Analysis of Tumor Size between Imaging of Preoperative Ultrasound, MRI and Pathologic Measurements in Early Breast Carcinoma

Purpose@#Preoperative tumor size is associated with clinical stage, treatment plan and even survival rate of patient. We investigated the accuracy of tumor size estimation between magnetic resonance imaging (MRI) and ultrasonography (US) findings, comparing these with pathologic tumor size in the diagnosis of early breast carcinoma. @*Methods@#Between 2011 and 2016, 136 patients with early breast cancer were analyzed and their tumor size on US and MRI findings were compared with their pathologic tumor size retrospectively. The background parenchymal enhancement of MRI was categorized as minimal, mild, moderate, and extreme. The patients who underwent neoadjuvant chemotherapy, had positive resection margins, underwent excisional biopsy for cancer diagnosis, and had non-mass lesions on MRI scans, were excluded. @*Results@#In all, 83.1% of the cases showed concordance between MRI findings and pathologic tumor size within 0.5cm. MRI overestimated the findings by 10.3% and underestimated them by 6.6%; 78.7% showed concordance between US findings and pathologic tumor size within 0.5cm. US overestimated the findings by 5.9% and underestimated them by 15.4%. The tumor size on MRI (r=0.87) showed a stronger correlation to the pathologic tumor size than that on US (r=0.64) in early breast cancer patients. US had a tendency to underestimate the tumor size. The degree of breast parenchyma did not affect the accuracy of the measurement of preoperative tumor size. @*Conclusion@#MRI is relatively more accurate than US for assessing preoperative tumor size in breast cancer patients. US tends to underestimate tumor size.

Comparison of the Clinical Outcomes between Angiojet Pharmacomechanical Thrombectomy and Hybrid Surgical Thrombectomy for Thrombotic Occlusion of Hemodialysis Access

Purpose@#This retrospective study aimed to compare the clinical outcomes between hybrid surgical thrombectomy (ST) and AngioJet pharmacomechanical thrombectomy (PMT) for thrombotic occlusion of arteriovenous graft. @*Materials and Methods@#This study enrolled patients who underwent either hybrid ST or AngioJet PMT in Presbyterian Medical Center from July 2018 to December 2018. We primarily compared the technical and clinical success rates between the two groups immediately after the procedures. Subsequently, the postprocedure clinical outcomes, including the primary and secondary patency rates and complications, were also compared. @*Results@#The hybrid ST group had a significantly higher bleeding amount than the AngioJet PMT group (P=0.02). The technical and clinical success rates were 96.7% and 93.3% in the AngioJet PMT group and 100% and 100% in the hybrid ST group, respectively. There was no significant difference in complications between the groups. The primary and secondary patencies at 12 months were not statistically different between the groups. @*Conclusion@#Comparable clinical outcomes were observed between the AngioJet PMT and hybrid ST groups, highlighting an equivalent efficacy of these two methods. Although the cost is more expensive, AngioJet PMT lowered the bleeding amount. Therefore, it can be considered in selected patients who are at risk of bleeding or reluctant to surgery.

Comparison of the Clinical Outcomes between Angiojet Pharmacomechanical Thrombectomy and Hybrid Surgical Thrombectomy for Thrombotic Occlusion of Hemodialysis Access

Purpose@#This retrospective study aimed to compare the clinical outcomes between hybrid surgical thrombectomy (ST) and AngioJet pharmacomechanical thrombectomy (PMT) for thrombotic occlusion of arteriovenous graft. @*Materials and Methods@#This study enrolled patients who underwent either hybrid ST or AngioJet PMT in Presbyterian Medical Center from July 2018 to December 2018. We primarily compared the technical and clinical success rates between the two groups immediately after the procedures. Subsequently, the postprocedure clinical outcomes, including the primary and secondary patency rates and complications, were also compared. @*Results@#The hybrid ST group had a significantly higher bleeding amount than the AngioJet PMT group (P=0.02). The technical and clinical success rates were 96.7% and 93.3% in the AngioJet PMT group and 100% and 100% in the hybrid ST group, respectively. There was no significant difference in complications between the groups. The primary and secondary patencies at 12 months were not statistically different between the groups. @*Conclusion@#Comparable clinical outcomes were observed between the AngioJet PMT and hybrid ST groups, highlighting an equivalent efficacy of these two methods. Although the cost is more expensive, AngioJet PMT lowered the bleeding amount. Therefore, it can be considered in selected patients who are at risk of bleeding or reluctant to surgery.

