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Delayed Presentation of a Post-traumatic Mesenteric Arteriovenous Fistula: A Case Report (외상 후 지연성으로 발생한 장간막 동정맥루: 증례보고)

  • Cho, Jayun;Jung, Heekyung;Kim, Hyung-Kee;Lim, Kyoung Hoon;Chun, Jae Min;Huh, Seung;Park, Jinyoung
    • Journal of Trauma and Injury
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    • v.26 no.3
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    • pp.248-251
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    • 2013
  • Introduction: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare. Case Report: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA's orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month follow-up period. Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.

Long-term Outcome after Surgery for Biliary Atresia (Study of 10 patients surviving more than 10 years) (담도 폐쇄증으로 Kasai 수술 받은 환아들의 장기간의 추적관찰 (10년 이상 생존한 환아들을 대상으로))

  • Rhim, Si-Youn;Jung, Poong-Man
    • Advances in pediatric surgery
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    • v.13 no.1
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    • pp.1-12
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    • 2007
  • Biliary atresia (BA) is the result of fibrosing destructive inflammatory process affecting intrahepatic and extrahepatic bile ducts, which lead to cirrhosis and portal hypertension. Kasai portoenterostomy has been the standard operative procedure in biliary atresia. Recently, there has been remarkable increase in the survival rate in cases of BA. However, long-term survivors are not clearly evaluated in Korea. To define long-term prognosis factors of patients who underwent surgery for BA, a retrospective study was undertaken of 10 (37 %) patients surviving more than 10 years among 27 patients who underwent one of Kasai procedures between 1981 and 1995. Hepatomegaly was present in 4 and splenomegaly in 7 patients. Serum bilirubin was normalized at 1 year after operation. Aspartate aminotransferase (AST, GOT), Alanine aminotransferase(ALT, GPT) were normalized at 12 years and alkaline phosphatase(ALP) was normalized at 13.5 years. Cholangitis developed mainly within 5 years after operation so close follow up is needed. Life long follow-up is needed because of progressive deterioration of liver function even after 10 years.

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A Case report of ascites in Liver cirrhosis treated with Taeumjowetang-gamibang (태음조위탕가미방(太陰調胃湯加味方)으로 복수를 동반한 간경변 환자 치험 1례)

  • Kim, Jung-Chul;Lee, Hae-Yeon;Park, Jung-Han;Lee, Jae-Jun;Lee, You-Kyung;Han, Dong-Youn;Cho, Hyun-Seok
    • The Journal of Internal Korean Medicine
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    • v.25 no.3
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    • pp.625-632
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    • 2004
  • Liver cirrhosis is a disease of the liver in which normal cells are replaced by scar tissue. This condition results in the failure of the liver to perform many of its usual functions. Liver cirrhosis include acsites, jaundice, portal hypertension, varices etc. This report is about one case of ascites with liver cirrhosis. In this case, we administrated Taeumjowetang-gamibang was administered and acupuncture was done in treatment of ascites and its symptoms. After administration of Taeumjowetang-gamibang medication, clinical symptoms and prominently improved and ascites dwindled to nothing. This reports suggests Taeumjowetang-gamibang has desirable effected on ascites.

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Budd-Chiari Syndrome Complicating Behcet's Disease -Report of one case- (Behcet's 병을 동반한 Budd-Chiari 증후군 -1례 보고-)

  • O, Bong-Seok;Kim, Bo-Yeong;Kim, In-Gwang
    • Journal of Chest Surgery
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    • v.29 no.2
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    • pp.219-222
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    • 1996
  • A 34-year-old man was admitted to the hospital because of ascites, abdominal fullness. computed tomography and cavography revealed inferior vena cavil occlusion just above the hepatic vein and diagnosed as Budd-Chiari syndrome. conservative medical therapy failed to control the symptoms produced from both portal hypertension and versa caval stasis. Therefore, under extracorporeal circulation with moderate hypothermia and normal cardiac contraction, membranoto y and inferior vena casa venoplasty with Gore-tex (10mm) was performed. Postoperatively, physical examination revealed oral ulceration, subcutaneous thrombophlebitis, folliculitic lesions. uveitis And increased reactivity of the skin to needle punctures. 10 month later, superior vena ciiva obstruction symptom was found. Hehcet's disease was diagnosed.

