Adventitial Cystic Disease of the Superficial Femoral Vein without a Joint Connection: A Case Report

Adventitial cystic disease (ACD) of the veins is a rare vascular disease. Most cases of venous ACD are located adjacent to the joint area, such as the common femoral, external iliac, and popliteal veins. To the best of our knowledge, 67 cases of venous ACD have been reported, and ACD of the superficial femoral vein (SFV) has never been reported. Herein, we report the case of a 57-year-old male who presented with swelling and discomfort in the left leg. Computed tomography venography revealed multiple cystic lesions in the left distal SFV. The patient underwent cyst excision, which relieved the compression in the vein, although mild stenosis prevailed in the SFV. After a week, thrombosis developed in the popliteal vein. The thrombosis resolved after three months of anticoagulant therapy, and the patient showed no recurrence of ACD during three years of follow-up.

Adventitial Cystic Disease of the Superficial Femoral Vein without a Joint Connection: A Case Report

Adventitial cystic disease (ACD) of the veins is a rare vascular disease. Most cases of venous ACD are located adjacent to the joint area, such as the common femoral, external iliac, and popliteal veins. To the best of our knowledge, 67 cases of venous ACD have been reported, and ACD of the superficial femoral vein (SFV) has never been reported. Herein, we report the case of a 57-year-old male who presented with swelling and discomfort in the left leg. Computed tomography venography revealed multiple cystic lesions in the left distal SFV. The patient underwent cyst excision, which relieved the compression in the vein, although mild stenosis prevailed in the SFV. After a week, thrombosis developed in the popliteal vein. The thrombosis resolved after three months of anticoagulant therapy, and the patient showed no recurrence of ACD during three years of follow-up.

Antithrombotic therapy has no beneficial effect in conservative treatment of spontaneous isolated superior mesenteric arterial dissection

Purpose@#Initial conservative treatment with selective endovascular or surgical intervention has shown successful outcomes in the treatment of spontaneous isolated superior mesenteric artery dissection (SISMAD). However, the benefits of antithrombotic therapy as a part of conservative treatment have not been clarified. This study aimed to investigate the clinical course of SISMAD patients and determine differences in clinical outcomes between the antithrombotic and noantithrombotic groups. @*Methods@#We retrospectively reviewed 79 cases of SISMAD that were treated conservatively from January 2004 to December 2019 at Chonnam National University Hospital. Clinical outcomes, including the length of hospital stay, pain resolution time, image remodeling, and maximal remodeling time, were compared between the antithrombotic and noantithrombotic groups. @*Results@#There were 30 patients in the no-antithrombotic group and 49 patients in the antithrombotic group. There was no significant difference in clinical characteristics between the 2 groups, except for dyslipidemia (P = 0.011). The follow-up period (32.6 months vs. 14.6 months, P = 0.009) and imaging follow-up period (31.6 months vs. 13.9 months, P = 0.011) were longer in the antithrombotic group than in the no-antithrombotic group. The length of hospital stay (5.1 days vs. 7.7 days, P = 0.002) was significantly shorter in the no-antithrombotic group than in the antithrombotic group because patients in the antithrombotic group required longer hospitalization for warfarin titration. @*Conclusion@#In patients with SISMAD, conservative treatment without antithrombotic therapy may have clinical benefits such as decreased length of hospital stay compared with conservative treatment with antithrombotic therapy.

Vascular Complications Related to Posterior Lumbar Disc Surgery

PURPOSE: To evaluate patients who underwent surgical or endovascular treatment after vascular injury related to posterior lumbar disc surgery. MATERIALS AND METHODS: We retrospectively reviewed seven cases of vascular injuries (four lacerations, one arteriovenous fistula [AVF], and two pseudoaneurysms) related to lumbar disc surgery by a posterior approach from January 1997 to December 2016 at Chonnam National University Hospital. Information of patient characteristics, diagnosis, treatment strategies, and outcomes were analyzed. RESULTS: Five out of seven cases were inhospital cases. In three laceration cases, each patient instantly became hypotensive and a life-threatening arterial injury was suspected. Therefore, the patient was immediately turned to the supine position and surgical repair was performed. The patients with pseudoaneurysm and AVF were treated by endovascular intervention. Remaining two were referred cases under the impression of vascular injuries. One laceration case of them was in preshock condition, and the left common iliac artery was surgically repaired. The other referred patient showed pseudoaneurysm which was treated with stent graft insertion. There was no surgery or endovascular intervention related death and none of the patients suffered any sequela related to vascular injury. CONCLUSION: Vascular injury associated with posterior lumbar disc surgery is not common, but can be fatal. Early recognition, diagnosis, and prompt treatment are essential to prevent fatal outcomes. Recently, endovascular intervention is increasingly and preferably used because of its low morbidity and mortality. However surgery is still the best option for the patients with unstable vital sign and endovascular approach can be applied to stable patients.

