• Title/Summary/Keyword: Vascular status

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A Congenital Giant Hepatic Hemangioendothelioma Treated with Interferon-$\alpha$ and Complete Tumor Resection (인터페론 투여 후 완전 절제를 시행한 거대 선천성 간내 혈관내피종)

  • Cho, Min-A;Yu, Jae-Eun;Park, Moon-Sung;Park, Jun-Eun;Hong, Jeong;Kim, Young-Bae
    • Neonatal Medicine
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    • v.15 no.2
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    • pp.183-189
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    • 2008
  • Infantile hepatic hemangioendotheliomas (IHHEs) are benign vascular tumors, but can be associated with the life-threatening complications, such as congestive heart failure, disseminated intravascular coagulation, and massive bleeding. Various therapeutic options have been developed and the treatment response depends on the patient's clinical status and the nature of the lesion. In the case of a symptomatic IHHE, a non-invasive and precise diagnosis should be performed promptly before the therapeutic method is chosen. Additionally, it should be kept in mind that the residual lesions have malignant potential. We report a case of a congenital giant IHHE that was successfully reduced in size by interferon-$\alpha$ and completely removed by surgical tumor resection with a hepatic lobectomy.

Metastasis via Peritumoral Lymphatic Dilation in Oral Squamous Cell Carcinoma

  • Kim, Han-Seok;Park, Young-Wook
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.36 no.3
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    • pp.85-93
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    • 2014
  • Purpose: Nodal metastasis is the main prognostic factor in the patients with oral squamous cell carcinoma (OSCC). We investigated the association between tumor-associated lymphatics and OSCC characteristics. Methods: Thirty-four specimens were used for the immunohistochemical staining with the antibody for vascular endothelial growth factor (VEGF)-C, VEGF-D, VEGF receptor (VEGFR)-3, phosphorylated VEGFR-3, D2-40, and matrix metallproteinases (MMPs). We observed the distribution of the lymphangiogenic factors and quantified the degree of expression. We determined lymphatic vessel density (LVD) and lymphatic vessel dilatation with D2-40 immunostaining. We assessed the association of LVD or lymphatic vessel dilatation with tumor progression or tumor differentiation. Results: OSCC cells expressed lymphangiogenic ligands. Lymphangiogenic receptor, VEGFR-3, was expressed and activated in some tumor cells as well as in tumor-associated endothelial cells. LVD was not associated with tumor size or nodal status, but lymphatic vessel dilatation was higher in tumors with nodal metastasis, and also higher in poorly differentiated tumors. In stromal area of OSCC, MMP-1 and MMP-10 were up-regulated and the basement membrane of tumor-associated endothelial cells was destroyed by these collagenases. Conclusion: In the primary tumors with nodal metastasis, especially in poorly differentiated OSCC, tumor cells invaded the dilated lymphatic vessels via ruptured sites. MMP-1 and MMP-10 are important in the lysis of the glycocalyx inside the tumor-associated lymphatic endothelial cells.

The supraclavicular artery island flap: a salvage option for head and neck reconstruction

  • Lee, Sanghoon;Cho, Hye-Min;Kim, Jin-kyu;Nam, Woong
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.40
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    • pp.25.1-25.4
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    • 2018
  • Background: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review. Case presentation: Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites. Conclusion: SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.

Intraovarian vascular enhancement via stromal injection of platelet-derived growth factors: Exploring subsequent oocyte chromosomal status and in vitro fertilization outcomes

