In the Dept. of Thoracic Surgery, Korea University Hospital, Preoperative diagnosis as Ebstein anomaly was made on the 11-year old female through the preoperative examination including right cardioangiography and the Glenn Operation was performed to this patients as palliative treatment. During closure of the thoracic wall just after the anastomosis of S.V.C. and right pulmonary artery, sudden cardiac arrest developed. One day later after death, autopsy was performed in order to confirm the pathologic anatomy of the cardiac anomaly and to clarify the cause of death. Pathologic anatomy of the heart revealed the huge dilatation of right atrium, Patent Foramin Ovale, and the deformed and descended posterior and the septal leaflets of tricuspid value by which right ventricle was devided into the atrialized and the functional portion. The diagnosis of the autopsy showed (1) Ebstein Anomaly (2) bilateral total atelectasis of the lung, (3) multiple petechial hemorrhage and edema of the myocardium, brain and liver due to acute hypoxia, (4) fibrocaseous tuberculosis of the liver and tuberculous pericholangitis.
Anoxia ; Autopsy ; Brain ; Cause of Death ; Child ; Death, Sudden, Cardiac ; Diagnosis ; Dilatation ; Ebstein Anomaly* ; Edema ; Female ; Heart ; Heart Atria ; Heart Ventricles ; Hemorrhage ; Humans ; Korea ; Liver ; Lung ; Myocardium ; Palliative Care ; Pulmonary Artery ; Pulmonary Atelectasis ; Thoracic Surgery ; Thoracic Wall ; Tuberculosis

No abstract available.
Coronary Artery Bypass* ; Coronary Vessels*

OBJECTIVE: In recent years, the neurosurgeon's role in managing cerebrovascular diseases (CVD) has becomes rapidly challenged and overlapped with other specialists. Furthermore, the patterns of CVD and patient recruitment have also changed. We conducted a retrospective study regarding the practical trends of CVD with reference to the management paradigms at our institute. METHOD: We reviewed all the available data, including the annual reports, the daily department records, the medical records and the radiographic films of the CVD patients who had been admitted to our Neurosurgery Department during the five years between Jan. 2004 and Dec. 2008. RESULTS: The total numbers of CVD operations showed a slight initial increase, but then they remained steady for the latter 3 years. The number of cases of non-angiomatous hemorrhage has been relatively steady, regardless of surgery. The total numbers of treated aneurysms increased, but the main body of this increment was attributed to the initiation of endovascular treatment and increased identification of unruptured vascular lesions. Vascular malformations were sustained with a small number of cases due to referring them to other institutes for radiosurgery, except for the cases that required urgent hemorrhagic evacuation. CONCLUSION: Hemorrhagic CVDs tended to decrease either due to increasing identification before rupture or shifting such patients into a large volume hospital. The increasing awareness of ischemic CVD, the early detection of unruptured aneurysms, and the separation of medical responsibilities from neurologists have all pushed neurosurgeons to make treatment plans in a more cooperative fashion, instead of a competitive way. Neurosurgeons should be furnished with several revolutionary surgical options to widen their scope of managing patients with CVD.
Academies and Institutes ; Aneurysm ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Medical Records ; Neurosurgery ; Patient Selection ; Radiosurgery ; Retrospective Studies ; Rupture ; Specialization ; Subarachnoid Hemorrhage ; Vascular Malformations ; X-Ray Film

Polydactyly is one of the most common congenital anomalies of the foot, but there are few papers on polydactyly of the foot reported in Korea. Forty-six supernummerary toes in thirty-semen patients were operated at Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, from May 1985 to May 1995. A clinical review was performed on these cases and the results were as follows : 1. Of the 37 patients, the proportion of unilateral involvement to bilateral was 28(76%) to 9 (24%). 2. Of the 46 toes, postaxial type was a majority involving 35 toes(76%) followed by the preaxial type 7 (15%) and central type 4(9%). 3. In anatomical pattern, Wassel's type IV and Stelling and Turek's type II were the most common ones in 7 toes of preaxial type and 39 toes of central and postaxial types. 4. The excellent results could be made by individualized reconstructive methods performed before walking age.
Classification ; Foot* ; Humans ; Korea ; Plastics ; Polydactyly* ; Toes ; Walking