Bilateral Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in Korea

No abstract available.

Colon perforation due to embolization coil for internal iliac aneurysm

Coil migration is an extremely rare but hazardous complication of aneurysmal coil embolization. Only 1 case report has described coil migration following endovascular exclusion to gastrointestinal (GI) tract. We report the experience of a case of colon penetration caused by embolization coil placed for internal iliac aneurysm. A 66-year-old man visited the Emergency Department for hematochezia that had persisted for 3 months. Stent insertion and coil embolization of left internal iliac artery aneurysm had been performed on the patient 18 months ago. Colonoscopy was performed. It suggested penetration of sigmoid colon by embolization coil and diverticulum. Angiography revealed extravasation of contrast media at left internal iliac artery. Covered stent deployment was done in the left internal iliac artery. One week after the stent insertion, the patient underwent anterior resection, aneurysm resection, and coil removal. The patient recovered without complications. He was discharged at 2 weeks after the operation.

Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in an Elderly Korean Man

No abstract available.

Changes in suprarenal and infrarenal aortic angles after endovascular aneurysm repair

PURPOSE: We investigated whether suprarenal and infrarenal aortic angles change after the endovascular aneurysm repair (EVAR) procedure and during follow-up, and investigated the correlation between infrarenal aortic angle after EVAR and type Ia endoleaks. METHODS: Data collected on 70 EVAR procedures for a fusiform infrarenal aortic aneurysm performed between May 2006 and December 2012 were supplemented with a retrospective review of charts and radiographs. RESULTS: The greater the preoperative infrarenal aortic angle, the greater the suprarenal aortic angle (r = 0.72, P < 0.001). The infrarenal aortic angle decreased after the EVAR procedure and continued to decrease slowly thereafter (all P < 0.001). Suprarenal aortic angle decreased immediately after the EVAR procedure and continued to decrease during the first month (P < 0.001). No differences in angulation were observed based on stent graft type. Type Ia endoleaks occurred with significantly greater incidence in patients with a larger post EVAR infrarenal angle (P = 0.037). CONCLUSION: The infrarenal aortic angle decreased significantly immediately after the EVAR procedure and continued to decrease slowly thereafter. Suprarenal aortic angle decreased immediately after the EVAR procedure and continued to decrease during the first month. We found a correlation between infrarenal and suprarenal aortic angle. Type Ia endoleaks occurred with greater incidence in patients with a larger infrarenal angle immediately after EVAR.

Alteration of Ankle-Brachial Index after Kidney Transplantation / 대한이식학회지

BACKGROUND: A steno-occlusive disease of the iliac artery can mimic renal vascular hypertension, and is an important cause of renal dysfunction in renal transplant recipients. We assessed the alternation of postanastomotic arterial blood flow of lower extremities by ankle-brachila index (ABI). METHODS: We analyzed 50 patients who underwent kidney transplantation between March, 2010 and November, 2012 at Chonnam National University Hospital. This study was performed prospectively and case selection by renal transplantation patients who got first operation on right iliac fossa. All operational procedures were end to side anastomosis of the external iliac artery to the renal artery. We measured and compared the preoperative and postoperative (1 week, 6 months, 1 year) ABI. We analyzed the diameter of the recipient external iliac artery and renal artery of the transplanted kidney. RESULTS: Among 50 patients, 34 were male (68%) and 16 were female (32%). The mean age of recipients was 44.37+/-11.42 years. The mean preoperative ABI at the right lower extremity was 1.17+/-0.11, postoperative 1 week, 6 months, and 1 year was 1.14+/-0.10, 1.15+/-0.11, 1.17+/-0.15, respectively. Alternation of preoperative ABI and postoperative 1 week, 6 months, and 1 year was P=0.331, P=0.864, and P=0.992, respectively. CONCLUSIONS: Alternation of ABI on the ipsilateral lower extremity was not significant in renal transplanted recipients. We recommend a long-term study with more cases.

