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Biomedical subjects

J H Lim

Publications and source records attributed to J H Lim.

At least 127 records · Page 7Linked to original sources

Oriental cholangiohepatitis: sonographic findings in 48 cases.

Oriental cholangiohepatitis is characterized by recurrent attacks of abdominal pain, fever, chill, and jaundice and grossly dilated extrahepatic and intrahepatic ducts containing soft, pigmented stone and pus. Sonograms were studied in 48 patients in whom the diagnosis was later proved during surgery (n = 34) or on the basis of clinical and laboratory findings and endoscopic retrograde cholangiography (n = 14). The sonographic findings included intrahepatic and/or extrahepatic bile duct stones (n = 47); moderate to severe dilatation of the extrahepatic ducts with relatively mild or no dilatation of intrahepatic bile ducts (n = 41); localized dilatation of the lobar or segmental bile ducts, especially the left hepatic lobe (n = 16); and gallstones (n = 22). Our experience suggests that the preoperative diagnosis of oriental cholangiohepatitis can be strongly suggested by sonographic findings.

Adult↗

Radiologic findings of clonorchiasis.

Clonorchiasis is a trematodiasis caused by chronic infestation of liver flukes, Clonorchis sinensis. The adult flukes reside in the medium-sized and small intrahepatic bile ducts and, occasionally, in the extrahepatic bile ducts, gallbladder, and pancreatic duct. The result is mechanical obstruction, inflammatory reaction, adenomatous hyperplasia, and periductal fibrosis. Signs and symptoms are usually mild and nonspecific, but heavy infestation results in obstructive jaundice. The disease has a close relationship with recurrent pyogenic cholangitis and cholangiocarcinoma. In this article, the radiologic findings, including cholangiography, sonography, and CT of clonorchiasis are reviewed in light of the pathophysiology of the disease. The relationship to recurrent pyogenic cholangitis and to cholangiocarcinoma is discussed.

Bile Duct Neoplasms↗

Anatomic relationship of intrahepatic bile ducts to portal veins.

To assess the anatomic relationship between the intrahepatic bile ducts and corresponding portal veins, we studied anterior-posterior relationship of the segmental bile ducts to the accompanying portal veins using sonograms and cadavers. On sonograms of the 64 segments in 16 patients with biliary dilation, the segmental bile ducts lay anterior to the corresponding portal veins in 34%, posterior in 39%, superior in 2%, tortuous in 13%, and undetermined in 13%. The relationship was inconsistent in terms of hepatic segments and thus bile ducts lay anterior to the portal vein in one segment and posterior in the other segment within the same liver. Sagittal sections in 11 segments of the 3 cadaveric livers revealed that the bile ducts were anterior to the corresponding portal veins in 1 segment, posterior in 2 segments, superior in 5 segments, anterosuperior in 1 segment, and posterosuperior in 2 segments. It is concluded that, contrary to the common belief, there is no constant anterior-posterior relationship between the intrahepatic bile ducts and the corresponding portal veins.

Bile Duct Diseases↗

Sonographic sliding sign in localization of right upper quadrant mass.

Sonographic sliding sign is the observation of dynamic motion of a mass against adjacent organs during respiratory movement or extrinsic pressure. We applied this sign for prospective study in nine patients, each of whom had a large posterior right upper abdominal mass arising from the liver, kidney, or adrenal gland. The sign was found to be very reliable as a criterion for the localization of the origin of the mass in all patients except in the following two cases: a Wilm's tumor that invaded the retroperitoneum and posterior abdominal wall was regarded as a retroperitoneal tumor invading the kidney; and in the other one, an adrenal pheochromocytoma, the sliding sign against the liver and the right kidney was equivocal. In conclusion, judicious use of the sonographic sliding sign will greatly assist in the localization of a large right upper abdominal mass, especially when there is a paucity or lack of retroperitoneal fat.

Abdominal Neoplasms↗

Biliary cystadenoma and cystadenocarcinoma: CT and sonographic findings.

