PURPOSE: We report the results of a policy of primary surgical closure of large ventricular septal defects(VSDs) applied over the past 3 years to all symptomatic infants regardless of patient weight, location or number of VSDs. To analyze the early postoperative mortality and other surgical complications in young infants, comparison of preoperative and outcome variables were made between infants weighing 6 kg or less and those weighing mort than 6 kg at the time of operation. METHODS: Forty-eight infants met criteria for inclusion in the study, and were divided into two groups based on body weight: group 1 infants weighed 6 kg or less(n=24), and group 2 infants weighed more then 6 kg(n=24). Both groups had similar variation in ventricular septal defect location and the ratio of the flow. resistance. RESULTS: The major associated cardiac defects were more in group 1. The overall mortality rate of this study was 4%(2/48): Two early deaths occurred in only group 1(8%). Both infants had a doubly committed subarterial defect and mild degree of coarctation of aorta (one was a preductal type). One received a coatctation-repari. There was o only one patch dehiscence(in group 1). No surviving patients required a second ventricular septal defect opetation, and the majority no longer received anticongestive therapies. CONCLUSIONS: These results indicate that primary surgical closure of large ventricular septal defects can be performed in small infants with no difference in mortality or serious complication rates compared with larger infants. Protracted medical efforts to achieve larger size before primary repair and palliative pulmonary artery banding are not necessary.
Aortic Coarctation ; Body Weight ; Heart Septal Defects, Ventricular* ; Humans ; Infant* ; Mortality ; Pulmonary Artery

Acute necrotizing pancreatitis is a disease with high morbidity and mortality despite the progress made in intensive care. Gas gangrene of the pancreas, usually caused by anaerobe infection, is an extremely rare, but severe form of acute necrotizing pancreatitis. Several severity-of-illness classifications for acute pancreatitis are used to identify patients at risk for complications. Pancreatic necrosis is diagnosed radiographically by dynamic intravenous contrast-enhanced computed tomography (CT) of the abdomen. Early CT in patients with suspected necrotizing pancreatitis contributes to early intervention and many advantageously enhance survival. We report here on two cases of necrotizing pancreatitis with gas gangrene in 49-year-old male patient and 86-year-old female patient.
Abdomen ; Aged, 80 and over ; Classification ; Critical Care ; Early Intervention (Education) ; Female ; Gas Gangrene* ; Humans ; Male ; Middle Aged ; Mortality ; Necrosis ; Pancreas ; Pancreatitis* ; Pancreatitis, Acute Necrotizing

OBJECTIVE: To investigate the clinical significance of atypical glandular cells (AGC) by analyzing the prevalence and histologic outcomes of patients with AGC according to Pap smear. METHODS: The medical records of 83 patients who were diagnosed AGC on Pap tests at the Pusan National University Hospital outpatient department and health care center from January 1998 to March 2006 were reviewed. RESULTS: The prevalence of AGC was 55 of 54,160 (0.10%) and 28 of 54,160 (0.05%) for AGC-not otherwise specified (NOS) and neoplastic associated AGC, respectively. The histopathologic results of the AGC-NOS group (n=55) were as follows: low-grade squamous intraepithelial lesion, 7 (12.7%); high-grade squamous intraepithelial lesion, 4 (7.2%); adenocarcinoma of cervix, 3 (5.4%); endometrial carcinoma, 2 (3.6%); and other malignancies including 2 ovarian cancer cases and 1 breast cancer case, 3 (5.4%). The histopathologic results for the AGC-associated neoplastic group (n=28) were as follows: low-grade squamous intraepithelial lesion, 1 (3.5%); high-grade squamous intraepithelial lesion, 3 (10.7%); adenocarcinoma of cervix, 5 (17.8%); endometrial carcinoma, 4 (4.8%); and additional malignancies including 3 stomach cancer cases, 2 ovarian cancer cases, and 2 breast cancer cases; 7 (25%). CONCLUSION: AGCs may represent a variety of benign and malignant lesions. AGC-associated neoplastic findings may be related to gynecological or extrauterine malignancies. Thus, when AGCs, especially neoplastic AGCs, are encountered, it is best to evaluate the cervix not only for typical maladies, but also for gynecological and non-gynecological malignancies.
Adenocarcinoma ; Breast Neoplasms ; Cervix Uteri ; Delivery of Health Care ; Endometrial Neoplasms ; Female ; Humans ; Medical Records ; Outpatients ; Ovarian Neoplasms ; Prevalence ; Stomach Neoplasms

