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Management of endoscopic retrograde cholangiopancreatography-related perforations
Byung Seup Kim,In-Gyu Kim,Byoung Yoon Ryu,Jong Hyeok Kim,Kyo Sang Yoo,Gwang Ho Baik,Jin Bong Kim,Jang Yong Jeon 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.3
Purpose: The purpose of this study is to analyze the treatment strategies of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. This is a retrospective study. Methods: We experienced 13 perforations associated with ERCP. We reviewed the medical recordsand classified ERCP-related perforations according to mechanism of injury in terms of perforating device. Injury by endoscopic tip or insertion tube was classified as type I, injury by cannulation catheter or sphincterotomy knife as type II, and injury by guidewire as type III. Results: Of four type I injuries, one case was managed by conservative management after primary closure with a hemoclip during ERCP. The other three patients underwent surgical treatments such as primary closure orpancreatico-duodenectomy. Of five type II injuries, two patients underwent conservative management and the other three cases were managed by surgical treatment such as duodenojejunostomy, duodenal diverticulization and pancreatico-duodenectomy. Of four type III injuries, three patients were managed conservatively and the remaining patient was managed by T-tube choledochostomy. Conclusion: Type I injuries require immediate surgical management after EPCP or immediate endoscopic closure during ERCP whenever possible. Type II injuries require surgical or conservative treatment according to intra- and retro-peritoneal dirty fluid collection findings following radiologic evaluation. Type III injuries almost always improve after conservative treatment with endoscopic nasobilliary drainage.
In-Gyu Kim,Byung Seup Kim,Jang Yong Jeon,Jae Woo Kwon,Joo Seop Kim,Doo Jin Kim,Jae Pil Jung,Seong Eun Chon,Han Joon Kim,Eui Yong Jeon,Min-Jeong Kim,Kwanseop Lee 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.3
Liver transplantation with preservation of the recipient vena cava (piggyback technique) has been performed as an alternative to the conventional method. Outflow disturbance or obstruction of the vena cava in the early period after liver transplantation is associated with high morbidity and mortality. We used side-to-side cavo-caval anastomosis (modified piggyback technique) in a deceased-donor liver transplantation (DDLT) for venous outflow reconstruction. On postoperative day 9, the patient developed abdominal discomfort, and abnormal liver function showing serum total bilirubin of 6.2 mg/dl and serum AST/ALT of 297/597 IU/L. Doppler ultrasound showed mono-phasic wave forms of the hepatic vein. Computed tomography showed focal narrowing of 9.5 mm±2 mm in diameter at the cavo-caval anastomosis site. Liver biopsy was showed that there was no evidence of acute allograft rejection. Direct venogram showed stenosis of the cavo-caval anastomosis with a pressure gradient of 12 mmHg. An interventional stent was inserted in the stenotic site of the inferior vena cava, and the pressure gradient decreased to 2 mmHg. He was discharged from hospital on postoperative day 23 without any other complications. Herein we report a case of deceased-donor liver transplantation using the modified piggyback technique, who received an inferior vena cava stent due to stricture of the reconstructed orifice of the vena cava. (Korean J Hepatobiliary Pancreat Surg 2011;15:184-188)
Abdominal compartment syndrome caused by a bulimic attack in a bulimia nervosa patient
Byung Seup Kim,Jae Woo Kwon,Min Jung Kim,So Eun Ahn,박형철,이봉화 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.6
We present a rare case of abdominal compartment syndrome due to a bulimic attack in a 19-year-old female patient with bulimia nervosa. She was admitted to our emergency room with complaints of progressive abdominal pain following bulimia. Computed tomography showed dilated stomach with food and air pressed other visceral organs and major abdominal vessels. Decompression using nasogastric tube or gastric lavage tube failed. At laparotomy, we performed gastrotomy and decompression was performed. After decompression, she fell into hypovolemic shock due to bleeding in the intra-gastric and peritoneal cavity. Twelve hours after the operation, the patient died due to refractory hypovolemic shock from uncontrolled bleeding following decompression of abdominal compartment. It should keep in mind that binge-eating habits in patients with bulimic nervosa could cause abdominal compartment syndrome due to gastric distension and this may be a potentially fatal condition.
Laparoscopic colectomy of colonic intussusceptions in adults
Byung Seup Kim,Kyung Ho Kang,Hyoung Chul Park,Bong Hwa Lee 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.6
Adult intussusception is a rare entity. Most adult intussusceptions require surgical intervention because they have a high rate of pathologic leading point. Mandatory laparotomy and en bloc resection is recommended in colonic intussusceptions due to the possibility of malignancy. We report herein 3 cases of adult colonic intussusceptions. The intussusceptions were located in the sigmoid and rectum, which were managed by laparoscopic colectomy. Case 1 was managed by laparoscopic anterior resection and diverting ileostomy combined with perineal reduction. Perineal approach facilitated laparoscopic reduction. In case 2, intraoperative colonoscopy was performed to determine the distal resection margin. Intraoperative colonoscopy showed edematous bowel mucosa as well as leading point after reduction of intussusceptions. Case 3 showed asymptomatic transient rectorectal colonic intussusceptions.