  • Wood, Samuel H.;Sills, E. Scott
    • Clinical and Experimental Reproductive Medicine
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    • v.47 no.2
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    • pp.94-100
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    • 2020
  • The inverse correlation between maternal age and pregnancy rate represents a major challenge for reproductive endocrinology. The high embryo ploidy error rate in failed in vitro fertilization (IVF) cycles reflects genetic misfires accumulated by older oocytes over time. Despite the application of different follicular recruitment protocols during IVF, gonadotropin modifications are generally futile in addressing such damage. Even when additional oocytes are retrieved, quality is frequently poor. Older oocytes with serious cytoplasmic and/or chromosomal errors are often harvested from poorly perfused follicles, and ovarian vascularity and follicular oxygenation impact embryonic chromosomal competency. Because stimulation regimens exert their effects briefly and immediately before ovulation, gonadotropins alone are an ineffective antidote to long-term hypoxic pathology. In contrast, the tissue repair properties (and particularly the angiogenic effects) of platelet-rich plasma (PRP) are well known, with applications in other clinical contexts. Injection of conventional PRP and/or its components (e.g., isolated platelet-derived growth factors as a cell-free substrate) into ovarian tissue prior to IVF has been reported to improve reproductive outcomes. Any derivative neovascularity may modulate oocyte competence by increasing cellular oxygenation and/or lowering concentrations of intraovarian reactive oxygen species. We propose a mechanism to support intrastromal angiogenesis, improved follicular perfusion, and, crucially, embryo ploidy rescue. This last effect may be explained by mRNA upregulation coordinated by PRP-associated molecular signaling, as in other tissue systems. Additionally, we outline an intraovarian injection technique for platelet-derived growth factors and present this method to help minimize reliance on donor oocytes and conventional hormone replacement therapy.

Spontaneous Hemothorax in a Patient with Type I Neurofibromatosis (자발성 혈흉을 동반한 제1형 신경섬유종증)

  • Jang, Won-Chae;Jeong, In-Seok;Lee, Kyo-Seon;Oh, Bong-Suk
    • Journal of Chest Surgery
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    • v.40 no.2 s.271
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    • pp.140-142
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    • 2007
  • Vascular involvement is a rare and life threatening complication of type I neurofibromatosis. A twenty-eight years old female with a family history of type I neurofibromatosis had sudden onset of upper back pain and dyspnea. Chest CT showed right massive hemothorax with aneurysmal rupture of the intercostal artery. She underwent an emergency operation on unstable hemodynamic status. We report a case of surgical treatment of spontaneous hemothorax in a patient with type I neurofibromatosis.

Current Status and Recent Update of Imaging Evaluation for Peri-Hilar Cholangiocarcinoma (간문주변부 담관암 영상 진단의 최신 지견)

  • Dong Ho Lee
    • Journal of the Korean Society of Radiology
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    • v.82 no.2
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    • pp.298-314
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    • 2021
  • Owing to the anatomic complexity of the hepatic hilum, it has been considered difficult to diagnose and treat peri-hilar cholangiocarcinoma. Currently, imaging studies, including contrast-enhanced CT and MRI, play a crucial role in the detection, characterization, staging, and resectability assessment of peri-hilar cholangiocarcinoma. In this review, the classification of perihilar cholangiocarcinoma and proposed imaging protocol for the evaluation will be discussed. The typical imaging finding of peri-hilar cholangiocarcinoma, evaluation of longitudinal tumor extent, adjacent vascular invasion, and distant metastasis will also be mentioned. Finally, traditional concepts and recent updates for the resectability assessment of peri-hilar cholangiocarcinoma will be introduced.

The Clinical Significance of Measurement of Serum Vascular Endothelial Growth Factor in Patients with Hemoptysis (객혈환자에서 혈청 Vascular Endothelial Growth Factor 검사의 유용성)

