Revascularizations of 14 occlusive arterial diseases in the lower extremities with the Transluminal Endarterectomy Catheter was done successfully. The causes of occlusions were atherosclerosis in 9 cases and cardiogenic thromboembolism in 5 cases. The site of lesions were at the common femoral artery in 1 case, the superficial femoral artery in 6 cases and the popliteal artery in 7 cases. The length of the lesion were below 5cm(n=3), 5-10cm(n=2), 11-20cm(n=6) and 21-30cm(n=3). Complications were distal embolism(n=1) and hematoma at the puncture site(n=1). No symptoms recurred in any cases during 2 months -15 months followup. Endarterectomy with Transluminal Endarterectomy Catheter was found to be an effective method for revasculizations of occlusive arterial disease in the lower extremity, especially in long segmental occlusion.
Atherosclerosis ; Catheters ; Endarterectomy* ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Lower Extremity* ; Methods ; Popliteal Artery ; Punctures ; Thromboembolism

[Background] Over the last thirty years, majority of researches on clinical effectiveness of acupuncture have been explanatory (or experimental) randomized controlled trial. The benefits of acupuncture in clinical trials are stillcontroversial and most studies concluded that further control studies were required. Standardized combinations of acupuncture points for all the experimental subjects in various past studies have been criticized because such treatments do not reflect current routine clinical treatment.
[Objective] This paper aims to review pragmatic clinical trials on the effect of acupuncture treatment and to develop the ideal clinical research methodology of acupuncture study.
[Method] Clinical studies of acupuncture relevant with pragmatic or individualized trials were searched mainly in Pubmed and Science direct databases. All articles were fully reviewed by researchers, and data were evaluated by usage of a standardized form.
[Results & Suggestion] Pragmatic acupuncture researches were tried for various symptoms (eg. low back pain, hypertension, depression during pregnancy, sleep quality in HIV disease, chronic poststroke leg spasticity, headache, etc). Individualized acupuncture treatments based on oriental disease pattern diagnosis reflexes practical treatments which is more effective than unified and fixed acupuncture treatments without any theoretical basis of oriental medical philosophy.
[Conclusion] To overcome the controversies and limitations of past explanatory acupuncture trials, more individualized and tailored acupuncture trials with the theoretical basis of oriental medical diagnosis is highly recommended. Also clear definition and categorization of pattern identification should be established for further active clinical researches and applications of acupuncture.

No abstract available.
Pancreatic Neoplasms*

Seven patients with giant cavernous hemangioma of the liver were treated surgically with success at Pusan Gospel Hospital, Kosin Medical College, Pusan, from 1980 through 1989. They were 3 males and 4 females, and their ages ranged from 6 to 59 years. The tumors were located on the right lobe of the liver in 5 patients and on the left lobe in 2. The lesions were solitary in all patients, and their sizes varied from 4cm to 15cm in diameter. All patients underwent hepatic resection: 1 right hepatic lobectomy and 4 partial resections for tumors on the right lobe, and 1 left lobectomy and 1 left lateral segmentectomy for tumors on the left lobe. There was no surgical death, but 1 patient had a postoperative complication: multiple stress ulcers on the stomach and ileum. The pathologic diagnosis was cavernous hemangioma in all cases. In the long-term follow-up, there was no recurrence of preoperative symptoms in any patient.
Adult ; Child ; Female ; Hemangioma, Cavernous/*surgery ; Humans ; Ileal Diseases/etiology ; Liver Neoplasms/*surgery ; Male ; Middle Aged ; Postoperative Complications/etiology ; Prognosis ; Stomach Ulcer/etiology ; Stress, Physiological/etiology ; Ulcer/etiology

The presence of A-V shunting in hepatocellular carcinoma is an important factor for deciding the prognosis and in the management with transarterial chemoembolization. Twenty-four patients with hepatocellular carcinoma performed with CO2-DSA and iodinated-DSA were reviewed for the evaluation of visibility of A-V shunting. It was classified by the visibility into clearly visible, faintly visible and invisible. Also the authors evaluated neovascularity and tumor staining. And we checked side effects after the injection of CO2 gas during CO2-DSA. A-V shunting was noted in 19 cases(63%), which were clearly visible in 15 of 19 cases(79%) on CO2-DSA and in 7 of 19 cases(37%) on iodinated-DSA. In 3 cases, A-V shunting was noted only on CO2-DSA. CO2-DSA(17%)was inferior to iodinated-DSA in detection of neovasculaity and tumor staining. Side effects from CO2-DSA were abdominal pain(1 case) and chest discomfort(1 case) but improved within several minutes. In conclusion, CO2-DSA is a sensitive and effective method for the detection of A-V shunting in hepatoma.
Carcinoma, Hepatocellular* ; Humans ; Methods ; Prognosis ; Thorax

