BACKGROUND: Left ventricular dysfuction is common in immediate postoperative periods after surgical correction of heart diseases with chronic left ventricular volume overload. We speculated postoperative changes of left ventricular volume and unction in patients with patent ductus osus(PDA) who had underwent surgical repair at ages older than 16 years. Factors influencing postoperative left ventricular volume and function were also analyzed. MATERIAL AND METHOD: From August 1989 to August 1999 thirty-siz adult patients with PDA 28 females and 8 males. were enrolled in this study. Their age ranged from 16 years to 57 years(mean :32 years). Types of surgical repair were division with primary closure in 22, division with patch closure in 6, internal obliteration using cardiopulmonary bypass in 4 and ligation in 4. Aortic clamping was combined during surgical repair in 22(61%) and cardiopulmonary bypass was used in 8(22%) Two-dimensional echocardiography studies were performed in 34(94%) preoperatively and in 25(66%) immediate postoperatively to assess postoperative changes of left ventricular internal dimensions. left ventricular volume and ejection fraction. Duration of postoperative follow-up ranged from 1 month to 99 months (mean:22 months) and 10 patients underwent 16 echocardiographic evaluation during this period. RESULT: Preoperative and postoperative left ventricular systolic dimensions(LVIDs) were 42+/-8.0mm and 42+/-8.3mm left ventricular diastolic dimensions(LVIDd) were 64+/-10.0mm and 56+/-7.4mm left ventricular end systolic volumes(LVESV) were 62+/-19cc (z=1.87+/-0.06) and 59+/-24cc(z=1.78+/-0.08) left ventricular end diastolic volumes(LVEDL) were 169+/-40cc(z-1.17+/-0.1) and 112+/-29cc(z=0.85+/-0.1) and ejection fractions(EF) were 66+/-6.7% and 48+/-12.6% respectively. There were statistically significant differences between preoperative and postoperative values in LVDIDd(p=0.001) LVEDV(p=0.001) and EF(p=0.0001) while no significant difference is LVIDs and LVESV. Postoperative depression of ejcection fraction was significantly related with z-score of preoperative LVESV and LVEDV by univariateanalysis while LVEDV only was significant risk factor for postoperative LV dysfunction by multiple regressioin analysis (deltaLVEF=-13.3-4.62xLVEDV(z), p=0.001) During the follow-up periods ejection fractions become normalized in all except one patients. CONCLUSION: Left ventricular function is usually deteriorated after the surgical correction of PDA in adult age and preoperative LVEDV is a major determinant of postoperative LV function.
Adult* ; Cardiopulmonary Bypass ; Constriction ; Depression ; Echocardiography ; Female ; Follow-Up Studies ; Heart Diseases ; Humans ; Ligation ; Male ; Postoperative Period ; Risk Factors ; Ventricular Function, Left

BACKGROUND AND OBJECTIVES: This study sought to investigate operative and late mortality in aortic valve surgery and to identify risk factors for operative and late mortality. MATERIALS AND METHODS: We examined operative mode, operative and late mortality, and survival rate of aortic valve surgery performed at Asan Medical Center between June 1989 and December 1996. RESULTS: 227 patients (148 men) with a mean age 49+/-15 years underwent aortic valve surgery. Aortic valvular lesions were classified as dominant stenosis (n=66), dominant regurgitation (n=133), and balanced stenoinsufficiency (n=28) according to the echocardiographic findings. Surgical procedures were aortic valve replacement with mechanical prosthesis in 180 (79 %) and with bioprosthesis in 27 (12 %) and aortic valve repair in 20 (9 %). The overall operative mortality was 4.8 %. Bacterial endocarditis and long bypass time were independent factors associated with high operative mortality (p < 0.05). During follow up (mean 33+/-24 months) of operative survivors, there were 9 late deaths, 12 re-do operations, and 11 clinical events (bacterial endocarditis, stroke, major bleeding, and admission for heart failure). There was no single identifiable risk factor for late mortality but age was significantly associated with development of clinical event and late mortality (p < 0.05). One-, Three-, and Seven-years survival rate after successful operation were 98+/-1 %, 96+/-2 %, and 92+/-3 %, respectively. Late clinical event-free survival rate was 67+/-8 % at seven years after aortic valve surgery. CONCLUSIONS: Aortic valve surgery could be done with low operative and late mortality. Complications related with bacterial endocarditis and long-term anticoagulation therapy following valve replacement surgery still remained high, which needs further improvement.
Aortic Valve* ; Bioprosthesis ; Chungcheongnam-do ; Constriction, Pathologic ; Disease-Free Survival ; Echocardiography ; Endocarditis ; Endocarditis, Bacterial ; Follow-Up Studies ; Heart* ; Hemorrhage ; Humans ; Mortality ; Prostheses and Implants ; Risk Factors ; Stroke ; Survival Rate ; Survivors ; Thoracic Surgery*

