Palma-Dale Operation for Chronic Ilio-femoral Vein Thrombosis

PURPOSE: Deep vein thrombosis is usually managed conservatively or with radiologic intervention. Yet deep vein reconstruction is of value as one of the treatments for a small group of patients who present with significant chronic venous insufficiency due to hypoplastic, absent or occluded deep venous outflow such as occurs because of chronic ilio-femoral vein thrombosis. Therefore, we evaluate the improvement of symptoms and graft patency after a Palma-Dale operation as a treatment modality for chronic ilio-femoral vein thrombosis. METHODS: From January 2001 to August 2008, a retrospective study was performed on 15 patients with chronic ilio-femoral vein thrombosis that was treated with a Palma-Dale operation. RESULTS: The mean age of the patients was 51.1+/-15.9 years. The ratio of males to females was 8 to 7. All the patients had lower limb swelling. A Palma-Dale operation was performed on all the patients. Simultaneous thrombectomy was done for 1 patient and arteriovenous fistulas were used to improve graft patency in four patients. The mean follow-up period was 36.3+/-24.0 months. Postoperatively, there was improvement of symptoms in all the patients. However, there was recurrence of symptoms in three patients after two or three months. The rate of graft patency was 84.1% at one year after surgery. CONCLUSION: The Palma-Dale operation has the possibility of recurrence of deep vein thrombosis and postoperative complications. Yet in patients with significant chronic venous insufficiency due to chronic ilio-femoral vein thrombosis, this type of surgery is obviously of value with respect to improvement of symptoms and an acceptable graft patency rate.

Surgical Treatments for Takayasu's Arteritis

PURPOSE: Takayasu's arteritis (TA) is a chronic inflammatory, stenotic or aneurysmal disease of an unknown etiology. TA occurs worldwide, but it disproportionately affects young females of Asian descent. TA is known to affect a variety of vessels, but the subclavian artery, axillary artery, carotid arteries and infraabdominal aorta are most frequently affected. In this article, we evaluated surgical treatment as a modality for the management for TA. METHOD: We retrospectively reviewed 20 patients with TA and who were operated on from January 1994 to December 2007. RESULT: The ages of patients were ranged from 12 to 56 years. The ratio of males to females was 1 to 19. The main affected vessels were the subclavian artery (n=10), the common carotid artery (n=10), the abdominal aorta (n=4) and the renal artery (n=4). 20 patients with TA were operated on. 17 of them underwent arterioarterial bypass, and 5 patients received angioplasty. There were 8 cases of reoperation due to the effect on other arteries, or due the stenosis or occlusion of the previous bypass graft. Angioplasty and stenting can be used in the treatment of shorter stenoses such as those encountered in the renal arteries. CONCLUSION: Symptomatic patients who have Takayasu's arteritis can be operated on. Our surgical experiences have showed low mortality and the surgical procedures relieved the symptoms. Surgical therapy for Takayasu's arteritis was safe and it showed good results.

Aorta and Peripheral Arterial Diseases in Renal Transplant Patients / 대한이식학회지

BACKGROUND: In the era of surgical advancement of transplantation, renal transplant patients with risks of atherosclerosis have improved its survival rate. And these renal transplant patients with aortic or peripheral arterial diseases required surgical treatment. Herein, we discussed the prevalence and treatment options for the atherosclerotic disease in renal transplant patients. METHODS: We retrospectively reviewed 1,163 patients who underwent renal transplant surgery from Jan. 1990 to May. 2007. Among them, we found 10 patients with atherosclerotic disease of aorta and peripheral arteries. Four patients had abdominal aortic aneurysm (AAA), five patients had atherosclerosis obliterans in the lower extremities, and one had renal artery stenosis in transplanted kidney. RESULTS: Four patients with AAA had aorto-biiliac bypass surgery with bifurcated grafts. Two of them had transplanted kidney protection during surgery, the others did not. Five patients with atherosclerosis obliterans in lower extremities had arterial bypass surgery. One patient with renal artery stenosis had patch angioplasty with great saphenous vein graft. CONCLUSIONS: Renal transplant patients also have possibilities to have severe atherosclerotic disease. Furthermore, transplanted kidney could be damaged during operation. Therefore, we have to do our best to prevent development and aggravation of atherosclerotic condition and try to minimize the ischemic injury of transplanted kidney during vascular operation in renal transplant patients.

