• Journal of Chest Surgery
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• v.11 no.3
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• pp.326-332
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• 1978

There appears some conduction defects frequently after total correction of Tetralogy of Fallot. Common defect is right bundle branch block due to surgical intervention. We experienced complete A-V block which occured 3 months later after total correction of Tetralogy of Fallot in a 8 year old boy. The patient was completely free of any A-V block after the operation for 3 months, and sudden onset of A-V block with coupled premature ventricular contractions resulted him in shock state during the attack of severe bronchopneumonia for 4 days prior to the second visit. Emergency implantation of Cordis demand type temporary pacemaker was necessary to control the complete heart block with bradyarrhythmia and frequent ventricular fibrillation. Permanent cardiac pacemaker was implanted two weeks later as indicated with Cordis Stanicor lambda demand pacemaker, and the patient was discharged uneventfully on the 8th post implantation day with the heart rate of 72/min. Another 3 months after the implantation, the patient was transported to this hospital as dead on arrival after an accidental fall from a 2 meter height, and all possible cardiopulmonary resuscitation was performed for 60 minutes at the emergency room in vain. Autopsy was done to find out the cause of sudden death and the etiology of complete heart block. Microscopic focal infarctions with scar formation were noted along the course of conduction system in the interventricular septum, which might be the main cause of complete heart block during the attack of severe bronchopneumonia complicated with acute bacterial endocarditis. The tip of the pacemaker wire was slipped from the granulation scar at the apex of the right ventricular cavity, and this might be the direct cause of pacing failure and death.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.220-231
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• 1992

We have performed 28 single lung transplantation in mongrel dogs transplanting the left lung exclusively from November 1989 to September 1991, in the department of thoracic surgery of Seoul National University Hospital. In the donor dogs, the main pulmonary artery was divided proximal to its bifurcation, and the left atrium was incised freeing the left veins with a generous atrial cuff. We used cold saline in the first 7 transplantations and Euro-Collins or modified Euro-Collins solution in the remaining 17 transplantations as a lung preservatives. The bronchus was divided at two cartilage rings proximal to the upper lobe bronchus take off. In the recipient procedure, we used a Fogarty catheter as a bronchus block. Left atrial anastomosis was performed first using 5-O prolene and the pulmonary artery was anastomosed using 6-O prolene. The bronchus was anastomosed next with 4-O vicryl interruptedly and covered with a greater omentum which had been prepared previously. All dogs received cyclosporin A and azathioprine as immunosuppressants and were divided into two group. In the 10 Group I dogs, they survived within 6 days, mean survival time was 66.8$\pm$53.4 hours. In remainder 14 Group lI dogs, they survived above 6 days, mean survival time was 9. 5$\pm$5.6 days. The cause of death were as follows: 2 cases of sacrifice, 2 cases of respiratory insufficiency during operation, 2 cases of arrhythmia immediate postoperatively, 2 cases of bleeding, others in Group I, and 6 cases of sacrifice, 4 cases of sepsis, 3 cases of bleeding, others in Group lI. Results of bronchoscopic findings were obstruction above 50% in 12 cases of 16 performance cases within 5th day. Early chest radiologic haziness were showed, and total lung perfusion defect was frequently showed in both group within 7th day. Main autopsy findings were left atrial and pulmonary arterial thrombi and bronchial obstruction The major histologic findings of Group I were pleural exudate, hemorrhagic infarct, pulmonary congestion, and interesting histologic findings of Group II were 3 cases of perivascular or peribronchial lymphocyte infiltration, 3 cases of hemorrhage infarct, 2 cases of interstitial pneumonitis. The structual change of bronchioles, suggesting bronchiolitis obliterans was not observed due to improper preparation of proximal pulmonary tissue and short term survival times.

