• Journal of Chest Surgery
• /
• v.50 no.2
• /
• pp.105-109
• /
• 2017

Coronary arterial involvement in Takayasu arteritis (TA) is not uncommon. Herein, we describe a case of TA with celiac trunk and superior mesenteric artery occlusion combined with coronary artery disease. Bilateral huge internal thoracic arteries (ITAs) and the inferior mesenteric artery provided the major visceral collateral circulation. After percutaneous intervention to the right coronary artery, off-pump coronary artery bypass grafting for the left coronary territory was done using a right ITA graft and its large side branch because of its relatively minor contribution to the visceral collateral circulation.

• Journal of Chest Surgery
• /
• v.28 no.12
• /
• pp.1079-1095
• /
• 1995

Recently endogenous digitalis-like substances were found in the blood of various cardiovascular diseases and they have been considered one of the causes of evoking hypertension. However, the mechanism of endogenous digitalis-like substances-induced hypertension is not clarified yet. Therefore, the effects of Na-K pump inhibition on the contractility of vascular smooth muscle[conduit and resistant artery were investigated, using organ bath and bioassay experiment. Aortic and carotid arterial rings[conduit artery and the branches of brachial and superior mesenteric artery[resistant artery were used to find the effect of Na-K pump inhibition. The results obtained were as followes;The magnitudes of contractions induced by norepinephrine, serotonin, or acetylcholine in all these arteries were significantly increased by the inhibition of Na-K pump. The increased contractile responses to these agonists, especially to serotonin, were much more prominant in resistant arteries. Nitroprusside-induced relaxations were attenuated by Na-K pump inhibition and there were no significant differences in the effects of Na-K pump inhibition on nitroprusside-induced relaxations of these blood vessels. Endothelium-dependent relaxation was suppressed by the inhibition of Na-K pump, especially by the administration of ouabain, and this inhibitory effect was much more prominent in the branches of superior mesenteric artery, compared with other arteries. In the branches of superior mesenteric arteries, endothelium-dependent relaxation was completely blocked by ouabain. The release of EDRF was partially suppressed by Na-K pump inhibition.From the above results, it is suggested that the hypertension due to the increase in vascular resistance can be evoked by the inhibition of Na-K pump and endogenous digitalis-like substances induce hypertension through this mechanism.

• The Korean Journal of Physiology
• /
• v.28 no.2
• /
• pp.151-157
• /
• 1994

Intracellular free $Ca^{2+}$ contributes to regulation of various events occurring in vascular smooth muscle cells. One of these events is modulating the membrane iou currents. Single smooth muscle cells were isolated from rabbit mesenteric artery. Three kinds of $Ca^{2+}-activated\;current$ were studied with the patch clamp method. $Ca^{2+}-activated\;K^+\;current$ with a large oscillation was recorded in the depolarized potential range. The single channel conductance of this current was about 250 pS. It was abolished by replacing intracellular $K^+\;with\;Cs^+$. A $Ca^{2+}-activated$ nonselective cation current was observed in both the depolarized and hyperpolarized potential ranges. And it was blocked by replacement of extracellular $Na^+$ with N-methylglucamine (NMG) or extracellular application of $Cd^{2+}$. $Ca^{2+}-activated\;Cl^-\;current$ was revealed in the whole voltage range and was blocked by niflumic acid. These results indicate that at least three kinds of $Ca^{2+}-activated$ ionic currents exist in smooth muscle cells from rabbit superior mesenteric artery.

• Journal of Trauma and Injury
• /
• v.26 no.3
• /
• pp.248-251
• /
• 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.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.26 no.5
• /
• pp.284-289
• /
• 2023

A 14-year-old girl was admitted to the emergency department for excessive bile-containing vomiting and severe abdominal pain. She had been healthy until she intentionally lost 25 kg over a 6-month period. Thick, bloody bile-mixed food particles were drained from the stomach through a nasogastric tube. Abdominal computed tomography revealed huge stomach dilatation with extensive gastric pneumatosis, possible near rupture, acute pancreatitis, and a very narrow third of the duodenum, indicating superior mesenteric syndrome. Gastrofibroscopy revealed multiple hemorrhagic ulcers and numerous beadlike cystic lesions in the stomach. Laboratory examination results were notable for severe deficiencies in critical nutrients, including iron, zinc, proteins, and prealbumin, as well as undernutrition-associated endocrine complications such as hypothyroidism and hypogonadotropic hypogonadism. Excessive vomiting ceased after the endoscopic removal of stagnant gastric contents. Gastric pneumatosis improved after 3 days of supportive care.

• The Korean Journal of Physiology and Pharmacology
• /
• v.3 no.4
• /
• pp.415-425
• /
• 1999

