1/39. Clinical evaluation of three-dimensional MR-cholangiopancreatography using three-dimensional Fourier transform fast asymmetric spin echo method (3DFT-FASE): usefulness of observation by multi-planar reconstruction.MR-cholangiopancreatography (MRCP) is a new method that is non-invasive and permits volume data collection and three-dimensional expression. With the three-dimensional Fourier transform fast asymmetric spin echo (3DFT-FASE) method, a higher spatial resolution can be obtained both in-pain and in slice selecting direction. In this paper, the usefulness of this new technique is investigated in the clinical diagnosis of MIP images and MPR. The study was performed in 10 normal volunteers and 21 patients with abnormalities in the pancreas or bile-duct sustem. The study was done using a 1.5 Tesla super-conductive machine. The MRCP images were interpreted by three radiologists. In most cases good images were obtained. The additional clinical information provided by MPR was remarkably useful in cystic lesions, especially in mucinous cystic neoplasm of the pancreas. Even when the intestine overlapped the pancreas, it was possible to evaluate the pancreatic duct by MPR. Three-dimensional observation and clinically useful diagnosis were possible by utilizing the advantageds of the 3DFT-FASE method appears quite useful in clinical application.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
2/39. Advanced adenosquamous carcinoma of the gallbladder with bilio-biliary fistula: an uncommon case treated by hepatopancreatoduodenectomy.A 70 year-old female, who presented with jaundice and abdominal pain, was found to have an advanced gallbladder cancer involving the liver parenchyma, duodenum, and transverse colon. This was complicated by a bilio-biliary fistula between the gallbladder and both the right and left hepatic ducts. After obtaining an accurate pre-operative diagnosis, the patient underwent hepatopancreatoduodenectomy (HPD) with lymph node dissection around the hepatic pedicle, celiac trunk, aorta, and inferior vena cava. Histologic examination revealed adenosquamous carcinoma. This rare variant accounts for 3.5% of gallbladder cancers, and is associated with a worse prognosis than adenocarcinoma. The patient is in good condition without any signs of recurrence 42 months after the HPD. In this case report, we discuss the histological type and internal biliary fistula with regard to the literature, and the usefulness of an aggressive surgical procedure such as HPD with extended lymph node dissection which can improve survival and quality of life in selected patients.- - - - - - - - - - ranking = 62395.014630728keywords = gallbladder, cancer (Clic here for more details about this article) |
3/39. Hepato-biliary abnormalities secondary to ceftriaxone use: a case report.ceftriaxone was approved in 1997 for the treatment of otitis media despite previous studies that documented an association of ceftriaxone with elevated hepato-biliary enzymes and transient biliary stasis. The case cited here highlights the need for continued awareness education for physicians who may use ceftriaxone to treat common illnesses such as acute exudative tonsillitis and otitis media in children. Specifically, for children with a family history of gallbladder, biliary tract, liver or pancreas dysfunction, ceftriaxone may not be the drug of choice since the likelihood of complications is increased in this population. Additionally, ceftriaxone may cause problems in either adults or children with preexisting disease, who may not be well-nourished, or who may be dehydrated.- - - - - - - - - - ranking = 8911.9964158566keywords = gallbladder (Clic here for more details about this article) |
4/39. Radiologic findings of mirizzi syndrome with emphasis on MRI.We have reported a case of mirizzi syndrome preoperatively diagnosed using MR cholangiopancreatography. MRCP and T2-weighted image using a single-shot fast spin-echo sequence accurately depicted all components of mirizzi syndrome, including impacted stone in the neck of the gallbladder compressing the common hepatic duct and wall-thickening of the gallbladder without any evidence of malignancy. The combination of MRCP and T2-weighted image can be counted on to replace conventional modalities of diagnosing mirizzi syndrome without any loss of diagnostic accuracy.- - - - - - - - - - ranking = 17823.992831713keywords = gallbladder (Clic here for more details about this article) |
