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: Popliteal artery entrapment syndrome (PAES) is rare but major cause of non-atheromatous popliteal arterial insufficiency in young. Because of its rareness, it is often neglected or misdiagnosed as thrombosis or embolism. Consequently surgeons would lose the appropriate time of treatment. METHOD: We reviewed 11 cases of PAES from 1994 to 2002 regarding to clinical characteristics, image findings, management and their results. RESULT: Two of 11 patients had bilateral involvement. All patients were male and aged 12 to 45 year old (mean; 32.1). Intermittent claudication was presented as initial symptom in all. One had toe gangrene. Conventional arteriography (11 cases) was used as initial diagnostic method. CT (7 cases) and MR (4 cases) angiography were also used to make diagnosis. Type II PAES were most common in 7 limbs. 11 limbs of 10 patients underwent operation. One was managed conservatively because of advanced liver cirrhosis. Resection of medial head of gastrocnemius and popliteal arterial bypass were performed in 7 limbs. One myectomy with femoroposterotibial bypass, one femoropopliteal bypass without myectomy, and myectomy with patch angioplasty were performed. Postoperative complication occurred in two limbs. One had occlusion of graft, another had occluded segment of endarterectomised popliteal artery. Primary graft patency at 6 mo, 1 yr and 3 yr were 81% 81%, 81% respectively. CONCLUSION: In young patients with claudication who have localized lesion at popliteal artery, clinicians should pay attention to rule out PAES. Accurate diagnosis can be achieved by CT or MR angiography. Early surgical correction is recommended to minimize surgical procedure and reduce complication of the disease.
Angiography ; Angioplasty ; Diagnosis ; Embolism ; Extremities ; Gangrene ; Head ; Humans ; Intermittent Claudication ; Liver Cirrhosis ; Male ; Middle Aged ; Popliteal Artery* ; Postoperative Complications ; Thrombosis ; Toes ; Transplants

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

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: Venous reflux in primary varicose vein arises from the saphenofemoral junction (SFJ), and the saphenopopliteal junction (SPJ) and it can arise from the non-junctional great saphenous vein (GSV) tributaries and, the non-saphenous veins. Superficial venous surgery (SVS) is associated with a significant improvement in the lower leg venous hemodynamics. We performed a retrospective study to examine the prevalence of the reflux pattern in the primary varicose veins and, to observe any change of non-junctional GSV reflux. METHOD: From May 2004 to July 2005, 481 patients (766 limbs) were diagnosed with venous incompetence by performing a duplex ultrasound examination. A follow-up duplex ultrasound examination was performed for a group of non-junctional GSV reflux patients and for a group of patient having both superficial vein reflux and deep vein reflux. RESULT: The prevalence of SFJ reflux, SPJ reflux, below the knee GSV reflux with competent SFJ and, non saphenous vein reflux was 82%, 13%, 10% and, 4.5% respectively. In the patients with SVS who had deep vein reflux (DVR), DVR was absent in only on two patients (6%). Eight patients (9.1%) of the 88 primary varicose vein patients had asymptomatic left iliac vein obstruction detected by performing an ascending venogram during radiofrequency ablation (RFA). On the duplex findings after SVS, the reflux pattern of left deep venous system was not different from the right deep venous system. CONCLUSION: Varicose veins may occur in any vein, even if junctional reflux is predominant. Careful duplex ultrasound evaluation will delineate the changing pattern of venous reflux with/without SVS. Although superficial venous surgery must fit the patient's map, the results might be variable. Prospective studies are needed to analyze the dynamics of venous reflux after SVS.
Catheter Ablation ; Follow-Up Studies ; Hemodynamics ; Humans ; Iliac Vein ; Knee ; Leg ; Prevalence ; Retrospective Studies ; Saphenous Vein ; Ultrasonography ; Varicose Veins* ; Veins

Effectively functioning arterio-venous fistula (AVF) is so important as to be called a lifeline of the patient with end stage renal disease by maintaining hemodialysis. Not infrequent development of complications of AVF is a major cause of patient's admission and medical cost. Rescue therapy of complicated AVF had several advantages; delay or prevention of new AVF formation, prevention of temporary percutaneous central vein cannulation, and maintenance of psychologic stability. PURPOSE: In order to analyse the patterns of AVF complications and the short- and long-term results of rescue therapy, we made a clinical review retrospectively. PATIENTS & METHODS: We performed AVF in 1503 cases from Jan. 1986 to Dec. 1997. Among them, we performed 93 rescue therapies in 70 patients. Rescue therapy is defined to be a secondary procedure to correct complications while maintaining the primary anastomosis. Secondary procedures in immediate postoperative failure due to technical cause, such as improper selection of vein, were excluded. RESULTS: The most common indication of rescue therapy in 93 cases was thrombosis (78 cases, 83.9%), which is followed by aneurysm in 9 cases, venous hypertension in 2 cases, steal syndrome in 2 cases, high output cardiac failure in 1 case. Autogenous veins were used in initial operation in 55 cases and PTFEs in 38 cases. Early failure within 1 month after rescue therapy happened in 20 cases (21.5%). Complications occured in 4 cases, such as infection (2), brachial plexus injury (1), and arm edema. (1) Mean follow up duration was 3.9 months (1~123 months). Secondary patency rate after 3, 6, 12, 24 months were 70.3+/-3.97, 62.0+/-4.89, 50.6+/-5.85, 37.9+/-7.03% respectively. Secondary patency rate in successfully rescued patients excluding early failure within 1 month after rescue therapy were 91.5+/-3.11, 80.9+/-4.46, 68.9+/-6.15, 54.1+/-8.19%. CONCLUSIONS: Thrombosis or malfunction due to neointimal hyperplasia was the most common complication in AVF. Early and proper rescue therapy in complicated fistula could salvage the AVF. So careful and prompt evaluation of the inflow and outflow of the complicated fistula is necessary, and every effort to rescue the fistula should be made.
Aneurysm ; Arm ; Brachial Plexus ; Catheterization ; Edema ; Fistula* ; Follow-Up Studies ; Heart Failure ; Humans ; Hyperplasia ; Hypertension ; Kidney Failure, Chronic ; Polytetrafluoroethylene ; Renal Dialysis* ; Retrospective Studies ; Thrombosis ; Veins