BACKGROUND: Current studies on multimodal strategy for N2 non-small cell lung cancer are being high interest have drawn much attention. N2 lung cancer, however, is composed of is divided into several subgroups with that have different prognoses. The prognostic factors still ramain controversial. METHODS: Between January 1990 and June 1999, 180 patients with N2 lung cancer who underwent surgical resection were investigated, excluding 10 of these for surgical mortality. All patients underwent mediastinal lymph node dissection. 20 clinicopathologic factors were investigated by univariable and multivariable analyses to identify significant prognostic factors among resected N2 disease. RESULTS: The overall 5-year survival rate was 20.6%. Multivariable analyses among overall patients revealed 3 significant prognostic factors:Age, Histologic type, Vascular invasion. Based on the result, 49 patients with both age more than 60 and pathologic Non-squamous cell showed a 5-year survival of 5.0%, whereas 37 patients with neither of the factors showed a 5-year survival of 56.6%(p<0.001). And 12 patients with both vascular invasion and pathologic Non-squamous cell showed a 5-year survival of 11.9%, whereas 67 patients with neither of the factors showed a 5-year survival of 33.6%(p=0.01). CONCLUSION: The prognosis of surgically resected N2 disease varies according to the 2 significant prognosis factors. Tumor size may be an additional influencing factor in the prognosis of N2 disease.
Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms ; Lung* ; Lymph Node Excision ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis* ; Prognosis ; Survival Rate

No abstract available.
Muscle Strength*

We report a case of the successful anatomical correction of the Taussig-Bing anomaly associated with the interrupted aortic arch and intramural left coronary artery for an 38 day-old infant. Aortic arch and neoaortic reconstructions were conducted without any prosthetic or pericardial patch. Intramural left coronary was separated from right one after partial detachment of aortic commissure and both coronary artery buttons were transferred separately to the proximal main pulmonary artery(neo-aorta). Delayed sternal closure was done 3 days after the operation and hospital discharge was delayed for a month because of postoperative pneumonia. Now he is 5 months old and free of symptoms and cardiac drugs.
Aorta, Thoracic* ; Coronary Vessels* ; Double Outlet Right Ventricle* ; Humans ; Infant ; Pneumonia

BACKGROUND: Follow-up studies have shown that although outcomes have improved substantially over time,results of the Fontan operation and its modifications remain suboptimal.In this study,we reviewed our experience with the extracardiac conduit Fontan operation,with a focus early and midterm change of internal diameter of PTFE conduit. MATERIAL AND METHOD: Between April 1997 and July 2000 were reviewed.Twelve patients (M:6,F:6,mean age 42.04 +/- 12.43months,mean body weight 13.80 +/- 1.94kg)underwent extracardiac conduit Fontan operation with expanded PTFE graft.Mean cardiopulmonary bypass time was 109.7 +/- 26.99minute and mean operation time was 455 +/- 89.51minute. Intraoperative fenestration was performed in 10 patients.The aortic cross clamping was not performed in all patients. RESULT: There was no early deaths and no postoperative dysrhythmia. Postoperative protein losing enteropathy and prolonged pleural effusion occurred in 1(8.3%)and 4 patients(33.3%).Conduit patency was evaluated by magnetic resonance imaging studies.A 9.84 +/- 3.84%mean reduction in conduit internal diameter and there was no statistical correlation between the change of internal diameter of conduit and the postoperative duration after partial correlation analysis(r=0.019,p=0.955). CONCLUSION: These results demonstrate that the extracardiac conduit Fontan operation provies good early and midterm results and may reduce the prevalence of late arrhythmia.And there is no correlation between the change of internal diameter of conduit and the postoperative duration after extracardiac conduit Fontan operation with the expanded PTFE graft conduit.
Body Weight ; Cardiopulmonary Bypass ; Constriction ; Follow-Up Studies ; Fontan Procedure* ; Humans ; Magnetic Resonance Imaging ; Pleural Effusion ; Polytetrafluoroethylene ; Prevalence ; Protein-Losing Enteropathies ; Transplants

