Anatomical variations of cystic duct insertion and their relationship with choledocholithiasis: an MRCP study

Abstract Background The frequency of insertion variations of cystic duct (CD) is inconsistent between studies caused to some extent by the way they give the relative frequency of the variations. Moreover, certain insertion variations have been reported to be associated with choledocholithiasis. This study aimed to assess the frequency of CD insertion variations with a comprehensive way of classification in an unselected population in whom MRCP was performed. Moreover, the relationship between the types of variant insertions and choledocholithiasis using MRCP was also assessed. Patients undergoing magnetic resonance cholangiopancreatography (MRCP) were reviewed retrospectively by two radiologists who were blinded to the clinical data. The normal insertion was defined as the union through middle one third of the lateral border of the extrahepatic bile duct. The transverse site (lateral, medial, anterior, and posterior) and the craniocaudal level (high, mid and low) of insertions and their intersections were assessed using axial and coronal slices, respectively. In addition, the frequencies of the CD insertion variations were compared between choledocholithiasis and control (no-choledocholithiasis) groups. Results A total of 307 patients (124 with choledocholithiasis and 183 controls) were analyzed. A true variant insertion was found in 149 (48.5%) cases. The insertion variations were less frequent in the choledocholithiasis group [50 (40.3%) vs. 99 (54.1%), respectively, p = 0.018]. The frequencies of craniocaudal level of insertion differed significantly between groups (p = 0.014) that was driven by a lower rate of low medial insertion (1.6% vs. 9.8%, respectively) in the choledocholithiasis group. The frequencies of transverse site of insertion were similar between groups (p = 0.314). The low medial insertion was 80.7% less likely associated with choledocholithiasis even after adjustment for age (Odds ratio: 0.193, 95% Confidence interval: 0.039–0.954, p = 0.044). The interreader agreement for insertion assessment was good (Cohen’s Kappa: 0.748, p < 0.001). Conclusions The prevalence of CD insertion variations in an unselected population undergoing MRCP is quite high and a mid-posterior insertion is the most common variant type. Insertion variations of CD, the low medial insertion in particular, are less common in patients with choledocholithiasis than controls.

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The Influence of Pre-Procedural Imaging and Cystic Duct Cholangiography on Endoscopic Transpapillary Gallbladder Drainage in Acute Cholecystitis

Diagnostics ◽

10.3390/diagnostics11071286 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1286

Author(s):

Junya Sato ◽

Kazunari Nakahara ◽

Yosuke Michikawa ◽

Ryo Morita ◽

Keigo Suetani ◽

...

Keyword(s):

Computed Tomography ◽

Acute Cholecystitis ◽

Cystic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Procedure Time ◽

Technical Success ◽

Factors Affecting ◽

Gallbladder Drainage ◽

Procedural Evaluation ◽

The Relationship

Endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis is challenging. We evaluated the influence of pre-procedural imaging and cystic duct cholangiography on ETGBD. Patients who underwent ETGBD for acute cholecystitis were retrospectively examined. The rate of gallbladder contrast on cholangiography, the accuracy of cystic duct direction and location by computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), and the relationship between pre-procedural imaging and the technical success of ETGBD were investigated. A total of 145 patients were enrolled in this study. Gallbladder contrast on cholangiography was observed in 29 patients. The accuracy of cystic duct direction and location (proximal or distal, right or left, and cranial or caudal) by CT were, respectively, 79%, 60%, and 58% by CT and 68%, 55%, and 58% by MRCP. Patients showing gallbladder contrast on cholangiography underwent ETGBD with a significantly shorter procedure time and a lower rate of cystic duct injury. No other factors affecting procedure time, technical success, and cystic duct injury were identified. Pre-procedural evaluation of cystic duct direction and location by CT or MRCP was difficult in patients with acute cholecystitis. Patients who showed gallbladder contrast on cholangiography showed a shorter procedure time and a lower rate of cystic duct injury.

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Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

Radiology Research and Practice ◽

10.1155/2016/3021484 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Radha Sarawagi ◽

Shyam Sundar ◽

Sanjeev K. Gupta ◽

Sameer Raghuwanshi

Keyword(s):

Magnetic Resonance ◽

Cystic Duct ◽

Imaging Modality ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Anatomical Variations ◽

Common Hepatic Duct ◽

Clinical Implications ◽

Imaging Features ◽

Type Iv

Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures.Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population.Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented.Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst.Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.

