Background/Aims: Papillary adenocarcinoma is classified to differentiated-type gastric cancer and is indicated for endoscopic submucosal dissection. However, due to its rare nature, there are limited studies on it. The purpose of this study was to determine the outcome of endoscopic submucosal dissection in patients with papillary-type early gastric cancer and to find the risk factors of lymph node metastasis. Methods: Patients diagnosed with papillary-type early gastric cancer at eight medical centers, who underwent endoscopic submucosal dissection or surgical treatment, were retrospectively reviewed. The clinical results and long-term outcomes of post-endoscopic submucosal dissection were evaluated, and the risk factors of lymph node metastasis in the surgery group were analyzed. Results: One-hundred and seventy-six patients with papillary-type early gastric cancer were enrolled: 44.9% (n=79) in the surgery group and 55.1% (n=97) in the endoscopic submucosal dissection group. As a result of endoscopic submucosal dissection, the en bloc resection and curative resection rates were 91.8% and 86.6%, respectively. The procedure-related complication rate was 4.1%, and local recurrence occurred in 3.1% of patients. Submucosal invasion (odds ratio, 3.735; 95% confidence interval, 1.026 to 12.177; p=0.047) and lymphovascular invasion (odds ratio, 7.636; 95% confidence interval, 1.730 to 22.857; p=0.004) were the risk factors of lymph node metastasis in papillary-type early gastric cancer patients. Conclusions The clinical results of endoscopic submucosal dissection in papillary-type early gastric cancer were relatively favorable, and endoscopic submucosal dissection is considered safe if appropriate indications are confirmed by considering the risk of lymph node metastasis.

We report a case of concurrent saccular aneurysms caused by a penetrating atherosclerotic ulcer of the thoracic and abdominal aorta that were successfully treated by staged endovascular repair. Even though surgical open repair or endovascular repair is the treatment option, use of endovascular repair is now accepted as an alternative treatment to surgery in selected patients. To prevent contrast medium-induced nephropathy and spinal cord ischemia caused by a simultaneous endovascular procedure, a saccular aneurysm of the descending thoracic aorta was excluded by stent graft, followed by the placement of a bifurcated stent graft in the infrarenal abdominal aorta one month later.
Aneurysm ; Aorta, Abdominal ; Aorta, Thoracic ; Aortic Aneurysm ; Contrast Media ; Endovascular Procedures ; Humans ; Spinal Cord Ischemia ; Stents ; Ulcer

PURPOSE: The aim of this study is to evaluate the results of aspiration thrombectomy (AT) in the endovascular treatment for iliofemoral deep vein thrombosis (DVT) through the comparison of catheter directed thrombolysis (CDT) alone group and CDT with AT group. METHODS: From November 2001 to April 2011, 100 patients received endovascular treatment with CDT alone or CDT with AT for iliofemoral DVT at Yeungnam University Medical Center. We compared procedure, clinical outcomes and complications between the two groups. RESULTS: The mean age of patients was 60.48 +/- 14.57 years. The patients consisted of 41 men and 59 women. CDT alone and CDT with AT were performed in 29 and 71 patients, respectively. The mean procedural time of the CDT-alone group was longer than the CDT with AT group (P < 0.001) and dose of urokinase used during the procedure significantly decreased in the CDT with AT group (P < 0.001). There were no statistically significant differences in clinical outcomes between the two groups. Cases of pulmonary embolism was not noted in each group in our series, but entrapped thrombus during procedure was noted in 6 of 37 in the CDT with AT group and 0 of 9 in the CDT-alone group among 46 patients with prophylactic inferior vena cava (IVC) filter insertion. CONCLUSION: In conclusion, CDT with AT is safe and effective for the treatment of an acute iliofemoral DVT. In AT treatment, prophylactic IVC filter insertion should be considered for the prevention of pulmonary embolism by floating thrombi.
Academic Medical Centers ; Catheters ; Female ; Humans ; Male ; Pulmonary Embolism ; Thrombectomy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Vena Cava Filters ; Vena Cava, Inferior ; Venous Thrombosis

