Mid- to Long-term Results of Surgical Treatment of ASD in Patients over 60 Years Old

BACKGROUND: There is controversy about the benefit of surgical correction of an atrial septal defect (ASD) in patients over 60 years old. The purpose of this study was to determine whether surgical treatment is beneficial in those 60 years of age or older. MATERIALS AND METHODS: We reviewed the clinical course of 57 patients (mean age: 63.54+/-5.59 years) diagnosed with an isolated secundum ASD after the age of 60. The 24 patients (group A) who underwent surgical repair were compared with the 33 patients (group B) who were treated non-surgically. The mean follow-up period was 6.8+/-4.5 years. RESULTS: One operative death, 5 late deaths (20.8%) in group A, and 9 deaths (27.3%) in group B occurred in the study period. Symptomatic improvement was noted in 18 patients (75%) of group A after surgery. However 13 patients (39.4%) of group B showed symptomatic improvement during the follow-up period (p=0.012). The incidence of new atrial arrhythmia of the two groups was significantly different (16.7% vs 36.7%, p=0.038). The actuarial 10 year survival rate was 79% in group A and 73% in group B. CONCLUSION: Although surgical correction of ASD did not increase survival in patients over 60 years old, the surgical outcomes of ASD showed low operative mortality and resulted in symptomatic improvement in the majority of these patients. This study has shown the benefits of surgical closure of ASD even in advanced age in comparison to medical treatment.

Pilomatrix Carcinoma in the Chest Wall Around an Eloesser Open Window: A case report

Pilomatrix carcinoma originates in the matrix cell and is marked by exophytic growing and common local recurrence. There is no established treatment for wide local invasion and metastasis of the pilomatrix besides wide surgical resection. We report a case of rapidly progressive pilomatrix carcinoma, which arose around an Eloesser open window with direct invasion to the adjacent tissue.

Aortic Thrombus with Myocardial Infarction: 2 case reports / 대한흉부외과학회지

A thrombus in the aorta is a rare condition that is generally detected after cerebral, visceral or peripheral emboli. We reported here on two cases of aortic thrombus with myocardial infarction.

Bronchopathia Osteochodroplastica Mimicking Lung Malignancy / 대한흉부외과학회지

Tracheobronchopathia osteochondroplastica (TO) is an uncommon benign disease of an unknown etiology and it affects the cartilaginous walls of large airways. Most cases of TO have been reported to involve the lower two-thirds of the trachea and the proximal bronchi. Unlike the usual cases of TO, exclusive bronchial involvement and the formation of a solitary mass are very rare. We experienced an unusual case that had exclusive bronchial involvement and the formation of a solitary mass and this all mimicked lung malignancy. After surgical resection, we were finally able to diagnose the mass as bronchopathia osteochondroplastica.

A Trial of Radiesse(R) for Facial Soft Tissue Augmentation

Ideal charateristics of soft tissue fillers include longevity, biocompatibility, low adverse event profile and a reasonable cost. Radiesse(R) have many advantage as the desirable properties of facial filler. Authors introduce Radiesse(R) was recently introduced as a facial filler agent. Radiesse(R) was injected to 81 male and female patients in the study, using 27G fine needle. The age range of the patients was 22 to 48 years. The injected areas were nasal root, tip, nasolabial folds and jaw. We measured patient satisfaction scale during the period of follow up 2 to 6 months. The scale of satisfaction was good to excellent in 69 cases of 81 cases and fair in 9 cases of 81 cases. Patients satisfaction was poor in only 3 cases. Patients were observed no systemic effects but minimal adverse events which are leakage, nodule and subclinical inflammation. Radiesse(R) was highly effective, long lasting material for facial soft tissue augmentation. If a precise injection technique were applied, Radiesse(R) can be a very good option for real volumetric facial soft tissue augmentation.

