BACKGROUND: Tapered grafts, which have a smaller diameter on the arterial side, have been increasingly used for arteriovenous fistula (AVF) formation. We compared the outcomes of 4–6-mm tapered and 6-mm straight forearm loop arteriovenous grafts. METHODS: A total of 103 patients receiving forearm loop arteriovenous grafts between March 2005 and March 2015 were retrospectively analyzed and separated into 2 groups (group A, 4- to 6-mm tapered grafts, n=78; group B, 6-mm straight grafts, n=25). In each group, complications and patency rates after surgery were assessed. RESULTS: Clinical characteristics and laboratory results, except for cerebrovascular disease history (group A, 7.7%; group B, 28.0%; p=0.014), were similar between the groups. No significant differences were found for individual complications. Kaplan-Meier survival analysis revealed no significant differences in 1-year, 3-year, and 5-year patency rates between groups (61.8%, 44.9%, and 38.5% vs. 62.7%, 41.1%, and 35.3%, respectively). CONCLUSION: We found no significant differences in complication and patency rates between the tapered and straight graft groups. If there are no differences in complication and patency between the two graft types, tapered grafts may be a valuable option for AVF formation in light of their other advantages.
Arteriovenous Fistula* ; Cerebrovascular Disorders ; Forearm* ; Humans ; Polytetrafluoroethylene* ; Retrospective Studies ; Transplants*

BACKGROUND: This study was performed to investigate the outcomes of vascular operations that were done in patients with atheroscerosis obliterans (ASO) of lower limb. MATERIAL AND METHOD: Forty patients underwent vascular operations from December 1996 to June 2004. The patient's records were analyzed retrospectively. Mean age was 66+/-8 years (range, 47~81 years). Gender ratio was 37:3 (male:female). RESULT: The operations were done on 50 lower limbs of 40 patients. The names of operations were femoropopliteal bypass in 12 patients (30%), femorofemoral bypass in 12 (30%), femorofemoral bypass and femoropopliteal bypass in five (12.5%), aorta-lower limb artery bypass in five (12.5%), axillofemoral bypass in two (5%), iliopopliteal bypass in two (5%), and endarterectomy in two (5%). All bypass surgeries were done with prosthetic conduits. Mean follow up period was 33.2+/-23.2 months (range, 3.8~90.2 months). The cumulative patency rates of 1 and 5 years were 75.5 and 58.7% respectively. In six patients, amputation of the lower limb was done. In eight patients, 12 complications occurred. After the first operation, 10 patients underwent reoperations. CONCLUSION: Our lower limb arterial bypass surgery revealed acceptable patency rate, but not a few patients required reoperations. An epochal treatment modality that can inhibit the progress of ASO and improve long term patency should be established.
Amputation ; Arteries ; Atherosclerosis* ; Endarterectomy ; Extremities ; Follow-Up Studies ; Humans ; Lower Extremity* ; Retrospective Studies

Studies in animals indicate that aconitine or aconite has toxic effects in the visual system of a rabbit model. Such a toxic effects causes myelo-optic neuropathy in the visually evoked cortical potential(VECP) and histopathologic studies. Whether the administration of intravenous high-dose of methyprednisolone(MP) in the myelo-optic neuropathy caused by aconitine(1.5ml/kg, equivalent to 0.7mg/kg of aconitine) is experimentally effective remains uncertain. The group treated with MP(daily 30mg/kg X 2 for 3 days followed by 15mg/kg for 3 days) in addition to aconite was compared with the aconite alone group and the normal control group. In the MP treated group, increased recovery of onset latency, peak latency, and amplitude in VECP in comparision with the aconite alone group was recorded at 2 weeks (p<0.05). The MP treated group in comparision with the normal control group showed a significant delay in onset latency at 1 month and 2 months(p<0.05). But, the amplitude in both the MP treated group and the aconite alone group increased at 2 months and did not show a significant difference in comparision with the normal group(p<0.05). In histopathologic study, pathologic findings of myelin sheath in the MP treated group were less severe than in the aconite alone group generally. The true benefit of high-dose MP was at least clear within 2 weeks. The authors conclude that treatment with intravenous high-dose MP immediate after aconite injection may have some beneficial effects in recovery of neurologic function although such a treatment do not have the definite recovery in aconite induced myelo-optic neuropathy.
Aconitine ; Aconitum* ; Animals ; Methylprednisolone* ; Myelin Sheath

