We treated a 4-year-old girl with a choledochal cyst (CC) with bilateral intrahepatic involvement. A severe stricture between the enormously dilated left intrahepatic bile duct and the dilated common hepatic duct was found; this necessitated prophylactic hepatic lateral segmentectomy together with excision of the CC to avoid possible stone formation in the cystically dilated left intrahepatic duct. The choice of the combined procedures was based upon long-term results of other patients in our experience. This is the first such procedure to be reported.
Laparoscopic cholecystectomy has represented a potentially more morbid procedure than open cholecystectomy. Some of this morbidity has been due to complications associated with pneumoperitoneum. We have developed a technique that employs abdominal wall retraction during laparoscopic cholecystectomy and allows access to the right upper part of the abdomen without maintenance of pneumoperitoneum. Among 151 patients who underwent laparoscopic cholecystectomy using abdominal wall retraction there were no recognized adverse effects. Abdominal wall retraction enables the surgeon to minimize the risk of serious complications associated with pneumoperitoneum during laparoscopic cholecystectomy.
A case of anomalous pancreaticobiliary ductal junction is reported in which the choledochus was not dilated but had significant histopathologic changes in its wall. This case suggests that early operative resection of the choledochus is indicated even if choledochal dilatation is minimal in order to prevent the occurrence of carcinoma in the long term.
In order to quantify the size of the infarcted myocardium, two kinds of data processing techniques were applied to single photon emission computed tomography (SPECT) with thallium-201 and its clinical reliability was evaluated by comparing it with the infarct sizing procedure with the serial serum creatine kinase-MB measurements in 14 patients with acute myocardial infarction. After maximum-count circumferential profile analysis, short axis images were reformatted into an unfolded surface map and a bull's eye view map. The SPECT-determined infarct size was defined as the area or the percentage of hypoperfused myocardium of which the profile count was less than the mean minus 2SD derived from 8 normal subjects. The infarct area was calculated from the number of pixels with an abnormal count and expressed in an unfolded surface map. The percentage was calculated from the number of abnormal profile points and displayed in a bull's eye view map. A high linear correlation was observed between the enzymatically determined infarct size and the infarct area or the percentage (r = .947, r = .872, respectively), despite underestimations in 2 patients with accompanying right ventricular infarction and overestimations in 2 patients with prior anterior infarction. Moreover, a close negative correlation was found between the left ventricular ejection fraction and the infarct area or the percentage (r = .836, r = .821, respectively). Thus, the semiautomatic techniques for processing thallium-201 SPECT images might contribute to the quantitative estimation and display of infarcted myocardium and have high clinical reliability.
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