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1.  Comparison of long-term results of above-the-knee femoro-popliteal bypass with autogenous vein and polytetrafluoroethylene grafts 
To analyze the long-term results of above-the-knee femoro-popliteal bypass (ATKFPB) with vein grafts compared with polytetrafluoroethylene (PTFE) grafts.
A database of patients with chronic atherosclerotic occlusive disease who underwent ATKFPB was retrospectively reviewed. Characteristics of patient and arterial lesion, and follow-up results were compared between vein grafts and PTFE grafts. Graft patency was determined by periodic examinations of duplex ultrasonography or CT angiograms. Graft patency and limb salvage rates were calculated using the Kaplan-Meier method.
In total, 253 ATKFPBs (107 vein grafts; 146 PTFE grafts; critical limb ischemia, 32%) were performed on 228 patients (mean age, 68.5 years; male, 87.7%). No significant differences were observed between the two groups with respect to demographic characteristics, characteristics of arterial lesions, or distal runoff score. During the mean follow-up period of 41 months (range, 1-122 months), 14.5% patients died, and 94% of all limbs were available for follow-up. The primary patency rates were not significantly different between the two groups at 10 years after treatment (75% vs. 42%, P = 0.330). However, the primary-assisted patency rates (88% vs. 42%, P = 0.003) and secondary patency rates (91% vs. 49%, P = 0.013) were significantly higher in the vein grafts compared with the PTFE grafts. Graft occlusion developed more often in the PTFE grafts (5.6% vs. 20.5%, P = 0.001). When graft occlusion occurred, acute limb ischemia was significantly more frequent in the PTFE grafts than in the vein grafts (0% vs. 53%, P = 0.027).
After ATKFPB, autologous vein grafts showed significantly better long-term results compared with PTFE grafts.
PMCID: PMC4279987  PMID: 25553322
Comparative study; Vascular graft occlusion; Peripheral arterial occlusive disease
2.  Infected Aneurysm: Current Management 
Annals of Vascular Diseases  2010;3(1):7-15.
PMCID: PMC3595820  PMID: 23555382
3.  Open surgical decompression of celiac axis compression by division of the median arcuate ligament 
Median arcuate ligament syndrome is a rare cause of abdominal pain which results from compression of the celiac artery (CA) or rarely, the superior mesenteric artery by a ligament formed by the right and left crura of the diaphragm. We report a case of open surgical decompression of the CA by division of the median arcuate ligament for a 37-year-old female patient who had suffered from chronic postprandial epigastric pain and severe weight loss. We described clinical features, characteristic angiographic findings and details of the surgical procedure for the patient with this rare vascular problem.
PMCID: PMC3729994  PMID: 23908968
Median arcuate ligament; Celiac artery stenosis
4.  Treatment of failing vein grafts in patients who underwent lower extremity arterial bypass 
We attempted to determine risk factors for the development of failing vein graft and optimal treatment in patients with infrainguinal vein grafts.
We retrospectively reviewed a database of patients who underwent infrainguinal bypass using autogenous vein grafts due to chronic atherosclerotic arterial occlusive disease of lower extremity (LE) at a single institute between September 2003 and December 2011. After reviewing demographic, clinical, and angiographic features of the patients with failing grafts, we analyzed those variables to determine risk factors for the development of failing grafts. To determine an optimal treatment for the failing vein grafts, we compared results of open surgical repair (OSR), endovascular treatment (EVT) and conservative treatment.
Two hundred and fifty-eight LE arterial bypasses using autogenous vein grafts in 242 patients were included in this study. During the follow-up period of 39 ± 25 months (range, 1 to 89 months), we found 166 (64%) patent grafts with no restenosis, 41 (15.9%) failing grafts, 39 (15.1%) graft occlusions, and 12 (4.7%) grafts lost in follow-up. In risk factor analysis for the development of a failing graft, no independent risk factors were identified. After 50 treatments of the 41 failing grafts (24 OSR, 18 EVT, 8 conservative management), graft occlusion was significantly more common in conservative treatment group and severe (>75%) restenosis was significantly more common following EVT than OSR (P = 0.001). Reintervention-free graft patency was also superior in the OSR group to that of the EVT group (87% vs. 42%, P = 0.015).
OSR of failing grafts has better outcomes than EVT or conservative management in treating failing grafts.
