During the period from january, 1972, to march, 1979, Twenty-four patients underwent mitral valve replacement at the seoul national University Hospital. Their ages ranged from 8 years to 20 years, with 11 patients being 16 years of age or younger at the time of operation. There were 12 males and 12 females and their weight ranged from 25 to 53 Kilograms. Seventeen patients had advanced stages of heart disease as evidenced by the functional classification: 14 cases were in functional class III and 3 cases in functional class IV (New York heart Association). A history suggestive of rheumatic fever was elicited in 75 per cent of our patients. Radiographic evaluation demonstrated marked cardiomegaly in the majority of the patients. The cardiothoracic ratio was over 70 per cent in 5 patients and between 60 and 70 per cent in 17 patients. Cardiac catheterization was carried out in all patients before operation. There were 3 patients with evidence of severe pulmonary hypertension. In 2 patients the pulmonary artery pressures were normal. On physical and hemodynamic examinations, 3 patients had associated with aortic regurgitation, 2 patients had tricuspid regurgitation, 1 patient had tricuspid and aortic regurgitations and 3 patients had atrial septal defect or ventricular septal defect or transposition of great arteries. The pathologic findings of the mitral valve indicated rheumatic valvulitis in 16 patients, while in the remaining 7 the etiology was undetermined. In only one patient the cause was congenital cardiac anomaly. Seventeen patients had predominant mitral regurgitation and 7 patients predominant mitral stenosis. Twenty-nine cardiac prosthetic and bioprosthetic valves were replaced in 24 patients in the past 8 years. This series included 24 mitral, 4 aortic and 1 tricuspid valve replacement. Including in this group were patients who had concomitant aortic valve replacement(3 patients), tricuspid valve replacement(1 patient), tricuspide annuloplasty and closure of ventricular septal defect(1 patient), and closure of atrial septal defect and ventricular septal defec(3 patients). There were five deaths in the postoperative period, resulting in an operative mortality rate of 20.8 per cent. high postoperative mortality was seen in the patients with associated aortic valvular disease and congenital cardiac anomaly.
Adolescent* ; Aortic Valve ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Child* ; Classification ; Female ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Male ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Mortality ; Postoperative Period ; Pulmonary Artery ; Rheumatic Fever ; Seoul ; Transposition of Great Vessels ; Tricuspid Valve ; Tricuspid Valve Insufficiency

During the period from january, 1972, to march, 1979, Twenty-four patients underwent mitral valve replacement at the seoul national University Hospital. Their ages ranged from 8 years to 20 years, with 11 patients being 16 years of age or younger at the time of operation. There were 12 males and 12 females and their weight ranged from 25 to 53 Kilograms. Seventeen patients had advanced stages of heart disease as evidenced by the functional classification: 14 cases were in functional class III and 3 cases in functional class IV (New York heart Association). A history suggestive of rheumatic fever was elicited in 75 per cent of our patients. Radiographic evaluation demonstrated marked cardiomegaly in the majority of the patients. The cardiothoracic ratio was over 70 per cent in 5 patients and between 60 and 70 per cent in 17 patients. Cardiac catheterization was carried out in all patients before operation. There were 3 patients with evidence of severe pulmonary hypertension. In 2 patients the pulmonary artery pressures were normal. On physical and hemodynamic examinations, 3 patients had associated with aortic regurgitation, 2 patients had tricuspid regurgitation, 1 patient had tricuspid and aortic regurgitations and 3 patients had atrial septal defect or ventricular septal defect or transposition of great arteries. The pathologic findings of the mitral valve indicated rheumatic valvulitis in 16 patients, while in the remaining 7 the etiology was undetermined. In only one patient the cause was congenital cardiac anomaly. Seventeen patients had predominant mitral regurgitation and 7 patients predominant mitral stenosis. Twenty-nine cardiac prosthetic and bioprosthetic valves were replaced in 24 patients in the past 8 years. This series included 24 mitral, 4 aortic and 1 tricuspid valve replacement. Including in this group were patients who had concomitant aortic valve replacement(3 patients), tricuspid valve replacement(1 patient), tricuspide annuloplasty and closure of ventricular septal defect(1 patient), and closure of atrial septal defect and ventricular septal defec(3 patients). There were five deaths in the postoperative period, resulting in an operative mortality rate of 20.8 per cent. high postoperative mortality was seen in the patients with associated aortic valvular disease and congenital cardiac anomaly.
Adolescent* ; Aortic Valve ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Child* ; Classification ; Female ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Male ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Mortality ; Postoperative Period ; Pulmonary Artery ; Rheumatic Fever ; Seoul ; Transposition of Great Vessels ; Tricuspid Valve ; Tricuspid Valve Insufficiency

