Tetrasomy 18p, one of the most commonly observed isochromosomes, consists of two copies of the p arms on chromosome 18[i(18p)]. It is known as a de novo occurrence of non-disjunction or centromeric mis-division during meiosis II in the vast majority of cases. It has a prevalence of 1/140,000-180,000 live births and affects both genders equally. A 28-year-old woman was referred at 33+2 weeks gestation to rule out fetal congenital heart disease. Her prenatal ultrasonography showed intrauterine growth retardation, cardiomegaly, and imperforate anus. Doppler ultrasonographic finding showed fetal anemia. Tetrasomy 18p was confirmed by conventional karyotyping and fluorescence in situ hybridization. Because of its very low prevalence rate, only several cases of tetrasomy 18p has been reported worldwide and it has not yet been reported in Korea before. Therefore, we report a case of prenatally diagnosed tetrasomy 18p.
Anemia ; Aneuploidy ; Anus, Imperforate ; Arm ; Cardiomegaly ; Chromosomes, Human, Pair 18 ; Coat Protein Complex I ; Female ; Fetal Growth Retardation ; Fluorescence ; Heart Diseases ; Humans ; In Situ Hybridization ; Isochromosomes ; Karyotyping ; Korea ; Live Birth ; Meiosis ; Pregnancy ; Prenatal Diagnosis ; Prevalence ; Tetrasomy ; Ultrasonography, Prenatal

BACKGROUND AND OBJECTIVES: Low concentration hypochlorous acid is known for being an endogenous anti-bacterial and anti-viral agent. Saline irrigation has been used as an adjunctive treatment for patients with chronic sinusitis. In this study, we tried to compare the effectiveness of hypochlorous acid and saline nasal irrigation to patients with intractable sinusitis after surgery. SUBJECTS AND METHOD: A total of 35 patients who had a frequent relapse of chronic sinusitis or had persisting symptoms post-surgically were recruited. The experimental group was given hypochlorous acid and saline nasal irrigation, while the control group was given saline nasal irrigation for eight weeks. The curative effects were assessed on the basis of the symptom score, nasal endoscopic score, bacterial culture, and inflammatory cytokines on the first day, fourth week, and eighth week after treatment. RESULTS: A total of 26 participants were assessed. The study finally consisted of 15 patients in experimental group and 11 in the control group. The symptom scores in the experimental group were substantially lower before, and after four and eight weeks of treatment. However, there was no specific difference in symptom score improvement between the two groups. The endoscopic score improved in experimental group (p<0.01). Similar tendencies were shown in the bacterial culture test of both groups. In the experimental group, the values of TNF-alpha, IL-8, and IL-1beta decreased in the fourth week, whereas they increased in the eighth week. CONCLUSION: Hypochlorous acid nasal irrigation may be to used as an alternative adjunctive treatment in addition to saline irrigation.
Cytokines ; Humans ; Hypochlorous Acid ; Interleukin-8 ; Nasal Cavity ; Nasal Lavage ; Recurrence ; Sinusitis ; Tumor Necrosis Factor-alpha

It is very important to tallow that pelvic lymphadenectomy associated with proctectomy must be based on the principle of oncologic surgery and encompass all predictable pathways of extension of rectal cancer for curative surgical resection. We investigated the characteristis of lymph node metastasis in patients with rectal cancer prospectively. 108 consecutive patients with rectal cancer underwent curative surgical resection were enrolled in this study. Rectal cancers were divided into two groups, upper and mid-lower. Upper rectal cancer was defined as the tumor above the peritoneal reflexion. Lymph nodes were stratified as mesorectum, distal mesorectum (defined as distal part more than 2 cm from the lower margin of the tumor), intemal iliac, common iliac, presacral, superior rectal artery, inferior mesenteric artery, paraaortic lymph node. Average number of sampled nodes in these groups 18.5+/-10.7, 3.6+/-3, 2.3+/-3, 1.8+/-1.3, 4 +/-4.1, 1.6+/-2, 3.1+/-3.2, 5.4+/-4.7 respectively. 60 of all patients showed positive lymph node. The over all percentages of patients with positive lymph node was 53% in mesorectum, 12% in distal mesorectum, 8% in intemal iliac, 4.5% in common iliac, 4.5% in presacral, 10% in superior rectal artery, 6.5% in inferior mesenteric artery, 4% in paraaortic lymph node. The over all percentages of patients with positive lymph nodes in each group were 60% (27/45), 9% (4/45), 6.5% (3/45),2% (1/45), 2% (1/45), 13% (6/45), 11% (5/45), 1% (1/45) respectively in upper rectal cancer, 49% (31/63), 14% (9/63), 9.5% (6/63), 6% (4/63), 6% (4/63), 8% (5/63),3% (2/63),5% (3/63) respectively in mid-lower rectal cancer. There were skip metastasis in 3 patients with upper rectal cancer, 2 patients with mid-lower rectal cancer. Age, depth of invasion, tumor size, tumor differentiation among clinicopathologic factors were predictive factors of lymph node metastasis to mesorectum. Risk factors of metastasis to extra-mesorectal lymph node were younger age (<40), poorly differentiation, larger tumor size (>5.0 cm), involved circimferential (>50%), and positive CA 19-9 (>37 U/ml). These results suggest that more careful upward lymphadenectomy must be carried out especially in upper rectal cancer and also careful lateral dissection in selected patients and more generous excision of distal mesorectum especially in mid-lower rectal cancer is needed for curative resection according to clinicopathologic factors.
Arteries ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Mesenteric Artery, Inferior ; Neoplasm Metastasis* ; Prospective Studies* ; Rectal Neoplasms* ; Risk Factors

