No abstract available.
Tomography, Emission-Computed, Single-Photon*

No abstract available.
Cholangitis* ; Pancreatitis*

Inflammatory myofibroblastic tumor (IMT) of the biliary tree is extremely rare and is generally a benign condition, though malignant change is possible. Making a differential diagnosis between this lesion and other malignant conditions is very difficult on preoperative imaging studies. Hence, the final diagnosis of IMT may be made during or after operation depending on the pathologic examination. We treated a 63-year-old woman who received right hepatectomy with caudate lobectomy under the suspicion of hilar cholangiocarcinoma. Frozen biopsy during the operation showed carcinoma in situ and there were stromal cells in the bile duct's resection margins. The postoperative hospital course was uneventful except for minor bile leakage. At postoperative month 4, she developed jaundice, ascites and pleural effusion. Computed tomography images showed a mass-like lesion in the porta hepatis with portal vein thrombosis and a right chest wall mass. Excisional biopsy was done and the pathology report was malignant spindle cell tumor suggestive of an aggressive form of IMT. Her condition rapidly deteriorated regardless of the best supportive care and she expired at postoperative month 5. Further investigation is necessary to clarify the reasons for recurrence and infiltration of this disease.
Ascites ; Bile ; Bile Ducts ; Biliary Tract ; Biopsy ; Carcinoma in Situ ; Cholangiocarcinoma ; Diagnosis, Differential ; Female ; Hepatectomy ; Humans ; Jaundice ; Middle Aged ; Myofibroblasts ; Pleural Effusion ; Portal Vein ; Recurrence ; Stromal Cells ; Thoracic Wall ; Thrombosis

Gallstones form as the culmination of a complex series of events that results in precipitation of insoluble substances including cholesterol or bilirubin in the gallbladder. Bile formation is essential for lipid digestion and the removal of excess cholesterol from the body either by direct excretion or after conversion to bile acids. Gallstones occur when insoluble lipids and inorganic salts secreted by the liver cannot be solubilized as they normally are in bile by the detergent properties of bile salts. For this to occur, metabolic events must take place to produce bile that contains excess amounts of either cholesterol or bilirubin (supersaturation), both of which are relatively insoluble in aqueous solution. Additionally, physical factors must allow rapid nucleation within the residence time of bile in the biliary tree.
Bile ; Bile Acids and Salts ; Bilirubin ; Cholesterol ; Detergents ; Digestion ; Gallbladder ; Gallstones ; Hypogonadism ; Liver ; Mitochondrial Diseases ; Ophthalmoplegia ; Salts

Stool examination is believed to be the most reliable method for detecting Clonorchis sinensis (CS) eggs. However, it has limited value for diagnosing clonorchiasis when the biliary tract is obstructed or when there is a light infection. We evaluated the infection states of CS in patients with biliary tract diseases using a bile sample. From January 2001 to August 2003, 238 patients who had undergone endoscopic biliary drainage were prospectively included in the study. The patients' bile samples were obtained directly from the nasobiliary drainage tube and then analyzed to detect CS eggs. The overall CS egg positive rate was 28.2% (35.4% in males, 19.4% in females). The egg positive rate was similar in all age groups examined: 26.7% in 30-39 years, 25.0% in 40-49 years, 24.4% in 50-59 years, 30.2% in 60-69 years, 35.3% in 70-79 years, and 25.0% in 80 years of age and over. There were no significant differences in the egg positive rate between the disease groups: 32.6% in bile duct cancer, 38.5% in gallbladder cancer, and 26.4% in gallstone diseases. Our results show that the CS infection rate was very high, regardless of the age, gender, and type of diseases of the patients. Although the study population was limited to patients with biliary tract diseases, it is assumed that clonorchiasis is still an endemic disease in Ulsan, Korea.
Korea/epidemiology ; Humans ; Clonorchis sinensis/embryology/*isolation & purification ; Clonorchiasis/complications/*diagnosis ; Biliary Tract Diseases/*complications ; Bile/*parasitology ; Animals

There are many causes of extrahepatic biliary obstruction. The most common causes are gallstones and malignant or benign strictures. Web of the common bile duct is a rare disease, and it may produce obstructive jaundice. On cholangiography, a common bile duct web typically appears as a shelf--like radiolucent ring. It is frequently associated with bile duct stone, and it is occasionally related to bile duct trauma or primary sclerosing cholangitis. We report here on a case of a web of the common bile duct without choledocholithiasis in a 27-year-old man. The patient was treated by Roux-en-Y choledochojejunostomy above the level of the web.
Adult ; Bile Ducts ; Cholangiography ; Cholangitis, Sclerosing ; Choledocholithiasis ; Choledochostomy ; Common Bile Duct ; Constriction, Pathologic ; Gallstones ; Humans ; Jaundice, Obstructive ; Rare Diseases