Results of Absorbable Mesh Insertion and Patient Satisfaction in Breast-Conserving Surgery

PURPOSE: Breast-conserving surgery (BCS) is a standard treatment for breast cancer. Occasionally, patients may be dissatisfied with the breast shape due to deformity after BCS. To ensure satisfactory cosmetic results, a procedure with absorbable mesh after BCS was introduced in 2005. The purpose of this study was to identify the safety and effectiveness of this procedure. METHODS: From November 2013 to December 2015, patients who underwent BCS for a malignant breast mass at Jeonju Presbyterian Medical Center were reviewed, and 63 patients were included in this study. Based on data collected from medical records and telephone interviews, the subjects were divided into two groups as follows and retrospectively compared and analyzed: BCS with absorbable mesh (n=31) and BCS without absorbable mesh (n=32). Patient data included age, body mass index, underlying disease, tumor location and size, specimen size, operative time, axillary dissection based on frozen biopsy results, postoperative wound infection, postoperative radiotherapy, adjuvant chemotherapy, and follow-up period. To compare patient satisfaction between the two groups, a brief questionnaire consisting of four items was administered. RESULTS: Infection occurred in six patients (19.4%) in the absorbable mesh group and one (3.1%) in the BCS only group; however, the difference was not significant (p=0.053). Overall satisfaction, postoperative pain and postoperative motion limitation between the two groups were also not statistically significantly different. However, patients who underwent BCS with absorbable mesh insertion were better satisfied with the breast shape than those who underwent BCS without mesh from 1 year after operation (p=0.011). CONCLUSION: BCS with absorbable mesh is a simple and easy method to improve patient satisfaction for breast shape.

Clinical Experience with a Hybrid Procedure Using the Adherent Clot Catheter for Salvage of Thrombosed Hemodialysis Access: A Comparison with the Standard Fogarty Balloon Catheter

PURPOSE: This study aimed to compare the efficacy of two different catheters in hybrid surgery for salvage of thrombosed hemodialysis accesses. MATERIALS AND METHODS: The hybrid salvage procedure (surgical thrombectomy followed by endovascular angioplasty) of the thrombosed hemodialysis access, was performed using adherent clot (AC) catheter in 140 cases and Fogarty balloon catheter in 68 cases. Procedure-related outcomes such as the clot removal status, clinical success, complications, and primary patency rates were analyzed retrospectively. RESULTS: The proportion of cases with good clot removal scores in the AC catheter and Fogarty balloon catheter groups was 77.9% and 91.2%, respectively (P=0.018). Clinical success was achieved in 90.7% of the cases in the AC catheter group and in 98.5% of the cases in the balloon catheter group (P=0.035). The mean patency rates of the two groups were 50.7% and 63.2% at 3 months, 40.7% and 47.1% at 6 months, and 17.9% and 19.1% at 12 months. The complication rates (12.1% and 5.9%) and primary patency rates between the two catheters were not statistically different (P=0.328). On the analysis of the patency rate on access type of autologous (P=0.169) and prothetic graft (P=0.423), there was no significant difference between the two catheter groups. CONCLUSION: In terms of clot removal and clinical success, the AC catheter did not demonstrate better outcomes than the Fogarty balloon catheter. However, primary patency was not related to the type of catheter. Adherent clot catheter can be a useful alternative to Fogarty balloon catheter for thrombosed hemodialysis access.