  • Lo, Dae-Keun;Kim, Seung-Joon;Lee, Sook-Young;Kim, Young-Kyoon;Kim, Kwan-Hyoung;Moon, Hwa-Sik;Song, Jeong-Sup;Park, Sung-Hak
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.2
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    • pp.137-144
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    • 2002
  • Background: Hemoptysis is an often alarming presenting symptom and VEGF is a major regulator of both normal and abnormal angiogenesis, including many inflarrunatory diseases. In this report the clinical significance of the serum VEGF level in patients with hemoptysis was investigated. Methods: Thirty-two patients with hemoptysis were evaluated. The estimated amount of hemoptysis, etiology and serum VEGF level was examined at admission and bronchial angiography was performed in 22 patients. In order to objectify the neovascularization status, one point for the presence of the A-V shunt, hypervascularity, vascular tortuosity was designated for a total of 0-3 points. Results: Mean quantity of hemoptysis was $172.4{\pm}270.4ml$. The mean angiographic neovascularization score was $1.23{\pm}0.75$. The serum VEGF level correlated with the quantity of hemoptysis(r=0.524, p=0.002) and with the angiographic neovascularization score(r=0.441, p=0.04). Using the standard diagnostic criterion for massive hemoptysis, the serum VEGF level of patients with massive hemoptysis($642.4{\pm}545.6$ pg/ml, n=13) was found to be higher than that of patients with non-massive hemoptysis($394.6{\pm}225.8$ pg/ml, n=19) (p=0.069). Conclusion: Regardless of the etiology, the serum VEGF may contribute to abnormal neovascularization in patients with hemoptysis. Therefore, it is suggested that serum VEGF measurements may help in predicting a massive hemoptysis.

Improvement of the Accuracy of Wrist Noninvasive Blood Pressure Measurement Using Multiple Bio-signals (다중 생체 신호를 통한 손목 혈압 측정의 정확도 향상)

  • Jung, Woon-Mo;Sim, Myeong-Heon;Jung, Sang-O;Kim, Min-Yong;Yoon, Chan-Sol;Jung, In-Chol;Yoon, Hyung-Ro
    • The Transactions of The Korean Institute of Electrical Engineers
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    • v.60 no.8
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    • pp.1606-1616
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    • 2011
  • The blood pressure measuring equipment, which is being supplied and used most widely by being recognized convenience and accuracy now generally, is oscillometric blood pressure monitor. However, a change in blood pressure is basically influenced by diverse elements such as each individual's physiological status and physical condition. Thus, the measurement of blood pressure, which used single element called oscillation in blood pressure of being conveyed to cuff, is not considered on physiological elements such as cardiovascular system status and blood vessel stiffness index, and on external elements, thereby being quite in error. Accordingly, this study detected diverse bio-signals and body informations in each individual as the measurement subject such as ECG, PPG, and Korotkoff Sound in order to enhance convenience and accuracy of measuring blood pressure in the complex measurement equipment, thereby having extracted regression method for compensation in error of oscillometric blood pressure measurement on the wrist, and having improved accuracy of measuring blood pressure. To verify a method of improving accuracy, the blood pressure value in each of SBP, DBP, MAP was acquired through 4-stage experimental procedure targeting totally 51 subjects. Prior to experiment, the subjects were divided into two groups such as the experimental group for extracting regression method and the control group for verifying regression method. Its error was analyzed by comparing the reference blood pressure value, which was obtained through the auscultatory method, and the oscillometric blood pressure value on the wrist. To reduce the detected error, the blood pressure compensation regression method was calculated through multiple linear regression analysis on elements of blood pressure, individual body information, PTT, HR, K-Sound PSD change. Verification was carried out on improving significance and accuracy by applying the regression method to the data of control group. In the experimental results, as a result of confirming error on the reference blood pressure value in SBP, DBP, and MAP, which were acquired through applying regression method, the results of $-0.47{\pm}7.45$ mmHg, $-0.23{\pm}7.13$ mmHg, $0.06{\pm}6.39$ mmHg could be obtained. This is not only the numerical value of satisfying the sphygmomanometer reference of AAMI, but also shows the lower result than the numerical value in SBP : $-2.5{\pm}12.2$ mmHg, DBP : $-7.5{\pm}8.4$ mmHg, which is the mean error in the experimental results of Brram's research for verifying accuracy of Omron RX-M, which shows relatively high accuracy among wrist sphygmomanometers. Thus, the blood pressure compensation could be confirmed to be made within significant level.

