• Clinical and Experimental Pediatrics
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• v.50 no.10
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• pp.995-1004
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• 2007

Purpose : Kawasaki disease is a systemic vasculitis, leading cause of pediatric acquired heart disease. Vascular endothelial growth factor (VEGF) has functions as vascular permeability factor, plays an important role in coronary artery lesion (CAL). We studied the clinical significance of serum VEGF in Kawasaki disease. Methods : Kawasaki group was 49 patients, and control group was 15 patients. Diagnosis followed AHA (American Heart Association) diagnostic criteria, with blood sampling in acute, subacute, and convalescent phase. Echocardiographic abnormalities were defined and the definition of intravenous gamma globulin (IVGG)-responsive and IVGG-resistant was determined. Results : Serum VEGF of Kawasaki group was significantly higher than of control group. Comparison of serum VEGF between CAL and non-CAL group, between carditis group and non-carditis group showed no significant differences. Subacute serum VEGF was statistically higher in IVGG-resistant group than in IVGG-responsive group, and serum VEGF of IVGG-resistant group in subacute phase was statistically higher than in the other phases. Serum VEGF of convalescent CAL and non-CAL group in acute and subacute phase had meaningful differences. Total fever duration and subacute serum VEGF had positive correlation. Acute serum VEGF had positive correlation with ESR and CRP, all phases serum VEGF had also positive correlation with WBC. Acute and subacute serum VEGF had negative correlations with hemoglobin and albumin. Conclusion : Serum VEGF can help to determine the severity of Kawasaki disease, especially subacute serum VEGF seems to be used as a prognostic factor of coronary complication. Afterward, further studies needed with more strict diagnostic criteria and more study groups.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1197-1204
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• 1997

Between April 1981 and June 1996, 65 patients had aortic root replacement at our institution. Disease entities were pure aortic annuloectasia in 31 patients(47.7%), Stanford type A aortic dissection with annuloectasia in 8(43.1%), atherosclerotic aneurysm with aortic regurgitation in 4(6.2%), and paravalvular leakage after aortic valve replacement in 2(3.1 %). 34 patients(52.3%) had the clinical stigmata of the Marfan syndrome. The operative procedures were Bentall operation in 61 patients(93.8%); 3 of conventional procedure and 58 of Cabrol's modification, aortic valve-sparing operation in 2(3.1 %), and root replacement with homograft in 2(3.1%). Hospital deaths occurred in 3 patients(4.8%) because of uncontrolled bleeding(1) and bypass weaning failure due to low cardiac output(2), and all had emergency operation with Cabrol's procedure. Postoperative complications developed in 19(29.2%) patients and most of them were transient. Surviving 62 patients have been followed up to cumulative total 315.0 patient-years(mean 60.2 $\pm$42.4 months). Late deaths occurred in 7 patients(11.3%), aneurysmal changes of remaining aorta were detected in 12 patients(19.4%). Actuarial survival rate at 10 years was 72.0 $\pm$ 9.7%, and the subsequent aortic operation-free rate at 10 years was 68.0$\pm$ 8.9% In a multivariate analysis, Marfan syndrome, emergency operation, preoperative dissection, combined arch replacement, and total circulatory arrest emerged as significant risk factors for hospital death or subsequent aortic operation. Over 60 years of age was the only risk factor for late death. Our 16 years'cummulative experience shows that aortic root replacement, mainly by means of Cabrol's procedure, can be applied successfully to variety of aortic root disease. However, long-term follow up will be needed to determine the late result of aortic valve-saving operation and root replacement with homograft. When dissection is present or the distal native aorta is diseased in'Marfan patients, close follow-up is necessary because of the subsequent aneurysmal change of remaining aorta.

