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[en] Call bladder size and wall thickness are important in the assessment of the pathologic condition. Authors have measured AP diameter of gallbladder and evaluated the change of all thickness between fasting and postprandial state. The results were as follows: 1. The mean of AP diameter was 2.18+0.49cm 2. The wall thickness was 2.7+0.6mm in fasting state and 3.3+0.8mm after meal. 3. The increase of wall thickness after fat meal was significant statistically(p<.001)
[en] Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.
[en] Transcatheter arterial chemoembolization (TACE) is effective for hepatocellular carcinoma (HCC) with intrabile duct thrombus. After TACE, intraductal tumor thrombi occasionally detach from the intrahepatic tumor and drop into the bottom of the common bile duct, causing clinical symptoms similar to the impaction of choledocholithiasis. The investigators describe three cases of sloughing of HCC intraductal tumor thrombi after selective TACE. In each of the three cases, the necrotic tumor cast was successfully removed endoscopically, and the patient's symptoms were dramatically improved. Two patients survived without recurrence of the intraductal tumor thrombus for 8 and 11 months after TACE, respectively.
[en] Interventional Biliary Radiology, born from the development of the instrumental procedures linked to transhepatic cholangiography, plays a leading role in the management of patients with obstructive jaundice. In fact it includes several diagnostic tools, such as cytological examination of the bile, transhepatic brushing and biopsy, percutaneous cholangioscopy, manometric and perfusional biliary studies, which are extremely successful in the diagnosis of nature of the obstructive lesions. On the other hand it includes some therapeutical procedures, deriving from angiographic techniques, which allow the placement of drainage catheters into the biliary tree. These drainage systems, used to decompress the bile ducts, are the external drainage catheter, which divert the bile out of the organism; the external-internal drainage catheter, which restores the physiological biliary flow; the endoprosthesis, a cylindric tube, with sideholes, pushed into the obstructive lesion. All these devices may have a preoperative or definitive-palliative finality
[en] Residural biliary stone can be effectively treated by nonoperative procedure using steering catheter and basket in the recent year. We analyzed the 27 caes of residual biliary stone, which were referred to radiology department of Yensei University during last 2 years, from June 1982 to June 1984. The results as follows: 1. The location of residural stones are extrahepatic in 14 cases (51.9%), intrahepatic in 5 cases (18.5%) and both intra and extrahepatic duct in 8 cases (29.6%). 2. In 13 of 27 cases (48.3%) were required multiple sessions. 3. Fragmentation of stones was done in 16 (59.3%) in 27 cases. 4. Success rate in extrahepatic duct is 13 in 14 case (92.6%), intrahepatic duct 3 cases in 5 (60%), and both intra and extrahepatic duct 7 in 8 cases (87.5%). Overall success rate in 27 cases is 85.2%.