PMCID: PMC3491233  PMID: 23166890
Lower extremity; Bypass; Failing graft; Stenosis; Graft occlusion
5.  Renal and abdominal visceral complications after open aortic surgery requiring supra-renal aortic cross clamping 
The aim of this study was to assess renal or abdominal visceral complications after open aortic surgery (OAS) requiring supra-renal aortic cross clamping (SRACC).
We retrospectively reviewed the medical records of 66 patients who underwent SRACC. Among them, 17 followed supra-celiac aortic cross clamping (SCACC) procedure, 42 supra-renal, and 7 inter-renal aorta. Postoperative renal, hepatic or pancreatic complications were investigated by reviewing levels of serum creatinine and hepatic and pancreatic enzymes. Preoperative clinical and operative variables were analyzed to determine risk factors for postoperative renal insufficiency (PORI).
Indications for SRACC were 25 juxta-renal aortic occlusion and 41 aortic aneurysms (24 juxta-renal, 12 supra-renal and 5 type IV thoraco-abdominal). The mean duration of renal ischemic time (RIT) was 30.1 ± 22.2 minutes (range, 3 to 120 minutes). PORI developed in 21% of patients, including four patients requiring hemodialysis (HD). However, chronic HD was required for only one patient (1.5%) who had preoperative renal insufficiency. RIT ≥ 25 minutes and SCACC were significant risk factors for PORI development by univariate analysis, but not by multivariate analysis. Serum pancreatic and hepatic enzyme was elevated in 41% and 53% of the 17 patients who underwent SCACC, respectively.
Though postoperative renal or abdominal visceral complications developed often after SRACC, we found that most of those complications resolved spontaneously unless there was preexisting renal disease or the aortic clamping time was exceptionally long.
PMCID: PMC3433553  PMID: 22977763
Renal insufficiency; Visceral ischemia; Abdominal aortic aneurysm; Aortic occlusive disease; Suprarenal aortic cross clamping
6.  Risk factors for delayed recanalization of calf vein thrombosis 
To determine the risk factors of delayed recanalization of isolated calf vein thrombosis (CVT).
One hundred fifty limbs of 110 patients with CVT between September 2007 and April 2010 were enrolled. We used ultrasonography for the diagnosis and follow-up examinations of CVT. We calculated recanalization rates at 1 and 3 months after initial diagnosis and analyzed the risk factors associated with delayed recanalization of CVT.
CVTs were located in the muscular calf vein in 110 (73.3%), in the deep calf vein in 18 (12%), and in both in 22 cases (14.7%). Among all CVTs, 94 limbs (63%) were symptomatic. Major risk factors for CVT were orthopedic surgery (87.3%), malignancy (21.3%), and immobilization (15.3%). Sixty-seven patients (60.9%) were treated with oral anticoagulation therapy, while 43 patients by low molecular weight heparin (n = 19) or by conservative methods including elastic compression stockings and ambulation (n = 21). The cumulative recanalization rate at 1 and 3 months was 23% and 82% and it was significantly higher in patients who underwent oral anticoagulation therapy compared with patients without oral anticoagulation therapy (84% vs. 65%, P = 0.008 by log-rank test). Malignancy (odds ratio [OR], 2.789; P = 0.043) and immobilization (OR, 4.191; P = 0.029) were independent risk factors for delayed recanalization of CVT and oral anticoagulation (OR, 0.300; P = 0.020) was an independent factor in promoting recanalization in multivariate analysis.
For patients with isolated CVT, no oral anticoagulation resulted in higher rates of delayed recanalization compared to oral anticoagulation treatment. Immobilization and having malignancy were independent risk factors for delayed recanalization.
PMCID: PMC3341480  PMID: 22563538
Thrombosis; Venous thrombosis; Deep vein thrombosis
7.  Spontaneous aortic rupture in a patient with neurofibromatosis type 1 
Neurofibromatosis type I (NF-1) is a rare autosomal dominant genetic disorder occurring in 1 in 3,000 individuals. Vasculopathy is a rarely reported finding in patients with NF-1. Here, we report a case of recurrent aortic pseudoaneurysm after endovascular aneurysm repair in a 49-year-old male patient with NF-1. On the sixth postoperative day following a successful open surgical repair of an aortic pseudoaneurysm, he developed hemoperitoneum due to a delayed rupture of the mesenteric artery branch. This was treated with endovascular coil embolization. We report the clinical features and histologic findings of this rare vascular disorder with a review of the relevant literature.
