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PubMed2001

Dye-staining stereomicroscopic examinations for fine mucosal structures of the gallbladder.

BACKGROUND: In order to diagnose an unsuspected gallbladder carcinoma and to examine whether a differential diagnosis could be made between cancer and noncancerous lesions during surgery, we evaluated the findings of fine structures of various types of gallbladder mucosa. METHODS: We used stereomicroscopy with a dye-contrast technique under water and measured the maximum blood vessel diameters of the gallbladder mucosa: normal gallbladder, chronic cholecystitis, and carcinoma. RESULTS: All normal gallbladders showed fine-reticular-type findings. In chronic cholecystitis, 5.8% of the specimens (n = 69) had fine reticular type, 87.0% had rough reticular type, and 7.2% had atrophic type. All the cases of adenomyomatosis (n = 16) showed rough reticular type. In eight specimens of pancreaticobiliary maljunction, 75% of them showed high reticular type, and the other 25% showed papillary type. The two adenoma specimens showed fine granular type. In five gallbladder carcinomas, the lattice-like pattern completely disappeared and showed rough granular type. The average of maximum vessel diameters in the gallbladder mucosa were 41.0 microm in normal gallbladders, 99.1 microm in patients with chronic cholecystitis, and 614.8 microm in patients with a carcinoma. There were significant differences among them (p < 0.05). CONCLUSION: This study showed that differential diagnosis between cancer and noncancerous lesion is possible by dye-staining mucosal pattern and measurement of maximum vessel diameters by stereoscopic examination.

Adenoma↗

PubMed1994

Effect of single and multiple administrations of cisapride on postprandial gallbladder emptying in healthy humans.

Effects of a clinical dose of the prokinetic drug, cisapride, on postprandial gallbladder emptying were evaluated in 8 healthy normal volunteers. Gallbladder and gastric emptying after a liquid test meal were simultaneously measured by ultrasonography. Compared with placebo, a single oral dose of cisapride (5 mg) accelerated gastric emptying, but not gallbladder contraction. Cisapride enhanced gallbladder refilling. The same individuals took oral cisapride (15 mg TID) for 14 days, and were reassessed on the following day after oral 5 mg of cisapride. Fasting gallbladder volume was significantly increased. Although gallbladder contractility was not affected, the residual volume was significantly large. Gastric emptying rate returned to the control value. Fasting and post-test meal plasma CCK levels were not significantly attenuated by either single or multiple administration of cisapride. These results suggest that a clinical dose of cisapride may attenuate gallbladder motor function via mechanisms other than direct neural stimulation of the gallbladder.

Administration, Oral↗

PubMed1998

Sonographic analysis of gallbladder findings in Salmonella enteric fever.

The purpose of this study was to analyze gallbladder sonographic findings associated with Salmonella typhi enteric fever. Sixty-two patients with culture positive Salmonella enteric fever were analyzed with serial sonography. The following gallbladder sonographic findings were noted: globular gallbladder distention (33 of 62 patients, 530%), positive sonographic Murphy sign (25 patients, 40%), pericholecystic edema or fluid (25 patients, 40%), gallbladder wall thickening > 4 mm (21 patients, 34%), low-level nonshadowing intraluminal echoes or sludge (nine patients, 15%), intramural linear sonolucency or striation (eight patients, 13%), and mucosal irregularity or sloughed membrane (four patients, 6%). Using the sonographic findings a gallbladder score was devised to assess the severity of gallbladder changes, and the score was correlated with the following clinical parameters--duration of fever, multidrug resistance, and clinical outcome. An abnormal gallbladder score was noted in 37 patients (60%), and multidrug resistance was noted in 35 of these patients (95%). The gallbladder scores showed a strong positive correlation with the duration of fever and the frequency of multidrug resistance. All 62 patients were treated with intensive antibiotic therapy without any deaths.

Acute Disease↗

PubMed1998

Gallbladder cancer: can ultrasonography evaluate extent of disease?

