The academic trend of Oriental Medicine during the Japanese colonial period as observed through the publication of medical books / 의사학

This thesis examines the academical trend of Oriental Medicine in the Japanese colonial period observed through medical books published during the Japanese colonial period. This is a period in which Western Medicine was introduced, and due to the lean-to-one-side policy by the Japanese, Western Medicine became the mainstream medical science while Oriental Medicine was pushed to the outskirts. Even after all this, the academic activity was flourishing during this period compared to any other periods. This article is divide into various chapters each with its own theme in order to understand the academic trend of Oriental Medicine during the Japanese colonial period. Focusing on the publication of medical books, this article is divided and observed according to various themes such as the study of Dong-Eui-Bo-Gam, the study of Bang-Yak-Hap-Pyeun, the study of Sang-Han-Ron, the study of Sa-sang constitutional medicine, the study of Eui-Hak-Ip-Mun, the study about Bu-Yang-Ron, On-Bo-Ron, and pediatrics, compromise between Western and Oriental Medicine, the study of experience medicine, the study of acupuncture and moxibustion, and etc.

A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features

Malignant insulinoma in the beta cells of the pancreatic islet is rare and usually presented as hypoglycemia. We report a case of large malignant insulinoma in a 53-year-old Korean woman. A presumptive clinical diagnosis was made before surgery, based on the high plasma insulin-to-glucose ratio and a large solitary heterogeneous pancreatic mass by abdominal computed tomography and endosonography. The tumor measured 5.8X4.7X4.5 cm in dimension and showed capsular invasions and metastases in two of four peripancreatic lymph nodes. The tumor cells were strongly immunoreactive to insulin and had a high Ki-67 labeling index (13%) and atypical membranous electron-dense granules, ranging from 120 to 400 nm in diameter, in the cytoplasm on electron microscopy. The patient was treated by distal pancreatectomy with splenectomy and rapidly recovered without neurohypoglycemic symptoms. This case showed not only lymph node metastases, the most reliable parameter for malignancy in pancreatic endocrine tumors, but also other valid diagnostic clues, such as high Ki-67 labeling index, heterogeneous enodosonographic findings, capsular invasions with large tumor and pure atypical secretory granules.

The effect of upper gastrointestinal endoscopy using conscious sedation with propofol / 대한내과학회지

BACKGROUND: Propofol can be used to provide general anesthesia or sedation. The objectives of this study were to assess propofol as sedative agents for outpatient GI endoscopy, amnestic effects, hemodynamic state and oxygenation during the procedure. METHODS: From April and June 2000, 50 patients scheduled outpatient gastrointestinal endoscopy were enrolled in this study. 30 healthy outpatients requesting sedation at diagnostic gastroscopy were received a bolus dose of propofol 2.5 mg/kg and compared with 20 patients with non-sedation. Pulse rate, blood-pressure and arterial oxygen saturation was monitored. RESULTS: Statistically significant decrease in arterial oxygen saturation were observed since 5 min after endoscopy in patients receiving propofol (p=0.006). Patients receiving sedative endoscopy, pulse rate during endoscopy was significantly increased compared with propofol group (p=0.009). Patients receiving propofol are more tolerable than patients with non-sedative endoscopy (p=0.001), therefore all patients receiving propofol wanted the same sedative endoscopy in their next endoscopy. CONCLUSION: Propofol is believed to be a useful, safe sedative agent for upper gastrointestinal endoscopy with satisfactory sedation and conditions. However, due to its untoward effect of hypoxia, careful monitoring is recommended.

A case of mesenteroaxial type of acute gastric volvulus associated with diaphragmatic eventration / 대한내과학회지

Acute gastric volvulus is extremely rare emergency surgical condition by abnormal rotation of stomach. It presents a puzzling picture which makes early diagnosis difficult, yet surgical interference must be accomplished early if life is to be saved. Gastric volvulus can be classified anatomically as organoaxial or mesenteroaxial. The symptoms triad of gastric volvulus are severe nausea with a paradoxical inability to vomiting, localized epigastric pain and impossibility of introducing a gastric tube. The diagnosis of it may be suspected on plain radiographic examination of the abdomen and symptoms, it is confirmed by specific findings on the upper gastrointestinal series. We experienced a case of mesenteroaxial type of acute gastric volvulus associated with diaphragmatic eventration. We treated this patient with reduction of volvulus, repair of diaphragmatic eventration, gastrojejunostomy and gastropexy. The authors report this case with a brief review of recent literatures.