The type and incidence of malignancy in 1500 renal transplant recipients at Kangnam St. Mary's Hospital / 대한내과학회지

BACKGROUND: Strong immunosuppressive regimens have steadily improved both graft and patient survival, but posttransplant malignancy is still a clinical issue that needs to be resolved. METHODS: There were 1,500 transplant recipients between 1969 and 2005 at Kangnam St. Mary's hospital. The mean follow-up period was 108 77 months. We retrospectively analyzed the incidence, clinical course, treatment and prognosis of malignancy in the kidney transplant recipients. RESULTS: The incidence of malignancy after transplantation was 7.0% (10.5 cases out of 103 patients). The incidence of malignant lymphoma, thyroid cancer, renal cell carcinoma and Kaposi's sarcoma were higher in the renal transplanted patients than in the general population. The cancer incidence for women was higher than that for men, with stomach cancer being the most common in males and uterine cervix cancer the most common in females. The cumulative incidence of posttransplant malignancy at 1990, 1995, 2000 and 2005 were 0.72%, 2.91%, 4.62% and 7.0%, respectively. The cancer incidence with the use of initial immunosuppressive agents was 8.3% for azathioprine, 7.6% for cyclosporine, and 3.4% for tacrolimus. The mean times for making the diagnosis of malignancy after transplantation were 172+/-61 months for azathioprine, 91+/-49 months for cyclosporine, and 57+/-28 months for tacrolimus, respectively. During the observational period, 37 patients died (21 patients died of cancer) and 51 patients were still alive (7 grafts failed). CONCLUSIONS: The incidence of malignancy after renal transplantation increases according to the longer follow-up period. An active screening program is needed to lower the incidence of malignancy in renal transplant recipients.

Four Cases of Combined Liver-Kidney Transplantation / 대한신장학회잡지

Combined liver-kidney transplantation (LKT) has been increasingly performed procedure for end-stage liver and kidney disease. We experienced four cases of LKT. All patients were affected by viral hepatopathy. There were three patients of hepatocellular carcinoma, treated with trans-arterial chemoembolization or chemotherapy and one cirrhotic patient. The causes of chronic renal failure were polycystic kidney disease in one patient, glomerulonephropathies in two, and diabetes mellitus in one. Three of them were on dialysis treatment. All patients were selected based on blood group identity and negative cross-match before LKT. There was no post-operative surgical complication or acute rejection. At the mean follow-up of 37 months after LKT, all patients showed normal hepatic and renal function except for one case of biopsy-proven tacrolimus nephrotoxicity. Seroconversions of HBsAg, HBeAg, and HBV-DNA were achieved in hepatitis B positive patients. However, HCV-RNA was sustained in hepatitis C positive patient after LKT. Alpha-fetoprotein was normalized in every HCC patient. Combined liver-kidney transplantation can be a proper therapeutic procedure for the patient with liver failure and irreversible renal disease, and it can be done safely and effectively.

Second and Third Kidney Transplantation in the Catholic Organ Transplantation Center / 대한이식학회지

