Neoadjuvant concurrent chemoradiotherapy has been increasingly used to obtain secondary resectability for locally advanced pancreatic cancers. Although most patients require biliary decompression, only a few studies have investigated the safety of biliary stenting with chemoradiotherapy. Herein, we report a rare case of delayed hemorrhage of the hepatic artery caused by biliary stenting after chemoradiotherapy. The serial follow-up CT demonstrated that the biliary stent was approaching the right hepatic artery and eventually caused acute angulation and indentation. Diagnostic catheter angiography revealed contrast extravasation at the right hepatic artery, and endovascular embolization was performed. This report highlights the relevance of anatomical deformation after chemoradiotherapy, which can result in fatal complications. Indentation of the hepatic artery caused by biliary stents should be recognized as a warning sign of vascular injury.

No abstract available in English.
Clinical Study ; Dislocations ; Spine

The purpose of this study are to delineate the temporal and spatial changes of bone mineralization at the distraction gap and adjacent parent bone, and to investigate the effect of microaxial dynamization on regenerate bone healing and on development of regional osteopenia at the adjacent parent bone, during callotasis. Sixteen Korean adult mongrel dogs underwent bilateral tibial lengthening by callotasis. To the right hindlimbs, no dynamization was applied and served as control group (group I, and axial elastic dynamization was conffered to the left hindlimbs (group II). Bone mineral density(BMD) was measured by dual X-ray absorptionmetry(DXA) at immediate post-operative day, post-operative 12 day, 22 day, 36 day, 50 day, 65 day, and 85 day. Quantitative computed tomogram(Q-CT) was also taken after sacrifice to analyze temporal changes of mineralization pattern in the distraction gap. The following results were obtained; 1. In both group I and II, the BMD was lowest at the interzone in the distraction gap and increased linearly toward the corticotomy surface. This pattern did not change with time until the consolidation of the distraction gap, but the difference of BMD between the interzone and adjacent parent bone decreased with progress of consolidation. 2. During the distraction period, BMD increased progressively at the distraction gap and adjacent parent bone in both group I and II. During consolidation period, although BMD of the distraction gap still increased progressively, that of the adjacent parent bone decreased progressively in group I; the more distant from the corticotomy surface, the more decreased the relative BMD. in group II, the decrease in BMD of the adjacent parent bone was less than that in group I which was statistically significant in mid-consolidation period. In conclusion, the new bone in the distraction gap during callotasis appeared to form in bilateral direction with linear gradient from interzone toward corticotomy surface. Dynamization during callotasis not only stimulated regenerate bone healing in the distraction gap, but also prevented the occurrence of transient regional osteopenia at the distant part of the adjacent bone during midconsolidation period.
Adult ; Animals ; Bone Density ; Bone Diseases, Metabolic ; Calcification, Physiologic ; Dogs ; Hindlimb ; Humans ; Miners ; Osteogenesis, Distraction ; Parents ; Tibia

The methanol extract from the leaves of Petasites japonicus Maxim (PJ) was studied for its (anti-)mutagenic effect with the SOS chromotest and reverse mutation assay. The (anti-)carcinogenic effects were evaluated by the cytotoxicity on human cancer line cells and by the function and the expression of gap junctions in rat liver epithelial cell. PJ extracts significantly decreased spontaneous beta-galactosidase activity and beta-galactosidase activity induced by a mutagen, ICR, in Salmonella (S.) typhimurium TA 1535/pSK 1002. All doses of the extract (0.08-100 mg/plate) decreased the reversion frequency induced by benzo (alpha)pyrene (BaP) in S. typhimurium TA 98. It decreased not only the spontaneous reversion frequency but also that induced by BaP in S. typhimurium TA 100. PJ extract showed greater cytotoxic effects on human stomach, colon and uterus cancer cells than on other cancer cell types and normal rat liver epithelial cells. Dye transfers though gap junctions were significantly increased by PJ extracts at concentrations greater than 200 microg/mL and the inhibition of dye transfer by 12-O-tetradecanoylphorobol-13-acetate (TPA) was obstructed in all concentrations of PJ. PJ significantly increased the numbers of gap junction protein connexin 43, and increased the protein expression decreased by TPA in a dose-dependent manner. Based on these findings, PJ is suggested to contain antimutagenic and anticarcionogenic compounds.
Animals ; Cell Line, Tumor ; Cell Survival/*drug effects ; Formazans/chemistry ; Gap Junctions/*metabolism ; Humans ; Mutagenicity Tests ; Petasites/*metabolism ; Plant Extracts/*pharmacology ; Plant Leaves/metabolism ; Rats ; Tetrazolium Salts/chemistry

