BACKGROUND: To secure a rapid and safe approach which is at the same time cosmetically appealing, we employed the right anterolateral thoracotomy incision for repair of atrial septal defects and valvular heart diseases in the adult. MATERIAL AND METHOD: Between October 1989 and June 1998, 44 adult patients underwent open heart surgery through right anterolateral thoracotomy at our institution. Operative time, cardiopulmonary bypass time, aortic cross clamp time, blood loss until chest tube removal, length of ICU stay, days to discharge, and survival were compared with those that received cardiac surgery via conventional sternotomy. RESULT: No significant differences were observed between the two groups. There was no death and no additional morbidity directly related to this approach. Cosmetically satisfying results were obtained with safety using the right anterolateral thoracotomy approach. CONCLUSION: Our data show that the right anterolateral thoracotomy approach is a safe alternative to conventional median sternotomy as it offers excellent exposure and aesthetically more acceptable wounds while not adding on to the operative risks.
Adult* ; Cardiopulmonary Bypass ; Chest Tubes ; Heart Septal Defects, Atrial ; Heart Valve Diseases ; Humans ; Operative Time ; Sternotomy ; Thoracic Surgery* ; Thoracotomy* ; Wounds and Injuries

PURPOSE: To compare the safety and effectiveness of transarterial oily chemoembolization (TOCE) and transar-terial embolization (TAE) with Gelfoam in cases of ruptured hepatocellular carcinoma (HCC), and to describe the most important prognostic factors involved in emergency embolization. MATERIALS AND METHODS: Forty-two consecutive patients with spontaneously ruptured HCC underwent emergency TOCE (n = 22) or TGE (n = 20). In the TOCE group, Lipiodol (3 -10 cc), Adriamycin (20 -50 mg), and Mitomycin (2 -10 mg) were used, and these were followed by blockade of the hepatic arterial flow with gelatin sponge particles. In the TAE group, patients underwent only Gelfoam embolization. Using the Kaplan-Meier method, survival time from the time of embolization was estimated, and to analyze prognostic factors, Cox 's proportional hazard regression model was used. RESULTS: Successful hemostasis was achieved in 41 patients (97.6%). Mean survival time was 201 and 246 days in the TOCE and TAE group, respectively, but the difference was not tatistically significant (p > 0.05). Five of the TOCE group (22.7%) and three of the TAE group (15.0%) died of hepatic failure. Analysis of the prognostic factors showed that portal vein involvement by the tumor was the most important factor influencing survival. CONCLUSION: Although TOCE and TAE effectively controlled hemorrhaging from a ruptured HCC, the procedures involve a high risk of hepatic failure. Their goal should, therefore, be solely to achieve hemostasis, and thus decrease parenchymal injury.
Carcinoma, Hepatocellular* ; Doxorubicin ; Emergencies ; Ethiodized Oil ; Gelatin ; Gelatin Sponge, Absorbable* ; Hemorrhage* ; Hemostasis ; Humans ; Liver Failure ; Mitomycin ; Porifera ; Portal Vein ; Rupture, Spontaneous* ; Survival Rate

