Background: Korea recently established 70 emergency medical service areas. However, there are many concerns that medical resources for stroke could not be evenly distributed through the country. We aimed to compare the treatment quality and outcomes of acute stroke among the emergency medical service areas. Methods: This study analyzed the data of 28,800 patients admitted in 248 hospitals which participated in the 8th acute stroke quality assessment by Health Insurance Review and Assessment Service. Individual hospitals were regrouped into emergency service areas according to the address of the location. Assessment indicators and fatality were compared by the service areas. We defined the appropriate hospital by the performance of intravenous thrombolysis. Results: In seven service areas, there were no hospitals which received more than 10 stroke patients for 6 months. In nine service areas, there were no patients who underwent intravenous thrombolysis (IVT). Among 167 designated emergency medical centers, 50 hospitals (29.9%) responded that IVT was impossible 24 hours a day. There are 97 (39.1%) hospitals that meet the definitions of appropriate hospital. In 23 service areas (32.9%) had no appropriate or feasible hospitals. The fatality of service areas with stroke centers were 6.9% within 30 days and 15.6% within 1 year from stroke onset than those without stroke centers (7.7%, 16.9%, respectively). Conclusions There was a wide regional gap in the medical resource and the quality of treatments for acute stroke among emergency medical service areas in Korea. The poststroke fatality rate of the service areas which have stroke centers or appropriate hospitals were significantly low.

PURPOSE: Deep vein thrombosis is usually managed conservatively or with radiologic intervention. Yet deep vein reconstruction is of value as one of the treatments for a small group of patients who present with significant chronic venous insufficiency due to hypoplastic, absent or occluded deep venous outflow such as occurs because of chronic ilio-femoral vein thrombosis. Therefore, we evaluate the improvement of symptoms and graft patency after a Palma-Dale operation as a treatment modality for chronic ilio-femoral vein thrombosis. METHODS: From January 2001 to August 2008, a retrospective study was performed on 15 patients with chronic ilio-femoral vein thrombosis that was treated with a Palma-Dale operation. RESULTS: The mean age of the patients was 51.1+/-15.9 years. The ratio of males to females was 8 to 7. All the patients had lower limb swelling. A Palma-Dale operation was performed on all the patients. Simultaneous thrombectomy was done for 1 patient and arteriovenous fistulas were used to improve graft patency in four patients. The mean follow-up period was 36.3+/-24.0 months. Postoperatively, there was improvement of symptoms in all the patients. However, there was recurrence of symptoms in three patients after two or three months. The rate of graft patency was 84.1% at one year after surgery. CONCLUSION: The Palma-Dale operation has the possibility of recurrence of deep vein thrombosis and postoperative complications. Yet in patients with significant chronic venous insufficiency due to chronic ilio-femoral vein thrombosis, this type of surgery is obviously of value with respect to improvement of symptoms and an acceptable graft patency rate.
Arteriovenous Fistula ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Thrombectomy ; Thrombosis ; Transplants ; Veins ; Venous Insufficiency ; Venous Thrombosis

BACKGROUND: In the era of surgical advancement of transplantation, renal transplant patients with risks of atherosclerosis have improved its survival rate. And these renal transplant patients with aortic or peripheral arterial diseases required surgical treatment. Herein, we discussed the prevalence and treatment options for the atherosclerotic disease in renal transplant patients. METHODS: We retrospectively reviewed 1,163 patients who underwent renal transplant surgery from Jan. 1990 to May. 2007. Among them, we found 10 patients with atherosclerotic disease of aorta and peripheral arteries. Four patients had abdominal aortic aneurysm (AAA), five patients had atherosclerosis obliterans in the lower extremities, and one had renal artery stenosis in transplanted kidney. RESULTS: Four patients with AAA had aorto-biiliac bypass surgery with bifurcated grafts. Two of them had transplanted kidney protection during surgery, the others did not. Five patients with atherosclerosis obliterans in lower extremities had arterial bypass surgery. One patient with renal artery stenosis had patch angioplasty with great saphenous vein graft. CONCLUSIONS: Renal transplant patients also have possibilities to have severe atherosclerotic disease. Furthermore, transplanted kidney could be damaged during operation. Therefore, we have to do our best to prevent development and aggravation of atherosclerotic condition and try to minimize the ischemic injury of transplanted kidney during vascular operation in renal transplant patients.
Angioplasty ; Aorta ; Aortic Aneurysm, Abdominal ; Aortic Diseases ; Arteries ; Atherosclerosis ; Humans ; Kidney ; Kidney Transplantation ; Lower Extremity ; Peripheral Arterial Disease ; Prevalence ; Renal Artery Obstruction ; Retrospective Studies ; Saphenous Vein ; Survival Rate ; Transplants

