ABSTRACT
Although the subspecialization of surgical practice and fellowship training have progressed well in most of the university hospitals in Korea, no apparent supervision system has yet been activated. There have recently been active debates and discussions between society members on the issue of a certification for fellowship training, which ultimately prompted the Korean Surgical Society to prepare appropriate measures. In order to facilitate the process of establishing ideal measures, in our unique circumstance of surgical practice, I can suggest some of my personal opinions. First of all, I recommend that the Korean Surgical Society and its all member to strive against government interference and achieve an attending system for surgical practice and to obtain reasonable insurance reimbursement for surgeons' work, which are all prerequisites for both general and subspecialty surgical practices. Rigorous criteria for approval and credentialing of a fellowship training program should be established, whether certification will be given or not. Certification should be offered only when there is agreement between all the members of subspecialty boards and the association of practicing surgeons. All measures should be taken so as not to compromise surgical residency training by subspecialty fellowship. As subspecialization progresses, the specialty of general surgery also needs to be redefined. A discreet long-range plan of the surgical work force should be done to keep the proper number of both generalist- general surgeons and subspecialist-general surgeons. In order to take the initiative for the moderation of the interests between different subspecialty boards, and to establish a structured fellowship training program, the Korean Surgical Society should reinforce its administrative functions.
Subject(s)
Humans , Certification , Credentialing , Education , Fellowships and Scholarships , Hospitals, University , Insurance , Internship and Residency , Korea , Organization and AdministrationABSTRACT
PURPOSE: Iliac vein compression syndrome (IVCS), first characterized by Cockett and Thomas in 1965, is the development of iliofemoral deep venous thrombosis due to compression of the left common iliac vein against the spine and pelvic brim by the right common iliac artery. Thrombectomy treatment of the underlying compression is essential if significant long-term sequelae are to be avoided. Surgical treatment options include venous reconstruction or venous bypass, but treatment using endovascular techniques have recently been described. This study was conducted to evaluate the usability of endovascular treatment (esp. thrombolysis with stent insertion) in a venous outflow obstruction resulting from IVCS. METHOD: During a 2-year period, 20 patients (17 women, 3 men; mean age, 60 years) presented with clinical and imaging findings consistent with IVCS. All patients presented with leg edema or pain. The mean duration of symptom onset was 6.6+/-4.4 days, ranging from 1 to 15 days. All patients were evaluated using a Duplex scan, computerized tomography and venography. After the ascending venography had been performed, an infusion catheter system was placed, and urokinase infused locally into the thrombus burden. After near complete clot dissolution, the residual left common iliac vein stenosis was treated by means of angioplasty and the placement of a Wallstent. All patients continued to receive oral warfarin. Patients were followed-up by means of clinical visits, and the stent patency was assessed by means of a Duplex scan or computerized tomography. RESULT: The total dose of urokinase used and the duration of infusion were 2.28+/-0.93 million unit, ranging from 1.00 to 5.20 and 46.8+/-14.8 hours, ranging from 14 to 72 hours, respectively. Grade III (complete lysis) thrombolysis was achieved in 17 patients. All 17 patients successfully received a Wallstent. The initial clinical success was 100%, with complete resolution of symptoms in all patients. One patient, with combined ovarian cancer, had a recurrent symptomatic deep vein thrombosis and complete occlusion of the stent due to thrombosis 2 months after treatment. However, no other patients showed evidence of deep vein thrombosis after treatment. The overall patency rate of the stenting at 18 months was 94.1%. There were no deaths, pulmonary embolism, cerebral hemorrhage or major bleeding complications. CONCLUSION: These results suggested that the treatment of iliac vein compression syndrome, using catheter directed thrombolytic therapy and venous stent insertion, was a safe and effective method at the mid term evaluation. These patients will continue to be followed up with screening tests to further define the long-term patency.
Subject(s)
Female , Humans , Male , Angioplasty , Catheters , Cerebral Hemorrhage , Constriction, Pathologic , Edema , Endovascular Procedures , Hemorrhage , Iliac Artery , Iliac Vein , Leg , Mass Screening , May-Thurner Syndrome , Ovarian Neoplasms , Phlebography , Pulmonary Embolism , Spine , Stents , Thrombectomy , Thrombolytic Therapy , Thrombosis , Urokinase-Type Plasminogen Activator , Venous Thrombosis , WarfarinABSTRACT
While endovascular aneurysm repair (EVAR) is prevailing for the treatment of abdominal aortic aneurysm (AAA) in modern vascular practice, PURPOSE: we conducted nationwide questionnaire survey to investigate the current status of AAA treatment and their results in Korea. METHOD: We reviewed the replies from 28 hospitals (33 departments) to the questionnaire inquiring annual number, clinical features, mode of treatment and results of AAA patients during the period from Jan. 2000 to Jul. 2004. Results: 980 AAA patients were reported including 292 ruptured AAA (29.8%) and 688 non-ruptured AAA (70.2%). For treatment of AAA, 834 (85.1%) surgical repairs (SRs) and 111 (11.3%) endovascualr aneurysm repairs (EVARs) were performed while 35 patients (3.6%) died of AAA rupture before operation. The locations of AAA were infrarenal in 889 (90.7%), juxtarenal in 62 (6.3%), and suprarenal in 29 patients (3.0%). Among 834 patients undergoing SR, 577 patients (69.2%) had non-ruptured AAAs and 257 patients (30.8%) had ruptured AAAs. Mean operative mortality rate was 4.1% after elective SRs, 30.7% after SR for ruptured AAAs, and 2.3% after EVARs. The reported brand name of stent graft devices were various including domestic custom-made in 56 (50.5%), imported brand in 18 (16.2%) while 37 (33.3%) stent grafts were not reported their brand name. The frequencies of type I and III endoleaks after EVAR were reported 5.8% and 5.8% respectively in 86 patients with an available data. CONCLUSION: SR has been used as a major treatment option in Korea for the treatment of AAA patients while EVAR is increasing. The mortality rate of SR of AAA was comparable to western multi-center trial reports but mortality or morbidity rates of EVAR were unable to know in this questionnaire survey.
