Neurologic complications after open-heart surgery are not only relatively common but also often fatal. In order to know the clinical characteristics and causative risk factors, we carried out the retrospective study on 655 patients who had been admitted and undergone OHS at Seoul National University Children's Hospital during 2-year period from July 1990 to June 1992. The results were as follows; 1) The incidence of neurologic complications after OHS was 4.7% (31 cases) of the total 655 cases. 2) In the viewpoint of the pre-op diagnosis, neurologic complications developed in 20 cases (7.8%) among cyanotic congenital heart disease and in 11 cases (2.9%J among acyanotic CHD. 3) In the viewpoint of the type of operation, the incidence of neurologic complications was 33.3% in Jatene procedure and 12.1% in Fontan procedure. 4) Compared with the group who didn't develp neurologic complications (624 cases), cardiopulmonary bypass time, aorta cross clamp time, and total arrest time were longer and the degree of hypothermia was lower in the group who had neurologic complications (31 cases), which are statistically significant each other(p<0.01). 5) In 25 cases (80.6%), neurologic complications occurred within 72 hours after OHS. 6) Clinical manifestations of neurologic complications were seizures (26 cases, 84%), consciousness change (13 cases, 42%), hemiplegia (1 case), and decreased muscle tone (1 case). 7) Of the 31 cases, 16 cases showed more than one abnormal finding among EEG, Brain CT, or Brain MRI. 8) The possible etiologies of neurologic complications were diffuse hypoxic ischemic encephalopathy (16 cases, 51.6%), focal or multiple ischemic stoke that was thought to be due to microembolisms (3 cases, 9.7%), electrolyte or acid-base imbalance (8 cases, 25.8%), and the remainders were unknown (4 cases. 12.9%) 9) In the course of neurologic complications, 11 cases (35.5%) expired, 14 cases(45.2%) recovered at discharge, 3 cases (9.7%) were controlled at discharge, and 2 cases (6.5%) had long-term sequela(one spastic quadriplegia and one hemiparesis). 10) The cause of death among mortality cases were mainly due to brain damage (7 cases), while 4 cases had other direct causes such as heart failure, respiratory failure, or sepsis.
Acid-Base Imbalance ; Aorta ; Brain ; Cardiopulmonary Bypass ; Cause of Death ; Child* ; Consciousness ; Diagnosis ; Electroencephalography ; Fontan Procedure ; Heart Defects, Congenital ; Heart Failure ; Hemiplegia ; Humans ; Hypothermia ; Hypoxia-Ischemia, Brain ; Incidence ; Magnetic Resonance Imaging ; Mortality ; Muscle Hypotonia ; Quadriplegia ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Seizures ; Seoul ; Sepsis

Echocardiographic study was performed in 31 cases with dilated cardiomyopathy and 31 normal persons. measurement values of the aortic valve and root echocardiogram were compared with those in normal. The resuts were followings. 1. There were 22 males and 9 females of 31 cases with dilated cardiomyopathy whose average ages were 53 years. 2. LAD 3.86+/-0.76cm, AoD/LAD ratio 0.74+/-0.21 in dilated cardiomyopathy were significantly changed with those in normal(p<0.01). 3. C-E slope 2.14+/-0.68 cm in dilated cardiomyopathy was significantly decreased with that in normal(p<0.01). 4. cAoD 3.24+/-0.50 cm, AoPWT 0.46+/-0.14 cm in dilated cardiomyopathy were significantly decreased with those in normal(p<0.01). 5. cAVD 1.56+/-0.29cm, cAvD/mAvD ratio 0.79+/-0.10 in dilated cardiomyopathy were significantly decreased with those in normal(p<0.01). 6. AvOT or ET 0.24+/-0.03 sec. in dilated cardiomyopathy was significantly shortened with that in normal(p<0.01).
Aortic Valve ; Cardiomyopathy, Dilated* ; Echocardiography* ; Female ; Humans ; Male

