• Annals of Clinical Neurophysiology
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• v.1 no.1
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• pp.70-75
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• 1999

Trancranial Doppler(TCD) monitoring is a new application of ultrasonography which allows the nonivasive detection of blood flow velocity in the horizontal (M1) segment of the middle cerebral artery (MCA) and detects microembolic phenomena in the cerebral circulation. Recent studies emphasized the potential of using this technique in vascular surgery (carotid endarterectomy, cardiopulmonary bypass), interventional and intensive care setting. Although the disparity between CBF and blood flow velocity and number of microemboli could be used to prevent cerebral ischemic and embolism based on clinical studies. A reduction of more than 60% of MCA can reflex hemodynamic ischemic state and acoustic feedback of high intensity transient signals(HITS) from the TCD monitoring unit has a direct influence on surgical technique. TCD monitoring can immediately provide information about thromboembolism and hemodynamic changes, which may be a useful tool in the study and prevention of stroke.

• Annals of Clinical Neurophysiology
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• v.11 no.2
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• pp.54-58
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• 2009

Background: Obstructive sleep apnea (OSA) is associated with several cardiovascular diseases. However, the mechanisms are not completely understood. The measure of common carotid artery intima-media thickness (IMT) has been extensively used as an early marker of atherosclerosis. The aim of this study was to test the hypothesis that early signs of atherosclerosis are present in patients with OSA and correlate with OSA severity Methods: Eleven male patients with OSA were studied by using full standard overnight polysomnography and high-definition echo-tracking device to measure intima-media thickness and carotid artery diameter. Eight healthy volunteers matched for age and sex were studied by portable respiratory monitoring device. All participants were free of hypertension, diabetes, and were not on any medications. Patients with OSA were naive to treatment. Results: All patients and normal controls were male. There was no significant difference of age between patients and controls ($48.4{\pm}8.85$ and $48.0{\pm}9.77$). Significant differences existed between control subjects and patients with mild to moderate and severe OSA (apnea-hypopnea index, $1.51{\pm}1.15$ and $38.51{\pm}19.13$ respectively) in intima-media thickness ($0.59{\pm}0.064$ and $0.93{\pm}0.16$; P=0.0023), and carotid diameter ($5.79{\pm}0.44$ and $6.47{\pm}0.51$; P=0.0227). Multivariate analyses showed that the apnea-hypopnea index correlated independently with intima-media thickness and carotid diameter (r=0.79, P=0.0008, and r=0.47, P=0.0482). Conclusions: Middle-aged patients with OSA who are free of overt cardiovascular diseases have early signs of atherosclerosis, which further supports the hypothesis that OSA plays an independent role in atherosclerosis progression.

• Journal of Preventive Medicine and Public Health
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• v.39 no.6
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• pp.477-484
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• 2006

Objectives : This study was conducted to examine the association between the carotid artery intima-media thickness (IMT), plaque and cardiovascular risk factors according to gender and age. Methods : The data used for this study were obtained from 1,507 subjects (691 men, 816 women), aged 20-74 years, who participated in 'Prevalence study of thyroid diseases' in two counties of Jeollanam-do Province during July and August of 2004. The body mass index (BMI) and waist hip ratio (WHR) were calculated by anthropometry The blood pressure, pulse rate, pulse pressure, total cholesterol, triglyceride, HDL cholesterol and fasting blood sugar level were also measured. Ultrasonography was used to measure the carotid artery IMT and plaque. IMT measurements were performed at 6 sites, including both common carotid arteries, and the bulb and internal carotid arteries. The definition of the 'mean IMT' was mean value obtained from these 6 sites. Results : The ${\pm}$ standard deviation IMT values were $0.65{\pm}0.14\;and\;0.60{\pm}0.13mm$ in men and women (p<0.001), respectively. The data were analyzed according to gender and the 50 year age groups. In a multiple linear regression analysis, age and hypertension were positively associated with the mean IMT in both men and women, aged<50 years. Age, total cholesterol and smoking (current) were positively associated with the mean IMT in men $(\geq50\;years)$. Age was positively associated with the mean IMT in women $(\geq50\;years)$, but the HDL cholesterol level was negatively associated. The prevalence of plaques was 44.2%(196/443) in men and 19.4%(89/459) in women, for those greater than 50 years of age. In a multiple logistic regression analysis, age (OR=1.090, 95%CI=1.053-1.129), HDL cholesterol (OR=0.964, 95%CI=0.944-0.984), total cholesterol (OR=1.009, 95%CI=1.002-1.017)and BMI (OH=0.896, 95%CI=0.818-0.983) were independently associated with plaques in men; whereas, age (OR=1.057, 95%CI=1.012-1.103), HDL cholesterol (OR=0.959, 95%CI=0.932-0.986), pulse pressure (OR=1.029, 95%CI=1.007-1.050) and triglycerides (OR=0.531, 95%CI=0.300-0.941) were independently associated with plaques in women. Conclusions: There were significant gender and aging differences in the association between the IMT, plaque and cardiovascular risk factors. Therefore, for the prevention of atherosclerosis, selective approaches should be considered with regard to gender and age factors.