Factors Affecting the Endoleaks of Endovascular Aneurysm Repair in Infrarenal Abdominal Aortic Aneurysms / 대한혈관외과학회지

PURPOSE: The purpose of this study is to evaluate the factors affecting the endoleaks of endovascular aneurysm repairs in infrarenal abdominal aortic aneurysms. METHODS: On a retrospective basis, we analyzed 122 patients, who underwent endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm between March, 2006 and June, 2011. According to the endoleak, the patients were divided into 2 groups: endoleak group and non-endoleak group. We compared the following variables between the 2 groups: patient clinical characteristics (age, gender, body mass index, history of smoking, hypertension, diabetes mellitus, and coronary artery disease) and anatomical features of the aneurysms. RESULTS: A total of 111 male and 11 female patients were included. Fifty-two patients showed endoleak (42.6%) during follow-up periods (median: 4.6 years). There was no significant difference between endoleak and non-endoleak group according to patient's clinical characteristics and used devices. However, there were significant differences between two groups according to the anatomical features of the aneurysm, such as the morphology, size of the aneurysm, and the size and angle of the neck of the aneurysm. CONCLUSION: Endoleak indicated high frequency when the aneurysm size is large, and when the neck aneurysm is large, with the neck angle being more than 60 degrees. Thus, patients with more than one of the above three characteristics may need more attentive and cautious procedures as well as a closer follow-up.

Evaluation of the Korean Network for Organ Sharing Expanded Donor Criteria in Deceased Donor Renal Transplantation / 대한이식학회지

BACKGROUND: This study was conducted in order to evaluate the propriety of expanded donor criteria in Korea and to identify the preoperative factors influencing allograft survival and function. METHODS: We studied 404 patients who received deceased renal transplants from five transplantation centers of 2, 3 territory from 2000 to 2010. Differences in 1-year graft function, delayed graft function (DGF) rate, and graft survival rate between the standard criteria donor (SCD) and expanded criteria donor (ECD) were compared retrospectively. The preoperative factors influencing graft function and graft survival were analysed. RESULTS: SCD showed significantly better 1-year graft function than ECD (P=0.011). No differences in 1-year acute rejection rate were observed between SCD (13.2%) and ECD (16.9%) (P=0.449). Significantly higher DGF rate was observed for ECD (25.4%) than for SCD (14.1%) (P=0.022). Graft type had no significant influence on 5-year graft survival (SCD 94.5% vs. ECD 93.7%) (P =0.835). Advanced donor age (P=0.001), donor hypertension history (P=0.047), high serum creatinine (P=0.002), and cerebral infarction as cause of death (P=0.004) had a negative influence on 1-year allograft function. Significantly low graft survival was observed for advanced donor age (P =0.002). CONCLUSIONS: Graft function, DGF rates of ECD were poorer than those of SCD. Graft survival rate of ECD was comparable to that of SCD kidney. Korean Network for Organ Sharing expanded criteria may underestimate the organ quality of deceased kidney and modification may be needed in order to expand the potential donor pool through nationwide study.

