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PubMed1996

Scanning of polypoid gallbladder lesions by ultrasonic microprobes using transpapillary catheterization.

BACKGROUND AND STUDY AIMS: Polypoid lesions of the gallbladder can be diagnosed by transabdominal ultrasonography and endoscopic ultrasonography. However, the image resolution is limited, and the histopathology of these lesions is difficult to determine. We report here on our preliminary results in four patients using a high-frequency (20 MHz) ultrasonic microprobe introduced into the gallbladder via the transpapillary approach. PATIENTS AND METHODS: Insertion of the microprobe into the gallbladder through the papilla of Vater was attempted in four patients with gallbladder diseases without preceding endoscopic sphincterotomy. RESULTS: The lesions in the gallbladder were clearly visualized in three of the four patients. We tried to correlate the characteristic ultrasound findings with the histopathology of the lesions, which were found to be early cancer, adenoma, and adenomyomatosis on histopathology of the specimens after cholecystectomy. No complications occurred. CONCLUSIONS: High-resolution endoscopic transpapillary ultrasonography of the gallbladder is feasible and safe, and may contribute to the diagnosis of gallbladder diseases, particularly of small polypoid lesions.

Adenoma↗

PubMed1992

Evaluation of laparoscopic cholecystotomy in the treatment of gallbladder stones.

Laparoscopic cholecystotomy (LCT) was attempted in 34 patients with biliary type symptoms; 33 patients suffered from gallbladder stones and one patient from gallbladder polyps. In one patient the gallbladder was not accessible with the laparoscope due to extensive adhesions. In the other patients endoscopic removal of stones and polyps was possible in all cases. In the first five patients the gallbladder was drained with a Foley type catheter at the end of the procedure; in the other patients the incision of the gallbladder was closed primarily with clips and fibrin glue. At the beginning of the series two cases of complications were observed: balloon catheter deflation due to material defect and postoperative bleeding into the gallbladder; after conventional cholecystectomy the two patients made an uneventful recovery. LCT is a one-session procedure suitable for removal of symptomatic stones in well functioning gallbladders with no restrictions concerning the composition, number or size of the stones.

Adult↗

PubMed2000

Wound recurrence from gallbladder cancer after open cholecystectomy.

BACKGROUND: Reports of port site recurrences from gallbladder cancer after laparoscopic cholecystectomy have raised considerable concern as to whether the laparoscopic technique implies an increased risk of metastatic disease. In a previous study of gallbladder cancer and laparoscopic cholecystectomy, we reported a frequency of 16% port site metastases. The purpose of the present study was to determine the frequency of wound metastases from gallbladder cancer after open cholecystectomy. METHODS: The registers from the Swedish Oncological Centers and the National Board of Health and Welfare were checked for reported cases of gallbladder cancer and surgical classification codes for open cholecystectomy from 1991 to 1994. The study included all 8 university and 24 county hospitals in Sweden. The files from all patients with gallbladder cancer who had an open cholecystectomy were retrospectively reviewed. RESULTS: The study included 270 patients who had a cholecystectomy, of which 215 were classified as open and 55 as laparoscopic. Of the 215 patients, 11 patients were excluded because of an incorrect or deficient histopathologic or surgical classification. In 186 patients (91%), sufficient data were obtained for follow-up. Twelve patients (6.5%) had wound metastases from their gallbladder cancer. All patients with wound metastases died with a median survival of 10 months (range, 3 to 65 months). CONCLUSIONS: Wound metastases from gallbladder cancer after open cholecystectomy may be more common than previously assumed.

Aged↗

PubMed1970

A model for gallbladder function and cholesterol gallstone formation.

