Replacement of cardiac valves in the pediatric patients is infrequent compared with in adult for the treatment of diseased heart valve. Furthermore, uncertainties regarding the long term fate of prosthetic value and effects of a fixed-orifice walve in the growing children are the main concern in pedriatric patients. Between January 1974 and October 1979, in 10 children, 15years or younger, cardiac valves were replaced becasuse of congenital or acquired valvular heart diseases in the Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital. There were 8 mitral valves, one aortic valve and one mitral and aortic valve replaced. Indications for valve replacement were intractable congestive heart failure or apperently progressing cardiac symptoms and signs. Early postoperative death was noticed in one due to arrythmia, and late postoperative death in one due to cerebral thromboembolism after 9 months of double valve replacement. All Survlvors showed clinical improvement and good cardiac condition during postoperative and follow-up period till now.
Child ; Adult ; Male ; Female ; Humans

Aneurysms of the pulmonary artery are uncommon in general but have a potentially fatal prognosis. This is derived from the potential for rupture of the aneurysm from the fact that there is commonly underlying severe pulmonary hypertension. Most cases are documented in the large postmortem series. Aneurysms of the pulmonary artery can be classified as congenital or acquired. Possible symptoms include dyspnea on exertion, cough, hemoptysis, and thoracic pain. When a large aneurysm formation of the pulmonary artery is diagnosed, surgical intervention is indicated because conservative treatment of the aneurysm will undoubtedly result in rupture with fatal outcome. We report a case of 46-year old patient with a giant left pulmonary artery aneurysm associated with severe pulmonary hypertension. A Doppler echocardiogram and a computed tomographic scan showed a giant saccular aneurysm of the left pulmonary artery (12 cm in diameter) and estimated systolic right ventricular pressure of 80 mmHg.
Aneurysm* ; Cough ; Dyspnea ; Fatal Outcome ; Hemoptysis ; Humans ; Hypertension, Pulmonary* ; Middle Aged ; Prognosis ; Pulmonary Artery* ; Rupture ; Ventricular Pressure

Ischemic heart disease is a common complication of thyrotoxicosis, although the exact mechanism has not been defined. In patient with dextrocardia as a part of situs inversus, coronary heart disease may occur with similar frequency and manifestation as in the general population. A case is reported of angina and thyrotoxicosis in patient with situs inversus totalis in which the angina was manifested by ST-segment elevation during graded exercise, relieved by antithyroid treatment. This unusual case establishes an association between hyperthy-roidism and ischemic heart disease.
Coronary Disease ; Dextrocardia ; Humans ; Hyperthyroidism* ; Myocardial Ischemia ; Situs Inversus* ; Thyrotoxicosis

The hydrophobicity assay and DNA probe hybridization assay were compared for analysis of enterotoxigenic Escherichia coli(ETEC), heat-labile enterotoxin(LT) and heat-stable enterotoxin (ST). The ETEC isolated from diarrheal patients were serotyped and investigated for the presence of colonization factor antigens CFA/1, CFA/II, CFA/III and CFA/IV with the expression of mannose-resistant hemagglutination(MRHA) and the levels of surface hydrophobicity. The following results were obtained. 1. Out of these 48 strains, 34 strains were found to be positive for LT production by DNA probe hybridization assay. Out of 34 strains, 1 strain was ST producer, 25 strains were LT producers, and 8 strains were produced both ST+LT producers by DNA probe hybridization assay. 2. Out of 34 strains of positive DNA probe hybridization test, 31 strains was positive in the hydrophobicity test. Among strains of positive hydrophobicity test, 20, 1, and 7 strains produced only LT, only ST and both ST-LT, respectively. Screening efficiency for identifying ETEC by salting out test was 82.4% in sensitivity and 78.6% in specificity. For ETEC detection, the hydrophobicity assay was the least sensitive but was simple, rapid and a good substitute for the DNA probe hybridization assay. 4. CFAs were identified in 43.8% of ETEC strains; 2.1% of the CFAs strains with CFAs harbored CFA/I, 29.2% carried CFA/II, 16.7% carried CFA/III and CFA/IV. And 35.4% expressed none of these CFAs. CFA/I was found in ETEC of serotype 0128: K67, CFA/II was 0128: K67, 0142: K+ and 0159: K+, CFA/III was 086a: K15 and 0128: K67, CFA/IV was 0 86a: K15, 0128: K67, 0125: K70 and 0148: K+.
Colon ; DNA* ; Enterotoxigenic Escherichia coli* ; Enterotoxins ; Escherichia ; Humans ; Hydrophobic and Hydrophilic Interactions* ; Mass Screening ; Sensitivity and Specificity

