A totally implanted venous access system was inserted in 19 children with cancer. The devices were utilized for the administration of antineoplastic drugs, parenteral fluids, antibiotics, and blood products. Total duration of implantation was 4,046 days for 23 implanted system (range 7-445 days). Complications included cather infection (0.247/100 catheter days), occlusion (0.692/100 catheter days), and dislodgement of needle (0.643/100 catheter days). There were major complications that necessitated removal of catheters, including systemic infections (0.09/100 catheter days) and complete occlusions (0.09/100 catheter days). The system was thought to be safe and convenient in chemotherapy, and permitted full physical activity.
Anti-Bacterial Agents ; Antineoplastic Agents ; Catheters ; Child* ; Drug Therapy ; Humans ; Motor Activity ; Needles ; Prospective Studies*

PURPOSE: Surgical excision has been the primary treatment for hepatoblastoma and hepat-ocellular carcinoma. However, at presentation, only one third of such tumors are surgically resectable. Without operation, the disease is fatal. Therefore, neoadjuvant chemotherapy has been introduced for conversion of the unresectable tumors into the resectable ones. We studied th e effects of chemotherapy for hepatic malignancy in children. METHODS: Between November 1986 and August 1993, 30 children presented with hepatoblastomas or heptocellular carcinoma, which were diagnosed by histology. We analysed the laboratory findings of hepatic tumors and the outcome of chemotherapy. RESULTS: Laboratory findings revealed mild anemia, elevated SGOT/SGPT, and extremely increased AFP level. Twenty-six among 30 patients entered into surgery or neoadjuvant chemotherapy. Initial complete resection of tumor was attempted in 11 case, and was successful in 9 cases. Fifteen cases with initially unresectable tumors were treated with chemotherapy including cisplatin and/or doxorubicin. Nine of 15 showed significant reduction in tumor size, and delayed resection of the primary lesion was possible. But one case did not respond to chemotherapy, and 5 cases was droped out due to death(n=2) and refusal of chemotherapy(n=3). Twenty p atients were enrolled in survival analysis. Over-all 3 year survival rate was 61%, and 2 year survival rates of hepatoblastoma and hepatocellular carcinoma were 85% and 33% respectively(P=0.06). According to the stage, 2 year survival rate of stage I and III were 87% and 75% respectively. None of patient with metastasis survived at 16 months. Chemotherapy was tolerable in most patients and its principal toxicities were myelosuppression and fever. Three patients developed decreased left ventricular shortening fraction and their cumulative dose of doxorubicin were 771mg/m2, 557mg/ m2, and 390mg/ m2. CONCLUSIONS: Chemotherapy including cisplatin and/or doxorubicin is an effective treatment in inducing surgical resectability in hepatoblastomas which are unresectable at diagnosis.
Anemia ; Carcinoma, Hepatocellular* ; Child* ; Cisplatin ; Diagnosis ; Disulfiram ; Doxorubicin ; Drug Therapy* ; Fever ; Hepatoblastoma* ; Humans ; Neoplasm Metastasis ; Survival Rate

Diaphragm injuries are very important because, if both thoracic and abdominal viscera are damaged, a combination of shock and acute respiratory distress may develop. It can be highly lethal. This evaluation was based on the reviews of 17 cases of traumatic diaphragm injuries treated at the Department of Cardiovascular Surgery, Seoul Adventist Hospital during 5 years from March 1993 to February 1997. The mean age of the patients was 37.2 years and sex ratio was 3.2:1 with male dominance. Blunt trauma(N=5, Rt.=4, Lt.=1) was 29.5%, penetrating trauma(N=12, Rt.=5, Lt.=7) was 70.5%. Dyspnea(76%) was the most common symptom. Blunt trauma(9.8 3.7 Cm) was larger than the penetrating trauma(3.2 1.3 Cm)(P<0.05) in the size(mean SD) of the injury. All of the patients had associated injuries and repaired immediatley with thoracic approach 11 cases(64%), abdominal approach 3 cases(18%) and thoracoabdominal approach 3 cases(18%). 5 cases of penetrating diaphragmatic trauma was diagnosed on the operation of other organ injury. Now we suggest that diaphragmatic injury should be suspected in all patients with penetrating as well as blunt injury of the chest and abdomen to protect the patient from its late complications.
Abdomen ; Diaphragm ; Humans ; Male ; Seoul ; Sex Ratio ; Shock ; Thorax ; Viscera ; Wounds, Nonpenetrating

No abstract available.
Anemia, Dyserythropoietic, Congenital*

The aims of this study were to estimate the incidences of BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions in childhood acute lymphoblastic leukemia (ALL), to identify new abnormalities, and to demonstrate the usefulness of interphase fluorescence in situ hybridization (FISH). We performed G-banding analysis and FISH using probes for BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions on 65 childhood ALL patients diagnosed and uniformly treated at a single hospital. Gene rearrangements were identified in 73.8% of the patients using the combination of G-banding and FISH, while the chromosomal abnormalities were identified in 49.2% using G-banding alone. Gene rearrangements were disclosed by FISH in 24 (72.7%) of 33 patients with normal karyotype or no mitotic cell in G-banding. Among the gene rearrangements detected by FISH, the most common gene rearrangement was p16 deletion (20.3%) and the incidences of others were 14.1% for TEL/AML1, 11.3% for MLL, and 1.8% for BCR/ABL translocations. Infrequent or new aberrations such as AML1 amplification, MLL deletion, ABL deletion, and TEL/AML1 fusion with AML1 deletion were also observed. We established the rough incidences of gene rearrangements in childhood ALL, found new abnormalities and demonstrated the diagnostic capability of interphase FISH to identify cryptic chromosome aberrations.
Adolescent ; Child ; Child, Preschool ; *Chromosome Aberrations ; Chromosome Banding ; DNA-Binding Proteins/*genetics ; Female ; Fusion Proteins, bcr-abl/*genetics ; Gene Deletion ; *Gene Rearrangement ; Humans ; In Situ Hybridization, Fluorescence ; Infant ; Interphase ; Leukemia, Lymphocytic, Acute/*genetics ; Male ; Oncogene Proteins, Fusion/*genetics ; Protein p16/*genetics ; Proto-Oncogenes/*genetics ; Transcription Factors/*genetics ; Treatment Outcome

