Simultaneous Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm Combined with Saccular Thoracic Aortic Aneurysm

With the recent increase in imaging tests, coexisting abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms (TAAs) are being discovered accidentally.We report two cases of simultaneous endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) for AAA and TAA. Both 74-year-old and 79-year-old male with infrarenal AAA and saccular TAA were treated simultaneously with EVAR and TEVAR. Saccular TAAs were identified in the upper thoracic aorta during the evaluation of AAA. During endograft placement, carotid-subclavian bypass and cerebrospinal fluid (CSF) drainage were performed. Both patients were successfully discharged without spinal cord ischemia. Simultaneous EVAR and TEVAR can be considered for patients with AAA and saccular TAA in the upper thoracic aorta. Moreover, CSF drainage may be necessary to protect the spinal cord.

A prospective study of the correlation between hepatic fibrosis and noninvasively measured fibrosis markers including serum M2BPGi and acoustic radiation force impulse elastography / 고신대학교의과대학학술지

Background@#Mac-2 binding protein glycosylation isomer (M2BPGi) was introduced as a noninvasively measurable serologic marker for liver fibrosis. Acoustic radiation force impulse imaging (ARFI) elastography is another noninvasive method of measuring hepatic fibrosis. There are limited data about the correlations between histologic fibrosis grade and noninvasively measured markers, including M2BPGi and ARFI. @*Methods@#This prospective study was conducted among patients admitted consecutively for liver resection, cholecystectomy, or liver biopsy. ARFI elastography, serum M2BPGi levels, and the AST to Platelet Ratio Index (APRI) score were evaluated before histologic evaluation. Histologic interpretation was performed by a single pathologist using the METAVIR scoring system. @*Results@#In patients with high METAVIR scores, M2BPGi levels and ARFI values showed statistically significant differences between patients with fibrosis and those without fibrosis. In 41 patients with hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels also tended to increase (p=0.161). ARFI values changed significantly as METAVIR scores increased (p=0.039). In 33 patients without hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels significantly increased (p=0.040). ARFI values also changed significantly as METAVIR scores increased (p=0.033). M2BPGi levels were significantly correlated with ARFI values (r=0.604, p<0.001), and APRI values (r=0.704, p<0.001), respectively. @*Conclusions@#Serum M2BPGi levels increased with liver fibrosis severity and could be a good marker for diagnosing advanced hepatic fibrosis regardless of the cause of liver disease.

Alpha-fetoprotein is correlated with intrahepatic recurrence of hepatocellular carcinoma after a hepatectomy

Purpose@#Intrahepatic recurrence has a significant effect on the survival of hepatocellular carcinoma (HCC) patients. We aimed to determine if there are useful indicators in predicting the recurrence of liver cancer after a hepatic resection. @*Methods@#We retrospectively reviewed medical records of 210 HCC patients who underwent hepatectomy between January 2009 and December 2015. We examined clinic-pathological variables comparing 2 groups of HCC patients, either intrahepatic recurrence or not. @*Results@#We divided 184 patients into 2 groups; 94 patients (51.1%) with intrahepatic recurrence and 90 patients (48.9%) without intrahepatic recurrence. Multivariate analysis showed operation type, preoperative α-FP, postoperative protein induced by vitamin K absence-II (PIVKA-II) elevation, and multiple tumor number were closely associated with intrahepatic recurrence. The preoperative PIVKA-II level was not statistically significant in postoperative intrahepatic recurrence rate. The recurrence rate was 46.2% in 132 of 184 cases of α-FP 200 ng/mL was 38 of 184 cases, 21 of which recurred (55.3%). According to the multivariate analysis, OR ratio was 8.003 (95% confidence interval [CI], 1.549–41.353) in the α-FP 100–200 ng/mL group and 1.867 (95% CI, 0.784–4.444) in α-FP 200 ng/mL or higher group (P = 0.013). Three-year survival rate of intrahepatic recurrence patients was 80.7%, 3-year survival rate of no intrahepatic recurrence patients was 95.0%. @*Conclusion@#The intrahepatic recurrence rates were high in the group preop α-FP over 100 ng/mL. Close observation is needed. Prospective study for α-FP genes of HCC patients should be planned for predicting intrahepatic recurrence after hepatectomy.

