BACKGROUND: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. METHODS: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of 58.4+/-43.6 months. RESULTS: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). CONCLUSION: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.
Adult* ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Heart Failure ; Heart Transplantation* ; Heart* ; Heart-Lung Transplantation ; Hemorrhage ; Humans ; Incidence ; Kidney Transplantation ; Korea ; Length of Stay ; Lymphocele ; Mortality ; Pericardial Effusion ; Postoperative Complications* ; Renal Insufficiency ; Stroke ; Transplants ; Wound Infection

PURPOSE: Studies of penile length in children have been rarely conducted. In Korea, great improvements in height and weight have been observed because of economic development over the past 25 years. We investigated the current status of penile length in Korean children and compared the results with those of a previous Korean study conducted in 1987. MATERIALS AND METHODS: The subjects in this study were 233 boys aged 1 to 158 months, each of whom had been brought to outpatient clinics between April and October 2011. Penile length was measured according to the stretched penile length (SPL) technique; testicular size was measured (in ml) by using orchidometry. A comparison of penile lengths between the current study and the 1987 study was made by using Student's t-test. RESULTS: SPL increased significantly by 0.7 to 1.1 cm in most age groups (p<0.05). Current anthropometric measures of Korean children such as height, body weight, and testicular size have increased compared with those from 1987. CONCLUSIONS: Penile length has increased significantly over the last quarter century. Therefore, it is suggested that novel reference values for penile length in prepubertal Korean children be determined in studies with a larger community-based population in order to diagnose and treat size-related penile disorders.
Aged ; Ambulatory Care Facilities ; Anthropometry ; Body Height ; Child ; Economic Development ; Humans ; Korea ; Male ; Penis ; Reference Values

Heart transplantation is now regarded as the treatment of choice for end-stage heart failure. To improve long-term results of the heart transplantation, we analyzed causes of death relative to time after transplantation. A total of 201 consecutive patients, 154 (76.6%) males, aged > or = 17 yr underwent heart transplantation between November 1992 and December 2008. Mean ages of recipients and donors were 42.8 +/- 12.4 and 29.8 +/- 9.6 yr, respectively. The bicaval anastomosis technique was used since 1999. Mean follow up duration was 6.5 +/- 4.4 yr. Two patients (1%) died in-hospital due to sepsis caused by infection. Late death occurred in 39 patients (19.4%) with the most common cause being sepsis due to infection. The 1-, 5-, and 10-yr survival rates in these patients were 95.5% +/- 1.5%, 86.9% +/- 2.6%, and 73.5% +/- 4.1%, respectively. The surgical results of heart transplantation in adults were excellent, with late mortality due primarily to infection, malignancy, and rejection. Cardiac deaths related to cardiac allograft vasculopathy were very rare.
Adult ; Anastomosis, Surgical/methods ; Female ; Follow-Up Studies ; Graft Rejection/mortality ; Heart Transplantation/*mortality ; Humans ; Immunosuppression/methods ; Infection/mortality ; Male ; Middle Aged ; Neoplasms/mortality ; Postoperative Complications/mortality/surgery ; Survival Rate ; Transplantation/*mortality ; Treatment Outcome

BACKGROUND: B-type natriuretic peptide (BNP) is a cardiac hormone that is primarily synthesized by the ventricular cardiac myocytes. Increased plasma BNP levels have been observed in patients suffering with congestive heart failure, ventricular hypertrophy and myocaridits and also during heart transplantation rejection. We investigated the serum BNP level as a predictive marker for rejection after heart transplantation. MATERIAL AND METHOD: To test the usefulness of measuring the BNP level in cardiac transplant patients, consecutive blood samplings for BNP, right ventricular endomyocardial biopsies, hemodynamic measurements and transthoracic echocardiogram were all done in 10 such patients between January 2004 and August 2005 at the Department of Thoracic and Cardiovascular Surgery in Asan Medical Center. Two groups were identified with using the median value: the low BNP group (n=28, BNP: < or =290 pg/mL) and the high BNP group (n=29, BNP: >290 pg/mL). We retrospectively analyzed rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy, the pulmonary capillary wedge pressure and the right atrial pressure between the 2 groups. RESULT: There were no differences in age, gender, rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy and the right atrial pressure between the 2 groups (p>0.05). However, a higher pulmonary capillary wedge pressure and a higher mean pulmonary atrial pressure were observed in the high BNP group (p<0.05). Further, BNP has linear correlation with the pulmonary capillary wedge pressure (r=0.590, p<0.001). Using the cut-off value of 620 pg/mL, the BNP predicted a high PCWP (>12 mmHg) with a sensitivity of 83.3% and a specificity of 91.1% (AUC: 0.900+/-0.045, p<0.001). CONCLUSION: The BNP level after heart transplantation does not show any significant correlation with rejection, yet it might be a predictive marker of ventricular diastolic dysfunction.
Atrial Pressure ; Biopsy ; Chungcheongnam-do ; Heart Failure ; Heart Transplantation* ; Heart* ; Hemodynamics ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Myocytes, Cardiac ; Natriuretic Peptide, Brain* ; Plasma ; Pulmonary Wedge Pressure ; Retrospective Studies ; Sensitivity and Specificity ; Tricuspid Valve Insufficiency

