No abstract available.
Helicobacter pylori* ; Helicobacter*

Incomplete fixation of pancreas, which may be associated with a wide mobility of root of SMA, result in chronic midgut volvulus. Movable pancreas is an uncommon form of incomplete intestnal fixation and rotation. Herein, we present a caae of movable pancreas. A patient was a 32-year-old male with the complaint of colicky intermittent abdomnal pain. The abdominal ultrasonography and CT showed a movable pancreas. The head of pancreas was located in the left of the abdominal aorta during the inspiratory time and left decubitus position. At surgery, pancreas was mobile and the root of mesentery was very weak and fibrotic. Duodenum and mesentery were fixed by 0.7 mm Dacron patch along the right peritoneal gutter and the retroperitoneum from ligament of Treitz to the ileocecal attachment. Duodenojejunostomy was performed for the prevention of SMA syndrome. The symptoms disappeared and recovery was prompt. Following the procedure, the patient remains asymptomatic until 10 months after operation
Adult ; Aorta, Abdominal ; Duodenum ; Head ; Humans ; Intestinal Volvulus* ; Ligaments ; Male ; Mesentery ; Pancreas* ; Polyethylene Terephthalates ; Ultrasonography

Spontaneous perforation of bile duct in adults is very rare, with less than 30 cases described in the literature to date. We repoit a case of a 65-year-old man who presented with severe colicky abdominal pain and fever, just like symptoms of peritonitis. ERCP provided a preoperative noninvasive confirmation of the diagnosis of the rupture of right intrahepatic duct. The patient was performed T-tube choledochotomy and drainage of retroperitoneal bile collection. The etiolgy, diagnosis, and treatment of spontaneous perforation of bile duct is discussed.
Abdominal Pain ; Adult ; Aged ; Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis* ; Drainage ; Fever ; Humans ; Peritonitis ; Rupture

Obstructive jaundice of the bile duct resulting from tumor-producing copious, thick mucin, causing ductal obstruction and dilatation, has been reported very rarely. Also, the benign bile duct neoplasm is extremely rare. We report a case of a mucin-secreting villous adenoma of common hepatic duct causing obstructive jaundice and cholangitis. The patient was a 72-year-old male and had a 3 yeared history of common hepatic mass unchanged remarkably in size. The abdominal ultrasonogram and computed tomography revealed well circumscribed, more than 2cm sized mass on the CHD and ductal dilatation. We were able to get an interesting cholangioram showing irregular, nodular, ill defined filling defect in the extrahepatic bile duct, different from US and CT findings, And it was just caused by thick, copious mucin from the tumar. This case was confirmed as mucin-secreting villous adenoma after surgery.
Adenoma, Villous* ; Aged ; Bile Duct Neoplasms ; Bile Ducts ; Bile Ducts, Extrahepatic ; Cholangitis ; Dilatation ; Hepatic Duct, Common* ; Humans ; Jaundice, Obstructive ; Male ; Mucins* ; Ultrasonography