BACKGROUND: The current study was undertaken to investigate the results of a modification in the conventional Maze III Procedure devised by the authors. The aim of the technical modification was in improving the left atrial contractility. MATERIAL AND METHOD: Between July 1997 and December 1998, 34 patients with chronic atrial fibrillation for more than 1 year duration underwent a modified Maze III procedure. The assessment of the left atrial function was made by various echocardiographic measurements and SA nodal recovery was evaluated by HRV Holter monitoring. RESULT: All 34 patients were in sinus rhythm. On echocardiography, right atrial contraction was detected in 32 patients(94.1%) and left atrial contraction in 33 patients(97.1%). The echocardiographic A wave at 1, 6, and 12 months or more were 50.5+/-31.5, 62.1+/-25.1, 66+/-20.6 cm/sec, respectively, and the E wave measurements at the same time points were 152+/-31.1, 134.4+/-35.2, 133+/-27.5 cm/sec. The corresponding A/E ratios were 0.32+/-0.13, 0.48+/-0.18, 0.5+/-0.15, showing a rising trend. Treadmill evaluation at 6 months showed a mean 82% increase in heart rate after excising, and the SDNN and SDANN upon HRV Holter at 1 and 3 months postoperatively were 65.3+/-28.1/87.8+/-27.2 ms, and 60.0+/-24.1/83.4+/-25.7 ms, respectively, showing a predoinant autonomic recovery in the parasympathetic system(PSDNN = 0.01, PSDANN =0.015). CONCLUSION: The results of our data suggest that the current modification in the conventional Maze III Procedure was efective in enhancing the postoperative left atrial contractility.
Atrial Fibrillation ; Atrial Function, Left* ; Echocardiography ; Electrocardiography, Ambulatory ; Heart Rate ; Humans

PURPOSE: To compare changes in human central corneal thickness after instillation of proparacaine with those after oxybuprocaine instillation, over a period of 10 minutes. METHODS: Eighteen healthy young participants were recruited. Baseline central corneal thicknesses were measured every 30 seconds for 10 minutes using a noncontact specular microscope. Changes in central corneal thickness were measured every 20 seconds for 10 minutes after the administration of one drop of 0.5% proparacaine into the right eye, and one drop of 0.4% oxybuprocaine into the left eye. RESULTS: Mean baseline central corneal thickness was 531 +/- 45 micrometer in the right eye and 531 +/- 42 micrometer in the left. The central corneal thickness after proparacaine instillation increased to 8.6 micrometer (4.5-12.6 micrometer, 95% CI) and then returned to baseline within 80 seconds. Central corneal thickness after oxybuprocaine instillation increased to 7.7 micrometer (3.6-11.2 micrometer, 95% CI) and then returned to baseline within 80 seconds. There was a second transient increase about 5 minute after proparacaine instillation but no additional transient increase after oxybuprocaine instillation. CONCLUSIONS: The severity of oxybuprocaine's effect on central corneal thickness is similar to that of proparacaine. Central corneal thickness instability may occur for 5 minutes after proparacaine administration. Therefore, changes in central corneal thickness after topical anesthetics instillation should be considered when measuring central corneal thickness.
Anesthetics* ; Humans

Wilson`s disease is a hereditary disorder in hepatic excretion of copper that results in toxic accumulations of the metal in liver, brain and other organs. Though there have been some reports of Wilson's disease with hepatic, neurologic, psychiatric symptoms, or hemolytic anemia, a case of Wilson's disease with abnormal secretion of pituitary hormones is, to our best knowledge, the first report in Korea. We report a case of Wilson`s disease with abnormal secretion of pituirary hormones, chronic active hepatitis with feature of early cirrhosis and hemolytic anemia in 18-year-old man showing delayed puberty. And also we describe a case of successful desensitization to penicillamine in a penicillamine hypersensitivity.
Adolescent ; Anemia, Hemolytic ; Brain ; Copper ; Fibrosis ; Hepatitis, Chronic ; Hepatolenticular Degeneration ; Humans ; Hypersensitivity ; Korea ; Liver ; Penicillamine ; Pituitary Hormones* ; Puberty, Delayed

