BACKGROUND: Peripheral blood stem cell transplantation in children has some difficulties compared with adult cases. Despite the children's total blood volume is small, they have a relatively higher volume of blood per weight than adults. Also, it is hard for the children to maintain 2 central vein during leukapheresis to shorten the time consumed. We compared the artery-harvest and central vein-harvested group for possible risk and stem cell yield in pediatric patients with malignancies. METHODS: From August, 1995 to January, 1997, 21 leukapheresis was performed by 7 patients. The patients who could have 2 central veins for leukapheresis were included in vein-harvested group and the patients who could have only 1 central vein were included in artery-harvested group. The peripheral vein was not used for leukapheresis. COBE Spectra(COBEBCT, Lakewood, CO) was used and priming was done by packed RBCs in patients weighing less than 20kg. Stem cell yield was assessed by MNC, CD34+, CFU-GM, respectively. During leukapheresis, the patients were closely monitored for change in vital sign, evidence for thrombosis, bleeding, hypocalcemia, etc. RESULTS: There was no serious complication in each group of patients. After the leukapheresis, WBC and platelet count decreased but Hb level was increased due to reinfusion of primed packed RBCs. Average flow rate was higher in vein-harvested group but there was no difference in time consumed and results in stem cell assay. CONCLUSION: Peripheral stem cell harvest in children by radial artery can be performed safely and easily without an increased risk or complication. In younger children, it is possible to achieve even more higher stem cell yield. If the patient is unable to maintain 2 central vein for leukapheresis, transient radial arterial catheterization is a safe and convenient method.
Adult ; Blood Volume ; Catheterization* ; Catheters* ; Child ; Colony-Forming Units Assay ; Granulocyte-Macrophage Progenitor Cells ; Hemorrhage ; Humans ; Hypocalcemia ; Leukapheresis ; Peripheral Blood Stem Cell Transplantation ; Platelet Count ; Radial Artery ; Stem Cells* ; Thrombosis ; Veins ; Vital Signs

BACKGROUND: Whether or not the excitation-contraction (EC) uncoupler, diacetyl monoxime (DAM) and cytochalacin D (Cyto D) alter the ventricular fibrillation activation patterns is unclear. METHODS: We recorded single cell action potentials and performed optical mapping in isolated perfused swine right ventricles at different concentrations of DAM and cyto D during ventricular fibrillation and dynamic pacing. RESULTS: Increasing concentration of DAM results in progressively shortened action potential duration measured to 90% repolarization (APD90), reduced slope of the action potential duration restitution(APDR) curve, decreased Kolmogorov-Sinai entropy, and reduced number of ventricular fibrillation wavefronts. In all right ventricles, 15 to 20 mmol/l DAM converted ventricular fibrillation to ventricular tachycardia. The ventricular fibrillation could be reinduced after the DAM was washed out. In comparison, cyto D (10 to 40 mol/l) has no effects on APDR curve or the dynamics of ventricular fibrillation. The effects of DAM on ventricular fibrillation are associated with reduced number of wavefronts and dynamic complexities in ventricular fibrillation. CONCLUSION: These results are compatible with Restitution Hypothesis of ventricular fibrillation and suggest that DAM may be unsuitable as an EC uncoupler for optical mapping studies of ventricular fibrillation in the swine right ventricles.
Action Potentials ; Diacetyl ; Entropy ; Heart Ventricles* ; Swine* ; Tachycardia, Ventricular ; Ventricular Fibrillation*

No abstract available.
Hemosiderosis* ; Humans ; Kidney Failure, Chronic* ; Seizures*

So many modalities have been suggested for the treatment of servere pain and ankylosis of the elbow with destruction of the articular surfaces. Among them, two major methods which have been widely used are resection arthroplasty and prosthetic replacement arthroplasty. However prosthetic replacement arthroplasty has some problems. Its indications are limited in the elderly inactive subjects. And there have been many kinds of complications including loosening and infection. Also, resection arthroplasty in now rarely indicated due to severe instability. From July 1980 to July 1987, we tried distraction arthroplasty in 8 cases of elbow with severe destruction of its articular surfaces, mainly in the young active persons. The average follow-up period was 45 months. The effect of distraction arthroplasty on relief of pain was not remarkable. The average increase in ROM, including that of one reankylosed elbow, was 51 ±22 degrees in flexion-extension and 48 ±23 degrees in pronstion-supinstion. No deep wound infection and instability which was main complication of resection arthroplasty were observed with our method of distraction arthroplasty. On the basis of functional results, the the results were excellent in 4, good in 1, fair in 2 and poor in 1 cases. In conclusion, distraction arthroplasty of the elbow can be one of the of effective methods reconstruction for the young active patients with the destruction of the elbow, if they are intelligent and motivated.
Aged ; Ankylosis ; Arthroplasty ; Arthroplasty, Replacement ; Elbow ; Follow-Up Studies ; Humans ; Methods ; Wound Infection

