Secondary gallbladder hydatidosis and nonfragmanted germinative membrane sourced obstructive jaundice caused by intrabiliary ruptured hepatic hydatid cyst (a case report): two rare complication of the intrabiliary ruptured hepatic hydatid cyst.

Intrabiliary rupture is the most frequently seen complication of the hepatic hydatid cysts. Obstructive jaundice can be seen as a complication of the intrabiliary ruptured hepatic hydatid cysts due to the migrated cystic content into bile ducts. In this study, we present two rare complications seen in a patient who has intrabiliary ruptured hepatic hydatid cyst. Obstructive jaundice and secondary gallbladder hydatidosis depending on to the intrabiliary ruptured hepatic hydatid cyst in a 58-year-old man patient were diagnosed and treated. A large choledochal nonfragmanted germinative membran was found in the choledochus as the reason of biliary obstruction. Hepatic hydatid cyst is a world-wide disease. Intrabiliary rupture must be kept in mind in the patients who has hepatic hydatid cyst and biliary tract problems.

Incidental findings of cardiac MSCT: who might benefit from scanning the entire thorax on Ca score imaging?

PURPOSE: We aimed to report incidental noncoronary findings of coronary MSCT angiography and to evaluate the feasibility of scanning the entire thorax on Ca score imaging. METHODS: 514 patients underwent cardiac MSCT. Instead of scanning just the heart, 124 of them were scanned extensively from the lung apex to the base in order to evaluate the entire thorax for additional findings. Furthermore, we calculated dose length product (DLP) in order to determine mean increase of radiation exposure resulting from lengthened scan field. RESULTS: Coronary artery disease were established in 122 patients (24%) and 273 noncoronary findings were identified in 189 patients (37%). 37 pulmonary nodules (PN) > or =5 mm, 6 of which were over the level of pulmonary trunk, were detected. The mean age (62+/-8 vs.49+/-10, respectively; p<0.0001) and the smoking rate (74% vs. 56%, respectively; p<0.05) of the patients with PN were significantly higher than subjects without PN. All patients with PN over the level of pulmonary artery were smokers >50 of age. On Ca score imaging, radiation exposure of widely scanned group was significantly higher than the others (221.3+/-35.2 mGy cm vs.145.3+/-11.7 mGy cm of DLP, respectively; p<0.0001). CONCLUSION: Since MSCT data contain also information about the other structures in the thorax, the images should be evaluated by radiologist in addition to cardiologist. It seems reasonable to scan the entire thorax on Ca score imaging for smokers over 50 in order to detect pulmonary nodules having malignancy potential.

Treatment of a patient with cleft lip and palate using an internal distraction device.

A 24-year-old man with a bilateral cleft lip and palate was treated by a multidisciplinary team composed of an orthodontist, plastic surgeon, and prosthodontist with assistance from an engineer. Before treatment, clinical photographs, dental casts, lateral and posteroanterior cephalograms, periapical and panoramic radiographs, and three-dimensional computed tomography (3D CT) images were obtained. He presented with a narrow and retrognathic maxilla with a 23-mm anterior open bite. Following maxillary expansion with rapid palatal expansion, a Le Fort I maxillary osteotomy was performed, and an internal distractor was placed. After a 5-day latency period, internal maxillary distraction was performed at a rate of 1 mm/day achieved by two activations per day. Cephalometric analysis showed a 7-mm maxillary advancement. Mandibular bilateral sagittal split osteotomy was also performed to close the open bite following maxillary distraction and a 3-month stabilization period. Finally, the treatment was completed with prosthetic rehabilitation. The changes in speech production were evaluated using an automatic speech recognition system.

The effect of inhaled budesonide and formoterol on bronchial remodeling and HRCT features in young asthmatics.

Asthma is a chronic disease that may cause remodeling of the airways. We aimed to observe the effects of the combined use of inhaled budesonide and formoterol on both the reversibility of remodeling and structural changes in the airways. Thirty-six male patients (age range, 20-31) with mild-to-moderate persistent asthma were given inhaled formoterol and budesonide treatment for three months. Bronchial diameter (BD) and bronchial wall thickness (BWT), as measured by high-resolution computerized tomography, and reticular basement membrane thickness (RBMT), assessed in bronchoscopic biopsy specimens, were compared with pretreatment findings. Twenty-two age-matched male controls were also enrolled. BDs of the patients were significantly smaller than in the controls, whereas BWT and RBMT were greater. After three months BWT and RBMT of the subsegmental airways significantly decreased and BD increased. There was a prominent eosinophilic and lymphocytic infiltration in the bronchial mucosa of the asthmatics, and the eosinophilic infiltration significantly improved with treatment. Both serum total IgE and eosinophil counts were related to eosinophilic infiltration in the biopsy samples (r = 0.494 and r = 0.463, respectively). FEV(1) was positively correlated with the diameters of the segmental and subsegmental airways (r = 0.491 and r = 0.265, respectively) and negatively correlated with BWT of the subsegmental airways (r = -0.293) and with the RBMT of both the segmental and subsegmental airways (r = -0.597 and r = -0.590, respectively). We suggest that treatment with inhaled formoterol and budesonide may reverse increased RBMT and BWT as part of remodeling in patients with asthma.