• Childhood Kidney Diseases
• /
• 제14권2호
• /
• pp.240-245
• /
• 2010

호두까기 증후군은 대동맥과 상장간막 동맥 사이에 좌신 정맥이 압박되어 혈뇨나 단백뇨가 보이는 임상 증후군으로 그 유전성에 대해서는 알려져 있는 바가 없다. 저자들은 무증상 혈뇨를 주소로 내원한 형제에게 모두 도플러 초음파로 진단된 호두까기 증후군을 접하였기에 간단한 문헌 고찰과 함께 보고하는 바이다.

• 한국간담췌외과학회지
• /
• 제26권3호
• /
• pp.229-234
• /
• 2022

When planning pancreaticoduodenectomy for pancreatic head cancer, the prevalence of anatomical variation of the proximal jejunal vein (PJV), the associated short-term surgical outcomes, and the level of PJV convergence to the superior mesenteric vein must be carefully analyzed from both technical and oncological points of view. The prevalence of the first jejunal trunk (FJT) and PJV located ventral to the superior mesenteric artery is 58%-88% and 13%-37%, respectively. Patients with the FJT had a larger amount of intraoperative bleeding and a higher proportion of patients requiring transfusions compared to those without a common trunk. The risk of transfusion was higher in patients with ventral PJV compared to those with dorsal PJV. Although less frequent, sacrificing the FJT can result in fatal venous congestion of the jejunum. Therefore, a well-planned approach for pancreaticoduodenectomy, based on preoperative evaluation of anatomical variation in the PJV, may help reduce intraoperative bleeding and postoperative morbidity. Additionally, the importance of invasion into the PJVs should be revisited in terms of resectability and oncological clearance.

• The Korean Journal of Physiology and Pharmacology
• /
• 제21권6호
• /
• pp.687-694
• /
• 2017

Plumbagin, a hydroxy 1,4-naphthoquinone compound from plant metabolites, exhibits anticancer, antibacterial, and antifungal activities via modulating various signaling molecules. However, its effects on vascular functions are rarely studied except in pulmonary and coronary arteries where NADPH oxidase (NOX) inhibition was suggested as a mechanism. Here we investigate the effects of plumbagin on the contractility of skeletal artery (deep femoral artery, DFA), mesenteric artery (MA) and renal artery (RA) in rats. Although plumbagin alone had no effect on the isometric tone of DFA, $1{\mu}M$ phenylephrine (PhE)-induced partial contraction was largely augmented by plumbagin (${\Delta}T_{Plum}$, 125% of 80 mM KCl-induced contraction at $1{\mu}M$). With relatively higher concentrations (>$5{\mu}M$), plumbagin induced a transient contraction followed by tonic relaxation of DFA. Similar biphasic augmentation of the PhE-induced contraction was observed in MA and RA. VAS2870 and GKT137831, specific NOX4 inhibitors, neither mimicked nor inhibited ${\Delta}T_{Plum}$ in DFA. Also, pretreatment with tiron or catalase did not affect ${\Delta}T_{Plum}$ of DFA. Under the inhibition of PhE-contraction with L-type $Ca^{2+}$ channel blocker (nifedipine, $1{\mu}M$), plumbagin still induced tonic contraction, suggesting $Ca^{2+}$-sensitization mechanism of smooth muscle. Although ${\Delta}T_{Plum}$ was consistently observed under pretreatment with Rho A-kinase inhibitor (Y27632, $1{\mu}M$), a PKC inhibitor (GF 109203X, $10{\mu}M$) largely suppressed ${\Delta}T_{Plum}$. Taken together, it is suggested that plumbagin facilitates the PKC activation in the presence of vasoactive agonists in skeletal arteries. The biphasic contractile effects on the systemic arteries should be considered in the pharmacological studies of plumbagin and 1,4-naphthoquinones.