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A Sphaghetti Sign in the Abdominal Radiograph Consistent with Spleno-Systemic Shunts in a Cat

  • Oh, Donghyun;Hwang, Jaewoo;Yoon, Junghee;Choi, Mincheol
    • Journal of Veterinary Clinics
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    • v.37 no.4
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    • pp.227-230
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    • 2020
  • A 8-year-old spayed female Korean short-haired cat was presented with respiratory distress. CBC, serum chemistry analysis, plain radiography, and abdominal ultrasonography were performed. Besides hypertrophic cardiomyopathy (HCM) suspected by the thoracic radiograph, a tubular, tortuous soft tissue structure was detected at the region of the left retroperitoneal cavity on the abdominal radiograph. On the abdominal ultrasonography, a shunt vessel is identified caudo-lateral to the left kidney region. These findings are consistent with spleno-systemic shunts in cats. Furthermore, portal hypertension and diffuse hepatic lesion were also identified. Although the cause of a shunt vessel is not easy to diagnose, it is important to include spleno-systemic shunt into differential diagnosis list, when convoluted, tubular soft tissue opacity is seen on the digital radiography (DR). This report will allow clinicians to raise awareness of complications of portosystemic shunt (PSS) and better treat PSS suspected feline patients when the advanced modalities such as computed tomography and magnetic resonance imaging are not available.

Noninvasive markers for esophageal varices in children with cirrhosis

  • Rahmani, Parisa;Farahmand, Fatemeh;Heidari, Ghobad;Sayarifard, Azadeh
    • Clinical and Experimental Pediatrics
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    • v.64 no.1
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    • pp.31-36
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    • 2021
  • Background: The diagnosis of esophageal varices (EV) is based on the findings of esophagogastroduodenoscopy (EGD), biopsy, and serum markers. Thus, noninvasive cost-effective tests through which high-risk EV children can be diagnosed are needed. Purpose: This cross-sectional study aimed to identify the noninvasive markers for EV in children with liver cirrhosis. Methods: A total of 98 children with liver cirrhosis were evaluated in this study. The spleen size, platelet count, serum albumin, liver function test results, and risk scores were evaluated prior to endoscopy. The endoscopic investigations aimed to identify the presence of EV and red signs, and determine varices sizes. Results: Endoscopy revealed varices in 43 subjects (43.9%). The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index (APRI), platelet count to spleen size ratio, and risk score differed significantly between patients with and without EV on univariate analysis; however, the logistic regression analysis showed no differences, indicating that none of these parameters were independently associated with the presence of EV. Conclusion: Platelet count, risk score, platelet count to spleen size, and APRI can be useful tools for the identification of high-risk patients with EV and might reduce the need for invasive methods like EGD.

Potentials of Chenpi on Metabolic Syndrome: A Review

  • Lee, Yoo-na;An, Yu-min;Kim, Jun-seok;Baek, Kyungmin
    • The Journal of Internal Korean Medicine
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    • v.42 no.4
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    • pp.645-671
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    • 2021
  • Objectives: Metabolic Syndrome (MetS) is strongly related with central obesity, hypertriglyceridemia, low high-density lipoprotein-cholesterol (HDL-C), hyperglycemia, and hypertension. This study reviewed the potential of Chenpi in treatment of MetS through amelioration of co-related diseases, such as diabetes mellitus, hyperlipidemia, obesity, hepatic steatosis, and inflammation. Methods: Six electronic databases (Oriental Medicine Advanced Searching Integrated System (OASIS), Korean Traditional Knowledge Portal, Korea Institute of Oriental Medicine (KIOM), Research Information Sharing Service (RISS), PubMed, and Embase) were used to search for in vitro, in vivo, and clinical research that discusses the potential effects of Chenpi (Citrus unshiu Markovich, Citrus reticulata Blanco) on diabetes mellitus, hyperlipidemia, obesity, hepatic steatosis, and inflammation. Results: This review suggests the potential of Chenpi as a candidate for the treatment of metabolic syndrome through improvement of co-related diabetes, hyperlipidemia, obesity, hepatic steatosis, and inflammation. However, comparison of the results of each study was limited by a lack of quantification of the experimental materials.

Primary hepatic sarcoidosis presenting with cholestatic liver disease and mimicking primary biliary cholangitis: a case report

  • Park, Young Joo;Woo, Hyun Young;Kim, Moon Bum;Ahn, Jihyun;Heo, Jeong
    • Journal of Yeungnam Medical Science
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    • v.39 no.3
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    • pp.256-261
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    • 2022
  • Sarcoidosis often involves the liver. However, primary hepatic sarcoidosis confined to the liver without evidence of systemic involvement is rare. We report the case of a 37-year-old man with hepatic sarcoidosis who initially presented with elevated liver enzymes and suspicious cirrhotic nodules on computed tomography. The patient had cirrhosis but did not have portal hypertension. Based on the initial histopathologic finding of chronic granulomatous inflammation and the common clinical characteristics of sarcoidosis, he was initially diagnosed with primary biliary cholangitis, and his daily dosage of ursodeoxycholic acid was increased to 900 mg. After 14 months of treatment, his total serum bilirubin concentration was 10.9 mg/dL (upper normal limit, 1.2 mg/dL). Additionally, a transjugular liver biopsy revealed multiple noncaseating granulomas. He was diagnosed with primary hepatic sarcoidosis involving the lungs, heart, spleen, kidneys, and skin. Treatment with methylprednisolone was initiated. Two weeks later, he was started on azathioprine, and the dose of steroid was simultaneously reduced. These findings indicate the importance of including hepatic sarcoidosis as a possible diagnosis in patients with elevated liver enzymes or cryptogenic cirrhosis.

