• Title/Summary/Keyword: Restenosis

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Surgical Study in Treatment of the Tracheal Stenosis (기관협착증 치료에 대한 외과적 고찰)

  • 지청현
    • Journal of Chest Surgery
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    • v.24 no.8
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    • pp.765-772
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    • 1991
  • Between 1985 and 1990, 41 patients underwent treatment of the tracheal stenosis. Nineteen patients underwent resection and end-to-end anastomosis including three cases of the subglottic stenosis. Other patients had had treatment such as LASER therapy, bronchoscopic removal, insertion of the Montgomery silastic T-tube or stent insertion Nineteen patients which underwent resection and end-to-end anastomosis were excellent result from three years to sixth months. Other patient were followed at OPD for the other complication or restenosis. There were no hospital death but one patient was managed by bronchoscopic removal of the granulation tissue and other one patient had underwent reoperation for the dehiscence at the anastomotic site.

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Tracheaoplasty with autologous pericardium for tracheal invasion in lung cancer (폐암에 의한 기관침범 환자에서 자가심막을 이용한 기관 성형술)

  • 조현민;이두연;정은규
    • Korean Journal of Bronchoesophagology
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    • v.8 no.1
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    • pp.66-70
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    • 2002
  • In patient with lung cancer, the resection margin of right main bronchus was invaded by tumor intraoperatively. So we performed tracheal reconstruction with autologous pericardium after resection of lower trachea including carina. Postoperatively, the patient discharged well and followed up for 5 months without any evidence of tumor recurrence or restenosis.

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Effect of Triple Compared to Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Percutaneous Coronary Intervention (관상동맥 약물 용출 스텐트 삽입 후 항혈소판제제 3제요법과 2제요법의 임상적 효과 비교)

  • Ye, Kyong-Nam;Kim, Jeong-Tae;Lee, Suk-Hyang
    • Korean Journal of Clinical Pharmacy
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    • v.22 no.2
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    • pp.113-122
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    • 2012
  • ACC/AHA/SCAI Guideline recommends for administration dual antiplatelet therapy after drug-eluting stent (DES) to prevent restenosis and stent thrombosis in patients with percutaneous coronary intervention (PCI). Recently triple antiplatelet therapy including cilostazol is known to reduce restenosis and stent thrombosis significantly after DES implantation. However, there is lack of data providing the efficacy of triple antiplatelet therapy. The purpose of this study is to evaluate the clinical effects of the triple therapy after DES implantation compared with the dual therapy. This retrospective study collected data from medical charts of 251 patients who received DES implantation between Jul 2006 and Jun 2008. They received either dual antiplatelet therapy (N = 154 clopidogrel and aspirin; Dual group) or triple antiplatelet therapy (N = 97 cliostazol, clopidogrel and aspirin; Triple group). Major adverse cardiac event rates (MACE, included total death, myocardial infarction, target lesion revascularization) at 12 months, 24 months, stent thrombosis, rates of bleeding complications and adverse drug reactions were compared between these two groups. Compared with the dual group, the triple group had a similar incidence of the MACE rates at 24months (12.3% vs. 12.4%, p = 0.99). There is no difference in overall stent thrombosis between two groups (Dual group 2.6% vs. Triple group 4.1%, p = 0.5). Subgroup analysis showed that diabetic patients got more benefit in reducing MACE rates but, there is no statistical difference. Bleeding complications and adverse drug effects were not different significantly. As compared with dual antiplatelet therapy, triple antiplatelet therapy did not reduce the 12-months, 24-months MACE rates and stent thrombosis. Bleeding complications and adverse drug effects were not different.

Surgical Result of Tracheal Resection and Primary Anastomosis in Tracheal Stenosis (기관 협착증 환자에서 기관 절제 및 단단 문합술의 성적에 대한 고찰)

