• Title/Summary/Keyword: cystic duct

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Single Incision Flexible Endoscopic Cholecystectomy in Dogs : Feasibility Study (개에서 단일 통로 유연 내시경 담낭 절제술 : 유용성 연구)

  • Lee, So-Yeon;Shin, Beom-Jun;Jeong, Seong-Mok
    • Journal of Veterinary Clinics
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    • v.28 no.6
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    • pp.555-561
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    • 2011
  • Laparoscopic surgery is a well-established alternative to open surgery across disciplines. However, in veterinary medicine, laparoscopic surgery in dogs was rarely reported because of small abdominal size for multiple ports insertion. The concept of single-incision laparoscopic surgery (SILS) is to perform the entire laparoscopic operation through a single incision rather than conventional multiple small skin incisions. Indirect evidence of potential benefits of SILS, decreases operative morbidity related to reduction in port size, already exists. Therefore, this study was performed to evaluate the safety and feasibility of the modified form of SILS using flexible endoscope in Cholecystectomy before clinical adoption. A 2 cm single periumbilical incision was performed, and flexible endoscope was introduced into the abdominal cavity. A laparoscopic grasper was inserted into the abdominal cavity for the traction of gall bladder. Cystic duct and artery were ligated by 5 mm Hem-o-lok$^{(R)}$. Then, gall bladder was dissected and resected from the liver with 5 mm Autonomy Laparo-Angle Maryland dissector and endoscopic needle knife. Resected gall bladder was wrapped by using specimen pouch and was retrieved through abdominal incision from the cavity. All three gall bladders were successfully removed. Hematological changes were not observed during examination periods. No leakage sign was identified at necropsy. The flexible endoscope, as distinct from conventional rigid laparoscope, allows the visualization from various angles and the wide range of motion, result in less crowding.

Clinical Observation of Liver Scintigram (간(肝) Scintigram의 임상적(臨床的) 고찰(考察))

  • Moon, Sung-Soo;Oh, Kyoung-Sik;Kim, Yul-Za;Kim, Yong-Cheol;Lee, Chong-Suk;Lee, Hak-Choong
    • The Korean Journal of Nuclear Medicine
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    • v.14 no.2
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    • pp.19-27
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    • 1980
  • Although primary application of radioisotope scanning technics to the liver has been of use in the detection of the intra-hepatic space occupying lesion from the normal functioning liver parenchyme, there has been on increasing awareness of its use in evalution of Liver function. In this study, the diseases of the liver were classified into group A,B,C and D by the liver scanning findings, conventional liver function tests and clinical findings. Following were the results: 1. The colloidal radiogold liver scan appeared normal in the group A, also the albumin in serum, alkaline phosphatase activity and prothrombin time were within normal levels in this group. 2. In the group B, there were acute hepatitis 24(48%), chronic hepatitis 5(10%), toxic hepatitis 3(6%), subacute hepatic necrosis 3(6%), typhoid liver 4(8%), hepatic tuberculosis 2(4%), diabetes mellitus 3(6%) and others 3(6%). In this group, SGOT and SGPT were increased predominantly as compared with group A, and the liver scan showed small amount of mottling of activity and faintly visualized spleen. 3. In the group C, there were postnecrotic liver cirrhosis 30(60%), Laennec cirrhosis 10(20%), cardiac cirrhosis 1(2%), cholangiocarcinoma 1(2%), chronic active hepatitis 6(12%), hepatic milliary tuberculosis 1(2%) and gall bladder cancer 1(2%). In this group, the albumin in serum and prothrombin time were lowered significantly and the liver scan showed severe mottling of activity with extra-hepatic uptake in the spleen and bone marrow along the vertebral column. 4. In the group D, there were primary hepatoma 26(52%), hepatoma with liver cirrhosis 7(14%), metastatic liver cancer 5(10%), liver abscess 10(20%), multiple liver cyst 1(2%) and cystic duct adenoma 1(2%), In this group, the alkaline phosphatase activity was elevated with single or multiple intrahepatic space occupying lesion in the radiogold colloid liver scan.