PURPOSE: This study was designed to review the results of 2nd and 3rd kidney transplantation at our center. METHODS: Total 1,500 patients who had undergone kidney transplantation from 1968 to Aug 2005 at the Catholic Medical Center were retrospectively analyzed. The graft and patient survival were determined using Kaplan-Meier actuarial survival curves, compared with those of first transplant and assessed for significance using the log rank test. RESULTS: The patient of 2nd transplantation was 77 cases (male 55, female 22, mean age: 48.9+/-2.4 years) and 3rd transplantation was 5 patients (male 4, female 1, mean age 46.8+/-6.0 years). The 82 kidneys included from living donors in 67 patients and from cadaveric donors in 15 patients. The most common cause of renal failure of retransplanted kidney was chronic GN (2nd: 62 cases (80.5%), 3rd: 5 cases (100%)). The immunosuppressive regimen was mainly based on cyclosporine (2nd: 61 cases (79.2%), 3rd: 3 cases (60%)). The mean duration of the second transplantation from the first was 89.0 months and the third transplantation from the second was 32.7 months. There were 16 cases of death patients and the main cause of death was infection and cardiovascular events. The graft survival of 2nd & 3rd transplantation in 1 year were over 80%. CONCLUSION: Renal retransplantation is safe, effective, and the treatment of choice in patients with failed previous kidney transplantation for patient's quality of life and not associated with increased mortality retransplantation. The results of graft survival for retransplantation seem to be excellent for primary transplantation under cyclosporine or tacrolimus-based immunosuppression. The use of the potent and appropriate immunosuppression and surgical technique for retransplantation could help to improve better results.

A Case of Benign Retroperitoneal Cyst of Mullerian Type in Kidney Transplant Patient / 대한이식학회지

Retroperitoneal cysts are rare, usually asymptomatic, lesions. Mullerian cyst of the retroperitoneum is one of extremely rare disease entities and is considered to be a subtype of urogenital cysts. We present the case of a 38-year-old woman with retroperitoneal Mullerian cyst which was found during her second cadaveric kidney transplantation operation. The two-fist sized cyst was found in left retroperitoneal pelvic space extended from left common iliac artery to pre-vesical region, which compromised iliac vessels for vascular anastomosis during kidney transplantation. After complete cyst excision, the kidney transplant operation could be performed. Histologically, the cyst was lined with benign Mullerian-type epithelium. We report the pathologic findings in a rare case of benign retroperitoneal cyst of Mullerian type which was incidentally found during kidney transplant surgery.

Report of 1,500 Kidney Transplants at the Catholic University of Korea / 대한이식학회지

Purpose: The present study aims to determine the clinical outcome of kidney transplantation and to provide data of long-term graft and patient survival. Methods: Between 1969 and 2005, 1,500 kidney transplants were performed at the Kangnam st. Mary's hospital. We analyzed the clinical characteristics and outcomes of kidney transplant recipients retrospectively. Results: The mean follow-up period was 112 months. Chronic glomerulonephritis was the leading cause of primary renal diseases, but the proportion of has increased from 1 % before 1985 to 6% afterwards. First renal transplantation was 94.5% (n=1418), and retransplantation was 5.4% (n=82). Type of donor source was mostly living-related, with the recent decrease in the number of living- unrelated donors. Currently, 72l patients are alive with functioning grafts, 297 cases had graft failure, 277 cases died, 205 cases were transferred or lost during follow-up. Main cause of graft failure was chronic allograft nephropathy (n=316). Overall, 1-, 5-, 10-, and 20-year graft survival were 92%, 81%, 66%, and 29% respectively. 1-, 5-, 10-, and 20-year patient survival were 93%, 88%, 81%, and 69% respectively. Conclusion: This review of 36-years experience in a single center showed that the graft survival has improved compared to the initial transplantation era.

Abdominal Aortic Aneurysm in Marfan's Syndrome: Two Cases

Marfan syndrome is an inherited autosomal dominant disorder of the connective tissues, and the afflicted patients present with abnormalities of the skeletal, ocular, and cardiovascular system. The progressive dilatation of the proximal aorta leading to dissection and rupture is the typical feature and this can be a lethal complication of this disease. The incidence of Marfan syndrome is estimated to be 1 in 10,000 in most racial and ethnic groups. We experienced two cases of aortic aneurysm in Marfan syndrome. The first case was 32-year-old woman. She was admitted because of sudden onset of a painful abdominal mass for 2 days. Aortic aneurysm was diagnosed by CT and an echocardiogram showed severe mitral regurgitation (area ratio: 13/15). She underwent successful abdominal aortic aneurysm (AAA) repair and was discharged on postoperative 14th day; she was then prepared for open cardiac surgery for mitral valve replacement. The second case was 19- year-old woman. She was admitted with a known abdominal aortic aneurysm that she'd had for 1.5 years. She also underwent abdominal aortic aneurysm (AAA) repair that was technically successful, but she died on postoperative 10th day due to sudden cardiac arrest.