Subject(s)
Humans , Aneurysm , Aortic Aneurysm , Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis , Endoleak , Korea , Mortality , Surveys and Questionnaires , Rupture , Treatment OutcomeABSTRACT
PURPOSE: Bilateral breast cancer is categorized as synchronous or metachronous. The aim of this study was to evaluate the characteristics of synchronous and metachronous breast cancers. METHODS: Between 1989 and 2003, 1111 patients were treated for breast cancer at Yeung-Nam University Hospital. We retrospectively analyzed 27 women with bilateral breast cancer. RESULTS: Among the 27 cases (2.4% of the patients) of bilateral cancers, 7 (0.6%) were synchronous and 20 (1.8%) were metachronous. The mean age of the patient with synchronous and metachronous cancer was 46.9 and 41.1 years, respectively. Eighty percent (16/20) of the metachronous cases were under the age of 50. For the metachronous cancers, 65% of the cases (13/20) were down-staged, and 20% and 15% of the patients were up-staged and at same stage, respectively, compared to the primary cancer. The ER, PR, C-erbB2 and p53 positivity was 20% (4/20), 15%, 21.1% and 52.9% in metachronous cancers, respectively, compared to 65%, 60%, 31.6% and 41.2% in the primary cancers, respectively. During the mean follow up of 74.3 months, the recurrence rate and mortality rate was 42.9% and 28.6%, respectively, for the synchronous cancers, and 5% and 5%, respectively, for the metachronous cancers. CONCLUSION: The stage of the metachronous cancer was lower than that of the primary cancer, and this was probably due to careful follow-up. The lower proportion of ER and/or PR positive tumor in metachronous cancer might be associated with the effect of tamoxifen treatment. The prognosis was less favorable for the synchronous cases than for the metachronous second breast cancers in this study.
Subject(s)
Female , Humans , Breast Neoplasms , Breast , Follow-Up Studies , Mortality , Prognosis , Recurrence , Retrospective Studies , TamoxifenABSTRACT
PURPOSE: Buerger's disease (Thromboangiitis obliterans, TAO) is characterized by non- atheromatous inflammatory disease, and segmental inflammatory thrombotic occlusions of the small & middle-sized arteries and veins of the upper or lower extremities. Any epidemiological study of Buerger's disease in Korea has not been carried out until now. This study was undertaken to investigate the incidence of Buerger's disease in Korea among the patients suffering with arterial disease. METHODS: We collected and analyzed the data on 11,128 patients who were admitted to or visited the participating 22 hospitals for chronic arterial diseases throughout the major region of the South Korea from January 1986 to December 2003. The clinical diagnostic inclusion criteria for Buerger's disease were the followings: (1) a history of smoking or tobacco abuse; (2) an age of onset less than 50 years; (3) infrapopliteal, segmental arterial occlusions with sparing of the proximal vasculature; (4) frequent distal upper extremity arterial involvement (Raynaud's syndrome or digital ulceration) or-superficial phlebitis; and (5) the absence of arteriosclerotic risk factors other than smoking. RESULTS: The incidence rate of Buerger's disease among the arterial disease (11,128 patients) was 93 patients (0.83%) when the strict criteria of Shionoya was applied. 699 male-patients (6.55%) and 30 female patients (4.12%) who met the less strict criteria (the extended clinical diagnostic criteria group) were also reviewed. The 4th and 5th decades were the most common ages with-249 patients (34.2%) and 222 patients (30.5%) respectively, being found at these ages. The mean age was 40.4+/-1.6 years (age range: 16~83 years) and this was similar in both the strict criteria group and the less strict criteria group. CONCLUSIONS: This study suggests there was a low incidence of Buerger's disease in Korea among the patients who visited the participating hospitals when the strict diagnostic criteria were used. The incidence was lower than expected even when the less strict criteria were used. The more accurate incidence of Buerger's disease among the general population can be obtained by performing careful prospective study that is participated in by not only vascular surgeons, but also the other medical specialists with utilizing the strict diagnostic criteria.