Effects of Total Thyroidectomy and Radioactive Iodine Therapy for Thyroid Cancer Patients on Sleep Apnea and Snoring / 신경정신의학

OBJECTIVES: Some paper claim thyroidectomy decreases snoring and sleep apnea symptoms and the opposite. The aim of this study is to evaluate and compare the effects of sleep apnea and snoring by total thyroidectomy and radioactive iodine (RI) therapy. METHODS: A total of 88 patients who underwent total thyroidectomy and RI therapy for thyroid cancer in the outpatient clinic of the department of surgery of a general hospital were recruited. Interviewers completed their demographic data, past medical history, and data on total thyroidectomy and sleep apnea with snoring, and also preoperative and postoperative Pittsburgh Sleep Quality Index (PSQI), preoperative and postoperative Epworth Sleepiness Scale (ESS), preoperative and postoperative Snoring Index (SI), preoperative and postoperative global life satisfaction (index of well-being) scale, and postoperative Beck Depression Inventory. RESULTS: The Wilcoxon Signed Ranks Test showed PSQI preoperative-postoperative p=0.750, ESS preoperative-postoperative p=0.000, SI preoperative-postoperative p=0.034, life satisfaction preoperative-postoperative p=0.216 (based on negative ranks). CONCLUSION: The above results indicate that snoring and daytime sleepiness increased after total thyroidectomy and RI therapy, suggesting that the patency of upper airway (UA) was reduced or the collapsibility of the UA increased after total thyroidectomy and RI therapy. That is, the above results indicate that sleep apnea and snoring were aggravated after total thyroidectomy and RI therapy.

Clinical Comprehension and Application of Angiosome Concept in Critical Limb Ischemia / 대한혈관외과학회지

Ian Taylor introduces the angiosome concept, separating the body into distinct three-dimensional blocks of tissue fed by source arteries. Understanding the angiosome of the foot and ankle and the interaction among their source arteries is clinically useful in surgical bypass or endovascular treatment of the foot and ankle, especially in the critical limb ischemia. The angiosome concept may provide useful information on the human vascular anatomy and related pathology, with specific applications in surgical and endovascular treatment. This knowledge may become particularly beneficial in critical limb ischemia, while treating advanced atherosclerotic disease. The implementation of angiosome derived strategies in critical limb ischemia may afford encouraging wound healing and limb salvage rates for both, surgical bypass or endovascular techniques. However, the angiosome concepts have several limitations, and thus, large comparative studies are necessary to support these concepts. This paper reviews the available literature on this revascularization strategy and focuses on the potential benefit of angiosome-guided treatment for patients of critical limb ischemia.

The Comparative Analysis between Surgical Thrombectomy and Hybrid Treatment in Salvage Operation / 대한혈관외과학회지

PURPOSE: Salvage operation is performed to improve the functional deficit of vascular access. This study is planned to evaluate the utility of the hybrid surgery through a comparative analysis between the results of surgical thrombectomy and those of hybrid surgery, combining surgical methods and endovascular treatments. METHODS: From January 2007 to December 2008, surgical thrombectomy had been done to 55 patients, whereas hybrid surgery had been done to 111 patients from January 2009 to December 2011. We have done a comparative analysis on the patency rate after the salvage operation for each group, retrospectively. Medical records were reviewed for patient information and radiographic data was used for checking the stenosis site in the hybrid surgery group. RESULTS: There were no statistically significant differences between the two groups, including age, gender, diabetes status, hypertension, and vascular access site or type. The primary patency rate was significantly higher in arteriovenous fistulas (65%) compared with arteriovenous grafts group (55%), at 12 months (P<0.01). At one year after the salvage operation, the secondary patency rate was higher in the hybrid surgery group compared to the surgical thrombectomy group (43.8% vs. 23.7%, P<0.01). CONCLUSION: This study shows that hybrid surgery combining surgical methods and endovascular treatments can be more useful for the salvaging of thrombosed vascular access than performing only surgical thrombectomy.