2-Flap Palatoplasty for Troublesome Cleft Palate

PURPOSE: If the primary palatoplasty fails, mobilization of the mucoperiosteal flap will become difficult because of mucoperiosteal scarring. Likewise, cleft palate with wide gap makes it difficult to secure a sufficient mobilization of the periosteal flap. Authors have achieved satisfactory results with the operation of troublesome cleft palate using two-flap palatoplasty with dissection of neurovascular bundle from the mucoperiosteal flap. MATERIAL & METHODS: From January to December of 2005, Authors treated 3 troublesome cleft palates with two-flap palatoplasty with dissection of neurovascular bundle from the mucoperiosteal flap. Authors dissected pedicle wide enough to check it from operation field to make mobilization of flap easier, so that any restriction on mobilization of flap or wide gap of cleft palate can be overcome. Among the three patients, two patients are boys and one patient is a girl. Incomplete cleft palate is one case, and complete cleft palates are two cases. Two patients ware treated with cleft palate in the past. But, there still remained the cleft with marginal scarring. One patient has cleft palate with wide gap. RESULTS: All of the cleft palates were repaired with one- stage operation. There was no morbidity or complication reported such as flap necrosis, hemorrhage, palatal fistula and delayed wound healing. CONCLUSION: The excellence of two flap palatoplasty has proved by numerous authors, and it has been widely used as a primary palatoplasty. The two flap palatoplasty by our method is useful for mobilization of the flap. Dissection of neurovascular bundle from the mucoperiosteal flap creates sufficient mobilization, reduces injury on soft tissue, and eliminates tension when the cleft is closed. Also, no other donor site was needed. As two flap palatoplasty boasts many more advantages than those mentioned above, authors applied it to troublesome cleft palate as an alternative to other complicate operation methods to acquire good and positive results.

The Relationship between the Variable Measurements of Nose and the Amount of Harvested Septal Cartilage

The nose is the most 3-dimensional structure located on the central area of the face. Rhinoplasty using autogenous tissues and alloplastic materials has been performed for augmentation of nasal tip and dorsum in Asia. For batten graft, spreader graft, columellar strut and/or tip plasty, autogenous tissue especially nasal septal cartilage is very useful. Sometimes surgeon is faced to the situation when usable septal cartilage is too small so other tissues or materials are needed during the operation. The purpose of this study is that we should predict the amount of obtainable septal cartilage by variant measurements of the nose and investigated relationship each other. From December 2002 to February 2004, on the 31 cases that operated rhinoplasty using septal cartilage, we took variable measurements such as nasal length, tip width, nasal basal width, nasal height, columellar width and length of nostril long axis preoperatively. Then we investigated the relationship with amount of actual harvested septal cartilage. As a result, the nasal length was the most correlated with cartilage amount statistically and tip and base width were correlated as well. In this study we concluded that nasal length was the most indicating parameter to predict amount of septal cartilage.

Various Utility of Perforator Flaps in Head and Neck Reconstruction

There are various types of flap in head and neck reconstruction. We chose the appropriate flap considering the indication and patient's condition. In case of conventional flaps, its type is decided according to the reconstruction site. In other words, the types of considerable flaps are limited in a way. But, perforator flaps can reduce donor limitation and harvest flaps depending on the condition of the recipient. Therefore, the flap is very useful for the head and neck reconstruction needed for 2-dimensional or 3-dimensional reconstruction. We report the 29 cases of perforator- based flap including 8 cases of latissimus dorsi perforator free flap, 5 thoracodorsal perforator free flap, 4 anterolateral thigh perforator free flap, 3 peroneal osteocutaneous perforator free flap and 9 submental perforator island flap for the head and neck reconstruction. Free flaps include 2 cases of chimeric pattern, 7 controlled resurfacing pattern, 4 3-D pattern, 3 dermoadiposal pattern, 1 folded pattern and 3 osteocutaneous pattern. The flaps were successfully used for the head and neck reconstruction. But one patient died during a follow up period because of the recurrence of tumor. Various perforator flaps(island/free pattern) can be highly competitive to the conventional flaps in the head and neck reconstruction, considering a thin character for resurfacing, more flexible and versatile option, variable composition, long pedicle with donor structures saved, and less prominent donor morbidity.

