Although it is commonly appreciated that there is an inordinately large number of anormalies associated with the excretory ducts of the liver, comparatively little attention has been paid to the position of the orfice of the common bile duct into the duodenum. But, obiviously the site of entrance of the common bile duct into the duodenum becomes of great importance to the endoscopist, radiologist, and surgeon in diseases of the extra-hepatic biliary tract diag-nostically and therapeutically. We report 'a case of anomalous termination of the common bile duct into the duodenal bulb with the gall bladder empyema.
Biliary Tract ; Cholecystitis* ; Common Bile Duct* ; Duodenum ; Liver

PURPOSE: To determine whether spontaneous a splenorenal shunt can be used as an imaging predictor of early renal hemodynamic changes in patients with cirrhosis. MATERIALS AND METHODS: The study included 82 cirrhotic patients and 41 control subjects. Three-phase CT was performed and CT attenuation values (Hounsfield units) of the renal cortex in three phases were measured to evaluate renal perfusion. Likelihood ratio tests for trend were conducted for age, presence of ascites, and Child's grade. RESULTS: The mean CT attenuation values of the renal cortex in cirrhotic patients were significantly lower than the values of control subjects in three phases: 153.3 +/- 37.9 versus 173.3 +/-25.2 in the arterial phase, 172.6 +/- 41.0 versus 197.6 +/- 26.5 in the portal phase and 136.9 +/- 26.0 versus 152.7 +/- 20.0 in the delayed phase, respectively. The mean CT attenuation value of cortices in patients with renal hypoperfusion was 119.9 +/- 11.8 in the portal phase. Child's class C (aOR: 58.4, 95% CI: 3.6-956.2; p < 0.01) and the presence of a renal shunt (aOR: 7.5, 95% CI: 1.8-30.5; p < 0.01) were associated with renal hypoperfusion. The incidence of renal hypoperfusion was associated with Child's grade (trend: p < 0.01), and not with the grade of ascites or age. CONCLUSION: A dilated spontaneous splenorenal shunt may be a risk factor for renal hypoperfusion in cirrhosis.
Ascites ; Fibrosis ; Hemodynamics ; Humans ; Incidence ; Liver ; Liver Cirrhosis ; Perfusion ; Risk Factors ; Splenorenal Shunt, Surgical

One family with asymmetric septal hypertrophy was reported. The propositus of this family was 31 years old man who was admitted because of transient syncope. His father and one brother were affected but asymptomatic. His sister was suddenly died at age 21 years. The interventricular septal thickness to left ventricular posterior wall thickness ratios were measured using M-mode echocard ogram. In the affected family, echocardiogram revealed asymmetric septal hypertrophy (1.5:1, 2:1, 1.9:1 respectively). In the propositus, cardiac catheterization and simultaneous biventricular cineangiography were performed. Pressure study revealed mild peak systolic pressure gradient within left ventricular apex and left ventricular outflow tract (4mm Hg respectively). Biventricular cineangiogram showed the septal width increased inferiorly, and left ventricular endocardial surface of the septum was straight, while the right ventricular border convex toward the right ventricle.
Adult ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Cineangiography ; Fathers ; Heart Ventricles ; Humans ; Siblings ; Syncope

This study aimed to evaluate the refractive and visual results of the cases temporally overcorrected after laser in situ keratomileusis (LASIK). Among 582 myopic eyes that underwent LASIK using VISX STAR from March 1997 to October 1998, 105 eyes were overcorrected more than one diopter (D) one week after LASIK. 105 eyes were divided into three groups according to their spherical equivalent (SE) at one week: Group l (> or = 3D, 9 eyes), group ll (2-2.9D, 14 eyes), and group lll (1-1.9D, 82 eyes).Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), SE, and complications were studied one day, one week, two months, and six months after LASIK. The mean preoperative SE was -11.17 +/-2.57D in group l,-9.40 +/-2.91D in group lland -8.09 +/-1.92D in group lll. At 6 months, the mean SE was 1.81 +/-1.61D, 0.04 +/-0.43D and -0.37 +/-0.76D in group l, ll and lll, respectively. The mean regression of SE from one day to six months was 1.85D, 2.27D and 1.73D in group l,ll and lll, respectively (p>0.05). The proportion of eyes that lost two or more lines of UCVA after LASIK compared to preoperative BCVA was 33.3% in group l, 10% in group ll, and 9.2% in group lll. There were central island (5 eyes), capsular wrinkling (3 eyes), free cap (1 eye), subepithelal metalic debris (1 eye), epithelial ingrowth (1 eye)as complications in all groups. With these results it might be concluded that hyperopia less than 3D one week after LASIK is temporary and disappears 6 months after surgery without any additional treatment, whereas hyperopia equal or more than 3D one week after LASIK still showed hyperopic refraction even after 6 months. Therefore, these eyes need further evaluation for the correction of hyperopia.
Follow-Up Studies* ; Hyperopia ; Keratomileusis, Laser In Situ* ; Visual Acuity