This study reviews the spectrum of sonographic findings in patients with gallbladder cancer, attempts to determine if sonography can identify patients with potentially resectable disease, and emphasizes the limitations of ultrasonography in the evaluation of -gallbladder cancer. Thirty-five consecutive patients with histologically proven gallbladder carcinoma who had preoperative abdominal ultrasonography and surgery were identified. Involvement of the gallbladder and gallbladder fossa, metastases, bile ducts, portal vein, and adjacent lymph nodes was assessed sonographically. The extent of disease and staging as revealed by sonography was compared to operative and surgical pathologic findings. Masses in the gallbladder or gallbladder fossa were present at surgery in 26 patients; 22 (85%) of these masses were shown by sonography. Sonography identified six (67%) of nine cases of pathologically confirmed liver metastases, 11 (79%) of 14 cases of bile duct involvement, and two (67%) of three cases of portal venous involvement by tumor. Sonography revealed lymph node metastases in only five (36%) of 14 patients. None of the 12 cases with peritoneal metastases was identified sonographically. By surgical staging 16 (46%) patients had potentially resectable disease (stage III or less), and 19 (54%) patients had unresectable stage IV disease. Sonography correctly identified 15 (94%) of 16 patients with potentially resectable disease and seven (37%) of 19 patients with advanced disease. Twelve patients with advanced disease were under-staged: nine had peritoneal metastases, two had liver metastases, and one had celiac adenopathy, which was not shown by sonography. In conclusion, sonography is reliable in the detection of a primary gallbladder mass or of local extension of tumor into the liver. However, sonographic findings do not accurately reflect the full extent of disease, and sonography is particularly limited in the diagnoses of metastases to the peritoneum and lymph nodes.

Adult↗

PubMed2003

[Is the laparoscopic approach appropriate for porcelain gallbladder?].

Contrary to the fears raised in surgical publications of the 1950's and 60's, the prognosis of porcelain gallbladder is not automatically associated with an increased risk of gallbladder carcinoma. Two recent cohort studies have allowed a better definition of the appropriate therapeutic attitude for a patient with a calcified gallbladder. In cases of "true" porcelain gallbladder, i.e., the presence of complete transmural calcification of the entire gallbladder wall, indications for cholecystectomy are based on biliary symptoms, all the more so since choledocholithiasis is often associated with porcelain gallbladder. In the case of partial calcification of the gallbladder, i.e., focal plaques of calcification involving the mucosa, prophylatic operative treatment is indicated. In these cases, the incidence of malignancy is markedly increased (14 times that of a control population). Cholecystectomy can still be performed laparascopically as long as the rules for prevention of peritoneal dissemination of tumor cells are scrupulously observed--the gallbladder should not be opened nor bile spilled, the specimen should be placed in a bag for removal through the abdominal wall, the pneumoperitoneum should be evacuated with the trocars still in place and the specimen should be opened and examined after removal with immediate frozen section pathologic exam if there is any question of tumor.

Biopsy↗

PubMedDate not supplied

Gallbladder motility in healthy volunteers: effects of age, gender, body mass index, and hair color.

BACKGROUND/AIMS: Ultrasonographic determination of gallbladder motility is sparsely performed in clinical practice as the examination is considered to be time consuming and there is uncertainty about a number of parameters possibly influencing the results. The aims of this study were a) to establish normal values for a simple ultrasonographic test and b) to evaluate the influence of different parameters on gallbladder motility. METHODOLOGY: In 62 systematically age- and sex-matched healthy volunteers, ultrasonographic measurements of gallbladder volume (ellipsoid method, planimetry and sum-of-cylinders method) were performed fasting and 5, 10, 20, 30, 40, 50, 60, 70 and up to 75 min after stimulation with a standardized high-caloric liquid meal. RESULTS: Using the ellipsoid method, gallbladder fasting volume (V0) reached a mean value (+/- SD) of 24.6 +/- 10.0 mL with an ejection fraction of 65.9 +/- 19.1%. Age, gender and hair color did not influence parameters of gallbladder contraction. Body mass index showed a weak correlation with V0 but not with ejection fraction. There was a highly significant correlation between the ellipsoid method and longitudinal planimetry and the sum-of-cylinders method, respectively. CONCLUSIONS: Ultrasonographic measurement of gallbladder motility in healthy volunteers shows a very wide scattering of normal values. In the interpretation of gallbladder emptying, age, gender and body mass index do not have to be considered. Determination of gallbladder motility may be performed by a rather simple approach with oral stimulation and ellipsoid method or longitudinal planimetry as easily applicable ultrasonographic measurements.

Adolescent↗

PubMed2005

Color Doppler ultrasonographic examination on the relationship between the gallbladder bed and major branch of the middle hepatic vein.

