The Operative Mortality in Renal Transplant and Dialysis Patient for End-Stage Renal Disease Undergoing Major Abdominal Surgery / 대한이식학회지

PURPOSE: There are steadily increasing number of patients with end-stage renal disease in dialysis and renal transplants. A few reports described the outcome of patients in dialysis those undergoing major abdominal surgery, but in renal transplants such a report has not been reported. METHODS: We reviewed 43 patients who underwent major abdominal surgery including 22 patients undergoing dialysis (dialysis group), 7 patients undergoing dialysis with rejected renal transplants (rejected group), and 14 renal transplant with graft function (transplanted group). RESULTS: Emergency operation was performed in 24 (55.8%) patients : 12 in dialysis group, 5 in rejected group, and 7 in transplanted group, The indication of surgery included malignant disease in 16 (37.2%), bowel perforation in 9 (20.9%), adhesive ileus in 5 (11.6%), gastrointestinal bleeding in 4 (9.3%) and etc. The operative mortality rate was 25.6% (11/43) and developed all in emergency surgery including 2 in dialysis group (9.1% : 2/22), 4 in rejected group (57.1% : 4/11), and 5 in transplanted group (35.7% : 5/14). The most common diseases in operative mortality cases were bowel perforation in 4 and gastrointestinal bleeding in 3, The cause of death were sepsis in 5, and, pneumonia, heart failure, and disseminated intravascular coagulation in 2, respectively. CONCLUSION: The emergency major abdominal surgery in patients with renal transplantation and with rejected renal transplantation patients has high operative mortality rates than that of dialysis patients.

Spontaneous Rupture of Aortoiliac Aneurysm into Left Common Iliac Vein Combined with Gastric Leiomyoma: A case report

The spontaneous rupture of abdominal aorto-iliac aneurysm into inferior vena cava or iliac vein is rare, with a reported incidence of 3% to 4% of all ruptured aneurysm(1,2). This is the most frequent cause of a major abdominal arteriovenous fistula (AVF)(1). We experienced a spontaneous rupture of abdominal aorto-iliac aneurysm into left common iliac vein with gastric leiomyoma in a 64 year-old female patient. The management of abdominal aortic aneurysm with neoplasm of digestive organ is still controversial. We have successfully managed these two lesions by simultaneous operation without any surgical complication. We report the case and briefly review the literature.

The Angiographic Change of Iliac Arteries after Bypass Surgery for the Atherosclerotic Occlusive Disease of Lower Extremity

PURPOSE: In the initiation and progression of the atherosclerosis many factors are related each other. The individual variations also complicate the prediction of the atherosclerotic process. The purpose of this study was to investigate the morphologic changes by angiography in iliac arterial segments of the patients who had received bypass operation for the infrainguinal atherosclerotic occlusive disease of the lower extremities. METHODS: Forty-five common iliac artery (CIAs) and forty-two external iliac arteries (EIAs) in twenty nine male patients who underwent angiography for graft failure of lower extremity bypass surgery was included in this retrospective study, and their clinical chart and angiographic findings of iliac arteries were reviewed. Acute arterial occlusive cases were excluded from this study. The mean interval from the previous bypass surgery was 38.9 months (from 6 to 96 months) and the patient ages ranged from 34 to 81 years (average age 59 years). It was considered as change, that is disease progression, when luminal narrowing of iliac artery was more than 25% compared to the previous angiography at bypass surgery. RESULTS: Of 45, fifteen CIAs (33.3%) showed change. In 3 patients, the change was bilateral; in 4, ipsilateral to the failed graft limb; and in 5, contralateral. Considering EIAs, 13 of 42 (31.0%) were changed. In 1 patient, the change was bilateral; in 6, ipsilateral to the failed graft limb; and in 5, contralateral. Therefore the side of the changed iliac arteries had no statistical significance in relation to the side of limb at which graft failure occurred (P<0.05). There was no significant correlation between age or interval between bypass operation and repeat angiography and the progression of atherosclerosis of iliac arteries. CONCLUSION: The progression of atherosclerosis is not dominated in iliac arteries ipsilateral to the side in which bypass surgery was performed and graft failure occurred. In iliac artery, the short-term progression of atherosclerosis observed by angiography may vary among individuals independently withage, interval between operation and repeat angiography, and the hemodynamic change of the infrainguinal arteries.