$[K^+]_o$ can be increased under a variety of conditions including subarachnoid hemorrhage. The increase of $[K^+]_o$ in the range of $5{\sim}15$ mM may affect tensions of blood vessels and cause relaxation of agonist-induced precontracted vascular smooth muscle $(K^+-induced$ relaxation). In this study, effect of the increase in extracellular $K^+$ concentration on the agonist-induced contractions of various arteries including resistant arteries of rabbit was examined, using home-made Mulvany-type myograph. Extracellular $K^+$ was increased in three different ways; from initial 1 to 3 mM, from initial 3 to 6 mM, or from initial 6 to 12 mM. In superior mesenteric arteries, the relaxation induced by extracellular $K^+$ elevation from initial 6 to 12 mM was the most prominent among the relaxations induced by the elevations in three different ways. In cerebral arteries, the most prominent relaxation was produced by the elevation of extracellular $K^+$ from initial 1 to 3 mM and a slight relaxation was provoked by the elevation from initial 6 to 12 mM. In superior mesenteric arteries, $K^+-induced$ relaxation by the elevation from initial 6 to 12 mM was blocked by $Ba^{2+}\;(30\;{\mu}M)$ and the relaxation by the elevation from 1 to 3 mM or from 3 to 6 mM was not blocked by $Ba^{2+}.$ In cerebral arteries, however, $K^+-induced$ relaxation by the elevation from initial 3 to 6 mM was blocked by $Ba^{2+},$ whereas the relaxation by the elevation from 1 to 3 mM was not blocked by $Ba^{2+}.$ Ouabain inhibited all of the relaxations induced by the extracellular $K^+$ elevations in three different ways. In cerebral arteries, when extracellular $K^+$ was increased to 14 mM with 2 or 3 mM increments, almost complete relaxation was induced at 1 or 3 mM of initial $K^+$ concentration and slight relaxation occurred at 6 mM. TEA did not inhibit $Ba^{2+}-sensitive$ relaxation at all and NMMA or endothelial removal did not inhibit $K^+-induced$ relaxation. Most conduit arteries such as aorta, carotid artery, and renal artery were not relaxed by the elevation of extracellular $K^+.$ Among conduit arteries, trunk of superior mesenteric artery and basilar artery were relaxed by the elevations of $[K^+]_o.$ These data suggest that $K^+-induced$ relaxation has two independent components, $Ba^{2+}-sensitive$ and $Ba^{2+}-insensitive$ one and there are different mechanisms for $K^+-induced$ relaxation in various arteries.

• Journal of Chest Surgery
• /
• v.14 no.2
• /
• pp.175-178
• /
• 1981

Since the first report by Freeman of renal artery repair for renovascular hypertension in 1954, there has been a gradual improvement in the results of renovascular reconstruction. This is case report of renovascular hypertension due to diffuse primary arteritis, which was performed aorto-bllateral renal bypass graft with using of Y -woven dacron graft. This 33 y-o male has complained intermittent headache, facial edema & malignent hypertension symptoms for 1.5 years. He had the history of Rt. B-K amputation due to unhealed wound after trauma of the Rt. great toe about 7 years ago. The abdominal aortography revealed nearly not visualized the Rt. renal artery & severe narrowing of the Lt. renal arterly. During postop. course, Blood pressure was well controlled. At postop. 3rd week, systolic pressure was down to 130-140mmHg But, diastolic pressure was remained to 100-110mmHg. At postop. 30th day, exploration was done due to intestinal obstruction signs. But severe ischemic enteritis was occured due to fibrotic obstruction of the superior mesenteric artery. The next day, he was dead. in spite of Rt. common iliac artery-sup. mesenteric artery bypass graft.

• Journal of The Korean Society of Emergency Medicine
• /
• v.29 no.5
• /
• pp.551-556
• /
• 2018

Cases of repeated acute gastric dilatations after binge eating in one patient are rarely reported. We report here a case of repeated acute gastric dilatations in a 22-year-old woman with bulimia nervosa. Her repeated acute gastric dilatations seem to have been related to superior mesenteric artery syndrome. On her last visit due to acute gastric dilatation, she underwent emergency gastric decompression surgery because of abdominal compartment syndrome; however, she eventually died because of ischemia reperfusion injury. Emergency physicians should be aware of the need to manage acute gastric dilatation in patients with eating disorder and should pay attention to the signs and distinctive clinical features of abdominal compartment syndrome.

• Childhood Kidney Diseases
• /
• v.27 no.2
• /
• pp.89-96
• /
• 2023

Renal nutcracker syndrome (NCS) is the entrapment of the left renal vein between the abdominal aorta and superior mesenteric artery. Although uncommon in pediatric patients, early diagnosis is crucial to avoid potential severe complications, such as anemia or renal vein thrombosis. NCS presents a variety of symptoms, most commonly including "Triade's symptoms"-hematuria, proteinuria, and flank pain. Diagnosis and treatment include invasive and noninvasive management, although due to a lack of pediatric clinical studies, management is widely variable. Conservative diagnosis and treatment are recommended as a first-line option for pediatric patients; however, invasive surgical treatment may be recommended based on symptom severity. This review aims to provide a comprehensive overview of NCS in children to better understand the widely variable incidence, occurrence, and management from early on to allow for early-onset management.

• The Korean Journal of Physiology and Pharmacology
• /
• v.5 no.4
• /
• pp.323-331
• /
• 2001

A splanchic artery occlusion for 90 min followed by reperfusion of the mesenteric circulation resulted in a severe form of circulatory shock characterized by endothelial dysfunction, severe hypotension, marked intestinal tissue injury, and a high mortality rate. The effect of rutin, a flavonoid having antiprostanoid, anti-inflammatory, antithrombotic, antioxidant effect, were investigated in a model of splanchnic artery occlusion (SAO) shock in urethane anesthetized rats. Occlusion of the superior mesenteric artery for 90 min produced a severe shock state resulted in a fatal outcome within 120 min of reperfusion in many rats. Rutin was given as a bolus (1.28 mg/kg) 10 min prior to reperfusion. Administration of rutin significantly improved mean arterial blood pressure in comparison to vehicle treated rats (p＜0.05). Rutin treatment also resulted in a significant attenuation in the increase in plasma amino nitrogen concentration, intestinal myeloperoxidase activity, intestinal lipid peroxidation, infiltration of neutrophils in intestine and thrombin induced adherence of neutrophils to superior mesentric artery segments. These results suggest that rutin provides beneficial effects in part by preserving endothelial function and attenuating neutrophil accumulation in the ischemic reperfused splanchnic circulation.