Approximately 100 cases of collecting duct carcinoma have been reported in the medical literature. We herein report on a case of collecting duct carcinoma of the kidney in a 75-year-old patient. The abdominal sonography depicted a relatively poorly defined 7X6 cm sized, isoechoic mass lesion, as compared to the normal parenchyma, at the left kidney lower pole and the affected kidney showed preservation of the reniform shape. CT revealed a heterogeneous poorly defined low-attenuation mass that was mainly located in the medulla with involvement of the cortex and the lower half of the renal pelvis. Retrograde ureteropyelography showed a filling defect at the lower renal pelvis and severe narrowing of the left proximal ureter. We initially thought this lesion was invasive transitional cell carcinoma. Subsequent surgery confirmed a collecting duct carcinoma.
Aged ; Carcinoma, Renal Cell* ; Carcinoma, Transitional Cell* ; Humans ; Kidney ; Kidney Neoplasms ; Kidney Pelvis ; Ureter

Heterotopic pregnancy, simultaneous intrauterine and extrauterine pregnancy, is an extremely rare case. The incidence of heterotopic pregnancy was about 1 to 30,000 pregnancy, but it has been increased. Ectopic pregnancy is associated with significant mortality if not promptly diagnosed. Careful pelvic examination combined serial beta-hCG determinations and transvaginal sonography to evaluation the adnexal region are necessary prerequisites for early diagnosis. We report a case of discovery of heterotopic pregnancy after elective abortion with brief review of literature.
Early Diagnosis ; Female ; Gynecological Examination ; Incidence ; Mortality ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic*

PURPOSE: To compare 2-year clinical outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) in patients with bullous keratopathy. METHODS: A retrospective chart review was performed to obtain 2 years of follow-up data of DSAEK or PK at a single center from March 2009 to September 2012. The study comprised 15 eyes of DSAEK and 11 eyes of PK. Outcome measures included best-corrected visual acuity (BCVA), spherical and keratometric changes, central corneal thickness, endothelial cell density, intraocular pressure, and postoperative complications. Graft survival rate was assessed by Kaplan-Meier survival analysis. RESULTS: There were no differences in patient baseline characteristics between the two groups. At postoperative 2 years, better BCVA of 0.69 ± 0.51 logarithm of the minimum angle of resolution (logMAR) was found after DSAEK compared to 0.88 ± 0.48 logMAR after PK. Refractive cylinder in DSAEK and PK was −2.60 ± 1.53 and −6.00 ± 1.05 diopters (D), respectively, and keratometric cylinder was 3.27 ± 3.70 and 6.34 ± 3.51 D, respectively, at postoperative 2 years. The difference of mean spherical equivalents between postoperative 1 month and 2 years was 0.84 D after DSAEK and 2.05 D after PK. A hyperopic shift of 1.17 D was present after 2 years of DSAEK. The mean endothelial cell density at postoperative 2 years was 1,548 ± 456 cells/mm² for DSAEK and 1,052 ± 567 cells/mm² for PK, with a cell loss of 19.96% vs. 52.38%, respectively when compared to postoperative 1 month. No significant difference in central corneal thickness was found between DSAEK and PK (592 ± 75 vs. 563 ± 90 µm, respectively). Finally, the 2-year survival rate did not differ significantly between DSAEK and PK (93.3% vs. 81.8%, respectively, p = 0.344). CONCLUSIONS: Compared to PK, DSAEK provided more stable refractive errors with better visual outcome, lower endothelial cell loss, and a lower rate of graft rejection at postoperative 2 years in patients with bullous keratopathy.
Cornea/diagnostic imaging/*surgery ; Corneal Diseases/diagnosis/*surgery ; Descemet Stripping Endothelial Keratoplasty/*methods ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Keratoplasty, Penetrating/*methods ; Male ; Middle Aged ; *Refraction, Ocular ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Visual Acuity