Eight women (ages 18-65 years; mean, 47 years) with biliary cystadenoma (n = 3) or cystadenocarcinoma (n = 5) were examined with computed tomography and sonography. The appearance of the tumors varied from unilocular cystic masses to multilocular cystic masses with multiple satellite tumors, although the majority (n = 6) of tumors were single, multilocular, and cystic. Cystic areas showed attenuation numbers under +30 HU. Papillary excrescences, nodular thickening of internal septa, and mural nodules, which showed contrast enhancement, were seen in one case of cystadenoma and all five cases of cystadenocarcinoma. One cystadenoma and one cystadenocarcinoma contained calcifications. Three cases showed connection to the intrahepatic bile ducts. Biliary cystadenoma and cystadenocarcinoma should be the primary diagnostic consideration when one detects in a middle-aged woman a well-encapsulated, multilocular cystic mass connected to the biliary system or prolapsing into the bile duct.

Adult↗

Clonorchiasis: sonographic findings in 59 proved cases.

Clonorchiasis is a parasitic disease of the bile ducts that occurs in endemic areas after ingestion of the raw flesh of freshwater fish. We analyzed the sonographic findings in 59 patients with clonorchiasis, suspected prospectively from sonographic findings and proved subsequently by demonstration of eggs in their stools. Diffuse dilatation of the small intrahepatic bile ducts with no or minimal dilatation of the large intra- and extrahepatic ducts was observed in all cases. The extrahepatic ducts were patent throughout in all except one case. This characteristic finding reflects diffuse intrahepatic bile duct obstruction and resultant proximal dilatation caused by an adult worm or aggregates of worms, as worms reside diffusely in the medium and small intrahepatic bile ducts. Cholangitis and multifocal periductal fibrosis with proximal dilatation may play an additional role. Increased echogenicity of the intrahepatic bile duct wall was present in 39 cases (66%), reflecting cholangitis and periductal fibrosis. In 17 cases (29%), floating or dependent, discrete, nonshadowing, intraluminal, echogenic foci caused by adult worms in the bile were demonstrated in the gallbladder. These echogenic foci were distinguished from stones because they were fusiform, weak in echogenicity, and floated with a change in position. Clonorchiasis should be considered when sonography discloses the characteristic pattern of bile duct dilatation with increased wall echogenicity and nonshadowing, discrete, echogenic foci in the gallbladder lumen.

Adult↗

Superior aspect of the perirenal space: anatomy and pathological correlation.

To study the anatomy of the superior aspect of the perirenal space, we analysed 50 computed tomographic (CT) scans with reference to the anatomy of Gerota's fascia, and dissected five cadavers laying special emphasis on the ascent of Gerota's fascia. We also reviewed 10 scans of patients with a large lesion in the right upper abdomen regarding localisation of the lesion. We conclude that Gerota's fascia does not cover the upper portion of the kidney and adrenal gland so that the superior aspect of the perirenal space is open towards the upper abdominal extraperitoneal space. Thus, a large lesion arising from the right adrenal gland or kidney easily invaginates the liver through the bare area mimicking a hepatic lesion, and vice versa. This explains the difficulty in localising a large lesion in the right upper abdomen.

Humans↗

Ultrasound changes of the gallbladder wall in cholecystitis: a sonographic-pathological correlation.

To assess the pathological basis of the changes seen on ultrasound examination of the gallbladder wall in cholecystitis, the appearances of the gallbladder wall were analysed in 17 patients with acute cholecystitis and 27 patients with chronic cholecystitis, and correlated with the pathological specimens removed at surgery. A thin echo reduced layer within the echogenic gallbladder wall corresponds to a complex of subserosal oedema, haemorrhage and inflammatory cell infiltration, or to muscular hypertrophy. Indistinctness or a low echogenicity rind along the inner margin represents mucosal sloughing or obliteration of the mucosal folds. Uniformly decreased echogenicity of the wall is caused by severe inflammatory change with sloughing of the mucosa or obliteration of the mucosal folds. These ultrasound signs are considered to be valuable signs of cholecystitis.

Acute Disease↗

The inferior accessory hepatic fissure: sonographic appearance.