BACKGROUND: We analysed differences in operative methods and postoperative outcome according to the severity of preoperative cyanosis in adult ToF (Tetralogy of Fallot) patients. MATERIAL AND METHOD: From August 1989 to June 2001, thirty three adult patients, 18 females and 15 males, underwent total correction for ToF. Their age ranged from 15 years to 54 years (median: 34). Patients were divided into 2 groups by preoperative SaO2 (arterial oxygen saturation): group I (n=cyanotic, SaO2 < or =94%) and group II (acyanotic, SaO2 > or =95%). Preoperative median hemoglobin level was higher in group I compared to group II (17.5 g/dl vs 15 g/dl). Postoperative follow-up duration ranged from 1 to 94 months (670 patient-month, median: 14 months), and 63 two-dimensional echocardiographic examinations were done during this period. RESULT: There were no early or late mortality. With regard to RVOT (right ventricular outflow tract) reconstruction, trans-annular patch and RV-PA extracardiac conduit were used in 7 and 3 patients respectively, and all of them belonged to group I. In group I, cardiopulmonary bypass time, aortic cross-clamping time, ICU day, hospital day were significantly longer than in group II, and postoperative inotropic support was significantly greater than in group II. There was no ventricular arrhythmia in both groups, and one patient in group I suffered from atrial arrhythmia, which was resolved spontaneously after tricuspid and pulmonary valve replacement. During follow-up periods, functional class, residual RVOT stenosis and pulmonary regurgitation, tricuspid regurgitation, occurrence of ventricular and atrial arrhythmias were comparable between two groups. CONCLUSION: In adult ToF patients with severe preoperative cyanosis, more aggressive RVOT reconstruction and careful postoperative care are mandatory. However intermediate-term outcome of this group of patients is comparable to the patients with minimal or no preoperative cyanosis.
Adult ; Arrhythmias, Cardiac ; Cardiopulmonary Bypass ; Constriction, Pathologic ; Cyanosis* ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Mortality ; Oxygen ; Postoperative Care ; Pulmonary Valve ; Pulmonary Valve Insufficiency ; Tetralogy of Fallot* ; Tricuspid Valve Insufficiency

BACKGROUND: We assessed the intermediate-term result of tricuspid annuloplasty (TAP) for tricuspid valve regurgitation (TR) associated with congenital heart disease in adults. Risk factors for residual TR were also analysed. MATERIAL AND METHOD: From August 1989 to June 2001, seventy three adult patients, 51 females and 22 males, underwent TAP for TR associated with various congenital heart disease. Their age ranged from 16 years to 73 years (mean:43). Associated heart anomalies were atrial septal defect (55), ventricular septal defect (6), partial anomalous pulmonary venous return (4) and others (8). Preoperative and postoperative TR velocities were 3.25 m/sec and 2.56 m/sec respectively, and the types of TAP were De Vega in 43, Kay in 18 and Ring annuloplasty in 12. Postoperative follow-up duration was 2,347 patient-month (mean: 32.6 months), and 134 two-dimensional echocardiographic examinations were done during this period. Residual TR greater than III/IV was considered as TAP failure. RESULT: TAP failure was observed in 7 patients (9.6%), and one patient among them underwent tricuspid valve replacement. Risk factors for TAP failure were diagnosis other than atrial septal defect (p=0.001), preoperative (p=0.038) and postoperative (p=0.028) high TR velocity. There was no statistical significance in terms of TAP methods. CONCLUSION:Careful evaluation of valve morphology and aggressive surgical intervention are mandatory for the repair of TR with preoperative or residual RV pressure overload.
Adult* ; Diagnosis ; Echocardiography ; Female ; Follow-Up Studies ; Heart ; Heart Defects, Congenital* ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart Valve Diseases ; Humans ; Male ; Risk Factors ; Scimitar Syndrome ; Tricuspid Valve ; Tricuspid Valve Insufficiency*

