OBJECTIVES: The goal of operation for degenerative lumbar diseases is to relieve radiculopathy and low back pain and to prevent further degeneration. The authors analyzed the surgical results of posterior lumbar interbody fusion(PLIF) and 360degrees fixation to evaluate the proper treatment policy in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. MATERIAL AND METHODS: The authors performed PLIF on 92 patients and 360degrees fixation on 138 patients with spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. We retrospectively studied clinical outcomes and subjective satisfaction of these patients by several criteria such as visual analog scale(VAS), Prolo's economic and functional outcome scale, medication usage after operation and questionaire for overall outcome. RESULT: Pre- and postoperative VAS on back pain and leg pain showed decrease of pain from 6.5, 6.7 to 2.2, 2.4 in PLIF group and from 7.0, 7.2 to 2.5, 2.7 in 360degrees fixation group. Excellent and good outcomes on Prolo's scale were 81.5% in PLIF group and 82.6% in 360degrees fixation group. Medication usage after operation was reduced in 79.3% of PLIF group and in 78.3% of 360degrees fixation group. Patients' self-reported overall success of their procedure showed 82% in PLIF group and 84% in 360degrees fixation group. CONCLUSION: Both PLIF and 360degrees fixation showed good outcomes and provided biomechanically stable fusion in spinal stenosis, degenerative spondylolisthesis and low grade isthmic spondylolisthesis. Therefore, only PLIF seems necessary and considered a proper surgical treatment for these disorders.
Back Pain ; Humans ; Leg ; Low Back Pain ; Radiculopathy ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis

BACKGROUND: Increasing interest in the use of arterial conduites is based on the better patency of the internal thoracic artery(ITA) than the saphenous vein graft and the hope that other arterial conuits will perform similarly over the long term. MATERIAL AND METHOD: Between May 1997 and July 1998, 43 patients underwent coronary artery bypass grafting with ITA and the radial artery(RA). There were 28 men and 15 women with a mean age of 61.5 years(range, 35 to 78). In 43 patents, 30 bilateral ITA(including 7 diabetes mellitus, 5 more older 70 years), 8 bilateral ITA only, 2 left ITA and both RA, 11 left ITA and left RA and 22 both ITA and left RA were used. RESULT: There was 1 hospital mortality. Of the 42 patients alive, 39 patients are asymptomatic. Postoperative complications were postoperative bleeding in 1 patients, and low cardiac output syndrome in 3. Follow-up angiography was performed in 5 patients after the operation(mean 3 months), and all ITA & RA grafts showed excellent results. CONCLUSION: We conclude that complete arterial revascularization with internal thoracic artery and radial artery is technically feasiale with low mortality and morbidity, and but long term follow-up is needed.
Angiography ; Cardiac Output, Low ; Coronary Artery Bypass* ; Coronary Vessels* ; Diabetes Mellitus ; Female ; Follow-Up Studies ; Hemorrhage ; Hope ; Hospital Mortality ; Humans ; Male ; Mammary Arteries ; Mortality ; Postoperative Complications ; Radial Artery* ; Saphenous Vein ; Transplants

Aortic valve replacement in young patients has its problems. Biologic prosthetic valves degenerate and need replacement. Metalic prosthetic valves are more durable, however, anticoagulation which has its inherent problems is inevitable. The use of Ross procedure in young patients is gaining wider acceptance. The need of foreign pulmonary valve in right ventricular outflow tract (RVOT) will require reoperation due to RVOT obstruction, later. To overcome this problem, we reimplanted the native aortic valve in the pulmonary position in 21 year old female patient operated on utilizing the Ross procedure for aortic insufficiency. We experienced that the diseased aortic valve worked well in the pulmoanry position because of low pulmonary artery pressure and resistance.
Aortic Valve* ; Female ; Humans ; Pulmonary Artery ; Pulmonary Valve* ; Reoperation ; Transplantation, Autologous ; Young Adult

Ebstein's anomaly is a complex malformation that can be treated by various surgical techniques, either repair or replacement of the abnormal tricuspid valve, with variable results. The essence of the malformation is the downward displacement of the septal and posterior leaflets into the ventricle, resulting in the formation of an atrialized portion of the right ventricle. The aim of surgical repair is to correct the tricuspid valve dysfunction and to plicate the atrialized portion of the right ventricle A 12-months old female was admitted with the diagnosis of Carpentier type A of Ebstein's anomaly with severe tricuspid regurgitation. She successfully underwent operation with vertical plication of right ventricle and reimplantation of tricuspid leaflets. Postoperatively cardiac size was significantly reduced and tricuspid regurgitation was trivial in echocardiography. She was diacharged the 14th postoperative day.
Diagnosis ; Ebstein Anomaly* ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Infant ; Replantation ; Tricuspid Valve ; Tricuspid Valve Insufficiency

Bacterial endocarditis of the native aortic valve is associated with significant morbidity and mortality despite aggressive medical and surgical treatment, especially when perivalvular tissue was invaded and destructed. The pulmonary autograft is full viable and immune compatible tissue. This paper describes successful Ross operation as total root replacement in 38 years old native valve endocarditis patient with aortic root abscess.
Abscess* ; Adult ; Aortic Valve ; Autografts* ; Endocarditis ; Endocarditis, Bacterial ; Humans ; Mortality

Recent advances in understanding the anatomy of complete atrioventricular septal defect have led to alternative methods of repairing these defects. Here we report two cases of complete atrioventricular septal defect repair by direct closure of the ventricular element of the defect. Follow-up for average of 3 months suggests that, when direct closure can be performed, the results can be comparable with those of the standard technique. Our initial success with this approach is encouraging; however, longer follow-up and more experiences are required to establish whether it will be broadly applicable.
Follow-Up Studies