BACKGROUND AND OBJECTIVES: The purpose of this study was to assess the results of a newly developed aortic valve repair technique. SUBJECTS AND METHODS: Between December 1997 and April 2005, 75 aortic valvuloplasties were performed using a new technique that addressed the 3 main components of the aortic root; annulus, sinotubular junction and leaflet. An internal synthetic strip and ring were implanted along the fibrous annulus to reduce the annulus and sinotubular junction, and additional leaflets were implanted for leaflet correction. Based on the primary pathology, there were 35, 22 and 18 cases of isolated aortic regurgitation, aortic regurgitation due to ascending aortic aneurysm and aortic regurgitation due to annuloaortic ectasia, respectively. RESULTS: The average age of the subjects was 46.4+/-16 years; there were 51 and 24 males and females, respectively. There was no operative mortality, with a 2-year freedom from reoperation rate of 97%. Follow up echocardiograms showed significant improvements in the grade of aortic regurgitation, from a preoperative mean of 3.1+/-1.2 to 1.08+/-0.7 immediate postoperatively, to 1.15+/-0.6 at the final follow up. CONCLUSION: The results of the current study showed this technique to be effective in the treatment of aortic regurgitation of various causes. Although long-term results are pending, it is our contention that this aortic valve repair technique will be a reliable method in the future.
Aortic Aneurysm ; Aortic Valve Insufficiency ; Aortic Valve* ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Freedom ; Humans ; Male ; Marfan Syndrome ; Mortality ; Pathology ; Reoperation

BACKGROUND: Cefcapene pivoxil hydrochloride is a new oral cephem which has a broad-spectrum activity with expanded potency against Gram-positive bacteria, including Staphylococcus aureus and Streptococcus, as well as Gram-negative bacteria. In this study, we examined the in vitro activity of cefcapene against recently isolated clinical specimens from patients in a tertiary hospital. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of cefcapene and other cephalosporins against 450 clinical isolates from of patients in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by agar dilution method according to the recommendations of National Committee for Clinical Laboratory Standards. RESULTS: Compared with other cephalosporins (cefaclor, cefpodoxime, and cefixime), cefcapene had lower MIC distributions for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and methicillin-susceptible S. aureus. Cefcapene had variable activity against Enterobateriaceae. CONCLUSION: Cefcapene had excellent in vitro antimicrobial activities against common typical bacterial respiratory tract pathogens and methicillin-susceptible S. aureus. Cefcapene appears to be a promising agent for treatment of community-acquired respiratory tract infections and infections caused by methicillin-susceptible S. aureus.
Agar ; Cephalosporins ; Chungcheongnam-do ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Haemophilus influenzae ; Humans ; Moraxella (Branhamella) catarrhalis ; Respiratory System ; Respiratory Tract Infections ; Staphylococcus aureus ; Streptococcus ; Streptococcus pneumoniae ; Tertiary Care Centers

BACKGROUND: Cefcapene pivoxil hydrochloride is a new oral cephem which has a broad-spectrum activity with expanded potency against Gram-positive bacteria, including Staphylococcus aureus and Streptococcus, as well as Gram-negative bacteria. In this study, we examined the in vitro activity of cefcapene against recently isolated clinical specimens from patients in a tertiary hospital. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of cefcapene and other cephalosporins against 450 clinical isolates from of patients in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by agar dilution method according to the recommendations of National Committee for Clinical Laboratory Standards. RESULTS: Compared with other cephalosporins (cefaclor, cefpodoxime, and cefixime), cefcapene had lower MIC distributions for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and methicillin-susceptible S. aureus. Cefcapene had variable activity against Enterobateriaceae. CONCLUSION: Cefcapene had excellent in vitro antimicrobial activities against common typical bacterial respiratory tract pathogens and methicillin-susceptible S. aureus. Cefcapene appears to be a promising agent for treatment of community-acquired respiratory tract infections and infections caused by methicillin-susceptible S. aureus.
Agar ; Cephalosporins ; Chungcheongnam-do ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Haemophilus influenzae ; Humans ; Moraxella (Branhamella) catarrhalis ; Respiratory System ; Respiratory Tract Infections ; Staphylococcus aureus ; Streptococcus ; Streptococcus pneumoniae ; Tertiary Care Centers