Expression of p27(Kip1) in gastric cancers and precancerous lesions / 대한내과학회지

BACKGROUND: The cyclin-dependent kinase inhibitor p27(Kip1) is a negative regulator of cell cycle progression at G1/S transition. Recently, the expression level of p27(Kip1) was decreased in many cancers such as breast, pituitary gland, colon and stomach. We studied the expression of p27(Kip1) in gastric cancers, precancerous lesions and normal gastric tissues and analysed its correlation to clinicopathologic data including tumor differentiation, tumor depth, nodal and distant metastasis in gastric cancers. METHODS: p27(Kip1) were immunohistochemically stained in the tissue specimens of 62 resected cancers, 110 corresponding adjacent non-neoplastic tissues, 22 gastric adenomas and 10 normal gastric tissues. Adjacent non-neoplastic tissues consisted of 32 chronic gastritis, 29 intestinal metaplasia and 49 transitional mucosa. RESULTS: Gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with non-neoplastic lesions and adenomas. Labeling index of p27(Kip1) were more decreased in chronic gastritis, intestinal metaplasia and transitional mucosa than in normal mucosa. Early gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with advanced gastric cancers. In gastric cancers, p27(Kip1) labeling index was significantly decreased in diffuse type and presence of nodal metastasis however did not show relationship with distant metastasis and tumor depth of advanced gastric cancers. CONCLUSION: We suggest that p27(Kip1) may be decreased in the early stage of gastric carcinogenesis and play an important role in the progression and differentiation of gastric cancers. More further studies are thought to be necessary in order to evaluate its prognostic factor in gastric cancers.

A clinical study of patients with acute liver injury caused by herbal medication in Gyeongju area / 대한내과학회지

BACKGROUND: The prevalence of acute viral liver injury is decreasing, but drug induced liver injury by herbal medicine and health foods is on an increasing trend after introduction of vaccination. Nevertheless, there is no consensus of diagnostic method and causality assessment for acute liver injury. Therefore, the cause, clinical features, prevalence and pattern of acute liver injury caused by herbal medicine and health foods in Gyeongju area were analyzed. Moreover, Council for International Organization of Medical Science (CIOMS) scale and Maria and Victorino (MandV) scale, clinical scales for causality assessment in hepatotoxicity were compared. METHODS: 78 patients in whom there was definite evidence of taking medicine and there was one more increase of over 2N (upper limit of the normal range) in alanine aminotransferase (ALT) or total bilirubin (TB) or alkaline phosphatase (ALP) and self-remitted after drug stop were selected excluding patients with previous liver disease history and history of alcohol, metabolic liver disease and hapatobiliary disease and viral, autoimmune, unknown origin hepatitis among 150 patients of admission due to acute liver injury, from April 1997 to March 2001. Each case was investigated retrospectively about taken medicine, the pattern of liver injury, recovery period after drug stop, history of alcohol, other hepatobiliary disease, pregnancy, recent hypotension, rechallenge and viral markers of hepatitis, aspartate aminotransferase (AST), ALT, TB, ALP. Also, herbal medicine and western medicine groups were compared and consistency with CIOMS scale and MandV scale were investigated. RESULTS: For four years, among 150 cases, drug-induced liver injury were 78 cases (52.0%), occurred the highest prevalence. In taken medicine, western medicine were 39 cases (50.0%), herbal medicine and health foods were 39 cases (50.0%), too. Among those cases, herbal medication were 23 cases (58.9%), pellet 5 cases (12.8%), In-jin-ssuk 3 cases (7.7%), deer extract 3 cases (7.7%), kitosan 2 cases (5%) and pumpkin extract, carp, plant roots was 1 case (2.5%) respectively. In the pattern of liver injury, hepatocellular liver injury were 48 cases (61.5%), occurred the highest prevalence. Between CIOMS and MandV scale, best correlation were only 2 cases (2.6%), therefore, their agreement was very low. CONCLUSION: The prevalence of drug induced liver injury is on an increasing trend in Gyeongju area and acute liver injury caused by herbal medicine and health foods had very high incidence was ascertained. Therefore, we should attend to indiscreet use of herbal medicine and health foods and should give a warning to our society. And a new clinical scale suitable for characteristic of our country that had high prevalence of liver injury caused by herbal medicine and health food is needed.