An analysis of fluid mechanics and diffusion in the gallbladder predicts that there is a thin layer of high bile-constituent concentration near the gallbladder wall. Cholesterol may precipitate in this layer, even when the average cholesterol concentration in the gallbladder is below saturation. The amount precipitated increases with time, with increased average cholesterol concentration, and with decreased average lecithin concentration. If the gallbladder does not empty completely, the precipitated cholesterol particles may grow over many cycles of gall bladder filling and emptying. The analysis explains why cholesterol-gallstone formation is not correlated with bile-constituent concentration alone, why a flaccid, noncontractile, gallbladder has a greater chance of forming gallstones, why small stones are frequently found near the gallbladder wall, and why stones may be found in only one limb of a double gallbladder.

Bile Acids and Salts↗

PubMed1995

p53 protein immunoreactivity in cancers of the gallbladder, extrahepatic bile ducts and ampulla of Vater.

Immunohistochemical expression of the p53 protein was investigated in carcinoma of the gallbladder (n = 13), common bile duct (n = 7) and ampulla of Vater (n = 9) using the polyclonal, CM1, and monoclonal, DO7, antibodies (Novocastra). This was compared with cases of chronic cholecystitis (n = 11) and preneoplastic lesions of the gallbladder (n = 4) and ampulla (n = 3). Nuclear immunostaining for p53 protein was found only in the poorly differentiated adenocarcinomas of the gallbladder (n = 9) and were associated with a shorter patient survival period (median: 18.6 mths). The moderately differentiated adenocarcinomas (n = 4) did not show p53 immunostaining and were associated with a longer median survival period (26 mths). The gallbladder dysplasias and adenoma also had no p53 protein immunoreactivity. The common bile duct carcinomas did not stain for p53. Focal p53 immunoreactivity was present in only one (11%) of the cases of ampullary carcinoma and in one (9%) of chronic cholecystitis. In summary, increased p53 immunostaining was associated with reduced patient survival and found more frequently in poorly differentiated adenocarcinoma of the gallbladder but not in the better differentiated carcinoma, chronic cholecystitis or preneoplastic lesions of the gallbladder. The differences in p53 immunohistological expression between gallbladder, common bile duct and ampullary carcinomas justify further investigation into the molecular mechanisms responsible for their development.

Adenocarcinoma↗

PubMed2000

Gallbladder motility in Crohn disease: influence of disease localization and bowel resection.

BACKGROUND: Patients with Crohn disease (CD) have an increased risk of developing gallstones. Among other factors, gallbladder motility may have a role in the pathogenesis of gallstone formation. We have evaluated whether gallbladder motor function is affected in Crohn disease with special emphasis on the influence of disease localization and previous bowel resection. METHODS: Thirty-seven patients (20 females and 17 males, age 36 +/- 2 years) with inactive Crohn disease (CDAI < 150) were studied: 15 patients after ileocecal resection and 22 non-operated patients; 12 had small bowel disease and 10 had large bowel disease. Nineteen healthy subjects (10 female; 9 male, age 30 +/- 2 years) served as controls. Gallbladder volumes were measured in the fasting state and at regular intervals for 2 h after ingestion of a solid meal (780 kcal). Blood samples were drawn at regular intervals for determination of cholecystokinin (CCK) and peptide YY (PYY). RESULTS: Fasting gallbladder volumes were significantly (P < 0.05) reduced in patients with large bowel disease (20.8 +/- 2.1 ml) or after ileocecal resection (18.3 +/- 2.4 ml) compared to patients with small bowel disease (28.0 +/- 2.1 ml) and controls (27.2 +/- 1.8 ml). Fasting plasma CCK levels were significantly (P < 0.05) higher in patients with large bowel disease or after ileocecal resection compared to patients with small bowel disease and controls. Postprandial gallbladder emptying and endogenous plasma CCK and PYY secretion in patients with Crohn disease were not different from controls. CONCLUSIONS: Fasting gallbladder volume is decreased and fasting plasma CCK levels are increased in patients with Crohn disease of the large bowel and patients after ileocecal resection. Postprandial gallbladder motility, CCK and PYY release were not affected in patients with Crohn disease.

