No abstract available.
Hemodynamics* ; Hepatocytes* ; Ischemia* ; Liver* ; Urokinase-Type Plasminogen Activator* ; Verapamil*

PURPOSE: This study was aimed to elucidate the effect of hyperthermia on neuronal nitric oxide synthase(nNOS) expression in both cerebral hemispheres after left common carotid artery occlusion in gerbils. METHODS: Using Mongolian gerbils, cerebral ischemia was produced by occluding carotid artery for 1-4 hours. Rectal temperature was maintained at 36degrees C for normothermia and 40degrees C for hyperthermia by heating pad. Western blot and RT-PCR was used to examine the nNOS and the mRNA expression. Neuronal damages were observed by histological study. RESULTS: After cerebral ischemia, mRNA of nNOS was expressed more abundantly in ischemic hemisphere than control in both normothermia and hyperthermia. Hyperthermia reduced nNOS protein expression markedly. In pathological study, neurons of hippocampal region were degenerated by ischemia. Hyperthermia by itself induced neuronal degeneration in both control and ischemic region. In immunohistochemistry of brain, there was no significant difference of nNOS expression between normothermia and hyperthermia. CONCLUSION: These findings suggest that increase in body temperature might enhance nNOS mRNA expression but reduce nNOS protein, and that hyperthermia aggravates neuronal damage by ischemia, independent of nNOS gene expression.
Blotting, Western ; Body Temperature ; Brain ; Brain Ischemia* ; Carotid Arteries ; Carotid Artery, Common ; Cerebrum ; Fever* ; Gene Expression ; Gerbillinae* ; Heating ; Hot Temperature ; Immunohistochemistry ; Ischemia ; Neurons* ; Nitric Oxide ; Nitric Oxide Synthase Type I* ; RNA, Messenger

Primary peptic ulcer disease in not known to be the result of underlying illness or trauma. These are most frequently duodenal or prepyloric. Since clinical features of peptic ulcer in children can easily be confused with many other disorders, the diagnosis is usually made when one of the more dramatic presentations, such as perforation, bleeding and obstruction. Recently, we experienced 2 cases of duodenal obstruction due to peptic ulcer in children. So, we report it with review of references.
Child* ; Diagnosis ; Duodenal Obstruction* ; Hemorrhage ; Humans ; Peptic Ulcer*

No abstract available.
Nifedipine* ; Vasopressins*

No abstract available.
Varicose Veins

Portal vein thrombosis is a rare condition occurring in association with a wide variety of precipitating factors. Among these, liver cirrhosis and neoplasm constitute the major etiology of portal vein thrombosis. In oriental countries, as compared with western countries, liver cirrhosis has been reported to be extremely rare cause of portal vein thrombosis. The authors experienced a case of portal vein thrombosis in a 46-years-old man with liver cirrhosis who admitted to our hospital due to abdominal pain. Abdominal CT, angiography and laparotomy showed involvement of portal vein with thrombus and there were no evidences of neoplastic disease. The screening tests for hypercoagulable states were normal. The patient was treated with portal vein thrombectomy and anticoagulation therapy. We report this case with brief review of literature.
Abdominal Pain ; Angiography ; Humans ; Laparotomy ; Liver Cirrhosis* ; Liver* ; Mass Screening ; Portal Vein* ; Precipitating Factors ; Thrombectomy ; Thrombosis ; Tomography, X-Ray Computed ; Venous Thrombosis*

