Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100%, although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age(>or=60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(<1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05). This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.
Acute Kidney Injury ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Vessels* ; Graft Occlusion, Vascular ; Hemorrhage ; Humans ; Linear Models ; Mammary Arteries ; Multivariate Analysis ; Radial Artery ; Risk Factors ; Saphenous Vein ; Seoul ; Transplants* ; Veins

Endoscopic retrograde cholangiopancreatography(ERCP) procedures are more difficult in patients who have undergone partial gastrectomy with Billroth II anastomosis. Because its altered anatomical relationship. the endoscopist is presented with additional problems: (i) Dfficulties in entering the afferent loop, depending on the surgical techiques used. (ii) The endoscope may be too sort to reach the papillary region unless the loops are suecessfully straightened out. (iii) Difficulties in passing the ligament of Treitz, especially in patients with Braun's anastomosis, (iv) Problems in cannulating the papilla and especially the common bile duct from a reversed position. (v) Problems in carrying out a papillotomy in a correct position. We attempted endoscopic sphincterotomy in 3 opatients previously subjected to gastrectomy with needle knife, and succeeded in 2 of them. In the two patients, successful billary drainage was achieved. And one patients with Billroth II gastrectomy, presented with CBD stone and cholangit, was successfully treated with endoscopic stone retriveial. The patient with a Billroth-II operation may unergo endscopic diagnostic as well as therapeutic procedures with a high rate of success, and can be suitable candidates for ERCP and endoscopic sphincterotomy
Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Drainage ; Endoscopes ; Gastrectomy* ; Gastroenterostomy* ; Humans ; Ligaments ; Needles ; Sphincterotomy, Endoscopic

BACKGROUND: Although there is a controversy on the optimal timing for active infective endocarditis(IE), recently good results of early surgical intervention have been published. Herein, we analyzed the results of surgery for active IE according to the duration of preoperative antibiotic treatment. MATERIAL AND METHOD: Retrospectively, we analyzed 51 patients who underwent operation for active IE at the department of thoracic and cardiovascular surgery of Samsung medical center from Mar. 1995 to Oct. 2001. Male to female ratio was 39:12, mean age of the patients was 44.5+/-17.8 years(range : 13~74). Infected valves were mitral valve in 17(33.3%), aortic valve in 15(29.4%), mitral and aortic valve in 12(23.5), and tricuspid valve in 5(9.8%) cases. Among them, prosthetic valve endocarditis was present in 10(19.6%) cases. Infecting organism was Staphylococcus in 19 (37.3%), Streptococcus in 17(33.3%), Enterococcus in 3(5.9%), fungus in 3(5.9%), and other bacteria in 5(9.8%) cases. Organism was not isolated in 6(11.8%) cases, and two organisms were isolated in 4(7.8%) cases. Dividing these patients into two groups according to the duration of preoperative antibiotic treatment(A: less than 7 days, B: more than 8 days), we compared the surgical results between the two groups. RESULT: There were 16 cases in group A and 35 in group B. Annular reconstruction was performed in 10(62.5%) cases in group A and 10(28.6%) cases in group B, which has statistically significance(p<0.05). There was one early death in group B. Forty nine patients(96.1%) except two were followed up with mean follow-up duration of 28.7+/-23.6 months. Endocarditis was recurred in one in group A, and two in group B. Three late deaths occurred in group B. Recurrence rate and survival were not statistically different between the two groups. CONCLUSION: Early surgery for active IE showed good results as the result of that which was performed after prolonged antibiotic treatment; therefore, we believe that early surgery for active IE could effectively eradicate the infection.
Aortic Valve ; Bacteria ; Endocarditis* ; Enterococcus ; Female ; Follow-Up Studies ; Fungi ; Humans ; Male ; Mitral Valve ; Recurrence ; Retrospective Studies ; Staphylococcus ; Streptococcus ; Tricuspid Valve