Radiofrequency Ablation for Benign Thyroid Nodules Performed by Surgeon / 대한내분비외과학회지

PURPOSE: The ability to apply radiofrequency ablation (RFA) has provided for a greater diversity of approaches for treatment of benign thyroid nodules. This study evaluated the efficacy and safety of RFA performed by a surgeon. METHODS: From January 2009 to November 2010, a total of 47 benign thyroid nodules were treated with RFA performed by one surgeon. Nodular patterns were divided into mainly cystic, mixed, and mainly solid (soft solid, hard solid) nodules, and ultrasonography was performed for assessment of the volume-reduction radio (VRR) of each nodule. Follow-up ultrasonography was performed three to 19 months after ablation. And complication was observed. One session of RFA was performed. RESULTS: The median volume before ablation was 7.8 cm³ (range 1.3~43.2 cm³). After ablation, the median volume was 0.9 cm³ (range 0.0-21.6 cm³) and VRR was 81.5±17.3%. RFA in mainly cystic nodules resulted in significant decreases in VRR (93.7±5.0%, P=0.009). It was the largest among the nodular types. VRR was 81.4±13.1% in mixed nodules, 77.2±19.2% in mainly solid nodules, 85.9±11.0% in soft solid nodules, and 54.2±17.3% in hard solid nodules 95.7% of nodules (45 nodules) showed more than 50% reduction, while the two remaining nodules, which were hard solid nodules, showed less than 50% reduction. Complications included pain, voice change, nausea, and transient voice change. CONCLUSION: Results of this study demonstrated the safety and effectiveness of RFA performed by a surgeon for reducing nodule volume.

Follicular Variant of Papillary Thyroid Carcinoma: Clinicopathological Features According to Histologic Subgroup / 대한내분비외과학회지

PURPOSE: The follicular variant of papillary thyroid carcinoma (FVPTC) is difficult to diagnose due to pathologic features. There is also debate on the optimal extent of surgery. We separated FVPTC into two groups and compared the clinical features in an attempt to apply the treatment. METHODS: All 40 patients with FVPTC who were diagnosed between 1990 and 2009 were reviewed and separated into two groups, an encapsulated group and an infiltrative group, based on whether a capsule was formed or infiltration occurred. These two different subtypes of FVPTC were compared on the traits of sensitivity of diagnosis and clinicopathologic features. RESULTS: After review by a pathologist, 21 of 40 patients (55%) were found to have encapsulated tumors, and 18 patients (45%) had infiltrative tumors. There was no difference in age, sex, or size. Patients with encapsulated FVPTC had a significantly lower rate of lymph node metastasis (4.5%), multicentric tumors (18.2%), and thyroid capsular invasion (9.1%) compared with the infiltrative tumor group (50%, 50% and 50%, P<0.05). There was no difference in FNA sensitivity between the two groups, but the sensitivity to frozen biopsy was higher in the infiltrative group. There was no recurrence in the encapsulated group, but 4 patients (22.2%) experienced recurrence in the infiltrative group. CONCLUSION: FVPTC can be separated into two subgroups by histologic features, and there are some clinicopathologic differences between the two groups. Patients who had encapsulated FVPTC had a lower rate of lymph node metastasis, multicentric tumors, and thyroid capsular invasion. They also showed a lower rate of recurrence than the infiltrative group. It is suggested that the encapsulated group can be treated with limited surgery and the infiltrative group needs aggressive treatment.

