BACKGROUND: Although there have been few reports about minimal skin incision for the repair of congenital heart lesions, minimizing an unsightly scar is a particularly important factor in growing children. We have adopted a technique that permits standard full sternotomy, conventional open chest cardiopulmonary bypass, aortic cross-clamping, left atrial vent, and antegrade cardioplegia with minimal surgical scar. MATERIAL AND METHOD: With minimal skin incision and full sternotomy, 40 patients with congenital heart disease underwent open heart surgery from April 1997 through September 1997. Defects repaired included 30 ventricular septal defects, 4 atrial septal defects, and 1 sinus Valsalva aneurysm in 35 children(M:F=17: 18), and 3 Atrial septal defects, 1 ventricular septal defect, and 1 partial atrioventricular septal defect in 5 adults(M:F=1:4). Midline skin incision was performed from the second intercostal space to 1 or 2 cm above the xiphoid process. For full sternotomy, we used the ordinary sternal saw in sternal body, and a special saw in manubrium under the skin flap. During sternal retraction, surgical field was obtained by using two retractors in a crossed direction. RESULT: The proportion of the skin incision length to the sternal length was 63.1+/-3.9%(5.2~11cm, mean 7.3cm) in children, and 55.0+/-3.5%(10~13.5cm, mean 12cm) in adults. In every case, the aortic and venous cannulations could be done through the sternal incision without additional femoral cannulation. There was no hospital death, wound infection, skin necrosis, hematoma formation, or bleeding complication. CONCLUSION: We conclude that minimal skin incision with full sternotomy can be a safe and effective alternative method for the repair of congenital heart diseases in children and adults.
Adult ; Aneurysm ; Cardiopulmonary Bypass ; Catheterization ; Child ; Cicatrix ; Heart Arrest, Induced ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Hematoma ; Hemorrhage ; Humans ; Manubrium ; Necrosis ; Skin* ; Sternotomy* ; Thoracic Surgery* ; Thorax ; Wound Infection

BACKGROUND: As the early outcome after coronary artery bypass grafting(CABG) has been stabilized, neurologic complication has now become one of the most important morbidity. The aim of this study was to find out the risk factors associated with the neurologic complications after CABG. MATERIAL AND METHOD: In 351 patients who underwent CABG, the incidence and features of neurologic complications, with associated perioperative risk factors, were retrospectively reviewed. Neurologic complication was defined as a new cerebral infarction confirmed by postoperative neurologic examination and radiologic studies, or delayed recovery of consciousness and orientation for more than 24 hours after the operation. RESULT: Neurologic complications occurred in 18 patients(5.1%), of these nine(2.6%) were diagnosed as having new cerebral infarctions(stroke). Stroke was manifested as motor paralysis in four patients, mental retardation or orientation abnormality in four, and brain death in one. Statistical analysis revealed the following variables as significant risk factors for neurologic complications by both univariate and multivariate analyses: cardiopulmonary bypass longer than 180 minutes, atheroma of the ascending aorta, carotid artery stenosis detected by Duplex sonography, and past history of cerebrovascular accident or transient ischemic attack. Age over 65 years, aortic calcification detected by simple X-ray, and intraoperative myocardial infarction were significant risk factors by univariate analysis only. Neither the severity of carotid artery stenosis nor technical modifications such as cannulation of the aortic arch or single clamp technique, which were expected to affect the inciden e of neurologic complications, had significant relationship with the incidence. CONCLUSION: This study confirmed the strong association between neurologic complications after CABG and atherosclerosis of the arterial system. Therefore, to minimize the incidence of neurologic complications, systematic evaluation focused on atheroscleroti.
Aorta ; Aorta, Thoracic ; Atherosclerosis ; Brain Death ; Cardiopulmonary Bypass ; Carotid Stenosis ; Catheterization ; Cerebral Infarction ; Consciousness ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Incidence ; Intellectual Disability ; Ischemic Attack, Transient ; Multivariate Analysis ; Myocardial Infarction ; Neurologic Examination ; Paralysis ; Plaque, Atherosclerotic ; Postoperative Complications ; Retrospective Studies ; Risk Factors* ; Stroke

