No abstract available.
Intussusception* ; Peutz-Jeghers Syndrome*

BACKGROUND/AIMS: It have been reported that operative mortality and morbidity rate rise significantly when emergency cholecystectomy is performed in critically ill patients with acute cholecystitis(AC), and many studies have also concluded that delayed or interval laparoscopic cholecystectomy(LC) in patients with AC demonstrated high conversion rate and complication rate compared with early LC. However, if the acutely inflamed gallbladder(GB) is decompressed by emergent percutaneous gallbladder drainage(PGBD), it may decrease the technical difficulty of LC allowing successful delayed LC or may decrease the wound complication of delayed open cholecystectomy, when the patient is in better condition. The purpose of this retrospective study was to assess the outcome of delayed cholecystectomy focused on LC following PGBD in patients with AC METHODS: A total of 181 patients with AC were divided into PGBD(n= 66) and non-PGBD group(n= 115), and each group were subdivided into PGBD-delayed LC(after 72 hours of admission, n= 32), PGBD-open cholecystectomy(n= 20), non-PGBD-early LC(within 72 hours of admission, n= 40), non- PGBD-delayed LC(n= 17), non PGBD-open cholecystectomy group(n= 58) and others. PGBD group had higher incidence of comorbidity compared with non-PGBD group. Outcomes of cholecystectomy was assessed by conversion rate and morbidity rate(chi2 test), LC time and hospital stay(median test) for LC, and morbidity for open cholecystectomy in PGBD group compared with those of non PGBD group. RESULTS: PGBD promptly relieved of symptom of AC in 94 % of patients and showed 3 % of technical failure and 4.5 % of complication rate. Compared with non PGBD-early and delayed LC group, the PGBD-delayed LC group showed longer LC time(median 110 min vs 82.5, p < 0.05, vs 95 min), a little lower conversion rate(12.5 % vs 22.5 % vs 17.6 %), similar morbidity rate(19% vs 17.5 % vs 29 %) and prolonged total hospital stay(median 12.5 days vs 7 days, p < 0.001, vs 10 days). In open cholecystectomy series, PGBD group showed lower morbidity rate compared with non PGBD group(5% vs 24 %, p < 0.05) CONCLUSION: Unlike to open cholecystectomy series, PGBD did not significantly improve the outcome of LC for AC as assessed by conversion and morbidity rate and hospital stay compared with non PGBD. Thus we can conclude that although PGBD is a safe and effective emergency procedure for AC, it should be limited to higher risk group such as elderly or critically ill patients and to acalculous cholecystitis.
Acalculous Cholecystitis ; Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute* ; Comorbidity ; Critical Illness ; Drainage* ; Emergencies ; Gallbladder* ; Humans ; Incidence ; Length of Stay ; Mortality ; Retrospective Studies ; Wounds and Injuries

PURPOSE: Varicella-zoster virus (VZV) infection is a common childhood disease. However, old and immune compromised patients are also at risk. Necrotizing fasciitis is a life threatening infection of the subcutaneous tissues, rapidly extending along the fascial planes. It is associated with a significant mortality rate, reported between 20% and 50%, and is therefore regarded as a surgical emergency. The authors treated a patient, who developed skin necrosis of her nose and left hemifacial area, following VZV infection. There are few literatures concerning this case; therefore, we present a rare case with review of literature. METHODS: A 39-year-old woman had shown a localized, painful, multiple bullae and eschar formation in her nose and left hemifacial area for several days. Her skin lesion had rapidly worsened in size and morphology. RESULTS: We diagnosed her as a necrotizing fasciitis, following herpes zoster, and then we performed a debridement of necrotic tissue and took a full thickness skin graft on her nose and left hemifacial area. Now, she was followed up with acceptable aesthetic result after 6 months. CONCLUSION: Secondary bacterial skin infection following VZV, can cause a result in a higher risk of complications. Among the complication, a necrotizing fasciitis of the head and neck is uncommon, and involvement of the nose is even more rare. Through this uncommon case report, we intend to emphasize the fact that early diagnosis of necrotizing fasciitis is very important, since it frequently necessitates surgical treatment which improves morbidity and leads to good recovery.
Adult ; Blister ; Debridement ; Early Diagnosis ; Emergencies ; Fasciitis, Necrotizing ; Female ; Head ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Neck ; Necrosis ; Nose ; Skin ; Subcutaneous Tissue ; Transplants