CT has facilitated early recognition and treatment of focal brain injuries in patients with head trauma. However. CT shows relatively low sensitivity in identifying nonhemorrhagic contusion and injuries of white matter. MR is known to be superior to CT in detection of which matter injuries, such as diffuse axonal injury. MR imaging in 14 cases of diffuse axonal injury on 2.0T was studied. The corpus callosum, especially the body portion, was the most commonly involved site. The lesions ranged from 5 to 20 mm in size with ovoid to elliptical shape. T2WI was the most sensitive pulse sequence in detecting lesions such as white matter degeneration, hemorrhagic and nonhemorrhagic contusion. The lesions were nonspecific as high and low signal intensities on T2WI and T1WI respectively. CT showed white matter abnormality in only 1 case of 14 cases. We propose MR imaging as the primary imaging procedure for the detection of diffuse axonal injury because of its multiplanar capabilities and higher sensitivity.
Brain Injuries ; Contusions ; Corpus Callosum ; Craniocerebral Trauma ; Diffuse Axonal Injury* ; Humans ; Magnetic Resonance Imaging* ; White Matter

BACKGROUND: Recently, clinical use of fresh frozen plasma(FFP) has increased in all blood transfusion activity. But inappropriate uses of FFP may be serious problem due to adverse transfusion reactions, viral transmission, and economic aspects. The aim of this study is to justify clinical indication of FFP by receiving the inappropriate use of them. METHODS: Analyzing hospital records of 115 patients transfused with FFP at Kyung Hee Medical Center from January to April 1998, retrospectively, we investigated the purpose of transfusions, the volume of transfused FFP, and the results of pre- and post-coagulation tests. RESULTS: The most common purpose of transfusions of FFP was plasma volume replacement after surgical operation. Coagulation tests of pre- and post-transfusion were performed 85% and 47%, respectively. Fifty-seven patients(88%) transfused FFP have shown normal results in pre-coagulation tests, and the volume replacement with FFP was done inadequately in 62 cases(54%). CONCLUSION: We conclude that, in order to eliminate side effects due to inappropriate use of FFP, and protect patients, it is necessary to make guidelines of FFP transfusion, educate hospital staffs regularly, and perform pre- and post-coagulation tests routinely for the patients who need FFP transfusion. (Korean J Blood Transfusion 10(1): 5-12, 1999)
Blood Group Incompatibility ; Blood Transfusion ; Hospital Records ; Humans ; Plasma Volume ; Plasma* ; Retrospective Studies

Blue Rubber Bleb Nevus syndrome, or Bean's syndrome is a very rare disease characterized by an association of 1) hemangioma cutis in which the nevi feel like rubber blebs; 2) hemangiomas of the digestive organs; 3) iron-deficiency anemia due to hemorrhage from the digestive tract. Sometimes, the bleeding is so severe and massive that the patient needs blood transfusions and/or emergency operations. We present a 29-year-old man with Blue Rubber Bleb Nevus syndrome. This patient was admitted to out hospital due to recently aggrevated dizziness and intermittent rectal bleeding. Multiple bluish tumors were noted on the palm, sole and glans penis. Laboratory examination revealed severe iron-deficiency anemia. Barium studies revealed multiple polypoid masses in the stomach, small bowel and colorectum. On esophagogastroduodenoscopy and colonoscopy, three or four dozens of hemangiomas with variable size and shape were noted in the stomach, duodenum at or around the ampulla of Vater and colorectum. This patient was of particular interest because rectal bleeding occurred from rectal lesion which protruded out of anus and caused bleeding during defecation, and which showed as a 2.0 cm Yamada type III polypoid lesion. Endoscopic ultrasonography confirmed us that this lesion was confined to the mucosa and submucosa without extension into muscle layer. Endoscopic polypectomy of this lesion was performed because which considered as the main focus of current rectal bleeding. He was discharged without any complication and 4 months later, he was well without rectal bleeding and his hemoglobin level increased upto 13.5 g/dl. To our knowledge, this is the first case of Blue Rubber Bleb Nevus syndrome in Korea.
Adult ; Ampulla of Vater ; Anal Canal ; Anemia, Iron-Deficiency ; Barium ; Blister* ; Blood Transfusion ; Colonoscopy ; Defecation ; Dizziness ; Duodenum ; Emergencies ; Endoscopy, Digestive System ; Endosonography ; Gastrointestinal Tract ; Hemangioma ; Hemorrhage ; Humans ; Korea ; Male ; Mucous Membrane ; Nevus* ; Penis ; Rare Diseases ; Rubber* ; Stomach

No abstract available.

