PURPOSE: We designed this study to find out the risk factors affecting the patency rate after creation of arteriovenous fistula (AVF) for maintenance hemodialysis. METHODS: From March 1997 to April 1999, a total of 206 AVF creation operations [126 of radiocephalic fistula (RCF), 59 of brachiocephalic fistula (BCF), and 21 of grafted fistula] in 165 patients were undertaken by single surgeon under the same surgical technique and principles. In 128 cases (62.1%), operation was performed for the first time and in 42 cases (20.4%), the trial was second time. However in remaining 36 cases (17.5%), the operation was three or more than three times. RESULTS: After a mean follow-up of 9 months, 27 patient death and 53 fistula failure were identified. The overall patency rate at 1- and 2-year were 72.6% and 61.1%. The success patency rate, excluding the early failure cases, at 1-and 2-year were 78.4% and 65.9%. In multivariate analysis, the presence of 2 or more than 2 times failed AVF episodes was the significant risk factor forecasting the poor fistula patency (p<0.05, odd ratio=2.72). Although the odd ratio in patients with grafted fistula or in diabetic patients was 1.39 or 1.48 in multivariate analysis, these factors did not reach the statistical significance in multivariate analysis (P>0.05). In univariate analysis, the 1- and 2 year patency rate of more than third AVF trial group were 53.2% and 25.3%, which showed significant poor patency rate comparing with the ones of first or second AVF trial group (76.73% in 1- and 67.9% in 2-year) (p=0.0197). CONCLUSION: In conclusion, repeated trial of AVF creation (= or >3) in itself was the most powerful significant risk factor affecting the patency rate after AVF creation. The successful first or second trial is very important to expect a long-term patency. Well designed surgery under delicate surgical technique in early referred patient should promise the long-term patency even in patients with diabetes or patients requiring grafted fistula.
Arteriovenous Fistula* ; Fistula ; Follow-Up Studies ; Forecasting ; Humans ; Multivariate Analysis ; Renal Dialysis* ; Risk Factors* ; Transplants

BACKGROUND: Food restriction has been reported to ameliorate diabetes and obesity. In this study, we examined the effects of the food restriction on phenotypes of TALLYHO/JngJ (TH) mouse, a recently developed diabetic model animal. METHODS: 3 week-old TH mice were divided into 2 groups (n = 20 each for food-restricted (THR) and free-fed (THF)) and THR mice were fed the same amount of food as normal control mice (C57BL/6, n = 20). Body weight was weekly monitored till 14 weeks of age. The half of animals were sacrificed at 8 weeks of age, and liver, kidney, and fat weight were measured. The histopathology of liver and brown fat tissues and mRNA expression of leptin in adipose tissue were analyzed. The oral glucose tolerance test and insulin resistance test was done at 14 weeks of age. The plasma concentrations of glucose, free fatty acid, triglyceride, cholesterol and leptin were analyzed. RESULTS: The THR mice had lower body weights than the THF mice, similar to C57BL/6 mice, with reduced fat deposition in liver and brown fat tissue. The plasma levels of glucose, triglyceride and free fatty acid were decreased in the THR group. The THR mice, however, carried more fat than normal mice, with increased plasma leptin concentration and leptin mRNA expression in fats and no alteration in plasma cholesterol levels. Furthermore, the THR mice revealed glucose intolerance with impaired after-meal insulin secretion and slight insulin resistance CONCLUSION: The food restriction apparently ameliorated the obesity and diabetic phenotypes of TH mice. However, plasma concentration of cholesterol were not improved in THR mice with increased adiposity index and glucose intolerance, suggesting the genetically prone tendency of obesity and diabetes development in TH mice possibly with an impairment in cholesterol metabolism.
Adipose Tissue ; Adipose Tissue, Brown ; Adiposity ; Animals ; Body Weight ; Cholesterol ; Diabetes Mellitus ; Fats ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Insulin ; Insulin Resistance ; Kidney ; Leptin ; Liver ; Mice ; Obesity ; Phenotype ; Plasma ; RNA, Messenger