• Journal of Chest Surgery
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• v.36 no.4
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• pp.261-266
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• 2003

Background: Surgery of abdominal aortic aneurysm revealed high operative mortality. We reviewed our 11-years' experiences of abdominal aortic aneurysm operation and wish to obtain information on the treatment. Material and Method: From Jan. 1990 to Dec. 2000, 48 patients were operated due to abdominal aortic aneurysm in Yonsei Cardiovascular Center Mean age was $62.8{\pm}12.7$ and there were 40 males and 8 females. Among 48 patients, nine patients had ruptured abdominal aortic aneurysm, and mean aneurysm diameter of non-ruptured cases was $8.8{\pm}2.4$cm. Result: There were 6 early deaths, and early mortality was 12.5%. Among 9 patients of preoperative aneurysm rupture, three patients died (33.3%), and among 39 patients of non-ruptured cases, 3 patients died (7.7%). Among preoperative variables, age (p<0.05), preoperative BUN level (p<0.05), and DM (p<0.05) were risk factors of early mortality. Among discharged 42 patients, 40 patients were followed up (f/u rate=95.2%) and mean follow up was $3.6{\pm}0.2$ years. During follow up periods, five patients died (late mortality=11.9%), and Kaplan-Meier survival analysis revealed $81.7{\pm}7.6$% survival rate at five and ten year. Linealized incidence of graft related event was 3.53% per patient-year. Conclusion: Surgical mortality of ruptured abdominal aortic aneurysm was higher than non-ruptured cases; therefore, early resection of the aneurysm can decrease the surgical mortality.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.485-489
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• 2001

Background: The most important factor in preventing sternal complications is stable sternal approximation. We have tried to find the most effective sternal closure method by examining the incidence of sternal dehiscence with or without infection in patients with cardiac surgery through median sternotomy. Material and Method: This study was performed in 489 patients over 45 years of age with median sternotomy for open cardiac surgery. Simple closure with interrupted 6 wires was performed in 159 patients, figure-of-8 closure technique in 119, overlapping interrupted closure using 10 wires in 150, and combined closure technique of interrupted simple closure and figure-of-8 suture closure in 61. Two hundred thirty-four patients underwent valve and aortic operations and 213 patients coronary artery bypass surgery. Result: Sternal dehiscence with or without infection occurred in 12 (2.5 %) patients. The complication developed in 5 of 159 patients (3.1%) with six interrupted simple closure, in 4 of 119 patients (3.4%) with figure-of-8 closure, and in 3 of 150 patients (2.0%) with overlapping interrupted closure using 10 wires, but there was no complication in 61 patients with combined closure technique (relative risk for other closure techniques, p<0.05). There was no significant difference in the incidence of the sternal complication between valve and aortic operation group and coronary artery bypass group (3.0% vs 2.3%, not significant), but diabetes mellitus was a significant independent risk factor (odds ratio and multivariate analysis, p<0.05). Conclusion: The sternal closure technique that combines simple interrupted suture closure and figure-of-8 suture closure may be a more useful technique to enhance sternal stabilization compared to other closure techniques, such as simple interrupted closure, 8-figure closure, and overlapping interrupted closure.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.696-703
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• 2009

Background: A Comprehensive Aortic Root and Valve Reconstruction (CARVAR) procedure is comprised of aortic root wall reconstruction and corrections of the leaflets for treating various aortic valve diseases. We evaluated our recent early clinical experience with the CARVAR procedure. Material and Method: From October 2007 to September 2008, 114 cases (66 males) of CARVAR procedures were performed, The mean patient age was 53 years (range: 14~84) The patients were divided into 4 groups: 1) the AAR group: aortic regurgitation with aortic root wall deformity such as annulo-aortic ectasia or ascending aortic aneurysm (n=18), 2) the IAR group: isolated AR with leaflet abnormality (n=42), 3) the IAS group: isolated aortic stenosis (n=51) and 4) the PAVR group: previous aortic valve replacement (n=3). Sinotubular junction (STJ) reduction was done in all the patients, leaflet correction was done in 10 of the AAR group patients and in all the patients of the other groups, annulus reduction was done in 14 of the MR group patients and in 6 of the IAR group patients. Aortic dissection was excluded from this analysis. Result: There was no mortality or follow-up death. The diameter of the aortic sinus decreased from $54.6{\pm}8.4$ mm to $38.3{\pm}3.8$ mm in the AAR group, the mean AR grade decreased from 3.2 to 0.2 in the IAR group, the mean aortic valve pressure gradient decreased from $47.1{\pm}24.4$ mmHg to $15.1{\pm}11.7$ mmHg in the IAS group and the mean AR grade decreased to 0 in the PAVR group. Balloon type coronary perfusion cannula-related coronary ostial stenosis developed in 4 patients and this was treated with OPCAB in three patients and with PTCA in one patient. Two patients developed postoperative infectious endocarditis. All the patients were discharged and followed up in a stable condition. Conclusion: The CARVAR procedure showed excellent short term results, but a good further follow up result is required to apply this procedure to most kinds of aortic valve diseases.