Authors report two cases of central neurocytoma with unusual surgical pitfall. The one of these presented with postoperative intraventricular hemorrhage with hydrocephalus. The other case developed motor aphasia and hemiplegia due to brain retration during operation. We describe peripoerative courses of these cases and discuss possible causes of postoperative complications.
Aphasia, Broca ; Brain ; Hemiplegia ; Hemorrhage ; Hydrocephalus ; Neurocytoma ; Postoperative Complications

To determine the incidence, clinical characteristics and coronary angiographic findings of postinfarction angina, clinical course and coronary angiogram were studied in 45 patients with acute myocardial infarction. During a mean follow-up period of 12 weeks, 17 patients(37.8%) developed angina. Of 5 patients with postinfarction angina within 1 week of infarction, 2 patients died during hospitalization, whereas all 12 patients with postinfarction angina which occured more than 1 week after acute myocardial infarction were discharge alive. The frequency of stenosis over 90% and multivessel disease by coronary angiography were 51.7% and 64.7% respectively in patients with postinfarction angina, and 25%, 28.5% respectively in patients without postinfarction angina.
Constriction, Pathologic ; Coronary Angiography ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Infarction ; Myocardial Infarction

Aretrospective study on operative results was carried out in a series of 164 patients who were performed by microdiscectomy and 57 patients by automated percutaneous lumbar discectomy(APLD) for herniated lumbar discs between January 1, 1990 and June 30, 1996. The operative results were analysed, and the correlation between preoperative clinicoradiological factors and postoperative clinical results were statistically assessed. The major results were as follows: 1) Of 164 microdiscectomy cases, 102 were males and 62 were females, mean age was 42.4 years and incidence was the highest in the 5th decade. Among 57 APLD cases, 43 were males and 14 females, mean age 32.2 years, and the highest incidence in the 3rd decade. 2) The preoperative symptoms and signs in microdiscectomy and APLD cases were lumbago(98.2% vs 98.2%), radiating pain(96.3% vs 98.2%), positive straight leg raising test(77.4% vs 70.2%), motor weakness(27.4% vs 17.5%), claudication(13.4% vs 0%) and voiding difficulty(2.4% vs 0%). 3) Number of operated levels were 226 in microdiscectomy and 74 in APLD. The most commonly operated levels in both groups were L4-5. 4) Operative results. (1) The overall success rates by Prolo's scale were 87.1% in microdiscectomy and 80.7% in APLD, respectively. (2) In younger age group(below 30 years) and in non-compensatory group, success rates were significantly higher in microdiscectomy(100%, 89.9% vs 76.7%, 62.5% respectively). (3) As to protrusion and degeneration on MRI, a clinical result, from patients with mild to moderate protrusion and degeneration of discs was significantly better in microdiscectomy group, and that of mild protrusion and degeneration of discs in APLD group was significantly better. (4) The most common cause of failure was inadequately removed disc material in microdiscectomy cases and operated for sequestered discs in APLD cases. There results indicate that there were no differance in overall success rates between microdiscectomy and APLD. But it should be emphasized that clinical results may have been influenced by age, existence of compensation, and the degree of protrusion and degeneration of discs as prognostic factors. The authors believe that if the selection of operative procedure is carefully decided with details of clinical and radiologic findings of the patients, a good outcome can be expected.
Compensation and Redress ; Diskectomy, Percutaneous* ; Female ; Humans ; Incidence ; Leg ; Magnetic Resonance Imaging ; Male ; Surgical Procedures, Operative