PMCID: PMC3319782  PMID: 22493769
Aortic aneurysm; Aortic rupture; Neurofibromatosis 1
8.  Measurement of carotid artery stenosis: correlation analysis between B-mode ultrasonography and contrast arteriography 
To evaluate the efficacy of B-mode ultrasonography (US) in measurement of carotid stenosis% (CS%).
One hundred and thirth-three carotid arteries in 96 patients who underwent both carotid US and carotid arteriography (CA) were included in this retrospective study. To measure CS% on US, a cross sectional view of the most stenotic segment of the internal carotid artery was captured and residual diameter and original diameter of that segment were measured with electronic caliper on the same plane and in the same direction. To measure CS% on an angiogram, we used European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) methods. Pearson's correlation analysis and linear regression analysis were used to determine the correlation between CS% on an US and angiogram.
Pearson's correlation coefficient (R) between CS% measured in US and CA were 0.853 (ECST method, P < 0.001) and 0.828 (NASCET method, P < 0.001). Accuracies of B-mode US were 93.2%, 88.0%, and 81.2% for estimating CS% by ECST method and 86.5%, 82.7%, and 82% for estimating CS% by NASCET method.
CS% measured in B-mode US was simpler and showed a strong positive correlation with that measured on an arteriogram either ECST or NASCET method.
PMCID: PMC3204697  PMID: 22066059
Carotid stenosis; Ultrasonography; Accuracy; Arteriography
9.  Prevalence of Asymptomatic Critical Carotid Artery Stenosis in Korean Patients with Chronic Atherosclerotic Lower Extremity Ischemia: Is a Screening Carotid Duplex Ultrasonography Worthwhile? 
Journal of Korean Medical Science  2010;25(8):1167-1170.
This study aimed to investigate prevalence of asymptomatic carotid artery stenosis (ACAS) in Korean patients with peripheral arterial disease (PAD) and identify predictive factors of ACAS in patients with PAD. Between 1994 and 2008, 546 patients who underwent bypass surgery due to PAD were identified in a single tertiary teaching hospital. Of those, 409 patients underwent preoperative screening carotid duplex ultrasonography (CDUS). Patients who had an episode of cerebrovascular event or previous carotid artery intervention were excluded and then a retrospective analysis was made of 340 patients. The degree of internal carotid artery (ICA) stenosis was determined by the criteria of Society of Radiologists in Ultrasound Consensus Conference. To determine the risk factors of ACAS, demographic, coexisting medical condition and lesion characteristics were tested with binary logistic regression model. The prevalence of ≥70% ICA stenosis was 14%. ICA occlusion was detected in 7.1%. Multivariate analysis revealed age >65 yr (OR: 2.610, 95% CI: 1.197-5.691) and coronary artery disease (CAD, OR: 2.333, 95% CI: 1.169-4.657) are predictive factors of ≥70% stenosis. A PAD patient who needs revascularization, particularly, >65 yr or has a concomitant CAD, can be a good candidate of screening CDUS.
PMCID: PMC2908785  PMID: 20676327
Duplex ultrasonography; Peripheral Vascular Diseases; Carotid Stenosis
10.  Successful Surgical Treatment of Aortoenteric Fistula 
Journal of Korean Medical Science  2007;22(5):846-850.
In order to establish optimal management for aortoenteric fistula (AEF) the records of five patients treated for AEF (four aortoduodenal and one aortogastric fistula) were retrospectively reviewed. The arterial reconstruction procedures were selected according to the surgical findings, underlying cause, and patient status. In situ aortic reconstructions with prosthetic grafts were performed on three patients who had no gross findings of periaortic infection, whereas axillo-bifemoral bypass was carried out in the other two patients with periaortic purulence. In all patients, after retroperitoneal irrigation a pedicled omentum was used to cover the aortic graft or aortic stump. In the preoperative abdominal computed tomography (CT) scan there was a periaortic air shadow in four out of five patients. There was no surgical mortality or graft infection observed during a mean follow-up period of 40 months (range, 24-68 months). Therefore, the treatment results of an AEF can be improved using intravenous contrast-enhanced abdominal CT for rapid diagnosis and selection of an appropriate surgical procedure based on the surgical findings and underlying cause.
