Purpose: Determination of pulmonary to systemic blood flow ratio (QP/QS) is important for the management of patients with left-to-right shunt. This study was performed to assess the agreement of Qp/Qs ratio using the radionuclide method and oxymetry, to investigate the factors influencing the agreement, and to know how interchangeable the results of each technique. Materials and Methods: We compared the Qp/Qs measured by single-pass radionuclide angiocardiography and oxymetry during catheterization in 207 patients who underwent both studies. In radionuclide method, Qp/Qs was calculated from the pulmonary time-activity curves using a gamma variate fit. The correlation and Bland-Altman analysis were performed according to the levels of shunt and associated lesions. Results: The mean Qp/Qs was $1.83{\pm}0.50$ by radionuclide, and $1.74{\pm}0.51$ by oxymetry. The overall correlation coefficient was 0.86(p<0.001), and Bland-Altman range of agreement encompassing 4SD was 1.05. For atrial septal defect, ventricular septal defect, patent ductus arteriosus, tricuspid and mitral insufficiency, the correlation coefficient was 0.78, 0.90, 0.84, 0.63 and 0.44, and Bland-Altman range was 1.51, 0.74, 0.96, 1.57, and 1.50, respectively. Conclusion: There is good agreement but wide variance between the Qp/Qs ratios by radionuclide method and oxymetry. Associated atrioventricular valvar insufficiency decreases the correlation coefficient and widens the variance. Wide overall variance suggests that Qp/Qs measurements by two techniques should not be used interchangeably.
Objective: To confirm the immediate gait improvement in a post-stroke gait disturbance patient equipped with a weighted vest. Methods: We selected a patient who was able to walk without another’s help or with tools. The selected patient had an unstable gait because she had only started an independent gait within the past week, so we thought that a weighted vest could be very helpful for her. We first collected gait parameters using a treadmill gait analysis system while the patient walked on the treadmill without the weighted vest. After a 10-minute break, gait parameters were collected again while the patient walked on the treadmill while wearing the weighted vest. The gait parameters we collected included step length (cm), stance phase (%), swing phase (%), SW/ST, and gait line length (mm). For objective evaluation of gait improvement, we calculated the ratio of gait parameters of the right and left limbs. Results: The gait of the post-stroke patient was more symmetrical when wearing the weighted vest than without the weighted vest. Without the weighted vest, her step length ratio was 0.78, stance phase ratio was 0.88, swing phase ratio was 1.50, SW/ST ratio was 1.70, and gait line length ratio was 0.91. With the weighted vest, her step length ratio was 0.88, stance phase ratio was 0.90, swing phase ratio was 1.38, SW/ST ratio was 1.54, and gait line length ratio was 0.98. No side effects were observed due to the weighted vest.
From 1983, until June, 1990, 10 patients with various type of truncus arteriosus underwent total surgical correction including Rastelli procedure at Seoul National University Hospital. The age at operation ranged from 1 month to 9 years [mean 2.1 years]. Six patients had truncus type I, 3 patients had truncus type II, and one patients had truncus type IIIc. Right ventricular pulmonary artery continuity was established with a porcine valved conduit in 6 patients, mechanical valved conduit in 1 patient, and bovine pericardial conduit in 3 patients. The postoperative right ventricular /left ventricular pressure ratio ranged from 0.4 to 0.71 [mean 0.51${\pm}$0.14]. The lung histology revealed grade II pulmonary obstructive disease even at 4 month of age. Five patients were dead in hospital [50%], and they were less than 2 year of age. One patient, who had severs congestive heart failure preoperatively, died of low output syndrome and the other died of low output syndrome with postoperative bleeding. There were three death, because of a pulmonary hypertensive crisis that might have been prevented. Two of the five survivors had conduit failure over a mean follow up of 42 months [range 1 to 78 months]. Obstructed conduit was removed and a new conduit constructed using the conduit bed as the posterior wall and the patch of bovine pericardium and Dacron as patch the roof of the conduit. One patient died of acute cardiac failure during the operation. Although results in infants less than 2 years old have not been good, current improvement of intra-and postoperative care suggested that prompt repair is indicated for infants with truncus arteriosus.
Tetralogy of Fallot is characterized by the interventricular septal defect associated with obstruction of the right ventricular outflow. The importance of the latter anatomic malformation was clinically evaluated according to the angiographic measurements of the pulmonary arteries along with the pulmonary valve annulus. Seventy of a total 76 patients operated on during a whole year of 1981 were the patients for clinical evaluation. Fifteen patients died within 1 month after operation with the operative mortality of 21.4%. The young age and the severity of pulmonary arterial hypoplasia were ones among the surgical risk factors at a total corrective surgery of tetralogy. Preoperative angiographic measurements of the pulmonary arteries to speculate the expected postoperative ratio between the left ventricular and the right ventricular pressures were retrospectively calculated according to the formula. The predicted values of P RV/LV greater than 0.5 carried apparenliy higher complication and mortality rates than the group of P RV/LV less then 0.5. The selection of the candidates for either a total correction or the staged operation In tetralogy of Fallot can be evaluated on the preoperative angiographic measurements and the expected Improvements of the clinical results were discussed.