• Pediatric Infection and Vaccine
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• v.25 no.3
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• pp.148-155
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• 2018

Purpose: The purpose of this study was to investigate the clinical significance of Bacille Calmette-$Gu{\acute{e}}rin$ (BCG) site reaction in terms of diagnosis and outcome prediction in young children with Kawasaki disease (KD). Methods: The incidence of BCG site reaction in the respective age ranges was investigated in 1,058 patients who were admitted at Asan Medical Center between January 2006 and February 2017. The 416 patients under 18 months of age were enrolled as subjects for the analysis of the association between BCG site reaction and other laboratory and clinical findings. The analysis was performed separately in complete and incomplete KD groups. Results: The incidence rate of BCG site reaction was peaked at 6-12 months (83%) and decreased with increasing age after 12 months in 1,058 patients (P<0.001). The incidence rate was above 70% in KD aged less than 18 months and more frequent than those of cervical lymphadenopathy. The logistic regression analyses showed that the principal clinical findings including conjunctivitis (P=0.781), red lips/oral mucosa (P=0.963), rash (P=0.510), cervical lymphadenopathy (P=0.363), changes in extremities (P=0.283) and the coronary artery aneurysm (P=0.776) were not associated with the BCG site reaction. Conclusions: The BCG site reaction could be a useful diagnostic tool independent to principal clinical findings in KD developing in children aged <18 months, who underwent BCG vaccination. Outcome of KD patients was not different between groups with or without the BCG site reaction in both complete KD and incomplete KD.

• Journal of Acupuncture Research
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• v.25 no.1
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• pp.139-154
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• 2008

목적 : 홍화(紅花)는 활혈거어(活血祛瘀), 해독지통(解毒止痛)의 효능이 있어 관절염, 동맥경화(動脈硬化), 종양(腫瘍), 월경부조(月經不調), 뇌혈전(腦血栓)에 사용되어 왔다. 이에 홍화약침액(紅花藥鍼液)의 분자생물학적 효능 분석을 하고자 Lipopolysaccharide(LPS)로 염증을 유발한 RAW 264.7 cell의 유전자(遺傳子) 발현(發顯)에 미치는 영향을 Microarray를 통하여 관찰하였다. 방법 : RAW cell을 배양하고 홍화약침액(紅花藥鍼液)의 세포 독성을 확인한 후 (1) LPS, (2) 홍화약침액(紅花藥鍼液), (3) 홍화약침액(紅花藥鍼液)과 LPS를 처치했을 때의 유전자 발현양상을 microarray를 이용하여 관찰하였다. 대조군에 비해 2배 이상 발현의 차이가 있는 경우를 유의한 것으로 보았다. 결과 : 8,170개의 유전자 중 (1) LPS를 처치하였을 경우 35개의 유전자에서 발현이 상승되었고, (2) 홍화약침액(紅花藥鍼液)을 처치하였을 경우 11개의 유전자에서 발현이 상승되고 53개의 유전자에서 발현이 억제되었으며, (3) 홍화약침액(紅花藥鍼液)과 LPS를 동시에 처치하였을 경우에는 47개의 유전자에서 발현이 상승되었고 11개의 유전자에서 발현이 억제되었다. LPS 자극으로 발현이 상승되었지만 홍화약침액(紅花藥鍼液)을 처치할 때 발현이 억제되는 유전자는 SUMO1/sentrin specific protease 7(SENP7), Serine(or cysteine) proteinase inhibitor, clade B(ovalbumin), member 7(SERPINB7), M-phase phosphoprotein, mpp8(HSMPP8), Glycogenin 2(GYG2), InaD-like(Drosophila)(INADL), Copine III(CPNE3), Loss of heterozygosity, 11, chromosomal region 2, gene A(LOH11CR2A), Chromosome 9 open reading frame 33(SHC3), NADH dehydrogenase(ubiquinone) 1 beta subcomplex, 2, 8kDa(NDUFB2)로 9개가 있었다. 요약 : 홍화약침액(紅花藥鍼液)이 LPS로 염증을 유발시킨 RAW 264.7 cell의 유전자 발현에 미치는 영향을 Microarray를 통해 분석하였다. 홍화약침액(紅花藥鍼液)이 LPS로 발현을 항진시킨 35개의 유전자 중 9개를 효과적으로 억제하는 것을 확인하여 염증 치료 기전을 시사하는 유용한 자료를 얻을 수 있었으며 홍화약침액(紅花藥鍼液)이 발현을 항진시킨 유전자들을 통해 혈관생성과 종양억제 등 보다 넓은 범위에 대한 연구가 가능할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• v.65 no.3
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• pp.216-221
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• 2008

