알코올로 유도한 만성위궤양 흰쥐 모델에서 비타민 E 보충이 위궤양 치유에 미치는 영향

모정민(Jung-Min Mo),이선혜(Sun-Hye Lee),박미나(Mi-Na Park),이연숙(Yeon-Sook Lee) 한국식품영양과학회 2008 한국식품영양과학회지 Vol.37 No.3

본 연구에서는 알코올을 이용하여 만성위궤양 실험동물모델을 확립하고 설정된 동물모델을 대상으로 비타민 E 투여 수준(결핍 0 ㎎/mL oil/day, 정상 1 ㎎/mL oil/day, 보충 10 ㎎/mL oil/day)에 따른 위궤양 치유효과를 살펴보고자 수행되었다. 비타민 E를 투여시킨 기간은 총 7일로서 위의 조직학적 검사, 혈청의 gastrin 농도, 위 조직의 histamine 농도, 위 조직 내의 항산화 효소인 GPx 활성도와 catalase 농도 및 MPO 활성도를 측정하였으며 그 결과를 요약하면 다음과 같다. 만성군에서 식이섭취량과 15% 에탄올 식수섭취량에는 유의적인 차이가 없었으나 체중증가량은 비타민 E 결핍군에서 유의적으로 낮았다. 급성군에 비해 만성군에서 위 무게가 유의적으로 낮게 나타났다. 또한 급성군에서 다량의 출혈과 선상의 괴사가 나타났으며 비타민 E 결핍군 또한 약간의 출혈과 선상의 궤양이 남아있었으나 비타민 E 정상군과 보충군의 경우 출혈이나 궤양은 관찰되지 않았다. 혈청 gastrin의 경우 비타민 E 결핍군에서 유의적으로 높았으며 비타민 E 투여수준에 따라 유의적으로 낮아졌다. 또한 위 조직에서 histamine 농도는 급성군보다 만성군에서 유의적으로 높게 나타났지만 만성군에서 비타민 E의 투여수준에 따른 histamine 농도의 차이는 나타나지 않았다. 위 조직에서의 MDA 농도는 비타민 E 결핍군과 정상군에 비해 보충군에서 유의적으로 높게 나타났으며 급성과 만성유도에 따른 MDA 농도 차이는 관찰되지 않았다. 또한 대표적인 항산화 효소인 GPx와 catalase의 경우 비타민 E 정상군과 보충군에서 유의적으로 낮게 나타났다. 위 조직에서의 MPO 활성도는 비타민 E 결핍군에 비해 정상군과 보충군에서 유의적으로 낮게 나타났다. 결론적으로 알코올로 유도한 만성위궤양 실험동물 모델에서 비타민 E의 보충은 위궤양 치유효과가 있는 것으로 평가되었다. 비타민 E 보충은 혈청 gas trin 농도를 감소시켜 위에서의 산 분비를 감소시키며 또한 위 조직 내의 MPO 활성도를 감소시켜 proinflammatory cytokine을 방출을 억제시키고 결과적으로 위 세포내로의 호중구 침투를 감소시켜 위궤양 치유과정을 촉진시키는 것으로 보인다. 따라서 비타민 E의 결핍상태보다 비타민 E를 보충하였을 때 빠른 위궤양 치유효과가 있는 것으로 사료되며, 평소 권장량을 충족시킬 수 있는 비타민 E의 충분한 식이섭취가 중요하다고 생각한다. This study was carried out to examine the effects of vitamin E on chronic gastric ulcer induced by alcohol treatment in rats. Chronic gastric ulcer model was established by oral administration of 70% ethanol at one time and supply of 15% ethanol for additional 7 days. Male Sprague-Dawley rats, approximately 200 g, were fasted for 24 hours and orally gavaged with 1 mL of 70% ethanol for the induction of acute ulcer. A supply of 15% ethanol dissolved in distilled water for 7 days were followed to maintain chronic gastric ulcer. Acute ulcer group was sacrificed at 3 hours after oral administration of 1 mL of 70% ethanol. Chronic groups were divided into three groups according to vitamin E levels; low-vitamin E (LVE, 0 ㎎/mL oil/day), normalvitamin E (NVE, 1 ㎎/mL oil/day) and high-vitamin E (HVE, 10 ㎎/mL oil/day). These groups were fed vitamin E free diets which were made of vitamin E free vitamin mix followed AIN-93M pattern for 7 days. Histological findings of congestion, hemorrhage and necrosis in gastric tissue were shown severely in acute ulcer group and LVE group of chronic ulcer groups. The concentration of gastrin in serum was significantly higher in LVE group. The content of histamine in stomach was lower in acute ulcer group but there was no significant difference among the chronic groups regardless of vitamin E levels. Content of malondialdehyde (MDA) in gastric tissue was higher in HVE group and activities of antioxidant enzyme, glutathione peroxidase (GPx) and catalase, were lower in HVE group. Myeloperoxidase (MPO) activities as a marker of neutrophils infiltration was significantly higher in LVE group. These results suggested that vitamin E supplementation has positive effects on healing of alcohol-induced chronic gastric ulcer through alleviation of gastric tissue injuries and reduction of the MPO activity in gastric tissue and gastrin in serum.

