PURPOSE: To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. METHODS: Between Jan. 1999 and Dec. 2002, 29 consecutive patients with DVT had received thrombolytic therapy. The male: female ratio was 6: 23 and the mean age was 50.3+/-13.5 years. The mean duration of symptom was 9.9+/-22.1 days. Catheter-directed infusions of urokinase were administrated via ipsilateral popliteal veins and the angioplasty and stent placement performed after the thrombolytic procedure. The mean dosage of urokinase and duration of thrombolysis were 2, 435, 000+/-887, 000 units and mean duration of thrombolysis was 36.8+/-17.9 hours. Oral medication of warfarin continued at least six months or more. To evaluate the venous patency, duplex ultrasonography or CT venography were performed. RESULTS: Lysis was complete in 17 patients (58.6%, all acute DVT), partial in 11 (37.9%), with only one patient failing. Iliac vein stenosis had shown in 16 patient after thrombdysis. Which were treated with balloon angioplasty and stent insertion. As a postprocedural complication, vaginal bleeding occurred in two patients; one was treated with transfusion but the other stopped without treatment. CONCLUSION: Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. However further study will be reguired to evaluate the relationship between the incidence of postthrombotic syndrome and thrombolytic therapy alone.
Angioplasty ; Angioplasty, Balloon ; Constriction, Pathologic ; Female ; Humans ; Iliac Vein ; Incidence ; Lower Extremity ; Male ; Phlebography ; Popliteal Vein ; Postthrombotic Syndrome ; Stents ; Thrombolytic Therapy ; Ultrasonography ; Urokinase-Type Plasminogen Activator* ; Uterine Hemorrhage ; Venous Thrombosis* ; Warfarin

BACKGROUND: Pulsed Doppler measurement of transmitral flow has been widely used to assess the left ventricular relaxation abnormality noninvasively in patients with failing heart. However pulsed Doppler-derived indices are affected by multiple factors, including active relaxation and distensibility of the left ventricle, the pressure gradient between the left ventricle and atrium, and altered loading condition. The purpose of this study is to assess the role of new index, the rate of propagation of left ventricular peak filling flow in early diastole using color M-mode Doppler for the evaluation of left ventricular diastolic function. METHOD: The study group comprised 41 patients(24 males, 17 felames, mean age: 56+/-12). The clinical diagnosis were angina pectoris 32, acute myocardial infarction 3, peripheral arterial obstructive disease 2 and atypical chest pain 4. We measured rate of propagation(ROP) and propagation ratio of peak early filling flow by color M-mode Doppler echocardiography using baseline shifted first aliasing limit technique and compared with pulsed Doppler measurements of transmitral flow. RESULTS: 1) Pulsed Doppler-derived indices of mitral flows were as below. The maximal velocity of E wave was 65.4+/-21.3cm/sec in control group, 54.3+/-7.9cm/sec in group I patients(p<0.05 versus control group) and 70.9+/-15.2cm/sec in group II patients(p<0.01 versus group I). The maximal velocity of A wave was 70.0+/-20.9cm/sec in control group, 78.6+/-3.8cm/sec in group I patients and 60.0+/-14.1cm/sec in group II patients(p<0.01 versus group I). The E/A ratio was 1.01+/-0.42 in control group, 0.69+/-0.10 in group I patients(p<0.05 versus control group) and 1.19+/-0.16 in group II patients(p<0.01 versus group I). The deceleration time was 166.7+/-36.3msec in control group, 202.9+/-17.0msec in group I patients(p<0.01 versus control group) and 160.0+/-10.0msec in group II patients(p<0.01) versus group I). 2) The rate of propagation was 145.0+/-83.4cm/sec in control group, 50.0+/-13.2cm/sec in group I patients(p<0.01 versus control group) and 59.9+/-26.0cm/sec in group II patients(p<0.01 versus control group). 3) The propagation ratio was 2.27+/-1.29cm/sec in control group, 0.93+/-0.25cm/sec in group I patients(p<0.05 versus control group) and 0.86+/-0.36cm/sec in group II patients(p<0.01 versus control group). CONCLUSION: Analysis of filling flow propagation by color M-mode Doppler is an easy and noninvasive method for evaluation of left ventricular diastolic function and may be an additional tool to pulsed Doppler measurement of transmitral flow, especially in differentiation between normal and pseudonormal, but care must be taken in interpretation because of overlapping of values.
Angina Pectoris ; Arterial Occlusive Diseases ; Chest Pain ; Deceleration ; Diagnosis ; Diastole ; Echocardiography, Doppler* ; Heart ; Heart Ventricles ; Humans ; Male ; Myocardial Infarction ; Relaxation

