Acute mobile thrombus of the abdominal aorta after chemotherapy is a very unusual finding, which can be a potential source of arterial embolism. We report here on a case of an acute mobile aortic thrombus with renal infarction. We successfully treated the patient with hybrid operation-open surgical and endovascular approach. Our case shows that hybrid treatment using wire-directed balloon catheter thrombectomy is a feasible, minimally-invasive treatment for a mobile aortic thrombus.
Angioplasty ; Aorta ; Aorta, Abdominal ; Catheters ; Chimera ; Embolism ; Humans ; Infarction ; Thrombectomy ; Thrombosis

Diagnosis of a thymic carcinoid was made on transthoracic fine needle aspiration in a 36-year old woman who had an anterior mediastinal mass on chest X-ray and CT scan. The aspiration smears showed numerous anastomosing ribbons and cords of small round tumor cells. The tumor cells had slightly eccentric nuclei and some granular cytoplasm. The small and uniform nuclei of the tumor cells had finely granular chromatin and thin nuclear membrane. The cytologic diagnosis of a carcinoid was confirmed on histopathologic, immunohistochemical, and electromicroscopic examination of surgical specimen.
Adult ; Alleles* ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carotid Body ; Child* ; Chromatin ; Cytoplasm ; Diagnosis ; Female ; Humans ; Immunoglobulin A* ; Nuclear Envelope ; Paraganglioma ; Thorax ; Tomography, X-Ray Computed

In recent years, the interest in minimally invasive surgery has grown, and the same trend is observed in vascular surgery and interventional radiology, leading to what is called endovascular surgery. Since the first use of a stent-graft for the endovascular exclusion of an abdominal aortic aneurysm (AAA), endovascular aneurysm repair (EVAR) has greatly expanded, and more than 50,000 devices have been implanted until now. The endovascular graft can be implanted from a remote access site in the groin with a less anesthetic requirement. The endovascular graft is advanced over guidewires up the femoral and iliac arteries. Once in position, the graft is deployed immediately distal from the renal arteries. The aorta is not clamped and the blood loss is less than with open surgery. EVAR for AAA offers an important new alternative to open surgical procedure. The mortality rates after EVAR are reported between 0~5%. Long-term follow-up reports are not available, but mid-term follow-up of EVAR reveals an incidence of re-intervention between 10~20% and a rate of late rupture of between 0.5~1.5% per year. The problems of endoleaks and graft failure continue to be the challenges that require technological innovations. Based on the currently available evidence, EVAR is an appropriate treatment for selected patients, especially those at high risk for open surgical repair.
Aneurysm* ; Aorta ; Aortic Aneurysm, Abdominal ; Endoleak ; Groin ; Humans ; Iliac Artery ; Incidence ; Inventions ; Mortality ; Radiology, Interventional ; Renal Artery ; Rupture ; Stents ; Surgical Procedures, Minimally Invasive ; Transplants

BACKGROUND: The inhibitory effects of nitric oxide(NO) on platelet adhesion and vascular smooth muscle cell(VSMC) proliferation may have a possible role inhibiting development of neointima following balloon catheter induced injury. We tested the hypothesis that L-arginine, the precursor of NO, would attenuate neointima formation following balloon catheter induced injury via regulation of antagonistic balance between proliferation and apoptosis of VSMC. METHODS: Adult, male Sprague-Dawley rats(300 to 400g) were anesthetized with ketamine (100mg/kg intraperitoneally). The left common and external carotid artery were exposed. For endothelial denudation, 2mm angioplasty catheter was introduced through the left external carotid artery into the left common carotid artery. The catheter was inflated at I atm. and withdrawn three times. Animals were randomized to receive 2.25% L-arginine in their drinking water(n=14) or placebo(n=16) from 2 days prior to and 9 days following denudation. VSMC proliferation was quantified by immunohistochemical staining with an antibody to the proliferating cell nuclear antigen(PCNA). The cells undergoing apoptosis were identified by terminal nucleotidyl transferase-mediated nick end labeling(TUNEL) method and morphologic changes by computerized planimetry and transmission electron microscopy. RESULTS: 1) The neointimal area in injured arteries were significantly reduced in L-arginine supplemented animals compared with placebo group(p<0.05). 2) L-arginine administration significantly reduced the number of PCNA positive cells in neointima when compared with placebo at 9 days(p<0.05). 3) Positive TUNEL cells were not influenced by L-arginine supplementation. 4) On transmission electron microscopy, there were no cells showing characteristics of apoptosis in neointima. CONCLUSION: These results suggested that the inhibitory effect of L-arginine on neointima formation is due to reduced VSMC proliferation, but is not due to increased VSMC apoptosis at the early time period after initmal injur .
Adult ; Angioplasty ; Animals ; Apoptosis ; Arginine* ; Arteries ; Blood Platelets ; Carotid Artery, Common ; Carotid Artery, External ; Catheters ; Drinking ; Humans ; In Situ Nick-End Labeling ; Ketamine ; Male ; Microscopy, Electron, Transmission ; Muscle, Smooth, Vascular ; Neointima* ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley ; Vascular System Injuries*

