Abscence of right superior vena cava(SVC) in visceroatrial situs solitus is a rare(0.07% to 0.13%) congenital cardiovascular malformation, and little is known about the type and frequency of additional heart defects and arrhythmias. We reviewed previous publications and report the case of 8 month old male infant with absent right superior vena cava and persistent left superior vena cava and large secundum atrial septal defect, mild pulmonary valvular stenosis.
Arrhythmias, Cardiac ; Constriction, Pathologic ; Heart ; Heart Septal Defects, Atrial* ; Humans ; Infant ; Male ; Vena Cava, Superior*

No abstract available.
Adenocarcinoma*

Arthroscopic surgery of the knee is now a widely performed orthopedic technique. Of this, arthrosoopic surgery of discoid meniscus is one of the most technically demanding procedures of this field. In our experience, discoid meniscus was appeared to be frequently accompanied with villous hypertrophied synovium, which obstructed the arthroscopic view. The purpose of this study is to prove the presence of synovial hypertrophy in discoid meniscus and to develop an adequate portal of entry for successful arthroscopic surgery of discoid meniscus. 155 cases of arthroscopy of the knee were performed at the Department of Orthopedic Surgery, College of Medicine, Seoul National University between January 1987 and March 1988. Of these, 25 cases were discoid menisci and they were all lateral. Operative findings were observed through arthroscopy and they were also reviewed by recorded video tapes in 25 cases of arthroscopic surgery of discoid meniscus and 57 cases of non-discoid meniscal lesions for the presence of synovial hypertrophy. Synovial biopsy was performed in selected cases with synovial hypertrophy for observation of histological findings. Hypertrophied synovium in discoid meniscus was mainly localized in anterior compartment and intercondylar area of tibia. Therefore, when conventional anterolateral or anteromedial portals were used, much difficulty was confronted because hypertrophied synovium obstructed the visual field and crowding with surgical instruments was occurred in restricted space of discoid meniscus. Much more clear visual field was obtained when the medial midpatellar portal was used instead of conventional portals. The conclusions of this study are as follows : 1. The incidence of discoid meniscus was 16.1%. 2. Synovial hypertrophy was present in all 25 cases of discoid meniscus and 21 cases among 57 non-discoid meniscal lesions(35%) on operative findings 3. Synovial biopsy of hypertrophied synovium showed irritative nonspecific inflammatory lesions but there was no histologicsl differences between discoid and non-discoid meniscus. 4. Medial midpatellar portal is considered to be better approach than conventional portals for clear visual field and less crowding with instruments in arthroscopic surgery of lateral discoid meniscus.
Arthroscopy ; Biopsy ; Crowding ; Hypertrophy ; Incidence ; Knee ; Orthopedics ; Seoul ; Surgical Instruments ; Synovial Membrane ; Tibia ; Visual Fields

BACKGROUND: Percutaneous mitral balloon valvuloplasty(PMV) is a good treatment modality for patient with mitral stenosis(MS). But it is considered relatively contraindicated in patients with left artrial thrombi because of high risk of embolism. Limitted studies have suggested the feasibility of PMV in patients with left atrial appendage(LAA) thrombi. This study was performed to evaluate the feasibility and safty of PMV in patients with LAA thrombi using Inoue balloon under the transesophageal echocardiographic (TEE) monitoring. METHOD: PMV was performed in 5 patients diagnosed as MS with LAA thrombi from October, 1995 to July, 1996. Four cases were female, and one case was male. Their mean age was 525(46-58years old). Two of them had history of cerebrovascular accident(CVA). The duration of anticoagulant treatment was 6-49 moths. All patients underwent PMV using Inoue balloon catheter under the TEE monitoring. RESULTS: EKG finding of all 5 patients were atrial fibrillation(Af). Their mitral valve score were 5-10(Mean score was 82). Transmitral mean pressure gradient was decreased from 14.62.1 to 5.82.0mmHg, and mitral valve increased from 0.840.43 to 1.720.19 after PMV. There was no procedure related complication. In 3 cases of them LAA thrombi diappeared in the follow up TEE. In two patients, the LAA thrombi were calcified and remained unresolved at the time of follow up TEE( 6month-and 12 month-F/U, eath). CONCLUSION: Although the reported number of PMV in patients with LAA thrombi is small in this study, we believe that, with special precaution and TEE monitoring, LAA thrombi is no longer an absolute contraindication to PMV.
Atrial Appendage* ; Balloon Valvuloplasty* ; Catheters ; Echocardiography ; Electrocardiography ; Embolism ; Female ; Follow-Up Studies ; Humans ; Male ; Mitral Valve ; Moths

No abstract available.
Liver*

A 51-year-old man had small, tender, skin colored firm nodule on the helix of the both ears for eight months. He was found to have classic features of chondrodermatitis nodularis chronica helicis, namely, tender nodule less than 1 cm in length with central crusting, localization to helix, age, men, and histologic findings. The histologic examination of the biopsy specimen showed the presence of thinned epiderrnis on center. acanthosis on the adjacent epidermis, with hyperkeratosis and parakeratosis, and cleft between epidermis and dermis. In the dermis, highly vascularized connective tissue and chronic inflarnmatory infiltrate were visible with perichondrial fibrosis. Elastic tissue stain showed degeneration of elastic fibers. After complete excision, no recurrence was obsered until now.
Biopsy ; Connective Tissue ; Dermis ; Ear ; Elastic Tissue ; Epidermis ; Fibrosis ; Humans ; Hypertrichosis ; Male ; Middle Aged ; Parakeratosis ; Recurrence ; Skin