Brachio-basilic Arteriovenous Fistula Using Transposed Basilic Vein: An Alternative Vascular Access for Hemodialysis

PURPOSE: Effective hemodialysis for a patient with end-stage renal disease (ERDS) is dependent upon a durable, low-morbidity vascular access. Although It is generally agreed that the distal radiocephalic fistula originally discribed by Brescia and Cimino is the most effective primary access constrruction, no consensus exists regarding primary and secondary alternatives for patients with inadequate of failed rediocephalic prodedures. Many options are available, but the relative value of these alternative operations is unclear. Therefore the place of the basilic vein in secondary acccess construction needs to be assessed. We evaluated if the basilic vein can be used to construct a durable, low-morbidity access. METHODS: A native brachio-basilic arterio-venous fistula with superficial transposition has been performed, for lack of usuable vein on 54 forearm in 47 patients from August 1995 to October 1999 (Male: 15, female: 32) with mean age 51 years (26 to 70 years). RESULTS: The main cause of renal insufficiency were: diabetes 27 (57.4%), hypertensive 19 (40.4%), renal tuberculosis 2 (4.3%) and renal cyst 1 (2.1%). The waiting period before vascular access puncture has been 28 6 days. Eight (17.0%) stenosis has been detected and, forearm and/or hand edema occured in three (6.4%); thrombosis in two (4.3%); bleeding in two (4.3%); pseudoaneurysm in one. Through the follow-up periods of 50 months, the primary patency was 80.9% at 12 months and 78.7% at 24 months. CONCLUSION: The brachio-basilic fistula with superficial transposition of basilic vein is a valuable vascular access for diabetes, female old patients, and can remain an alternative method for even younger patients by avoiding the installation of artificial graft after failed forearm arteriovenous fistula.

The Effect of Anoxia and Reoxygenation on Synthesis of Nitric Oxide, ICAM-1 and VCAM of Umbilical Vein Endothelium

PURPOSE: The reperfusion flowing ischemia are associated with high systemic complication rates and severe local tissue injuries, which are primarily related to the reperfusion process. Anoxia or hypoxia and reoxygenation are principal components of ischemia and reperfusion (I/R) and in I/R injury model endothelial cell injury is known to be a initial event. The purpose of this study is to examine the changes of the levels of nitric oxide (NO), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM) of the cultured endothelial cells following anoxia and reoxygenation. METHODS: Experimental groups were divided into 4 groups: control group, without any treatment; anoxia group (A-G), treatment with anoxic air (93% N2, 5% CO2, 2% H2) for 20 minutes; reoxygenation group (RO-G), treatment with 100% O2 for 90 minutes; superoxide dismutase (SOD) group, treatment with SOD just before reoxygenation. Endothelial cells were isolated from human umbilical vein and cultured in M-199 medium. Using microelectrode and ELISA we studied the time-course changes of the levels of NO, ICAM-1 and VCAM of 4 groups. RESULTS: The concentration of NO in A-G was lower than that of control group (P<0.05). NO concentration of RO-G at 30 minutes reached the highest level of 4809.01 444.69 nM/1 105 cells/ml (P<0.005) and after then decreased. The concentration of ICAM-1 in A-G was higher than that of control group (P<0.005). ICAM-1 concentration of RO-G at 15 minutes reached the highest level of 7.18 0.62 ng/1 105 cells/ml (P<0.005) and then decreased to the lowest level but after 75 minutes increased again. The concentration of VCAM in A-G was higher than control group (P<0.005). VCAM concentration of RO-G at 15 minutes reached the highest level of 5.50 0.55 ng/1 105 cells/ml (P<0.05) and then decreased to the lowest level at 45 minutes, but after 60 minutes the concentration increased again. SOD group showed a little change of NO, ICAM-1 and VCAM concentration comparing with both A-G and RO-G. CONCLUSION: This study showed that endothelial cell function of reoxygenation group decreased significantly compared with anoxia group. In anoxia and reoxygenation group, the levels of two adhesion molecules of ICAM-1 and VCAM increased faster than those of NO and the change of the level of ICAM-1 was more sensitive than that of VCAM. In reoxygenation group SOD treatment could inhibit the changes of the levels of NO, ICAM-1 and VCAM.