We analyzed clinical results of eexcimer laser photorefractive keratedomy (PRK) on 182 consecutive eyes followed up more than 6 months among 1.187 eyes receivng PRK from April 1991 to December 1991. Myopic patients were divided into 3 groups according to their myopic amount (degree) (group I: -2.0D ~ 6.0D, group II: -6.25 ~ -9.75D, group III: -10.0 Follow-Up Studies* ; Humans ; Intraocular Pressure ; Lasers, Excimer* ; Photorefractive Keratectomy* ; Postoperative Complications ; Visual Acuity

BACKGROUND/AIMS: Lamivudine, an oral nucleoside analogue, effectively suppresses HBV replication and improves liver enzymes as well as liver histology. Long-term lamivudine therapy can induce the emergence of drug resistant HBV strains in some patients. The aim of this study was to evaluate the effects of lamivudine, the breakthrough rate, and the relapse rate of discontinuing therapy after HBeAg loss. METHODS: A total of 190 patients with HBeAg and HBV DNA positive showing abnormal serum levels of aminotransferases for at least 6 months received 100 mg of lamivudine once daily. The duration of lamivudine therapy was from 6-36 months (mean 14 months). Responder was defined as the ALT normalization with sustained suppression of HBV DNA and HBeAg loss. Therapy was to be stopped after HBeAg loss. Post-treatment monitoring continued for 1-21 months (mean 6 months). RESULTS: The cumulative HBeAg loss rates at 12 months and 18 months were 35% and 43%, respectively. Pretreatment serum HBeAg quantitation, and the duration of lamivudine therapy were independent predictive factors for HBeAg loss. The cumulative breakthrough rates at 18 and 24 months were 38% and 57%, respectively. Pretreatment HBV DNA level was the only predictable factor for breakthrough. Therapy was discontinued after HBeAg loss in 52 patients. Most episodes of relapse (15/16) occurred within 6 months after cessation of lamivudine. The cumulative relapse rates at 3 months and 6 months were 21% and 50%, respectively. A predictive factor for post-treatment relapse after HBeAg loss was the duration of lamivudine therapy. CONCLUSIONS: These results suggested the pretreatment quantitative HBeAg in serum and duration of lamivudine therapy are independent predictive factors for HBeAg loss. The HBeAg response of lamivudine-induced HBeAg loss was not durable after discontinuing therapy.
DNA ; Hepatitis B e Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Lamivudine* ; Liver Diseases* ; Liver* ; Recurrence ; Transaminases

Gallbladder agenesis is a rare congenital biliary anomaly that may be associated with other biliary and extrabiliary congenital anomalies. Awareness of this condition is important because many of these patients may have vague biliary symptoms that lead to unnecessary operations. We treated a 46-year-old woman who was diagnosed with gallbladder agenesis during performance of gynecologic laparoscopic surgery. The gallbladder was not visualized by the preoperative abdominal ultrasonography, the abdominal computed tomography and the MRCP. The hepatobiliary scan revealed non-visualization of the gallbladder. Based on these imaging studies, there was a high suspicion of a sclero-atrophic gallbladder or agenesis of the gallbladder. At surgery, we carefully examined the porta hepatis and found that the gallbladder was absent. The operation involved only examination with a laparoscope. The patient has remained well and asymptomatic. It is extremely difficult to diagnose gallbladder agenesis in clinical settings; the identification of gallbladder agenesis is often an incidental finding. For cases where the gallbladder is not visualized preoperatively, a diagnostic laparoscopy can be an alternative diagnostic tool prior to performing laparotomy.
Female ; Gallbladder ; Humans ; Incidental Findings ; Laparoscopes ; Laparoscopy ; Laparotomy ; Middle Aged

BACKGROUND/AIMS: Impacted papillary stone (IPS) may lead to complete biliary obstruction and acute cholangitis. We evaluated clinical characteristics and endoscopic findings of IPS. METHODS: Data were obtained from patient recordings, radiologic and endoscopic reports in 14 patients. RESULTS: All patients had severe epigastric pain, but only 3 patients showed typical presentation of acute cholangitis. Radiologically, IPS was not found in 6 patients, but subsequently found as be a single IPS (n=5) and sandy stones filled in the bile duct and gallbladder (n=1). All patients showed a bulging and swollen papilla. Patients (n=9) without peripapillary diverticulum, or with extradiverticular papilla showed more posteriorly displaced papillary orifice and more frequent mucosal changes compared with patients (n=5) with intradiverticular papilla or juxtapapillary diverticulum. The stones were completely removed in 11 patients endoscopically, and the remainders, who had intradiverticular papilla, underwent surgical treatment. CONCLUSIONS: To predict IPS, clinical assessment is very important because the only characteristic manifestation is severe epigastric pain and radiological studies seem to be occasionally insufficient for detecting IPS. The characteristic endoscopic findings of IPS are bulging and swollen papillae with posterioriy displaced orifice and frequent mucosal changes, which may be influenced by presence or absence, and types of peripapillary diverticulum.
Bile Ducts ; Cholangitis ; Diverticulum ; Gallbladder ; Humans