A procedure descried by Fontan and Baudet in 1971 successfully bypassed the right ventricle in Tricuspid Atresia patients, after then many modification of the Fontan operation had been described and applied to many cyanotic complex heart patients. Forty patients with a variety of cardiac malformation underwent the Fontan operation at Seoul National University hospital (September 1978 to June 1986). The age at operation ranged 2 months to 18 years. Each number of cases according to basic cardiac anomaly was as follows; 17 in Tricuspid Atresia, 17 in Univertricular Heart, 2 in Double outlet of Right Ventricle, 2 in Transposition of the Great Arteries and 2 in Criss-cross heart. Total mortality rate after the Fontan operation was 50%. There was only one late death (>30 days). Mortality rate under 4 years of age (67%) was higher than that between 4 and 18 years of age (40%). we observed a significantly higher mortality for patients who, in the immediate postoperative period, had central venous pressure greater than 25cm H2O. 45% among survivals did not require further medication. Although mortality rate after the Fontan operation is much higher than that in the foreign literature, operative mortality will decline with the increased expirence of surgeon and the effective patients selection.
Arteries ; Central Venous Pressure ; Crisscross Heart ; Fontan Procedure* ; Heart ; Heart Ventricles ; Humans ; Mortality ; Postoperative Period ; Seoul ; Tricuspid Atresia

BACKGROUND AND OBJECTIVES: Kawasaki disease (KD) is an acute inflammatory process affecting the arterial walls that results in panvasculitis. Recent studies have shown that even after resolution of the disease, endothelial dysfunction persists and may progress to atherosclerosis. The pulse wave velocity (PWV) and the ankle-brachial index (ABI) are simple and non-invasive methods for evaluating the degree of atherosclerosis, and are known as the predictors of cardiovascular disease in adults. Carotid intima-media thickness (cIMT) is also known as a predictor of cardiovascular disease. We conducted this study to determine the change in arterial stiffness by measuring the PWV, ABI, and cIMT in children who have recovered from KD. SUBJECTS AND METHODS: Twenty-five patients with KD and coronary aneurysm were recruited. They all recovered from KD and were normal for more than 8 years. Fifty-five healthy children were evaluated as the control group. Their height, weight, body mass index, and blood pressure (systolic, diastolic, and the mean) were measured. The PWV, ABI, ejection time (ET), and pre-ejection period (PEP) were measured by ultrasonography. The cIMT was measured by ultrasonography. RESULTS: The left brachial ankle PWV was significantly higher in the KD group (1020.6+/-146.5 cm/sec) than the control group (984.0+/-96.5 cm/sec). The ABI did not differ between the two groups. There was no difference in PEP/ET and cIMT. CONCLUSION: The PWV in children who recovered from KD was higher than the control group. Long-term follow up is necessary in children after recovery from KD even if there is no abnormality in echocardiography.
Adult ; Animals ; Ankle ; Ankle Brachial Index ; Atherosclerosis ; Blood Pressure ; Body Weight ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Intima-Media Thickness ; Child ; Coronary Aneurysm ; Echocardiography ; Humans ; Mucocutaneous Lymph Node Syndrome ; Pulse Wave Analysis ; Vascular Stiffness

The article aims at providing theoretical foundation for security of moxibustion through analyzing chemical compositions of Artemisia Argyi of different years from Qichun County, Hubei Province, and moxa wool refined in different proportions. Artemisia Argyi from Qichun on 2007, 2008 and 2009 were taken as raw materials, and processed into moxa wool with the proportions of raw material and product as 3 : 1, 5 : 1, 8 : 1 and 15 : 1, respectively. Essential oils of Artemisia Argyi and the refined moxa wool were extracted by steam distillation. Their chemical compositions were identified by gas chromatography-mass spectrometry (GC-MS) and calculated with semiquantitative method. The result showed that chemical compositions of Artemisia Argyi of different years and moxa wool refined in different proportions were almost the same, but their contents were with obvious difference. The relative content of volatile substances decreased with the age prolonged and a rise in the proportion of the refined moxa wool, while the involatile material increased. Therefore it can be concluded that the essential oil of Artemisia Argyi from Qichun and the refined moxa wool is basically safe. Involatile substances such as Juniper camphor, Caryophyllene oxide and Caryophyllene etc. are the main contents of high proportional moxa wool of old year. And these substances may be the effective components in moxibustion treatment.
Artemisia ; chemistry ; Gas Chromatography-Mass Spectrometry ; Oils, Volatile ; analysis ; Time Factors

Anaplastic carcinoma of the thyroid(ACT0 is a rare subtype of thyroid neoplasm. This tumor represents approximately 5-10% of all thyroid malignancies and has poor prognosis. ACT often arises in a long-standing thyroid nodule and has been documented to be associated with a variety of more with a variety of more well-differentiated thyroid carcinomas. We experienced a case of anaplastic thyroid carcinoma who had had about a year history of thyroid goiter. The patients had been injected with sclerosing agents in treatment of preexisting goiter. The ACT in this case had varied cytologic and histologic appearances pleomorphic, giant cells, spindle and squamoid. Immunohistochemically, strong cytoplasmic positivity for cytokeratin was seen in all kinds of tumor cells. Ultrastructurally. the evidences of epithelial differentiation were seen such as intercellular junctions and tonofibrils.
Carcinoma ; Cytoplasm ; Giant Cells ; Goiter* ; Humans ; Intercellular Junctions ; Keratins ; Prognosis ; Sclerosing Solutions ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule

