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PubMed1991

[Imaging diagnosis of cancer of the gallbladder].

Imaging modalities are used for diagnosis of cancer of the gallbladder. Ultrasound is most useful for early diagnosis of cancer of the gallbladder. Ultrasonic findings of cancer of the gallbladder are classified into 3 patterns: massive tumor, irregular thickness of wall and localized tumor. In advanced cancer of the gallbladder, ultrasound can make the definitive diagnosis. Early cancer of the gallbladder is reported as polypoid type or flat type. Ultrasound can visualize the abnormalities of the gallbladder in the polypoid type, but the flat type is difficult to detect by any methods. Other imaging modalities (color Doppler flow mapping, Endoscopic ultrasonography, Cholangiography, X-ray CT, Cholecytoscopy and Angiography) are also useful for diagnosis of cancer of the gallbladder or diagnosis of progress of the cancer.

Aged↗

PubMed1990

Gallbladder emptying following cholecystokinin and fatty meal in normal subjects.

A quantitative study of gallbladder emptying using 99mTc-HIDA as a bile tracer was performed with either CCK or a fatty meal as gallbladder stimulant. Its aims were to establish; (1) the reproducibility of CCK- and fatty-meal-induced gallbladder contraction, and (2) temporal patterns of gallbladder emptying following a physiological meal. Nineteen healthy, fasted volunteers were selected for 3-minute CCK administration (IV Boots Pancreozymin 2CHR units/kg) or a 40 g fatty meal. Each underwent repeat scans not less than 14 days after the first. Quantitative activity/time curves were drawn with computer analysis establishing gallbladder ejection fractions (GBEF) for each stimulus. Our results demonstrated: (1) poor reproducibility of CCK-induced gallbladder contraction precluding its diagnostic use, (2) improved but still variable meal-induced gallbladder contraction, and (3) evidence for a neurocephalic emptying response with a fatty meal stimulus.

Adult↗

PubMed1990

Effects of steroidal contraceptives on gallbladder: a review.

In regard to gallbladder disease and oral contraceptive use, more than ten controlled epidemiologic studies have been reported and reviewed in this paper. The findings presented concerning the association of oral contraceptive use with the development of a gallbladder disease are contradictory. Oral contraceptive use and use of estrogens in postmenopausal women have been reported to be associated with increased attack-rates of a gallbladder disease, but the increased risk is found higher in those using estrogens than progestin based oral contraceptives. Other studies, however, have reported little overall effect of oral contraceptive use on the risk of the gallbladder disease. Where increased risk has been documented, this has been more related to duration than overall. The increased risk of oral contraceptive use to gallbladder disease has been observed higher in the 6-12 months of usage. Only one study has reported increased risk of gallbladder disease in long-term users. The increased gallbladder disease in oral contraceptive users may be greater in multiparae than in nulliparae; pregnancy and obesity may also pose an increased risk to the disease in oral contraceptive users. However, these findings are not widely accepted.

Adult↗

PubMed1989

[The effect of gastrectomy on cholecystokinin (CCK) release and gallbladder contraction in patients with early gastric cancer--preliminary report].

Gastrectomy has been implicated in cholelithiasis. Impaired gallbladder motor function after the operation has been thought to be one of the major mechanisms. This study was undertaken to determine the effect of gastrectomy on release of cholecystokinin and contractile motility of gallbladder in five patients with early gastric cancer. After 14 hours fast, the gallbladder area was estimated by ultrasonography every 10 minutes for 120 minutes both before and after oral administration of 200 ml of Clinimeal. Blood samples were collected simultaneously via a peripheral vessel for measurement of plasma CCK levels by radioimmunoassay. Gallbladder contraction correlated well with the elevation of plasma CCK levels indicating that CCK might be one of the major factors governing gallbladder contraction both in pre- and post-gastrectomized conditions. Compared with preoperative cases, the postgastrectomized patients showed a significantly exaggerated postprandial response of CCK release in the initial 60 minutes, however, their gallbladder, responding to rapid reduction of plasma CCK levels, refilled significantly earlier. Postprandial rapid gastric emptying was thought to be related to the exaggerated postprandial CCK release, and the early refilling of the gallbladder might be attributed to the indefinite vagal or sympathetic denervation that might occurs during the necessarily wide lymph node dissections for gastric cancer operations.

Aged↗

PubMed1989

Gallbladder motility before and after extracorporeal shock-wave lithotripsy.