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From Container to Claustrum: Projective Identification in Couples

Couple and Family Psychoanalysis ◽

10.33212/cfp.v4n2.2014.136 ◽

2014 ◽

Vol 4 (2) ◽

Cited By ~ 1

Author(s):

Tamara Feldman

Keyword(s):

Psychological Health ◽

Projective Identification ◽

The Self ◽

The Other ◽

Intimate Partners ◽

And Control ◽

The Relationship ◽

As If

This paper is a contribution to the growing literature on the role of projective identification in understanding couples' dynamics. Projective identification as a defence is well suited to couples, as intimate partners provide an ideal location to deposit unwanted parts of the self. This paper illustrates how projective identification functions differently depending on the psychological health of the couple. It elucidates how healthier couples use projective identification more as a form of communication, whereas disturbed couples are inclined to employ it to invade and control the other, as captured by Meltzer's concept of "intrusive identification". These different uses of projective identification affect couples' capacities to provide what Bion called "containment". In disturbed couples, partners serve as what Meltzer termed "claustrums" whereby projections are not contained, but imprisoned or entombed in the other. Applying the concept of claustrum helps illuminate common feelings these couples express, such as feeling suffocated, stifled, trapped, held hostage, or feeling as if the relationship is killing them. Finally, this paper presents treatment challenges in working with more disturbed couples.

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Content Analysis (Analisis Isi) terhadap Peraturan Daerah Bernuansa Syariat Islam di Kabupaten Banyumas

Jurnal Suara Hukum ◽

10.26740/jsh.v1n2.p121-141 ◽

2019 ◽

Vol 1 (2) ◽

pp. 121

Author(s):

Dody Nur Andriyan

Keyword(s):

Disease Management ◽

Public Interest ◽

Islamic Law ◽

Alcoholic Beverages ◽

Public Issues ◽

Criminal Sanctions ◽

Qualitative Descriptive ◽

Administrative Sanctions ◽

And Control ◽

The Relationship

Regional Regulation (Perda) which regulates public issues such as prostitution, alcoholic beverages, gambling, and the relationship between men and women turns out to be identified as a Regional Regulation with nuances of Islamic law. in Banyumas Regency there is a Regional Regulation which if used by the identification of Arfiansyah above, it can be referred to as a Regional Regulation with nuances of Islamic law. The regulation is: Banyumas District Regulation Number 15 of 2014 concerning Control, Supervision and Control of Circulation of Alcoholic Beverages and Regional Regulations of Banyumas Regency Number 16 of 2015 concerning Community Disease Management. This research has two formulations of the first problem related to the results of the content of the analysis on the Perda that are nuanced by Islamic law in Banyumas Regency. Both of the results of the analysis content on the Regional Regulations that are nuanced by Islamic law in Banyumas Regency are not contrary to Law-Invitation Number 12 of 2011? This research is a qualitative-descriptive study. The research method used is normative juridical. The main source of data is the Banyumas District Regulation Number 15 of 2014 concerning Control, Supervision and Control of Circulation of Alcoholic Beverages and Regional Regulations of Banyumas Regency Number 16 of 2015 concerning Community Disease Management. Interviews were also conducted with resource persons. Furthermore, the results of the analysis were carried out. Regional Regulation No. 15 of 2014 is actually a Regional Regulation that has a broad purpose of public interest, for the nation and state. So that the claim that Perda No 15 of 2014 as a Regional Regulation with nuances of Islamic law is not true. Regional Regulation No. 16 of 2015 is actually a Regional Regulation that has a broad purpose of public interest, for the nation and state. So that the claim that Perda No 16 of 2015 as a Regional Regulation with nuances of Islamic law is not true. Both of these Perda (Perda No 15 of 2014 and Perda No. 16 of 2015) are not in conflict with Law No. 12 of 2011 concerning the Establishment of Legislation. Both in terms of content, principles, goals, arrangements, administrative sanctions and criminal sanctions. Formally and procedurally the two Perda are in accordance with Law Number 12 of 2011

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The effect of type of water supply on water quality in a developing community in South Africa

Water Science & Technology ◽

10.2166/wst.1997.0706 ◽

1997 ◽

Vol 35 (11-12) ◽

pp. 35-40 ◽

Cited By ~ 6

Author(s):

B. Genthe ◽

N. Strauss ◽

J. Seager ◽

C. Vundule ◽

F. Maforah ◽

...