• Journal of Chest Surgery
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• v.7 no.2
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• pp.189-200
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• 1974

The mitral valve replacement with Beall prosthetic valve was performed on three patients, and double valve replacement. aortic and mitral valve, was performed in this department.1) The preoperative studies about the first case were compatible with mitral steno-insufficency.The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary hypass using hypothermic hemodilution technique. The total perfusion time was eighty minutes. Immediate postoperative course was smooth, but this patient was died of asphyxia due to tracheomalacia complicated after tracheostomy 3 months after operation. Autopsy on this patient revealed that no thrombus and no ball variance could be found, and endothelization on the valve cuff was satisfactory. 2) The preoperative studies on the second case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve under the cardiopulmonary bypass using hypothermic hemodilution technigue. The total perfusion time was 123 minutes. This patient was discharged in good condition and follow-up study after 16 months revealed the patient had enjoyed healthy life. 3) The preoperative studies about the third case were compatible with aortic insufficiency and mitral stenoinsufficiency. The diseased valves were replaced with type 2 sutureless Magovern aortic valve and the medium sized Beall mitral prosthesis under cardiopulmonary bypass using hypothermic hemodilution technIque and coronary artery perfusion. The total perfusion time was 155 minutes. This patient was discharged in good condition, but thromboembolism was developed 2 months after discharge. 4) The preoperative studies about the fourth case were compatible with mitral insufficiency. The diseased mitral valve was replaced with the medium sized Beall prosthetic valve. The total perfusion time was 132 minutes. The atrioventricular block developed just after operation but converted to normal sinus rhythmn on the third postperative day. The preoperative NYHA functional classification IV was converted to Class 1 or 11 at the time of discharge and this patient enjoyed healthy life. Attendum; The fifth case, nineteen years old male with mital insufficiency underwent Beall valve replacement and his course was uneventful 2 weeks after operation.

• The Korean Journal of Pesticide Science
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• v.15 no.2
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• pp.104-113
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• 2011

We investigated the systemic effects of leaf folder (Cnaphalocrocis medinalis) resistant rice (transgenic rice, Nakdongbyeb) in Sprague-Dawley rats for 13 weeks. Leaf folder resistant rice was added to the diet at percentage levels of 0, 5 and 20 percentage/feeder and was administered for 13 weeks. The results did not show any changes in food and water intake. There were also no biologically significant changes in both body and organ weights, hematological and blood biochemical parameters, autopsy and histopathology between the treatment and control groups. Based on these results, no observed adverse effect level (NOAEL) of transgenic rice was considered to be more than 10,000 mg/kg b.w. under the conditions of the present study.

• Journal of Veterinary Clinics
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• v.6 no.1
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• pp.185-191
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• 1989

A dog which was hospitalized to Veterinary Teaching Hospital, College of Veterinary Medicine, Jeonbug National University on December 28, 1988 was revealed severe anemia: hemoglobinuria and weakness. In the inspections, abdominal pain and spleno megaly at the ventral abdomen were detected by palpations. In the examinations of blood, the obtained results were summarized as follows: Babesla spp. was identified on the blood smear stained with Giemsa. The Babesia spp. was assumed to the Babesia gibsoni for the their small size and pleomorphism such as comma form, ring form and dot form. In the blood examinations of the patient, Ht: 22.5％, RBC:354${\times}$10$^4$/${\mu}\ell$, Hb: 8.8g/dl, serum protein: 8g/dl, and WBC count was 21, 425/${\mu}\ell$. In the chemical examinations of serum, the value of AST(GOT) was 30iu and ALT(GPT) was 20iu, respectively. The blood sugar was 60mg/d1. In the urine test, urine protein was 30mg/d1 and the hemoglobin In the urine was the ＋＋＋ and occult blood reaction(Benzidine test) in the feces was ＋＋＋. Splenomegaly was confirmed by X-ray examination. To confirm for the Babesia spp. infection, 5ml of the whole blood of the patient(3％ of Parasitized erythrocytes) were inoculated into the cephalic vein of the two normal dogs. In the blood of experimental dogs which were inoculated parasitized blood, Babesia spp. was detected in the two doss and pleomorphic parasites were observed, too. In the blood examinations of No. 1 the Ht and RBC were decreased to 6.8％ and 52${\times}$10$^4$/${\mu}\ell$, respectively. WBC count was 10.600/${\mu}\ell$ and serum protein was 6.8g/dl. The rates of parasitized erythrocytes were 15％ in the experimental dog. Also ＋＋＋ of the hemoglobin was detected in the urine. In the X-ray examination, splenomegaly was comfirmed and it was confirmed by autopsy of the experimental dog(No. 1).

