• Journal of Chest Surgery
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• v.53 no.6
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• pp.417-419
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• 2020

Surgeons avoid creating arteriovenous fistulae in obese patients owing to deep vessels, cannulation complications, and inconsistent outcomes. We describe placing an arteriovenous polytetrafluoroethylene (PTFE) graft between the brachial artery and axillary vein to avoid these complications. A 39-year-old super-obese woman with end-stage renal disease had undergone several hemodialysis access procedures on both arms. We traced the course of the arteriovenous graft course with the patient sitting and lying down. The ideal course was more accurate with the patient sitting; thus, the patient sat when the course was drawn, before lying on the operating bed. The PTFE graft was placed between the right brachial artery and axillary vein, according to the course in the opposite arm. No anastomotic dehiscence or pseudoaneurysm has taken place during 2 years of follow-up. In super-obese patients, the ideal course for arteriovenous grafts should be drawn while they are sitting, avoiding skin folds. This tip could avoid anastomotic dehiscence and pseudoaneurysm between the axillary vein and a PTFE graft.

• 대한핵의학회:학술대회논문집
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• 1979.05a
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• pp.17.2-18
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• 1979

• Journal of Pharmaceutical Investigation
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• v.1 no.1
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• pp.85-89
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• 1971

The renal action of furosemide was investigated in the chicken, a species which has poorly developed loops of Henle and only rudimentary counter-current system in the kidney. Furosemide was infused into a hindleg vein, which is known to lead to the peritubular capillaries, forming renal portal system. A dose of 0.03 mg/kg/20 min. furosemide elicited a profound diuresis with saluresis, limited only to the infused side. This action rests on the inhibition of sodium reabsorption in the tubules, as the GFR remained unchanged or even decreased. It is thus inferred that the action of furosemide on Henle's loop contributes to the overall diuretic action only a negligible degree.

• YAKHAK HOEJI
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• v.45 no.4
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• pp.397-406
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• 2001

It has been demonstrated previously that R(-)-2,10,11-trihydroxy-N-n-propylnora porphine (TNPA), a dopamine D$_2$receptor agonist, produced the antidiuresis through changes of central friction in dog. This study was investigated about effects of renal denervation and raclopride, a dopamine D$_2$receptor antagonist, on the antidiuresis of TNPA in order to elicidate the mechanism involved in this central antidiuresis induced by TNPA. Antidiresis exhibited by TNPA given into the vein or into carotid artery was not influenced by renal denervation, whereas antidiuresis of TNPA administered into carotid artery was blocked almost perfectly by raclopride pretreated into carotid artery. From these observations it is concluded that central antidiuresis induced by TNPA is brought about through activation of dopamine D$_2$receptor localized in brain, not related to renal nerve activity.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.5
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• pp.2303-2307
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• 2014

Background: Renal cancer is a serious public health problem which may be under reported and registered in our setup, since the Karachi cancer registry documented only 43 cases out of 4,268 incident cancer cases over 3 year duration. Therefore we aimed to determine the clinicopathologic characteristics of adult renal tumors in our setup. Materials and Methods: The study was conducted in histopathology department, Liaquat National Hospital and included total of 68 cases of adult renal tumors over 4 years. Detailed histopathologic characteristics of tumors were analyzed. Results: Mean age of patients was 56.4 (18-84) years. Renal cell carcinoma (RCC) was the most common cell type (78%) cases; followed by transitional/urothelial carcinoma (12.5%), leiomyosarcoma (4.7%), oncocytoma (1.6%), squamous cell carcinoma (1.6%) and high grade pleomorphic undifferentiated sarcoma (1.6%). Among 50 RCC cases; 62% were conventional/clear cell RCC (CCRCC) type followed by papillary RCC(PRCC), 24%; chromophobe RCC(CRCC), 6% and sarcomatoid RCC(SRCC), 8%. Mean tumor size for RCC was 7.2 cm. Most RCCs were intermediate to high grade (60% and 40% respectively). Capsular invasion, renal sinus invasion, adrenal gland involvement and renal vein invasion was seen in 40%, 18%, 2% and 10% of cases respectively. Conclusions: We found that RCC presents at an earlier age in our setup compared to Western populations. Tumor size was significantly larger and most of the tumors were of intermediate to high grade. This reflects late presentation of patients after disease progression which necessitates effective measures to be taken in primary care setup to diagnose this disease at an early stage.

• Journal of Chest Surgery
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• v.26 no.10
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• pp.761-768
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• 1993

Angioaccess has become increasingly important to vascular surgeons as more patients with end stage renal disease[ESRD] are being supported by hemodialysis. Because of the rapid increase in the number of patients undergoing hemodialysis in recent years, it has become necessary to develope alternative vascular access procedures. During the period from December 1986 to December 1992, 290 cases of arteriovenous fistula and associated operations for hemodialysis were performed at Department of Thoracic & Cardiovascular Surgery, Seoul Paik Hospital, Inje University. They Consisited of 175 male and 115 female, ranging in age from 8 and 79 years. The procedure of first choice, the Brescia`s original radial artery-cephalic vein arteriovenous fistula was performed upon 219 patients. In many patients, the radial artery-cephalic vein fistula cannot be performed because of inadequate vein or failure of previous radial artery-cephalic vein fistula. The waiting time until initiation of venous puncture for the first hemodialysis session was 3 days. The second choice of angioaccess, using the brachiocephalic arteriovenous fistula and brachiobasilic arteriovenous fistula at antecubital fossa, ulnobasilic arteriovenous fistula, femorosaphenous arteriovenous fistula, and radiobasilic arteriovenous fistula with saphenous in situ routes, was obtained in 17, 7, 4, 2 and 1 patients. Interposition grafts, the third choice of angioaccess, were performed upon 2 patients. Twenty seven patients underwent revisions or thrombectomies. The purpose of this report is to review the technique of this procedure and discuss the longterm results.