To determine whether extracorporeal shock-wave lithotripsy of gallbladder stones alters gallbladder motility, gallbladder contraction in response to intravenous cholecystokinin was investigated by ultrasound. Twenty-one patients with symptomatic gallstones were studied before and after shock-wave lithotripsy, 12 with and 9 without concomitant litholytic therapy (combination of ursodeoxycholic acid and chenodeoxycholic acid). Gallbladder emptying was significantly delayed and less complete in both groups of patients before shock-wave treatment (with bile salts: residual volume, 51% +/- 10% and half-ejection time, 40 +/- 5 min; without bile salts: residual volume, 46% +/- 7%; half-ejection time, 30 +/- 4 min) compared with healthy controls (residual volume, 15% +/- 4%; half-ejection time, 18 +/- 2 min). Gallbladder motility was not altered in either group 1 day and 1 yr after lithotripsy. The findings indicate (a) that extracorporeal shock-wave lithotripsy has no immediate or long-term adverse effects on gallbladder motility and (b) that the defect of gallbladder motility associated with gallstone disease is not abolished by removal of the stone.

Adult↗

PubMed1986

[Concentrations of cefmenoxime and cefotiam in the bile and gallbladder tissue following intravenous administration in patients with biliary tract diseases].

To test the effectiveness of cefmenoxime (CMX) and cefotiam (CTM) in patients with biliary tract diseases, concentrations of either antibiotic were measured after an intravenous bolus injection of 1.0 g of CMX or CTM, or simultaneous injection of both (1.0 g each). CMX or CTM was injected in 76 patients with biliary tract diseases (mostly cholelithiasis) prior to a cholecystectomy and concentrations of CMX or CTM were measured by the bioassay (agar well) method at 30 to 60 minutes after the injection. Average concentrations of both CMX and CTM in gallbladder bile and gallbladder tissue sufficiently exceeded the minimal inhibitory concentration (MIC) against main causative organisms of biliary tract infections. Concentrations of both antibiotics in gallbladder bile were significantly higher in patients with patent cystic ducts than with obstructed cystic ducts. Concentrations of both antibiotics in the gallbladder tissue reached at a similar high level regardless of the patency of the cystic ducts, but concentrations were lower in severely inflamed gallbladders. CMX and CTM were administered alternatively (cross-over fashion), or simultaneously (combined) to 13 patients with T-tube drainage or percutaneous transhepatic cholangio-drainage, and concentrations of both antibiotics in bile from the drainage tube were measured by high performance liquid chromatography at hourly intervals after the injection. Concentrations of both antibiotics were far greater than MICs against main attributable microorganisms in biliary tract infections. The concentration of CMX slightly exceeded that of CTM. Concentrations of both antibiotics were lower in bile of patients showing abnormally high serum GTP, A1-P, and total bilirubin levels than in bile of patients with normal values of these variables. It is speculated that the secretion of both antibiotics in the bile may decrease in cases with severe hepatic failure, but effective concentrations of both antibiotics in the gallbladder tissue should be maintained as long as the blood circulation in the gallbladder was maintained.

Aged↗

PubMed1983

Impaired gallbladder emptying before gallstone formation in the prairie dog.

Several human and experimental observations suggest that gallbladder stasis is an important link between the hepatic secretion of cholesterol saturated bile and the formation of cholesterol gallstones. In the cholesterol-fed prairie dog model, gallbladder stasis occurs before gallstone formation. In this study we sought to determine the specific defects in extrahepatic biliary physiology responsible for gallbladder stasis in this model. Adult male prairie dogs were fed either a trace cholesterol or a 0.4% cholesterol-enriched diet. In acute terminal experiments, gallbladder contents were examined for cholesterol crystals and gallstones, and gallbladder function was determined at rest and in response to intravenous cholecystokinin-octapeptide. The following alterations in gallbladder function developed concurrently with biliary cholesterol crystallization, but before gallstone formation: (a) decreased gallbladder emptying, (b) increased intragallbladder pressure in response to cholecystokinin-octapeptide, (c) increased cystic duct closing pressure, and (d) increased resistance to outflow through the cystic duct.

Animals↗

PubMed1984

Long-term effects of cholecystostomy on gallbladder function.

In eight patients without a history of gallbladder disease, cholecystostomy was performed for acute pancreatitis (four patients) and blunt abdominal trauma (four patients). In one case only, acute cholecystitis developed after discontinuation of the cholecystostomy. Six patients were followed for a mean period of 3.9 years, after which the gallbladder function was evaluated. Cholecystography and ultrasonography demonstrated good visualisation of the gallbladder without signs of gallstones. The contraction of the gallbladder produced by cholecystokinin varied. This could be due to adhesions impairing the motility of the gallbladder. After cholecystostomy in a previously normal gallbladder, its function will become normal in most patients. If no signs of gallbladder disease develop within the first year after cholecystostomy, the risk of late complications is minimal.