BACKGROUND: Multidrug-resistant tuberculosis(MDR-TB) in patients is mainly caused by acquired drug resistance, However, a small proportion of MDR-TB is caused by initial drug resistance(IDR), which may be somewhat different from acquired drug resistance. This study analyzed the clinical characteristics of IDR in MDR-TB patients to use the results as basic data in managing the disease. METHODS: A retrospective study of 30 IDR cases in MDR-TB patients from Jan. 1995 to Dec. 1998 was perormed. In order to analyzed the clinical charcteristics, the age, sex, family history, duration of negative conversion, number of resistant drugs, treatment regimens, duration of treatment, extent of disease and cavitary lesion on the chest X-ray was examined. In order too analyzed the level of improvement, the extent of the disease and cavitary lesion on the chest X-ray, tested by Wilcoxon signed rank sum test, and the disease free interval rate of 1-year and 4-year was examined using the Kaplan-Meier method. RESULTS: The mean age of the patients was 46.6 years and the sex ratio 1:1. Six(20%) patients had a family history. The mean negative conversin of the sputum AFB stain was 2.6 months. The number of resistant drugs was 7.6 and the number of used drugs 3.6. Twenty-three(67%) patients were treated for less than 12months and 28(93%) patients were treated with first-line drugs. The extent of the disease and the cavitary lesion on the chest X-ray improved after treatment(p<0.05). Among 13 patients who were followed up for 22.6 months, 2(15%) patients relapsed and the disease free interval rate of 1-year and 4-year was 85%. CONCLUSION: It is recommended that the duration of treatment of IDR in MDR-TB with first-line drugs be 9-12 months even if the extent of disease and cavitary lesion on the chest X-ray improves.
Drug Resistance* ; Humans ; Retrospective Studies ; Sex Ratio ; Sputum ; Thorax ; Tuberculosis, Multidrug-Resistant

PURPOSE: To evaluate the accuracy of postoperative refractive outcomes of combined phacovitrectomy for epiretinal membrane (ERM) in comparison to cataract surgery alone. MATERIALS AND METHODS: Thirty-nine eyes that underwent combined phacovitrectomy with intraocular lens (IOL) implantation for cataract and ERM (combined surgery group) and 39 eyes that received phacoemulsification for cataract (control group) were analyzed, retrospectively. The predicted preoperative refractive aim was compared with the results of postoperative refraction. RESULTS: In the combined surgery group, refractive prediction error by A-scan and IOLMaster were -0.305+/-0.717 diopters (D) and -0.356+/-0.639 D, respectively, compared to 0.215+/-0.541 and 0.077+/-0.529 in the control group, showing significantly more myopic change compared to the control group (p=0.001 and p=0.002, respectively). Within each group, there was no statistically significant difference in refractive prediction error between A-scan and IOLMaster (all p>0.05). IOL power calculation using adjusted A-scan measurement of axial length based on the macular thickness of the normal contralateral eye still resulted in significant postoperative refractive error (all p<0.05). Postoperative refraction calculated with adjusted axial length based on actual postoperative central foveal thickness change showed the closest value to the actual postoperative achieved refraction (p=0.599). CONCLUSION: Combined phacovitrectomy for ERM resulted in significantly more myopic shift of postoperative refraction, compared to the cataract surgery alone, for both A-scan and IOLMaster. To improve the accuracy of IOL power estimation in eyes with cataract and ERM, sequential surgery for ERM and cataract may need to be considered.
Aged ; Biometry/methods ; Case-Control Studies ; Cataract Extraction ; Epiretinal Membrane/*surgery ; Eye ; Female ; Humans ; *Lens Implantation, Intraocular ; *Lenses, Intraocular ; Male ; Optics and Photonics ; Phacoemulsification/*methods ; Postoperative Period ; Refraction, Ocular/physiology ; Retrospective Studies ; Treatment Outcome ; Vision Tests ; Visual Acuity ; Vitrectomy/*methods

Recently, acute pseudomonas keratitis is reported to occur more frequently. If treatment is not adequate after the invasion of Pseudomonas into the cornea, corneal perforation ensues within 48 hours. Hence the rapid diagnosis and treatment is required, and the treatment mostly depends on the antibiotics. Pseudomonas keratitis induced in the rabbit cornea by inoculating Pseudomonas aeruginosa (lID 1210). Then the keratitis was treated with topical antibiotics available in Korea Chloramphenicol(R), Polyspectran(R), Tobra(R), Gentamicin(R), Tarivid(R). The effect of the antibiotics on Pseudomonas keratitis was evaluated clinically as well as bacteriologically and irritation of the antibiotics against the eye was also obsesved. 1. Polyspectran(R), tobra(R), gentamicin(R), tarivid(R) treated experimental Pseudomonas keratitis in the rabbit eyes but chloramphenicol(R) and saline did not inhibit the bacterial growth of the rabbit corneas. 2. Against the rabbit eyes, chloramphenicol(R) and polyspectran(R) were the most irritable aptibiotics, where as Gentamicin(R) and tarivid(R) were the moderate, and tobra(R) and saline were the least in the extent of irritation.
Anti-Bacterial Agents* ; Cornea ; Corneal Perforation ; Diagnosis ; Keratitis* ; Korea ; Pseudomonas aeruginosa ; Pseudomonas*