PMCID: PMC2693851  PMID: 17982233
Aorta; Intestinal Fistula; Aortic Aneurysm
11.  Risk Factor Analysis for Development of Asymptomatic Carotid Stenosis in Koreans 
Many risk factors for atherosclerosis have been proposed to identify high risk individuals. We conducted a retrospective study to determine the risk factors for development of carotid stenosis (CS) in Koreans. Database of 2,805 subjects who underwent a check up of carotid artery for health examination were analyzed. Stenosis (%) of common carotid artery or proximal internal carotid artery was examined with ultrasonography. Subjects were divided into 2 groups (Group I; CS <10%, Group II; CS ≥30%). We compared demographic, laboratory and clinical data between 2 groups to determine the risk factors of CS. One hundred ninety seven subjects (7.0%) were categorized as Group II. At age- and sex-adjusted multivariate analysis, diabetes mellitus, hypertension, cerebrovascular disease, ischemic heart disease, hyperlipidemia, aspirin medication, current smoking, fasting glucose, total cholesterol, low density lipoprotein-cholesterol (LDL-C) and leukocyte count were significant risk factors of CS. At stepwise logistic regression analysis, age, hypertension, hyperlipidemia, LDL-C and leukocyte count were independent risk factors. At subgroup analysis by smoking, age and leukocyte count were independent risk factors in smoker and age and hypertension in nonsmoker.
PMCID: PMC2733964  PMID: 16479058
Carotid Stenosis; Atherosclerosis; Risk Factors
12.  Comparisons between prosthetic vascular graft and saphenous vein graft in femoro-popliteal bypass 
Infrainguinalfemoropopliteal bypass (IFPB) is recommended to peripheral arterial disease (PAD) with a long occlusion of the superficial femoral artery (SFA). The aims of our study were to determine the patency of graft materials, and identify the risk factors of graft failure.
From January 1995 to April 2011, we had performed 380 IFPBs in 351 patients, including 302 femoro-above the knee (AK) bypasses and 78 femoro-below the knee (BK) bypasses. We compare age, sex, severity of ischemia between polytetra-uoroethylene (PTFE) graft and saphenous vein (SV) graft, and evaluate patency rate rates of the two groups.
The primary patency rates at 5 years for SV (n = 76 limbs) and PTFE grafts (n = 226 limbs) in AK were 85.2% and 64.5% (log rank = 0.03), and the secondary patency rates at 5 years for SV and PTFE grafts in AK were 88.2% and 79.0% (log rank = 0.13). The primary patency rates at 5 years for SV (n = 50 limbs) and PTFE grafts (n = 28 limbs) in BK were 63.2% and 40.0% (log rank = 0.08), and the secondary patency rates at 5 years for SV and PTFE grafts in BK were 71.6% and 55.5% (log rank = 0.18).
There was no statistical significant difference in secondary patency rates between SV and PTFE in IFPB. PTFE grafts as SV grafts can be a good alternative bypass material in IFPB instead of SV grafts.
PMCID: PMC4091446  PMID: 25025025
Polytetrafluoroethylene; Saphenous vein; Graft; Patency
13.  Clinical Utility of Coronary CT Angiography with Stress Perfusion CT in Preoperative Cardiac Risk Evaluation 
Korean Circulation Journal  2014;44(3):170-176.
Background and Objectives
Vascular surgery carries high operative risk. Recently developed cardiac computed tomography (CT) provides excellent imaging of coronary artery disease (CAD), as well as myocardial perfusions. We investigated the role of stress perfusion CT with coronary computed tomography angiography (CCTA) using 128-slice dual source CT (DSCT) in preoperative cardiac risk evaluation.
Subjects and Methods
Patients scheduled for vascular surgery were admitted and underwent the adenosine stress perfusion CT with CCTA using DSCT. Patients who presented with unstable angina, recent myocardial infarction, decompensated heart failure, or renal failure were excluded. Stress perfusion CT was first acquired using sequential mode during adenosine infusion, after which, scanning for CT angiography was followed by helical mode. Perioperative events were followed up for 1 month.