Adult↗

PubMed2006

Interstitial cells of Cajal in the murine gallbladder.

OBJECTIVE: The presence of interstitial cells of Cajal (ICC) has been described throughout the digestive tract. In this study, we investigated whether ICC also exist in the gallbladder wall of CD1 mice. MATERIAL AND METHODS: Immunofluorescent confocal microscopy was used to identify the morphology and distribution of ICC in either whole-mount flat preparations or enzyme-dispersed cells from the gallbladder of CD1 mice. Methylene blue staining and transmission electron microscopy were performed to detect the presence of ICC, and reverse transcription-polymerase chain reaction (RT-PCR) and Western blot were used to confirm the expressions of ICC-specific marker c-kit in the gallbladder tissues. RESULTS: The presence of c-kit-positive cells was demonstrated in both the gallbladder wall and the enzyme-dispersed cells. The ICC were distributed throughout the wall of the gallbladder and organized into a network. Under transmission electron microscopy, ICC were characterized by their well-developed perinuclear endoplasmic reticulum, abundant mitochondria, free ribosomes and intermediate filaments, and distinctive caveolae and lack of myosin filaments. The expressions of ICC-specific marker c-kit were also confirmed in the gallbladder tissue. CONCLUSION: The murine gallbladder wall contains ICC.

Animals↗

PubMed2001

Circadian variations in the responsiveness of human gallbladder to sulfated mineral water.

It is well known that the intake of sulfate-containing natural mineral waters leads to contraction of the gallbladder, probably induced by the release of cholecystokinin (CCK). As early as 1959, there were some hints in the literature of circadian variations in gallbladder response; to find out whether this applies with sulfate as a stimulus, a pretest for basic information about gallbladder reaction to sulfate-containing mineral water was carried out on 19 healthy volunteers. On this basis, 15 healthy subjects of both sexes were then studied. After 6h of fasting, 500 mL of a sulfate-containing mineral water (2,800 mg SO4(2-)/L) were ingested within 5 min. The size of the gallbladder was registered ultrasonographically before and 15, 30, 60, and 120 min after drinking. The experiments were carried out seven times at different hours of the day for each volunteer. After the intake of the mineral water, the mean gallbladder size decreased significantly, followed by an increase after 60 min (P < .001). Significant circadian spontaneous variation in gallbladder size was detected (acrophase around 09:00; amplitude was 30.0% of daily average, P < .001). The contraction induced by the sulfate-containing water was most marked in the early morning hours and minimal around mid-day; the amplitude of this variation accounting for 29.0% of the daily average (P < .01). In contrast, the postdrinking relaxation was maximal around 18:00 and minimal around 9:00 (amplitude 38.5%. P < .001). These results show that the basal size of the gallbladder and its reaction to stimuli show a marked circadian variation: Whereas contractibility is maximal in the morning, dilatation is stronger in the afternoon.

Adult↗

PubMed1985

Gallbladder disease epidemiology in Mexican Americans in Starr County, Texas.

The prevalence of gallbladder disease (surgery or complaints) among Mexican Americans in Starr County, Texas, is demonstrated to be some threefold higher than in Framingham, with 13% and 26% of males and females, respectively, over the age of 35 years having the disease. The population aggregation of gallbladder disease in Amerindian groups and those genetically admixed with them (as the present case) is consistent with an underlying genetic mechanism which is further substantiated here by examining relative risks in sibs, offspring, and spouses of individuals with gallbladder disease. It is shown that in females under the age of 45 years, there is evidence for a significant association between gallbladder disease and diabetes beyond that which could be explained by body mass. Significant gallbladder disease by nonlinear age interaction effects was detected for serum cholesterol. The predicted regression lines of cholesterol by age were uniformly lower for individuals with gallbladder disease than those without it except for ages 40-55 years, in which the lines were equal. When coupled with previous results on diabetes, the results presented document the extent to which diabetes and gallbladder disease dominate the health status of Mexican Americans in southern Texas and likely elsewhere.