A chronic expanding hematoma (CEH) in the thorax is a rare and specific condition of chronic empyema. CEHs in the thorax are often associated with tuberculosis and/or previous surgical procedures. While the incidental detection of a pleural mass and dyspnea are common clinical manifestations, a few cases present with hemoptysis. We encountered a case of CEH in the thorax. This case is unique in that it developed without a prior history of tuberculosis or surgery and presented with massive hemoptysis accompanied by bronchopleural fistula. We report the third case of CEH in the thorax in Korea with a summary of the clinical characteristics of previous cases.

• Journal of Life Science
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• v.14 no.5
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• pp.874-881
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• 2004

Angiogenesis has been implicated in progression of inflammation, arthritis, psoriasis, atherosclerosis as well as tumor growth and metastasis. Intensive studies have been carried out to develop a strategy for cancer treatment by blocking angiogenesis. During angiogenesis, endothelial proliferation and migration essentially occurs upon activation. In this study, we compared the expression profiles of human umbilical endothelial cells activated by incubating in vitro in the rich medium containing several growth factors, and non-activated ones. cDNA targets derived from total RNAs of HUVEC activated for 13 h in M199 medium containing endothelial cell growth supplement, 20% fetal bovine serum, and heparin, after reaching 70～80% confluency, or non-activated, were hybridized onto oligonucleotide microarrays containing 1,8864 genetic elements. Unsupervised hierarchical clustering analysis resulted in two subgroups on dendrogram exhibiting activated and non-activated HUVECs. We then extracted 122 outlier genes which were shown to be up-regulated or under-expressed by at least 2-folds in activated HUVECs. Among these, 32 annotated genes were up-regulated and 38 were down-regulated in activated HUVECs. Interestingly, genes involved in cell proliferation, motility, and inflammation/ immune response were up-regulated in activated HUVEC, whereas genes for cell adhesion or vessel morphogenesis/function were down-regulated. Unexpectedly, the expression of genes well-characterized as angiogenesis markers was not changed except Eph-B4, which was down-regulated about 4 folds. 52 unknown genes were also up- or down-regulated. Therefore, these results could provide an opportunity to targeting new vascular molecules for the development of anti-angiogenic molecules.

• Journal of Yeungnam Medical Science
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• v.23 no.2
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• pp.182-192
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• 2006

Background: Atherosclerosis has emerged as the leading cause of death in developed countries. At present, human umbilical vein endothelial cells (HUVEC) are most commonly used for the investigation of Endothelial cells (EC). However, HUVEC are not found in arteries but only in veins. Currently there are many reports on methods used to isolate EC;, most of these methods require special equipment to remove contaminating smooth muscle cells (SMC). Materials and Methods: The method described here may be used to isolate not only ECs but also SMCs;,the approach presented here did not require special equipment. Rat aorta was treated with 2 mg/ml of type II collagenase solution for 45 minutes. The isolated cells from the aorta were incubated in medium G for a week;, only ECs could be separated. After the collagenase treatment, the rest of aorta was cut lengthwise, and left undisturbed to obtain SMCs in the culture dish for 10 days. To verify the purity of the isolated cells, we performed immunofluorescence and evaluated the results with transmission electron microscopy analysis. Results: The immunofluorescence study demonstrated specific expression of CD31 and ${\alpha}$-smooth muscle actin in the isolated ECs and SMCs, respectively. Cultured ECs and SMCs showed their own fine structure characteristics. Conclusion: These results suggest that this method for isolating ECs and SMCs may be especially useful for the study of atherosclerosis.