Glucocorticoids, dexamethasone, 6 alpha-methylprednisolone are routinely administered to brain tumor patients to reduce peritumoral edema before surgical removal of the tumor. In addition, the glucocorticoids can inhibit growth of several cell lines. Retinoic acid, a derivative of vitamin A is also known to inhibit growth of several cell lines. Sometimes inhibition of growth accompany morphological changes. In the present study, we compared the effects of dexamethasone, 6 alpha-methylprednisolone, and retinoic acid on the growth and on the morphology of a rat glioma cell line, C6. We found that all of them can maximally inhibit the growth of C6 by approximately 30%(p<0.0025) in the presence of 10 microM of either dexamethasone, 6 alpha-methylprednisolone or retinoic acid under our experimental conditions. However, only retinoic acid could induce the morphological changes of C6 at the concentrations over 1 microM concentration, which was elongation of the cells. The morphological changes were observed both at the subconfluent and confluent cell population. When mixture of 10 microM of dexamethasone and 10 microM of retinoic acid was added, no further increase in the inhibition of growth was observed compared with the inhibition obtained by adding 10 microM of dexamethasone only. The results suggest that the glucocorticoids might have effedts of growth inhibition of the glial tumor in vivo.
Animals ; Brain Neoplasms ; Cell Line* ; Dexamethasone* ; Edema ; Glioma* ; Glucocorticoids ; Humans ; Rats* ; Tretinoin* ; Vitamin A

Basilar artery (BA) perforator aneurysms are exceedingly rare causes of subarachnoid hemorrhage. Therefore, the natural history and optimal treatment have not been established, and surgical, endovascular, and conservative management have been used. However, there is no consensus on the optimal treatment strategy. Herein, we report the case of a 52-year-old man presenting with a ruptured BA perforator aneurysm. First, we deployed an Enterprise stent from the left P1 segment to the BA because the microcatheter could not enter the aneurysm. Then, we deployed a helical coil on the orifice of the BA perforator. Finally, we deployed another Enterprise stent, sandwiching the helical coil between the two Enterprise stents. The aneurysm was completely obliterated without recurrence on the follow-up angiography. Our technique of sandwiching the small helical coil between two Enterprise stents might help other surgeons by offering another feasible treatment option for ruptured BA perforator aneurysms.

Iliofemoral vein thrombosis is a serious disease causing major morbidity, such as phlegmasia alba dolens, phlegmasia cerulea dolens, fatal pulmonary embolism, and post-thrombotic syndrome. Systemic anticoagulation therapy with heparin and coumadin often shows no effect and thrombectomy often results in poor long term patency due to recurrent thrombosis. Some recent studies have reported good results by catheter-guided thrombolysis therapy (CGTT) in iliofemoral vein thrombosis. Authors have experienced a good result by CGTT in an old (aging 7 weeks) iliofemoral vein thrombosis. (Case) A 21 years-old female patient with diffuse edema of left thigh and leg was admitted in SNUH. Her parents notified her abnormal gait at the age of three, but no treatment was done. In Jan. 1998, she was diagnosed as spastic diplegia due to cerebral palsy and underwent orthopedic surgery (semitendinosus tendon transfer) at other hospital. After long leg cast for 6 weeks, swelling of her left thigh developed, which waxed and waned. Seven weeks thereafter, she was diagnosed to have left iliofemoral vein thrombosis and transferred to our hospital. After initial evaluation and systemic heparin therapy, we performed CGTT via left popliteal vein puncture. After successful passage of guidewire, serial balloon dilatation and intra-clot urokinase infusion was done. Total 3.5 million units of urokinase was infused for 28 hours with simultaneous intravenous heparin. Despite of some residual thrombi, the venous flow of iliofemoral vein was restored with no complication and her symptom has much improved. Patent venous flow was detected at 6 months follow-up doppler examination.
Cerebral Palsy ; Dilatation ; Edema ; Female ; Follow-Up Studies ; Gait ; Heparin ; Humans ; Leg ; Orthopedics ; Parents ; Popliteal Vein ; Pulmonary Embolism ; Punctures ; Tendons ; Thigh ; Thrombectomy ; Thrombolytic Therapy* ; Thrombophlebitis ; Thrombosis* ; Urokinase-Type Plasminogen Activator ; Veins* ; Warfarin ; Young Adult

