The congenital esophageal atresia with proximal tracheoesophageal fistula is a developmental defect with incomplete septation of the foregut of embryonic period and is often associated with other congenital anomaly. We experienced a case of the esophageal atresia with proximal tracheoesophageal fistula in a 1-day old male patient who was transferred from an obstetric clinic due to respiratory distress soon after birth. The baby was treated not by primary anastomosis but by operation of ligation of proximal part of fistula and gastrostomy because of too long distance of 4cm between proximal and distal pouches of esophageal atresia. His weight gain has been good in the treatment of reverse gastric tube interposition for 9 months after birth. We presented the case with brief review of the related literatures.
Esophageal Atresia* ; Fistula ; Gastrostomy ; Humans ; Ligation ; Male ; Parturition ; Tracheoesophageal Fistula* ; Weight Gain

BACKGROUND AND OBJECTIVES: Anatomical knowledge of microsurgical anatomy of the perigeniculate ganglion area is essential to the exploration of the facial nerve via translabyrinthine approach or middle fossa approach. This study was designed to investigate the surgical anatomy of the perigeniculate ganglion area of the facial nerve in view of translabyrinthine and middle fossa approach. MATERIALS AND METHOD: We dissected 15 human cadaveric temporal bones under a microscope and measured the lengths of the proximal part of tympanic segment, the labyrinthine segment, and the angle between the tympanic segment and the labyrinthine segment in the view of translabyrinthine approach. We dissected 20 human temporal bones under a microscope using a middle fossa approach, and measured the angle between the lines drawn from the malleus head to the vertical crest and from the malleus head to the geniculate ganglion, and the distance from the malleus head to the geniculate ganglion. RESULTS: The distance of facial nerve from the cochleariform process to the geniculate ganglion was 3.8+/-0.7 mm. The length of the labyrinthine segment of facial nerve was 4+/-0.8 mm. The angle between the tympanic segment and the labyrinthine segment in the view of translabyrinthine approach was 26+/-5degrees. The angles between the lines drawn from the malleus head to the vertical crest and from the malleus head to the geniculate ganglion, and the distance from the malleus head to the geniculate ganglion were found to be 23+/-2degreesand 6.5+/-0.3 mm, respectively. CONCLUSION: Precise knowledge about the microsurgical anatomy of the perigeniculate ganglion area of facial nerve is imperative for facial nerve decompression by a translabyrinthine and middle fossa approach.
Cadaver ; Cranial Fossa, Middle ; Decompression ; Facial Nerve* ; Ganglion Cysts* ; Geniculate Ganglion ; Head ; Humans ; Malleus ; Temporal Bone

Corneal neovascularization, which is associated with complications in corneal diseases, can cause lipid deposit, decreasing vision, and graft rejection after penetrating keratoplasty (PKP). Corneal laser photocoagulation using an argon laser or yellow dye laser for ablation of corneal neovascularization has been described. We performed corneal argon laser photocoagulation (CALP) in two male patients with corneal neovascularization after herpetic keratitis. One PKP was performed after CALP and restored good vision with no rejection of the graft during an 8 month follow-up period. In the other case we observed visual improvement and no recurrence of corneal neovascularization after CALP.
Adult ; Corneal Neovascularization/etiology/*surgery ; Follow-Up Studies ; Humans ; Keratitis, Herpetic/complications ; *Laser Coagulation ; Male ; Middle Aged ; Visual Acuity

