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PubMed1991

Thin-layer chromatography to monitor cholesterol gallstone dissolution by methyl tert-butyl ether.

We describe a simple and inexpensive method of monitoring methyl tert-butyl ether (MTBE) dissolution of cholesterol gallstones with thin-layer chromatography (TLC) in 10 patients. TLC is a routine semiquantitative laboratory method that can be used to measure the cholesterol concentration present in the MTBE and bile mixture aspirated through the cholecystostomy catheter during gallstone dissolution. TLC is practical in the clinical setting because it can be used to determine if gallstone dissolution is occurring and when MTBE lavage is no longer effective. TLC is performed in the laboratory with routine material and is completed in 15 min. Each TLC measurement costs about $1. The procedure provides objective and specific chemical information on effectiveness and progression of gallstone dissolution, apart from the radiologic and sonographic studies. In our study, TLC signaled effective dissolution in the initial phase of gallstone dissolution by detecting large amounts of cholesterol in the MTBE and bile mixture even before a visible change in size or shape of the stone became apparent by transcatheter cholecystography or by sonography (six of 10 patients). Conversely, lack of cholesterol on TLC after 1 hr or more of MTBE infusion indicates that the stones are pigmented or contain substantial calcium. This means that dissolution with MTBE will be ineffective and that solvent infusion should be terminated. In those cases in which dissolution is progressing well, when TLC shows decreasing amounts of cholesterol in the effluent, only residual fragments insoluble to MTBE remain or the stone is sequestered from MTBE; at this point, solvent infusion should be discontinued or the catheter must be repositioned. Monitoring the rate of cholesterol dissolution by TLC provides important complementary information to cholecystography and sonography during gallstone treatment with MTBE.

Adult↗

PubMed1988

How to image the gallbladder in suspected cholecystitis.

As a result of important advances in medical imaging, the oral cholecystogram is no longer the primary test of gallbladder function and anatomy. Real-time ultrasonography and cholescintigraphy, both highly sensitive and specific tests, are the two major methods for assessing gallbladder pathology. Oral cholecystography, endoscopic retrograde pancreatography, and percutaneous gallbladder puncture serve as supplementary tests. Decisions about which test to use depend on the kind of gallbladder disease that is suspected as well as the estimated likelihood of the disease before the information is obtained from the procedure. Thus, ultrasonography is the test of choice for chronic cholecystitis, with oral cholecystography reserved for situations in which the diagnosis is uncertain after ultrasonography. When acute cholecystitis is suspected, ultrasonography is also the test of choice in most patients, and cholescintigraphy is used to resolve uncertainty.

Cholecystitis↗

PubMedDate not supplied

Comparison of real-time and static-mode gray-scale ultrasonography in the diagnosis of cholelithiasis.

Real-time and conventional articulated-arm gray-scale static-mode scanning were performed on 100 patients in a prospective study to determine the complementary or duplicative roles of these two ultrasound modalities in the confirmation of clinically suspected cholelithiasis. Twenty-five abnormal findings were documented ultrasonographically, including 21 cases of cholelithiasis (12 confirmed by oral cholecystography and/or surgery), two cases of biliary sludge, one case of a gallbladder polyp, and one case of a probable blood clot. There was no instance of gallbladder lumen nonvisualization. Except in one case (that of a 420-pound patient), real-time ultrasonography documented all the gallbladder abnormalities shown by the articulated-arm static scans. In two cases, one corroborated by oral cholecystography, cholelithiasis was documented by real-time and not by static-mode ultrasonography. In most cases, real-time ultrasonography can be used to document the presence of cholelithiasis and obviate the need for conventional articulated-arm static-mode scanning.

Cholecystography↗

PubMed1956

Intravenous cholangiography; some observations on the use of cholografin.

Intravenous cholangiography with cholografin is a safe procedure, most useful for the study of patients who have had cholecystectomy and later have symptoms related to the biliary ducts. When jaundice or liver impairment is present, the examination is usually unsuccessful. However, these conditions are not absolute contraindications to the procedure. There may be failure to visualize the biliary ducts even in the presence of a normal liver. Planigraphy is helpful in eliminating confusing superimposed structures and when there is only faint visualization of the common duct. Intravenous cholecystography is only of questionable value as a supplementary examination to oral cholecystography. It may prove useful in certain instances when patients are unable to retain or absorb the oral media or where emergency operation is contemplated.

