RESUMO
BACKGROUND: Venous thromboembolism is a serious medical problem causing considerable morbidity and mortality. Risk factors of thrombosis are surgery, trauma, pregnancy, tumor, oral contraceptive as well as genetic risk factors (deficiencies of protein C, protein S, antithrombin III) though genetic risk factors were found in about 5 to 10% of cases. Recently, it is known that point mutations in the factor V gene and the prothrombin gene are common risk factors of idiopathic deep vein thrombosis (DVT) in Caucasian. But the frequency of these mutations in Asian population are reported lower than Caucasian's. We investigated the incidence of hereditary risk factors of venous thrombosis at single institution. METHOD: From April 1998 to June 1999, patients who were diagnosed as venous thromboembolism and under 50 years old were enrolled. All patients were requested for protein C, protein S (total, free), antithrombin III, APC resistance test, factor VIII activity, anticardiolipin antibody, lupus anticoagulant (LA), anti-beta2-glycoprotein-I (anti-beta2-GPI). Point mutations of factor V (Arg506->Gln, Arg306->Thr, Arg306->Gly, A4070G) and prothrombin G20210A allele mutation were checked by allele specific PCR amplification. RESULTS: Thirty-four patients (M:F=19:15, median age 38, 22-49) were diagnosed as DVT (7), pulmonary embolism with/without other site venous thrombosis (5/7), retinal vein occlusion (10), venous thrombosis of unusual site (5). Nine patients had past thrombosis history. One patient had familial DVT history. Thirteen patients had acquired risk factors of thrombosis. All the results of APC resistance test were within normal range. There was no single case of factor V mutations or prothrombin G20210A allele mutation. Three patients had positive anti-beta2-GPI and one patient had positive LA. We also found free protein S deficiency : 5/31, combined deficiency of free protein S and antithrombin III: 3/31. Twenty-five patients (73.5%) had elevated factor VIII (>150%). CONCLUSION: In this study, we couldn't detect factor V point mutations, prothrombin G20210A allele mutation in thromboembolic patients. But we found high prevalence of elevated factor VIII. Follow-up test for factor VIII and clinical observation for recurrent thrombosis are in progress.
Assuntos
Humanos , Pessoa de Meia-Idade , Gravidez , Resistência à Proteína C Ativada , Alelos , Anticorpos Anticardiolipina , Antitrombina III , Povo Asiático , Fator V , Fator VIII , Seguimentos , Incidência , Inibidor de Coagulação do Lúpus , Mortalidade , Mutação Puntual , Reação em Cadeia da Polimerase , Prevalência , Proteína C , Proteína S , Deficiência de Proteína S , Protrombina , Embolia Pulmonar , Valores de Referência , Oclusão da Veia Retiniana , Fatores de Risco , Tromboembolia , Trombose , Tromboembolia Venosa , Trombose VenosaRESUMO
PURPOSE: To describe clinical experiences of the use of Bird's Nest inferior vena cava(IVC) filter. MATERIALS AND METHODS: Between August 1991 and August 1997, IVC filter was percutaneously inserted in 51 patientswith pulmonary embolism(PE) and deep vein thrombosis of the lower extremities. Indications for the placement ofthis filter were contraindication to anticoagulation in 17 patients, prophylaxis of PE in 17, failedanticoagulation in 11, massive PE with residual floating thrombus in three and complications involvinganticoagulation in 3. In order to delineate the location of renal vein and extension of deep vein thrombosis intothe IVC, all patients under went inferior vena cavography before filter placement. Thirty filters were insertedthrough the right femoral vein, 19 through the right internal jugular vein and three through the left femoralvein. The patients involved were followed up for periods ranging from one week to six years (mean, 10 months). RESULTS: A Bird's Nest IVC filter was placed in the infrarenal IVC in 44 patients and in the suprarenal IVC in7. Certain complicatioins ensued. IVC penetration occurred in three patients(5.9%), and in seven(1.37%) the filterwire prolapsed. Except for transient pain, however, there were no serious IVC penetration-related complicationsand no evidence of recurrence of PE in the cases involving prolapse of the filter wire. During follow up,clinically suspected recurrent PE was noted in two patients(3.9%), but there was no evidence of newly developedocclusion of the IVC. CONCLUSION: In patients who under went follow up, Bird's Nest IVC filter effectivelyprevented the development and recurrence of PE, and there were no complications. To prevent of penetration of theIVC and prolapse of the filter, however, technical skill was needed.
