PURPOSE: Directional atherectomy (DA) was introduced for the management of infrainguinal arterial stenosis or occlusive lesions. The procedure success rate in the DEFINITIVE LE study was determined using radiologic imaging. The aim of our study was to determine the usefulness of intraoperative ultrasonography (USG) during DA for evaluating the early results of this procedure. METHODS: Patients who underwent DA from January to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral artery stenosis (>70% stenosis) with short segment occlusive lesions (<2 cm in length) were treated. Among 20 lesions, 3 were treated with the TurboHawk system with a protective device due to lesion calcification. The percentage of stenosis during and after DA was determined with USG. RESULTS: Median follow-up was 5.1 months, and the procedural success rate (<30% stenosis at the end of the procedure) was 100% on angiography, but only 30% on intraoperative USG. On USG, median residual stenosis was 40% (range, 28%–42%) at the end of DA, 40% (range, 30%–55%) at 1 month, 55% (range, 35%–85%) at 6 months, and 64% (range, 60%–100%) at 1 year. There was one dissection, but no cases of perforation, pseudoaneurysm, or thrombosis. Primary patency, which was defined as a peak systolic velocity ratio ≤3.5 with no reintervention at 6 months, was found in 18 lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic symptoms such as claudication at 6 months. CONCLUSION: Our results demonstrated that DA with intraoperative USG is an effective treatment option for short segment occlusive lesions of the femoral artery.
Aneurysm, False ; Angiography ; Atherectomy* ; Constriction, Pathologic ; Femoral Artery ; Follow-Up Studies ; Humans ; Protective Devices ; Retrospective Studies ; Thrombosis ; Ultrasonography*

BACKGROUND: There are few information about the differences of the effective dose (ED) of cisatracurium between the adult and the elderly. We investigated the ED and the onset time of cisatracurium in the adults and the elderly. METHODS: We studied two hundred patients of the adults aged 20 through 64 years and the elderly aged ≥ 65 years, with American Society of Anesthesiologists physical status I or II. Each 100 patients with 20 patients of each dose group, randomly selected from 30, 40, 50, 60 or 70 µg/kg of cisatracurium, were randomly allocated to the adults and the elderly groups. We recorded the 0.1 Hz single twitch responses of the adductor pollicis and the onset times to maximal blockade. The magnitude of muscle relaxation was recorded by using an acceleromyography. The effect of cisatracurium on single twitch was calculated as percent reduction. After converting each drug dose into logarithm and percent reduction of the muscle reduction into probit, the EDs representing the muscle relaxation effects of 5%, 25%, 50%, 75% and 95% were estimated using the linear regression analysis. RESULTS: No significant differences were found in age, weight, height, or body mass index within or between the groups. The ED₅₀ and ED₉₅ of the adult group were 35.39 and 59.58 µg/kg. The ED₅₀ and ED₉₅ of the elderly group were 34.89 and 55.50 µg/kg, respectively. The onset times were 375.4 ± 76.9 seconds in the adult group and 369.1 ± 70.0 seconds in the elderly group. CONCLUSIONS: The ED and the onset time were not significantly different between the adult and the elderly.
Adult* ; Aged* ; Body Mass Index ; Humans ; Linear Models ; Muscle Relaxation

Cone beam CT, usually used in dental area, could easily obtain 3-dimensional images using cone beam shaped ionized radiation. Cone beam CT is very useful for direct percutaneous sac injection (DPSI) which needs very precise measurement to avoid puncture of inferior vena cava or vessel around sac or stent graft. Here we describe two cases of DPSI using cone beam CT. In case 1, a 79-year-old male had widening of preexisted type II endoleak after endovascular aneurysm repair (EVAR). However, transarterial embolization failed due to tortuous collateral branches of lumbar arteries. In case 2, a 72-year-old female had symptomatic sac enlargement by type II endoleak after EVAR. However, there was no route to approach the lumbar arteries. Therefore, we performed DPSI assisted by cone beam CT in cases 1, 2. Six-month CT follow-up revealed no sign of sac enlargement by type II endoleak.
Aged ; Aneurysm ; Arteries ; Blood Vessel Prosthesis ; Cone-Beam Computed Tomography* ; Embolization, Therapeutic ; Endoleak* ; Endovascular Procedures ; Female ; Follow-Up Studies ; Humans ; Male ; Punctures ; Vena Cava, Inferior