• Journal of Chest Surgery
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• v.23 no.5
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• pp.1003-1008
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• 1990

Primary choriocarcinoma of the lung is extremely rare and have been reported ten and several cases only in the literature. It is very difficult to confirm the "Pure primary pulmonary choriocarcinoma" clinically, so most cases that have been reported in the literature confirmed by autopsy and the prognosis is relatively poor compared with metastases. We experience one case of the primary pulmonary choriocarcinoma. She was 53 year old multiparous woman[4 \ulcorner0 \ulcorner2 \ulcorner0] who complain right chest pain for 4 years. On plain film and computerized tomogram of the thorax at admission, 2.5cmx3.5cmx5 cm sized, well demarcated ovoid mass was founded on the right middle lobe just below the parietal pleura and growing rapidly on plain film to 5cm x 6.5cm x 7cm after 15 days. We confirm the choriocarcinoma in the lung by percutaneous needle aspiration biopsy and strongly suspect primary after various examination for rule out metastases from the ovary or uterus. We perform middle lobe lobectomy because that can not confirm the primary or the metastases because there are not complete histological examination by bilateral ovariectomy and hysterectomy, and under the belief that extragestational or extragonadal primary choriocarcinoma is more resistant to the chemotherapy, and could be reduce the duration of hospitalization and the amount of chemotherapy used to achieve remission On 14th postoperative day, serum p-HCG level was returned to normal limit, and perform chemotherapy two times on 3rd and 5th week for prevention surgical traumatic hematogenous metastases or undetected microfocus, but the patient expire on 68th postoperative day due to intracerebral hemorrhage in the intracranial choriocarcinoma which strongly suspected surgical traumatic hematogenous metastases.etastases.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.844-853
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• 1990

We have performed 27 cases of orthotopic homologous cardiac transplantation using Korean mongrel dogs and one case of sham operation for the evaluation of harmful effect of cardiopulmonary bypass itself on the dog from April, 1989 to June, 1990. Our previous reports have already demonstrated basal hemodynamic and hematologic data on the canine homologous heart transplantation and the fundamental principles of transplantation of the heart. The mean body weight of recipients was 13.2$\pm$1.2kg with a rage of 11 ~ 15kg, and the hemodynamic and hematologic pictures were almost same as the result of previous reports from our hospital, except marked decrease in postoperative platelet count[from 3.18 $\pm$0.80x106/mm3 to 1.41$\pm$0 37x 106/mm3]. Mean survival time was 24.82$\pm$49.40 hours with the longest survival of 264 hours. Donor cardiectomy included coronary vasodilatation with diltiazem, potassium arrest, and the rapid cooling of the heart suspending in the specially designed ice-bath. Median sternotomy provided excellent exposure of the surgical field. 6 \ulcorner0 prolene suture was used for the anastomosis of both atrial cuffs and the great arteries, and we found the fact that stenosis, bleeding, thrombus formation around the anastomotic site could be decreased with the use of everted horizontal mattress suture techniques. Immunosuppression was done with a combination of lower dose Cyclosporin-A, Azathioprine, methyl-prednisolone, but our cases still showed too short survival to worry about graft rejection. Still poor was our quality control of experimental animal, we had much difficulties in postmortem evaluation of the dogs. Low cardiac output due to biventricular failure, intractable supraventricular or ventricular tachyarrhythmia, postoperative massive bleeding, sepsis were most frequent findings that could be thought as a cause of death. A few cases showed subendocardial patch hemorrhage in both ventricular cavity or atrial septum at autopsy, suggesting acute subendocardial infarction. Although our team overcome most of the technical problems of orthotopic heart transplantation, we should pile up further knowledges about donor heart preservation, quality control of animal, infection, rejection, the effect of the cardiopulmonary bypass to improve the results.

