Spontaneous internal biliary fistula is not an uncommon complication of neglected cholelithiasis, peptic ulcer, and carcinoma. The indidence, as given by various authors, differs but seems to vary between 3 and 5% of all cases of biliary disease. Until development of endoscopy, diagnosis has depended on the presence of air or barium in the biliary tree as radiologic findings or symptoms. Recently endoscopic examination, biopsy in appropriate case, and cannulation of the fistula for precise radiographic delineation will help to make a diagnosis. The main typesof fistulas are cholecystoduodenal, cholecystocolic, choledochoduodenal. Cholecystogastric or choledochogastric fistula is very rare type of internal biliary fistulas. Recently we encountered two cases who had suffered from fever and right upper abdominal pain with pneumobilia as ultrasonographic findings. They were confirmed as having cholecystogastric fistula, and choledochogastric fistula due to complicated gallstones by ERCP and surgical exploration. So we report two cases of biliary-gastric fistula of these patients with a review of relevant literatures.
Abdominal Pain ; Barium ; Biliary Fistula ; Biliary Tract ; Biopsy ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Cholelithiasis ; Diagnosis ; Endoscopy ; Fever ; Fistula ; Gallstones ; Gastric Fistula* ; Humans ; Peptic Ulcer

No abstract available.

PURPOSE: To investigate the in vivo proton MRS features of various focal hepatic lesions and to distinguish these features according to the involved. MATERIALS AND METHODS: Twenty-five hepatic lesions [hepatocellular carcinoma (n=7), cholangiocarcinoma(n=3), metastatic tumor (n=9), hemangioma (n=3), hepatic abscess (n=2), lymphoma (n=1)] underwent proton MR spectroscopy using a 1.5T unit and a localized proton STEAM sequence, without respiratory interruption, The findings of this in-vivo sequence were then reviewed, with particular attention to the presence and location of dominant peaks. RESULTS: In-vivo proton MR spectra were successfully acquired in all cases. A dominant lipid peak appeared in the MR spectra of the hepatocellular carcinomas, metastatic tumors, hepatic abscesses, lymphoma, one hemangioma and one cholangiocarcinoma(88%) at 1.3ppm, but not in two cholangiocarcinomas and one hemangioma. The spectral peaks of other metabolites appeared very irregular and even different in the same disease. CONCLUSION: In focal hepatic lesions, the spectra obtained during in-vivo proton MRS were useful, and a lipid peak was most frequent and dominant. Among the various neoplasms there were, however, no specific MR spectral features, and nor did such features vary according to the specific pathologic entity.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Hemangioma ; Liver Abscess ; Lymphoma ; Magnetic Resonance Spectroscopy ; Protons* ; Steam

We describe the magnetic resonance imaging findings in a case of focal sparing in fatty liver that showed homogeneous hyperintensity on gadolinium-enhanced opposed-phase gradient-echo images and mimicked a hypervascular mass due to paradoxical suppression of signal intensity of surrounding liver parenchyma with fatty infiltration.
Fatty Liver* ; Liver ; Magnetic Resonance Imaging

We report a case of metastatic signet ring cell carcinoma of the ureter, The patient a 50-year-old man, presented with pain in the left flank. Radiologic examination revealed partial obstruction in the mid-portion of the left ureter. Microscopically, numerous signet ring cells were infiltrated in the muscle and serosa. Although multiple bone metastases were noted, the primary site was not identified after complete clinical examination in this case, which is unique to us and may be of interest to others.
Carcinoma, Signet Ring Cell* ; Humans ; Middle Aged ; Neoplasm Metastasis ; Serous Membrane ; Ureter*

Pancreaticopleural fistula (PPF) a fistulous connection between the pancreas and pleural space due to prolonged chronic pancreatitis (CP). PPF is a very rare complication which presents in 0.4% of chronic pancreatitis cases, especially among children. We report a case involving a 3-year-old boy who presented with pleural effusion caused by a PPF, a complication of hereditary pancreatitis, which was, for the first time in Korea, successfully managed with endoscopic treatment. Chest radiography and computed tomography showed massive pleural effusion. Percutaneous catheter drainage was performed. High amylase levels were observed in the pleural fluid and serum, suggesting PPF. The patient was managed with bowel rest and octreotide infusion. Endoscopic retrograde cholangiopancreatography revealed CP, and pleural effusion was successfully managed with stent placement. PRSS1 genetic screening revealed R122H mutation.
Amylases ; Catheters ; Child ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Fistula ; Genetic Testing ; Humans ; Korea ; Male ; Octreotide ; Pancreas ; Pancreatic Fistula ; Pancreatitis ; Pancreatitis, Chronic ; Pleural Effusion ; Radiography ; Stents ; Thorax

