ABSTRACT
PURPOSE: The purpose of our investigation was to explore the natural course, and the factors that influence the natural course, in ostium secundum atrial septal defect(ASD) diagnosed within the first 4 weeks of life. METHODS: We studied patients with ASD diagnosed within the first 4 weeks of life during the period from September 1995 to September 1999 in our hospital. The diagnosis and measuring of the size of ASD was carried out by two-dimensional echocardiogram(2DE, Hewlett-Packard Sonos 2500 ) from subcostal long and short axis views. RESULTS:There were 61 patients - 29 males and 32 females. According to the size of their defects, we divided them into four groups; group A(less than 4 mm : 24 cases), group B(four mm- six mm : 27 cases), group C(six mm-eight mm : six cases), group D(more than eight mm : four cases). In groups A and B, 22 of 24 patients(91.7%) and 23 of 27 patients(85.2%) had each closed spontaneously. In group C, four of six patients had closed spontaneously. In group D, no patient had closed spontaneously and three of four patients had been closed surgically. There were significant differences in the rate of spontaneous closure between less than six mm group and more than six mm group in the size of the defect(P<0.05). There were no significant differences in the rate of spontaneous closure between ASD combined with simple cardiac defect and isolated secundum ASD. CONCLUSION: We conclude that defects smaller than six mm in diameter are very likely to close spontaneously.
Subject(s)
Female , Humans , Male , Axis, Cervical Vertebra , Diagnosis , Heart Septal Defects, AtrialABSTRACT
PURPOSE: In the clinical field, the closing time of patent ductus arteriosus(PDA) varies among patients after indomethacin administration. We tried to predict it by analyzing related factors, and also by understanding what affects it. METHODS: Among 30 cases of PDA at the NICU, 24 cases(male 14 cases, female 10 cases) were selected. Fifteen cases closed early(within 36 hours) and 9 cases closed late(after 36 hours) after indomethacin administration, cases of surgical ligation were excluded. PDA was confirmed by echocardiography which was done in an hour after murmur was heard, and then indomethacin was administered. Every 6 hours, 2D echocardiography was done and minimum internal diameter of ductus was measured. The magnitude and direction were gauged by flow mapping of the color Doppler. Ductal closure time is defined when there is no ductal flow. RESULTS: The median of the patent time was 28 hours in the early closed group and 50 hours in the late closed group. There were no significant factors statistically between the two groups in perinatal factors. The clinical status and several factors of study population at indomethacin administration were also not significant. Whereas, there were statistical differences in ductal size between the two groups(P<0.05). CONCLUSION: When indomethacin is intravenously administered to treat the PDA, ductal size differed between the two groups. This ductal size, measured by echocardiography before indomethacin administration is an important factor in predicting the closing time of PDA.
Subject(s)
Female , Humans , Ductus Arteriosus, Patent , Echocardiography , Indomethacin , LigationABSTRACT
Subvalvular aortic stenosis developed after patch closure of perimembranous VSD is rarely reported. A 18-month-old, 8 kg child with this complication after VSD closure 8 months ago in other hospital has been treated medically and was admitted to this hospital because of severe cardiomegaly and sign of heart failure. Cardiac catheterization revealed 55 mmHg of pressure gradient between aorta and LV cavity. We report one successful redo case of surgically relieved subvalvular aortic stenosis in a child after patch closure of perimembranous VSD.
Subject(s)
Child , Humans , Infant , Aorta , Aortic Stenosis, Subvalvular , Cardiac Catheterization , Cardiac Catheters , Cardiomegaly , Heart FailureABSTRACT
PURPOSE: The value of serum lipid in children after recovery of Kawasaki disease may be important because of the predilection of this disease for the coronary artery. METHODS: We measured serum high density lipoprotein (HDL)-cholesterol, total cholesterol, triglycerides in 22 patients (mean age 38months, range 6 to 93 months) with Kawasaki disease during 10 days or less after onset and 2 months later after recovery. RESULTS: The level of serum HDL-cholesterol was depressed in the acute stage compaired with the level after recovery (33.6+/-15.2mg/dl vs. 54.8+/-8.3mg/dl, mean+/-S.D., p<0.05). Total cholesterol, triglycerides were normal during the acute stage (125.3+/-46.1mg/dl, 142.1+/-32.2mg/dl, respectively) and after recovery (147.4+/-35.5mg/dl, 130.6+/-74.9mg/dl, respectively). Echocardiography confirmed coronary aneurysm in 7 patients (31.8%) and otherwise, normal coronary figures (n=15). In the patients with coronary aneurysm, the level of serum total cholesterol, HDL-cholesterol were 134.0+/-34.1mg/dl, 34.5+/-14.9mg/dl, respectively and in the patients without coronary aneurysm 147.7+/-36.7mg/dl, 29.5+/-12.8mg/dl, respectively. They showed no significant differences between two groups (p=0.5, p=0.43, respectively). CONCLUSIONS: Significantly reduced HDL-cholesterol level, which is considered a risk factor for coronary atherosclerosis, is transient finding in the acute stage of Kawasaki disease and not associated with the incidence of coronary aneurysm. Further basic research is needed to elucidate the pathophysiology by which this abnormality is produced.