Artificial lung support may be necessary in various conditions during the performance of bilateral lung transplantation, and cardiopulmonary bypass (CPB) has usually been used. Yet using the conventional CPB techniques may increase risk of bleeding and early allograft dysfunction due to the large dosages of heparin and the complement activation. Extracorporeal membrane oxygenation (ECMO) is able to support gas exchange and maintain the hemodynamics without administering high-dose heparin for anticoagulation. We performed sequential bilateral lung transplantation with ECMO support. ECMO is a valuable tool when performing lung transplantation and it has the potential to replace CPB.
Cardiopulmonary Bypass ; Complement Activation ; Extracorporeal Circulation ; Extracorporeal Membrane Oxygenation ; Hemodynamics ; Hemorrhage ; Heparin ; Lung ; Lung Transplantation ; Transplantation, Homologous

BACKGROUND AND OBJECTIVES: The treatment for active infective endocarditis (IE) with a paravalvular abscess results in a high morbidity and mortality. Recently, some good results with a reconstruction of the annulus or fibrous skeleton in active IE have been published. However, there are few papers on this subject reported in Korea. SUBJECTS AND METHODS: The hospital records of 29 patients who had undergone surgery for active IE with a paravalvular abscess from Mar. 1995 to Jun. 2002 were retrospectively reviewed. The mean age was 43.8 +/-16.9 (range : 13-69) years. The NYHA functional class was either III or IV in 11 cases (37.9%) and prosthetic valve endocarditis was present in 8 cases (27.6%). The mean duration of preoperative antibiotic treatment was 13.3+/-11.9 days. RESULTS: The aortic annulus was reconstructed in 7 patients, an aortic annulus+the aorto-mitral continuity was done in 8 cases, an aortic annulus+mitral annulus+aorto-mitral continuity was done in 1 case, and a mitral annulus was done in 13 cases. There was one (3.4%) early death due to a non-cardiac cause. The postoperative complications were as follows : additional surgery due to bleeding in 3 cases (10.3%), mediastinitis in 1 case (3.4%), a complete atrioventricular block in 1 case (3.4%), and a cerebral hemorrhage in 2 cases (6.9%) who had had a history of cerebral embolism. All patients (100%) were followed up with a mean follow-up duration of 22.0+/-19.2 months. There was 1 late death (3.6%) and 2 additional procedures including one recurrence. CONCLUSION: Reconstruction of the annulus and intervalvular fibrous skeleton in these patients showed a relatively low morbidity and mortality, and recurrence rate. Therefore, it is recommended that these patients be treated aggressively.
Abscess ; Atrioventricular Block ; Cerebral Hemorrhage ; Endocarditis* ; Follow-Up Studies ; Heart Valves ; Hemorrhage ; Hospital Records ; Humans ; Intracranial Embolism ; Korea ; Mediastinitis ; Mortality ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Skeleton*

OBJECTIVE: To investigate the expression of apoptosis related proteins and apoptotic cells on the human ovarian follicles. MATERIALS AND METHODS: Thirty five Formalin-fixed paraffin-embedded human ovarian tissue blocks were selected from the surgical pathology files of the department of pathology, College of Medicine, Yonsei University, for the period from 1996 to 1998. All specimen were from premenopausal women aged from 32~45. Ovarian tissues were collected from the patients performing hysterectomy for benign uterine diseases. Immunohistochemical staining was performed for the detection of DNA fragmented cell, Bcl-2, Bax, Fas and Fas-ligand. RESULTS: Bcl-2 and bax were not expressed on the surrounding cells and oocyte of the primary, primordial and preantral follicles. Fas and Fas-ligand (Fas-L) were not expressed on the surrounding cells on the primordial and primary follicles. But expressed on the surrounding granulosa cells and oocyte in the primordial and primary follicles. In the healthy follicles, Bcl-2 was expressed on the granulosa cells, however, Bax was not expressed. DNA fragmented cells were expressed on the inner granulosa cell layer of atretic follicles. CONCLUSION: Fas, Fas-ligand, and Bax may be responsible for the follicular atresia and Bcl-2 may be involved in the follicular survival in the human ovary.
Apoptosis* ; DNA ; Female ; Follicular Atresia ; Granulosa Cells ; Humans* ; Hysterectomy ; Oocytes ; Ovarian Follicle* ; Ovary ; Pathology ; Pathology, Surgical ; Uterine Diseases