MicroRNA profiling of tacrolimus-stimulated Jurkat human T lympocytes / 대한외과학회지

PURPOSE: This study investigated the Jurkat T cell line expresses cytotoxicity when treated with different concentrations of FK506, and analyzed the expression pattern of microRNA when stimulated by FK506 using the microRNAs microarray, as well as the expression pattern of a gene that is related to the differentiation, activation and proliferation of T cells after being affected by the change of microRNAs. METHODS: To investigate the effects of FK506 on microRNA expression, we purified total RNA of Jurkat cells treated with 20 microM FK506 for 72 hours and used to analyze microRNA profiling by using Agilent's chip. RESULTS: These results demonstrated that treatment with FK506 markedly induced the down-regulation of 20 microRNAs as well as the up-regulation of 20 microRNAs in a time-dependent manner. The genes that down-regulated by FK506 include let-7a*, miR-20a*, and miR-487a. Otherwise miR-202, miR-485-5p, and miR-518c* are gradually up-regulated in expression. Sanger Institute and DAVIDs bioinformatics indicated that microRNAs regulated the several transcriptomes including nuclear factor of activated T cell-related, T cell receptor/interleukin-2 signaling, and Ca(2+)-calmodulin-dependent phosphatase calcineurin pathways. CONCLUSION: As a result of treating FK506 to a Jurkat cell line and running the microRNA microarray, it was found that FK506 not only took part in the suppression of T cell proliferation/activation by inhibiting calcineurin in Jurkat apoptosis, but also affected the microRNAs that are involved in the regulation of various signal transduction pathways.

Clinical Experiences of Transarterial Embolization after Abdominal Surgery in Trauma Patients / 대한혈관외과학회지

PURPOSE: Transarterial embolization has been known as an effective nonsurgical treatment for selected patients with intraabdominal hemorrhage. This study was conducted to evaluate the clinical outcomes of transarterial embolization after emergency operation in the blunt abdominal trauma patients with hemoperitoneum. METHODS: Between January 2004 and December 2008, a total of 13 consecutive blunt abdominal trauma patients with intraabdominal hemorrhage who received transarterial embolization after abdominal surgery were included. The characteristics, procedures, and the clinical outcomes of patients were analyzed, retrospectively. RESULTS: There were 6 males and 7 females. Age ranged between 21 and 77 years (mean 42.3 years). The most common injured organ was the liver (10 patients, 76.9%), and the most common embolized artery was hepatic artery (8 patients, 61.5%). Transarterial embolizations were intended to control the continued bleeding (9 patients, 69.2%), delayed bleeding (3 patients), and arteriovenous fistula (1 patient). Further, technical success was achieved in all 13 patients. One of 13 patients died of multiorgan failure. No procedure-related complications were observed. CONCLUSION: Angiography has a high detection rate of bleeding sites in patients with intraabdominal hemorrhage after blunt abdominal trauma. Transarterial embolization is considered as an effective and safe method in the management of intraabdominal hemorrhage after abdominal surgery in trauma patients.

Long Term Outcomes for Living Renal Donors / 대한이식학회지

BACKGROUND: Kidney donation is a relatively safe procedure with minimal adverse effects. But some reports have described the development of proteinuria and hypertension in donors after nephrectomy. There have been a number of non-Korean studies which conclude that the procedure is relatively safe and a good quality of life is expected for living donors after kidney transplantation, but not enough of these studies have been published in Korea. We evaluated the physiologic and psychosocial impacts after kidney donation in this study. METHODS: Between April 1988 and April 2010, we performed 201 living donor nephrectomies and obtained information for 88 (43.7%) of the donors. We measured their estimated glomerular filtration rate (GFR), blood pressure, body mass index, hemoglobin and cholesterol level, and assessed the prevalence of hypertension and proteinuria in this group. These donors completed a questionnaire regarding their health status and psychosocial outcomes after donation. RESULTS: The average time of the donor assessment after nephrectomy was 95.05+/-85.45 months (range, 6~261). The left kidney was used in 76 patients (86%). There was a total complication rate of 8%, but no serious complications were observed. Proteinuria was found in 9 patients (10%) and hypertension in 11 patients (11%). GFR decreased from 103.65+/-25.02 mL/min to 76.12+/-19.90 mL/min (P<0.001) and hemoglobin decreased from 13.91+/-1.62 g/dL to 13.01+/-1.72 g/dL (P<0.001). Five patients (6%) developed a post-donation GFR between 40 and 60 mL/min, with 2 patients being observed to have a post-donation GFR below 20 mL/min. In the questionnaire responses, most donors did not report problems affecting routine life or any economic impact. Their donation satisfaction results were very high (92%). CONCLUSIONS: Living kidney donors were observed to result in reduced GFR after nephrectomy. Follow-up visits with living kidney donors is essential in order to monitor risk factors related to the deterioration of their residual kidney function.

