No abstract available.
Humans ; Kidney Transplantation* ; Living Donors*

Vasodilatory shock has been implicated in life-threatening complications after cardiac surgery. This syndrome may result from the vasopressin deficiency following cardiopulmonary bypass (CPB), which do not respond to fluids or usual intravenous inotropes. We used arginine-vasopressin in adults with vasodilatory shock coming off cardiopulmonary bypass. Therefore, we report these cases with a review of articles.
Adult ; Arginine Vasopressin* ; Arginine* ; Cardiopulmonary Bypass* ; Diabetes Insipidus, Neurogenic ; Humans ; Shock* ; Thoracic Surgery ; Vasodilation ; Vasopressins

No abstract available.

We present the case of a 7 year-old child who underwent angioplasty with a stent for anastomosis site stenosis between a left subclavian artery free graft and the left main coronary artery in an arterial switch operation.
Angioplasty* ; Child* ; Constriction, Pathologic ; Coronary Vessels ; Humans ; Stents* ; Subclavian Artery ; Transplants ; Transposition of Great Vessels

This prospective study was performed to determine the effective antibiotics for use in treating acute appendicitis patients during the perioperative period. To identify the sensitive antibiotics, the peritoneal fluid was cultured during operation. Also, wound infection was defined as pus or serous discharge in the wound or when we opened the wound under suspicious of a wound problem. The results were obtained as follows: 1) A total of 138 cases treated during the two years from January 1995 to December 1996 were examined; 84 of them (60.87%) were found to have positive peritoneal fluid cultures, of which 29 (34.52%) were monomicrobial and 55 (65.48%) were polymicrobial. 2) The most common species were Escherichia coli (73.81%), Bacteroides (32.14%), Klebsiella (16.67%), Pseudomonas (9.52%), and Streptococcus (9.52%). 3) In the sensitivity test, the most sensitive drugs were aminoglycosides and cefotaxime. 4) Infectious complications, which developed in 27 (19.6%) patients, were wound infection and intraabdominal abscess. 5) The average length of stay for all patients 9.9 days (range: 3 to 32 days). 6) The common organisms curtured from the complication cases were E. coli and Bacteroides.
Abscess ; Aminoglycosides ; Anti-Bacterial Agents* ; Appendicitis* ; Ascitic Fluid ; Bacteroides ; Cefotaxime ; Escherichia coli ; Humans ; Klebsiella ; Length of Stay ; Perioperative Period ; Prospective Studies ; Pseudomonas ; Streptococcus ; Suppuration ; Wound Infection ; Wounds and Injuries

BACKGROUND: Large abdominal wall defect resulting from trauma, invasive infection, tumor resection, or other causes continue to be major problems for patients and surgeons. The lack of sufficient tissue may require the insertion of prosthetic materials. This study compares the results of PPM mesh and e-PTFE patch for repairs of abdominal wall defects. METHODS: The anterior abdominal walls of Sprague-Dawley rats, including fascia, muscle, and peritoneum were removed. The defects were repaired with a PPM mesh or an e-PTFE patch. Animals were killed at 1, 2, 6, and 12 weeks after the operation, and the implant were excised along their margins and evaluated for gross and microscopic differences. RESULTS: Histological examination showed that PPM was progressively infiltrated by whorled disorganized collagen fiber, which became densely adherent to the mesh. In contrast, the e-PTFE was infiltrated by fine fibrils of collagen, which progressively penetrated the interstices of the material, binding it firmly to the tissue. One of the most serious complications associated with fascial closure with PPM was the development of visceral adhesions. CONCLUSIONS: e-PTFE patch material has a lower foreign body reaction, a lower infectability, and a lower rate of adhesion formation than PPM mesh.
Abdominal Wall* ; Animals ; Collagen ; Fascia ; Foreign-Body Reaction ; Humans ; Peritoneum ; Polypropylenes* ; Polytetrafluoroethylene* ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Vasodilatory shock has been implicated in life-threatening complications after open heart surgery, where the systemic inflammatory reaction is attributed to the cardiopulmonary bypass (CPB). The secretion of arginine vasopressin (AVP) has been found to be defective in a variety of vasodilatory shock states and administration of AVP markedly improves vasomotor tone and blood pressure. So we reviewed our experience of AVP therapy in patients with vasodilatory shock following heart surgery using CPB. MATERIAL AND METHOD: From January 2004 to July 2006, we reviewed the records of patients who received AVP therapy for vasodilatory shock following heart surgery using CPB. Vasodilatory shock was defined as a mean arterial pressure lower (MAP) than 70 mmHg, a cardiac index greater than 2.5 L/min/m2, peripheral vascular resistance lower than 800 dyn/s/cm5, and vasopressor requirements. The hemodynamic responses of patients who received AVP therapy for vasodilatory shock after cardiac surgery were analyzed retrospectively. RESULT: One hundred ninety nine open cardiac surgery patients were consecutively included in this study. Twenty two patients (11.1%) met criteria for vasodilatory shock. Despite the administration of high dose catecholamine vasopressor, all patients were hypotensive with a mean arterial pressure less than 70 mmHg. AVP therapy increased MAP from 53.3+/-7.4 to 82.0+/-12.0 mmHg at 1 hour (p <0.001) and decreased other vasopressor requirements from 25+/-7 to 18+/-6 at 1 hour (p <0.001) and individually maintained it for 12 hours. CONCLUSION: Our date suggest that AVP may be a safe and an effective vasopressor in patients with vasodilatory shock. In patients exhibiting vasodilatory shock after heart surgery, replacement of AVP increases blood pressure and reduces catecholamine vasopressor requirements.
Arginine Vasopressin* ; Arginine* ; Arterial Pressure ; Blood Pressure ; Cardiopulmonary Bypass ; Hemodynamics ; Humans ; Retrospective Studies ; Shock* ; Thoracic Surgery* ; Vascular Resistance ; Vasodilation ; Vasopressins