• The Journal of Internal Korean Medicine
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• v.30 no.2
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• pp.422-430
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• 2009

Background : Stroke is the second leading cause of death in Korea, following cancer. Stroke consists of ischemic and hemorrhagic stroke, and ischemic stroke can be largely classified as atherothrombotic stroke or embolic stroke. Carotid intima-media thickness (IMT) is an indicator of atherosclerosis used commonly as a screening test for abnormalities of the coronary artery. 24-hour ambulatory ECG is widely used to screen for underlying diseases that causes syncope, palpitation, arrhythmia, etc. Objectives : Since both carotid IMT and 24-hour ambulatory ECG are used to screen for cardiac problems, we endeavored to explore the correlation between carotid IMT and 24-hour ambulatory ECG of stroke patients. Methods : The records of ischemic stroke patients who were admitted to Kyunghee Medical Center Oriental Hospital ward from March 2006 to May 2009 were reviewed. 28 patients who had both carotid Doppler US and 24-hour ambulatory ECG test undertaken during their admission were analyzed. The relationship of abnormal ambulatory results and common carotid artery(CCA) IMT were statistically analyzed using Fisher's exact test and t-test. Results : The mean age of the abnormal ambulatory group was older than the normal group (74${\pm}$ 8.0 vs. 61${\pm}$12.1, p=0.0098). Although insignificant, the abnormal ambulatory group showed much thicker CCA-IMT than normal ambulatory group (2.l7${\pm}$ 1.16 vs. 1.51${\pm}$0.97. p=0.l389). Conclusion: No significant correlation was observed between abnormal ambulatory results and CCA-IMT. However, the difference in CCA-IMT between the two groups was too big to be ignored and further investigation with larger and better controlled trials are warranted.

• Advances in pediatric surgery
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• v.2 no.1
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• pp.64-67
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• 1996

Aberrant migration of thymic tissue occurs as an ectopic thymus in the mediastinum, base of skull, tracheal bifurcation, and cervical region. A recent review of the literature by Nowak et al. showed over 70 reported cases of aberrant thymus or thymic cyst in patients who presented with primary neck masses. Authors experienced a case of ectopic cervical thymus and reviewed the literature. A one-year-old boy with left neck swelling which had been noticed since one month of age visited out patient clinic. Ultrasonography showed a well-defined cystic mass containing homogeneous, low-echogenic content locating in the lateral aspect of the left carotid sheath. Operation was performed under the impression of branchial cleft cyst. At surgery, a multiseptated, well-encapsulated, brownish and doughy mass which was extending into the vicinity of the carotid bifurcation with sland stalk-like portion ending between the hypoglossal nerve and external carotid artery was excised completely. The cut-surface showed homogenous solid mass, and on frozen section the tissue revealed a normal thymic histology. Postoperative ultrasonography showed bilateral thymus in the superior mediastinum. The patient has no immunologic problem and is doing well now.

