A total of 3,119 cardiac valves were replaced in 2,471 patients with acquired valvular heart diseases at Seoul National University Hospital during a period of 26 years from 1968 to 1994. Mechanical valves including St. Jude, Carbomedics, Bjork-Shiley and Duromedics were used in 1,609 cases(52%) and bioprosthetic valves including Lonescu-Shiley, Hancock and Angell Shiley were implanted for the rest of the patients(1,510 cases, 48%). A total of 308(12.5%) redo valve replacement was performed during the same period, and 10 of 308 patients underwent second redo valve replacements. The single valve replacement was done in 1,846 cases, double valve replacement in 602 cases and triple valve replacement in 23 cases. Among the single valve replacement, the mitral valve replacement was performed most frequently(1,377 cases). The male to female ratio was almost equal(1.223 : 1,248) and the mean age was 37.9+/-10.5 years old. But the mean age has been increasing year by year and it reached to 44.8 years old in the 1990's. The overall hospital mortality was 5.3%, and 6.8% in redo valve replacement. However, the hospital mortality for the recent 10 years dropped to 1 to 4%. The number of redo valve surgery has been increasing since the mid-1980's because of structural deterioration of bioprostheses that were replaced during the late-1970's and early 1980's. Redo valve surgery comprised 34% for all valve replacement in 1994. The causes of the redo valve operation were structural deterioration(81.5%), prosthetic valve endocarditis(11.7%), paravalvular leakage(5.6%), and valve thrombosis(0.9%). The actuarial freedom from overall valve failure in Ionescu-Shiley were 81.0+/-7.1%(5 year) in mitral position, 89.1+/-1.8%(7 year) in aortic position and 88.9+/-7.6% in double valve replacement. The 5 year actuarial freedom from all complications in Carbomedics were 90.1+/-3.1% in mitral position, 84.9+/-4.2% in aortic position and 81.7+/-5.1% in double valve replacement. The 10 year actuarial freedom from all complications in St. Jude were 80.9+/-3.8%, 81.4+/-6.1%, 72.4+/-10.7% in each positions. In conclusion, the mean age of patients was younger than that of western countries, but it showed increasing tendency year by year. Bioprosthetic valves were used during the initial period until mid-1980's when mechanical valves were used instead of bioprosthetic valves, mainly because of the structural deterioration of the bioprostheses. In terms of thromboembolism, both bioprostheses and mechanical valves seems to be almost comparable although the comparison of both valves was impossible because of the different period of operation, various surgeon and level of the prothrombin time and so on. Recently the number of valve replacement has been decreased since the 1990's and the number of redo valve surgery and valve repair has been increased.
Bioprosthesis ; Female ; Freedom ; Heart Valve Diseases ; Heart Valves* ; Hospital Mortality ; Humans ; Male ; Mitral Valve ; Prothrombin Time ; Seoul* ; Thromboembolism

BACKGROUND: The purpose of this study is to evaluate the validity of a combined high saphenous vein division and sclerotherapy without sacrificing saphenous vein for varicose vein. MATERIAL AND METHOD: Between August 2004 and October 2005, 70 limbs in 50 patients were treated by a combined high saphenous vein division and sclerotherapy. The operative indication is valvular incompetence of femoral-saphenous or popliteal-saphenous junction. Patients received local anesthesia and were treated by a combined high saphenous vein division, ligation of incompetent perforating vein and 1~3% sclerosant. Patients received 1 day hospitalization and applied in compression stocking for 6 weeks. Patients followed after 1 week, 1 and 3 months. RESULT: Mean age of patients was 50+/-11. The female was more common. 8 patients was no symptom, another 42 patients complained of pain, heaviness and fatigue of limbs. The symptoms of varicose vein disappeared 1 month after the procedure in all symptomatic patients. 8 patients needed a adjuvant sclerotherapy for residual varicose vein on 1 week after the procedure. There were only minor complications such as hematoma (1), wound infection (1), thrombophlebitis (20), skin blister (10), hyper-pigmentation (1), and skin ulcer (1). CONCLUSION: We concluded that a combined high saphenous vein division and sclerotherapy without sacrificing saphenous vein for varicose vein is simple, less invasive, economical, and effective treatment for primary varicose vein, and it has a special advantage that saphenous vein can be used as a bypass conduit later. The method was selective in old aged patients.
Anesthesia, Local ; Blister ; Extremities ; Fatigue ; Female ; Hematoma ; Hospitalization ; Humans ; Ligation ; Saphenous Vein ; Sclerotherapy* ; Skin ; Skin Ulcer ; Stockings, Compression ; Thrombophlebitis ; Varicose Veins* ; Veins ; Wound Infection

