Experinece in the management of 74 patients with delayed traumatic intracranial hemorrhage(DTICH) of 474 head injury from January 1996 to December 1996 is poresented with emphasis on the incidence, occurring time, risk factors and outcome. The incidence of DTICH was 15.6% of all hospitalized head-injury patients. After an injury, every patient had an immediate computerized tomography(CT) scan to diagnose intracranial pathology and then CT follow-up was carried out according to intial CT finding and reurological deficit. The lesion was almost occurred in patients with initial abnormal CT finding(85.1%). 82.4% of DTICH were noted within 72 hours after injury. The delayed epidural hematoma and intracerebral hemorrhage were almost noted in first 72 hours(>90%), but the delayed subdural hemorrhage was found after a time interval varying from 6 hours to 10 days. So we strongly recommend CT follow-up in 4-8hour, 24-72hour, and then 7th day after head injury, especially in patients with initial abnormal CT findings. The risk factor of the delayed lesion was not hypotension, hypoxia, and consciousness level, but age of patients and the initial CT finding. The development of DTICH was not heralded by neurological deterioration. The prognosis of DTICH was not worse than non-DTICH. The patient with delayed subdural hemorrhage was better than the patient with non-delayed lesion(including hemorrhage and normal CT finding).
Anoxia ; Cerebral Hemorrhage ; Consciousness ; Craniocerebral Trauma* ; Follow-Up Studies ; Head* ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Intracranial Hemorrhages* ; Pathology ; Prognosis ; Risk Factors

No abstract available.

The pulmonic autograft as a replacement for the diseased aortic valve has become increasingly popular due to the potential to do away with anticoagulation and superior durability. There has not been any case of mitral valve replacement with pulmonic autograft reported in Korea. A 53-year-old female patient with rheumatic mitral steno-insufficiency, chronic atrial fibrillation, tricuspid insufficiency, and obstruction of the left circumflex artery, received mitral valve replacement using pulmonic autograft, maze procedure, tricuspid valvuloplasty and coronary artery bypass. The postoperative course was uneventful with a well functioning pulmonic autograft in the mitral position on echocardiogram. She is currently doing well without anticoagulation.
Aortic Valve ; Arteries ; Atrial Fibrillation ; Autografts* ; Coronary Artery Bypass ; Female ; Humans ; Korea ; Middle Aged ; Mitral Valve* ; Transplantation, Autologous

A 65-year-old male patient with preoperative severe left ventricular dysfunction and mitral and tricuspid insufficiency went into low cardiac output and failure to wean, biventricular assistance was provided with centrifugal pumps. The patient survived the ordeal. This is the first reported case of a survival after biventricular assistance using the centrifugal pump.
Adult* ; Aged ; Cardiac Output, Low ; Heart Diseases* ; Heart* ; Humans ; Male ; Ventricular Dysfunction, Left

BACKGROUND: The optimal treatment for mitral regurgitation from leaflet prolapse or multiple leaflet pathology is not yet established. Recently, new chordae formation(NC) with olytetra-fluoroethylene(PTFE) has become increasingly popular. The aims of the current study was to see the effects of new chordae formation on mitral alvuloplasty. MATERIAL AND METHOD: From January 1994 to december 1999 322 patients receiving itral valvuloplasty were divided into two groups in which 144 patients(Group I) received NC and 178 patients(group II) received mitral valvuloplasty without NC. Echocardiograms were performed in the immediate postoperative period, at 6 months and 1 year after surgery and annually thereafter. RESULT: Mitral valvuloplasty was performed for mitral regurgitation in 95%(322/ 337) of the patients and the mean followup period was 27+/-20.6 months of which follow-up was complete for 95.4%(306/ 322). The degree of mitral regurgitation in both groups I and II improved from 3.8+/-0.4 to 1.3+/-0.9 and 3.6+/-0.3 to 1.1+/-0.7, respectively. There was also no significant difference in the mean mitral area or transvavular pressure gradient across the mitral valve. The overall early and late mortality rates were 0.9%(3) and 1.2%(4), also showing no significant difference between the two groups. The late survival rate(97.8+/-1.6 vs 97.7+/-1.6%), freedom from structural degeneration 93.7+/-3.6 vs 90.7+/-3.4%) freedom from reoperation(99.3+/-0.7 vs 96.6+/-1.8%), freedom from thromboembolism, freedom infective endocarditis, and valve related complications showed no significant difference between the two groups. CONCLUSION: Mitral valvuloplasty with NC not only resulted in an increase in the volume of mitral reconstruction(r=0.98, p<0.01) but enhanced urability and stability comparable to currently established methods. Mitral valvuloplasty with NC was especially effective in the treatment of pan valvular pathology, commissural lesions and multiple leaflet pathology which would otherwise have been difficult to treat with current methods.
Endocarditis ; Follow-Up Studies ; Freedom ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Mitral Valve* ; Mortality ; Pathology ; Postoperative Period ; Prolapse ; Thromboembolism