PURPOSE: Takayasu's arteritis (TA) is a chronic inflammatory, stenotic or aneurysmal disease of an unknown etiology. TA occurs worldwide, but it disproportionately affects young females of Asian descent. TA is known to affect a variety of vessels, but the subclavian artery, axillary artery, carotid arteries and infraabdominal aorta are most frequently affected. In this article, we evaluated surgical treatment as a modality for the management for TA. METHOD: We retrospectively reviewed 20 patients with TA and who were operated on from January 1994 to December 2007. RESULT: The ages of patients were ranged from 12 to 56 years. The ratio of males to females was 1 to 19. The main affected vessels were the subclavian artery (n=10), the common carotid artery (n=10), the abdominal aorta (n=4) and the renal artery (n=4). 20 patients with TA were operated on. 17 of them underwent arterioarterial bypass, and 5 patients received angioplasty. There were 8 cases of reoperation due to the effect on other arteries, or due the stenosis or occlusion of the previous bypass graft. Angioplasty and stenting can be used in the treatment of shorter stenoses such as those encountered in the renal arteries. CONCLUSION: Symptomatic patients who have Takayasu's arteritis can be operated on. Our surgical experiences have showed low mortality and the surgical procedures relieved the symptoms. Surgical therapy for Takayasu's arteritis was safe and it showed good results.
Aneurysm ; Angioplasty ; Aorta ; Aorta, Abdominal ; Arteries ; Asian Continental Ancestry Group ; Axillary Artery ; Carotid Arteries ; Carotid Artery, Common ; Constriction, Pathologic ; Female ; Humans ; Male ; Renal Artery ; Reoperation ; Retrospective Studies ; Stents ; Subclavian Artery ; Takayasu Arteritis ; Transplants

BACKGROUND: Strong immunosuppressive regimens have steadily improved both graft and patient survival, but posttransplant malignancy is still a clinical issue that needs to be resolved. METHODS: There were 1,500 transplant recipients between 1969 and 2005 at Kangnam St. Mary's hospital. The mean follow-up period was 108 77 months. We retrospectively analyzed the incidence, clinical course, treatment and prognosis of malignancy in the kidney transplant recipients. RESULTS: The incidence of malignancy after transplantation was 7.0% (10.5 cases out of 103 patients). The incidence of malignant lymphoma, thyroid cancer, renal cell carcinoma and Kaposi's sarcoma were higher in the renal transplanted patients than in the general population. The cancer incidence for women was higher than that for men, with stomach cancer being the most common in males and uterine cervix cancer the most common in females. The cumulative incidence of posttransplant malignancy at 1990, 1995, 2000 and 2005 were 0.72%, 2.91%, 4.62% and 7.0%, respectively. The cancer incidence with the use of initial immunosuppressive agents was 8.3% for azathioprine, 7.6% for cyclosporine, and 3.4% for tacrolimus. The mean times for making the diagnosis of malignancy after transplantation were 172+/-61 months for azathioprine, 91+/-49 months for cyclosporine, and 57+/-28 months for tacrolimus, respectively. During the observational period, 37 patients died (21 patients died of cancer) and 51 patients were still alive (7 grafts failed). CONCLUSIONS: The incidence of malignancy after renal transplantation increases according to the longer follow-up period. An active screening program is needed to lower the incidence of malignancy in renal transplant recipients.
Azathioprine ; Carcinoma, Renal Cell ; Cervix Uteri ; Cyclosporine ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Incidence* ; Kidney ; Kidney Transplantation ; Lymphoma ; Male ; Mass Screening ; Prognosis ; Retrospective Studies ; Sarcoma, Kaposi ; Stomach Neoplasms ; Tacrolimus ; Thyroid Neoplasms ; Transplantation* ; Transplants

Combined liver-kidney transplantation (LKT) has been increasingly performed procedure for end-stage liver and kidney disease. We experienced four cases of LKT. All patients were affected by viral hepatopathy. There were three patients of hepatocellular carcinoma, treated with trans-arterial chemoembolization or chemotherapy and one cirrhotic patient. The causes of chronic renal failure were polycystic kidney disease in one patient, glomerulonephropathies in two, and diabetes mellitus in one. Three of them were on dialysis treatment. All patients were selected based on blood group identity and negative cross-match before LKT. There was no post-operative surgical complication or acute rejection. At the mean follow-up of 37 months after LKT, all patients showed normal hepatic and renal function except for one case of biopsy-proven tacrolimus nephrotoxicity. Seroconversions of HBsAg, HBeAg, and HBV-DNA were achieved in hepatitis B positive patients. However, HCV-RNA was sustained in hepatitis C positive patient after LKT. Alpha-fetoprotein was normalized in every HCC patient. Combined liver-kidney transplantation can be a proper therapeutic procedure for the patient with liver failure and irreversible renal disease, and it can be done safely and effectively.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Diabetes Mellitus ; Dialysis ; Drug Therapy ; Follow-Up Studies ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis C ; Humans ; Kidney ; Kidney Diseases ; Kidney Failure, Chronic ; Liver ; Liver Failure ; Polycystic Kidney Diseases ; Tacrolimus ; Transplantation

