Pseudoaneurysm occurs rarely after percutaneous cannulation of a peripheral artery. A 90 years old male patient with cholangiocarcinoma of distal common bile duct was underwent palliative surgery. Arterial cannulation of a dorsalis pedis artery was done for continuous arterial blood pressure monitoring and blood sampling, and it was removed 7 days after cannulation. Pseudoaneurysm was developed 25 days after cannulation. We report the pseudoaneurysm of dorsalis pedis artery and describe the related mechanisms and predisposing factors.
Aged, 80 and over ; Aneurysm, False* ; Arterial Pressure ; Arteries* ; Catheterization* ; Causality ; Cholangiocarcinoma ; Common Bile Duct ; Humans ; Male ; Palliative Care

Fourty one cases with coronary occlusive disease were anesthetised for aortocoronary bypass graft from May 1977 to December 1983 st Severance Hospital, Yonsei University Medical Center. The main anesthetic agents were diazepam-morphine-pancuronium-O2-N2O in most cases, and supplemented with halothane, enflurane of methoxyflurane in some cases. Nitroglycerin, nitroprusside, triflupromasine, and dopamine were used for keeping the hemodynamic stability before, during and after anesthesia depending on the needs. Two operative death occured in our early years. The mortality rate was 4.87% and no late deaths. The overall anesthetic management for aortocoronary bypass graft surgery is disscussed.
Academic Medical Centers ; Anesthesia* ; Anesthetics ; Coronary Artery Bypass ; Dopamine ; Enflurane ; Halothane ; Hemodynamics ; Methoxyflurane ; Mortality ; Nitroglycerin ; Nitroprusside ; Transplants*

The fetus is an unstable subject for an isolated physiological and biochemical study. To study the fetus in a controlled and stable environment, a trial was done using 12 goat fetuses. Extrauterine incubation system was devised using an extracorporeal membrane oxygenation system. The system consisted of a venous reservoir with a servo-controlled roller pump and a membrane oxygenator. The extra-corporeal circuit and membrane oxygenator were primed with the maternal whole blood of 200 mL. Fetal umbilical cords was exposed by Cesarean section. Fetal umbilical arterial blood was drained via the drainage cannula. The drained blood was perfused to the oxygenator by the roller pump. The highly oxygenated and decarboxylated blood was returned to an umbilical vein via the perfusion catheter. The blood flow rate was controlled manually using a roller pump. Fetal heart rate, blood pressure, and electrocardiogram were continuously recorded. Gas analysis of drained and perfused bood was performed hourly. With this system, the fetuses were able to survive under fairly stable physiological condition for periods of up to 34 hr. The extrauterine incubation system used in this study could therefore be a encouraging future experimental model in researching the artificial placenta for premature fetuses.
Animals ; Extracorporeal Membrane Oxygenation/adverse effects/*methods ; Female ; Fetal Blood/metabolism ; Fetus/*blood supply/*physiology ; Goats ; Humans ; Infant, Newborn ; Infant, Premature ; Models, Animal ; Pregnancy ; Time Factors ; Umbilical Arteries ; Umbilical Veins

OBJECTIVE: The electric analog circuit model can be used to analyse the various function of the cardio vascular system and the dynamic characteristics on each part of human body. According to the previous studies, viscous resistance, flow inertia, and vascular compliance in the cardiovascular system are analogous to resistance, inductance, and capacitance in electric circuit, so the cardiovascular system models have been represented by the electric circuit models. These approaches were to propose suitable models for the interested part of body and to simulate the various characteristics on the cardiovascular system. METHODS: This paper tried to put the characteristics of morphologic structure into the suggested electric circuit model. After setting parameter values of the model the dynamic characteristics of the cardio vascular system is simulated using VisSim, which is one of the simulation tools. RESULTS: The derived simulation results have represented major cardiovascular functions of normal adults. Also simulation results reflect the variation due to the pathophysiological state. CONCLUSION: The controller by baroreceptor, which is one of controllers to control the cardiovascular system, is appended in the model. The dynamic response characteristics and the procedure to restore blood pressure to normal state was observed by simulation lasted a certain period of bleeding.
Adult ; Blood Pressure ; Cardiovascular System* ; Compliance ; Hemorrhage ; Human Body ; Humans ; Pressoreceptors

