• Advances in pediatric surgery
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• 제4권2호
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• pp.156-162
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• 1998

저자들은 1983년 1월부터 1998년 1월까지 총담관낭 환아 28례 중 4례(14.2 %)에서 자연적으로 발생한 총담관낭 천공에의한 담즙성 복막염을 경험하였고 이 중 3례에서 일차적인 낭종 절제와 간관공장 문합술을 시행하였으며 이 모든 예에서 합병증 없이 회복되었기에 문헌 고찰과 함께 보고하는 바이다. 총담관낭 천공에의한 답즙성 복막염치료는 일차적 낭종 절제와 간관 공장 문합술이 안전하고 효과적인 방법이라고 생각된다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제21권3호
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• pp.203-208
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• 2018

Purpose: The aim of this study was to describe our treatment experiences with patients who had acute abdomen (AA) with common bile duct (CBD) dilatation. Methods: The treatment outcomes in children with AA and CBD dilatation were retrospectively reviewed. According to the shape of the intrahepatic bile ducts on ultrasonography (US), the origin of the pain was estimated as choledochal cyst (CC) complication or choledocholithiasis in normal CBD. Patients with complicated CC underwent surgery, and patients with choledocholithiasis in a normal appearing CBD underwent symptomatic treatment initially. Results: Of the 34 patients, 30 (88.2%) were female. The mean age of the patients was $6.4{\pm}4.9$ (range, 0.8-17) years. Seventeen (50.0%) patients had CBD stones and 17 (50.0%) did not. Surgical treatment was performed in 20 (58.8%) patients, 2 of whom underwent preoperative stone removal with endoscopic retrograde cholangiopancreatography and an operation. Conservative treatment was applied in 12 (35.3%) patients (8 with and 4 without stones), 1 of whom developed symptom relapse and underwent an operation. Among the 8 patients with CBD stones, 4 (4/17, 23.5%) had complete resolution of the stones and recovery of the CBD diameter after conservative treatment. US findings of patients with stone showed a fusiform or cylindrical shape of the CBD in 14 (82.4%) patients. Conclusion: The presence of stones in the distal CBD and the US features of CBD dilatation may be helpful to diagnose and treat the causes of biliary dilatation. Conservative treatment can be considered as initial therapy in patients with uncomplicated CBD dilatation with stone.

• 한국임상수의학회지
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• 제27권5호
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• pp.605-609
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• 2010

10년령의 중성화 암컷 요크셔 테리어가 구토와 식욕부진으로 내원하였다. 신체검사, 혈액검사 및 복부 방사선 초음파검사와 컴퓨터단층촬영 검사 결과 췌장염, 간신증후군을 동반한 폐쇄성 총담관결석으로 진단되었다. 수술적으로 총담관결적을 제거하였으나, 10일 후 사망하였다. 본 증례를 통하여 담낭절제술을 한 환자에서 재발성 담관 결석, 췌장염과 같은 합병증에 대한 정기적인 모니터링이 필요하고, 진단 및 수술에 대한 정확한 평가를 위해 CT가 유용함을 알수 있었다.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.322-327
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• 2023

Situs inversus totalis (SIT) is a rare condition in which cardiac and abdominal organs are inverted from their normal left-sided orientation. Mirizzi syndrome, characterized by the obstruction of the common hepatic duct or the common bile duct by gallstone, is a rare condition. Mirizzi syndrome co-occurrence in SIT patients is rare. Gallbladder in sinistroposition is extremely uncommon in SIT patients. We report a known case of diabetes, ventricular septal defect with transposition of the great arteries in a 32-year-old female who presented with jaundice, cholangitis, chills, and fever that had lasted for 10 days. She was confirmed to have SIT with type III Mirizzi syndrome following a series of diagnostic procedures. Primarily, endoscopic retrograde cholangiopancreatography along with common bile duct stenting was performed to initially reduce cholangitis. After an eight-week follow-up after the reduction of cholangitis, surgery was conducted. Mirror-imaged ports were used for the laparoscopic procedure, and the surgeon was on the patient's right side rather than the usual left side. The patient was discharged from the hospital following two days of uneventful healing.

