BACKGROUND: Cardiovascular diseases of chronic dialysis patients are often undertreated because of their higher surgical risk. This study aimed to assess mortality and morbidity after open heart surgery in chronic dialysis patients compared to those with normal renal function and identify risk factors for postoperative outcomes. METHODS: We retrospectively analyzed 2,432 patients who underwent open heart surgery from 2002 to 2017 and collected data from 116 patients (38 patients on dialysis and 78 age-, sex-, and diabetes mellitus status-matched control patients with normal kidney function). We assessed comorbidities, New York Heart Association (NYHA) class, laboratory data, surgical methods, and postoperative outcomes. RESULTS: The dialysis group had more comorbidities, higher NYHA classes, and greater need for urgent surgeries compared to the control group. They exhibited significantly higher postoperative mortality (18.4% vs. 2.6%, P = 0.005) and more overall complications (65.8% vs. 25.6%, P < 0.001). Dialysis itself significantly increased relative risk for in-hospital mortality after adjustment. EuroSCORE II was not as useful as in the general population. Multivariate logistic regression analysis demonstrated that total (adjusted odds ratio [AOR], 10.7; P = 0.029) and in-hospital death risk (AOR, 14.7; P = 0.033), the durations of postoperative hospitalization (AOR, 4.6; P = 0.034), CRRT (AOR 36.8; P = 0.004), and ventilator use (AOR, 7.6; P = 0.022) were significantly increased in the dialysis group. CONCLUSION: The dialysis group exhibited a higher risk for mortality and overcall complications after open heart surgery compared to the patients with normal renal function. Therefore, the benefit of surgical treatment must be balanced against potential risks.
Cardiovascular Diseases ; Comorbidity ; Diabetes Mellitus ; Dialysis ; Heart ; Hospital Mortality ; Hospitalization ; Humans ; Kidney ; Kidney Failure, Chronic ; Logistic Models ; Mortality ; Odds Ratio ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Thoracic Surgery ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the non-dissected anatomic structures and abnormal computed tomographic findings that contribute to the recurrence of chronic rhinosinusitis (CRS) or the trail of revision endoscopic sinus surgery (ESS). SUBJECTS AND METHOD: The medical records of 34 subjects who were diagnosed with recurrent chronic rhinosinusitis, and required to undergo revision endoscopic sinus surgery were collected retrospectively. The subjects' computed tomography results were examined by a radiology specialist. RESULTS: The most common anatomic factors associated with the revision ESS for recurrence of CRS or retained inflammation were residual uncinate process (47.0%) and residual anterior ethmoidal cells followed by undissected posterior ethmoidal cells (38.2%) and obstructed sphenoid sinus ostium (32.3%). In addition, the uncorrected septal deviation, retained agger nasi cells or Haller cells and lateralized middle turbinate were also identified in the patients. CONCLUSION: From these data, we analyzed anatomical structures and CT findings related to the failure of primary ESS. We suggest that careful attention be given to these structures after primary ESS so as to reduce the failure rate and increase successful outcomes.
Humans ; Inflammation ; Medical Records ; Recurrence ; Retrospective Studies ; Sinusitis ; Specialization ; Sphenoid Sinus ; Turbinates

No abstract available.
Cheek ; Hidrocystoma

Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.
Adult ; Antidiuretic Agents/therapeutic use ; Coronary Artery Bypass/*adverse effects ; Coronary Vessels ; Deamino Arginine Vasopressin/therapeutic use ; Diabetes Insipidus, Neurogenic/*diagnosis/drug therapy/etiology ; Humans ; Hypothalamus/radionuclide imaging ; Magnetic Resonance Imaging ; Male ; Pituitary Gland/radionuclide imaging ; Polyuria/diagnosis/etiology ; Postoperative Complications/*diagnosis/drug therapy/etiology

PURPOSE: We designed this study to evaluate the interobserver reliability of magnetic resonance imaging (MRI), post-myelographic computed tomography (CT-myelogram) and myelography for the diagnosis of lumbar spinal stenosis. MATERIALS AND METHODS: Thirty two patients with lumbar spinal stenosis were evaluated preoperatively by MRI, CT-myelography, and myelography by four observers. For each set of scans, the examiners assessed the presence or absence of; 1) intervertebral disk protrusion, 2) facet arthrosis, 3) ligamentum flavum hypertrophy, and 4) nerve root impingement. The severities of 1) central, 2) lateral, 3) foraminal and 4) entire spinal stenosis were graded using a four-point scale range from 1 (no stenosis) to 4 (severe stenosis). RESULTS: Kappa statistical analysis revealed moderate interobserver agreement in terms of disk protrusion (0.49), nerve root impingement (0.42) and lateral stenosis grade based on MRI. Low levels of agreement were found for facet arthrosis and ligamentum flavum hypertrophy. Relatively higher levels of agreement were found for nerve root impingement, lateral stenosis and entire stenosis, graded by MRI and for central stenosis graded by myelography. CONCLUSION: The results of this study reflect that MRI showed relatively higher levels of interobserver reliability than the other diagnostic modalities in the evaluation of patients with lumbar spinal stenosis.
Constriction, Pathologic ; Diagnosis ; Humans ; Hypertrophy ; Intervertebral Disc ; Ligamentum Flavum ; Magnetic Resonance Imaging* ; Myelography ; Spinal Stenosis*

