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김영욱,허승,나목찬,윤우성 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1
Purpose: Flush high ligation of the saphenofemoral or saphenopoplieal junction combined with invaginated stripping of the greater saphenous vein to just below the knee or perforate invaginate stripping of the proximal lesser saphenous vein appears to be the method of choice for good clinical results and low incidence of damage to the saphenous or sural nerve, and is important in the prevention of recurrence. Method: From January 2001 to August 2001, we performed 84 operations for 72 patients with varicose veins. Among them, 77 flush high ligations (62 saphenofemoral and 15 saphenopopliteal) and 64 invaginated strippings (55 greater and 9 lesser saphenous veins) were performed. Result: Seventy seven flush high ligations were successfully performed in all patients, but 2 invaginated strippings were failed due to their large branches of greater saphenous veins. All of 9 proximal invaginated strippings for lesser saphenous veins were completely performed without any complications. As early postoperative complications related with invaginated strippings for greater saphenous veins, 24 (43.6%) cases of ecchymosis and 5 (9.1%) cases of paresthesia were occurred at thigh. One case of wound infection at popliteal fossa and 3 cases of wound inflammation at inguinal area were occurred. But those complications were recovered within 10 days. Conclusion: The results show that the invaginated stripping is very useful for patients with varicose veins, especially in stripping of lesser saphenous veins and the flush high ligation is safe for the treatment of junctional incompetence.
대퇴-슬상부 슬와동맥간 우회로술 후 자가정맥 이식편과 인조혈관 이식편의 성적비교
김영욱,허승,나목찬,김종열 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1
Purpose: Though it has been well known that the autologous vein graft is conduit of choice for infragenicular leg artery bypass, it is still less clear for above-knee femoro-popliteal artery bypass. we attempted to evaluate the outcomes of reversed saphenous vein graft in comparison with polytetrafluoroethylene (PTFE) graft in above-knee femoro-popliteal bypasses for the patients with chronic arterial occlusive disease. Method: In a period of 7 years and 9 months, 108 above-knee femoro-popliteal bypasses were performed in 96 patients (91 male, 5 female, mean age 67.3 years). The indications for bypass operation were short distance claudication 54 (50%), rest pain in 36 (33%), and toe, foot ulcer or gangrene in 18 (17%) limbs. As bypass conduit, autologouse reversed saphenous vein was used in 67 limbs, and PTFE graft in 41 limbs. We compared early (<31 days) postoperative complications, primary patency rates of grafts, and late outcomes of the limbs with proven graft occlusion between 2 patients groups (vein graft group vs. PTFE graft group). Primary cumulative graft patency rate were determined by Kaplan Meier method and compared them with log-rank test. Result: Early postoperative complications were not singificantly different between two groups. During the follow-up period, 20 (18.5%) grafts were lost to follow-up and 14 patients were dead. Primary cumulative patency rates at 1, 3, 5 years were 97.44±, 91.11±4.94%, and 75.92±14.46% for vein grafts and 81.76±7.49%, 36.15±13.42, and 36.15±13.42% for PTFE grafts respectively. Conclusion: In the patients underwent autologous vien graft for above-knee femoro-popliteal bypass, we experienced significantly better long-term patency, less serious surgical complication and less severe recurrent ischemic symptom after graft occlusion than in patients with PTFE graft.
대퇴-대퇴동맥간 우회로술 후 하지 허혈증상 재발 및 이식편 폐색의 원인
김형기,김영욱,허승,나목찬 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1
With increasing number of high-risk advanced atherosclerotic patients, crossover femoro-femoral pypass (FFB) became commonly chosen extra-anatomic bypass for symptomatic iliac artery occlusive disease. But the causes FFB graft failure have not been clarified yet. Purpose: We aimed to investigate the natural course of native artery disease, the causes of graft occlusion and recurrent leg ischemia after FFBs. Method: Among 162 primary FFBs for ??atherosclerotic iliac occlusive disease, 45 patients who underwent follow-up arteriography for recurrent ischemic symptom were enrolled. We investigated the interval changes between initial preoperative and follow-up angiograms and categorized then as inflow, outflow and/or graft lesion into stenosis >50% or occlusion. And the patients were divided into 2 groups as patent FFB group and occluded FFB group. We compared interval changes on angiograms between patient and occluded FFB groups to find out any difference and tried to determine the ultimate causes of recurrent leg ischemia considering not only the interval changes but the preexisting, untreated leg arterial lesions. Result: The follow-up angiography was most commonly performed within 1 year after FFV with mean interval of 21.2 ± 21.6 months. Interval changes between 2 angiograms were 24 (53.3%) FFB grafts occlusion, 8 (17.8%) inflow iliac disease progression, and 26 (57.8%) outflow arterial occlusion. Comparing the interval changes between patent and occluded FFB groups, the significantly higher frequency of outflow occlusion was noted in occluded FFB group (75% ??vs 38.1%, P=0.012). The most common finding on follow-up ??angiongram responsible for the recurrent ischemia was also outflowarterial occlusion even in patent FFB group. Conclusion: The most common cause of graft occlusion and recurrent leg ischemia was outflow arterial occlusion after FFB.
