PURPOSE: To report our initial experience with laparoscopic mini-gastric bypass (LMGB) in Korean obese patients.MATERIALS AND METHODS: From July 2016 to February 2018, 14 male patients underwent LMGB for morbid obesity at a single institution. Five trocars were placed in a U-shape formation and 1 trocar was placed at the epigastrium as a liver retractor; a window was created between the vagal nerve and lesser curvature at the gastric angle for entering the lesser sac; a narrow gastric tube (~100–120 ml volume) was made; a linear-stapled gastrojejunostomy was created after bypassing the jejunum 200 cm from the Treitz' ligament; and the Petersen defect was closed to prevent internal hernia. Patient demographics, operative time, estimated blood loss, postoperative hospital stay, complications, weight loss, and resolution of comorbidities were evaluated during 1 year of follow-up.RESULTS: All procedures were successful by laparoscopy. The average age was 29 (19–49) years; weight, 164.9 (127-250) kg; and body mass index, 51.0 (42.4–81.6) kg/m². In 1 case, nephrectomy was simultaneously performed for early renal cell carcinoma. The mean operative time was 148.8 (120-175) min. The mean postoperative hospital stay was 1.9 (1–4) days. The percentage excess weight loss at 1, 3, 6, 9, and 12 months was 16.6%, 31.0%, 41.4%, 45.4%, and 50.4%, respectively. The resolution rate of type 2 diabetes mellitus, hypertension, and dyslipidemia was 75%, 40%, and 66.7%, respectively. There was no major complication including mortality during the follow-up.CONCLUSION: LMGB is a technically simple, safe, and effective procedure in Korean obese patients.
Bariatric Surgery ; Body Mass Index ; Carcinoma, Renal Cell ; Comorbidity ; Demography ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Follow-Up Studies ; Gastric Bypass ; Hernia ; Humans ; Hypertension ; Jejunum ; Laparoscopy ; Length of Stay ; Ligaments ; Liver ; Male ; Mortality ; Nephrectomy ; Obesity, Morbid ; Operative Time ; Peritoneal Cavity ; Postoperative Hemorrhage ; Surgical Instruments ; Weight Loss

BACKGROUND: Free fibular flap is one of the most useful methods in the hard tissue reconstruction of the maxilla-mandible. Free fibular flap presents some advantages in which the reconstruction of both soft and hard tissues can be done at the same time. It also provides a safe and successful bone graft for the reconstruction, along with a low rate of complications. Despite these advantages and the rarity of a postoperative complication, particularly in oral and maxillofacial surgery procedures, a prolonged operation might exhibit some complications related with rhabdomyolysis. We experienced the rare event of rhabdomyolysis after oral cancer surgery. CASE PRESENTATION: In this article, we report the case of a patient who developed rhabdomyolysis after undergoing free fibular flap surgery. CONCLUSIONS: Despite the advantages of the free fibular flap operation, clinicians must be aware of the risk of complications because there are multiple factors that could result in rhabdomyolysis, such as duration of operation, position of the subject, and pre-existing conditions of diabetes and hypertension. Once the diagnosis of rhabdomyolysis is confirmed, a prompt treatment plan should be made and applied as soon as possible. This will increase the chance of a full recovery for the patient who is exhibiting symptoms of rhabdomyolysis.
Diagnosis ; Humans ; Hypertension ; Mandibular Reconstruction ; Mouth Neoplasms ; Postoperative Complications ; Preexisting Condition Coverage ; Renal Insufficiency ; Rhabdomyolysis ; Surgery, Oral ; Transplants

Obesity is a serious worldwide health problem causing numerous obesity-related comorbidities such as hyperlipidemia, hypertension, diabetes, and cardiovascular dysfunctions. Recently, many studies indicate that obesity is strongly related with high rate of renal lesions and reducing weight with surgical intervention can improve renal parameters in obese patients, but the effect of bariatric surgery on obesity-induced chronic kidney disease (CKD) is hardly documented. This review study shows that bariatric surgery demonstrates beneficial reduction in proteinuria and albuminuria leading to improve both glomerular hyperfiltration and chronic kidney disease in obese population. Yet, bariatric surgery is not a definite treatment of choice for the obese patients with CKD because of lack of evidence explaining the risk of complications following bariatric surgery and clarification on estimating glomerular filtration rate (eGFR) in obese patients. Future, high quality studies with a long term follow up are required to determine the effective durability of bariatric surgery on obese-related CKD patients.
Albuminuria ; Bariatric Surgery* ; Comorbidity ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Hyperlipidemias ; Hypertension ; Obesity ; Proteinuria ; Renal Insufficiency, Chronic*