BACKGROUND/AIMS: Ultrasonography is the easiest, fastest procedure for the diagnosis of choledocholithiasis, but the diagnostic failure are mostly because of the intrapancreatic level of this condition and the absence of bile duct dillatation. Endoscopic ultrasonography is a promising procedure for the diagnosis of extrahepatic cholestasis due to noninvasiveness and accuracy in the digestive gas interposition. The aim of this study was to prospectively compare the diagnostic accuracy of endoscopie ultrasonography with abdominal ultrasonography and endoscopic retrograde cholangiography in 66 patients with suspected choledocholithiasis. METHODS: All of the patients had abdominal ultrasonography, endoscopic ultrasonography ~and endoscopie retrograde cholangiography within 72 hours and final diagnosis was determined by endoseopic retrograde cholangiography with sphincterotomy. RESULTS: (l) Choledocholithiasis was confirmed in 45 patients: Thirteen patients had nondilated common bile ducts and 20 patients had stones with diamerer < 1 cm. (2) Endoscopic ultrasonography was more sensitive(95.5%) than abdominal ultrasonography (44.4%: P<0.0001) and similar to endoscopic retrograde cholangiography (97.8%). Specificity was same as 100% in 3 diagnostic tools. (3) Endoscopic ultrasonography was superior to abdommal ultrasonography for the diagnosis of choledocholithiasis with nondilated common bile duct(100% vs 15.3%, P<0.0001) and with less than 1cm sized small stone(100% vs 10.0%, P<0.0001). Endoscopic ultrasonography results did not depend on stone diameter or common bile duct dilatation. CONCLUSIONS: Endoscopic ultrasonography could be an accurate and safe diagnostic tool for the diagnosis of choledocholithiasis and could be promising especially in the cases with difficult cannulation of bile duct and gal1 stone pancreatitis.
Bile ; Bile Ducts ; Biliary Tract* ; Catheterization ; Cholangiography ; Choledocholithiasis* ; Cholestasis, Extrahepatic ; Common Bile Duct ; Diagnosis ; Dilatation ; Endosonography* ; Humans ; Pancreas* ; Pancreatitis ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography

Endoscopic mucosal resection (EMR) has been standardized for the treatment of intestinal type of intramucosal gastric carcinomas, and careful histological examination of the resected specimen is important for further treatment. To evaluate the diagnostic utility of p53 expression in gastric EMR samples, using immunohistochemical staining, we examined 24 gastric carcinomas (22 intestinal types and two diffuse types) and 20 adenomas removed by EMR. Intestinal type of adenocarcinomas revealed strong p53 expression in 13 cases (59%), weak in four cases (18%), and negative in five cases (23%). Resection margins of 11 carcinomas were involved in the carcinoma cells, which showed the same p53 expression pattern with main carcinoma cells. Squeezed carcinoma cells, remaining in resection margins, were definitely identified by strong p53 expression in seven cases of which the main tumor strongly expressed p53. Microscopic in situ carcinoma could be easily detected in p53 immunostaining. Multifocal involvement and submucosal invasion of carcinomas could be demarcated easily and definitely by strong p53 expression of carcinoma cells. All adenomas showed diffuse weak p53 expression. The difference of p53 expression (p< 0.001) could be used as a differential diagnosis between adenomas and carcinomas. According to these results, we propose that for careful histological examination in hospital diagnosis, both histological evaluation and p53 immunostaining are important diagnostic parameters in EMR samples of the intestinal type of gastric carcinomas.
Adenocarcinoma/surgery ; Adenocarcinoma/pathology ; Adenoma/surgery* ; Adenoma/pathology* ; Endoscopy* ; Gastric Mucosa/metabolism ; Gastric Mucosa/chemistry ; Human ; Immunoenzyme Techniques ; Protein p53/diagnostic use* ; Protein p53/biosynthesis ; Protein p53/analysis ; Stomach Neoplasms/surgery* ; Stomach Neoplasms/pathology* ; Tumor Markers, Biological

Cardiovascular syphilis is one of the most important complications of tertiary syphilis, although its incidence is decreasing in recent years. Aortitis is the primary manifestation of cardiovascular syphilis, resulting most commonly in aortic aneurysm, aortic regurgitation and coronary artery ostial obstruction. The authors experienced 46-year-ole male with a history of chancre 20 years ago, and several bouts of right chest pain since last year. Serologic tests revealed reactive in VDRL (1:64) and in TPHA test. Chest x-ray, chest CT, echocardiogram and aortogram showed aneurysm of ascending aorta with no evidence of aortic regrugitation of coronary obstruction. Histologic findings of involved aorta revealed "tree bark" appearance in gross, and microscopically adventitial thickening with endarteritis of the vasa vasorum and destruction of elastic tissue of media, showing moth-eaten appearance. The patient was underwent excision of the aneurysm and dacron aortic prosthetic graft was replaced with success.
Aneurysm* ; Aorta* ; Aortic Aneurysm ; Aortic Valve Insufficiency ; Aortitis ; Chancre ; Chest Pain ; Coronary Vessels ; Elastic Tissue ; Endarteritis ; Humans ; Incidence ; Male ; Polyethylene Terephthalates ; Serologic Tests ; Syphilis ; Syphilis, Cardiovascular ; Thorax ; Tomography, X-Ray Computed ; Transplants ; Vasa Vasorum

