A 75-year-old male patient without any significant medical and habitual risk factors for acute atherosclerosis obliterans except for hypertension was diagnosed with coronavirus disease 2019 with dyspnea, coughing, and mild fever. After a week of hospitalization, he complained of right foot pain and numbness. The symptoms were aggravated during the next week, resulting in a complete toe color change and loss of dorsalis artery pulse. Enhanced 3-dimensional computed tomography angiography revealed thrombus formation in the right common iliac artery and a loss of blood flow below the popliteal artery on both sides. The patient underwent percutaneous balloon angioplasty with stent insertion followed by medical therapy for anticoagulation. The clinical symptoms immediately were improved after the intervention, but the great toe necrosis was not recovered. Finally, amputation of the great toe was performed.
Park, In Sil;Lee, Ki Mo;Lee, In Sun;Han, Jae Il;Jeon, Won Kyung
The Korea Journal of Herbology
/
v.28
no.5
/
pp.33-38
/
2013
Objectives : The aim of this study was to examine anti-thrombotic effect of traditional herbal extracts in a rat model of ferric chloride ($FeCl_3$)-induced carotid arterial thrombosis. Methods : Thirty minutes prior to a 35% $FeCl_3$ application, Sprague Dawley(SD) rats were injected with the 10 types of traditional herbal extracts (100mg/kg, intraperitoneal injection), respectively. The effect of these herbal extracts was examined for time to occlusion(TTO) using the Laser doppler flow meter and measured for thrombus weight (TW) in $FeCl_3$-induced thrombosis model. Results : In the TTO, Salvia miltiorrhiza (Sm, $2.30{\pm}0.28$ min, p<0.001) and Santalum album (Sa, $2.19{\pm}0.19$ min, p<0.001) showed significantly delayed TTO more than twice compared with Saline-treated group. Cnidium officinale (Co), Psoralea corylifolia (Pc), Scutellatia baicalensis (Sba), Panax notoginseng (Pn), Angelica tenuissima (At), Scrophularia buergeriana (Sbu), Rhus verniciflua (Rv) and Picrasma quassioides (Pq), except for Rhus verniciflua (Rv) also meaningfully impeded TTO more than one fold. In addition, Salvia miltiorrhiza, Santalum album, Cnidium officinale, Psoralea corylifolia and Scutellatia baicalensis significantly reduced TW more than 10% compared with Saline-treated group. Especially, Salvia miltiorrhiza and Santalum album showed the most excellent anti-thrombotic effect among the 10 herbal extracts tested on the restoration of altered TTO and TW. Conclusions : These results suggest that Sm and Sa extracts have outstanding anti-thrombotic effect in $FeCl_3$-induced thrombosis model and is potentially useful as herbal medicines for the treatment and prevention of thrombosis.
Purpose: In this study, we investigated the anti-thrombotic and antiinflammatory efficacy of "Gamijoukyungtang(GJKT)". Methods: We studied inhibitory effects of platelet aggregation, FXa activation, $TXB_2$ and $PGE_2$ biosynthesis and suppressive effects of GPIIb/IIIa activity and oxidative damage, pro-inflammatory cytokine reduction effects of 'GJKT(by press extractor)/GJKT-1(by pressless extractor)' in vitro. Also, we studied suppression of pulmonary embolism, AV shunt model in rats and shortening of Rat tail bleeding time in vivo. Results: GJKT/GJKT-1 extract showed inhibitory effects on GPIIb/IIIaactivities and platelet aggregation induced by ADP, epinephrine, collagen and arachidonic acid. They suppressed biosynthesis of $PGE_2$ but GJKT-1 only supressed biosynthesis of $TXB_2$. In FXa assay, they inhibited activation of FXa. they suppressed pulmonary embolism triggered by collagen and epinephrine. In AV shunt model, they decreased the weights of AV shunt thrombus. they inhibited pro-inflammatory cytokines and decreased oxidative damages caused by DPPH. Conclusion: We confirmed the anti-thrombosis, and ant-inflammatory efficacy of 'GJKT(by press extractor)/GJKT-1(by pressless extractor)'.
Nephrotic syndrome (NS) is associated with cerebral venous sinus thrombosis (CVST), which is a rare cerebrovascular disorder in children. Systemic anticoagulation with heparin is the standard therapy for CVST, and mechanical thrombectomy (MT) has been described as a salvage treatment for adult anticoagulant refractory CVST, However, it has never been reported in children. We describe a case of MT for refractory CVST in a child with NS. A 13-year-old boy with newly diagnosed NS presented to an emergency department with acute headache. A head computed tomography showed acute thrombus in the superior sagittal sinus, straight sinus and transverse sinus. The child was started on heparin therapy, but clinically deteriorated and became unresponsive. In view of the rapid deterioration of the condition after anticoagulation treatment, the patient received intravascular treatment. Several endovascular technologies, such as stent retriever and large bore suction catheter have been adopted. After endovascular treatment, the patient's neurological condition was improved within 24 hours, and magnetic resonance venography of the head demonstrated that the CVST was reduced. The child recovered with normal neurological function at discharge. This case highlights the importance of considering MT for refractory CVST, and we suggest that MT may be considered for refractory CVST with NS in children.