Actins ; metabolism ; Adult ; Antigens, CD34 ; metabolism ; Carcinoma, Renal Cell ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Glomus Tumor ; metabolism ; pathology ; Hemangiopericytoma ; metabolism ; pathology ; Humans ; Hypertension ; etiology ; Juxtaglomerular Apparatus ; metabolism ; pathology ; surgery ; ultrastructure ; Kidney Neoplasms ; complications ; metabolism ; pathology ; surgery ; ultrastructure ; Nephrectomy ; Wilms Tumor ; metabolism ; pathology

Percutaneous catheter-based therapy has recently been introduced to decrease blood pressure by ablation of efferent and afferent sympathetic renal nerves. The patient described here had a seven-year history of hypertension and presented with poorly controlled blood pressure despite antihypertensive therapy with four different drugs. A 44-yr-old man underwent percutaneous renal denervation under local anesthesia using an ablation catheter. After six months of follow-up his blood pressure had dropped 49/37 mmHg with a decrease in 24-hr ambulatory BP of 20/18 mmHg. Renal Doppler ultrasound showed no significant stenosis in either renal artery. This is the first case of successful percutaneous renal denervation, which has recently become available in Korea.
Adult ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Heart Failure/complications ; Humans ; Hypertension/complications/*surgery ; Kidney/ultrasonography ; Male ; Renal Artery/radiography ; Republic of Korea ; Sympathectomy

This study investigated the effects of benazepril administered in the morning or evening on the diurnal variation of renin-angiotensin-aldosterone system (RAAS) and clock genes in the kidney. The male Wistar rat models of 5/6 subtotal nephrectomy (STNx) were established. Animals were randomly divided into 4 groups: sham STNx group (control), STNx group, morning benazepril group (MB) and evening benazepril group (EB). Benazepril was intragastrically administered at a dose of 10 mg/kg/day at 07:00 and 19:00 in the MB group and EB group respectively for 12 weeks. All the animals were synchronized to the light:dark cycle of 12:12 for 12 weeks. Systolic blood pressure (SBP), 24-h urinary protein excretion and renal function were measured at 11 weeks. Blood samples and kidneys were collected every 4 h throughout a day to detect the expression pattern of renin activity (RA), angiotensin II (AngII) and aldosterone (Ald) by radioimmunoassay (RIA) and the mRNA expression profile of clock genes (bmal1, dbp and per2) by real-time PCR at 12 weeks. Our results showed that no significant differences were noted in the SBP, 24-h urine protein excretion and renal function between the MB and EB groups. There were no significant differences in average Ald and RA content of a day between the MB group and EB group. The expression peak of bmal1 mRNA was phase-delayed by 4 to 8 h, and the diurnal variation of per2 and dbp mRNA diminished in the MB and EB groups compared with the control and STNx groups. It was concluded when the similar SBP reduction, RAAS inhibition and clock gene profile were achieved with optimal dose of benazepril, morning versus evening dosing of benazepril has the same renoprotection effects.
Animals ; Antihypertensive Agents ; administration & dosage ; Benzazepines ; administration & dosage ; CLOCK Proteins ; metabolism ; Circadian Rhythm ; Drug Chronotherapy ; Gene Expression Profiling ; Hypertension, Renal ; drug therapy ; physiopathology ; Kidney ; drug effects ; physiopathology ; surgery ; Male ; Nephrectomy ; Rats ; Rats, Wistar ; Renin-Angiotensin System ; drug effects ; Treatment Outcome

Catheter Ablation ; methods ; Humans ; Hypertension ; surgery ; Renal Artery ; Sympathectomy ; methods

Catheter Ablation ; methods ; Humans ; Hypertension, Renal ; surgery ; Kidney ; innervation ; surgery ; Sympathectomy