Subject(s)
Female , Humans , Age of Onset , Arteries , Epidemiologic Studies , Incidence , Korea , Lower Extremity , Phlebitis , Risk Factors , Smoke , Smoking , Specialization , Thromboangiitis Obliterans , Nicotiana , Upper Extremity , VeinsABSTRACT
PURPOSE: Thrombus formation enhances both neointima formation and clinical restenosis after vascular injury or angioplasty. Thrombotic occlusions and intimal hyperplasia limit the success of vascular reconstructive procedures. Thrombolysis is expected to improve the outcome for both restenosis and acute arterial occlusion after injury. Tissue-type plasminogen activator (tPA) is commonly used clinically, and it is thought to play a critical role in vascular remodeling by mediating intravascular clot lysis and modulating cell migration within the vessel wall. However, there is controversy about the late effects of tPA on the vascular lumen either for preventing or enhancing intima hyperplasia in vivo. Thus, this study was done to evaluate the impact of a clinical infusion of tPA on the neointima formation after a balloon injury. METHOD: Forty male Sprague- Dawley rats weighting of 250~300 gm each were underwent aortic intimal denuation with a 2F balloon catheter. The rats were divided into two groups: the control group (n=20: normal saline infusion), and the*ean IMAR on the 21st day was 1.14+/-0.16 in the control group and 1.10+/-0.11 in the experiment group. The mean IMAR was lower in the experiment group, but the result was not statistically significant. In comparison to the gelatinolytic activity of MMP-9 and, activated MMP-2, there was no significant difference between the two groups. CONCLUSION: These results suggest that the effect of tPA on intimal hyperplasia after balloon injury to rat aorta showed minimal significance.
Subject(s)
Animals , Humans , Male , Rats , Angioplasty , Aorta , Catheters , Cell Movement , Hyperplasia , Negotiating , Neointima , Thrombosis , Tissue Plasminogen Activator , Vascular System InjuriesABSTRACT
PURPOSE: There is growing evidence that thrombosis and inflammation are closely interrelated and that the inflammatory response may play a role in the development of the syndrome of post-thrombotic, chronic venous insufficiency. A thrombus contains biologically active factors that stimulate cellular and structural alterations and lead to post-thrombotic venous abnormalities. Prolonged exposure to thrombus may result in the development of more severe pathologic conditions. To assess the effect of prolonged thrombus exposure on the development of secondary venous wall changes, the level of D-dimer test and the microscopic findings of thrombosed vein were analyzed in a rat venous thrombosis model. METHOD: The left iliac vein of male Sprague-Dawley rats weighing of 250 to 300 gm were thrombosed by means of either proximal ligation or temporary 24-hour occlusion with a microvascular clamp. The rats were divided into three groups: control group (n=10), thrombosis model by proximal ligation of the iliac vein only; group A (n=10), thrombosis model by proximal ligation of the iliac vein with treatment of low molecular weight heparin (LMWH; Clexane(r) 0.5 mg/kg, s.c.b.i.d); and group B (n=10), thrombosis model by temporary 24-hours clamp of the iliac vein without treatment of LMWH. The vein located 2 cm below from the initial ligation was harvested at time intervals of 7 and 14 days after ligation or clamp. Thrombi were identified by gross findings and indirectly quantitated with D-dimer test. RESULT: The levels of D-dimer test on days 7 and 14 after ligation or occlusion were significantly higher in the control group than in groups A and B (P<0.05). However, gross findings of intraluminal thrombosis were not present only in group B. These findings suggest that injection of LMWH did not prevent the development of thrombi around the ligation area. The neutrophilic infiltration of the perivascular area was evaluated microscopically (Hematoxylin-Eosin stain, x100). Severe perivascular neutrophilic infiltration was found in the control group and group A, whereas in group B neutrophilic infiltration was decreased to a mild or moderate degree. The vein wall thickness was evaluated by counting cells on representative sections through the mid vein area and by direct measuring of the vein wall usinga scale bar. The rat vein walls on days 7 and 14 were significantly thicker in the control group and group A than in group B (P<0.05). CONCLUSION: These results suggest that prolonged exposure of thrombus plays a major role in the development of secondary venous wall changes. However, the injection of LMWH did not prevent the development of secondary venous wall changes during the prolonged exposure of thrombus.