PURPOSE: Although progenitor cells may contribute to intimal hyperplasia (IH) after arterial injury, positive contribution of IH is variable with type of injury or cells. This study was designed to examine whether differentiated muscle derived stem cells (MDSC) attenuate IH in rat. METHODS: MDSCs were retrieved using preplate techniques from rat calf muscle and MDSCs (preplate 6th culture fraction, pp6) were exposed to VEGF (50 ng/ml) for endothelial differentiation prior to injection. Male rats were divided into two groups (cell treated vs. control) and underwent carotid balloon injury with 2-Fr catheter. The virus containing Green fluorescent protein (GFP) gene was transfected into cells for monitoring. Cells (5x10(6)) were indwelled into carotid artery for 30 minutes after injury and then blood flow was restored. Arteries were harvested at various intervals (1, 2 and 4 weeks) after injury. The intima to media thickness ratio (IMTR) was calculated with morphometric analysis. RESULTS: Endothelial surface markers such as VE-CADHERIN were strongly expressed on differentiated MDSCs. At 4 weeks after injury, IH was predominantly observed in control group compared to cell treated group. The intensity of GFP was strongly observed at 1 week and declined at 4 weeks in carotid artery wall at MDSC group. CD31(+) endothelial cells were observed at MDSC group compared to control. The mean IMTR in cell treated groups were significantly lower than control at 2 weeks (P=0.005) and 4 weeks (P< or =0.001). CONCLUSION: Our study demonstrates that MDSCs therapy promotes re-endothelialization and leads to attenuation of IH after balloon injury in rat.
Animals ; Antigens, CD ; Arteries ; Cadherins ; Carotid Arteries ; Catheters ; Endothelial Cells ; Humans ; Hyperplasia ; Male ; Muscles ; Rats ; Stem Cells ; Vascular Endothelial Growth Factor A ; Viruses

PURPOSE: The aims of this study were to analyze clinical characteristics of the patients with AAA (Abdominal aortic aneurysm) and to report the results of AAA repair. We also compared the results of open repair (OR) with those of endovascular repair (ER) to evaluate the short-term efficacy of ER, especially in high-risk patients. METHODS: We reviewed the medical records of 118 (28 ruptured, 90 unruptured) patients who underwent AAA repair in Seoul National University Hospital from September 1986 to September 2002. We also compared the treatment outcomes of ER (n=21) with those of conventional OR (n=37) for unruptured AAA during the period July 1995 to September 2002. RESULTS: The mean aneurysm size was larger in ruptured AAA patients (8.49 cm vs. 6.67 cm, P<0.01). The most frequent comorbidity was hypertension (51.7%, n=61). Abdominal discomfort or pain was the most frequent symptom. The hospital mortality in ruptured AAA was higher than in unruptured AAA (35.7% vs. 4.4%, P=0.01), especially in intraabdominal free rupture (80%). The complications of OR were rather systemic, but those of ER repair were all local or vascular complications such as endoleak and graft thromboembolism. The graft failure rate was significantly higher in ER than in OR (P=0.001), but ER resulted in shorter operation time and length of ICU stay, less blood loss and a lower necessity for general anesthesia than OR. No significant difference was found in hospital mortality or survival rate. CONCLUSION: Ruptured AAA still has high operative mortality, especially in free ruptured AAA. We suggest that elective operation be performed before rupture occurs. Because the short-term outcomes of ER are considered to be acceptable, ER may be helpful especially in the patients with high operative risk. But further study of the long-term results of ER for AAA should be followed.
Anesthesia, General ; Aneurysm ; Aortic Aneurysm, Abdominal* ; Comorbidity ; Endoleak ; Hospital Mortality ; Humans ; Hypertension ; Medical Records ; Mortality ; Rupture ; Seoul ; Survival Rate ; Thromboembolism ; Transplants