PURPOSE: Reconstruction of severe postburn hand deformities with flexion or extension contractures with finger webbing deformities, large hypertrophic scars of dorsal hand are frequently encountered problems in burn hand surgery. To obtain the good results after correction of various type of postburn scar hand deformities, we have used the sophisticated reconstructive procedures such as scar contracture release, skin graft, and use of acellular dermal matrix (ADM). We report reliability and usefulness of these novel updated procedures according the type of postburn hand deformities, and reviewed the literatures. METHODS: We had 82 postburn hand deformities. Among them we selected 7 patients of severe postburn hand deformities, which had different affected sites involving over 1/3 of hand. To reconstruct the finger flexion contractures, the scar contracture release and full thickness skin graft was most frequently performed. For correction of finger webbing deformities, the 5 flap Z-plasty for 1(st) web, dorsal and volar interposition flap for 2, 3 and 4 web, FTSG were used. The diffuse hypertrophic scar of dorsum of hand was reconstructed with total excision of scars, skin coverage with one piece of medium thickness STSG, and postoperative clenched hand position. The postburn palmar contractures was reconstructed with extensive contracture release followed by resurfacing with ADM (AlloDerm™) and thin STSG. The severe postburn abduction contractures of wrist was treated by total excision of scars, ADM (CGDerm™), and thin STSG. RESULTS: After 1 month to 1.6 years follow up, relatively satisfactory results were obtained in all patients. As complications, 1 case of recurrent palmar contractures, which was reconstructed with ADM (AlloDerm™) with thin STSG, were noticed. CONCLUSION: The postburn finger flexion contractures could be managed by the scar contractures release and FTSG. This method is very safe and reliable. For reconstruction of postburn finger webbing deformities, it is mandatory to use 5-flap Z-plasty for 1(st) webbing deformities, and dorsal and volar interposition flap for 2, 3 and 4(th) webbing deformities concomitantly with resurfacing with FTSG. The diffuse hypertrophic scars of dorsum of hand was managed by total excision of scars, resurfacing with one large piece of over medium thickness STSG, and postoperative clenched hand position. After release of scar contractures of hand, acellular dermal matrix (ADM) with thin STSG can be used in case of deficient FTSG donor site.
Acellular Dermis ; Burns ; Cicatrix* ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Contracture ; Fingers ; Follow-Up Studies ; Hand Deformities* ; Hand* ; Humans ; Methods ; Skin ; Tissue Donors ; Transplants ; Wrist

We report a case of prolonged extreme reactive thrombocytosis in a post-splenectomy patient with hereditary spherocytosis. A 29-year-old female patient presented with gall stones detected incidentally by abdominal ultrasonography. Her laboratory findings showed hemolytic anemia with spherocytosis on the peripheral blood smear and increased osmotic fragility. She was diagnosed with hereditary spherocytosis and underwent a laparoscopic cholecystectomy and splenectomy. After undergoing surgery, the hemolytic anemia was resolved but thrombocytosis was newly detected. Nineteen months after the splenectomy, the thrombocytosis was still persistent and extremely high. To our knowledge, this is the first report of a prolonged extreme reactive thrombocytosis after a splenectomy in Korea.
Adult ; Anemia, Hemolytic ; Cholecystectomy, Laparoscopic ; Female ; Gallstones ; Humans ; Korea ; Osmotic Fragility ; Spherocytosis, Hereditary ; Splenectomy ; Thrombocytosis

Although a pathogenic mechanism of hemolytic anemia complicated with viral hepatitis is unknown, it is suggested that there are four mechanisms; 1) In the individual who has predisposition to hemolytic anemia, viral infection accelerates the red cell destruction & hemolysis become obvious. 2) Directly, virus itself injures to the red cell membrane. 3) The serious liver failure & hypersplenism induce the hemolysis. 4) Autoimmune hemolytic anemia because of immunological abnormality caused by viral infection. We experienced a case of autoimmune hemolytic anemia in 33-year-old male patient who was diagnosed as chronic lobular hepatitis B with biopsy. Diagnosis was estabilished by clinical features, blood cell count, routine urinalysis, direct & indirect Coombs test, liver function test, immunoglobulin quantitations, hepatitis B marker, bone marrow aspiration, and liver biopsy. This case was treated with corticosteroid and transfusion. During follow-up, he has been well tolerated.
Adult ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune* ; Biopsy ; Blood Cell Count ; Bone Marrow ; Cell Membrane ; Coombs Test ; Diagnosis ; Follow-Up Studies ; Hemolysis ; Hepatitis B* ; Hepatitis* ; Humans ; Hypersplenism ; Immunoglobulins ; Liver ; Liver Failure ; Liver Function Tests ; Male ; Urinalysis

