Double-orifice mitral valve is a rare congenital anomaly. Most cases of double-orifice mitral valve are hemodynamically normal and remain symptomless, so that it is usually discovered incidentally in autopsy or during surgical correction of a cardiovascular abnormality. Recently, however, it is increasingly recognized as such, since the echocardiography has gained wide acceptance as a non-invasive diagnostic tool by the M-mode, two-dimensional and color Doppler echocardiogram. Two separate mitral valve apparatuses can be used on the M-mode echocardiogram. In the two-dimensional echocardiography, the parasternal and subcostal short-axis views can show two separate glass-like orifices in the left ventricle, and the parasternal long-axis view as well as the apical four-chamber view can show the anomaly. And the color Doppler echocardiogram can visualize two mosaic-pattern flows between the left atrium and ventricle. We present herewith two cases of double-orifice mitral valve, as diagnosed by means of echocardiography. The first case was an isolated one with mitral stenosis, showing two parachute mitral valves. The second was associated with perimembranous ventricular septal defect, and showed the accessory mitral valve directly attached to the ventricular septum, with the chordae crossing the ventricular outflow tract.
Autopsy ; Cardiovascular Abnormalities ; Echocardiography* ; Heart Atria ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Mitral Valve Stenosis ; Mitral Valve* ; Ventricular Septum

BACKGROUND: Video assisted thoracic sympathectomy or sympathicotomy is a safe and effective therapy for the treatment of palmar hyperhidrosis with immediate symptomatic imporvement. However the degree of satisfaction may diminish with time due to cmpensatory sweating or excessive hand dryness. Therefore by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathectomy or sympathicotomy at various levels we aim to determine the optimal level of sympathetic nerve block which will result in minimal side effects and maximal benefit. MATERIAL AND METHOD: Among 194 patients having undergone video assisted thoracic sympathectomy or sympathicotomy between January 1996 and June 1999, 137 patients who responded to either telephone interview or questionnaire were included in the current study. The patients were divided into three groups. Group I(n=61) ; patients having undergone T2,3,4 sympathectomy group II(35) ; patients having undergone T2 sympathicotomy and group III(41) ; patients having undergone limited T2 sympathicotomy which consist of block of interganglionic neuronal fiber on the third rib. The parameters studied comprised of pre- and post-operative palmar temperature change treatment satisfaction the degree of compensatory sweating or discomfort from palmar dryness postoperative complication and changes in plantar sweating. RESULT: There was no difference in age and sex among the groups and the mean postoperative elevation in palmar temperature was 21.59degrees C without any differences among the groups. Patients expressing satisfaction were 65.6%, 62.9% and 90.24% in groups I, II and III, respectively(p<0.05) Moderate to severe compensatory sweating was present in 65.6% 51.4%, and 24.39%, in group I, II, and III, respectively (p<0.05) Slight but comfortable amount of palmar humidness was expressed in decreasing order group III(41.6%) group I(24.6%) and group II(5.7%) (p<0.05) Ineffectiveness or recurrence was present in 5patients in group I(8.2%) 1 patient in group II(2.9%) and none in group III. With regards to plantar sweating decrease in sweating was expressed in 43 patients(31.4%) while similar degree of sweating in 61 patients(44.5%) and increase in sweating in another 33 patinets(24.1%). CONCLUSION: Limited T2 sympathicotomy resection of the lower interganglionic neuronal fiber of the second sympathetic ganglion on the third rib showed immediate effect in palmar hyperhidrosis and caused lesser compensatory sweating and hand dryness.
Autonomic Nerve Block ; Ganglia, Sympathetic ; Hand ; Humans ; Hyperhidrosis* ; Interviews as Topic ; Neurons ; Postoperative Complications ; Surveys and Questionnaires ; Recurrence ; Ribs ; Sweat ; Sweating ; Sympathectomy

