Fibropolycystic disease: A case report / 한국간담췌외과학회지

Hepatobiliary fibropolycystic disease is cause of hepatosplenomegaly & portal hypertension. This disease entities was composed of polycystic liver disease, congenital hepatic fibrosis, choledochal cyst, Caroli's disease(communicating, cavernous biliary ectasia), & von Meyenburg's complex. Clinical symptoms are space occupying lesion, portal hypertension, & cholangitis. The pathogenesis of hepatobiliary fibropolycystic disease is unknown. Two theories has been suggested. In one, the basic defect is attributable to malformation of the embryonal ductal biliary plates. In the other theory, cyst formation occurs because of an abnormal pancreaticobiliary junction with resultant chronic pancreatic reflux into the biliary tree. We report a case of fibropolycystic disease with review of the literature.

The Results of Revascularization for Disabling Intermittent Claudication

PURPOSE: Traditionally vascular reconstruction has been reserved for patients with limb threatening ischemia. So, the surgery for claudication has been discouraged by the fear of bypass graft failure, limb loss, and significant perioperative complication that may be worse than the natural history of the disease. However, in a minority of patients with claudication, the symptoms progress and a severe disability can result, which limit normal daily activities. In these patients intervention may be regarded as worthwhile. METHODS: To evaluate the benefit or risk of revascularization that performed in patients with disabling or incapacitating intermittent claudication, the clinical data of patients who underwent the revascularization for disabling claudication at Yeungnam University hospital were collected and analyzed retrospectively. RESULTS: From January 1990 to June 1999, 98 patients with disabling claudication were performed the surgical or interventional management (13.7% of all lower limb arterial disease registration in our unit). The patients were 93 males and 5 females ranging from 35 to 76 years of age. The mean age was 59, with the highest incidence among people in their 50s, followed by those in their 60s and then in their 70s. History of smoking was noted in 82.7% of the cases. The major arterial occlusive site were aortoiliac artery in 42 cases (42.9%), femoral artery in 23 cases (23.5%), iliofemoral artery in 13 cases (13.3%), popliteal artery in 4 cases (4.1%), tibial artery in 5 cases (5.1%) and multi-level occlusion in 11 cases (11.2%). The operative procedures for disabling claudication were bypass graft operation in 70 cases, thromboembolectomy in 5 cases, endarterectomy in 4 cases and percutaneous transluminal angioplasty (PTA) in 19 cases. Arterial bypass operations were aortobifemoral or aortobipopliteal bypass in 17 cases, iliofemoral bypass in 8 cases, femoropopliteal bypass in 16 cases, femorotibial bypass in 3 cases, popliteotibial bypass in 6 cases, axillobifemoral bypass in 7 cases and femorofemoral bypass in 13 cases. In 98.4% of the operative cases, the early outcome was good with 3 to 2 rating according to Rutherford criteria and cumulative 12, 24, 60-month primary and secondary patency rates were 83.3%, 76.4%, 71.3% and 87.8%, 86.3%, 81.8%. The operative mortality rates were 0% and no limb loss was noted in this series. CONCLUSION: In summary, arterial reconstruction for disabling claudication is noted as safe and durable procedure in some selective patients. Therefore, surgical intervention are valid treatment option in selected patients with disabling claudication.

Noncancerous Right Portal Vein Occlusion: 2 cases / 한국간담췌외과학회지

Portal vein thrombosis is a rare condition occuring in association with a wide varitey of precipitation factors. Among these, advanced hepatoma constitute the major etiology of portal vein thrombosis. Noncancerous intrahepatic portal vein occlusion was reported in some cases of repeated cholangitis. Generally, Intrahepatic stones occures in Lt. lobe of liver and repeated inflammatory precesses occlude peripheral branch of Lt. portal vein. So, noncancerous Rt. portal vein occlusion is extremly rare condition. Two Patients visited our hospital with Rt. upper quadrant abdominal pain and fever. Preoperative abdominal ultrasonography, computerlized tomography, endoscopic retrograde cholagiopancreaticography revealed multiple Rt. intrahepatic stones and Rt. portal vein 1st branch occlusion. Rt. lobectomy of liver were performed. Pathologic reports were portal vein occlusion due to inflammatory thrombi, not tumor thrombi. Thus authors experienced 2 cases of Rt. portal vein 1st branch occlusion due to noncancerous benign condition, such as multiple intrahepatic stones, we report these cases with brief review of literature.