만성피부궤양과 편평세포암의 MMP-7과 MMP-13 발현에 관한 면역조직화학적 연구

정윤 ( Yun Jeong ),성기한 ( Kee Han Sung ),이숙경 ( Sook Kyung Lee ) 대한피부과학회 2006 대한피부과학회지 Vol.44 No.11

Background: The risk of squamous cell carcinoma (SCC) is significantly increased in chronic cutaneous ulcers. Moreover, if the proliferating epithelium of the ulcer margin shows pseudoepitheliomatous hyperplasia, it can be very difficult to discriminate between the two diseases. Enzymes such as matrix metalloproteinases (MMPs) are thought to be implicated at all stages of tumorigenesis. Objective: We investigated the expression patterns of epithelial MMP-7 and MMP-13 in chronic ulcers and SCCs by an immunohistochemical technique and the usefulness in differentiating these two entities. Methods: Formalin-fixed and paraffin-embedded tissues obtained from 16 chronic ulcers and 12 SCC patients were studied using an immunohistochemical staining method for MMP-7 and MMP-13. Results: MMP-7 and MMP-13 were expressed by the malignant tumor cells of 4 (33.3%) and 9 SCC samples (75%), respectively, while they were absent from the proliferating epithelium of chronic ulcers. Conclusion: Our results suggest that epithelial expression of both MMP-7 and MMP-13 have a specificity in differentiating the benign epithelial proliferation of chronic ulcer from malignant tumor cells, but MMP-13 seems to be a more sensitive and useful marker due to the lower sensitivity of MMP-7 in SCCs. (Korean J Dermatol 2006; 44(11):1284~1289)

Ganoderma Lucidum Pharmacopuncture for Teating Ethanol-induced Chronic Gastric Ulcers in Rats

박재형,장경준,김철홍,김정희,김영균,윤현민 대한약침학회 2015 Journal of pharmacopuncture Vol.18 No.1

Objectives: The stomach is a sensitive digestive organ that is susceptible to exogenous pathogens from the diet. In response to such pathogens, the stomach induces oxidative stress, which might be related to the development of both gastric organic disorders such as gastritis, gastric ulcers, and gastric cancer, and functional disorders such as functional dyspepsia. This study was accomplished to investigate the effect of Ganoderma lucidum pharmacopuncture (GLP) on chronic gastric ulcers in rats. Methods: The rats were divided into 4 groups of 8 animals each: the normal, the control, the normal saline (NP) and the GLP groups. In this study, the modified ethanol gastritis model was used. The rats were administrated 56% ethanol orally every other day. The dose of ethanol was 8 g/kg body weight. The normal group received the same amount of normal saline instead of ethanol. The NP and the GLP groups were treated with injection of saline and GLP respectively. The control group received no treatment. Two local acupoints CV12 (中脘) and ST36 (足三里) were used. All laboratory rats underwent treatment for 15 days. On last day, the rats were sacrificed and their stomachs were immediately excised. Results: Ulcers of the gastric mucosa appeared as elongated bands of hemorrhagic lesions parallel to the long axis of the stomach. In the NP and GLP groups, the injuries to the gastric mucosal injuries were not as severe as they were in the control group. Wound healings of the chronic gastric ulcers was promoted by using GLP and significant alterations of the indices in the gastric mucosa were observed. Such protection was demonstrated by gross appearance, histology and immunehistochemistry staining for Bcl-2-associated X (BAX), B-cell lymphoma 2 (Bcl-2) and Transforming growth factor-beta 1 (TGF-β1). Conclusion: These results suggest that GLP at CV12 and ST36 can provide significant protection to the gastric mucosa against an ethanol induced chronic gastric ulcer.

