Journal of Yeungnam Medical Science

Original article

Preemptive pyloroplasty for iatrogenic vagus nerve injury in intrahepatic cholangiocarcinoma patients undergoing extensive left-sided lymph node dissection: a retrospective observational study: Shin Hwang, Dong-Hwan Jung, Eun-Kyoung Jwa, Yumi Kim; J Yeungnam Med Sci. 2022;39(3):235-243. Published online December 14, 2021; DOI: https://doi.org/10.12701/yujm.2021.01550

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Background
Intrahepatic cholangiocarcinoma (ICC) of the left liver often shows left-sided lymph node (LN) metastasis. If gastric lesser curvature is extensively dissected, it can induce an iatrogenic injury to the extragastric vagus nerve branches that control motility of the pyloric sphincter and lead to gastric stasis. To cope with such LN dissection-associated gastric stasis, we performed pyloroplasty preemptively. The objective of this study was to analyze our 20-year experience of preemptive pyloroplasty performed in 10 patients.
Methods
We investigated clinical sequences of 10 patients with ICC who underwent preemptive pyloroplasty following left hepatectomy and extended left-sided LN dissection. Incidence of gastric stasis and oncological survival outcomes were analyzed.
Results
All 10 patients were classified as stage IIIB due to T1-3N1M0 stage according to the 8th edition of American Joint Committee on Cancer staging system. The overall patient survival rate was 51.9% at 1 year, 25.9% at 2 years, and 0% at 3 years. Seven patients showed uneventful postoperative recovery after surgery. Two patients suffered from gastric stasis, which was successfully managed with supportive care. One patient suffered from overt gastric paresis, which was successfully managed with azithromycin administration for 1 month.
Conclusion
We believe that preemptive pyloroplasty is an effective surgical option to prevent gastric stasis in patients undergoing extensive left-sided LN dissection. Azithromycin appears to be a potent prokinetic agent in gastroparesis.

Citations

Citations to this article as recorded by

Clinical implications and optimal extent of lymphadenectomy for intrahepatic cholangiocarcinoma: A multicenter analysis of the therapeutic index
Yuzo Umeda, Kosei Takagi, Tatsuo Matsuda, Tomokazu Fuji, Toru Kojima, Daisuke Satoh, Masayoshi Hioki, Yoshikatsu Endo, Masaru Inagaki, Masahiro Oishi, Takahito Yagi, Toshiyoshi Fujiwara
Annals of Gastroenterological Surgery.2023; 7(3): 512. CrossRef

Case report

Clinical characteristics of hereditary neuropathy with liability to pressure palsy presenting with monoparesis in the emergency department: Changho Kim, Jin-Sung Park; Yeungnam Univ J Med. 2020;37(4):341-344. Published online July 31, 2020; DOI: https://doi.org/10.12701/yujm.2020.00472

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Abstract PDF: Hereditary neuropathy with liability to pressure palsy (HNPP) is a rare neurological genetic disease caused by deletion of the peripheral myelin protein 22 gene and presents in childhood or young adulthood. We report four cases of HNPP with typical and rare presentations, reflecting the broad clinical spectrum of this disease. Two patients presented with mononeuropathies that are frequently observed in HNPP; the remaining two presented with bilateral neuropathy or mononeuropathy anatomically present in the deep layer. This reflects the broad clinical presentation of HNPP, and clinicians should differentiate these conditions in young patients with monoparesis or bilateral paresis. Although HNPP is currently untreatable, early diagnosis in the emergency department can lead to early detection, eventually resulting in less provocation and recurrence which may cause early motor nerve degeneration.

Original Article

Distribution of Weakness at the Lower Extremity of Hemiparesis Patients.: Gun Ju Park, Jung Sang Hah, Wook Nyeun Kim; Yeungnam Univ J Med. 1997;14(1):101-110. Published online June 30, 1997; DOI: https://doi.org/10.12701/yujm.1997.14.1.101

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Abstract PDF: The maximal voluntary strength of knee extension and flexion on both the right and left sides was measured in patients with hemiparesis of upper motor neuron type and in a group of normal subjects. Significant differences of maximal voluntary strength were found between male and female but the ratio of flexor to extensor strength did not vary significantly between the sides, between the exs in normal subjects. The maximal voluntary strength of uninvolved side were not reduced significantly but involved side reduced significantly in patients. The ratio of flexor to extensor strength in hemiparetic side was significantly less than the ratio for the normal subjects but not significant difference in uninvolved side of patients. According to the above results, the maximal voluntary strength of flexion was more reduced than that of the extension on lower extremity of hemiparesis patients. The strength ratio of flexion to extension was a useful parameter for guiding the rehabilitation of hemiparesis.

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