Fifteen Years or Greater Follow-Up of Pediatric Differentiated Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Thyroid cancer is rare in childhood. Although thyroid cancer is biologically more aggressive in children because of the high incidence of lymph node metastasis and distant metastasis when compared with that of adults, the prognosis is better. This study investigated the prognosis of pediatric differentiated thyroid cancer with 15 years or greater follow-up and we consider the proper treatment of pediatric differentiated thyroid cancer. METHODS: From January, 1979 to December, 1994 during 16 years, 17 patients younger than 17 years old and who underwent thyroid surgery for well differentiated thyroid cancer at the Department of Surgery at Presbyterian Medical Center were retrospectively reviewed by the medical records and they were interviewed by telephone. RESULTS: Total thyroidectomy was performed in 4 patients (23.5%), subtotal thyroidectomy was performed in 10 patients (58.8%) and lobectomy was performed in 3 patients (17.7%). The mean follow-up period was 23.5 years (range: 15~28.2 years) and recurrence was found in 7 cases (41.3%). Five cases (29.5%) showed locoregional recurrence and 2 cases (11.8%) showed distant metastasis. Postoperative radioiodine (¹³¹I) therapy was done in 6 cases (35%) and 6 cases (35%) underwent radioiodine therapy as a therapeutic modality for metastasis. CONCLUSION: The pediatric well differentiated thyroid cancer in this study showed high rates of lymph node metastasis at the time of diagnosis and a high recurrence rate, but the prognosis was good (100% overall survival rate during the follow-up period). Therefore, total thyroidectomy, radical lymph node dissection and postoperative radioiodine therapy are considered the initial patient management. This aggressive therapeutic management can decrease of the recurrence rate and increase the therapeutic effect. A radioiodine scan and thyroglobulin can used for follow-up.

Feasibility of Ultrasound-guided Fine Needle Aspiration Cytology Using Extended Tube for a Thyroid Mass / 대한내분비외과학회지

PURPOSE: Fine needle aspiration cytology (FNAC) is a very useful procedure for the diagnosis and management of thyroid disease. The use of FNAC has increased over the years. We determined the incidence of complications associated with ultrasound-guided FNAC using an extended tube for a thyroid mass and the factors that contribute to such complications. METHODS: A retrospective chart review was conducted to identify patients who underwent FNAC. Two hundred fifty-four patients underwent 325 procedures between July and September 2009. RESULTS: There were no major complications associated with ultrasound-guided FNAC using an extended tube for a thyroid mass. The most minor complication was neck pain, which occurred in 16.1% of the patients (41/254). Multiple FNACs, anti-coagulant medications, abnormal thyroid function tests, nature of the mass, and size of the mass did not contribute to the complications in this study. CONCLUSION: Using an extended tube during ultrasoundguided FNAC for a thyroid mass is safe and convenient.

Initial Experience with an Endovascular Suite (A Hybrid Operating Room)

PURPOSE: Endovascular interventions have seen explosive growth over the last decade. One of the critical factors to perform safe and reliable endovascular procedures is the availability of a well-equipped endovascular suite. The aim of this study is to clarify the necessity and benefits of an endovascular suite through our initial experience. METHODS: We performed an overview of the basic equipment and the adjunctive hardware and software of an endovascular suite for performing open surgical exposures or/and endovascular procedures. We also conducted a review of the endovascular procedures that were performed for 2 months in a newly built endovascular suite. RESULTS: The endovascular suite should offer sterile conditions to provide the endovascular specialist a complete gamut of options to treat patients with complex vascular diseases. The number of vascular and endovascular treatments increased about two fold after the establishment of the endovascular suite. CONCLUSION: The establishment of a modern endovascular suite arranged in an ergonomically devised fashion is helpful to remain on the cutting edge of medical practice. A endovascular suite will undoubtedly enhance the ability of vascular surgeons to provide quality health care to the patients who have a variety of arterial and venous disorders.

The Diagnostic Value of High Resolution Ultrasonography as Examined by Surgeons for the Differentiation of Thyroid Nodules / 대한내분비외과학회지

