• Journal of Trauma and Injury
• /
• v.34 no.3
• /
• pp.208-211
• /
• 2021

Gallbladder injuries are rare in cases of blunt abdominal trauma and are usually associated with damage to other internal organs. If the physician does not suspect gallbladder injury and check imaging studies carefully, it may be difficult to distinguish a gallbladder injury from gallbladder stone, hematoma, or bleeding. Therefore, in order not to miss the diagnosis, the clinical findings and correlation should be confirmed. In the present case, a 60-year-old male presented to a local trauma center complaining of pain in the upper right quadrant and chest wall following a motor vehicle collision. Abdominal computed tomography (CT) showed a hepatic laceration and hematoma in the parenchyma in segments 4, 5, and 6 and active bleeding in the lumen of the gallbladder. Traumatic gallbladder injuries generally require surgery, but in this case, non-operative management was possible with cautious follow-up consisting of abdominal CT and angiography with repeated physical examinations and hemodynamic monitoring in the intensive care unit.

• Annals of Hepato-Biliary-Pancreatic Surgery
• /
• v.28 no.2
• /
• pp.214-219
• /
• 2024

Backgrounds/Aims: Open cholecystectomy is becoming obsolete and laparoscopic cholecystectomy has become the treatment of choice in gallstone diseases. Difficult gallbladders are encountered whenever there is a frozen calot's triangle, obliterated cystic plate, or both. Rather than converting to open procedure, there has been a growing preference for laparoscopic subtotal cholecystectomy (LSC) during difficult gallbladders. This study aimed to assess the advantages, indications, and viability of LSC in difficult gallbladders. Methods: The study included patients undergoing laparoscopic cholecystectomy in NIMS Hospital, Jaipur, from January 2021 to January 2023. Data of the patients who underwent LSC for difficult gallbladders included demographics, comorbidities, operative time, conversion to open cholecystectomy, length of hospital stay, and complications. LSC was classified into three types depending on the part of the gallbladder remnant. Results: A total of 728 patients underwent laparoscopic cholecystectomy. Among them, 41 patients (5.6%) were attempted for LSC. However, one patient was converted to an open procedure and the rest 40 underwent LSC. LSC was divided into 3 types, 4 patients underwent LSC type I, 34 patients underwent type II, and 2 patients type III. The average operating time and postoperative length of hospital stay were 86.2 minutes and 2.1 days, respectively. Two patients had surgical site infection. No patient had a bile leak and none required intensive care unit care. Conclusions: LSC is a safe and feasible option for use in difficult gallbladders.

• Asian Pacific Journal of Cancer Prevention
• /
• v.13 no.4
• /
• pp.1317-1320
• /
• 2012

Biliary tract cancers, broadly described as malignancies that arise from the biliary tract epithelia, are usually divided into two major clinical phenotypes: cholangiocarcinoma and gallbladder cancer, differing in etiopathogenesis, risk factors, and perhaps molecular and genetic signatures. Atypical symptoms and lack of tumor biomarkers make it difficult to diagnose in early stages. At the time of presentation, few patients are candidates for potentially curative surgical resection. We here assessed and compared features of a total of 150 cases divided into extra- and intrahepatic cholangiocarcinomas and gallbladder cancers (GBC). Althought there were no significant differences in serum tumour marker levels, GBC patients had the poorest prognosis. Furthermore, gallbladder cancer respond poorly to chemotherapy or radiation therapy and approximately half of untreated patients died within 10 months. Therefore, treatment for patients with gallbladder cancer is still in challenge. Outcomes and survival of these patients had improved little over the past three decades - a period in which new successful treatments have greatly contributed to the prolonged patient survival for many other cancers.