Subject(s)
Child , Humans , Cholesterol , Cholesterol, HDL , Coronary Aneurysm , Coronary Artery Disease , Coronary Vessels , Echocardiography , Incidence , Lipoproteins , Mucocutaneous Lymph Node Syndrome , Risk Factors , TriglyceridesABSTRACT
BACKGROUND: The value of serum lipid in children after recovery of Kawasaki disease may be important bacause of the predilection of this disease for the coronary artery. METHODS: To determine the alterations in serum total cholesterol(TC) and high density lipoprotein(HDL)-cholesterol levels in Kawasaki disease(KD), we measured serum HDL-cholesterol and TC in 35 patients(mean age 36.8+/-22.0 months, range 6 to 93 months) with Kawasaki disease(KD) during 10 days or less after the onset(group A) and 2 months later after recovery. TC and HDL-cholesterol were also measured in an acute febrile respiratory illness group(group B) and a nonfebrile respiratory illness group(group C) to compare with those of KD. RESULTS: HDL-cholesterol levels in group A were depressed(29.6+/-11.0mg/dl) compared with group B and C(47.3+/-13.3mg/dl and 45.1+/-12.4mg.dl, respectively, p<0.01). TC levels in group A(145.1+/-33.1mg/dl) were not significantly different from those of group B(146.8+/-33.4mg/dl) and C(157.1+/-29.6mg/dl). Also the level of serum HDL-cholesterol in the acute phase of KD was significantly lower when compared with that after recovery(30.2+/-13.2mg/dl vs 50.0+/-10.2mg/dl, p<0.05). In KD patients, TC levels were not significantly different between the acute & recovery phase(145.0+/-26.6mg/dl, 153.4+/-32.6mg/dl). Echo-cardiography confirmed coronary artery aneurysms in 11 patients(31.4%) and otherwise, normal findings(n=24) in the KD group. There were no significant difference in TC level(140.7+/-27.6mg/dl vs. 146.9+/-35.4mg/dl, p=NS) and HDL cholesterol level(30.1+/-12.5mg/dl vs. 29.2+/-10.7mg/dl, p=NS) between patients with and without coronary aneurysms. CONCLUSIONS: HDL-cholesterol levels were significantly depressed only in the acute phase of KD but TC levels did not change significantly. Both levels were not related to coronary artery aneurysm.
Subject(s)
Child , Humans , Aneurysm , Cholesterol, HDL , Coronary Aneurysm , Coronary Vessels , Mucocutaneous Lymph Node SyndromeABSTRACT
No abstract available.
Subject(s)
Cardiomyopathies , Congenital Hypothyroidism , EchocardiographyABSTRACT
There are many methods in reconstruction for skin defect in hand and forearm. Among them, reverse ulnar artery forearm flap has several advantages which are versatile, safe and convenient flap. We report 6 cases of our experiences.
Subject(s)
Forearm Injuries , Forearm , Hand , Skin , Ulnar ArteryABSTRACT
So far with the advancement in treatment modalities for malignant bone and soft tissue sarcomas the survival rate become higher. Till now there are some questions who can survive. Temporary procedure not affecting the treatment schedule would have more advantages than primary permanent one. When there is higher possibility of survival, this can be switched to permanent one. From Dec. 1986 to Jan. 1994, we had performed 40 cases of temporary arthrodesis after segmental resection of malignant bone and soft tissure tumors around the knee by using intramedullary nail andbone cement. Thirty eight cases of bone tumors[osteosarcoma(33), malignant fibrous histiocytoma(MFH)(3), chondrosarcoma(1), Ewing's sarcoma(1)] and 2 cases of soft tissue sarcomas[MFH(1), squamous cell carcinoma(1)] were analysed. Types of intramedullary nail used were rigid(Huckstep, 23 cases) or flexible(Ender, 17 cases). Six cases(15%) showed mechanical implant failure due to fracture (Huckstep;5, Ender;1) between 2 to 20 months after operation. Rearthrodesis using Ender nail and bone cement(5) or arthroplasty using Kotz prosthesis(1) were done for fractured cases. The other complicaitons were deep infection(2), peroneal nerve palsy(2), or transfixing screw fracture(2). Second reconstruction procedure was carried out in 2 cases with arthroplasty using Kotz prothesis. For IM nail, multiple Ender nailing seems to be superior to the Huckstep in mechanical strength. Contrary to the primary permanent reconsturction of the bone defect, this procedure has several advantages: 1) simple and does not hinder postoperative chemotherapy, 2) even in the extensively involved cases, can save the limb if the neurovascular structures are spared, 3) in Stage III, can save the salvagable limb, 4) economic and immediate stability can be helpful in the patient's quality of life, 5) two years later, when the survival approaches plateau, we can switch to another kinds of salvage operation, 6) Ender nail was superior to Huckstep in mechanical stability, 7) can be used for children expecting leg lengthening near puberty. It is useful for sarcoma patients around knee who require prolonged chemotherapy anbd whose life expectancy is relatively unexpectable.