Adolescent↗

PubMed1986

A study of a possible association between breast cancer and gallbladder disease.

Because gallstones and breast cancer were reported to have several of the same risk factors, a study was conducted in Washington County, Maryland to determine if women with breast cancer have an increased risk of prior gallbladder disease. Living white female breast cancer cases (n = 133), who were diagnosed from 1973 to 1983, were identified from the county's cancer registry and interviewed along with an equal number of sex-, race-, and age-matched controls about a history of gallbladder disease and other risk factors. Medical records were used to verify a history of gallbladder disease in interviewed cases and controls and to search for a diagnosis of gallbladder disease in 52 white female breast cancer cases who were diagnosed and died between 1974 and 1983, and 52 matched controls. No difference was found in gallbladder disease frequency among living or deceased cases and their matched controls. The results confirm the known association of several risk factors with breast cancer and with gallbladder disease, but most of the risk factors hypothesized to be the same for the two diseases were not the same. However, an unexpectedly strong association was found between gallbladder disease and history of myocardial infarction; this result deserves further study.

Aged↗

PubMed1989

Central adiposity and gallbladder disease in Mexican Americans.

Obesity is widely recognized as a risk factor for gallstones. However, to the authors' knowledge, only one study has examined the effect of body fat distribution on the prevalence of gallbladder disease. Mexican Americans are a population characterized by both a high prevalence of gallbladder disease and an unfavorable body fat distribution. The authors examined whether central adiposity (as measured by the ratio of subscapular-to-triceps skinfold) was related to clinically evident gallbladder disease in 1,202 Mexican Americans and 908 non-Hispanic whites in the San Antonio Heart Study from 1979 to 1982. After adjustment for overall adiposity (as measured by body mass index) and the ratio of subscapular-to-triceps skinfold, an increased prevalence of gallbladder disease was still observed in Mexican-American women. Both body mass index and the ratio of subscapular-to-triceps skinfold were positively and independently associated with gallbladder disease in women, while in men, body mass index, but not the subscapular-to-triceps skinfold ratio, was associated with gallbladder disease. Central adiposity is also related to the adverse pattern of cardiovascular risk factors observed in women with gallbladder disease.

Adult↗

PubMed1991

Plasma lipids and gallbladder disease.

The relation between plasma lipids and gallbladder disease was examined by using data collected between 1984 and 1987 from 1,303 Rancho Bernardo, California, women aged 50 years and older. In univariate analyses and after adjustment for age and body mass index, high density lipoprotein cholesterol (HDL cholesterol) and low density lipoprotein cholesterol (LDL cholesterol) were inversely related and triglyceride level was positively related to gallbladder disease. However, using multiple logistic regression, only LDL cholesterol, triglycerides, age, and body mass index were significantly related to a history of gallbladder disease, whereas HDL cholesterol was no longer associated with gallbladder disease. The risk of gallbladder disease increased with greater age, body mass index, and triglyceride level, but decreased with increasing LDL cholesterol level. Total amount of alcohol consumed per week, number of cigarettes smoked per day, and current estrogen use were not significantly associated with gallbladder disease. The relation of HDL cholesterol and LDL cholesterol to the risk of gallbladder disease requires further investigation.

Age Factors↗

PubMed1982

The effect of vagotomy on gallbladder function and bile composition in man.

