Risk Analysis of the Long-Term Outcomes of the Surgical Closure of Secundum Atrial Septal Defects

BACKGROUND: Closure of a secundum atrial septal defect (ASD) is possible through surgical intervention or device placement. During surgical intervention, concomitant pathologies are corrected. The present study was conducted to investigate the outcomes of surgical ASD closure, to determine the risk factors of mortality, and establish the effects of concomitant disease correction. METHODS: Between October 1989 and October 2009, 693 adults underwent surgery for secundum ASD. Their mean age was 40.9±13.1 years, and 199 (28.7%) were male. Preoperatively, atrial fibrillation was noted in 39 patients (5.6%) and significant tricuspid regurgitation (TR) in 137 patients (19.8%). The mean follow-up duration was 12.4±4.7 years. RESULTS: There was no 30-day mortality. The 1-, 5-, 10-, and 20-year survival rates were 99.4%, 96.8%, 94.5%, and 81.6%, respectively. In multivariate analysis, significant preoperative TR (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.09 to 3.16; p=0.023) and preoperative age (HR, 1.04; 95% CI, 1.01 to 1.06; p=0.001) were independent risk factors for late mortality. The TR grade significantly decreased after ASD closure with tricuspid repair. However, in patients with more than mild TR, repair was not associated with improved long-term survival (p=0.518). CONCLUSION: Surgical ASD closure is safe. Significant preoperative TR and age showed a strong negative correlation with survival. Our data showed that tricuspid valve repair improved the TR grade effectively. However, no effect on long-term survival was found. Therefore, early surgery before the development of significant TR mat be beneficial for improving postoperative survival.

Video Polysomnographic Analysis of Dream-Enacting Behaviors in the Patients with REM Sleep Behavior Disorder

OBJECTIVES: The aim of this study is to analyze dream-enacting behaviors (DEB) using video REM sleep behavior disorder severity scale (RBDSS) during night polysomnography (PSG) and compare them between in patients with idiopathic RBD (iRBD) and patients with symptomatic RBD (sRBD). METHODS: 21 consecutive patients with either iRBD or sRBD were recruited (15 female and 10 male, mean age 63.6+/-13.86 years). Video analysis of DEB in all the REM sleep during their night PSGs was retrospectively performed using RBDSS. According to the clinical history depicting behaviors were also categorized by RBDSS-C to compare with the video RBDSS. Comparison of difference of RBDSS in between patients with iRBD and in those with sRBD was done. The frequency of DEB during the night PSG was measured as RBD density. RESULTS: iRBD patients had higher RBD density than sRBD despite the same disease duration. iRBD patients also tended to have higher RBDSS than sRBD, compatible with higher prevalence of injury history. Night-night variability was observed in the patients comparing RBDSS and RBDSS-C. CONCLUSIONS: RBDSS is an easy tool to analyze severity of DEB in patients with RBD. Analysis of clinical feature of DEB may give a clue to differentiation of RBD patients as well as the alarm for the treatment of RBD to prevent potential injury.

Ursolic Acid-Induced Elevation of Serum Irisin Augments Muscle Strength During Resistance Training in Men

Ursolic acid (UA), a type of pentacyclic triterpenoid carboxylic acid purified from natural plants, can promote skeletal muscle development. We measured the effect of resistance training (RT) with/without UA on skeletal muscle development and related factors in men. Sixteen healthy male participants (age, 29.37+/-5.14 years; body mass index=27.13+/-2.16 kg/m2) were randomly assigned to RT (n=7) or RT with UA (RT+UA, n=9) groups. Both groups completed 8 weeks of intervention consisting of 5 sets of 26 exercises, with 10~15 repetitions at 60~80% of 1 repetition maximum and a 60~90-s rest interval between sets, performed 6 times/week. UA or placebo was orally ingested as 1 capsule 3 times/day for 8 weeks. The following factors were measured pre-and post-intervention: body composition, insulin, insulin-like growth factor-1 (IGF-1), irisin, and skeletal muscle strength. Body fat percentage was significantly decreased (p<0.001) in the RT+UA group, despite body weight, body mass index, lean body mass, glucose, and insulin levels remaining unchanged. IGF-1 and irisin were significantly increased compared with baseline levels in the RT+UA group (p<0.05). Maximal right and left extension (p<0.01), right flexion (p<0.05), and left flexion (p<0.001) were significantly increased compared with baseline levels in the RT+UA group. These findings suggest that UA-induced elevation of serum irisin may be useful as an agent for the enhancement of skeletal muscle strength during RT.

Corrigendum to: Ursolic Acid-Induced Elevation of Serum Irisin Augments Muscle Strength During Resistance Training in Men

The original version of this article contained misspelled name of author. The name of Figueroa Arturo is replaced with Arturo Figueroa.

Sick Sinus Syndrome Mimicking Complex Partial Seizure

No abstract available.