A Case of Aberrant Right Subclavian Artery with Aneurysmal Change

An aberrant right subclavian artery is the most common arch anomaly, and it occurs in approximately 1.0% of the population. It is caused by obliteration of the right fourth aortic arch during the early embryologic development. Aberrant right subclavian artery originates from a diverticulum; this was originally described by Kommerell. Aneurysms arising in an aberrant subclavian artery are rare, but they constitute a potentially lethal condition that can be treated successfully when this is appropriately identified. The presence of an aneurysm of the artery or Kommerell's diverticulum at its aortic origin is more likely to produce symptoms from the esophageal compression. Virtually all these patients have a superior mediastinal mass that may be asymptomatic, but such patients usually have symptoms of dysphagia, chest pain, or shortness of breath. The presence of an aneurysm of an anomalous subclavian artery is an indication for surgical resection. Resection of the aneurysm may be approached through either a right or left thoracotomy. We present here a case of an aberrant origin of the right subclavian artery together with a review of the literature.

Successful Abdominal Aortic Aneurysm Repair in Ninety-Five Years Old Man

The overall life expectancy of the population is rising and more elderly patients with abdominal aortic aneurysm (AAA) have been reported. The management of AAA is open surgical or endovascular repair because neglected AAA usually yields an eventually fatal course. Older age is commonly considered as a risk factor for AAA repair due to the concomitant age-related diseases such as coronary artery disease. The chronological and physiological age are not always identical, and sometimes a patient's physiological age appears younger than the chronological age. We report here on successful open surgical repair of AAA in a 95 years old man (birth date: April 11, 1911) who looked younger and healthier than his chronological age. The preoperative CT angiography showed an infrarenal saccular AAA 4.2 cm in diameter with fingertip-sized outpouching of the aneurysmal wall, which suggested possible impending rupture. His preoperative work-up was within normal limits. This 95 years old gentleman well tolerated all the surgical procedures with a smooth postoperative course. We propose that the age limitation for AAA repair should be considered individually for each case.

Successful Abdominal Aortic Aneurysm Repair in Ninety-Five Years Old Man

The overall life expectancy of the population is rising and more elderly patients with abdominal aortic aneurysm (AAA) have been reported. The management of AAA is open surgical or endovascular repair because neglected AAA usually yields an eventually fatal course. Older age is commonly considered as a risk factor for AAA repair due to the concomitant age-related diseases such as coronary artery disease. The chronological and physiological age are not always identical, and sometimes a patient's physiological age appears younger than the chronological age. We report here on successful open surgical repair of AAA in a 95 years old man (birth date: April 11, 1911) who looked younger and healthier than his chronological age. The preoperative CT angiography showed an infrarenal saccular AAA 4.2 cm in diameter with fingertip-sized outpouching of the aneurysmal wall, which suggested possible impending rupture. His preoperative work-up was within normal limits. This 95 years old gentleman well tolerated all the surgical procedures with a smooth postoperative course. We propose that the age limitation for AAA repair should be considered individually for each case.

MAP Kinase (ERK1/2, p38) can be Phosphorylated by Shear Stress Independent of PECAM-1 (CD31) in Vascular Endothelial Cells: PECAM-1 as a Mechanoreceptor