• 한국간담췌외과학회지
• /
• 제28권1호
• /
• pp.59-69
• /
• 2024

Backgrounds/Aims: Pancreaticoduodenectomy (PD) is the only radical treatment for periampullary malignancies. Superior mesenteric artery (SMA) first approach combined with total meso-pancreas (MP) excision was conducted to improve the oncological results. There has not been any previous research of a technique that combines the SMA first approach and total MP excision with a detailed description of the MP macroscopical shape. Methods: We prospectively assessed 77 patients with periampullary malignancies between October 2020 and March 2022 (18 months). All patients had undergone PD with SMA first approach combined total MP excision. The perioperative indications, clinical data, intra-operative index, R0 resection rate of postoperative pathological specimens (especially mesopancreatic margin), postoperative complications, and follow-up results were evaluated. Results: The median operative time was 289.6 min (178-540 min), the median intraoperative blood loss was 209 mL (30-1,600 mL). Microscopically, there were 19 (24.7%) cases with metastatic MP, and five cases (6.5%) with R1-resection of the MP. The number of lymph nodes (LNs) harvested and metastatic LNs were 27.2 (maximum was 74) and 1.8 (maximum was 16), respectively. Some (46.8%) patients had pancreatic fistula, but mostly in grade A, with 7 patients (9.1%) who required re-operations. Some 18.2% of cases developed postoperative refractory diarrhea. The rate of in-hospital mortality was 1.3%. Conclusions: The PD with SMA first approach combined TMpE for periampullary malignancies was effective in achieving superior oncological statistics (rate of MP R0-resection and number of total resected LNs) with non-inferior short-term outcomes. It is necessary to evaluate survival outcomes with long-term follow-up.

• The Korean Journal of Physiology and Pharmacology
• /
• 제2권4호
• /
• pp.511-519
• /
• 1998

This study investigated the role of nitric oxide on the oxidative damage in gastric mucosa of rats which received ischemia/reperfusion and its relation to mucus. Nitric oxide synthesis modulators such as L-arginine and $N^G-nitro-L-arginine$ methyl ester, and sodium nitroprusside, a nitric oxide donor, were injected intraperitoneally to the rats 30 min prior to ischemia/reperfusion which was induced by clamping the celiac artery and the superior mesenteric artery for 30 min and reperfusion for 1 h. Lipid peroxide production, the contents of glutathione and mucus, and glutathione peroxidase activities of gastric mucosa were determined. Histological observation of gastric mucosa was performed by using hematoxylin-eosin staining and scanning electron microscopy. The result showed that ischemia/reperfusion increased lipid peroxide production and decreased the contents of glutathione and mucus as well as glutathione peroxidase activities of gastric mucosa. Ischemia/reperfusion induced gastric erosion and gross epithelial disruption of gastric mucosa. Pretreatment of L-arginine, a substrate for nitric oxide synthase, and sodium nitroprusside prevented ischemia/reperfusion-induced alterations of gastric mucosa. However, $N^G-nitro-$ L- arginine methyl ester, a nitric oxide synthase inhibitor, deteriorated oxidative damage induced by ischemia/reperfusion. In conclusion, nitric oxide has an antioxidant defensive role on gastric mucosa by maintaining mucus, glutathione, and glutathione peroxidase of gastric mucosa.

• 한국산학기술학회논문지
• /
• 제20권3호
• /
• pp.188-193
• /
• 2019

경동맥 화학색전술은 널리 이용되며 빠르게 발전하고 있는 간세포암의 비수술적 치료법이다. 만족할만한 치료결과를 얻기 위해서는 환자의 해부학적 특성을 이해하고 종양 공급 동맥을 찾아내서 올바른 치료 계획을 세워야 한다. 본 연구에서는 간세포암의 경동맥 화학색전술 중에 방해요인으로 작용한 후천성 동정맥 기형의 증례를 보고하고자 한다. 72세 남자가 2일전부터 지속된 복통으로 내원하였다. 만성 B형 간염환자로 10년 전 간세포암에 대한 고식적 경동맥 화학색전술을 시행 받고 완치된 과거력이 있었다. 전산화 단층 촬영상 간우엽의 8분절에 결절성 간세포암이 발견되었으며 우간동맥은 상장간막동맥에서 기시하는 기형을 가지고 있었으며 종양 주변에 과혈관성 종양 구조가 관찰되었다. 1차 경동맥 화학색전술을 실시하였을 때 좌간동맥에서 기시하는 종양 공급동맥을 찾아 이를 약물방출미세구와 Adriamycin 50mg을 이용하여 화학색전하였다. 우간동맥조영술을 시행하였을 때 동정맥 기형이 관찰되었으며 간세포암은 관찰되지 않았다. 1개월 후 시행한 전산화 단층 촬영상 괴사된 종양과 남은 병변이 관찰되어 2차 경동맥 화학색전술을 시행하였다. 우간동맥을 통하여 미세유도철사와 카테터를 이용하여 동정맥 기형을 지나쳐 초선택하였고 시행한 조영술에서 남은 간세포암의 병변이 조영됨을 확인할 수 있었다. 이를 약물방출미세구와 Adriamycin을 이용하여 화학색전하였다. 시술 후 혈관 조영술에서 간세포암이 조영되지 않는 것을 확인하였고, 그 후 환자는 특별한 합병증 없이 퇴원하였다. 저자들은 매우 드물게 발생하는 간세포암 주변의 후천성 동정맥 기형을 발견하였고, 방해요인으로 작용한 동정맥 기형을 넘어 초선택적 경동맥화학색전술을 시행하여 간세포암을 치료하였다.