An aberrant right subclavian artery is the most common arch anomaly, and it occurs in approximately 1.0% of the population. It is caused by obliteration of the right fourth aortic arch during the early embryologic development. Aberrant right subclavian artery originates from a diverticulum; this was originally described by Kommerell. Aneurysms arising in an aberrant subclavian artery are rare, but they constitute a potentially lethal condition that can be treated successfully when this is appropriately identified. The presence of an aneurysm of the artery or Kommerell's diverticulum at its aortic origin is more likely to produce symptoms from the esophageal compression. Virtually all these patients have a superior mediastinal mass that may be asymptomatic, but such patients usually have symptoms of dysphagia, chest pain, or shortness of breath. The presence of an aneurysm of an anomalous subclavian artery is an indication for surgical resection. Resection of the aneurysm may be approached through either a right or left thoracotomy. We present here a case of an aberrant origin of the right subclavian artery together with a review of the literature.
Aneurysm* ; Aorta, Thoracic ; Arteries ; Chest Pain ; Deglutition Disorders ; Diverticulum ; Dyspnea ; Humans ; Subclavian Artery* ; Thoracotomy

Marfan syndrome is an inherited autosomal dominant disorder of the connective tissues, and the afflicted patients present with abnormalities of the skeletal, ocular, and cardiovascular system. The progressive dilatation of the proximal aorta leading to dissection and rupture is the typical feature and this can be a lethal complication of this disease. The incidence of Marfan syndrome is estimated to be 1 in 10,000 in most racial and ethnic groups. We experienced two cases of aortic aneurysm in Marfan syndrome. The first case was 32-year-old woman. She was admitted because of sudden onset of a painful abdominal mass for 2 days. Aortic aneurysm was diagnosed by CT and an echocardiogram showed severe mitral regurgitation (area ratio: 13/15). She underwent successful abdominal aortic aneurysm (AAA) repair and was discharged on postoperative 14th day; she was then prepared for open cardiac surgery for mitral valve replacement. The second case was 19- year-old woman. She was admitted with a known abdominal aortic aneurysm that she'd had for 1.5 years. She also underwent abdominal aortic aneurysm (AAA) repair that was technically successful, but she died on postoperative 10th day due to sudden cardiac arrest.
Adult ; Aorta ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Cardiovascular System ; Connective Tissue ; Death, Sudden, Cardiac ; Dilatation ; Ethnic Groups ; Female ; Humans ; Incidence ; Marfan Syndrome* ; Mitral Valve ; Mitral Valve Insufficiency ; Rupture ; Thoracic Surgery

The overall life expectancy of the population is rising and more elderly patients with abdominal aortic aneurysm (AAA) have been reported. The management of AAA is open surgical or endovascular repair because neglected AAA usually yields an eventually fatal course. Older age is commonly considered as a risk factor for AAA repair due to the concomitant age-related diseases such as coronary artery disease. The chronological and physiological age are not always identical, and sometimes a patient's physiological age appears younger than the chronological age. We report here on successful open surgical repair of AAA in a 95 years old man (birth date: April 11, 1911) who looked younger and healthier than his chronological age. The preoperative CT angiography showed an infrarenal saccular AAA 4.2 cm in diameter with fingertip-sized outpouching of the aneurysmal wall, which suggested possible impending rupture. His preoperative work-up was within normal limits. This 95 years old gentleman well tolerated all the surgical procedures with a smooth postoperative course. We propose that the age limitation for AAA repair should be considered individually for each case.
Aged ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal* ; Coronary Artery Disease ; Humans ; Life Expectancy ; Risk Factors ; Rupture

The overall life expectancy of the population is rising and more elderly patients with abdominal aortic aneurysm (AAA) have been reported. The management of AAA is open surgical or endovascular repair because neglected AAA usually yields an eventually fatal course. Older age is commonly considered as a risk factor for AAA repair due to the concomitant age-related diseases such as coronary artery disease. The chronological and physiological age are not always identical, and sometimes a patient's physiological age appears younger than the chronological age. We report here on successful open surgical repair of AAA in a 95 years old man (birth date: April 11, 1911) who looked younger and healthier than his chronological age. The preoperative CT angiography showed an infrarenal saccular AAA 4.2 cm in diameter with fingertip-sized outpouching of the aneurysmal wall, which suggested possible impending rupture. His preoperative work-up was within normal limits. This 95 years old gentleman well tolerated all the surgical procedures with a smooth postoperative course. We propose that the age limitation for AAA repair should be considered individually for each case.
Aged ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal* ; Coronary Artery Disease ; Humans ; Life Expectancy ; Risk Factors ; Rupture