Beneficial Effect of Cholecystography following PGBD for Complicated Acute Cholecystitis: Detection of Unsuspected CBD Stone

PURPOSE: Frequency of combined CBD stones on cholelithiasis has been known to range 5~20% in several reports, and diagnostic tools are USG, MDCT, MRCP and ERCP. Predictive factors of CBD stone for cholelithiasis were diameter of CBD, elevated liver enzyme, multiple small sized GB stones and concurrent pancreatitis. However, unsuspected CBD stone for acute cholecystitis is troublesome for patients and surgeons. METHODS: We retrospectively reviewed Percutaneous gallbladder drainage (PGBD) for acute complicated cholecystitis from October 1996 to October 2006. Indications for PGBD are clinical symptoms (sepsis) & signs of peritonitis and radiologic findings such as GB empyema, gangrenous cholecystitis and pericholecystic fluid collection. Total laparoscopic cholecystectomy was 1,357 cases, and PGBD for acute complicated cholecystitis was 13.8%. RESULTS: Combined CBD stone rate was 13.6%. Whereas, unsuspected CBD stone was 0.5% (9 cases), 7 in calculous and 2 in acalculous cholecystitis. No. of stone was 1 in 7 cases, 2 in 1 case and 3 in 1 case. Size of stone was less than 5 mm in all cases. Diameter of CBD was not increased in all cases (less than 1 cm) and liver enzymes showed no elevation in all cases. Management for unsuspected CBD stone was preoperative endoscopic lithotripsy in 8 cases and postoperative fluoroscopic lithotripsy in 1 case. CONCLUSION: Cholecystography following PGBD for acute complicated cholecystitis is a useful diagnostic modality for detection of unsuspected CBD stone.

Effects of Different Kinds of Korean Soybeans on Body Lipids and Lipid Peroxidation in Rats

This study was conducted to investigate the effect of different kinds of traditional Korean soybeans on blood and liver lipids and lipid peroxidation. SD male rats (n =48 )were assigned to six different groups and provided expe-rimental diets for 28 days. The protein source of the diet was casein, isolated soy protein (ISP ), or casein plus traditional soy powders (yellow bean, huktae, jinuni or seorietae ). The ISP, jinuni and seorietae diet decreased blood triglyceride compared to casein group. The ISP groups had lower hepatic total lipid and triglycerides than casein groups. The yellow bean and seorietae group had hepatic lipid lowering effects, but the effect was not found in huktae and jinuni group. The glutamate-oxaloacetate transaminase activity was significantly decreased in ISP and jinuni groups than in casein group. The glutamate-pyruvate transaminase activity was also decreased in ISP group. The results of this study suggest that jinuni, yellow bean and seorietae groups are more effective in lowering body lipids than huktae group.

Percutaneous Gallbladder Drainage and Optimal Timing for Successful Laparoscopic Cholecystectomy in Acute Complicated Cholecystitis

PURPOSE: Laparoscopic cholecystectomy (LC) has been standard in the treatment of uncomplicated symptomatic gallstone disease, but it has been limited for the management of more complicated cholecystitis because of technical difficulties, high conversion rate and postoperative complication rate. Percutaneous gallbladder drainage (PGBD) could been a feasible option for successful LC in patients with acute complicated cholecystitis. Optimal timing of successful LC in acute complicated cholecystitis have been controversy. Aim of this study is to evaluate clinical usefulness of PGBD and optimal timing of successful LC for acute complicated cholecystitis, which is to determine whether PGBD can reduce the conversion or complication rate and shorten the operative time or postoperative hospital stay and timing of LC. METHODS: We retrospectively reviewed the medical records of total 230 patients underwent LC for acute cholecystitis during Jan.1994-March 2005 at DongKang hospital. We divided 2 groups patients into complicated cholecystitis and cholecystitis, Which were subdivided each into PGBD and non-PGBD group by whether PGBD performed and PGBD subdivided into the early LC. RESULTS: Summarized results described above firstly non- PGBD complicated cholecystitis showed higher conversion rate and postoperative complication rate and longer OP. time compared to PGBD group, secondly following PGBD, delayed LC have advantages of lower conversion rate and complication rate and shorter OP. time compared to early LC group. CONCLUSION: PGBD for LC is safe and effective method to immediate LC in the management of acute complicated cholecystitis. Delayed LC after PGBD would be best option of management for acute complicated cholecystitis.