PURPOSE: High resolution ultrasonography has recently become a useful tool to differentiate malignant thyroid nodules from benign thyroid nodules. We performed this study in order to determine the usefulness of an ultrasonography examination that's performed by endocrinologic surgeons through the analysis of the sonographic characteristics. METHODS: A retrospective review was undertaken for 312 patients who underwent surgery and a US examination by the operator before surgery due to thyroid nodules at Jesus Hospital from February 2006 to March 2008. The review consisted of the characteristics of the sonographic parameters, such as the margin, structure, shape, echogenicity, homogeneity, calcification, sponge sign and the width/height ratio. RESULTS: On univariate analysis of the non-follicular neoplasm, the significant parameters were the margin, structure, shape, echogeneity, homogeneity, calcification and the width/height ratio. On the logistic regression analysis, the margin, structure, shape and echogenecity were significant parameters. On a univariateanalysis of the follicular neoplasm, the significant parameters were the shape, echogenecity, homogeneity and calcification. On the logistic regression analysis of the total thyroid nodules, the margin, structure, shape and echogenecity were significant parameters. Especially, hypoechoic and solid structures are the most potent malignant characteristics. CONCLUSION: Among the ultrasonographic characteristics checked by surgeons before surgery, the hypoechogenecity and solid structures are the most useful ones when planning operative management of thyroid nodules.

Diagnostic Value of Ultrasound-guided Fine Needle Aspiration Cytology by a Endocrine Surgeon / 대한내분비외과학회지

PURPOSE: Fine needle aspiration is a safe and relatively accurate procedure for distinguishing benign and malignant lesions. We determined the diagnostic value of ultrasoundguided fine needle aspiration using an extension tube and examination by an endocrine surgeon. METHODS: We reviewed the medical records of 257 consecutive patients receiving surgery for thyroid nodules in the Department of Surgery, Jesus Hospital, from January, 2006, to August, 2008. All patients received ultrasound-guided fine needle aspiration with an extension tube. RESULTS: The male to female ratio was 1:5.5. Definitive histopathological diagnosis revealed benign lesions in 120 cases (47%) and malignant lesions in 137 cases (53%). Benign lesions were composed of nodular goiter (102 cases), follicular adenoma (13 cases), and Hashimoto thyroiditis (5 cases). Malignant lesions were composed of papillary carcinoma (131 cases) and follicular carcinoma (6 cases). Fine needle aspiration cytology revealed benign lesions in 103 cases and malignant lesions in 126 cases. The Overall results of ultrasound-guided FNA were: sensitivity, 94.5%, specificity, 95.0%, positive predictive value, 96.0%, negative predictive value, 93.2%, accuracy rate, 94.7%, false negative, 5.4%, and false positive, 4.9%. Most specimens (96.4%) were amenable for diagnosis. CONCLUSION: Fine needle aspiration is a good method for the differential diagnosis of thyroid nodules. High resolution ultrasound-guided FNA with an extension tube is helpful for obtaining good specimens.

Histologic Degree of Invasion and Prognosis in Follicular Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Follicular thyroid carcinoma (FTC) is the second most common malignancy of the thyroid after papillary thyroid carcinoma, constituting about 10% of all thyroid malignancies. The objective of the current investigation was to determine whether there was a direct relationship between the histologic degree of invasion, tumor recurrence, and patient survival. METHODS: We retrospectively reviewed the records of 55 patients with a histologic diagnosis of pure follicular carcinoma of the thyroid who were treated from 1990 to 2003 at the Presbyterian Medical Center in Jeonju, Korea. Their mean follow-up period was 8.4 years (range, 1~15 years). The following criteria were used to histologically define malignant follicular neoplasms: 1) minimally invasive, tumor invasion through the entire thickness of the tumor capsule; 2) moderately invasive, tumor with angioinvasion (with or without capsular invasion); and 3) widely invasive, broad area or areas of transcapsular invasion of thyroid and extrathyroid tissue. RESULTS: Among 33 patients with capsular invasion only, 2 patients (6%) developed recurrent disease. Of the 16 patients who had angioinvasion with or without capsular invasion, 4 patients (25%) developed recurrent disease. Among 6 patients who had widely invasive FTC, 5 patients (83%) developed recurrent disease, and 2 of those 6 patients (33%) with widely invasive FTC died of the disease. Patients who had widely invasive FTC had greater recurrence rates than patients who had a capsular or angioinvasion (P<0.001). The overall death rate for patients with widely invasive FTC was 33%. CONCLUSION: This study shows that patients with widely invasive FTC had greater recurrence rates and poorer survival than patients who had capsular or angioinvasion; this difference was statistically significant. The authors conclude that patients who had widely invasive FTC need close follow-up and active treatment.

