PURPOSE: The pathogenesis of carotid atherosclerosis (CA) is known to involve several pathologic processes, such as lipid disturbances, thrombosis, oxidative stress and apoptosis. However, the genetic factors contributing to the development of CA, are, poorly understood. Thus, this study was performed to clarify the genes that are related with CA by comparing the expression patterns of mRNA in the arteries of a control group and in the arteries of a CA patients group. MATHODS: The total RNAs in the arteries of both groups were obtained from the abdominal aorta of 5 brain death donors and also the carotid arteries of 10 CA patents, and the DNAs were then reversely transcribed into complementary DNA (cDNA). The annealing control primer (ACP) method was applied to identify the differentially expressed messenger RNAs (mRNAs). RESULTS: The prominently expressed genes in the CA group compared with the control group were those of apolipoprotein C1 (apoC1) and ferritin light chain (FTL). There was a difference in the gene and protein expressions in the development of vascular disease between the coronary and carotid arteries, i.e., the transcriptional pathway for the FTL expression in CA patient arteries, and the posttranscriptional pathway in the coronary artery disease. The ApoC1 gene was another prominently expressed gene in the current study, and it has been reported to promote apoptosis in the cultured smooth muscle cells of human aorta. CONCLUSION: The increased expression of the apoC1 and FTL genes in the carotid artery might increase the possibility of CA via the apoptosis and oxidation of the increased LDL and VLDL.
Aorta ; Aorta, Abdominal ; Apoferritins ; Apolipoprotein C-I ; Apoptosis ; Arteries ; Brain Death ; Carotid Arteries ; Carotid Artery Diseases* ; Coronary Artery Disease ; DNA ; DNA, Complementary ; Humans* ; Myocytes, Smooth Muscle ; Oxidative Stress ; Pathologic Processes ; RNA ; RNA, Messenger ; Thrombosis ; Tissue Donors ; Vascular Diseases

Tumors in the pelvic cavity frequently involve the iliac vessels. Common and external iliac arteries should be reconstructed to restore the flow to the lower extremity if the tumor directly invades these arteries. We report herein a 58-year-old female patient with a 10x11 cm, recurred uterine leiomyosarcoma. We performed en bloc resection of the tumor mass including the sigmoid colon, left ureter and 5 cm of the left external iliac artery. After complete resection, restoration of arterial flow to the lower extremity was made with a novel strategy of hypogastric artery transposition. There was no evidence of tumor recurrence or vascular insufficiency at 12 months after surgery.
Arteries* ; Colon, Sigmoid ; Female ; Humans ; Iliac Artery* ; Leiomyosarcoma ; Lower Extremity ; Middle Aged ; Recurrence ; Ureter

No abstract available.
Humans ; Spinal Stenosis*

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

We report a rare cause of lung cavities, occurring in a patient with intrapulmonary cystic teratoma. Computed tomography (CT) provided us more detailed informations about the tumor characteristics containing fat and calcification, which could not be distinguished on the plain radiographs. In addition, CTscans clearly demonstrated the dilated anterior segmental bronchus of the left upper lobe entering the posterior aspect of the cavity.
Bronchi ; Humans ; Lung* ; Teratoma*

Abdominal aortic aneurysm (AAA) is a disease in which the abdominal aorta is swollen to a diameter as large as 3.0cm or even more. Although the symptoms are usually not prominent, it is fatal once it bursts. If AAA is diagnosed early and treated, the majority of deaths from ruptured AAA can be prevented. It is screened for with ultrasonography, which is a fast, cheap and safe diagnosis tool. Most patients can also tolerate the screening well. Several countries are operating national AAA screening programs in efforts to reduce AAA-related deaths. For instance, the Screening Abdominal Aortic Aneurysms Very Efficiently program in the United States and the National Health Service Abdominal Aortic Aneurysm Screening Programme in the United Kingdom are some of the prominent programs currently available. If Korea conducts AAA screening programs for a target population similar to these cases, the cost is estimated to be 25.7 billion Korean won (23.4 million US dollars [USD]). If the target population is extended to males 65 years of age and above with experience smoking more than 5 pack-years of cigarettes, the cost is estimated to be 36.4 billion Korean won (33.1 million US dollars [USD]). However, considering the actual screening rate of the current national cancer screening program, the realistic costs are estimated to be 10.6 billion Korean won (9.7 million US dollars [USD]) and 15.0 billion Korean won (13.7 million US dollars [USD]), respectively. Given the success of AAA screening programs in other countries, it is necessary to introduce a national AAA screening program in Korea.
Aortic Aneurysm, Abdominal* ; Early Detection of Cancer ; Cost-Benefit Analysis ; Great Britain ; Health Services Needs and Demand ; Humans ; Korea* ; Male ; Mass Screening* ; Patient Selection ; Program Evaluation ; Smoke ; Smoking ; Tobacco Products ; Ultrasonography ; United States

The noninvasive vascular laboratory has become central to the evaluation of patients with peripheral arterial occlusive disease (PAOD) of the lower extremities. Most such patients have atherosclerosis as the cause of PAOD. Because noninvasive vascular laboratory techniques are widely available, relatively inexpensive, well-tolerated, and provide quantitative physiologic information, they are most commonly used as the first line objective modalities to confirm the diagnosis, establish the severity of ischemia, and estimate the anatomic level of involvement in patients that are suspected as having PAOD based on history and physical signs. This article focuses on the commonly used instruments, examination techniques, interpretive guidelines, and clinical application of each modality.
Arterial Occlusive Diseases ; Atherosclerosis ; Humans ; Ischemia ; Lower Extremity