No abstract available.
Bile Ducts, Extrahepatic*

The oculocardiac reflex is provoked by pressure applied to the globe of the eye or traction on the surrounding structures. It has been known that children and adults undergo eye muscle surgery under general anesthesia are most susceptible. When it occurs the most common manifestation is sinus bradycardia and other arrhythmia including atrioventricular block, ventricular premature beat and cardiac arrest. Endoscopic sinus surgery has been used popularly for treatment of chronic paranasal sinusitis. However endoscopic sinus surgery can be difficult for narrow visual field and anatomical variations. Oculocardiac reflex during endoscopic sinus surgery is rare case but potentially it can be life threatening event. The authors report the case of oculocardiac reflex during endoscopic sinus surgery with a review of literature.
Adult ; Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Atrioventricular Block ; Bradycardia ; Cardiac Complexes, Premature ; Child ; Eye ; Heart Arrest ; Humans ; Muscles ; Reflex ; Reflex, Oculocardiac ; Sinusitis ; Traction ; Visual Fields

BACKGROUND/AIMS: Recent studies suggest possibility of continuous and prolonged liver ischemia exceeding one hour. We compared mortality rates, liver function, serum Interleukin-6(IL-6) concentration and liver cell necrosis after continuous and intermittent hepatic ischemia in rats. METHODS: Sixty rats were divided into 6 groups to compare 7 day mortality rate. Continuous and intermittent left hepatic inflow occlusion was performed for a total period of 45, 60 and 90 minutes. In a separate study, following 90 minutes continuous or intermittent ischemia, systemic blood was sampled at 0 minute, 6 hours and 24 hours after final clamp release for measurement of SGOT, SGPT and IL-6. Pathologic examination was performed 24 hours or 7 days after reperfusion accordingly. RESULTS: There were no differences in the mortality rates within seven days. There were no differences in the level of SGOT, SGPT and IL-6 between each experimental group. In a pathologic examination, similar liver cell necrosis was found in each group until 24 hours of reperfusion. However, at 7 days after reperfusion, significantly higher grade of hepatic necrosis was noted in the group having continuous ischemia compared with intermittent ischemia of 90 minutes(p<0.05). CONCLUSION: Continuous ischemia is associated with significant risk in the aspect of pathologic study, although it did not affect short term mortality rates.
Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Interleukin-6 ; Ischemia ; Liver ; Mortality ; Necrosis ; Rats* ; Reperfusion ; Reperfusion Injury*

PURPOSE: Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. It usually occurs after a period of weight loss, nausea or vomiting due to a partial obstruction of the third portion of the duodenum. If conservative management fails, then a laparotomy, with a duodenojejunostomy, is indicated. A minimally invasive laparoscopic approach to the retroperitoneum, or duodenal, operation has recently been introduced. Although the role of laparoscopy in the management of SMA syndrome is not clearly defined, a laparoscopic duodenojejunostomy may be an alternative approach for its surgical treatment. METHODS: We retrospectively reviewed and analysed our experience of 8 cases of SMA syndrome, and included another 45 cases that had previously been reported in the Korean literature since 1967. RESULTS: There was no gender predominance, but SMA syndrome was more common in younger patients. There were several diseases, or underlying conditions, associated with gastrointestinal, or other general conditions, in SMA syndrome. With respect to its surgical management, most cases in Korea were treated with a duodenojejunostomy. We recently experienced two cases of superior mesenteric artery syndrome, which were treated laparoscopically. The operation time and lenghth of hospital stay were acceptable, with no complications. CONCLUSION: SMA syndrome shows a greater predominance in young age, and is associated with many other diseases, or conditions, in Korea. A duodenojejunostomy is the best choice of operative procedure for the treatment of SMA syndrome. A laparoscopic duodenojejunostomy is also a feasible, alternative option in the treatment of SMA syndrome, providing the benefits of a definitive and minimally invasive surgical technique for a duodenal obstruction.
Arteries* ; Duodenal Obstruction ; Duodenum ; Humans ; Korea ; Laparoscopy ; Laparotomy ; Length of Stay ; Mesenteric Artery, Superior ; Mesentery* ; Nausea ; Retrospective Studies ; Superior Mesenteric Artery Syndrome ; Surgical Procedures, Operative ; Vomiting ; Weight Loss