PURPOSE: Vascular smooth muscle cell (VSMC) proliferation plays an important role in the development and progression of chronic allograft vasculopathy. Mycophenolic acid (MPA) inhibits various mesenchymal cell proliferation, and reactive oxygen species (ROS) are involved in the anti-pro-liferative effect of MPA. In this study, we investigated the effects of MPA on oleic acid (OA)-induced VSMC proliferation and also the role of ROS in these processes. METHODS: Primary cultured rat VSMCs from Sprague-Dawley were stimulated with OA 100micrometer. MPA 0.1~10micrometer and N-acetylcystein (NAC) 5 mM were administered 1 hour before adding the OA. Cell proliferation was measured by Methylthiazoletetrazolium (MTT) assay, proliferating cell nuclear antigen (PCNA) expression by Western blot analysis, and dichlorofluorescein (DCF)-sensitive cellular ROS by flow cytometry. RESULTS: OA at 100micrometer significantly increased MTT level by 1.6-fold as well as PCNA expression at 48 hours in rat VSMCs. OA also induced DCF-sensitive cellular ROS by 1.6-fold at 5 minutes and the increment of cellular ROS remained for up to 1 hour. MPA at above 1micrometer inhibited OA- induced VSMC proliferation and cellular ROS in a dose-ependent manner. NAC 5 mM also inhibited OA-induced rat VSMC activation. CONCLUSION: These results suggest that MPA inhibits OA-induced VSMC proliferation partially through the inhibition of cellular ROS.
Allografts ; Animals ; Blotting, Western ; Cell Proliferation* ; Flow Cytometry ; Muscle, Smooth, Vascular* ; Mycophenolic Acid* ; Oleic Acid ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley ; Reactive Oxygen Species

PURPOSE: Neck masses, in pediatric population, derive from a multitude of congenital, inflammatory, or neoplastic diseases. The majority of these masses represent benign conditions. However, thorough clinical evaluation is required to rule out malignant diseases. We evaluated the causes, clinical characteristics and outcomes of children with neck masses who underwent tissue biopsy. METHODS: A total of 28 medical records of children with neck mass who underwent tissue biopsy at Chungnam National University Hospital, from January 2000 to March 2004 were retrospectively analyzed. The methods of biopsy were ultrasonography guided core biopsy (CB), fine needle aspiration biopsy (FNAB) and excisional biopsy. RESULTS: Out of 28 patients, half were boys. The most common location of the mass was the posterior cervical area (N=19, 67.9%). Laboratory findings of peripheral blood and serologic studies were nonspecific. In 25 (89.3%) cases, CB or FNAB was initially performed for neck masses. Among them 10 cases (40%) were reactive hyperplasia, 8 (32%) inflammatory granulation tissues, 4 (16%) necrotizing lymphadenitis, and 3 (12%) acute suppurative inflammations. Initially, excisional biopsy was performed for diagnosis in 3 (10.7%) cases. Diagnosis of these cases was thyroglossal duct cyst, dermoid cyst and lymphoblastic lymphoma, respectively. CONCLUSION: Most neck masses in children were benign. CB and FNAB were safe methods for tissue sampling, without need for general anesthesia.
Anesthesia, General ; Biopsy* ; Biopsy, Fine-Needle ; Child* ; Chungcheongnam-do ; Dermoid Cyst ; Diagnosis ; Granulation Tissue ; Humans ; Hyperplasia ; Inflammation ; Lymphadenitis ; Medical Records ; Neck* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Thyroglossal Cyst ; Ultrasonography

BACKGROUND: Doctors' white coats and neckties can become contaminated with potentially pathogenic bacteria and have a possibility of causing cross infections. Our objective was to determine the level of bacterial contamination and detect methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and Clostridium difficile present on the white coats and neckties of residents. METHODS: We sampled 28 long-sleeved white coats and 14 neckties worn by residents. The tested sites for white coats were the cuffs and lower front surfaces, and for neckties, the lower surfaces. Impressions of these sites were taken with the plates containing blood agar (BAP), mannitol salt agar supplemented with oxacillin (6microgram/mL), enterococcus screening agar supplemented with vancomycin (6microgram/mL) and phenyl ethanol agar. The colonies grown on each plate were Gram stained and identified by standard microbiological methods. RESULTS: Of the 28 white coats, 7 (25.0%) carried MRSA, and of the 14 neckties, 1 (7.1%) carried MRSA. The majority of white coats (96.4%) and all neckties (100.0%) carried methicillin-resistant coagulase negative staphylococci (MRCNS). None of the white coats and neckties carried VRE or C. difficile. CONCLUSION: Our results showed that white coats and neckties worn by residents were contaminated with MRSA and MRCNS. The preventive measures for clothing-borne cross contamination should be considered, especially when performing invasive procedures or having close contact with patients.
Agar ; Bacteria ; Clostridium difficile ; Coagulase ; Cross Infection ; Enterococcus ; Ethanol ; European Continental Ancestry Group ; Humans ; Mannitol ; Mass Screening ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Vancomycin