No abstract available.
Choledochal Cyst*

STATEMENT OF PROBLEM: Magnesium oxide may increase pH of alginate, and supply magnesium ions to the polymerization reaction of alginate. PURPOSE: This study was designed to evaluate the influence of incorporation of magnesium oxide to alginate composition. MATERIAL AND METHOD: Seven kinds of experimental alginates were prepared and used for the experiments. Components with unchanging concentrations were sodium alginate 15%, calcium sulfate 14%, sodium phosphate 2%, and zinc fluoride 3%. Contents of magnesium oxide were varied as 0%, 1%, 2%, 3%, 4%, 5%, 6%. Diatomaceous earth were added to each experimental groups as balance to be 100%. Control group was a MgO 0% group. Working time, setting time, elastic recovery, strain in compression, compressive strength and tear resistance were measured were measured. Sample size for each groups were 10. Arithmetic means were used as each groups representative values. Regression test between MgO contents and results, Duncan's multiple range test, and One-way ANOVA test were done between groups at level of 0.05. RESULTS: 1. Magnesium oxide made the working time and setting time as longer(p<0.0001). 2. Magnesium oxide did not alter the elastic recovery(p>0.05). 3. Magnesium oxide contents between 2% and 4% exhibited the lowest strain in compression on alginates(p<0.0001). 4. Magnesium oxide made the compressive strength and the tear resistance stronger(p<0.0001). CONCLUSION: These results mean that setting time of alginate maybe controlled and that mechanical properties maybe improved by the incorporation of magnesium oxide into alginate, without any reduction of elasticity.
Alginates* ; Calcium Sulfate ; Compressive Strength ; Diatomaceous Earth ; Elasticity ; Fluorides ; Hydrogen-Ion Concentration ; Ions ; Magnesium Oxide* ; Magnesium* ; Polymerization ; Polymers ; Sample Size ; Sodium ; Tears ; Zinc

BACKGROUND: Pressure-controlled intermittent coronary sinus occlusion(PICSO) as well as synchronized retrograde perfusion(SRP) have emerged as a new technique that can redirect blood through the coronary sinus to nourish ischemic myocardium beyond a coronary occlusion. Also, coronary sinus occlusion pressure(CSOP) can be measured during application of PICSO. This experimental study was to determine the characteristics of CSOP and the effects of PICSO on the reduction of infarct size in experimentally induced acute myocardial infarction. METHOD: 22 dogs were included in this study, 9 in control group and 13 in PICSO group. Thirty minutes after experimental ligation of proximal left anterior descending artery, PICSO device was applied to PICSO group for 4 hours. Systolic and end-diastolic pressure of CSOP, LVEDP(left ventricular end-diastolic pressure), LVSP and aortic pressure with heart rate were measured every 1 hour. After 4 hours, heart was excised and 1% TTC(triphenyl tetrazolium cholride) solution was perfused distal to left anterior descending(LAD) coronary artery to measure the area of viable myocardium in LAD territory. 'The area at risk(LAD territory/LV surface area)' and 'the area of necrosis(necrosis area/LAD territory)' were calculated with cut surface of LV using planimetry. RESULTS: 1) End-diastolic pressure of CSOP and left ventricular end-diastolic pressure(LVEDP) were closely equalized and significantly correlated each other(p<0.001). 2) Aortic pressure profiles, left ventricular pressure profiles and heart rate during coronary occlusion did not differ significantly from the control group. Aortic and left ventricular systolic and mean pressures declined significantly after 1 hour of coronary occlusion. Also LVEDP increased significantly after 1 hour of coronary occlusion(p<0.01). 3) The area of myocardium at risk was similar in both groups(control 12.0+/-2.1 %, PICSO 11.5+/-1.2%). But the results of the area of necrosis within the area of risk showed that PICSO significantly reduces myocardial infarct size(control 79.1+/-4%, PICSO 25.3+/-5%). CONCLUSION: PICSO can be indicated in acute coronary syndrome to reduce the myocardial necrosis especially in LAD territory. In addition, PICSO can be used to evaluated LVEDP by measuring CSOP,especially in patients with severe aortic valvular stenosis. Further study is needed upon the effectiveness of PICSO on clinical situations and precise metabolic effects of PICSO on myocardium.
Acute Coronary Syndrome ; Animals ; Arterial Pressure ; Arteries ; Constriction, Pathologic ; Coronary Occlusion ; Coronary Sinus* ; Coronary Vessels ; Dogs ; Heart ; Heart Rate ; Humans ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Ventricular Pressure