Risk factors for peptic ulcer disease in patients with end-stage renal disease receiving dialysis

( Minah Kim ),( Chang Seong Kim ),( Eun Hui Bae ),( Seong Kwon Ma ),( Soo Wan Kim ) 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.1

Background: Compared to the general population, patients with end-stage renal disease have more gastrointestinal symptoms and a higher prevalence of peptic ulcer. Risk factors for peptic ulcer disease in patients with end-stage renal disease, however, remain poorly defined. This study aims to better identify those risk factors. Methods: We analyzed 577 patients with end-stage renal disease from 2004 to 2016. We excluded patients with lifethreatening conditions. All patients underwent upper endoscopy. We analyzed patient medical records, medication history, and endoscopic findings. Independent sample t test, chi-square test, Fisher’s exact test, and multiple logistic regression analysis were used in statistical analyses. Results: Of the 577 patients with end-stage renal disease, 174 had peptic ulcer disease (gastric or duodenal ulcer). Patients on hemodialysis had a higher prevalence of peptic ulcer disease than those on peritoneal dialysis. Patients with peptic ulcer disease had lower serum albumin level and higher blood urea nitrogen level than those without peptic ulcer disease. Positive scores on two or more nutritional indices (albumin, serum cholesterol, uric acid, and creatinine levels) were associated with peptic ulcer disease in end-stage renal disease. Conclusion: Hemodialysis, hypoalbuminemia, and multiple malnutrition indices were associated with the prevalence of peptic ulcer disease in patients with end-stage renal disease receiving dialysis.

Ganoderma Lucidum Pharmacopuncture for Teating Ethanol-induced Chronic Gastric Ulcers in Rats

Park, Jae-Heung,Jang, Kyung-Jun,Kim, Cheol-Hong,Kim, Jung-Hee,Kim, Young-Kyun,Yoon, Hyun-Min KOREAN PHARMACOPUNCTURE INSTITUTE 2015 Journal of pharmacopuncture Vol.18 No.1

Objectives: The stomach is a sensitive digestive organ that is susceptible to exogenous pathogens from the diet. In response to such pathogens, the stomach induces oxidative stress, which might be related to the development of both gastric organic disorders such as gastritis, gastric ulcers, and gastric cancer, and functional disorders such as functional dyspepsia. This study was accomplished to investigate the effect of Ganoderma lucidum pharmacopuncture (GLP) on chronic gastric ulcers in rats. Methods: The rats were divided into 4 groups of 8 animals each: the normal, the control, the normal saline (NP) and the GLP groups. In this study, the modified ethanol gastritis model was used. The rats were administrated 56% ethanol orally every other day. The dose of ethanol was 8 g/kg body weight. The normal group received the same amount of normal saline instead of ethanol. The NP and the GLP groups were treated with injection of saline and GLP respectively. The control group received no treatment. Two local acupoints CV12 (中脘) and ST36 (足三里) were used. All laboratory rats underwent treatment for 15 days. On last day, the rats were sacrificed and their stomachs were immediately excised. Results: Ulcers of the gastric mucosa appeared as elongated bands of hemorrhagic lesions parallel to the long axis of the stomach. In the NP and GLP groups, the injuries to the gastric mucosal injuries were not as severe as they were in the control group. Wound healings of the chronic gastric ulcers was promoted by using GLP and significant alterations of the indices in the gastric mucosa were observed. Such protection was demonstrated by gross appearance, histology and immunehistochemistry staining for Bcl-2-associated X (BAX), B-cell lymphoma 2 (Bcl-2) and Transforming growth factor-beta 1 (TGF-${\beta}1$). Conclusion: These results suggest that GLP at CV12 and ST36 can provide significant protection to the gastric mucosa against an ethanol induced chronic gastric ulcer.