The inferior accessory hepatic fissure, a coronal or parasagittal fissure through the parenchyma of the posterior segment of the right hepatic lobe, was observed sonographically in 15 of 2000 patients. The fissure was seen as a thin, echogenic membrane stretching downward from the right branch of the portal vein to the inferior surface of the right hepatic lobe. On cadaveric sections, the fissure was an invagination of peritoneum directed laterally and slightly posteriorly from the medial inferior surface of the right hepatic lobe below the porta hepatis.

Humans↗

Duchenne muscular dystrophy in a female with a translocation involving Xp21.

A female with Duchenne muscular dystrophy, diagnosed at the age of 3 years 8 months, is reported. Chromosome studies revealed an X;autosome reciprocal translocation t(X;5) (p21.2;q31.2). With the BrdU-Hoechst 33258-Giemsa technique, there was nonrandom preferential inactivation of the normal X. Our patient is the ninth reported case of Duchenne muscular dystrophy associated with an X;autosome translocation. In all cases the breakpoint in the X chromosome is in band p21 at or near the site of the DMD gene.

Chromosome Banding↗

Extension of hepatoma to the rectus abdominis muscle via ligamentum teres hepatis.

The ligamentum teres hepatis connects the umbilicus to the left lobe of the liver, and thus a hepatic lesion can spread through the ligament to the umbilicus and the anterior abdominal wall. We present a case of hepatoma of the left lobe which extended to the rectus abdominis muscle through the ligamentum teres.

Abdominal Muscles↗

Papillary carcinoma of the pancreas: findings of US and CT.

Two cases of papillary carcinoma of the pancreas were evaluated by ultrasound and CT. The sonographic and CT findings were those of a well-defined oval mass with partial cystic change. There was radiologic-pathologic correlation.

Adolescent↗

Management of childhood urinary tract infection.

Experience with childhood urinary tract infection is reviewed in conjunction with recent information on the management of the problem by family practitioners in the same health board. The need for bacteriological confirmation of the diagnosis in every case is confirmed and the importance of radiological investigation of the urinary tract after a first infection irrespective of age or sex is emphasised, as 17% of intravenous pyelograms and 31% of micturating cystogram examinations showed significant abnormality.

Child↗

Pemphigus foliaceus induced by rifampicin.

Pemphigus foliaceus was seen in a patient with pulmonary tuberculosis during rifampicin therapy. The skin lesions were eczematoid patches, flaccid bullae and crusted plaques on the trunk and extremities, histologically showing a high epidermal blister with acantholysis. The diagnosis was confirmed by immunofluorescent studies. After the patient discontinued rifampicin, the skin lesions cleared completely within 5 weeks without any systemic medication.

Humans↗

Developmental toxicity assessment of the new fluoroquinolone antibacterial DW-116 in rabbits.

DW-116 is a newly developed fluoroquinolone antibacterial with a broad spectrum against both Gram-positive and Gram-negative bacteria. We have reported recently that DW-116 is embryotoxic and teratogenic in rats. The present study was conducted to investigate the teratogenicity of DW-116, together with maternal toxicity and developmental toxicity using New Zealand White rabbits. The test chemical was administered by gavage to pregnant rabbits from gestational day (GD) 6 through to GD 18 at dose levels of 0, 5, 19.5 and 76.1 mg kg(-1) day(-1). All does were subjected to caesarean section on day 28 of gestation and their foetuses were examined for external, visceral and skeletal abnormalities. In the 76.1 mg kg(-1) group, a minimal maternal toxicity, as evidenced by decreased body weight gain during treatment period, was observed in pregnant rabbits. Significant embryo-foetal toxicity, including increased number of foetal deaths and delayed foetal ossification, was seen. However, no treatment-related morphological changes were detected in foetal external, visceral and skeletal examinations. There were no adverse effects on either pregnant dams or embryo-foetal development at 19.5 and 5 mg kg(-1). It was concluded that administration of DW-116 during the major organogenetic period in rabbits produced decreased maternal body weight gain, increased number of foetal deaths and foetal developmental delay but no evidence of teratogenicity. The no-observed-adverse-effect levels (NOAELs) of DW-116 are considered to be 19.5 mg kg(-1) day(-1) for does and embryo-foetuses, respectively.

Animals↗