From July 1988 to September 1992, we experienced 15 cases of thrombolysoangioplasty (TLA) at Chonnam University Hospital. Among 15 cases, 5 had claudication (Clinical stage II according to Modified Fontaine Classification), pain at rest (III), and gangrene(IV). Duration of symptoms was 1-7 months except patients of clinical stage IV unable to guess occlusion age. The occlusion length was 5-10cm in 8 cases, 10-20cm in 4 cases, and above 30cm in 2 cases. In all cases, thromolytic therapy was performed with intraarterial urokinase infusion. The total amount of urokinase ranged from 300,000 IU to 2,000,000 IU and infusion time ranged from 2 to 50 hours except three cases infused bolus dose only. Complete successful TLA was defined as technical (less than 50% of residual stenosis) and clinical success. Partial success was defined as technical success but clinical failure. Follow-up angiography could be performed in 8 cases. Overall initial success rate was 86.6% (13/15). Among them. Complete success was in 11 cases and partial success was in 2 cases. Recurrence of disease was not noted on all cases(n=8). Severe complications, such as hemorrhage, did not occurred. TLA was considered to be effective and safe way to recanalized chronic long artery occlusion in lower extremity.
Angiography ; Arteries ; Follow-Up Studies ; Hemorrhage ; Humans ; Jeollanam-do ; Lower Extremity ; Recurrence ; Urokinase-Type Plasminogen Activator

PURPOSE: To establish the proper approach and management of an urachal anomaly in children. MATERIALS AND METHODS: We retrospectively reviewed the medical records and imaging studies of 33 children (21 boys, 12 girls) treated for an urachal anomaly over a ten-year period. RESULTS: Twenty-four patients were equally diagnosed with either an urachal sinus or urachal cyst; the other nine patients were confirmed to have a patent urachus. Umbilical discharge (14 patients) and umbilical granuloma (9 patients) were the most common presentations. The 12 patients with an urachal sinus underwent ultrasonography (USG) (10; diagnostic), 2 fistulography (all; diagnostic). Those with an urachal cyst underwent either USG (6/12; diagnostic), computed tomography (CT) (3; diagnostic), fistulography (2; diagnostic), or magnetic resonance imaging (MRI) (1; diagnostic). One subject was affected by acute appendicitis, which was confirmed by CT. Of the 9 children with patent urachus, 7 underwent USG (all; diagnostic); exploration without further imaging studies was performed on the remaining 2 subjects. Surgical excision was performed in 30 patients. Omphalomesenteric duct or Meckel's diverticulum were incidental findings, which were simultaneously repaired. Conservative treatment was successful in only 3 patients. CONCLUSIONS: Urachal anomalies in children mainly manifest as umbilical discharges and umbilical granuloma, but may present non-specific symptoms in some cases. USG is a useful method for diagnosis, but other imaging modalities can be useful to establish the differential diagnosis. A limited number of children with urachal anomalies, mainly presenting with an umbilical discharge, can be managed conservatively. However, complete surgical excision of the lesion, with the possible associated anomalies, should be the basic scheme for children with urachal anomalies.
Appendicitis ; Child* ; Diagnosis ; Diagnosis, Differential ; Granuloma ; Humans ; Incidental Findings ; Magnetic Resonance Imaging ; Meckel Diverticulum ; Medical Records ; Retrospective Studies ; Ultrasonography ; Urachal Cyst ; Urachus ; Vitelline Duct