Subject(s)
Animals , Humans , Male , Rats , Heparin, Low-Molecular-Weight , Iliac Vein , Inflammation , Ligation , Neutrophils , Rats, Sprague-Dawley , Thrombosis , Veins , Venous Insufficiency , Venous ThrombosisABSTRACT
PURPOSE: This study was designed to determine the clinical factors affecting the long-term graft patency of leg arterial bypass for the patients with chronic lower limb arterial occlusion. METHOD: The clinical data of 81 femoro-distal bypasses performed at Yeungnam University Hospital from January 1996 to December 2002 were included for this retrospective study. A Log-Rank test of Kaplan-Meier method and Cox proportional hazard analysis were performed to identify those main effects that were predictive of graft patency. The patients, 79 males and 2 females, ranged from 37 to 81 years of age, with a mean age of 64. The highest incidence occurred among those in their 60s and 70s. Associated diseases were hypertension in 42 cases (51.8%), diabetes mellitus in 15 (18.8%), cardiac disease in 26 (32.1%) and cerebrovascular disease in 6 (7.4%). A history of smoking was noted in 76.5% of the cases. As for the clinical grades of chronic limb ischemia according to SVS/ISCVS classification, 21 limbs (25.9%) were classified as grade I (category 3), 40 (49.4%) as grade II, and 20 (24.7%) as grade III. The site of distal anastomosis was above the knee popliteal artery in 53 limbs (65.4%), below the knee popliteal artery in 8 (9.9%) and tibial artery in 20 (24.7%). As bypass conduit, autologous vein graft was used in 67 limbs (82.7%) and polytetrafluoroethylene (PTFE) graft in 14 (17.3%). There were no hospital mortalities or major perioperative complications. RESULT: From the univariate analysis of 21 clinical variables (age, sex, smoking, hypertension, diabetes mellitus, coronary arterial disease, congestive heart failure, chronic pulmonary disease, cerebrovascular disease, malignancy, hypercholesterolemia, clinical grade of chronic limb ischemia by SVS/ISCVS, level of occlusion, preoperative ankle-brachial index, type of graft, site of distal anastomosis, operation time, status of inflow artery, postoperative ankle-brachial index, clinical outcome criteria by SVS/ISCVS, postoperative anticoagulation therapy), 5 factors were identified as being associated with long-term graft patency: preoperative clinical grade (P=0.03), preoperative ankle-brachial index (P=0.00), level of occlusion (P=0.03), type of graft (P=0.00) and clinical outcome criteria (P=0.00). In multivariate analysis, type of graft, PTFE graft (vs. autologous vein graft, P=0.002), and clinical outcome criteria, minimally improved (vs. moderately, and markedly improved, P=0.029), showed a lower graft patency rate. CONCLUSION: These results suggest that autogenous vein is more acceptable for leg arterial bypass and poor early clinical outcome predicts poor long term graft patency rate.
Subject(s)
Female , Humans , Male , Ankle Brachial Index , Arteries , Classification , Diabetes Mellitus , Extremities , Heart Diseases , Heart Failure , Hospital Mortality , Hypercholesterolemia , Hypertension , Incidence , Ischemia , Knee , Leg , Lower Extremity , Lung Diseases , Multivariate Analysis , Polytetrafluoroethylene , Popliteal Artery , Retrospective Studies , Risk Factors , Smoke , Smoking , Tibial Arteries , Transplants , Vascular Patency , VeinsABSTRACT
PURPOSE: Despite recent progress in the procedures of revascularization, acute limb ischemia continues to account for a wide variety of complications, culminating very often in limb loss or death. These poor results after treatment of acute limb ischemia still remains a major challenge in vascular surgery. METHOD: To evaluate the clinical characteristics and risk factors for early limb loss in acute limb ischemia, the clinical data of 87 limbs (8 upper and 79 lower limbs) in 83 patients. that underwent revascularization for acute limb ischemia at Yeungnam University Hospital from January 1995 to February 2003 were analyzed retrospectively. A Log-Rank test of Kaplan-Meier method and Cox proportional hazard analysis were performed to identify those main effects predictive of amputation free survival. RESULT: The patients, 78 males and 9 females, ranged from 30 to 83 years of age, with a mean age of 67. The highest incidence occurred among people in their 50s and 60s. The underlying causes of acute limb ischemia were arterial embolism in 42 limbs (42/87, 48.2%), arterial thrombosis in 36 (36/87, 41.3%), bypass graft occlusion in 9 (9/87, 10.3%). The primary sources of embolism were cardiac origin in 25 cases (25/42, 59.5%), aneurysmal origin in 2 (2/42, 4.8%) and unknown origin in 15 (15/42, 35.7%). As for the severity of ischemia according to SVS/ISCVS classification, 40 limbs (40/87, 46.0%) were classified as category IIa, 39 (39/87, 44.8%) as category IIb, and 8 (8/87, 9.2%) as category III. For the treatment, 66 thromboembolectomies (including 20 cases treated with intraoperative thrombolytic therapy), 19 arterial bypasses and 2 catheter directed thrombolytic therapies were performed. There were 13 major amputations and 8 mortalities at 6 months after revascularization. Cumulative 15 day, and 1, 2, 4, and 6-month amputation-free survival rate of all survival patients were 88.8%, 85.7%, 83.9%, 83.9% and 81.4% respectively. Among the univariate analysis of 26 clinical variables, 10 factors were identified as being associated with amputation-free surviva: age (P=0.01), preoperative tissue gangrene (P=0.03), preoperative skin color change (P=0.00), preoperative muscle status (P=0.00), preoperative motor and sensory deficit (P=0.00, P=0.00), severity of ischemia by clinical category (P=0.00), symptom duration (P=0.02), length of occlusion (P=0.01), and cause of occlusion (P=0.01). In multivariate analysis, age (P=0.04), and preoperative skin color change (P=0.00) predicted a poorer response to therapy. The major limb amputations were performed in 2 limbs (2/41, 4.9%) of the emboli group, and 11 limbs (11/42, 26.2%) of the thrombi group. For the limb with thrombosis, the major limb amputations were performed in 9 limbs (9/26, 34.6%) of the thromboembolectomy group and in 2 limbs (2/16, 1.3%) of the arterial bypass group. CONCLUSION: These results suggest that prompt and appropriate treatment is critically important in the management of acute limb ischemia. In thrombi cases Especially, a more aggressive surgical approach may be necessary for limb salvage.
