In the preoperative evaluation before coronary artery bypass surgery, review of the coronary arteriogram is the most important step. Expected "normal" lumen diameter at a given coronary anatomic location is a basis for quantative estimation of coronary disease severity that could be more useful than the traditional "percent stenosis". The distribution and number of major coronary artery branches are determinants of number of bypass grafts needed. We reviewed the coronary artery anatomy in 174 adult patients who revealed no coronary pathology in angiographic studies done from September 1994 to June 1996. Quantative analysis was done in all cases by a single person using a Computerized System (Arripro 35(r)). The results were follows; 1) The mean diametre of left main coronary artery was 4.45 mm (range 2.74~6.72). The pattern of branching was bifurcation in 67.24%, trifurcation in 28.74% and quadrifurcation in 4.02% of the patients. 2) The mean diametre of left anterior descending artery was 3.17 mm (range 2.10~5.85), 2.79 (range 1.55~5.59) and 2.17 mm (range 1.37~3.81) in the proximal, mid, and the distal portions, respectively. The number of diagonal branches of left anterior artery was from one to four (mode=2). 3) The mean diametre of proximal and distal left circumflex artery were 3.17mm (range 1.74~4.89) and 2.19 mm (range 1.21~4.46). The number of obtuse marginal branches of left circumflex artery is from one to six (mode 2). 4) The mean diametre of proximal and distal right coronary artery, the posterior descending artery and the largest posterolateral branch were mean 3.51 mm (range 2.07~5.67), 2.09 mm (range 1.42~3.60), 2.09 mm (range 1.02~3.60) and 2.30 mm (range 1.39~4.39). 5) The right coronary artery dominant was 163 cases (93.68%) of the total 174 cases. 6) The large significant acute marginal artery was visualized in more than half of the people.
Adult ; Arteries ; Computer Systems ; Coronary Artery Bypass ; Coronary Disease ; Coronary Vessels ; Humans ; Pathology* ; Single Person ; Transplants

No abstract available.
Animals ; Gonadal Steroid Hormones* ; Rats*

No abstract available.
Truncus Arteriosus*

The scimitar syndrome is a rare malfomation that can be defined as a partial or complete right pulmonary venous return into inferior vena cava immediately above or below the siaphragm. This malfomation is often associated with hypoplasia of right lung, anomalous arterial supply of the lower part of the lung, and cardiac dextroversion. We experienced a case of scimitar syndrome in a 15 years old girl and presenting the case with a brief review of the literature.
Adolescent ; Female ; Humans ; Lung ; Scimitar Syndrome* ; Vena Cava, Inferior

