SEARCH · PubMed Health

Results for “Gallbladder”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources

PubMed2004

Relation of abnormal gallbladder arterioles to gallbladder emptying in patients with gallstone and diabetes mellitus.

BACKGROUND: Diabetes mellitus is thought to be related to gallstone formation in emptying the gallbladder. Diabetes mellitus may lead to many changes in microarterioles and micronerves; the aim of this study was to investigate the abnormality of arterioles in the gallbladder and its relation to gallbladder hypomotility in patients with gallstone and diabetes mellitus. METHODS: Thirty patients with simple gallstones and 30 patients with gallstones and diabetes mellitus were analyzed, and their gallbladder emptying function was measured with B ultrasound before operation. After operation, the arterioles of the gallbladder rinsed with periodic acid-schiff (PAS) reagent in photos were used for analysis of the tublar area and stereo system with the Beihang CM-2000B biological and medical photo system. RESULTS: In patients with gallstones and diabetes mellitus, the gallbladder emptying function was significantly impaired, the area ratio of the arteriole wall to whole arterioles in cross section was significantly higher than that in patients with simple gallstones (0.81+/-0.09 vs. 0.58+/-0.15, P<0.01), and the average sound density was also higher (0.41+/-0.07 vs. 0.30+/-0.12, P<0.01) in patients with gallstones and diabetes mellitus than in those with simple gallstones. The size of arterioles (diameter) was not significantly related to the area ratio (P>0.05). CONCLUSION: In patients with diabetes mellitus, the sedimentation of PAS positive material in the wall of arterioles leads to the stenosis of arterioles. It is probably contributive to hypomotility of the gallbladder.

Adult↗

PubMed1989

[Lymphatic and vascular systems of the gallbladder--with special reference to carcinoma of the gallbladder].

To understand the spreading modes of cancer of the gallbladder concerning its surgical treatment, relation between the infiltration depth of the cancer and the lymph and blood vessel systems in the gallbladder was investigated. Clinico-pathological studies of 23 cases of the gallbladder carcinoma showed that the infiltration depth related to the degree of differentiation, invasiveness to lymph and blood vessel, and the metastasis of lymph nodes. Lymphatic and vascular systems of the gallbladder and bile duct were examined in 22 dogs. The vasculature in the wall of the gallbladder was divided into three layers. The veins at the liver bed were communicated with the intrahepatic portal veins. The lymphatic system in the wall was more clearly shown after obstruction of lymph vessels by ligation of soft tissues in the hepatoduodenal ligament and revealed four layers. The lymph vessels draining from the gallbladder descended along the cystic duct and the bile duct. They passed the portal and pancreatoduodenal lymph nodes and entered the cisterna chyli. In addition, lymph obstruction revealed other lymph tracts to the hepatic parenchyma of the hepatic hilum, retroperitoneum, celiac axis and the splenic vessel regions. The findings suggest that (1) simple cholecystectomy is suitable for the intramucosal carcinoma. (2) for the carcinoma infiltrating to the lamina muscularis, vascular invasion and spreading to the liver through the liver bed of gallbladder is suspected, and (3) for the carcinoma with subserosal infiltration, hepatic segmentectomy with complete resection of the extrahepatic bile duct and removal of the regional lymph nodes of the hepatoduodenal ligament and the vicinity of the gastropancreatic region are required because vascular and lymphatic spreads are suspected. Adjuvant therapy should be required and strict follow up survey should be maintained.

Adenocarcinoma↗

PubMed1981

Ultrasonography of the gallbladder. Investigation of the nonvisualized gallbladder at oral cholecystography.