Mycophenolic acid mediated mitochondrial membrane potential transition change lead to T lymphocyte apoptosis / 대한외과학회지

PURPOSE: This study demonstrated that apoptosis induced by mycophenolic acid (MPA) is mediated by mitochondrial membrane potential transition (MPT) changes in Jurkat cells. METHODS: Cell viability and MPT changes were measured by flow cytometry. Western blotting was performed to evaluate the expression of Bcl-2 family proteins, Bid, truncated Bid (tBid), cytochrome c, voltage dependent anion channel (VDAC), poly ADP-ribose polymerase (PARP), and protein kinase C-delta (PKC-delta). The catalytic activity of caspase-9 and -3 was also measured. RESULTS: Cell viability was decreased in time- and dose-dependent manners. Bcl-2 protein expression was decreased, but Bax protein expression was identified. A decreased Bcl-XL /Bcl-XS ratio was also noted. The expression of tBid protein also increased in a time-dependent manner in Jurkat cells treated with MPA. While normal MPT appeared as orange fluorescence, abnormal MPT corresponded to green fluorescence. Green fluorescence increased as orange decreased in the MPA-treated cells. Significantly increased concentrations of MPA induced the release of cytosolic cytochrome c. MPA also augmented the catalytic activity of caspase-9 and caspase-3 in Jurkat cells. Our findings demonstrated that MPA-induced apoptosis is mediated by MPT changes accompanied by decreased Bcl-XL expression and the appearance of tBid protein. The release of cytosolic cytochrome c from mitochondria and increased catalytic activity of caspase-9 and caspase-3 were observed in MPA-treated Jurkat cells. CONCLUSION: These results suggest that mitochondrial dysfunction caused by MPA induces human T lymphocyte apoptosis.

Effects of Heme Oxygenase-1 Expression in Mycophenolic Acid Induced Apoptosis of Jurkat Cell Lines

PURPOSE: This study demonstrates that pharmacologic induction of heme oygenase-1 (HO-1) along with catalytic activation significantly modulated apoptosis of Jurkat cells induced by mycophenolic acid (MPA). METHODS: Cells were cultured with the presence or absence of MPA. Flow cytometric analysis was performed after propidium iodide staining. Western blotting of HO-1, Bcl, and Bax was also performed. Cells were stained 4'-6-Diamidino-2-phenylindole (DAPI) and measured by flow cytometry in the absence or presence of CoPPIX. RESULTS: Treatment of MPA decreased cell viability in a dose- and time-dependent manner. MPA-induced cell death was confirmed as apoptosis characterized by sub G0/G1 phase arrest. Expression of HO-1 assumes a pattern of decline after rising at the initial phase. CoPPIX, HO-1 inducer, significantly inhibited the cisplatin-induced apoptosis. Treatment of MPA resulted in reactive oxygen species (ROS) generation in Jurkat cells. CoPPIX attenuated ROS production in MPA-treated cells. CONCLUSION: This result suggests that the protective mechanism of HO-1 on MPA-induced cytotoxicity is associated with direct inhibition of ROS generation and mitochondrial permeability transition.

Clinical Implications of Multiple Endovascular Treatments for Patients with Lower Limb Deep Vein Thrombosis

PURPOSE: The aim of this study is to assess the clinical benefits of endovascular treatment for lower extremity deep vein thrombosis. Particularly, we wanted to define the factors that affect the recurrence of deep vein thrombosis (DVT) after repeated endovascular treatments. METHODS: Eighty six patients who were diagnosed with DVT from January 2003 to December 2008 were retrospectively examined. All the patients were diagnosed by lower extremity computed tomography scanning. Multimodality therapy was performed to achieve primary venous patency. The multimodality strategy included catheter-directed thrombolysis followed by percutaneous transluminal balloon angioplasty and stenting for any residual stenosis. RESULTS: Fifteen patients (17%) underwent repeated endovascular treatment. The onset of symptoms and a history of DVT were the factors that affected the recurrence of DVT. Repeated endovascular treatment showed considerably significant differences for recurrence between the single and multiple groups (28/71 [39.6%] vs. 9/15, respectively, [60%]) and for the mean venous patency duration (29.1 months [confidence interval (CI), 22.6~35.7] vs. 12.4 months, respectively, [CI, 6.7~20.2]) (P=0.001). CONCLUSION: Although multiple endovascular treatment demonstrated a favorable primary outcome, there were no definite benefits of multiple endovascular treatment on the long term follow-up. In the subgroup that has focal remnant thrombus, one more additional endovascular treatments would benefit for the recurred lower extremity deep vein thrombosis.

