Safety and Efficacy of Aspiration Thrombectomy or Pharmacomechanical Thrombectomy after Catheter-Directed Thrombolysis for the Treatment of Acute Iliofemoral Deep Vein Thrombosis

Purpose@#To evaluate the safety and efficacy of additional aspiration thrombectomy (AT) or pharmacomechanical thrombectomy (PMT) after catheter-directed thrombolysis (CDT) for the treatment of acute iliofemoral deep vein thrombosis (AIFDVT). @*Materials and Methods@#Between May 2017 and December 2018, 40 patients with AIFDVT were enrolled. Twenty underwent AT after CDT (CDTAT), while the remaining 20 underwent PMT using an AngioJet TM device after CDT (CDTPMT).Thrombus clearance was assessed using computed tomography venography at 1 week after the procedure, as follows: grade I, ≤50%; grade II, 51% to 75%; grade III, >75%. Grade III was considered a successful outcome. Treatment outcomes (thrombus clearance, thrombolytic therapy duration, urokinase dose, major complications, residual filter thrombosis, and Villalta score) were compared between the groups. @*Results@#Successful thrombus clearance was achieved in 95% of the patients in both groups. Significant decreases in the thrombolytic therapy duration (P=0.018) and urokinase dose (P=0.014) were noted in the CDTPMT group. Major complications were not noted in both groups. Residual filter thrombi >10 mm were found in 6 filters in the CDTAT group and in 1 filter in the CDTPMT group (P=0.038). The Villalta scores at 6 months were 1.47±1.24 and 1.12±0.92 in the CDTAT and CDTPMT groups, respectively (P=0.372). @*Conclusion@#Both methods may be safe and effective management options for patients with AIFDVT. CDTPMT can reduce urokinase dosage, time and remained filter thrombus compared to CDTAT. Studies conducted in the future should compare the effects of overnight CDT followed by PMT with those of single-session PMT on patients with AIFDVT.

Surgical Removal of the Inferior Vena Cava Filter Using Minimal Cavotomy: A Case Report

The use of retrievable inferior vena cava (IVC) filters has markedly increased in the recent years. However, the failure rate for the retrieval of the IVC filters using the endovascular method is reported to be up to 19%. Open surgical removal of the IVC filters is technically challenging and may require longitudinal cavotomy, clamping, and repair of the IVC. Here, we present a case of successful open surgical removal of the IVC filter using minimal cavotomy. This technique is an effective method after a failed endovascular removal attempt.

The Advantage of Common Femoral Endarterectomy Alone or Combined with Endovascular Treatment

PURPOSE: Although common femoral artery endarterectomy (CFAE) is regarded as the standard treatment modality for common femoral artery (CFA) disease, availability of advanced endovascular techniques has resulted in an increased number of CFA disease being treated. We evaluated clinical outcomes in a contemporary series of patients who were treated for CFA disease using endarterectomy alone or combined with endovascular treatment. MATERIALS AND METHODS: We retrospectively reviewed 46 patients from November 2001 through December 2007. The treated lesions were divided into 4 groups based on operative procedure: group I (n=11), CFAE alone; group II (n=15), CFAE and iliac artery (IA) endovascular treatment; group III (n=6), CFAE and superficial femoral artery (SFA) endovascular treatment; group IV (n=14), CFAE and IA and SFA endovascular treatment or bypass surgery. RESULTS: The degree of CFA steno-occlusion was not different among the groups. The 3-year primary patency rates of each group were 88.9±10.5%, 60.0±14.5%, 62.5±21.3%, and 83.9±10.4%, respectively. The 3-year primary assisted patency rates were 100%, 70.0±13.0%, 62.5±21.3%, and 89.3±10.4%, while 3-year secondary patency rates were 100%, 80.0±13.0%, 62.5±21.3%, and 92.3±7.4%, respectively. There was no procedure-related mortality. Significant improvement of ankle-brachial index was achieved in all groups. CONCLUSION: CFAE alone is the treatment of choice for excellent patency and clinical improvement in steno-occlusive lesions confined to the CFA. In multiple steno-occlusive diseases, this procedure could be combined with endovascular procedures to reduce the operative risk in conditions with high morbidity.

Management of inferior vena cava thrombosis after blunt liver injury

Inferior vena cava (IVC) thrombosis after traumatic liver injury is an extremely rare condition, and only 12 cases have been reported in the English literature since 1911. We report a case of a 26-year-old man who presented with IVC thrombosis after blunt liver injury. IVC thrombosis was incidentally detected by computed tomography 15 days after conservative management of blunt liver injury. The patient denied any symptoms of thrombophlebitis and did not have any evidence of hypercoagulable state. We placed an IVC filter via the right jugular vein and started the anticoagulation treatment. The patient recovered successfully without operative treatment and IVC thrombosis disappeared completely two months later. We suggest that that the possibility of IVC thrombosis should be considered in patients with a large hematoma of the liver, which may cause compression of the IVC.