One hundred and one patients with nonvisualized gallbladder at double dose oral cholecystography were examined with ultrasonography. In 41 of 44 operated patients, ultrasonography suggested gallbladder disease. Operation in all of these cases confirmed the diagnosis. In three of the patients with cholelithiasis operation revealed in addition gallbladder carcinoma. In three patients, in which ultrasonography demonstrated normal appearance of the gallbladder surgery revealed chronic cholecystitis and stone impacted in the cystic duct. The diagnostic value of ultrasonography as complementary method for evaluation of gallbladder disease, particularly in cases of nonvisualization of the gallbladder at ultrasonography is stressed. The high incidence of gallbladder carcinoma in the present material in patients with cholelithiasis point to the fact that this group of patients should be the subject for careful investigation.

Adult↗

PubMed1991

Histological changes of the gallbladder and liver after extracorporeal shock wave lithotripsy for gallbladder.

The histological changes of the gallbladder and liver following extracorporeal shock wave lithotripsy (ESWL) were investigated in a canine model. After performing ESWL on human cholesterol stones placed in the gallbladder of 8 dogs, the gallbladder and livers were removed for pathological study. The mucosa of the gallbladder showed erosion and ulceration in three of the eight dogs. Edema and bleeding were found in the stroma of the gallbladder beds. Hemorrhagic necrosis and vacuolar degeneration occurred in liver parenchyma adjacent to the gallbladder bed, but the portal area was fairly well preserved. It can be said that ESWL caused damage to both the liver and the gallbladder, but its effects on the liver may be only slight because of the preservation of the portal area.

Animals↗

PubMed1991

Gallbladder sensitivity to cholecystokinin in coeliac disease. Correlation of gallbladder contraction with plasma cholecystokinin-like immunoreactivity during infusion of cerulein.

The present study was undertaken to determine whether alterations in the gallbladder sensitivity to cholecystokinin (CCK), apart from a reduced endogenous CCK secretion, contribute to the abnormally decreased postprandial gallbladder contraction in patients with coeliac disease. Gallbladder emptying, measured by cholescintigraphy, and plasma CCK levels, measured by radioimmunoassay, were studied during infusion of graded doses of the CCK analog cerulein in six coeliac patients with subtotal villous atrophy, six coeliac patients on a gluten-free diet with normal villous architecture, and nine control subjects. Both in the patients and in the controls infusion of stepwise increasing doses of cerulein, in the range of 1-16 ng.kg-1.h-1, induced dose-related changes in plasma CCK-like immunoreactivity (CCK-LI) (r = 0.99; p less than 0.001) and gallbladder emptying (r greater than 0.97; p less than 0.01-p less than 0.001). Plasma CCK-LI and gallbladder responses were not significantly different among untreated coeliac patients, treated coeliac patients, and controls. Gallbladder sensitivity to cerulein in untreated and treated coeliac patients was not significantly different from that in controls. It is concluded that the abnormally decreased gallbladder contraction in coeliac patients is the result of a reduced endogenous CCK secretion and not of a lack of end-organ responsiveness to CCK.

Celiac Disease↗

PubMedDate not supplied

Two incidental cases of abdominal aortic aneurysm and gallbladder cancer. Further data influencing the management of patients affected by aneurysm and gallbladder disease.

Abdominal aortic aneurysm and cholelithiasis are two common diseases in the elderly population. The prevalence of abdominal aortic aneurysms ranges between 1.8 and 6.6% in autoptic series and it's estimated that 2.5% of the over sixty year old population is affected. Carcinoma of the gallbladder is the most common malignant tumor of the biliary tract and in the United States is the fifth most frequent digestive tract malignancy; it's incidence ranges between 2 to 10 cases of 100,000 persons/year. No adequate guidelines are now available to assist the surgeon, in the case of concomitant gallbladder disease and abdominal aortic aneurysm. In this paper the management of abdominal aortic aneurysm in a patient with gallbladder disease is discussed in order to assist the surgeon deciding whether to perform concomitant aneurysm resection and cholecystectomy. In 162 aneurysmectomies (1987-1997) 18 (11.11%) patients underwent combined aneurysmectomy and cholecystectomy operation. The patients ranged in age from 49 to 88 years (average 69 years). In two cases the anatomo-histological specimen examinations (twelve sections) demonstrated a gallbladder carcinoma. The overall mortality rate was 5.56% either for aneurysmectomy alone or for combined therapy. In case of abdominal aortic aneurysm and concomitant gallbladder disease, in choosing simple endoaneurysmectomy, the surgeon has to consider the risk of early and late complications of leaving a diseased gallbladder in place. In case of concomitant performance of both operations, the risks of a possible septic graft contamination must be considered. We believe that the patient may be best served by performing the vascular and nonvascular procedures in the same operation. In this paper a new proof, till now never considered in the international literature, is presented to support our opinion: the possibility of concomitant unknown cancer or precancerous lesions in a lithiasic gallbladder. Diagnosis of these lesions is, indeed, not easy to perform in the preoperative phase and is often a postoperative anatomo-histological detection.