Choong-hyun Park;Sun-woo Kwon;Yi-jae Kwon;Jung-min Son;Hye-soo Youn;Eun-chang Lee;Ji-yoon Lee;Hyo-jeong Lee;Jung-eun Lee
The Journal of Internal Korean Medicine
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v.44
no.5
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pp.999-1010
/
2023
This case report shows the effect of Korean medicine treatment in a patient with deep vein thrombosis (DVT) after cerebral infarction who is suspected of having post-thrombotic syndrome (PTS) due to the loss of thrombus after receiving new oral anticoagulant (NOAC) treatment. The patient was treated with Korean medicine (Boyanghwano-tang and Hyulbuchuko-tang) three times a day. Acupuncture, moxibustion, infrared, and extra-physical therapy were given to the patient for 24 days. Clinical assessment - grading of edema and circumference of the left lower extremity were observed twice a week until the end of the treatment. NOAC treatment was continued for 24 days. After treatment, the patient's edema grade and circumference of the extremity improved. On the 24th day, the patient's chief complaints improved, and she requested termination of treatment. The results suggest that Korean medicine treatments, including Boyanghwano-tang, Hyulbuchuko-tang, and acupuncture therapy, can be effective in improving the clinical symptoms of DVT and PTS.
Chan Kang;Jae-Hwang Song;Yougun Won;Eric W. Tan;Gi-Soo Lee
Journal of Korean Foot and Ankle Society
/
v.28
no.1
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pp.27-30
/
2024
Several types of soft tissue masses occur in the lower extremities. A mass associated with blood vessels is often difficult to diagnose. A 15-year-old male patient visited the author's hospital with discomfort and edema in his right calf that had persisted for six months. A physical examination showed no palpable mass other than mild edema. Three masses were found during the ultrasound scan along the small saphenous vein. The masses had a cyst-like appearance and were filled with thrombus. In duplex ultrasound, vascular reflux was represented inside the masses. During surgery, it was suspected that vascular deformation occurred in the small saphenous vein, and simple ligation and resection treatments were performed. The patient was finally diagnosed with venous aneurysms accompanied by thrombosis based on the histology tests. The symptoms disappeared after surgery, and there were no recurrences or unusual findings at the follow-up one year later. Venous aneurysms occurring in the superficial veins of the lower extremities are rarely reported, but treatment and diagnosis are important. This paper reports a case of an aneurysm on the small saphenous vein.
This study investigated the effect of belly fat on the plasma lipid concentrations in rats. The results were obtained from the rats that had been fed the experimental purified diets containing 5% corn oil (C) as the control, 5% commercial lard (Tl), 5% belly fat (T2), 10% belly fat(T3), and those given diet(T4) by feeding either C or T3 alternately every 3 days for 30 days. The food intake and food efficiency were not show any significant difference among the treatments. The body weight gain tended to significantly increased when the feeding of added-belly fat in diets (p<0.05). The plasma triacylglycerides of T3 was higher than the other treatments, and significantly elevated as the number of feeding days of the diets with the belly fat passed when compared to diet C (p<0.05). The plasma total cholesterol of T3 showed the highest levels in the treatment groups, and was high in the order of T1, T2, T4, and there was a significant difference between the rats given the diet with belly fat and C (p<0.05). The plasma HDL-C of T2 and T3 was showed the lowest levels in the treatment groups. The plasma HDL-C of T1, T2, T3 and T4 groups were significantly decreased as the number of feeding days of the diets with the belly fat increased when compared to diet C (p<0.05). The plasma LDL-C and Al of T3 showed the highest levels in the treatment groups, and the levels were in order of T1, T2, T4. There was a significant difference between the groups of rats given the belly fat and C (p<0.05). The bleeding times significantly decreased as the number of feeding days of the belly fat diets increased, and T3 showed the lowest levels, there was a significant difference among the treatment groups (p<0.05). The whole blood clotting times of T3 showed the lowest values, and significantly decreased according to the number of days of the rats were fed the belly fat diet (p<0.05). These results showed that frequent consumption and high intake of pork belly can elevate the plasma triacylglyceride and cholesterol levels, and also accelerate red thrombus formation because belly fat contains high levels of saturated fatty acids and cholesterol.