BACKGROUND: Balloon mitral valvuloplasty is a favorable procedure as a therapy for mitral stenosis because it minimizes morbidity and shorten hospital stay compared with surgical mitral commissurotomy or mitral valve replacement. Recent reports about concomitant transesophageal echocardiography guide in addition to fluoroscopy suggest that transesophageal echocardiograpy can provide additional benefits during balloon mitral valvuloplasty especially in transseptal puncture, balloon positioning, evaluation of immediate result, and early detection of complications. We performed this study to identify the potential benefits of on-line transesophageal echocardiography guide during balloon mitral valvuloplasty. METHOD: We performed balloon mitral valvuloplasty under on-line transesophageal echocardiography guide in addition to fluoroscopy in 70 patients(male:14, female:56, mean age:44+/-13) with rheumatic mitral stenosis from May 1995 to May 1996. Thirty-two(46%) patients had atrial fibrillation. Included patients were symptomatic with more than NYHA class 2 symptom. Patients with mitral valve score more than 11 and mitral regurgitation more than 2/4 were excluded. Inoue balloons were utilized in all cases. RESULTS: The average mitral valve area increased from 0.9+/-0.2cm2 before valvuloplasty to 1.8+/-0.4cm2 after valvuloplasty(p<0.0001). The averagetransmitral pressure gradient measured by continuous wave Doppler decreased from 14+/-6mmHg before valvuloplasty to 5+/-2mmHg after valvuloplasty(p<0.0001), and the average left atrial pressure measured by catheterization decreased form 22+/-8 mmHg before valvuloplasty to 11+/-5mmHg after valvuloplasty(p<0.0001). The average procedure time was 64+/-22 minutes(ranged from 13 to 150 minutes) and the average fluoroscopy time was 19+/-15 minutes(ranged from 1 to 94 minutes). Two patients underwent surgery due to severe mitral regurgitation associated with papillary muscle rupture which developed after valvuloplasty. In one patient, transesophageal echocardiography detected pericaridal tamponade during the procedure and the transducer was quickly switched to transthoracic transducer to guide the pericardial puncture site. The pericardial tamponade was drained with pigtail catheter and the patient underwent balloon mitral valvuloplasty successfully a week later. Four patients were pregnant at the time of the valvuloplasty procedure and the valvuloplasty was successfully performed with minimal fluoroscopy time(1-3 minutes) without complications in all four patients. Five patients had thrombus in left atrial appendage, but the transesophageal echocardiography was useful in monitoring the ballon position during the procedure and the valvuloplasty was successfully performed without embolic complications in all five patients. CONCLUSION: The transesophageal echocardiography is a very useful guiding adjunct during balloon mitral valvuloplasty in transseptal puncture, balloon positioning, evaluation of immediate result, early detection of complications, and shortening fluoroscopy time especially in pregnant women.
Atrial Appendage ; Atrial Fibrillation ; Atrial Pressure ; Cardiac Tamponade ; Catheterization ; Catheters ; Echocardiography, Transesophageal* ; Female ; Fluoroscopy ; Humans ; Length of Stay ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Papillary Muscles ; Pregnant Women ; Punctures ; Rupture ; Thrombosis ; Transducers

The purpose of this study is to compare the biologic properties of tendon to hone healing and hone to hone healing in knee ligament reconstruction. The lateral 4mm of patellar tendon which was detached from its tihial insertion site either subperiostcally(group I) or with a bone block(group II) was implanted and fixed using pullout method to the proximal tihia. Ten rabbits were killed at each of four time periods (two, four, eight and twelve weeks after the implantation), and the histological and biomechanical characteristics of thc graft healing sites were evaluated. Serial histological analysis of tendon to hone healing group revealed organization of the healing site similar to normal tendon to hone attachment by twelve weeks, while hone to bone healing group demonstrated direct hony union by eight weeks. The tension failure test for the patellapatellar tendon graft - tihia complex revealed that group II had significantly higher values than group I at four and eight weeks. The findings ot this study demonstrated that bone to hone healing has more rapid process than tendon to hone healing, although no significant difference was noted once the healing has matured. We can suggest lhat the duration and extent of postoperative protection of the knee for pntients who had a reconstruction of a ligament using hone - lendon autograft should be longer and higher than lor patients who had a reconstruction using hone - tendon hone autogralf.
Autografts* ; Dronabinol ; Humans ; Knee ; Ligaments ; Patellar Ligament* ; Rabbits* ; Tendons* ; Transplants

Hemangiopericytoma was first described by Stout & Murray in 1942 and was an uncommon soft tissue tumor thought to be derived from vascular pericytes. Approximately 10-15% of the cases occur in children have a propensity to develop in the region of head, neck and lower extremities. We experienced a case of congenital hemangiopericytoma of small bowel in a male neonate who showed vomiting and abdorninal distension. We reported a case of congenital hemangiopericytoma of small bowel with brief review of related literature.
Child ; Head ; Hemangiopericytoma* ; Humans ; Infant, Newborn ; Intestinal Obstruction* ; Intestine, Small ; Lower Extremity ; Male ; Neck ; Pericytes ; Vomiting

A 51-year-old female had disseminated, symmetrically distributed, brownish black pigmentation and papillary hypertrophy on the intertriginous and flexural areas for 6 months, and gastric adenocarcinoma was confirmed during the evaluation of internal malignancy, The cutaneous finding of acanthosis nigricans was a significant cutaneous marker of internal malignancy in this case.
Acanthosis Nigricans* ; Adenocarcinoma* ; Female ; Humans ; Hypertrophy ; Middle Aged ; Pigmentation