It has been well known that dilated cardiomyopathy (D-CMP) has characterized by systolic dysfunction of left ventricle (LV). But there are few studies about LV diastolic and right ventricular (RV) dysfunction in D-CMP. The purpose of this study is to assess the LV and RV systolic function as well as diastolic function in D-CMP. The purpose of this tudy is to assess the LV and RV systolic function as well as diastolic function in D-CMP. The gated blood pool scan (GBPS) was undertaken in 14 patients with D-CMP and 14 normal controls. The results are as follows : 1) Compared to normal controls, the global and regional ejection fraction of LV were significantly reduced (P<0.001) in D-CMP. But, there was no significant difference in LV ejection time between the two groups. 2) Peak filling rate and peak filling time were significantly reduced (P<0.001, P<0.05) in D-CMP 3) Global ejection fraction of RV was also significantly reduced in D-CMP compared to normal controls (P<0.001) But there was no significant difference in ejection rate of right ventricle between the two groups. 4) There was close correlation (R=0.802) between ejection fraction and filling rate of LV : filling rate was also reduced as ejection fraction decreased. And LV filling rate was also reduced with reduction of ejection rate. It is concluded that D-CMP shows diastolic impairment as well as systolic pumping failure and this systolic dysfunction is accounted for the diastolic impairment in D-CMP. And D-CMP shows also right ventricular dysfunction in almost all cases, as well as left ventricular dysfunction.
Cardiomyopathy, Dilated* ; Heart Ventricles ; Humans ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right

Agenesis of dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas. It may be associated with diabetes mellitus, pancreatic exocrine dysfunction, or abdominal pain. Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case is herein described involving a complete agenesis of dorsal pancreas and diabetes mellitus. A 38-year-old man with a 7-months history of non-insulin dependent diabetes mellitus was admitted due to weight loss and abdominal pain. Abdominal ultrasonography and computed tomography showed a normal biliary tree and enlarged head of the pancreas without visualization of the pancreatic body and tail. Endoscopic retrograde cholangiopancreatography (ERCP) revealved the short duct of Wirsung in the uncinate process and a head without opacification of any ducts in the pancreatic body or tail. The patient underwent explo-laparotomy for evaluation of the suspected pancreatic cancer. The patient was diagnosed as having complete agenesis of the dorsal pancreas by ERCP, CT, and surgery.
Abdominal Pain ; Adult ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Diabetes Mellitus ; Endoderm ; Head ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatic Neoplasms ; Ultrasonography ; Weight Loss

The carcinoid tumor of the ampulla of Vater is extremely rare. We report a case of 57-year old male with carcinoid tumor of ampulla of Vater. This patient had been presented with bronchial asthma for one year. Abdominal CT finding revealed diffuse dilatation of common bile duct and pancreatic duct, and also ampullary soft mass protruded into duodenal lumen. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsy. Pancreatico- duodenectomy with lymph nodes dissection was performed. Malignant carcinoid tumor originating from ampulla of Vater was diagnosed with pericholedochal lymphatic metastasis. Surgical removal led to complete resolution of asthmatic symptoms.
Ampulla of Vater* ; Asthma ; Biopsy ; Carcinoid Tumor* ; Cholangiography ; Common Bile Duct ; Diabetes Mellitus ; Diagnosis ; Dilatation ; Humans ; Insulin Resistance ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Middle Aged ; Obesity ; Pancreatic Ducts ; Polymerase Chain Reaction ; PPAR gamma ; Tomography, X-Ray Computed