• The Journal of Advanced Prosthodontics
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• v.2 no.4
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• pp.122-127
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• 2010

PURPOSE. The aim of this study was to examine the relationship between tooth loss and sub-clinical atherosclerosis in Korean adults. MATERIALS AND METHODS. The subjects were part of a cohort study conducted in Ansan city by the Korea University medical school as part of the Korean Genome project. 749 subjects over than 40 years old were evaluated. After taking panoramic radiography, the amount of tooth loss was calculated. The intima-media thickness (IMT) was assessed by using ultrasonography at the common carotid artery. Traditional cardiovascular risk factors for atherosclerosis were also evaluated. The relationship between tooth loss and the IMT was evaluated using ANOVA with Scheffe's multiple comparison method in univariate analysis. Multiple regression analysis was also performed to determine the significance between the IMT and tooth loss. RESULTS. With age, tooth loss increased, but there was no significant increase in other traditional cardiovascular risk factors. Univariate analysis revealed the IMT to be positively related with the amount of tooth loss. Regression analysis of the IMT in the anterior and posterior tooth loss revealed that only the posterior tooth loss was significantly related with the IMT at all sites of the common carotid artery (right far wall, P = .015; left far wall, P = .008; right near wall, P < .001; left near wall, P = .001). CONCLUSION. This study verified the positive relationship between the increased tooth loss at the posterior area and the accumulation of atheroma in arteries.

• The Journal of Internal Korean Medicine
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• v.29 no.4
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• pp.950-961
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• 2008

Objectives : The purpose of this study was to compare cerebral biood flow between hypertensives and normotensives using transcranial doppler ultrasonography (TCD). Methods : I investigated cerebral blood flow of 72 hypertensives and 127 normotensives. To evaluate the cerebral blood flow, I measured the systolic peak velocity(Vs) and mean How velocity (Vm) of the middle cerebral artery(MCA), anterior cerebral artery(ACA), posterior cerebral artery(PCA), basilar artery(BA), and internal carotid artery(ICA) in the two groups using TCD. Result : 1. There was a decrease in the Vs and Vm of all examined vessels of hypertensives in comparison with normotensives. There was a significant difference in the Vs of ACA and Vm of ACA, PCA, ICA. 2. In males, there was a decrease in the Vs of ACA, PCA, ICA and Vm of MCA, ACA, PCA, ICA of hypertensives in comparison with normotensives. However, there was no significant difference in the Vs or Vm of all examined vessels. 3. In females, there was a decrease in the Vs and Vm of all examined vessels of hypertensives in comparison with normotensives. There was a significant difference in the Vs of MCA, ACA and BA and Vm of ACA, PCA and BA. 4. In 30-49 year-olds, there was a decrease in the Vs and Vm of all examined vessels of hypertensives in comparison with normotensives. There was a significant difference in the Vs of ACA and Vm of ACA. 5. In 50-69 year-olds, there was a decrease in the Vs of ACA, PCA, BA, ICA and Vm of all examined vessels of hypertensives in comparison with normotensives. However, there was no significant difference in the Vs or Vm of all examined vessels. 6. In 70-89 vests old. there was a decrease in the Vs. Vm of PCA, BA, ICA of hypertensives in comparison with normotensives. But, there was no significant difference in the Vs, Vm of all examined vessels. Conclusions : There was a significant difference in the cerebral blood now velocity between hypertensives and normotcnsives. These results suggest that blood pressure has influence on cerebral blood flow.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.180-192
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• 2007