Influence of Androgen Receptor Expression on the Survival Outcomes in Breast Cancer: A Meta-Analysis / 한국유방암학회지

PURPOSE: Despite the fact that the androgen receptor (AR) is known to be involved in the pathogenesis of breast cancer, its prognostic effect remains controversial. In this meta-analysis, we explored AR expression and its impact on survival outcomes in breast cancer. METHODS: We searched PubMed, EMBASE, Cochrane Library, ScienceDirect, SpringerLink, and Ovid databases and references of articles to identify studies reporting data until December 2013. Disease-free survival (DFS) and overall survival (OS) were analyzed by extracting the number of patients with recurrence and survival according to AR expression. RESULTS: There were 16 articles that met the criteria for inclusion in our meta-analysis. DFS and OS were significantly longer in patients with AR expression compared with patients without AR expression (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.40-0.90; OR, 0.53; 95% CI, 0.38-0.73, respectively). In addition, hormone receptor (HR) positive patients had a longer DFS when AR was also expressed (OR, 0.63; 95% CI, 0.41-0.98). For patients with triple negative breast cancer (TNBC), AR expression was also associated with longer DFS and OS (OR, 0.44, 95% CI, 0.26-0.75; OR, 0.26, 95% CI, 0.12-0.55, respectively). Furthermore, AR expression was associated with a longer DFS and OS in women (OR, 0.42, 95% CI, 0.27-0.64; OR, 0.47, 95% CI, 0.38-0.59, respectively). However, in men, AR expression was associated with a worse DFS (OR, 6.00; 95% CI, 1.46-24.73). CONCLUSION: Expression of AR in breast cancer might be associated with better survival outcomes, especially in patients with HR-positive tumors and TNBC, and women. Based on this meta-analysis, we propose that AR expression might be related to prognostic features and contribute to clinical outcomes.

Successful Access Rate and Risk Factor of Vascular Access Surgery in Arm for Dialysis

PURPOSE: Preservation of adequate vascular access is of vital importance for patients undergoing chronic dialysis in renal failure. The aim of this study is to evaluate the successful access rate and risk factors of arteriovenous fistula (AVF) in the arm for dialysis at a single center. MATERIALS AND METHODS: Patients undergoing vascular access operation between January 2006 and December 2011 were retrospectively identified. RESULTS: A total of 362 vascular access operations were performed. There were 338 autologous AVFs (93.4%) and 24 prosthetic grafts (6.6%). Men comprised 58.3% of all subjects. Mean age was 59.5+/-14.7 years. There were 187 diabetes mellitus patients (51.7%). There was a mean duration of 70.3+/-21.1 days between access creation to first cannulation. Overall successful access rate for dialysis was 95.9%. Of 338 autologous AVFs, 326 patients had patent AVFs for dialysis (96.4% surgical success rate), while 21 of 24 prosthetic grafts were patent (87.5% surgical success rate). A total of 141 patients (38.9%) came to surgery with preoperative central venous catheters (CVC) of which 130 (35.9%) AVFs had a patent fistula in the arm. The only risk factor related to successful access rate of AVF was preoperative CVC placement (P=0.012). CONCLUSION: Successful vascular access rate was 95.9%. The only risk factor related to patent access of AVF was preoperative CVC placement. At least 6 months prior to expected dialysis, AVF surgery is recommended, which may overcome the challenge of co-morbid conditions from having a preoperative CVC.

Vitamin C modulates lead excretion in rats / 대한해부학회지

Lead, one of the most toxic heavy metals, takes longer time to be excreted from the body than other heavy metals. The purpose of this study is, by measuring lead excretion via urine and feces, to find out the effect of vitamin C in lead chelation. Thirty-six rats were randomly assorted into four groups. All 33 rats except for the control group were administered with lead, before orally administered with different doses of vitamin C per kilogram of body weight. The lead excretion levels in urine and feces as well as the survival rate were then measured for each group. The rats with lead administrations (10/13, 76.9%) with lead administrations only, 10/11 rats (90.9%) with lead administrations and low dose of vitamin C, 9/9 rats (100%) with lead administrations and high dose of vitamin C survived. Among the 29 surviving rats, low vitamin C intake group exhibited higher urinary excretion than the lead only group. The urinary excretion level in high dose vitamin C intakegroup was significantly higher than the lead only group. In addition, fecal lead excretion seemed to be increased in the high dose vitamin C intake group, compared to the group with lead administrations only with statistical significance. Through animal experiment, it was found out that administrating high dose of vitamin C accelerated the excretion of lead in body compared to low dose of vitamin C.

Intrahepatic and extrahepatic intraductal papillary neoplasms of bile duct

There has been an increase in the number of reported cases of biliary neoplasm of the hepatobiliary system characterized by markedly dilated and multifocal papillary epithelial lesions of the bile ducts or cystic biliary lesions with or without mucin secretion, and mucinous lesions or tumors, possibly due to recent advances in radiological diagnosis. This lesion of the bile duct is believed to show a better clinical course than non-papillary biliary neoplasm. Therefore, the early recognition and treatment is important. We report two cases of intrahepatic and extrahepatic intraductal papillary neoplasm of the bile duct that were completely resected.