PURPOSE: Mechanical forces, including shear stress (SS), trigger signal transducing events and modulate gene expression in vascular endothelial cells (ECs). However, the primary steps of mechanoreception are still unknown. PECAM-1 (CD31), a member of the immunoglobulin (Ig) superfamily of cell adhesion molecules, is localized to the interendothelial cell adhesion site. PECAM-1 tyrosine phosphorylation has been observed following mechanical stimulation, but the role it plays in mechanosensing in ECs is controversial. The aim of this study was to confirm the involvement of PECAM-1 in ECs signaling cascades in response to SS. METHOD: In this study, PECAM-1 knock-out (KO) and wild-type (WT) rat microvascular ECs, and 50 and 100% confluent bovine aortic ECs (BAECs) were exposed to oscillatory SS (14 dyne/cm2) for 0, 5, 10, 30 or 60 minutes. Activation of the PECAM-1 and the mitogen activated protein (MAP) kinase were assessed by determining the phosphorylation of PECAM-1, extracellular signal-regulated kinase1/2 (ERK1/2) and p38 using immunoprecipitation and immunoblotting. RESULT: The tyrosine-phosphorylation level of PECAM-1 immunoprecipitated from SS-stimulated WT ECs increased. While PECAM-1 was phosphorylated in 100% confluent BAECs, its phosphorylation level in 50% confluent BAECs was not detected by SS. However, ERK1/2 and p38 were also activated by SS in both PECAM-1 KO ECs and 50% confluent BAECs. CONCLUSION: Our results indicate that ERK1/2 and p38 were activated by SS in PECAM-1 KO ECs and 50% confluent BAECs despite no PECAM-1 phosphorylation. This suggests that PECAM-1 can not be a major mechanoreceptor for the activation of MAP kinase in ECs; therefore, other more important mechanoreceptors maybe present in ECs to detect SS and trigger intercellular signal transduction.

Report of Nation-wide Questionnaire Survey for Abdominal Aortic Aneurysm Treatment in Korea

While endovascular aneurysm repair (EVAR) is prevailing for the treatment of abdominal aortic aneurysm (AAA) in modern vascular practice, PURPOSE: we conducted nationwide questionnaire survey to investigate the current status of AAA treatment and their results in Korea. METHOD: We reviewed the replies from 28 hospitals (33 departments) to the questionnaire inquiring annual number, clinical features, mode of treatment and results of AAA patients during the period from Jan. 2000 to Jul. 2004. Results: 980 AAA patients were reported including 292 ruptured AAA (29.8%) and 688 non-ruptured AAA (70.2%). For treatment of AAA, 834 (85.1%) surgical repairs (SRs) and 111 (11.3%) endovascualr aneurysm repairs (EVARs) were performed while 35 patients (3.6%) died of AAA rupture before operation. The locations of AAA were infrarenal in 889 (90.7%), juxtarenal in 62 (6.3%), and suprarenal in 29 patients (3.0%). Among 834 patients undergoing SR, 577 patients (69.2%) had non-ruptured AAAs and 257 patients (30.8%) had ruptured AAAs. Mean operative mortality rate was 4.1% after elective SRs, 30.7% after SR for ruptured AAAs, and 2.3% after EVARs. The reported brand name of stent graft devices were various including domestic custom-made in 56 (50.5%), imported brand in 18 (16.2%) while 37 (33.3%) stent grafts were not reported their brand name. The frequencies of type I and III endoleaks after EVAR were reported 5.8% and 5.8% respectively in 86 patients with an available data. CONCLUSION: SR has been used as a major treatment option in Korea for the treatment of AAA patients while EVAR is increasing. The mortality rate of SR of AAA was comparable to western multi-center trial reports but mortality or morbidity rates of EVAR were unable to know in this questionnaire survey.

Deep Vein Thrombosis after Surgery for Gastrointestinal Cancer: Incidence and Correlation with Risk Factors

PURPOSE: Deep vein thrombosis (DVT) is recognized as a common complication in surgical patients in western countries, and especially for high risk patients. However there is little informations on the incidence and risk factors of DVT after gastrointestinal cancer surgery in Korea. The aim of this study is to evaluate the incidence and risk factors of DVT after gastrointestinal cancer surgery that is performed without antithrombotic prophylaxis. METHOD: From August 2003 to February 2004, 107 patients who underwent gastrointestinal cancer surgery were evaluated prospectively. Hypercoagulability studies were done before the operation or before any blood transfusion, and the other clinical risk factors were also examined. All the patients were examined between the 5th and 10th postoperative day with duplex ultrasonographic assessment of both lower extremities. RESULT: DVT was found in 8 patients (7.5%) and two patients had symptomatic DVT. Five patients showed thrombi in there calf veins, two patients in the popliteal vein, and one patient in the iliac vein. The DVT group showed a significantly higher incidence of hyperhomocysteinemia than non-DVT group. There was no statistically significant difference between the DVT and non-DVT group according to other risk factors. CONCLUSION: The incidence of DVT after intra-abdominal cancer surgery in Koreans is significantly lower than for the patients in western countries. Considering the lower rate of proximal DVT, routine prophylaxis for DVT appears to be unwarranted in Koreans before and after intra-abdominal cancer surgery. Finally we did not identify a correlation between DVT and the so-call risk factors except for hyperhomocysteinemia. It would be interesting to perform further studies to clarify the association between hyperhomocysteinemia and DVT in cancer patients.

Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta

The tuberculous aortic aneurysm is exceedingly rare. Kamen L. first described tuberculous aortic aneurysm in 1899. Since then, only about 40 cases have been reported in the literature 1945 to 2001, and among them only 19 cases have affected the thoracic aorta. The incidence and prevalence of tuberculosis is still reported to be far too high, and the demographic and geographic disease distribution has changed rapidly because of immigration and traveling from endemic areas, and also this is due to the increasing use of immunosuppression or because of HIV cases. Multi-resistant strains and comorbidities impair the effects of medical therapy and so this might result in surgical complications. The tuberculous aortic aneurysm generally occurs in the setting of disseminated tuberculosis, and it has a high mortality rate. This report describes a 35-year-old woman who had miliary pulmonary tuberculosis, and she underwent a surgical operation for tuberculous pseudoaneurysm of the thoracic aorta. Early detection and the proper surgical and medical combination therapy are essential for the optimal treatment of thoracic aortic pseudoaneurysm, as was done in this successful case.

Analysis of Pretransplant ELISA-Panel Reactive Antibody in Kidney Transplant Patients / 대한이식학회지

BACKGROUND: HLA antibodies have been shown to be associated with graft loss of organ transplants in prior studies. This study was designed to analyze the results of ELISA- panel reactive antibody (ELISA-PRA) in kidney transplant patients and the impact of this test on the clinical outcome. METHODS: We have investigated ELISA-PRA results from 110 living donor renal transplant patients from Nov. 2001 to Apr. 2004. RESULTS: ELISA-PRA positivity was found in 22 (20%) patients and was higher in the female patients than male (P<0.05). Pretransplant transfusion, pregnancy or transplantation history was not significantly correlated with ELISA- PRA result. ELISA-PRA (+)patients had more rejection episodes of 41% (n=9) (P=0.0005) and graft failures of 18% (n=4) (P=0.028) than ELISA-PRA (-), which had 8% (n=7) and 3% (n=3), respectively. Patients group with a result of ELISA-PRA/flowcytometric crossmatch (FCXM) (+/ -) or (+ / +) had worse clinical outcome than ELISA- PRA/FCXM ( -/- ). ELISA-PRA/FCXM (+ /+ ) correlated with higher incidence of allograft rejection than ELIS- PRA/FCXM (+ /- ) or ( -/+ ). CONCLUSION: These results suggest that in conjunction with FCXM results, pretransplant ELISA-PRA test is useful predictor of clinical outcome in renal transplant recipients.

Graft Functions and Survivals according to the Serum Creatinine Level at 3 Days after Renal Transplantation in Living-donor Renal Transplantation / 대한이식학회지

PURPOSE: The aim of this study was to evaluate whether serum creatinine levels at 3 days after renal transplantation can predict long-term graft survival and its associated clinical aspects. METHODS: Three hundred and seventy six renal transplant recipients who received grafts from living donors were included. Recipients were classified into two groups according to their serum creatinine levels (1.2 mg/dL group) at 3 days after renal transplantations. Demographic characteristics (age, sex, weight, body mass index, donor/recipient body weight ratio, pre-transplant dialysis type, underlying disease and pre-transplant transfusion), transplant variables (immuno-suppressive agents, HLA mismatch and HLA DR mismatch) and post-transplant variables (routine graft biopsy, number of acute rejection episodes within first year after renal transplantation, serum creatinine level and graft survival at each first, second, and fifth years) were assessed. RESULTS: Among total 376 recipients, serum creatinine 1.2 mg/dL groups were 224 (59.6%) recipients. The characteristics of patients with good graft function (serum creatinine 1.2 mg/dL group (first year, 100% vs. 95.7%; fifth year, 96.7% vs. 89.8%; P<0.05). Conclusion: Serum creatinine levels at 3 days after renal transplantation can predict long-term kidney transplant survival. It was associated with immunological (frequency of acute rejection) and non- immunological aspect (match of kidney size and donor's age).