BACKGROUND: This study investigated the protective mechanism of Prostagladin E1 (PGE1) against intimal hyperplasia after vein interposition grafts in rabbits. It has been demonstrated that active oxygen species contribute to vascular smooth muscle cell growth via early cell cycle gene activation. We attempted to study whether PGE1 had an effect on the inhibition of the oxidative stress injury index (8-OHdG, MDA). METHODS: Forty-eight jugular vein grafts were inserted into the carotid arteries of male hyperlipidemic New Zealand white rabbits, which were divided into 2 groups (saline group and PGE1 group). Saline and Prostaglandin E1 (0.1 microgram/kg/min) were administered as a continuous infusion for 2 hours every day from just before graft interposition to harvest. The vein grafts were harvested at 6 hour, 1 day, 1 week, and 2 week after grafting and rapidly stored in liquid nitrogen ( 70oC). 8-OHdG was measured by using high performance liquid chromatography coupled with electrochemical detection (HPLC-EC), and malondialdehyde (MDA) was measured by using thiobarbituric acid (TBA) assay. PC 10 index and intimal thickness of the grafts were measured with a computer digitalized image analyzer. RESULTS: There was no difference in 8-OHdG levels between the saline and the PGE1 groups. PGE1 had more inhibitory effect on the MDA level as an oxidative stress injury index, but its action was restricted to 1 day. A morphometric analysis and an immunohistochemical study showed that the PGE1 group had more suppressive effects both in intimal thickeness and proliferating cell nuclear antigen (PCNA) expression than the saline group (p<0.05). CONCLUSION: These results suggest that PGE1 is effective in preventing intimal hyperplasia after vein interposition grafts in rabbits and may play a role in inhibiting oxidative stress injury.
Alprostadil ; Carotid Arteries* ; Chromatography, Liquid ; Genes, cdc ; Humans ; Hyperplasia ; Jugular Veins ; Male ; Malondialdehyde ; Muscle, Smooth, Vascular ; Nitrogen ; Oxidative Stress* ; Proliferating Cell Nuclear Antigen* ; Rabbits ; Reactive Oxygen Species ; Transplants* ; Veins*

Ischemic steal syndrome is an infrequent but potentially serious complication that can be difficult to manage while maintaing vascular access surgery. Traditional procedures directed toward increasing the resistance in the fistula have yielded unreliable results. The technique of distal revascularization interval ligation provides a more physiologic approach. We report that 79-year-old man with ischemic hand after angioaccess surgery was successfully treated after DRIL procedure.
Aged ; Fistula ; Hand ; Humans ; Ischemia* ; Ligation*

Acute rejection in renal transplantation is a major risk factor threatening the longterm graft survival. Acute rejections refractory to conventional anti-rejection therapy using steroid pulse or antilymphocyte preparations occur in minority, preceding to progressive deterioration of renal function and graft loss. Recent reports showed that tacrolimus rescue therapy in this refractory rejections has converted rejection process. In order to evaluate the clinical outcome of tacrolimus rescue therapy in refractory rejections, we performed a retrospective study. Since April 1997, we performed tacrolimus rescue therapy intent-to-treat for steroid- or OKT3- resistant rejections in 5 patients. All rejections were histologically confirmed according to Banff criteria. As conventional antirejection therapy, steroid pulse therapy (solumedrol 500~1000 mg iv for 3 days) or OKT3 therapy (5 mg/day for 14 days) was performed. The outcome of the rescue therapy is classified into three categories by the change of serum creatinine level or the histologic findings; Improvement-return of serum creatinine level (sCr) to or below the prerejection baseline (nadir) level, Stabilization-arrested sCr increase, Failure-progressive deterioration of renal function, or graft loss. All were men and the mean age was 38 years. Living related- & unrelated-donor transplantation were 2 and 3 cases respectively. Immunosuppression were done with CsA Pd+ (3) or CsA+ Pd+ AZA (2). Acute rejection grades according to Banff criteria were mild (2) or moderate (3). The mean interval between transplantation and tacrolimus conversion was 54.4 days. The outcome was as follows; improvement 2 cases, stabilization 1 case and failure 2 cases. During 3~10 months followup PTLD occured in 1 case, treated with graft nephrectomy and no other complications in other 4 cases. In conclusion, we can convert ongoing refractory rejections to steroid and OKT3 therapy by tacrolimus rescue therapy in 60% (3/5) successfully. Although longterm followup result is necessary to confirm the efficacy and safety of the tacrolimus rescue therapy, the result of this early trial is so good that we may try tacrolimus in refractory rejections for rejection reversal.
Creatinine ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Male ; Muromonab-CD3 ; Nephrectomy ; Retrospective Studies ; Risk Factors ; Tacrolimus* ; Transplants