Background: Low-density lipoprotein cholesterol is an important marker highly associated with cardiovascular disease. Since the direct measurement of it is inefficient in terms of cost and time, it is common to estimate through the Friedewald equation developed about 50 years ago. However, various limitations exist since the Friedewald equation was not designed for Koreans. This study proposes a new low-density lipoprotein cholesterol estimation equation for South Koreans using nationally approved statistical data. Methods: This study used data from the Korean National Health and Nutrition Examination Survey from 2009 to 2019. The 18,837 subjects were used to develop the equation for estimating low-density lipoprotein cholesterol. The subjects included individuals with low-density lipoprotein cholesterol levels directly measured among those with high-density lipoprotein cholesterol, triglycerides, and total cholesterol measured. We compared twelve equations developed in the previous studies and the newly proposed equation (model 1) developed in this study with the actual low-density lipoprotein cholesterol value in various ways. Results: The low-density lipoprotein cholesterol value estimated using the estimation formula and the actual low-density lipoprotein cholesterol value were compared using the root mean squared error. When the triglyceride level was less than 400 mg/dL, the root mean squared of the model 1 was 7.96, the lowest compared to other equations, and the model 2 was 7.82. The degree of misclassification was checked according to the NECP ATP III 6 categories. As a result, the misclassification rate of the model 1 was the lowest at 18.9%, and Weighted Kappa was the highest at 0.919 (0.003), which means it significantly reduced the underestimation rate shown in other existing estimation equations. Root mean square error was also compared according to the change in triglycerides level. As the triglycerides level increased, the root mean square error showed an increasing trend in all equations, but it was confirmed that the model 1 was the lowest compared to other equations. Conclusion The newly proposed low-density lipoprotein cholesterol estimation equation showed significantly improved performance compared to the 12 existing estimation equations. The use of representative samples and external verification is required for more sophisticated estimates in the future.

Biliary atresia (BA) is the major cause of cholestasis and the leading indication for liver transplantation (LT). However, the incidence of BA in Korea has not been reported. The aim of this study was to investigate the incidence and clinical outcomes of BA in Korea. We used the Korean universal health insurance database and extracted data regarding BA patients younger than 18 years of age admitted between 2011 and 2015. The incidence of BA was calculated by dividing the number of BA patients by the number of live births. Two hundred forty infants were newly diagnosed with BA. A total of 963 BA patients younger than 18 years of age were followed up for 5 years. The overall incidence of BA was 1.06 cases per 10,000 live births. The incidence of BA was 1.4 times higher for female patients than for male patients. Additionally, significant seasonal variation was observed; in particular, the incidence of BA was 2 times higher from June through August than from December through February. Congenital anomalies were found in 38 of 240 patients (15.8%). Congenital heart diseases were major associated congenital anomalies (6.3%). Several complications developed during the study period, including cholangitis (24.0%), varix (6.2%), and gastrointestinal bleeding (4.4%). Three hundred and one of the 963 BA patients under 18 years of age (31.3%) received LT for BA. The incidence of BA is higher in Korea than that in Western countries. We also report significant gender-associated differences and seasonal variation with respect to the incidence of BA.

PURPOSE: To determine the predictability of an aberrant hepatic artery by detection of a vessel in the portocaval space or fissure for the ligamentum venosum, as seen on arterial-phase spiral CT images. MATERIALS AND METHODS: Axial spiral CT scans (10mm section thickness, 10mm table feed) were obtained in 100 patients with hepatic mass and were examined by two radiologists. In each case, each determined whether a vessel was located in the portocaval space or fissure for the ligamentum venosum, and the type of aberrant artery. All patients underwent conventional angiography and the results were interpreted by another radiologist and compared with the results as shown on CT. RESULTS: Twelve-one cases with a vessel within the portocaval space and 14 with a vessel within the fissure for the ligamentum venosum showed variation of the hepatic artery. When a vessel was located transversely in the portocaval space, sensitivity, specificity, and positive and negative predictive value of an aberrant hepatic artery were 94%, 100%, 100%, and 99%, respectively; when a vessel was located in the fissure for the ligamentum venosum, the corresponding rates were 88%, 100%, 100%, and 98%. CONCLUSION: The detection on arterial-phase spiral CT images of a vessel in the portocaval space or fissure for the ligamentum venosum can reliably predict the existence of an aberrant hepatic artery.
Angiography ; Arteries ; Diagnosis* ; Hepatic Artery* ; Humans ; Sensitivity and Specificity ; Tomography, Spiral Computed*

The traumatic middle meningeal arteriovenous fistula is a rare condition complicated from head injury and usually found incidentally by carotid angiography. A few articles reported previously showed this condition if formed due to tearing of the walls of middle meningeal vessels by skull fracture and regarded as a wonderful defence mechanism keeping from a big intracranial hematoma. We have encountered 3 cases of them, all of which were accompanied by skull fracture. On of them had a big epidural hematoma and others only small amount. We show these cases in detail with the review of literatures.
Angiography ; Arteriovenous Fistula ; Craniocerebral Trauma ; Hematoma ; Skull Fractures