BACKGROUND: Total occlusion of the infrarenal abdominal aorta is a very rare disease in clinical practice. The clinical outcome may be poor unless management is attempted promptly. Surgical bypass has been recommended as the treatment of choice for these lesions. However, there was relatively high surgical mortality and morbidity associad with aorto-bifemoral bypass graft in patients with other systemic disease, especially coronary artery disease. As a result, the use of, thrombolysis with percutaneous transluminal angioplasty (PTA) has recently been extended to this disease as an alternative method to surgery. PTA is technically simpler with less morbidity and mortality than surgery.We report our experience with thrombolysis and balloon angioplasty of total aortic occlusion in 14 patients between March 1991 and December 1996. METHODS: Fourteen patients, whose mean age was 59+/-13 years (11 male, 3 female), serve as the study's patients. Aortography was introduced via transbrachial artery. The end hole multipurpose catheter with guidewire was introduced into the thrombotic portion of the total occlusion. Urokinase was infused into the thrombus through the catheter if there were no contraindications. in sysremic thrombolysis. Thrombolytic therapy was continued until the thrombi was resolved and flow was restored. Balloon dilatation was followed in residual stenotic lesions. Stents were implanted in case of suboptimal results after ballooning. RESULTS: Clinical findings were resting leg pain in 6 patients, gangrene in 5 patients, and claudication in 3 patients. The causes of aortic occlusion were thromboembolism in 4 patients and thrombosis of an atherosclerotic aorta in 10 patients. Location of obstruction was below the renal artery in all cases. The clinical outcome of interventional therapy was successful in all cases except one patients. Operative treatment was undertaken in 2 cases because they could not received thrombolytic therapy due to contraindication and complication of thrombolytic therapy (gastrointestinal bleeding). Near normal revascularization was achieved in 3 patients by thrombolytic therapy only. PTA was performed at the stenotic after thrombolytic therapy in 4 patients. Stenting were performed at the stenotic sites after balloon dilatation in another 4 patients. There was bleeding complication in one case. CONCLUSIONS: Interventional therapy such as thrombolytic therapy with PTA is an effective and safe treatment modality for abdominal aortic total occlusion in selected cases. These techniques were very useful in some high risk patients who received surgical bypass procedures.
Angioplasty ; Angioplasty, Balloon ; Aorta ; Aorta, Abdominal* ; Aortography ; Arteries ; Catheters ; Coronary Artery Disease ; Dilatation ; Gangrene ; Hemorrhage ; Humans ; Leg ; Male ; Mortality ; Rare Diseases ; Renal Artery ; Stents ; Thromboembolism ; Thrombolytic Therapy ; Thrombosis ; Transplants ; Urokinase-Type Plasminogen Activator

Pfeiffer syndrome, an unusual type of acrocephalosyndactyly, is a complex of associated malformations, first described by Pfeiffer in 1964. In addition to the common head and face anomalies seen in other acrocephalosyndactylies, its characteristics are broad thumbs and big toes, minimal syndactyly and normal intelligence. It is inherited in autosomal dominant pattern and shows various clinical features. The author's case was a 7-year old boy, who had been managed since birth for bilateral congenital resistant clubfeet including cast correction for six months and two operations. At present he represents not only the common features described above but also some unique features, e.g. pectus excavatum, posterior dislocation of both elbows, mild genu valgum, metatarsus adductus and complex malalignment of carpal and tarsal bones. To our knowledge, there is no report on Pfeiffer syndrome in Korea. The authors report a case of Pfeiffer syndrome with review of literatures.
Acrocephalosyndactylia ; Dislocations ; Elbow ; Funnel Chest ; Genu Valgum ; Head ; Humans ; Intelligence ; Korea ; Male ; Metatarsus ; Parturition ; Syndactyly ; Tarsal Bones ; Thumb ; Toes