Keyword(s):

Water Quality ◽

Water Supply ◽

Cross Sectional Study ◽

Cross Sectional ◽

E Coli ◽

Guideline Values ◽

Developing Communities ◽

Quality Guideline ◽

And Control ◽

The Relationship

Efforts to provide water to developing communities in South Africa have resulted in various types of water supplies being used. This study examined the relationship between the type of water supply and the quality of water used. Source (communal taps, private outdoor and indoor taps) and point-of-use water samples were examined for heterotrophic plate counts (HPC), total and faecal coliforms, E. coli, and coliphages. Ten percent of samples were also analysed for enteric viruses, Giardia and Cryptosporidium. Approximately 320 households were included in a case-control study. In addition, a cross-sectional study was conducted. Both studies examined the relationship between different types of water facilities and diarrhoea among pre-school children. The source water was of good microbial quality, but water quality was found to have deteriorated significantly after handling and storage in both case and control households, exceeding drinking water quality guideline values by 1-6 orders of magnitude. Coliphage counts were low for all water samples tested. Enteric viruses and Cryptosporidium oocysts were not detected. Giardia cysts were detected on one occasion in case and control in-house samples. Comparisons of whether in-house water, after handling and storage, complied with water quality guideline values demonstrated households using communal taps to have significantly poorer quality than households using private outdoor or indoor taps for HPC and E. coli (χ2 = 14.9, P = 0.001; χ2 = 6.6, P = 0.04 respectively). A similar trend (although not statistically significant) was observed for the other microbial indicators. The cross-sectional study demonstrated an apparent decrease in health risk associated with private outdoor taps in comparison to communal taps. This study suggests that a private outdoor tap is the minimum level of water supply in order to ensure the supply of safe water to developing communities.

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Delegation and Control Revisited

10.1093/oso/9780190672454.003.0008 ◽

2018 ◽

Author(s):

Dan Honig

Keyword(s):

Foreign Aid ◽

International Development ◽

Local Knowledge ◽

Entry And Exit ◽

Country Ownership ◽

Development Organization ◽

Workplace Experience ◽

And Control ◽

The Relationship

This chapter traces the relationship between political authorizing environments, international development organization (IDO) management, and IDO field agents, drawing on the empirics presented in chapters 6 and 7. It digs into the experience of working for USAID as compared to DFID. It also extends the discussion of delegation to implementing contractors and brings this book’s theorizing of Navigation by Judgment into conversation with other foreign aid solutions aimed at incorporating local knowledge, such as establishing country offices or ensuring projects have country ownership. This chapter connects Part II’s empirics more tightly to the mechanisms theorized in Part I , particularly the role of authorizing environment insecurity and the need to “manage up” (Chapter 4) and their implications for the workplace experience of agents (Chapter 3) and the entry and exit of personnel.

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Public Powers, Private Powers, and the Exploitation of Metals for Coinage

10.1093/oso/9780198777601.003.0029 ◽

2018 ◽

Author(s):

Giovanna Bianchi

Keyword(s):

Middle Ages ◽

Field Research ◽

Mineral Resources ◽

Medieval Period ◽

Early Medieval ◽

Early Medieval Period ◽

Italian Journal ◽

Open Questions ◽

And Control ◽

The Relationship

In 1994, an article appeared in the Italian journal Archeologia Medievale, written by Chris Wickham and Riccardo Francovich, entitled ‘Uno scavo archeologico ed il problema dello sviluppo della signoria territoriale: Rocca San Silvestro e i rapporti di produzione minerari’. It marked a breakthrough in the study of the exploitation of mineral resources (especially silver) in relation to forms of power, and the associated economic structure, and control of production between the twelfth and thirteenth centuries. On the basis of the data available to archeological research at the time, the article ended with a series of open questions, especially relating to the early medieval period. The new campaign of field research, focused on the mining landscape of the Colline Metallifere in southern Tuscany, has made it possible to gather more information. While the data that has now been gathered are not yet sufficient to give definite and complete answers to those questions, they nevertheless allow us to now formulate some hypotheses which may serve as the foundations for broader considerations as regards the relationship between the exploitation of a fundamental resource for the economy of the time, and the main players and agents in that system of exploitation, within a landscape that was undergoing transformation in the period between the early medieval period and the middle centuries of the Middle Ages.