Subject(s)
Female , Humans , Male , Amputation, Surgical , Aneurysm , Catheters , Classification , Embolism , Extremities , Gangrene , Incidence , Ischemia , Limb Salvage , Mortality , Multivariate Analysis , Retrospective Studies , Risk Factors , Skin , Survival Rate , Thrombolytic Therapy , Thrombosis , TransplantsABSTRACT
No abstract available.
ABSTRACT
PURPOSE: Migration and proliferation of vascular smooth muscle cells (VSMCs) are important for neointimal formation after arterial injury. Migration of VSMCs requires the degradation of basement membrane and extracellular matrix surrounding the cell. There is increasing evidence that VSMCs produce extracellular matrix-degradating proteinases, such as matrix metalloproteinases (MMPs) after arterial injury. METHOD: To assess the effect of gabexate mesylate, an MMP inhibitor, in VSMCs proliferation, migration and intimal thickening, the gelatinolytic activity of MMPs and the expression of VSMC alpha-actin mRNA were analyzed in the balloon-injured rat aorta model. Forty male Sprague-Dawley rats, weighing of 250 to 300 g, underwent aortic intimal denudation with a 2 F balloon catheter. The rats were divided into two groups: the control group (n=20: no medication), and the treatment group (n=20: daily intraperitoneal injection of gabexate mesylate (5.0 mg/kg)). The aorta was harvested at various time intervals, 1, 5, 7, and 21 days after the injury. MMP expression was analyzed by using gelatin zymography, the VSMC alpha-actin mRNA expression was analyzed by RT-PCR, and the intima to media area ratio (IMAR) were evaluated microscopically. RESULT: The treatment group showed significant suppression of intimal hyperplasia compared to the control group on day 21 (P<0.05). Mean IMAR on day 21 were 1.18+/-0.2 in the control group and 0.61+/-0.06 in the treatment group. The gelatinolytic activity of MMP-9 on day 1 after injury was significantly lower in the treatment group compared to the control group (P<0.05). The gelatinolytic activity of activated MMP-2 on days 5, 7, and 21 after injury, decreased significantly in the treatment group compared to the control group (P<0.05). The expression of VSMC alpha-actin mRNA increased on days 7 and 21 after injury. Although the expression of VSMC alpha-actin mRNA was lower in the treatment group, it was not statistically significant. CONCLUSION: These results suggest that gabexate mesylate suppresses intimal hyperplasia formation after arterial injury by decreasing activation of MMP.
Subject(s)
Animals , Humans , Male , Rats , Actins , Aorta , Basement Membrane , Catheters , Extracellular Matrix , Gabexate , Gelatin , Hyperplasia , Injections, Intraperitoneal , Matrix Metalloproteinases , Muscle, Smooth , Muscle, Smooth, Vascular , Myocytes, Smooth Muscle , Peptide Hydrolases , Rats, Sprague-Dawley , RNA, MessengerABSTRACT
PURPOSE: A sentinel lymph node mapping with blue dye has been well accepted as a common procedure in breast cancer surgery. However, it is well known that blue dye absorbed into the circulation may interfere pulse oximetery reading. The aim of this study was to evaluate the change of pulse oximetery reading by isosulfan blue dye injection during sentinel lymph node mapping. METHODS: Thirteen breast cancer patients with normal preoperative cardiopulmonary functions were studied. Four ml of isosulfan blue dye was injected subdermally when the patient became stable after induction of general anesthesia. The pulse oximetery was monitored continuously. Multiple arterial blood gas analyses (ABGA) were performed before dye injection and 10, 30, 40 minutes after dye injection. The results of oxygen saturturation by oximetery (SpO2) and the results of arterial oxygen tension (SaO2) and arterial oxygen saturation (SaO2) by ABGA were compared. RESULTS: The value of both SaO2 and PaO2 measured by ABGA has not been altered by isosulfan dye injection. However SpO2 decreased by isosulfan dye injection. SpO2 decrease started 8.2+/-1.5 (2~0) minutes after dye injection and returned to preinjection level by 85.7+/-5.6 (60~126) minutes after injection. The lowest vaule of SpO2 was 95.6+/-1.2% (93~97). Mean duration of SpO2 decrease was 77.5+/-6.2 (40~117) minutes. The duration of SpO2 decrease was longer in the aged patients, but it was not statistically significant (p=0.3). There was no siginificant difference in duration of SpO2 decrease according to injection site, operation method, and body mass index (BMI). CONCLUSION: .Isosulfan dye injection using for sentinel lymph node mapping causes no change in true ABGA results but causes a mild reversible decrease in SpO2, It is important to look for other causes when SpO2 decrease is significant and persistent.