Purpose: The goal of study was to evaluate the clinical and radiographic performance of the proximal modular cementless femoral stem for use in revision total hip arthroplasty. Material and method: Fifty seven patients (57 hips) were followed for longer than 24 months or up to 8.4 years after performing revision total hip arthroplasty with using the proximal modular cementless femoral stem between January 1997 and December 2002. The preoperative diagnosis included 45 cases of aseptic loosening, 5 cases of septic loosening (re-revision operation), 6 cases of periprosthetic fracture and 1 case of recurrent dislocation. The bone deficiencies were classified according to the Paprosky classification: there were 27 cases of Type I and II, 19 cases of Type IIIA, 9 cases of Type IIIB and 2 cases of Type IV. Results: The average Harris hip score improved from 47 to 87.6. Clinically satisfactory results were noted in 50 patients (87.7%). Radiographically, distal stable fixation was observed in 54 patients (94.7%). Intraoperative complications included two greater trochanteric fractures and two proximal femur fractures. Postoperative complications included 5 femoral stem subsidences (2hips< 5mm, 3 hips>20mm), 4 deep infections, 2 non-unions of the greater trochanter and the osteotomy site and set screw dissociation was noted in 1 case. 5 proximal component changes were done due to progressive subsidence in two cases, non-union at the osteotomy site and trochanteric displacement in two cases and set screw dissociation in one hip. For the infection cases, the proximal segment was removed and re-revised with a 2nd stage operation. (Ed note: check this.) The subsidence of the femoral stems was showed in 3 Paprosky grade IIIA cases and in 2 cases of grade IIIB or more. There was no postoperative periprosthetic fracture observed at the last follow-up. Conclusion: Revision total hip arthroplasty using the proximal modular cementless femoral stem showed good results in the face of the infection of the proximal component and deficient proximal bony support. This procedure appears to be convenient for the surgeon to correct anteversion of the femoral head and leg length discrepancy.
Arthroplasty, Replacement, Hip ; Classification ; Diagnosis ; Dislocations ; Femur ; Follow-Up Studies ; Head ; Hip ; Hip Fractures ; Humans ; Intraoperative Complications ; Leg ; Osteotomy ; Periprosthetic Fractures ; Postoperative Complications ; Prostheses and Implants*

No abstract available.
Lower Extremity*

BACKGROUND: There has been reports which suggest that non-specific symptom of patients with mitral valve prolapse is associated with autonomic dysfunction. METHODS: To assess autonomic dysfunction of patients, we examined five cardiovascular reflex tests in 25 asymptomatic MVP patients(identified as MVP group), 25 symptomatic MVP patients(identified as MVP syndrome group) and 25 control group. RESULTS: In the five cardiovascular autonomic function tests, abnormalities of Valsalva ratio were detected in 1(4%) control group, 7(28%) MVP group, 9(36%) MVP syndrome group, heart rate response to deep breathing in 0(0%), 2(8%), 4(16%) respectively, immediate heart rate response to standing in 0(0%), 2(7.4%), 2(8%) respectively and in postural hypotension, there were no abnormal group. Abnormalities of blood pressure response to sustained handgrip were only detected in 2(8%) MVP syndrom group. According to the five categories of cardiovascular autonomic functon tests, normal in 24(96%) and early damage in 1(4%) were detected in control group. In the MVP group, normal 17(68%), early damage 6(24%) and definite damage 2(8%) were noted. In the MVP syndrome group, normal 9(36%), early damage 13(52%), definite damage 1(4%) and combined damage 2(8%) were detected. In case of heart rate response to deep breathing, we found significant differences between control and MVP syndrome group(p=0.043), and between MVP and MVP syndrome group(p=0.0043). In case of heart rate response to standing, between control and MVP syndrome group(p=0.0009), between MVP and MVP syndrome group(p=0.001), the differences were noted. In case of blood pressure response to standing, between control group and MVP group(p=0.0019), between MVP and MVP syndrome group(p=0.0075), we found significant differences. Resulting from our study, heart rate response to deep breathing and standing, blood pressure response to standing were of considerable value in assessing the autonomic dysfunction of patients with mitral valve proapse. CONCLUSION: We found autonomic dysfunction in addition to increased autonomic tone and responsiveness which have been already known previously in mitral valve prolapse. And autonomic dysfunction was more severe in symptomatic patients with mitral valve prolapse than asymptomatic ones.
Blood Pressure ; Heart Rate ; Humans ; Hypotension, Orthostatic ; Mitral Valve Prolapse* ; Mitral Valve* ; Reflex ; Respiration