In Order to evaluate determinants of successful percutaneous transluminal coronary angioplasty (PTCA), PTCA was performed for 172 coronary arterial lesions in 120 patients (89 male, 31 female) at Yeungnam university hospital from Sep. 1992 to Aug. 1993. The corinary artery luminal diameter at the site of the original stenosis was eveluated from end-diastolic frames of identical projections of the preangioplasty and immediate post angioplasty. The coronary luminal and balloon diameters were measured with using of computer measuring system. Overall success rate of 172 attempted lesions was 87.2%. Success rate of female patients was 93.5% and higher than those of male patients. According to the clinical diagnosis, success rate in stable angina was 93.7% and higher than those of post myocardial infarction angina, unstable angina and acute myocardial infarcrion. Success rate of American Heart Association type C lesion was 65.5% and lower those of type A (95.7%), type B (89.5%). There was signfifcantly difference in preangioplasty luminal stenosis, elastic recoil and length of lesion between successful PTCA group and failed PTCA group. Success rate of lesion location at a bend > $45^{\circ}$ and presence of intracoronary thrombus were lower than than those of other angiographic findings. In coclusion, primary angioplasty success was affected by specific angiographic factors. Stenosis severity, thrombus, lesion location at a bend > $45^{\circ}$, elastic recoil, and length of lesion were the principle of determinants of coronary angioplasty success rate.
Kim, Yang-Ki;Lee, Young Mok;Kim, Ki-up;Uh, Soo-taek;Kim, Yong Hoon;Park, Choon Sik;Hwang, Jung-Hwa;Kim, Dong Hun;Goo, Dong-Erk;Choi, Deuk-Lin
Tuberculosis and Respiratory Diseases
/
v.59
no.5
/
pp.473-479
/
2005
Background : A pulmonary embolism often presents with nonspecific symptoms and signs. However, a delayed diagnosis can result in catastrophic outcome. The majority of preventable deaths associated with a pulmonary embolism can be ascribed to a missed diagnosis rather than to the failure of existing treatments. Therefore, accurate and rapid diagnostic methods are essential for the management of a pulmonary embolism. The recent generation of multidetector-row spiral CT scanners appears to outperform other imaging modalities in detecting a central and peripheral pulmonary embolism. However, there are some variations in the interpretations of the findings between observers. This study examined the inter-observer differences of the diagnoses in patients with a pulmonary embolism. Method : 64 patients who were diagnosed with a pulmonary embolism either clinically or with spiral chest CT from 2002 to 2004, were included. Two thoracic radiologists interpreted the multidetector-row spiral CT in terms of the diagnosis of a pulmonary embolism and the location of the thrombus independently. Among 64 patients, 14 patients were excluded because there was no evidence of a pulmonary embolism or there was different interpretation of the pulmonary embolism between radiologists. A clinical diagnosis was based on "Rules for predicting the probability of embolism". Results : The mean score of the patients according to the Wells method was $3.91{\pm}0.30$ (0-9). The accordance of the radiologists was 95% in the main, 85% in the lobar, 91.2% in the segmental, and 96% in the sub-segmental pulmonary arteries. After excluding the negative interpretation from both radiologists, their agreement was 76.2%(${\kappa}.$ 0.83) in the main, 57.6%(${\kappa}.$ 0.63) in the lobar, 51.5%(${\kappa}.$ 0.63) in the segmental, and 34.6%(${\kappa}.$ 0.49) in the sub-segmental pulmonary arteries. Conclusion : Chest CT has been recently applied to patients suspected of having a pulmonary embolism. It was found that spiral CT is a rapid test for diagnosing a thrombus, and there was reliable accordance between the observers from the area of the large pulmonary arteries. However, there was a lack of agreement between the observers in diagnosing thrombi located distal to the sub-segmental arteries.
In this study we purified a fibrinolytic enzyme from Cordyceps militaris using a combination of ion-exchange chromatography on a DEAE Sephadex A-50 column, gel filtration chromatography on a Sephadex G-75 column, and FPLC on a HiLoad 16/60 Superdex 75 column. This purification protocol resulted in a 191.8-fold purification of the enzyme and a final yield of 12.9 %. The molecular mass of the purified enzyme was estimated to be 52 kDa by SDS-PAGE, fibrin-zymography, and gel filtration chromatography. The first 19 amino acid residues of the N-terminal sequence were ALTTQSNV THGLATISLRQ, which is similar to the subtilisin-like serine protease PR1J from Metarhizium anisopliae var. anisopliase. This enzyme is a neutral protease with an optimal reaction pH and temperature of 7.4 and $37^{\circ}C$, respectively. Results for the fibrinolysis pattern showed that the enzyme rapidly hydrolyzed the fibrin $\alpha$-chain followed by the $\gamma$-$\gamma$ chains. It also hydrolyzed the $\beta$-chain, but more slowly. The A$\alpha$, B$\beta$, and $\gamma$ chains of fibrinogen were also cleaved very rapidly. We found that enzyme activity was inhibited by $Cu^{2+}$ and $Co^{2+}$, but enhanced by the additions of $Ca^{2+}$ and $Mg^{2+}$ ions. Furthermore, fibrinolytic enzyme activity was potently inhibited by PMSF and APMSF. This enzyme exhibited a high specificity for the chymotrypsin substrate S-2586 indicating it's a chymotrypsin-like serine protease. The data we present suggest that the fibrinolytic enzyme derived from the edible and medicinal mushroom Cordyceps militaris has fibrin binding activity, which allows for the local activation of the fibrin degradation pathway.
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