INTRODUCTION: In traditional society, the roles of housewives were to do housework, to look after her children and to give her family emotional stability. With rapid social and economic change, the traditional sense of value changes and the concepts of sexual roles, too. However, they are in a transition period yet. These discord and tension followed by role change appeared as the form of psychological instability or social pathological problem in modern family. Thus, this study aimed to avaluate the effect of employment on depression of housewives who play importent roles in family and their commumity. METHODS: From May to July 1996, the questonnaires were distributed to 179 housewives who have university education background(including community college), and have one or more children and live in Bundang-Ku of Sungnam city, making a distinction between working housewives and nonworking housewives. Regarding the subjects of this study, the non-working housewives are restricted to full-time housewives who have no job, and working housewives who have full-time job. As tools of measurement, we used BDI questionnaires consisted of 15 items in Korean. We performed statistical analysis among the data by means of SPSS/PC+. We analyzed statistical data for significance using one-way ANOVA and analyzed categorical data for significance using S-test. RESULTS: The average score on BDI for working housewives was 12.22(standard deviation 7.42) and this is rather higher than that of non-working housewives(10.80, standard deviation : 7.42). But the number of children increased, the BDI score were higher significantly in both groups. And the BDI score was high in working Housewives groups whose husbands had professional job or dommerce job, whose family system is a multi-generation family, and who feel a lot of fatigue after work. In case of non-working housewives, the BDI score was high with age(especially between 50-59), duration of marriage, lower income and Duvalls family life cycle 6, 7. CONCLUSIONS: There is no difference in depression tendency between working housewives and nonworking housewives. But in case of working housewives, some factors have influence on their depression tendency, the number of children, husbands job, family type, degree of fatigue after work. And in case of non-working housewives, the factors are the number of children, age, duration of marriage, income, family life cycle.
Child ; Depression* ; Education ; Employment ; Fatigue ; Gyeonggi-do ; Housekeeping ; Humans ; Marriage ; Seoul* ; Spouses ; Surveys and Questionnaires

Multiple primary lung cancer is not common and classified as a synchronous primary lung cancer and a metachronous primary lung cancer. We experienced one case of the triple synchronous primary lung cancer of different cell types. We conducted right pneumonectomy for preoperative diagnosed neuronendocrine tumor of the RUL and adenocarcinoma of the RLL. Pathologic examination revealed the carcinoid tumor of RUL bronchus, the squamous carcinoma of the RML and the adenocarcinoma of the RLL.
Adenocarcinoma ; Bronchi ; Carcinoid Tumor ; Carcinoma, Squamous Cell ; Lung Neoplasms* ; Lung* ; Pneumonectomy

A 65 year-old male had chest pain which was diagnosed as unstable angina needing urgent coronary artery bypass surgery. Physical examination demonstrated signs of severe anemia and hemoglobin level was 5.7 g/dL. Gastrofiberscopy showed a 4 cm sized fungating mass at the lesser curvature with active bleeding. The mass was adenocarcinoma by pathologic examination. Simultaneous coronary artery bypass surgery and total gastrectomy were planned due to bleeding of the mass. Off-pump coronary bypass grafting was done first, followed by total gastrectomy. The postoperative course was smooth. He was discharged from the hospital after 12 days and was on surveillance for 9 months. We report a rare case of simultaneous surgery for angina and gastric cancer.
Adenocarcinoma ; Aged ; Anemia ; Angina, Unstable ; Chest Pain ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Gastrectomy* ; Hemorrhage ; Humans ; Male ; Physical Examination ; Stomach Neoplasms ; Transplants

