Complete and optimal visualization of the mitral apparatus is a prerequisite for accurate repair or replacement of the mitral valve. A vertical left atriotomy just posterior to the interatrial groove is the most commonly used approach. However,exposure can be difficult under certain circumstances,such as small left atrium or reoperation. Other approaches have been advocated to deal with this difficult situations. We used an extended transseptal approach in 10 patients and good clinical results and excellent educational effects were obtained. The extended transseptal approach combines two semicircular atrial incisions circumscribing the tricuspid and mitral annuli anteriorly and superiorly,allowing exposure of the mitral valve by deflecting the ventricular side using stay sutures. The right atrium is opened anteriorly along the atrioventricular sulcus. The atrial septum is incised vertically through the fossa ovalis. Right atrial and septal incisions are joined at the superior end of the interatrial septum and extended across the dome of the left atrium to the left atrial appendage. The mitral valve was replaced in all 10 patients. Four of 10 patients had other simultaneous valve procedure: one had aortic valve replacement: 2 underwent tricuspid annuloplasty: 1 had aortic valve replacement and tricuspid annuloplasty. There was no hospital death and complication. Among the 5 patients who had atrial fibrillation preoperatively,4 had atrial fibrillation postoperatively,1 converted to sinus rhythm. The five patients who were in normal sinus rhythm preoperatively remained in sinus rhythm after replacement. A review of our results with this approach confirms the efficacy and safty of this method. So we recommanded this approach for routine mitral valve procedure,especially difficult situations,such as a small left atrium or the redo operation.
Lee, Chee-Hoon;Seo, Dong Ju;Bang, Ji Hyun;Goo, Hyun Woo;Park, Jeong-Jun
Journal of Chest Surgery
/
v.47
no.4
/
pp.389-393
/
2014
Retroesophageal aortic arch, in which the aortic arch crosses the midline behind the esophagus to the contralateral side, is a rare form of vascular anomaly. The complete form may cause symptoms by compressing the esophagus or the trachea and need a surgical intervention. We report a rare case of a hypoplastic left heart syndrome variant with the left retroesophageal circumflex aortic arch in which the left aortic arch, retroesophageal circumflex aorta, and the right descending aorta with the aberrant right subclavian artery encircle the esophagus completely, thus causing central bronchial compression. Bilateral pulmonary artery banding and subsequent modified Norwood procedure with extensive mobilization and creation of the neo-aorta were performed. As a result of the successful translocation of the aorta, the airway compression was relieved. The patient underwent the second-stage operation and is doing well currently.
An excessive Q-angle has been implicated in the development of knee injuries by altering the lower-extremity locomotion kinematics. The purpose of this study was measured the Q-angle and the CTA when the foot moves pronation and supination of the foot in the standing status. The participants of this examination were 60 adult(30 men and 30 women) who had no orthopaedic and neurological impairment, aged between 20 and 40years. The foot tilt(FT 1)is made of acrylic plate and the slope of the suface is altered as $0^{\circ}$, pronation ($10^{\circ},20^{\circ},30^{\circ}$)and supination($10^{\circ},20^{\circ},30^{\circ}$). The results were as follows : 1. The result about the left/right Q-angle and the left/right CAT There was no statistical significant difference between the left and the right side of the Q-angle with different position of the foot(P > 0.05). While significant difference in the left CTA at the $0^{\circ}$, pronation($10^{\circ},20^{\circ},30^{\circ}$) and supination($10^{\circ},20^{\circ}$) has been observed(P < 0.05). 2. The result about the Q-angle and the CTA between male and female There was significant difference in the Q-angle between male and female with different position of the foot(P < 0.05). while significant different in the right CTA at the $0^{\circ}$ pronation ($20^{\circ}$)(P < 0.05), no significant difference in the left CTA have been observed(P > 0.05). 3. The result about correlation between the left/right Q-angle and the left/right CAT There was statistical significant positive correlation between the left/right Q-angle and the left/right CAT with the different position of the foot(P < 0.01).
Purpose: This study examined the effects of the right or left knee lift during push up plus in the quadruped position on the serratus anterior (SA) muscle activity. Methods: Twenty-one subjects (male 11, female 10) performed the quadruped position on push up plus. The muscle activities of the lower trapezius (LT), SA, and upper trapezius (UT) were measured by surface electromyography. Repeated measurements of one-way ANOVA were performed for statistical analysis of the data, and the criterion for statistical significance was set to p<0.05 and comparative analysis of the UT and SA ratio using a Paired t-test. Results: The right SA increased the muscle activity of the right knee lift during quadruped position push up plus (p<0.05). In particular, the right SA muscle activity was higher than the left. In addition, comparative analysis of the UT and SA ratio to the right knee lift during quadruped position push up plus was performed (p<0.05). The right was found to be a significant statistic compared to the left, but the left SA increased the muscle activity of the left knee lift during quadruped position push up plus (p<0.05). The left SA muscle activity was higher than right. In addition, comparative analysis of UT and SA ratio to the left knee lift during quadruped position push up plus was performed (p<0.05). The left was found to be a significance statistic than the right. In addition, the interaction effect between the groups showed significant differences (p<0.05). Conclusion: Knee lift during push up plus is recommended for the selective activation of a research exercise protocol of one side of the serratus anterior.