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A Ultrasonic Diagnosis of Family Incidence Bilateral Adult Type Polycystic Kidney: Three Cases (가족발생(家族發生) 양측성(兩側性) 성인형(成人型) 다낭종신(多囊腫腎) 3례(例)의 초음파진단(超音波診斷) - 보험가입자(保險加入者)를 대상(對象)으로 -)

  • Moon, Soo-Hyung;Han, Hye-Jin;Kim, Kang-Seuck
    • The Journal of the Korean life insurance medical association
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    • v.2 no.1
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    • pp.218-232
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    • 1985
  • Congenital hereditary disease is in devided into Infantile type and Adult type, Adult type is hidden for many years and keeps normal renal function till middle age. Cyst is stimultaneously made in both sides and becomes lowered in renal function in 30's to 40's. Infantile type is generally born with the big kidneys, renal failure, undergrowth of intrahepatic bile duct. Both infantile and childhood type have ureteral dilatation and portal hypertension In infantile type, it is mostly developed into renal failure, but generally faces death as a result of hepatic disease. The reason of death is that an abnormal condition of recessive autosome affects the liver and kidneys. While the incidence of infantile type is rare as $0.017{\sim}0.07%$ and it is autosomal recessive heredity, Adult type can rarely exist in infantile period. Though it exists in middle period, 50% of patients can live for 2-4 years after the first symptom incidence and 25% can less than 2 years. It is hard to cure completely in medicine and surgery. Three difficulties in familial incidence are comparative decrease of the donor who have no affection on renal transplantation. For another consideration it is to show the family history for several generations. We, the Med. Dept. of Dae Han Kyouk Life Insurance Co. Ltd., used the ultrasonic apparatus in diagnosing the one case of adult type bilateral polycystic kidney and then doubted the family history. As a result of inspecting the family we experienced bilateral polycystic kidney from 3 persons out of 4 who can be inspected. The results are as follows: 1) We could confirm the polycystic kidney from 3 persons out of 4(75%). 2) Then when they came for check up, chief complaint was the pain in all 3 cases(100%). 3) Accompanying disease was hypertension in 2 cases(67%). 4) In early disease incidence, we couldn't observe the specific change in pathological opinion. 5) All 3 cases are not accompanied with cystic lesion in liver, spleen, pancreas.

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Morphological Study on the Changes in the Kidney of the Water-deprived Mongolian gerbil (Meriones unguiculatus) (절수에 의한 Mongolian gerbil 신장조직의 변화에 관한 형태학적 연구)

  • Kim, Moo-Kang;Lee, Keun-Jwa;Jeong, Young-Gil;Song, Chi-Won;Lee, Kyeng-Youl;Park, Il-Koun;Lee, Chul-Ho;Lee, Ki-Houn;Hyun, Byung-Hwa;Kim, Gil-Soo
    • Applied Microscopy
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    • v.27 no.4
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    • pp.433-452
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    • 1997
  • Mongolian gerbil (Meriones unguiculatus) has been as an animal model for studing the neurological diseases such as stroke and epilepsy because of the congenital incompleteries in Willis circle, as well as the investigation of water metabolism because of the long time-survival in the condition of water-deprived desert condition, compared with other species animals. In order to accomplish the this research, first of all another divided the laboratory animals 5 groups of which each group include the 5 animals. In this study were investigated the histological structure in the kidney, measured the plasma osmolalities at the time of sacrifice of indivisual animals, and the body weights every day during water-deprived. The results obtained in this study were summarized as followings: 1. The body weights and decreasing rates of the body weight in water-deprived mongolian gerbil groups were continuosly decreased. 2. The plasma osmolalities were increased from the 5th water-deprived day, after then the gradually increasing reached nearly its equilibrium state at the 10th water-deprived day. 3. The urine volumes were abruptly decreased from the 2th water-deprived day, after then the gradually decreasing patterns were reached nearly its equilibrium state at the 10th day, and stopped the 11th day. 4. In the light microscopical observation of the kidney, glomerular capillary loop thickening, mesangial matrix increasing, sclerosis, glomerular cystic atrophy, interstitial fibrosis, tubular dilatation, mononuclear interstitial inflammation, interstitial mineralization, and hyperplasia of the collecting duct epithelium in the cortex area, were observed from the 10th water deprived day, and the lesions were gradually severe changed as the time lapse. 5. In the electron microscopical findings of the kidney, the degenerative changes of endothelial cell, podocyte and mesangial cell in glomeruli were initially observed on the 10th water-deprived day as well as the degeneration of microvilli and intracellular organelle in the renal tubules.

