• Title/Summary/Keyword: Aorta, Abdomen

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Intracardiac Migration of a Renal Stent from the Left Renal Vein to the Right Ventricle during the Treatment of Nutcracker Syndrome - A case report - (Nutcracker Syndrome를 위해 왼콩팥정맥에 삽입한 스텐트의 우심실 이동 - 1예 보고 -)

  • Kim, JaeBum;Choi, Sae-Young;Park, Nam-Hee;Kum, Dong-Yoon;Park, Hoon;Hwang, Eun Ah
    • Journal of Chest Surgery
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    • v.43 no.1
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    • pp.100-103
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    • 2010
  • We report her on a rare case of a renal stent that migrated into the right ventricle in a patient with nutcracker syndrome. A 29-year-old woman was admitted to the hospital and she was suffering from flank pain. The computed tomography of the abdomen demonstrated that the left renal vein was compressed between the abdominal aorta and the superior mesenteric artery (nutcracker syndrome). A self expandable stent was placed across the left renal vein for treating her nutcracker syndrome. The next day after the procedure, the follow up chest radiograph showed that the displaced stent had migrated into the right ventricle. After percutanous endovascular stent removal had failed, the stent was ultimately removed by performing cardiac surgery. At the $6^{th}$ postoperative month, there have been no abdominal or cardiac symptoms.

Clamp and Sew Technique without Distal Perfusion for the Management of Traumatic Descending Thoracic Aortic Rupture (외상성 흉부 하행 대동맥 파열에서 원위부 관류 없이 시행한 겸자 봉합술)

  • Seok, Yang-Ki;Lee, Jong-Tae;Kim, Gun-Jik;Park, Il;Cho, Joon-Yong
    • Journal of Chest Surgery
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    • v.40 no.8
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    • pp.558-563
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    • 2007
  • Background: Traumatic aortic rupture is a highly fatal condition in which a patient's outcome is strongly affected by other associated injuries. Selection of the appropriate surgical timing and the management plan is important. Material and Method: The medical records of the 15 traumatic descending thoracic aortic rupture patients who underwent the clamp & sew technique were retrospectively reviewed and checked for the presence of associated injuries and the postoperative course. Result: The hospital mortality was 6.07% (one patient). This patient died intra-operatively and the cause of the death was delayed hemoperitoneum. The mean operative time and aortic clamp time were $231{\pm}53.1$ and $13.1{\pm}5.3$ minutes, respectively. One patient complained the bowel obstructive symptoms at postoperative 10 days. We found the mechanical bowel obstruction on computed tomography of the abdomen, and segmental bowel resection was done. Conclusion: Although several surgical strategies may be appropriate for managing traumatic aortic rupture, the clamp & sew technique is a safe and effective method for the treatment of traumatic aortic injury.

Contrast Media in Abdominal Computed Tomography: Optimization of Delivery Methods

  • Joon Koo Han;Byung Ihn Choi;Ah Young Kim;Soo Jung Kim
    • Korean Journal of Radiology
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    • v.2 no.1
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    • pp.28-36
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    • 2001
  • Objective: To provide a systematic overview of the effects of various parameters on contrast enhancement within the same population, an animal experiment as well as a computer-aided simulation study was performed. Materials and Methods: In an animal experiment, single-level dynamic CT through the liver was performed at 5-second intervals just after the injection of contrast medium for 3 minutes. Combinations of three different amounts (1, 2, 3 mL/kg), concentrations (150, 200, 300 mgI/mL), and injection rates (0.5, 1, 2 mL/sec) were used. The CT number of the aorta (A), portal vein (P) and liver (L) was measured in each image, and time-attenuation curves for A, P and L were thus obtained. The degree of maximum enhancement (Imax) and time to reach peak enhancement (Tmax) of A, P and L were determined, and times to equilibrium (Teq) were analyzed. In the computed-aided simulation model, a program based on the amount, flow, and diffusion coefficient of body fluid in various compartments of the human body was designed. The input variables were the concentrations, volumes and injection rates of the contrast media used. The program generated the time-attenuation curves of A, P and L, as well as liver-to-hepatocellular carcinoma (HCC) contrast curves. On each curve, we calculated and plotted the optimal temporal window (time period above the lower threshold, which in this experiment was 10 Hounsfield units), the total area under the curve above the lower threshold, and the area within the optimal range. Results: A. Animal Experiment: At a given concentration and injection rate, an increased volume of contrast medium led to increases in Imax A, P and L. In addition, Tmax A, P, L and Teq were prolonged in parallel with increases in injection time The time-attenuation curve shifted upward and to the right. For a given volume and injection rate, an increased concentration of contrast medium increased the degree of aortic, portal and hepatic enhancement, though Tmax A, P and L remained the same. The time-attenuation curve shifted upward. For a given volume and concentration of contrast medium, changes in the injection rate had a prominent effect on aortic enhancement, and that of the portal vein and hepatic parenchyma also showed some increase, though the effect was less prominent. A increased in the rate of contrast injection led to shifting of the time enhancement curve to the left and upward. B. Computer Simulation: At a faster injection rate, there was minimal change in the degree of hepatic attenuation, though the duration of the optimal temporal window decreased. The area between 10 and 30 HU was greatest when contrast media was delivered at a rate of 2 3 mL/sec. Although the total area under the curve increased in proportion to the injection rate, most of this increase was above the upper threshould and thus the temporal window was narrow and the optimal area decreased. Conclusion: Increases in volume, concentration and injection rate all resulted in improved arterial enhancement. If cost was disregarded, increasing the injection volume was the most reliable way of obtaining good quality enhancement. The optimal way of delivering a given amount of contrast medium can be calculated using a computer-based mathematical model.

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