The aortic dissection is an acute aortic syndrome, caused by an intimal tear and subsequent splitting of the media by the pulsatile blood flow. Though there would be differences in the origin of aortic dissection and therapeutic modalities, the intermediate and long-term prognoses are poor. Endovascular Stent-graft implantation is a revolutionary technique in the treatment of aortic dissection. The endovascular stent grafting in aortic dissection is less invasive and feasible method and is an effective tool for closing the entry site and promoting clot formation, reducing the size of the false lumen. Therefore, endovascular Stent-graft implantation makes possible the desirable remodelling of aorta. We report 33 year-old male with aortic dissection in the thoracic aorta, which was treated with endovascular Stent-graft implantation. Over the favorable remodelling, his dissection was healed completely by the endovascular treatment using Stent-graft.
Adult ; Aorta ; Aorta, Thoracic* ; Blood Vessel Prosthesis ; Humans ; Male ; Prognosis

PURPOSE: The purpose of this study was to evaluate the safety, feasibility and effectiveness of an endoluminally-placed bifurcated stent-graft (Vanguard) for the treatment of infrarenal abdominal aortic aneurysm (AAA). METHODS: Transluminal endovascular stent-graft placements were attempted in 29 patients (28 male, mean age 69+/-7 years) with AAAs involving the common iliac arteries from Aug. 1997 to Jan. 1999. Endovascular therapy was performed in the cardiac catheterization laboratory with epidural anesthesia. One side of the femoral artery was opened by surgical cutdown for the bifurcated stent-graft entry and the other side was punctured percutaneously for the straight stent-graft. Computed tomography and/or intraarterial angiography were performed during an average follow-up of 10 months (2-18 months). RESULTS: Primary success rate was 75.9% (22 of 29 patients) and the overall success rate was 79.3% with successful correction of one perigraft leak. Twenty patients (69.0%) had significant coronary artery disease. There were two technical failure cases, the one was tortuous iliac vessel with spasm, the other was disconnection of the stent-graft connecting portion. Complications related to procedure occurred in 13.8% of patients (4 of 29 patients) and two of these four patients had procedure-related mortality because of acute renal failure following contrast overdose and sepsis after operation. CONCLUSIONS: Endovascular treatment of infrarenal AAA with bifurcated stent-graft (Vanguard<0A397>) is effective, feasible and relatively safe. However, further investigation for the outcome, complication and long-term follow-up are needed.
Acute Kidney Injury ; Anesthesia, Epidural ; Angiography ; Aortic Aneurysm, Abdominal* ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Artery Disease ; Endoleak ; Femoral Artery ; Follow-Up Studies ; Humans ; Iliac Artery ; Male ; Mortality ; Sepsis ; Spasm

PURPOSE: Post-authorization survey(PAS) is a useful tool for obtainting wider range of data on the safety and efficacy of new drugs following their approval, as they can detect uncommon, unreported adverse events(AEs), which enables more attention to be directed to the practioners. Especially, the limited number of patients in oncology trial cannot usually give the actual incidence of AEs. METHODS: Since Nov. 1998, when docetaxel gained Korean approval in the treatment of breast cancer, a PAS to investigate its safety profiles has been conducted targeting more than 600 patients over 4 calendar years. RESULTS: Case report forms from 626 out of 646 patients were assessable for safety and 444 for efficacy. The patient characteristics are: mean age, 48.1 years; male/female 4/622; Wt/Ht/BSA 57.9 kg/156.1 cm/1.56 m2 ; stage I-II/III/IV 109 (18.2%)/125 (20.8%)/366(61.0%). In 344 patients, 960 AEs were reported in severity of mild/moderate/severe in 6.7, 40.9 and 51.1 % of cases. From AE results, 36.0% needed dose reduction; 34.3% transient interruption of the cycle; and 1.3% permanent discontinuation of docetaxel. Thirty five serious AEs such as febrile neutropenia, alopecia, diarrhea, abdominal pain and headache were reported in 21 patients. Unexpected AEs such as skin ulcer, discoloration of skin, H. Zoster infection, ulticaria, facial flush, chest pain, hemoptysis, pneumonia, stridor, nasal bleeding, photophobia, haematuria, Cushing's syndrome, hyperglycemia and insomnia were reported regardless of any causal relationship. Factors affecting the development of AEs were age, stage, concomitant medication other than chemotherapeutic agents and the number of cycles treated. The efficacy was evaluable in 444 patients with overall response rate of 36.5% (CR/PR 6.3/30.2%). Factors affecting the efficacy were stage, concommitant medication other than chemotherapeutic agents and the number of treatment cycles. CONCLUSION: This post-authorization survey on the safety and efficacy of docetaxel in breast cancer offers oncology practice in the real world without subject selection as is the case in clinical trials, although it was performed to fulfill the registrative requirement of the Korean health authority with limited data. The efficacy and safety profile of docetaxel in breast cancer was no much different from those reported in clinical trials.
Abdominal Pain ; Alopecia ; Breast Neoplasms* ; Breast* ; Chest Pain ; Cushing Syndrome ; Diarrhea ; Epistaxis ; Febrile Neutropenia ; Headache ; Hemoptysis ; Herpes Zoster ; Humans ; Hyperglycemia ; Incidence ; Photophobia ; Pneumonia ; Respiratory Sounds ; Skin ; Skin Ulcer ; Sleep Initiation and Maintenance Disorders