Right Common Iliac Artery Thrombosis and Aortic Artery Thrombosis Associated with Renal Infarction in Adult Minimal Change Nephrotic Syndrome / 대한신장학회잡지

The nephrotic syndrome frequently causes a hypercoagulable state, leading to thromboembolic complications in veins, but arterial thrombosis is relatively rare, and is usually associated with a poor prognosis. We report 50-year-old female patient who presented with minimal change disease complicated with aortic and right iliac arterial thrombosis. She was admitted to our hospital with severe pain in her right leg and left flank. No pulse was palpable in her right femoral artery. Aortography demonstrated a focal eccentric thrombus attached to the left wall of aorta, in which the left renal artery was occluded, and another thrombus obstructing the right common iliac artery. An emergency thrombectomy was performed. Although the patient had satisfactory reperfusion of right common iliac artery, her left renal function was not recovered. A renal biopsy revealed histologic evidence of minimal change of glomerulonephritis. After 8 weeks of steroid therapy, cytoxan was started. After 3 weeks, she developed pneumonitis and died with sepsis.

Preoperative Diagnosis of Strangulated Obturator Hernia Using CT

Obturator hernia is a rare pelvic hernia, occuring most frequently in elderly, debilitated women. Because of nonspecific symptoms, the diagnosis of obturator hernia is often delayed until laparotomy for bowel obstruction. This leads to high bowel resection and mortality rates, which represents a diagnostic and therapeutic challenge for surgeons today. We experienced an unusual case of right obturator hernia with strangulation in an 81-year-old female patient who presented with intermittent generalized, particularly right lower quadrant, abdominal pain and distension. The hernia was diagnosed by computed tomography (CT) scan and repaired using the lower midline transperitoneal approach. CT scan in the evaluation of patients with nonspecific intermittent gastrointestinal symptoms leads to a diagnosis of occult hernia. We report these findings with a brief review of the literature focusing on finding indicators leading to early diagnosis and treatment.

Comparison of effect of interferon-alpha, lamivudine monotherapy and combination therapy in chronic hepatitis B / 대한내과학회지

BACKGROUND: Alpha-interferon achieves HBeAg seroconversion in about 30 to 40% of patients with chronic hepatitis B, and recently discovered lamivudine, an oral nucleoside analogue, inhibits hepatitis B virus replication and reduces hepatic necroinflammation in patients with chronic hepatitis B effectively. In this study, we compared the efficacy and safety of alpha-interferon, lamivudine and their combination regimen. METHODS: Fourty chronic hepatitis B patients, who were diagnosed through HBV DNA, HBeAg positivity, alanine aminotransferase elevation, and liver biopsy were enrolled in this study. Twelve patients were treated with 500 MU of alpha-interferon subcutaneously 3 times a week for 6 months, 9 patients were treated with 150 mg of lamivudine and alpha-interferon, and 19 patients were treated with 150 lamivudine daily for 6 months. RESULTS: After treatment, all of the three groups showed rapid decline in HBV DNA level, but lamivudine group showed more clearance of HBV DNA than interferon group (alpha-interferon: 75%, combination group: 89%, lamivudine group: 100%, respectively) (p=0.04). HBeAg seroconversion rate was 25% for interferon group, 11% for combination group, 26% for lamivudine group, showing no difference between three groups (p=0.705). Mean serum ALT level and rate of ALT normalization during therapy showed no differnece (83% for interferon group, 78% for combination group, 84% for lamivudine group). CONCLUSION: It is suggested that the efficacy of combination interferon/lamivudine therapy appears disappointing and further study should be done for appropriate combination or monotherapy of lamivudine for patients with chronic hepatitis B.