BACKGROUND: It has been known that cryopreservation can reduce the rejection in the tracheal homograft implantation with preserving its viability. However, the effect of difference in the temperature and duration of storage on the rejection has not been proven. Therefore we investigated the effects of storage temperature and duration on the rejection of cryopreserved rat tracheal homograft. MATERIAL AND METHOD: Twenty four rat's tracheas were harvested from rats and stored in -80degrees C deep freezer and -196degrees C nitrogen tank for 1, 3, and 6 months respectively. The forty eight tracheal segment(each trachea divided into two) were implanted in peritoneal cavity with omental wrapping. The 48 recipient rats were divided into six groups(8 rats/group). Group 1, 3, and 5 were rats implanted with trachea of preservation in -80degrees C for 1 month, 3 months and 6 months respectively. And Group 2, 4, and 6 were rats implanted with trachea of preservation in -196degrees C for 1 month, 3 months and 6 months, respectively. Group 7(n=8) was control group that fresh trachea without cryopreservation was implanted. After 14 days, the implanted tracheas were harvested and the degrees of rejection were investigated with moncellular infiltration and luminal obliteration of trachea by fibrous tissue. RESULT: Most of the tracheas in each group showed moderate or severe degree of moncellular infiltration and there was no statistically significant difference between the 7 groups. The luminal obliterations were less in groups 1,2,3,4,5, and 6 compared to group 7, however, there was no statistical difference. The cartilages were maintained their viability even in the severe perichondral moncellular infiltration in all groups. CONCLUSION: There was no difference in rejection between groups of different storage temperature and duration. It is supposed that proper use of immunosuppressants is required even after cryopreserved tracheal homograft implantation.
Allografts* ; Animals ; Cartilage ; Cryopreservation ; Immunosuppressive Agents ; Nitrogen ; Peritoneal Cavity ; Phenobarbital ; Rats* ; Trachea

Bronchial artery aneurysm is a rare but life-threatening disease when it ruptures, and it requires prompt treatment to prevent from catastrophic ruptures.A 78-year-old woman was referred to our hospital to evaluate mediastinal massfound on chest computed tomography. We did a selective bronchial artery angiography and diagnosed as bronchial artery aneurysm. Aneurysmectomy with division of afferent and efferent arteries was performed through standard thoracotomy without cardiopulmonary bypass. The patient recovered uneventfully and was discharged on postoperative 8th day without any complications.
Aged ; Aneurysm* ; Angiography ; Arteries ; Bronchial Arteries* ; Cardiopulmonary Bypass ; Female ; Humans ; Rupture ; Thoracotomy ; Thorax

