A Case of Biliary Fascioliasis Mimicking Neoplasia of the Common Hepatic Duct / 대한내과학회지

Fascioliasis is a rare zoonotic disease caused by Fasciola hepatica, the liver fluke. Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants containing viable metacercariae. There are two disease stages: the hepatic (acute) and biliary (chronic) stages. The biliary stage of this zoonotic infection is often misdiagnosed because the symptoms are subclinical, with intermittent cholangitis as the only sign. Endoscopic retrograde cholangiopancreatography (ERCP) has been described in the diagnosis of a few cases of fascioliasis. We used this modality to diagnose biliary fascioliasis in a 39-year-old woman with chronic hepatitis B who had intermittent abdominal pain for three years with irregular wall thickening and luminal narrowing of the common hepatic duct (CHD), which resembled neoplasia of the CHD. Following the correct diagnosis, the adult worm was removed using endoluminal forceps via endoscopic sphincterotomy. This case report confirms the diagnostic and therapeutic value of ERCP in patients with biliary fascioliasis that may mimic neoplasia of the CHD.

A Case of Colonic Perforation after Acute Necrotizing Pancreatitis / 대한내과학회지

Colonic perforation after acute necrotizing pancreatitis is a very rare but critical complication. The mortality rate is greater than 50%. Therefore, a high index of suspicion is needed for early detection of the complication. We present a case of a 50-year-old man diagnosed as colonic perforation after acute necrotizing pancreatitis. During the treatment course, fecal material was drained via a pleural drainage tube. Colonic perforation was confirmed on CT scan. The pathogenesis of colonic perforation in this case involved direct spread of pancreatic enzymes and inflammatory exudate. He was treated successfully with colectomy, ileostomy, debridement of necrotic tissue, and drainage.

The Efficacy of Ultrasonography in Identifying Fracture Patterns of Nasal Bone

PURPOSE: The purpose of this study was to know whether ultrasonography is proper diagnostic tool for decision of treatment method or not, as compared the efficacy of US in allowing identifying fracture patterns of nasal bone with that of CT. MATERIALS AND METHODS: Fifty patients with nasal trauma were investigated prospectively by CT and US. According to CT and ultrasonographic findings, each case of nasal bone injury were rated as grade 1 (nasal injury but not fracture), grade 2 (simple fracture without displacement), grade 3 (unilateral simple fracture with displacement), grade 4 (bilateral simple fractures with displacement), and grade 5 (bilateral comminuted fractures with depression). Assessment for ultrasonographic method were defined as overestimations or underestimation according to whether the nasal fracture had been assigned a higher or lower grade at the review of the findings of CT. The correlation between the results of CT and ultrasonography were measured. RESULTS: In ultrasonographic estimation of grade of 50 cases of nasal bone injuries, there were correctly graded in 42 cases, overestimated in 5 cases, underestimated in 3 cases. In allowing accurate grading of nasal bone injury, images of nasal ultrasonography correlated closely with those of CT (r = 0.796). CONCLUSION: Nasal ultrasonography is a reliable method that allows appropriate grading of nasal bone injury and would be a useful first line imaging method in providing the detail necessary for proper management of patients with mild simple nasal bone injury.

Grifola frondosa water extract alleviates intestinal inflammation by suppressing TNF-alpha production and its signaling