The Effect of Anoxia and Reoxygenation on Synthesis of Nitric Oxide, ICAM-1 and VCAM of Umbilical Vein Endothelium

PURPOSE: The reperfusion flowing ischemia are associated with high systemic complication rates and severe local tissue injuries, which are primarily related to the reperfusion process. Anoxia or hypoxia and reoxygenation are principal components of ischemia and reperfusion (I/R) and in I/R injury model endothelial cell injury is known to be a initial event. The purpose of this study is to examine the changes of the levels of nitric oxide (NO), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM) of the cultured endothelial cells following anoxia and reoxygenation. METHODS: Experimental groups were divided into 4 groups: control group, without any treatment; anoxia group (A-G), treatment with anoxic air (93% N2, 5% CO2, 2% H2) for 20 minutes; reoxygenation group (RO-G), treatment with 100% O2 for 90 minutes; superoxide dismutase (SOD) group, treatment with SOD just before reoxygenation. Endothelial cells were isolated from human umbilical vein and cultured in M-199 medium. Using microelectrode and ELISA we studied the time-course changes of the levels of NO, ICAM-1 and VCAM of 4 groups. RESULTS: The concentration of NO in A-G was lower than that of control group (P<0.05). NO concentration of RO-G at 30 minutes reached the highest level of 4809.01 444.69 nM/1 105 cells/ml (P<0.005) and after then decreased. The concentration of ICAM-1 in A-G was higher than that of control group (P<0.005). ICAM-1 concentration of RO-G at 15 minutes reached the highest level of 7.18 0.62 ng/1 105 cells/ml (P<0.005) and then decreased to the lowest level but after 75 minutes increased again. The concentration of VCAM in A-G was higher than control group (P<0.005). VCAM concentration of RO-G at 15 minutes reached the highest level of 5.50 0.55 ng/1 105 cells/ml (P<0.05) and then decreased to the lowest level at 45 minutes, but after 60 minutes the concentration increased again. SOD group showed a little change of NO, ICAM-1 and VCAM concentration comparing with both A-G and RO-G. CONCLUSION: This study showed that endothelial cell function of reoxygenation group decreased significantly compared with anoxia group. In anoxia and reoxygenation group, the levels of two adhesion molecules of ICAM-1 and VCAM increased faster than those of NO and the change of the level of ICAM-1 was more sensitive than that of VCAM. In reoxygenation group SOD treatment could inhibit the changes of the levels of NO, ICAM-1 and VCAM.

Superior Mesenteric Artery Syndrome due to an Abdominal Aortic Aneurysm in a Renal Transplant Recipient

Superior mesenteric artery syndrome (SMAS) is a rare disease and is seldom seen in patients with abdominal aortic aneurysms. We experienced a SMAS as a result of an enlarged abdominal aortic aneurysm in a 52 year-old female patient who had undergone renal transplant in the right iliac position 8 years previously. The abdominal aortic aneurysm was successfully resected without an extracorporeal bypass during crossclamping, and postoperatively the patient's symptoms were improved and her renal function was well preserved.

Hypereosinophilic Syndrome Accompanied by Digital Necrosis

Hypereosinophilic syndrome (HES) is a heterogeneous group of disorders with the common feature of prolonged eosinophilia of unknown cause and associated dysfunctions of organ systems, including the hematologic, cardiovascular, cutaneous, neurologic and respiratory systems, as well as the spleen, liver, eye, and gastrointestinal tract. Bone marrow is involved in almost all subjects, and the most severe complications involve the heart and the central nervous systems. We report a case of HES observed in a 37-year-old man with digital necrosis and persistent eosinophilia lasting for more than 6 months. This patient also showed signs of peripheral neuropathy, cutaneous manifestations, and eosinophilic hyperplasia on the bone marrow biopsy.