PURPOSE: Intimal hyperplasia is a pathologic condition that is commonly observed with the atherosclerotic change of blood vessels; this condition is usually observed after arterial operation and interventions such as angioplasty, endaterectomy and bypass grafting, and it remains a major cause for hindering for arterial patency. It is a multiple processes that includes smooth muscle cell migration, proliferation, and expression of extracellular matrix proteins, such as fibronectin. Nitric oxide (NO) has been found to possess many different vasoprotective properties: inhibition of platelet aggregation and adherence, inhibition of leukocyte chemotaxis, inhibition of vascular smooth muscle cell proliferation and migration, inhibition of endothelial cell apoptosis and stimulation of endothelial cell growth. Overexpression of nitric oxide synthase (NOS) in the vascular wall has been used to regulate vasomotor function, prevent neointimal formation after balloon injury or vein grafting, and to prevent transplant vasculopathy. NOS gene transfer to the vascular wall holds great promise as a means of controlling local vascular function. METHOD: We investigated whether the inducible NOS (iNOS) gene transfer to the arterial wall has an inhibitory effect on intimal hyperplasia after endothelial denudation and on the change of the level of extracellular matrix fibronectin expression in the rabbit common carotid artery. Rabbits were divided into three groups: the saline only (without injury) normal group, the injury + saline intima injury group, and the injury + recombinant adenoviral vector encording human iNOS (AdiNOS) gene transfer group (n=5 per group). AdiNOS (1.6x10(10) plaque-forming units [pfu]) were used for the iNOS gene delivery and the virus was intraluminally infected to the balloon-injured common carotid arterial wall for 20 minutes. The NO levels were assessed in the blood of all the animals at the three time point: before-, 1 hr after-, and 14 days after the surgical procedures. The left common carotid arteries were harvested from the animals at 14 days after balloon injury and they were then assessed for fibronectin expression and intimal hyperplasia. RESULT: 14 days after AdiNOS infection, the NO levels were increased 67% in the gene transfer group compared with those levels obtained before the gene transfer (333.5+/-11.5 vs. 557.4+/-72.1, respectively, P<0.05), and the intima/intima+media ratio and the FN expression were reduced by 60% and 50%, respectively, in the gene transfer group compared with the intima injury group (41.5+/-5.6 vs. 16.6+/-2.8, respectively, P<0.05 and 307.9+/-38.3 vs. 154.3+/-20.2, respectively, P<0.05). CONCLUSION: Our results show that iNOS gene transfer to the arterial wall resulted in increased NO levels in the blood, and the procedure greatly inhibited intimal hyperplasia and it reduced fibronectin expression in the arteriaql wall.
Angioplasty ; Animals ; Apoptosis ; Blood Vessels ; Carotid Arteries* ; Carotid Artery, Common ; Cell Proliferation ; Chemotaxis, Leukocyte ; Endothelial Cells ; Extracellular Matrix ; Extracellular Matrix Proteins ; Fibronectins* ; Humans ; Hyperplasia* ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II* ; Platelet Aggregation ; Rabbits ; Transplants ; Veins

BACKGROUND: The prognosis after an aortic valve replacment can be affected significantly by the transprosthetic pressure gradient which is determined mainly by the size of the patients body and the prosthesis used. We analyzed the hemodynamic feature of two relatively new prosthese the ATS and the evensized Medtronic-Hall(M-H) valves by measuring the transprosthetic pressure gradient in the cases where small sizes (23mm or smaller) were used. MATERIAL AND METHOD: There were 94 patients who received whom aortic valve replacement with prosthesis smaller than 23 mm from October 1994 to June 1998. In these patients the transprosthetic pressure gradient clalculated from the pressure half time during postoperative Dopper echocardiographic examination was compared between the prostheses of different sizes. The body surface area of each patient was also taken into consideration. RESULT: The mean pressure gradient and body surface area in each group were 21.7+/-10.2 mmHg and 1.52+/-0.14m2 in ATS 19mm 11.4+/-6.5 mmHg and 1,57+/-0.20m2 in M-H 20mm 15.2+/-6.3 mmHg and 1.54+/-0.13m2 in ATS 21mm 9.3+/-2.5 mmHg and 1.63 +/-0.14m2 in M-H 22 mm and 12.9+/-5.3 mmHg and 1.69+/-0.13m2 in ATS 23mm. CONCLUSIONS: The 19mm ATS prosthesis showed significant trasprosthetic pressure gradient which is similar to the values previously reported with other bileaflet prosthesesm Close follow-up was needed in terms of exercise capacity and change in left ventiricular geometry. In patients with small aortic valve annulus the 20mm M-H valve is recomendable as an alternative to 19mm bileaflet valves because it has less pressure gradient with similar outer diameter.
Aortic Valve* ; Body Surface Area ; Echocardiography ; Follow-Up Studies ; Heart Valve Prosthesis ; Hemodynamics ; Humans ; Prognosis ; Prostheses and Implants*