PURPOSE: Residual thrombus is known as a risk factor of recurrent deep vein thrombosis (DVT) and may induce functional impairment of the affected vein and post-thrombotic syndrome. This study was constructed to examine recanalization rates in patients with DVT at 6 months after treatment and to identify the predictors of recanalization. METHODS: From June 2006 to December 2009, we retrospectively reviewed the medical records of 40 patients who underwent a follow-up duplex scan or computed tomography venography at 6 months following treatment. The degree of recanalization on duplex scans was categorized as "complete recanalization", "partial recanalization" and "occlusion". Univariate and multivariate analyses were conducted to identify the independent predictors of "complete recanalization". RESULTS: The mean age of individuals within the study was 59 years (33-85 years) and 40% was the participants were female. Ten patients (25%) had transient risk factors, such as immobilization, recent trauma, orthopedic or major surgery. Complete recanalization, partial recanalization, and occlusion at 6 months were obtained in 58%, 25%, 18% (50%, 31%, 19% in anticoagulation alone group and in 71%, 14%, 14% in catheter-directed thrombolysis group, P=0.489, respectively). With regards to the multivariate analysis including the binary logistic regression model, the presence of transient risk factors was the only independent predictor of "complete recanalization" (P=0.041). CONCLUSION: In our series, complete recanalization rate at 6 months was 58%. Furthermore, complete modulation of transient risk factors during the follow up period seems to be an important predictive factor concerning complete recanalization.
Female ; Follow-Up Studies ; Humans ; Immobilization ; Logistic Models ; Lower Extremity ; Medical Records ; Multivariate Analysis ; Orthopedics ; Phlebography ; Retrospective Studies ; Risk Factors ; Thrombosis ; Veins ; Venous Thrombosis

PURPOSE: Potential benefits of eversion carotid endarterectomy (eCEA) compared with conventional carotid enderterectomy (cCEA) are more simple and faster reanastomosis with a low risk of restenosis. However, in Korea, eCEA is not popular having only one report of eCEA. This study aimed to investigate the results of eCEA. METHODS: From July 2008 to September 2010, authors performed 36 eCEAs for patients with carotid artery stenosis in our hospital. Patients' demographics and clinical data were retrospectively reviewed. Regarding early (<30 days) results including the frequency of postoperative stroke, myocardial infarction, cerebral hyperperfusion syndrome, bleeding, cranial nerve palsy, new brain lesions (NBLs) on diffuse-weighted MRI (DW-MRI) and mortality were examined. Mid-term results such as stroke, death and restenosis after over thirty days were also examined. RESULTS: Mean age was 66.6 years old and 88.9% of the patients were male. Twenty-four patients (66.7%) had a previous neurological event in the preceding 6 months. A carotid shunt was used in 3 cases (8.3%) and mean carotid clamping time was 25.4 minutes. One case (2.8%) of non-disabling ipsilateral stroke, 1 case (2.8%) of wound hematoma and 1 case (2.8%) of cranial nerve palsy developed after operation. DW-MRI was conducted in 27 patients (75.0%) and NBLs were detected in 4 patients (11.1%). One case (2.8%) of restenosis was discovered during the follow-up period (mean, 9.0 months), and there were no strokes or death. CONCLUSION: Early and mid-term postoperative stroke and complication rates of eCEA were acceptable in our series. However, to assess efficacy of eCEA, further large-volumed and long-term follow-up studies are needed.
Brain ; Carotid Arteries ; Carotid Stenosis ; Constriction ; Cranial Nerve Diseases ; Demography ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Korea ; Male ; Myocardial Infarction ; Retrospective Studies ; Stroke

PURPOSE: This study aimed to investigate early and mid-term outcomes of carotid artery stenting (CAS). METHODS: We retrospectively reviewed 111 patients who were treated for carotid stenosis between October 2004 and December 2009 (42 CASs and 69 carotid endarterectomies [CEAs]). RESULTS: CAS group was older than CEA group (70 years vs. 67 years, P = 0.001). Coronary artery disease and high lesion above the 2nd cervical vertebral body were more common in CAS group (29% vs. 13%, P = 0.002; 4% vs. 24%, P = 0.004). The 30-days stroke rate was higher in CAS group (10% vs. 1% in CEA group, P = 0.067, Fisher's exact test). New brain lesions on diffusion-weighted magnetic resonance imaging were more common in CAS group (48% vs. 20% in CEA group, P = 0.002, chi-square test). The 1-, 3-year freedom from stroke were 91%, 84% in CAS group and 99%, 99% in CEA group (P = 0.007, log-rank test). Univariate analysis showed that female gender and age > 70 years were related with postprocedural neurological complications (P = 0.046 and P = 0.007, log-rank test). However, none were independent risk factors on multivariate analysis. CONCLUSION: In our series, the rates of peri-procedural neurological complications in CAS group were significantly high. These results suggest that more experience and restricted patient selection will be needed for CAS.
Brain ; Carotid Arteries ; Carotid Stenosis ; Coronary Artery Disease ; Endarterectomy ; Endarterectomy, Carotid ; Female ; Freedom ; Humans ; Magnetic Resonance Imaging ; Patient Selection ; Penicillanic Acid ; Retrospective Studies ; Risk Factors ; Stents ; Stroke

