• Journal of Chest Surgery
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• v.43 no.3
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• pp.266-272
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• 2010

Background: Deep vein thrombosis (DVT) is a serious disease that causes life-threatening pulmonary embolism and chronic venous insufficiency. Anticoagulation is the standard therapy for DVT. However, the results of standard anticoagulation for treating DVT have been disappointing, so endovascular treatment is commonly performed nowadays. The aim of this study was to evaluate the efficacy of an endovascular procedure for treating patients with DVT. Material and Method: We retrospectively evaluated the clinical data of 29 DVT patients who underwent an endovascular procedure between December 2006 and July 2008. We compared the results of the 29 patients with the results of another 45 patients who were treated with only aspirin and heparin. Result: The patient’s mean age was 55.4 years in the intervention group and 53.7 years in the control group. DVT occurred more frequently in the females. Catheter-directed thrombolysis was performed in 22 patients (75.8%). Aspiration thrombectomy was performed in 18 patients (62%) and a endovascular stent was placed in 25 patients (86.2%). Fifteen patients (51.7%) underwent percutaneous insertion of a retrievable IVC filter for the prevention of pulmonary embolism. In the control group, thirty nine patients (86.7%) were treated with low-molecular heparin, and seven patients (15.6%) who were contraindicated for warfarin were treated with aspirin. No bleeding complications occurred during thrombolysis or anticoagulation. We analyzed the statistical data according to recurrence of DVT and the incidence of post-thrombotic syndrome (PTS) during the follow-up period. The intervention group had a significantly lower incidence of PTS (p-value=0.008), but they had the same result as the control group for the recurrence of DVT. In addition, death from the DVT did not occur in the intervention group. Thus, we obtained better clinical outcomes in the intervention group as compared to those in the anticoagulation only group. Conclusion: Endovascular procedures are effective alternative modalities, as compared to systemic anticoagulation, for the treatment of DVT. But more studies are needed to determine the specific indications and to validate the long-term efficacy of endovascular procedures for the treatment of DVT.

• Journal of Chest Surgery
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• v.38 no.11 s.256
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• pp.746-760
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• 2005

Background: Following the implantation of heart valve prostheses, it is important to maintain therapeutic INR to reduce the risk of thromboembolism. The objectives of this study were to determine the causes of nontherapeutic INRs, and to identify the factors associated with nonadherences to warfarin therapy in Korean outpatients with prosthetic heart valves managed by a pharmacist-run anticoagulation service (ACS). Material and Method: A retrospective chart review was completed for all patients enrolled in the ACS at Seoul National University Hospital from March, 1997b to September, 2000. The data on 868 patients (5,304 visits) who were at least 6 months post-valve replacement were included. All possible causes of nontherapeutic INRs were documented for each patient visit. The association of covariates to noncompliance was investigated by univariate analysis. Result: The reasons for nontherapeutic INRs were identified as follows: inadequate dosage adjustment $(21\%)$, nonadherences to dosing regimen $(13\%)$, drug/herbal interactions $(12\%)$, changes in diet $(7\%)$, and indeterminate cause $(42\%)$. Younger age, shorter duration of ACS and longer duration of warfarin therapy were associated with nonadherence. Conclusion: In this study, nonadherence and interactions between diet and medications were found to be important factors influencing nontherapeutic INRs. Longer duration of enrollment in the ACS affected the adherence to warfarin therapy Positively whereas younger age and longer duration of warfarin therapy affected negatively.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.193-200
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• 2009

Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. Material and Method: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: $47.4{\pm}15.1$): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (AVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. Result: The follow-up period was 835.3 patient-years (mean: $5.9{\pm}3.5$) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs $(2.16{\pm}0.23)$ of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those $(2.03{\pm}0.27)$ measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). Conclusion: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients’ compliance should be done for achieving more effective anticoagulation therapy.

• The Journal of the Korean bone and joint tumor society
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• v.14 no.2
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• pp.163-171
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• 2008

Purpose: We analyze the characteristics of soft tissue sarcomas presented with hematoma, which were misdiagnosed as simple hematoma initially and the proper management were delayed. Materials and Methods: The 7 patients with histologically proven soft tissue sarcoma with hematoma presented since February 1997 were evaluated retrospectively. Neither patient had a medical history of bleeding tendency nor anticoagulant therapy. Two of them had minor traumas. There were 2 men and 5 women. Average follow up period was 58 months. MRI findings, provided treatments and oncologic outcome were reviewed with the reference of related articles. Results: Retrospective review of initial MR images revealed deep seated intramuscular masses with focal solid enhanced nodules at the peripheral margin. The diagnoses were delayed at least 1 month in 3 of them which included 2 cases of simple hematoma evacuation without biopsy initially. After histologic diagnosis of soft tissue sarcoma, wide resections were performed in 4 cases. one patient underwent above knee amputation and the remained 2 patients were managed with wide resection followed by amputation due to local recurrence. At last follow up there were CDF and NED in 2 cases, respectively and AWD in 3 cases. Conclusion: To avoid the delay of diagnosis and treatment of soft tissue sarcomas presented with hematoma, high degree of clinical suspicion, careful analysis of MR images and early biopsy were important.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.480-486
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• 2009