OBJECTIVES: The aim of this study was to observe the nystagmus of totally unilateral vestibular function loss on galvanic vestibular stimulation and the diagnostic value of galvanic vestibular stimulation. Additionally we wanted to evaluate which portions may be stimulated by galvanic vestibular stimulation. MATERIALS AND METHODS: We evaluated the three parameters of galvanic stimulation in fourteen patients with totally unilateral vestibular function loss, 1)spontaneous nystagmus, 2)galvanic stimulating nystagmus, 3)Post galvanic stimulating nystagmus through 3-dimensional video-oculography technique. RESULTS: When negative electrode was attached to the intact side, The nystagmus on galvanic vestibular stimulation was directed to the negative electrode side in all patients and post galvanic stimulating nystagmus was directed to the opposite side but on functional loss side, we couldn't detect any nystagmus on galvanic vestibular stimulation and in 10 patients, post galvanic stimulating nystagmus was observed and directed to the intact side. CONCLUSIONS: Galvanic vestibular stimulation is very useful for evaluating the vestibular function and for diagnosing the vestibular disease.
Electrodes ; Humans ; Vestibular Diseases

In patient with severe adhesion between lung and aorta, there is some limitation in approaching the distal arch or descending thoracic aorta through the usual left thoracotomy. We report a case of a successfully managed distal arch and descending thoracic aortic aneurysm through the median sternotomy without any manipulations of the lung in a 66 year old man who presented hemoptysis.
Aged ; Aorta ; Aorta, Thoracic* ; Aortic Aneurysm, Thoracic ; Hemoptysis ; Humans ; Lung ; Sternotomy* ; Thoracotomy

PURPOSE: The tunneled hemodialysis catheter has been widely used for a temporary or an alternative permanent vascular access in patients requiring hemodialysis. The tunneled hemodialysis catheter is also widely used for a reliable vascular access in children who need stem cell transplantation. METHOD: We reviewed the results of 150 catheters inserted in 108 patients for the duration of the indwelling catheter, the complication rate and the reasons for insertion and removal. RESULT: The mean duration of the indwelling catheter was 5.7 months (1 d~52.2 mo). In the stem cell transplantation group, the mean duration of the indwelling catheter was significantly longer than for the hemodialysis group (mean: 9.9 mo vs. 3.6 mo, P<0.05). Fifty-one catheters (39.8%) were removed due to complications. The most common complications were infection (n=23: 17.9%) and dislocation (n=15: 11.7%). In the hemodialysis group, the complication-related catheter removal was more frequent than in the stem cell transplantation group (43.9% vs. 32.6%, P<0.05). CONCLUSION: The tunneled hemodialysis catheter remains a reliable short-term vascular access for hemodialysis and a good vascular access in stem cell transplantation.
Catheterization, Central Venous ; Catheters* ; Catheters, Indwelling ; Child* ; Dislocations ; Humans ; Renal Dialysis* ; Stem Cell Transplantation

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disease. The theories of can-alolthiasis and cupulolithisis of posterior semicircular canal are commonly accepted in BPPV. Recently, not only posterior canal but also lateral canal BPPV were reported. The purposes of this study are to analyze the result of lateral canal BPPV treatment and to introduce effective schedule of reposition maneuvers and follow up. MATERIALS AND METHODS: Sixty two patients who were diagnosed as lateral semicircular canal BPPV were included in this study. Supine head turning test was done and eye movement was documented with videonystagmography. In the canalolithiasis type, barbecue rotation maneuver was performed and in the cupulolithiasis type, cupulolith reposition maneuver was performed. In each type of BPPV, we analyzed the number of treatment until nystagmus was disappeared, recurrence rate and relationship between recurrence and age, sex of patients. RESULTS: Canalolithiasis type was 55% and cupulolithiasis type was 37%. Eight percents of patients showed combined type. All except 2 cases (congenital malformation) were healed by the reposition maneuver. Vertigo recurred in about 30% of patients, and they were retreated with the reposition maneuver. There was no correlation between recurrence and age, sex of patients. CONCLUSION: In lateral semicircular canal BPPV, the reposition maneuver was a effective treatment method. The reposition maneuver was recommended to perform continuously once a day until nystagmus disappeared. Because recurrence rate was about 30%, continuous follow-up was needed.
Appointments and Schedules ; Eye Movements ; Follow-Up Studies ; Head ; Humans ; Recurrence ; Semicircular Canals* ; Vertigo ; Vestibular Diseases