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Cognitive Treatment for OCD

10.1093/oxfordhb/9780195376210.013.0076 ◽

2012 ◽

Author(s):

Maureen L. Whittal ◽

Melisa Robichaud

Keyword(s):

Term Treatment ◽

Future Directions ◽

Cognitive Treatment ◽

Long Term Treatment ◽

Inflated Responsibility ◽

And Control ◽

The Relationship ◽

Control Of Thoughts

The cornerstone of cognitive treatment (CT) for OCD is based upon the knowledge that unwanted intrusions are essentially a universal experience. As such, it is not the presence of the intrusion that is problematic but rather the associated meaning or interpretation. Treatment is flexible, depending upon the nature of the appraisals and beliefs, but can include strategies focused on inflated responsibility and overestimation of threat, importance and control of thoughts, and the need for perfectionism and certainty. The role of concealment and the relationship to personal values are important maintaining and etiological factors. The short-term and long-term treatment outcome is reviewed, along with predictors of treatment response and mechanisms of action, and the chapter concludes with future directions regarding CT for OCD.

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Coercive Controlling Behaviors and Reporting Physical Intimate Partner Violence in Australian Women: An Exploration

Violence Against Women ◽

10.1177/1077801220985932 ◽

2021 ◽

pp. 107780122098593

Author(s):

Brittany Patafio ◽

Peter Miller ◽

Arlene Walker ◽

Kerri Coomber ◽

Ashlee Curtis ◽

...

Keyword(s):

Intimate Partner Violence ◽

Partner Violence ◽

Online Survey ◽

Physical Violence ◽

Intimate Partner ◽

Physical Intimate Partner Violence ◽

Differential Utility ◽

And Control ◽

The Relationship ◽

Controlling Behaviors

This study explores two approaches to measuring coercive controlling behaviors (CCBs)—counting how many different CCB types and examining the frequency of each CCB experienced—to examine their utility in explaining the relationship between CCBs and physical intimate partner violence (IPV). Australian women aged 18–68 years ( n = 739; Mage = 31.58, SDage = 11.76) completed an online survey. Count and frequency CCB approaches yielded similar significant associations with increased physical IPV. Both approaches suggest that frightening behaviors in particular are significantly indicative of also experiencing physical IPV; however, when you count CCB types, public name-calling becomes important, whereas when you examine the frequency of each CCB type, jealousy/possessiveness becomes important. These findings suggest differential utility between measures of CCBs, which examine the frequency of specific CCB types and which count CCB types, and that both approaches are useful in understanding how coercion and control relate to physical violence within intimate relationships.

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Research Progress of Desertification and Its Prevention in Mongolia

Sustainability ◽

10.3390/su13126861 ◽

2021 ◽

Vol 13 (12) ◽

pp. 6861

Author(s):

Xiya Liang ◽

Pengfei Li ◽

Juanle Wang ◽

Faith Ka Shun Chan ◽

Chuluun Togtokh ◽

...

Keyword(s):

Model Development ◽

Mitigation Strategies ◽

Research Progress ◽

Prevention Measures ◽

Interdisciplinary Approaches ◽

The World ◽

Impacting Factors ◽

Decoupling Analysis ◽

And Control ◽

The Relationship

Mongolia is a globally crucial region that has been suffering from land desertification. However, current understanding on Mongolia’s desertification is limited, constraining the desertification control and sustainable development in Mongolia and even other parts of the world. This paper studied spatiotemporal patterns, driving factors, mitigation strategies, and research methods of desertification in Mongolia through an extensive review of literature. Results showed that: (i) remote sensing monitoring of desertification in Mongolia has been subject to a relatively low spatial resolution and considerable time delay, and thus high-resolution and timely data are needed to perform a more precise and timely study; (ii) the contribution of desertification impacting factors has not been quantitatively assessed, and a decoupling analysis is desirable to quantify the contribution of factors in different regions of Mongolia; (iii) existing desertification prevention measures should be strengthened in the future. In particular, the relationship between grassland changes and husbandry development needs to be considered during the development of desertification prevention measures; (iv) the multi-method study (particularly interdisciplinary approaches) and desertification model development should be enhanced to facilitate an in-depth desertification research in Mongolia. This study provides a useful reference for desertification research and control in Mongolia and other regions of the world.

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