BACKGROUND AND OBJECTIVES: The maze procedure is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). We compared the left atrial mechanical function (LAMF) of patients whose rhythm was converted to SR after maze procedure with that of patients whose rhythm was not converted to SR and determined if preoperative left atrial volume index (LAVI) and immediate postoperative LAMF could predict conversion of AF to SR. SUBJECTS AND METHODS: We prospectively evaluated 80 patients with AF treated with the maze procedure between March 2005 and February 2007. LAMF was assessed by looking at left atrial ejection volume (LAEV) and ejection fraction (LAEF) during echocardiography before, 2 weeks after, and 6 months after the procedure. RESULTS: Of the 80 enrolled patients, 71 were converted to SR after the maze procedure (SR group), and 9 were not converted to SR (AF group). There were no significant differences in age, sex, hypertension, diabetes mellitus, renal failure, stroke, thyroid dysfunction, or smoking history between the groups. Pre-operative LAVI (p=0.010) was a predictor of conversion of AF to SR. LAEF gradually increased in the SR group during follow-up, but not in the AF group. CONCLUSION: LAMF recovered in the SR group after the maze procedure, irrespective of clinical presentation and initial LAMF. Preoperative LAVI predicted SR conversion.
Atrial Fibrillation ; Atrial Function, Left ; Diabetes Mellitus ; Echocardiography ; Follow-Up Studies ; Humans ; Hypertension ; Mitral Valve ; Prospective Studies ; Renal Insufficiency ; Smoke ; Smoking ; Stroke ; Thoracic Surgery ; Thyroid Gland

BACKGROUND: Owing to the fact that the average life span has increased and the progress in medical science has been made, the number of patients with chronic renal failure (CRF) who have to take hemodialysis (HD) has been going up gradually. Accordingly, it is considered to be as a significant issue to obtain blood vessels which can be used repetitively and supply enough blood flows. Therefore, there have been various kinds of study on an inosculation rate andfactors influencing it following an arteriovenous fistula (AV fistula) and lots of studies are ongoing for the purpose of escalating the inosculation rate. The authors analyzed the effects of short-term result, age, sex, diabetes and hypertension on arteriovenous inosculations in 134 anatomical snuffbox operated subjects among the patients who have taken an AV fistula at this center. MATERIAL AND METHOD: Based on 134 patients who underwent an AV fistula at the department of thoracic surgery of this center from July, 2000 to May, 2004, the difference in arteriovenous inosculation rate was compared and analyzed depending on age (discriminated by 65-year-old), sex and the condition of the presence or absence of diabetes and hypertension. Correlation analyses were conducted for each parameter and statistical tests were performed by using SPSS for windows Release 11.0.1, which were determined to be statistically significant if p value was below 0.05. RESULT: The total number of operations was 169 including 35 of re-operations. The male/female rate was 70:64 (52%:48%). The average age was 56.3+/-12.26 years and there were 33 (24%) old aged patients above 65-year-old; there were 103 (71%) patients with hypertension and 90 (67%) patients with diabetes. Overall arteriovenous inosculation rate was 93+/-2.4%, 91+/-2.7%, 89+/-3.0% at 6, 12, 24 months, respectively. The arteriovenous inosculation rate of above 65-year-old patient group was 85+/-4.8%, 80+/-5.8%, 80+/-5.8% and below 64-year-old patient group's was 85+/-4.8%, 80+/-5.8%, 80+/-5.8% at given time points, respectively, which showed higher inosculation rate in below 64-year-old patient group with a statistical significance (p=0.0034). However, no statistical significance was found between the patients with hypertension and diabetes and the patients with no complication. In addition, there was no statistical significance in inosculation rate between male and female. CONCLUSION: The arteriovenous inosculation ratewas higher in the treated patient below 64-year-old than in the treated patient above 65-year-old. Thus it is advantageous for increase in long-term inosculation rate to obtain hemodialysis routes at an early age. The conditions of sex and the presence or absence of diabetes and hypertension do not make statistically significant effect on the arteriovenous inosculation rate.
Aged ; Arteriovenous Fistula* ; Blood Vessels ; Female ; Fistula ; Humans ; Hypertension ; Kidney Failure, Chronic* ; Male ; Middle Aged ; Renal Dialysis ; Thoracic Surgery