5/39. Spontaneous perforation of the bile duct.We present a classic but rare case of spontaneous perforation of the bile duct in infancy and a previously undescribed treatment technique. The patient, a male age 5 weeks, was admitted with abdominal distention, ascites, and conjugated hyperbilirubinemia. Ultrasound revealed ascites but did not provide visualization of the gallbladder. Although hepatobiliary scintigraphy with technetium [dimethyl iminodiacetic acid (HIDA scan)] showed normal uptake peritoneal excretion suggested perforation of the common bile duct (CBD). Exploratory laparotomy revealed 200 cm3 dark amber ascitic fluid in the peritoneal cavity and cholestasis of the liver. Intraoperative cholangiogram performed via the gallbladder showed a large perforation at the cystic duct/CBD junction. The perforation was large and leakage of contrast prevented demonstration of the distal CBD despite our attempt to primarily repair the perforation. The CBD was explored; a T-tube was placed. T-tube cholangiogram demonstrated flow of contrast into the duodenum. A large leak remained at the cystic CBD junction. A cholecystectomy was performed and a vascularized flap of the gallbladder wall was used to repair the CBD over the T-tube. The T-tube was clamped intermittently beginning 3 weeks postoperatively. T-tube cholangiogram performed 6 weeks postoperatively revealed no extravasation and normal intra- and extrahepatic biliary tree. The T-tube was subsequently discontinued and liver function tests remained normal at 6 months follow-up.- - - - - - - - - - ranking = 26735.98924757keywords = gallbladder (Clic here for more details about this article) |
6/39. Does pancreatico-biliary maljunction play a role in spontaneous perforation of the bile duct in children?Spontaneous perforation of the bile duct (SPBD) is a rare disease in children. Pancreatico-biliary maljunction (PBM) has been postulated to contribute to its etiology. We have treated three children with SPBD over 30 years, two of whom had PBM. There was one boy and two girls aged 10 months to 2 years with symptoms of abdominal distension, vomiting, abdominal pain, jaundice, and acholic stools. The diagnosis of SPBD was made by paracentesis showing biliary ascites, and primary biliary and intra-abdominal drainage was performed in all cases. The site of perforation was at the connection of the common bile duct (CBD) with the cystic duct in all cases. In two cases reflux of contrast into the pancreatic duct was noted, the common channel was long (17 and 12 mm, respectively), and the bile amylase level in the CBD was abnormally high (50,000 and 67,000 IU/l, respectively). In the third patient there was no reflux of contrast into the pancreatic duct and the bile amylase and trypsin levels in the CBD and gallbladder were not measurable. Thus, SPBD in children may not be due solely to PBM, but may involve multiple mechanisms.- - - - - - - - - - ranking = 8911.9964158566keywords = gallbladder (Clic here for more details about this article) |
7/39. Intrahepatic cholangiocarcinoma arising 10 years after the excision of congenital extrahepatic biliary dilation.A 52-year-old woman was found to have a liver tumor during treatment for a liver abscess. The tumor was diagnosed as intrahepatic cholangiocarcinoma by closer examinations, including a percutaneous needle biopsy. Ten years previously, she had undergone excision of a choledochal cyst, with reconstruction by Roux-en-Y hepaticojejunostomy, as treatment for Todani's type Ia congenital biliary dilation, which had been confined only to the extrahepatic bile duct. The significant association between congenital biliary dilation and hepatobiliary malignancies is well known. Some patients have been reported to develop biliary cancer long after the excision of the entire extrahepatic bile duct and hepaticoenterostomy. However, in these patients, the development mostly took place in the remnant choledochal cyst, the anastomotic site, or in the dilated intrahepatic bile duct of Todani's type IV-A congenital biliary dilation. The development of intrahepatic cholangiocarcinoma after operation has not been reported previously in a patient with Todani's type I congenital biliary dilation. This case suggests that the entire biliary tree may have a high risk of field cancerization, even in extrahepatic congenital biliary dilation.- - - - - - - - - - ranking = 11.039719732357keywords = cancer (Clic here for more details about this article) |