Background: It is well known that the addition of CO2 gas during cardiopulmonary bypass (CPB) can increase cerebral blood flow (CBF). In this study, we tried to find whether the increase of CBF by CO2 gas could be expressed on the measurement of body temperatures. Methods: This study included 22 adult patients who underwent CPB with moderate hypothermia and were assigned randomly to two groups by adding CO2 gas (CO2 group and Air group). We measured each tympanic (TM), nasopharyngeal (NP), oral, forehead, finger, rectal and CPB arterial line temperatures of CPB circuit for 20 times during cooling in every one minute for 20 minutes and during rewarming every two minutes for 40 minutes. Results: During cooling and rewarming, the TM, NP and oral temperatures changed more rapidly than the rectal and finger temperatures. In TM temperature, as time changed, the percent changes of temperature varied more prominently in the CO2 gas group than in the Air group. The statistical differences were significant especially during 13 minutes to 20 minutes in cooling and 8 minutes to 20 minutes during rewarming. Conclusion: From this data, we can postulate the effect of CO2 gas on CBF indirectly by measuring several sites of body temperatures.
Adult ; Body Temperature* ; Carbon Dioxide ; Cardiopulmonary Bypass* ; Fingers ; Forehead ; Humans ; Hypothermia ; Rewarming* ; Vascular Access Devices

BACKGROUND: It is known that low birth weight is a risk factor for poor outcome in cardiac surgery for many cardiac defects.We reviewed our recent surgical experiences on congenital heart defect (other than patent ductus arteriosus)in low birth wei ght babi es.Material and METHOD: From September 1994 to February 2001,31 consecutive infants weighing 2500 g or less underwent cardiac surgery with (OHS group n=12)or without cardiopulmonary bypass (CHS group n=19).A retrospective study was carried out to evaluate short-and intermediate-term outcome.Mean gestational age and age at operation were 36.9 weeks(range,32.3-42weeks)and 32.1days (range,0-87days)respectively.Mean body weight at birth and operation were 1972g (range,1100-2500g)and 2105g (range,1450-2500 g)respectively.There was no difference between the two groups in age and body weight.Defects included ventricular septal defect (VSD)(n=3),VSD with arch anomaly (n=2),total anomalous pulmonary venous return (n=2),transposition of the great arteries (TGA)(n=2),truncus arteriosus (n=2),and univentricular heart with cor triatriatum (n=1)in OHS group,and coarctation of aorta (n=7),tetralogy of Fallot (TOF)(n=3),TOF with pulmonary atresia (n=3), multiple muscular VSDs (n=1),double outlet right ventricle (n=1),pulmonary atresia with intact ventricular septum (n=2),tricuspid atresia (n=1),and TGA with multiple VSD (n=1)in CHS group.13 patients (41.9%)were intubated pre-operatively. RESULT: There were 4 early deaths (<30 days);1 (8.3%)in OHS group and 3 (15.8%)in non-OHS group.All these early deaths were related to the pulmonary artery banding(PAB).There was no operative mortality in infants undergoing complete repair and palliative operations other than PAB.Delayed sternal closure was required in 3 patients.Prolonged postoperative mechanical ventilation (>7days)was required in 7 patients (58.3%)in OHS and 7 (38.8%)in CHS group.Late mortality occurred in 3 patients,two of which were non-cardiac.A patient in OHS group was documented to have neurologic sequelae.All the survivors except two are in NYHA class I. CONCLUSION: Complete repair and palliative operations other than PAB can be performed in low birth weight infants with low operative mortality and an acceptable intermediate-term result.However,about a half of the patients required long-term postoperative mechanical ventilation.
Aortic Coarctation ; Arteries ; Body Weight ; Cardiopulmonary Bypass ; Cor Triatriatum ; Gestational Age ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Mortality ; Parturition ; Pulmonary Artery ; Pulmonary Atresia ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Scimitar Syndrome ; Survivors ; Thoracic Surgery* ; Ventricular Septum