A patient, 59 years old male, with paroxysmal AV reentrant tachycardia utilizing a concealed left lateral accessory pathway with long VA conduction time is presented. During tachycardia P waves were negative in leads I, aVL, and V6 and positive in leads aVR and V1. The R-P/P-R ratio was 1.6. Radiofrequency catheter ablation was successful to interrupt the VA conduction through the accessory pathway.
Catheter Ablation ; Humans ; Male ; Middle Aged ; Tachycardia*

BACKGROUND: A paradoxical embolism through the patent foramen ovale has been suggested as a possible cause of ischemic cerebrovascular disease in young patients without other cardiovascular risk factors, however, the transesophageal contrast echocardiographic examination is proved to be sensitive and accurate to detect the patent foramen ovale in vivo by demonstration a right-to-left shunting of microbubbles at the interatrial septum. METHODS: Transesophageal contrast echocardiographic examinations were performed in 16 young patients(32+/-6 years, 19~39) with ischemic cerebrovascular diseases without other cardiovascular risk factors. Contrast agents were injected twice in each patients, one with Valsalva maneuver and the other with coughing and the presence of the patent foramen ovale was confirmed by demonstrating echogenic contrast crossing the interatrial septum. RESULTS: The patent foramen ovale was demonstrated in five of sixteen patients(31.2%) during transesophageal contrast echocardiographic examination. Although the prevalence of the patent foramen ovale in normal population has not been examined in this study, the prevalence in patient group appears to be significantly higher than that of normal population. CONCLUSIONS: Taken together, a paradoxical embolism through the patent foramen oval appears to be one of the causative factors and a transesophageal contrast echocardiography is recommended especially in young ischemic cerebrovascular disease patients who have normal transesophageal echocardiographic findings and no known risk factors.
Contrast Media ; Cough ; Echocardiography* ; Embolism, Paradoxical ; Foramen Ovale, Patent* ; Humans ; Microbubbles ; Prevalence* ; Risk Factors ; Valsalva Maneuver

Staphylococcus lugdunensis is a coagulase-negative staphylococcus. However, it causes various clinically important human infections and behaves similar to Staphylococcus aureus. S. lugdunensis reportedly causes infective endocarditis, skin and soft tissue infection, bone and joint infection, septicemia, endarteritis, urinary tract infection, ocular infection, and peritonitis. There are no reports of septic arthritis by this organism in Korea. We presented a case of septic arthritis due to S. lugdunensis in an elderly patient with diabetes mellitus after an intra-articular injection.
Aged ; Arthritis* ; Arthritis, Infectious ; Diabetes Mellitus ; Endarteritis ; Endocarditis ; Eye Infections ; Humans ; Injections, Intra-Articular* ; Joints ; Knee Joint ; Knee Prosthesis ; Knee* ; Korea ; Peritonitis ; Sepsis ; Skin ; Soft Tissue Infections ; Staphylococcus ; Staphylococcus aureus ; Staphylococcus lugdunensis* ; Urinary Tract Infections

BACKGROUND: Better imaging resolution and less flow masking with TEE than with TTE makes it easier to evaluate the prosthetic valve dysfunction. However, direct comparison between two methods to evaluate prosthetic valve dysfunction remains elucidated. METHODS: Both TTE and TEE were performed in 19 patients with suspected prosthetic valve dysfunction who were admitted to Seoul National University Hospital for evaluating porsthetic valve dysfunction from July, 1992 to May, 1993 and those findings were compared with those of cardiac catheterization and angiography, and surgery 19 cases were included in this study. RESULTS: 11 patients with congestive heart failure underwent TTE, TEE and angiography and each finding was compared to one another. We could see that there is good correlation between transesophageal echocardiographic and angiographic grading in the severity of regurgitation but poor correlation between transthoracic echocardiographic and angiographic finding in that of regurgitation. We also could differentiate between central and eccentric leakage with TEE and in 2 cases TEE enabled us to detect a vegetation on prosthetic valve not detected with TTE and in 1 case the cause of cardiac hemolysis could be known with TEE : eccentric leakage in prosthetic mitral valve. Left atrial thrombi were detected with TEE in two patients with recent cerebral infaction history. CONCLUSION: We conclude that TEE is a good method that enables us to diagnosize the prosthetic valve dysfunction and detect the structural abnormalities surrounding prosthetic valve such as paravalvular leakage, vegetation, cardiac hemolysis and Left atrial thrombi not detected easily by TTE.
Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Heart Failure ; Hemolysis ; Humans ; Masks ; Mitral Valve ; Seoul

No abstract available.
Endocarditis*