PURPOSE: The purpose of this study was to evaluate the role of mast cell and histamine as typical product of mast cell in ischemia-reperfusion injury of muscle flap using H2 receptor blocker and mast cell stabilizer. METHODS: Thirty-five Sprague-Dawley rats weighing 250-300 gm were divided into four groups; Group I: Control group without ischemia, Group II: Normal saline injection group with ischemia, Group III: Cimetidine injection group with ischemia, Group IV: Sodium cromoglycate injection group with ischemia. Well established single pedicled transverse rectus abdominis musculocutaneous(TRAM) flap was designed in all rats and were rendered ischemia by clamping the artery for 150 minutes. All injections were applied intramuscular around gluteal area 30 minutes before reperfusion. The flap survival was evaluated at 7 days after operation. Neutrophil counts and mast cell counts were evaluated 24 hours after reperfusion. RESULTS: The difference of skin flap survival between control group and cimetidine injection group was not significant. In the normal saline injection group flap survival was markedly decreased compared to that of control group. The muscle flap survival was similar to the results of skin flap survival. The neutrophil counts were significantly decreased in control group and sodium cromoglycate injection group than normal saline injection group. The mast cell counts were significantly decreased in cimetidine injection group and control group than both normal saline injection and sodium cromoglycate injection groups. The protective effect of sodium cromoglycate was not seen in the skin flap, but the muscle flaps showed protective effects of sodium cromoglycate compared to normal saline injection group. CONCLUSION: It is suggests that commonly used antihistamine(H2 receptor blocker) has protective effect against ischemia-reperfusion injury to skin and muscle flaps by reducing neutrophil and mast cell. The mast cell stabilizer was not effective for skin flap but, possibly, for muscle flap.
Animals ; Arteries ; Cimetidine ; Constriction ; Cromolyn Sodium ; Histamine ; Ischemia ; Mast Cells* ; Neutrophils ; Rats* ; Rats, Sprague-Dawley ; Rectus Abdominis ; Reperfusion ; Reperfusion Injury* ; Skin

The P19 embryonal carcinoma cell line is a useful model cells for studies on cardiac differentiation. However, its low efficacy of differentiation hampers its usefulness. We investigated the effect of 5-azacytidine (5-aza) on P19 cells to differentiate into a high-efficacy cardiomyocytes. Embryoid-body-like structures were formed after 6 days with 1 micrometer of 5-aza in a P19 cell monolayer culture, beating cell clusters first observed on day 12, and, the production of beating cell clusters increased by 80.1% (29 of 36-wells) after 18 days. In comparison, the spontaneous beating cells was 33.3% (12 of 36-wells) for the untreated control cells. In response to 1 micrometer of 5-aza, P19 cells expressed bone morphogenetic protein-2 (BMP-2), BMP-4, Bmpr1a and Smad1 at day 6 or 9, and also cardiac markers such as GATA-4, Nkx2.5, cardiac troponin I, and desmin were up-regulated in a time-dependent manner after induction of BMP signaling molecules. Immunocytochemistry revealed the expression of smooth muscle a-actin, sarcomeric a-actinin, cardiac myosin heavy chain, cardiac troponin T and desmin, respectively. The proportion of sarcomeric a-actinin positive cells accounted for 6.48% on day 15 after 5-aza exposure as measured by flow cytometry. This study has demonstrated that 5-aza induces differentiation of P19 cells into cardiomyocytes in a confluent monolayer culture in the absence of prior embryoid formation and dimethyl sulfoxide exposure, depending in part on alteration of BMP signaling molecules. These results suggest that 5-aza treatment could be used as a new method for cardiac differentiation in P19 cells.
Animals ; Azacitidine/*pharmacology ; Bone Morphogenetic Proteins/genetics/metabolism ; Cell Differentiation/drug effects/genetics ; Cell Line, Tumor ; Cell Proliferation/drug effects ; DNA-Binding Proteins/genetics/metabolism ; Embryo/cytology ; Gene Expression ; Homeodomain Proteins/genetics/metabolism ; Mice ; Muscle Proteins/analysis/genetics/metabolism ; Myocytes, Cardiac/*cytology/immunology/physiology ; Research Support, Non-U.S. Gov't ; Stem Cells/*drug effects/metabolism ; Transcription Factors/genetics/metabolism