Assuntos
Humanos , Veia Femoral , Seguimentos , Veias Jugulares , Extremidade Inferior , Prolapso , Recidiva , Veias Renais , Trombose , Filtros de Veia Cava , Veia Cava Inferior , Trombose VenosaRESUMO
BACKGROUND: Women with end-stage renal disease have low fertility. Following renal transplantation, the reproductive function returns to normal, and pregnancy becomes possible. METHOD: At our medical center, between June 1990 and February 1998, 263 female patients underwent renal transplantations, and 14 of them later became pregnant. The outcomes from 23 pregnancies in these 14 kidney transplant recipients were analyzed. RESULT: Forty-three percent (43%) of the pregnancies ended in artificial (9 cases) or spontaneous abortion (1 case), and 11 of 13 deliveries were successful. A vaginal delivery was performed in 9 cases (69%) and a cesarian section was done in 4 cases (31%). All of the 11 pregnancies that continued over 30 weeks ended successfully. The mean age of the recipients at the first pregnancy was 29.4 +/- 4.6 years (23-37). The mean time to first pregnancy since renal transplantation was 22.6 +/- 12.3 months (1-50). Thirteen (13) recipients were maintained on cyclosporin-based immunosuppressive regimens before and during pregnancy. One recipient, who was considered to have developed immune tolerance later, stopped the immunosuppressive drug at 3 months prior to the first pregnancy. The renal function remained stable and unchanged in all the recipients, and no rejection episodes occurred during and after pregnancy in any of the recipients. Preeclamsia occurred in 8 cases (35%) and a previous rupture of membrane in 1 case (4%). Of the 11 live births, 4 (36%) were premature (<37 weeks), 1 (9%) had a lowbirth-weight (<2500 gm), 1 (9%) had transient apnea, and 3 (27%) had transient neutropenia. The mean Apgar score at 1 minute was 7.8 (7-9), with only 2 children having a score below 7. No congenital anomalies were documented. The later development and health of all of the children were good during a mean follow-up of 16.6 +/- 10 (1-38) months. Two (2) recipients who had a successful first pregnancy had a second baby. CONCLUSION: From these results, we can conclude that pregnancy does not adversely affect graft function and fetal development, provided that the graft function was stable at the time of conception and prudent fetal monitoring could be done.
Assuntos
Criança , Feminino , Humanos , Gravidez , Aborto Espontâneo , Índice de Apgar , Apneia , Fertilidade , Fertilização , Desenvolvimento Fetal , Monitorização Fetal , Seguimentos , Tolerância Imunológica , Rim , Falência Renal Crônica , Transplante de Rim , Nascido Vivo , Membranas , Neutropenia , Ruptura , Transplante , TransplantesRESUMO
In cadaveric renal transplantation, the graft survival from multiorgan donor (MOD) and kidney donor alone (KDA) can be suspected to be different due to a different situation. In MOD, more complicated procurement procedure and least priority of kidney can be a negative impact on graft survival. While in KDA, poor donor status can be an negative factor for graft survival. We have evaluated the characteristics of MOD and KDA group, and analyzed to find out whether there is a disparity in graft survival between the two groups. Among the 137 cadaveric renal allografts from 1991 to 1997, 80 patients(58%) underwent renal allograft from MOD and 57(42%) from KDA. Because of the limited organ resources, we managed every donor carefully as a potential multiorgan donor and final decision to harvest multiorgans was made during the exploration. The average donor age of MOD was younger than that of KDA(26yr vs 32yr, p=0.02) and proportion of category A (donors who had spent less than 6 days in the ICU and had received dopamine less than 5 microgram/kg/min and had not experenced cardiac arrest) was higher in MOD(p=0.03). There were fewer recepients with the ABO minor mismatching in the MOD group (p=0.04). Mean cold ischemic time for both groups did not differ significantly (9.5 hr vs 8.1 hr, p=0.9). Postoperative ATN (33.8% vs 38.6%, p=0.6) and rejection (22.5% vs 24.6%, p=0.7) did not differ significantly in both groups. The one -and 5-year graft survival of MOD group were 88% and 85% compared with 89% and 84% in KDA group. From these results, we can conclude that graft survival did not show any difference between the two groups, regardless of multifactorial differences in renal allograft between MOD and KDA.