  • 조성래
    • Journal of Chest Surgery
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    • v.28 no.2
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    • pp.156-161
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    • 1995
  • Although there are many kinds of method in treatment of tracheal stenosis, tracheal resection and primary anastomosis can be performed for management of various kinds of tracheal stenosis because it is considered the most anatomical ideal therapeutic modality. During a 10-year period we performed 18 tracheal resection on 18 patients with no operative mortality and some morbidity. 13 patients had tracheal stenosis caused by endotracheal intubation [eight patients or tracheostomy [five patients ; and five patients caused by a variety of neoplastic lesions [four primary and one secondary . The length of tracheal stenosis were various from 1.5cm to 5.5cm and site of tracheal stenosis were cervical[17patients and thoracic [one patient . Operative techniques were tracheal resection and primary anastomosis[18 patients and additional procedures were cricoid cartilage reconstruction with costal cartilage [one patient , primary repair of esophagus[one patient and suprahyoid laryngeal release technique[eight patients without any complications. We have eight complications; tracheal restenosis were developed in five patients[growth of grannulation tissue at anastomotic site in three patients, delayed restenosis in two patients , anastomotic disruption in one patient, hoarseness and pneumonia in each of two patients. We managed tracheal complications with T-tube insertion in two patients, permanent tracheostomy in three patients and insertion of Gianturco tracheal stent in one patient, but tracheal stent did not reveal good result because it caused persistent production of sputum. We concluded that it is necessary to access full length of normal trachea including suprahyoid laryngeal release technique to avoid anastomotic tension in tracheal surgery and develope new ideal techniques to manage postoperative tracheal complications, because we suppose tracheal complications are developed due to anastomotic tension.

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Inhibitory Effects of A-8 on Abnormal Rat Aortic Vascular Smooth Muscle Cell Proliferation (동맥혈관 평활근세포 증식에 대한 오보바톨 유도체(A-8)의 억제효과)

  • Lim, Yong;Lee, Mi-Yea;Tudev, Munkhtsetseg;Park, Eun-Seok;Jung, Jae-Kyung;Yun, Yeo-Pyo
    • YAKHAK HOEJI
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    • v.55 no.2
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    • pp.116-120
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    • 2011
  • Abnormal proliferation of vascular smooth muscle cells (VSMCs) plays an important role in the development and progression of proliferative cardiovascular diseases, including hypertension and atherosclerosis. To find antiproliferative agent (A)-8 had inhibitory effect on VSMCs proliferation. Therefore, we examined the antiproliferative effect of A-8, a newly synthesized obovatol derivative. To investigate the antiproliferative effect of A-8, we examined cell counting and [$^3H$]-thymidine incorporation assays. The pre-incubation of A-8 (1~4 ${\mu}M$) significantly inhibited proliferation and DNA synthesis of 5% fetal bovine serum (FBS)-stimulated rat aortic VSMCs in concentration-dependent manner. Whereas, A-8 did not show any cytotoxicity in rat aortic VSMCs in this experimental condition by WST-1 assay. In addition, A-8 significantly inhibited 5% FBS-induced cell cycle progression in rat aortic VSMCs. These results show that A-8 may be developed as a potential antiproliferative agent for treatment of angioplasty restenosis and atherosclerosis. Furthermore, A-8 should be examined for further clinical application either as a single agent or in combination with other angioplasty restenosis or atherosclerosis agents.

Murrayafoline A Induces a G0/G1-Phase Arrest in Platelet-Derived Growth Factor-Stimulated Vascular Smooth Muscle Cells

  • Han, Joo-Hui;Kim, Yohan;Jung, Sang-Hyuk;Lee, Jung-Jin;Park, Hyun-Soo;Song, Gyu-Yong;Nguyen, Manh Cuong;Kim, Young Ho;Myung, Chang-Seon
    • The Korean Journal of Physiology and Pharmacology
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    • v.19 no.5
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    • pp.421-426
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    • 2015
  • The increased potential for vascular smooth muscle cell (VSMC) growth is a key abnormality in the development of atherosclerosis and post-angioplasty restenosis. Abnormally high activity of platelet-derived growth factor (PDGF) is believed to play a central role in the etiology of these pathophysiological situations. Here, we investigated the anti-proliferative effects and possible mechanism(s) of murrayafoline A, a carbazole alkaloid isolated from Glycosmis stenocarpa Guillamin (Rutaceae), on PDGF-BB-stimulated VSMCs. Murrayafoline A inhibited the PDGF-BB-stimulated proliferation of VSMCs in a concentration-dependent manner, as measured using a non-radioactive colorimetric WST-1 assay and direct cell counting. Furthermore, murrayafoline A suppressed the PDGF-BB-stimulated progression through $G_0/G_1$ to S phase of the cell cycle, as measured by [$^3H$]-thymidine incorporation assay and cell cycle progression analysis. This anti-proliferative action of murrayafoline A, arresting cell cycle progression at $G_0/G_1$ phase in PDGF-BB-stimulated VSMCs, was mediated via down-regulation of the expression of cyclin D1, cyclin E, cyclin-dependent kinase (CDK)2, CDK4, and proliferating cell nuclear antigen (PCNA), and the phosphorylation of retinoblastoma protein (pRb). These results indicate that murrayafoline A may be useful in preventing the progression of vascular complications such as restenosis after percutaneous transluminal coronary angioplasty and atherosclerosis.