Comparison of Functional Gene Annotation of Toxascaris leonina and Toxocara canis using CLC Genomics Workbench

The ascarids, Toxocara canis and Toxascaris leonina, are probably the most common gastrointestinal helminths encountered in dogs. In order to understand biological differences of 2 ascarids, we analyzed gene expression profiles of female adults of T. canis and T. leonina using CLC Genomics Workbench, and the results were compared with those of free-living nematode Caenorhabditis elegans. A total of 2,880 and 7,949 ESTs were collected from T. leonina and T. canis, respectively. The length of ESTs ranged from 106 to 4,637 bp with an average insert size of 820 bp. Overall, our results showed that most functional gene annotations of 2 ascarids were quite similar to each other in 3 major categories, i.e., cellular component, biological process, and molecular function. Although some different transcript expression categories were found, the distance was short and it was not enough to explain their different lifestyles. However, we found distinguished transcript differences between ascarid parasites and free-living nematodes. Understanding evolutionary genetic changes might be helpful for studies of the lifestyle and evolution of parasites.

Early experience of thoracic endovascular aortic repair: a local single hospital experience / 대한외과학회지

PURPOSE: The purpose of this retrospective study was to evaluate the short- to mid-term results of thoracic endovascular aortic repair (TEVAR) in Wonkwang University School of Medicine & Hospital. METHODS: Between February 2009 and May 2011, 8 consecutive patients had undergone endovascular stent-grafting for thoracic aortic diseases. Five patients were treated for traumatic thoracic aortic injuries, two patients were treated for thoracic aneurysms and one patient was treated for a pseudoaneurysm due to penetrating aortic ulcers. Attempted stent-graft deployment was performed electively in 6 patients and emergently in 2. Follow-up was performed at 1-month, 6-month, 1-year, and annually thereafter. RESULTS: Technical success rates were achieved in 87.5% and the 30-day mortality rate was 0%. Mean hospital length of stay after TEVAR was 30 days in traumatic thoracic aortic injuries and 10 days in thoracic aneurismal diseases. Intra-operative Type I endoleak due to migration at deflation was visualized in 1 patient, which was treated by insertion of another stent-graft. During follow-up, a major complication was encountered in one patient who received carotid-subclavian bypass to relieve left arm ischemia. After 5 months he was treated with arch replacement for aortic arch aneurysm with type I endoleak at proximal site after endovascular treatment. The 30-day mortality rate was 0%. However, 1 case of mortality (12.5%) was observed during the follow-up period. CONCLUSION: The short and mid-term results of endovascular repair of thoracic aortic diseases are promising. TEVAR is an effective procedure in the management of thoracic aortic diseases.

Isolation of Genes Specifically Expressed in Different Developmental Stages of Pleurotus ostreatus Using Macroarray Analysis

The oyster mushroom (Pleurotus ostreatus) is one of the most important edible mushrooms worldwide. The mechanism of P. ostreatus fruiting body development has been of interest both for the basic understanding of the phenotypic change of the mycelium-fruiting body and to improve breeding of the mushrooms. Based on our previous publication of P. ostreatus expressed sequence tag database, 1,528 unigene clones were used in macroarray analysis of mycelium, fruiting body and basidiospore developmental stages of P. ostreatus. Gene expression profile databases generated by evaluating expression levels showed that 33, 10, and 94 genes were abundantly expressed in mycelium, fruiting body and basidiospore developmental stages, respectively. Among them, the genes specifically expressed in the fruiting body stage were further analyzed by reverse transcription-polymerase chain reaction and Northern blot to investigate temporal and spatial expression patterns. These results provide useful information for future studies of edible mushroom development.

Laparoscopic Partial Nephrectomy: An Useful Method of Decision Making for Determining the Approach and Surgical Method Based on the Systematic Classification of Tumor Location / 대한비뇨기과학회지

PURPOSE: Laparoscopic patial nephrectomy is still one of challenging surgeries in laparoscopic urologic field and needs skillful technique of surgeons. When performing laparoscopic partial nephrectomy, initial plan of how to approach affects the whole course of the surgery. To propose a systematic decision guideline, we used the tumor location as the determining factor for selecting initial plan and analyzed our initial experience. MATERIALS AND METHODS: From September 2005 to April 2008, we performed 22 LPNs for small renal tumors less than 40mm in diameter, as measured from the preoperative computed tomography scans. We divided the tumor locations into 18 categories with the combinations of the anterior and posterior renal axes, and the upper, middle, lower parts of the kidney and the peripheral, central and hilar locations of the tumor. According to the tumor location categories, we performed LPNs through the retroperitoneal simple and complex approaches, and the transperitoneal simple and complex approaches. RESULTS: Twenty of twenty-two tumors(91%) were removed successfully through 4 different approaches, but 2 cases were converted to laparoscopic radical nephrectomies(LRNs). The mean operation time was 203 minutes, including a mean warm ischemic time(WIT) of 30.7 minutes. Among the 17 cases of RCC, 15 tumors were successfully removed via LPNs, and there were no cases with positive margins and no tumor recurrence during a mean of 14.9 months follow-up with a maximum follow-up period of 34 months. CONCLUSIONS: Dividing the tumor location into 18 categories is useful for deciding on the appropriate laparoscopic approach.