Vagotomy and gastric surgery have been implicated in gallstone formation, although the association remained unproven. Gallbladder function was investigated in 11 patients with a pyloroplasty and truncal vagotomy, 5 with a subtotal gastrectomy, and 16 healthy controls. Gallbladder filing and emptying in response to cholecystokinin (CCK 0.01 U/kg min), when quantitated by 99m-Tc-HIDA cholescintigraphy, did not show any differences between the control and the surgical groups. In each group, over 70% of hepatic activity partitioned into the gallbladder rather than the duodenum, filing the gallbladder at 2.1%/min. Gallbladder emptying began five minutes after initiating the CCK infusion and ejected half of its contents during the next 12 minutes. Biliary lipid compositions was determined in 20 patients who underwent elective pyloroplasty and vagotomy for duodenal ulcer disease. Gallbladder bile collected at surgery was compared to bile-rich duodenal fluid aspirated eight months after recovery from surgery. Cholesterol saturation decreased significantly (p less than 0.05) both in terms of the relative cholesterol content (6.9% leads to 5.2%) and the lithogenic index (1.24 leads to 0.84). To determine if a selective increase in one of the conjugated bile salts could explain this improvement, bile salt composition was analyzed by high pressure liquid chromatography in eight patients and showed no change after surgery. Thus, vagotomy does not adversely affect gallbladder function, but instead improves cholesterol solubility.

Adolescent↗

PubMed1985

The role of neurotensin in human gallbladder motility.

Gallbladder contraction in response to a fatty meal is thought to be caused by release of cholecystokinin (CCK). We have previously demonstrated a close correlation between circulating concentrations of CCK and contraction of the gallbladder in normal humans and in gallstone patients. Recent studies in animals, however, have shown that other potentially cholecystokinetic hormonal agents are released by a fatty meal, which suggests that other hormones may be involved in postprandial gallbladder contraction. Neurotensin, a 13-amino acid peptide, is released by fat; we have shown it to cause gallbladder contraction in dogs. In the present study, we measured release of neurotensin in seven normal adult volunteers. We determined the effects of infused neurotensin (4 pmol/kg-min) on gallbladder contractility, measured by ultrasonography in 10 adult volunteers, and we evaluated release of neurotensin in eight patients with gallstones. After ingestion of fat, we found significant release of neurotensin in normal volunteers from a mean basal concentration of 15.9 +/- 3.5 pg/ml to a maximum of 34.7 +/- 0.2 pg/ml. In the gallstone patients after fat ingestion, neurotensin rose from a basal of 16.8 +/- 3.1 pg/ml to a maximum of 53.4 +/- 28.1 pg/ml, which was a significantly greater release than in controls. Intravenous infusion of neurotensin produced dilatation of the gallbladder (from a mean basal volume of 13.7 +/- 2.3 cc to 20.0 +/- 1.8 cc). Neurotensin causes relaxation of the gallbladder in humans and, by contributing to stasis, may be involved in the formation of gallstones.

Adult↗

PubMed1994

A reversed sequence of gallbladder and small bowel visualization during cholescintigraphy. Its relationship to chronic cholecystitis.

During the first hour of cholescintigraphy, both the gallbladder and small bowel are visualized in the majority of normal subjects and patients with chronic cholecystitis. Usually, radioactive bile flows initially into the gallbladder followed by passage into the small bowel. To determine whether a reversed sequence of bile flow (i.e., small bowel followed by gallbladder) could serve as an indicator of chronic cholecystitis, 141 hepatobiliary scans were reviewed retrospectively with attention to the relative order of gallbladder and small bowel appearance during the first hour. The scintigraphic findings were correlated with results from real-time gallbladder ultrasonography in all 141 patients and gallbladder histopathology in a subset of 35 (25%). The specificity of a reversed sequence for chronic cholecystitis was 79% using ultrasonography and 100% for histopathology. This phenomenon likely reflects altered biliary flow dynamics secondary to recurrent inflammation and fibrosis. In patients referred for possible biliary tract disease, visualization of the gallbladder after the small bowel appears to predict chronic cholecystitis.

Aniline Compounds↗

PubMedDate not supplied

The present status of imaging of the gallbladder.