Ninety-one patients completed the study. Most patients (94.5%) had coronary atherosclerosis, with 36 (39.6%) patients had more than 50% coronary artery stenosis. Perfusion defects with significant stenosis were found in 12 cases (13.2%). Revascularization after DSCT was rarely performed. Four patients (4.4%) experienced cardiac events in the perioperative period: two experienced heart failure and two had non-fatal myocardial infarction.
We cannot conclude that the stress perfusion CT, with CCTA using DSCT, plays a significant role in preoperative risk evaluation from this study. However, the coronary atherosclerosis and the significant CAD were commonly found. The perfusion defects with significant lesions were found in only small fraction of the patients, and did not contribute to perioperative myocardial infarction or heart failure.
PMCID: PMC4037639  PMID: 24876858
Vascular surgical procedure; Coronary artery disease; Multidetector computed tomography; Myocardial perfusion imaging
14.  Lactobacillus brevis Strains from Fermented Aloe vera Survive Gastroduodenal Environment and Suppress Common Food Borne Enteropathogens 
PLoS ONE  2014;9(3):e90866.
Five novel Lactobacillus brevis strains were isolated from naturally fermented Aloe vera leaf flesh. Each strain was identified by Random Amplified Polymorphic DNA (RAPD) analysis and 16S rRNA sequence comparison. These strains were highly tolerant to acid, surviving in pH2.5 for up to 4 hours, and resistant to 5% bile salts at 37°C for 18 hours. Due to its tolerance to acid and bile salts, one strain passed through the gastric barrier and colonised the intestine after oral administration. All five strains inhibited the growth of many harmful enteropathogens without restraining most of normal commensals in the gut and hence named POAL (Probiotics Originating from Aloe Leaf) strains. Additionally, each strain exhibited discriminative resistance to a wide range of antibiotics. The L. brevis POAL strains, moreover, expressed high levels of the glutamate decarboxylase (GAD) gene which produces a beneficial neurotransmitter, γ-aminobutyric acid (GABA). These characteristics in all suggest that the novel L. brevis strains should be considered as potential food additives and resources for pharmaceutical research.
PMCID: PMC3944883  PMID: 24598940
15.  The Clinical Utility of Automated Breast Volume Scanner: A Pilot Study of 139 Cases 
Journal of Breast Cancer  2013;16(3):329-334.
The aim of this study is to evaluate the clinical utility of automated breast volume scanner (ABVS) for detecting and diagnosing the breast lesions.
From December 2010 to January 2012, bilateral whole breast examinations were performed with ABVS for 139 women. Based on the Breast Imaging Reporting and Data System (BI-RADS) categories, the breast lesions were evaluated on coronal multiplanar reconstruction images using the ABVS workstation. Then, the imaging results were compared with those on conventional handheld ultrasound (HHUS) images. Histological diagnoses were performed on BI-RADS category 4 and 5 lesions.
A total of 453 lesions were detected by ABVS. On the HHUS, 33 new lesions were detected but 69 lesions were not detected. BI-RADS category 2 and 3 matched to those on ABVS at 73.5% (61/83) and 85.4% (276/323). In 47 lesions of BI-RADS category 4 or 5, there was an exact match to those on ABVS. In addition, 47 lesions were classified as BI-RADS category 4 and 5, for which an ultrasound-guided core needle biopsy was performed. The malignant lesions of BI-RADS category 4 and 5 showed the following: 2/27 (7.4%) in 4A, 4/5 (80%) in 4B, 2/2 (100%) in 4C, and 13/13 (100%) in 5. The ABVS showed 21 true positives and a positive predictive value of 44.7% (21/47).
There was considerable agreement in the assessment of the breast lesions by ABVS and HHUS. The ABVS had advantages of high diagnostic accuracy, examiner-independence, multislice visualization of the whole breast and less time-consuming. Our results indicate that ABVS might be a useful modality in diagnosing breast lesions.
PMCID: PMC3800730  PMID: 24155763
Three dimentional; Breast neoplasms; Carcinoma; Ultrasonography
16.  The relationship between depressive symptoms among female workers and job stress and sleep quality 
Recently, workers' mental health has become important focus in the field of occupational health management. Depression is a psychiatric illness with a high prevalence. The association between job stress and depressive symptoms has been demonstrated in many studies. Recently, studies about the association between sleep quality and depressive symptoms have been reported, but there has been no large-scaled study in Korean female workers. Therefore, this study was designed to investigate the relationship between job stress and sleep quality, and depressive symptoms in female workers.