Clinical Study of Cleft Lip and Cleft Palate

Incidence of congenital anomalies decreased due to decrease in birth rate and popularization of prenatal examination. But there has been relatively high incidence of congenital cleft lip and cleft palate among congenital anomalies. In spite of many studies, the cause of clefting has not been clarified yet. Purpose of this study is to investigate clinical status and etiologic factors of cleft lip and cleft palate. We reviewed clinical records of 1111 cases of cleft lip and palate patient who were treated with primary cheiloplasty and palatoplasty at Hanyang University Hospital from January, 1990 to December, 2002. Clinical analysis of these 1111 cases of cleft lip and palate patients were carried out and summarized as follows. The rate among cleft lip, cleft lip & palate, and cleft palate were 1.5:1.4:1. The rate among left side, right side, and bilateral were 2.5:1.5:1. Male versus Female was 1.3:1. In cleft palate group, the ratio was 0.7:1, conversely. 1st baby was most common in patient group. 5.9 % of patients had congenital anomalies. Medication was the most possible factor with cleft lip and palate in pregnancy. 6.4 % of patients had history of cleft lip or palate in their family trees. For the closure of cleft lip, Millard's rotation advancement method was most commonly used at about 3months of age. In cleft palate group, pushback palatoplasty was most popular method and the timing of surgery was at about 12-18 months of age. Based on the above data, it may be concluded that outbreaks of cleft are affected by multiple factors and that there is no significant difference of clinical status and treatment modalities between this and other investigations. To investigate the correlation between proposed factors and effects, prospective study method is more suitable than retrospective study like this. Good study design for data collection and appropriate control group are also required. For this purpose, I propose construction of new data collecting system and multi-center study for birth monitoring system.

Prospective Analysis of Psychological Changes in Patients Undergone Free TRAM Breast Reconstruction

This study was performed to report psychosocial aspects of breast reconstruction patients through the prospective analysis. Total 35 patients who underwent reconstruction with free TRAM flap were surveyed from October, 1999 to January, 2003. Patients were surveyed by questionnaires both before reconstruction and 1 year after reconstruction. These questionnaires consisted of 6 parts. The delayed reconstruction group had more expectations about the operation than the immediate reconstruction group. Preoperative body image of the delayed reconstruction group showed more negative aspects than the immediate reconstruction group, which means that the reconstruction of breast helps the patient's body image change in a positive way. Psychological status was improved in both groups in terms of somatization, obsessive-compulsive, depression and anxieties. The satisfaction of the operation was higher in delayed reconstruction group than in the immediate reconstruction group in subjective evaluation. Regarding the quality of life, physical health domain was improved after reconstruction in the immediate group. On the other hand, not only physical health domain but also psychological domain and social relationships domains were improved in the delayed group. To sum up, results of this study show differences between both groups according to the reconstructive time. Nevertheless, in both breast reconstruction groups the body image, psychological state, and quality of life were improved. This study reports that breast reconstruction contributes to improve psychosocial aspects as well as to correct physical deformity.

Relationship between sarcoplasmic reticular calcium release and Na+-Ca2+ exchange in the rat myocardial contraction

Suppressive role of Na+-Ca2+ exchange in myocardial tension generation was examined in the negative frequency-force relationship (FFR) of electric field stimulated left atria (LA) from postnatal developing rat heart and in the whole-cell clamped adult rat ventricular myocytes with high concentration of intracellular Ca2+ buffer (14 mM EGTA). LA twitch amplitudes, which were suppressed by cyclopiazonic acid in a postnatal age-dependent manner, elicited frequency-dependent and postnatal age-dependent enhancements after Na+-reduced, Ca2+-depleted (26 Na-0 Ca) buffer application. These enhancements were blocked by caffeine pretreatment with postnatal age-dependent intensities. In the isolated rat ventricular myocytes, stimulation with the voltage protocol roughly mimicked action potential generated a large inward current which was partially blocked by nifedipine or Na+ current inhibition. 0 Ca application suppressed the inward current by 39 +/- 4% while the current was further suppressed after 0 Na-0 Ca application by 53 +/- 3%. Caffeine increased this inward current by 44 +/- 3% in spite of 14 mM EGTA. Finally, the Na+ current-dependent fraction of the inward current was increased in a stimulation frequency-dependent manner. From these results, it is concluded that the Ca2+ exit-mode (forward-mode) Na+-Ca2+ exchange suppresses the LA tension by extruding Ca2+ out of the cell right after its release from sarcoplasmic reticulum (SR) in a frequency-dependent manner during contraction, resulting in the negative frequency-force relationship in the rat LA.