Cardiac valve replacement in patient less than 16 years of age (16세 미만에서의 심장판막치환술)

  • Kim, Eung-Jung;Seo, Gyeong-Pil;Lee, Yeong-Gyun
    • Journal of Chest Surgery
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    • v.19 no.1
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    • pp.108-115
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    • 1986
  • During 12 years period from 1974 to 1985, 76 valve replacement procedures were performed at Seoul National University Hospital in 67 pediatric patients aging up to 15 years [mean 12.3 years] and it was 7.3% of total valve replacement procedures in same period. Sixty seven patients were composed of 44 males and 23 females. Of the 67 patients, 43 patients had acquired valve lesions and 24 patients congenital valve lesions. Sixty cases received single valve replacement, 7 cases double or triple valve replacement and 9 cases redo-valve replacement. Sixty seven patients received 84 valves [65 bioprosthetic valves and 19 prosthetic valves by] 76 operations, Sixty three of 65 bioprosthetic valves had been replaced before 1983 and 15 of 19 prosthetic valves in recent 2 years. Eleven patients [14.6%] died within one month post-operatively and 8 patients [10.5%] during the follow-up period with the overall mortality rate of 25.1%. There were early post-operative complication of 23 cases [30.3%] and late post-operative complication of 27 cases [35.3%] with the total complication rate of 65.8%. In 58 patients received bioprosthetic valves, there were 14 cases of restenosis of replaced valves. Of the 14 cases of bioprosthetic valve restenosis, 8 cases received redo-valve replacement procedures without mortality in 1 5/12-5 years after initial operation but 4 cases died without reoperation and 2 cases lost during follow-up. The overall mortality and complication rate were still high but they markedly decreased during recent 2 years. So, in spite of its containing many problems, valve replacement in children is becoming safe and useful procedure in whom valve reconstructive procedures are impossible.

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Ex vivo Morphometric Analysis of Coronary Stent using Micro-Computed Tomography (미세단층촬영기법을 이용한 관상동맥 스텐트의 동물 모델 분석)

  • Bae, In-Ho;Koh, Jeong-Tae;Lim, Kyung-Seob;Park, Dae-Sung;Kim, Jong-Min;Jeong, Myung-Ho
    • Journal of the Korean Society of Radiology
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    • v.6 no.2
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    • pp.93-98
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    • 2012
  • Micro-computed tomography (microCT) is an important tool for preclinical vascular imaging, with micron-level resolution. This non-destructive means of imaging allows for rapid collection of 2D and 3D reconstructions to visualize specimens prior to destructive analysis such as pathological analysis. Objectives. The aim of this study was to suggest a method for ex vivo, postmortem examination of stented arterial segments with microCT. And ex vivo evaluation of stents such as bare metal or drug eluting stents on in-stent restenosis (ISR) in rabbit model was performed. The bare metal stent (BMS) and drug eluting stent (DES, paclitaxel) were implanted in the left or right iliac arteries alternatively in eight New Zealand white rabbits. After 4 weeks of post-implantation, the part of iliac arteries surrounding the stent were removed carefully and processed for microCT. Prior to microCT analysis, a contrast medium was loaded to lumen of stents. All samples were subjected to an X-ray source operating at 50 kV and 200 ${\mu}A$ by using a 3D isotropic resolution. The region of interest was traced and measured by CTAN analytical software. Objects being exposed to radiation had different Hounsfield unit each other with values of approximately 1.2 at stent area, 0.12 ~ 0.17 at a contrast medium and 0 ~ 0.06 at outer area of stent. Based on above, further analyses were performed. As a result, the difference of lengths and volumes between expanded stents, which may relate to injury score in pathological analysis, was not different significantly. Moreover, ISR area of BMS was 1.6 times higher than that of DES, indicating that paclitaxel has inhibitory effect on cell proliferation and prevent infiltration of restenosis into lumen of stent. And ISR area of BMS was higher ($1.52{\pm}0.48mm^2$) than that of DES ($0.94{\pm}0.42mm^2$), indicating that paclitaxel has inhibitory effect on cell proliferation and prevent infiltration of restenosis into lumen of stent. Though it was not statistically significant, it showed that the extent of neointema of mid-region of stents was relatively higher than that of anterior and posterior region in parts of BMS as showing cross-sectional 2-D image. suggest that microCT can be utilized as an accessorial tool for pathological analysis.