Objective: To report the experiences of triplet pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser coagulation at a single center. Methods: Herein, we conducted a retrospective analysis to investigate the management and perinatal outcomes of triplet pregnancies with TTTS treated at a single institution between 2017 and 2022. Results: Seven of the 98 triplet pregnancies (7.1%) encountered were complicated by TTTS, and all were dichorionic triamniotic triplets. Of the seven triplet pregnancies complicated by TTTS, four were treated with fetoscopic laser coagulation at our center, at a median gestational age of 20 weeks. No procedure-related complications or maternal complications were observed. The survival rate was higher and perinatal outcomes were better in fetoscopic laser coagulation cases than in other management cases. Four donor and four recipient triplets survived, with a median gestational age of 33 weeks at delivery. Although there were no cases of poor neonatal outcomes, one case was diagnosed with white matter injury, suspected to be hypoxic-ischemic encephalopathy on postnatal investigation. Conclusion Fetoscopic laser coagulation is a feasible treatment option for triplet TTTS, provided the attending specialists have extensive experience with this technique.

OBJECTIVETo determine the current prevalence of overweight and obesity among children and adolescents (2-18 years) in Beijing and its distribution by age, gender and urban-rural residence.

METHODSAs part of the Beijing Child and Adolescent Metabolic Syndrome Study, a stratified cluster representative sample of 23,422 children aged 0-18 years was selected. Anthropometric measures including weight and height were collected from 21,198 subjects aged 2-18 years from April to October in 2004. Overweight and obesity were defined according to body mass index [BMI, weight(kg)/height(m2)] cutpoints. For national and international comparisons, three sex-age-specific BMI criteria were used:1) The BMI cutoffs recommended by the Chinese Working Group on Obesity for Children (WGOC) aged 7-18 years; 2) The US 2000 CDC Growth Charts (CDC 2000) frac 34, the 85th and 95th percentiles; 3) The International Obesity Task Force (IOTF) reference.

RESULTSThe overall combined prevalence of overweight and obesity was 18.6% with obesity as 8.1% based on the CDC 2000 criteria, The figures were 17.4% and 5.1% based on the IOTF criteria. According to the WGOC criteria, the combined prevalence of obesity was 20.9% and 8.9% in children aged 7-18 years. The combined prevalence was higher in school-age children (6-18 years) than in preschool-age children (19.8% vs. 14.8%, based on the CDC 2000 criteria). Among school-age children, the prevalence was higher in boys than in girls (26.7% vs. 16.5%), in urban than in rural areas (27.0% vs. 15.9%). However, these differences were not observed in preschool-age children. It was estimated that approximately 450 000 children from 2 through 18 years of age,were overweight or obesity in Beijing.

CONCLUSIONData from our study indicated that one fifth of the children and adolescents in Beijing were under overweight or obesity situation which was the highest in the nation. Obesity among children and adolescents in Beijing had already become a serious public health problem which deserved greater attention.

Adolescent ; Child ; Child, Preschool ; China ; epidemiology ; Humans ; Infant ; Obesity ; epidemiology ; Overweight ; epidemiology ; Prevalence

BACKGROUND: Intracranial pressure monitoring gives useful information in many neurosurgical conditions. And, measurement of the extradural pressure has always seemed an attractive alternative for intracranial pressure (ICP) monitoring. Also, choice of anesthetic agent may affect the management of intracranial pressure. The aim of this study was to evaluate the effect of propofol, isoflurane and enflurane on ICP by measuring lumbar epidural pressure. METHODS: Forty seven adult patients scheduled for elective orthopedic surgery were randomly allocated to three groups according to anesthetic agent for maintenance: group I (isoflurane, n = 15), group P (propofol, n = 17), and group E (enflurane, n = 15). Premedication was performed by intramuscular injection of 0.2 mg of glycopyrrolate. ECG, noninvasive blood pressure monitoring device, and pulse oximeter was used for patient monitoring. A twenty gauge epidural catheter was placed 3-4 cm above the insertion site (L3-4). The pressure monitoring kit was connected to a catheter and was zeroed at the middle ear level. Epidural pressure was cheked every 10 min and compared to the control and among groups during maintenance of anesthesia. RESULTS: Demographic data showed no difference among groups. Preinduction epidural pressures were 7.4 +/- 1.4, 7.1 +/- 1.1, 7.2 +/- 1.0 mmHg in group P, I and E, respectively. During maintenance, group I did not show any statistically significant changes in epidural pressure, but pressure was reduced in group P and elevated in group E significantly 100 min after administering the maintenance anesthetics. CONCLUSIONS: Among the three anesthetic agents, propofol may be a more suitable maintenanace anesthetic agent for patients with increased ICP.
Adult ; Anesthesia ; Anesthetics ; Blood Pressure Monitors ; Catheters ; Ear, Middle ; Electrocardiography ; Enflurane* ; Glycopyrrolate ; Humans ; Injections, Intramuscular ; Intracranial Pressure ; Isoflurane* ; Monitoring, Physiologic ; Orthopedics ; Premedication ; Propofol*