Background: The Fogarty thromboembolectomy catheter technique was devised to extract distal arterial emboli and it represents a milestone for the treatment of patients with acute arterial occlusion since the 1960s. The major causes of arterial occlusion have changed from emboli of a heart origin to atherosclerosis over the past 30 years. Accordingly, questions have been raised about the effectiveness of simple Fogarty thromboembolectomy. Material and Method: During the period from March 1990 through August 2008, 156 patients who requiring Fogarty thromboembolectomy were analyzed. The patients were divided into two groups: those with simple Fogarty thromboembolectomy (Group 1, 79 patients) and those with additional vascular bypass graft surgery (Group 2, 77 patients). The duration of symptoms, the cause of thrombi, admission via the emergency room, a history of acupuncture or misdiagnosis, combined diseases, the anatomic occlusion site and the cause of death were analyzed using T-tests, cross tab tests, Chi square tests and Kaplan-Meier tests, respectively. Result: The mean age was 64$\pm$10 years in the 2 groups. The duration of symptoms (pain) in Group 1 vs Group 2 was 12$\pm$4 days vs 71$\pm$14 days (p=0.001). 50 (63%) patients in Group 1 were admitted via the emergency room vs 18 (23%) patients in Group 2 (p=0.005). Misdiagnosis and the treatment for herniated intervertebral disc or acupuncture were given to, 20 (25%) patients in Group 1 vs 30 (39%) patients in Group 2. Anticoagulation treatment before admission was performed in 22 (28%) patients in Group 1 vs 11 (14%) patients in Group 2. The causes of thrombi were heart disease in, 24 (30%) patients in Group 1 vs 6 (8%) patients in Group 2 (p=0.001), atherosclerosis in 46 (58%) patients in Group 1 vs 67 (87%) patients in Group 2 (p=0.001) and trauma in 9 (11%) patients in Group 1 vs 6 (8%) patients in Group 2. The combined diseases were cerebrovascular accident, hypertension and diabetes mellitus in 22 $\sim$ 37% of the total patients. The occlusion sites were mainly in the iliac and femoral arteries. Endarterectomy was performed in 7 (9%) patients in Group 1 vs 18 (23%) patients in Group 2 (p=0.012). Treatment was successful in 27 (34%) patients in Group 1 and in 40 (52%) patients in Group 2 (p=0.019). Reocclusion occurred in 37(47%) patients in Group 1 vs 20 (26%) patients in Group 2 (p=0.000), Amputation was done in 4 (5%) patients in Group 1 vs 12 (16%) patients in Group 2 (p=0.012) and death occurred in 10 (13%) patients (Group 1) vs 3(4%) patients (Group 2) (p=0.044). Conclusion: The recent past has shown a decline in the effectiveness of simple Fogarty thromboembolectomy with a changing pattern of acute arterial occlusion from a rheumatic heart origin to atherosclerosis. Additional bypass procedures play a role for the treatment of arterial occlusion instead of always performing simple Fogarty thromboembolectomy.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.889-898
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• 1997

Pulmonary Embolism can develop in variable conditions, and presents with nonspecific symptoms and signs. If diagnosis is delayed, it can be resulted in catastrophic results. Therefore, early diagnosis and adequate treatment is crucial in Pulmonary Embolism. Lung Perfusion Scan is useful screening test. Negative result can exclude pulmonary embolism. But, perfusion defects don't always mean pulmonary embolism. To find the better methods of interpretation of lung perfusion scan and To evaluate the clinical course and outcomes of the patients, in whom pulmonary embolism was suspected by lung perfusion scan, we reviewed the clinical records of 49 cases suspected by lung perfusion scan at Seoul National University Hospital during the period of January, 1995 to July, 1996. The results are as follows. First impression of cases in which PE was present at time of admission were pulmonary embolism (63%), heart diseases (26%), and pneumonia (11%) in orders. Underlying diseases of cases in which PE developed during admission were malignancy (36.5%), ICH (22.7%), sepsis (13.7%), and SLE (9.1%) in orders. The predisposing factors were operation (20%), cancer (16%), immobility (16%), connective tissue disease (16%), heart dis. (10%), old age (10%), and preg/pelvic dis. (8%) The results, of lung perfusion scan were HPPE 40 cases(26.8 %), IPPE 21 cases(14.1%), LPPE 88 cases (59.1%), and cases(%) of treatment in these cases were HPPE 34 cases(85%), IPPE 9 cases(42.9%), LPPE 0 case(0.0%). Treatments were heparin and warfarin (69.5%), heparin alone (8.2%), warfarin alone (2.0%), embolectomy (4.1%), thrombolytics (2.0%), IVC filter (2.0%), and no treatment (12.2%) In 34 cases (69.4%), follow up could be done, and 5 cases were recurred (10.2%). The causes of recurrence was incomplete anticoagulant therapy (3 cases) and recurrence of predisposing factor (2 cases). Expired case due to pulmonary embolism was one who was expired just before trial of thrombolytic therapy. Conclusion : Efforts should be made to shorten the interval from onset of Sx to Dx, ie, high index of suspision.