No abstract available.
Diaphragm* ; Rupture*

It is well known that in studying the effects of hypophysectomy, removal of the pituitary must be essentially complete without injury of the neighboring region of the brain. We devised a new method of total hypophysectomy using microsurgical instruments, and observed the effects on the gonad in the dog. 1. Operative method. The animals were anesthetized with pentobarbital sodium 30 mg/kg body weight and then a wooden bar, about 5 cm in diameter, was inserted in the mouth to displace the mandibular angle anteriodownwardly. After aseptic draping at operative field vertical incision from the midline of the vertex to just behind the mandibular angle was made on the right side of frontotemporal region. Temporal muscles were also incised vertically and retractor was applied to expose the frontotemporal bone. Following wide craniectomy down to the base of middle cranial fossa and careful opening of the dura mater, temporal lobe was retracted upward and medially at the tip of the middle cranial fossa with narrow brain retractor. As the 3rd cranial nerve and internal carotid artery were exposed, arachnoid membrane was torn with microforceps and microscissors, and aspirated the cerebrospinal fluid slowly to obtain wider exposure, then elevated posterior communicating artery to expose the pituitary body and stalk. The stalk was clipped or crushed with microforceps and then sectioned with microscissors, then pituitary body was isolated with microelevator and removed in a piece with microforceps or sucked out with suction. The wound was closed in layers. 2. Postoperative management and the results. Among these experimental animals, 6 dogs were observed for the period of 43-77 days, and in 6 dogs dexamethasone was given intramuscularly for one or two weeks following hypophysectomy, the rest were used as normal control. Following clinical observation, these animals were sacrificed with intracarotid arterial infusion of 0% neutral formalin solution and removed the brain and the gonads, and fixed in 10% neutral formalin solution. The removed brain was examined and pituitary fossa was also scrutinized. The gonads were stained with hematoxylin-eosin. Periodic acid Sciff(PAS) and toluidine blue staining methods. The observed results were as follows: 1) Average diameter of testicular seminiferous tubules was 0.17 mm in normal control group. but became markedly reduced to 0.10 mm following hypophysectomy. With administration of dexamethasone for 1 and 2 weeks, diameter ranged 0.09 mm and 0.13 mm, respectively. 2) Testicular lesions in hypophysectomy group were characterized by marked reduction of spermatogenic activity, representing stage of germ cell aplasia with loss of spermatogonia, spermatocytes and spermatids. But in cases with dexamethasone administration, the pattern resembled various stages of germ cell arrest as with increased mitotic activities of spermatogonia and spermatocytes. 3) Those numerical alternations of spermatogenic cells accompanied secondary histological manifestations which included relative increase of Sertoli cell, mild thickening of basement membrane and Leydig cell hyperplasia. The findings following administration of dexamethasone became modified to reveal less prominent Sertoli cells and rather distinct Leydig cell clustering. Basement membrane thickening remained unchanged. 4) Ovarian changes in hypophysectomized dogs on the other hand, disclosed reduction of overall size accompanying decrease in number and size of Grafian follicles, atrophy of follicular and cortical stremal cells, degeneration of cva and absence of corpus luteum. Follicular and stromal cells appeared responded to administration of dexamethasone relatively in considerable degree. 5) Mast cells normally distributed mainly in the tunica albuginea of both testis, and ovary, increased following hypophysectomy to extend along fibrotic interstitial tissue of testis, but became reduced to the level of normal control group following administration of dexamethasone.
Animals ; Arachnoid ; Arteries ; Atrophy ; Basement Membrane ; Body Weight ; Brain ; Carotid Artery, Internal ; Cerebrospinal Fluid ; Corpus Luteum ; Cranial Fossa, Middle ; Cranial Nerves ; Dexamethasone ; Dogs* ; Dura Mater ; Female ; Formaldehyde ; Germ Cells ; Gonads* ; Hand ; Hyperplasia ; Hypophysectomy* ; Mast Cells ; Membranes ; Mouth ; Ovary ; Pentobarbital ; Periodic Acid ; Seminiferous Tubules ; Sertoli Cells ; Spermatids ; Spermatocytes ; Spermatogonia ; Stromal Cells ; Suction ; Temporal Lobe ; Temporal Muscle ; Testis ; Tolonium Chloride ; Wounds and Injuries

BACKGROUND: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. MATERIAL AND METHOD: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs (43-70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy (24) and CT scans (7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects (6), refusal (1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. CONCLUSION: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.
Biopsy ; Carcinoma, Non-Small-Cell Lung ; Cause of Death ; Chemoradiotherapy* ; Cisplatin ; Disulfiram ; Drug Therapy ; Esophagitis ; Female ; Fever ; Humans ; Lung Neoplasms ; Male ; Mortality ; Neoplasm Metastasis ; Radiation Pneumonitis ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed

From 1981 to 1993, one hundred and thirty eight patients had been treated by free flap or island flap, for the tissue defects of the extremities. Among these 138 patients, vascularized bone graft was 29 cases, soft tissue free flap 40, replantation 22, local island flap 45, and lymphovenous shunt 2. Average age at the time of operation was 27 years(1-66 years), and men were 110, women 28. Average duration of follow-up was 2 years and 8 months(4 months-11 years and 8 months). Twenty nine cases of vascularized bone graft was consisted of fibular graft in 15 patients, ilium 8, joint transplantation 4, thumb reconstruction using big toe 1, and rib 1. Four of them were failed. Among 40 patients of soft tissue free flap, latissimus dorsi flap was 12 cases, dorsalis pedis flap 11, scapular flap 8, wraparound procedure 7 and gracilis flap 2. Seven of them were failed. The levels of replantations were both lower extremities in one patient, leg 1, arm 2, distal forearm 2, and finger(s) 16. In six patients, replantation was nor successful. Among 45 patients of local island flap, lateral supramalleolar island flap was performed in 8 patients, dorsalis pedis flap 2, Chinese flap 10, reverse ulnar artery flap 4, reverse posterior interosseous artery flap 3, neurovascular island flaps for fingers 14, and others 4. Two of them were failed. Two cases of lymphovenous shunt for the treatment of lymphedema were successful. As a whole, 119 cases were successful(86%) among 138 cases including local island flap 45 cases.
Arm ; Arteries ; Asian Continental Ancestry Group ; Extremities ; Female ; Fingers ; Follow-Up Studies ; Forearm ; Free Tissue Flaps ; Hallux ; Humans ; Ilium ; Joints ; Leg ; Lower Extremity ; Lymphedema ; Male ; Replantation ; Ribs ; Superficial Back Muscles ; Surgical Flaps ; Thumb ; Transplants ; Ulnar Artery