In the preoperative evaluation before coronary artery bypass surgery, review of the coronary arteriogram is the most important step. Expected "normal" lumen diameter at a given coronary anatomic location is a basis for quantative estimation of coronary disease severity that could be more useful than the traditional "percent stenosis". The distribution and number of major coronary artery branches are determinants of number of bypass grafts needed. We reviewed the coronary artery anatomy in 174 adult patients who revealed no coronary pathology in angiographic studies done from September 1994 to June 1996. Quantative analysis was done in all cases by a single person using a Computerized System (Arripro 35(r)). The results were follows; 1) The mean diametre of left main coronary artery was 4.45 mm (range 2.74~6.72). The pattern of branching was bifurcation in 67.24%, trifurcation in 28.74% and quadrifurcation in 4.02% of the patients. 2) The mean diametre of left anterior descending artery was 3.17 mm (range 2.10~5.85), 2.79 (range 1.55~5.59) and 2.17 mm (range 1.37~3.81) in the proximal, mid, and the distal portions, respectively. The number of diagonal branches of left anterior artery was from one to four (mode=2). 3) The mean diametre of proximal and distal left circumflex artery were 3.17mm (range 1.74~4.89) and 2.19 mm (range 1.21~4.46). The number of obtuse marginal branches of left circumflex artery is from one to six (mode 2). 4) The mean diametre of proximal and distal right coronary artery, the posterior descending artery and the largest posterolateral branch were mean 3.51 mm (range 2.07~5.67), 2.09 mm (range 1.42~3.60), 2.09 mm (range 1.02~3.60) and 2.30 mm (range 1.39~4.39). 5) The right coronary artery dominant was 163 cases (93.68%) of the total 174 cases. 6) The large significant acute marginal artery was visualized in more than half of the people.
Adult ; Arteries ; Computer Systems ; Coronary Artery Bypass ; Coronary Disease ; Coronary Vessels ; Humans ; Pathology* ; Single Person ; Transplants

Diffuse glomerular basement membrane (GBM) lamellation, reminiscent of Alport's syndrome, has rarely, and exclusively, been reported in renal allografts from pediatric donors to adult recipients. We report on a similar lesion, identified in a 42-year-old male, who received a kidney from an unrelated 21-year-old living male donor. The disease of the recipient was unknown. Renal allograft biopsies were performed 3.5 and 4.8 years after the renal transplantation, due to massive proteinuria and serum creatinine elevation. The histological features of both biopsies were similar, but more advanced in the second biopsy. Glomerular mesangium was widened and had an IgA deposit in the first biopsy. In addition to the presence of mesangial electron dense deposits, the GBM showed diffuse lamellation and splintering on the subepithelial side, but no definite deposits. In the second biopsy, IgA deposits were extended to the peripheral capillary walls, but electron microscopic examination was not available. Two months after the second biopsy, the patient returned for hemodialysis.
Adult ; Basement Membrane/*pathology ; Case Report ; Glomerulonephritis, IGA/*etiology/*pathology ; Human ; Kidney Glomerulus/*pathology ; *Kidney Transplantation/*adverse effects ; Male