PURPOSE: A definite guideline for the surgical approach to patients suffering with combined coronary and carotid artery disease remains controversial. The aim of this study was to compare the cardiovascular and neurologic complications between the staged approach and the synchronous approach. METHODS: This study reviewed the outcomes following each procedure in 17 cases from 1995 to 2004; 8 patients underwent combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) (group I), 6 patients underwent CEA followed by CABG (group II) and the remaining 3 patients underwent CABG followed by CEA (group III). RESULTS: In group I, the mean percentage of internal carotid artery stenosis was 77.9%. Preoperatively, 3 patients had neurologic symptoms, and all the cases had triple vessel disease. Off-pump CABG (OPCABG) was performed for 4 cases. In group II, the mean percentage of internal carotid artery stenosis at the time of CEA was 78.7%; all cases had triple vessel disease and/or left mainstem coronary artery disease and 4 cases had neurologic symptoms. OPCABG was performed for 1 case. In group III, the mean percentage of internal carotid artery stenosis at the time of CABG was 76.7%. One patient had neurologic symptoms;all cases had triple vessel disease. OPCABG was performed for 2 cases. Neurologic complication occurred in 1 patient of group III. CONCLUSION: Because the data was reviewed retrospectively, there were limitations for understanding the reasons for the staged or synchronous approach. However, we obtained the result that the synchronous approach resulted in fewer perioperative neurologic complications and this might be a good operative strategy, while OPCABG allowed the use of the synchronous approach.
Carotid Arteries* ; Carotid Artery Diseases* ; Carotid Stenosis ; Coronary Artery Bypass ; Coronary Artery Disease ; Endarterectomy ; Endarterectomy, Carotid ; Humans ; Neurologic Manifestations ; Retrospective Studies

BACKGROUND: Bronchial sleeve resection for centrally located primary lung cancer is a lung- parenchyma-sparing operation in patients whose predicted postoperative lung function is expected to diminished markedly. Because of its potential bronchial anastomotic complications, it is considered to be an alternative to pneumonectomy. However, since sleeve lobectomy yielded survival results equal to at least those of pneumonectomy, as well as better functional results, it became and accepted standard procedure for patients with lung cancer who have anatomically suitable tumors, regardless of lung function. In this study, from analyzing of occurrence rate of postoperative complication and survival rate, we wish to investigate the validity of sleeve resection for primary lung cancer. MATERIAL AND METHOD: From January 1989 to December 1998, 45 bronchial sleeve resections were carried out in the Department of Thoracic Surgery of Seoul National University Hospital. We included 40 men and 5 women, whose ages ranged from 23 to 72 years with mean age of 57 years. Histologic type was squamous cell carcinoma in 35 patients, adenocarcinoma in 7, and adenosquamous cell carcinoma in 1 patients. Right upper lobectomy was performed in 24 patients, left upper lobectomy in 11, left lower lobectomy in 3, right lower lobectomy in 1, right middle lobecomy and right lower lobectomy in 3, right upper lobectomy and right middle lobecomy in 2, and left pneumonectomy in 1 patient. Postoperative stage was Ib in 11, IIa in 3, IIb in 16, IIIa in 13, and IIIb in 2 patients. RESULT: Postoperative complications were as follows; atelectasis in 9, persistent air leakage for more than 7 days was in 7 patients, prolonged pleural effusion for more than 2 weeks in 7, pneumonia in 2, chylothorax in 1, and disruption of anastomosis in 1. Hospital mortality was in 3 patients. During follow-up period, bronchial stricture at anastomotic site were found in 7 patients under bronchoscopy. Average follow-up duration of survivals(n=42) was 35.5+/-29 months. All of stage I patients were survived, and 3 year survival rate of stage II and III patients were 63%, 21%, respectively. According to N stage, all of N0 patients were survived and 3 year survival rates of N1 and N2 were 63% and 28% respectively. CONCLUSION: We suggest that this sleeve resection, which is technically demanding, should be considered in patients with centrally located lung cancer, because this lung-saving operation is safer than pneumonectomy and is equally curative.
Adenocarcinoma ; Bronchoscopy ; Carcinoma, Squamous Cell ; Chylothorax ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Pleural Effusion ; Pneumonectomy ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Seoul ; Survival Rate ; Thoracic Surgery