BACKGROUND: Pressure-controlled intermittent coronary sinus occlusion(PICSO) as well as synchronized retrograde perfusion(SRP) have emerged as a new technique that can redirect blood through the coronary sinus to nourish ischemic myocardium beyond a coronary occlusion. Also, coronary sinus occlusion pressure(CSOP) can be measured during application of PICSO. This experimental study was to determine the characteristics of CSOP and the effects of PICSO on the reduction of infarct size in experimentally induced acute myocardial infarction. METHOD: 22 dogs were included in this study, 9 in control group and 13 in PICSO group. Thirty minutes after experimental ligation of proximal left anterior descending artery, PICSO device was applied to PICSO group for 4 hours. Systolic and end-diastolic pressure of CSOP, LVEDP(left ventricular end-diastolic pressure), LVSP and aortic pressure with heart rate were measured every 1 hour. After 4 hours, heart was excised and 1% TTC(triphenyl tetrazolium cholride) solution was perfused distal to left anterior descending(LAD) coronary artery to measure the area of viable myocardium in LAD territory. 'The area at risk(LAD territory/LV surface area)' and 'the area of necrosis(necrosis area/LAD territory)' were calculated with cut surface of LV using planimetry. RESULTS: 1) End-diastolic pressure of CSOP and left ventricular end-diastolic pressure(LVEDP) were closely equalized and significantly correlated each other(p<0.001). 2) Aortic pressure profiles, left ventricular pressure profiles and heart rate during coronary occlusion did not differ significantly from the control group. Aortic and left ventricular systolic and mean pressures declined significantly after 1 hour of coronary occlusion. Also LVEDP increased significantly after 1 hour of coronary occlusion(p<0.01). 3) The area of myocardium at risk was similar in both groups(control 12.0+/-2.1 %, PICSO 11.5+/-1.2%). But the results of the area of necrosis within the area of risk showed that PICSO significantly reduces myocardial infarct size(control 79.1+/-4%, PICSO 25.3+/-5%). CONCLUSION: PICSO can be indicated in acute coronary syndrome to reduce the myocardial necrosis especially in LAD territory. In addition, PICSO can be used to evaluated LVEDP by measuring CSOP,especially in patients with severe aortic valvular stenosis. Further study is needed upon the effectiveness of PICSO on clinical situations and precise metabolic effects of PICSO on myocardium.
Acute Coronary Syndrome ; Animals ; Arterial Pressure ; Arteries ; Constriction, Pathologic ; Coronary Occlusion ; Coronary Sinus* ; Coronary Vessels ; Dogs ; Heart ; Heart Rate ; Humans ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Ventricular Pressure

BACKGROUND: Maze operation is aimed for the restoration of sinus rhythm. But restoration of atrial mechanical function has not been demonstrated in all patients converted to sinus rhythm. METHOD: From Apr. 1994 to Feb. 1996, maze operations were performed in 32 pts (M:F=13:19, mean age 47.1+/-9.0 years) combined with valvular surgery(n=26), CABG(n=3), and others(n=3). Presence of atrial mechanical function was serially examined before discharge, in 3mo, 6mo and 1 yr using Doppler echocardiography. RESULTS: In 22 patients(pts), sinus rhythm was maintained without antiarrhythmic agents. In 4 patients antiarrhythmic agent was required to maintain sinus rhythm while in another 4 patients showed paroxysmal Af despite of the treatment with antiarrhythmic agents. In 30 pts with sinus rhythm or paroxysmal Af, right atrial function was restored in all pts while left atrial function was restored in only 19/30(63%). Peak A velocity and A/E ratio were 0.38+/-0.12m/s, 0.74, respectively on tricuspid inflow(TI), and 0.46+/-0.14m/s, 0.40, respectively on mitral inflow(MI ). MI peak A velocity and A/E ratio were significantly lower than the 16 control postoperative pts (0.75<0.29, 0.80 : p+/-0.01). In pts with atrial mechanical function, the duration of Af was significantly shorter than patients without atrial function (1.9+/-2.9 yr vs 7.1+/-3.0 yr : p<0.01), but no significant differences in the LA size and volume. CONCLUSION: Maze operation is effective in restoring sinus rhythm. But restoration of sinus rhythm was not always associated with restoration of atrial mechanical function, and the restored atrial function was incomplete. The duration of Af could be a markker for predicting the restoration of atrial function.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Atrial Function, Right ; Echocardiography, Doppler ; Humans

