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

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 and withdrawn three times.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*

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

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

Intussusception of the appendix is an uncommon condition and the diagnosis is rarely made preoperatively. Intussusception of the appendix may mimic a neoplastic lesion. Colonoscopy is a valuable tool for diagnosis of the appendiceal intussusception. A 17-yr-old female admitted with repeated abdominal pain, nausea, vomiting and febrile sensation. We diagnosed as appendiceal intussusception by colonoscopy, which showed a polypoid tumor (about 1.5 cm) in the cecum. This sessile polypoid mass looks like foreskin or glans. We present colonoscopic finding of appendiceal intussusception and review the literature.
Adolescent ; *Appendix ; Cecal Diseases/*diagnosis ; *Colonoscopy ; Female ; Humans ; Intussusception/*diagnosis

Endovascular aneurysm repairs for a ruptured AAA (EVAR for r-AAA) have been reported with limited results although endovascular aneurysm repairs for elective AAA (EVAR for e-AAA) have shown good early and late results. In this case report, the authors described successful EVAR for r-AAA. A 93-year-old female underwent emergent EVAR for r-AAA. An aortic occlusion balloon was inserted before general anesthesia for hemodynamic stability. Zenith endograft was deployed under general anesthesia. Completion angiography showed no endoleak but there was coverage of the right renal artery. She was discharged 2 weeks after overcoming transient acute renal insufficiency. We concluded that EVAR for r-AAA can be an alternative option for the treatment of ruptured AAA.
Acute Kidney Injury ; Anesthesia, General ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal ; Endoleak ; Female ; Hemodynamics ; Humans ; Renal Artery ; Rupture ; Stents