The authors have experienced a case of extrascleral extension of choroidal malignant melanoma. The patient has suffered from the ocular pain and proptosis of right eye. We performed Kronlein operation under the clinical impression of the retrobulbar mass and obtained the histopathological diagnosis of malignant melanoma. Fifteen days after the operation, we performed exenteration and the rotation flap of temporalis muscle was inserted into the right eye ball socket through the lateral wall of the orbit.
Choroid* ; Diagnosis ; Exophthalmos ; Humans ; Melanoma* ; Orbit

Communication between coronary arteries and cardiac chambers or large vessels is unusual type of congenital malformation. Aneurysmal formation of a coronary arteriovenous fistula is even rare. We report a case of 83-year-old women with giant aneurysm of the coronary arteriovenous fistula from the left anterior descending coronary artery treated by percutaneous deployment of embolization coil.
Aged, 80 and over ; Aneurysm* ; Arteriovenous Fistula* ; Coronary Vessels ; Embolization, Therapeutic ; Female ; Humans

PURPOSE: There were no accurate data of hematologic changes in the high school students in Korea since 1980'. Because of rapid growing of Korean students recently, it is necessary to reevaluate Korean data. So we compared hematologic changes in the students of general (GHS) and athletic high school (AHS) in Seoul city. METHODS: We reassured red cell count (RBC), hemoglobin (Hb), hematocrit (Hct), and related hematologic factors in the 452 GHS (male 290, female 162) as control group and the 138 AHS (male 70, female 68) as exercised group. Hematologic comparisons were performed between the students of AHS and GHS and the male and female students with t-test. RESULTS: 1) Values of RBC, Hb, Hct, MCHC, RDW were 4.6+/-0.3x1012/L, 13.4+/-1.2g/dL, 41.5+/- 3.4%, 32.2+/-0.5g/dL, 12.1+/-0.9% respectively in the male AHS and 5.2+/-0.3x1012/L, 15.2+/- 1.0g/dL, 46.7+/-3.0%, 32.5+/-0.5g/dL, 12.3+/-0.6% respectively in male GHS, and there were significant between compared data. 2) Values of RBC, Hb, Hct MPV were 4.5+/-0.3x1012/L, 13.6+/-1.2g/dL, 40.5+/-3.2%, 9.0+/- 0.6fl respectively in the female AHS and 5.0+/-0.5x1012/L, 14.9+/-1.3g/dL, 44.8+/-3.4%, 8.7+/- 0.8fl respectively in the female GHS, and significance were between compared data. 3) Values of MCH, MCHC, RDW, MPV were 30.1+/-1.8pg, 33.6+/-1.1g/dL, 12.8+/-1.1%, 9.0+/-0.6fl respectively in the female AHS and 29.3+/-1.8pg, 32.2+/-0.5g/dL, 12.1+/-0.9%, 8.7+/-0.9fl respectively in the male AHS, and there were significant between compared data. 4) Values of RBC, Hct, MCH, MCHC, RDW, PLT were 5.0+/-0.5x1012/L, 44.8+/-3.4%, 30.0+/-2.1pg, 33.4+/-1.1g/dL, 12.7+/-1.0%, 29.8+/-5.8x104/mm3 respectively in the female non-AHS, and 5.2+/-0.3x1012/L, 46.7+/-3.0%, 29.4+/-1.4pg, 32.5+/-0.5g/dL, 12.3+/-0.6%, 28.7+/- 5.8x104/mm3 respectively in the male non-AHS, and there were significant between compared data. CONCLUSIONS: Among the high school students, exercise caused several hematologic changes that were significant decline of the values of RBC, hemoglobin, hematocrit compared to control group regardless of sex. In female students, their values of MCH, MCHC, RDW were significantly increased compared to male students regardless of exercise.
Cell Count ; Female ; Hematocrit ; Humans ; Korea ; Male ; Seoul ; Sports

