A study on 76 cases have worm in bile duct at Viet Duc hospital from 1/2001 to 8/2002. The result showed that: Most of patients were from suburb of Ha Noi and other provinces with high risk of to be infected by worm. The mainly clinical symptom: pain in parasternal region with vomit, 44.6% patient without gall operation history; 29.1% with gall former operation and 26% with history of GCOM. SACL result and endoscopy in the same day to take worm out: 80.4%, without worm: 19.6%. SACL and endoscopy in other day to take worm out: 43.4%, without worm: 56.6%. GCOM is popular not only in Viet Nam but also in other under develop countries with humidity and high temperature climate. Nowadays, SACL and endoscopy to take worm out were performed at all levels. SACL has priority in diagnosis and follow up GCOM. To improve the effective diagnosis GCOM by SACL, the related factors and intervention issues need to pay attention.
Helminths ; Bile Ducts ; Diagnosis ; Ultrasonography

BACKGROUND AND AIMS: A cholangiogram, immediately taken after bile duct stone removal, does not always provide adequate information about the presence of fragmented small stones in the bile duct, due to a large amount of bowel gas around the commom bile duct (CBD) or air-bubbles in the bile duct. We performed this study to evaluate the clinical usefulness of intraductal ultrasonography (IDUS) on the detection of small remnant stones after endoscopic papillary balloon dilatation (EPBD). METHODS: Among the 42 patients treated with EPBD for the removal of CBD stones, 19 patients who had undergone ESWL or mechanical lithotripsy with basket, were evaluated by IDUS for the detection of remnant bile duct stones. RESULTS: 17 out of 19 (89.5%) patients were successfully performed IDUS. Among the 17 patients, 13 showed no definite stones on cholangiogram, but CBD stones were detected using IDUS in 4 patients (30.7%). Among the 4 whose cases were difficult to differentiate air-bubbles from stones on a cholangiogram, 3 patients were diagnosed as having air-bubbles and 1 patient was diagnosed as having stones, through IDUS. During the process of conducting IDUS 19 times, one ultrasonic miniature probe was damaged. CONCLUSIONS: IDUS is very effective in detecting remnant small bile duct stones that are occasionally undetected on cholangiogram, and in differentiating stones from air-bubbles just after the removal of stones using EPBD. More efforts, however, are needed to improve the durability of the ultrasonic miniature probe.
Bile Ducts ; Dilatation* ; Humans ; Lithotripsy ; Ultrasonics ; Ultrasonography*

In a jaundiced patient, it is important to ascertain as early as possible whether the bile duct is dilated. Ultrasonography, computed tomography & conventional cholangiography are widely accepted methods of determining the size of the extrahepatic bile ducts. But there is a considerable discrepancy among the size of the bile duct as measured from them. So the author analyzed and compared the respective diameters of the bile ducts in Korean normal adults as measured from cadaver, IV cholangiography, ultrasoud and computed tomography. The materials were 45 cases of cadaver, 38 cases of IV cholangiography, 100 cases of ultrasonography & 55 cases of computed tomography. The results were as follows ; 1. The diameters of the bile ducts were 7.58±2.26mm at CHD & 8.04±2.42mm at CBD from cadaver ; 5.38±1.90mm at CHD & 6.58±2.37mm at CBD from IV cholanglography ; 3.24±1.13mm at CHD & 4.71±1.48mm at CBD from ultrasonography ; and 4.56±1.51mm at CHD & 5.87±1.68mm at CBD from computed tomography. 2. The diameter of the bile duct was greatest in cadaver, and then reduced in IV cholangiography, computed tomography and ultrasonography in this orde.r 3. There were no size discrepancy between the diameter of the common hepatic duct and that of the common bile duct. 4. There were no discrepanry of the diameter of the bile duct by sex.
Adult* ; Bile Ducts* ; Bile Ducts, Extrahepatic ; Bile* ; Cadaver ; Cholangiography ; Common Bile Duct ; Hepatic Duct, Common ; Humans ; Ultrasonography

Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of therapy for pancreatobiliary diseases. While ERCP is safe and highly effective in the general population, the procedure remains challenging or impossible in patients with surgically altered anatomy (SAA). Endoscopic ultrasound (EUS) allows transmural access to the bile or pancreatic duct (PD) prior to ductal drainage using ERCP-based techniques. Also known as endosonography-guided cholangiopancreatography (ESCP), the procedure provides multiple advantages over overtube-assisted enteroscopy ERCP or percutaneous or surgical approaches. However, the procedure should only be performed by endoscopists experienced in both EUS and ERCP and with the proper tools. In this review, various EUS-guided diagnostic and therapeutic drainage techniques in patients with SAA are examined. Detailed step-by-step procedural descriptions, technical tips, feasibility, and safety data are also discussed.
Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Endoscopy* ; Humans ; Pancreatic Ducts ; Ultrasonography

Among several diagnostic tools for clonorchiasis (Clonorchis sinensis infection), radiologic examinations are commonly used in clinical practices. During the 2 past decades, many reports regarding imaging findings of clonorchiasis were introduced. The basic imaging finding of clonorchiasis is diffuse dilatation of the peripheral intrahepatic bile ducts, without dilation of the large intrahepatic or extrahepatic bile ducts. By this finding, however, active clonorchiasis cannot be differentiated from cured infection. Some recent radiologic studies suggested specific findings of active clonorchiasis. Besides direct demonstration of worms, increased periductal echogenicity on sonography and periductal enhancement on dynamic contrast-enhanced CT or MR imaging possibly represent active clonorchiasis. Those images of the liver clonorchiasis are known to be correlated with worm burdens (EPG counts) in their frequency and also severity. The images of cholangiocarcinoma associated with clonorchiasis show both the tumor with obstruction images and diffuse dilatation of the peripheral intrahepatic bile ducts. Radiological images can be a good practical alternative diagnostic method of clonorchiasis.
Bile Ducts/parasitology/pathology ; *Cholangiography ; Clonorchiasis/*diagnosis/ultrasonography ; Humans

The encapsulated hepatocellular (HCC) is a pathologic subtype of HCC. It is a well defined tumor that tends to grow slowly, and has a better prognosis than any other gross forms of HCC. Twenty surgically resected HCC were evaluated retropectively to correlate the thickness of pseudocapsules in pathology with those in computed tomography and ultrasound. At a histologic examination, pseudocapsules of seven cases were composed of two layers, an inner compact fibrous zone and outer loose fibrous zone interlaced with compressed liver parenchyma containing small vessels and newly formed bile ducts. Sonographic thickness and pathologic measurements of pseudocapsule relatively well correlated, but the former slightly overestimated the thickness of pathologic pseudocapsule (r=0.825, y=2.56x-1.23, P<0.05). On the other hand, thickness in CT and pathologic measurement did not correlate well. Thirteen cases showed one layer of pseudocapsule in which two cases were composed of thin layer of compact fibrosis and eleven cases composed of loose fibrosis. There were poor correlations in this group between thickness of pseudocapsules in pathology and those in images. Image overtly overestimated the thickness of the pseudocapsules in pathology. In conclusion, radiologic pseudocapsule of HCC may represent the compressed liver parenchyma as well as the fibrous pseudocapsule.
Bile Ducts ; Carcinoma, Hepatocellular* ; Fibrosis ; Hand ; Liver ; Pathology ; Prognosis ; Ultrasonography

The encapsulated hepatocellular (HCC) is a pathologic subtype of HCC. It is a well defined tumor that tends to grow slowly, and has a better prognosis than any other gross forms of HCC. Twenty surgically resected HCC were evaluated retropectively to correlate the thickness of pseudocapsules in pathology with those in computed tomography and ultrasound. At a histologic examination, pseudocapsules of seven cases were composed of two layers, an inner compact fibrous zone and outer loose fibrous zone interlaced with compressed liver parenchyma containing small vessels and newly formed bile ducts. Sonographic thickness and pathologic measurements of pseudocapsule relatively well correlated, but the former slightly overestimated the thickness of pathologic pseudocapsule (r=0.825, y=2.56x-1.23, P<0.05). On the other hand, thickness in CT and pathologic measurement did not correlate well. Thirteen cases showed one layer of pseudocapsule in which two cases were composed of thin layer of compact fibrosis and eleven cases composed of loose fibrosis. There were poor correlations in this group between thickness of pseudocapsules in pathology and those in images. Image overtly overestimated the thickness of the pseudocapsules in pathology. In conclusion, radiologic pseudocapsule of HCC may represent the compressed liver parenchyma as well as the fibrous pseudocapsule.
Bile Ducts ; Carcinoma, Hepatocellular* ; Fibrosis ; Hand ; Liver ; Pathology ; Prognosis ; Ultrasonography