BACKGROUND: Nuss et al introduced a less invasive method for inserting a stainless steel bar through the small incision on the lateral chest wall into the pectus excavatum. This study was undertaken to assess the effect of the Nuss operation on lung mechanics, CT-Index and hemodynamics. METHODS: Twenty patients (age 4 to 17 years) with severe pectus excavatum underwent the Nuss operation. CT-Index (the internal transverse distance of the thorax/the vertebral-sternal distance at greatest depression) was evaluated before operation. Lung mechanics (dynamic compliance [Cdyn], static compliance [Cstat] and airway resistance [Raw]), hemodynamic changes (heart rate [HR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]), and gas exchange (arterial oxygen tension [PaO2], arterial carbon dioxide tension [PaCO2], pulse oximeter saturation [SPO2] and end-tidal carbon dioxide tension[PETCO2]) were measured before and after the operation. RESULTS: Cdyn and Cstat decreased significantly (P < 0.05), but Raw did not change. PaCO2 and PETCO2 decreased significantly (P < 0.05), and SBP and DBP increased significantly (P < 0.05) postoperatively. CONCLUSIONS: It is concluded that decreased compliance after the Nuss operation may result from reduced thoracic elastance, not to a change of lung parenchyma.
Airway Resistance ; Blood Pressure ; Carbon Dioxide ; Compliance ; Funnel Chest* ; Hemodynamics ; Humans ; Lung* ; Mechanics* ; Oxygen ; Stainless Steel ; Thoracic Wall

BACKGROUND: Hip replacement arthroplasty (HRA) is highly traumatic and performed in a lateral position for several hours and dead-space ventilation may increase. So, the difference between arterial and end-tidal PCO2 was investigated depending on the changes in the patient's posture during HRA in elderly patients. METHODS: Forty-three patients scheduled for a HRA were divided into two groups; Adult Group (n = 21, A-Group) and Elderly Group (n = 22, E-Group). Mean arterial pressure (MAP), heart rate (HR), PaO2, PaCO2, and end-tidal carbon dioxide tension (P(ET)CO2) were simultaneously measured at 10 min after anesthesia in a supine position (S[10]), at 30 min intervals from 30 min (L[30]) to 180 min (L[180]) in a lateral position and at 10 min in a supine position after the end of surgery (ES[10]) in both groups. The PaCO2-P(ET)CO2 gradient (P[a-ET]CO2) and dead space ventilation (Vd/ Vt) were calculated. RESULTS: At S(10), P(a-ET)CO2 in the A- and E-Groups was 7.0 +/- 5.0 and 7.2 +/- 3.3 mmHg respectively. From L(30) to ES(10), the P(a-ET)CO2 and the ratio of Vd/Vt in both groups increased significantly and progressively (P < 0.05 vs the control value) and the slope in the E-Group rose two times as compared to that in the A-Group. The correlation coefficient between P(a)CO2 and P(ET)CO2 was very significant from S(10) to L(90) and ES(10) in the A-Group, and from S(10) to L (60) in the E-Group (P < 0.01). CONCLUSIONS: For maintaining adequate ventilation of the elderly patient during HRA, PaCO2 should be measured intermittently along with the position changes after anesthesia in addition to the constant monitoring of PETCO2.
Adult ; Aged* ; Anesthesia ; Arterial Pressure ; Arthroplasty, Replacement, Hip* ; Carbon Dioxide ; Heart Rate ; Hip* ; Humans ; Posture ; Supine Position ; Ventilation