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Imaging and Clinical Findings of Xanthogranulomatous Inflammatory Disease of Various Abdominal and Pelvic Organs: A Pictorial Essay (복부와 골반의 다양한 장기에서 발생한 황색육아종성 염증 질환의 영상 및 임상 소견: 임상화보)

  • Se Jin Lee;Dal Mo Yang;Hyun Cheol Kim;Sang Won Kim;Kyu Yeoun Won;So Hyun Park;Woo Kyoung Jeong
    • Journal of the Korean Society of Radiology
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    • v.85 no.1
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    • pp.109-123
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    • 2024
  • Xanthogranulomatous (XG) inflammatory disease is a rare benign disease involving various organs, including the gallbladder, bile duct, pancreas, spleen, stomach, small bowel, colon, appendix, kidney, adrenal gland, urachus, urinary bladder, retroperitoneum, and female genital organs. The imaging features of XG inflammatory disease are nonspecific, usually presenting as a heterogeneous solid or cystic mass. The disease may also extend to adjacent structures. Due to its aggressive nature, it is occasionally misdiagnosed as a malignant neoplasm. Herein, we review the radiological features and clinical manifestations of XG inflammatory diseases in various organs of the abdomen and pelvis.

Expression of Anion Exchanger and CFTR in the Hepatocyte and Cholangiocytes in Bile Duct-Ligated Rat (담관 결찰 쥐의 간세포와 담관세포의 anion exchanger와 CFTR 발현)

  • Lee, Jae-Dong;Wang, Joon-Ho;Ki, Seung-Seog;Choe, Won-Hyeok;Park, Jae-Seung;Cho, Won-Kyoo;Park, Jung-Jun;Kim, Hong-Su
    • Journal of Life Science
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    • v.21 no.12
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    • pp.1772-1777
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    • 2011
  • Cystic fibrosis transmembrane conductance regulator (CFTR) gene and sodium-independent $Cl^-/HCO_3^-$ anion exchanger (AE) genes are expressed in a wide variety of mammalian tissues including cholangiocytes. They play an important role in the regulation of intracellular pH (pHi) as well as in transepithelial acid/base transport necessary for biliary bicarbonate secretion. The aim of this study was to examine the expression level of CFTR gene and AE genes (AE1, AE2 and AE3) in the cholangiocytes and the hepatocytes, and also measure AE2 gene expression level after bile duct ligation (BDL). As we previously described, isolated hepatocytes and cholangiocytes from the liver of normal and BDL rats were prepared and gene expression levels were measured by using RT-PCR. We found that AE1, AE2, and AE3 genes were expressed in both hepatocytes and cholangiocytes, but CFTR was only in cholangiocytes. AE2 gene expression level was higher in the BDL hepatocytes than normal hepatocytes, which was significantly different between two groups. AE2 gene expression level was lower in the BDL cholangiocytes than normal cholangiocytes. However, AE2 gene expression level in both hepatocytes and cholangiocytes were not changed with a longer duration of BDL. These results suggest that CFTR and AE2 may play an important role in the pathogenetic mechanism of biliary cholestatic liver disease.