Assuntos
Humanos , Aloenxertos , Cadáver , Isquemia Fria , Dopamina , Sobrevivência de Enxerto , Transplante de Rim , Rim , Doadores de TecidosRESUMO
The main object of treatment in chronic occlusive arterial disease is to increase blood flow for ischemic limb. In case of severe symptoms and signs such as rest pain, ischemic ulcer and gangrene with poor angiographic distal run-off, conservative medical treatment is recommended. Beraprost sodium(TRK-100) is the oral preparation of a prostaglandin I2,that has known to increase blood flow, prevent secondary thrombi formation, suppress platelet aggregation,increase oxygen perfusion pressure, increase deformability of erythrocyte, and protect endothelial cell from ischemia and inflammation. From September 1995 to January 1997, 23 patients among 42 patients with severe ischemic ulcer and poor angiographic distal run-off underwent Beraprost oral treatment in the Department of Surgery, Ulsan-chungang and Yeungnam University Hospital: Buerger's disease(TAO) in 14 and arteriosclerosis obliterans(ASO) in 9 cases. Daily dose was 120microgram(6 tablets #3) and medicated for consecutive 6 weeks. To detect the changes of symptoms, signs & ischemic ulcer size and occurrence of side reactions, inquiries, photography and laboratory tests were checked at prior to medication and 2, 4 & 6 weeks after medication. The results were as follows. There were 21 men and 2 women, ranging in age from 23 to 77 years old with mean of 44 years old and in body weight from 43 to 75kg with mean of 61kg. Forteen cases(60.9%) were improved but 2 cases(6.2%) were aggravated on rest pain and coldness. Improval rate on ischemic ulcer & granulation size was 70%(16 cases) and 82.6%(19 cases) respectively. There noted infection in 7 cases(30.4%). Overall improval rates were 70.0%(16 cases), general safety rates were 95.7%(22 cases), and usefulness of the drug was shown in 16 cases(70.0%). One case(3.2%) of indigestion was reported as side reaction. There noted no significant hematologic, urinary or biochemical abnormalities. In conclusion, Beraprost treatment for severe ischemic limb had a beneficial effect on relieving pain and ulcer healing and proved safety in its use.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Arteriosclerose , Plaquetas , Peso Corporal , Dispepsia , Células Endoteliais , Epoprostenol , Eritrócitos , Extremidades , Gangrena , Inflamação , Isquemia , Oxigênio , Perfusão , Fotografação , Sódio , Comprimidos , ÚlceraRESUMO
Incidence of vascular diseases in Korea has been increasing and their researches are undertaken actively. However, experience of single institute about various vascular diseases is to be limited, a nationwide vascular registry is needed for sharing common protocols and experiences. We devolped a customized vascular registry program calling VasBase for nation-wide sharing and analysis. The characteristics of VasBase are as follows; clinician-oriented intuitive software, complete adherence to vascular protocols based on practical experiences, error-free input by presetting numeric codes, data protection, multi-user tasking, integration of graphic data, open source, easy modification of protocol and one-step export to statistical analysis software. We propose this VasBase as a nation-wide vascular registry program.