• Journal of Trauma and Injury
• /
• 제34권3호
• /
• pp.208-211
• /
• 2021

Gallbladder injuries are rare in cases of blunt abdominal trauma and are usually associated with damage to other internal organs. If the physician does not suspect gallbladder injury and check imaging studies carefully, it may be difficult to distinguish a gallbladder injury from gallbladder stone, hematoma, or bleeding. Therefore, in order not to miss the diagnosis, the clinical findings and correlation should be confirmed. In the present case, a 60-year-old male presented to a local trauma center complaining of pain in the upper right quadrant and chest wall following a motor vehicle collision. Abdominal computed tomography (CT) showed a hepatic laceration and hematoma in the parenchyma in segments 4, 5, and 6 and active bleeding in the lumen of the gallbladder. Traumatic gallbladder injuries generally require surgery, but in this case, non-operative management was possible with cautious follow-up consisting of abdominal CT and angiography with repeated physical examinations and hemodynamic monitoring in the intensive care unit.

• 한국간담췌외과학회지
• /
• 제28권2호
• /
• pp.214-219
• /
• 2024

Backgrounds/Aims: Open cholecystectomy is becoming obsolete and laparoscopic cholecystectomy has become the treatment of choice in gallstone diseases. Difficult gallbladders are encountered whenever there is a frozen calot's triangle, obliterated cystic plate, or both. Rather than converting to open procedure, there has been a growing preference for laparoscopic subtotal cholecystectomy (LSC) during difficult gallbladders. This study aimed to assess the advantages, indications, and viability of LSC in difficult gallbladders. Methods: The study included patients undergoing laparoscopic cholecystectomy in NIMS Hospital, Jaipur, from January 2021 to January 2023. Data of the patients who underwent LSC for difficult gallbladders included demographics, comorbidities, operative time, conversion to open cholecystectomy, length of hospital stay, and complications. LSC was classified into three types depending on the part of the gallbladder remnant. Results: A total of 728 patients underwent laparoscopic cholecystectomy. Among them, 41 patients (5.6%) were attempted for LSC. However, one patient was converted to an open procedure and the rest 40 underwent LSC. LSC was divided into 3 types, 4 patients underwent LSC type I, 34 patients underwent type II, and 2 patients type III. The average operating time and postoperative length of hospital stay were 86.2 minutes and 2.1 days, respectively. Two patients had surgical site infection. No patient had a bile leak and none required intensive care unit care. Conclusions: LSC is a safe and feasible option for use in difficult gallbladders.

• Asian Pacific Journal of Cancer Prevention
• /
• 제13권4호
• /
• pp.1317-1320
• /
• 2012

Biliary tract cancers, broadly described as malignancies that arise from the biliary tract epithelia, are usually divided into two major clinical phenotypes: cholangiocarcinoma and gallbladder cancer, differing in etiopathogenesis, risk factors, and perhaps molecular and genetic signatures. Atypical symptoms and lack of tumor biomarkers make it difficult to diagnose in early stages. At the time of presentation, few patients are candidates for potentially curative surgical resection. We here assessed and compared features of a total of 150 cases divided into extra- and intrahepatic cholangiocarcinomas and gallbladder cancers (GBC). Althought there were no significant differences in serum tumour marker levels, GBC patients had the poorest prognosis. Furthermore, gallbladder cancer respond poorly to chemotherapy or radiation therapy and approximately half of untreated patients died within 10 months. Therefore, treatment for patients with gallbladder cancer is still in challenge. Outcomes and survival of these patients had improved little over the past three decades - a period in which new successful treatments have greatly contributed to the prolonged patient survival for many other cancers.

• 셀메드
• /
• 제3권3호
• /
• pp.21.1-21.5
• /
• 2013

Cholesterol gallstones are a digestive disease of high prevalence that has many risk factors; for this reason, research has focused mainly on how to prevent it rather than how to treat it. Many molecules of the hepatic, bile and intestinal systems are involved in the pathophysiology of this disease, making it very difficult to find a therapeutic target. The pharmacological treatment is limited, so when gallstones generate symptoms, medical treatment indicates gallbladder removal. Ursodeoxycholic acid is used to dissolve cholesterol stones, and ezetimibe and statins are other drugs with possible applications in the treatment of this disease. Given the small number of drugs that have been developed for treating this disease, the research of natural products becomes of paramount importance. Resources such as black radish, glucosinolates, fenugreek, capsaicin, curcumin, garlic, and onion, have all shown significant effects in the prevention and treatment of cholesterol gallstones. In this review, we made a synthesis of the scientific reports that deal with these natural products and that can serve as antecedents for finding a way to treat the most common disease of the gallbladder.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권15호
• /
• pp.6025-6027
• /
• 2014

Background: Because of the relative rarity of biliary tract cancers (BTCs), defining long term survival results is difficult. In the present study, we aimed to evaluate the survival of a series of cases in Turkey. Materials and Methods: A totally of 47 patients with billiary tract cancer from Mersin Goverment Hospital, Acibadem Kayseri Hospital and Kayseri Training and Research Hospital were analyzed retrospectively using hospital records between 2006-2012. Results: The median overall survival was $19.3{\pm}3.9$ months for all patients. The median disease free and overall survivals were $24.3{\pm}5.3$ and $44.1{\pm}12.9$ months in patients in which radical surgery was performed, but in those with with inoperable disease they were only $5.3{\pm}1.5$ and $10.7{\pm}3.2$ months, respectively. Conclusions: BTCs have a poor prognosis. Surgery with a microscopic negative margin is still the only curative treatment.