OBJECTIVE: We wanted to investigate the usefulness of a computer-aided diagnosis (CAD) system in assisting radiologists to diagnosis malignant solitary pulmonary nodules (SPNs), as compared with diagnosing SPNs with using direct personal drawing. MATERIALS AND METHODS: Forty patients with SPNs were analyzed. After the pre-contrast scan was performed, an additional ten series of post-contrast images were obtained at 20-second intervals. Two investigators measured the attenuation values of the SPNs: a radiologist who drew the regions of interest (ROIs), and a technician who used a CAD system. The Bland and Altman plots were used to compare the net enhancement between a CAD system and direct personal drawing. The diagnostic characteristics of the malignant SPNs were calculated by considering the CAD and direct personal drawing and with using Fisher's exact test. RESULTS: On the Bland and Altman plot, the net enhancement difference between the CAD system and direct personal drawing was not significant (within +/- 2 standard deriation). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of diagnosing malignant SPNs using CAD was 92%, 85%, 75%, 96% and 88%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of diagnosing malignant SPNs using direct drawing was 92%, 89%, 79%, 92% and 88%, respectively. CONCLUSION: The CAD system was a useful tool for diagnosing malignant SPNs.
Adult ; Aged ; Contrast Media ; Diagnosis, Computer-Assisted/*methods ; Diagnosis, Differential ; Female ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Lung Neoplasms/*radiography ; Male ; Middle Aged ; Predictive Value of Tests ; Radiographic Image Enhancement/*methods ; Retrospective Studies ; Sensitivity and Specificity ; Solitary Pulmonary Nodule/*radiography ; Tomography, Spiral Computed/*methods

PURPOSE: To evaluate the efficacy of 0.05% cyclosporine A on tear film parameters and corneal aberration after cataract surgery. METHODS: Patients who underwent cataract surgery were divided into 2 groups. Patients in Group I (23 eyes) were treated with cyclosporine A from 1 week before surgery to 3 months after surgery. Patients in Group II (24 eyes) underwent surgery without cyclosporine treatment. Tear film break-up time (BUT), Schirmer's test I, Oxford scheme, Ocular surface disease index (OSDI), and corneal aberrations were evaluated before surgery and at 1 and 3 months after surgery. RESULTS: In Group I, BUT was significantly improved at 3 months (p = 0.026) after surgery compared with the preoperative value. OSDI decreased significantly at 1 (p = 0.033) and 3 months (p = 0.003) after surgery compared with the preoperative value. However, there were no significant differences between preoperative and postoperative values of BUT and OSDI in Group II. Schirmer's test results and the Oxford scheme were not significantly changed in either group. Preoperative root mean square (RMS) total values were not different between the 2 groups, but was different at postoperative 3 months (p = 0.015). Group I had a significantly lower value for total RMS than Group II. In Group I, Coma 7 (Z3(-1)) (p = 0.018) and spherical aberration (Z4(0)) (p = 0.031) were significantly decreased after surgery. In Group II, Trefoil 6 (Z3(-3)) (p = 0.033) was significantly increased after surgery. CONCLUSIONS: 0.05% cyclosporine A may be effective for improving dry eye syndrome and corneal aberration after cataract surgery.
Cataract* ; Coma ; Cyclosporine* ; Dry Eye Syndromes ; Humans ; Lotus ; Tears*

BACKGROUN/AIMS: We performed this study to review and compare the clinical characteristics of choledochal cyst between children and adults. METHODS: We reviewed medical records of patients with choldochal cyst who underwent surgical treatment between January 1984 and December 1996. We analyzed clinical symptoms, laboratory data and procedures. To compare clinical characteristics, patients under age 15 were grouped as children and the others were as adults. RESULTS: Sixty-eight patients, 21 children and 47 adults, underwent surgical treatment, Female predominance is common in both group. Abdominal pain was the most frequent symptom in both groups. Abdominal mass and jaundice were observed more frquently in children. Fever and chilling is more common in adults. The combined disease were more common in adults. Two adult patients had combined malignant diseases, cholangiocarcinoma and pancreas adenocarcinoma respectively. According to Todani's classsification, the most common type was type I in both group. The most common surgical procedure is cyst excision and hepaticojejunostomy in both groups. CONCLUSION: There was no significant difference in choledochal cysts between child and adults clinically. But combined diseases were common in adults, early detection and early surgry will be needed in this disease.
Abdominal Pain ; Adenocarcinoma ; Adult* ; Child* ; Cholangiocarcinoma ; Choledochal Cyst* ; Female ; Fever ; Humans ; Jaundice ; Medical Records ; Pancreas