Relation between gastric epithelial cell proliferation and expression of CagA and VacA in Helicobacter pylori infection / 대한내과학회지

BACKGROUND: Infection with Helicobacter pylori (H. pylori) has been associated with an increased risk for developing gastric cancer. This risk is further enhanced with CagA positive H. pylori strains. Increased epithelial cell proliferation is associated with an increased risk for gastric cancer. The aim of the study was to investigate whether the gastric epithelial cell proliferation was related to the expression of CagA and VacA in H. pylori infection. METHODS: The subjects were 77 patients who had undergone diagnostic esophagogastroduodenoscopy with biopsy; 18 gastritis, 18 gastric ulcer, 17 duodenal ulcer and 24 gastric cancer. The expression of cytotoxic genes was determined indirectly by assaying serum IgG antibodies to specific antigens of H. pylori. Gastric epithelial cell proliferation was assessed using immunohistochemical method using Ki-67 monoclonal antibody. Acute and chronic inflammation, intestinal metaplasia and glandular atrophy were scored according to the updated Sydney system. RESULTS: Ki-67 labeling index, acute and chronic inflammation were significantly higher in H. pylori infected persons (n=70, 90.9%) than in uninfected persons (n=7, 9.1%) (p< 0.05), but the difference in intestinal metaplasia and glandular atrophy between the two groups was not statistically significant. Ki-67 labeling indices in persons infected with CagA positive strains (n=56, 80.0%) were significantly higher than in persons infected with CagA negative strains (n=14, 20%) (0.55+/-0.13 vs 0.37+/-0.17, p< 0.05), but the differences in acute and chronic inflammation, intestinal metaplasia and glandular atrophy between the two groups were not statistically significant. No significant difference was found in Ki-67 labeling index, acute and chronic inflammation, intestinal metaplasia and glandular atrophy according to expression of VacA. CONCLUSION: Gastric mucosal cell proliferation, which might be closely involved in the pathogenesis of gastric carcinoma, was significantly higher in CagA positive H. pylori infected persons.

Two Cases of Misdiagnosis of Acute Appendicitis in a Patient with Hemorrhagic Fever with Renal Syndrome and a Patient with Tsutsugamushi Disease

Both tsutsugamushi disease and hemorrhagic fever with renal syndrome frequently cause abdominal pain with tenderness; therefore they are occasionally misdiagnosed as surgical abdomen. Two patients presented with symptoms of acute abdomen, and under the suspicion of acute appendicitis they underwent appendectomies. Nevertheless there were no operative findings of acute appendicitis in both patients, and the clinical conditions were deteriorated after the operation. Acute infectious disease was suspected by thrombocytopenia, elevated liver enzymes, and proteinuria. Indirect immunoflourescence test confirmed tsutsugamushi disease and hemorrhagic fever with renal syndrome, respectively. The patient with tsutsugamushi disease improved with administration of doxycycline and the patient with hemorrhagic fever with renal syndrome spontaneously improved.

Unusual Spontaneous Gallbladder Perforation in the Body Portion

Spontaneous gallbladder perforation is a rare complication of acute cholecystitis. The mechanism for the development of this complication is not clear, although a vascular anomaly and ischemia of the gallbladder appear to be important predisposing factors. It is rarely diagnosed preoperatively, and the delay in making the definitive diagnosis usually accounts for the increased incidences of morbidity and mortality associated with this complication. We experienced the unusual case of a 64-year-old male pa tient who presented with a 1-h history of generalized, especially right upper quadrant, abdominal pain. He had no history of traumatic, atherosclerotic, cardiovascular, metabolic disease. Abdominal ultrasono graphy demonstrated generalized free intraperitoneal fluid, especially in right lower quadrant, and was otherwise unremarkable. On palpation, his abdomen was rigid, and a provisional diagnosis of perforated peptic ulcer was made. The patient underwent a cholecystectomy. Gross examination of the gallbladder showed a pinhole perforation (1.2x1.0 mm2) in the body, but no gallstones. Microscopic examination of the wall revealed some neutrophile and lymphocyte infiltration and Widal test was negative. The patient had an uneventful recovery.

High-Output Cardiac Failure due to Expressive Arteriovenous Fistula Blood Flow in a Hemodialysis Patient / 대한신장학회잡지

Although excessive arteriovenous fistula blood flow may be a factor in the development of high-output cardiac failure, this diagnosis is easily over-looked. Surgical reduction of fistula blood flow can improve the condition. We here report a case of high-output cardiac failure due to excessive arterio-venous fistula blood flow in a hemodialysis patient. A 51-year-old man who had been treated with hemodialysis since 5 years ago was admitted for increasing cardiac failure. Echocardiographic evaluation of cardiac output and duplex measurement of the fistula confirmed the diagnosis of high-output cardiac failure due to excessive arteriovenous fistula blood flow. After surgical closure of the fistula, the signs and symptoms of cardiac failure subsequently subsided and both systolic and diastolic dimension of left ventricle much decreased.