We have experienced two cases of coronary revascularization without extracorporeal circulation in a 63 year old female patient and a 75 year old male patient. The first patient had the lesion which was the nearly total occulusion of mid-LAD, about 90% luminal narrowing of second diagonal branch and less than 50% stenosis of proximal RCA. The other male patient had a single vessel disease involving about 95% stenosis of proximal LAD and 1st diagonal branch. PTCA failed in the first patient because of relatively long sinus pause during procedure. In both of the patients, the coronary revascularizations were done at distal LAD and diagonal branch using left internal mammary artery and saphenous vein graft under the beating state, respectively. The postoperative courses were uneventful and the patients were discharged without any complications.
Aged ; Constriction, Pathologic ; Extracorporeal Circulation* ; Female ; Humans ; Male ; Mammary Arteries ; Middle Aged ; Phenobarbital ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Transplants

PURPOSE: Acute thrombosis of arteriovenous graft (AVG) has been treated by surgical thrombectomy; however, endovascular treatment became an alternative treatment option recently. The purpose of this study is to evaluate the effectiveness of endovascular treatment for acute thrombosis of AVG (EndoAVG) by primary endovascular treatment strategy. METHODS: This is a retrospective study of patients who underwent EndoAVG from January 2003 to December 2010 in Inha University Hospital. The patients' clinical characteristics and EndoAVG procedures were reviewed by electronic charts and X-ray films. Clinical success was defined as the residual stenosis below 30% or success of hemodialysis. RESULTS: Thirty-eight patients were enrolled. The mean age was 64+/-15.4 years in the success group and 58+/-17.2 years in the failed group. The mean duration from AVG formation to endovascular thrombectomy was 19.2+/-29.5 months. The success rate of EndoAVG was 84.2% (32/38). There were three complications after EndoAVG: two brachial artery thromboses and one rupture of a vein at the ballooning site. Six months, twelve months and twenty-four months secondary patency rate were 77.5%, 65.5%, and 42.5%, respectively. CONCLUSION: The success rate of EndoAVG was 84.2%. Its result is compatible with open thrombectomy and can be a good alternative option for the treatment of acute thrombosis of AVG. Larger number of cases is required for stronger study.
Arteriovenous Fistula ; Brachial Artery ; Constriction, Pathologic ; Electronics ; Electrons ; Humans ; Renal Dialysis ; Retrospective Studies ; Rupture ; Thrombectomy ; Thrombosis ; Transplants ; Veins ; X-Ray Film

PURPOSE: Traumatic duodenal injury is rare. There is no consensus on what type of repair should be performed for duodenal perforations with respect to their varying severity. As a result, surgeons are confronted with the dilemma of choosing between several diagnostic tests and many surgical procedures. In this study, we report our experience with treating traumatic duodenal injury and also offer a review of the literature. METHODS: Seventeen patients with duodenal injury following abdominal trauma were treated by several methods between January 1992 and October 2006. Based on review of the medical records, we classified the patients as having grade I through V duodenal injury using the scale constructed by the American Association for the Surgery of Trauma (AAST). We also noted clinical features, operative management, and outcome. RESULTS: Among 17 patients, one patient who had a duodenal intramural hematoma was treated by conservative management. Seven patients were treated by duodenojejunostomy, with only one complication. The remaining 9 patients underwent various operations, including primary closure alone (n=3), primary closure with jejunal patch (n=1), primary closure with duodenostomy (n=3), and pancreaticoduodenectomy (n=2). The complication rate among patients who underwent surgery within 24 hours after injury was 1 case among 13. However, complications occurred in all 4 surgical cases undertaken more than 24 hours after injury. CONCLUSION: Early diagnosis (within 24 hours) and thorough inspection during exploration provide the best means toward reducing complications associated with traumatic duodenal injury.
Consensus ; Diagnostic Tests, Routine ; Duodenostomy ; Early Diagnosis ; Hematoma ; Humans ; Medical Records ; Pancreaticoduodenectomy