PURPOSE: There were no accurate data of hematologic changes in the high school students in Korea since 1980'. Because of rapid growing of Korean students recently, it is necessary to reevaluate Korean data. So we compared hematologic changes in the students of general (GHS) and athletic high school (AHS) in Seoul city. METHODS: We reassured red cell count (RBC), hemoglobin (Hb), hematocrit (Hct), and related hematologic factors in the 452 GHS (male 290, female 162) as control group and the 138 AHS (male 70, female 68) as exercised group. Hematologic comparisons were performed between the students of AHS and GHS and the male and female students with t-test. RESULTS: 1) Values of RBC, Hb, Hct, MCHC, RDW were 4.6+/-0.3x1012/L, 13.4+/-1.2g/dL, 41.5+/- 3.4%, 32.2+/-0.5g/dL, 12.1+/-0.9% respectively in the male AHS and 5.2+/-0.3x1012/L, 15.2+/- 1.0g/dL, 46.7+/-3.0%, 32.5+/-0.5g/dL, 12.3+/-0.6% respectively in male GHS, and there were significant between compared data. 2) Values of RBC, Hb, Hct MPV were 4.5+/-0.3x1012/L, 13.6+/-1.2g/dL, 40.5+/-3.2%, 9.0+/- 0.6fl respectively in the female AHS and 5.0+/-0.5x1012/L, 14.9+/-1.3g/dL, 44.8+/-3.4%, 8.7+/- 0.8fl respectively in the female GHS, and significance were between compared data. 3) Values of MCH, MCHC, RDW, MPV were 30.1+/-1.8pg, 33.6+/-1.1g/dL, 12.8+/-1.1%, 9.0+/-0.6fl respectively in the female AHS and 29.3+/-1.8pg, 32.2+/-0.5g/dL, 12.1+/-0.9%, 8.7+/-0.9fl respectively in the male AHS, and there were significant between compared data. 4) Values of RBC, Hct, MCH, MCHC, RDW, PLT were 5.0+/-0.5x1012/L, 44.8+/-3.4%, 30.0+/-2.1pg, 33.4+/-1.1g/dL, 12.7+/-1.0%, 29.8+/-5.8x104/mm3 respectively in the female non-AHS, and 5.2+/-0.3x1012/L, 46.7+/-3.0%, 29.4+/-1.4pg, 32.5+/-0.5g/dL, 12.3+/-0.6%, 28.7+/- 5.8x104/mm3 respectively in the male non-AHS, and there were significant between compared data. CONCLUSIONS: Among the high school students, exercise caused several hematologic changes that were significant decline of the values of RBC, hemoglobin, hematocrit compared to control group regardless of sex. In female students, their values of MCH, MCHC, RDW were significantly increased compared to male students regardless of exercise.
Cell Count ; Female ; Hematocrit ; Humans ; Korea ; Male ; Seoul ; Sports

PURPOSE: A common side effect of the scalp reduction is a creation of a 'slot' with the hair growing in the opposite directions away from the scar. Overcoming the unnatural appearance of the slot has been a vexing problem in the scalp reduction surgery. None of the conventional corrective surgical techniques provides a complete and satisfactory aesthetic result. The Frechet flap is a triple transposition flap used for the correction of the slot defect secondary to scalp reduction surgery, seldom needing further scar revision. The Frechet technique provides a solution to the problem of the central slot concealment that is unattainable by other means, such as; Z-plasty and mini-graft. METHODS: Authors applied the Frechet technique to Asian patients who had undergone scalp reduction and operated on 4 patients from March, 2000 to January, 2001. Average follow-up period was 13 months. Patients with long scars passing through the temporoparietoccipital zone were excluded. All the undermining was performed in the subgaleal plane, reaching the upper auricular sulcus and stopping just above the nuchal ridge. RESULTS: None of the patients experienced infection, hematoma, nor any permanent hair loss. Transient telogen effluvium at the distal end of flap 2 and 3 was noticeable in one case. CONCLUSION: In conclusion, the results are aesthetically satisfactory without any significant complications.
Asian Continental Ancestry Group ; Cicatrix ; Follow-Up Studies ; Hair* ; Hematoma ; Humans ; Scalp