From Mar 2011 to Aug 2011, 4,833 female workers in the manufacturing, finance, and service fields at 16 workplaces in Yeungnam province participated in this study, conducted in combination with a worksite-based health checkup initiated by the National Health Insurance Service (NHIS). In this study, a questionnaire survey was carried out using the Korean Occupational Stress Scale-Short Form(KOSS-SF), Pittsburgh Sleep Quality Index(PSQI) and Center for Epidemiological Studies-Depression Scale(CES-D). The collected data was entered in the system and analyzed using the PASW (version 18.0) program. A correlation analysis, cross analysis, multivariate logistic regression analysis, and hierarchical multiple regression analysis were conducted.
Among the 4,883 subjects, 978 subjects (20.0%) were in the depression group. Job stress(OR=3.58, 95% CI=3.06-4.21) and sleep quality(OR=3.81, 95% CI=3.18-4.56) were strongly associated with depressive symptoms. Hierarchical multiple regression analysis revealed that job stress displayed explanatory powers of 15.6% on depression while sleep quality displayed explanatory powers of 16.2%, showing that job stress and sleep quality had a closer relationship with depressive symptoms, compared to the other factors. The multivariate logistic regression analysis yielded odds ratios between the 7 subscales of job stress and depressive symptoms in the range of 1.30-2.72 and the odds ratio for the lack of reward was the highest(OR=2.72, 95% CI=2.32-3.19). In the partial correlation analysis between each of the 7 subscales of sleep quality (PSQI) and depressive symptoms, the correlation coefficient of subjective sleep quality and daytime dysfunction were 0.352 and 0.362, respectively.
This study showed that the depressive symptoms of female workers are closely related to their job stress and sleep quality. In particular, the lack of reward and subjective sleep factors are the greatest contributors to depression. In the future, a large-scale study should be performed to augment the current study and to reflect all age groups in a balanced manner. The findings on job stress, sleep, and depression can be utilized as source data to establish standards for mental health management of the ever increasing numbers of female members of the workplace.
PMCID: PMC3923333  PMID: 24472381
17.  Hypermagnesemia Accompanied with Colonic Perforation in a Hemodialysis Patient 
Yonsei Medical Journal  2013;54(3):797-800.
We report a case of a chronic hemodialysis patient who developed hypermagnesemia due to an overdose of magnesium-containing laxative and paralytic ileus resulting in colonic perforation. Despite intravenous calcium infusion and daily hemodialysis, the patient developed ischemic colitis and intestinal perforation. Colonic perforation accompanied with hypermagnesemia in hemodialysis patients has rarely been reported. This case suggests that hypermagnesemia should be considered in renal failure patients as this can result in life-threatening events despite prompt treatment.
PMCID: PMC3635627  PMID: 23549833
Hypermagnesemia; paralytic ileus; colonic perforation; hemodialysis
18.  Association between Genetic Instability and Helicobacter pylori Infection in Gastric Epithelial Dysplasia 
Background. In gastric carcinogenesis, changes of DNA methylation appear to be an early molecular event, and the genome-wide methylation state is closely correlated with the level of long interspersed nucleotide element-1 (LINE-1) methylation. In this study, we measured LINE-1 methylation level according to genetic instability and evaluated the effect of Helicobacter pylori infection on genetic instability in gastric epithelial dysplasia. Methods. Total 100 tissue samples of gastric epithelial dysplasia were analyzed. Seven loci that linked to tumor suppressor genes were used to identify significant structural chromosomal aberrations. Microsatellite status was investigated for two different microsatellite marker loci (BAT25 and BAT26). Also, we measured LINE-1 methylation level by combined bisulfite restriction analysis (COBRA-LINE-1) method. Results. There were no significant differences of LINE-1 methylation level according to chromosomal/microsatellite instability and H. pylori state. In the dysplastic lesions with H. pylori infection, LINE-1 methylation level of MSI lesion was significantly lower than that of microsatellite stable (MSS) lesion (40.23 ± 4.47 versus 43.90 ± 4.81%, P < 0.01). Conclusions. In gastric epithelial dysplasia with H. pylori infection, MSI is correlated with reduced LINE-1 methylation level. Coexistence of H. pylori infection and MSI might be a driving force of gastric carcinogenesis.