BACKGROUND: little is known about the mechanisms responsible for ventricular tachycardia during myocardial ischemia and reperfusion. The purpose of this study was to evaluate the effects of the autonomic nervous system on ventricular tachycardia in dogs. METHODS: Four groups of eight dogs were studied. The control group had intact autonomic neural innervation:the stellectomy group had bilateral transection of stellate ganglia:the vagotomy group had bilateral transection of cervical vagi; and the autonomic denervation group underwent bilateral transection of stellate ganglia and cervical vagi. Open-chest dogs anesthetized with ketamine were studied in 3 sequential steps: denervation, ischemia, and reperfusion stage. At the end of each step, we estimated effective refractory period (ERP) at four sites : the apex of non-ischemic area, the base of non-ischemic area, the apex of ischemic area, and the base of ischemic area. We observed early afterdepolarization (EAD) through recording monophasic action potential on the ischemic epicardium during ischemia and reperfusion stages. RESULTS: In ischemia stage, deltaERPs(ERPmax.-ERPmin.) were significantly prolonged, compared to deltaERPs at denervation stage, and deltaERPs of the vagotomy group tended to be prolonged to 60 minutes after myocardial ischemia, as compared to those of the stellectomy group and the autonomic denervation group. The incidence of ventricular tachycardia during ischemia presented a significant increase in the vagotomy group, compared to the control group. However, there was no difference in incidence of ventricular tachycardia between the stellectomy group and the control group. deltaERP at the group with the occurrence of ventricular tachycardia were significantly prolonged , compared to the other group without the occurrence of ventricular tachycardia. In terms of the incidence of EAD, there was no difference between the groups and it was not associated with ventricular tachycardia. deltaERP was significantly decreased to 30 minutes after reperfusion, at which point there was no significant difference between the groups. There was no correlation between EAD and ventricular tachycardia. However, deltaERP with ventricular tachycardia indicated much more significant increase than deltaERP without ventricular tachycardia. CONCLUSIONS: Sympathetic nerve may be related to prolongation of deltaERP and incidence of ventricular tachycardia in the ischemic period. However, EAD is not related to ventricular tachycardia during ischemia and reperfusion. These findings suggest that the major mechanism of ventricular tachycardia may be a reentry in ischemia and reperfusion period.
Action Potentials ; Animals ; Autonomic Denervation* ; Autonomic Nervous System ; Denervation ; Dogs ; Heart* ; Incidence ; Ischemia* ; Ketamine ; Myocardial Ischemia ; Pericardium ; Reperfusion* ; Stellate Ganglion ; Tachycardia* ; Tachycardia, Ventricular ; Vagotomy

PURPOSE: We evaluated the imaging abnormalities of the brain observed during and after treatment of acute childhood lymphoblastic leukemia. MATERIALS AND METHODS: The study group consisted of 30patients (male: female= 19:11; mean age, 64months) with acute childhood lymphoblastic leukemia during the previous ten-year period who had undergone pro-phylaxis of the central nervous system. Irrespective of the CNS symptoms, baseline study of the brain involving CT and follow-up CT or MRI was undertaken more than once. We retrospectively evaluated the imaging findings, methods of treatment, associated CNS symptoms, and the interval between diagnosis and the time at which brain abnormalities were revealed by imaging studies. RESULTS: In 15 (50% ; male : female=9:6 ; mean age, 77months) of 30 patients, brain abnormalities that included brain atrophy (n=9), cerebral infarctions (n=4), intracranial hemorrhage (n=1), mineralizing microangiopathy (n=2), and periventricular leukomalacia (n=3) were seen on follow-up CT or MR images. In four of nine patients with brain atrophy, imaging abnormalities such as periventricular leukomalacia(n=2), infarction (n=1) and microangiopathy (n=1) were demonstrated. Fourteen of the 15 patients underwent similar treatment; the one excluded had leukemic cells in the CSF. Six patients had CNS symptoms. In the 15 patients with abnormal brain imaging findings, the interval between diagnosis and the demonstration of brain abnormalities was between one month and four years. After the cessation of treatment, imaging abnormalities remained in all patients except one with brain atrophy. CONCLUSION: Various imaging abnormalities of the brain may be seen during and after the treatment of acute childhood lymphoblastic leukemia and persist for a long time. In children with this condition, the assessment of brain abnormalities requires follow-up study of the brain.
Atrophy ; Brain* ; Central Nervous System ; Cerebral Infarction ; Child* ; Diagnosis ; Follow-Up Studies ; Humans ; Infant, Newborn ; Infarction ; Intracranial Hemorrhages ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging ; Male ; Neuroimaging ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Retrospective Studies ; Withholding Treatment

Purpose: To analyze changes in refractive error among elementary school children under the age of 13 who visited an outpatient clinic for eye examinations before and after the onset of the COVID-19 pandemic. Methods: A retrospective analysis of medical records was conducted to calculate the spherical equivalent refractive error of the right eye for 3,854 children aged 6 to 12 who attended our ophthalmology department from 2016 to 2023. We analyzed the average refractive error and myopia prevalence by year and subsequently performed a subgroup analysis by dividing the children into two age groups: 6-9 years old and 10-12 years old. To provide insight into long-term trends, data from 4,351 subjects aged 6-12 years from the 4th, 5th (2008-2012), and 7th (2016) Korea National Health and Nutrition Examination Surveys were also analyzed for reference. Results: The mean refractive error for subjects visiting our clinic throughout the study period was -1.51 ± 2.12 D. A trend of increasing myopic values in refractive error was observed from 2017 to 2021, with a more substantial change noted in 2020 compared to other years, though not reaching statistical significance. In the subgroup analysis, the change in refractive error for the 6-9-year-old group was more pronounced in 2020 but did not reach statistical significance, and no specific trend was identified in the 10-12-year-old group. Myopia prevalence exhibited a consistent increase since 2019 in the 6-9 age group, with a higher proportion of moderate myopia in 2020 compared to previous years. Conversely, no distinct trend was observed in the 10-12-year-old group. Conclusions Although statistical significance was not reached, it appears that the increase in indoor activities due to COVID-19 had an impact on the changes in refractive values for elementary school children, especially in the lower grades of elementary school in 2020.