Purpose: The safety and efficacy of minimally invasive techniques in congenital heart surgery were tested in this study. Materal and method: Between July 1997 and November 1997, a total of 46 children were underwent minimally invasive cardiac operations at Seoul National University Children's Hospital. Age and body weight of the patients averaged 34.6+/-41.8 (Range: 1~148) months and 14.5+/-9.9 (Range: 3.0~40.0) kg, respectively. Twenty eight patients were male. Preoperative surgical indications included 15 atrial septal defects, 25 ventricular septal defects, 1 foreign body in aorta, 3 partial atrioventricular septal defects, 1 total anomalous pulmonary venous connection (cardiac type), and 1 tetralogy of Fallot. After creating a small lower midline skin incision starting as down as possible from the sternal notch, a vertical midline sternotomy extended from xyphoid process to the level of the second intercostal space, where one of the T-, J-, I-or inverted C-shaped lower lying mini-sternotomy was completed with a creation of unilateral right or bilateral trap door sternal opening. A conventional direct aortic and bicaval cannulation was routine. RESULT: A mean length of skin incision was 6.1+/-1.0 (range: 4.0~9.0) cm. A mean distance between the suprasternal notch and the upper most point of the skin incision was 4.0+/-1.1 (range: 2.0~7.0) cm. Mean cardiopulmonary bypass time, aortic cross-clamp time, and the operation time were 62.9+/-20.0 (range: 28~147), 29.8+/-12.8 (range: 11~79), and 161.1+/-34.5 (range: 100-250) minutes. A mean total amount of postoperative blood transfusion was 71.0+/-68.1 (range: 0~267) cc. All patients were extubated mean 11.3+/-13.8 (range: 1~73) hours after operation. A mean total amount of analgesics used was 0.8+/-1.8 (range: 0~9) mg of morphine. The mean duration of stay in intensive care unit and hospital stay were 35.0+/-32.2 (range: 10~194) hours and 6.2+/-2.0 (range: 3~11) days. There were no wound complications and hospital deaths. CONCLUSION: This short-term experience disclosed that the minimally invasive technique can be feasibly applied in a selected group of congenital heart disease as well as is cosmetically more attractive approach.
Analgesics ; Aorta ; Blood Transfusion ; Body Weight ; Cardiopulmonary Bypass ; Catheterization ; Child* ; Deception ; Foreign Bodies ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Morphine ; Seoul ; Skin ; Sternotomy ; Surgical Procedures, Minimally Invasive ; Tetralogy of Fallot ; Thoracic Surgery* ; Wounds and Injuries

One hundred forty-four patients underwent operation for coarctation of the aorta at Seoul National University Children's Hospital between June 1986 and Decembsr 1995. Age ranged 0.1 to 191 months. Of these 78.5%(113) were infants. We classified the patients in terms of the anatomic location of coarctatiln and the associatCd anomalies(I[40]= primary coarctation, II[74]=isthmic hypoplasia, lII[30]=tubular hypoplasia involving transverse arch, A[63]=with ventricular septal defect, B[28]=with other major cardiac defects). Subcalvian flap coarctoplasty(60), resection and anastomosis(44), extended aortoplasty(26), and onlay patch(14) were used as surgical methods. Overall operative mortality was 16.0(23/144)%. The hospital mortality was significantly higher in patheints with type III, subtype B, younger age(under 3 months), extended aortoplasty(p<0.01). However, one-stage total repair in patients with subtype A or B were not found to be a predictor of hospital death. Restenosis had occured in 18 patients among 121 survivals(14.9%). The mean follow-up period was 29.1+/-28.8(0~129.2) months. Preoperative, immediate postoperative(within 3 months after operation) and postoperative(later than 6 months after operation) echocardiographic data on the dimensions of ascending aorta(AA), transverse arch(TA), an4 aortic isthmus(Al) were available in 77 patients(I=20, II=42, III= 15). Preoperative and postoperative aortic isthmus(All) and tra sverse arch indices(TAI), defined as TA/AA and AI/AA respectively, were compared. Immediate postoperative All in type I, II and TAI in type III were significantly smaller in stenotic than non-stenotic group suggesting incomplete relieves of stenotic segment Younger age, subclavian coarctoplasty in patient under 3 months of age were round to be the risk factors for restenosis in this series. In conclusion, We found that aortic arch index and transverse arch index can be a useful tool to figure out the anatomic and clinical characteristics of the patients with aortic coarctation, and that anatomy, associated anomalies, age, and surgical methods may influence the surgical outcome of the coarctation repair.
Aorta, Thoracic ; Aortic Coarctation* ; Echocardiography ; Follow-Up Studies ; Heart Septal Defects, Ventricular ; Hospital Mortality ; Humans ; Infant ; Inlays ; Mortality ; Risk Factors ; Seoul

We experienced a case of unusual complication following esophageal reconstruction. In 1969, accidentally the patient swallowed lye and was developed benign esophageal stricture one year later. In 1972, esophageal reconstruction with right colon was done but pus was drained out of the abdominal wound. After then wound disruption and healing were repeated. In 1996, stenosis of colonic graft was found and resection of stenotic area and end to end anastomosis was done. We concluded that it was developed inflammatory change of graft by intraoperative infection.
Abscess* ; Colon ; Constriction, Pathologic* ; Esophageal Stenosis ; Humans ; Lye ; Postoperative Complications ; Suppuration ; Transplants ; Wounds and Injuries

No abstract available.
Animals ; Dogs* ; Heart* ; Heart-Lung Transplantation*

No abstract available.
Heart, Artificial*

No abstract available.
Paralysis* ; Phrenic Nerve*

No abstract available.
Aorta* ; Endothelium-Dependent Relaxing Factors*