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental contaminants present in air and food. Among PAHs, benzo(a)pyrene(BaP), phenanthrene (PH) and pyrene (PY) are considered to be important for their toxicity or abundance. To investigate the changes of biomarkers after PAH exposure, rats were treated with BaP (150 microgram/kg) alone or with PH (4,300 microgram/kg) and PY (2,700 microgram/kg) (BPP group) by oral gavage once per day for 30 days. 7-ethoxyresorufin-O-deethylase activity in liver microsomal fraction was increased in only BaP groups. The highest concentration (34.5 ng/g) of BaP, was found in muscle of rats treated with BaP alone at 20 days of treatment; it was 23.6 ng/g in BPP treated rats at 30 days of treatment. The highest PH concentration was 47.1 ng/g in muscle and 118.8 ng/g in fat, and for PY it was 29.7 ng/g in muscle and 219.9 ng/g in fat, in BPP groups. In urine, 114-161 ng/ml 3-OH-PH was found, while PH was 41-69 ng/ml during treatment. 201-263 ng/ml 1-OH-PY was found, while PH was 9-17 ng/ml in urine. The level of PY, PH and their metabolites in urine was rapidly decreased after withdrawal of treatment. This study suggest that 1-OH-PY in urine is a sensitive biomarker for PAHs; it was the most highly detected marker among the three PAHs and their metabolites evaluated during the exposure period and for 14 days after withdrawal.
Adipose Tissue/chemistry/drug effects ; Animals ; Benzo(a)pyrene/analysis/metabolism/*toxicity ; Biological Markers/metabolism/urine ; Blood Chemical Analysis ; Body Weight/drug effects ; Cytochrome P-450 CYP1A1/metabolism ; Environmental Pollutants/blood/metabolism/*toxicity/urine ; Female ; Liver/drug effects/enzymology ; Lymphocytes/drug effects/metabolism ; Muscle, Skeletal/drug effects/metabolism ; Organ Size/drug effects ; Phenanthrenes/blood/metabolism/*toxicity/urine ; Pyrenes/analysis/metabolism/*toxicity ; Rats ; Rats, Sprague-Dawley ; Time Factors

OBJECTIVE: A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG®, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model. METHODS: Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections. RESULTS: At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group. CONCLUSION: The current study suggests that the TSAA agent, Guardix-SG®, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion.
Cicatrix ; Collagen ; Inflammation ; Laminectomy* ; Lumbar Vertebrae ; Rabbits

OBJECTIVE: Incidence of chronic subdural hematoma (CSDH) is gradually increasing in young adults for several reasons. In this study, we aimed to identify features of CSDH noted in young adults that distinguish the disease from CSDH diagnosed in the elderly. METHODS: One hundred eighty-two patients with CSDH who underwent a total of 218 surgical procedures between January 2003 and February 2010 were retrospectively reviewed with regard to clinical presentation, radiographic results and prognosis including recurrence. To compare younger patients with the elderly, patients were divided into three groups on the basis of age (Group A: < or =40, Group B: 41-64, Group C: > or =65 years). RESULTS: Group A showed a male predominance (p=0.0001), lower rate of recurrence (p=0.0012), shorter symptom duration (p=0.035), and fewer leading signs such as hemispheric symptoms (p=0.005) compared to Groups B and C. Radiologic findings such as maximal hematoma thickness (p<0.0001) and degree of midline shift (p=0.028) were less severe in Group A than Groups B and C. Alcoholism was the most prevalent illness in all three groups. When exempting infants with hematologic malignancy, non-recurrence, previous trauma history, headache as leading symptom, and no mortality were all common in younger adults (all p<0.05). CONCLUSION: Young adults with CSDH show less severe clinical and radiologic features as well as fewer recurrences than noted in the elderly population. Even if a clinician's index of suspicion of CSDH in young adults complaining of headache is not high, meticulous radiologic surveillance could find CSDH, leading to satisfactory results including less frequent recurrence.
Adult ; Aged ; Alcoholism ; Headache ; Hematologic Neoplasms ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Incidence ; Infant ; Male ; Prognosis ; Recurrence ; Retrospective Studies ; Young Adult

