INTRODUCTION: Percutaneous transluminal angioplasty(PTA) has been widely accepted for the treatment of arterial stenosis. However, acute thrombosis, localized dissection or recoiling may occur as complication, resulting in acute occlusion. Restenosis is also a problem in long term follow up. Recent advance of metallic stent is considered as a good relief for the problems of PTA. PURPOSE: We analyzed 11 patients with metallic stent in the treatment of the iliac artery stenosis. METHOD: Subjects were male patients aged from 53 to 79 years old. All were suffered from claudication of lower extremities, pain and discolorization and diagnosed as atherosclerosis. Pelvic arteriography was performed to localize the stenotic lesion. Through the ipsilateral arterial puncture, metallic stent was inserted after PTA. The metallic stents were Wall stent in 7, Hanaro stent in 2, Palmaz stent 2 and Memotherm stent in 2 lesions. RESULT: The indications for metallic stent were long segment patients, in all cases, the stent was successfully inserted. The pressure gradient measured improved significantly after procedure. For the 3 to 24 months follow up, symptoms has not relapsed clinically. CONCLUSION: On the basis of our priliminary experience, Metallic stent is safe and effective for the treatment of iliac arterial stenosis in conjunction with PTA and surgery.
Aged ; Angiography ; Atherosclerosis ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Iliac Artery ; Lower Extremity ; Male ; Punctures ; Stents ; Thrombosis

PURPOSE: This study was done to evaluate the efficacy and safety of percutaneous sclerotherapy or endovascular treatment of hemangioma and venous malformation. METHODS: 9 interventional procedures were performed in 7 patients whose age ranged from 16 years to 52 years. Five of these patients had arteriovenous malformation, the remaining had hemangioma and venous malformation. N-buty1-2-cyanoacrylate was injected percutaneously in 4 procedures and intraarterially in one procedure. Ethanol with lipiodol(10%) was injected percutaneously in 2 procedures. 1valon particle was embolized intraarterial in 1 procedure. RESULTS: N-buty1-2-cyanoacrylate injection, Contour arterial embolozation, Etanole with lipiodo1, sclerotherapy followed by physician and was judged beneficial in 7 of 7 patients. One pateint had minor complication(skin ulcer) but no long term sequelae. CONCLUSIONS: Percutaneous sclerotherapy and endovascular treatment, either or before surgery is a safe and effective method of managing hemangioma and arteriovenous malformations.
Arteriovenous Malformations ; Ethanol ; Hemangioma ; Humans ; Sclerotherapy

PURPOSE: Portal triad clamping and total or intermittent hepatic vascular exclusion are usually used to reduce blood loss during a major liver resection. Here we report the results of hepatectomy without vascular clamping. METHODS: From January 2003 to December 2005, 143 hepatectomies were performed without vascular clamping. There were 102 men and 41 women, with a mean age of 56.4 years. The indications were 79 hepatocellular carcinomas, 20 intrahepatic duct stones, 13 metastases, 13 gallbladder carcinomas, 7 intrahepatic cholangiocarcinomas, 5 Klatskin's tumors, and 6 others. All procedures were carried out using an ultrasonic dissector and intraoperative ultrasonography. RESULTS: There were 11 complications (7%) including intra-abdominal abscess (3), hyperbilirubinemia (3), postoperative bleeding (2), hepatic failure (1), ARDS (Acute respiratory distress syndrome) (1), and massive ascites (1). Sixty-one patients (42.6%) required a blood transfusion. The mean blood transfusion requirement was 1.4 pints. The liver function test results were similar to those previously reported on days 1,3,5, and 7 postoperatively, with a return to normal values after 1 week. CONCLUSIONS: Hepatectomy without vascular clamping reduces liver injuries, including ischemia of the remnant liver and splanchnic congestion. Reduction of bleeding during hepatectomy, requires accurate knowledge of the vascular anatomy, meticulous dissection of the liver parenchyma and maintenance of a low central venous pressure. Our experience with liver resections showed that hepatectomy without vascular clamping can be safely performed using intraoperative ultrasound and an ultrasonic dissector.
Abdominal Abscess ; Ascites ; Blood Transfusion ; Carcinoma, Hepatocellular ; Central Venous Pressure ; Cholangiocarcinoma ; Constriction* ; Estrogens, Conjugated (USP) ; Female ; Gallbladder ; Hemorrhage ; Hepatectomy* ; Humans ; Hyperbilirubinemia ; Ischemia ; Klatskin's Tumor ; Liver ; Liver Failure ; Liver Function Tests ; Male ; Neoplasm Metastasis ; Reference Values ; Ultrasonics ; Ultrasonography

Cerebral arterial embolism which resulted in total occlusion of right proximal middle cerebral artery was occured in 33 years old female patients with severe mitral stenosis and atrial fibrillation during percutaneous mitral balloon valvuloplasty(PMV). The occluded artery could be detected by transfemoral carotid angiography and recanalized immediately by intra-arterial infusion of urokinase. There were no cerebral hemorrhage by CT scan after intra-arterial urokinase infusion and the patients discharged without any neurologic sequale 7 days after thrombolysis. We report a case of successful recanalization with intraarterial infusion of urokinase in patient with cerebral arterial embolism occurred during PMV.
Adult ; Angiography ; Arteries ; Atrial Fibrillation ; Cerebral Hemorrhage ; Embolism* ; Female ; Humans ; Infusions, Intra-Arterial* ; Intracranial Embolism ; Middle Cerebral Artery ; Mitral Valve Stenosis ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator*

