Evlauation of pulmonary vascular changes and pre-and postoperative hemodynamic findings were performed in 25 patients who had ventricular septal defect associated with sevese pulmonary hypertension. Lung biopsy were done preoperatively in two patients and during operation in twenty three patients. Also the postoperative systemic and polmonary arterial pressure were obtained about 10-20 minutes after the cardiopulmonary bypass. The results were as follow: 1) There was no relationship between the severity of pulmonary vascular changes(Health-Edwards classification) and the patients age(X2=4.4427, P=0.2175). 2) There was a good correlation between preoperative ratio of pulmonary to systemic vascular resistance(Rp/Rs) and ratio of pre-and postoperative pulmonary to systemic arterial pressure(r=0.4846, P<0.05). 3) There was a significant correlation between the degree of medial wall thickness and preoperative Rp/Rs(r=0.6535, P<0.005). 4) There was no correlation between perioperative hemodynamic findings and medial wall thickness in the patients aged below 2 years.
Arterial Pressure ; Biopsy ; Cardiopulmonary Bypass ; Heart Septal Defects, Ventricular* ; Hemodynamics* ; Humans ; Hypertension, Pulmonary ; Lung

No abstract available.
Eating* ; Foreign Bodies*

BACKGROUND: Pancreatic pseudocysts are localized collections of pancreatic secretions in a cystic structure that lack an epithelial lining and occur as a result of surrounding tissues walling off and containing a pancreatic duct disruption. METHODS: This is paper presents a clinical analysis of 32 cases of pancreatic pseudocysts treated from January 1987 to July 1997 at Pusan Medical Center. RESULTS: The results are summarized briefly as follows: 1) The age and the sex distributions of these patients showed that 19 cases occurred between the 3rd and the 4th decades and the male-to-female ratio was 10.3:1. 2) Pancreatitis was most frequently associated with pancreatic pseudocysts (75%). 3) Common clinical manifestations were abdominal pain (89%), abdominal tenderness (78%), nausea and vomiting (56%), abdominal mass (32%), abdominal distension (31%). 4) Abdominal CT and ultrasound were major diagnostic methods. 5) The location of the peudocysts were the body (41%), head and tail (31%), the tail (22%), and others (6%). 6) The sizes of the pseudocysts were as follows less than 5 cm (5 cases), 5-10 cm (19 cases), above 11 cm (8 cases) in 32 cases. 7) Valuable laboratory data for a pancreatic pseudocyst were blood WBC count (above 10,000/mm in 78%), serum amylase (above 160 unit/L in 62%), urine amylase (above 300 unit/L in 56%), blood glucose (above 110 mg/L in 50%), serum alkaline phosphatase (above 250/L in 44%). 8) The surgical methods in 29 cases were excision (1 case), external drainage (4 cases), cystogastrostomy (7 cases), cystojejunostomy (16 cases), cystoduodenostomy (1 case). 9) Postoperative complications were encountered in 13 cases, and many of the cases involved pulmonary complications and wound infections. CONCLUSIONS: Currently, treatment of patients with pancreatic pseudocysts is based on the clinical setting, the presence or absence of symptoms, the age and size of the pseudocyst, and the presence or absence of complications. In the most common clinical settings, a pseudocyst is discovered after an episode of acute alcoholic pancreatitis.
Abdominal Pain ; Alkaline Phosphatase ; Amylases ; Blood Glucose ; Busan ; Drainage ; Head ; Humans ; Nausea ; Pancreatic Ducts ; Pancreatic Pseudocyst* ; Pancreatitis ; Pancreatitis, Alcoholic ; Postoperative Complications ; Sex Distribution ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting ; Wound Infection