Aged↗

PubMed1993

Percutaneous gallbladder and urinary bladder rotational lithotripsy and a model for gallbladder sclerotherapy after lithotripsy. Clinical and experimental studies.

In experiments in pigs, fragmentation of stones implanted into the gallbladder and the urinary bladder, respectively, was successfully achieved by mechanical rotational lithotripsy with the Rotolith lithotriptor. The stones could be fragmented into pieces about 1 mm in diameter. Ten patients were selected for percutaneous rotational lithotripsy of gallbladder stones. The procedure was completed in 7 of these 10 patients. Employing a suprapubic approach, the instrument was also used for lithotripsy of urinary bladder stones in 6 male patients. Percutaneous rotational lithotripsy is well suited for elderly patients with symptomatic gallbladder stones and concurrent disease making them high-risk patients for surgery and general anesthesia. Fragmentation of urinary bladder stones in the clinical setting was not as successful as in our experimental series, probably due to the larger volume of the human urinary bladder and the high specific weight of the bladder stones. The feasibility of rotational lithotripsy of urinary bladder stones is conceivable, but when compared with current methods, the use of the Rotolith lithotriptor did not yield any advantage. Ablation of the gallbladder is of great interest to prevent recurrence of cholecystolithiasis after lithotripsy. Rotational lithotripsy of gallbladder stones was performed in an experimental model in 42 pigs to study chemical and thermal sclerotherapy with various agents in edematous gallbladders. A total ablation of the gallbladder mucosa was difficult to effect. Remnants of mucus-producing epithelium persisted in a high percentage of the histologic specimens. Sclerotherapy cannot be considered an effective method for "nonsurgical cholecystectomy."

Adult↗

PubMed2026

Hereditary Diffuse Gastric Cancer With Poorly Differentiated Gallbladder Adenocarcinoma: A Case Report Suggesting Carcinogenesis in the Stomach and Gallbladder Caused by a Pathogenic Germline Variant in CDH1.

BACKGROUND/AIM: Hereditary diffuse gastric cancer (HDGC) is an autosomal dominant cancer syndrome primarily characterized by a high lifetime risk of diffuse gastric cancer and lobular breast cancer. It is predominantly caused by inactivating germline variants in the tumor suppressor gene CDH1. While the association between HDGC and these two specific malignancies is well-established, the co-occurrence of extra-gastric malignancies in other organs remains exceptionally rare. In particular, the clinical and genetic relationship between HDGC and gallbladder adenocarcinoma has not been previously clarified. CASE REPORT: We present the case of a 67-year-old female initially referred for surgical management of gallbladder cancer (GBC) following an initial cholecystectomy for progressive wall thickening. Pathological examination of the gallbladder revealed a de novo, poorly differentiated adenocarcinoma invading the subserosal layer with reduced E-cadherin expression. Given the atypical histopathology and a significant family history-her father and brother both died of gastric cancer at young ages-a preoperative gastric endoscopy was performed. The endoscopy identified multiple faded mucosal lesions, which biopsy confirmed as signet-ring cell carcinoma. The patient subsequently underwent total gastrectomy and gallbladder bed resection. Postoperative pathology identified 22 distinct malignant gastric lesions, predominantly signet-ring cell carcinoma (pT1a), showing variable or lost E-cadherin expression. Germline genetic testing via direct sequencing identified a pathogenic frameshift mutation in exon 5 of the CDH1 gene. CONCLUSION: This represents the first reported case of synchronous HDGC and primary gallbladder adenocarcinoma associated with a germline CDH1 mutation. Our findings suggest that pathogenic CDH1 variants may contribute to the carcinogenesis of poorly differentiated gallbladder adenocarcinoma. Clinicians should consider the possibility of extra-gastric malignancies in HDGC patients.