소화성 궤양 출혈에서 노인군과 청장년군의 임상 특징과 경과의 후향 비교

나윤주 ( Youn Ju Na ),심기남 ( Ki Nam Shim ),강민정 ( Min Jung Kang ),정지민 ( Ji Min Jung ),김성은 ( Seong Eun Kim ),정성애 ( Sung Ae Jung ),유권 ( Kwon Yoo ),문일환 ( Il Hwan Moon ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.5

목적: 소화성 궤양 출혈은 H. pylori 감염과 비스테로이드소염제가 주된 원인으로 알려져 있다. 그러나 최근 노인 환자의 소화성 궤양에 대한 연구에서 H. pylori의 역할은 감소되고, 비스테로이드소염제 및 동반된 만성질환 등이 궤양의 형성에 더 기여하고 있다고 한다. 이에 이번 연구는 소화성 궤양 출혈을 동반한 환자들을 노인군과 청장년군으로 나누어 각각의 임상 특징과 임상 경과를 비교해 보았다. 대상 및 방법: 2006년 1월부터 12월까지 상부위장관출혈로 내원하여 응급 상부위장관내시경검사를 시행하여 소화성 궤양 출혈로 진단되어 입원한 환자들을 대상으로 65세 이상의 노인군과 65세 미만의 청장년군의 두 군으로 나누어 의무기록을 후향 분석하고 비교하였다. 음주력, 흡연력, 만성질환, 궤양 유발성 약물의 복용력, 상부위장관내시경 소견 및 H. pylori의 유무 등을 조사하였고, 임상 경과인 수혈량, 재원기간, 중환자실 재원기간, 재출혈률, 수술률, 사망률 등을 알아보았다. 결과: 소화성 궤양 출혈로 진단된 88명 중에서 노인군은 34명, 청장년군은 54명이었다. 노인군에서 만성질환 특히 고혈압(52.9% vs. 24.1%), 심혈관계 질환(35.3% vs. 13.0%) 및 만성폐쇄폐질환(20.6% vs. 3.7%)이 유의하게 많았다(p<0.05). 궤양유발 약물의 복용력은 노인군에서 유의하게 많았으며(64.7% vs. 33.3%), 아스피린과 항혈전제인 클로피도그렐(Plavix(R))의 병합 사용군(17.0%)이 가장 많았다. H. pylori 음성 궤양 출혈(25.9% vs. 18.4%)의 빈도는 노인군과 청장년군 간에 차이가 없었다. 노인군과 청장년군의 수혈량, 중환자실 재원기간, 재출혈률, 수술률, 사망률은 차이가 없었으나, 노인군에서 재원기간이 길었으며(12.3±10.6 vs. 7.2±5.9, p<0.05), 궤양유발성 약물과 만성질환의 위험인자를 보정하여도 65세 이상의 노인군에서 유의하게 재원기간이 길었다. 결론: 출혈성 소화성 궤양을 동반한 노인군은 청장년군에 비하여 재출혈률, 수술률, 사망률에는 차이가 없었으나, 재원기간이 유의하게 길었다. 출혈성 궤양의 위험인자가 될 수 있는 H. pylori의 제균 치료와 함께 동반된 만성질환의 유무와 궤양유발 약물의 복용력을 반드시 확인해야 한다. Background/Aims: In geriatric patients with peptic ulcer, the use of NSAID and prevalence of chronic illness have been increased, but the Helicobacter pylori (H. pylori) infected portion decreased. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with peptic ulcer bleeding and compare with non-geriatric patients (less than 65 years old). Methods: We conducted a retrospective study of 88 patients with peptic ulcer bleeding treated with therapeutic endoscopy from January 2006 to December 2006. We compared the clinical characteristics and outcomes of geriatric patients (n=34, 38.6%) with those of non-geriatric patients (n=54, 61.4%). Results: Hypertension (52.9% vs. 24.1%), cardiovascular disease (35.3% vs. 13.0%), and chronic obstructive pulmonary disease (20.6% vs. 3.7%) were more prevalent in the geriatric group, compared with the non-geriatric group (p<0.05). The geriatric group had taken more ulcerogenic drugs than the non-geriatric group (64.7% vs. 33.3%, p<0.05); aspirin plus clopidogrel (23.6% vs. 13.0%) and aspirin (20.6% vs. 11.0%). Sixteen (21.1%) of the 76 cases had H. pylori-negative ulcer. Between the two groups, there was no difference in the prevalence of H. pylori-negative ulcer (25.9% vs. 18.4%, p>0.05). The amount of transfusion length of ICU stay, rebleeding rate, operation rate and mortality were not different between the two groups. The length of hospital stay in the geriatric patients was significantly longer than the non-geriatric group (12.3±10.6 vs. 7.2±5.9 days, p<0.05). In multiple regression analysis, old age was a significant risk factor for longer hospital stay (p<0.05). Conclusions: The geriatric patients with bleeding peptic ulcer had longer hospital stay than the non-geriatric patients in our study. The important emerging etiologies such as ulcerogenic drug and associated chronic illness should be checked and treated in these patients. (Korean J Gastroenterol 2009;53:297-304)