A Clinical Observation of Children with Urachal Anomalies

PURPOSE: Urachal anomalies are rare but are known to develop several complications, especially infection. Moreover, uniform guidelines for management have not been presented because of the variable clinical characteristics of these anomalies. The purpose of this report is to review our experience with urachal anomalies and attempt to determine the optimal management. METHODS: We retrospectively reviewed the records of fourteen children with a variety of urachal anomalies who had been treated from January 1996 to June 2005 at Dong Kang General Hospital. RESULTS: The age distribution of the patients(mean age; 3.8 years) was six neonates, one infant, five preschool-age and two school-age children. The male to female ratio was 1:1. Six cases of urachal cyst, four cases of patent urachus, two cases of urachal sinus and two cases of urachal diverticulum were found. Three patients with patent urachus and one with urachal cyst had hydronephrosis. Other associated anomalies included an inguinal hernia in one patient with urachal sinus and a vesicoureteral reflux in one patient with urachal diverticulum. As a first-line diagnostic tool, high-resolution ultrasound examination was performed in thirteen cases and computed tomography in one case. Surgical excision was performed in nine patients with urachal anomaly. Five cases out of six neonatal cases experienced spontaneous improvement during a three-month follow up period. Due to frequent infection of the umbilicus, surgical excision was performed on one neonate with urachal sinus. CONCLUSION: All patients with urachal anomalies should undergo investigation for associated anomalies. The neonate with urachal anomalies, especially patent urachus, do not require surgical excision unless the patient has multiple episodes of recurrent infection.

Biliary Web: A Rare Cause of Extrahepatic Biliary Obstruction

A biliary web is a rare lesion, which may produce an extrahepatic biliary obstruction. Even though congenital in nature, they usually present later in life, due to their initial patency, which allows bile drainage from the liver. Herein, a case of an operation on an isolated mucosal web of the common hepatic duct, in a 45 years old male, is presented.

Ultravist(R) Test in Postoperative Small Bowel Obstruction

PURPOSE: To determine whether Ultravist(R) test can enable the surgeon to differentiate complete from partial small bowel obstruction in patients with adhesive small bowel obstruction and whether partial small bowel obstruction can be treated nonoperatively. METHODS: Ninety-two patients who had postoperative small bowel obstructions without any toxic signs underwent Ultravist(R) test. Ultravist(R) (40 ml) mixed with 40 ml of distilled water was administrated either orally or via nasogastric tube to each patient. Serial plain abdominal radiographs were taken 4, 6, and 8 hours later. RESULTS: A total of 58 patients (63%) whose contrast medium reached the colon within the first 8 hours were considered to have partial obstruction (test positive) and were successfully treated with intravenous hydration and nasogastric decompression. The remaining 34 patients (36.9%), in whom the contrast medium failed to reach the colon within the first 8 hours (test negative), were regarded as having complete obstruction. Twenty-three of those patients (67.6%) underwent surgery and the other 11 (32.4%) received conservative treatment. Adhesion bands with complete bowel obstruction were observed in all 23 surgical patients during laparotomy. All the patients with partial bowel obstruction were treated successfully with nonoperative methods. Positive Ultravist(R) test as an indicator for nonoperative treatment had a sensitivity of 84.5%, a specificity of 100%, an accuracy of 88% and a false negative rate of 12%. CONCLUSION: Ultravist(R) can be used to differentiate partial from complete intestinal obstruction. All patients with evidence of Ultravist(R) reaching the colon within 8 hours were treated successfully with non-operative methods.