PURPOSE: Since Caffey et al. first described the anomaly in pelvis among the Down patients, decreased iliac and pelvic indexes have been helpful in diagnosing the syndrome. For Korean cases, however, no definitive data are available as yet, prompting us to evaluate the pelvic changes in Korean Down's patients. METHODS: Subjected to this study were 68 children with Down's syndrome. As the control group served 126 patients with other diseases that do not affect the pelvis. The acetabular angle (AA) and the iliac angle (IA) were measured, and the iliac and pelvic indexes wer calculated from the following equations : Iliac index (Ii) = X + Y: pelvic index (Pi) = 0.3X + 0.42Y (where X is the mean of both acetabular angles, and Y is the mean of both iliac angles) RESULTS: 1) The sex ratio of the patients was 1.5 to 1, male prepondering. Their ages ranged from 1 day to 13 years, with the mean of 9.5 months, the majority (55.9%) falling under 1 month. The karyotype most frequently found in them was 21-trisomy (97%), followed by translocation (3%). 2) The AA of the Down patients was 18.49+/-4.92 (M+/-SD), significantly lower than that of the control group with 25.21+/-5.73; and the IA of the affected measured 43.53+/- 5.97, also signficantly (p<0.001) lower than the control (52.68+/-7.93). 3) The Ii and Pi of the Down groups were calculated as 62.01+/-9.04 and 23.83+/-3.38; both values were significantly lower than those of the control with 77.87+/-11.28 and 29.69+/-4.26, respectively. 4) The maximum likelihood estimate of Ii for Down syndrome was found to be 64, and at that level, the specificity 87.30%, and the sensitivity 66.18%. 5) In the Neonatal and infantile period, all parameters of Down syndrome were very significantly lower values when compared with those of the control of corresponding age In the childhood age, however, the AA of both groups did not significantly differ from each other, but the Down children had significantly lower values in the other parameters. The Ii decreased in relation to the increasing age in the control group, while no significant correlation was noted in the Down patients. 6) In the control group, a significant gender difference was found in the Ii, with females having higher values. In the Down patients, however, both sex did not significantly differ in the Ii. CONCLUSIONS: Decreased iliac and pelvic indexes manifested in Korean Down cases were quantitively evaluated in this study and it was found that an iliac index below 64 strongly supports the diagnosis of Down syndrome. For the Down cases, the Ii did not signficantly correlate with age, nor did both sexes differ in the Ii, in contrast to the control group which showed an age-related decrease and higher female values.
Acetabulum ; Child ; Diagnosis ; Down Syndrome* ; Female ; Humans ; Karyotype ; Korea* ; Likelihood Functions ; Male ; Pelvis ; Sensitivity and Specificity ; Sex Ratio

PURPOSE: Ciliary abnormalities of the respiratory system usually accompany recurrent or persistent respiratory diseases such as paranasal sinusitis, bronchiectasis, rhinitis, and/or otitis media, since they cause certain derangements in ciliary cleaning activities. This disease is usually inherited by autosomal recessive trait, but may also be found to be acquired or transient in rare cases after heavy exposure to pollutants, cigarette smoking or severe infection. We performed this study in children with frequently recurrent or persistent respiratory diseases to clarify if the ciliary abnormalities are preceding factors. METHODS: We enrolled 17 children with suspected respiratory ciliary abnormalities. The indications for evaluation of ciliary ultrastructure were recurrent or persistent respiratory infections. Children with immunologic abnormalities were excluded. From August 2000 to July 2003, we performed a biopsy on nasal mucosa and examined the structure of ciliary status by using an electron microscope. RESULTS: Of the subjects, there were seven males and 10 females, aged 2 to 10 years. Out of the 17 subjects, 12 cases of chronic paranasal sinusitis, nine chronic coughs, nine frequent upper respiratory infections, seven cases of recurrent otitis media, four cases of recurrent pneumonia, and four cases of bronchial asthma were found. Out of the 17 cases on which histologic examinations were conducted, four cases showed pathologic findings, including one case of inner dynein arm defect, one of microtubular transposition, one of supernumerous tubules, and one singlet, respectively. CONCLUSION: It is essential for differential diagnosis and effective treatment to identify the abnormalities of ultrastructure of nasal cilia in children with symptoms of frequently recurrent or persistent respiratory diseases, if immunodeficiency or respiratory allergy could be excluded.
Arm ; Asthma ; Biopsy ; Bronchiectasis ; Child* ; Cilia* ; Cough ; Diagnosis, Differential ; Dyneins ; Female ; Humans ; Hypersensitivity ; Male ; Nasal Mucosa ; Otitis Media ; Pneumonia ; Respiratory System ; Respiratory Tract Infections ; Rhinitis ; Sinusitis ; Smoking

