Three Cases of Gallstone Ileus / 대한소화기내시경학회지

Gallstone ileus is a mechanical obstruction caused by the impaction of one or more gallstones within the lumen of any part of the gastrointestinal tract. Gallstone ileus is frequently proceeded by an episode of acute cholecystitis. The resulting inflammation and adhesions facilitate the erosion of the offending gallstone through the gallbladder wall forming a cholecystoenteric fistula and allowing the passage of the gallstone. Fifty five-year-old, 71-year-old, and 74-year-old female patients were admitted to the Asan Medical Center for nausea, vomiting, and nonspecific abdominal pain. Erect abdominal plain film revealed several moderately dilated loops of small bowel with air fluid levels. Computed tomography showed the classic triad of findings of gallstone ileus. Dilated loops of small bowel, air in the biliary tree and an ectopic stone in the ileum were demonstrated. These impacted stones were removed by surgical intervention.

Estimation of Kidney Size by Ultrasonography in Normal Korean Adults / 대한신장학회잡지

BACKGROUND: The kidney size is important in differentiating many renal diseases. Some studies have been reported about the normal kidney size in the foreign countries. However, no studies were performed by using ultrasonography in Korea. Therefore, we investigated the normal kidney length, the factors affecting the kidney length and the relationship of each other. METHODS: One thousand three hundred eighty eight healthy Koreans were scanned for the kidney length by ultrasonography and were measured for their body index(height, weight, body surface area, total body water, and fat free mass). We analyzed the association between kidney length and body index. RESULTS: Eight hundred four male and five hundred eighty four female were involved in this study and their mean age was 47.8+/-10.3 in male, 48.1+/-9.5 in female. 1) The average value of left and right kidney was 10.65+/-0.80cm, 10.50+/-0.78cm respectively, and the left kidney was greater than right one(P<0.01). 2) The difference between male and female was 10.77+/-0.79cm, 10.49+/-0.78cm respectively in the left kidney and 10.66+/-0.76cm, 10.27+/-0.75cm in the right kidney(P<0.01). 3) The aging process nearly does not affects the kidney size from 4th decade to 7th decade. However, the kidney size is getting smaller after 8th decade. 4) The correlation coefficient between the kidney size and height, weight, body surface area, total body water, fat free mass was 0.37, 0.41, 0.43, 0.37, 0.38(P<0.01) respectively. CONCLUSION: The kidney length showed normal distribution in normal Korean adult and the length greater than 12.36cm, smaller than 8.76cm means out of its range of normal(+/-2SD) irrespective of sex and position. The body surface area has the largest correlation with kidney size in both sex(r=0.38/0.44; left/right, P<0.01).

Comparison of Diagnostic Accuracy of Three- Dimensional MR Cholangiopancreatography and ERCP in Various Extrahepatic Biliary Lesions

PURPOSE: To evaluate the diagnostic role of a three-dimensional MR cholangiopancreatography(MRCP) over endoscopic retrograde cholangio- pancreatography(ERCP) in various extrah-epatic biliary disease. MATERIALS AND METHODS: MRCP and ERCP were performed in 45 consecutive patients with suspected extrahepatic biliary diseases. MRCP was obtained using a reverse fast imaging with a steady-state free precession (reverse FISP : PSIF) sequences, and then images were reconstructed by standard MIP algorithm. The predictability of biliary dilatation and level of obstruction of MRCP was evaluated using ERCP as a gold standard. The accuracy distinguishing malignant from benign lesions, and overall diagnostic accuracy were compared between MRCP and ERCP. RESULTS: The sensitivity, specificity and accuracy of MRCP in predicting biliary dilatation were 94.6%, 75.0% and 91.1%, respectively. The level of obstruction was accurate in 87.0% with MRCP. The sensitivity, specificity and accuracy MRCP and ERCP in distinguishing malignant from benign lesions were 76.2%, 87.5% and 82.2% and 71.4%, 83.3% and 77.8%, respectively. The overall diagnostic accuracy was 60.0% with MRCP and 55.6% with ERCP. CONCLUSION: 3D MRCP shows a good diagnostic value compared to that of ERCP, and can replace a ERCP.