Moon, Byung Seok,Kil, Hee Seup,Park, Jun Hyung,Kim, Ji Sun,Park, Jimin,Chi, Dae Yoon,Lee, Byung Chul,Kim, Sang Eun Royal Society of Chemistry 2011 Organic & Biomolecular Chemistry Vol.9 No.24
<P>Aromatic radiofluorination of the diaryliodonium tosylate precursor with [<SUP>18</SUP>F]fluoride ions has been applied successfully to access [<SUP>18</SUP>F]flumazenil in high radiochemical yields of 67.2 ± 2.7% (decay corrected). The stability and reactivity of the diaryliodonium tosylate precursor plays a key role in increasing the production of <SUP>18</SUP>F-labelled molecules under the fluorine-18 labelling condition. Various conditions were explored for the preparation of [<SUP>18</SUP>F]flumazenil from different diaryliodonium tosylate precursors. Optimum incorporation of [<SUP>18</SUP>F]fluoride ions in the 4-methylphenyl-mazenil iodonium tosylate precursor (5f) was achieved at 150 °C for 5 min by utilizing 4 mg of the precursor, K<SUB>2.2.2</SUB>/K<SUB>2</SUB>CO<SUB>3</SUB> complex, and the radical scavenger in <I>N</I>,<I>N</I>-dimethylformamide. This approach was extended to a viable method for use in automated synthesis with a radiochemical yield of 63.5 ± 3.2% (decay corrected, <I>n</I> = 26) within 60.0 ± 1.1 min. [<SUP>18</SUP>F]Flumazenil was isolated by preparative HPLC after the reaction was conducted under improved conditions and exhibited sufficient specific activity of 370–450 GBq μmol<SUP>−1</SUP>, with a radiochemical purity of >99%, which will be suitable for human PET studies.</P> <P>Graphic Abstract</P><P>Various conditions were explored using different diaryliodonium tosylate precursors with fluorine-18 for the efficient preparation of [<SUP>18</SUP>F]flumazenil <IMG SRC='http://pubs.rsc.org/services/images/RSCpubs.ePlatform.Service.FreeContent.ImageService.svc/ImageService/image/GA?id=c1ob06277h'> </P>
갑상선유두암에서 Galectin-3, p53, Ki-67 단백질의 발현과 임상학적 의미
김병섭(Byung Seup Kim),강경호(Kyung Ho Kang),임영아(Young Ah Lim),김이수(Lee Su Kim) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.1
Purpose: There are few molecular markers useful in practice for predicting prognosis of papillary thyroid carcinoma (PTC) despite numerous basic researches. The objective of this study was to evaluate the prognostic values of several candidate markers of PTC (p53, Ki-67 and galectin-3) using immunohistochemistry (IHC), one of the most practical methods. Methods: IHC for p53, Ki-67 and galectin-3 were performed on formalin-fixed paraffin-embedded tissues of 160 PTC specimens using monoclonal antibodies. The associations of the expressions of these markers with multiple clinicopathologic prognostic factors were assessed. Results: The overexpresion rates of p53, Ki-67 and galectin-3 were 48.8%, 64.3% and 97.8%, respectively. Overexpression of p53 protein was positively associated with extrathyroidal extension (P<0.001). In addition, p53 immunoreactivity was more prevalent among Ki-67 overexpressed specimens (P<0.001). Ki-67 immunoreactivity was positively correlated with tumor size (P<0.05), which became more distinct when accompanied with p53 overexpression (P<0.01). In contrast, no relationship between galectin-3 immunoreactivity and clinical prognostic factors was found. Conclusion: Our results suggest that overexpression of p53 protein and Ki-67 in papillary thyroid carcinoma is associated with tumor progression and that IHC for these proteins could be useful for predicting prognosis of patients with PTC.
김병섭(Byung Seup Kim),임영아(Yong-Ah Lim),장경미(Kyung Mi Jang),김인규(In-Gyu Kim),전장용(Jang Yeong Jeon) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.5
Internal abdominal hernia is an unusual cause of intestinal obstruction. Paraduodenal hernia is relatively rare congenital malformations resulting from incomplete rotation of the midgut with entrapment of the small intestine beneath the developing colon. We report a case of paraduodenal hernia treated by laparoscopic approach. The patient was a 45-year-old man presenting with severe abdominal pain for 5 hours. Left paraduodenal hernia with jejunum hernia containing jejunal loops showed in abdominal CT. At operation, herniation of the small intestine into a retroperitoneal space through a defect on the left mesocolon was noted. After the herniated bowel was fully reduced, the hernia orifice was closed intra-corporeally in the manner of interrupted sutures with absorbable suture materials. The patient was discharged home without any serious complications on postoperative day 9. Conclusively, we think laparoscopic surgery in left paraduodenal hernia is feasible.