PURPOSE: In this study we investigated the safety level of the national standard for tinted soft contact lenses by comparing the standards in various countries. METHODS: To evaluate the current guidelines for tinted soft contact lenses such as form and appearance, diameter, curvature radius, vertex power, cylindrical refractivity and cylindrical axis, luminous/ultraviolet ray (UV) transmittance, moisture content, oxygen permeability coefficient, extractables, elution test, cytotoxicity, sensitization, eye irritation test, acute systemic/subchronic/subacute toxicity, genotoxicity and biocompatibility safety test using rabbit eyes and sterility test. We compared the standards of International Organization for Standardization (ISO), Food and Drug Administration (FDA) of the United States, Ministry of Health, Labor and Welfare (MHLW) of Japan and Ministry of Food and Drug Safety (MFDS) of Korea. RESULTS: The guidelines for tinted soft contact lenses of ISO, FDA and MFDS are similar to soft contact lenses but MHLW of Japan classifies these lenses and sets specific guidelines. First, the oxygen permeability coefficient measured at 6mm from the center should be maintained over 80%. Also, coloring should not affect the oxygen permeability coefficient significantly. Regarding the physical (form and appearance, diameter, curvature radius, moisture content) and optical (vertex power, cylindrical refractivity and cylindrical axis, luminous/UV transmittance, oxygen permeability coefficient) characteristics, no differences were found between ISO and MFDS. However, several differences were found in chemical characteristics (extractables, elution test) and biological stability (cytotoxicity, sensitization, eye irritation test, acute systemic/subchronic/subacute toxicity test, genotoxicity, biocompatibility safety test using rabbit eyes, sterility test). For example, the elution test is required only by MFDS. CONCLUSIONS: The reinvestigation into the effectiveness of the elution test is needed and new evaluation measures including scanning electron microscopy and atomic force microscopy designed for tinted soft contact lenses to evaluate the size of the optical area, the location and roughness of the pigmented layer are required.
Axis, Cervical Vertebra ; Contact Lenses* ; Contact Lenses, Hydrophilic ; Infertility ; Japan ; Korea ; Microscopy, Atomic Force ; Microscopy, Electron, Scanning ; Oxygen ; Permeability ; Radius ; Toxicity Tests ; United States ; United States Food and Drug Administration

BACKGROUND: Agonists of the peroxisome proliferator-activated receptor gamma may help to regulate inflammation by modulating the production of inflammatory mediators and adhesion molecules. The purpose of this study was to determine the anti- inflammatory effects of rosiglitazone on renal injury in sepsis model. METHODS: In lipopolysaccharide (LPS)-induced mouse sepsis, we examined the effect of rosiglitazone on LPS-induced overproduction of inflammatory mediators, on the expression of adhesion molecules, on the infiltration of inflammatory cells and on renal function. RESULTS: Rosiglitazone significantly decreased serum tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta levels during sepsis. The levels of blood urea nitrogen and creatinine were significantly lower in mice pretreated with rosiglitazone than that in LPS-treated mice. Rosiglitazone reduced the expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in renal tissue of LPS-treated mice. Pretreatment with rosiglitazone reduced the infiltration of macrophages/ monocytes in renal tissue. CONCLUSION: These results indicate that pretreatment with rosiglitazone attenuated the production of TNF-alpha and IL-1beta and reduced adhesion molecule expression and infiltration of inflammatory cells in renal tissue of LPS-treated mice. Therefore, rosiglitazone may have a protective effect in maintaining renal function and reducing mortality and morbidity in sepsis.
Animals ; Blood Urea Nitrogen ; Creatinine ; Inflammation ; Intercellular Adhesion Molecule-1 ; Interleukins ; Mice ; Monocytes ; Mortality ; PPAR gamma ; Sepsis* ; Tumor Necrosis Factor-alpha ; Vascular Cell Adhesion Molecule-1