Long-term clinical outcomes after endovascular management of ruptured pseudoaneurysm in patients undergoing pancreaticoduodenectomy

PURPOSE: Recent studies have analyzed the short-term clinical outcomes of ndovascular management. However, the long-term outcomes are unknown. This study aimed to investigate clinical outcomes after endovascular management for ruptured pseudoaneurysm in patients after pancreaticoduodenectomy (PD). METHODS: The medical records of 2,783 patients who underwent PD were retrospectively reviewed at a single center. Of 62 patients who received intervention after pseudonaeurysm rupture, 57 patients (91.9%) experienced eventual success of hemostasis. The patients were composed as follows: (embolization only [EMB], n = 30), (stent-graft placement only [STENT], n = 19) and (both embolization and stent-graft placement simultaneously or different times [EMB + STENT], n = 8). Long-term complications were defined as events that occur more than 30 days after the last successful endovascular treatment. RESULTS: Among 57 patients, short-term stent-graft related complications developed in 3 patients (5.3%) and clinical complication developed in 18 patients (31.5%). Nine (15.8%) had long-term stent-graft related complications, which involved partial thrombosis in 5 cases, occlusion in 3 cases and migration in 1 case. Except for 1 death, the remaining 8 cases did not experience clinical complications. The stent graft primary patency rate was 88.9% after 1 month, 84.2% after 1 year, and 63.2% after 2 years. Of 57 patients, 30 days mortality occurred in 8 patients (14.0%). CONCLUSION: After recovery from initial complication, most of patients did not experience fatal clinical complication during long-term follow-up. Endovascular management is an effective and safe management of pseudoaneurysm rupture after PD in terms of long-term safety.

Portal Vein Stenting for Delayed Jejunal Varix Bleeding Associated with Portal Venous Occlusion after Hepatobiliary and Pancreatic Surgery

OBJECTIVE: The study aimed to describe portal stenting for postoperative portal occlusion with delayed (≥ 3 months) variceal bleeding in the afferent jejunal loop. MATERIALS AND METHODS: Eleven consecutive patients (age range, 2–79 years; eight men and three women) who underwent portal stenting between April 2009 and December 2015 were included in the study. Preoperative medical history and the postoperative clinical course were reviewed. Characteristics of portal occlusion and details of procedures were also investigated. Technical success, treatment efficacy (defined as disappearance of jejunal varix on follow-up CT), and clinical success were analyzed. Primary stent patency rate was plotted using the Kaplan-Meier method. RESULTS: All patients underwent hepatobiliary-pancreatic cancer surgery except two children with liver transplantation for biliary atresia. Portal occlusion was caused by benign postoperative change (n = 6) and local tumor recurrence (n = 5). Variceal bleeding occurred at 27 months (4 to 72 months) and portal stenting was performed at 37 months (4 to 121 months), on average, postoperatively. Technical success, treatment efficacy, and clinical success rates were 90.9, 100, and 81.8%, respectively. The primary patency rate of portal stent was 88.9% during the mean follow-up period of 9 months. Neither procedure-related complication nor mortality occurred. CONCLUSION: Interventional portal stenting is an effective treatment for delayed jejunal variceal bleeding due to portal occlusion after hepatobiliary-pancreatic surgery.

Usefulness of intraopertive ultrasonography during directional atherectomy using SilverHawk/TurboHawk system

PURPOSE: Directional atherectomy (DA) was introduced for the management of infrainguinal arterial stenosis or occlusive lesions. The procedure success rate in the DEFINITIVE LE study was determined using radiologic imaging. The aim of our study was to determine the usefulness of intraoperative ultrasonography (USG) during DA for evaluating the early results of this procedure. METHODS: Patients who underwent DA from January to December 2014 were reviewed retrospectively. Twenty lesions from 14 patients with femoral artery stenosis (>70% stenosis) with short segment occlusive lesions (<2 cm in length) were treated. Among 20 lesions, 3 were treated with the TurboHawk system with a protective device due to lesion calcification. The percentage of stenosis during and after DA was determined with USG. RESULTS: Median follow-up was 5.1 months, and the procedural success rate (<30% stenosis at the end of the procedure) was 100% on angiography, but only 30% on intraoperative USG. On USG, median residual stenosis was 40% (range, 28%–42%) at the end of DA, 40% (range, 30%–55%) at 1 month, 55% (range, 35%–85%) at 6 months, and 64% (range, 60%–100%) at 1 year. There was one dissection, but no cases of perforation, pseudoaneurysm, or thrombosis. Primary patency, which was defined as a peak systolic velocity ratio ≤3.5 with no reintervention at 6 months, was found in 18 lesions (90%), and 11 of 14 patients (78.6%) were free of ischemic symptoms such as claudication at 6 months. CONCLUSION: Our results demonstrated that DA with intraoperative USG is an effective treatment option for short segment occlusive lesions of the femoral artery.