BACKGROUND: Magnesium is known to reduce the requirement of analgesic agents by blocking calcium channels that exist at the neuronal and neuromuscular junctions. However, former studies have shown inconsistent results regarding this concept. Therefore, we investigated the effects of magnesium on remifentanil requirements for achieving hemodynamic stabilization in patients undergoing laparoscopic gastrectomy. METHODS: Laparoscopic gastrectomy patients (n = 30) were randomly divided into two groups. Group M received 50 mg/kg of magnesium sulfate for 15 minutes prior to the induction of anesthesia. Then, 20 mg/kg/h of magnesium was administered during the operation time. Group N was administered the same amount of saline. Anesthesia was maintained with intravenous propofol and remifentanil injection. Vecuronium (0.1 mg/kg) was administered before intubation, and an additional 0.02 mg/kg was administered if a T1 twitch response was observed during surgery. Anesthetic time was standardized to provide an appropriate comparison of all patients. During 100 minutes, total anesthetic requirements and anesthetic requirements at every 10 minutes were analyzed. Postoperative pain was controlled with a patient controlled analgesia device. RESULTS: The remifentanil and vecuronium requirements during 100 minutes were significantly lower in Group M. There was no significant difference in propofol requirements between the two groups. No significant difference was observed in mean arterial pressure and heart rate. Postoperative VAS, PONV, or shivering also did not show any difference between the two groups. CONCLUSIONS: Magnesium reduced remifentanil and vecuronium requirements but not propofol requirements. Magnesium seems to have antinociceptic properties and reduces remifentanil requirements.
Analgesia, Patient-Controlled ; Analgesics ; Anesthesia ; Arterial Pressure ; Calcium Channels ; Gastrectomy* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Laparoscopy* ; Magnesium ; Magnesium Sulfate* ; Neuromuscular Junction ; Neurons ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Propofol ; Shivering ; Vecuronium Bromide

Several postharvest diseases of table grapes (Vitis vinifera) occur during storage, and gray mold rot is a particularly severe disease because the causal agent, Botrytis cinerea, grows at temperatures as low as 0degrees C. Other postharvest diseases, such as those caused by Penicillium spp. and Aspergillus spp., also often lead to deterioration in the quality of table grapes after harvest. The use of plant essential oils such as thymol and linalool, to reduce postharvest diseases in several kinds of fruits, including table grapes and oranges, has received much attention in European countries. However, to the best of our knowledge there has been no report of the use of thymol fumigation to control gray mold in table grapes in Korea. Thymol (30 microg/mL) and linalool (120 microg/mL) significantly inhibited mycelial growth and conidia germination of B. cinerea. The occurrence rate of gray mold rot of B. cinerea and other unknown fungi was significantly reduced by fumigation with 30 microg/mL thymol in several table grape cultivars, such as Campbell early, Muscat Bailey A, Sheridan, and Geobong. In this study, fumigation with 30 microg/mL thymol, had no influence on the sugar content and hardness of grapes, but reduced fungal infection significantly. This suggests that 30 microg/mL thymol could be utilized to reduce deterioration of grapes due to gray mold and other fungal infections during long-term storage.
Aspergillus ; Botrytis ; Citrus sinensis ; Fruit ; Fumigation* ; Fungi ; Germination ; Hardness ; Korea ; Oils, Volatile ; Oman ; Penicillium ; Plants ; Spores, Fungal ; Thymol* ; Vitis*