Acyclovir-Induced Encephalopathy in a Patient with Normal Renal Function / 대한임상신경생리학회지

No abstract available.

Severe Restless Legs Syndrome in a Pregnant Woman Leading to Induced Premature Birth

Restless legs syndrome (RLS) often develops or is commonly aggravated during pregnancy in women. Due to potential teratogenic risk of the medication for RLS, non-pharmacologic management is commonly tried during pregnancy instead of medication. We report a 30-year-old pregnant woman who intentionally delivered a baby at 32 weeks 5 days to take medication due to severe RLS and insomnia. Depending on gestational period, more active treatments should be considered to prevent serious adverse pregnancy outcome for pregnant women with severe RLS.

A Case of Congenital Sensorineural Hearing Loss with Multinodular Goiter / 대한이비인후과학회지

Pendred syndrome is an autosomal recessive condition classically characterized by congenital deafness and goiter, and is the most common cause of hereditary deafness in Korea. It is caused by mutations in the PDS gene (SLC26A4) located in 7q31. The PDS gene encodes a chloride-iodide transport protein called pendrin, which plays a role in the reabsorption of endolymph and the maintenance of the endolymph homeostasis in the inner ear and in the uptake and organification of iodide in the thyroid gland. A mutation in PDS also causes non-syndromic recessive deafness (DFNB4) and therefore securing the diagnosis is important for genetic counseling purposes. The perchlorate discharge test and radiological conformation of the inner ear anomaly are useful diagnostic aids but have limited diagnostic value. However, because PDS mutations are widely distributed along the gene, it consumes too much time and money to perform molecular studies in clinics. We present a case of congenital sensorineural hearing loss with multinodular goiter, which shows definite findings of Pendred syndrome.

Surgical Outcome of Tetralogy of Fallot in Adolt: Implication of Preoperative Cyanosis / 대한흉부외과학회지

BACKGROUND: We analysed differences in operative methods and postoperative outcome according to the severity of preoperative cyanosis in adult ToF (Tetralogy of Fallot) patients. MATERIAL AND METHOD: From August 1989 to June 2001, thirty three adult patients, 18 females and 15 males, underwent total correction for ToF. Their age ranged from 15 years to 54 years (median: 34). Patients were divided into 2 groups by preoperative SaO2 (arterial oxygen saturation): group I (n=cyanotic, SaO2 or =95%). Preoperative median hemoglobin level was higher in group I compared to group II (17.5 g/dl vs 15 g/dl). Postoperative follow-up duration ranged from 1 to 94 months (670 patient-month, median: 14 months), and 63 two-dimensional echocardiographic examinations were done during this period. RESULT: There were no early or late mortality. With regard to RVOT (right ventricular outflow tract) reconstruction, trans-annular patch and RV-PA extracardiac conduit were used in 7 and 3 patients respectively, and all of them belonged to group I. In group I, cardiopulmonary bypass time, aortic cross-clamping time, ICU day, hospital day were significantly longer than in group II, and postoperative inotropic support was significantly greater than in group II. There was no ventricular arrhythmia in both groups, and one patient in group I suffered from atrial arrhythmia, which was resolved spontaneously after tricuspid and pulmonary valve replacement. During follow-up periods, functional class, residual RVOT stenosis and pulmonary regurgitation, tricuspid regurgitation, occurrence of ventricular and atrial arrhythmias were comparable between two groups. CONCLUSION: In adult ToF patients with severe preoperative cyanosis, more aggressive RVOT reconstruction and careful postoperative care are mandatory. However intermediate-term outcome of this group of patients is comparable to the patients with minimal or no preoperative cyanosis.

Risk Factor Analysis for SaO2 Instability after Systemic-pulmonary Shunt / 대한흉부외과학회지

BACKGROUND: Arterial oxygen saturation (SaO2) instability frequently takes place after systemic-pulmonary shunt without shunt occlusion. We analyzed actual incidence and risk factors for SaO2 instability after shunt operations, and possible mechanisms were speculated on. MATERIAL AND METHOD: Ninety three patients, who underwent modified Blalock-Taussig shunt from January 1996 to December 2000, were enrolled in this study. Adequacy of shunt was verified in all patients, either by ensuing one ventricle or biventricular repair later on or by appropriate pulmonary artery growth on postoperative angiogram. Age, body weight, hemoglobin level at operation were 3 day to 36 years (median: 1.8 months), 2.5 kg to 51 kg (median: 4.1 kg) and 10.7~24.3 gm/dL (median: 15.2 gm/dL) respectively. Preoperative diagnoses were functional single ventricle with pulmonary stenosis or atresia in 39, tetralogy of Fallot in 38 and pulmonary atresia with intact ventricular septum in 16. Pulmonary blood flow (PBF) was maintained pre-operatively by patent ductus or previous shunt in 64 and by forward flow through stenotic right ventricular outflow tract (RVOT) in 29. SaO2 instability was defined as SaO2 less than 50 % for more than 1 hour with neither anatomic obstruction of shunt nor respiratory problem. RESULT: 10 patients (10.7%) showed SaO2 instability after shunt operation. After shunt occlusion was ruled out by echocardiogram, they received measures to lower pulmonary vascular resistance (PVR), which worked within a few hours in all patients. Risk factors for SaO2 instability included older age at operation (p=0.039), lower preoperative SaO2 (p=0.0001) and emergency operation (p=0.001). PBF through stenotic RVOT showed marginal statistical significance (p=0.065). CONCLUSION: SaO2 instability occurs frequently after shunt operation, especially in patients with severe hypoxia pre-operatively or unstable clinical condition necessitating emergency operation. Temporary elevation of pulmonary vascular resistance is a possible mechanism in this specific clinical setting.