A 6-month-old, female poodle presented with a three-month history of persistent regurgitation immediately after eating. On physical examination, the patient was emaciated and dehydrated. Thoracic radiography showed ventral displacement of the trachea and increased radiopacity in the mediastinum, cranial to the heart base. A severely dilated esophagus was identified cranial to the heart on esophagram. Computed tomography (CT) revealed the esophagus was filled with gas, fluid and a little of contrast and dilated from caudo-cervical to cranio-thoracic part. The esophageal diameter was markedly decreased at the heart base. In addition, the trachea was displaced to the left-ventral side of the right aortic trunk and an aberrant left subclavian artery originating from the aorta was identified. There was no evidence of abdominal vascular anomaly. Based on diagnostic imaging, persistent right aortic arch (PRAA) with an aberrant left subclavian artery was diagnosed. The patient did not undergo surgery and died at 15 days after diagnosis. This report describes imaging diagnosis, including CT and radiography in a weaned dog with regurgitation due to esophageal obstruction by PRAA. When PRAA is suspected and conventional radiography or contrast study is insufficient for diagnosis, CT may be helpful for diagnosing PRAA.
We managed 80 patients of bronchiectasis from Jan.1983 to Dec.1992 admitted to the department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital. We evaluated clinically these patients and summarized as follows. Alpha-hemolytic streptococcus was the most commonly found bacterial strain in microbial study. For the conservative treatment, first generation cefalosporins, aminoglycosides and ampicillin were used as antibiotic therapy in this order of frequency. The preoperative final diagnosis was made by bronchography and HRCT. In the image study saccular type bronchiectasis was 47.1%, cylindrical 27.5%, mixed 17.6% and varicose 7.8%. Anatomically left side involvement was more frequent than the right as 61.2% to 38.8% and the most commonly invading lobar area was left lower. Reversibility after conservative treatment for all the types of bronchiectasis was 66%. Surgical treatment were done in 50 cases, among these left lower lobectomy was 38.0%, left lower lobectomy with ligular segmentectomy 22.0%, right middle and lower bilobectomy 16.0%, right lower lobectomy 10.0%, left pneumonectomy 10.0%, right pneumonectomy 4.0%. In 10 cases, there remained some lesion in the other sites of lung parenchyme after first attempt surgical resection because the distribution of lesion is too broad to resect out in single thoracotomy hoping improvement by medical management.
Electoromyographic studies were performed on the action of the muscles of the temporomandibular joints following exfoliation of the deciduous teeth. The subjects examined, being 50 children. between the age of 6 and 13 years, divided into 5 groups. They were; 1) Deciduous dentition were complete in the first group. 2) Deciduous incisors were missing in either upper or lower jaw in the second group. 3) Deciduous canine and molars were missing in the left side of either upper or lower jaw in the third group. 4) Deciduous canine and molars were missing in the right side of either upper or lower jaw in the fourth group. 5) Permanent dentition completed in the fifth group(except third molars). Electromyogram was recorded with 4 channel polygraph (Grass model VII modified for 7P3). Electrodes which were the cup-typed gold discs, 9 millimeters in the diameter, were located on the anterior, middle and posterior lobes of the temporal muscles, and also on the superficial and deep layers of the masseter muscles. Paired electrodes were held by electrode cream so that they were pressed on the skin surface at right angle, adhesive tape being used to anchor them. The distance of the pair electrodes was about 5 millimeters. The results obtained were as follow: 1) In rest position of mandible; All groups showed slight, electrical activities in the muscles involved, but in the middle lobe of temporal muscle they were slightly higher. 2) In molar occlusion of mandible; High activity-anterior lobe of temporal muscle and superficial layer of masseter muscle. Moderate activity-deep layer of masseter muscle. Low activity-middle and posterior lobes of masseter muscle. There were no differences among the first, the second and the fifth groups. In the third group the muscle activity was weaker than that of the right, and in the fourth group opposite characteristics was revealed. 3) In incisal bite of mandreble; Hight activity-superficial layer of masseter muscle. Modertae activity-deep layer of masseter muscle. Low activity-anterior, middle and posterior lobes of temporal muscle. The first, the third, the fourth and the fifth groups showed no differences but the second group showed less activity than those of others. 4) In protrusion of mandible; High activity-deep layer of masseter muscle Moderate activity-superficial layer of masseter muscle. Low activity-anterior, middle and posterior lobes of temporal muscle. In the first, the fourth and the fifth groups, there were no differences in the activities, but the second group showed less activity than the others. 5) In retrusion of mandible; High activity-deep layer of masseter muscle. Moderate activity-superficial layer of masseter muscle. Low activity-anterior, middle and posterior lobes of temporal muscle. In the first, the third, the fourth and the fifth groups, there were no differences but the second group showed less activity than the others. 6) In lateral excursion of the mandible (either direction); High activity-posterior lobe of temporal muscle. Moderate activity-anterior and middle lobes of temporal muscle. Low activity-superficial and deep layers of masseter muscle. The muscle action potentials were weaker than those of the right side in the third group and vice ver'sa in the fourth group. 7) In chewing movement; Temporal muscle activities were higher than those of masseter, especially in the middle lobe of temporal muscle the activity was highest. Right side muscle activities were higher than those of the left in the third group and, on the contrary, the left side was dominant over the right in the fourth group.