In 33 patients with congenital superior oblique palsy, we examined whether patients fixed with paretic or nonparetic eye in primary, head tilted positions to the right and left, and whether they could fuse in the characteristic head tilt postion or not. Of the 33 patients, 27 had horizontal deviation, 21 had vertical deviation and 17 had both horizontal and vertical deviation. There were 10 'V' patterns in 13 bilateral cases. In unilateral cases, both the paretic and nonparetic eye could be the fixating eye in primary position. There was a tendency to fix with right eye in the left head tilt, with left eye in the right head tiltin both the unilateral and bilateral cases. Twelve ot the 13 patients could not fuse with Worth 4 dot test preoperatively even in head tilted position.
Head ; Humans ; Paralysis*

A 51-year-old female patient who has had pemphigoid since 110 years ago visited Seoul National University Hospital with the chief complaint of ocular pain and bilateral cilia touching the cornea. Her visual acuity was light sense in the right eye and finger count/1Ocm in the left eye. She had bilateral severe trichiasis, entropion, corneal opacity and total symblepharon. Bilateral symblepharon lysis and mucous membrane graft with buccal mucosa was done Left side was successful, but in the right side, there was hyperplastic proliferation of the grafted buccal mucosa and recurrence of the symblepharon. We performed symblepharon lysis and mucous membrane graft using vaginal mucosa in the right eye. Grafted vaginal mucosa looked healthy and no recurrence of symblepharon ocurred during the follow-up period of 1 year. We would like to suggest that if there is no available oral mucosa, mucous membrane graft can be done with vaginal mucosa in female patient.
Cilia ; Cornea ; Corneal Opacity ; Entropion ; Female ; Fingers ; Follow-Up Studies ; Humans ; Middle Aged ; Mouth Mucosa ; Mucous Membrane* ; Pemphigoid, Bullous ; Recurrence ; Seoul ; Transplants ; Trichiasis ; Visual Acuity

A 51-year-old female patient who has had pemphigoid since 110 years ago visited Seoul National University Hospital with the chief complaint of ocular pain and bilateral cilia touching the cornea. Her visual acuity was light sense in the right eye and finger count/1Ocm in the left eye. She had bilateral severe trichiasis, entropion, corneal opacity and total symblepharon. Bilateral symblepharon lysis and mucous membrane graft with buccal mucosa was done Left side was successful, but in the right side, there was hyperplastic proliferation of the grafted buccal mucosa and recurrence of the symblepharon. We performed symblepharon lysis and mucous membrane graft using vaginal mucosa in the right eye. Grafted vaginal mucosa looked healthy and no recurrence of symblepharon ocurred during the follow-up period of 1 year. We would like to suggest that if there is no available oral mucosa, mucous membrane graft can be done with vaginal mucosa in female patient.
Cilia ; Cornea ; Corneal Opacity ; Entropion ; Female ; Fingers ; Follow-Up Studies ; Humans ; Middle Aged ; Mouth Mucosa ; Mucous Membrane* ; Pemphigoid, Bullous ; Recurrence ; Seoul ; Transplants ; Trichiasis ; Visual Acuity

Corneal neovascularization, which is associated with complications in corneal diseases, can cause lipid deposit, decreasing vision, and graft rejection after penetrating keratoplasty (PKP). Corneal laser photocoagulation using an argon laser or yellow dye laser for ablation of corneal neovascularization has been described. We performed corneal argon laser photocoagulation (CALP) in two male patients with corneal neovascularization after herpetic keratitis. One PKP was performed after CALP and restored good vision with no rejection of the graft during an 8 month follow-up period. In the other case we observed visual improvement and no recurrence of corneal neovascularization after CALP.
Adult ; Corneal Neovascularization/etiology/*surgery ; Follow-Up Studies ; Humans ; Keratitis, Herpetic/complications ; *Laser Coagulation ; Male ; Middle Aged ; Visual Acuity

No abstract available.
Genes, ras* ; Humans