The effect of percutaneous angioplasty on the treatment of poor maturation of the native arteriovenous fistula / 대한내과학회지

BACKGROUND: Although percutaneous transluminal angioplasty (PTA) is effective on the treatment of chronic venous stenosis during hemodialysis, its effect on poor maturation of native arteriovenous fistula (AVF) before cannulation is not well known. We evaluated the effect of PTA on the treatment of poor maturation of native AVF before cannulation in hemodialysis patients. METHODS: Venography was performed in 17 patients with poor maturation of native AVF before cannulation. If the stenosis was a 70% or greater decrease in lumen diameter, PTA was performed. RERULTS: The incidence of diabetes mellitus was 70.6% (n=12). Of those patients studied, total occlusion was observed in 3 cases, discrete stenosis in 12 cases, no stenosis with multiple accessory veins in 2 cases. Of the 15 patients with stenosis or total occlusion, 9 had such lesions in the proximal vein and 4 at the AV anastomosis and 2 in the artery. Of thirteen of 15 patients with these lesions who underwent PTA, 12 patients initially had successful dilatation and the follow up patency rate at 6.0+/-5.8 months was 61.5%. Two of the patients with restenosis underwent re-PTA with successful dilatation. CONCLUSION: PTA seems to be effective on the treatment of poor maturation of native AVF before cannulation.

Short-term Outcome of Lichtenstein Versus Bassini Herniorrhaphy

BACKGROUND: To compare the results of Lichtenstein tension-free mesh herniorrhaphy with conventional Bassini herniorrhaphy under general anesthesia. METHODS: One hundred eighteen adult patients were randomized to undergo either Lichtenstein mesh (n=61) or Bassini inguinal hernia repair (n=57) between January 1995 and December 1998 at the Department of Surgery, Uijongbu St. Mary's Hospital. Operation time, postoperative pain, narcotic use, time until discharge, morbidity, and time to resumption of usual activities were recorded. RESULTS: The Lichtenstein tension-free mesh herniorrhaphy had significantly shorter operation time than Bassini's operation (69.7 15.7 minutes vs 86.9 23.4 minutes, p<0.005). Patients in Lichtenstein group felt less pain than those in Bassini group 90 days after operation (9.8% vs 26.3%, p=0.019). The incidence of urinary retention of Lichtenstein group tended to be less than that of Bassini group, but there was no statistical difference between two groups (8.2% vs 19.3%, p=0.078). There was no difference between the herniorrhaphy methods with respect to postoperative pain, narcotic use, time until discharge, time to resumption of usual activities, and recurrence. CONCLUSIONS: Lichtenstein herniorrhaphy is a promising technique for hernia repair in adults because it is fast, less painful and offers the same excellent recurrent rate as conventional methods.

Isolation of rice allergenic cDNA clones from a rice cDNA library by immunoscreening with a polyclonal antibody specific to 16 kD rice allergenic protein

Clinical cases of type-1 hypersensitive reaction to rice (Oryza sativa) have been reported in western countries as well as in Japan. Among rice proteins, 14-16 kD globulin proteins encoded by multiple gene family have been identified as major rice allergens. In this study, a rice cDNA library was constructed using lambda UniZap vector and screened with a rat anti-16 kD globulin protein polyclonal antibody in order to isolate Korean rice allergenic cDNA clones. Five independent cDNA clones, termed RAK1-5, were obtained after second rounds of plaque assay and immunoblot analysis. These clones encoded 13-19 kD recombinant proteins upon IPTG induction, which were identified by the polyclonal antibody in immunoblot analysis. DNA sequencing analysis showed that RAK1-4 have 99% sequence homology with RA5b, and RAK5 is closely related with RA14c. This result indicated that RA5b gene is widely distributed in our cDNA library among other possible rice allergenic genes, and more study is needed to isolate heterogeneous or novel rice allergen genes. Copyright 2000 Academic Press.