한국인에서의 만성적 궤양을 동반하는 대장염에 대한 임상적 고찰

이풍렬,윤한두,김나영,정숙향,유권,정현채,이효석,윤용범,송인성,최규완,김정룡,최상운 대한내과학회 1990 대한내과학회지 Vol.38 No.3

The purpose of this study is to compare the differences of the symptoms, signs and laboratory findings among colitis with chronic ulceration, such as ulcerative colitis, Behcet's colitis, tuberculous colitis and Crohn's disease in Korea. Were studied in Seoul National University Hospital from August 1982 to Oocober 1988. Forty-two cases of ulcerative colitis, 23 cases of Behcet's colitis, 53 cases of tuberoulous colitis and four cases of Crohn's disease were analyzed in terms of age, sex, symptomatology, laboratory findings and consequence of treatment. 1) The sex ratio of ulcerative colitis, Behcet's, colitis tuberculous colitis and Crohn's disease was 1 : 1.63, 4.74 : 1, 1 : 1. 30, and 3 : 1, respectively, and the mean age was 36.1, 34.3, 33.4, 22.5 years, respectively. 2) The duration of symptoms in tuberculous colitis was significantly shorter than in other diseases. 3) The items of symptoms and signs showed that significant differences were rectal bleeding, diarrhea, weight loss, tenesmus, oral ulcer, skin lesion and genital ulcer. 4) The items of laboratory findings revealed that significant differences were anemia, increased ESR, hypoalbuminemia and the evidenoe of tuberculous lesion on chest X-ray. 5) In view of the anatomical distribution of the lesions, the rectums of all the cases were involved in ulcerative colitis. In most cases of Behcet's colitis and tubercuious colitis, the right colon, including the cecum and the ileum, was involved. In Crohn's disease, the ileum and the jejumum were frequently involved. 6) From a discriminant analysis, we could find several items that differentiated the four diseases. There were rectal bleeding, diarrhea, oral ulcer, hypoalbuminemia and evidence of tuberculosis on chest X ray.

신경병성 당뇨환자의 족부 궤양에 대한 수술적 치료

김재영(J-Young Kim),이재준(Jae-Jun Rhee) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.1