No abstract available.
Thoracic Surgery*

BACKGROUND: As cardiac disorders, especially coronary artery disease is increasing in end-stage renal disease patients, the indications for coronary artery bypass surgery are increasing now. They have high risks for postoperative morbidity and mortality after coronary artery bypass surgery. MATERIAL AND METHOD: Between March of 1996 and May of 2000, medical records of 25 patients with end-stage renal disease who underwent coronary artery bypass surgery at Asan medical center were reviewed retrospectively. We reviewed the short-term results of preoperative risk factors, preoperative renal function, perative methods, operation results, hospital course, postoperative morbidity and mortality. RESULT: Preoperative creatinine clearance was 12.68+/-5 ml/min and serum creatinine level was 6.18+/-3 mg/dL(range 1.7-14. 4). Preoperatively, 11 patients(44%) received dialysis and the others(14 patients, 56%) were not supported by dialysis due to adequate urine output. Of the non-dialysis patients(14 cases), 8 patients were newly supported by dialysis, perioperatively. Of the preoperative hemodialysis patients(9 cases), two patients changed dialysis method postoperatively to peritoneal dialysis. Operative mortality occured in 2 patients(8%) and the causes of death were sepsis from aspiration pneumonia and mediastinitis, and postoperative bleeding and mediastinitis, respectively. Postoperative complications were developed in 14 patients(56%). There were 2 cases(8%) late mortalities and the cause of death was catheter-induced peritonitis. The actuarial survival rates in hospital survivals at 4 years was 82+/-13%. CONCLUSION: The coronary artery bypass surgery of end-stage renal disease patients were performed with acceptable mortality(8%). However , because the morbidity and mortality from morbidity were very frequent, perioperative prevention of infectious complications and careful patient management are very important.
Cause of Death ; Chungcheongnam-do ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Creatinine ; Dialysis ; Hemorrhage ; Humans ; Kidney Failure, Chronic* ; Mediastinitis ; Medical Records ; Mortality ; Peritoneal Dialysis ; Peritonitis ; Pneumonia, Aspiration ; Postoperative Complications ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Sepsis ; Survival Rate

PURPOSE: Both the beta-catenin and p53 play a crucial role in the process of colon carcinogenesis. The expression of beta-catenin and/or p53 has been reported to be associated with pathologic features of tumor and prognosis of patients. In addition, several recent studies have suggested a close biological association between p53 expression and nuclear beta-catenin level. We analyzed the pathologic variables and p53 expression according to the intra-nuclear beta-catenin expression in colon cancer to make such assumptions more clear since they are still controversial issues. METHODS: The expressions of beta-catenin, p53 and Ki-67 protein in colon cancer were determined by immunohistochemical staining. The relationship between these protein expressions and tumor characteristics was statistically analyzed. RESULTS: The intra-nuclear beta-catenin accumulation was not associated with any of the pathological variables including lymph node metastasis and tumor differentiation, but it was correlated with higher level of Ki-67 proliferation index (P=0.006) and negative staining of p53 (P=0.015). Positive p53 staining was significantly associated with lymph node metastasis (P=0.006), lymphatic invasion (P=0.03) and venous invasion (P=0.02). CONCLUSION: These results support the suggestion that intra-nuclear accumulation of beta-catenin may regulate the p53 activity in colorectal cancer. In addition, positive staining of p53 may be used as a valuable prognostic indicator since it was strongly associated with lymph node metastasis, lymphatic and venous invasion.
beta Catenin* ; Carcinogenesis ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms* ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Negative Staining ; Neoplasm Metastasis ; Prognosis

BACKGROUND: Heart transplantation is a definite treatment modality of the patients with end-stage heart failure. Heart transplantation has been performed in Korea since 1992, and currently it is an established procedure for the management of terminal heart failure. The purpose of this study is to clarify the Korean status of heart transplantation. METHODS: Six major heart transplantation centers' 137 cases during the period November 1992 through May 1999 are analyzed to evaluate the general demographics, underlying heart diseases, postoperative management, complications, and survival. RESULTS: The mean age of the patients is 37 years old, and the mean follow-up period is 25 months (1 day - 80 months, median 20 months). Most common underlying disease related to heart failure is cardiomyopathy (86%). Total 16% of patients underwent cellular rejection of ISHLT (International Society of Heart and Lung Transplantation) grade 3A or more within 1 year after transplantation. The most common type of clinical infection is bacterial (18%), and the most common organism is Herpes zoster virus (6.4%). Graft coronary artery disease examined by coronary angiography detected in 3.7% of recipients within 12 months after transplantation. One, 2, 3, and 5-year overall survival rates of recipients are 81% , 72%, 71%, and 62%, respectively. CONCLUSION: Distribution of underlying heart diseases and the frequency of graft coronary artery disease of Korean heart transplantation recipients were different from those of the western patients. Although the history of heart transplantation in Korea is relatively short, the early and long-term results are comparable with well-established centers.
Adult ; Cardiomyopathies ; Coronary Angiography ; Coronary Artery Disease ; Demography ; Follow-Up Studies ; Heart Diseases ; Heart Failure ; Heart Transplantation* ; Heart* ; Herpesvirus 3, Human ; Humans ; Korea* ; Lung ; Survival Rate ; Transplants