BACKGROUND: With the development of cardiac surgical technique, we need more prosthetic materials for repairing the intra- and extracardiac defects. Although bovine pericardial bioprosthesis treated with glutaraldehyde (GA) solution is one of the most popular materials, it has a drawback of later calcific degeneration. The purpose of this study is to investigate the effectiveness of several materials and methods in reducing the calcific degeneration of bovine pericardium. MATERIAL AND METHOD: Forty square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4 g/L MgCl2.6H2O as a control group (group 1). Other 40 pieces pre-treated with 1% SDS (group 2) and 40 pieces post-treated with 8% glutamate (group 3) and 2% chitosan (group 4) were also fixed in the same GA solution. Other 40 pieces pre-treated with 1% SDS and post-treated with 8% glutamate and 40 pieces post-treated with 2% chitosan were also fixed in the same GA solution (group 5, 6). The pericardial pieces were implanted into the belly of 40 Fisher 344 rats subdermally and were extracted 1 month, 2 months, 3 months, and 6 months after the implantation. With an atomic absorption spectrophotometry, we measured the calcium amount deposited and examined the tissue with microscope. RESULT: The calcium deposition in 1 month was less in group 2, 5, 6 than that in group 1 (p<0.05). It was most prominent in group 5 (p<0.01). This finding continued in 2 month. In 3 month, the calcium deposition was less in group 3 and 4 as well as group 2, 5, and 6 than in group 1. In 6 month, the calcium deposition in group 2, 3, 4, 5, and 6 was less than that in group 1 and the difference was more than that of 1, 2, and 6 month. The microscopic calcium deposition was also less in group 2 and 5. Calcium deposition developed in the whole layer of pericardium, beginning with the surrounding the collagen fiber and progressing inwardly. CONCLUSION: Pre-treatment with SDS, post-treatment with glutamate or chitosan, and SDS pre-treatment and post-treatment with glutamate or chitosan were effective in reducing the calcium deposition in bovine pericardium. Moreover, the combined method of SDS pre-treatment and glutamate post-treatment was more effective than other methods.
Animals ; Bioprosthesis ; Calcium ; Chitosan ; Collagen ; Glutamic Acid ; Glutaral ; Heterografts* ; Pericardium ; Rats ; Spectrophotometry, Atomic

Epidermoid cysts are commonly encountered benign lesions in the field of plastic surgery, but their malignant transformation into squamous cell carcinoma (SCC) is extremely rare. A 68-year old woman with a cystic mass on her left lower back presented to our department. We excised the lesion under the suspicion of an epidermoid cyst or metastatic colon cancer based on the patient’s medical history. The skin defect was covered with a split-thickness skin graft, and histopathological evaluation revealed the presence of SCC. Because of the low incidence of SCC arising from an epidermoid cyst, the mechanism of transformation of such cysts to SCC and the prognosis of this condition have not yet been well established. We therefore share the details of this rare case to contribute to the growing base of knowledge about SCC that arises from an epidermoid cyst.

PURPOSE: In outbreaks of infectious disease, medical students are easily overlooked in the management of healthcare personnel protection although they serve in clinical clerkships in hospitals. In the early summer of 2015, Middle East respiratory syndrome (MERS) struck South Korea, and students of Sungkyunkwan University School of Medicine (SKKUSOM) were at risk of contracting the disease. The purpose of this report is to share SKKUSOM's experience against the MERS outbreak and provide suggestions for medical schools to consider in the face of similar challenges. METHODS: Through a process of reflection-on-action, we examined SKKUSOM's efforts to avoid student infection during the MERS outbreak and derived a few practical guidelines that medical schools can adopt to ensure student safety in outbreaks of infectious disease. RESULTS: The school leadership conducted ongoing risk assessment and developed contingency plans to balance student safety and continuity in medical education. They rearranged the clerkships to another hospital and offered distant lectures and tutorials. Five suggestions are extracted for medical schools to consider in infection outbreaks: instant cessation of clinical clerkships; rational decision making on a school closure; use of information technology; constant communication with hospitals; and open communication with faculty, staff, and students. CONCLUSION: Medical schools need to take the initiative and actively seek countermeasures against student infection. It is essential that medical schools keep constant communication with their index hospitals and the involved personnel. In order to assure student learning, medical schools may consider offering distant education with online technology.
Clinical Clerkship ; Communicable Diseases ; Communicable Diseases, Emerging ; Coronavirus Infections* ; Decision Making ; Delivery of Health Care ; Disease Outbreaks ; Education ; Education, Medical ; Humans ; Korea ; Leadership ; Learning ; Lectures ; Middle East* ; Risk Assessment ; Schools, Medical* ; Students, Medical