Background: As determined from the recent investigations of discordant cardiac xenotransplantation, hyperacute rejection occurs mainly at the endothelial cells in donor microvascular systems, but this does not occur at cardiac valve leaflets or at medium-to-large caliber vessels. On the basis of this background, this study was performed to look into the biocompatibility for transplantation of a middle or large diameter xenogenic blood vessel by conducting xenogenic arterial transplantation with the carotid artery in a pig-to-goat model. Material and Method: The experimental group was composed of 10 pairs of pig-to-goat combinations. They were divided into each period of 1 week, and 1, 3, 6 and 12 months. Four carotid artery grafts obtained through collection of the bilateral carotid arteries from two pigs were preserved at $-70^{\circ}C$ without other treatment, and then they were transplanted into the bilateral carotid arteries of two goats. Doppler ultrasonography was done on a periodic basis after transplantation to evaluate the patency of the grafted blood vessel. At the ends of a predetermined period, the grafts were explanted from the goats and they underwent gross examination. Hematoxylin-eosin and Masson's trichrome staining were conducted. In addition, in order to examine the immunological rejection of the grafted xenogenic blood vessel, immunohistochemical staining was conducted with T-lymphocyte indicator and von Willebrand factor. Result: Two goats at the each one-week period and the one-year period died during the experimental period because of a reason unrelated to the experimental procedure, and the remaining 8 goats survived until the end of each experiment period. On Doppler ultrasonography, unilateral carotid artery occlusion was found in a goat, whose period was specified as 3 months, among the 8 survived goats. However, the vascular patency was maintained well and there was no graft that formed aneurysms in the other goats. On gross examination, the region of vascular anastomosis was preserved well, and calcification of the grafted blood vessel was not shown. Histologically, the endothelial cells of the graft disappeared one week after transplantation, and then there was progressive spread of the recipients' endothelial cells from the anastomotic site. The reendothelialization occurred over the whole graft at one month after transplantation. The neointimal thickening and adventitial inflammation became severe by 3 months after transplantation, but this lessened at 6 months and 12 months, respectively. The rate of CD3 positive cells was very low among the infiltrated inflammatory cells. Conclusion: The fresh-frozen xenogenic artery kept its patency without being greatly influenced by xenogenic immune reaction.

• Journal of Periodontal and Implant Science
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• v.54 no.1
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• pp.37-43
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• 2024

Purpose: The inflammatory response due to inflammatory cytokines, bacterial pathogens, and the altered lipoprotein metabolism in patients with periodontitis indicates that infection with periodontal anaerobic bacteria may influence atherogenesis in vitro and in vivo. We aimed to explore the effect of periodontitis concerning clinical and ultrasound markers of early atherosclerosis. Methods: In this case-control study, a total of 30 systemically healthy adults (15 with periodontitis and 15 without periodontitis) over 40 years of age were studied. Periodontitis was determined by measuring the clinical attachment level (CAL) and radiographic bone loss (RBL). Conventional cardiovascular risk factors, including body mass index, serum levels of total cholesterol (TCH), triglycerides (TG), and high-density and low-density lipoprotein (HDL and LDL, respectively) cholesterol were evaluated. Carotid artery intima-media thickness (IMT) was measured using ultrasonography. Results: The mean values of the CAL and carotid IMT were 5.02±0.9 mm and 0.084±0.01 cm vs. 1.6±0.61 mm and 0.072±0.02 cm in the periodontitis and healthy groups, respectively, reflecting statistically significant differences (P=0.001 and P=0.037, respectively). There were statistically significant differences in the serum levels of TCH, TG, and LDL between the 2 groups (P=0.017). The CAL and RBL were positively associated with carotid IMT and serum cholesterol levels, except for HDL, whereas tooth loss was not associated with any markers (P<0.05). Compared to the healthy group, participants with periodontitis exhibited 2.09 times higher odds (95% confidence interval, 1.22-3.59) of having subclinical atherosclerosis. Conclusions: The presence of periodontitis increased the risk of atherosclerosis.

• Journal of radiological science and technology
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• v.32 no.2
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• pp.161-168
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• 2009

The carotid intima-media thickness (IMT) is an early structural marker of the atherosclerotic process and is the only non-invasive test that is currently recommended by the American Heart Association for evaluation of the risk. However, use of this parameter has a limitation because it assumes uniform thickness throughout the blood vessel, whereas atherosclerosis is a focal phenomenon that is confined to intima. In fact, plaque can be found along the atherosclerotic blood vessels even though its value is unknown. The aim of this study is to analyze the carotid plaque and IMT in the stroke patients. We investigated the patients with ischemic stroke, who were admitted to the department of neurology at the Stroke Special Hospital from January to March 2008. After the carotid IMT and plaque were assessed by B-mode ultrasonography, IMT and carotid plaque to risk variables (age, sex) were analyzed. The distribution of CCA IMT was significantly different in terms of age (p = 0.004). Likewise, the distribution of carotid plaque was also significantly different in terms of age (p = 0.006). Carotid plaque was 69 and 92% in normal and abnormal CCA IMTs respectively. The results showed that the CCA IMT was closely associated with carotid plaque.