In Tetralogy of Fallot, the most common congenital cyanotic heart disease, the mortality is decreasing continuously with adequate type and timing of operation. At S.N.U.H., 195 patients were operated from January 1982 to December 1983 and 176 patients among them were analysed in the view of pre-operative pulmonary arterial condition measured by cardiac cineangiogram. The most common associated anomaly was PFO and ASD and they did not affect the postoperative course and mortality. The overall mortality rate was 8.5% in 1982 and 6.8% in 1983 but under 2 years of age, the mortality rate was relatively high as 25% in 1982 and 16.7% in 1983, and when transannular patch widening of Right Ventricular Outflow Tract was used, the mortality rate was 12.5% in 1982 and 27.3% in 1983. Preoperative angiographic measurements of the pulmonary arterial status for prediction of the ratio between the Left Ventricular and Right Ventricular peak systolic pressure were calculated retrospectively according to the Blackstones formula, and the predicted value of PRV/LV greater than 0.6 carried apparently high complication and mortality rate as 16.6% M.R. in 1982 and 11.1 % in 1983. Among postoperative complications, c-RBBB occurred most frequently about 50% but did not influenced to mortality, Low Cardiac Output Syndrome was developed in about 40%. If we select the patient who should have the staged operation including shunt operation and choose the type of RVOT relief, we expect the improvement of postoperative clinical results.
Surgical procedures to relieve congenital right ventricular outflow tract[RVOT] obstruction of heart were performed on 125 patients from September 1985 to August 1992. There were 65 males and 60 females. Ages ranged from 7 months to 33 years with a mean age of 8 years. All the patients were divided into three main groups[I, II, III] depending on the presence or absence of cyanosis and combined anomalies. The patient were classified into two groups; A and B according to the outcome after surgical repair. Group A included the patients who had a good postoperative outcome with or without mild complications such as wound disruption, or hydrothorax. Group B included the patients who had a poor outcome including hospital death and significant postoperative complications such as heart failure, low output syndrome, respiratory failure, hepatic failure and others. And the results were summarized as follows. 1. There were no significant differences in age, body surface area and aortic dimension among the group I, II, and III, but there were significant differences among groups in pulmonary arterial dimension, ACT[aortic cross clamping time], TBT [total bypass time], preoperative and postoperative ratio of systolic pressure of right and left ventricles [pre PRV/RV and post PRV/LV], and the size of Hegar dilator which passed through the RVOT postoperatively [p<0.05]. 2. In the group A and B, there were significant differences in pulmonary arterial dimension [group A:1.6$\pm$0.5 cm, group B:1.9$\pm$0.6 cm], ACT [group A:102.3$\pm$ 46.0 minute, group B:76.1$\pm$46.1 minute], TBT [group A:133.9$\pm$56.6 minute, group B:94.9$\pm$51.9 minute], pre PRV/LV [group A:1.06$\pm$0.24, group B:0.8$\pm$0.32], post PRV/LV [group A:0.58$\pm$0.18, group B:0.43$\pm$0.16].It has been concluded that postoperative prognosis of RVOT obstruction was influenced by pulmonary arterial dimension, ACT, TBT, severity of RVOT obstruction [pre PRV/LV] and post PRV/LV.
This study is a retrospective analysis of 1244 cases of the inguinal hernia in children under the age of fifteen years who were operated at the department of pediatric surgery, Inje University Busan Paik Hospital from March, 1997 to February, 2007. The ratio of male to female was 3.6:1. The type of hernia was indirect in all of the cases. The hernia was on the right side in 656 cases (53.9 %), left side in 467 cases (37.5 %), and bilateral in 121 cases (9.7 %). The hernia presented most frequently in infants under age 12 months; 364 cases (29.2 %). Fifty-nine cases (21.7 %) were in female and 305 cases (31.3 %) in male. There were 428 cases (33.6 %) in 1-3 years age group, 295 cases (23.7 %) in 4-6 years, 112 cases (9.0 %) in 7-9 years, 39 cases (3.1 %) in 10-12 years and 16 (1.2 %) in 13-15 years. The content of hernia sac was small bowel (59 %), omentum (31 %) in males and the ovary and tube (54 %) and small bowel (26 %) in female. The incidence of combined operation at the time was 3.2 %, and consisting of orchiopexy (67.5 %), frenulotomy (12.5 %), appendectomy (10 %), circumcision (5 %), and fistulotomy (5%). The incidence of combined disease was 2.8 % and consisting of undescended testis, Hirschsprung's disease, idiopathic hypertrophic pyloric stenosis, imperforate anus, and congenital heart disease. After unilateral inguinal hernia repairs, contralateral hernias developed in 34 patients. The laterality of the primary site of hernias were left in 19 cases (55.8 %), and right 15 cases (44.1 %). The 936 cases (75.2 %) were operated under general anesthesia; Mask bagging 663 cases (53.2 %), endotrachea intubation 257 cases (20.6 %), and laryngeal mask 16 cases (1.2 %). The remainder 308 cases (24.7 %) were operated under regional caudal anesthesia.