Successful Angioplasty using Gadopentetate Dimeglumine in a Patient with Chronic Renal Insufficiency / 대한신장학회잡지

Iodinated contrast-induced acute renal failure is estimated to occur in 0.15 to 2% of all patients undergoing contrast imaging studies. Incidence is higher in patients with renal insufficiency, diabetes mellitus, dehydration, multiple myeloma, congestive heart failure, advanced age. We here report successful vascular interventional procedure by using gadopentetate dimeglumine(Gd-DTPA) as a contrast agent in a patient with chronic renal insufficiency and right superficial femoral artery stenosis. The patient had a history of iodinated contrast-induced acute renal failure. Gd-DTPA(0.17mmoVkg) diluted 1: 1 with 0.9% norrnal saline was used as contrast agent for the interventional procedure. Percutaneous transluminal angioplasty was successfully performed and there was no evidence of contrast material- induced acute renal failure after the procedure. Gd- DTPA is an alternative contrast agent for patients with chronic renal insufficiency.

The Effect of Anoxia and Reoxygenation on the Production of Prostaglandin I2 from the Endothelial Cells of Umbilical Vein

The successful revascularization and reperfusion of ischemia are still associated with high systemic complication rates and severe local tissue injuries. The morality rates after revascularization have been reported to range from 10% to 20% and the amputation rates from 12% to 22%. It is well recognized that the microvasculature is highly sensitive to ischemia-reperfusion (I/R) and that the initial damage of endothelial cells contributes to I/R-induced tissue injury. In an effort to define the mechanisms responsible for reperfusion-induced vascular injury number of in vitro models have been developed to stimulate the responses of endothelial cells to I/R. Because of its simplicity, many investigators have used monolayers of cultured endothelial cells exposed to anoxia and reoxygenation as a model system to minic I/R-induced vascular changes in vivo. The endothelium serves as an important modulator of vascular homeostases by secreting various levels of both thrombotic and antithrombotic agents. One of the important product of endothelial cells, prostaglandin I2 or prostacyclin (PGI2) helps to maintain hemostasis through its involvement in coagulation, platelet activation, leukocyte migration and adhesion, vascular tone regulation and growth control. PGI2 synthesis is a readily quantifiable index of endothelial cell perturbation and thus serves as a marker for the identification of injurious stimuli. Endothelial cells were isolated from human umbilical vein and cultured in M-199 medium plus 20% fetal calf serum. Purity of culture was determined by immunological fluorescent staining of factor VIII related antigen, phase-contrast microscopy. TRK 790 radio-immunoassay kit was used for the measuring of 6-keto-PGF1 alpha released by endothelial cells. The results were as follows: 1) The concentration of PGI(2) released from the cultured endothelial cells was 33.44 +/- 2.26 pg/1 105 cells/mL 2) Incubation of endothelial cells with anoxia and reoxygenation resulted in PGI(2) release of 42.98 +/- 2.29 pg/1x10(5) cells/ml and 62.44 2.11 pg/1 105 cells/ml, respectively. 3) Incubation of endothelial cells with allopurinol (20 mumol/L) decreased the PGI(2) release to 40.68 +/- 2.99 pg/1x10(5) cells/ml. In conclusion, our data showed that the damage of endothelial cells in reoxygenotion group was significantly increased comparing anoxia group (p<0.005) and that allopurinol can inhibit reoxygenation-induced injury of endotheial cells.

The Relation between Radial Artery, Cephalic Vein Diameter and Early Obstruction of Radiocephalic Arteriovenous Fistula in Hemodialysis Patients