OBJECTIVE: Although most of hypertensive intracerebral hematoma (HICH) are static after ictus, a minority of them can enlarge in the acute phase after onset. This study performs to find the predicting factors and signs of hematoma enlargement in patients with HICH. METHODS: Among 140 cases of HICH treated during 1.5 years, the authors selected 107 cases who underwent contrast enhanced and nonenhanced initial CT scanning within 12 hours after symptom onset and a follow-up CT scan in order to investigate the enlargement of hematoma. Those cases were divided into two groups:hematoma enlargement (group I) and non-enlargement group (group II). The comparison of predicting factors (bleeding tendency, abnormal liver function and blood pressure) and signs (enhanced focus in hematoma on CT) of hematoma enlargement between group I and II was performed. RESULTS: There were 8 cases in group I and 99 cases in group II. The incidence of an enhanced focus in hematoma on CT scan was higher in group I than group II (87.5% vs. 9.1%, p<0.05). The systolic blood pressure (BP) at 6 hours after symptom onset and at the time of the first CT scan was higher in group I than group II (172.5 vs. 152.0 mm Hg, and 182.5 vs. 158.6 mm Hg, respectively, p<0.05). There was no difference in the incidence of bleeding tendency and abnormal liver function between group I and II. CONCLUSION: Contrast enhanced brain CT scan to detect the enhanced focus in the hematoma is one of useful methods to predict the early enlargement of hematoma in patients with HICH. The continuance of a high BP in spite of medication of antihypertensive drugs during the acute period after the onset of symptoms is another predictive sign of hematoma enlargement in patients with HICH.
Antihypertensive Agents ; Blood Pressure ; Brain ; Follow-Up Studies ; Hematoma* ; Hemorrhage ; Humans ; Incidence ; Liver ; Tomography, X-Ray Computed*

Angina pectoris is a state of coronary artery disease, If the myocardial oxygen consumption (MVO2) is greater than the coronary blood flow from any cause, myocardial ischemic damage will almost always follow due to lack of oxygen. The authors experienced cardiac arrest in a patient of unstable angina pectoris during induction of general anesthesia. External cardiac massage was carried out and essential drugs were given immediately, but they did not restore the normal sinus rhythm. We then gave 100 J. of DC countershock at first with failure, then another 200, 300 and 400 J. were given intermittently under the observation of continuous ECG monitoring. Thereafter, complete normal sinus rhythm was restored without any dysrrhythmias, and the patient regained consciousness from the stuporous state due to the induction agents. Because of the light premedicants and also the light induction agents and pancuronium during intubation, the patient's heart could not endure any more in this state of oxygen lack. Patients who have serious organic heart diseases should indeed be prepared with great caution before and during an anesthesia.
Anesthesia* ; Anesthesia, General ; Angina Pectoris* ; Angina, Unstable ; Consciousness ; Coronary Artery Disease ; Drugs, Essential ; Electrocardiography ; Heart ; Heart Arrest ; Heart Diseases ; Heart Massage ; Humans ; Intubation ; Oxygen ; Oxygen Consumption ; Pancuronium ; Stupor

Rastelli repair has been considered the procedure of choice for surgically repairing transposition of the great arteries combined with ventricular septal defect and pulmonary stenosis. However, the long term results have been less than optimal and these patients who ungo this procedure can eventually display conduit obstruction, left ventricular outflow tract obstruction and arrhythmias. Many new procedures are now available and they are technically challenging for making a more normal anatomic repair. In our hospital, two patients who had a TGA with VSD and PS have been repaired with a Half Turned Truncal Switch Operation and a Lecompte maneuver in 2003 and 2006, respectively. We report on our two experiences with performing a Half Turned Truncal Switch Operation, and we discuss the changes of the biventricular outflow tract.
Arrhythmias, Cardiac ; Arteries ; Heart Septal Defects, Ventricular ; Humans ; Pulmonary Valve Stenosis ; Transposition of Great Vessels