BACKGROUND: The several forms of treatment of Graves disease-thyroidectomy, antithyroid drugs and radioiodide therapy-are in wide use now. But which therapy is best is a matter of debate. Some authors reported that in patients who underwent thyroidectomy, higher titers of serum antimicrosomal antibody were associated with 1) higher formation rates of germinal centers, 2) more lymphocyte infiltration in the thyroid tissue, 3) higher incidence of hypothyroidism, and 4) lower incidence of recurrence. We were interested in the relationship of thyroid autoantibody titers, ADCC(antibody-dependent cell-mediated cytotoxicity) activity and the clinical response to antithyroid medication. METHODS: We measured ADCC activities from patients in Graves disease(n-48), Hashimoto thyroiditis(n=17) and normal control(n=9). The patients of Graves disease were followed up for more than 1 year, and they were grouped into A(n=17, well responsed group to antithyroid medication) and B(n=31, poorly responsed group). We examined ADCC activities of patients' sera by chromium release assay. RESULTS: 1) Mean age of patients with Graves disease was 34.4210.4 years and 15 patients were male(31%). 2) Results of thyroid function tests of the Graves' patients were T 585.9 +/- 255.3 ng/dL, T4 21.3 +/- 12.2 mg/dL, TSH 0.11 +/- 0.06mIU/mL. Concentrations of antimicrosomal antibody, antithyroglobulin antibody and thyrotropin binding inhibitory immunoglobulin were 1279.1 +/- 1486.7 IU/mL, 488.1 +/- 751.1 IU/mL, and 38.5 +/- 33.4U/L respectively. 3) There was no significant difference between levels of thyroid hormones or concentrations of thyroid autoantibodies and ADCC activities in graves patients. 4) The ADCC activity of the Graves patient group(24.49%) was significantly higher than that of the normal control group(3.76%), and significantly lower than that of the Hashimotos thyroiditis group(36.34%). 5) There was no significant difference in ADCC activity between group A(18.24 +/- 13.44%) and B(27.91 +20.02%). CONCLUSION: From this results, we suggested that ADCC activity seems to be no value as a prognostic factor in predicting the response to antithyroid drugs in Graves disease patients. But, further studies, larger number of patients and long-term follow up, are needed.
Antibody-Dependent Cell Cytotoxicity ; Antithyroid Agents ; Autoantibodies ; Chromium ; Follow-Up Studies ; Germinal Center ; Graves Disease* ; Humans ; Hypothyroidism ; Immunoglobulins ; Incidence ; Lymphocytes ; Recurrence ; Thyroid Function Tests ; Thyroid Gland ; Thyroid Hormones ; Thyroidectomy ; Thyroiditis ; Thyrotropin

Crohn's disease is a chronic and insidious condition characterized by an inflammatory process that may extend across all layers of the entire gastrointestinal tract. The common sites involved by Crohn's disease are the terminal ileum and ascending colon. Crohn's disease limited to the appendix is uncommon. Since its first report in 1953 by Meyerding and Bertram, 156 cases of appendiceal Crohn's disease have been documented in the world literature. We experienced a case of Crohn's disease limited to the appendix in a-35year-old female who were performed an ileocecectomy.
Appendix* ; Colon, Ascending ; Crohn Disease* ; Female ; Gastrointestinal Tract ; Humans ; Ileum