Subject(s)
Humans , Anesthesia, General , Blood Gas Analysis , Body Mass Index , Breast Neoplasms , Lymph Nodes , Oxygen , ReadingABSTRACT
PURPOSE: It has been reported that c-erbB-2 overexpression is associated with a resistance to tamoxifen therapy in many trials, but this is controversial. The aim of this study was to evaluate the c-erbB-2 status, and the response to tamoxifen, in breast cancer patients. METHODS: We enrolled 294 patients who had been treated with tamoxifen, 261 (88.8%) were ER and 33 PR positive respectively. The expressions of c-erbB-2 were analyzed using immunohistochemical methods. The median follow up was 36 months. We medical records retrospectively reviewed, and the recurrence rate analyzed and compared with other prognostic factors and survival rates, according to the c-erbB-2 status. RESULTS: The mean age of the patients was 45.23+/-10.47 (20~83). The incidence of invasive ductal carcinomas, invasive lobular carcinomas and DCIS were 91.2, 4.8 and 4.1%, respectively. The recurrence rate was 10.9% (32/294), and 22 of 225 (9.8%) in ER/PR (+/+), 7 of 36 (19.4%) in ER/PR (+/-) and 3 of 33 (9.1%) in ER/PR (-/+). The recurrence rates, according to the TNM stages 0, I, IIa, IIb, III were 0, 5.4, 6.5, 15.2 and 36.7%, respectively (P=0.000). The recurrence rates, according to the c-erbB-2 stati, were 16.5 and 8.4% in the positive and negative groups, respecively (P=0.039). The nuclear grade was higher in the c-erbB-2 positive group than in the negative group, but there was no relationship between the c-erbB-2 status and the other prognostic factors, such as axillary lymph node status, TNM stage or histological grade. The overall and disease free survivals were significantly shorter in the c-erbB-2 positive than the negative group (P<0.05). CONCLUSION: The patients with tumors positive for c-erbB-2 had shorter overall and disease free survivals, compared to patients with tumors negative for c-erbB-2, when treated with tamoxifen. Overexpression of c-erbB-2 may reduce the efficacy of tamoxifen therapy, although our number of patients was small and the follow up relatively short.
Subject(s)
Humans , Breast Neoplasms , Carcinoma, Ductal , Carcinoma, Intraductal, Noninfiltrating , Carcinoma, Lobular , Follow-Up Studies , Incidence , Lymph Nodes , Medical Records , Recurrence , Retrospective Studies , Survival Rate , TamoxifenABSTRACT
PURPOSE AND METHOD: To access the value and results of femoro-femoral bypass for the treatment of unilateral iliac artery occlusion, the clinical data of 53 patients who underwent femoro-femoral bypass graft at Yeungnam University Hospital between January 1994 to December 2000 were analyzed retrospectively. The influence of several variables (such as, age, sex, preoperative symptom, risk factors and associated medical illness, status of distal artery, preoperative ABI) on the long term patency was evaluated by univariate statistical analysis. RESULT: The patients were 47 males and 6 females ranging from 37 to 84 years of age. The mean age was 65, with the highest incidence among people in their 60s, followed by those in their 70s and then in their 50s. Associated diseases were hypertension in 28 cases (52.8%), diabetes mellitus in 10 cases (18.8%), cardiac disease in 19 cases (32.0%) and cerebrovascular disease in 4 cases (7.5%). History of smoking was noted in 77.4% of the cases. Focal stenosis of donor site iliac artery has been found in 2 cases and combined distal outflow occlusion has been found in 21 cases. 2 donor site iliac artery ballon angioplasty was performed preoperatively and 14 adjuvant procedures (9 femoro-popliteal bypass, 2 femoro-tibial bypass, 3 profundoplasty) was performed simultaneously during the operation. Cumulative 1, 3, 5,-year primary and secondary patency rates of all femoro-femoral bypass were 87.0%, 76.6%, 68.1% and 91.7%, 85.7%, 73.5%. There was no operative mortality and major perioperative complications. Univariate analysis showed that the patients without distal arterial occlusion had significantly better 1-, 3- and 5-year primary patency rates (93.0%, 89.0% and 74.2% versus 76.6%, 45.9% and 45.9%, P=0.02) compared with the patients with distal arterial occlusion. No significant effect was exerted by all other variables on long term results. CONCLUSION: These results suggest that femoro-femoral bypass is a safe and durable operation that results in good patency in a good runoff.