MT1-MMP and Egr-1 Expressions Induced by Different Strengths of Shear Stress in Endothelial Cell

PURPOSE: Membrane type-1-matrix metalloproteinase (MT1-MMP) plays a key role in endothelial cell (EC) migration, matrix remodeling, and angiogenesis. Previous studies demonstrated that a cyclic strain (CS) increases MT1-MMP expression by displacing specific protein 1(Sp1) with increased early growth response-1 (Egr-1) expression; and shear stress (SS) decreases MT1-MMP expression by Sp1 phosphorylation. However, the difference in MT1-MMP expression according to the change of SS is poorly understood. The aim of this study is to determine the effects of low or high SS on Egr-1 and MT1-MMP transcription and translation. METHOD: Bovine aortic ECs were exposed to oscillatory SS (low=0.1 dyne/cm2 or high=14 dyne/cm2) with orbital shaker for 0, 1, 4, or 8 hours. Activation of Egr-1 and MT1-MMP was assessed by the Northern blot and Western blot. RESULT: Although Egr-1 mRNA transcription and protein translation were induced (7.3-, 5.8-fold and 4.0-, 4.9-fold, respectively) in response to low SS (n=5, 0, 1, and 4 hr; P<0.05), MT1-MMP mRNA transcription and protein levels did not change remarkably. Egr-1 mRNA transcription and translation were induced (7.6-fold at 1 hr; 3.7- and 5.2-fold at 1 and 4 hr, respectively) in response to high SS (n=5; P<0.05). We observed that high SS decreased MT1-MMP mRNA transcription and translation in a time-dependent fashion (10%, 50%, and 90% reduction at 1, 4, and 8 hr, respectively; n=5, P<0.05). CONCLUSION: High SS induces Egr-1 up-regulation and inhibits MT1-MMP expression. But low SS has no effect on MT1-MMP expression in spite of Egr-1 up-regulation. These observations illustrate that the expression of MT1-MMP is dependent on, not only the type of hemodynamic forces, but also the strength of force (SS) in vascular endothelial cells.

Surgical Option in Managing Recurring Pseudoaneurysms in Behcet's Vasculitis

PURPOSE: Behcet's disease is a systemic condition with multiple clinical manifestations, the basis of which is a vasculitis with unknown etiology. The most common cause of death in Behcet's disease is secondary to arterial complications. The pathogenesis of these arterial complications is related to the diseased arterial wall or vasa vasorum seen in the Behcet's disease process. Although vascular lesions are not listed among the criteria for diagnosis of Behcet's disease, up to 25~35% of patients develop vascular complications and probably even a greater proportion of patient may have small vessel vasculitis as the pathological basis for the systemic manifestation. Therefore, early diagnosis and aggressive management can result in the long-term salvaging of both limbs and may allow early intervention of arterial complications and prevent the usual fatal outcome. METHOD: We report 59 cases of Behcet's disease, involving the abdominal aorta and its main branches with variable operative procedure. The medical records of these 59 cases were retrospectively reviewed to examine the operation characteristics. RESULT: To manage recurrent aneurysms at previous anastomosis sites, we used PTFE (polytetrafluoroethylene), or autogenous vein and artery (internal iliac artery) as bypass or patch material. The results of the autogenous vessel grafts for arterial reconstructions in Behcet's vasculitis were superior to those of artificial grafts. CONCLUSION: In one case of multiple recurrent anastomotic aneurysm, we attempted aortic blood flow diversion after closure of the false anastomotic aneurysm. This aortic blood flow diversion should be considered as an adopted surgical treatment of recurrent false AAA in Behcet's vasculitis.