BACKGROUND: We performed surveillance cultures of the surfaces of X-ray cassettes to assess contamination with methicillin-resistant Staphylococcus aureus (MRSA). METHODS: The surfaces of 37 X-ray cassettes stored in a radiology department were cultured using mannitol salt agar containing 6 microg/mL oxacillin. Suspected methicillin-resistant staphylococcal colonies were isolated and identified by biochemical testing. Pulsed-field gel electrophoresis (PFGE) analysis was performed to determine the clonal relationships of the contaminants. RESULTS: Six X-ray cassettes (16.2%) were contaminated with MRSA. During the isolation procedure, we also detected 19 X-ray cassettes (51.4%) contaminated with methicillin-resistant Staphylococcus haemolyticus (MRSH), identified as yellow colonies resembling MRSA on mannitol salt agar. PFGE analysis of the MRSA and MRSH isolates revealed that most isolates of each organism were identical or closely related to each other, suggesting a common source of contamination. CONCLUSIONS: X-ray cassettes, which are commonly in direct contact with patients, were contaminated with MRSA and MRSH. In hospital environments, contaminated X-ray cassettes may serve as fomites for methicillin-resistant staphylococci.
Anti-Bacterial Agents/pharmacology ; Diagnostic Equipment/*microbiology ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus/drug effects/*isolation & purification ; Microbial Sensitivity Tests ; Oxacillin/pharmacology ; Staphylococcus haemolyticus/drug effects/*isolation & purification

No abstract available.
Pulmonary Atresia*

PURPOSE: Mesangial cell extracellular matrix (ECM) synthesis plays an important role in various renal diseases. Mycophenolic acid (MPA), which is an inhibitor of inosine monophosphate dehydrogenase (IMPDH), inhibits mesangial cell proliferation and ECM synthesis. However, the exact mechanism of MPA has not been clearly elucidated in mesangial cells. To examine the relative importance of IMPDH on the inhibitory action of MPA, we compared the effects of MPA or IMPDH2 siRNA on platelet-derived growth factor (PDGF)-induced fibronectin secretion and cellular reactive oxygen species (ROS) in mouse mesangial cells (MMC). METHODS: MMC were stimulated with PDGF 10 ng/ml with or without MPA 0.1~10micrometer, IMPDH2 siRNA 10~50 nM, or N-acetylcystein (NAC). IMPDH2 siRNA was transiently transfected by lipofectamine for 24 hours. MPA 0.1~10micrometer, ribavirin 10~100micrometer, and NAC 5 mM were administered 1 hour before the stimulation. Cell viability was measured by methylthiazoletetrazolium (MTT) assay, fibronectin secretion by Western blot analysis, and dichlorofluorescein (DCF)-sensitive cellular ROS by flow cytometry. RESULTS: PDGF 10 ng/ml effectively increased fibronectin secretion and cellular ROS in MMC. MPA and NAC at concentration without affecting basal level of fibronectin and cellular ROS ameliorated PDGF-induced fibronectin secretion and cellular ROS. However, IMPDH2 siRNA only partially reduced PDGF- induced fibronectin secretion and cellular ROS in MMC. CONCLUSION: These results suggest that MPA may inhibit PDGF-induced fibronectin secretion partly through IMPDH2 or cellular ROS in MMC, and there may be other mechanisms on the inhibitory action of MPA in mesenchymal cells.
Animals ; Blotting, Western ; Cell Survival ; Extracellular Matrix ; Fibronectins* ; Flow Cytometry ; Inosine Monophosphate* ; Inosine* ; Mesangial Cells* ; Mice* ; Mycophenolic Acid ; Oxidoreductases* ; Platelet-Derived Growth Factor ; Reactive Oxygen Species* ; Ribavirin ; RNA, Small Interfering