Long-term results of orthotopic heart transplantation vary among different institutions. The purpose of the present study was to assess the factors, which might affect long-term survival and complications. Between November 1992 and July 2003, 112 heart transplantations (M/F=89: 23) were performed. The standard technique was used in the first 57 patients and the bicaval technique in the latter 55 patients. Indications for transplantation in decreasing order of frequency were dilated cardiomyopathy (75%), ischemic cardiomyopathy (7%), and others (18%). The mean follow up duration was 51.8 +/- 31.3 months with 98 patients remaining alive. Preoperatively, all patients were either in NYHA functional class III or IV. Postoperatively, all patients showed improvement to functional class II or I, except 3 patients that remained in NYHA class III. The mean number of rejection cases within the first year was 0.6 +/- 0.8, with humoral rejection noted in 3 cases. The graft vascular disease (GVD) -free survival at 3 and 5 years was 96% and 83%, respectively. The 7-year survival after heart transplantation was 84%. There were 16 deaths, of which infection (n=4) was the most common followed by rejection (n=3), and malignancy (n=2). The present long-term results, were relatively superior to those seen in western countries. The relatively low GVD-free survival rate is thought to have contributed. The complications encountered after transplantation were mostly immunosuppressive drug related, suggesting further potentials for improvement in long-term survival.
Adult ; Female ; Follow-Up Studies ; Graft Rejection/epidemiology ; *Heart Transplantation/mortality ; Humans ; Incidence ; Kidney/blood supply ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis ; Vascular Diseases/epidemiology

BACKGROUND: Arbekacin was introduced to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. It is an aminoglycoside with proven in vitro activity against MRSA strains. Pharmacokinetic advantages such as concentration-dependant bactericidal activity, prolonged post-antibiotic effect are its feature of aminoglycoside like others. But there are only few clinical data of this new kind of antibiotics outside of Japan, the first country approved its use against MRSA infections. We studied the clinical and bacteriological efficacy and safety of arbekacin in the treatment of infections caused by MRSA. METHODS: During the period between December 2001 and October 2002, we prospectively enrolled 21 patients with culture proven MRSA infection and evaluated the clinical and bacteriological efficacy and adverse events of arbekacin. Patients were treated with arbekacin sulphate 100 mg intravenously twice daily for 14 days. RESULTS: Patients were included if they had signs and symptoms of active MRSA infection including bacteremia, soft tissue infection, urinary tract infection, pneumonia etc. A total of 21 patients with MRSA infection were enrolled. Four patients experienced adverse events; 3 nephrotoxicities, 1 hepatotoxicity. One of them with elevated creatinine was unable to continue the study. Efficacy were evaluated on 19 patients with duration of arbekacin longer than 9 days. A favorable bacteriological response (eradicated or presumed eradicated) occurred in 13 (68.5%) patients. CONCLUSION: Although this clinical study was limited in number and in proper randomization, arbekacin alone was less effective than combination therapy with glycopeptides for the treatment of MRSA infection. However, our limited data suggested the efficacy of arbekacin alone for the treatment which needs shorter duration. The combination treatment of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycosides. The combination therapy of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycoside.
Aminoglycosides ; Anti-Bacterial Agents ; Bacteremia ; Creatinine ; Glycopeptides ; Humans ; Japan ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Pneumonia ; Prospective Studies ; Random Allocation ; Soft Tissue Infections ; Urinary Tract Infections

BACKGROUND: The aim of the current study was to assess the effects of total arterial myocardial revascularization (TAMR) with bilateral internal mammary arteries. MATERIAL AND METHOD: 139 consecutive patients who underwent off pump coronary artery bypass surgery from January 2000 to December 2001 were included in the current retrospective study. Patients were divided into those receiving bilateral internal mammary artery, BITA (n=85) and those receiving single internal mammary artery, SITA (n=54). RESULT: There was only one death in each group. No significant differences were noted in the total ICU and hospital stay; 2.4+/-1.7 and 11.2+/-17.7 days, in the BITA group, respectively and 2.8+/-2.7 and 9.7+/-7.1 days in the SITA group, respectively (P>0.05). The mean number of distal anastomosis of 3.9+/-0.7 was slightly higher in the BITA group compared to the SITA group, which was 3.1+/-0.8. Myocardial infarction occurred in 7 patients (BITA group: 2, SITA group: 5) and deep sternal infection necessitating reoperation occurred in 4 patients (BITA group: 3, SITA group: 1). Coronary angiogram was performed in the immediate postoperative period in 104 patients (BITA group: 64/85, SITA group: 40/54). Of these patients, stenosis in the LAD anastomosis site occurred in 4 patients (BITA group: 2, SITA group: 2). A total of 8 anastomotic sites were stenotic in the entire series of which percutaneous intervention was performed in 3 patients and none required reoperative coronary artery bypass. CONCLUSION: The results of the current data did not show a significant difference in patency rate with bilateral internal mammary artery use for CABG supporting the feasibility of its use as a viable alternative method for TAMR.
Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Humans ; Length of Stay ; Mammary Arteries* ; Myocardial Infarction ; Myocardial Revascularization ; Postoperative Period ; Reoperation ; Retrospective Studies ; Skeleton* ; Surgical Procedures, Minimally Invasive ; Transplants*