8/39. Treatment of extrahepatic bile duct disease in infancy and early childhood.Extrahepatic bile duct disease is a rare finding in infancy and early childhood. However, there is an increasing number of patients operated at this age reported in the literature. This increase may have multifactorial reasons, e.g. real increase, better ability of detection as a result of better diagnostic techniques and knowledge of predisposing factors of extrahepatic bile duct disease in childhood, especially in early childhood and infancy. The following report describes three cases of extrahepatic bile duct disease in infancy and early childhood treated at the Department of Surgery of the University of technology in Aachen, germany. From 1986 to 1998 28 patients below 18 years were operated at our Department of Surgery. There was a recognizable increase of patients in 1996, 1997 and 1998. Whereas from 1986 to 1995 an average of 1.5 Cholecystectomies in pediatric patients were done, the years from 1996 to 1998 show an average of 5,33 patients operated per year. Every patient obtained a cholecystectomy -- 15 conventional open Cholecystectomies and 13 Laparoscopies, which were primarily performed in children in our clinic in 1991. Besides cholecystectomy in one case a Hepaticoenterostomy was necessary and in another case surgical treatment of the Papilla of Vater and the common bile duct was performed. In 22 patients symptomatic cholelithiasis was the indication for a cholecystectomy. Another Patient had a gallbladder polyp consisting of heterotopic Duodenal glands, two patients showed a shock gallbladder following trauma and cardiac operation and three patients had chronic cholecystitis without gallstones. Clinical data was collected and retrospectively reviewed. Additionally, we created a personal questionnaire to carry through a follow-up. Three patients were less than 3 1/2 years old. The youngest patient was only 5 months old and presented with cholelithiasis and choledocholithiasis. Another male patient, aged 2 years received a cholecystectomy and a Hepaticoenterostomy because of a choledochal cyst Type Ib (Todani-classification). And a 3-year-old-girl had a shock gallbladder caused by thromboembolism following cardiac operation nine days before.- - - - - - - - - - ranking = 26735.98924757keywords = gallbladder (Clic here for more details about this article) |
9/39. Liver metastasis of pancreatic cancer managed by intra-arterial infusion chemotherapy combined with degradable starch microspheres.A patient with liver metastasis of pancreatic cancer received chemotherapy using mitomycin C and degradable starch microspheres. The patient was a 52-year-old woman who had undergone surgery for cancer of the head of the pancreas in October 1996. She had stage III disease and was followed up as an outpatient on oral therapy with a combined uracil and tegafur preparation. In October 2000, abdominal computed tomography (CT) scans detected multiple liver metastases. Three courses of intra-arterial infusion of mitomycin C and microspheres (1000 mg) resulted in regression of her tumor and a decrease of tumor marker levels. After three more courses of this therapy, the patient developed bile duct necrosis and died of disseminated intravascular coagulation. As her metastases were controlled for about 7 months, hepatic arterial infusion of mitomycin C and degradable starch microspheres appears to be useful for treating liver metastasis of pancreatic cancer, but careful attention should be paid to the risk of severe complications such as bile duct necrosis.- - - - - - - - - - ranking = 38.63901906325keywords = cancer (Clic here for more details about this article) |
10/39. The isolation of plesiomonas shigelloides in polymicrobial septicaemia originating from the biliary tree.The first two cases are reported in which plesiomonas shigelloides was isolated from patients with mixed aerobic/anaerobic septicaemia originating from the biliary tree. The first patient who was previously well survived after removal of a gangrenous gallbladder. The second patient suffered from an extrahepatic cholangiocarcinoma and died of infection thus highlighting the poor prognostic outcome of P. shigelloides septicaemia in immunocompromised patients. Furthermore these cases demonstrate that P. shigelloides can be isolated from mixed infections and may act synergistically with other bacteria to produce disease.- - - - - - - - - - ranking = 8911.9964158566keywords = gallbladder (Clic here for more details about this article) |
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