Recently significant neurotoxicity has been reported with the use of carcineurin inhibitors. An 11-year-old-girl had undergone a transplantation of kidney from her mother. On post-operative day 12, hypertension, headache, and left motor weakness (grade I) suddenly occurred. The brain-magnetic resonance imaging and magnetic resonance angiography showed acute cerebral infarction at subcortical white matter of the right hemisphere and multiple stenoses of both anterior cerebral artery and middle cerebral artery. While stopping tacrolimus treatment, we experienced clinical and radiological improvement. So, the neurological complications of this patient seem to have been caused by the use of tacrolimus.
Anterior Cerebral Artery ; Cerebral Infarction ; Constriction, Pathologic ; Headache ; Humans ; Hypertension ; Kidney ; Kidney Transplantation ; Magnetic Resonance Angiography ; Middle Cerebral Artery ; Mothers ; Neurotoxicity Syndromes ; Tacrolimus ; Transplants

Adventitial cystic disease (ACD) of venous system is an extremely rare condition. Very few reports of ACD in venous system have been described. In this report we discuss two cases of common femoral vein ACD that presented with a swollen leg by the obstruction of the vein. Ultrasound imaging showed the typical hypoechoic fluid filled cyst with a posterior acoustic window. Computed tomography scan and ascending venogram showed a stenosis to flow in the common femoral vein caused by an extrinsic mass. Trans-adventitial evacuation of cyst with removal of vein wall was performed for both cases. During operation we found the gelatinous material in the cysts arising in the wall of the common femoral vein and compressing the lumen. The patients were released after short hospitalization and have remained symptom free with no recurrence.
Acoustics ; Adventitia ; Constriction, Pathologic ; Femoral Vein ; Gelatin ; Hospitalization ; Humans ; Leg ; Recurrence ; Veins

Cilostazol is a selective inhibitor of phosphodiesterase 3 that increases intracellular cAMP levels and activates protein kinase A, thereby inhibiting vascular smooth muscle cell (VSMC) proliferation. We investigated whether AMP-activated protein kinase (AMPK) activation induced by heme oxygenase-1 (HO-1) is a mediator of the beneficial effects of cilostazol and whether cilostazol may prevent cell proliferation and reactive oxygen species (ROS) production by activating AMPK in VSMC. In the present study, we investigated VSMC with various concentrations of cilostazol. Treatment with cilostazol increased HO-1 expression and phosphorylation of AMPK in a dose- and time-dependent manner. Cilostazol also significantly decreased platelet-derived growth factor (PDGF)-induced VSMC proliferation and ROS production by activating AMPK induced by HO-1. Pharmacological and genetic inhibition of HO-1 and AMPK blocked the cilostazol-induced inhibition of cell proliferation and ROS production.These data suggest that cilostazol-induced HO-1 expression and AMPK activation might attenuate PDGF-induced VSMC proliferation and ROS production.
AMP-Activated Protein Kinases ; Cell Proliferation ; Cyclic AMP-Dependent Protein Kinases ; Heme ; Heme Oxygenase-1 ; Muscle, Smooth, Vascular ; Phosphorylation ; Platelet-Derived Growth Factor ; Reactive Oxygen Species ; Tetrazoles

BACKGROUND AND PURPOSE: There is little information available about the effects of Emergency Medical Service (EMS) hospital notification on transfer and intrahospital processing times in cases of acute ischemic stroke. METHODS: This study retrospectively investigated the real transfer and imaging processing times for cases of suspected acute stroke (AS) with EMS notification of a requirement for intravenous (IV) tissue-type plasminogen activator (t-PA) and for cases without notification. Also we compared the intra-hospital processing times for receiving t-PA between patients with and without EMS prehospital notification. RESULTS: Between December 2008 and August 2009, the EMS transported 102 patients with suspected AS to our stroke center. During the same period, 33 patients received IV t-PA without prehospital notification from the EMS. The mean real transfer time after the EMS call was 56.0+/-32.0 min. Patients with a transfer distance of more than 40 km could not be transported to our center within 60 min. Among the 102 patients, 55 were transferred via the EMS to our emergency room for IV t-PA. The positive predictive value for stroke (90.9% vs. 68.1%, p=0.005) was much higher and the real transfer time was much faster in patients with an EMS t-PA call (47.7+/-23.1 min, p=0.004) than in those without one (56.3+/-32.4 min). The door-to-imaging time (17.8+/-11.0 min vs. 26.9+/-11.5 min, p=0.01) and door-to-needle time (29.7+/-9.6 min vs. 42.1+/-18.1 min, p=0.01) were significantly shorter in the 18 patients for whom there was prehospital notification and who ultimately received t-PA than in those for whom there was no prehospital notification. CONCLUSIONS: Our results indicate that prehospital notification could enable the rapid dispatch of AS patients needing IV t-PA to a stroke centre. In addition, it could reduce intrahospital delays, particularly, imaging processing times.
Emergencies ; Emergency Medical Services ; Humans ; Retrospective Studies ; Stroke ; Tissue Plasminogen Activator