PURPOSE: Modified radical neck dissections (MRND) in papillary thyroid cancer surgery usually leave a long incision in the neck, causing cosmetic problems. We introduce a new surgical approach to MRND, with minimal lateral extension of transverse collar incisions, using the Iron-Intern. METHODS: Between Jan 2008 and Dec 2008, 135 patients with papillary thyroid cancer who had undergone MRND were enrolled in this study. Total thyroidectomy and central node dissection with Kocker transverse collar incision with minimal additional lateral extension were performed before MRND. MRND were performed including level II, III, IV and V. Among 135 patients, we performed MRND with the Iron-Intern in 70 patients (Group I) and 65 patients who had MRND performed without the Iron-Intern (Group II) were included as a control group. In Group I, the Iron-Intern, with some modifications, was applied during the dissection of the level II area. The postoperative outcomes of the patients were analyzed and compared retrospectively. RESULTS: The median hospital stay was significantly lower in Group I compared to Group II (P=0.003). The median operation time was significantly higher in Group I than Group II (P=0.002). The median numbers of harvested central and lateral lymph nodes were 10, 29 (group I) and 8, 23 (group II), respectively (P=0.073, P=0.148). Median levothyroxine off thyroglobulin levels were 1.2 and 1.8 in Group I and II, respectively (P=0.110). CONCLUSION: MRND, with minimal lateral extension using the Iron-Intern, can be easily and safely performed, leaving only minor scars in the neck.
Cicatrix ; Humans ; Length of Stay ; Lymph Nodes ; Neck ; Neck Dissection* ; Retrospective Studies ; Thyroglobulin ; Thyroid Neoplasms ; Thyroidectomy ; Thyroxine

BACKGROUND/AIMS: The prevalence of occult HBV infection (OBI) in patients with chronic hepatitis C (CHC) in Korea has not been reported. Additionally, it is unclear whether OBI influences treatment outcome in CHC patients. We investigated the prevalence of OBI and its impact on treatment outcome in patients with CHC. METHODS: Seventy-six patients with CHC were enrolled and treated with pegylated or conventional interferon and ribavirin. Hepatitis B virus (HBV) DNA was detected by nested polymerase chain reaction. RESULTS: Among the 68 patients who completed treatment and follow-up, HBV DNA was detected in serum from nine (13.2%) patients, liver tissue from 10 (14.7%), and serum or liver tissue from 15 (22.1%). OBI was diagnosed in nine (12.7%) control subjects. No difference in the prevalence of OBI between patients with CHC and controls was observed (13.2 vs. 12.0%; p = 0.92). No significant differences in age, sex, genotype 1 frequency, amount of hepatitis C virus RNA, anti-hepatitis B surface antigen/anti-hepatitis B core-IgG seropositivity, staging, or histology grading were observed in patients with or without HBV DNA. Sustained virological response was achieved in 73.3% of patients with OBI and 83.0% without OBI (p = 0.46). CONCLUSIONS: These results demonstrate that a significant proportion of patients with CHC have occult HBV infection and that OBI does not affect treatment outcome in patients with CHC.
DNA ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis B virus ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Korea ; Liver ; Prevalence ; Ribavirin ; RNA ; Treatment Outcome