PURPOSE: Traumatic duodenal injury is rare. There is no consensus on what type of repair should be performed for duodenal perforations with respect to their varying severity. As a result, surgeons are confronted with the dilemma of choosing between several diagnostic tests and many surgical procedures. In this study, we report our experience with treating traumatic duodenal injury and also offer a review of the literature. METHODS: Seventeen patients with duodenal injury following abdominal trauma were treated by several methods between January 1992 and October 2006. Based on review of the medical records, we classified the patients as having grade I through V duodenal injury using the scale constructed by the American Association for the Surgery of Trauma (AAST). We also noted clinical features, operative management, and outcome. RESULTS: Among 17 patients, one patient who had a duodenal intramural hematoma was treated by conservative management. Seven patients were treated by duodenojejunostomy, with only one complication. The remaining 9 patients underwent various operations, including primary closure alone (n=3), primary closure with jejunal patch (n=1), primary closure with duodenostomy (n=3), and pancreaticoduodenectomy (n=2). The complication rate among patients who underwent surgery within 24 hours after injury was 1 case among 13. However, complications occurred in all 4 surgical cases undertaken more than 24 hours after injury. CONCLUSION: Early diagnosis (within 24 hours) and thorough inspection during exploration provide the best means toward reducing complications associated with traumatic duodenal injury.
Consensus ; Diagnostic Tests, Routine ; Duodenostomy ; Early Diagnosis ; Hematoma ; Humans ; Medical Records ; Pancreaticoduodenectomy

PURPOSE: Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical emergency of infants that exhibits clearly unique characteristic symptoms, but its etiology and pathogenesis are still obscure. The Fredet-Ramstedt pyloromyotomy has gained worldwide acceptance. The advantages of this operation are immediate solution of the problem and few complication. Cosmetically circumumbilical incision or laparoscopic pyloromytomy can be used. METHODS: Forty cases of IHPS admitted to the Chuncheon Sacred Heart Hospital from Jan 1997. to Dec 2002 were reviewed retrospectively. These cases underwent Fredet-Ramstedt's operation. RESULTS: The most prevalent age group was 21~30 days (10 cases: 25%), mean age was 41.4+/-9.9 days, and the males to females ratio was 4.7: 1. Among the 40 cases, 24 (60%) involved the first baby. The mean gestation age was 39.9+/-1.7 weeks and mean birth weight was 3.3+/-0.5 Kg. The mean duration of symptom was 4.1+/-1.6 days. The common symptoms were non-bile stained, projectile vomiting in all cases, an olive-shaped mass in the right upper quadrant abdomen in 21 cases (52.5%), visible peristalsis on epigastrium in 16 cases (40%), and jaundice in 1 case (2.5%). Hypokalemic alkalosis was observed in 3 cases (7.5%). The mean length and thickness of the stenotic canal, as measured in the operation, were 28.8+/-8.5 mm and 4.9+/-0.6 mm, respectively. Postoperative complications were one case each (2.5%) pneumonia, wound seroma, and recurrence. Conclusion: Fredet-Ramstedt's pyloromyotomy for IHPS is an effective operation after the correction of dehydration and electrolyte imbalance.
Abdomen ; Alkalosis ; Birth Weight ; Dehydration ; Emergencies ; Female ; Gangwon-do ; Heart ; Humans ; Infant ; Jaundice ; Male ; Peristalsis ; Pneumonia ; Postoperative Complications ; Pregnancy ; Pyloric Stenosis, Hypertrophic* ; Recurrence ; Retrospective Studies ; Seroma ; Vomiting ; Wounds and Injuries

PURPOSE: The purpose of this study was to determine the effect of anchorage systems and palatal coverage of denture base on load transfer in maxillary implant-supported overdenture. MATERIAL AND METHODS: Maxillary implant-supported overdentures in which 4 implants were placed in the anterior region of edentulous maxilla were fabricated, and stress distribution patterns in implant supporting bone in the case of unilateral vertical loading on maxillary right first molar were compared with each other depending on various types of anchorage system and palatal coverage extent of denture base using three-dimensional photoelastic stress analysis. Two photoelastic overdenture models were fabricated in each anchorage system to compare with the palatal coverage extent of denture base, as a result we got eight models : Hader bar using clips(type 1), cantilevered Hader bar using clips(type 2), Hader bar using clip and ERA attachments(type 3), cantilevered milled-bar using swivel-latchs and frictional pins(type 4). RESULT: 1. In all experimental models, the highest stress was concentrated on the most distal implant supporting bone on loaded side. 2. In every experimental models with or without palatal coverage of denture base, maximum fringe orders on the distal ipsilateral implant supporting bone in an ascending order is as follows; type 3, type 1, type 4, and type 2. 3. Each implants showed compressive stresses in all experimental models with palatal coverage of denture base, but in the case of those without palatal coverage of denture base, tensile stresses were observed in the distal contralateral implant supporting bone. 4. In all anchorage system without palatal coverage of denture base, higher stresses were concentrated on the most distal implant supporting bone on loaded side. 5. The type of anchorage system affected in load transfer more than palatal coverage extent of the denture base. CONCLUSION: To the results mentioned above, in the case of patients with unfavorable biomechanical conditions such as not sufficient number of supporting implants, short length of the implant, and poor bone quality, selecting a resilient type attachment or minimizing the distal cantilevered bar is considered to be an appropriate method to prevent overloading on implants by reducing cantilever effect and gaining more support from the distal residual ridge.
Denture Bases* ; Denture, Overlay* ; Dentures* ; Friction ; Humans ; Maxilla ; Models, Theoretical ; Molar