BACKGROUND: Congenital aortic stenosis in children is characterized by "excessive" left ventricular hypertrophy with reduced left ventricular systolic wall stress that allows for supernormal ejection performance. We hypothesized that left ventricular wall stress was decreased immediately after surgical correction of pure congenital aortic stenosis. Also measuring postoperative left ventricular wall stress was a useful noninvasive measurement that allowed direct assessment for oxygen consumption of myocardium than measuring the peak systolic pressure gradient between ascending aorta and left ventricle for the assessment of surgical results. MATERIAL AND METHOD: Between September 1993 and August 1999, 8 patients with isolated congenital aortic stenosis who underwent surgical correction at Yonsei cardiovascular center were evaluated. There were 6 male and 2 female patients ranging in age from 2 to 11 years(mean age, 10 years). Combined Hemodynamic-Ultrasonic method was used for studying left ventricular wall stress. We compared the wall stress peak systolic pressure gradient and ejection fraction preoperatively and postoperatively. RESULT: After surgical correction peak aortic gradient fell from 58.4+/-17.6, to 23.7+/-17.7 mmHg(p=0.018) and left ventricular ejection fraction decreased but it is not statistically significant. In the consideration of some factors that influence left ventricular end-systolic wall stress excluding one patient who underwent reoperation for restenosis of left ventricular outflow tract left ventricular end-systolic pressure and left ventricular end-systolic dimension were fell from 170.6+/-24.3 to 143.7+/-27.1 mmHg and from 1.78+/-0.4 to 1.76+/-0.4 cm respectively and left ventricular posterior wall thickness was increased from 1.10+/-0.2, to 1.27+/-0.3cm but it was not statistically singificant whereas left ventricular end-systolic wall stress fell from 79.2+/-24.9 to 57.1+/-27.6 kdynes/cm2(p=0.018) in 7 patients. For one patient who underwent reoperation peak aortic gradient fell from 83.0 to 59.7 mmHg whereas left ventricular end-systolic wall stress increased from 67.2 to 97.0 kdynes/cm2 The intervals did not change significnatly. CONCLUSION: We believe that probably some factors that are related to left ventricular geometry influenced the decreased left ventricular wall stress immediately after surgical correction of isolated congenital aortic stenosis. Left ventricular wall stress is a noninvasive measurement and can allow for more direct assesment than measuring peak aortic gradient particularly in consideration of the stress and oxygen consumption of the myocardium therefore we can conclude it is a useful measurement for postoperative assessment of congenital aortic stenosis.
Aorta ; Aortic Valve Stenosis* ; Blood Pressure ; Child ; Equidae ; Female ; Follow-Up Studies* ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular ; Male ; Myocardium ; Oxygen Consumption ; Reoperation ; Stroke Volume

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most useful diagnostic tool in biliary and pancreatic disease. However, ERCP cannot be performed successfully in all patients. Cannulation failure is the most common cause of failure of ERCP. Mechanical pathologies, such as peri-Vater diverticulum, cancer of the papilla of Vater, and impacted stone were the common causes of cannulation failure. We experienced two cases of carcinoma of the papilla of Vater in whom cholangiography and insertion of the nasobiliary tube were performed througth an artificial choledoehoduodenal fistula made by a needle type diathermy knife, beacuse cannulation to the duct was failed due to the tumor.
Catheterization ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Diathermy ; Diverticulum ; Fistula* ; Humans ; Needles ; Pancreatic Diseases ; Pathology

The authors retrospectively evaluated 75 diabetic patients (92 eyes) who underwent cataract surgery between January 1995 and December 1997. The minimum follow up period was one year. We analysed retrospectively the final visual cuity, the incidence and risk factors of progression of diabetic retinopathy after cataract surgery. The improvement of visual acuity more than 2 lines was achieved in 81 eyes (88.0%). Seventy two eyes (78.3%) achieved the final visual acuity of more than 0.5. In moderate or severe nonproli- ferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy(PDR)groups, visual acuity improvement was less than in no or mild NPDR group (p=0.001). Progression of retinopathy occurred in 21 out of 82 eyes (25.6%)one year following surgery and was associated with presence of diabetic nephropathy (p=0.018). The rates of retinopathy progression were higher in patients with longer duration of diabetes or insulin treatment than shorter duration of diabetes, or dietary or oral hypoglycemic treatment, but differences did not reach a significant level.
Cataract* ; Diabetic Nephropathies ; Diabetic Retinopathy ; Follow-Up Studies ; Humans ; Incidence ; Insulin ; Retrospective Studies ; Risk Factors ; Visual Acuity

No abstract available.
Blepharoptosis*