Photocatalytic Bactericidal Effect of Titanium dioxide(TiO2) Thin Film for Escherichia coli, Aspergillus fumigatus and Mucobabterium tuberculosis / 병원감염관리

BACKGROUND: Titanium dioxide (TiO2) thin film photocatalyst generates strong oxidizing power when illuminated with Ultra Violet (UV) light with wavelengths of less than 385 nm. In this study, we evaluated the bactericidal activity of it against Escherichia coli, Aspergillus fumigatus and Mycobacterium tuberculosis. METHODS: The TiO2 film were prepared from titanium isopropoxide solution and it was coated on either inner(test) or outer(control) side on Petri dish. annealing at 500 degrees C. The test and control suspension of E. coli, A. fumigatus and M. tuberculosis were grown in the chamber coated inner and outer side. respectively with UV light. For the blank, cell suspensions were grown in TiO2 coated Petri dishes without UV light. The bactericidal activities were estimated by survival ratio calculated from the number of viable cells which form the nutrient agar. RESULTS: In the test, the survival ratio for E. coli and M tuberculosis decreased to a negligible level (i.e., essentially complete sterilization) within 1hr and 2 hr, respectively. and that for 11. fumigatus decreased markedly to about 15% within 6 hr. In the control, the survival ratio for E. coli, A. fumigatus and M. tuberculosis decreased to 40% within 150 min. 6 he and 2 hr, respectively. In the blank, the survival ratio for E. coli and M tuberculosis decreased only about 67% within 150 min and 40% within 2hr. In A. fumigatus, TiO2 only caused little Sterilization within 4 hr. CONCLUSIONS: TiO2 photocatalysts under UV light clearly showed bactericidal activity against E. coli, A. fumigarus and M. tuberculosis. This feature render TiO2 photocatalysts to be applicable to eliminate microorganism from indoor air environment combined with ventilation.

Redo Heart Transplantation after Previous Cardiac Operations / 대한이식학회지

PURPOSE: Heart transplantation on patients with previous cardiac operations has become more and more popular nowadays, and we assessed retrospectively the clinical features and surgical outcome of the patients who underwent redo heart transplantation after various cardiac operations. METHODS: From November 1992 to June 2002, one hundred and six patients received heart transplantation, and, among them, 12 patients (11.3%), 7 men and 5 women, had had previous cardiac operations (Group I). Their age ranged from 14 years to 61 years (median: 36). Previous cardiac procedures were mitral valve surgery in 3, coronary artery bypass in 3, total correction of tetralogy of Fallot in 2, tricuspid valve surgery in 2, Aortic valve surgery in 1 and placement of left ventricular assist device (LVAD) in 1. Interval between primary operation to cardiac transplantation ranged from 18 months to 142 months (median: 78 months) when we exclude one patient who underwent transplantation 1 month after LVAD placement. HLA cross matching was done in all patients to rule out the presence of preformed anti-HLA antibody in recipients' sera. Postoperative follow-up duration was 423 patient-months (median 36 months), and intra- operative findings and postoperative outcome were compared with those of 94 patients who received cardiac transplantation as a primary operation (Group II). RESULTS: There were no early and late mortality. Pre-bypass anesthetic time were longer in Group I (140 min) compared to Group II (100 min), and intra-operative events were more frequent in Group I (pre-bypass Hemodynamic instability in 5, Bleeding during reentry in 2, defibillation for ventricular fibrillation in 1, unplanned femoral cannulation in 1 and delayed sternal closure in 1. But there were no differences in bypass time, post-bypass anesthetic time, ventilatory support, ICU stay, hospital stay, inotropic support, chest tube drainage and transfusion amount between two groups. There was no space problem due to fibrotic and restrictive pericardial cavity in all but one patient, whose body weight was only 65% of donor body weight and pericardial cavity was relatively small. During the follow-up period, 3 patients (25%) experienced acute rejection necessitating steroid pulse therapy. CONCLUSION: Redo heart trasplantation is more complicated procedure compared to primary cardiac transplantation, but early and intermediate term result is comparable to the latter. Space problem may ensue if pericardial cavity is small and Donor-Recipient body weight mismatch is great.