It is difficult to immunize human lymphocytes in vitro by conventional cell culture methods. Activation of lymphocytes requires not only specific antigen stimulation but also delicate cell to cell interaction. If the cellular organization could be maintained in culture system, lymphocytes could be immunized in vitro with higher frequency. For the purpose of in vitro immunization of human lymphocytes, we used slice culture system which could maintain morphological and functional organization. Human tonsils resected from eleven -year old boy were evenly divided into two pieces, and one was cultivated in conventional cell culture and the other in slice culture system. In the former system, tonsilar mononuclear cells, separated by Ficoll -Hypaque density gradient centrifugation, were cultivated in RPMI 1640 supplemented with 10% human type AB serum in the cell density of 5 x10 6 /ml. In the latter, tonsillar tissues were sliced into small pieces of 8 mm 3 , and were cultivated in Waymouth MB 752/1 medium supplemented with 10% Human type AB serum, gassed under 5% CO2 and 95% O2 at 37 C. After stabilized for one hour, each system wasw challenged with 50 microgram/ml of KLH or 100 microgram/ml of LPS. At 3, 6, 12 and 24 hours after antigen challenge, culture supernatants were assayed for the specific antibody by ELISA, and cells or tissues were analyzed for the expression of CD23 by flow cytometry. The result showed that tonsilar B lymphocytes in slice culture system expressed CD23 as early as 3 hours after antigen challenge, while those in cell culture system expressed CD23 from 6 hours after challenge. Specific antibodies were detected only in supernatants of slice culture system from 6 hours after challenge. These results suggested thathuman lymphocytes could be immunized in vitro if the cellular organization was maintained.
Antibodies ; B-Lymphocytes ; Cell Communication ; Cell Count ; Cell Culture Techniques ; Centrifugation, Density Gradient ; Enzyme-Linked Immunosorbent Assay ; Ficoll ; Flow Cytometry ; Humans* ; Immunization* ; Lymphocytes* ; Male ; Palatine Tonsil

Diabetes is a leading cause of end-stage renal disease. Therefore, prevention of renal dysfunction is an important treatment goal in the management of diabetes. The data of landmark cardiovascular outcome trials of sodiumglucose cotransporter-2 (SGLT2) inhibitors showed profound reno-protective effects. The Korean Diabetes Association and the Korean Society of Nephrology reviewed clinical trials and performed a meta-analysis to assess the effects of SGLT2 inhibitors on the preservation of estimated glomerular filtration rate (eGFR). We limited the data of SGLT2 inhibitors which can be prescribed in Korea. Both eGFR value and its change from the baseline were significantly more preserved in the SGLT2-inhibitor treatment group compared to the control group after 156 weeks. However, some known adverse events were increased in SGLT2 inhibitor treatment, such as genital infection, diabetic ketoacidosis, and volume depletion. We recommend long-term use of SGLT2 inhibitors in patients with type 2 diabetes mellitus (T2DM) for attenuation of renal function decline. However, we cannot generalize our recommendations due to the lack of long-term clinical trials testing the reno-protective effects of every SGLT2 inhibitor in a broad range of patients with T2DM. This recommendation can be revised and updated after the publication of several large-scale renal outcome trials.

Diabetes is a leading cause of end-stage renal disease. Therefore, prevention of renal dysfunction is an important treatment goal in the management of diabetes. The data of landmark cardiovascular outcome trials of sodium-glucose cotransporter-2 (SGLT2) inhibitor showed profound reno-protective effects. The Korean Diabetes Association and the Korean Society of Nephrology reviewed clinical trials and performed meta-analysis to assess the effects of SGLT2 inhibitors on the preservation of estimated glomerular filtration rate (eGFR). We limited the data of SGLT2 inhibitors which can be prescribed in Korea. Both eGFR value and its change from the baseline were significantly more preserved in the SGLT2 inhibitor treatment group compared to the control group after 156 weeks. However, some known adverse events were increased in SGLT2 inhibitor treatment, such as genital infection, diabetic ketoacidosis, and volume depletion. We recommend the long-term use SGLT2 inhibitor in patients with type 2 diabetes mellitus (T2DM) for attenuation of renal function decline. However, we cannot generalize our recommendation due to lack of long-term clinical trials testing reno-protective effects of every SGLT2 inhibitor in a broad range of patients with T2DM. This recommendation can be revised and updated after publication of several large-scale renal outcome trials.