Effect of Casing Layer on Growth Promotion of the Edible Mushroom Pleurotus ostreatus

Various bacteria were isolated from the casing layer soil of the culture bed of P. ostreatus and their role in fruiting body induction of the edible mushroom, P. ostreatus, was investigated. Analysis of the bacterial community isolated from the casing layer soil revealed that the composition of genera and number of cultivable bacteria were different for each sterilizing treatment. Bordetella was predominant in the bulk soil whereas Flavobacterium was predominant after sterilization of the casing layer soil. Fluorescent Pseudomonas was predominant in the non-sterilized casing layer soil. Total number of the bacterial genera in the casing layer soil was higher than that in the bulk soil. In particular, an increase in the fluorescent Pseudomonas population was observed in the non-sterilized casing layer accompanied by induction of fruiting body and enhanced mushroom production yield. The results suggested that specific bacterial populations in the casing layer play an important role in the formation of primodia and the development of basidiome in P. ostreatus.

Analysis of Nursing Interventions Performed by Chosunjok Nurses in Yanbian Using NIC / 간호학회지

PURPOSE: To identify nursing interventions performed by Chosunjok nurses in Yanbian using NIC. METHODS: The sample consisted of 36 nurses working in 2 hospitals. The Nursing Interventions Use Questionnaire developed by the Iowa Intervention Project team was used for data collection. The instrument was translated to Korean using the method of back-translation. RESULTS: Twenty-eight interventions were performed at least daily. Interventions in the Physiological: Basic domain were most frequently used at least daily. The most frequently used interventions was Positioning, followed by the interventions Pressure Ulcer Prevention, Intravenous (IV) Therapy, Hypothermia Treatment and Intravenous (IV) Insertion. The least frequently used interventions was Electronic Fetal Monitoring: Antepartum. Nurses working in special medical care units performed interventions most often, while nurses working in general surgical units performed them least. Nurses working in general medical, special medical and other care units performed interventions in the Physiological domain more often than the nurses working in general surgical units. CONCLUSION: Chosunjok nurses in Yanbian performed physiological interventions frequently. Further studies will be needed to compare interventions performed by nurses in two countries.

Do the family physicians having their clinic in seoul want to join in education for students and resident

BACKGROUNDS: The education by the family physician. is important for more practical primary care medicine education. In this study, we try to know the presnent state of education and the future and the number of education resource and how to multiply this resource. METHODS: we have got the list of family physicians who have their clinic in Seoul by the help of the Korean Academy of Family Medicine. And we performed telephone questionary. We also asked the demographic factors RESULTS: 134 persons were asked questionary by the telephone. 17persons were joining in education. Trainee by the 3rd grade hospitals was the major, the next was by 2nd grade hospital, and doctors who did not have the training. 14 persons have begun education by asking of the training hospital, 3 persons wanted it, but none thought it beneficial to them. 44 persons wanted to join education in the future, and there was no difference between the 3rd and the 2nd grade hospital trainee. CONCLUSION: There was no difference between the 3rd and 2nd grade hospital trainee but 2nd grade hospital trainee was less joining than the 3rd. This shows that the 2nd grade hospital trainee can be the good pool of the future education if there are adequate supply. So many adequate supply is necessary.

Follow-up examination of atypical squamous cells of undetermined significance and low grade squamous intraepithelial lesion

BACKGROUND: The New Bethesda System terminology has opened a series of problems about the atypical squamous cells of undetermined significance and low grade squamous intraepithelial lesion categories, particularly on their follow up. METHODS: We observe 12300 Pap smear examination, from jan 1995 to Dec 1999, in the Health promotion Center in a university hospital. Subjects were defined a the Health Promotion Center in a university hospital by electrical record and chart review. RESULTS: We find 48 cases of ASCUS and 33 cases of LSIL. When it is followed up by Pap smear, 34 cases of ASCUS are confirmed normal 19 cases(55.9%), benign cellular change 6 cases(17.6%), ASCUS 5 cases(14.7%), HSIL 4 cases(11.8%) and 27 cases of LSIL are confirmed normal 11 cases(40.7%), benign cellular change 3 cases(11.1%), ASCUS 3 cases(11.1%), LSIL 8 cases(29.6%), HSIL 2 cases(7.4%). 14 cases of ASCUS and 23 cases of LSIL are diagnosed by biopsy. Hostologic results of 14 cases of ASCUS are confirmed cervicitis 10 cases(71.4%), Moderate dysplasia 2 cases(14.3%), carcinoma in sute 2 cases(14.3%) and histologic results of 23 cases of LSIL are confirmed cervicitis 15 cases(65.2%), mild dysplasia 3 cases(13%), moderated dysplasia 3 cases(13%), sever dysplasia 1 cases(4.3%), carcinoma in situ 1 case(4.3%). Pap smear only was used for follow-up at family medicine clinic and 14 cases(29.2%), 4 cases(12.1%) are follow-up loss. CONCLUSION: After it is diagnosed ASCUS or LSIL Lesion of Pap smear in healthy care visitors, Follw-up loss is high in only follow-up Pap smear examination and follow-up results are presented more we severe lesions. To reduce follow-up loss, aggressive diagnosis and managements may be needed more than Pap smear follow-up examination.