BACKGROUND: Several different patterns of wavebreak have been described by mapping of the tissue surface during fibrillation. However, it is not clear whether these surface patterns are caused by multiple distinct mechanisms or by a single mechanism. METHODS: To determine the mechanism by which wavebreaks are generated during ventricular fibrillation, we conducted optical mapping studies and single cell transmembrane potential recording in 6 isolated swine right ventricles. RESULTS: Among 763 episodes of wavebreak (0.75 times/sec/cm2), optical maps showed 3 patterns: 80% due to a wavefront encountering the refractory waveback of another wave, 11.5% due to wavefronts passing perpendicularly each other and 8.5% due to a new (target) wave arising just beyond the refractory tail of a previous wave. Computer simulations of scroll waves in 3-D tissue showed that these surface patterns could be attributed to two fundamental mechanisms: head-to-tail interactions and filament break. CONCLUSION: We conclude that during sustained ventricular fibrillation in swine RV, surface patterns of wavebreak are produced by two fundamental mechanisms: head-to-tail interaction between waves and filament break.
Computer Simulation ; Heart Ventricles* ; Membrane Potentials ; Swine* ; Ventricular Fibrillation*

A synophthalmia, another form of cyclopia, in which the element of the two eyes are partially fused to form an apparently single eye in the middle of the forehead. The synophthalmia is a result of complex, neural plate misdevelopment syndrome involving the eye, brain, skull and face. It is well known that synophthalmia is due to heterogenous causes, most of which chromosomal imbalances. We experienced a case of synophthalmia associated with proboscis, alobar holoprosencephaly and chromosomal anomaly 46, XX, -15,t (15 q, 21 q). Diagnosis was confirmed by brain MRI and autopsy, The patient died about 20 hours of age and autopsy was done. A brief review of the literatures was also presented.
Autopsy ; Brain ; Diagnosis ; Forehead ; Holoprosencephaly ; Humans ; Magnetic Resonance Imaging ; Neural Plate ; Skull

Torsades de pointes, a polymorphic ventricular tachycardia associated with prolonged QT interval, is a well-known life-threatening arrhythmia, which has been found to be induced by various causes such as drugs, electrolyte imbalances, and severe bradycardia. Cisapride is a gastrointestinal prokinetic drug, which is widely used to treat gastroesophageal reflux disease or other functional gastrointestinal disorders. Cisapride can cause torsades de pointes and cases of torsedes de pointes induced by cisapride have been reported in other countries. Cases of torsades de pointes associated with antihistamine drugs have been reported in Korea, however, cisapride-induced torsades de pointes case has not been reported. We report a case of 31 year-old female patient who experienced repeated loss of consciousness due to cisapride-induced torsades de pointes.
Adult ; Arrhythmias, Cardiac ; Bradycardia ; Cisapride* ; Female ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Humans ; Korea ; Tachycardia, Ventricular ; Torsades de Pointes* ; Unconsciousness

Radiofrequency catheter ablation (RFCA) has been established as an effective and safe treatment modality for atrioventricular nodal reentrant tachycardia and WPW syndrome. Surgical ablation or direct current catheter ablation had been performed to cure focal atrial tachycardia (AT), however, these treatments had limitations such as the need of open thoracotomy or the risk of barotrauma. RFCA could be an effective treatment modality for cure of AT. We performed RFCA for AT in 22 patients (male 13, mean age 38.1+/-15.4 years) among 831 patients who underwent electrophysiologic study between Jul. 1996 and May. 1999. Clinical pattern of tachycardia was paroxysmal (17 patients) or incessant (mean duration of symptoms, 41.1+/-42.3 months). Associated cardiac diseases were tachycardia-mediated cardiomyopathy (3 patients), aortic stenosis (1 patient) and ventricular septal defect with pulmonic stenosis (1 patient). AT was induced by programmed electrical stimulation in 17 patients: AT in the other 5 patients was incessant. The RFCA was successful in 17 patients (77.3%). The mean interval between atrial electrogram of mapping catheter and P wave of surface ECG was -53.5+/-24.9msec in 17 successful sites. Fractionated atrial activities were invariably found in the successful sites. Successful sites of RFCA for right AT were around coronary sinus ostium (5), crista terminalis (4), lower portion of sinus node (1), inferior portion of tricuspid annulus (1), and His area (1), respectively. In left AT, lateral portion near atrioventricular groove (2), inferoposterior portion (2) and near left atrial appendage (1) were successful site. During follow-up (mean 23 months), one patient had recurrence (recurrence rate 5.9%). RFCA for AT is an effective and curative treatment in selected cases.
Aortic Valve Stenosis ; Atrial Appendage ; Barotrauma ; Cardiomyopathies ; Catheter Ablation* ; Catheters ; Coronary Sinus ; Electric Stimulation ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Follow-Up Studies ; Heart Diseases ; Heart Septal Defects, Ventricular ; Humans ; Pulmonary Valve Stenosis ; Recurrence ; Sinoatrial Node ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Thoracotomy ; Wolff-Parkinson-White Syndrome