PMCID: PMC3546497  PMID: 23346103
19.  Primary cutaneous malignant melanoma of the breast 
Cutaneous malignant melanoma of the breast can be divided into two categories: primary and metastatic lesions. Cutaneous malignant melanoma of the breast is a rare tumor, accounting for less than 5% of all malignant melanomas. Clinical features and diagnostic methods of primary cutaneous malignant melanoma of the breast are similar to those arising from other cutaneous areas. Treatment of choice is wide local excision with adequate resection margin according to tumor thickness. Sentinel lymph node biopsy should be performed because the presence of lymph node metastasis is the most important prognostic factor. There have been only limited reports involving primary cutaneous malignant melanoma of the breast. Thus, we report a case of primary cutaneous malignant melanoma in a 59-year-old woman with a review of the recent literature.
PMCID: PMC3514482  PMID: 23230558
Breast neoplasms; Melanoma; Sentinel lymph node biopsy
20.  Successful Management of Pulmonary and Inferior Vena Cava Tumor Embolism from Renal Cell Carcinoma 
Pulmonary tumor embolism can be a cause of respiratory failure in patients with cancer even though it occurs rarely. We describe a 56-year-old man who underwent a pulmonary tumor embolectomy using cardiopulmonary bypass on beating heart combined with inferior vena cava embolectomy and right radical nephrectomy. Aggressive surgical treatment in this severe case is necessary not only to reduce the fatal outcome of pulmonary embolism in the short run, but also to improve the oncological prognosis in the long term.
PMCID: PMC3487017  PMID: 23130307
Pulmonary embolism; Cancer; Great vessels; Embolectomy
21.  Ten year outcomes after bypass surgery in aortoiliac occlusive disease 
Most outcome studies of bypass surgery are limited to five years of follow-up. However, as human life expectancy has increased, analyses of more long-term outcomes are needed. The aim of this study is to evaluate 10-year outcomes of anatomical bypasses in aortoiliac occlusive disease.
From 1996 to 2009, 92 patients (82 males and 10 females) underwent aortic anatomical bypasses to treat aortoiliac occlusive disease at Samsung Medical Center. The patients were reviewed retrospectively. Kaplan-Meier survival analyses were performed using PASW ver. 18.0 (IBM Co).
A total of 72 patients (78.3%) underwent aorto-femoral bypasses (uni- or bi-femoral), 15 patients (16.3%) underwent aorto-iliac bypasses (uni- or bi-iliac), and 5 patients (5.4%) underwent aorto-iliac and aorto-femoral bypasses. The overall primary patency rates of the 92 patients were 86.2% over 5 years and 77.6% over 10 years. The 10-year limb salvage rate and overall survival rate were 97.7% and 91.7%, respectively.
The overall patency rates of bypass graft and limb salvage rates decreased as time passed. The analysis of results after bypass surgery to treat arterial occlusive disease will be needed to extend for 10 years of follow-up.
PMCID: PMC3373986  PMID: 22708098
Aortoiliac occlusive disease; Leriche syndrome; Bypass
22.  A hybrid operation in a patient with complex right subclavian artery aneurysm 
We report a hybrid surgery including endovascular aneurysm repair and debranching procedures to treat a patient with a complex right subclavian artery aneurysm. The patient was a 70-year-old woman who presented with dry cough and hoarseness. The aneurysm was characterized by the absence of a proximal neck, and involvement of the origin of the right vertebral artery. She underwent carotid-vertebral artery bypass, stent graft from the innomiate artery to the common carotid artery and carotid-axillary artery bypass. Great saphenous vein was used for the carotid-vertebral artery bypass and 7 mm reinforced polytetrafluoroethylene graft was used for the carotid-axillary artery bypass. The postoperative course was uneventful.
PMCID: PMC3294115  PMID: 22403755
Subclavian artery; Aneurysm; Hybrid operation
23.  Prevalence of Asymptomatic Carotid Stenosis in Korea Based on Health Screening Population 
Journal of Korean Medical Science  2011;26(9):1173-1177.