Humans↗

PubMed2006

A case of gallbladder carcinoma associated with pancreatobiliary reflux in the absence of a pancreaticobiliary maljunction: A hint for early diagnosis of gallbladder carcinoma.

A 62-year-old man with progressive thickening of the gallbladder wall visited our outpatient clinic. The biliary amylase level in the common bile duct was 19,900 IU/L and that of the gallbladder was 127,000 IU/L, although endoscopic retrograde cholangiopancreatography revealed no pancreaticobiliary maljunction. Histology demonstrated a moderately differentiated adenocarcinoma of the gallbladder. Pancreatobiliary reflux and associated gallbladder carcinoma were confirmed in the present case, in the absence of a pancreaticobiliary maljunction. Earlier detection of the pancreatobiliary reflux and progressive thickening of the gallbladder wall might have led to an earlier resection of the gallbladder and improved this patient's poor prognosis.

Adenocarcinoma↗

PubMed1991

Cholecystokinin cholescintigraphy: detection of abnormal gallbladder motor function in patients with chronic acalculous gallbladder disease.

CCK cholescintigrams were performed in 374 patients with recurrent postprandial right upper quadrant pain, biliary colic, and a normal gallbladder sonogram and/or cholecystogram. The results of these examinations were correlated with the patients' final medical/surgical diagnoses. Twenty-seven patients recruited as control volunteers without objective clinical evidence of biliary disease also underwent CCK cholescintigraphy to determine if the degree of gallbladder contraction post-CCK differs in symptomatic versus asymptomatic subjects. Decreased gallbladder motor function was identified (maximal gallbladder ejection fraction response to CCK less than 35%) in 94% of patients with histopathologically confirmed chronic acalculous cholecystitis or the cystic duct syndrome and in 88% of patients clinically believed to have chronic acalculous biliary disease. Decreased gallbladder motor function does not distinguish symptomatic from asymptomatic gallbladder disease.

Cholecystokinin↗

PubMed2005

Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease.

BACKGROUND: Endoscopic stent insertion into the gallbladder entails placement of a double-pigtail polyethylene stent between the gallbladder and the duodenum at ERCP. This procedure may be an effective temporary measure in patients with severe comorbid conditions, especially end-stage liver disease, that subsequently allows more definitive therapy, including liver transplantation. METHODS: The records for 29 patients who underwent attempted endoscopic gallbladder stent insertion between May 1999 and May 2004 were reviewed retrospectively. RESULTS: Mean patient age was 47 years; 86% of the patients were listed for liver transplantation, with a mean model for end-stage liver disease score of 15; 72% had Child's class B cirrhosis. Indications for gallbladder stent placement included recurrent biliary colic (69%), acute cholecystitis (17%), acalculous cholecystitis (7%), and gallstone pancreatitis (7%). Of the 29 patients who underwent ERCP, stent placement was successful in 26 (90%). Median follow-up was 9.4 months (range 0.1-40.5 months). Of those who had a stent placed, 6 (22%) subsequently underwent liver transplantation and another 15 (56%) were alive, most awaiting liver transplantation. Only 3 patients had late a complication or recurrence of biliary symptoms after stent placement. CONCLUSIONS: Endoscopic stent placement in the gallbladder is a safe and an effective palliative treatment for patients with symptoms caused by gallbladder disease who are poor surgical candidates.