• Journal of Korean Neurosurgical Society
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• v.47 no.3
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• pp.169-173
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• 2010

Objective : The normal anatomic relationships characteristic of the pituitary stalk area were previously thought to involve only one location. The purpose of this study was to re-evaluate the anatomic location of the pituitary stalk and possible varying locations in relation to the tuberculum sellae and dorsum sellae using morphometric evaluation and anatomic dissection of human cadaveric specimens. The surgical implications of the variations are discussed. Methods : The calvaria were removed via routine autopsy dissections, and the brains were removed from the skull while preserving the pituitary stalk. The diaphragma sellae, tuberculum sellae, and the location of the pituitary stalk were examined in 60 human cadaveric heads obtained from fresh adult cadavers. Empty sellae were excluded. Results : The openings of the diaphragma sellae averaged $6.62{\pm}1.606mm$ (range, 3-9 mm). The distance between the tuberculum sellae and the posterior part of the pituitary stalk was 1 to 8 mm. The upper face of the diaphragma sellae appeared flat in 26 (43%), concave in 24 (40%), and convex in 6 cases (10%), with a prominent tuberculum sellae in 4 cases (7%). The location of the chiasm was normal in 47 cases (78%), with a prefixed chiasm in 3 cases (5%) and a postfixed chiasm (17%) in the 10 cases. Four cadaver specimens had prominent tuberculum sellae and other parameters were not evaluated. Conclusion : When opening the chiasmatic cistern, neurosurgeons should be aware about the relationship between the pituitary stalk and the surrounding structures to prevent inadvertent injury to the pituitary stalk.

• Journal of Chest Surgery
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• v.28 no.6
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• pp.533-541
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• 1995

We recently developed a new model of moving actuator type totally implantable artificial heart[TIAH , based on the reverse position of the aortic and pulmonary conduits. This concept was proposed by one of surgeons in our team[Joon-Ryang Rho, M.D. to facilitate anatomical fitting of TIAHs. The moving actuator type electromechanical TIAH consisted of the left and right blood sacs, and the moving actuator including a motor. The inverted umbrella type polyurethane valves were used in the blood pumps. The aortic conduit was positioned anterior to the pulmonary conduit, which was the opposite relation to the conventional configuration of other total artificial hearts. We also adapted slip-in connectors for the aortic and pulmonary conduits. Two sheep , weighing 60-69 kg, were used for implantation. After small cervical incision and trans-sternal bilateral thoracotomy, cardiopulmonary bypass [CPB was administered using an American Optical 5-head pump and a membrane oxygenator[Univox-IC, Bentley . The anterior and posterior vena cavae were drained separately for venous return. An arterial return cannula was inserted into the right common carotid artery. During CPB, almost all of the ventricular myocardium was excised down to the atrioventricular groove and the artificial heart was implanted. We achieved 3-day survival in the first sheep and 2-day survival in the second. The day after operation the first sheep was successfully extubated and the second sheep was weaned from a respirator with good condition. After extubation, the first sheep walked around in the cage and fed herself. Serial laboratory and hemodynamic examinations were done during the experiments. In both sheep, pulmonary dysfunction was gradually developed, which was accompanied by acute renal failure. The animals were sacrificed and autopsy was done. Unexpected pregnnacy was incidentally found in both sheep. To our knowledge this is the first report of significant survival cases in the orthotopic implantation of electric TIAH using sheep.

• Advances in pediatric surgery
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• v.5 no.2
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• pp.146-151
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• 1999

Neurocristopathy originates from aberrant development of the neural crest by genetic abnormality. Dysgenetic or neoplastic neurocristopathy mayor may not combine at one or more organs. Congenital central hypoventilation syndrome (Ondine's curse) is characterized by the respiratory depression during sleep, although showing normal ventilation while awake, because the baby does not responde to hypercapnea or hypoxia. One newborn girl, full-term, 3,020 g of birth weight with neurocristopathy is reported. It showed poor respiration at birth, and temporary Improvement with oxygen and respiratory stimulations. Abdomen was distended. Abdominal x-ray revealed small bowel obstruction and calcified opacity at the right lower quadrant. Because transitional zone was noticed at the distal jejunum during laparotomy, jejunostomy was performed. Several times trial of extubation have failed becaused of the repeated apneas. Brain sonography and echocardiogram were normal. The patient died of sepsis at 37 days of age. Para-aortic ganglioneuroblastoma was found at autopsy. In this case, congenital central hypoventilation syndrome, Hirschsprung's disease and congenital ganglioneuroblastoma are combined as a neurocristopathy.