• 대한한의학원전학회지
• /
• 제33권2호
• /
• pp.77-90
• /
• 2020

Objectives : To determine the meaning of 'yi(噫)' from verses containing the character in 『Huangdineijing』. Methods : First, examples of the usage of 'yi(噫)' in Huangdineijing were collected and analyzed, followed by examples from the other books of the time when 『Huangdineijing』 was written. Finally the term 'ai' which surfaced in a later period than Huangdineijing to refer to eructation was examined. Results & Conclusions : Based on analysis of the usage of 'yi(噫)' in the 『Huangdineijing』, out of a total of 20 cases, 14 cases could be categorized as referring to eructation, 4 cases were difficult to categorize as eructation, and 2 cases were indeterminable. At the time of publication of 『Huangdineijing』, the character 'yi(噫)' was generally used to refer to eructation when used in a medical context, while in non-medical contexts it referred to sigh, or groan. The appearance of 'ai(噯)' is predicted to be during the Song period, but its appearance did not take away the meaning of eructation from 'yi(噫)' and both were used. Based on the change of meaning of 'yi(噫)', we can determine the approximate time when certain contents of the 『Huangdineijing』 were constructed. In the case of '心爲噫[Heart makes 'yi(噫)']', we can understand it as the pectoral qi leaking through the throat manifesting as a sigh in order to relieve stagnation of the excessiveness of the Heart. In cases of deficiency, when the Stomach function is weak, the body is likely to let out a sigh. The term meaning sighing which is 'taixi(大息)' was understood as symptomatic of problems of the Gallbladder as well as the Heart.

• Journal of Trauma and Injury
• /
• 제29권2호
• /
• pp.56-59
• /
• 2016

Patients with pelvic bone fractures with gastrointestinal perforations are reported in 4.4% of the cases and in very rare cases jejunum (0.15) is involved. However, intestinal perforations are often undiagnosed on the first examination before peritonitis is evident. We are presenting a report where a patient with anteroposterior compression injury, who was expected to undergo an internal fixation procedure, did not show any jejunum perforations on abdominal CT or other physical exams but was found on abdominal CT 1 week after right before surgery, therefore excision and anastomosis surgery, pelvic open reduction and internal fixation was simultaneously done with favorable results. In our case, we present a 61 year old male patient with liver trauma, adhesion at the abdominal cavity, with a past history of gallbladder excision, but without abdominal pain, fever, or infection symptoms. Therefore, this was a case that was difficult to initially diagnose the patient with jejunum perforation and peritonitis. The diagnosis was further supported during laparotomy when peritonitis around the area of intestinal perforation was observed. Generally, it is understood that pelvic bone fracture surgery is not immediately done on patients with peritonitis. However, this kind of patient who had peritonitis with intestinal adhesion and other complications could undergo surgery immediately as infection or other related symptoms did not coexist and the patient was rather stable, and as a result the treatment was successful.

• 한국방사선학회논문지
• /
• 제17권1호
• /
• pp.157-165
• /
• 2023

초음파 영상(ultrasound imaging)이란 주파수의 음파를 이용하여 서로 다른 조직의 경계에서 반사, 흡수, 굴절, 투과 등의 물리적인 작용을 일으킨다. 초음파 장비로부터 생성되는 데이터 특성상의 잡음이 많고, 실제로 관찰하고자 하는 조직의 경계가 모호해서 형태의 파악이 어렵기 때문에 개선이 필요하다. 영상 화질의 감소로 인하여 경계면이 뭉쳐 보이는 경우를 해결하기 위한 방법으로 윤곽선(edge) 강조 방법을 사용한다. 본 논문에서는 경계면을 강화시키는 방법으로 언샤프닝 마스크와 하이부스트를 이용하여 각 영상에서 고주파 부분인 경계면을 강화시켜 화질 향상을 확인하였으며 원 영상과 화질이 향상된 영상을 정량적으로 평가하기 위해 MSE, RMSE, PSNR, SNR 등으로 측정하여 각 영상에 사용한 마스크 필터링을 평가했다. 필립스의 epiq 5 g , affiniti 70 g와 알피니언의 E-cube 15 초음파 장비로부터 복부, 머리, 심장, 간, 신장, 유방, 태아 영상을 획득하였다. 알고리즘 구현에 사용된 프로그램은 MathWorks의 MATLAB R2022a으로 구현하였다. 언샤프닝과 하이부스트 마스크 배열 크기는 3×3으로 설정하였으며 윤곽선 강조 영상을 만들 때 사용하는 공간필터인 라플라시안(laplacian) 필터를 두 마스크 모두 동일하게 적용하였다. 화질 정량 평가는 ImageJ 프로그램을 사용하였다. 다양한 초음파 영상에서 마스크 필터를 적용한 결과 주관적인 화질은 원 영상에서 언샤프닝과 하이부스트 마스크를 적용하였을 경우 영상의 전반적인 윤각선이 뚜렷하게 보였으며 또한 하이부스트 마스크에서는 언샤프닝 마스크 영상보다 밝은 명암비를 보여주었다. 정량적인 영상의 품질 비교 시 원 영상보다 언샤프닝 마스크와 하이부스트 마스크를 적용한 영상의 화질이 높게 평가되었다. 간문맥, 머리, 쓸개, 신장의 영상에서는 하이부스트 마스크를 적용한 영상의 SNR, PSNR, RMSE, MAE이 높게 측정되었으며 심장, 유방, 태아 영상은 반대로 언샤프닝 마스크 적용 영상이 SNR, PSNR, RMSE, MAE 값이 높은 값으로 측정되었다. 영상에 따라 최적의 마스크를 사용하는 것이 영상 품질 향상에 도움이 될 것으로 사료되며 각 부위의 초음파 영상의 윤곽 정보를 제공하여 영상의 품질을 향상시켰다.