OBJECTIVES: Rapid increase in engineered nanoparticles (ENPs) in many goods has raised significant concern about their environmental safety. Proper methodologies are therefore needed to conduct toxicity and exposure assessment of nanoparticles in the environment. This study reviews several analytical techniques for nanoparticles and summarizes their principles, advantages and disadvantages, reviews the state of the art, and offers the perspectives of nanometrology in relation to ENP studies. METHODS: Nanometrology is divided into five techniques with regard to the instrumental principle: microscopy, light scattering, spectroscopy, separation, and single particle inductively coupled plasma-mass spectrometry. RESULTS: Each analytical method has its own drawbacks, such as detection limit, ability to quantify or qualify ENPs, and matrix effects. More than two different analytical methods should be used to better characterize ENPs. CONCLUSIONS: In characterizing ENPs, the researchers should understand the nanometrology and its demerits, as well as its merits, to properly interpret their experimental results. Challenges lie in the nanometrology and pretreatment of ENPs from various matrices; in the extraction without dissolution or aggregation, and concentration of ENPs to satisfy the instrumental detection limit.
Limit of Detection ; Microscopy ; Nanoparticles ; Spectrum Analysis

PURPOSE: This study sought to evaluate the treatment modality, morbidity and mortality after surgery, the method of nutritional support and the survival rate for patients with cancer of the hypopharynx, larynx and cervical esophagus. METHODS: A retrospective review was undertaken of 17 hypopharyngeal, laryngeal and cervical esophageal carcinoma patients who had undergone surgical treatment in the Department of Surgery and Otorhinolaryngology, Yonsei University, College of Medicine, from January 1995 to April 2000. All patients underwent transhiatal esophagectomy in order to avoid pulmonary complications. Outcome measures were calculated using the Kaplan-Meier estimator. RESULTS: The 17 consecutive patients included 11 cases of hypopharyngeal cancer, 3 glottic cancers, 2 cervical esophageal cancers and one thyroid cancer with invasion of the trachea and esophagus. Fifteen patients (88%) presented with an advanced tumor stage. As for nutritional support following surgery, 12 underwent feeding jejunostomy, 4 a nasoenteric tube feeding and the other recieved total parenteral nutrition. Nine patients (53%) developed complications following surgery. One of the patients who had surgery died postoperatively. The mean survival time was 26 months and the 2-year and 4-year overall survival rates were 69.5% and 53.0%, respectively. CONCLUSION: Reconstruction of the hypopharynx and esophagus using stomach was low mortality and low severe morbidity. A total pharyngolaryngoesophagectomy with gastric transposition and primary hypopharyngogastric anastomosis offers the best chance for cure or palliation with acceptable morbidity and degree of function for selected patients with advanced hypopharyngeal, laryngeal and cervical esophageal carcinomas.
Enteral Nutrition ; Esophageal Neoplasms ; Esophagectomy ; Esophagus* ; Head and Neck Neoplasms ; Humans ; Hypopharyngeal Neoplasms ; Hypopharynx* ; Jejunostomy ; Larynx ; Mortality ; Nutritional Support ; Otolaryngology ; Outcome Assessment (Health Care) ; Parenteral Nutrition, Total ; Retrospective Studies ; Stomach* ; Survival Rate ; Thyroid Neoplasms ; Trachea

To evaluate effect of coronary collateral circulation on left ventricular function in patients with acute myocardial infarction, global ejection fraction(EF), left ventricular end distolic pressure(LVEDP), peak creatine kinase(CK) level and regional wall motion were analysed and compared in 30 patients with acute myocardial infarction according to grade of coronary collateral circulation. Patients with total or near total(above 95% of diameter) occlsion of left anterior descending coronary artery without significant lesion in right coronary artery or left circumflex artery were selected and divided into 3 groups according to the degree of collateral circulation on coronary angiography, to be compared by the index of ejection fraction, peak creatine kinase level, left ventricular and diastolic pressure and regional wall motion. The result are as following : 1) There were no statistically significant differences in ejection fraction, peak creatine kinase level, left ventricualr and diastolic pressure among the groups. 2) Regional wall motion of infarct related area of G2+3 group(adequate collateral) were better than that of G0(no collateral) group(p<0.05). Therefore, adequate coronary collateral circulation in acute myocardial infarction is thought to have beneficial effect on left ventricular function especially in regional wall motion of infarct related area.
Arteries ; Blood Pressure ; Collateral Circulation* ; Coronary Angiography ; Coronary Vessels ; Creatine ; Creatine Kinase ; Humans ; Myocardial Infarction* ; Ventricular Function, Left*