Comparison of the determinants in the differences in force-frequency relationships between rat and rabbit left atria

The underlying mechanism commonly applicable for both the positive and negative force-frequency relationships (FFR) was pursued in left atria (LA) of rat and rabbit. The species differences in the roles of Na+/Ca2+ exchanger and sarcoplasmic reticulum (SR), which are major intracellular Ca2+ regulatory mechanisms in the heart, were examined in the amplitude accommodation to the frequency that changed from 3 Hz to the variable test frequencies for 5 minutes in the electrically field stimulated left atria (LA) of rat and rabbit. Norepinephrine strongly increased the frequency-related amplitude accommodation in both of rat and rabbit LA, while monensin, oubain or the reduced Na+ and 0 mM Ca2+ containing Tyrode solution increased the frequency-related amplitude accommodation only in the rabbit LA. Monenisn was also able to increase the frequency-related amplitude accommodation only in 1-day old rat LA but not in 4-week old rat LA that had 75% less Na+/Ca2+ exchanger with 97% higher SR than 1-day old rat LA. Taken together, it is concluded that the differences in the prevalence between myocardial Na+/Ca2+ exchanger and SR in the amplitude accommodation to the frequency-change determine the difference in the FFR between rat and rabbit heart.

Roles of Na+-Ca2+ exchange in the negative force-frequency relationship

Frequency-force relationships (FFR) were studied in electrically field stimulated rat left atria (LA) by reducing the stimulation frequency from resting 3 Hz to test frequencies (0.1-1 Hz) for 5 minutes. The twitch amplitudes of LA elicited the typical negative staircases with 3-phased changes: the initial rapid increase, the second decrease and the following plateau at test frequencies. Verapamil (3 X 10-5 M) pretreatment elicited frequency-dependent suppression of the twitch amplitudes, exaggerating the negative staircase. Monensin pretreatment enhanced not the peak but the plateau amplitudes in a concentration-dependent manner. When the Na+-Ca2+ exchange was blocked by Na+ and Ca2+ depletion in the Krebs Hensleit buffer (0 Na+-0 Ca2+ KHB), the twitch amplitudes increased in a frequency-dependent manner, changing the negtive staircase into the positve one. Meanwhile, the 0 Na+-0 Ca2+ KHB applicationinduced enhancement was strongly suppressed by caffeine (5 mM) pretreatment. Only dibucaine among the local anesthetics increased the basal tone during frequency reduciton. There were no differences in 45Ca uptakes between 0.3 Hz and 3 Hz stimulation except at 1 min when it was significantly low at 0.3 Hz than 3 Hz, illustrating net Ca2+ losses. Monensin pretreatment enhanced the rate of this Ca2+ loss. Taken together, it is concluded that Na+-Ca2+ exchange extrudes more SR released Ca2+ out of the cell in proportion to the frequency, resulting in the negative rate staircase in the rat LA.

Studies on the roles of Na+/-Ca2+ exchange according to postnatal age in the negative staircase effect of the rat heart

Recent reports revealed that the Na+/-Ca2+ exchangers and feet structures of sarcoplasmic reticulum (SR) are located in close vicinity in the specific compartment. Therefore, we investigated the possibility that the Na+/-Ca2+ exchanger may decrease the tension development by transporting the Ca2+ out of the cell right after it released from SR, on the basis of this anatomical proximity. We examined the negative force-frequency relationship of the developed tension in the electrically field stimulated left atria of postnatal developing rat (1, 3 day, 1 week and 4 week old after birth). Cyclopiazonic acid (3 X 10(-5) M) treatment decreased the developed tension further according to postnatal age. Monensin (3 X 10(-6) M) treatment did not increase the maximal tension in 4 week-old rat, preserving negative staircase, while the negative staircase in the younger rat were flattened. Ca2+ depletion in the buffer elicited more suppression of the maximal tension according to the frequency in all groups except the 4 week-old group. The % decrease of the maximal developed tension of 4 week-old group at 1 Hz to that of 0.1 Hz after Na+ and Ca2+ depletion was only a half of those of the younger groups. Taken together, it is concluded that the Na+/-Ca2+ exchange transports more Ca2+ released from SR out of the cell in proportion to the frequency, and this is responsible for the negative staircase effect of the rat heart.