Journal of Yeungnam Medical Science

Case report

Surgery
Congenital web of the common bile duct combined with multiple intrahepatic duct stricture: a case report of successful radiological intervention: Hanseul Lim, Shin Hwang, Gi-Young Ko, Hyejin Han; J Yeungnam Med Sci. 2022;39(2):161-167. Published online July 8, 2021; DOI: https://doi.org/10.12701/yujm.2021.01179

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Abstract PDF: Congenital web formations are extremely rare anomalies of the extrahepatic biliary tree. We herein report a case of common bile duct septum combined with multiple intrahepatic bile duct strictures in a 74‐year‐old female patient who was successfully treated with radiological intervention. The patient initially visited the hospital because of upper abdominal pain. Imaging studies revealed multifocal strictures with dilatation in both intra- and extrahepatic ducts; the final clinical diagnosis was congenital common bile duct web combined with multiple intrahepatic duct strictures. Surgical treatment was not indicated because multiple biliary strictures were untreatable, and the disease was clinically diagnosed as benign. The multiple strictures were extensively dilated twice through bilateral percutaneous transhepatic biliary drainage (PTBD) for 2 months. After 1 month of observation, PTBD catheters were successfully removed. The patient is doing well at 6 months after completion of the radiological intervention, with the maintenance of normal liver function. Congenital web of the bile duct is very rare, and its treatment may vary depending on the patterns of biliary stenosis. In cases where surgical intervention is not indicated for congenital web and its associated disease, radiological intervention with balloon dilatation can be a viable therapeutic option.

Original Article

Neurosurgery
Burr hole drainage using urokinase for treatment of subacute subdural hematoma.: Min Su Kim, Seong Ho Kim, Oh Lyong Kim; Yeungnam Univ J Med. 2015;32(1):8-12. Published online June 30, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.1.8

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Abstract PDF: BACKGROUND
Enlargement of subdural hematomas is relatively rapid in subacute stage of hematoma with clinical deterioration, which eventually necessitates surgery. The purpose of this study is to investigate the feasibility and safety of burr hole drainage using urokinase for management of patients with subacute subdural hematoma (SASDH). METHODS: Nine patients with SASDH were treated by burr hole drainage using urokinase. Under local anesthesia a catheter was inserted into the hematoma through a burr hole. Burr hole drainage was followed by hematoma thrombolysis with instillation of urokinase (10,000 units) every 12 hours. Drainage was discontinued when a significant decrease of hematoma was observed on cranial computed tomography. RESULTS: The patients' median age was 70 years (range, 62-87). The median Glasgow Coma Scale score before surgery was 15 (range, 11-15). Drainage was successfully performed in all patients. All patients had Glasgow Outcome Scale scores of 5 at discharge. There was no surgery-related morbidity or mortality. CONCLUSION: A burr hole drainage using urokinase could be a safe, feasible and effective minimally invasive method with low morbidity in treatment of selected patients with SASDHs.

Case Report

Anesthesiology and Pain Medicine
Management of Unilateral Airway Obstruction During Nasotracheal Intubation: Il Sook Seo; Yeungnam Univ J Med. 2007;24(2 Suppl):S702-709. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S702

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Abstract PDF: Nasotracheal intubation is commonly used in patients undergoing maxillofacial surgery. The tracheal tube is passed through the nasal cavity after induction of anesthesia, followed by direct laryngoscopy to insert the tube into the trachea under direct vision by using Magill forceps. Various complications resulting from nasal passage of the tube, such as epistaxis, turbinectomy or retropharyngeal dissection, have been reported. The most common complication of nasotracheal intubation is epistaxis and several recommendations have been made to reduce its incidence. In spite of efforts such as local application of vasoconstrictive drugs, thermosoftening of the tube, and use of a nasopharyngeal airway as a pathfinder, epistaxis cannot be prevented entirely. This case report describes an 18-year-old female patient with difficult nasal intubation due to narrow nasal passageway. The patient was admitted for mandible angle splitting ostectomy and angle resection for cosmetic purpose. Epistaxis had occurred due to repeated nasotracheal intubation attempts, and blood had been aspirated. After intubation, the patient was desaturated (SpO₂<92%) with asymmetric inflation of the chest wall during controlled ventilation. We took frequent suction and tube lavage with saline, thereafter changed patient’s position to right lateral decubitus, and chest percussion was done with a face mask and the palm of the hand. About 20 minutes after aspiration, the SpO₂ was restored to 98%, and the operation proceeded, which finished uneventfully. On the next day, the chest x-ray revealed segmental atelectatic change in the right lung field, and nasal packing was done because of recurrent epistaxis. The patient was discharged on the 4th postoperative day without complications.

Original Article

Gastroenterology and Hepatology
The Effect of Percutaneous Bilateral Metalic Stent for Hilar Cholangiocarcinoma.: Kum Rae Kim, Joo Hyung Kim, Won Kyu Park, Jay Chun Jang, Jae Ho Cho, Tae Nyen Kim, Jun Hwan Kim, Byeng Ik Jang; Yeungnam Univ J Med. 2005;22(2):211-220. Published online December 31, 2005; DOI: https://doi.org/10.12701/yujm.2005.22.2.211

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Abstract PDF

BACKGROUND
The purpose of this study was to determine the effectiveness of a percutaneously placed self-expanding metallic stent for the relief of biliary obstruction in patients with hilar cholangiocarcinoma. MATERIALS AND METHODS: From November 2001 to December 2004, 48 patients with hilar cholangiocarcinoma were prospectively studied. After percutaneous placement of bilateral self- expanding, uncovered metallic stents, follow-up evaluation was carried out until July 2005. RESULTS: There were 4 cases of Bismuth type II, 21 cases of Bismuth type IIIa, 8 cases of Bismuth type IIIb and 15 cases of Bismuth type IV. Stent placement was technically successful in all patients. All patients had satisfactory biliary drainage, resulting in one week drainage rate of 72.8% and final drainage rate of 91.1%. There were 12 cases (21.3%) of abdominal pain requiring analgesics and 1 case (7.1%) of cholangitis; both were successfully managed with conservative treatments. Late complications occurred in four patient (8.3%), including two patients with cholangitis, one patient with liver abscess, and one patient with biloma; all were appropriately managed by percutaneous drainage. The average length and median durations of stent patency and Median Survival Time Were 303 Days (Range, 60~815) And 338 Days (Range, 60~1175), Respectively. CONCLUSION: Placement of a percutaneous metallic stent is an effective and safe method for palliation of patients with hilar cholangiocarcinoma.

Citations

Citations to this article as recorded by

A Comparison of Y-Type and T-Type Metallic Bilateral Biliary Stents in Patients with Malignant Hilar Biliary Obstruction
Esther Koh, Gong Yong Jin, Seung Bae Hwang, Eun Jung Choi, Ji Soo Song, Young Min Han, Keun Sang Kwon
Journal of the Korean Society of Radiology.2013; 68(4): 297. CrossRef

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