Portal Vein Anastomosis with using Growth Factor for Preventing Stricture and Thrombosis following Auxiliary Partial Liver Transplantation in Rat

PURPOSE: To overcome donor shortage, reduced-size liver transplantation, split-liver transplantation and partial liver transplantation from living donors for children are frequently used all over the world. Despite the difficulties of adequate volume reduction and the age difference between the donor and the recipent, all these techniques also share the problem of size mismatch between the vessels of the adult liver and those of the pediatric recipient. Portal vein reconstruction in a crucial factor for a successful transplantation because it allows blood flow to the liver graft, which ends the ischemic period for the graft, as well as the anhepatic period for the recipient. METHODS: In Group I (n=10, no growth factor), a partial liver of Sprague-Dawley(SD) rat was transplanted heterotopically, via microsurgical technique, to a SD rat with performing end-to-end portal vein anastomosis without applying growth factor to the suture of the portal vein. In Group II (n=10, 50-60% growth factor), a partial liver of a SD rat was transplanted heterotopically to a SD rat, via microsurgical technique, with applying growth factor to 50-60% of the diameter of the portal vein. In Group III (n=10, 80-100% growth factor), the portal vein was anastomosed, via microsurgical technique, with using growth factor to 80-100% of the diameter of the portal vein. RESULTS: In Group II, only one case has portal vein stenosis on the postoperative 14th day following portal vein anastomosis with growth factor. In Group I, 3 cases showed portal vein stenosis on the postoperative 7th day, and 5 cases showed portal vein thrombosis on the postoperative 14th day. In Group III, 6 cases died due to bleeding after declamping of the portal vein anastomosis with using 80-100% growth factor on the diameter and 1 case has portal vein thrombosis on the postoperative 14th day. CONCLUSION: Several surgical factors might have an important role in preventing vascular stenosis and thrombosis, and especially when transplanting a technical-variant liver graft like a reduced-size or split liver graft. To overcome the small caliber of the portal vein and the difference in caliber between the donor and recipient vessels, the growth-factor suture technique having 50-60% of one diameter might be helpful because it allows for expansion along the suture line and it also prevents a purse-string effect.

The Survival Rate of Gallbladder Carcinoma Based on the presence of Lymph Node Metastasis and the Depth of the Primary Tumor Invasion

PURPOSE: Carcinoma of the gallbladder is an aggressive, late-symptomatic disease and most patients are treated at an advanced stage, and these patients have a poor prognosis. During recent years, extended operations that combine a resection of the liver with wide lymph node dissection have improved the long-term survival. The aim of this study is to evaluate the surgical outcome for gallbladder carcinoma based on the presence of lymph node metastasis and the depth of the primary tumor invasion. METHODS: A retrospective analysis was done on 68 patients who underwent a surgical resection of gallbladder carcinoma from 1997 to 2004. The factors that nfluenced the 5-year survival were examined. RESULTS: The overall 5-year survival rate was 49.6%. The lymph node metastasis rate was 40.0% in T2 disease and 61.1% in T3/T4 disease. The 5-year survival rate (5-YSR) for T2 disease was 52.1% for the patients who underwent cholecystectomy with lymph node dissection and hepatic resection, and it was 51.2% for the patients who underwent only simple cholecystectomy. The 5-YSR for T3/T4 disease was 33.3% for the patients who underwent extended cholecystectomy, and it was 12.9% for the palliative cholecystectomy patients. CONCLUSION: The role of radical surgery seems to be limited for patients with more extensive tumor invasion or lymph node metastasis.

Low Dose Carbon Monoxide Inhalation Prevents Chronic Allograft Nephropathy following Kidney Transplantation in Rats. Heme Oxygenase-1 Derivatives Study I

PURPOSE: Carbon monoxide (CO), a product of heme catalysis by heme oxygenase (HO-1, HO-2, HO-3), induces cytoprotection against ischemia/reperfusion (I/R) injury in a variety of organs such as the heart, lungs, kidneys, and liver. I examined whether CO would prevent chronic allograft nephropathy (CAN) associated with renal transplantation in rats. METHODS: Kidneys from male Fisher rats were perfused and harvested for transplantation. Lewis rats were used as recipients. After reperfusion of the implanted kidney, the recipient's remaining kidney was removed promptly. Recipients were then immediately treated with the indicated regimen of CO in a Plexiglas exposure chamber. At 90 days after transplantation, the animals were sacrificed for graft histopathology, serum creatinine, and blood urea nitrogen (BUN) as markers of kidney function. RESULTS: CAN in rats was achieved using a model of Fisher-to-Lewis transplants and evaluating kidney function over the 90 days following transplantation. CO administered at 100 ppm for 1 hr/day for 7 days prevented CAN at 90 days post-transplant. CO also decreased histopathological alterations, including leukocyte infiltration and cell death. CONCLUSION: These data expand our understanding of the protective effects of low-dose CO inhalation in preventing the development of chronic fibro-inflammatory changes associated with chronic allograft nephropathy and allow us to devise methods for improving long-term renal allograft function.