No abstract available.
Seizures*

We have studied the overcorrection, undercorrection, astigmatic change and its incidence on time sequence after the excimer laser photorefractive keratectomy, and its relation with the degree of preoperative myopia, sex, and age. The study has been done with 429 eyes which we could assess for 6 months or more after excimer laser photorefractive keratectomy of myopia from July 1993 to march 1997. Overcorrection of more than -1D was common during the early postoperative periods and then gradually decreased with time. Overcorrection has been seen in 261 eyes(60.84%) after 1 month, but only 33 eyes(13.47%) after 1 year, and 13 eyes(11.02%) after 2 years. Undercorrection has been seen in 2 eyes(0.47%) after 1 month, but 25 eyes(10.20%) after 1 year, and 20 eyes(16.95%) after 2 years. Surgically induced astigmatism increased to 0.54+/-0.84D after 10 days and then decreased 0.19+/-0.75D after 12 months. Also, surgical induced astigmatism developed 1.13+/-1.10D in 247 eyes (57.58%) after 1 month, but decreased 0.89+/-0.45D in 107 eyes(43.67%) after 12 months. The occurrence of overcorrection and undercorrection was related to the severity of preoperative myopia(p<0.05), but with sex and age, it had no statistical correlation(p>0.05). The amount of postoperative astigmatism was related to preoperative astigmatism(p<0.05), but it had no statistical correlation with the degree of preoperative myopia, age, sex, and development and increase of surgically induced astigmatism(p>0.05).
Astigmatism ; Incidence ; Lasers, Excimer* ; Myopia* ; Photorefractive Keratectomy* ; Postoperative Period

Nuclear DNA content of 32 cases of prostate adenocarcinoma diagnosed 1986-1991 was determined by flow cytometry, with the use of paraffin-embedded archival tissue. The present study was done to define the relationship between clinical stage, histopathological grade, and DNA ploidy. Aneuploidy was found in 10(31.3%) cases including 7 cases of near-tetraploidy. Among diploid tumors, 36.4% were localized disease(stage A and B), 13.6% were characterized by invasion outside the prostate(stage C), and 50.0% showed distant metastasis(stage D). Among aneuploid tumors, 10.0% were stage B, 50.0% stage C, and 40.0% stage D. The degree of glandular differentiation was characterized by the Gleason score and the percentage of sampled tissue involved by carcinoma was graded by Dhom's method. Apparent correlation was found between Gleason grade and Dhom grade(P<0.05). All 13 tumors with a Gleason grade I(score of 2 to 5) were diploid. Four of 9 tumors with a Gleason grade II(score of 6 to 7) were aneuploid(near-tetraploidy 33.3%, aneuploidy 11.1%) and 60.0%, of tumors with a Gleason grade III(score of 8 to 10) were aneuploid(near-tetraploidy 40.0%, aneuploidy 20%). The percentage of aneuploid cases increased with advanced clinical stage, but the relationship between aneuploidy versus clinical stage was not significant. However, it can be concluded that DNA ploidy correlates well with Gleason grade(p<0.05), which may have predictive prognostic value for prostate adeno-carcinomas.
Adenocarcinoma

Prazosin hydrochloride, a new antihypertensive agent with a unique sympatholytic mode of action, was evaluated in 35 cases with essential hypertension. The treatment was started with 3 or 4 mg of prazosin daily divided into 2 or 3 doses, and the dosage was gradually increased weekly up to 20 mg per day depending on the response of the blood pressure. Observations with this drug varied from three to ten weeks, the average being five weeks. In 21 out of 35 cases (60.0%), satisfactory reductions in systolic and diastolic blood pressures with prazosin were noted in both supine and standing positions. These were accompanied by no significant postural hypotension. In 15 out of 21 cases of satisfactory responders, the diastolic blood pressure fell to 90mmHg or less, and in five cases out of 14 poor responders prazosin was given only for three weeks. The average time lapse before effectiveness of the drug in mild, moderate and severe hypertensive cases was 3.3, 3.5 and 6.5weeks, respectively. The average daily effective dosage of prazosin in these groups was 7.1, 9.1 and 12.0mg, respectively. The cardinal unpleasant symptoms appeared in eight out of 35 cases during the medication. These included postural dizziness, weakness, headache, drowsiness and urinary frequency. However, in all cases, except one in which urinary frequency was noted, the symptoms were mild and transient disappearing spontaneously despite continued administration of prazosin. No significant changes were noted in complete blood conuts and routine urinalysis as well as in S-GOT, S-GPT, blood urea nitrogen and serum creatinine levels examined during and after medication.
Blood Pressure ; Blood Urea Nitrogen ; Creatinine ; Dizziness ; Headache ; Hypertension ; Hypotension, Orthostatic ; Prazosin* ; Sleep Stages ; Urinalysis