Early obstruction of arteriovenous fistula (AVF) is one of the most frequent problems associated with vascular access in patients with chronic renal failure undergoing hemodialysis. It is concluded that old age and diabetes mellitus are risk factors for obstruction of AVF in hemodialysis patients. In order to evaluate the relation between radial artery, cephalic vein diameter and early obstruction of radiocephalic AVF within 3 months after operation, we measured radial artery, cephalic vein diameter and anastomosis length under the microscope during operation in 67 patients undergoing radiocephalic arteriovenous fistula. The mean age of patients was 50 13 (25~74) years old and male to female ratio was 0.8. Diabetic nephropathy was most common underlying renal disease. The incidence of early obstruction of AVF within 3 months after operation was 14.9% (10 patients). Radial artery diameter of successful group was statistically larger than that of failed group (2.77+/-0.70 mm vs 2.08+/-0.35 mm, p<0.001). But there was no difference in cephalic vein diameter (1.93+/-0.70 mm vs 1.64 0.40 mm, p=0.199) and in anastomosis length (1.66+/-0.23 cm vs 1.67+/-0.17 cm, p=0.913) between two groups. There was no statistical difference in age, sex, overweight, time of puncture after operation, blood pressure between successful and failed group. The incidence of diabetes mellitus of failed group tended to be higher than that of successful group, but there was no statistical difference between two groups (60.0% vs 40.3%, p=0.247). There was no statistical difference in all laboratory findings including hemoglobin, hematocrit, platelet, serum albumin, and total cholesterol between two groups. In conclusion, radial artery diameter was associated with the early obstruction of radiocephalic AVF, while cephalic vein was unrelated to early obstruction. If radial artery is small in patients undergoing radiocephalic AVF, AVF at elbow or synthetic graft should be considered.

Inhibitory Effect of Nitric Oxide on Intimal Hyperplasia after Rat Carotid Artery Intima Injury

Intimal hyperplasia is considered to be a most frequent cause attributing to occlusion of a blood flow after vascular surgeries such as endarterectomy, bypass surgery and angioplasty. Clearly this response is a significant cause of morbidity in patients undergoing vascular procedures and studies to find out the strategy for avoid intimal hyperplasia are of great importance. The precise pathophysiologic pathways leading to the development of intimal hyperplasia have not been yet clear. The initial event is thought to be damage to the vascular intimal endothelium. Intimal hyperplasia is the characteristic fibromuscular cellular response on intimal injury and some author advocated the "response-to-injury" hypothesis of atherogenesis to be inducing factors of intimal hyperplasia. Endothelial cells release a number of vasoactive substances such as relaxing factor, including nitric oxide(NO). The NO has not only relaxing effect to the smooth muscle cells, but also inhibitory effect to intimal hyperplasia. In this study, we investigated on rat inhibitory effect of NO donor(SNAP, SNP) to intimal hyperplasia on endothelial denudation and reversed by coadministration of the NO synthase inhibitor, L-NAME. Balloon catheter denudation of common carotid artery was performed in 35 rats pharmacologically treated from 3 days before to 14 days after surgery(5 mg/kg/day, intraperitoneally) and divided into 5 groups: control group, without any medical treatment; SNAP group, S-Nitroso-N- acetylpenicillamine; SNP group, sodium nitroprusside; SNAP+L group, both SNAP and N(G)-Nitro-L-arginine methylester; SNP+L group, both sodium nitroprusside and N(G)-Nitro-L-arginine methylester. Animals were killed and left common carotid arteries were perfused and fixed with 10% formalin solution at 14 days after endothelial denudation. Cross sectional intima-to-media area ratios(I-M ratio, intimal area/[intimal area medial area]x100) were calculated by an image analyzer system and serum level of NO was measured directly by electrochemical methods. The results of the this experimental study were as follows: 1) Morphometric analysis of cross sections showed marked intimal thickening in the control group with an mean I-M ratio of 64.71+/-4.96%. In contrast, the I-M ratios in the SNAP group were significantly reduced by 53.14+/-7.86%(P<0.05) and in the SNP group by 43.43+/- 9.32%(P<0.05). The IM ratios of animals treated with L-NAME in group SNAP-L and group SNP-L were 68.43+/-3.91% and 67.71+/-5.50% respectively(P=NS). No significant change was noted when L-NAME was coadministered with SNAP and SNP compared to control group. 2) The serum level of NO in SNAP group(2509.7+/-354.95 nM) and SNP group(3430.4+/-236.70 nM) were significantly increased compare to control group(1339.2+/-101.04 nM)(P<0.05). Coadministration of L-NAME in group SNAP-L(1719.8+/-483.65 nM) and group SNP-L(1415.7+/-219.04 nM)were no significant changed compare to control group(1339.2+/-101.04 nM). These experiments suggest that SNAP and SNP reduced intimal hyperplasia and increased serum level of NO, reversed by coadministration of L-NAME. The relation between the intimal hyperplasia suppression and NO increase should be speculated.