Adult↗

PubMed1998

Gallbladder fasting volume is reduced and gallbladder postprandial emptying is enhanced by intravenous erythromycin.

It has been recently shown that erythromycin, a macrolide antibiotic, exhibits prokinetic properties, by enhancing gastric emptying in health and disease and by inducing gallbladder contraction. The aim of the study was to further investigate the effect of intravenous erythromycin on gallbladder motility during fasting and postprandial states. In 10 healthy male subjects gallbladder emptying was assessed by ultrasonography on three different occasions, each in a random sequence, as follows: (1) after giving 300 ml of fresh milk and infusing normal saline as placebo (postprandial emptying), (2) after infusing 200 mg of erythromycin during the fasting state, and (3) after infusing 200 mg of erythromycin along with ingestion of 300 ml of fresh milk. Infusion of erythromycin and placebo lasted 10 min. From the emptying curves, the duration of the lag phase of emptying, the ejection fraction of emptying, and the time by which maximal emptying was achieved were calculated. Infusion of erythromycin induced an immediate contraction [lag phase (+/-SD): 1.3+/-2.6 SD min] of the gallbladder by 42.1+/-22% of its initial volume. Infusion of erythromycin during the postprandial state significantly decreased the duration of the lag phase (1.3+/-3.5 min after erythromycin plus test meal versus 3.6+/-4.2 min after test meal only, P < 0.04) and significantly increased the ejection fraction (78+/-8.5% after erythromycin plus test meal versus 60.6+/-8.5% after test meal only, P < 0.0008). It is concluded that intravenously given erythromycin induces contraction of the gallbladder during the fasting state and enhances postprandial gallbladder emptying by accelerating the initiation and increasing the extent of emptying.

Adult↗

PubMed1996

Should the presence of other diseases exclude subjects as controls in studies of gallbladder response to cholecystokinin octapeptide (sincalide)? Scintigraphic results in patients with malignancies but no known gallbladder disease.

Findings of hepatobiliary scintigraphy with intravenous cholecystokinin octapeptide (sincalide) were examined in 26 asymptomatic patients with various malignancies but no known pre-existing gallbladder disease, and normal hepatobiliary and gallbladder morphology on sonography. The maximum gallbladder ejection fraction (GBEF) following a 30 min infusion of 0.04 of micrograms kg-1 sincalide ranged from 2 to 100%, with a mean of 68%, a median of 78% and GBEF < 35% in five patients (19%), findings similar to those reported in 'normal' subjects. There was no correlation between decreased GBEF and the previous chemotherapy agents received, as well as with gallbladder wall thickness, volume, and whether the gallbladder or small bowel was seen first on scintigraphy. These results suggest that despite the presence of other diseases and histories which include extensive chemotherapy, asymptomatic patients with normal hepatobiliary sonography can serve as controls in studies of gallbladder contractility using sincalide.

Adult↗

PubMed1981

Gallbladder wall thickening: patients without intrinsic gallbladder disease.

Retrospective analysis of 22 patients with increased gallbladder wall thickness (4--10 mm) in the absence of gallbladder disease revealed that 19 were hypoalbuminemic (albumin less than 3.6 g/dl). To test the hypothesis that hypoalbuminemia was a causal factor, gallbladder wall thickness was measured in 40 patients selected prospectively solely on the basis of hypoalbuminemia. This group was compared to 25 normal volunteers. Hypoalbuminemic patients had significantly thickened gallbladder walls compared to volunteers (p less than 10(-9)). This thickening was associated not only with hypoalbuminemia, but also with increased main portal vein diameter, which reflects portal venous blood pressure. Gallbladder wall thickening unrelated to intrinsic gallbladder disease seems to be influenced by the same parameters as ascites formation--plasma colloid oncotic pressure and portal venous pressure.

Adult↗

PubMed2004

[Secondary malignant melanoma of the gallbladder. A contribution to the differential diagnosis of pigmented lesions of the gallbladder].