PURPOSE: Lymphoma originated from mucosa associated lymphoid tissue(MALT) is most common in gastrointestinal system, and rarely found in salivary gland, thyroid, bronchus or orbit. We experienced a case of MALT lymphoma which was originated from conjunctiva and involving lower eyelid without metastasis. METHODS: A 40-year-old man suffered palpable mass on right lower eyelid without pain. Orbital computed tomographic and ultrasonographic findings showed a conical mass(1.9x1.2x0.9cm size) inside lower eyelid. The mass was completely excised under local anesthesia and histopathological examination was followed. RESULTS: Microscopic finding showed a multiple follicular colonization. In the follicle, small lymphocytes and plasma cells differentiated to centrocyte-like cell, monocyte B cell, plasma cell were diffusely infiltrated. Immunophenotyping was preformed on fixed section. The majority of the small cells were immunoreactive for the B cell marker CD20. Based on the typical histological findings supported by immunostaining, the mass was defined as MALT lymphoma. After excision, SPECT, abdominal CT was carried out and there were no evidence of extraorbital disease. CONCLUSION: Biopsy and pathological examination should be performed in patients who complain palpable mass on lower eyelid because of possibility of MALT lymphoma. Although MALT lymphoma is rarely metastasized, it is necessary to evaluate the extraorbital involvement using SPECT or other radiologic exams. For detecting extraorbital involvement, periodic follow-up examination is need.
Adult ; Anesthesia, Local ; Biopsy ; Bronchi ; Colon ; Conjunctiva ; Eyelids ; Follow-Up Studies ; Humans ; Immunophenotyping ; Lymphocytes ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone ; Monocytes ; Mucous Membrane ; Orbit ; Plasma Cells ; Salivary Glands ; Thyroid Gland ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Multiple skin leiomyoma and uterine myoma bearing autosomal dominant traits are benign smooth muscle tumors which originate in skin or female uterus. Skin leiomyoma occurs after gene mutation originating from arrector pili muscle of hair follicle where its clinical manifestations vary significantly from person to person. Our department hereby reports the histological findings and genetic evaluations of this very rare disease. METHODS: A 57-year-old woman presented in our institute with multiple tumors in the left and central parts of her back that started to appear since 19 years ago. The patient was diagnosed as having uterine myoma 15 years ago and underwent hysterectomy. Biopsy has been done on the specimen, and genomic DNA was separated from Fumarate hydratase gene for it to go through PCR amplification. The results of PCR amplification were aligned by sequencer. RESULTS: According to the results of biopsy, tumor cells were spindle-shaped and were aligned in a bundle where there was no dysplasia or mitosis. Moreover, these cells had abundant eosinophilic cytoplasm with elongated nucleus, and benign leiomyoma that showed positive reactions to SMA stain were found. In genetic examination, mutations such as heterozygous single nucleotide substitutions were found in alignments of amplified DNA. CONCLUSION: Multiple skin leiomyoma and uterine myoma are relatively uncommon diseases that are transmitted through autosomally dominant traits from genetic mutations. When a patient's chief complaint lies upon skin-colored or brown masses that occur in multiples appearing in the trunk or extremities with characteristic clinical symptoms and histological findings, and when the patient's family history is acknowledged such as skin or uterine leiomyoma or renal tumor, necessary genetic examination on multiple skin leiomyoma and uterine myoma could be done, and thereby precise diagnosis could also be made.
Biopsy ; Cytoplasm ; Diagnosis ; DNA ; Eosinophils ; Extremities ; Female ; Fumarate Hydratase* ; Hair Follicle ; Humans ; Hysterectomy ; Leiomyoma* ; Middle Aged ; Mitosis ; Polymerase Chain Reaction ; Rare Diseases ; Skin ; Smooth Muscle Tumor ; Uterus

Parosteal lipoma is a rare and generally asymptomatic benign tumor of mature adipose tissue that is located in direct apposition to the external surface of the bone. These tumors are occasionally associated with reactive changes in the underlying bone. The reactive bone formation is generally restricted to the base of the tumor, that is, near the periosteum. We recently experienced a case of parosteal lipoma in the proximal femur, which displayed exuberant bone and cartilage formation, and this led us to a misdiagnosis of chondroblastic osteosarcoma on the initial biopsy. We report here on this case with a special emphasis on making the differential diagnosis from osteosarcoma.
Adipose Tissue ; Biopsy ; Cartilage ; Chondrocytes ; Diagnosis, Differential ; Diagnostic Errors ; Femur* ; Lipoma* ; Osteogenesis ; Osteosarcoma ; Osteosarcoma, Juxtacortical ; Periosteum