OBJECTIVE: To estimate the long-term skeletal responses to hormone replacement therapy(HRT) with or without active vitamin D(VD) by using short-term changes of bone markers in postmenopausal women (PMW). METHODS: Biochemical markers of bone formation(osteocalcin,OC) and (&) resorption(deoxypyridinoline, Dpd ) at 3 months & lumbar bone mineral density(BMD) at 1 year were measured in 64 natural PMW taking HRT(n=41) & HRT with calcitriol 0.25 microgram/day(n=23). The correlation of percent changes of bone markers after 3 months of Tx with those in lumbar BMD after 1 year was evaluated. RESULTS: 1. serum-OC & urine-Dpd showed decrease of 20.9% & 30.1% at 3months respectively & BMD increase of 3.8% after 1 year of Tx. 2. Among 58 PMW with decreased u-Dpd change, 49 (84.5%) revealed increase in BMD, while 40 (81.6%) among 49 PMW with decreased serum-OC change showed increased BMD. 3. Bone gainers showed significant decrease in changes of serum-OC(18.1% vs 9.2% p<0.05) & urine-Dpd(32.6% vs 20.4%, p<0.05) compared with those of bone losers. 4. No correlations of change of serum-OC (r=-0.174 p>0.05) & urine-Dpd (r=-0.091 p>0.05) at 3month with BMD changes at 1year were seen in total PMW, but urine-Dpd changes in HRT without active VD group revealed significantly inverse correlation(r=-0.376 p<0.05). CONCLUSION: Short-term changes of bone markers did not precisely predict the long-term changes of BMD in total PMW except urine- Dpd in HRT without active VD.
Biomarkers ; Bone Density* ; Calcitriol ; Estrogen Replacement Therapy* ; Female ; Humans ; Osteocalcin ; Vitamin D* ; Vitamins*

Bacterial endophthalmitis is an ocular emergency that requires rapid diagnosis and therapeutic decision making. Before the use of intravitreal antibiotics, endophthalmitis almost always resulted in the loss of vision in the affected eye. The introduction of intravitreal injection of antibiotics had been a major advancement because it has resulted in a marked improvement in visual outcome. Current therapy is to administer broad-spectrum antibiotic agents covering both gram-positive and gram-negative organisms. Typically, vancomycin hydrochloride and aminoglycoside, such as amikacin sulfate, are administered as separate intrvitreal injections on an empiric basis. We experienced a case of culture-proven Pseudomonas aeruginosa endophthalmitis treated with intravitreal ceftazidime injection. We present it with a review of literature.
Amikacin ; Anti-Bacterial Agents ; Ceftazidime* ; Decision Making ; Diagnosis ; Emergencies ; Endophthalmitis* ; Intravitreal Injections ; Pseudomonas aeruginosa* ; Pseudomonas* ; Vancomycin

Tangential vitreoretinal traction around fovea is known to be the principal cause in the pathogenesis of idiopathic macular holes. According to the recent study, the internal limiting membrane(ILM) may provide a scaffold for fibroblast proliferation and contraction, therefore play an important role in the enlargement of macular hole. We removed the ILM during macular hole surgery and assessed the anatomical and functional outcome of the macular hole surgery. Twelve consecutive patients with full-thickness macular hole were enrolled in this study. They were examed for best-corrected vision, fundus photography, fluorescein angiography, Humphrey automated perimetry, focal eletroretinogram, before and after surgery. After surgery, vision was improved in 8 eyes(67%), hole was closed in 10 eyes(83%). Macular thresholds on visual field was increased in 8 eyes and peripheral scotomas developed in 3 eyes postoperatively. The amplitude increased in 7 eyes and the implicit time decreased in 8 eyes on focal electroretinograms postoperatively. Out results suggested that the complete removal of ILM should be attempted to improve vision and to close holes during the full-thickness macular hole surgery.
Fibroblasts ; Fluorescein Angiography ; Humans ; Membranes* ; Photography ; Retinal Perforations* ; Scotoma ; Traction ; Visual Field Tests ; Visual Fields