목적: 신경병성 당뇨 환자에서 치유 되지 않는 만생 족저부 피부 궤양을 술기가 비교적 간단한 단 또는 이중 V-Y 전진 피판술을 이용하여 치료하고 그 결과를 분석하고자 한다. 대상 및 방법: 2004년 1월부터 2005년 12월까지 만성 당뇨병성 족저부 궤양으로 입원하여 치료를 받은 환자 중 단 또는 이중 V-Y 전진 피판술을 이용하여 상처를 치유하였던 29명의 환자를 대상으로 하였다. 대상 환자의 과거력, 당뇨, 혈류학적, 세균학적, 방사선학적 검사를 술 전 실시하였고, 상처의 위치 및 크기를 수술 중 조사하였으며, 괴사여부, 치유 기간, 재발 여부 등을 추시 기간 중 조사하였다. 결과: 대상 환자의 평균 나이는 53세(36-69)였다. 족저부 궤양의 발생 위치로는 전족부가 12예로 가장 많았고 후족부 9예, 발의 외측부 6예, 발의 내측부 2예였다. 족저부 궤양의 평균 이환 기간은 3.3개월(2-36)였고 궤양의 평균 면적은 2.05 ㎠ (0.8-3.9)였다. 수술 후 상처의 평균 치유 기간은 4.7주(3-8)였으며 다음날 부분적인 혈행의 장애 및 부분 괴사가 7예에서 발생하였으나 봉합사의 부분 발사와 이차 상처 치유 기전으로 모두 치유되었다. 추시 중 5예에서 재발이 있었다. 결론: 당뇨병 환자에서 발생한 신경병성 만성 족저부 궤양의 치료에 있어 V-Y 전진 피판술은 매우 유용한 치료로 사료되나 수술 상처의 지연 치유가 자주 발생하고 일반 환자군보다 더 오랜 기간 동안 발을 보호해야 함을 관찰할 수 있었다. Purpose: This study examined the results of a single or double V-Y advancement flap, which was found to be technically simple for the management of chronic plantar ulcer in patients with neuropathic diabetic foot. Materials and Methods: From January 2004 to December 2005, 29 patients who were hospitalized for the management of a neuropathic diabetic foot plantar ulcer were examined. All patients underwent single-or double-V-Y advancement flap for the management of the ulceration. Hematological, hemodynamic, diabetic, bacteriologic, and radiological tests wereperformed prior to surgery. The condition of the wound was checked during surgery, and the healing rate, healing time and recurrence during the follow-up examinations were evaluated after surgery. Results: The mean age of the patients was 53.4 years (36-69). The plantar ulcers were the most commonly found in the forefoot area (12 cases). Nine cases showed ulcers in the hindfoot area, 6 cases were found are in the lateral foot area, and 2 cases were identified in the medial foot area. The area covered with the V-Y advancement flap averaged 2.05 ㎠ (0.8-3.9). The mean healing time of the wound was 4.7 weeks (3-8). One day after surgery, there were 7 cases of partial circulation disturbance that were managed with a partial stitch out and secondary intension wound healing. There were 5 cases of recurrence of the wound. Conclusion: A V-Y advancement flap to manage chronic diabetic plantar ulcers can produce excellent or good results. However, a high incidence of delay in healing of the surgical wound can be expected, and a longer period is needed to protect the wound comparing with normal patients.

십이지장 궤양 발생과 Helicobacter pylori 균주의 cagA, vacA 및 iceA 유전자형과의 상관관계

이경아 ( Kyung A Lee ),명승재 ( Seung Jae Myung ),홍성수 ( Seong Soo Hong ),김진호 ( Jin Ho Kim ),조윤경 ( Yoon Kyung Cho ),정훈용 ( Hwoon Yong Jung ),이진혁 ( Gin Hyug Lee ),이윤정 ( Yun Jung Lee ),변정식 ( Jeong Sik Byeon ),양 대한내과학회 2005 대한내과학회지 Vol.69 No.3

Background: The aims of this study were to evaluate whether genotypes of Helicobacter pylori are different between the gastric antrum and duodenal bulb in order to assess the roles of duodenal H. pylori strains in development of duodenal ulcer. Methods: Forty-eight H. pylori infected patients (duodenal ulcer 28, chronic gastritis 20) were included for the study. Biopsy specimens were taken separately from the antrum and duodenal bulb for the histologic examination and H. pylori culture. cagA, vacA, and iceA genotypes of H. pylori were examined by polymerase chain reaction and H. pylori DNA subtypes by random amplified polymorphic DNA (RAPD) fingerprinting. Results: H. pylori genotypes were not significantly different between antrum and duodenal bulb of the duodenal ulcer and chronic gastritis. RAPD fingerprinting showed different H. pylori strains between the gastric antrum and duodenal bulb in 2 patients with duodenal ulcer. Most prevalent genotype was cagA+ vacA s1/m1 iceA1 in duodenal ulcer (15/16). Conclusion: The host factor or other genotypes may play the major roles in duodenal ulcerogenesis compared with H. pylori genotype itself. (Korean J Med 69:264-273, 2005)

장골정맥압박 증후군에 동반된 만성 하지궤양의 치험 1례

서광석,이백권,이종원,안상태 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.5

Iliac vein compression syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis, severe leg edema and ulceration.We experienced a 55-year-old male patient with recurrent left leg ulcer for 15 years. Skin grafting had been done three times, but none of them healed the patient. Femoral venography showed a complete occlusion of the left common iliac vein. Palma-Dale bypass grafting procedure(crossover saphenous vein bypass grafting) and arteriovenous fistula formation was done. The leg ulcer healed two months after the operation.