Purpose: To analyze changes in refractive error among elementary school children under the age of 13 who visited an outpatient clinic for eye examinations before and after the onset of the COVID-19 pandemic. Methods: A retrospective analysis of medical records was conducted to calculate the spherical equivalent refractive error of the right eye for 3,854 children aged 6 to 12 who attended our ophthalmology department from 2016 to 2023. We analyzed the average refractive error and myopia prevalence by year and subsequently performed a subgroup analysis by dividing the children into two age groups: 6-9 years old and 10-12 years old. To provide insight into long-term trends, data from 4,351 subjects aged 6-12 years from the 4th, 5th (2008-2012), and 7th (2016) Korea National Health and Nutrition Examination Surveys were also analyzed for reference. Results: The mean refractive error for subjects visiting our clinic throughout the study period was -1.51 ± 2.12 D. A trend of increasing myopic values in refractive error was observed from 2017 to 2021, with a more substantial change noted in 2020 compared to other years, though not reaching statistical significance. In the subgroup analysis, the change in refractive error for the 6-9-year-old group was more pronounced in 2020 but did not reach statistical significance, and no specific trend was identified in the 10-12-year-old group. Myopia prevalence exhibited a consistent increase since 2019 in the 6-9 age group, with a higher proportion of moderate myopia in 2020 compared to previous years. Conversely, no distinct trend was observed in the 10-12-year-old group. Conclusions Although statistical significance was not reached, it appears that the increase in indoor activities due to COVID-19 had an impact on the changes in refractive values for elementary school children, especially in the lower grades of elementary school in 2020.

Purpose: To analyze changes in refractive error among elementary school children under the age of 13 who visited an outpatient clinic for eye examinations before and after the onset of the COVID-19 pandemic. Methods: A retrospective analysis of medical records was conducted to calculate the spherical equivalent refractive error of the right eye for 3,854 children aged 6 to 12 who attended our ophthalmology department from 2016 to 2023. We analyzed the average refractive error and myopia prevalence by year and subsequently performed a subgroup analysis by dividing the children into two age groups: 6-9 years old and 10-12 years old. To provide insight into long-term trends, data from 4,351 subjects aged 6-12 years from the 4th, 5th (2008-2012), and 7th (2016) Korea National Health and Nutrition Examination Surveys were also analyzed for reference. Results: The mean refractive error for subjects visiting our clinic throughout the study period was -1.51 ± 2.12 D. A trend of increasing myopic values in refractive error was observed from 2017 to 2021, with a more substantial change noted in 2020 compared to other years, though not reaching statistical significance. In the subgroup analysis, the change in refractive error for the 6-9-year-old group was more pronounced in 2020 but did not reach statistical significance, and no specific trend was identified in the 10-12-year-old group. Myopia prevalence exhibited a consistent increase since 2019 in the 6-9 age group, with a higher proportion of moderate myopia in 2020 compared to previous years. Conversely, no distinct trend was observed in the 10-12-year-old group. Conclusions Although statistical significance was not reached, it appears that the increase in indoor activities due to COVID-19 had an impact on the changes in refractive values for elementary school children, especially in the lower grades of elementary school in 2020.