The main trend moves towards early excision and skin grafting as treatment for the deep second degree burns and the third degree burns. The ability to excision & skin grafting. This study prospectively evaluated the ability of laser doppler flow measurements obtained within 72 hours after burn injury to predict the depth of burn wounds. A Periflux system 4001 laser doppler flowmetry had been used to measure cutaneous microflow circulation of 100 selected points of burn wounds in 44 admitted patients from March 1993 to February 1994. The mean value of superficial second degree burn checked by laser doppler was 194.6 perfusion unit(PU). The deep second degree burn was 59.7 PU and third degree burn was 5.1 PU. The blood flow of more than 100 PU reliably predicted the superficial second degree burn with 90.2 percents accuracy. The blood flow between 100 PU and 10 PU predict the deep second degree dermal burn with 96.2 percents accuracy. That of less than 10 PU predict the third degree burn with 100 percents accuracy. There was also a significant correlation between initial flow measurements and the depth of burn wounds. We conclude that laser doppler flow measurements performed early after burn injury are useful in predicting the depth of burn wounds. The laser doppler flowmetry has the advantage of being easy to use, noninvasive, provide immediate result for early determination of burn depth. The laser doppler flowmetry is useful in selecting patients for early excision and grafting of burn wounds.
Burns* ; Humans ; Laser-Doppler Flowmetry* ; Perfusion ; Prospective Studies ; Skin Transplantation ; Transplants ; Wounds and Injuries

No abstract available.
Methotrexate* ; Pregnancy*

The enhanced recovery after surgery (ERAS) program, which has been recently introduced in the field of perioperative care, represents a multimodal strategy to attenuate the loss, and improve the restoration, of functional capacity after surgery. This program aims to reduce morbidity and enhance recovery by reducing surgical stress, optimizing pain control, and facilitating early resumption of an oral diet and early mobilization. Considering this perspective, protocols for enhanced recovery should include comprehensive and evidence-based guidelines for best perioperative care. Appropriate protocol implementation may reduce complication rates and enhance functional recovery and thereby reduce the duration of hospitalization.Current Concepts: In major abdominal surgeries, the recommended ERAS protocols involve common items such as preoperative counseling, preoperative optimization, prehabilitation, preoperative nutrition, fasting and carbohydrate loading, bowel preparation, thromboprophylaxis, antimicrobial prophylaxis, surgical access, drainage, nasogastric intubation, urinary drainage, early mobilization and prevention of postoperative ileus, postoperative glycemic control, and postoperative nutritional care. These items have been briefly reviewed with the relevant evidence.Discussion and Conclusion: ERAS is a comprehensive and evidence-based guideline for optimal perioperative care. Although a number of ERAS items still require high-level evidence through well-designed randomized controlled trials, the ERAS guidelines can serve as adequate recommendations for our practice. Thus, these items can be introduced and adopted with evidence. In addition, it is important to remove items that are not supported by evidence from routine procedures.

The cystic teratoma is the most common germ cell tumors in reproductive age women. The malignant change of cystic teratoma is rare, about 1~2%, and mostly change to squ-amous cell carcinoma. We experienced 4 cases of squamous cell carcinoma arising in cystic teratoma and re- port our cases with a brief review of the literature.
Carcinoma, Squamous Cell* ; Female ; Humans ; Neoplasms, Germ Cell and Embryonal ; Ovary* ; Teratoma*

No abstract available.
Renal Insufficiency*

PURPOSE: Gap junctions are intercellular channels to facilitate electrical and metabolic communication between adjacent cells. Connexin 43 is the most predominant type of connexin expressed on rat detrusor muscle cells. We investigated the connexin 43 expressions in various age groups of either sex in normal rats. METHODS: Eighty Sprague-Dawley rats were used for analysis. Each group was quantified by 8 rats at 1 week, 2 weeks, 1 month, 3 months, and 6 months of age in either sex. In each animal, bladder was removed without any kind of intervention and fresh-frozen in liquid nitrogen. Total RNA extraction was done with easy-BLUE total RNA extraction kit. Reverse transcription polymerase chain reaction was done for connexin 43 and glyceraldehyde-3-phosphate dehydrogenase as an internal control using ImProm-II Reverse Transcription System. RESULTS: In female rats, no age-related change was detected in connexin 43 expressions. In male rats, connexin expression at 3 months of age showed significant decrease compared with 1 week, 2 weeks, and 6 months of age (P<0.05). When connexin expression at the same age in male and female were compared, only 3 months group in male showed significant decrease than the same age group in female. CONCLUSIONS: Our data suggest that the expressions of connexin 43 mRNA in normal detrusor muscle cell showed age-related changes especially in male rats. Although it is difficult to interpret these findings at this stage, age should be considered as a possible compounding factor affecting connexin 43 expressions in male rats.
Animals ; Connexin 43 ; Female ; Gap Junctions ; Humans ; Male ; Muscle Cells ; Nitrogen ; Oxidoreductases ; Polymerase Chain Reaction ; Rats ; Rats, Sprague-Dawley ; Reverse Transcription ; RNA ; RNA, Messenger ; Urinary Bladder