The Practical Multidisciplinary Management of the Indeterminate Biliary Stricture and/or Dilatation -Radiological Differential Diagnosis: Challenging but Essential- / 대한췌담도학회지

The most important aspect of the imaging role for indeterminate bile duct stricture is to make a differential diagnosis on whether the stricture is highly likely to be malignant or benign. Compared to benign stricture, malignant stricture is longer, thicker, and has indistinct outer border and irregularity of the lumen in contrastenhanced computed tomography and magnetic resonance (MR). Also, in the contrast-enhanced portal phase, malignant stricture has a stronger enhancement than the liver parenchyma. There are studies to differentiate between malignant and benign stricture in diffusion weighted image, a functional MR image, but there remains controversial. Sometimes, malignant biliary stricture may be caused by bile duct invasion of gallbladder cancer, pancreatic cancer, hepatocellular carcinoma, biliary metastasis, and lymphoma. Among the potential causes of indeterminate biliary stricture, the characteristics of multifocal biliary stricture mainly suggest benign sclerosing cholangitis, and various external compression factors that cause biliary stricture can be differentiated by radiologic imaging. There are causes of biliary dilatation without obstructive lesion, radiologic diagnosis can be made by considering various characteristics.

Snapping Knee Caused by a Superiorly Displaced Medial Meniscus:Knee Dynamic Ultrasonographic Findings

The causes of snapping knee include meniscal instability, but dynamic ultrasonographic findings have rarely been reported. Here, we report a case of snapping knee due to direct trauma to the right knee of a 79-year-old woman. Dynamic ultrasonography is used to confirm the snapping phenomenon caused by the anterosuperior displacement of the truncated posterior horn and body of the right medial meniscus.

Snapping Knee Caused by a Superiorly Displaced Medial Meniscus:Knee Dynamic Ultrasonographic Findings

The causes of snapping knee include meniscal instability, but dynamic ultrasonographic findings have rarely been reported. Here, we report a case of snapping knee due to direct trauma to the right knee of a 79-year-old woman. Dynamic ultrasonography is used to confirm the snapping phenomenon caused by the anterosuperior displacement of the truncated posterior horn and body of the right medial meniscus.

Snapping Pes Anserinus Caused By Gracilis Tendon: A New Mechanism Proposed by Dynamic Knee Ultrasonography

Snapping pes anserinus is the main extra-articular cause of snapping on the medial side of the knee. There are limited articles that describe the mechanism of the condition, especially only when flexion of the knee. We report a case of snapping pes anserinus in a 23-year-old skier, which was reproduced on only active flexion of both knees in the posteromedial aspect of the tibia, with pain for 6 years, diagnosed using dynamic ultrasonography for elucidating a new mechanism of the gracilis tendon. We performed dynamic ultrasonography of the right knee of the patient; the gracilis tendon was twisting and folding and then, snapping occurred when the gracilis tendon passed by the sartorius muscle. The atypical movement of the gracilis tendon was considered the primary factor for snapping in this patient, which was diagnosed with dynamic ultrasonography.

Cranial nerve XII (hypoglossal nerve) palsy after arthroscopic shoulder surgery under general anesthesia combined with sono-guided interscalene brachial plexus block: A case report

Neurologic complications after shoulder surgery may result from surgical procedures or anesthesia. Hypoglossal nerve is a pure motor nerve that supplies mylohyoid and hyoglossus muscles. Isolated hypoglossal nerve injury may be caused by direct trauma, head malposition (hyperextension or hyperflexion), and indirect compression or traction during intubation. We report a case of left hypoglossal nerve palsy after arthroscopic left shoulder surgery in the beach chair position under general anesthesia combined with brachial plexus block.

Effects of Dexmedetomidine Infusion on the Recovery Profiles of Patients Undergoing Transurethral Resection

Transurethral resection has been the gold standard in the operative management of benign prostatic hyperplasia and bladder tumor; however, it is associated with several complications that may cause patient discomfort. We evaluated the usefulness of continuous infusion of dexmedetomidine on emergence agitation, hemodynamic status, and recovery profiles in patients undergoing elective surgery by a randomized clinical trial. Sixty patients aged 30 to 80 yr who were scheduled for elective transurethral resection under general anesthesia were included in this study. Participants were randomly assigned to two groups (control group, group C; dexmedetomidine group, group D). A total of 60 male patients were enrolled in this study and randomly assigned to group C (n=30) or group D (n=30). The quality of emergence in group D was marked by a significantly lower incidence of emergence agitation than in group C (P=0.015). Patients in group D therefore felt less discomfort induced by the indwelling Foley catheter than those in group C (P=0.022). No statistically significant differences were found between the two groups with respect to side effects including bradycardia (P=0.085), hypotension (P=0.640), and postoperative nausea and vomiting (P=0.389). Our study showed that intraoperative dexmedetomidine infusion effectively reduced the incidence and intensity of emergence agitation and catheter-induced bladder discomfort without delaying recovery time and discharge time, thus providing smooth emergence during the recovery period in patients undergoing transurethral resection (Clinical Trial Registry No. KT0001683).