A Retrospective Study for the Below-knee Amputation in the Critical Ischemia of Lower Extremity

PURPOSE: To evaluate the role of repetitive vascular surgery in below-knee amputation for critical lower-limb ischemia. METHODS: The data of the 39 below-knee amputee despite receiving one more vascular surgery for critical limb ischemia from Jaunary 1990 through October 1995 were retrospectively reviewed. A total of 102 surgical operation was included. RESULTS: The mean age was 46 years old ranged from 21 through 78 and the forth decade was the most prevalent group by proportion of 33% (13 cases). The frequency of Buerger's disease is 20, and that of atherosclerotic occlusion (ASO), ASO with diabetes, and diabetic arteriopathy (DA) were 11, 4, 3, respectively. The number of operative procedures before amputation and the total mean duration (TMD: days) from initial operation to final amputation for femoral, popliteal and tibial occlusion were 45/485, 26/921 and 13/1725, respectively. Those for Buerger's disease, ASO, ASO with diabetes and DA were 42/960, 25/865, 9.1027, and 7/251 respectively. The proportions of duration between initial vascular procedure and second one in the TMD for the patients of tibial occlusion and ASO with diabetes revealed 95.0% and 98.4%. Smoking revealed shortened the duration until amputation in cases of popliteal artery involvement. CONCLUSION: The frequency of below-knee amputation due to critical limb ischemia is high in Buerger's disease and in the age of fourth decade. Patients of the tibial artery involvement and ASO with diabetes may not have benifits from repetitive operative procedures after initial vascular surgery in postponing the below-knee amputation. More study is needed with incresed number of cases.

Abdominal Aortic Aneurysms in Patients with Confirmed Symptomatic Peripheral Arterial Disease

The early diagnosis of abdominal aortic aneurysms are difficult, especially when they are not clinically evident. Because of the generalized nature of atherosclerosis, there is reason to believe that there is a high incidence of aneurysms of the abdominal aorta in patients with peripheral vascular disease. But the screening test for hidden abdominal aortic aneurysms in patients with peripheral arterial disease has not been used for routine manner. So we retrospectively reviewed the 9 patients who had asymptomatic abdominal aortic aneurysms with symptomatic peripheral arterial disease during the last four and half-year period: among them three aneurysms were screened preoperatively by physical examination with their diameter more than 5 cm and 6 aneurysms were found intraoperatively with their mean diameter of 3.8 cm. The ages ranged from 66 through 84 years with the mean age 73 years. There were 7 men and 2 women. The sites of the peripheral occlusive disease is as follows: femoral artery only in 1, iliac artery only in 2, both iliac and femoral arteries in 5, and from iliac artery through tibial artery with thrombus formation in 1. We suggest that ultrasonographic screening for the presence of hidden abdominal aortic aneurysm preoperatively in patients with lower extremity occlusive arterial disease is needed, especially when the ages of patients is older than 65 years and the site of arterial disease include iliac segment.

Protective Effect of Tacrolimus and Prostaglandin E1 in Ischemia-Reperfusion Injury of Rat Livers