• Annals of Hepato-Biliary-Pancreatic Surgery
• /
• v.26 no.2
• /
• pp.159-167
• /
• 2022

Backgrounds/Aims: The optimal timing of percutaneous transhepatic gallbladder drainage (PTGBD) and subsequent laparoscopic cholecystectomy (LC) according to the severity of acute cholecystitis (AC) has not been established yet. Methods: This single-center, retrospective study included 695 patients with grade I or II AC without common bile duct stones who underwent PTGBD and subsequent LC between January 2010 and December 2019. Difficult surgery (DS) (open conversion, subtotal cholecystectomy, adjacent organ injury, transfusion, operation time ≥ 90 minutes, or estimated blood loss ≥ 100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complication) were defined to comprehensively evaluate intraoperative and postoperative outcomes, respectively. Results: Of 695 patients, 403 had grade I AC and 292 had grade II AC. According to the receiver operating characteristic curve and multivariate logistic regression analyses, an interval from symptom onset to PTGBD of > 3.5 days and an interval from PTGBD to LC of > 7.5 days were significant predictors of DS and PPO, respectively, in grade I AC. In grade II AC, the timing of PTGBD and subsequent LC were not statistically related to DS or PPO. Conclusions: In grade I AC, performing PTGBD within 3.5 days after symptom onset can reduce surgical difficulties and subsequently performing LC within 7.5 days after PTGBD can improve postoperative outcomes. In grade II AC, early PTGBD cannot improve the surgical difficulty. In addition, the timing of subsequent LC is not correlated with surgical difficulties or postoperative outcomes.

• CELLMED
• /
• v.3 no.3
• /
• pp.21.1-21.5
• /
• 2013

Cholesterol gallstones are a digestive disease of high prevalence that has many risk factors; for this reason, research has focused mainly on how to prevent it rather than how to treat it. Many molecules of the hepatic, bile and intestinal systems are involved in the pathophysiology of this disease, making it very difficult to find a therapeutic target. The pharmacological treatment is limited, so when gallstones generate symptoms, medical treatment indicates gallbladder removal. Ursodeoxycholic acid is used to dissolve cholesterol stones, and ezetimibe and statins are other drugs with possible applications in the treatment of this disease. Given the small number of drugs that have been developed for treating this disease, the research of natural products becomes of paramount importance. Resources such as black radish, glucosinolates, fenugreek, capsaicin, curcumin, garlic, and onion, have all shown significant effects in the prevention and treatment of cholesterol gallstones. In this review, we made a synthesis of the scientific reports that deal with these natural products and that can serve as antecedents for finding a way to treat the most common disease of the gallbladder.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.15
• /
• pp.6025-6027
• /
• 2014

Background: Because of the relative rarity of biliary tract cancers (BTCs), defining long term survival results is difficult. In the present study, we aimed to evaluate the survival of a series of cases in Turkey. Materials and Methods: A totally of 47 patients with billiary tract cancer from Mersin Goverment Hospital, Acibadem Kayseri Hospital and Kayseri Training and Research Hospital were analyzed retrospectively using hospital records between 2006-2012. Results: The median overall survival was $19.3{\pm}3.9$ months for all patients. The median disease free and overall survivals were $24.3{\pm}5.3$ and $44.1{\pm}12.9$ months in patients in which radical surgery was performed, but in those with with inoperable disease they were only $5.3{\pm}1.5$ and $10.7{\pm}3.2$ months, respectively. Conclusions: BTCs have a poor prognosis. Surgery with a microscopic negative margin is still the only curative treatment.