OBJECTIVE: To assess the reliability of triple marker screening test in midtrimester pregnancy for fetal Down syndrome. METHODS: From October 1, 1996 to May 31, 1998 at Nowon Eulji Hospital, 3700 Pregnant women underwent serum tiple marker screening for Down syndrome during 15-20weeks of gestational age. The results of serum triple marker screenig tests for Down syndrome and the outcomes of pregnancies were retrospectively assesed. RESULTS: Sixty seven of 3700 cases(1.81%) were positive in screening test, and 3633(98.18%) cases were negative. Among 67 cases of positive screening test, 1 case(1.49%) was diagnosed as Down syndrome. Among 3633 cases of negative screening test, 4 cases(0.1%) were diagnosed as chromosomal abnormalies postnatally. Two of these 4 cases of chromosomal abnormalies were Down syndrome. CONCLUSION: With this results, sensitivity of triple marker screeing test for Down syndrome is very low as 33.3%. In order to increase the sensitivity, some compensatory adjustment is required in triple marker screening test.
Down Syndrome* ; Equidae ; Female ; Gestational Age ; Humans ; Mass Screening* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second* ; Pregnant Women ; Retrospective Studies

From February 1987 through July 1990, the seventeen cases of inoperabelintracranial arteriovenous malformation (AVM) were treated using 6 MV linear accelerator at the Division of Therapeutic Radiology, Kang Nam St. Mary's Hospital. Of seventeen cases, fourteen were male and three were female. Ages ranged from 10 to 51 years (median age of 26 years). The main symptoms were headache, epilepsy and hemiparesis in decreasing order of frequency. The middle cerebral artery is the most common origin of the feeding vessel (41.2%). Four were treated by conventionally fractionated radiation therapy (CRT), thirteen were treated by stereotactic radiosurgery (RS). Duration of follow-up study, two of four CRT group showed minimal response. Of thirteen cases of RS group, two (15.4%) showed complete response, five (38%) partial response, two (15.4%) minimal response and four (30.7%) no response by the same assessment. There was no statistical significance in terms of follow-up period (p=0.22), size of lesion (p=0.82) and treated dose (p=0.65). Further accumulation of experience s recommended with proper case selection and sufficient follow-up period.
Arteriovenous Malformations ; Epilepsy ; Female ; Follow-Up Studies ; Headache ; Humans ; Intracranial Arteriovenous Malformations* ; Male ; Middle Cerebral Artery ; Paresis ; Particle Accelerators ; Radiation Oncology ; Radiosurgery*

BACKGROUND : Anomalous pancreaticobiliary ductal union (APBDU) is a congenital defect defined as a union of the pancreatic and the biliary ducts located outside the duodenal wall. Accordingly, this anomalous connection between the choledochus and the pancreatic duct is considered to be a factor in the development of biliary tract diseases such as choledochal cysts, pancreatitis, cholangitis, gallbladder cancer, and bile duct cancer. Our purpose is to analyze combined disease, especially biliary neoplasm, and to evaluate biliary tract microscopic changes in the biliary tract. METHODS : To study the clinical characteristics of APBDU, we reviewed 21 APBDU cases which were treated from June 1994 to January 1998. We studied the associated diseases, the surgical treatment, histological findings and the PCNA expression. We also analyzed the gallbladder epithelium in 10 control patients without APBDU. RESULTS : Among the 21 cases, 12 cases were accompanied by a choledochal cyst. A gallbladder carci noma occurred in 5 cases. Of the 13 operations, 4 involved a cholecystectomy only, and 9 involved a cholecystectomy, bile duct resection and hepaticojejunostomy. The histologic findings were reviewed in 13 cases. Bile duct metaplasia was found in 8 of the 9 cases with a bile duct resection, and gallbladder metaplasia was found in 8 of the 12 cases whereas metaplasia was detected in 1 of the 10 control patients. The PCNA expression was significantly high in APBDU group. CONCLUSIONS : The patients with APBDU showed a high incidence of gallbladder carcinoma and meta plasia in the epithelium of the gallbladder and the bile duct. This metaplasia in the gallbladder and the bile duct was thought to be related to the cancerous change.
Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Biliary Tract ; Biliary Tract Diseases ; Cholangitis ; Cholecystectomy ; Choledochal Cyst ; Common Bile Duct ; Congenital Abnormalities ; Epithelium ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Incidence ; Metaplasia ; Noma ; Pancreatic Ducts ; Pancreatitis ; Proliferating Cell Nuclear Antigen