BACKGROUND: Although the reports on re-operative coronary revascularization (redo-CABG) have increased, there are only limited reports on redo-CABG using arterial grafts. The aim of this study was to analyze the safety and feasibility of using various arterial grafts for redo-CABG. MATERIAL AND METHOD: A consecutive series of patients who underwent 33 redo-CABGs from March 2001 to July 2008 were retrospectively reviewed. We performed conventional CABG in 17 patients, on-pump beating CABG in 7, off-pump CABG in 7 and minimally invasive direct coronary artery bypass in 2. The grafted that were used included 34 internal thoracic arteries (ITA), 14 radial arteries, 14 right gastroepiploic arteries and others. Arterial composite grafts were constructed in 26 patients. Of these, a previously patent in-situ left ITA was re-used as the in-flow of a composite graft in 10 patients. RESULT: No hospital deaths or major wound problems occurred. The post-operative complications included 2 myocardial infarctions (6%), 1 intra-aortic balloon pump insertion (3%), 5 cases of atrial fibrillation (15.1%) and 3 neurologic complications (9.1%). The mean follow-up duration was 31.1+/-22.7 months and the 3 year survival rate was 86.4%. There were 4 late deaths (2 cardiac deaths) and no recurrent angina during the follow-up period. CONCLUSION: Redo-CABG with using various arterial grafts is currently a safe, feasible procedure, but further investigation and long term follow-up are needed.
Atrial Fibrillation ; Coronary Artery Bypass ; Follow-Up Studies ; Gastroepiploic Artery ; Humans ; Mammary Arteries ; Myocardial Infarction ; Radial Artery ; Reoperation ; Retrospective Studies ; Survival Rate ; Transplants

BACKGROUND: Since Ross and Sormeville first reported the use of aortic homograft valve for correction of pulmonary atresia in 1966, homograft valves are widely used in the repair of congenital anomalies as conduits between the pulmonary ventricle and pulmonary arteries. On the basis of these results, we have used it actively. In this report, we describe our experience with the use of cryopreserved valved homograft conduits for infants and children requiring right ventricle to pulmonary artery connection in various congenital cardiac anomalies. MATERIAL AND METHOD: Between January,1996 and December 2001, 27 infants or children with a median age of 16 months(range 9days to 18years) underwent repair of RVOTO using homograft valved conduit by two surgeons. We studied 22 patients who have been followed up at least more than one year. The diagnosis at operation included pulmonary atresia with ventricular septal defect (n=13), truncus arteriosus (n=3), TGA or corrected TGA with RVOTO (n=6). Homograft valved conduits varied in size from 15 to 26 mm (mean, 183.82 mm). The follow-up period ranged from 12 to 80.4 months (median, 48.4 months). RESULT: There was no re-operation due to graft failure itself. However, early progressive pulmonary homograft valve insufficiency developed in one patient, that was caused by dilatation secondary to the presence of residual distal pulmonary artery stenosis and hypoplasia after repair of pulmonary atresia with ventricular septal defect. This patient was required reoperation (conduit replacement). During follow-up period, there were significant pulmonary stenosis in one, and pulmonary regurgitation more than moderate degree in 3. And there were mild calcifications at distal anastomotic site in 2 patients. All the calcified homografts were aortic in origin. CONCLUSION: We observed that cryopreserved homograft conduits used in infant and children functioned satisfactorily in the pulmonic position at mid-term follow-up. To enhance the homograft function, ongoing investigation is required to re-establish the optimal strategy for the harvest, preservation and the use of it.
Allografts ; Child ; Constriction, Pathologic ; Cryopreservation ; Diagnosis ; Dilatation ; Follow-Up Studies* ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Infant ; Pulmonary Artery ; Pulmonary Atresia ; Pulmonary Valve Insufficiency ; Pulmonary Valve Stenosis ; Reoperation ; Transplantation, Homologous ; Transplants ; Truncus Arteriosus