Kim, Chan;Lee, Hee-Jeon;Lee, Hyo-Keun;Yang, Seung-Kon;Choi, Bong-Choon;Chae, Jin-Ho;Kim, Boo-Seong
The Korean Journal of Pain
/
v.9
no.1
/
pp.94-97
/
1996
Two hundred and eighty eight patients suffering from excessive sweating of palms, soles and axillae etc., visited our Neuro-Pain clinic from November 1991 to March 1996. The sex ratio was 1:1.2. the third decade of age was the major age group. the onset time of hyperhidrosis was prepubertal period (in 95.1% of them). the provocative factors fo excessive sweating were tension and stress from interpersonal relationship. they had the family history (30.9%) and the past history treated with herb medication (56.9%), medicine (30.6%), operation (1.4%), and no treatment (39.6%). We treated 113 patients by sympathetic ganglion block with pure alcohol. the average times of thoracic sympathetic ganglion block were 2.1 (left), 2.4 (right) and those of lumbar sympathetic ganglion block were 1.2 (left), 1.6 (right). Average admission period was 14.7 days. Recurrence rare was 7.1%. Most longstanding effective period was 45 months. We conclude from our results that sympathetic ganglion block is one of the most effective treatments for hyperhidrosis owing to its simple technique and low recurrence rate.
Ingrid Garcia Santos;Fernanda Ramos de Faria;Marcio Josse da Silva Campos;Beatriz Alvares Cabral de Barros;Gustavo Davi Rabelo;Karina Lopes Devito
Imaging Science in Dentistry
/
v.53
no.2
/
pp.153-159
/
2023
Purpose: The objective of this study was to assess the fractal dimension, lacunarity, trabecular microarchitecture parameters, and cortical linear measurements in the mandibles of male and female individuals to identify differences between them. Materials and Methods: In total, 116 cone-beam computed tomography scans of healthy individuals of different ages (57 men and 59 women, aged between 20 and 60 years) were selected. The following bone parameters were measured: 1) buccal, lingual, and basal cortical bone thickness in 5 standard parasagittal sections (the midline, the left and right sides of the lower lateral incisors, and the left and right sides of the lower canines); 2) the bone volume fraction of 10 sequential axial sections from each patient by creating a volume of interest in the area between the lower canines; and 3) fractal dimension and lacunarity using grayscale images of the same region of the volume of interest in the anterior mandible. Spearman correlation coefficients and the Mann-Whitney test were used. Results: A significant and positive correlation was found between age and cortical thickness, especially in the region of the central incisors. Significant differences between sexes in terms of fractal dimension, lacunarity, and bone volume were found. Women revealed lower fractal dimension values and higher lacunarity and bone volume ratio values than men. Conclusion: Fractal dimension, lacunarity, trabecular bone volume, and cortical thickness were different between men and women of different ages.
This study was undertaken to investigate the effects of n-6(corn oil) & n-3(fish oil) fatty acids on infarction size and the cerebral activities of antioxidant enzyme in rat focal brain ischemia model. Weaning Sprague-Dawley rats were fed with either corn oil supplemented diet(COD, 14% corn oil) or fish oil supplemented diet(FOD, 14% menhaden oil) for 6 weeks. The right middle cerebral artery was occluded for 2 hours with a silicon rubber coated nylon surgical thread. After 24 hours of recirculation, the rats were sacrificed and brain sections were photographed using CCD camera after staining with 2, 3, 5-triphenyltetrazolium chloride for 60 minutes in room temperature. The infarcted area was measured and the volume of infarction was calculated. Catalase(CAT), superoxide dismutase(SOD) activities, and fatty acid composition in the brain were also measured. The total and corrected infarction volumes were not significantly different between FOD and COD group. The docosagexaenoic acid(DHA) and DHA content/arachidonic acid(AA) ratio of the cerebral cortex, an index of defense against lipid oxidation, were significantly increased in FOD group compared to those of COD group(p<0.05). In the left cortex(non-infarction side) as well as the right cortex(infarction side) of FOD group, CAT and Cu/Zn SOD activities were higher than those of the COD group(p<0.05). However, CAT and Cu/Zn SOD activities were not significantly different between the left cortex(non-infarction side) and the right cortex(infarction side) of both FOD and COD group. GPx activities were also not significantly different between two groups. Our results demonstrate that the brain infarction size in FOD and COD were not significantly different. However, cerebral lipid composition and antioxidant enzyme activities in FOD and COD group were different. Fish oil, a source of n-3 polyunsaturated fatty acid(PUFA) and corn oil, that of n-6(PUFA) may have a protective effect against oxidative stress induced via different mechanisms.
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