• Applied Microscopy
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• 제22권2호
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• pp.15-29
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• 1992

The gallbladder is known to have the function of the storage and the concentration of the bile produced by the liver. This function is carried out by the removal of water and inorganic electrolytes. Extrahepatic cholestasis or the impairment of excretion of the bile leads to the distension and loss of the function of the gallbladder. The purpose of this study was to examine the ultrastructural characteristics of the normal gallbladder epithelial cells, and their structural changes induced by the ligation of common bile duct of the rabbit. Common bile duct ligation was performed under ether anesthesia. The rabbits were sacrificed on the 1st, 3rd, 5th, 7th and 14th day, respectively after operations. The tissue blocks of the gallbladder were fixed in 2.5% glutaraldehyde-1.5% paraformaldehyde prior to fixation in 1% osmium tetroxide, and embedded in the araldite mixture, and observed with JEM 100 CX-II electron microscope. The results were as follows: 1. The normal gallbladder epithelium of adult rabbit demonstrated two cell types, the ordinary epthelial cell and the dark cell. The dark cells have electron dense cytoplasm, and were found much infrequently, whereas ordinary epthelial cells were found quite numerous. 2. The ordinary epthelial cells of normal gallbladder were provided with the regular microvilli at the free surface and the images of pinocytotic activities in the apical cytoplasm, and exhibit highly convoluted lateral surfaces with elaborated microfolds. These figures of the cells suggest that they are resorptive in functional activity. 3. In the early stages (1st, 3rd, 5th day groups) following the ligation, the apical cytoplasm of some cells is protruding from the free surface and lost their microvilli. Numerous mucous granules filled in the apical and supranuclear cytoplasm compactly. 4. In the late stages (7th, 14th day groups) following the ligation, many light cells containing mumerous mucous granules are seen, between the ordinary epthelial cells. Mucous granules are fused each other, and are discharged into the lumen from the apical cytoplasm. The lateral membranes are straight or undulating without any interdigitations. From the above results, it was concluded that in the cholestasis induced by the common bile duct ligation, there is a tendency for the mucosal epithelium of the rabbit gallbladder to have secretory rather than an absorptive function.

• 대한디지털의료영상학회논문지
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• 제10권1호
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• pp.45-50
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• 2008

Recently, MR Cholangiography used mainly bu controlling of patient's breathing. There is breathing hold techniques to get images within shopt time and gating technique adjusted to respiration cycle for high resolution image. In this study, the aim of this experiment is to know on clinical usefulness compared with PACE and RTG thchniques. This study's period is from 2006 in November to 2007 in January. A total of 21 patients investigated at MAGNETOM Sonata 1.5T (SIEMENS Erlangen) with use of 12ch body coil. MR acquisition protocol used 3D turbo spin echo coronal sequence. Scan parameters applied to potimal setting in use as gating techniques, respectively. Analysis of consuming timing evaluated with rapidness. As analysis of quantity, the common bile duct, gall bladder measured in signal intensities, then these data were calculated by signal to noise ratio and contrast to noise ratio. Qualitative analysis, experienced 2radiologists and 3 RTs were evaluated into 3groups about artifact, accuracy of lesions, sharpness of the common bile duct or gall bladder. As a result of analysis, when compared to PACE, consuming time of the RTG took less than PACE, On both CNRs and SNRs, PACE technique was slightly high values than RTG(p<0.05). Qualitative analysis' results, discrimination of lesions in the common bile duct, gall bladder get a significance level in both RTG and PACE techniques but presence's artifact of breathing and pulsation highly demonstrate in PACE techniques. In conclusion, both PACE and RTG methods at MRCP provided prominently clinical information for the common bile duct, gall bladder. If machines have not limitation with performance, induction of breathing holding also will help getting diagnistic quality.