Percutaneous Transhepatic Cholangioscopic Lithotomy in Biliary Stones

PURPOSE: Percutaneous Transhepatic Cholangioscopic Lithotomy (PTCS-L) has been reported as an effective and safe therapeutic method for complicated hepatobiliary stones, particularly in high risk patients. However, there were some limitations and technical difficulties encountered in PTCS-L. The purpose of this retrospective study was to assess the result of PTCS-L in patients with recurrent or residual hepatobiliary stones. METHODS: The medical records of 61 consecutive patients (Jan.1997~Jun.2002) treated with PTCS-L for biliary stone were reviewed. There were 29 patients with primary treatment, and 32 patients with adjuvant treatment for residual stones. PTCS-L was performed within 2 weeks following progressive exchange of PTCS catheter after PTBD. Lithotomy was combined with either electrohydraulic lithotripsy (EHL), Dormia basket, or saline irrigation under fluroscopic guide. If stone was free on one or two consecutive cholangiography after final session lithotomy, then PTCS catheter was removed, but in cases of biliary stricture, 20Fr. of PTCS catheter was placed for average 71 (ranged; 27~270) days. RESULTS: Locations of stones were intrahepatic duct (IHD) in 22 cases, common bile duct (CBD) in 22 cases, CBD & IHD in 11 cases, cystic duct stump & CBD in 3 cases, GB in 2 cases and GB & CBD in 1 case. Routes for PTCS-L were of Rt. hepatic approach (B5 or B6) in 15 cases, Lt. hepatic approach (B3) in 42 cases, both hepatic approach in 2 cases and percutaneous gallbladder drainage (PGBD) tract in 2 cases. Sessions of PTCS-L were one in 22 cases, two in 26 cases, three in 9 cases and four in 4 cases, and overall in 1.5 session. Causes of multiple session in 39 cases were biliary stricture in 13 cases (33%), impacted stones in 10 cases (26%), large stone (>2 cm) in 9 cases (23%) and anatomical variation of IHD including severe ductal angulation in 7 cases (18%), which necessitated routine combined use of EHL (total 44 cases) and sometimes fluroscopic lithotomy (3 cases). Complications encountered following PTCS-L were transient hemobilia in 11 cases, catheter dislodgement in 1 case and hepatic abscess in 1 case, but mortality was nil. During followed up of median 17 months (1~53 months), recurrence of stone occurred in 1 case and one among of 13 patients with biliary stricture underwent operation on recurred biliary stricture. CONCLUSION: PTCS-L is very useful alternative treatment to surgery for residual or recurrent stones and is highly indicated for those of high risk patients. However, Electrohydraulic lithotripsy (EHL) should be combined for those of patients with technical difficulties encountered in case of multiple large impacted stones particularly in the strictured and angulated intrahepatic ducts.

Exposure to genistein does not adversely affect the reproductive system in adult male mice adapted to a soy-based commercial diet

Genistein, a soybean-originated isoflavone, is widely consumed by humans for putative beneficial health effects but its estrogenic activity may affect adversely the development of male reproductive system. Five-week-old ICR mice were purchased and fed with a soybean-based Purina Chow diet until 6 months of age. The animals were exposed by gavage to genistein (2.5 mg/kg/day) or 17beta-estradiol (7.5 microgram/kg/day) for five weeks. Corn oil was used for the negative control. The animals were fed the caseinbased AIN-76A diet throughout the experimental periods. There were no significant differences in body and organ weights of mice among experimental groups. No significant differences in sperm counts and sperm motile characteristics were found between the control and the genistein groups. Treatment of 17beta-estradiol caused a significant decrease in epididymal sperm counts compared to the control (p<0.05). The level of phospholipid hydroxide glutathione peroxidase in the epididymis of mice exposed to genistein was significantly higher than that of the control mice (p<0.05). 17beta-estradiol treatment caused a reduction of germ cells in the testis and hyperplasia of mucosal fold region in the prostate of mice. Genistein treatment did not cause any lesion in the testis, epididymis, and prostate. These results suggest that dietary uptake of genistein at adult stage of life may not affect male reproductive system and functions.