PURPOSE: Leptin is the product of the of gene secreted by adipocyte. The serum leptin concentration reflects the amount of adipose tissue in the body. We investigated whether leptin concentration was detectable in cord blood of newboms and assessed the effect of gestational age, birth weight, birth length, placental weight, body mass index and ponderal index on cord blood leptin concentration in full-term and preterm newboms. METHODS: Eighty-two newboms were enrolled in this study. Standard growth curves were used to categorize infants as appropriate (AGA), large (LGA), or small for gestational age (SGA). Gestational age, birth weight, length and placental weight were measured. Maternal age, weight and height were measured. Cord blood and maternal venous samples were collected and serum was separated and stored at -70C. Leptin was measured by radioimmunoassay. RESULTS: The mean leptin concentration in full term babies was 8.9+/-9.6 ng/ml compared with 3.5+/-0.6 ng/ml in preterm babies. Leptin concentrations in cord blood of full term babies were significantly increased in cornparison with those in cord blood of preterm babies. Mean serum leptin concentration of SGA infants was significantly lower than in AGA infants and that of LGA was higher than in AGA infants. In full-term and preterm neonates, there was significant positive correlation of leptin concentrations with birth weight, gestational age, birth length, BMI, ponderal index and placental weight. No gender differences were found in cord blood leptin. Maternal age, maternal body mass index, matemal weight at baseline (before pregnancy) and at birth were not significantly correlated with leptin concentration of full-term and preterm neonates. There was no significant correlation between leptin concentration of cord blood and matemal leptin concentration. CONCLUSION: The serum leptin concentration is highly correlated to the size of adipose tissue mass of newborn infant. Leptin may be responsible for regulation of body mass of human neonates and can be used as marker of the nutritional status and growth of fetal and neonatal period.
Adipocytes ; Adipose Tissue ; Birth Weight ; Body Mass Index ; Body Weight ; Fetal Blood* ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Leptin* ; Maternal Age ; Nutritional Status ; Parturition ; Radioimmunoassay

Despite recent advances in nutritional support, patient monitoring, and surgical intensive care, as well as some improvement in surgical techniques, post-operative fistulas have been regarded as one of the most serious complications in abdominal surgery. The present study was undertaken to evaluate the effectiveness of treatment with total parenteral nutrition (TPN) alone (group A, n=26) or with TPN combined with octreotide, a long-acting analog of somatostatin (group B, n=20) in post-operative enterocutaneous fistulas. In group A, we treated 2 biliary, 10 pancreatic and 14 intestinal cutaneous fistulas with total parenteral nutrition. In group B, we treated 6 biliary, 8 pancreatic and 6 intestinal cutaneous fistulas with octreotide. The results obtained from the analysis are as follows: 1) The spontaneous closure of the fistulas was 69.2% in group A and 75.0% in group B. 2) The mean interval of time to achieve the healing of the fistula was 30.44 days in group A and 14.53 days in group B. 3) The mean interval of time to achieve a fistula output reduction of 50% was 6.44 days in group A and 2.44 days in group B. 4) In patients with low-output fistulas, the spontaneous closure of the fistula was 81.8% in group A and 80.0% in group B. In patients with high-output fistulas, the spontaneous closure of the fistula was 60.0% in group A and 73.3% in group B. 5) In patients with low albumin (< 3.0 g/dl), the spontaneous closure of the fistula was 54.5% in group A and 50.0% in group B. In patients with high albumin (> or = 3.0 g/dl), the spontaneous closure of the fistula was 80.0% in group A and 85.7% in group B. 6) In patients with an abdominal abscess, the spontaneous closure of the fistula was 40.0% in group A and 40.0% in group B. In patients without an abdominal abscess, the spontaneous closure of the fistula was 87.5% in group A and 86.7% in group B. 7) As compared with TPN, the spontaneous closure of the fistulas treated with octreotide was increased in the gastroduodenum and the external biliary system, was similar in the small bowel and the pancreas, but was decreased in the colon. We conclude that octreotide is a useful therapeutic complement in the conservative treatment of selected patients with post-operative cutaneous fistulas, especially fistulas in the external biliary system and the gastroduodenum.
Abdominal Abscess ; Biliary Tract ; Critical Care ; Colon ; Complement System Proteins ; Cutaneous Fistula ; Fistula ; Humans ; Intestinal Fistula* ; Monitoring, Physiologic ; Nutritional Support ; Octreotide ; Pancreas ; Parenteral Nutrition, Total ; Somatostatin

Platelet-derived growth factor(PDGF) is known to accelerate soft tissue fracture and periodontal bone healing, but little information is available for characterizing the healing of articualr cartilage. This study was designed to demonstrate the regeneration potential of pasteurized autogeneous osteochondral graft when PDFG was applied locally in vivo. Eighteen rabbits in two groups were used in the experiment. The free osteochondral fragment(1x1x1 cm) were taken from distal femur. The fragment were pasteurized in 65degrees C for 5 minutes. In experimental group(group II), the fragment were soaked in 0.25 mg/ml of recombinant human PDGF mixed 5 ml normal saline and reimplanted to the resected site, and followed with local administration of 0.25 mg/ml PDGF to knee joint. In control group(group I), the pasteurized fragment were reimplanted in the resected site without any treatments. The histologic characteristics of the transplanted autografts for three rabbits in each group were observed at 3, 5 and 7 weeks postoperatively. The results were as follows; Group II revealed the more favorable regeneration of articular cartilage, less arthritic changes and more mature arrangement of chondrocytes than group I. Even thought the cartilage is avascular and the regeneration capacity of pasteurized cartilage is severely limited, the regeneration of grafted articular cartilage is thought to be accellerated by increased newly formed blood vessels and soft tissues due to the diffusion of PDGF on grafted cartilage, and probably also by differentiation of mesenchymal cells in the initial stage of experiment. The results of this study suggest that local administration of PDGF could be used for the treatment of posttraumatic or degenerative arthritis and various cartilage damages.
Autografts ; Blood Vessels ; Cartilage ; Cartilage, Articular ; Chondrocytes ; Diffusion ; Femur ; Humans ; Knee Joint ; Osteoarthritis ; Platelet-Derived Growth Factor* ; Rabbits* ; Regeneration* ; Transplants*