Oral cholecystography is still the basic modality for the diagnosis of gallbladder disease. Now, for the first time since the introduction of this procedure in 1924, this status is being challenged by another diagnostic technique, ultrasonography of the gall bladder. Ultrasound studies have major advantages over conventional cholecystography. These are sufficiently important that it can be safely predicted that ultrasonography will eventually become the primary diagnostic tool for evaluating the gallbladder. Just as the use of colonoscopy has provoked a new analysis of the barium enema examination in the evaluation of the colon, the introduction of ultrasound examination of the gallbladder has revealed the fact that false-negative oral cholecystograms are not rare. Before ultrasonography this information was unobtainable, because of the surgeon's proper reluctance to perform a cholecystectomy in patients with normal oral cholecystograms. Indeed, the availability of an accurate alternate diagnostic procedure has stimulated a reevaluation of other difficulties associated with oral cholecystography. These include problems involved with non-visualization and impaired visualization of the gallbladder after a single dose of contrast material, misunderstandings concerning the uses of oral cholecystography compared to those for intravenous cholangiography and uncertainty regarding the value of cholecystokinin cholecystography in the diagnosis of acalculous cholecystitis. Knowledge of the pharmacokinetics of the oral cholecystographic contrast agents has been long overdue, considering the extensive use of these compounds in clinical practice for more than 50 years. However, information on this subject has finally reached a stage where the data can be applied to ensure that cholecystography is done with maximun efficiency and safety and with the least radiation exposure. The purpose of this report is to review the problems involved with imaging of the gallbladder by oral cholecystography and to discuss the indications, interpretation and accuracy of gallbladder imaging with ultrasonography. Data concerning the use of computerized tomography for evaluation of the gallbladder are still preliminary but are discussed.

Administration, Oral↗

PubMed1990

Tissue response of the biliary and digestive system of rabbits after MTBE infusion into the gallbladder.

We evaluated the tissue response of the biliary and digestive system after Methyl-tert-Butyl-Ether (MTBE) gallbladder infusion in 32 rabbits. After laparotomy, MTBE (5-11 ml) was infused into the gallbladder for eight hours. Animals were sacrificed after eight hours or after two months. Control animals received saline solution infusion into the gallbladder. Afterwards the gallbladder, the common bile duct, the liver, the pancreas and the duodenum were examined histologically. All animals receiving MTBE had different degrees of gallbladder necrosis, common bile duct necrosis and necrosis of intrahepatic bile ducts. After two months, scar formation and a hyperplastic cholecystitis were observed. Control animals did not have comparable tissue reactions; only small areas of necrosis in the gallbladder and the common bile duct occurred after eight hours. The gallbladder, common bile duct and liver remained unchanged in those animals which survived two months. Although the results of this animal study cannot be directly transferred to humans, the data suggest that MTBE should be used in gallstone therapy with caution, and that if it is used, a well-controlled follow-up of these patients is necessary.

Animals↗

PubMed1993

Gallbladder ablation with gallstones in situ in an animal model.

RATIONALE AND OBJECTIVES: The authors evaluated a method of gallbladder sclerosis in the presence of cholelithiasis. METHODS: The study was performed in 20 pigs. The gallbladders of 16 pigs contained surgically placed human gallstones. Control groups included animals that had their gallbladders sclerosed in the absence of stones, as well as a surgical sham control. Sclerosis followed cystic duct ligation to prevent extravasation of the sclerosing agent (95% Ethanol with 2 mole% trifluoroacetic acid) into the biliary tree. After sclerosis, a pigtail catheter was placed in the gallbladder to drain any post-procedure fluid accumulations. Catheters were removed after all drainage had ceased. Animals were killed at either 8 weeks (n = 6) or 6 months (n = 14). RESULTS: Stones were enveloped within the sclerosed and fibrotic gallbladder remnant in 13 of 15 test animals (87%). CONCLUSIONS: Sclerosis of gallbladders with stones in situ was achievable. Total mucosal obliteration did not appear to be required to produce a dysfunctional gallbladder in the time frame of this study.

Animals↗