PubMed Health⌕ Search

Biomedical subjects

C B So

Publications and source records attributed to C B So.

24 records · Page 2Linked to original sources
PubMed1990

Carcinoma of the gallbladder: a risk associated with gallbladder-preserving treatments for cholelithiasis.

Five cases of carcinoma of the gallbladder associated with nonsurgical treatment of cholelithiasis are presented in view of the recent interest in gallbladder-preserving procedures. Three patients developed gallbladder cancer that was diagnosed 4, 11, and 72 years, respectively, after cholecystostomy. One other patient had gallbladder carcinoma diagnosed 7 months after extracorporeal shock wave lithotripsy for common bile duct stones. The tumor was probably present but not identified at the time of lithotripsy. The last patient had undiagnosed gallbladder malignancy at the time of cholecystostomy for treatment of acute calculous cholecystitis. Gallbladder carcinoma has been reported in 1% of patients undergoing cholecystectomy, and the risk of carcinoma developing in patients with asymptomatic cholelithiasis has been estimated at less than 1%. These figures should not diminish the role of gallbladder-preserving treatments in elderly and selected high-risk patients for whom cholecystectomy may be hazardous. However, such patients must undergo a thorough imaging assessment both before and after treatment to ensure that a gallbladder carcinoma is not overlooked.

Aged↗
PubMed1989

Gallstone recurrence after cholecystolithotomy.

Surgical cholecystostomy is performed often at our institution for emergent management of acute calculous cholecystitis in high-risk elderly patients. Gallstones are removed either during surgery or by subsequent radiologic manipulation. Most such patients do not undergo subsequent cholecystectomy. The frequency of gallbladder stone and/or biliary symptom recurrence was studied in 63 patients who had undergone successful cholecystolithotomy. Follow-up examinations in 48 of these patients, performed at a mean of 18 +/- 12 months after surgery, showed recurrence of gallstones in 13 patients (27%). This included 12 of 38 patients who had follow-up sonograms and one of two cadavers that underwent autopsy. None of eight patients who had a subsequent cholecystectomy had recurrent stones. Two of 17 patients studied within 1 year of cholecystolithotomy had recurrent calculi, as did six of 21 patients studied at 1-2 years, four of five patients studied at 2-3 years, and one of five patients studied at 3-4 years. Biliary symptoms were assessed in 46 of the 48 patients who had follow-up examinations (two patients died) and in the 15 other patients who had undergone successful cholecystolithotomy. Recurrent or residual symptoms were present in seven (11%) of 61 patients, including three of the 13 patients with recurrent calculi. Six of these seven patients underwent further hospital treatment. These results confirm the anticipated high frequency of stone recurrence after cholecystolithotomy. However, because most patients with recurrent stones were asymptomatic, routine interval cholecystectomy may not be necessary.

Acute Disease↗
PubMed1989

Accuracy of sonography for determining the number and size of gallbladder stones before and after lithotripsy.

Accurate knowledge of gallstone number and size is required both for selection of patients for treatment by lithotripsy and for the evaluation of therapeutic results. We measured the accuracy of sonography for use in counting and measuring gallstones and gallstone fragments in a three-part study. First, specimen gallstones of known size were examined in a water bath with four different sonographic units. Second, seven pigs with surgically implanted gallstones had sonography before and after lithotripsy. Finally, we compared the measurements made on the preoperative sonogram with postoperative surgical specimen measurements in 27 patients who underwent cholecystectomy. In vitro gallstone measurement errors were 1.0 mm or less with each of the four sonographic units. In the animal experiments, all prelithotripsy measurements were highly accurate (+/- 1.1 mm). The animal postlithotripsy measurements were similarly accurate in five of seven cases, but substantial errors were made in the remaining two cases. In precholecystectomy patients, the sonographic stone counts and measurements were accurate in all 16 patients who had fewer than six stones. In all 11 patients with six or more stones, we correctly determined with sonography that at least six stones were present, but in only four of 11 cases was the largest stone measured accurately (+/- 2.0 mm). We conclude that sonography can be used accurately to count and measure gallstones when fewer than six stones are present, can reliably determine when six or more stones are present, and, in many cases, can determine the size of the largest fragments remaining after lithotripsy.

Animals↗
PubMedDate not supplied

Severity of disease score as a predictor of mortality after caval filter insertion.

PURPOSE: To estimate 30-day mortality after vena caval filter insertion and assess the usefulness of a severity of disease score in predicting postprocedure 30-day survival. PATIENTS AND METHODS: Records of 40 consecutive patients undergoing inferior vena caval filter insertion over a 2 1/2-year period were retrospectively reviewed. A severity of illness score for each patient was calculated based on the weighting system described for the APACHE (Acute Physiology and Chronic Health Evaluation) II system. In addition, 30-day postprocedure survival was determined. RESULTS: Seven patients died within 30 days of the procedure (18%). The use of a severity of disease score of greater than 15 as a predictor of postprocedure 30-day mortality had a sensitivity of 50%, specificity of 97%, positive predictive value of 75%, a negative predictive value of 91.4%, and accuracy of 90%. CONCLUSIONS: The 30-day mortality after caval filter insertion is significant. A severity of disease score is a useful predictor of patients likely to survive following caval filter insertion. On this basis it may be possible to establish criteria for more beneficial use of vena caval filters.

APACHE↗