The penetrating atherosclerotic ulcer of the aorta resulting from the atherosclerosis of the aortic wall can clinically mimic type III aortic dissection, since both diseases produce the ulceration and dissection of aortic wall. However, their imaging features and pathophsiologies are distinctly different from each other. Familial hypercholesterolemia(FH) menifests overt hyperlipidemia that can results in premature atherosclerosis of the aorta as well as the coronary artery. We report a clinically and radiologically evident case of perntrating atherosclerotic ulcer of the descending thoracic aorta which was developed in a 36-year-oldd heterozygote FH male.
Aorta ; Aorta, Thoracic* ; Atherosclerosis ; Coronary Vessels ; Heterozygote* ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II* ; Male ; Ulcer*

No abstract available.
Caroli Disease*

This study is based on 155 patients of congenital me colon. For the diagnosis, 93 cases were histologically proven and the remaining 63 cases were diagnosed on clinical basis including barium enema or surgical gross findings. On histologic examination, 80 cases(86%) showed typical features of absence of ganglion cell in the myenteric plexus and the 13 cases(14%) had atypical features which were segmental absence Of ganglion cell in one case. There we 127 males(82%) and 28 females(18%). The age at diagnosis was younger than 30 days in 87 cases(56%), I month to 1 year in 39 cases(25%) and older than I year in 29 cases(18%). The levels of aganglionosis were variable: short segment (rectosigmoid) in 134 cases(86%), intermediate segment (more proximal colon) in 14 cases(100%). and 6 cases(4%) had total aganglionosis. Common clinical presentations were abdominal distention, delayed meconium passage or bilious vomiting in neonate, and chronic constipation in infancy or childhood. Following initial colostomy or ileostomy, a definitive procedure was performed in 151 cases(Duhamel type in 150 cases; Soave type in 2 cases; Swenson type in 3 cases). Frequently associated problems after definitive procedure were persistent constipation(ll%) due to septum formation, fecaloma, remnant aganglionic segment and rectal stenosis. Overall mortality rate was 4%, and increased mortality was associated with enterocolitis(14%) which was the most frequent cause of death. The follow-up study longer than 3 months was available in 138 patients who underwent a definitive procedure(mean 2 year 11 months). Seventy-three cases(53%) had normal bowel function, 38cases(27.5%) had occasionally used enema or stool softners, and 27 cases(19.5%) had severe constipation or soiling. The bowel habit improved with time, and were considered normal in 60% of patients after follow-up more than 3 years. The results of definitive procedures for congenital megacolon including Duhamel operation was satisfactory, and long-term follow-up appeared an important and critical component of patients'care.
Child ; Male ; Female ; Infant, Newborn ; Humans ; Mortality ; Follow-Up Studies

42 patients with the clinical evidences of endocarditis were examined by echocardiography. In 28 of 42 cases(66.7%) vegetation was present, whereas in 14(33.3%) vegetation was not visualized. Alpha-hemolytic streptococcus was the most common infecting organism(47.6%) and rheumatic heart disease was the most common predisposing heart disease(47.6%). Patients with echocardiographically demonstrable vegetation had a higher incidence of congestive heart failure compared to the patients without vegetation(75.0% vs. 21.4% p<0.05). But major embolism was not significantly different in the two groups. Mortality was higher in the patients with vegetation than in the patients without it(39.3% vs. 0%, p<0.05). Among vegetation positive patients, mortality was highest in aortic valve patients.(58.3%) So patietns with aortic valve vegetation should be regarded as high risk group and early surgical intervention should be considered if indicated. The causes of mortality were congestive heart failure(45.5%), cerebral embolism(36.4%), myocardial infarction(9.1%) and ventricular tachycardia(9.1%) in decreasing frequency.
Aortic Valve ; Echocardiography* ; Embolism ; Endocarditis ; Endocarditis, Bacterial* ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Humans ; Incidence ; Mortality ; Rheumatic Heart Disease ; Streptococcus

Takayasu's arteritis is an arteritis of undetermined etiology, which affects the aorta and the proximal portions of its major branches. But aortic regurgitation and coronary artery involvement were unusual manifestations in this disease. We experienced a patient of Takayasu's arteritis who represented these unusual manifestations. Aortogram revealed grade IV aortic regurgitation and proximal segment narrowing of left main coronary artery. A case of Takayasu's arteritis associated with aortic regurgitation and left main coronary artery involvement is reported with a review of literatures.
Aorta ; Aortic Valve Insufficiency* ; Arteritis ; Coronary Vessels* ; Humans ; Takayasu Arteritis*