BACKGROUND: Angiotensin converting enzyme (ACE) is heavily expressed in the lung and plays a role in the metabolism of angiotensin II, bradykinin and substance P. Nitric oxides, including those produced by endothelial nitric oxide synthase (ecNOS), may regulate vascular and airway tone in the lung and influence various aspects of airway homeostasis. They are potentially involved in the pathogenesis of asthma, but the role of ACE and ecNOS gene in bronchial asthma is not completely understood. OBJECTIVE: To examine the possible involvement of ACE and ecNOS genes in the genetic basis for bronchial asthma, we investigated the association between genetic polymorphism and bronchial asthma, and its severity. METHOD: We determined the ACE and ecNOS genotypes by the polymerase chain reaction in 160 patients with bronchial asthma and 121 healthy subjects. Severity of asthma was classified by the guideline of NHLBI/WHO workshop. RESULTS: The frequency of the ID genotypes of ACE and bb genotype of ecNOS was highest in both groups, respectively. The distribution of ACE genotypes did not differ between the two groups (p=0.27). There was a higher frequency of the bb genotype of ecNOS in the asthma group than in the control population (p=0.004). In asthmatic patients, there were no differences in the distribution of ACE and ecNOS genotypes in different severity groups (p= 0.17, 0.06). CONCLUSION: These results suggest that the polymorphism of the ecNOS gene, not ACE gene, may be associated with development of asthma. But, the severity of asthma may not be influenced by polymorphisms of the ecNOS and ACE genes.
Angiotensin II ; Angiotensins* ; Asthma* ; Bradykinin ; Education ; Genotype ; Homeostasis ; Humans ; Lung ; Metabolism ; Nitric Oxide Synthase Type III* ; Oxides ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Substance P

PURPOSE: To present the initial experience of percutaneous radiofrequency ablation (RFA) of inoperable primary lung cancer, and to assess the technical feasibility and potential complications. MATERIALS AND METHODS: Twenty patients with inoperable lung cancer underwent percutaneous RFA. Nineteen of 20 patients had stage III or IV non-small cell lung cancer, and the remaining one had stage I lung cancer with pulmonary dysfunction. The mean tumor size was 4.6+/-0.4 cm (range, 1.8-8.4 cm). RFA was performed with a single (n=18) or cluster (n=2) cool-tip RF electrode and a generator under CT guidance using local anesthesia and conscious sedation. Twenty tumors were treated in 28 sessions. Patients were assessed by contrast-enhanced CT in all cases at 1 week, 1 month, and 3 months. Eleven patients received chemotherapy (n=10) or radiotherapy (n=1) after RFA. RESULTS: RFA was technically successful and well tolerated in all patients. Complete necrosis was attained in 7 lesions (35%), near complete (90-99%) necrosis in 10 lesions (50%), and partial (50-89%) necrosis in 3 lesions (15%). During the mean follow up of 202 days (21 to 481 days), tumor size was decreased in 13 patients, unchanged in 3, and increased in 4. In the latter four, additional RFA was performed. One patient underwent surgery three months after RFA and the histopathologic findings showed a large cavity with thin fibrotic wall suggestive of complete necrosis. During or after the procedure, pneumothorax (n=10), moderate pain (n=4), blood tinged sputum (n=2), and pneumonia (n=2) were developed. Chest tube drainage was required in only 1 patient due to severe pneumothorax. Other patients were managed conservatively. Seven patients died at 61 to 398 days (mean, 230 days) after RFA. The remaining 13 patients were alive 21 to 481 days (mean, 187 days) after RFA. CONCLUSION: RFA appears to be a technically feasible and relatively safe procedure for the cytoreductive treatment of inoperable, non-small cell lung cancer and warrants further investigation as a complementary treatment to chemotherapy or radiation therapy.
Anesthesia, Local ; Carcinoma, Non-Small-Cell Lung ; Catheter Ablation* ; Chest Tubes ; Conscious Sedation ; Drainage ; Drug Therapy ; Electrodes ; Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Necrosis ; Pneumonia ; Pneumothorax ; Radiotherapy ; Sputum ; Tolnaftate ; Tomography, X-Ray Computed