Endoscopic Sphincterotomy Plus Endoscopic Papillary Large Balloon Dilatation for Large Bile Duct Stones / 대한소화기내시경학회지

BACKGROUND/AIMS: The extraction of large common bile duct (CBD) stones after an endoscopic sphincterotomy (EST) is successful in 80~90% of cases but it often requires a prolonged time and repeated trials. This study investigated the utility of a combined endoscopic papillary large balloon dilatation (EPLBD) and a mid-incision of an EST (m-EST) method for the removal of large CBD stones. METHODS: Thirty patients with large CBD stones were enrolled in this study. EPLBD was carried out using the one-step inflation of a 15~18 mm diameter balloon after m-EST. RESULTS: The maximum stone diameter was 21.62+/-5.38 mm. Twelve patients had more than 4 stones, 7 patients had 2 stones, and the remainder had a single large stone. Complete ductal clearance was achieved in all patients. After the procedure, the serum amylase and/or lipase levels were elevated in 3 patients (13.3%). However, there was no episode of true pancreatitis. Minor bleeding was encountered in only one patient (3.3%), and was easily controlled by an endoscopic epinephrine injection. The procedure was carried out safely in 6 patients with periampullary diverticulum. No perforation or mortality was encountered. CONCLUSIONS: Combined EPLBD and m-EST is a safe and effective method, and may be a good alternative treatment for removing large CBD stones.

Generation of Nitric Oxide in the Opossum Lower Esophageal Sphincter during Physiological Experimentation

Lipopolysaccharide (LPS), given in vivo, modulates opossum esophageal motor functions by inducing the inducible nitric oxide synthase (iNOS), which increases nitric oxide (NO) production. Superoxide, a NO scavenger, is generated during this endotoxemia. Superoxide is cleared by superoxide dismutase (SOD) and catalase (CAT) to protect the physiological function of NO. This study examined whether lower esophageal sphincter (LES) motility, NO release, and iNOS and nitrotyrosine accumulation in the LES are affected by LPS in vitro. Muscle strips from the opossum LES were placed in tissue baths containing oxygenated Krebs buffer. NO release was measured with a chemiluminescence NOx analyzer, and Western blots were performed to analyze iNOS and nitrotyrosine production. The percent change in resting LES tone after a 6-hour exposure to LPS was significantly increased compared to pretreatment values. The percent LES relaxation upon electrical stimulation was significantly decreased in the control group at 6 hours, indicating that the LPS treatment had an effect. The NO concentration in the tissue bath of LPS-treated muscle without nerve stimulation was significantly less than that of LPS treatment combined with SOD/CAT or SOD/CAT alone. iNOS and nitrotyrosine were detectable and increased over time in the LES muscle of both the control and LPS-treated groups. Antioxidant enzymes may play a role in regulating NO-mediated neuromuscular functions in the LES.

Tubular Adenoma of the Common Bile Duct: Endoscopic Diagnosis and Treatment / 대한소화기내시경학회지

Biliary adenoma of the common bile duct is a rare disease found in biliary tract encounterd in biliary mass lesion, and it is difficult to differentiate from their malignant counterparts. Symptoms and signs of these tumors can mimic choleliathiasis and malignant tumors. Therefore, this tumor is rarely diagnosed preoperatively. In addition, there has been no reported case of a tubular adenoma of the common bile duct in Korea, until recently. We experienced a case of tubular adenoma of the common bile duct, which was diagnosed and partially resected by percutaneous transhepatic cholangioscopy. The patient was a 84-year-old male who showed abnormal liver function test. Abdominal ultrasonography showed a dilated common bile duct, and a soft tissue was observed on endoscopic retrograde cholangiography. This was initially thought as a stone, but it became partially detachable from the common bile duct during an endoscopic retrograde cholangioscopic basket removal. The mass lesion was partially resected by a percutaneous transhepatic cholangioscopic snare. This resected tissue was confirmed as a tubular adenoma.

A case of hypokalemic perodic paralysis induced by hyperinsulinemia / 대한내과학회지

Hypokalemia periodic paralysis, a clinical syndrome characterised by systemic weakness and low serum potassium, is a rare but treatable cause of acute weakness. Attacks of flaccid paralysis can be associated with hypokalemia triggered by insulin. Insulin reduce the conductance of the inward rectifier K+ channel for outward-flowing currents. Therefore, insulin potentiates depolarization of hypokalmeic periodic paralysis. We have experienced a case of hypokalemic periodic paralysis induced by hyperinsulinemia in 38-year old man, with complaint of intermittent paralysis of extremities. On admission, serum K+ was 2.1 mEq/L. He was no family history of muscle weakness. Thyroid function was normal. Serum levels of aldosterone, renin and cortisol were normal. Random plasma glucose level was 129 mg/dL and serum insulin was 131 uIU/mL. Shortly after intravenous supplementation of potassium, muscle weakness was improved. Oral glucose tolerance test revealed impaired glucose tolerance and hyperresponse of insulin and phosphate.

A Case of Mechanical Thrombolysis of Thrombosed Native Hemodialysis Fistula Using Arrow Trerotola Percutaneous Thrombolytic Device / 대한신장학회잡지

Adequate care of patients with end-stage renal failure on hemodialysis requires permanent vascular access. Arteriovenous fistula obstruction due to venous thrombosis is commonly observed complication, contributing significantly to morbidity and hospitalization of dialysis patients. Percutaneous intervention using angioplasty and thrombolysis has become an accepted treatment of thrombosed vascular access and demonstrates comparable technical results and patency rates with those of surgery. Recently developed percutaneous mechanical thrombectomy (PMT) uses mechanical energy to clear thrombus percutaneously in combination with mechanical dissolution, fragmentation, and aspiration. PMT offers fast thrombus removal without complications related to thrombolytic therapy. We report a case of thrombosed hemodialysis native fistula which was successfully treated with percutaneous angioplasty and mechanical thrombolysis using newly introduced Arrow-Trerotola percutaneous thrombolytic device.