BACKGROUND: There is a controversy about the risk of injury to the branch of the middle hepatic vein during laparoscopic cholecystectomy. This study was conducted to further investigate the relationship between the gallbladder bed and the branch of the middle hepatic vein. METHODS: Color Doppler ultrasound was used to examine the anatomical relationship between the gallbladder bed and the branches of the middle hepatic vein in 143 healthy volunteers. RESULTS: Not all the middle hepatic vein extended close to the gallbladder bed, the branches and gallbladder beds in 23 subjects were not in the same plane during ultrasound scanning. In 21 of the 143 subjects the branch of the middle hepatic vein was completely adherent to the gallbladder bed with a diameter ranging from 1.2 mm to 3.6 mm. In 10 subjects the branches of the middle hepatic vein traversed approximately 1.0 mm from the gallbladder bed with a diameter ranging from 1.6 mm to 3.0 mm. CONCLUSIONS: In most subjects the branch of the middle hepatic vein and the gallbladder bed are well separated. Only patients with large branches of the middle hepatic vein close to the gallbladder bed are at risk of hemorrhage during laparoscopic cholecystectomy.

Cholecystectomy, Laparoscopic↗

PubMed2006

Effect of sequential administration of an opioid and cholecystokinin on gallbladder ejection fraction: brief communication.

UNLABELLED: This study was undertaken to test the effect of sequential administration of an opioid and intravenous cholecystokinin (CCK) on gallbladder ejection fraction. METHODS: Forty-nine patients who had received an opioid underwent quantitative cholescintigraphy with octapeptide of CCK (CCK-8). Gallbladder ejection fraction and CCK-8-induced paradoxical filling were calculated. RESULTS: In the basal state, more of the hepatic bile entered the gallbladder (67%) than the small intestine (33%). After CCK-8 infusion, gallbladder ejection fraction was low in 37 (76%) of 49 patients and normal in 12 (24%). All 5 types of opioids lowered ejection fraction. CCK-induced paradoxical filling of the gallbladder was noted in 7 patients, but only one showed paradoxical filling of greater than 20% and none had a normal gallbladder ejection fraction. The lowering effect of opioids on gallbladder ejection fraction may last as long as 18 h after intake. CONCLUSION: CCK-8 produced a normal gallbladder ejection fraction in 24% of patients who had received an opioid and thus could exclude both acute and chronic cholecystitis during a single hepatobiliary study.

Artifacts↗

PubMed1990

Ultrasonographic difficulties and pitfalls in diagnosing primary carcinoma of the gallbladder.

In order to more specifically define gallbladder carcinoma with real-time ultrasonography, a retrospective study was performed involving 29 sonographically false-negative and 22 sonographically false-positive cases of gallbladder carcinoma. Among the false negative cases, 18 (62.1%) were diagnosed as gallbladder stone only, 6 cases (20.7%) were incorrectly diagnosed as either acute or chronic cholecystitis, 2 cases (6.9%) were diagnosed as bile sludge, 2 cases (6.9%) were diagnosed as polyps, and 1 case (3.4%) was diagnosed as liver tumor. In false-positive cases, 8 (31.8%) were erroneously diagnosed as liver tumor. In false-positive cases, 7 (31.8%) were erroneously diagnosed as a mass projecting from the gallbladder wall but were pathologically proven to be polyps (4 cases) or bile sludge (3 cases); 8 cases (36.4%) were incorrectly diagnosed due to irregular thickening of the gallbladder wall but histology revealed them to be acute (3 cases) or chronic (5 cases) cholecystitis. Seven cases (31.8%) had a solid mass in porta hepatis, indicating gallbladder carcinoma; of these, 2 cases were lumps of bile sludge and 5 cases were acute cholecystitis with empyema. The differentiation of gallbladder carcinoma from cholecystitis (acute or chronic), polyps, and bile sludge is sometimes very difficult. With an understanding of the sonographic pitfalls and difficulties in the diagnosis of gallbladder carcinoma, a more specific diagnosis may be made.

Carcinoma↗

PubMedDate not supplied

Ultrasonography in carcinoma of the gallbladder.

Cholecystosonography in approximately 40,000 patients over five years in two university hospitals revealed 30 (75%) of the 40 macroscopic primary carcinomas. In 3 cases the carcinoma was obscured by gallstones with shadowing, in 3 cases the origin of a tumour mass was misinterpreted, and in 4 cases the neoplastic growth mimicked gallbladder inflammatory changes or sludge. Malignancy was incorrectly diagnosed or suggested in 25 patients. The most frequent cause of a false positive report was acute or chronic inflammation, found at surgery in 16 gallbladders. Four carcinomas of the pancreatic head were believed to be gallbladder tumours. Cirrhosis with marked gallbladder wall thickening, gastric carcinomas with metastases, a common duct carcinoma, and two cases of sludge (with normal control studies) caused a false suggestion of gallbladder carcinoma. The most frequent ultrasonographic finding in gallbladder carcinomas was a mass filling the gallbladder (15 diagnosed cases), followed by wall thickening (9 cases), and polypoid or fungating tumour (6 cases). Real-time ultrasonography is a useful method for the preoperative diagnosis of gallbladder carcinoma, but considerable diagnostic problems in the differentiation from inflammatory diseases may be encountered.