BACKGROUND: Liver ischemia and reperfusion injury is associated with activation of several inflammatory pathways including cytokines, tumor necrosis factor (TNF) and cell-mediated tissue damage. tacrolimus causes a regulatory effect on some inflammatory pathways, such as cytokines, TNF, adhesion molecule and inflammatory cells. Prostaglandin E1 (PGE1) has shown vasodilatation by relaxing vascular smooth muscles and inhibits the effect of proinflammatory cytokines which could reduce leukocyte- sinusoidal and platelet-sinusoidal interactions. METHODS: Liver ischemia was induced in rats by occluding the vessels, the supplying median segment, and the left lateral segment with an aneurysmal clip for 60 minutes. The rats received tacrolimus (0.5 mg/kg, tacrolimus group) or PGE1 (100 ug/kg, PGE1 group) or normal saline (Control group) 30 and 5 minutes before ischemia and reperfusion of the liver, respectively. The serum ALT, nitric oxide, and TNF were determined at 1, 24, and 48 hours after reperfusion, and hepatic necrosis was determined at the same times by using HE staining and a microscopic grading system. RESULTS: 1) In the control group, the serum ALT and TNF levels had peak values at 1 hour and were gradually decreased, but the serum nitric-oxide level was gradually increased after the time of reperfusion (p<0.05). No necrosis existed at in one hour, but the tissue necrosis at 24 hours was higher than that at 48 hours (p<0.05). 2) At one hour, the tacrolimus group had significantly lower serum ALT and TNF levels and a higher serum nitric-oxide level in the liver compared with the control group, but the serum nitric-oxide level did not change significantly after reperfusion (p<0.05). The extent of hepatic necrosis was significantly inhibited in the tacrolimus group when compared with that in the control group and the PGE1 group (p<0.05). 3) The PGE1 group exhibited improved hepatic necrosis compared with the control group (p<0.05). The improved hepatic necrosis was reflected in reductions of the serum ALT and TNF and an increase in the serum nitric-oxide level. CONCLUSIONS: These result suggest that tacrolimus and PGE1 protect the liver against ischemia- reperfusion injury by reducing the serum TNF level and increasing the serum nitric-oxide level. The protective effect of tacrolimus is more beneficial than that of PGE1.

Iliac Vein Compression Syndrome: 4 Case

Iliac vein compression syndrome is a rare clinical condition in which left common iliac vein is anatomically compressed between right common iliac artery and the fifth lumbar vertebrae or pelvic brim. Patients usually have marked edema of the left leg. Although the actual incidence is unknown, this syndrome most affects women in the second to fourth decade of life. We report 4 cases of iliac compression syndrome treated by surgical intervention during the last fifteen-year period. Among them, two women have suffered from chronic intermittent swelling and pain of left leg, and two men had acute or subacute symptoms. The fibrous web in the entrance of left iliac vein into vena cava existed in one case. Including this one, two were treated by transposition of iliac artery or vein with thrombectomy. One was decompressed the arterial compression by mobilization or adhesiolysis of the surrounding vessles with thrombectomy. To the last one in which the distal common iliac vein was compressed by tortous dilated left internal iliac artery, transsection and ligation of the internal iliac artery was performed. All patients have experienced improved left leg condition after operation. except the last one in which suffered from thrombosis of left popliteal vein after the iliac decompression.

A Retrospective Sudies about the Total Serum Cholesterol Level and Smoking Status in Atherosclerotic Arterial Occlusive Disease of the Lower Extremities

Many investigations about the development and progression of atherosclerosis have reported that hypertension, diabetes mellitus, serum lipids levels and somking status are major risk factors to the atherogenesis of peripheral arteries in Western countries. But the intensities of these epidemiological factors on atherogenesis are not supposed to be equal in oriental population owing to the different pattern of food intake or genetic factors. The aim of this study was to determine how the level of serum lipids and smoking status among the risk factors would be related with the presence of the atherosclerotic occlusive disease of lower extremity. 89 male patients with this disease were included in this study and same numbers of male surgical patients without peripheral arterial occlusive symptoms was used as control group. The levels of serum lipids (total-cholesterol and trglyceride) and smoking status were investigated retrospectively. The results were as follows. 1) serum total-cholesterol levels were higher in disease group than that of the control group (163.3+/-4.63 S.E. vs. 153.3+/-6.10 S.E.), but there was no statistical significance(P>0.05). 2) serum triglyceride levels were significantly higher in disease group than that of control group (148.5+/-11.0 S.E vs. 109.9 +/-.59 S.E., P<0.05 ANOVA). 3) the rate of smoking in disease group was 85.4% (76/89) which was significantly higher than that of the control group, 37.1% (33/89) (P<0.05, Chi-square test). These findings suggested that in our disease population studied, smoking has more strong impact on the development of atherosclerosis of lower extremity than serum total-cholesterol level.

