 years old male patient.
Adipocytes ; Diabetes Mellitus ; Humans ; Lipoma* ; Male ; Middle Aged ; Urinary Bladder Calculi

A 64-year-old man was admitted for gross hematuria. Preoperative study revealed right renal cell carcinoma with inferior vena cava(IVC) tumor thrombus. Right radical nephrectomy was performed, and deep hypothermic circulatory arrest(DHCA) with retrograde cerebral perfusion(RCP) was used for extraction of tumor thrombus in the IVC. The thrombus originated from the right kidney, which extended the orifice of the gonadal vein in the left renal vein laterally, the hepatic vein superiorly, and 3 cm below the right renal vein inferiorly. The thrombus was removed completely without caval wall injury under DHCA with RCP, and the postoperative course was uneventful. He received immunotherapy with interferon, and followed up without any surgical problem.
Carcinoma, Renal Cell* ; Circulatory Arrest, Deep Hypothermia Induced* ; Gonads ; Hematuria ; Hepatic Veins ; Humans ; Immunotherapy ; Interferons ; Kidney ; Middle Aged ; Nephrectomy ; Renal Veins ; Thrombosis ; Veins ; Vena Cava, Inferior