The Effect of FK506 to Generate Reactive Oxygen Species on T Lymphocyte Death

PURPOSE: Tacrolimus (FK506) has been widely used as an immunosuppressant in organ transplanted recipients to suppress organ rejection phenomenon. We investigated the role of oxidative stress and heme oxygense-1 by FK506 on human Jurkat T cells. METHODS: The cells viability was examined by DAPI stain, enzyme activity of caspase family proteins, and western blotting for Baks, PUMA, iNOS, HO-1. Cells were cultured in the absence or presence of CoPPIX or ZnPPIX and the fluorescence intensity was analyzed using a flow cytometry. RESULTS: Treatment with FK506 increased the generation of reactive oxygen species (ROS), including hydrogen peroxide and superoxide anion, and NO in Jurkat cells in a dose-dependent manner. Immunohistochemistry and Western blot analysis data revealed the hemoxygenase-1 (HO-1) was induced by the addition of FK506 in Jurkat cells. Induction of CoPP, HO-1 inducer, resulted in decreased intracellular H2O2 and NO concentrations. Instead ZnPP, an HO-1 competitive inhibitor did it reversely. In addition, ZnPP regulates iNOS protein synthesis by inhibition of HO-1. CONCLUSION: Increase of HO-1 expression would induce to decrease the intracellular H2O2 and NO concentrations. Also, HO-1 would regulate iNOS protein synthesis. Consequently, we can expect the regulation of HO-1 expression with concomitants use of FK506 to suppress organ rejection phenomenon by enhancing apoptosis.

Apoptosis Gene Expression Pattern Analysis of Jurkat Cells Treated with FK506

PURPOSE: FK506 (tacrolimus) is a widely used immunosuppressive agent in the treatment of various medical conditions, including autoimmune disease, bone marrow and organ transplantations. Previously FK506 was known to cause apoptotic death of human Jurkat T cells. METHODS: The current study was designed to analyze the gene expression pattern of Jurkat T cells after FK506 application by using cDNA microarray. Treatment of Jurkat T cells with FK506 resulted in a decrease of cell viability in a time- and dose-dependent manner. Next, total RNA of Jurkat T cells was extracted by using TRIzol reagent and used to carry out a confirmation test for the purity and integrity of total RNA. RESULTS: Gene expression levels related to apoptosis and cell cycle process were mainly focused to analyze in FK506-treated Jurkat T cells. According to the inhibition of calcineurin activity, MARCKS in PKC substrates and Sp3 transcription factor was markedly increased in FK506-treated cells. Also, cell cycle control gene Id1 and Id3 were induced in expression from FK506-treated Jurkat T cells. However, FK506 decreased the expression of Src homology 2, G protein, and MEK 2 genes in bioactive peptide induced signaling pathway. It also reduced the expression level of the insulin receptor, DRPLA and Bai1-associated protein 2 genes, which are involved in the regulation of cell motility and morphology control. CONCLUSION: The author will continue to pursue the exact functional roles of genes that are markedly changed in expression by FK506 in human Jurkat T cells in vitro and in vivo experimental models.

Chronic Constipation Led to Sigmoid Volvulus in a Child

Sigmoid volvulus is uncommon in children. Chronic constipation rarely leads to sigmoid volvulus. We report the experience of a case of sigmoid volvulus led by chronic constipation in a child. An 11-year-old girl complained abdominal pain and constipation, which had continued for previous 3 years. Under the impression of sigmoid volvulus by simple abdominal x-ray and abdominal computed tomography, emergency colonoscopic reduction of the volvulus tried to fail to the emergency segmental resection of the twisted sigmoid colon. After 3 months of operation, her constipation improved gradually with no other untoward symptoms so far.