Renal Artery Aneurysms: Report of 8 cases and review of literature

Renal artery aneurysm is a rare disease and a uniommon cause of renovascular hypertension. The estimated incidence of renal artery aneurysm in the normal population varies from 0.09% to 0.3%. Eight renal artery aneurysms that we experienced between February 1986 and January 1998 were reviewed. All were saccular including one iatrogenic pseudoaneurysm after balloon angioplasty for fibromuscular renal artery stenosis. The ages ranged from 20 through 66 years with the mean age of 42 years and there was no difference in sex distribution. Of the 8 patients, 6 were diagnosed on the basis of arteriography, 1 on the basis of computed tomography, and 1 at a urologic surgery. There was no aneurysm ruptured spontaneously. The aneurysm size ranged from 1.5 cm through 12.5 cm with the mean size of 4.1 cm, but 7 aneurysms were not greater than 5 cm in size. In 4 patients (50%) the aneurysm were calcified. Only four had symptoms such as pain or discomfort on trunk. 2 patients had associated renovascular hypertension. 5 patients (63%) underwent operation i.e. 3 arterial reconstruction and 2 nephrectomy that was inevitable due to complicated location or surrounding adhesion enough to unappreciable of vascular reconstruction. One associated hypertension was cured with operation, another renovascular hypertention was not resolved by operation. There was no operative mortality. This study reveals that the saccular type is predominant and spontaneous rupture is uncommon feature in renal artery aneurysm.

The Expression of c-erbB-2 and CD44 Gene in Breast Cancer / 대한암학회지

PURPOSE: There are some controversial opinions on the prognostic value of metastasis- associated tumor markers in breast cancer. Out of them, the overexpression of c-erbB-2 proto-oncogene or CD44 gene has been debated on their activities in promoting metastatic potential. MATERIALS AND METHODS: To detennine the relationship between expression of these genes, and, clinicopathological parameters and disease outcomes including relapse and survival, 48 archival paraffin-embeded breast-cancer tissues were stained using monoclonal antibody against each gene product by immunohistochemical staining method, and the result was analyzed. RESULTS: The positive expression rates of c-erbB-2 and CD44 genes were 45.8% and 18.8%, respectively. The expression rates of both genes were 14.6% and 50% of cases showed no expression of either gene. Except the statistically significant positive correlation between CD44 and tumor size (P=0.003), the expression of c-erbB-2 or CD44 expression had no significant relationship with tumor size, stage, lymph node status, and disease recurrence (P>0.05). In the positive expression cases for CD44, disesase-free survival (DFS) and overall survival (OS) in months were shorter than the negative ones (53+/- 8 vs. 64+/-5 and 67+/-8 vs. 77+/-5 S.E.). And, the c-erbB-2 positive cases had longer OS than the negative ones (78+/- 6 vs. 71+/- 6). The OS of positive co-expression cases with the c-erbB-2 and CD44 was shorter than that of one-gene expression ones (66+/- 6 vs. 75+/-7). Thus the OS result observed in the expression of c-erbB-2 alone was reversed in the co-expression study. Though these results had no statistically significant level (P> 0.05). CONCLUSION: We suggest a question if there is any interaction or dependency between c-erbB-2 and CD44 expression in view of disease process including OS. Finally, further randomised controlled studies are advisable for the reproducible and significant results.