BACKGROUND: Various hemodynamic changes occur during left ventriculography, such as myocardial depression, hypotension, peripheral circulatory changes, ECG changes(such as arrhythmias and conduction abnormalities) and anaphylactic reaction etc. These effects are somewhat caused by osmolality, ionic concentration of Na+, viscosity and molecular weight of contrast dye and underlying various heart disease itself during left ventriculography. We compared the hemodynamic differences between ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents during routine ventriculography. METHODS: In a prospective, randomized, double blind study of 124 patients underwent left ventriculography, we examined the various hemodynamic effects of the two contrast agents on left ventricle. All subjects were divided into 2 groups : ioxaglate and iopromide groups. Also, each agent was used in randomized double blind fashion in both groups ; normal control subjects(14 in ioxaglate group : 12 in iopromide group) and subjects whose ejection fraction less than 50%(12 in ioxaglate group : 16 in iopromide group). Left ventricular systolic pressure(LVSP), left ventricular end-diastolic pressure(LVEDP), maximum dP/dt, (dP/dt)/P ratio, peak - dP/dt and Tau were obtained immediately before and left ventriculography. RESULTS: 1) In total(normal+angina+MI) subjects of both groups, LVEDP(p<0.001) and maximum dP/dt(p<0.001) were increased and T(au) was reduced significantly(p<0.05). But LVSP(p<0.001) and peak - dP/dt(p<0.005) were increased significantly only in ioxaglate group. 2)In normal(control) subjects, there were no significant differences in both groups, except LVEDP that was increased by equal magnitude(p<0.001). 3) In subjects with ejection fraction less than 50%, there were no significant hemodynamic differences in both contrast agent groups bur LVEDP increased significantly in both groups(p<0.001). CONCLUSIONS: This present study showed that both ionic(ioxaglate) and non-ionic(iopromide) low osmolar contrast agents were very safe without any significant side effects except two agents caused an increase in LVEDP and did not show major differences between ioxaglate and iopromide contrast agents from a hemodynamic point of view. Two contrast agents tend to improve contractilities and diastolic properties of left ventricle since both caused an increase in maximum dP/dt and a reduce in Tau, in total subjects. This effect may be caused by cardiac compensation, probably because of osmolality, volume loading by contrast agents and secondary activation of sympathetic system immediately after injection of contrast agents. Thus, it is concluded that two ioxaglate and iopromide contrast agents amy be used safely in left ventriculography in patients with and without left ventricular dysfunction, with paying attention to an increase in LVEDP.
Anaphylaxis ; Arrhythmias, Cardiac ; Compensation and Redress ; Contrast Media* ; Depression ; Double-Blind Method ; Electrocardiography ; Heart Diseases ; Heart Ventricles ; Hemodynamics* ; Humans ; Hypotension ; Ioxaglic Acid ; Molecular Weight ; Osmolar Concentration ; Prospective Studies ; Ventricular Dysfunction, Left ; Viscosity

We studied the activity of adenosine deaminase in the urine of 38 patients who were divided into four groups :Urinary tract tuberculosis without ureteral obstruction(Group I ), Urinary tract tuberculosis with ureteral obstruction (Group II ), Urinary tract infection ( Group III ) and control subjects (Group IV). In patients with urinary tract tuberculosis with ureteral obstruction the adenosine deaminase activity in aspirated renal urine was significantly higher than for the rest of the groups (p<0.001). Adenosine deaminase activity in renal aspirated urine has proved to be a simple and reliable diagnostic method for urinary tract tuberculosis with ureteral obstruction.
Adenosine Deaminase* ; Adenosine* ; Humans ; Tuberculosis* ; Ureter ; Ureteral Obstruction ; Urinary Tract Infections ; Urinary Tract*

BACKGROUND: Cancellations of elective operations are due to various reasons, which can be categorized into those initiated by patients or their guardians and those initiated by hospital staff. Cancellations of elective operations result not only in time and economic loss but also in negative psychological effects for patients and guardians and operational inefficiency for hospitals among other problems. As such, by studying and analyzing the causes of such cancellations, one may categorize them into involuntary ones and preventable ones, with the aim to reduce the occurrence of the latter that will lead to reduction in cancellation of elective operations. METHODS: 11,082 cases of elective operation were reviewed and analyzed retrospectively from January 2002 to December 2006. Total number, department, anesthetic type and cause of cancellation were recorded daily. Emergency operation and operation under local anesthesia were excluded. RESULTS: Total number of cancellation was 762 cases and mean cancellation rate was 6.9%. The most common cause of cancellation was co-existing disease or abnormal laboratory finding (25.3%). Especially in urology the most common cause of cancellation was the relief from diseases or symptoms. Plastic surgery showed the highest cancellation rate among all at 12%. CONCLUSIONS: Setting up standards that help determine the driving factors behind cancellations of elective operations within anesthesiology departments and utilizing a patient evaluation system, after categorizing the causes of cancellations into involuntary and preventable ones and analyzing them, will lead to reduction in cancellation of operations and solve problems faced by patients and guardians, and hospitals and their staff.
Anesthesia, Local ; Anesthesiology ; Emergencies ; Humans ; Retrospective Studies ; Surgery, Plastic ; Urology