Adenocarcinoma↗

PubMed1985

Detection of occult gallbladder disease by duodenal drainage collected endoscopically. A clinical and pathologic correlation.

The bile of 100 patients with abdominal pain (suspected of having gallbladder disease) was collected from the duodenum at the time of esophagogastroduodenoscopy and examined for cholesterol and calcium bilirubinate crystals. Sixty of these patients had both negative oral cholecystograms and negative gallbladder sonograms, as well as no other objective evidence of gallbladder pathology. These patients are the subject of this report. Thirty-eight per cent of the 60 patients demonstrated crystals in bile collected at the time of endoscopy. None of the patients treated medically showed any improvement. Eight of the patients (35%) underwent cholecystectomy with 75 per cent of the gallbladders showing histologic pathology, and the remainder showing no pathology. However, all patients undergoing surgery who responded to a questionnaire improved whether or not pathology was found in the gallbladder. In contradistinction, of the patients undergoing surgery in whom no crystals were seen in the bile collected from the duodenum, pathology was found in only one third of the gallbladders and these patients' symptoms improved with surgery. Two thirds of the remaining patients had no pathologic changes in their gallbladder and only 50 per cent of these patients showed any improvement following surgery. However, patients who did not have crystals in their bile and were treated without surgery had a 58 per cent improvement rate with medical treatment alone. Duodenal drainage collected at the time of endoscopy and examination of the bile for cholesterol and bilirubinate crystals is a valuable adjunct in predicting which patients will respond favorably to cholecystectomy when there is no radiographic evidence of gallbladder disease.

Bile↗

PubMed1995

Modulation of gallbladder contraction by pirenzepine in humans.

OBJECTIVES: The mechanism(s) by which cholinergic innervation modulates gallbladder contraction are not fully understood. To elucidate the role of muscarinic M1 receptors in the mediation of gallbladder contraction, we investigated gallbladder volume reduction, plasma cholecystokinin (CCK), and pancreatic polypeptide (PP) responses in humans during cephalic and intestinal phases of a meal under M1 muscarinic receptor blockade with pirenzepine. METHODS: In eight healthy subjects, intraduodenal meal- and in seven subjects, sham feeding-induced gallbladder volume reduction was measured by real-time ultrasonography during saline or pirenzepine administration. Plasma CCK and PP were measured by radioimmunoassay. RESULTS: Pirenzepine partially inhibited gallbladder volume reduction in response to an intraduodenal fatty meal. The integrated gallbladder volume reduction over 120 min was 4462 +/- 445%.min compared with 6879 +/- 279%.min in the saline control group (p < 0.01). Integrated plasma CCK and PP responses were unchanged in the presence of pirenzepine. Pirenzepine abolished sham feeding-induced gallbladder contraction and plasma PP response. Sham feeding with either isotonic saline or pirenzepine infusion did not modify fasting plasma CCK levels. CONCLUSION: M1 muscarinic receptors play an important role in the intestinal and cephalic phases of gallbladder contraction. Plasma CCK response to intraduodenal meal is not influenced by M1 muscarinic receptor blockade with pirenzepine.

Adult↗

PubMed1994

Reproducibility of gallbladder emptying scintigraphic studies.