Purpose: To analyze changes in refractive error among elementary school children under the age of 13 who visited an outpatient clinic for eye examinations before and after the onset of the COVID-19 pandemic. Methods: A retrospective analysis of medical records was conducted to calculate the spherical equivalent refractive error of the right eye for 3,854 children aged 6 to 12 who attended our ophthalmology department from 2016 to 2023. We analyzed the average refractive error and myopia prevalence by year and subsequently performed a subgroup analysis by dividing the children into two age groups: 6-9 years old and 10-12 years old. To provide insight into long-term trends, data from 4,351 subjects aged 6-12 years from the 4th, 5th (2008-2012), and 7th (2016) Korea National Health and Nutrition Examination Surveys were also analyzed for reference. Results: The mean refractive error for subjects visiting our clinic throughout the study period was -1.51 ± 2.12 D. A trend of increasing myopic values in refractive error was observed from 2017 to 2021, with a more substantial change noted in 2020 compared to other years, though not reaching statistical significance. In the subgroup analysis, the change in refractive error for the 6-9-year-old group was more pronounced in 2020 but did not reach statistical significance, and no specific trend was identified in the 10-12-year-old group. Myopia prevalence exhibited a consistent increase since 2019 in the 6-9 age group, with a higher proportion of moderate myopia in 2020 compared to previous years. Conversely, no distinct trend was observed in the 10-12-year-old group. Conclusions Although statistical significance was not reached, it appears that the increase in indoor activities due to COVID-19 had an impact on the changes in refractive values for elementary school children, especially in the lower grades of elementary school in 2020.

BACKGROUND AND OBJECTIVES: It is known that angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor blockers (ACEIs and ARBs, respectively) are effective in preventing atrial fibrillation (AF) in high-risk patients. However, it is not known whether ACEIs and ARBs are effective in preventing the recurrence of AF after catheter ablation. SUBJECTS AND METHODS: One hundred fifty-two patients (mean age, 57+/-10 years; M : F=94 : 58) who underwent catheter ablation due to drug-refractory paroxysmal (mean age, 57+/-10 years; M : F=58 : 43) or persistent AF (mean age, 56+/-10 years; M : F=36 : 15) were enrolled. We compared the recurrence rates between the groups with and without ACEIs or ARBs use in paroxysmal and persistent AF. The mean duration of follow-up was 18+/-14 months. RESULTS: The overall recurrence rate after ablation therapy was 26% (n=39). The recurrence rate was significantly decreased in the patients with persistent AF with the use of ACEIs or ARBs (12.1% vs. 61.1%, p<0.01), but this difference was not observed in the patients with paroxysmal AF (24.2% vs. 22.9%, p=0.87). In patients with persistent AF with and without recurrence, the size of the left atrium (44.2+/-8.4 mm vs. 44.3+/-5.8 mm, respectively, p=0.45) and the ejection fraction (62+/-6.5% vs. 61.5+/-6.2%, respectively, p=0.28) were not significantly different. In multivariate analysis, the use of ACEIs or ARBs was independently associated with recurrence after adjusting for the size of the left atrium and the ejection fraction {odds ratio (OR)=0.078, 95% confidence interval (CI)=0.02-0.35, p<0.01}. CONCLUSION:ACEIs and ARBs were shown to be effective in preventing AF recurrence after catheter ablation in patients with persistent AF.
Angiotensin II Type 1 Receptor Blockers ; Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Atrial Fibrillation ; Catheter Ablation ; Follow-Up Studies ; Heart Atria ; Humans ; Multivariate Analysis ; Peptidyl-Dipeptidase A ; Recurrence

The nephrotic syndrome has been reported in association with a wide variety of neoplastic disease. The relationship between early gastric cancer and glomerulonephritis has not been well elucidated. Only 6 cases (5 cases in Korea and 1 case in Japan) have been reported associated with glomerulonephritis by this time. 5 cases in Korea included three cases of membranous glomerulonephritis, one case of IgA nephropathy and membranoproliferative glomerulonephritis. Four out of six cases including presented case were mucin secreting adenocarcinomas of stomach. Minimal change disease associated with solid tumors has been reported very rarely. Three cases of colon adenocarcinoma have been reported in association with minimal change disease by this time. Complete remission of nephrotic syndrome with tumor resection without corticosteroid therapy was reported in one of three cases, but two of them had to be on corticosteroid therapy in addition to tumor resection to get complete remissions. We report a 44-year-old man case with nephrotic syndrome associated with early gastric cancer. Renal biopsy findings were indicative of minimal change disease but with scanty IgA deposition. Low grade IgA nephropathy was suggested. Endoscopic biopsy on stomach demonstrated the adenocarcinoma with signet ring cells. Serum IgA concentration was 543 mg/dL, and decreased to 336 mg/dL after tumor resection. But, owing to persistent proteinuria and acute renal failure complicated, corticosteroid therapy was applied on the 30th day after operation. So we could not prove definite relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease. But, it is regarded that normalized serum IgAlevel and the complete remission of nephrotic syndrome with tumor resection and corticosteroid therapy can be indirect evidences for the relationship between early gastric cancer and the development of IgA nephropathy mimicking minimal change disease.
Acute Kidney Injury ; Adenocarcinoma ; Adult ; Biopsy ; Colon ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Humans ; Immunoglobulin A* ; Korea ; Mucins ; Nephrosis ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Proteinuria ; Stomach ; Stomach Neoplasms*