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RISS 인기검색어
- 검색키워드
- 저자 : 최향희(Hyung Hee Choi) (검색결과 5 건)
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김형기(Hyung-Kee Kim),최향희(Hyang Hee Choi),허승(Seung Huh) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.1
Primary aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in only 4% of ruptured cases and less than 1% of all AAAs. The hemodynamic changes resulting from the major shunt caused by the ACF include a sudden increase in inferior vena caval pressure and volume with renal venous hypertension and a decrease in total peripheral resistance. So, if untreated, it leads to irreversible high output heart failure. Preoperative diagnosis is crucial, as adequate preparation should be made for massive bleeding expected at operation. Successful treatment depends on management of perioperative hemodynamics, control of bleeding from fistula and prevention of thromboembolism. We report two cases of successfully treated spontaneous ACF with a review of the literature.
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김형기(Hyung-Kee Kim),조민정(Min-Jung Jo),최향희(Hyang Hee Choi),허승(Seung Huh),김영욱(Young-Wook Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.1
Purpose: The purpose of this study was to analyze the causes of late death and the long-term survival of patients following abdominal aortic aneurysm (AAA) repair. Methods: From 1993 to 2005, 146 (98 intact and 48 ruptured) consecutive AAA patients underwent open repair. The perioperative data was supplemented with a retrospective review of the medical records and the use of the database of the National Statistical Office to calculate the survival rates and the causes of death. Results: There was one operative death (1%) in the intact AAA group and 12 (25%) in the ruptured AAA group. After exclusion of the operative deaths, the survival rates of the intact AAA patients were 94.5% at 1 year, 77.0% at 5 years and 33.2% at 10 years; these findings demonstrated a significant longer survival for the intact AAA patients than for patients with ruptured AAA (86.1% at 1 year, 56.7% at 5 years and 0% at 10 years, respectively). The causes of late death included cardiovascular disease in 52.8% (coronary artery disease in 22.6%, cerebrovascular disease in 20.8%, other arterial aneurysms in 5.7% and graft-related death in 3.8%), malignancies in 11.3% and pulmonary disease in 11.3%. The multivariate analysis showed that the long-term survival rates were influenced by the rupture status, the history of cerebrovascular disease and hypertension. Conclusion: This study showed that the long-term survival after intact AAA repair was better than that for ruptured AAA repair even if we exclude the operative deaths. The most common cause of late death was cardiovascular disease. Our findings suggest that the patients with preoperative cerebrovascular disease and hypertension require additional care.
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하지정맥류 환자 및 정상인에서 대복재정맥의 기질 금속단백분해효소 및 금속단백분해효소-조직억제제의 발현도 분석
허승(Seung Huh),최향희(Hyang Hee Choi),김형기(Hyung-kee Kim),김상준(Sang Joon Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
Purpose: Although varicose veins are very common in adults, the mechanism of the disease has not been established. Degradation of the extracellular matrix is regulated by various matrix metallopreteinases (MMPs) and their inhibitors tissue inhibitor of metallaproteinase (TIMPs). This study was performed to analyse the relationship between venous wall degeneration and expression of these matrix proteinases. Methods: Twelve great saphenous vein (GSV) segments from 7 patients without varicose veins (control) and 86 GSV segments from 18 patients (22 limbs) with varicose veins (C2,4,5EPASPR) were used for this study. Light microscopic examination was used in the evaluation of vein wall degeneration, immunohistochemistry and Western blotting for the expression of MMPs (MMP-1, MMP-2, MMP-9 and MMP-13) and TIMPs (TIMP-1 and TIMP-2), and zymography for gelatinolytic activity of MMP-2 and MMP-9 were performed. Results: MMP-9 was more strongly expressed in the vein wall of both control and patient groups, especially in the endothelial cells and medial muscle layers and TIMP-2 followed. The expression of MMP-9 was closely related to the degree of venous wall degeneration. Activated MMP-2 and MMP-9 were observed in both groups and expressed more in the proximal GSV of the patients. In the Western blotting, the expression of MMP-9 and TIMP-1 were significantly higher than other MMPs and TIMP-2 in the patients with varicose veins. Conclusion: MMP-9 is much more expressed in the wall of degenerative veins. This matrix-degrading enzyme may play an important role in the degeneration of venous wall followed by its remodeling.
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하지정맥류 환자의 정맥벽에서 정수압 스트레스에 따른 기질 금속단백분해효소 발현도 분석
허승(Seung Huh),최향희(Hyang Hee Choi),김형기(Hyung-kee Kim) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.5
Purpose: The expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase (TIMPs) caused by hydrostatic pressure stress is important in the development of varicose veins (VVs). This study was performed to analyse the expression of various MMPs and TIMPs according to the hydrostatic stress and the anatomical level of human great saphenous vein (GSV). Methods: Forty-nine vein samples were obtained from 10 patients with VVs (control group), and 34 samples from 7 VV patients after 1-hour hydrostatic stress just before surgery (stress group) at each anatomical site (proximal, Hunter, Dodd, and Boyd perforators) of GSV. Light microscopic examination and immunohistochemistry for MMP-1, -2, -9, -13 and TIMP-1, -2 were performed. Results: Intimal hyperplasia, fragmentation and loss of elastic fibers, infiltration of collagen fibers, and disorganization of medial muscle layers were evident in most vein samples. The degree of vein wall degeneration was not different between the 2 groups, and the anatomical sites of GSV. By immunohistochemistry, the expression of MMPs and TIMPs was not significantly different according to the group and the site. The expression of MMP-9 was more intense than that of other MMPs and TIMPs in all samples. MMP-9 was well localized to endothelial cells, medial muscle layers, and adventitial vasa vasorum. Conclusion: There are no distinct differences in the varicose vein samples after short-term postural blood stasis compared to the resting group. MMP-9 may be the key enzyme of the venous wall remodeling.
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