The Expression of c-erbB-2 and CD44 Gene in Breast Cancer / 한국유방암학회지

There are some controversial opinions on the prognostic value of metastasis-associated tumor markers in breast cancer. Out of them, the overexpression of c-erbB-2 proto-oncogene or CD44 gene has been debated on their activities in promoting metastatic potential. To determine the relationship between expression of both genes, and, clinicopathological parameters and disease outcomes including relapse and survival, 48 archival paraffin-embedded breast-cancer tissues were stained using monoclonal antibody against each gene product by immunohistochemical staining method, and the result was analyzed. The positive expression rates of c-erbB-2 and CD44 genes were 45.8% and 18.8%, respectively. The co-expression rates of both positives and both negatives were 14.6% and 50.0%, respectively. Except the statistically significant positive correlation between CD44 and tumor size (P=0.003), the expression rates of c-erbB-2 and CD44 had no significant relationship with tumor size, stge, lymph node status, and disease recurrence (p>0.05). In the positive expression cases for CD44, disease-free survival (DFS) and overall survival (OS) in months were shorter than the negative ones (53+/-8 vs. 64+/-5 and 67+/-8 vs. 77+/-5 S.E.) And, the c-erbB-2 positive cases had longer OS than the negative ones (78+/-6 vs. 71+/-6). The OS of positive co-expression cases with the c-erbB-2 and CD44 was shorter than that of one-gene expression ones (66+/-6 vs. 75+/-7). So the OS result observed in the expression of c-erbB-2 alone was reversed in the co-expression study. Though these results had no statistically significant level (p>0.05), we suggest a question that if there is any interaction or dependency between c-erbB-2 and CD44 expression in a view of disease process including OS. Finally, further randomized controlled studies are advisable for the reproducible and significant results.

Clinical Review of the 12 Inflammatory Aneurysms

The optimal management of inflammatory aneurysm is still a matter of controversy, especially in surgical aspect. The disease is a infrequent entity and without surgical intervention, usually lead to uncontrolled sepsis or catastrophic hemorrhage. We report 12 cases of inflammatory aneurysms those admitted and were managed at Kangnam St. Mary's hospital during 6 years from April, 1991 through April, 1997. The medical records and dermographical datas of these patients were reviewed. Of these 12 patients, ten were male and three were female in age range from 37 through 80 years with a mean of 60 years. The diagnosis was mainly based on operative findings with aids of radiological and microbiological evidences. The number of location of involved arterial segments were 4 of thoracic aorta, 1 of suprarenal abdominal aorta, and 7 of infrarenal abdominal aorta including 2 of common iliac arteries. The main symptoms of these patients were abdominal or chest pain in 11 according to the location of the involved arterial segments, back pain in 6, fever and chillness in 8. The incidence of suspicious infected microorganisms of the patients, not of the credible direct cause of aneurysm itself, were 3 of Salmonellosis in Widal test, 2 of tuberculosis in AFB or sputum culture, 2 of G(-) bacilli in blood culture, and 1 of syphilis in FTA-ABS . 8 patients were operated by substituting the diseased arterial segments with artificial graft and 4 patients were medically managed. Of the 8 patients operated, one died within 48 hours after operation by sepsis. 7 patients were discharged by ambulation. In the 4 medically treated patients, one expired in hospital and three were discharged hopelessly. 7 patients those discharged after operation has been managed in out-patient department.

A case of Late Occlusion of Femoro-Post Tibial PTFE Graft due to Ectopic Bone Formation

The ectopic bone formation is a condition in which mature lamellar bone is formed in tissues that do not normally ossify, which was first described by Riedel in 1883. It has been observed at sites of chronic infection, hemorrhage, fibrous scarring or contracture. The pathophysiology of ectopic bone formation is not clearly identified but has complex and multifaceted causes, which resulted to differentiate the non-circulating pluripotent mesenchymal cells to osteoblastic stem cells. The local environment conditions of trauma, disruption of soft tissues and periostium, bone debris, hematoma, damaged muscle, uncommitted fibroblasts are suspected to be one of the causes of this condition. Comparing to simple soft tissue calcification, the ectopic bone has all the morphologic and biochemical characteristics of orthotopic bone, which is subjected to turnover and even has the ability for bone marrow formation. A case of late occlusion in a femoro-post. tibial PTFE graft about 5 months after vascular reconstruction due to ectotopic bone formation, which is confirmed by pathology around the graft is presented. After excision of the ectopic bone around the inflow vascular anastomosis site with re-vascularization, the patient was free from the ischemic leg symptoms. We reported a case of occlusion of vascular anastomosis site by ectopic bone formation with review of literature.

Point mutation of c-K-ras oncogene and p21 protein expression of v-K-ras & v-H-ras of dimethylhydrazine-induced colon cancer in rats / 대한암학회지

No abstract available.