Adult↗

PubMed1984

Filling of the gallbladder as studied by computer-assisted Tc-99m HIDA scintigraphy: concise communication.

Gallbladder filling was studied using computer-assisted cholescintigraphy in normal subjects who had fasted overnight. The gallbladder tended to visualize earlier than the distal part of the common bile duct. It appeared at approximately the same time regardless of whether or not there was passage of activity into the duodenum. This suggests that filling is not dependent on contraction of the sphincter of Oddi. Sequential images demonstrated that the activity entering the gallbladder rapidly reached the fundus. Time-activity curves showed a gradual buildup of activity in the bile ducts followed by sudden entrance into the gallbladder. Time-activity curves of the gallbladder's proximal and distal parts showed signs of an exchange of activity, suggesting that the gallbladder's motor function is not quiescent during fasting. Gallbladder motility could explain the periodic irregularities on the time-activity curve. These irregularities were smaller but not less frequent after morphine administration.

Adult↗

PubMed1983

[Transfer of piperacillin into the body water and gallbladder tissue in cholestasis].

Acute inflammation becomes severe and the risk of perforation of the gallbladder increases every time gall stone colic occurs in patients with cholelithiasis. In the surgical treatment for these patients, interval operation is said to be preferable to emergency operation in the acute stage. Furthermore, the flow of bile into gallbladder is blocked by incarceration of stones at the neck of the gallbladder and other causes in the acute stage. In this case, therefore, how an antibacterial agent in blood moves to the gallbladder wall is important in suppressing infections of the gallbladder wall. We divided 15 patients with cholelithiasis into cases positive for cholecystogram and negative cases and made a comparative study of piperacillin (PIPC) levels after intravenous drip infusion. PIPC level in bile in the gallbladder was very low in the cases negative for cholecystogram compared with the positive cases. However, no definite difference in levels of the gallbladder tissue was observed between positive for cholecystogram and negative cases. Accordingly, it is concluded that administration of PIPC is not ineffective even in severe cholecystitis in which transference of an antibacterial agent from bile can hardly be expected.

Adult↗

PubMed1983

The effect of lysophosphatidylcholine on gallbladder function in the cat.

The effects of lysoPC on gallbladder net fluid transport and motility were investigated by a perfusion technique in the anesthetized cat. It was found that addition of 1 mumol/ml lysoPC to the buffer perfusate resulted in an immediate contraction of the gallbladder and also a change in net fluid transport from a basal absorption of 0.71 ml/hr to a secretion of 0.34 ml/hr. An increased output of hexosamine and protein from the gallbladder accompanied the lysoPC treatment. Indomethacin--a prostaglandin synthetase inhibitor--at a dose of 2 mg/kg caused a relaxation of the gallbladder and abolished the secretion but did not return the gallbladder to its original rate of basal absorption. LysoPC, when added to bile, had a similar effect on net fluid transport but did not induce a contraction of the gallbladder. The results indicate that the effect of lysoPC on gallbladder function could be of importance in acute cholecystitis and that endogenous prostaglandin synthesis may play a part in this lysoPC-induced inflammatory response.

Animals↗

PubMed1982

Transmural fluid movement in the freshly excised human gallbladder.

Direct information concerning the incidence and nature of gallbladder dysfunction in symptomatic cholethiasis was obtained by examining the rate and direction of transmural fluid movement in the freshly excised gallbladder. Each specimen was emptied of bile, cannulated and filled with a measured volume of bicarbonated Ringer's solution, suspended in the same solution at 37 degrees C., gassed with 95 per cent oxygen and 5 per cent carbon dioxide and weighed at ten minute intervals for at least one hour. Of the 42 human gallbladders examined, concentrating activity, ranging from 1 to 20 per cent of intraluminal volume per hour, was found in 14 and no activity in 17. Direction of fluid transport was found to be completely reversed in 12 additional gallbladders, four of which presented as hydrops. Histologic alterations ranged from mild to severe and could not be correlated with functional status. Application of indomethacin to the solution bathing both surfaces of 13 nonfunctioning, or partially functioning, gallbladders restored or increased function in eight. It can be concluded from this study that the concentrating activity is retained in approximately 30 per cent of patients with symptomatic cholelithiasis; cholesterol stones form in gallbladders with normal concentrating activity; the spectrum of gallbladder dysfunction ranges from simple loss of concentrating activity to hydrops, the latter reflecting complete loss of this activity plus secretion into the lumen, and dysfunction is probably induced by chemical mediators of inflammation rather than by structural changes.