HUH, Sun Young,SHIN, Jung-Won,NA, Jung-Im,HUH, Chang-Hun,YOUN, Sang-Woong,PARK, Kyoung-Chan Wiley (Blackwell Publishing) 2010 The Journal of Dermatology Vol.37 No.4
<P>Abstract Melasma is an acquired pigmentary disorder that most commonly occurs in women of child-bearing age. Melasma is therapeutically challenging, and most commercially available hypopigmenting agents include tyrosinase inhibitors, which regulate the rate-limiting step of melanogenesis. 4-n-Butylresorcinol has received considerable attention as a novel hypopigmenting agent in the last 15 years because it has an inhibitory effect against tyrosinase and tyrosinase-related protein-1. However, the hypopigmenting effect of 4-n-butylresorcinol in human subjects has only been shown in a few studies. Liposome encapsulation is known to improve stabilization and enhance penetration of the product. Therefore, this study was conducted to evaluate the hypopigmenting efficacy and safety of liposome-encapsulated 4-n-butylresorcinol 0.1% cream in patients with melasma. This was a randomized, double-blind, vehicle-controlled and split-face comparison study. Twenty-three patients with a clinical diagnosis of melasma were included. 4-n-Butylresorcinol 0.1% cream or vehicle was applied to each side of the face twice daily for 8 weeks. Clinical and photographic evaluations, Mexameter measurements and assessment of patient satisfaction and side-effects were performed at baseline, 4 and 8 weeks. All subjects completed the study. Mexameter measurements demonstrated that the melanin index of the 4-n-butylresorcinol-treated side showed a significant decrease when compared with the vehicle-treated side after 8 weeks (P = 0.043). No adverse reactions were observed throughout the study. Subjectively, 4-n-butylresorcinol was considered to be efficacious in more than 60% of the patients after 8 weeks of treatment. In conclusion, liposome-encapsulated 4-n-butylresorcinol 0.1% cream was well tolerated and showed significant higher efficacy than vehicle alone for the treatment of melasma.</P>
( Sun Young Huh ),( Jung Won Shin ),( Jung Im Na ),( Chang Hun Huh ),( Sang Woong Youn ),( Kyoung Chan Park ) 대한피부과학회 2010 Annals of Dermatology Vol.22 No.1
Background: Melasma is a common acquired symmetrical hypermelanosis that occurs on sun-exposed areas, and it is frequently observed among women. Various treatment modalities have been tried, but none are completely satisfactory. 4-n-butylresorcinol, which is a resorcinol derivative that has an inhibitory effect on both tyrosinase and tyrosinase-related protein-1, was introduced in 1995 and it has received increasing attention as a new hypopigmenting agent. However, the hypopigmenting effect of 4-n-butylresorcinol in human subjects has only been shown in a few studies. Objective: The aim of this study was to investigate the hypopigmenting efficacy and safety of 4-n-butylresorcinol 0.1% cream for the treatment of melasma. Methods: Twenty patients with melasma were enrolled to this randomized, double-blind, vehicle-controlled, split-face comparative study. The patients were instructed to apply 4-n-butylresorcinol 0.1% cream or vehicle to each side of the face twice daily for 8 weeks. Mexameter measurements were performed along with photography at baseline, 4 weeks and 8 weeks. Adverse events were observed and recorded throughout the study. Results: All the patients completed the study. Mexameter measurements demonstrated that the melanin index of the treated side showed a significant decrease when compared with that of the vehicle-treated side after 4 weeks (p=0.006) and after 8 weeks (p<0.0005). All the adverse reactions were mild and transient. Conclusion: 4-n-butylresorcinol 0.1% cream showed rapid efficacy and it was well tolerated when used for the treatment of melasma. (Ann Dermatol 22(1) 21∼25, 2010)
Slowly Progressing Thrombotic Microangiopathy during Two Years of Treatment with Sunitinib
( Min Young Kim ),( Hee Jung Choi ),( Yoon Jung Kim ),( Na Ree Kang ),( Hye Ryoun Jang ),( Ghee Young Kwon ),( Woo Seong Huh ),( Young Suk Park ),( Yoon Goo Kim ),( Dae Joong Kim ),( Ha Young Oh ),( J 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.5
A 75-year-old man with mild renal impairment was started on sunitinib for a metastatic gastrointestinal stromal tumor. After 7 months of this therapy, proteinuria became aggravated. Serum creatinine concentration was increased from 1.34 to 2.57 mg/dL 24 months after sunitinib administration. Hematologic features of thrombotic microangiopathy (TMA) were absent. Renal histology revealed endothelial swelling and plasmatic insudation of the glomeruli. Proteinuria and renal function improved after discontinuation of sunitinib. Our experience suggests that TMA associated with sunitinib can be diverse in onset and severity, and that the hematologic features of TMA may be absent.