BACKGROUND: Modified Blalock-Taussig shunt using 3mm or 3.5mm PTFE graft has been performed in patients with small body weight or in candidates for single ventricle palliation. However, there are few reports concerning clinical outcomes in terms of pulmonary artery growth and shunt patency rate after shunt operations using such a small graft. MATERIAL AND METHOD: Twenty-five patients rate after shunt operations using 3 or 3.5 mm sized grafts from September 1996 to August 1999. We retrospectively assessed the pulmonary artery growth and the shunt patency rate by reviewing the pre-and post-operative pulmonary angiograms. The risk factors for late death and second shunt operations were also analyzed. To assess the presence of any correlation between body weight and selection of the graft size, regression analysis was done in 81 cases of shunt operations performed during the same period. RESULT: There were 1 (4%) early death and 5 (20%) late deaths. The survivors were followed up for an average of 7.34 months. The pulmonary artery index increased significantly from 129+/-66 mm2/m2 to 213+/-114 mm2/m2 (p=0.002). The shunt patency rate assessed at postoperative 2, 4, 6 and 8 months were 82.5%, 77%, 73% and 42% respectively with a marked decline between 6 and 8 months. Asplenia was a frequent finding for the patients with late death although the incidence failed to reach statistical significance (p=0.078). Pre-operative diagnosis of PA with VSD was found to be a statistically significant risk factor for a second shunt operation (p=0.01). Body weight(a) at operation and graft size (b) used in the shunt operations revealed strong correlation and could be expressed by the following formula; b=0.128a + 3.233. CONCLUSION: Adequate growth of pulmonary artery and satisfactory early patency rate could be obtained by modified Blalock-Taussing shunt using 3mm or 3.5mm graft. However, during 6 to 8 months after shunt operations, the patency rate fell sharply, which implicates that close observation and early intervention are mandatory in this period.
Blalock-Taussig Procedure ; Body Weight ; Diagnosis ; Early Intervention (Education) ; Humans ; Incidence ; Polytetrafluoroethylene* ; Pulmonary Artery ; Retrospective Studies ; Risk Factors ; Survivors ; Transplants*

We reviewed 49 cases of moderate or severe pericardial effusion on which we performed pericardiocentesis and percutaneous pericardial biopsy from Jan. 1987 to Sep. 1989. Of these, 11 cases were performed percutaneous pericardial biopsy in order to diagnose confirmative. We studied clinical manifestation including physical examination, ECG, and radiology, etiology and complication of pericardiocentesis and percutaneous pericardial biopsy. The results are as belows : 1) The physical examination of pericardial effusion were neck vein engorgement(73.5%), priction rub(25.5%), and pulsus paradoxus(4%). The ECG findings were low voltage(77.6%) and electrical alternans(16.5%), and most common x-ray finding was cardiomegaly (81.6%). 2) Underlying diseases were as follows : neoplastic disease(40.8%), tuberculosis(18.4%) systemic lupus erythematosus(10.2%), hemopericardium(8.2%), chronic renal failure(6.1%), congestive heart failure(4.1%), idiopathic pericarditis(4.1%), GVHD(2.0%), pyopericardium(2.0%), rheumatic carditis(2.0%), and postpericardiotomy syndrome(2.0%), in order. 3) Special etiologic diagnosis of neoplasm were lung cancer(50%), adenocarcinoma of unknown origin(20%), Malignant lymphoma(15%), stomach cancer(5%), hepatoma(5%), and malignant thymoma(5%), in order. From the percutaneous pericardial biopsy, the authors confirmed 36% by finding two cases of malignancy and two cases of tuberculosis. On the other hand, only one case was confirmed in cytology. These result in a rather low rate of diagnostic confirm. There were 8 cases of complication : hypotension(8.2%), premature ventricular contraction(6.1%) and ventricular tachycardia (2.0%) without death cases. In percutaneous pericardial biopsy, only two cases of hypotension were found with no death case. The result obtained from the above 11 cases of percutanous pericardial biopsy is not enough to make conclusive statement concerning rate of diagnostic confirmation and complication. We expect better results by examining more cases in the future.
Adenocarcinoma ; Biopsy* ; Cardiomegaly ; Diagnosis ; Electrocardiography ; Estrogens, Conjugated (USP) ; Hand ; Heart ; Humans ; Hypotension ; Lung ; Neck ; Pericardial Effusion ; Pericardiocentesis* ; Physical Examination ; Stomach ; Tachycardia, Ventricular ; Tuberculosis ; Veins