Primary Cementless Total Hip Arthroplasty with a Sandwich Type in Ceramic-Ceramic Articulation (Minimum 10-Year Follow up Results)

PURPOSE: To evaluate the minimum 10-year follow up results of primary total hip arthroplasty (THA) performed using a sandwich-type (alumina-polyethylene-titanium) ceramic bearing. MATERIALS AND METHODS: Thirty four patients (40 hips) who underwent a THA with sandwich typed liners from November 1998 to December 2000 were analyzed. Among the 34 patients, 25 were men and nine were women. Mean follow-up was 134 months (range, 120~145 months) and mean patient age at the time of THA was 47.1 years (range, 24~65 years). The clinical results were evaluated using the Harris hip score and level of thigh pain with a limping gait. The radiographic evaluation was done in terms of the endosteal new bone formation, radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening. RESULTS: The mean preoperative Harris hip score of 50.2 points (range, 31~87 points) was improved to 90.9 points (range, 75~99 points) at the final follow-up and thigh pain with limping gait in one case. All cases had fixation by bony ingrowth. No radiographically detectable loosening was observed in any hip. Fracture of ceramic liner in one case required change of the polyethylene liner. CONCLUSION: At the minimum 10-year follow up, survival rate as the end-point was favorable. However, fracture of the ceramic is still a major problem. Satisfactory results can be obtained by more precise surgical technique for acerabular inclincation and anteversion, and by improving the quality of the ceramic.

Ganglion Cyst in Acetabular Fossa of the Hip Joint: Case Report

Ganglions commonly occur on the hand, wrist, knee, ankle and foot, with occasional development around the hip joint. Ganglion in the acetabular fossa is rare. We present a case of a ganglion in the acetabular fossa of the hip with treatment.

Sequence analysis of segment A gene of a very virulent infectious bursal disease virus recently isolated in Korea / 대한수의학회지

Infectious bursal disease virus (IBDV) is a member of the Avibirnavirus genus of the Birnaviridae family which genome consists of two segments (A and B) of double stranded RNA. Segment A gene of KNU08010 isolate, which was isolated from a 15-day-old chicken flock in 2008, was sequenced and compared with other IBDV isolates including SH/92 strain, the first Korean very virulent (vv) IBDV isolate. The amino acid sequences of segment A gene showed that KNU08010 had 99.2% homology with SH92 strain. KNU08010 isolate had specific amino acids A222, I242, I256, I294 and S299 which are highly conserved among vvIBDV strains. Phylogenetic analysis based on the nucleotide sequences of variable region of the VP2 gene of 18 IBDV strains revealed that KNU08010 was grouped with vvIBDVs and was closely related to Korean vvIBDVs isolated from wild birds.

The Incidence and Medical Treatment of Congenital Nasolacrimal Duct Obstruction in Korean Infants

Congenital nasolacrimal duct obstruction(CNLDO) is the most common abnormality of the lacrimal apparatus in infants. The estimates of incidence of CNLDO had been made by many authors with variable range and the reports on the natural course of this condition in Korean infants are very seldom. We examined the patency of 990 nasolacrimal ducts in 495 newborn infants by the F.D.D.(fluorescein dye disappearance) test and lacrimal irrigation. In the 51 patients(10.3%), there were 69 obstructed nasolacrimal ducts(6.97%). The patients with eye discharge had higher incidence of CNLDO than the patients without eye discharge. There were no significant predilection of sex, chronologie age, birth weight, age of mother or type of delivery. All affected patients were followed prospectively with hydrostatic massage and topical antibiotics. Of the 46 ducts(32 infants) followed with medical treatment until 12 months after birth, 23 ducts(50%) became patent within one month after birth, 37 ducts(80%) were improved by the 2 months after birth. 45 ducts(98%) showed good patency by the 1 year after birth. In conclusion the incidence of the CNLDO in Korean infants was relatively high(10.3%), and CNLDO in newborn could be cured by the medical treatment only.

A Case of Capsule Contraction Syndrome following Continuous Curvilinear Capsulorhexis

Capsule contraction syndrome is severe constriction of the anterior capsular opening and equatorial capsular bag diameter after extracapsular cataract surgery. It is relatively common in patients with continuous curvilinear capsulorhexis, but rarely in can-opener capsulotomy or anterior radial capsular tears. It is due to capsular bag contraction from fibrous dysplasia of residual lens epithelial cells with weakened zonular resistance. We experienced a case of capsule contraction syndrome in a 72-year old woman with retinitis pigmentosa, who had phacoemulsification following an intact 5.0mm-continuous curvilinear capsulorhexis 4 months before. After successful YAG laser radial anterior relaxing capsulotomy, her visual acuity restored to 0.3, limited by cystoid macular edema.

Comparison of Corneal Astigmatism According to Varing Incision Location and Suture Method in Phacoemulsification

In order to evaluate the effects of incision location and suture method on induced astigmatism in cataract surgery, three different procedures were applied to 150 eyes which had phacoemulsification through 6 mm incision with 6 mm optic IOLs. The group 1(50 eyes) had posterior limbal incision followed by interrupted radial sutures. The group 2(50 eyes) had posterior limbal incision followed by continuous shoelace sutures. The group 3(50 eys) had scleral pocket incision at 2 - 2.5 mm apart from the surgical limbus followed by sutureless technique. The corneal astigmatism was ana lysed by algebraic and vector methods. Keratometric astigmatic changes with vector analysis on postoperative 1 day were 2.34 diopter(D), 1.41D, 0.74D in the group 1, group 2, gruop 3 respectively. There were statistically significant differences among the three groups(p<0.01). At postoperative 1 week. the keratometric astigmatic change of the group 3 was less than that of the group 1(p<0.01) and the visual acuity of the group 3 was better than that of the group 1(p<0.05). During postoperative 1 to 6 months, there was no statistically significant differences among the three groups in astigmatic changes or visual acuity. It could be concluded that scleral pocket incision with suture less technique showed significantly less astigmatism than other techniques initially, and continuous shoelace suture technique could have more stable and less astigmatism than interrupted radial suture technique.