UNLABELLED: This study was designed to investigate the reproducibility of the results obtained from 99mTc-dimethyliminodiacetic acid (99mTc-EHIDA) cholescintigraphy, when used as a method of estimating gallbladder emptying. METHODS: In a random controlled fashion, the reproducibility of scintigraphic gallbladder emptying studies was assessed in 30 subjects, of whom six were normal, four had duodenal ulcers and the remaining 20 had undergone antiulcer gastric surgery. In fasting subjects, who 30 min later drank 250 ml of fresh milk, 2 mCi of 99mTc-EHIDA was intravenously injected. Liver and gallbladder areas were scanned for 60 sec and then every 5 min for 1 hr. The study was repeated in all subjects within 2-5 wk. From the gallbladder emptying curves, the duration of the lag phase (time from milk ingestion to actual start of emptying), the ejection fraction of emptying (peak to least activity in the gallbladder), the time by which maximal emptying was achieved and the pattern of gallbladder emptying were calculated. RESULTS: Two subjects were excluded from the study because their gallbladders did not fill. Lag phase duration was well reproduced in duplicate studies (r = 0.87), as was ejection fraction (r = 0.84). The time by which maximal emptying was achieved was not sufficiently reproduced. The normal pattern of emptying (exponential function) was reproduced in all controls, subjects with duodenal ulcers and patients after antiulcer surgery that did not involve duodenal exclusion. The abnormal pattern of emptying, characterized by refilling, was reproduced in five of the seven patients with gastric surgery that mainly involved duodenal exclusion. CONCLUSION: Scintigraphy with 99mTc-EHIDA to assess gallbladder motility is a method with satisfactory reproducibility of both parametric variables and patterns of emptying.

Duodenal Ulcer↗

PubMed1996

Dynamic cholescintigraphy: induction and description of gallbladder emptying.

UNLABELLED: The main purposes of this study were to investigate the best parameter for describing gallbladder emptying and whether gallbladder bile emptying should be induced with a bolus injection or continuous infusion of cholecystokinin-octapeptide (CCK-8). METHODS: Gallbladder emptying was measured by dynamic cholescintigraphy. Twelve healthy subjects and six patients with gallstones were examined twice with CCK-8 infusion cholescintigraphy, 0.3 ng CCK-8 kg per min for 60 min under identical circumstances. Another six healthy subjects randomly received bolus injection (0.04 microgram/kg) and infusion of CCK-8 (0.3 ng/kg per min for 60 min), respectively, during cholescintigraphy on two separate occasions. The choice of bolus dose was based on recommendations from the CCK-8 manufacturer. The infusion dose was chosen to produce plasma CCK concentrations similar to postprandial plasma CCK levels. RESULTS: A parameter of gallbladder emptying, mean ejection fraction (EF), was defined as 100% minus the area under the time-activity curve normalized to 100% and divided by the time interval from maximum to minimum counts per minute. This parameter proved superior to the well known parameters, EFmax. and EF30, in regard to reproducibility in healthy subjects. The slope of the regression line for the mean EF was 0.998 and the intercept value approximately 0% (p = 0.0001). The mean coefficient of variation was 4%. Apart from a higher mean coefficient of variation, similar reproducibility results were seen in the six patients. The measurements of EF30 in healthy subjects scattered more widely around the mean compared to the mean EF and EFmax, which indicates poorer ability to separate normal from abnormal gallbladder emptying. Intravenous bolus injection of CCK-8 resulted in incomplete gallbladder emptying with a mean EF value of 16% (s.d. 9%; range 7%-32%) compared to 49% (s.d. 7%; range 37%-57%) following CCK-8 infusion (p = 0.004). Abdominal discomfort was observed in all subjects after administration of the bolus injection, whereas no complaints were reported during infusion. CONCLUSION: Mean EF is the best parameter for describing gallbladder emptying. Moreover, slow infusion of a physiological dose of CCK-8 is preferable to induce gallbladder emptying because it results in more complete emptying and has no side effects.

Adult↗

PubMedDate not supplied

Effect of bile salts on in vitro gallbladder motility: preliminary study.

Impaired postprandial gallbladder emptying may be an important factor in cholesterol crystals precipitation and subsequent gallstone formation. We previously found strongly increased bile salt concentrations in gallbladder bile of gallstone patients with weak (< 50% fasting volume) postprandial gallbladder contraction compared to patients with strong (> 50%) postprandial contraction. Therefore, we studied potential effects of various conjugated and unconjugated bile salts with different relative hydrophobicity on in vitro contractility of gallbladder muscle strips obtained at cholecystectomy. Strips were incubated 5 min with bile salt at concentrations of 10(-8)-10(-4)M. The effect of 10(-3)M acetylcholine was measured and related to preincubation control value. Bile salts used were, in order of increasing hydrophobicity: tauroursodeoxy-, ursodeoxy-, tauro-, taurodeoxy- and deoxycholate. Ursodeoxy- and tauroursodeoxycholate did not significantly reduce gallbladder contractility. Taurocholate significantly reduced contractility at concentrations of 10(-6) M and higher, taurodeoxycholate at 10(-7) M and higher and deoxycholate at 10(-5) M and higher. Contractility induced by acetylcholine 10(-3) M at a bile salt concentration of 10(-4) M was 66.0 +/- 11.7% (taurocholate), 50.2 +/- 6.2% (deoxycholate) and 44.8 +/- 11.5% (taurodeoxycholate) of control. The effect of bile salts correlated with their relative hydrophobicity (r = -0.97; p < 0.01). Suppressing effects on gallbladder muscle strip contractility were long lasting and remained after rinsing. Results show that bile salts in the physiological dose range inhibit in vitro gallbladder contraction. If this mechanism exists in vivo, it may have important implications for gallbladder motility regulation.