The plan type of Korean protestant church architecture underwent changes as following five stages according to the changes of the distinction between the sexes. First stage - At the beginning of missionary work in Korea, Koreans generally worshiped in missionary houses which were traditional Korean styles. The plan type of these houses was a simple '-' figure. At that time, men and women worshiped separately because of the idea of the distinction between the sexes. They either worshiped in different places at the same time or in the same place at the different time. Second stage - At this stage, men and women started to worship together in the same place. At the beginning of this stage, men sat in the front of the chapel on a rostrum, and women sat behind the men. The plan type of the chapel was a simple '-' or a rectangular figure. Later, they sat separately on the right and left side. There are the visual interceptions which were set up between them. As the number of church members increased rapidly, a new type of church architecture appeared. It was a 'ㄱ' figure. At that time the entrances were separated by the sexes. Third stage - At this stage, the visual interceptions disappeared as the idea of the distinction between the sexes became weak. As new churches had been constructed by the plan type of rectangular figure, the visual interceptions weren't set up anymore. Fourth stage - At this stage, the separated entrances were unified as one. But the arrangement of their seats didn't change because of the old idea of the distinction between the sexes. Fifth stage - In the final stage, the plan type of the church architecture was not determined by the idea of the distinction between the sexes but social, economical, technological facts and the influence of the foreign architecture. At this stage, new and various kinds of the plan type appeared such as the fan, round, squared, or oval figure as well as the rectangular figure. Men and women were not classified anymore. They started to sit and worship together in the same place. Also, when men and women sat separately from side to side because of the Idea of the distinction between the sexes, men sat on the right and women sat on the left side of rostrum. It didn't applied Confucian ideas but the idea of protestant church; protestant churches have the idea that the right side is more important but it does not in Confucianism.
The purpose of this case study was to introduce botulinum toxin A injection in cerebral palsy. Spasticity can be managed using a variety of methods. Eliminating aggravating sources, promoting stretching and bracing, and positioning are the least invasive methods of treatment. Botulinum toxin A injection is a relatively recent method of spasticity management in children with cerebral palsy. A 3-year old boy was evaluated for possible botulinum toxin injection to promote left side function. The patient had left hemiparetic cerebral palsy. He walked with bilateral intoning, much worse on the left than on the right and with excessive plantar flexion on the left. Botulinum toxin A was injected into the left medial gastrocnemius, with the goals of improving quality of gait. Finally, botulinum toxin treatment of would improve the motor function and ambulatory status in cerebral palsy by hypertonicity, spasticity, dynamic contracture and athetoid movement.
Temporomandibular joint is a major structure to play an important role in the function & stability of the occlusion as well as the stomatognathic system. Therefore, the TMJ is the structure that requires the complete analysis for diagnosing and planning treatment of pathologic changes by TMJ dysfunction and malocclusion. So, in this study, to evaluate TMJ situation in Korean malocclusion, based on the previous accomplishments, students of the dental college of Won-Kwang Univ. are surveyed and selected in terms of Angle's classification of malocclusion, whose TMJ radiographs were taken in the centric occlusion and centric relation. In each maiocclusion groups, the mean and standard deviation of anterior, posterior and superior joint space of the right, left and both side in CO & CR are evaluated and also those of the fossa height and the articular eminence angle of the right, left and both sides are evaluated. The obtained results were as follows: 1. In the correlation coefficient between the malocclusion groups, no other items except the posterior joint space of the right side in CR between in class I and class III are significant. 2. In the correlation coefficient between the right and left side, the each joint space in class I malocclusion group and class II malocclusion group are significant. 3. In the change of each joint space during the transmit from CO to CR, there is a tendency of increasing anterior joint space and decreasing posterior, superior joint spaces in class I, II malocclusion and increasing superior joint space and decreasing anterior, posterior joint space in class III malocclusion, which is significant in the correlation coefficient, but not significant in the T-test. 4. In each malocclusion group, the correlation coefficient between the posterior joint space and the superior joint space in C.R is highly significant. 5. The fossa height of class II malocclusion group is lesser than that of class I or class III, which is not significant in T-test. 6. In the correlation coefficient between Rt. and Lt. side in the fossa height, it is not significant in class I and class III group, but significant in class II malocclusion group. 7. The articular eminence angle of class II malocclusion group is larger then that of class I or class III groups, which is fairly significant. 8. In the correlation coefficient between Rt. and Lt. side in the articular eminence angle, it is significant in each malocclusion group.
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