• Journal of Yeungnam Medical Science
• /
• 제39권1호
• /
• pp.77-80
• /
• 2022

Fistulas between the arteries and the gastrointestinal tract are rare but can be fatal. We present a case of an ilioenteric fistula between the left external iliac artery and sigmoid colon caused by radiotherapy for cervical cancer, which was treated with endovascular management using a stent graft. A 38-year-old woman underwent concurrent chemoradiotherapy for cervical cancer recurrence. Approximately 9 months later, the patient suddenly developed hematochezia. On her first visit to the emergency room of our hospital, computed tomography (CT) images did not reveal extravasation of contrast media. However, 8 hours later, she revisited the emergency room because of massive hematochezia with a blood pressure of 40/20 mmHg and a heart rate of 150 beats per minute. At that time, CT images showed the presence of contrast media in almost the entire colon. The patient was referred to the angiography room at our hospital for emergency angiography. Inferior mesenteric arteriography did not reveal any source of bleeding. Pelvic arteriography showed contrast media extravasation from the left external iliac artery to the sigmoid colon; this was diagnosed as an ilioenteric fistula and treated with a stent graft. When the bleeding focus is not detected on visceral angiography despite massive arterial bleeding, pelvic arteriography is recommended, especially in patients with a history of pelvic surgery or radiotherapy.

• Journal of Digestive Cancer Research
• /
• 제5권1호
• /
• pp.23-27
• /
• 2017

Although laparoscopic pancreaticoduodenectomy (LPD) is considered as minimally invasive surgery, an advanced level of laparoscopic skill is still required. LPD comprises various procedures including reconstruction. Therefore, establishment of a safe approach at each step is needed. Prevention of intraoperative bleeding is the most important factor in safe completion of LPD. The establishment of effective retraction methods is also important at each site to prevent vascular injury. I also recommend the "uncinate process first" approach during initial cases of LPD, in which the branches of the inferior pancreaticoduodenal artery are dissected first, at points where they enter the uncinate process. This approach is performed at the left side of the superior mesenteric artery (SMA) before isolating the pancreatic head from the right aspect of the SMA, which allows safe dissection without bleeding. Safe and reliable reconstruction is also important to prevent postoperative complications. Laparoscopic pancreatojejunostomy requires highly skilled suturing technique. Pancreatojejunostomy through a small abdominal incision, as in hybrid-LPD, facilitates reconstruction. In LPD, the surgical view is limited. Therefore, we must carefully verify the position of the pancreaticobiliary limb. A twisted mesentery may cause severe congestion of the pancreaticobiliary limb following reconstruction, resulting in severe complications. We must secure the appropriate position of the pancreaticobiliary limb before starting reconstruction. We describe the incidence of intraoperative and postoperative complications and appropriate technique for safe performance of LPD.

• Journal of Chest Surgery
• /
• 제17권3호
• /
• pp.448-455
• /
• 1984

Coarctation of the Aorta is a congenital constriction of aorta of varying degree, usually located at or near the aortic ismuth with frequent associations of other cardiac anomalies. Various modes of surgical corrections, such as resection and end-to-end anastomosis, graft interposition, angioplasty using prosthetic patch or subclavian flap have been used according to the status of coarctation and age of the patient. We have experienced two cases of surgically treated coarctation of the aorta, one of which was preductal coarctation with hypoplastic aortic arch and ventricular septal defect in a 4 year old boy, and the other case was juxtaductal type with aortic regurgitation. Subclavian flap angioplasty with additional pulmonary artery banding procedure was done in the first case and wedge resection with end-to-end anastomosis and aortic valve replacement [St. Jude valve, 23mm] 20 days later of first operation in the other case. The first case developed massive tarry stool on 3rd POD, probably due to mesenteric arteritis with resultant bowl ecrosis, and expired the next day. Recovery was uneventful with the second case.

• Advances in pediatric surgery
• /
• 제12권2호
• /
• pp.257-261
• /
• 2006

Appendicitis is a common disease in children. But left lower abdominal pain in acute appendicitis is a rare clinical feature. A 6 year-old-girl complained of left sided abdominal pain for 2 days. Past medical history was not contributory. Abdominal tenderness and guarding in left lower quadrant were noticed. Abdominal sonography and abdominal computed tomography scan demonstrated reversed position between superior mesenteric artery and vein, and a mass in the left lower quadrant abdomen suggesting appendicitis. Acute appendicitis in left lower quadrant, associated with intestinal malrotation, was found at laparatomy.