Subject(s)
Female , Humans , Male , Angioplasty , Arteries , Constriction, Pathologic , Diabetes Mellitus , Heart Diseases , Hypertension , Iliac Artery , Incidence , Mortality , Retrospective Studies , Risk Factors , Smoke , Smoking , Tissue Donors , TransplantsABSTRACT
No abstract available.
ABSTRACT
PURPOSE: Vascular smooth muscle cells (VSMCs) migration and proliferation are important for neointimal formation after arterial injury. Migration of VSMCs requires degradation of basement membrane and extracelluar matrix surrounding the cell, and there is increasing evidence that VSMCs produce extracelluar matrix-degradating proteinases, such as matrix metalloproteinases (MMPs) after arterial injury. To assess the role of MMPs in VSMCs proliferation, migration and intimal thickening, we measured the expression of MMP-2 and MMP-9 in the balloon-injured rat aorta model. METHOD: Twenty-five male Sprague-Dawley rats weighting of 250~300 gm were underwent aortic intimal denudation with 2F balloon catheter. Aorta was harvested at various time intervals of 1, 3, 5, 7, 21 days and then analyzed the MMP expression used by gelatin zymography. Intimal hyperplasia caused by balloon injury was confirmed by microscopic examination. RESULT: MMP-2 (72 kD) was constitutively expressed in the normal aorta and was not increased substantially after injury. But the expression of 62 kd forms, which is activated form of MMP-2, was significantly increased during the period of 5 through 7 days after injury (P<0.05). The expression of MMP-9 (92 kD) was significantly increased at 1st day after injury and diminished thereafter (P<0.05). CONCLUSION: These results suggest that activated MMP-2 (62 kD) and MMP-9 (92 kD) may play an important role in VSMCs migration and formation of intimal hyperplasia after arterial injury. And the activated form of MMP-2 (62 kD) seems to be involved mainly in degradation of basement membrane and matrix.
Subject(s)
Animals , Humans , Male , Rats , Aorta , Basement Membrane , Catheters , Gelatin , Hyperplasia , Matrix Metalloproteinases , Muscle, Smooth, Vascular , Peptide Hydrolases , Rats, Sprague-DawleyABSTRACT
PURPOSE: Whereas cyclosporine is increasingly used not only in transplantation but also in autoimmune disorders, it may be associated with several side effects. Gingival hyperpalsia is one of the most frequent side effects and has been estimated to occur in 21-30% of all patients receiving the drug and may require surgical correction. Azithromycin is a macrolide antibiotics reported to coincidentally reduce gingival hyperplasia in renal transplant recipients treated for respiratory infections. To confirm the effect of azithromycin in cyclosporine induced gingival hyperplasia we tried clinical use of azithromycin in renal transplant patients with severe gingival hyperplasia. METHODS: Patients (n=9) with cyclosporine induced gingival hyperplasia were selected and took azithromycin for 5 days. Follow-up visits were conducted at week 4 and week 8. Changes in gingival hyperplasia were evaluated by measuring the ratio of clinical crown height and width in each of the four central incisors. RESULTS: Significant improvements were observed in periodontal measurement. The pre-treatment ratio of clinical crown height and width was 1.04+/-0.14 and it was increased to 1.17+/-0.16 in 4 weeks and 1.22+/-0.15 in 8 weeks. 88.9% (8/9) of patients reported an improvement in clinical symptoms. Azithromycin was tolerated and 77.8% (7/9) of patients reported that the treatment was at least somewhat useful. CONCLUSION: Azithromycin treatment for cyclosporine induced gingival hyperplasia is efficacious, cost effective, and has less morbidity compared with gingivectomy.
Subject(s)
Humans , Anti-Bacterial Agents , Azithromycin , Crowns , Cyclosporine , Follow-Up Studies , Gingival Hyperplasia , Gingivectomy , Incisor , Respiratory Tract Infections , TransplantationABSTRACT
PURPOSE: The main object of treatment in chronic occlusive arterial disease is to increase blood flow and to prevent progress of ischemic ulcer. In case of the symptoms and signs such as rest pain, ischemic ulcer and gangrene with poor angiographic distal run-off, conservative medical treatment is recommended. Argatroban (Novastan(R) ) has an arginine structure, is the first selective antithrombin in the world, showing the inhibitory effect of thrombin-induced fibrin formation, platelet aggregation and vasoconstriction. METHOD: From September 1995 to January 1999, 39 patients with chronic arterial occlusion as subjects, ulcers, resting pain and feelings of coldness participated in Novastan treatment in 3 institutions (Department of Surgery, Yeungnam University College of Medicine, Department of Surgery Vascular Division, Ulsan University College of Medicine and Asan Medical Center, Department of Surgery, Gachon Medical School) and 30 patients completed the study:thromboangitis obliterance (TAO) in 19 and atherosclerosis obliterans (ASO) in 11 cases. Administration dose was 20 mg (2 amples, q.d or b.i.d) and medicated for consecutive 4 weeks. To detect the changes of symptoms, ulcer size and occurrence of side effects, inquiries, photography and laboratory tests were checked at prior to medication and 2, 3 and 4 weeks after medication. RESULT: There were 29 men and 1 women, ranging in age from 18 to 80 years old with mean of 50 years old and in body weight from 44 to 86 kg with mean of 64 kg. Improvement rate on ulcer size and granulation appearance was 73.3% (22 cases/30) and 86.7% (26 cases/30) respectively. General improvement rates were 76.7% (23 cases/30), general safety rates were 97.4% (38 cases/39), and utility rates were 70.0% (21 cases/30). Side effects were observed in 3 cases (7.7%), and abnormal changes in laboratory tests were observed for 15 items in 9 cases. But there noted no significant side effects and abnormalities in laboratory tests. CONCLUSION: Argatroban had a beneficial effect in improving such clinical symptoms as ischemic ulcer, resting pain and the feeling of coldness, accompanying chronic arterial occlusion, it causes no serious side effects and it shows high clinical utility.