In order to determine the electrophysiologic properties of aberrant ventricular conduction we analyzed the electrophysiologic studies done for various reasons in SNUH(1983.3 -1987.8). All patients did not have underlying heart disease and were in sinus rhythm with normal PR intervals & no intraventricular conduction delay at the time of study. The patients of preexcitation syndrome were excluded. Only aberrant ventricular conduction induced by premature atrial stimulation at the high right atrium or(HRA) during sinus rhythm or HRA pacing was analyzed. 1) Aberrant ventricular conuction was induced by premature atrial extrastimulation in 34 subjects of 156 cases reviewed(21.8%). The patients were 16 to 70 years old(sixteen males and eighteen females). 2) The longest atrial coupling(A1S2) interval resulting in aberrant ventricular conduction approximated 45%(600-280) of the basic cycle length(450-1550 msec). 3) As a prerequisite for aberrant ventricular conduction, the functional refractory period(FRP) of the AV node should be less than the relative refractory period(RRP) of the His Purkinje System and the most important determinant of aberrant ventricular conduction by atrial extreastimulation was resultant H1H2 interval, which should be between RRP and effective refractory period(ERP) of HPS. 4) There was good linear correlation between the basic cycle length(BCL) and RRP of the HPS(RRP=0.247xBCL+247.048, r=0.885, p-value<0.001). 5) 155 different configurations of aberrant ventricular conduction were recorded during atrial extrastimulation till atrial ERP. The pattern frequencies were as follows : left anterior hemiblock, 6(3.9%) ; right bundle brach block, 92(59.4%) ; left bundle branch block, 28(18.0%) ; left anterior hemiblock combined with right bundle branch block, 14(9.0%) ; left posterior hemiblock combined with right bundle branch block, 9(5.8%) ; unclassified intraventricular conduction disturbances, 6(3.9%). 6) As the atrial coupling intervals were further shortened, aberrant conduction persisted up to the point of atrial ERP at 19/41 BCL's(46.3%). Other patterns of atrioventricular conduction were as follows : atrio-His block, 7(17.1%) ; His-ventricular block, 6(14.6%) ; normal conduction due to prolonged A2H2, 9(22.0%). But there was no statistical significance between the pattern of A-V conduction and the longest S2H2 & H2V2 intervals during VAB (p-value=0.235>0.050). In conclusion, atrial extrastimulation which is routinely done during clinical EPS is an effective method to induce aberrant ventricular conduction and to study the electrophysiologic characteristics of atrioventricular conduction. Further study with recording of bundle branch electrogram, after infusion of cardioactive drugs and pacing of HRA at fixed rate should be done to determine the electrophysiologic properties of VAB more completely.
Atrioventricular Node ; Bundle-Branch Block ; Heart Atria ; Heart Diseases ; Humans ; Male ; Pre-Excitation Syndromes

BACKGROUND: Video-assisted thoracic surgery (VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. MATERIAL AND METHOD: Group I (n=18) underwent video-assisted thoracic surgery, and group II (n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. RESULT: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I (155.6+/-77.8cc) than in group II (572.8+/-280.1cc) (p<0.05). CONCLUSION: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.
Analgesics, Opioid ; Anesthesia ; Chest Tubes ; Drainage ; Esophageal Achalasia ; Esophageal Diseases* ; Humans ; Leiomyoma ; Length of Stay ; Pain, Postoperative ; Pleural Effusion ; Thoracic Surgery, Video-Assisted* ; Thoracotomy* ; Vocal Cord Paralysis

In order to observe the changes in left ventricular function during coronary artery occlusion and reperfusion, left anterior descending (LAD) coronary arteries in the anesthetized dogs were occluded for 1 hour and then reperfused for 4 hours. Hemodynamic indexes of global systolic and diastolic function and regional wall thickness changes as a regional contractile index were measured during occlusion and reperfusion. The results were as follows; 1) Indexes of global systolic function (left ventricular peak systolic pressure, peak positive dP/dt) and global diastolic function (peak negative dP/dt, time constant, left ventricular end-diastolic pressure) showed deterioration in early occlusion period (10-30 minutes) but gradually improved even if coronary occlusion persisted. Reperfusion did not induce significant changes except that peak positive dP/dt transiently deteriorated 30 minutes after reperfusion and left ventricular end-diastolic pressure decreased 1.5-2 hours after reperfusion. 2) Indexed of regional function (i.e, end-diastolic thickness and % systolic thickening of anterior left ventricular wall) deteriorated by 10 minutes' occlusion which persisted during the entire occlusion period. Reperfusion induced no significant improvement in regional contractile function compared with occlusion 60 minutes' data, which suggested reperfusion for 4 hours after 1 hour's LAD occlusion may be insufficient for the ischemic region to recover its contractility. 3) Reperfusion arrhythmia (ventricular tachycardia) was noted in most (6/9) of the dogs, one of which deteriorated into ventricular fibrillation and the others spontaneously converted to normal sinus rhythm.
Animals ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels* ; Dogs ; Hemodynamics ; Reperfusion* ; Ventricular Fibrillation ; Ventricular Function, Left*