Management of Diabetic Mellitus in Low-income Rural Patients (일개 농촌지역 저소득층 당뇨병환자의 관리 상태)

  • Kim, Hye-Yeon;Yun, Woo-Jun;Shin, Min-Ho;Kweon, Sun-Seong;Ahn, Hye-Ran;Choi, Seong-Woo;Lee, Young-Hoon;Cho, Dong-Hyeok;Rhee, Jung-Ae
    • Journal of Preventive Medicine and Public Health
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    • v.42 no.5
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    • pp.315-322
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    • 2009
  • Objectives : Knowledge about the management status of diabetic melitus (DM) is essential to improve diabetic management. Moreover, low income is associated with poor adherence to treatment and increased mortality. This study was performed to evaluate the management status of DM in low-income patients in a rural area. Methods : We enrolled 370 patients with type 2 DM living in Gokseong county, JeollaNamdo. A well-trained examiner measured the height, weight, waist circumference, blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting blood sugar and glycosylated hemoglobin (HbA1c) levels. Carotid ultrasonography was used to measure carotid artery carotid artery intima media thickness (IMT) and plaque. anklebrachial index (ABI) was used to evaluate peripheral artery disease. A fundoscopic examination was performed to evaluate diabetic retinopathy. A history of diabetes complications and health-related questionnaires were also completed. Results : The age of diabetic subjects was 68.7$\pm$8.7 years and the duration of diabetes was 8.9$\pm$8.2 years. Most (63.5%) had hypertension, and 45.7% had triglycerides below 150 mg/dl, 38.1% had low density lipoprotein cholesterol (LDL) cholesterol below 100 mg/dl, 48.7% had urine albumin to creatinine ratio (UACR) below 30 mg/g. Less than half (45.9%) achieved the goal of HbA1c less than 7% suggested by the American Diabetes Association (ADA). 10.6% had peripheral vascular disease, 11.9% had retinopathy, and 60.8% had chronic kidney disease. Conclusions : DM management in low income patients is very poor and requires further work to improve.

Clinicopathologic Characteristics and Prognostic Factors in Patients with Operable HER-2 Overexpressing Breast Cancer

  • Liu, Ai-Na;Sun, Ping;Liu, Jian-Nan;Ma, Jin-Bo;Qu, Hua-Jun;Zhu, Hua;Yu, Cai-Yan;Zhang, Liang-Ming
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.4
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    • pp.1197-1201
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    • 2012
  • Objective: To study the relationship between clinical pathologic characteristics, treatment modalities and prognostic factors in HER-2 (Human Epidermal growth factor Receptor-2) overexpressed breast carcinoma. Materials and Methods: Major clinico-pathological factors including therapeutic modalities and survival status of 371 breast cancer patients with HER2 over-expression, teated at Yantai Yuhuangding Hospital from March of 2002 to December of 2010 were retrospectively studied, with special attention focused on survival-related factors. Results: The median age of the total 371 patients in this study was 48 years at time of diagnosis, among which, the leading pathological type was infiltrating ductal carcinoma (92.5%); 62.8% presented with a primary tomor larger than 2 cm in diameter at diagnosis, 51.0% had axillary lymph node (ALN) metastases; ER (Estrogen receptor)/PR (Progesterone receptor) double negative occured in 52.8% of cases, and PCNA (proliferation cell nuclear antigen) (+++) was found in 55.1%. HER-2 overexpressed patients were usually in advanced stage when the diagnosis was made (72.8% at stages IIA~IIIC). The prognosis and survival were assessed in 259 patients with complete follow-up data. 5-year DFS (disease-free survival) and OS (overall survival) rate was 68.0% and 78.0% respectively. Univariate analysis revealed that age, tumor size, ALN metastases, LVSI (lymph-vascular space involvement), PCNA status, hormonal therapy, chemotherapy cycles, and HER-2 overexpression, correlated closely with the prognosis. ALN metastases, LVSI, PCNA status and chemotherapy cycles were independent predictors of survival. Conclusions: HER-2 overexpressed breast cancer has special clinical and pathological characteristics, with advanced clinical stages and high rate of ER/PR double negative. Lymph node metastases, LVSI, PCNA and chemotherapy cycles are independent predictors of prognosis.