PURPOSE: Endovascular procedures are being used with increasing frequency for the treatment of patients with peripheral vascular disease. Vascular surgeons must adapt to this rapid change in treatment modalities toward less invasive procedures. These procedures require that the individual be familiar with intravascular catheter techniques. Therefore, the vascular surgeon should acquire endovascular treatment skills. The purpose of this study was to report the early experience of a vascular surgeon-handed digital subtraction angiography (DSA) and endovascular procedures. METHOD: From March 2006 to October 2007, 104 patients (male 83, female 21, mean age 56.5+/-17.2, range 16~94) underwent DSA or endovascular procedures. One vascular surgeon performed all of the procedures. The procedures were performed in the angiography suite equipped with INTEGRIS Allura 15 (Philips Medical Systems, DA Best, Netherlands). RESULT: Seventy-seven patients (74.0%) underwent diagnostic DSA during the period. The indications for DSA were limb ischemia in 34 patients, electric burn in 26 patients, and a non-healing wound of the extremity in 10 patients. Ascending venography was performed in nine patients (8.6%) with deep vein thrombosis, 1 patient with venous ulcer and in 1 patient with suspicious for venous thoracic outlet syndrome. Sixteen patients (15.3%) underwent endovascular treatment. Among them, 14 patients with critical limb ischemia received percutaneous balloon angioplasty and/or stent insertion and two patients with deep vein thrombosis received catheter-directed thrombolytic therapy. The technical success rate was 100%. After the procedures, one patient had a puncture site hematoma and two patients had contrast-agent allergic reactions. CONCLUSION: Surgeon-handed DSA and intervention showed a good success rate and reasonable complication rate.
Angiography* ; Angiography, Digital Subtraction ; Angioplasty, Balloon ; Burns, Electric ; Catheters ; Endovascular Procedures ; Extremities ; Female ; Hematoma ; Humans ; Hypersensitivity ; Ischemia ; Peripheral Vascular Diseases ; Phlebography ; Punctures ; Stents ; Thoracic Outlet Syndrome ; Thrombolytic Therapy ; Varicose Ulcer ; Venous Thrombosis ; Wounds and Injuries

Venous ulcer is a severe clinical manifestation of chronic venous insufficiency (CVI). Open venous ulcers occur in about 0.3% of the adult population and a history of open or healed ulceration occurs in about 1%. The prevalence of the venous ulcer increases with age. It is responsible for about 70% of chronic ulcers of the lower limbs. The high prevalence of venous ulcer has a significant socioeconomic impact in terms of medical care, daily work and reduced quality of life. The pathophysiology of venous ulcer and CVI are directly related. CVI is caused by a dysfunction in the muscular pump of the calf which is the primary mechanism to return blood from the lower limbs to the heart. This dysfunction leads to the ambulatory venous hypertension (AVH). AVH is the primary event result in the venous ulcer. There are many theories regarding the pathogenesis of venous ulcer. The oldest theories are venous stasis and arteriovenous shunts. The more recent theories have associated CVI with microcirculatory abnormalities, with the generation of an inflammatory response: pericapillary fibrin cuff formation; leukocyte adhesion and activation; tumor necrosis factor alpha (TNF-alpha); macromolecules, extravasation and fibrinolysis abnormalities; aggregate monocyte-platelet formation. Despite the many studies, the real mechanism of venous ulcer is still unknown. It is possible that each mechanism is important in some cases. Therefore, the pathophysiology of venous ulcer is still the subject of many current studies.
Adult ; Fibrin ; Fibrinolysis ; Heart ; Hemodynamics* ; Humans ; Hypertension ; Leukocytes ; Lower Extremity ; Prevalence ; Quality of Life ; Tumor Necrosis Factor-alpha ; Ulcer ; Varicose Ulcer* ; Venous Insufficiency

Venous ulcer is a severe clinical manifestation of chronic venous insufficiency (CVI). Open venous ulcers occur in about 0.3% of the adult population and a history of open or healed ulceration occurs in about 1%. The prevalence of the venous ulcer increases with age. It is responsible for about 70% of chronic ulcers of the lower limbs. The high prevalence of venous ulcer has a significant socioeconomic impact in terms of medical care, daily work and reduced quality of life. The pathophysiology of venous ulcer and CVI are directly related. CVI is caused by a dysfunction in the muscular pump of the calf which is the primary mechanism to return blood from the lower limbs to the heart. This dysfunction leads to the ambulatory venous hypertension (AVH). AVH is the primary event result in the venous ulcer. There are many theories regarding the pathogenesis of venous ulcer. The oldest theories are venous stasis and arteriovenous shunts. The more recent theories have associated CVI with microcirculatory abnormalities, with the generation of an inflammatory response: pericapillary fibrin cuff formation; leukocyte adhesion and activation; tumor necrosis factor alpha (TNF-alpha); macromolecules, extravasation and fibrinolysis abnormalities; aggregate monocyte-platelet formation. Despite the many studies, the real mechanism of venous ulcer is still unknown. It is possible that each mechanism is important in some cases. Therefore, the pathophysiology of venous ulcer is still the subject of many current studies.
Adult ; Fibrin ; Fibrinolysis ; Heart ; Hemodynamics* ; Humans ; Hypertension ; Leukocytes ; Lower Extremity ; Prevalence ; Quality of Life ; Tumor Necrosis Factor-alpha ; Ulcer ; Varicose Ulcer* ; Venous Insufficiency