OBJECTIVES: One hypothesis of obstructive sleep apnea syndrome (OSAS) is that long-standing snoring vibrations and hypoxia of the nerves cause a local neuropathy in the upper airway during sleep. The aim of this study was to investigate olfactory function in subjects comprising snorers and untreated subjects with OSAS, and to correlate data with polysomnographic parameters. METHODS: Sixty-nine patients were evaluated for snoring from January 2010 to December 2013. The mild group (apneahypopnea index [AHI]<15) consisted of 19 subjects, and the moderate-severe group (AHI≥15) consisted of 50 subjects. Exclusion criteria were conductive olfactory dysfunction, previous tonsil or soft palatal surgery, central sleep apnea, and medications that are known to affect peripheral nerves. Nocturnal polysomnography and olfactory function test such as Korean version of Sniffin’s stick test I, II (KVSS I, II) were performed. RESULTS: There was a significant difference in body mass index, average oxygen saturation (SaO2), lowest SaO2, average snoring duration, and KVSS I, II between the two groups. AHI was related to odor threshold score, and average SaO2 was related to odor discrimination score. But, odor identification score showed no relation with AHI and average SaO2 except for age. Average SaO2 and AHI were closely related to the function of smell. CONCLUSION: Hypoxia and low nasal airflow caused by OSAS may have an effect on the olfactory function. On comparison between the two groups, patients with a high AHI, especially those with OSAS, had an olfactory dysfunction. Also, low average oxygen is the main risk factor in determining the olfactory function. In people with OSAS, the possibility of olfactory dysfunction should be considered and an olfactory function test should be performed.
Anoxia ; Body Mass Index ; Discrimination (Psychology) ; Humans ; Odors ; Olfaction Disorders ; Oxygen ; Palatine Tonsil ; Peripheral Nerves ; Polysomnography ; Risk Factors ; Sleep Apnea Syndromes* ; Sleep Apnea, Central ; Sleep Apnea, Obstructive ; Smell ; Snoring ; Vibration

Acute mesenteric ischemia after cardiac surgery is a serious complication associated with high mortality. Superior mesenteric artery is most commonly affected artery. Acute obstruction of mesenteric artery generally has an unfavorable prognosis because of late diagnosis. The keys to a successful outcome are early diagnosis and appropriate operative intervention. We successfully treated a patient with acute mesenteric ischemia after aortic valve replacement. Therefore, we report a case with a review of articles.
Aortic Valve* ; Arteries ; Delayed Diagnosis ; Early Diagnosis ; Humans ; Ischemia* ; Mesenteric Arteries ; Mesenteric Artery, Superior ; Mortality ; Prognosis ; Thoracic Surgery

BACKGROUND: Vasodilatory shock after cardiac surgery may result from the vasopressin deficiency following cardiopulmonary bypass and sepsis, which did not respond to usual intravenous inotropes. In contrast to the adult patients, the effectiveness of vasopressin for vasodilatory shock in children has not been known well and so we reviewed our experience of vasopressin therapy in the small babies with a cardiac disease. MATERIAL AND METHOD: Between February and August 2003, intravenous vasopressin was administrated in 6 patients for vasodilatory shock despite being supported on intravenous inotropes after cardiac surgery. Median age at operation was 25 days old (ranges; 2~41 days) and median body weight was 2,870 grams (ranges; 900~3,530 grams). Preoperative diagnoses were complete transposition of the great arteries in 2 patients, hypoplastic left heart syndrome in 1, Fallot type double-outlet right ventricle in 1, aortic coarctation with severe atrioventricular valve regurgitation in 1, and total anomalous pulmonary venous return in 1. Total repair and palliative repair were undertaken in each 3 patient. RESULT: Most patients showed vasodilatory shock not responding to the inotropes and required the vasopressin therapy within 24 hours after cardiac surgery and its readministration for septic shock. The dosing range for vasopressin was 0.0002~0.008 unit/kg/minute with a median total time of its administration of 59 hours (ranges; 26~140 hours). Systolic blood pressure before, 1 hour, and 6 hours after its administration were 42.7+/-7.4 mmHg, 53.7+/-11.4 mmHg, and 56.3+/-13.4 mmHg, respectively, which shows a significant increase in systolic blood pressure (systolic pressure 1hour and 6 hours after the administration compared to before the administration; p=0.042 in all). Inotropic indexes before, 6 hour, and 12 hours after its administration were 32.3+/-7.2, 21.0+/-8.4, and 21.2+/-8.9, respectively, which reveals a significant decrease in inotropic index (inotropic indexes 6 hour and 12 hours after the administration compared to before the administration; p=0.027 in all). Significant metabolic acidosis and decreased urine output related to systemic hypoperfusion were not found after vasopressin administration. CONCLUSION: In young children suffering from vasodilatory shock not responding to common inotropes despite normal ventricular contractility, intravenous vasopressin reveals to be an effective vasoconstrictor to increase systolic blood pressure and to mitigate the complications related to higher doses of inotropes.
Acidosis ; Adult ; Aortic Coarctation ; Arteries ; Blood Pressure ; Body Weight ; Cardiopulmonary Bypass ; Child ; Diabetes Insipidus, Neurogenic ; Diagnosis ; Double Outlet Right Ventricle ; Heart Defects, Congenital* ; Heart Diseases ; Humans ; Hypoplastic Left Heart Syndrome ; Postoperative Care ; Scimitar Syndrome ; Sepsis ; Shock* ; Shock, Septic ; Thoracic Surgery ; Vasodilation ; Vasopressins*