No abstract available.
Hyperamylasemia*

Cubitus varus deformity is the late complication of the supracondylar fracture of humerus which is common in growing children. If the deformity is severe it causes tunctional problems as well as cosmetic ones necessitating conective osteotomy. Though many authors devised different methods of corrective osteotomy, the cosmetic results are not always satisfactory because of the development of the lazy S deformity hy the lateral prominence. Technically. the initial stahility of the osteotomy is also poor due to the poor contact of the osteotomy site. So we have devised a new quadrilateral displacement osteotomy to increase the initial stability of the osteotomy by creating a wedge on the osteotomy site & also to prevent the development of the lazy S deformity hy elimination of the Interal prominence. We treated 9 cases of cubitus varus deformity with the new quadrilateral displacement osteotomy. The correction technique was not difficult & the initial stahility of the osteotomy is rather good & the osteotomy is fixed by the conventional methods, & all of the cases were healed uneventfully. There developed no the lazy & deformity after osteotomy. We would like to report the details ot the supracondylnrquadrilateral displacemenl osteotomy.
Child ; Congenital Abnormalities* ; Humans ; Humerus ; Osteotomy*

Cryptococcal meningoencephalitis is one of the most cornInon fungal infections of the central nervous system, which mainly affects immunocompromised hosts, especially AIDS patients and patients with long-term steroid therapy. In advanced cases, it causes various complications such as encephailitis, hydrocephalus, and even death if not treated or inadequately treated. Authors have treated a case of cryptococcal meningoencephalitis with focal cerebellar lesion, whose primary infection sources were thought to be right frontal sinus and the ethmoidal sinus, with combination chemotherapy of amphotericine B and flucytosine.
Amphotericin B ; Central Nervous System ; Drug Therapy, Combination ; Flucytosine ; Frontal Sinus ; Humans ; Hydrocephalus ; Immunocompromised Host ; Meningoencephalitis*

Nineteen patients with benign pancreatic disease were managed with surgical treatment in Pusan Medical Center during three years from September 1993 to September 1995 and the results were reviewed retrospectively. The results were as follows; 1) This report includes five cases of severe(hemorrhagic in one case and necrotizing in four cases) acute pancreatitis,eight cases of pancreatic inury,three cases of pancreatic pseudocyst and three cases of chronic pancreatitis. 2)The most common etiology of benign pancreatic disease, excluding pancreatic injury, was alcohol ingestion. 3)Five cases of severe acute pancreatitis were represented with more than 4 of Ranson's prognostic factors and the surgical methods refered were external drainage with debridment or necrosectomy. All were effectively managed surgically except one case of death which had more than 6 of Ranson's prognostic factors. 4)The etiology of pancreatic injury was blunt abdominal trauma in seven cases and surgical complications in one case. The sites of injury were head in three cases,body in three cases and tail in one case. The operative methods used were drainage(all cases),distal pancreatectomy(3 cases),triple ostomy(1 case) and pancreaticoduodenectomy(1 case). 5)The sites of pancreatic pseudocysts were the body in two cases, head in one case. The operative method used was as follows; excision in one case, external drainage in one case and cystojejunostomy in one case. 6)Three cases of the chronic pancreatitis were diagnosed by intraoperative findings. 7)In conclusion, the most reliable treatment for benign pancreatic disease is early surgical intervention, in order to reduce the mortality rate and complications induced by pancreatic inflammation.
Busan ; Drainage ; Eating ; Head ; Humans ; Inflammation ; Mortality ; Pancreatic Diseases* ; Pancreatic Pseudocyst ; Pancreatitis ; Pancreatitis, Chronic ; Retrospective Studies