Isometric tension recording was performed in the transverse strips of porcine coronary arteries and rabbit aorta to observe the effects of the endothelium and endothelium-derived relaxing factor(EDRF) on vasomotor tone and to test the hypothesis that alcohol may have the deleterious effect on endothelium-dependent vasorelaxation. Tension-development by vasoconstrictor was markedly attenuated in the endothelium-intact strips compared to the endothelium denuded strips. Administration of hemoglobin(10-5M) to inhibit the action of EDRF increased tension selectively in the endothelium-infarct strips, which is suggestive of basal EDRF secretion. Nitro L-arginine(10-5M). an analogue of L-arginine(10-4M) partially reversed the inhibitory effect of nitro L-arginine. Ethyl alchol inhibited bradykinin-induced endothelium-dependent vasorelaxation of porcine coronary artery in dose dependent manner. These data suggest that the protective effect of vascular endothelium to the action of vasoconstirctor can be explained by exercise of basal EDRF release and damaged endothelium would be a great risk of induction of vasospasm. Also we believe that there is a relationship of competive inhibition between L-arginine. a precursor of EDRF, and its analogues on the action of EDRF and alcohol intake would be hazardous to the patients with coronary artey disease because its inhibitory action on endothelium-dependent vasorelaxation may evoke myocardial ischemia.
Aorta ; Arginine ; Coronary Vasospasm ; Coronary Vessels* ; Endothelium* ; Endothelium, Vascular ; Ethanol* ; Humans ; Myocardial Ischemia ; Spasm* ; Vasodilation

Human papillomavirus(HPV) has implicated in the development of cervical cancer. Several studies has suggested a strong correlation between HPV 16, 18 and cervical intraepithelial neoplasia(CIN). For detecting and typing HPV DNA in cervical tissues, recently the chemiluminescent molecular hybridization assay method has been widely used. This study was performed to determine the usefulness of hybrid capture assay for detecting high-risk HPV in cervical epithelial cells, and to compare the correlation among cervical cytology, biopsy finding and HPV infection, and to determine whether the addition of the hybrid capture assay to cytologic test would improve the ability to identify significant lesions. This study included 267 patients who visited the colposcopic clinic of the department of obstetrics and gynecology, Chonbuk University Hospital from May, 1997 to October 199S. Pap smears hybrid capture assays, and colposcopically directed biopsy were performed concurrently on al1 women. The results obtained were as follow; l. Using hybrid capture assay, the detection rate of high-risk HPV of all patients was 37.1%(99/267). There was no statistical significance in the detection rate of HPV between the age groups. 2. The false negative rate of Pap Smear was 53.3% and showed significant discrepancies between the cytologic and histologic diagnosis. 3. According to the cytologic diagnosis, the detection rates of high-risk HPV were 7.1% in normal, 25.3% in ASCUS or LSIL, and 61.6% in HSIL. In each cytologic group, the patients who had positive results for high-risk HPV showed higher incidence rate of high grade lesions than those with negative results(P<0.05). 4. According to the histologic diagnosis, the detection rates of high-risk HPV were 0.1% in normal, 11.1% in CIN I, and 72.7% in CIN II or CIN III. In each histologic group, the patients who had positive results for high-risk HPV showed higher incidence rate of high grade lesions than those with negative results(P<0.05). 5. According to the comparison of histologic diagnosis between positive and negative results of high-risk HPV test due to each cytology, there was no statistical significance in the incidence rate of cervical neoplasia, Above results suggest that high-risk HPV test using hybrid capture assay may be a useful method in supplement the pitfalls of cervical cytology. This test might also have prognostic value in the management of patients with CIN.
Biopsy ; Diagnosis ; DNA ; Epithelial Cells* ; Female ; Gynecology ; Human papillomavirus 16 ; Human Papillomavirus DNA Tests* ; Humans ; Incidence ; Jeollabuk-do ; Obstetrics ; Uterine Cervical Neoplasms

Meigs' sydrome is a relatively uncommon and the unusual condition of ascites and fluid in the chest associated with benign and solid tumors of the ovary with the gross appearance of a fibroma. The mechanism of this syndrome is not completely understood, but various lymphatics through the diaphragm seem the likely route for ascitic fluid into the chest. We present a case of Meigs' syndrome associated with fibrothecoma and elevate CA 125 with the brief review of literature.
Ascites ; Ascitic Fluid ; Diaphragm ; Female ; Fibroma ; Meigs Syndrome ; Ovary ; Thorax