BACKGROUND: Descending necrotizing mediastinitis (DNM) is a serious disease originating in odontogenic or oropharyngeal infection with high mortality despite adequate antibiotics and aggressive surgery. We analyzed results of treatment for DNM. MATERIAL AND METHOD: We studied 8 cases diagnosed as DNM from 1998 to 2007. All patients received emergent surgical drainage and debridement with broad spectrum antibiotics just after diagnosis. Antibiotics were changed after bacterial susceptibility testing. The surgical approach included 2 cases of cervicotomy, 6 cases of cervicotomy, and a thoracotomy. RESULT: The interval between symptom onset and hospitalization was 4.6+/-1.8 days (1~9 day). DNM originated in 4 cases of odontogenic infection (50%), 2 cases of oropharyngeal infection (25%), and 2 cases of unknown origin (25%). Causative organisms were found in 6 cases; Streptococcus in 4 cases, Staphylococcus in 1 case, and Klebsiella in 1 case. The Endo DNM classification was type I (2 cases), IIA (3 cases), and IIB (3 cases). The incidence of thoracotomy was 75%. The surgical mortality rate was 25% (2/8). The cause of death was multiple organ failure caused by septic shock. All mortality cases received only cervicotomy and aggravated infections after initial drainage. CONCLUSION: Early diagnosis, immediate surgical drainage, and adequate antibiotics, including covered anaerobes, are required. Thoracotomy should be performed with cervicotomy even for localized DNM.
Anti-Bacterial Agents ; Cause of Death ; Debridement ; Drainage ; Early Diagnosis ; Hospitalization ; Humans ; Incidence ; Klebsiella ; Mediastinitis ; Multiple Organ Failure ; Necrosis ; Shock, Septic ; Staphylococcus ; Streptococcus ; Thoracotomy

A rare small cell carcinoma of the trachea was managed in a 59 year old female patient. The diagnosis was confirmed by histopathological and immunohistochemical studies. Surgical resection and adjuvant chemotherapy were done. The patient died 6 months later due to multiple metastasis.
Carcinoma, Small Cell* ; Chemotherapy, Adjuvant ; Diagnosis ; Female ; Humans ; Middle Aged ; Neoplasm Metastasis ; Trachea* ; Tracheal Neoplasms

OBJECTIVE: Distal middle cerebral artery (MCA) aneurysms are the least frequent aneurysms of the MCA, and they represent about 1.1 to 5% of all MCA aneurysms. Patients with ruptured distal MCA aneurysms generally have a poor clinical outcome. The purpose of this article is to review the characteristics of distal MCA aneurysms to avoid the complications of microsurgical dissection and clipping of distal MCA aneurysms. METHODS: A total of 1187 patients with ruptured aneurysms were treated at our hospital between January 1997 and May 2008. All patients underwent surgical procedures. Computed tomography (CT) revealed rupture of distal MCA aneurysms in 15 (1.26%) patients. The location of the aneurysm were the M2 (insular) segment in seven patients, the M2-3 junction in three and the M3 (opercular) segment in five. Brain CT images revealed the presence of both subarachnoid hemorrhage (SAH) and intracranial hemorrhage (ICH) in 11 of 15 (77.3%) patients, with a mean ICH volume of 14.5 cc (range : 5 to 32 cc). Rebleeding occurred in 7 out of the 15 (46.7%) patients. RESULTS: All the patients underwent early surgical procedures, including clipping in seven, trapping in two, bypass surgery in four, Guglielmi detachable coil embolization in one and exploratory craniotomy in one patient. The aneurysm had a fusiform appearance in 9 out of 15 cases (60%), and the mean size of the aneurysm was 10.4 mm (range : 2 to 35 mm). Three patients died due to severe brain swelling (20%). CONCLUSION: In this study, distal MCA aneurysms had a relatively fusiform shape as well as high rates of rebleeding and ICH. A good clinical outcome was associated with early surgery for adequately controlling brain swelling and preventing rebleeding.
Aneurysm ; Aneurysm, Ruptured ; Brain ; Brain Edema ; Cerebral Hemorrhage ; Craniotomy ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Middle Cerebral Artery ; Rupture ; Subarachnoid Hemorrhage

Tracheo-innominate artery fistula is a rare, but it is one of the gravest complications next to tracheostromy. Early recognition and prompt surgical management is mandatory. The patient was a 66 year old women with MCA infarct who maintained tracheostomy for lyear. She had respiratory arrest due to the excessive bleeding through the tracheostomy site. We report an successful experience for control of bleeding by an innominate artery fistula division and primay suture closure under direct digital compression.
Aged ; Arteries* ; Brachiocephalic Trunk ; Female ; Fistula* ; Hemorrhage ; Humans ; Sutures ; Tracheostomy