Hallux valgus is a deformity that causes pain in the first metatarsophalangeal joint. Surgical methods are quite diverse and a range of osteotomies are used at the proximal and distal part of the metatarsal bone and proximal phalange. Fixation methods, such as plate, screw, K-wire, and others have been used in various ways. The fixation device is often removed with various side effects due to the fixation devices. In the case of instruments that are absorbed in vivo, these procedures are not necessary to remove and there is an advantage of not performing the second operation. Three patients were treated, in which a proximal chevron osteotomy was used with a bioabsorbable screw (K-MET™; U&I Corporation).
Congenital Abnormalities ; Hallux Valgus* ; Hallux* ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Osteotomy*

No abstract available.
Child* ; Humans

No abstract available.
Tracheoesophageal Fistula*

BACKGROUND: In most brain operations, the endotracheal tube is kept in postoperatively for airway maintenance during radiologic examinations. But the endotracheal tube causes tracheal irritation and hemodynamic changes. Inhalation anesthetics can not be administered during transport, and minimal concentration is exhaled for several hours after the end of inhalation. The present study was designed : (1) to determine the end tidal isoflurane concentration after the end of administration ; (2) to investigate the effects of intravenous anesthetics in patients with tracheal intubation during radiologic examination postoperatively. METHODS: We selected forty adult patients who were scheduled for elective neurosurgical operation with postoperative brain CT (computerized tomography). The study was performed in 2 steps; in the step 1 (n = 10), end tidal isoflurane concentration was checked after ending inhalation. In the step 2 (n = 30), patients were divided into one of three groups according to anesthesia method; group I (using isoflurane), group P (change from isoflurane to propofol about an hour before operation end), group M (using midazolam instead of propofol, compared to group P). In each group, the frequency of bucking and incidence of hypertension were checked during postoperative radiologic examinations. RESULTS: Minimal concentrations of isoflurane were detected in exhaled gas for about 2 hours after the end of isoflurane inhalation. The frequency of bucking was significantly lower in the group P and M than in group I (P = 0.002). In group P, the incidence of hypertension was significantly reduced compared to group M and I (P = 0.031). CONCLUSIONS: These results suggest that the change of anesthetic technique (from inhalation to intravenous) in the late period of operation, provides postoperative hemodynamic stability, a more comfortable state and minimal environmental pollution in comparison to inhalation anesthesia only.
Adult ; Anesthesia ; Anesthesia, Inhalation ; Anesthesia, Intravenous* ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Brain ; Environmental Pollution ; Hemodynamics ; Humans ; Hypertension ; Incidence ; Inhalation ; Intubation ; Isoflurane ; Midazolam ; Propofol

BACKGROUND: In most brain operations, the endotracheal tube is kept in postoperatively for airway maintenance during radiologic examinations. But the endotracheal tube causes tracheal irritation and hemodynamic changes. Inhalation anesthetics can not be administered during transport, and minimal concentration is exhaled for several hours after the end of inhalation. The present study was designed : (1) to determine the end tidal isoflurane concentration after the end of administration ; (2) to investigate the effects of intravenous anesthetics in patients with tracheal intubation during radiologic examination postoperatively. METHODS: We selected forty adult patients who were scheduled for elective neurosurgical operation with postoperative brain CT (computerized tomography). The study was performed in 2 steps; in the step 1 (n = 10), end tidal isoflurane concentration was checked after ending inhalation. In the step 2 (n = 30), patients were divided into one of three groups according to anesthesia method; group I (using isoflurane), group P (change from isoflurane to propofol about an hour before operation end), group M (using midazolam instead of propofol, compared to group P). In each group, the frequency of bucking and incidence of hypertension were checked during postoperative radiologic examinations. RESULTS: Minimal concentrations of isoflurane were detected in exhaled gas for about 2 hours after the end of isoflurane inhalation. The frequency of bucking was significantly lower in the group P and M than in group I (P = 0.002). In group P, the incidence of hypertension was significantly reduced compared to group M and I (P = 0.031). CONCLUSIONS: These results suggest that the change of anesthetic technique (from inhalation to intravenous) in the late period of operation, provides postoperative hemodynamic stability, a more comfortable state and minimal environmental pollution in comparison to inhalation anesthesia only.
Adult ; Anesthesia ; Anesthesia, Inhalation ; Anesthesia, Intravenous* ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Brain ; Environmental Pollution ; Hemodynamics ; Humans ; Hypertension ; Incidence ; Inhalation ; Intubation ; Isoflurane ; Midazolam ; Propofol