Acetylcholine↗

PubMedDate not supplied

Tauroursodeoxycholic acid, ursodeoxycholic acid and gallbladder motility in gallstone patients and healthy subjects.

Fasting and postprandial gallbladder volumes have been measured by sonography both in healthy subjects and gallstone patients ingesting: (a) tauroursodeoxycholic acid; (b) ursodeoxycholic acid; (c) placebo. Each bile salt was given at a dose of 10 mg kg-1. Sonography was repeated in gallstone patients fed tauroursodeoxycholic acid or ursodeoxycholic acid (10 mg kg-1 day-1) for 1 month. Gallstone patients had gallbladder stasis (increase in fasting and residual volumes) and decreased postprandial emptying. Acute ingestion of tauroursodeoxycholic acid or ursodeoxycholic acid did not modify postprandial gallbladder emptying in both groups of subjects. After one month's therapy with tauroursodeoxycholic acid or ursodeoxycholic acid, fasting gallbladder volume further increased in gallstone patients, although gallbladder emptying remained unchanged. Thus, therapeutic doses of tauroursodeoxycholic acid or ursodeoxycholic acid do not acutely modify postprandial gallbladder emptying in either healthy subjects or gallstone patients. Chronic treatment with either bile salts results in an increase in fasting gallbladder volume without interfering with the extent of postprandial gallbladder emptying.

Adult↗

PubMed1996

Visualization of routes of lymphatic drainage of the gallbladder with a carbon particle suspension.

BACKGROUND: Although carcinoma of the gallbladder frequently spreads lymphatically, few reports exist about the evaluation of routes of lymphatic drainage of the gallbladder by vital staining. The purpose of this study was to visualize drainage routes and the extent of lymphatic flow from the gallbladder by using vital staining with a carbon particle suspension (CH40). STUDY DESIGN: In 20 patients, 0.3 to 0.5 mL of carbon particle suspension was injected into first station nodes for the gallbladder, the cystic node or pericholedochal node, intraoperatively. After a Kocher maneuver was performed, lymph nodes and lymphatic vessels blackened by the stain were visualized macroscopically. RESULTS: Lymphatic pathways from the gallbladder were classified into three routes: right, left, and hilar. The right route, which ran along the common bile duct to the superior retropancreaticoduodenal node or the retroportal node and reached the para-aortic nodes, was stained in 95 percent of patients. The left route, which traveled toward lymph nodes medial to the hepatoduodenal ligament through the posterior aspect of the head of the pancreas, was stained in less than 50 percent of patients. Among lymph nodes along the left route, the posterior common hepatic node was most frequently stained (45 percent). The hilar route, which ascended toward the hepatic hilus, was stained in 20 percent of patients. CONCLUSIONS: These data demonstrate that the right route is a main pathway of lymphatic drainage from the gallbladder, while the left and hilar routes are branch lines. The para-aortic nodes, regarded as final regional nodes for the gallbladder, should be removed during radical surgery for advanced carcinoma of the gallbladder. Drainage along the hilar route may cause metastasis to the liver.

Carbon↗

PubMedDate not supplied

[The value of echotomographic measurement of gallbladder volume in the evaluation of its contractility].

Ultrasonographic examination of the gallbladder was performed in 2 patient groups: 20 volunteers (group I) and 20 patients with cholelithiasis (group II). Gallbladder volume was echotomographically measured before and after holagogue was administered. Dodd's ellipsoidal method was used for the elevation of gallbladder contractility. The mean value of gallbladder contractility was 69.9% in the group of volunteers. After the holagogue administration, the decrease of gallbladder volume was noticed in all the studied patients. In group of patients with cholelithiasis, the reaction after holagogue administration was different: the increase of gallbladder volume was noticed in 8 patients after the holagogue administration and the poor gallbladder contractility (below 50%) was noticed in 8 patients. Four patients had no reaction after the holagogue administration. Echotomography was determined to be reliable method in the diagnosis of gallbladder contractility disturbances.

Cholelithiasis↗