Ultrasound Guided Placement of Tunneled Hemodialysis Catheters

PURPOSE: To evaluate the usefulness of ultrasound guided confirm this change; the symbol has been corrupted in my version placement of tunneled hemodialysis catheters via internal jugular vein (IJV). METHOD: The outcomes of 52 hemodialysis catheters placed from January 2000 through December 2002 were retrospectively analyzed. Of 50 patients, 2 received two catheters. Initially, the patency of the IJV was evaluated with ultrasonography, after which the IJV puncturehe was performed under the guidance of ultrasonography. Under fluoroscopy, a 12.5 F double lumen hemodialysis catheter was placed at the caval atrial junction through a subcutaneous tunnel in the neck. To prevent initial failure we performed a flow test using a 50 cc syringe through the catheters in 47 patients. RESULT: Catheter placements were successful in all patients. Early complication was poorly functioning catheters immediately after placement (initial failure) in two cases (4%). However, no patients developed initial failure after we performed flow test using the 50 cc syringe through the catheters. There were no instances of pneumothorax or hemothorax. Nevertheless, late complications included injured catheters in two cases (4%), bacteremia in five (9.5%), and tunnel infection in 2 (4%). Mean duration of catheter use before removal was 86 days (3~55 days). The blood flow rate at first hemodialysis after catheter placement was 230+/-35.5 ml/min and after 1 month was 248+/-18.6 ml/min. Catheters were removed because of matured arteriovenous fistula in 36 cases (69%), bacteremia in five (9.5%), patient death in 7 (13.5%), injured catheters in two (4%) and tunnel infection in 2 (4%). Symptomatic central venous stenosis was not developed during the study period. CONCLUSION: Ultrasound guided placement of tunneled hemodialysis catheters via IJV is a safe method, and is useful for patients requiring long-term hemodialysis.

Clinical Analysis of Aortoiliac Occlusive Disease

PURPOSE: Aortoiliac occlusve diseases are common disease of chronic artherosclerosis in patients in lower extremities. We compared the operative results of anatomic reconstruction with those of an extraanatomic bypass to evaluate the true benefit of one over other procedure. METHOD: 115 patients who underwent surgery from January 1995 to May 2001 were retorspectively reviewed. The patients were classified in two group: a direct anatomic reconstruction group and an extraanatomic bypass group. Operative risk were analyzed by the scoring system recommended by the Subcommittee on Reporting Standards for Lower Extremity Ischemia of International Society for Cardiovascular Surgery(ISCVS). Risk factor, graft patency were analyzed between two group. RESULT: Graft patiency was better in anatomic reconstruction but it was not statistically significant. The important risk factors in deciding the extraanatomic bypass were age and degree of the organ injury, especially heart disease. CONCLUSION: Preoperative evaluation of the risk factors was important in decision making but statistically not significant. Patency of the deep femoral artery was sufficient for runoff and extensive profundaplasty prevented the femorodistal bypass.

Two Cases of Adult Intussusception

Intussusception can develop at any age but about 95% of patients are children under 2 years-old. Adult intussusception is a rare condition. Unlike children, nearly all adults with intussusception have a lead point such as benign or malignant small bowel tumors, intestinal tuberculosis, or Meckel's diverticulum. First case is a 48-year-old male who was admitted with 2 days of diffuse abdominal cramping pain and no other associated gastrointestinal symptoms. Barium enema revealed ileocolic intussusception with a round cecal mass after barium reduction. An ileocecectomy was performed electively. The pathologic report was cecal cyst, which was an intraluminal structure with an epithelial lining of colonic mucosa. The second case, a 53-year-old male, was admitted with 1 week of diffuse abdominal cramping pain and watery diarrhea. Barium enema revealed ileocecal intussusception. Emergency surgery (ileocecectomy), revealed a polypoid small bowel mass. The pathologic report was lipoma. Recently, we experienced two cases of adult intussusception and report these cases with a brief review of the literature.