We attempted to investigate the prevalence and risk factors of carotid artery stenosis in Korea. Twenty thousand seven hundred twelve individuals who underwent carotid artery ultrasonography for health screening between March 2005 and March 2010 were retrospectively evaluated. The population was divided into four groups, according to the degree of stenosis, as Group A, below 29%; Group B, 30% to 49%; Group C, 50% to 74%; Group D, above 75%. The medical records of the individuals were investigated, and Fisher's exact test, chi-square tests, Kruskal-Wallis tests and a binary logistic regression model were used for statistical analysis. The prevalence of carotid stenosis was Group B, 5.5%; Group C, 0.9%; Group D, 0.1%. Old age, male gender, hypertension, diabetes mellitus and ischemic heart disease were significantly higher in Groups C and D (P = 0.001, 0.001, 0.001, 0.048, and 0.001, respectively). Among the males aged over 65 yr, the prevalence of carotid stenosis ≥ 50% and ≥ 30% were 4.0% and 18.2%, respectively. Asymptomatic carotid stenosis is not uncommon in Korea. Carotid ultrasonography is necessary for people with above-listed risk factors.
PMCID: PMC3172654  PMID: 21935272
Carotid arteries; Stenosis; Prevalence
24.  External banding valvuloplasty for incompetence of the great saphenous vein: 10-year results 
External banding valvuloplasty (EBV) of the great saphenous vein (GSV) in patients with varicose veins is still controversial. The present study evaluated the effectiveness of EBV in selected patients with an insufficiency of the GSV after a mean follow-up of 92.6 months.
A total of 101 limbs underwent EBV for the treatment of a GSV insufficiency. Thirty-one limbs from 27 patients (three men, 24 women; mean age 44.2 years; range 19 to 58 years) were re-examined and followed for a mean of 92.6 months. The venous volume, venous filling index, ejection fraction and residual venous fraction were analyzed preoperatively and at the follow-up using air plethysmography. The diameter and reflux of the GSV were evaluated using duplex ultrasound.
Overall, the mean (± SD) follow-up time was 92.6±22.3 months (range 46 to 138 months). At the follow-up, the preoperative venous hemodynamic states had improved significantly, to the following values: venous volume 96.0±32.3 mL to 83.4±32.6 mL; venous filling index 3.6±2.9 mL/min to 2.4±2.2 mL/min; and residual venous fraction 39.7%±18.6% to 26.1%±16.8% (P<0.05). The diameter of the GSV was 6.4±1.4 mm preoperatively and 4.8±1.7 mm postoperatively (P<0.01). Reflux in the proximal GSV was demonstrated preoperatively in 19 (61.3%) of 31 limbs. During the follow-up period, four limbs (12.9%) had high ligation and stripping of the GSV performed due to the recurrence of varicosity.
EBV of the GSV provides good results in terms of the venous hemodynamics and decreasing the diameter of the GSV. EBV may be an alternative procedure to stripping or endovenous ablation therapy in selected patients.
PMCID: PMC2726565  PMID: 22477472
Hemodynamics; Valvuloplasty; Varicose vein
25.  Ethanol Sclerotherapy for the Management of Craniofacial Venous Malformations: the Interim Results 
Korean Journal of Radiology  2009;10(3):269-276.
We wanted to evaluate the safety and feasibility of ethanol sclerotherapy for treating craniofacial venous malformations (CVMs).
Materials and Methods
From May 1998 to April 2007, 87 patients (40 men and 47 women; age range, 2-68 years) with CVMs underwent staged ethanol sclerotherapy (range, 1-21 sessions; median number of sessions, 2) by the direct puncture technique. Clinical follow up (range, 0-120 months; mean follow up, 35 months; median follow up, 28 months) was performed for all the patients. Therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms in all patients, as well as the degree of devascularization, which was determined on the follow-up imaging, in 71 patients.
A total of 305 procedures with the use of ethanol were performed in 87 patients. Follow-up imaging studies were performed for 71 of 87 patients. Twenty-three (32%) of the 71 patients showed excellent outcomes, 37 patients (52%) showed good outcomes and 11 patients (16%) showed poor outcomes. Ethanol sclerotherapy was considered effective for 60 patients. All the minor complications such as bulla (n = 5) healed with only wound dressing and observation. Any major complication such as skin necrosis did not develop.
Percutaneous ethanol sclerotherapy is an effective, safe treatment for CVMs.
PMCID: PMC2672182  PMID: 19412515
Ethanol; Head and Neck; Sclerotherapy; Venous malformations

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