Bile Duct Dilatation after Subtotal Gastrectomy in Stomach Cancer: Comparison with Gastroduodenostmy (BillothI) and Gastro Jejunosto my (Billoth II)

PURPOSE: To evaluate the incidence and degree of bile duct dilatation after partial gastrectomy due togastric cancer and to determine any differences between gastroduodenostomy (Billoth I) and gastrojejunostomy(Billoth II). MATERIALS AND METHODS: We retrospectively analyzed the follow up abdominal CT findings in 113patients who had undergone partial gastrectomy without truncal vagotomy or cholecystectomy. In all cases,preoperative abdminal CT findings showed no evidence of bile duct dilatation. Among 113 patients, 41 underwentBilloth I surgery, and 72 underwent Billoth II. No case showed clinical or radiological evidence of obstructivecauses of bile duct dilatation. Among these patients, we decided the criteria for dilatation when this was noted.The grade was either mild (3 -4 mm), moderate (5 -8mm), or severe (over 9mm), as measured at the centralintra-hepatic duct. Extra-hepatic duct dilatation was graded as mild (6 -8mm), moderate (9 -12mm) or severe (over13 mm). We analyzed serum bilrirubin and alkaline phosphatase levels. RESULTS: When the central intrahepatic ductwas measured, 78 of 113 patients(69 %) showed bile duct dilata-tion; 24 of 41 cases(58.5 %) were in the billoth Igroup and 54 of 72 (75 %) were the in Billoth II group. After measurement of the extra hepatic duct, 22 of41cases(53.6%) in the Billoth I group and 54 of 72 (75 %) in the Billoth II group were found to be dilated. Theresults showed a slightly increased incidence of bile duct dilatation in the Billoth, II group but this was notstatistically significant(p>0.05). In the laboratory, total, direct, and indirect bilirubin, as well as alkalinephosphatase levels, were measured. Higher levels were found in Billoth II than in Billoth I but all findings werewithin normal limits. CONCLUSION: Mild dilatation of the bile duct after partial gastrectomy was a not uncommonfinding, and there was no significant difference of incidence or degree of dilatation according to the procedureperformed. If a patient has no clinical symptoms, it appears that clinical it appears that clinical evaluationdoes not require fur-ther study.

CT Findings of Non-specific Colonic Edema in Liver Cirrhosis

PURPOSE: To evaluate the CT findings and clinical significance of colonic edema in liver cirrhosis. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 221 cases of clinically diagnosed liver cirrhosis in 173 patients. In 30 of these [23 men and six women aged between 35 and 67 (mean, 54) years], colonic edema was present. We evaluated its distribution (ascending, transverse or descending colon), analysed serum albumin and bilirubin levels, and in both the colonic edema and non-colonic edema group, determined whether ascites was present. Thus, we sought correlation between the presence of colonic edema, the severity of liver cirrhosis, and each parameter. RESULTS: CT revealed colonic edema in 30 of 221 cases (14 %). Of the 30, 13 cases (43 %) were diffuse colonic edema and 17 (57 %) were regional edema. Among these 17 cases, 12 (71 %) were seen only in the ascending colon, while five (29 %) were seen in both the ascending and transverse colon. In the group with colonic edema, the mean level of serum albumin was 2.6 g/dl, and that of serum bilirubin was 4.9 mg/dl; 20 patients ( 67 %) had ascites. In the group without colonic edema, mean levels of serum albumin and serum bilirubin were 3.0 g/dl and 4.1 mg/dl, respectively ; 43 patients (30 %) had ascites. There was no significant statistical difference in serum albumin and bilirubin levels between the colonic edema and non-colonic edema group (p>0.05), though ascites was more common among the former group. CONCLUSION: In cases of liver cirrhosis, CT evidence of colonic edema is not uncommon. The ascending colon is most frequently involved, though disease severity does not vary significantly according to site. When CT reveals the presence of colonic edema, further diagnostic evaluation is not necessary if there is no evidence of clinical symptoms.

Cystic Lesions in the Stomach

Cystic lesions of the stomach are rare and usually detected incidentally during surgery or autopsy. Amongseven cases of cystic masses, duplication cysts accounted for four, retension cysts of ectopic pancreas for two,and cystic lymphangioma remaining one. In the upper gastrointestinal series, all were submucosally, whileendoscopic ultrasonography showed that the location of cystic masses was also submucosal. Except for two cases ofduplication cyst and cystic lymphangioma which were thin-walled, lesions were well-defined and showed lowattenuation. In addition, abdominal CT scanning showed two cases of retension cyst of ectopic pancreas.

The CT examination of changes in intracranial hematoma density

The study was undertaken to asses the changes in the size and densities of intracranial hematomas by analyzingthe sequential CT examination of 23 patients ar Soon Chun Hyang College Hospital from July '80 to Aug. '81. Theresuls were as follows; 1. The high densities of hematoma were the cause of hematoma, hematoma locaiton, age andsex of patients, and initial hematoma size. 3. The CT findings that indicate complete absorption of hematomas werenormalization of mass effect, not diappearence of hematoma densities. 4. In intracerebral hematoma, the highdensity of hematoma reduced it's density and mass effect about 4-6 weeks duration. 5. In subdural hematoma, about7 weeks after head trauma, the CT findings were normalized.

Brain CT findings in head injury with skull fracture

CT has revolutionized the evaluation and management of patients with head injuries. CT is noninvasive and rapidly provides accurate information regarding the presence, extent and nature of intracranial lesions resulting from trauma. We have reviewed the CT scans of 114 patients, who got head injury with confirmed to skull fracture in plain film. The result were as follows; 1. Of all cases, traffic accident was the most frequent cause and in children fall down was more than 50%. 2. Compound linear fracture was the most frequent type fractures in plain skull film. 3. Of all 114 case, epidural hematoma was 16%, subdural hematoma was 18.4%, intracerebral hematoma was14.4%, subdural hygroma was 2.4%, normal finding was 50%. 4. Mortality rate was 13.2%. 5. Fracture was detected by CT about 28.9%, depression fracture was more easily detected in CT. 6. Incidence rate of countercoup lesion was14.0% and mortality rate was higher than same site lesion, 7. The shape of epidural hematoma was biconvex in 75%, planoconvex in 25%. 8. The shape of subdural hematoma was crescentic shape 82.6%, biconvex shape 8.7%, planoconvex shape 8.7%.