Diffuse glomerular basement membrane (GBM) lamellation, reminiscent of Alport's syndrome, has rarely, and exclusively, been reported in renal allografts from pediatric donors to adult recipients. We report on a similar lesion, identified in a 42-year-old male, who received a kidney from an unrelated 21-year-old living male donor. The disease of the recipient was unknown. Renal allograft biopsies were performed 3.5 and 4.8 years after the renal transplantation, due to massive proteinuria and serum creatinine elevation. The histological features of both biopsies were similar, but more advanced in the second biopsy. Glomerular mesangium was widened and had an IgA deposit in the first biopsy. In addition to the presence of mesangial electron dense deposits, the GBM showed diffuse lamellation and splintering on the subepithelial side, but no definite deposits. In the second biopsy, IgA deposits were extended to the peripheral capillary walls, but electron microscopic examination was not available. Two months after the second biopsy, the patient returned for hemodialysis.
Adult ; Basement Membrane/*pathology ; Case Report ; Glomerulonephritis, IGA/*etiology/*pathology ; Human ; Kidney Glomerulus/*pathology ; *Kidney Transplantation/*adverse effects ; Male

PUROPSE: The liver is a major site for the metastatic spread of primary colorectal cancers.. Among the various modalities of treatment for hepatic metastasis of colorectal cancer, hepatic resection has been proven to be the most effective treatment. This analysis was intended to review our experience with hepatic resection for colorectal cancer liver metastases. MATERIALS AND METHODS: From 1989 to 2006, we retrospectively analyzed the clinical experience of 31 patients who were underwent hepatic resection for 20 synchronous and 11 metachronous hepatic metastases from colorectal cancer. The survival rate was calculated using the Kaplan-Meier method and the log rank test. The mean follow up period was 26.7 months. RESULTS: The mean survival length of the patients was 65.08 5.00 months. Resection mortality was not observed. Age, sex, the preoperative CEA level, location, differentiation, and the surgical method for the primary tumor did not influence the survival (p>0.05). The number, largest size, sum of the largest size, and surgical method (wedge resection, segmental resection, lobectomy) for the hepatic metastasis did not influence the survival (p>0.05).Considering the time from diagnosis of the primary tumor to detection of the metastatic lesion, patients that had metachronous lesions survived longer than patients that had synchronous lesions (p=0.05). Patients that had a longer disease free interval after hepatic resection had a longer survival period (p=0.04). CONCLUSIONS: Our results suggest that hepatic resection for colorectal cancer liver metastasis is a safe procedure with a survival benefit for the patients. We especially believe that hepatic resection for metachronous hepatic metastasis of colorectal cancer may offer a chance of longer survival to these patients.
Colorectal Neoplasms* ; Diagnosis ; Follow-Up Studies ; Humans ; Liver* ; Mortality ; Neoplasm Metastasis* ; Retrospective Studies ; Survival Rate

Primary mesenteric carcinoid tumor is very rare, although secondary mesenteric involvement is common, reported as 40% to 80%. And distant metastasis rate reported as 80% to 90%, when the size is larger than 2 cm. We present a case of very rare primary mesenteric carcinoid tumor showing benign character though large size. The patient visited St. Vincent's Hospital, The Catholic University of Korea with increasing palpable abdominal mass. At laparotomy, a well encapsulated mass arising from the mesentery near the ligament of Treitz was found without any adjacent organ invasion or distant metastasis. The mass was measured as 8.2 x 7.3 cm and histopathologically benign character. At 11 months of follow up, the patient was recurrence free.
Carcinoid Tumor ; Follow-Up Studies ; Humans ; Korea ; Laparotomy ; Ligaments ; Mesentery ; Neoplasm Metastasis ; Recurrence

Over Past years people have known rich medical information and knowledge through mass-media. It is needed to develop medical database, which makes people get proper medical information, So we made an effort to analysis health and medical consultation data. People easily access internet hospital of Gachon Medial School Gil Medical Center, coorperated with MIDAS Dongailbo. 4020 cases of "Questions and Answers "were conducted to access from March 25th, 1997 to March 25th, 1998. Using Java Servlet, Sybase, and Apache Web Server, we classified data. Those data present over 4000 databases, such as text (3644 cases), image (212 cases), moving picture (21 cases), and medical dictionary (416 dases). People can search symptome, or disease, what they want to know. Our database as a medical service is enhance people know about medical knowledge and information, so that they can take care of their health and prevent illness in advance.
APACHE ; Dictionaries, Medical ; Humans ; Indonesia ; Internet* ; Multimedia*