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.

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

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

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

No abstract available.
Pancreatic Neoplasms*

Unilateral brachial plexus injury is a rare complication of thoracoscopic sympathectomy, which is generally considered to be a simple and safe procedure. We report on a 20-year-old female patient who developed persistent pain and weakness of the left arm after thoracoscopic sympathectomy for hyperhidrosis. An electromyographic study revealed evidence of denervation at the C5-C7 level, and a nerve conduction study on the left brachial plexus showed decreased amplitude of the compound muscle action potential of the left musculocutaneous and axillary nerves. The above findings are compatible with left brachial plexopathy, with predominant involvement of the lateral and posterior cord. We suggest that this complication was caused by stretch and/or compression of the left brachial plexus when the arm was hyperabuducted upwards during the operation. Careful attention to positioning by the surgeon and anesthesiologist is needed to prevent this debilitating injury.
Action Potentials ; Arm ; Brachial Plexus Neuropathies ; Brachial Plexus* ; Denervation ; Female ; Humans ; Hyperhidrosis ; Neural Conduction ; Sympathectomy* ; Young Adult

BACKGROUND: Stimulation of iNOS with subsequent release of NO may play a critical role in pathophysiology or host defense reactions. NO can be produced by several cell types that reside in the skin. Increasing data indicate that NO serves as an autocrine and paracrine mediators in diverse and complex cellular processes throughout the skin. OBJECTIVE: The aim of the present study was to elucidate whether dendritic epidermal T cell can express iNOS and generate NO. In addition to that, this study was to evaluate whether NO may play a certain role in IL-3 production of activated dendritic epidermal T cell. METHODS: iNOS mRNA was isolated by RT-PCR at 12, 24, 48, 72 hours after stimulation and NO was measured by the Griess method. IL-3 levels were assessed with a basic cell proliferation bioassay system using supernatants from T cells cultured in 96 well plates. Units of IL-3 in the culture supernatants were measured using the cytokine-dependent DA-1 cell line. RESULTS: 1. NO generation was increased by UVB 100mJ/cm2 irradiation, concanavalin-A and lipopolysaccharide stimulation in dendritic epidermal T cell. The amount of NO was highest in LPS. 2. The expression of iNOS was increased by UVB 100mJ/cm2 irradiation, concanavalin-A and lipopolysaccharide stimulation in dendritic epidermal T cell. Induction of iNOS revealed peak at 72 hours after concanavalin-A and lipopolysaccharide stimulation, but in UVB irradiation that of iNOS was not observed except at 48 hours. 3. NO may play a role in IL-3 production in activated dendritic epidermal T cell. CONCLUSION: The results strongly suggest that the expression of iNOS and NO production in dendritic epidermal T cell are upregulated by UVB, concanavalin-A and lipopolysaccharide, and NO may play a role as mediator in IL-3 production of activated dendritic epidermal T Cell as autocrine manner.
Biological Assay ; Cell Line ; Cell Proliferation ; Interleukin-3* ; RNA, Messenger* ; Skin ; T-Lymphocytes

BACKGROUND: Irbersatan, an orally active antihypertensive agent, effectively reduce blood pressure by directly blocking angiotensin II receptors without any significant adverse effects. The purpose of this study is to evaluate the efficacy and safety of irbesartan in patients with mild to moderate hypertension. METHODS: This study enrolled 83 patients who had diastolic pressure above 95 mmHg and below 110 mmHg on two measurements. Sixty eight patients were administered 150mg of irbesartan, an angiotensin II receptor blocker, daily for four weeks as an initial dosage. If the sitting diastolic pressure was equal to or greater than 90 mmHg after a 4 week treatment period, the dosage was doubled until the end of 8 weeks. Baseline pressures, antihypertensive effect, side effects, laboratory findings were compared before and after treatment. RESULTS: Fourty two patients out of 53 patients having completed this study showed decreased blood pressure equal to or more than 5 mmHg of the sitting diastolic pressure (response rate=79%). Twenty one patients out of 53 patients showed normalized blood pressure below 90 mmHg of the sitting diastolic pressure (normalization rate=40%). The extent of decrease in diastolic and systolic blood pressure after eight week treatment was an average 11.7+/-10.1 mmHg and 16.3+/-18.9 mmHg, respectively (p<0.05). Nineteen ontoward side effects was observed in 17 patients out of 68 patients with medication (frequency of ontoward effects=25%). Only one case with headache was considered to be related to the medication. Abnormal laboratory findings were observed in eight patients, and only one case with elevation of bilirubin and ALT levels was considered to be related to the medication. CONCLUSION: In conclusion, irbesartan is a safe and effective antihypertensive drug in patients with mild to moderate hypertension with tolerable side effects.
Bilirubin ; Blood Pressure ; Headache ; Humans ; Hypertension* ; Receptors, Angiotensin

Isometric tension recording was performed in the transverse strips of porcine coronary arteries and rabbit aorta to observe the effects of the endothelium and endothelium-derived relaxing factor(EDRF) on vasomotor tone and to test the hypothesis that alcohol may have the deleterious effect on endothelium-dependent vasorelaxation. Tension-development by vasoconstrictor was markedly attenuated in the endothelium-intact strips compared to the endothelium denuded strips. Administration of hemoglobin(10-5M) to inhibit the action of EDRF increased tension selectively in the endothelium-infarct strips, which is suggestive of basal EDRF secretion. Nitro L-arginine(10-5M). an analogue of L-arginine(10-4M) partially reversed the inhibitory effect of nitro L-arginine. Ethyl alchol inhibited bradykinin-induced endothelium-dependent vasorelaxation of porcine coronary artery in dose dependent manner. These data suggest that the protective effect of vascular endothelium to the action of vasoconstirctor can be explained by exercise of basal EDRF release and damaged endothelium would be a great risk of induction of vasospasm. Also we believe that there is a relationship of competive inhibition between L-arginine. a precursor of EDRF, and its analogues on the action of EDRF and alcohol intake would be hazardous to the patients with coronary artey disease because its inhibitory action on endothelium-dependent vasorelaxation may evoke myocardial ischemia.
Aorta ; Arginine ; Coronary Vasospasm ; Coronary Vessels* ; Endothelium* ; Endothelium, Vascular ; Ethanol* ; Humans ; Myocardial Ischemia ; Spasm* ; Vasodilation