• Journal of Chest Surgery
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• v.28 no.1
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• pp.73-77
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• 1995

We are reporting one case of right subclavian vein thrombotic occlusion as a result of previous hemodialysis catheter placement in a patient with a functioning right brachio-cephalic arteriovenous fistula. Its complication was painful right arm swelling, limitation of motion and cellulitis. Diagnosis was confirmed by right subclavian venography and the complication was successfully managed by right subclavian vein-superior vena cava bypass with a GoreTex vascular graft. The arteriovenous fistula had remained to protect patency of the bypass at first, but two months later after the operation, the arteriovenous fistula had to be occluded because of the heart failure resulting from shunt over flow. After ligation of arteriovenous fistula, heart failure improved, and uncomfortable arm swelling did not develop again.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.15-20
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• 2005

Purpose : Nutcracker syndrome must be considered when hematuria or proteinuria occurs in a healthy child. The purpose of this study is to investigate the prevalence of nutcracker syndrome among children with asymptomatic hematuria or proteinuria, and to obtain the ratios of the peak velocity of the left renal vein between the aortomesenteric portion and the hilar portion in children with asymptomatic hematuna or protelnuria in which nutcracker syndrome was excluded and to observe whether the ratios are affected by sex, age or urinalysis findings. Methods : Using Doppler ultrasonography, we measured the flow velocity and obtained the peak velocity ratios of the left renal vein at the aortornesenteric portion and at the hilar Portion of the left kidney in children with asymptomatic hematuria or proteinuria who visited the Division of Pediatric Nephrology, Severance Hospital from May 2001 to March 2004. Results : Of 304 children with asymptomatic hematuna or proteinuria, 107 children(35.2%) were diagnosed with nutcracker syndrome. For 197 children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the mean ratio of the peak velocity was 2.54 $\pm$0.73, which was not affected by sex, age or urinalysis findings. Conclusion : Nutcracker syndrome was the major cause of asymptomatic hematuria or proteinurla In children, comprising 35% of all cases. Doppler ultrasonography was helpful in the screening of nutcracker syndrome and prevention of its complications. For children with asymptomatic hematuria or proteinuria excluding nutcracker syndrome, the peak velocity ratio of the left renal vein did not differ from that of normal children and was not affected by sex, age or urinalysis findings. (J Korean Soc Pediatr Nephrol 2005;9:15-20)

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.3
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• pp.264-270
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• 2023

Backgrounds/Aims: Proximal splenorenal shunt (PSRS) is a commonly performed procedure to decompress portal hypertension, in patients with refractory variceal bleed, especially in non-cirrhotic portal hypertension (NCPH). If conventional methods are hindered by any technical or pathological factors, alternative surgical techniques may be required. This study analyzes the effectiveness of various unconventional shunt surgeries performed for NCPH. Methods: A retrospective analysis of NCPH patients who underwent unconventional shunt surgeries during the period July 2011 to June 2022 was conducted. All patients were followed up for a minimum of 12 months with doppler study of the shunt to assess shunt patency, and upper gastrointestinal endoscopy to evaluate the regression of varices. Results: During the study period, 130 patients underwent shunt surgery; among these, 31 underwent unconventional shunts (splenoadrenal shunt [SAS], 12; interposition mesocaval shunt [iMCS], 8; interposition PSRS [iPSRS], 6; jejunal vein-cava shunt [JCS], 3; left gastroepiploic-renal shunt [LGERS], 2). The main indications for unconventional shunts were left renal vein aberration (SAS, 8/12), splenic vein narrowing (iMCS, 5/8), portalhypertensive vascular changes (iPSRS, 6/6), and portomesenteric thrombosis (JCS, 3/3). The median fall in portal pressure was more in SAS (12.1 mm Hg), and operative time more in JCS, 8.4 hours (range, 5-9 hours). During a median follow-up of 36 months (6-54 months), shunt thrombosis had been reported in all cases of LGERS, and less in SAS (3/12). Variceal regression rate was high in SAS, and least in LGERS. Hypersplenism had reversed in all patients, and 6/31 patients had a recurrent bleed. Conclusions: Unconventional shunt surgery is effective in patients unsuited for other shunts, especially PSRS, and it achieves the desired effects in a significant proportion of patients.

• Journal of Trauma and Injury
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• v.24 no.2
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• pp.164-167
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• 2011

Trauma is an important risk factor for a pulmonary thromboembolism, and anticoagulation is essential to prevent deep vein thrombosis (DVT) in patients with trauma. Low-molecular-weight heparin (LMWH) is excreted in the kidney; therefore, using LMWH in patients with renal insufficiency may increase the risk of bleeding complication. The following case describes a 55-year-old traffic accident victim who had massive bleeding and underwent a laparotomy for bleeding control. The patient had acute renal failure, and enoxaparin was administered for the prophylaxis of DVT. Although the patient suffered from serious complications such as pericardial hematoma, the patient recovered without sequellae and was discharged at day 84.