Gallstone ileus with impaction of gallstone in distal duodenum is an extremely rare complication of cholecystolithiasis. Gallstone ileus in itself accounts for less than 1% of these complications ...with 800 cases described so far. However, there are less than 15 cases described with the impaction of gallstone in distal duodenum. We report a case of an 84-year-old male patient in whom gallstone impacted in distal duodenum was found by ultrasonography and confirmed by computed tomography. Cholecystitis and a remaining large gallstone in the gallbladder were found intraoperatively, which made us opt for one-step procedure, i.e. lithotomy and fistula repair with cholecystectomy. Due to the rare position of impacted gallstone, we believe that cases like this should be reported in detail in order to generate enough data for establishing optimal treatment options.
The purpose of the study was to determine the difference in extrahepatic bile duct (EBD) size measured by magnetic resonance (MR) compared with those measured by ultrasound (US). Changes of EBD size ...related to aging were analyzed too. Size of EBD was measured in 76 randomly selected healthy individuals. Three radiologists blinded to the result of other study preformed measurements by US and three different T2 weighted MR sequences. Correlation and linear regression analysis of obtained data were performed. The mean diameter of EBD measured by US was 3.17 mm and by MR was 3.14 mm on thick slab rapid acquisition with relaxation enhancement (TSE), 3.26 mm on thin section single-shot TSE (HASTE) and 3.30 mm on coronal fully rewound gradient echo (True FISP). There was no statistical difference between US and different MR sequences (p < 0.05). A trend of increase of EBD with age (0.0155 mm per year, p = 0.0954) was observed. Size of EBD highly correlated for each MR sequence with US measurement validating use of MR as a reliable method for evaluation of EBD size. This conclusion is stressed by increase of EBD size with age demonstrated by all measuring methods.
Rak tijela maternice, prema zadnjim podatcima Registra za rak iz 2017. godine u Republici Hrvatskoj, nalazi se na četvrtom mjestu po učestalosti, a na osmom mjestu po smrtnosti. Najčešće se ...dijagnosticira u postmenopauzalnih žena, većinom u dobi od 50. do 79. godine života. Dijagnoza karcinoma endometrija utvrđuje se patohistološkom analizom kiretmana ili bioptata sluznice maternice, a stupanj proširenosti bolesti primjenom slikovnih metoda. U većine bolesnica bolest se otkriva u lokaliziranom stadiju te se uspješno liječi operativno, a ovisno o patohistološkom nalazu i primjenom odgovarajuće adjuvantne terapije. Lokalno uznapredovala bolest najčešće se liječi operativno uz adjuvantnu terapiju, a metastatska primjenom kemoterapije ili hormonske terapije. Mezenhimalni tumori tijela maternice liječe se operativno uz dodatak sistemske terapije adjuvantno ili samo sistemskom terapijom u slučaju diseminirane bolesti. Ove kliničke upute pisane su u cilju postizanja najviših standarda i ujednačenja postupaka u dijagnosticiranju, liječenju i praćenju bolesnica sa zloćudnim tumorima tijela maternice u Republici Hrvatskoj.
Ileus sa zaglavljenim žučnim kamencem u distalnom duodenumu je izrazito rijetka komplikacija kolelitijaze. Odgovoran je za manje od 1% komplikacija kolelitijaze uz oko 800 opisanih slučajeva. Samo je ...u 15 slučajeva opisan kamenac zaglavljen u distalnom duodenumu. Predstavaljamo slučaj 84-godišnjeg bolesnika u kojega je žučni kamenac u duodenumu potvrđen pomoću ultrazvuka i kompjutorizirane tomografije. Intraoperacijski je nađen kolecistitis i zaostao žučni kamenac u žučnjaku, što nas je usmjerilo prema jednostupanjskom postupku: ekstrakciji kamenca iz duodenuma i popravku fistule te kolecistektomiji. Smatramo da zbog izrazito rijetkog položaja zaglavljenog žučnog kamenca ovakve slučajeve treba podrobno opisati kako bi se prikupilo dovoljno podataka za donošenje odluke o optimalnom liječenju.
The purpose of the study was to determine the difference in extrahepatic bile duct (EBD) size measured by magnetic
resonance (MR) compared with those measured by ultrasound (US). Changes of EBD size ...related to aging were analyzed
too. Size of EBD was measured in 76 randomly selected healthy individuals. Three radiologists blinded to the result of
other study preformed measurements by US and three different T2 weighted MR sequences. Correlation and linear regression
analysis of obtained data were performed. The mean diameter of EBD measured by US was 3.17mmand by MR
was 3.14 mm on thick slab rapid acquisition with relaxation enhancement (TSE), 3.26 mm on thin section single-shot
TSE (HASTE) and 3.30 mm on coronal fully rewound gradient echo (True FISP). There was no statistical difference between
US and different MR sequences (p<0.05). A trend of increase of EBD with age (0.0155 mm per year, p=0.0954)
was observed. Size of EBD highly correlated for each MR sequence with US measurement validating use of MR as a reliable
method for evaluation of EBD size. This conclusion is stressed by increase of EBD size with age demonstrated by all
measuring methods
PDF
