Analysis of Effect and Prognostic Factors Associated with Catheter Intervention on Ascites in Terminal Cancer Patient / 한국호스피스완화의료학회지

PURPOSE: alignant ascites is a common complication in terminal cancer patients. Less-invasive pigtail catheter insertion is the most frequent procedure in patients who need repeated ascites drainage. This study investigated effects and adverse events associated with catheter insertion for ascites drainage and evaluated prognostic outcomes. METHODS: We reviewed medical records between 2010 and 2013 of hospice and palliative care institutions in Seoul, South Korea. Among 2,608 inpatients, 67 patients received ascites pigtail catheter drainage. We reviewed demographic data, palliative performance scale, laboratory data, duration of catheter insertion, prevalence and type of complications, use and duration of antibiotics, and survival time. Univariate and multivariate Cox regression models were used to evaluate prognostic outcomes related with catheter insertion. RESULTS: Ascites drainage was performed most commonly in hepatobiliary and gastric cancer patients. Ascites symptoms improved in 55 patients after the catheter drainage. Adverse events included pain (19.4%), leakage (14.9%), disconnection (7.5%), catheter occlusion (6%) and fever (4.5%). In Cox regression analysis, survival time from the catheter insertion was significantly associated with Palliative Performance Scale (PPS) (HR 0.73; P value 0.045) and serum sodium level (HR 2.77; P value 0.003) in a multivariate model. CONCLUSION: Patients' PPS and serum sodium level should be considered before making a decision of pigtail catheter insertion.

Animal Experiments of Heart Transplantation for Complicated Congenital Heart Disease in Neonate / 대한흉부외과학회지

BACKGROUND: Heart transplantation is considerated for a selected certain group of complicated congenital heart disease in neonates because corrective surgery is very difficult and has high mortality. Precise planning of transplantation is necessary to adequately fit the donor heart to the recipient. MATERIAL AND METHOD: We have performed 4 neonatal pig heart transplantations to test the technical feasibility. Experiment 1: The transplantation was performed using the same technique as the adult heart transplantation. Experiment 2: The transplantation for hypoplastic left heart syndrome was simulated as we reconstructed the whole aortic arch with donor aorta. Experiment 3: The heart transplantation was done with radical pulmonary artery reconstruction. Experiment 4: The experiment was performed for a long term survival. RESULT: Preoperative planning was very important for adequate fitting. All animals could be weaned from cardiopulmonary bypass, however, two animals died due to bleeding at pulmonary artery and left atrium. CONCLUSION: We concluded that the neonatal heart transplantation can be applied in some complicated Further using animal model is mandatory.

Para-condylar Foraminal Approach in Microvascular Decompression for Hemifacial Spasm

The ideal approach in microvascular decompression(MVD) for hemifacial spasm(HFS) should provide the shortest and perpendicular route to the facial nerve root exit zone(FNREZ) with minimal cerebellar retraction and early cerebrospinal fluid drainage to avoid surgical morbidity. Small basal craniectomy anterior, posterior and superior to the condylar foramen would be the ideal approach for HFS, because it is maximal basal route to FNREZ. We performed this approach in 15 patients with HFS. Slightly curved skin incision 5cm in length was placed from inferior nuchal line 2cm posterior to the mastoid notch toward the angle of the mandible and the neck muscles were splitted. Posterior condylar emissary vein was elevated from condylar fossa. Small basal craniectomy extending from the inferior nuchal line to the condylar foramen was made. Jugular process was drilled out along the superior margin of the occipital condyle to expose distal sigmoid sinus and the junction of sigmoid sinus and jugular bulb. Lateral margin of foramen magnum posteroinferior to the condylar foramen was removed for early drainage of CSF from lateral medullary cistern. Dura was opened in T-shaped manner. With minimal elevation of cerebellum, arachnoid around lower cranial nerves can be dissected and FNREZ can be identified easily and safely. In conclusion, para-condylar foraminal approach can be considered to be minimally invasive and maximally safe in MVD for HFS.

Central Neural Pathway for the Rat Tongue / 대한해부학회지

Bartha strain of pseudorabies virus[PRV-Ba] was utilized as a tracer to identify the neuronal axis of rat tongue muscles ; intrinsic muscles and extrinsic muscles, styloglossus, genioglossus, and hyoglossus muscle. After injection of 10 microliter of PRV-Ba into tongue muscles and 48-96 hours survivals, rats were perfused with 4% paraformaldehyde lysine periodate and brains were removed. PRV-Ba were localized in neural circuits by immunohistochemistry employing rabbit anti PRV-Ba as a primary antibody and ABC method. Injection of PRV-Ba into the tongue muscles resulted in uptake and retrograde transport of PRV-Ba in the rat brain. The result showed a circuit specific connection of many nerve cell groups along the time sequence : PRV-Ba immunoreactive cells appeared in hypoglossal nucleus and motor trigeminal nucleus ipsilaterally as seen with conventional tracers. Raphe nucleus, prepositus hypoglossal nucleus, spinal trigeminal nucleus, Al, A5 and facial nucleus of rhombencephalon showed immunoreactivity bilaterally. There were positive neurons in parabrachial nucleus, locus ceruleus, mesencephalic trigeminal nucleus, periaqueductal gray and A7 of mesencephalon and paraventricular nucleus, suprachiasmatic nucleus, organum vasculosum of lamina terminalis of diencephalon. Also positive reactions were showed in amygdala, insular cortex, frontal cortex and subfornical organ in telencephalon. Early immunoreactivity was appeared in hypoglossal nucleus and motor trigeminal nucleus, and there were positive neurons in the nuclei of the medulla oblongate, midbrain, pons, hypothalamus, cerebellum and medial preoptic area at middle stage. Subsequently the viral antigens were found in forebrain cell groups, paraventricular nuclei, suprachiasmatic nucleus, lateral hypothalamic area and primary motor cortex in frontal lobe bilaterally at 80-90hrs postinjection. These data demonstrate that the PRV-Ba can across synapses in the central nervous system with projection specific pattern, and this virus defines many elements of the neural network governing tongue. Therefore PRV-Ba are proved as a excellent neurotracer in the tract-tracing researches.