Absorption↗

PubMed1982

Halo around the gallbladder--a prognostic sign?

The implications of the finding of a sonolucent zone around the gallbladder, characterized on ultrasonography by loss of definition of the outer (serosal) aspect of the gallbladder wall with a moderately well defined inner (mucosal) surface in patients with signs and symptoms of acute cholecystitis, are described. Of the nine consecutive patients with this finding, five were found to have gangrenous cholecystitis and/or perforation of the gallbladder at surgery. Four of these patients were operated upon within 24 hours of the ultrasound study, one 19 days later. The pathologic basis for this finding is thought to represent massive thickening of the gallbladder wall, with a possible contribution from adherent edematous omentum in the region of the fundus of the gallbladder. Thus this finding of a sonolucent halo about the gallbladder was important in our series, being frequently an indicator of acute cholecystitis complicated by gangrene with or without perforation of the gallbladder.

Acute Disease↗

PubMed1981

Radionuclide ejection fraction: a technique for quantitative analysis of motor function of the human gallbladder.

A new noninvasive technique for the measurement of the gallbladder evacuation quantitatively is described. By using a radioactive bile marker [99mTc]HIDA, the evacuation of the gallbladder is measured nongeometrically in terms of ejection fraction (fractional bile volume emptied from the gallbladder) and ejection rate (dv/dt). The counts and volume in an in vitro gallbladder phantom under pinhole collimator geometry show a linear relationship (r = 0.998) enabling the replacement of gallbladder bile volume by bile counts before and after evacuation. The counts ejection-fraction shows a high degree of correlation (r = 0.998) with the measured-volume method. The movement of the gallbladder during respiration does not effect the measurement of ejection fraction. The technique allows simultaneous imaging and quantitation, and it is highly reproducible, carrying an interobserver and reproducibility mean error of 5%. This technique is suitable for studying the motor functions of the gallbladder and the effects of various pharmacologic agents on its evacuation. The clinical usefulness of the technique requires further testing.

Adult↗

PubMed1995

Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder.

BACKGROUND: Early case reports suggest more frequent and rapid recurrences of carcinoma of the gallbladder after laparoscopic cholecystectomy (LC) than after open cholecystectomy. This cancer has a poor prognosis and occurs in 1 percent of patients who undergo cholecystectomies. STUDY DESIGN: A recent community hospital series of gallbladder carcinoma (GBC) was reviewed and the total reported experience of GBC after LC was compiled. Diagnostic findings were compared for patients with GBC and a consecutive series of 24 patients who had LC for benign disease. RESULTS: Nine patients with GBC were found among 928 patients who had undergone cholecystectomy (0.97 percent incidence). Compared to patients without GBC, patients with carcinoma were older, had thicker gallbladder walls, and had more abnormalities detected intraoperatively (all p < or = 0.05). Recurrence of GBC occurred more rapidly after LC, and in diffuse peritoneal and port sites when compared with recurrence patterns after open cholecystectomy. CONCLUSIONS: In patients with GBC, LC may be sufficient when the disease is confined to the gallbladder mucosa and the gallbladder is excised intact without bile spillage. However, patients whose gallbladders are torn during dissection or patients who have invasive tumors should undergo laparotomy and local reexcision. In situ GBC can be implanted if the organ is torn during dissection. When gallbladders with suspicious wall thickening or adhesions are noted at LC, especially in older patients, the procedure should be converted to open cholecystectomy.

Aged↗

PubMed1994

[Diagnosis of gallbladder cancer by imaging techniques: problems, limitations and their explanations, especially with ss invasive cancer].

The preoperative diagnosis of less than ss depth gallbladder cancer is difficult. Its preoperative diagnosis rate was low (27.5%), and even lower with the presence of concomitant gallstone. In the latter case, the diagnosis rate was particularly low when the stones diameter was greater than 1 cm. Gallstones are frequently associated with macromorphologically invasive type of gallbladder cancer and this may be the reason for the lower diagnostic rate. We compared preoperative diagnosis rate of ultrasonography (US), computed tomography (CT) and drip infusion cholecystography (DIC) for each invasion depth. In US, the preoperative diagnosis rate for m depth invasion was 6/16 (37.5%), pm depth was 1/13 (7.7%), and ss depth was 14/41 (34.1%). In CT, its rate for m depth was 3/11 (27.3%), pm depth was 1/10 (10.0%), and ss depth was 11/37 (29.7%). In DIC, its rate for m depth was 3/11 (27.3%), pm depth was 1/10 (10.0%), and ss was depth 1/23 (4.3%). None of the currently used imaging techniques were very accurate in diagnosing gallbladder cancer. Thus, during preoperative work up, if one discovers a gallbladder full of stones, stones of greater than 1 cm in diameter, thickened gallbladder wall, or a non visualized gallbladder with DIC, gallbladder cancer must be highly suspected.