Computed Tomographic Features of Gallbladder Agenesis in a Golden Retriever

  • Yujung Lee;Dongjun Kim;Jeongin Choi;Youngwon Lee;Hojung Choi
    • Journal of Veterinary Clinics
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    • v.41 no.1
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    • pp.43-48
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    • 2024
  • A two-year-old, intact female Golden Retriever had previously been diagnosed with a portosystemic shunt (PSS) during an ultrasonographic examination at a local animal hospital. The serum biochemistry revealed elevated liver enzymes and bile acid levels. The abdominal radiographic examination revealed mild serosal detail loss and microhepatica, while abdominal ultrasonography revealed mild ascites and high-velocity flow to the caudal vena cava (CVC) suspected as a PSS. The gallbladder was not observed within the hepatic parenchyma during ultrasonography. Computed tomography (CT) revealed an absent gallbladder and dilation of the common bile duct (CBD). Dilations of the gastroduodenal, splenic, colic and renal veins were also observed. A dilated left phrenico-abdominal vein that entered the CVC was previously misinterpreted as a PSS on the ultrasound examination. Based on the imaging examinations, the dog was diagnosed with congenital gallbladder agenesis associated CBD dilation.

The Analysis of Study Trends of Wild ginseng, Bovis Calculus, Ursi Fel, Moschus and The Study on Applied Possibility as Obesity medications (산삼, 우황, 웅담, 사향의 연구 동향 분석 및 비만 치료제로써의 응용 가능성 탐색 연구)

  • Kim, Min-Woo;Song, Yun-Kyung;Lim, Hyung-Ho
    • Journal of Korean Medicine for Obesity Research
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    • v.11 no.2
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    • pp.41-68
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    • 2011
  • Objectives: After organizing segmentations related to obesity from classics and each studies, we would like to examine the value of wild ginseng, bovis calculus, ursi fel and moschus as a obesity medicine. Methods: We found out 4 drugs which are wild ginseng, bovis calculus, ursi fel and moschus from the classics, such as "Shin-Nong-Bon-Cho-Kyung", "Myoung-Eui-Byul-Lok", "Bon-Cho-Gang-Mok", "Bon-Cho-Jong-Shin", "Bon-Cho-Bi-Yo", "Bon-Cho-Gu-Jin" and "Deuk-Bae-Bon-Cho", we searched websites such as RISS, Korean traditional knowledge portal, the society of Korean medicine for obesity research, Korean pharmacopuncture institute, the Korean academy of oriental rehabilitation medicine and Korean acupuncture & moxibustion society as well. Results: 1. We couldn't find the contents related to the efficacy of improving obesity through wild ginseng, bovis calculus, ursi fel and moschus from the classics. 2. Wild ginseng had a study dealing with the efficacy of anticancer, obesity, toxicity, immunity, sulfation, diabetes, plasma proteins, depression, hypertension, endometriosis and hair loss. Especially among 6 studies related to obesity, apart from the study that treated extract of wild ginseng directly to the cell or oral administration to the animals, also have studies that had an efficacy of improving obesity through injecting pharmacopuncture to acupuncture point and vein, etc. 3. Bovis calculus had a study about efficacy related to arthritis, liver, inflammation of cornea, obesity, anticancer, immunity, antacid, heart, lumbar pain, hypertension, toxicity, a digestive organ and sasang constitution, especially in case of obesity, had each studies about oral administration of complex prescription and about cell unit experiment of pharmacopuncture. 4. Ursi fel had a study about efficacy related to liver, arthritis, inflammation of cornea, immunity, obesity, anticancer, antacid, lumbar pain, digestive organ, toxicity, cell protection, skin ailment, etc. Especially in case of obesity, had each studies about oral administration of animal experiment and about cell unit experiment of pharmacopuncture. 5. Moschus had a study about efficacy related to liver, the central nervous system, arthritis, inflammation of cornea, immunity, obesity, anticancer, hypertension, heart, lumbar pain, etc. Especially in case of obesity, had one study about oral administration of complex prescription. Conclusion: Through the result of probability as a obesity medicine of wild ginseng, bovis calculus, ursi fel and moschus, we could identify the possibility of each drug as a obesity medicine. Also in the future, it is considered that studies about one or complex prescription and pharmacopuncture as a obesity medicine will be needed.