BACKGROUND AND OBJECTIVES: Although generic clopidogrel is widely used, clinical efficacy and safety between generic and original clopidogrel had not been well evaluated. The aim of this study was to evaluate the clinical outcomes of 2 oral formulations of clopidogrel 75 mg tablets in patients with coronary artery disease (CAD) undergoing drug-eluting stent (DES) implantation. SUBJECTS AND METHODS: Between July 2006 and February 2009, 428 patients that underwent implantation with DES for CAD and completed >1 year of clinical follow-up were enrolled in this study. Patients were divided into the following 2 groups based on treatment formulation, Platless(R) (test formulation, n=211) or Plavix(R) (reference formulation, n=217). The incidence of 1-year major adverse cardiovascular and cerebrovascular event (MACCE) and stent thrombosis (ST) were retrospectively reviewed. RESULTS: The baseline demographic and procedural characteristics were not significantly different between two treatment groups. The incidence of 1-year MACCEs was 8.5% {19/211, 2 deaths, 4 myocardial infarctions (MIs), 2 strokes, and 11 target vessel revascularizations (TVRs)} in Platless(R) group vs. 7.4% (16/217, 4 deaths, 1 MI, 2 strokes, and 9 TVRs) in Plavix(R) group (p=0.66). The incidence of 1-year ST was 0.5% (1 definite and subacute ST) in Platless(R) group vs. 0% in Plavix(R) group (p=0.49). CONCLUSION: In this study, the 2 tablet preparations of clopidogrel showed similar rates of MACCEs, but additional prospective randomized studies with pharmacodynamics and platelet reactivity are needed to conclude whether generic clopidgrel may replace original clopidogrel.
Blood Platelets ; Coronary Artery Disease ; Drug-Eluting Stents ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Incidence ; Myocardial Infarction ; Retrospective Studies ; Stents ; Stroke ; Tablets ; Thrombosis ; Ticlopidine

Pachydermoperiostosis or primary hypertrophic osteoarthropathy is an uncommon disease of acromegaloid facial feature, but characterized by unique phenotype (digital clubbing and pachydermia) and distinctive radiographic appearances like periostosis. We experienced a case with complete form of pachydermoperiostosis accompanied by heart failure. He presented with typical features consisting of clubbing with enlargement of the hand, thickening of facial skin and periosteal new bone formation involving lower leg. Echocardiography revealed severely decreased left ventricular systolic function. Treatment with medications resulted in an improvement of cardiac function and symptom. There is no previous report documenting pachydermoperiostosis accompanied by heart failure. We report that case for the first time.
Echocardiography ; Hand ; Heart ; Heart Failure ; Leg ; Osteoarthropathy, Primary Hypertrophic ; Osteogenesis ; Phenotype ; Skin

Background: Peritoneal dialysis (PD) is improving as a renal replacement therapy for end-stage renal disease (ESRD) patients. We analyzed the main outcomes of PD over the last three decades at a single large-scale PD center with an established high-quality care system. Methods: As a retrospective cohort study, we included participants (n = 1,203) who began PD between 1990 and 2019. Major PD-related outcomes were compared among the three 10-year cohorts. Results: The 1,203 participants were 58.3% male with a mean age of 47.9 ± 13.8 years. The median PD treatment duration was 45 months (interquartile range, 19–77 months); 362 patients (30.1%) transferred to hemodialysis, 289 (24.0%) received kidney transplants, and 224 (18.6%) died. Overall, the 5- and 8-year adjust patient survival rates were 64% and 49%, respectively. Common causes of death included infection (n = 55), cardiac (n = 38), and cerebrovascular (n = 17) events. The 5- and 8-year technique survival rates were 77% and 62%, respectively, with common causes of technique failure being infection (42.3%) and solute/water clearance problems (22.7%). The 5-year patient survival significantly improved over time (64% for the 1990–1999 cohort vs. 93% for the 2010–2019 cohort). The peritonitis rate also substantially decreased over time, from 0.278 episodes/patient-year (2000–2004) to 0.162 episodes/patient-year (2015–2019). Conclusion PD is an effective treatment option for ESRD patients. There was a substantial improvement in the patient survival and peritonitis rates over time. Establishing adequate infrastructure and an effective system for high-quality PD therapy may be warranted to improve PD outcomes.