PURPOSE: Despite recent progress in the procedures of revascularization, acute limb ischemia continues to account for a wide variety of complications, culminating very often in limb loss or death. These poor results after treatment of acute limb ischemia still remains a major challenge in vascular surgery. METHOD: To evaluate the clinical characteristics and risk factors for early limb loss in acute limb ischemia, the clinical data of 87 limbs (8 upper and 79 lower limbs) in 83 patients. that underwent revascularization for acute limb ischemia at Yeungnam University Hospital from January 1995 to February 2003 were analyzed retrospectively. A Log-Rank test of Kaplan-Meier method and Cox proportional hazard analysis were performed to identify those main effects predictive of amputation free survival. RESULT: The patients, 78 males and 9 females, ranged from 30 to 83 years of age, with a mean age of 67. The highest incidence occurred among people in their 50s and 60s. The underlying causes of acute limb ischemia were arterial embolism in 42 limbs (42/87, 48.2%), arterial thrombosis in 36 (36/87, 41.3%), bypass graft occlusion in 9 (9/87, 10.3%). The primary sources of embolism were cardiac origin in 25 cases (25/42, 59.5%), aneurysmal origin in 2 (2/42, 4.8%) and unknown origin in 15 (15/42, 35.7%). As for the severity of ischemia according to SVS/ISCVS classification, 40 limbs (40/87, 46.0%) were classified as category IIa, 39 (39/87, 44.8%) as category IIb, and 8 (8/87, 9.2%) as category III. For the treatment, 66 thromboembolectomies (including 20 cases treated with intraoperative thrombolytic therapy), 19 arterial bypasses and 2 catheter directed thrombolytic therapies were performed. There were 13 major amputations and 8 mortalities at 6 months after revascularization. Cumulative 15 day, and 1, 2, 4, and 6-month amputation-free survival rate of all survival patients were 88.8%, 85.7%, 83.9%, 83.9% and 81.4% respectively. Among the univariate analysis of 26 clinical variables, 10 factors were identified as being associated with amputation-free surviva: age (P=0.01), preoperative tissue gangrene (P=0.03), preoperative skin color change (P=0.00), preoperative muscle status (P=0.00), preoperative motor and sensory deficit (P=0.00, P=0.00), severity of ischemia by clinical category (P=0.00), symptom duration (P=0.02), length of occlusion (P=0.01), and cause of occlusion (P=0.01). In multivariate analysis, age (P=0.04), and preoperative skin color change (P=0.00) predicted a poorer response to therapy. The major limb amputations were performed in 2 limbs (2/41, 4.9%) of the emboli group, and 11 limbs (11/42, 26.2%) of the thrombi group. For the limb with thrombosis, the major limb amputations were performed in 9 limbs (9/26, 34.6%) of the thromboembolectomy group and in 2 limbs (2/16, 1.3%) of the arterial bypass group. CONCLUSION: These results suggest that prompt and appropriate treatment is critically important in the management of acute limb ischemia. In thrombi cases Especially, a more aggressive surgical approach may be necessary for limb salvage.
Amputation ; Aneurysm ; Catheters ; Classification ; Embolism ; Extremities* ; Female ; Gangrene ; Humans ; Incidence ; Ischemia* ; Limb Salvage ; Male ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Skin ; Survival Rate ; Thrombolytic Therapy ; Thrombosis ; Transplants

BACKGROUND: Visceral ischemia-reperfusion produces injury both to the visceral organs that are made ischemic and to distant organs, such as the lung, that are not made ischemic. The pulmonary injury after visceral ischemia-reperfusion is, in part, a result of the production and release of a variety of humoral factors, such as proinflammatory cytokines, activated complements and lipid mediators. Two proinflammatory cytokines, tumor necrosis factoralpha (TNFalpha) and interleukin (IL)-1, have been implicated as early initiators of this response to visceral ischemia-reperfusion injury. Recently, additional concepts have been developed to block the synthesis and release of proinflammatory cytokines by using anti-inflammatory cytokine. Interleukin (IL)-10 inhibits proinflammatory cytokine which is produced by activated monocyte/ macrophages and prevents production of TNFalpha in acute inflammatory states. The purpose of this study is to determine the effect of exogenous administration of the anti-inflammatory cytokine, recombinant human IL-10, on proinflammatory cytokine production and pulmonary injury after visceral ischemia-reperfusion. METHODS: Two hours before 25 minutes of supraceliac aortic clamp, ICR mouse which weighed 30-40 g were injected with 0.2 microgram and 2.0 microgram of recombinant human IL-10 intraperitoneally and classified into A and B treatment groups, respectively. A control group underwent 25 minutes of supraceliac aortic clamp, and then reperfusion only. A sham group underwent laparatomy only. Two hours after reperfusion, all animals were sacrificed and submitted for a study of serology and histologic changes. To determine the pulmonary injury, wet/dry ratio, tissue myeloperoxidase (MPO) assay of the lung were measured and the microscopic findings for the lung tissue were analyzed. To evaluate the change in the cytokine during study, murine serum TNFalpha level was also measured. RESULTS: The wet/dry ratios of the lung tissue were significantly decreased in both IL-10 treatmentgroups (A and B treatment group) compared to the control group (p<0.05, p<0.05). The tissue MPO assays of the lung were significantly decreased in the IL-10 2.0 microgram treatment group (B treatment group) compared to the control group (p<0.05). The level of serum TNFalpha was also decreased in B treatment group compared to the control group (p<0.05). Microscopic findings revealed severe neutrophilic infiltration and microvascular congestion in the control group, but in both IL-10 treatment groups, neutrophilic infiltration and microvascular congestion were mild or moderate. CONCLUSIONS: The inhibitory effect of IL-10 on pulmonary neutrophil infiltration and on the level of TNFalpha during visceral ischemia-reperfusion injury was significant in the experiment. The use of exogenous IL-10 may offer a new therapeutic approach for decreasing the complications associated with visceral ischemia-reperfusion.
Animals ; Complement System Proteins ; Cytokines ; Estrogens, Conjugated (USP) ; Humans ; Interleukin-10* ; Interleukins ; Ischemia* ; Lung ; Lung Injury* ; Macrophages ; Mice ; Mice, Inbred ICR ; Necrosis ; Neutrophil Infiltration ; Neutrophils ; Peroxidase ; Reperfusion ; Reperfusion Injury ; Tumor Necrosis Factor-alpha