PURPOSE: Transrectal ultrasonography (TRUS)-guided prostate biopsy causes fear and pain in 65% to 90% of patients. This study was designed to evaluated the use of intravenous propofol anesthesia during TRUS-guided prostate biopsy. MATERIALS AND METHODS: Between January 2006 and June 2008, 195 men undergoing a transrectal prostate biopsy were divided into 2 groups according to anesthetic technique. Group A consisted of 99 patients who received intravenous propofol infusion through an 18 gauge needle during TRUS-guided prostate biopsy. Group B consisted of 96 patients who intrarectally received 10 ml of 2% lidocaine gel 10 minutes before TRUS-guided prostate biopsy. Pain scores were assessed on a visual analogue scale immediately after prostate biopsy. RESULTS: The pain score was significantly reduced in group A compared with group B. There was a significant difference in the mean pain score between the 2 groups (1.0+/-1.3 in group A versus 2.9+/-2.0 in group B; p<0.01). Also, there was a significant difference in the willingness to undergo rebiopsy between the 2 groups (83.8% in group A versus 17.7% in group B; p<0.01). However, the complication rates were not significantly different between the 2 groups. Gross hematuria was found in 14% of group A patients and 18% of group B patients. CONCLUSIONS: Our results proved the advantage of intravenous propofol anesthesia during TRUS-guided prostate biopsy. Intravenous propofol infusion can be a safe and simple technique that significantly reduces pain during TRUS-guided prostate biopsy.
Anesthesia ; Biopsy ; Hematuria ; Humans ; Imidazoles ; Lidocaine ; Male ; Needles ; Nitro Compounds ; Propofol ; Prostate

No abstract available.
Prognosis* ; Subarachnoid Hemorrhage, Traumatic*

Familial combined hyperlipidemia is one af the manogenic disorders frequently found in humans and is seen in 0.5~2% of the general populatian, accounting for at least 10% of persons with pemature atlmmcletusis. The distinguishing feature of familial combined hyperlipidemia, in camparison with other single-gene abnarmalities of lipoprotein metabolism, is that not all affected members have the same plasma lipid phenotype; some individuals have an elevation of cholesterol concentration alane(type IIa lipoprotein pattern), while some athers have an elevation of triglyceride concentration alone(type IV pattem), and still others have elevations of both values(type IIb pattem). In any one persan, the lipid phenotype can change as a result of dietary or drug treatment. Familial combined hyperlipidemia should be suspected in those subjects with moderate hypertriglyceridemia and/or moderate hypercholestaolemia (lipoprotein types IIa, Ilb, IV), especially when premature coronary heart disease is evident in the family histary. Low plasma HDL-cholesterol, obesity, insulin resistance and hyperuricemia are often . Family members affected by familial combined hyperlipidemia should be identified and be treated, since tbe condition is associated with premature caronary heart diasease. We have found one family of familial combined hyperlipidemia with one member(case 1) associated with insulin resistance, hyperuricemia and gout, and another member(case 2) associated with diabetes mellitus and infertiTity.
Cholesterol ; Coronary Disease ; Diabetes Mellitus ; Gout ; Heart ; Humans ; Hyperlipidemia, Familial Combined* ; Hypertriglyceridemia ; Hyperuricemia ; Insulin Resistance ; Lipoproteins ; Metabolism ; Obesity ; Phenotype ; Plasma ; Triglycerides