PURPOSE: Flow interruptor high frequency ventilator(HFV) on neonatal respiratory failure caused by various disorders has been applied in order to assess its therapeutic effect and safety. METHODS: Premature babies below 1.8kg with respiratory failure from 1991 to 1997 in the Fatima neonatal intensive care unit(NICU) for 6 year and 4 months are included. Flow interruptor HFV with low intermittent mandatory ventilation(IMV) has been applied in 74 cases. If clinical symptom and arterial blood gas analysis(ABGA) became stable for 6-12 hrs, we started weaning aggressively. RESULTS: Mean duration of HFV with low IMV was 5.4 4 days. Initial success rate of weaning was 63 cases(85.1%). Weaning failure rate was 11 cases(14.9%). Six cases was due to underlying sepsis. Four cases was caused by pneumothorax and one case resulted from patent ductus arteriosus(PDA) with congestive heart failure(CHF). Complication of HFV with combined low IMV was 5 cases of pneumothorax, 4 cases of grade III intraventricular hemorrhage and one case of bronchopulmonary dysplasia(BPD). Eleven cases of stage III or more retinopathy of prematurity(ROP) and 5 cases of periventricular leukomalasia(PVL) were confirmed. CONCLUSION: Flow interruptor HFV with low IMV can be used safely as conventional mechanical ventilators in the case of respiratory failure caused by various disorders. If MAP has been adjusted appropriately, incidence of pneumothorax and BPD are expected to diminish by aggressive weaning as clinical symptom become stable.
Estrogens, Conjugated (USP) ; Heart ; Hemorrhage ; High-Frequency Ventilation* ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Pneumothorax ; Respiratory Insufficiency* ; Sepsis ; Ventilators, Mechanical ; Weaning

Cardiopulmonary bypass in children is associated with capillary leak, which results in an increase in total body water after open heart surgery. The purpose of these studies was to assess the cardiopulmonary effects of modified ultrafiltration after pediatric open heart surgery. Study A: Twenty-six consecutive children aged 0.1~10 years(median 7 months) underwent cardiac operation incorporating modified ultrafiltration. After completion of cardiopulmonary bypass, modified ultrafiltration was commenced at the flow rate of 100~150l/min for 3~14 min. After modified ultrafiltration, elevation of hematocrit(28.3%+/-3.6% vs. 33.8%+/-4.0%, p<0.001), increased systolic blood pressure(66.7+/-11.2mmHg vs. 76.2+/-11.8mmHg, p<0.02), and decreased central venous pressure(7.8+/-3.7mmHg vs. 6.9+/-2.9mmHg, p<0.001) were observed. Study B: Twenty-six children who underwent cardiac operation with the diagnosis of VSD under 2 years were assigned to control(n=14) or modified ultrafiltration(n=12). Peak inspiratory pressure checked immediately after operation was significantly lower in modified ultrafiltration group than in control group(20.0+/-2.4 cmH2O vs. 22.4+/-2.3cmH2O, p< 0.03). Modified ultrafiltration after cardiopulmonary bypass in children improves early hemo- dynamics and pulmonary mechanics, and represents an excellent option for perioperative management of accumulation of fluid in the tissues. We will continually employ the modified ultrafiltration technique in pediatric cardiac operations.
Body Water ; Capillaries ; Cardiopulmonary Bypass ; Child ; Diagnosis ; Filtration ; Heart* ; Hemodynamics ; Humans ; Mechanics ; Thoracic Surgery* ; Ultrafiltration*