The history of gallbladder involvement by a malignant melanoma in a 65-year-old woman is reported. The gallbladder, clinically resected for cholecystitis, harboured a polypoid dark pigmented tumour. The tumour was identified as a malignant melanoma immunohistochemically by positive reactions for gp100 (HMB45), melan A, and MiTF. Clinically, the patient was treated for cutaneous malignant melanoma by local excision 10 years earlier. The literature of pigmented lesions of the gallbladder is reviewed. In conclusion, the most important differential diagnosis of pigmented lesions of the gallbladder is the secondary gallbladder melanoma.

Aged↗

PubMed2005

Intramural gallbladder hematoma mimicking gallbladder neoplasm in a 33-year-old male.

We report a case of intramural gallbladder hematoma mimicking gallbladder neoplasm in a 33-year-old male; bleeding was confined to the gallbladder wall without rupture into the lumen. The patient presented with sudden onset of right upper quadrant pain, with no history of abdominal trauma. The abdomen was soft, with mild tenderness over the right upper quadrant, and a positive Murphy's sign. Abdominal sonography, computed tomography, and endoscopic retrograde cholangiopancreatography all revealed the presence of a mass lesion in the gallbladder wall. Thus, a gallbladder tumor was highly suspected. Laparoscopic cholecystectomy was performed, and intramural hematoma was found intraoperatively. The cause of intramural hemorrhage was obscure.

Abdomen↗

PubMed1999

The relationship between in vivo emptying of the gallbladder, biliary pain, and in vitro contractility of the gallbladder in patients with gallstones: is biliary colic muscular in origin?

BACKGROUND: This study sought to determine whether there is a positive correlation between gallbladder emptying, biliary pain, and in vitro contractility. METHODS: Ultrasound measurements were carried out on 25 gallstone patients. The response of gallbladder strips to 1.75*10(-11) to 5.25*10(-7) M cholecystokinin-8 was recorded. In a second study 23 patients filled in pain questionnaires, and in vitro studies were again carried out. RESULTS: Of five patients with no gallbladder emptying, four had in vitro contraction. Overall, a significant, positive linear correlation was found (P < 0.0001). In the second study in vitro contractility showed a positive linear correlation with pain. CONCLUSION: Gallbladder emptying correlates with contractility. However, since most 'non-contractors' can contract, we suggest the term 'non-emptying' or 'emptying' to describe gallbladder dynamics. The positive correlation between pain and contractility suggests that biliary pain has a muscular component.

Cholelithiasis↗

PubMed2001

Diagnostic accuracy of 99Tcm-HIDA with cholecystokinin and gallbladder ejection fraction in acalculous gallbladder disease.

The diagnostic accuracy and clinical impact of 99Tcm hepatic iminodiacetic acid (HIDA) imaging with cholecystokinin (CCK) was investigated in a prospective study of 359 patients over an 11 year period. All patients presented with right upper quadrant biliary type pain and had a normal ultrasound investigation prior to imaging. CCK was administered as a 3 min infusion at peak gallbladder uptake of HIDA. A gallbladder ejection fraction (GBEF) was used to quantify the gallbladder response to CCK. Two hundred and forty-four of 359 (68%) patients had an abnormal GBEF (< or = 35%). One hundred and thirty-four of 141 (95%) patients who underwent cholecystectomy had abnormal surgical/histological findings and/or relief of symptoms on long-term (mean 5.7 years) follow-up. Clinical follow-up, mean of 5.9 years, of the patients with GBEF > 35% showed 73/79 (92%) of them with little evidence of gallbladder disease. For a total 261 patients with mean clinical follow-up of 5.7 years the sensitivity of GBEF measurement is 95%, specificity is 92% and overall accuracy is 94%. It is concluded that 99Tcm-HIDA imaging, with a 3 min infusion of CCK, is a highly accurate technique and valuable in the diagnostic management of patients with suspected acalculous gallbladder disease.

Adult↗