Cholecystography↗

PubMed1994

Roux-en-Y gastroenterostomy severely disturbs emptying of the gallbladder.

BACKGROUND: It is documented that truncal vagotomy and Billroth II gastroenterostomy disturbs the emptying of the gallbladder. The aim of the present prospective study was to assess the emptying of the gallbladder after Roux-en-Y gastroenterostomy. STUDY DESIGN: There were 34 patients, who had undergone either truncal vagotomy with pyloroplasty (TVP, 14 instances) or Billroth II gastrectomy (20 instances), and were subsequently subjected to Roux-en-Y gastroenterostomy. The emptying of the gallbladder was assessed before and after the Roux-en-Y procedure, by milk-technetium-99m labeled hepatoiminodiacetic acid (milk-99mTc-HIDA) scintigraphy. Milk-99mTc-HIDA scintigraphy was also performed on twenty-eight healthy subjects, who served as the control group. RESULTS: After excluding the subjects having spontaneous gallbladder evacuation before milk ingestion, there remained 26 subjects in the control group, 12 patients with TVP, and 19 with Billroth II gastrectomy. Truncal vagotomy with pyloroplasty was associated with delayed onset (p < 0.001) and decreased rate (p < 0.01) of emptying of the gallbladder compared with the control group. Truncal vagotomy with pyloroplasty also changed the normal pattern of emptying in two patients (sequential emptying and refilling events). Billroth II gastrectomy was associated with decreased extent and abnormal pattern of emptying compared with subjects in the control group (p < 0.0001) and patients having TVP. Roux-en-Y gastroenterostomy, performed upon patients with TVP, significantly increased lag phase duration (p < 0.001), decreased ejection fraction (p < 0.01), and changed the pattern of emptying of the gallbladder (p < 0.01). Roux-en-Y procedure performed upon patients with Billroth II gastrectomy significantly increased lag phase duration (p < 0.0001). CONCLUSIONS: Roux-en-Y gastroenterostomy severely disturbs all parameters of the emptying of the gallbladder.

Adult↗

PubMed1994

Effect of erythromycin on gastric and gallbladder emptying and gastrointestinal symptoms in scleroderma patients is maintained medium term.

OBJECTIVES: Scleroderma patients frequently present esophageal and gastric emptying abnormalities and small bowel dysfunction. Erythromycin, a macrolide antibiotic, has been found to accelerate gastric and gallbladder emptying in both healthy subjects and diabetic patients. Our objective was to investigate the effects of 4-wk oral erythromycin administration on the gastric and gallbladder emptying, gastrointestinal symptoms (early satiety, abdominal pain, nausea, bloating, vomiting, and constipation), and motilin plasma levels of patients with scleroderma. METHODS: 12 scleroderma patients were investigated before and after 4-wk treatment with 250 mg oral erythromycin three times a day. The effect of a single i.v. dose of 2 mg/kg/h erythromycin on gastric and gallbladder emptying before starting the oral treatment was also evaluated. Gastric and gallbladder emptying after a solid meal were evaluated by sonography. RESULTS: Single i.v. administration of erythromycin before the meal reduced gastric emptying T1/2 from 121.3 +/- 14.0 to 45.5 +/- 7.3 min (p < 0.01) and accelerated gallbladder emptying without affecting the peak. Four-week oral administration of erythromycin reduced gastric emptying T1/2 from 121.3 +/- 14.0 min to 46.5 +/- 8.3 min (p < 0.01). Peak gallbladder emptying was also significantly accelerated, while total emptying remained unchanged (p < 0.01). Furthermore, 4-wk erythromycin administration reduced both motilin plasma levels (from 223.4 +/- 53.8 to 145.4 +/- 67.2 pmol/L, p < 0.01) and symptoms of nausea, vomiting, and abdominal pain (p < 0.01), and increased bowel movements in a subset of scleroderma patients with intestinal pseudo-obstruction. CONCLUSIONS: Erythromycin stimulates gastrointestinal motility in patients with scleroderma. Administered medium-term, it accelerates gastric and gallbladder emptying and alleviates gastrointestinal symptoms.

Drug Administration Schedule↗