TNF-alpha is a major cytokine involved in inflammatory bowel disease (IBD). In this study, water extract of Grifola frondosa (GFW) was evaluated for its protective effects against colon inflammation through the modulation of TNF-alpha action. In coculture of HT-29 human colon cancer cells with U937 human monocytic cells, TNF-alpha-induced monocyte adhesion to HT-29 cells was significantly suppressed by GFW (10, 50, 100 microg/ml). The reduced adhesion by GFW correlated with the suppressed expression of MCP-1 and IL-8, the major IBD-associated chemokines. In addition, treatment with GFW significantly suppressed TNF-alpha-induced reactive oxygen species production and NF-kappaB transcriptional activity in HT-29 cells. In differentiated U937 monocytic cells, LPS-induced TNF-alpha production, which is known to be mediated through NF-kappaB activation, was significantly suppressed by GFW. In an in vivo rat model of IBD, oral administration of GFW for 5 days (1 g/kg per day) significantly inhibited the trinitrobenzene sulfonic acid (TNBS)-induced weight loss, colon ulceration, myeloperoxidase activity, and TNF-alpha expression in the colon tissue. Moreover, the effect of GFW was similar to that of intra-peritoneal injection of 5-aminosalicylic acid (5-ASA), an active metabolite of sulfasalazine, commonly used drug for the treatment of IBD. The results suggest that GFW ameliorates colon inflammation by suppressing production of TNF-alpha as well as its signaling through NF-kappaB leading to the expression of inflammatory chemokines, MCP-1 and IL-8. Taken together, the results strongly suggest GFW is a valuable medicinal food for IBD treatment, and thus may be used as an alternative medicine for IBD.

Comparison of Magnetic Resonance Cholangiopancreatography with Endoscopic Retrograde Cholangiopancreatography in the Evaluation of the Biliary Tract Diseases / 대한소화기내시경학회지

BACKGROUND/AIMS: This study was performed to evaluate the diagnostic accuracy and clinical applications of magnetic resonance cholangiopancreatography (MRCP) compared with endoscopic retrograde cholangiopan creatography (ERCP). METHODS: Prior to carrying out ERCP, MRCP was performed on 71 patients and the two examinations were compared using a double blank test. RESULTS: The results revealed that 15 patients had choledocholithiasis, 4 gall bladder stones, 28 cholangiocarcinomas, 12 pancreatic head cancers, 2 ampulla of Vater cancers, 1 gall bladder cancer with ductal invasion, 4 other benign diseases and 5 normal conditions. For the patients with choledocholithiasis, the values of MRCP's sensitivity, specificity and accuracy were 100%, 98.2% and 98.6%, respectively, and those of ERCP's were all 100%. For the patients with malignant obstructions, the values of MRCP's sensitivity, specificity and accuracy were 90.7%, 100% and 94.4%, respectively, and the values of ERCP's were 95.3%, 92.9% and 94.4%. CONCLUSIONS: These data show that MRCP has a rather high sensitivity, specificity and accuracy in the diagnosis of the biliary tract system, and therefore MRCP can be substituted for ERCP in the aspect of diagnosis.

Misregistration Artifact due to Respiratory Motion on Spiral CT of the Liver

PURPOSE: To determine the frequency and patterns of respiratory-induced misregistration artifact seen on spiral CT of the liver. MATERIALS AND METHODS: Two hundred patients with hepatic mass underwent spiral CT, and arterial phase images were compared with those of the portal phase in all cases and or of the delayed phase in 138. The patterns of misregistration artifact were divided into two groups: skipping, where at least two slices in the craniocaudal length of the mass were missed, and the partial volume veraging artifact thus excluded; and overlapping, where the same or reversed images were seen in succeeding sequences. We reviewed the location and size of the masses, and the presence or absence, and patterns of the misregistration artifact. RESULTS: Fourteen (7%) of 200 spiral CT scans demonstrated the misregistration artifact; in five of these there was skipping (involving a hepatic mass larger than 2 cm in two cases, and one smaller than 2 cm in three cases), and in nine there was overlapping (six masses larger than 2 cm, and three smaller than this). A lipiodol-laden mass measuring 5 mm was completely missed during the arterial phase. and in one case the spleen sequence was reversed. Thirteen (93%) of fourteen masses were located in the right lobe. CONCLUSION: Two patterns of misregistration artifact, skipping and overlapping, were observed, and their combined frequency was 7%. So as not to miss small hepatic masses or overestimate their size, careful respiratory control is therefore needed.