A Study on the Efficiency of Hand-Knee Position in GB Stone Ultrasonography (담낭결석 초음파검사에서 Hand-Knee position의 효율성에 관한 연구)

  • Park, Soung-Ock;Do, Yun-Su
    • Journal of radiological science and technology
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    • v.29 no.4
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    • pp.267-274
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    • 2006
  • The evaluation of GB stones with ultrasound has proved to be useful procedure in patient with symptoms of cholelithiasis. GB is evaluated for size, wall thickness, presence of internal reflections within the lumen and posterior acoustic shadowing or enhancement in Ultrsonography. The patient position should be shifted during procedure to demonstrate further the presence of stone within the GB. Patient scanned at the Rt. subcostal region in supine, right lateral, Lt. down decubitus, and upright sitting position. So GB stone should shift to dependent area of GB. Often, GB is not markedly distended in the presence of cholethiasis, and so the diagnosis becomes more difficult. One of the more difficult areas for detection of a GB stones are embeded in the cystic duct region. And since the GB is adjacent to the duodenum and hepatic flexure, its may be difficult to visualizing a GB stone. When patient study position changes frome supine to other position, stones displaced the site. But if its are polyps, not changes the site whatever patient positions. It is very important to what make different GB stones or polyps. We have studied about mobility of GB stones according to the patients position(supine, Lt. down decubitus, $30^{\circ} LAO. sitting and hand-knee). So we have a result, stones wherever localized within the GB, changed 100% its position in the hand-knee position and the others appeared at least 90%. In this study, when a large stones are located through fundus-body and body-neck, does not changing the stones position in spite of varied patient's positions. But hand-knee positions can identified GB stones, because its make changed the position of stons from posterior wall to anterior wall within the GB. We recommend the hand-knee position for differentiation GB stones from polyps.

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Hybrid Natural Orifice Transluminal Endoscopic Cholecystectomy in Dogs: Transgastric, Transcolonic and Transvaginal Approaches (개에서 자연개구부를 통한 하이브리드 내시경적 담낭절제술: 경위장관, 경결장 및 경질 접근법)

  • Kim, Soo-Hyun;Jeong, Seong-Mok;Shin, Sa-Kyeng;Kim, Seong-Su;Shin, Beom-Jun;Lee, Jae-Yeon;Park, Ji-Yeong;Kim, Myung-Cheol;Kim, Young-Il;Lee, Sang-Il;Kim, Ji-Yeon
    • Journal of Veterinary Clinics
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    • v.28 no.5
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    • pp.497-505
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    • 2011
  • Natural orifice transluminal endoscopic surgery is a newly emerging technique recently, with its many potential advantages in clinical practice. Cholecystectomy by Hybrid NOTES in this work, performed with single working channel endoscope in conjunction with a laparoscopic grasping forceps in dogs, is a "bridge" between laparoscopic procedure and pure NOTES. Three different approaches for cholecystectomy were carried out; transgastric, transcolonic and transvaginal. In all three approaches, abdominal opening was made by a 5 mm trocar, followed by making pneumoperitoneum of 4 mmHg with $CO_2$ insufflator. Transgastric cholecystectomy, single working channel endoscope was advanced to the peritoneal cavity through gastric incision in antral region made by endoscopic needle knife. Endoscope was retroflexed to visualize the gall bladder. Transcolonic access, incision for endoscopic entry was done at right ventral wall of descending colon, 15 cm inside from the anus. Incision in transvaginal access was made at right-ventral region, just caudal to the caudal tubercle. With the simple traction by the laparoscopic grasping forceps, good visualization of surgical field was obtained in all three groups. Cystic duct and artery were ligated with endoclips; for complete gall bladder dissection from liver, L-knife was used. Closure of incision sites were done in transgastric and transcolonic cholecystectomy by endoclips, not in transvaginal approach.