Anaphylaxis after consumption of abalone

Abalone is popular seafood in Asia; however, allergy to abalone was rarely reported. We report a case of anaphylaxis after consumption of abalone. A 24-year-old female visited an Emergency Department, complaining of cough, dyspnea, rhinorrhea, generalized urticaria, facial edema, and wheezing that had developed 1 hour after consumption of abalone. She was discharged when her symptoms subsided after antihistamine and dexamethasone were given. One month later, she was referred to our outpatient clinic. We performed skin prick tests, measurement of serum specific IgE antibody level, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) with IgE immunoblotting. Both skin prick and specific IgE antibody tests were positive for abalone crude extract. In SDS-PAGE with IgE immunoblotting, we identified possible antigens sized 55, 100, and 25 kDa, respectively. This is the first case of abalone-induced anaphylaxis in Korea.

Sensitization to animal allergens and allergic symptoms during exposure to them in Korean veterinary researchers

PURPOSE: Veterinary researchers are exposed to variable animal allergens. However, sensitization to them and allergic symptoms during exposure to them in this group are not sufficiently evaluated worldwide, especially in Korea. The objective of this study is to evaluate sensitization to animal allergens and allergic symptoms during exposure to them in Korean veterinary researchers. METHODS: Thirty-two veterinary researchers who participated in the 2016 annual symposium of the Korean Society of Veterinary Science were asked to answer questionnaires regarding allergic symptoms during animal exposure and underwent skin prick tests for animal allergens. Animal allergens consisted of chicken feather and 10 mammals, epithelia as well as cow's milk, hen's egg, and 7 animal types of meat. RESULTS: There were 13 subjects who complained of allergic symptoms during exposure to certain animal epithelia and 19 who did not. Between the 2 groups, there were no differences in age, sex, underlying allergic disease, family history of allergy, current occupation and its duration, numbers and specie of contact animals, or daily contact time. Meanwhile, the sensitization rates to mouse, horse, rabbit, and guinea pig were significantly higher in the symptomatic group. Rhinoconjunctivitis symptoms were the most common allergic symptoms related to animal exposure were most common followed by dermatologic symptom, and symptom of lower respiratory tract. CONCLUSION: We found that sensitizations to some animal epithelia were more frequent in Korean veterinary researchers with allergic symptoms during exposure to animal compared to those without it, and their most common symptoms were rhinoconjunctivitis symptoms.

Experience of direct percutaneous sac injection in type II endoleak using cone beam computed tomography

Cone beam CT, usually used in dental area, could easily obtain 3-dimensional images using cone beam shaped ionized radiation. Cone beam CT is very useful for direct percutaneous sac injection (DPSI) which needs very precise measurement to avoid puncture of inferior vena cava or vessel around sac or stent graft. Here we describe two cases of DPSI using cone beam CT. In case 1, a 79-year-old male had widening of preexisted type II endoleak after endovascular aneurysm repair (EVAR). However, transarterial embolization failed due to tortuous collateral branches of lumbar arteries. In case 2, a 72-year-old female had symptomatic sac enlargement by type II endoleak after EVAR. However, there was no route to approach the lumbar arteries. Therefore, we performed DPSI assisted by cone beam CT in cases 1, 2. Six-month CT follow-up revealed no sign of sac enlargement by type II endoleak.

Modulation of Alpha 1 Adrenergic Receptors on Urinary Bladder in Rat Spinal Cord Injury Model / 대한배뇨장애요실금학회지