Occlusion or stenosis of subclavian artery by atherosclerosis is uncommon pathology compare to atherosclerosis of lower extremity. Most of the cases involve left subclavian artery and show vertebral-basilic ischemia and/or arm ischemia. Surgical intervention including bypass or transposition are performed to relieve the symptoms of obstruction but percutaneous intraluminal angioplasty and insertion of stent also be done with comparable results. Here we report 4 cases of symptomatic subclavian artery occlusion which have been managed by authors, and summarize all the cases reported in korean literature.
Angioplasty ; Arm ; Arteries ; Atherosclerosis ; Constriction, Pathologic ; Extremities ; Ischemia ; Lower Extremity ; Pathology ; Stents ; Subclavian Artery*

No abstract available.
Hemolytic-Uremic Syndrome*

BACKGROUND: The most important hemodynamic disturbance in patients with hypertension is an increase in peripheral vascular resistance due to arteriolar constriction. The most desirable way to lower blood pressure is to decrease peripheral vascular resistance without any adverse effects to cardiovascular function. Accordingly, both alpha and beta-adrenoceptor antagonists are effective drugs for the treatment of hypertension. Amosulalol, a new drug which blocks both sympathetic nerve alpha and beta-receptors, has been developed. METHODS: In order to investigate the efficacy and safety of oral amosulalol on essectial hypertension, a daily dodse of 20mg to 60mg amosulalol was administered in 31 hypertensive patients(male : 14, female : 17, mean age : 52.7+/-7.9) with diastolic blood pressure in the range of 95mmHg-120mmHg while off all other anti-hypertensive agents. Blood pressure and heart rate were measured every 2 weeks. The complete blood count, blood chemistry by SMA-12 and derum electrolytes and urinalysis were performed at entry, 1st and 8th week of therapy. RESULTS: 1) Baseline blood pressure after 2 weeks of placebo at sitting positing were 167.5+/-12.0/107.8+/-6.6mmHg. There was statistically significant reduction of blood pressure after 2 weeks treatment of amosulalol which was maintained up to 8 weeks(167.5+/-12.0/107.8+/-6.6mmHg vs 157.9+/-12.4/103.7+/-9.5mmHg, P<0.05). There was a significant reduction of systolic and diastolic pressures after the treatment when comparing the average value of two observation periods with that of treatment period(161.1+/-31.6/104.8+/-20.3mmHg vs 145.1+/-13.5/94.7+/-8.8mmHG, P<0.05). 2) The proportion of the patient who had a tendency to decline of bloop pressure after treatment with amosulalol was 94%. When considering the safety and efficacy, 94% of patients demonstrated to be safe and efficacious. 3) There was a significant decrease of heart rate after amosulalol without severe bradycardia(72.7+/-8.3/min vs 67.5+/-7.2/min, p<0.05). 4) There were no significant changes in blood chemistry, serum electrolytes. hematologic findings except two patients who showed slight bilirubin elevation over the treatment period. 5) One patient experienced dizziness that requires to discontinue the medication. CONCLUSION: In patients with mild to moderate hypertension, twice daily amosulalol(20mg, 40mg and 60mg) provided significant anti-hypertensive effects without serious side effects.
Antihypertensive Agents ; Bilirubin ; Blood Cell Count ; Blood Pressure ; Chemistry ; Constriction ; Dizziness ; Electrolytes ; Female ; Heart Rate ; Hemodynamics ; Humans ; Hypertension* ; Urinalysis ; Vascular Resistance