Between August 1996 and August 1997, 22 patients underwent extracardiac Fontan operations. The basic diagnoses included univentricular heart of the right ventricular type (n=12); univentricular heart of the left ventricular type (n=4); tricuspid atresia (n=4); left isomerism, transposition of great arteries, ventricular septal defect and pulmonary stenosis (n=1); and criss-cross heart with uneven ventricle (n=1). The median age of the 14 men and 8 women was 29 months (range from 21 months to 26 years). Previous procedures included bidirectional cavopulmonary shunt (n=15, interval=15.6+/-3.4 months), Kawashima operation (n=4, interval=37.5+/-20 months), and classic Glenn shunt (n=1, interval=14 years). In 2 patients, extracardiac Fontan operations were done without any previous procedures. A 16-to 22-mm flexible Gore-Tex tube graft (n=18), Hemashield graft (n=3), or, alternatively, a nonvalved aortic allograft (n=1) was cut and anastomosed end-to-end between inferior vena cava and undersurface of pulmonary artery using Gore-Tex or Prolene suture in a running fashion. In risk Fontan patients (n=12), a communication between the extracardiac conduit and the right atrium was constructed. In the most 13 recent patients, the procedures were done without cross-clamping of the aorta and with a beating heart. Operative mortality was 9.1% (n=2). Complications included persistent chest tube drainage for more than 7 days (n=5), chorea (n=2), and low cardiac output (n=1). There were no late deaths. Follow-up echocardiogram (mean: 6 months) demonstrated satisfactory hemodynamic results in the surviving 20 patients. Potential advantages of this technique consist of minimization of surgical manipulation of atrial tissue, reduction or elimination of myocardial ischemia, creationof a uniform and stable inferior vena cava-to-pulmonary artery conduit, and increased flexibility and safety in certain high-risk patients such as those with increased pulmonary vascular resistance, pulmonary hypertension, and impaired ventricular function. Further investigations during a longer follow-up are needed to confirm the intermediate and long-term results, especially the reduction of late atrial arrhythmias.
Allografts ; Aorta ; Arrhythmias, Cardiac ; Arteries ; Cardiac Output, Low ; Chest Tubes ; Chorea ; Crisscross Heart ; Diagnosis ; Drainage ; Female ; Follow-Up Studies ; Fontan Procedure* ; Heart ; Heart Atria ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Isomerism ; Male ; Mortality ; Myocardial Ischemia ; Pliability ; Polypropylenes ; Polytetrafluoroethylene ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Running ; Sutures ; Transplants ; Transposition of Great Vessels ; Tricuspid Atresia ; Vascular Resistance ; Vena Cava, Inferior ; Ventricular Function

The radial artery as a graft for myocardial revascularization was introduced by Carpentier et al. in the early 1970s. Mid-term results were unfortunately discouraging, and the clinical experience with this graft was interrupted. At the end of the 1980s, these authors reproposed the same arterial conduit with more satisfying results, because of improved technique and pharmacological management of the graft. Between October 1994 and July 1995, 36 patients underwent myocardial revascularization with a radial artery graft in Sejong General Hospital. Left internal mammary artery was concomitantly used as a pedicled graft in 34 patients. Fifteen patients(42%) had a complete arterial graft revascularization. A total of 123 distal anastomoses were performed(average 3.4 per patient), including 36 left internal mammary artery grafts(two sequential in 2 patients), and 23 saphenous vein grafts. The remaining 64 distal anastomoses were performed with radial artery grafts (mean 1.8 per patient). The radial arteries were anastomosed to the circumflex(n=38), diagonal( n=18), right coronary(n=6), and left anterior descending coronary artery(n=2). The percentage of radial artery graft anastomoses(64) to the total anastomoses(123) was 52%. The radial artery was used as a single graft in 10 patients, as a sequential graft in 25 patients, and two grafts in 1 patient. Twenty patients underwent associated procedures : coronary endarterectomy(14), coronary artery patch angioplasty(4), mitral valve repair(1), and repair of ventricular septal rupture(1). One patient died of low cardiac output syndrome and the others had no perioperative myocardial infarction. There are no ischemic and functional complications in the arm or hand after removal of the radial artery. Only 1 patient required reexploration of the arm, for the hematoma evacuation, and 2 patients complained transient thumb dysesthesia of the side of the havested arm. This dysesthesia improved within one month. Postoperative angiographic controls were obtained in 11 patients(31%) postoperative 79 to 210 days(mean 126 days). The patency rate were as follows : left internal mammary artery(100%), saphenous vein(100%), and radial artery(95%). We concluded that the radial artery is useful alternative graft, but long term clinical and angiographic studies are required to dertermine whether wider application is warranted.
Arm ; Cardiac Output, Low ; Coronary Artery Bypass* ; Coronary Vessels* ; Hand ; Hematoma ; Hospitals, General ; Humans ; Mammary Arteries ; Mitral Valve ; Myocardial Infarction ; Myocardial Revascularization ; Paresthesia ; Radial Artery ; Saphenous Vein ; Thumb ; Transplants

The rhabdomyosarcoma(RMS), a leading malignant soft tissue tumor in the pediatric population, occurs most commonly in the craniocervical region. RMS has involved the temporal bone approximately 7% in the literature. Petrous bone invasion was very rare and the overall outcome was always fatal, in spite of the efficacy of multimodality therapy, until recent years. The authors report a case of primary RMS in the temporal bone invading petrous bone and the result of multimodality treatment.
Petrous Bone* ; Rhabdomyosarcoma* ; Temporal Bone*