Volume Flow Measurement of Autogenous and PTFE Graft Arteriovenous Fistulae for Hemodialysis of Chronic Renal Failure Patients

BACKGROUND: When it is difficult to insure adequate blood vessels, an expanded polytetrafluoroethylene (e-PTFE) graft has been accepted as an alternative although its long-term patency is not equal to that of an autogenous arteriovenous fistula (AVF) for the purpose of performing hemodialysis. There being no hemodynamic guidelines for creating an autogenous or e-PTFE AVF, we prospectively investigated the difference in blood flows between autogenous and e-PTFE AVFs after internal AVF creation in order to identify an ideal AVF. METHODS: We performed color doppler ultrasonography on 15 patients who experienced AVF creation between December 1997 and December 1998 at the Wallace Memorial Baptist Hospital in Pusan and compared the volume flow per minute, the peak systolic velocity, and the cross-sectional area between an autogenous and an e-PTFE AVF. RESULTS: Eight (8) patients experienced an autogenous vein AVF creation, and seven (7) patients experienced an AVF creation using 4x6 mm graded e-PTFE (Impra(R)). 1. Average volume flow: 1611.87 +/-687.52 mL/min for autogenous AVFs and 1725.28+/-269.06 mL/min for e-PTFE AVFs (p=0.67). 2. Average peak systolic velocity: 128.98+/-52.83 cm/sec for autogenous AVFs and 81.71+/-8.93 cm/sec in e-PTFE AVFs (p=0.04). 3. Average cross-sectional area: 0.23+/-0.10 cm2 for autogenous AVFs and 0.34+/-0.02 cm2 for e-PTFE AVFs (p=0.02). 4. There were no postoperative complications, such as venous hypertension or distal ischemia, except for one puncture-site infection. CONCLUSIONS: There was no significant difference in volume flows between autogenous AVFs and 4x6 mm graded e-PTFE graft AVFs after internal AVF creation. In the e-PTFE graft AVFs, the cross-sectionalarea was greater and the peak systolic velocity was smaller compared with those of autogenous AVFs. These results suggest that, in e-PTFE AVF creation in order to maintain on adequate minute volume flow, it is important to minimized the cross-sectional area of the outflow vessel where the lower compliance of the e-PTFE graft increases outflow resistance. Also, we conclude that choosing the appropriate blood vessels and using a meticulous surgical technique are mandatory in establishing optimal hemodynamics for arteriovenous fistulae.

A Design of Electronic Textbook Using the Multimedia Data Server / 대한의료정보학회지

Clinical education is difficult for actual practice of medical students. In particular, the practice in the field of obstetrics is more difficult to many students. Moreover, the education of sub-fields of obstetrics such as birth or abortion needs many materials of women's reproductive organs. However, the ordinary paper-based textbooks have some limitations for clinical education of obstetrics. The electronic textbook system based on multimedia data enables that many student, doctor, and public user overcome these difficulties, as a computer assisted learning. We developed multimedia database system which is connected with web using ODBC(Open DataBase Connectivity)and ASP(Active Server Page)/IDC(Internet DataBase Connection). Many text and multimedia data are gathered in the database. This system serves various multimedia data using internet and intranet in the student's class or home. In conclusion, providing multimedia data of obstetrics using ODBC, ASP/IDC method reduce the limitation of clinical education. This model of the electronic textbook would be a reference to develop multimedia database on the network.

Nation-Wide Registry of Vascular Diseases

Incidence of vascular diseases in Korea has been increasing and their researches are undertaken actively. However, experience of single institute about various vascular diseases is to be limited, a nationwide vascular registry is needed for sharing common protocols and experiences. We devolped a customized vascular registry program calling VasBase for nation-wide sharing and analysis. The characteristics of VasBase are as follows; clinician-oriented intuitive software, complete adherence to vascular protocols based on practical experiences, error-free input by presetting numeric codes, data protection, multi-user tasking, integration of graphic data, open source, easy modification of protocol and one-step export to statistical analysis software. We propose this VasBase as a nation-wide vascular registry program.

Subclavian Artery Stenosis and Malfunction of Axillobifemoral Bypass Graft: A case report

Though axillo-femoral bypass has been the preferred procedure since the introduction of the procedure by Blaisdell1) in 1963 for high risk patients who have aorto-iliac occlusive disease, widespread use of axillo-femoral bypass was limited in the past because long-term patency rates were inferior to aortofemoral bypass. Multiple mechanisms were mentioned for its inferior patency but delayed stenosis of the inflow artery(not at anastomosis site) were not reported frequently. The authors experienced one case of inflow malfunction of axillo-femoral bypass due to subclavian artery stenosis in a patient with coronary artery disease and carotid artery stenosis. Subclavian artery stenosis was treated by percutaneous transfemoral angioplasty with improvement of symptom and ABI.

Dissecting Aneurysm of Superior Mesenteric Artery: A case report

Aneurysmal disease of visceral arteries is found in only 0.2% of the general population. Aneurysms that involve the splenic artery account for more than 60% of all visceral aneurysms8,10). The hepatic artery is involved in 20%, whereas the celiac trunk is involved in 4.5% and the superior mesenteric artery in 5.5%. The remaining 10% include those of the branches of the superior mesenteric artery, the gastroduodenal, the pancreaticoduodenal arteries and the inferior mesenteric artery(5,13)). The etiology of visceral aneurysms include atherosclerosis, medial degeneration, infection, fibromuscular dysplasia, dissection and congenital anomalies(2,12,13)). The size and anatomic location of the aneurysm should be considered to determine the correct surgical treatment. The authors report a case of aneurysmal dissection of the superior mesenteric artery in a 56-year-old male patient who had acute abdominal pain and massive melena. Resection of dissecting aneurysm and PTFE interposition was performed, and post-operative course was uneventful.

Kinking of Axillobifemoral Bypass Graft: A case report

Axillofemoral bypass has been the preferred procedure for high risk patients who have aorto-iliac occlusive disease since the introduction of the procedure by Blaisdell in 1963. Widespread use of axillo- femoral bypass was limited in the past because long-term patency rates were inferior to aorto-femoral bypass. Since the mid-1980s, patency rates achieved with axillofemoral bypass have improved with the use of the externally supported prosthesis and the evolution of surgical thchnique. Reported pimary patency of axillo-femoral bypass is in excess of 70% at 5 years. Nowadays axillo-femoral bypass is a procedure of choice in elderly patients with associated comorbid risk factors, and its results is comparable to aorto-femoral bypass.The authors experienced one case of graft malfunction due to kinking of the graft at mid-portion which may not be infrequent.

A Case Report of Gallbladder Duplication

Congenital duplication of the gallbladder, including true duplication and septated gallbladder, is an uncommon but potentially complicated malformation. It presents biliary colic associated with acute or chronic cholecystitis. It can be diagnosed preoperatively by various imaging tools such as real-time ultrasonography, biliary scintigraphy, oral cholecystography, or endoscopic retrograde cholangiography. It can be safely managed by either laparoscopic or open procedures. This report describes a 6-year-old girl with true duplication of gallbladder diagnosed preoperatively by real-time ultrasonography and treated by open cholecystectomy.