A Case of Villous Adenomas in the Common Bile Duct and Cystic Duct / 대한내과학회지

Benign tumors of the extrahepatic bile duct are rare. They occur mostly in the common bile duct. Among them, papillomas and adenomas are most common. We experienced a case of villous adenomas in the common bile duct and also in the cystic duct. The ultrasound and the CT scan of the abdomen revealed markedly dilated common bile duct, subtle filling defect, and irregular mass narrowing the lumen of the common bile duct. The cholangiogram demonstrated movable, feathery, and marginated papillary mass with tumors, a broad base, and biopsy of this mass was done through the PTBD. The biopsy specimen showed villous adenoma. Even though it was diagnosed as benign, cholecystectomy and excision with Roux-en-Y hepaticojejunostomy was performed because of the high incidence of recurrences and malignant potential.

A Case of Subphrenic Esophageal Diverticulum Associated with Esophageal Leiomyoma / 대한내과학회지

Esophageal diverticulum is a disease that occurs mainly in adults. According to its location, it is named as pharyngoesophageal, paratracheal and epiphrenic diverticulum. Epiphrenic diverticulum is especially accompanied with esophageal leiomyoma sometimes. In this case. esophageal leiomyoma is combined with suhphrenic diverticulum. The authors present the case with review of literature. The diagnosis of subphrenic diverticulum was confirmed by esophagogastroscopy with biopsy, esophagogram and abdominal CT. Postoperative findings showed it to be accompanied with esophageal leiomyoma.

A Case of Chronic Idiopathic Pseudo-Obstruction Caused by a Degenerative

Intestinal pseudo-obstruction is characterized by symptoms and signs of mechanical bowel obstruction in the abscence of an occluding lesion of the intestinal lumen. The chronic forms of intestinal pseudo-obstruction are separated into primary and secondary in according to the underlying disorders. primary or chronic idiopathic intestinal pseudo-obstruction(CIIP) is not associated with systemic illness and a progressive nature with relapses and remissions. Since Dyer described the rare histologic subtype of idiopathic pseudo-obstruction, the primary abnormality is in the myenteric plexus of the bowel at first in 1969, only few cases are reported. We report a case of CIIP caused by degeneration of myenteric plexus of the colon and he was successfully treated with surgical management.

Transesophageal Echocardiographic Evaluation for Potential Sources of Embolism in the Patients with Ischemic Stroke

BACKGROUND: It has been reported that about one-sixth of all cerebral infarcts are due to cerebral embolism of cardic origin. But transthoracic echocardiographic examination(TTE) of patients with embolic strokes has made low yield for identifying the cause of cardiac or extracardiac source of embolism. Recently, transesophageal echocardiography(TEE) has been proved to be more sensitive than TTE for that purpose. We have studied to detect the potential sources of embolism and to asess the diagnostic yield of TEE in the patient with ischemic strokes. METHOD: Thirty-nine patients with recent cerebral ischemic events(19 men, 20 women, mean age 61), and thirty-eight control patients with other cardiac disease(14 men, 24 women, mean age 52) were examined by both TTE and biplane TEE. For detection of patent foramen ovale, transesophageal contrast echocardiography using 10 ml of agitated saline was performed in all patients. Thoracic aorta, arch of aorta, and ascending aorta were examined during pull back of esophageal probe. RESULTS: 1) TEE is superior to TTE for detection of potential sources pf embolism in the ischemic stroke patients(82 vs 21%, p < 0.001). 2) The potential sources of embolism diagnosed by TEE in the ischemic stroke patients were as follows : 18 aortic atherosclerotic plaque or clot, 11 left atrial(LA) spontaneous echo contrast, 8 LA appendage thrombus, 6 LA thrombus, 6 atrial septal aneurysm, 6 mitral stenosis, 3 patent foramen ovale and 1 prosthetic valve. 3) TEE is the unique procedure to diagnose aortic lesions, LA spontaneous echo contrast, atrial septal aneurysm and patent foramen ovale. 4) The incidence of the aortic lesions by TEE is significantly higher in the patients with ischemic stroke than in the controls(46 vs 11%, p < 0.01). CONCLUSION: Transesophageal echocardiography is useful for detection of potential cardiac and extracardiac sources of embolism compared with TTE and is a unique method for diagnosing aortic atherosclerotic lesion, left atrial spontaneous echo contrast, atrial septal aneutysm, patent foramen ovale and small left atrial appendage thrombus.