• Advances in pediatric surgery
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• 제7권1호
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• pp.7-14
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• 2001

Congenital anomalies of the head and neck region such as preauricular sinus and skin tag, thyroglossal duct cyst, branchial anomaly, cystic hygroma and dermoid cyst are common in pediatric population. It is important for pediatricians and pediatric surgeons to be familiar with the embryology and the anatomical characteristic of these lesions in order to diagnose and treat them properly. Three hundred and nineteen patients with congenital head and neck anomalies treated at Hanyang University Hospital between 1980 and 1999 were reviewed to determine the relative frequency of the anomalies and to analyze the method of management. Eight-four (25.1 %) of 335 lesions were preauricular sinus and skin tag, 81 (24.2 %) were thyroglossal duct cyst, 81 (24.2 %) branchial anomaly, 58 (17.3 %) cystic hygroma and 31 were (9.2 %) dermoid cyst. The male-to-female ratio was 1.4:1. Thyroglossal duct cyst most commonly present at 3-5years, however branchial anomalies commonly are diagnosed in children younger than 1 year. Preauricular sinus showed familial tendency in three patients and was bilateral is 33.8 %. Most head and neck anomalies in children have specific clinical and anatomical characterics. A careful history and physical examination is very useful for diagnosis and proper management. Experienced pediatric surgeons should do the initial surgery since the recurrence rate after incomplete surgical excision can be high.

• Toxicological Research
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• 제19권1호
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• pp.67-72
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• 2003

Cholestatic liver injury results from the accumulation of toxic bile salts within the liver. The aim of the present study is to elucidate the changes in expression and cellular localization of apoptosis related proteins in the liver of bile duct-ligated (BDL) rat. Extrahepatic cholestasis was induced by double ligation of the common bile duct and cut between the ligatures. Animals were sacrificed at day 3 and at week 1, 2, 4, 6, and 8 after BDL. The number of TUNEL positive cells was increased significantly after 3 days of BDL, decreased over 2 weeks and remained constant thereafter. Fas expression was not changed and activation of caspase 8 did not occur. Fas immunoreactivity was exclusively observed in the cytoplasm of hepatocytes, indicating that Fas expressed in rat hepatocytes is a soluble form. Hepatocyte apoptosis was associated with Bax expression, which showed a peak at day 3 and decreased over time gradually. Immnunostaining of Bax was observed in hepatocytes and bile duct epithelial cells (BEC) of control and BDL rats. Bcl-2 was increased over time in BDL rats. These results suggest that apoptosis of hepatocytes in BDL rats is independent of Fas and controlled by Bax expression.

• 대한두경부종양학회지
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• 제27권1호
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• pp.70-73
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• 2011

Nasopalatine duct cysts are the most common non-odontogenic developmental cyst originating in the incisive canal of maxilla and occuring in approximately 1% of the population. Clinical presentation is mostly asymptomatic in small cysts, but sometimes shows swelling, pain and drainage when it is infected. The definite diagnosis should be based on clinical, radiological and histopathologic findings. Marsupialization of the cystic tissue can be performed, however, complete surgical excision is the the choice of treatment of nasopalatine duct cysts. We report a case of nasopalatine duct cyst occurred in the midline of hard palate treated by complete excision via transoral approach.

• Advances in pediatric surgery
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• 제3권1호
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• pp.24-31
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• 1997

Thirty-four consecutive cases of thyroglossal duct lesions in children were reviewed at the Department of Surgery, Chonbuk National University Hospital. Twenty patients were males, and the most prevalent age of discovering was 2 to 4 years (52.9%). Resection was performed within 2 years after discovering the lesions in 19 cases, but was delayed untill 4 to 10 years in 6 cases. Cystic lesions (85.3%) were 5.8 times more common than fistulas. A midline upper neck mass was found in every cystic cases, and a draining sinus at hyoid region was noticed in fistula patients. The location of the lesion was on the hyoid bone in 34 cases, at the midline in 31 cases, slightly to the left in 2 cases, and slightly to the right in 1. Two cases were misdiagnosed as lymphadenopathy, and a single case of ectopic thyroid gland was misinterpreted as a thyroglossal duct cyst. Modified Sistrunk operation was performed in twenty-three cases(67.6%), Sistrunk operation in 9(26.5%), and cyst excision in 2(5.9%). Postoperative complications occurred in 4 cases(11.8%); 2 wound infections and 2 recurrences. One of recurrences was a fistula treated by modified Sistrunk operation, and the other was a cyst treated by cyst excision.