PURPOSE: To determine the usefulness of ultrasonic lithotripsy for the fragmentation of large impacted intrahepatic duct(IHD) stones. MATERIALS AND METHODS: Large impacted stones in five patients were fragmented with a 12.5F rigid ureterorenoscope and a 5.5F rigid ultrasonic oscillating burr via T-tube tract. Two to three dayslater, the fragmented stones were extracted via T-tube tract with basket. RESULTS: Disintegration was complete in three patients and partial in two. The fragmented stones were completely removed in four patients and partially in one. due to that patient's refusal. CONCLUSION: Insertion of a rigid endoscope and ultrasound drill into theorifice of the IHD can be performed without problem. Ultrasonic lithotripsy is an effective technique for the fragmentation of large impacted intrahepatic stones located in the or ifice of the IHD.
Bile Ducts, Intrahepatic* ; Disulfiram ; Endoscopes ; Humans ; Lithotripsy* ; Ultrasonics* ; Ultrasonography

Three siblings with congenital dilatation of the intrahepatic bile ducts (Caroli's disease) are presented. Bile duct pathology was associated with congenital hepatic fibrosis and polycystic renal disease in all three patients. On color Doppler imaging (CD imaingl, multiple small color Doppler signals were observed in or near the vascular radicles within the dilated bile ducts, besides other well-known sonographic findings such as bile duct dilatations, biliary calculi. Dopper frequency spectral analysis confirmed all these color Doppler signals as arterial origin in all patients, showing pulsatile wave pattern. Although portal venous radicles are well known in conventional sonograms or computed tomotraphy(CT), continuous wave patterns were not detected in all patients. In addition to previously reported sonographic findings about Caroli's disease, color Doppler signals showing arterial wave pattern in or around the portal venous radicles within dilated duets are another helpful diagnostic criteria and these findings are easily depicted on routine sonograms with color mapping.
Bile Ducts* ; Bile Ducts, Intrahepatic ; Bile* ; Caroli Disease* ; Dilatation ; Fibrosis ; Gallstones ; Humans ; Pathology ; Polycystic Kidney Diseases ; Siblings ; Ultrasonography

Ultrasonography is a predominantly accurate, relatively simple unique diagnsotic method of obstructive jaundice. The ultrasonographic findings of obstructive jaundice are dilated intra- and extrahepatic duct with intraluminal hyperreflective echo or mass in and/or around the bile duct. The superiority of high resolution real time ultrasonography for the diagnosis of obstructive jaundice is based on the easy detectability of extra-and intrahepatic bile ducts by its multiple sectional images in a short time, the flexibility of probe and the small crystal size. Author evaluated real time sonographic findings 46 obstructive jaundice patients confirmed by surgery or radiographical examinations. The results were: 1. Diameter of extrahepatic duct in obstructive jaundice were varied from normal to 4.0 cm, mostly 8 to 10 mm in diameter (26%). Degree of dilatation of biliary duct appeared more prominent in cancer patients than any other causes of obstruction. 2. The site of obstruction was detected in85% (39/46) and its common site was common bile duct in 63% (29/46). 3. The diagnostic accuracy of choledocholithiasis and cancer was 82% (22/27) and 44% (4/9), respectively. Diagnostic accuracy of the real time ultrasonography in obstructive jaundice was over all 75% (34/46).
Bile Ducts ; Bile Ducts, Intrahepatic ; Choledocholithiasis ; Common Bile Duct ; Diagnosis ; Dilatation ; Humans ; Jaundice, Obstructive ; Methods ; Pliability ; Ultrasonography