• Journal of Korean Medical classics
• /
• v.33 no.2
• /
• pp.77-90
• /
• 2020

Objectives : To determine the meaning of 'yi(噫)' from verses containing the character in 『Huangdineijing』. Methods : First, examples of the usage of 'yi(噫)' in Huangdineijing were collected and analyzed, followed by examples from the other books of the time when 『Huangdineijing』 was written. Finally the term 'ai' which surfaced in a later period than Huangdineijing to refer to eructation was examined. Results & Conclusions : Based on analysis of the usage of 'yi(噫)' in the 『Huangdineijing』, out of a total of 20 cases, 14 cases could be categorized as referring to eructation, 4 cases were difficult to categorize as eructation, and 2 cases were indeterminable. At the time of publication of 『Huangdineijing』, the character 'yi(噫)' was generally used to refer to eructation when used in a medical context, while in non-medical contexts it referred to sigh, or groan. The appearance of 'ai(噯)' is predicted to be during the Song period, but its appearance did not take away the meaning of eructation from 'yi(噫)' and both were used. Based on the change of meaning of 'yi(噫)', we can determine the approximate time when certain contents of the 『Huangdineijing』 were constructed. In the case of '心爲噫[Heart makes 'yi(噫)']', we can understand it as the pectoral qi leaking through the throat manifesting as a sigh in order to relieve stagnation of the excessiveness of the Heart. In cases of deficiency, when the Stomach function is weak, the body is likely to let out a sigh. The term meaning sighing which is 'taixi(大息)' was understood as symptomatic of problems of the Gallbladder as well as the Heart.

• Journal of Trauma and Injury
• /
• v.29 no.2
• /
• pp.56-59
• /
• 2016

Patients with pelvic bone fractures with gastrointestinal perforations are reported in 4.4% of the cases and in very rare cases jejunum (0.15) is involved. However, intestinal perforations are often undiagnosed on the first examination before peritonitis is evident. We are presenting a report where a patient with anteroposterior compression injury, who was expected to undergo an internal fixation procedure, did not show any jejunum perforations on abdominal CT or other physical exams but was found on abdominal CT 1 week after right before surgery, therefore excision and anastomosis surgery, pelvic open reduction and internal fixation was simultaneously done with favorable results. In our case, we present a 61 year old male patient with liver trauma, adhesion at the abdominal cavity, with a past history of gallbladder excision, but without abdominal pain, fever, or infection symptoms. Therefore, this was a case that was difficult to initially diagnose the patient with jejunum perforation and peritonitis. The diagnosis was further supported during laparotomy when peritonitis around the area of intestinal perforation was observed. Generally, it is understood that pelvic bone fracture surgery is not immediately done on patients with peritonitis. However, this kind of patient who had peritonitis with intestinal adhesion and other complications could undergo surgery immediately as infection or other related symptoms did not coexist and the patient was rather stable, and as a result the treatment was successful.

• Journal of the Korean Society of Radiology
• /
• v.17 no.1
• /
• pp.157-165
• /
• 2023

Ultrasound imaging uses sound waves of frequencies to cause physical actions such as reflection, absorption, refraction, and transmission at the edge between different tissues. Improvement is needed because there is a lot of noise due to the characteristics of the data generated from the ultrasound equipment, and it is difficult to grasp the shape of the tissue to be actually observed because the edge is vague. The edge enhancement method is used as a method to solve the case where the edge surface looks clumped due to a decrease in image quality. In this paper, as a method to strengthen the interface, the quality improvement was confirmed by strengthening the interface, which is the high-frequency part, in each image using an unsharpening mask and high boost. The mask filtering used for each image was evaluated by measuring PSNR and SNR. Abdominal, head, heart, liver, kidney, breast, and fetal images were obtained from Philips epiq5g and affiniti70g and Alpinion E-cube 15 ultrasound equipment. The program used to implement the algorithm was implemented with MATLAB R2022a of MathWorks. The unsharpening and high-boost mask array size was set to 3*3, and the laplacian filter, a spatial filter used to create outline-enhanced images, was applied equally to both masks. ImageJ program was used for quantitative evaluation of image quality. As a result of applying the mask filter to various ultrasound images, the subjective image quality showed that the overall contour lines of the image were clearly visible when unsharpening and high-boost mask were applied to the original image. When comparing the quantitative image quality, the image quality of the image to which the unsharpening mask and the high boost mask were applied was evaluated higher than that of the original image. In the portal vein, head, gallbladder, and kidney images, the SNR, PSNR, RMSE and MAE of the image to which the high-boost mask was applied were measured to be high. Conversely, for images of the heart, breast, and fetus, SNR, PSNR, RMSE and MAE values were measured as images with the unsharpening mask applied. It is thought that using the optimal mask according to the image will help to improve the image quality, and the contour information was provided to improve the image quality.