PURPOSE: Whereas many studies have focused on the vesical changes of the alpha1 adrenergic receptor (AR) subtypes in partial outlet obstruction, few studies have addressed the modulation of the alpha1 AR subtypes after spinal cord injury (SCI). Therefore, we studied the modulation of the alpha1 ARs in urinary bladder in a rat SCI model. METHODS: Four weeks after a SCI, the whole vesical bodies from eight female Sprague-Dawley rats and from eight controls were harvested. The total RNA was extracted from the samples and was used to prepare cDNA. We developed standard plasmid constructs of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and three alpha1 ARs (alpha1a, alpha1b, and alpha1d) to convert the cycle threshold (Ct) values from real-time polymerase chain reaction (RT-PCR) into subtype mRNA concentrations. The detected Ct values of 16 samples from RT-PCR were interpolated into the standard plasmid curves. RESULTS: All serially diluted standard samples showed very good linearity. The mRNA expression of GAPDH was higher in the SCI group, whereas the mRNA expression of all alpha1 ARs was lower in the SCI group than in the control animals. The alpha1a, alpha1b, and alpha1d mRNA expression in the controls was 81.7%, 3.3%, and 15.1%, respectively, whereas the alpha1a, alpha1b, and alpha1d mRNA expression in the SCI group was 33.5%, 5.2%, and 60.9%, respectively. CONCLUSIONS: SCI moderates the alpha1 AR mRNA subtypes in the urinary bladder. The relatively increased alpha1d or decreased alpha1a AR mRNA expression may be a therapeutic candidate for controlling the symptoms of neurogenic bladder after SCI.

Ten year outcomes after bypass surgery in aortoiliac occlusive disease / 대한외과학회지

PURPOSE: Most outcome studies of bypass surgery are limited to five years of follow-up. However, as human life expectancy has increased, analyses of more long-term outcomes are needed. The aim of this study is to evaluate 10-year outcomes of anatomical bypasses in aortoiliac occlusive disease. METHODS: From 1996 to 2009, 92 patients (82 males and 10 females) underwent aortic anatomical bypasses to treat aortoiliac occlusive disease at Samsung Medical Center. The patients were reviewed retrospectively. Kaplan-Meier survival analyses were performed using PASW ver. 18.0 (IBM Co). RESULTS: A total of 72 patients (78.3%) underwent aorto-femoral bypasses (uni- or bi-femoral), 15 patients (16.3%) underwent aorto-iliac bypasses (uni- or bi-iliac), and 5 patients (5.4%) underwent aorto-iliac and aorto-femoral bypasses. The overall primary patency rates of the 92 patients were 86.2% over 5 years and 77.6% over 10 years. The 10-year limb salvage rate and overall survival rate were 97.7% and 91.7%, respectively. CONCLUSION: The overall patency rates of bypass graft and limb salvage rates decreased as time passed. The analysis of results after bypass surgery to treat arterial occlusive disease will be needed to extend for 10 years of follow-up.

Spontaneous aortic rupture in a patient with neurofibromatosis type 1 / 대한외과학회지

Neurofibromatosis type I (NF-1) is a rare autosomal dominant genetic disorder occurring in 1 in 3,000 individuals. Vasculopathy is a rarely reported finding in patients with NF-1. Here, we report a case of recurrent aortic pseudoaneurysm after endovascular aneurysm repair in a 49-year-old male patient with NF-1. On the sixth postoperative day following a successful open surgical repair of an aortic pseudoaneurysm, he developed hemoperitoneum due to a delayed rupture of the mesenteric artery branch. This was treated with endovascular coil embolization. We report the clinical features and histologic findings of this rare vascular disorder with a review of the relevant literature.

Natural History of Type II Endoleaks after Endovascular Aneurysm Repair in Abdominal Aortic Aneurysm / 대한혈관외과학회지

PURPOSE: Endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA) has shown excellent early outcomes. However, long-term durability continues to be questioned because of endoleaks. The optimal management of type II endoleaks remains controversial because little is known about their long-term natural history. The purpose of this study was to evaluate the natural history of type II endoleaks and to study factors associated with persistent type II endoleaks. METHODS: On a retrospective basis, we analyzed 98 patients who underwent EVAR for incidence and outcome of type II endoleaks. Patients with type II endoleaks were evaluated using computed tomography angiography or Duplex scans at one, 6 and 12 months after their EVAR, and annually thereafter to evaluate both the persistence of the endoleak and the size of the aneurysm sac. RESULTS: Type II endoleaks were detected during the follow-up periods in 38 patients (39.8%), who underwent EVAR (mean follow-up: 23.7 months). Spontaneous sealing of type II endoleaks by 6 months after EVAR occurred in 15 patients (39.4%), meaning that there were 23 patients (60.6%) whose leaks were ongoing for more than 6 months. Four patients were treated using embolization because of an enlarging aneurysm sac. CONCLUSION: Most type II endoleaks are transient and do not require intervention. However, particularly persistent endoleaks could lead to aneurysm enlargement and to delayed aortic rupture. We did not find a significant difference in any number of preoperative patient factors between patients with transient, persistent, or no type II endoleaks. Further studies based on independent data sets are needed to validate these results.