BACKGROUND: Maze operation is aimed for the restoration of sinus rhythm. But restoration of atrial mechanical function has not been demonstrated in all patients converted to sinus rhythm. METHOD: From Apr. 1994 to Feb. 1996, maze operations were performed in 32 pts (M:F=13:19, mean age 47.1+/-9.0 years) combined with valvular surgery(n=26), CABG(n=3), and others(n=3). Presence of atrial mechanical function was serially examined before discharge, in 3mo, 6mo and 1 yr using Doppler echocardiography. RESULTS: In 22 patients(pts), sinus rhythm was maintained without antiarrhythmic agents. In 4 patients antiarrhythmic agent was required to maintain sinus rhythm while in another 4 patients showed paroxysmal Af despite of the treatment with antiarrhythmic agents. In 30 pts with sinus rhythm or paroxysmal Af, right atrial function was restored in all pts while left atrial function was restored in only 19/30(63%). Peak A velocity and A/E ratio were 0.38+/-0.12m/s, 0.74, respectively on tricuspid inflow(TI), and 0.46+/-0.14m/s, 0.40, respectively on mitral inflow(MI ). MI peak A velocity and A/E ratio were significantly lower than the 16 control postoperative pts (0.75<0.29, 0.80 : p+/-0.01). In pts with atrial mechanical function, the duration of Af was significantly shorter than patients without atrial function (1.9+/-2.9 yr vs 7.1+/-3.0 yr : p<0.01), but no significant differences in the LA size and volume. CONCLUSION: Maze operation is effective in restoring sinus rhythm. But restoration of sinus rhythm was not always associated with restoration of atrial mechanical function, and the restored atrial function was incomplete. The duration of Af could be a markker for predicting the restoration of atrial function.
Atrial Fibrillation ; Atrial Function ; Atrial Function, Left ; Atrial Function, Right ; Echocardiography, Doppler ; Humans

BACKGROUND: It is well known that collateral circulation has important roles in ischemic heart disease. It reduce ventricular remodelingand infarct size to improve ventricular function and survival. Extents and duration of ischemia are critical stimulants of the development of coronary collaterla circulation. We hypothesize that collateral circulation is poor in patients with lisions at branching points because atherosclerosis progress more rapidly not to allow the collateral circulation to develop. METHOD: We studied total 330 coronary angiography, which have more than 50% stenosis in any coronary artery, normal letf ventriculography and no history of myocardial infarction. In each coronary angiography, severity, site, proximity, length of lesions were analyzed, classified, and collaterale circulation was graded. We also observed whether the lesions involve branching point or not. RESULTS: While coronary collateral circulation developed well when stenosis was more than 90% in the severity, it was poor when the lesions involve branching points. Collateral circulation tended to be poor in case of eccentric lesion, but it was statistically insignificant. The above findings support our hypothesis of the accelerated atherosclerosis at branching points. CONCLUSIONS: The facts that the development of coronary collaterals is poor with lesions involving branching points suggest that atherosclerosis is accelerated at these lesions that is characterized by blood stasis, turbulence and lower arterial wall tension.
Angina Pectoris* ; Atherosclerosis ; Collateral Circulation* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Humans ; Ischemia ; Myocardial Infarction ; Myocardial Ischemia ; Ventricular Function