Subject(s)
Aged, 80 and over , Female , Humans , Male , Middle Aged , Arginine , Atherosclerosis , Body Weight , Fibrin , Gangrene , Photography , Platelet Aggregation , Ulcer , VasoconstrictionABSTRACT
BACKGROUND: Telomerase is a ribonucleoprotein, DNA polymerase that synthesizes telomere repeats onto chromosomal ends and maintains telomere length. Telomerase activity has been detected in a broad range of human malignant neoplasms, but not in normal somatic cells. So, activation of telomerase may represent an essential step in the malignant transformation of cells. However, the expression of telomerase in premalignant lesions remains relatively unexplored. This study was conducted to investigate the reactivation of telomerase in the carcinogenesis of human breast tissue. METHODS: In situ hybridization for the telomerase RNA component (human telomerase mRNA; hTR) was used in a normal breast tissue (n=41), florid ductal hyperplasia (FDH) (n=10), atypical ductal hyperplasia (ADH) (n=3), ductal carcinoma in situ (DCIS) (n=44) and invasive carcinoma (n=33). hTR expression in relation to p53 status and the pathologic parameters in breast cancer was also studied. RESULTS: Expression of hTR was demonstrated in 13 samples (31.7%) of normal breast tissues, 4 (40%) of FDH, 3 (100%) of ADH, 42 (95.5%) of DCIS, and 33 (100%) of invasive carcinoma. The rate of hTR expression of ADH was significantly different from that of FDH (p<0.05), and there were no differences in hTR expression rates among ADH, DCIS and invasive carcinomas. There was no correlation between hTR expression and nuclear grade, tumor size, and p53 status in invasive carcinomas. CONCLUSION: These results suggest that telomerase activation may be an early event and an essential step in the carcinogenesis of human breast tissue, and that telomerase has no correlations with p53 status and prognostic parameters.
Subject(s)
Humans , Breast Neoplasms , Breast , Carcinogenesis , Carcinoma, Intraductal, Noninfiltrating , DNA , Hyperplasia , In Situ Hybridization , Ribonucleoproteins , RNA , RNA, Messenger , Telomerase , TelomereABSTRACT
PURPOSE: Deep vein thrombosis and pulmonary embolism are common and potentially fatal complication among hospitalized patients. The first clinical manifestation of venous thromboembolism may be fatal pulmonary embolism. Therefore, some form of prophylaxis is warranted for patients at risk. Prolonged major surgery is well known as high risk factor in development of venous thromboembolism and venous thromboembolism following surgery remains a significant health care problem. But little data are available concerning the changes of venous hemodynamic during prolonged surgery. METHOD: To access the relationship of the lower leg venous congestion that occurred during prolonged and position-fixed surgery to the development of postoperative deep vein thrombosis, the venous pressure of lower leg were measured continuously. A flexible indwelling angiocatheter was inserted into the greater saphenous vein near ankle area and venous pressure was measured by pressure monitor. The data of patients (experimental group:n=10) who performed spinal operation in Jack-Knife position over 180 minutes, healthy volunteers (n=10) and patients (venous hypertension group) who diagnosed as lower leg deep vein thrombosis (n=7), chronic venous insufficiency (n=3) were collected and analyzed. RESULT: The mean age was 34 years old in experimental group and the patients were 7 males and 3 females. The mean lower leg venous pressures of healthy volunteer in Jack-Knife position were 42.89+/-3.52 mmHg at 30 minutes. In acute deep vein thrombosis and chronic venous insufficiency patients, the mean venous pressures were 73.14+/-4.78, 57.33+/-2.52 mmHg at 30 minutes and these data were statistically significant compared with control group (P<0.05). In experimental group, the changes of the mean venous pressures at 30, 60, 90, 120 and 180 minutes were 48.78+/-2.38, 45.89+/-2.09, 45.33+/-2.24, 45.11+/-2.03 and 46.33+/-2.18 mmHg and these data were not statistically significant compared with control group. There was no postoperative development of deep vein thrombosis. CONCLUSION: The surgical factors (prolonged operation time, fixed position) and anesthetic factor may not play a major role in development of postoperative deep vein thrombosis and other postoperative factors will intervene the development of deep vein thrombosis.