Infection of a prosthetic vascular graft is a perilous complication, difficult to eradicate, and if not recognized or adequately treated eventually caused the prosthesis to malfunction, often with life- threatening hemorrhage. Authors retrospectively evaluated the 17 cases of prosthetic vascular graft infection to determine treatment modalities of graft infection from May 1983 to April 1997 at department of surgery, Yeungnam University Hospital. Aortic and peripheral vascular graft infection were 2 and 15 cases, and mortality rate were 50% and 13.3%, respectively. Amputation rate was 13.3% in peripheral vascular graft infection. Most of the patients had experienced symptoms and signs of infection, such as fever, leukocytosis, pus discharge, wound disruption and/or bleeding due to anastomotic disruption. The Most common pathogen was Staphylococcus aureus(12 cases) and others were Staphylococcus epidermidis(4 cases), Escherichia coli(1 cases). The most common site of infection was inguinal area(7 cases) that associated with repeated operation for thromboembolectomy. The diagnosis was made with Duplex ultrasonography, computed tomography and sinography. In one case of aorto-iliac bypass, graft-cutaneous fistula was found by sinography. Treament modalities were local antibiotic soaking dressing only (4 cases), rotational muscle flap(1 case), graft excision with revascularization(4 cases), and graft excision without revascularization(6 cases) in peripheral graft infection and aortic graft excision with extra-anatomic bypass graft(2 cases) in aortic graft infection with systemic antibiotic administration. In conclusion, prevention of vascular graft infection and early diagnosis of infection are very important. The time to infection after operation, infection sites, bacteological pathogens and general condition of patients are also important to select treatment modalities, such as local care only, muscle flap application, interposition graft, and removal of graft with or without revascularization.
Amputation ; Bandages ; Diagnosis ; Early Diagnosis ; Escherichia ; Fever ; Fistula ; Hemorrhage ; Humans ; Leukocytosis ; Mortality ; Prostheses and Implants ; Retrospective Studies ; Staphylococcus ; Suppuration ; Transplants ; Ultrasonography ; Wounds and Injuries

External compression of the celiac artery by the median arcuate ligament of the diaphragm has been reported to result in a varient of chronic intestinal ischemia since 1963 by Harjola. Diaphragmatic compression of the celiac axis is frequently reversible and varies with respiration. The diagnosis remains one of exclusion and should be made only with very careful deliberation. Authors experienced only one case of celiac axis syndrome at Yeungnam University Hospital recently and reviewed literatures. A 29-year-old young tall and slender man complained of prolonged postprandial epigastric pain and an epigastric bruit especially during expiration for 10 years. Angiography demonstrated significant narrowing at the origin of the celiac artery. At operation, 1 cm distal portion of the celiac artery to the origin was found to be compressed by the median arcuate ligament of the diaphragm and ganglion nerve fibers, and these were divided. After division of the ligament, the blood flow through the celiac axis was increased and common hepatic artery was dilated grossly. Seven days later after surgery, abdominal pain was recurred following oral intake. So, we performed cine-angiogram of the celiac axis and found persistent the stenotic lesion, and then we performed percutaneous transluminal balloon dilatation. After this procedure, the patient has remained well and free of pain.
Abdominal Pain ; Adult ; Angiography ; Axis, Cervical Vertebra ; Celiac Artery ; Diagnosis ; Diaphragm ; Dilatation ; Ganglion Cysts ; Hepatic Artery ; Humans ; Ischemia ; Ligaments ; Nerve Fibers ; Respiration