Bile Ducts↗

PubMedDate not supplied

Radiographic diagnosis of bile duct cysts. Retrospective analysis of thirteen cases.

Twelve patients and a foetus with congenital bile duct cysts suggested in the majority of cases at routine upper abdominal sonography were examined by two or more of the following investigations: ultrasonography (10 patients), computed tomography (5 patients), CT-cholangiography (2 patients), oral cholecystography (7 patients), intravenous cholangiography (4 patients), endoscopic retrograde cholangiopancreatography (ERCP) (6 patients) and cholescintigraphy (2 patients). The sensitivity of each investigation for the diagnosis of bile duct cysts was: ultrasound 40 per cent, computed tomography 20 per cent, CT-cholangiography 100 per cent, oral cholecystography 17 per cent, intravenous cholangiography 75 per cent, ERCP 83 per cent and cholescintigraphy 50 per cent. When a bile duct cyst has been suggested by ultrasonography or other examinations, without a conclusive diagnosis being made, CT-cholangiography is recommended as the next examination. In patients with impaired biliary excretion of contrast medium, ERCP may be required to achieve the diagnosis.

Adolescent↗

PubMed1987

Radiologic appearance of gallstones and its relationship with biliary symptoms and awareness of having gallstones. Observations during epidemiological studies. Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO).

In the course of two cross-sectional epidemiological surveys carried out by the Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO), cholecystography was performed in 82 of 126 subjects identified by means of ultrasonography as having gallstones. In four subjects gallstones were not detected by cholecystography. The x-ray characteristics of the gallbladder and gallstones of the remaining 78 subjects were related to age, sex, presence of biliary symptoms in the five years prior to the study, and awareness of having gallstones. Twenty-three of the 78 gallstone subjects (29.5%) showed a nonvisualized gallbladder. Among the 55 subjects with visualized gallbladder, 16 (29.1%) and 28 (50.9%) showed radiopaque and solitary stones, respectively. The mean diameter of the largest stone was 19.7 mm +/- 11.2 (SD). Age was related inversely to the number of stones. X-ray characteristics of gallstones did not differ between men and women. Presence of biliary symptoms in the five years prior to the study or awareness of having gallstones were not related to any radiologic feature, either in univariate or multivariate statistical analysis which included age, sex, weight, and height as possible confounding variables. Nineteen (24.3%) of the 78 subjects showed gallstones which would have been suitable for medical therapy with bile acids (ie, radiolucent, with a diameter of less than 20 mm, and in a visualized gallbladder).

Adult↗

PubMed1979

[Duplication of the gallbladder. A rare anomaly, more often a diagnostic error (author's transl)].

A case of true duplication of the gallbladder and three cases with roentgen signs simulating duplication are reported. In true duplication the diagnosis was made by routine cholecystography which showed a double gallbladder with ductular shape. In three cases the cause for an incorrect diagnosis by cholecystography were an ampullary right renal pelvis visualized by heterotopic renal excretion of the contrast medium, a short loop of the first and second part of the duodenum and a diverticulum at the outer border of the duodenum.

Aged↗

PubMed1979

[Value of abdominal ultrasonography for indication of cholecystectomy].

A review of the gall-bladder content of the 193 patients that underwent a cholecystectomy at the University Hospital of Lausanne, Switzerland, in 1977, was done in order to find out the diagnostic accuracy of sonographic examination of the gall-bladder, oral cholecystography and intravenous cholangiography. Sonographic examination of the gall-bladder proofed to be accurate in 92.5% of 109 cases. We found a false negative rate of 4.5% (5 cases) and a false positive rate of 1% (1 case) as well as an indeterminate rate of 2% (2 cases). In 37% (46 cases) of the 124 patients that underwent oral cholecystography and/or intravenous cholangiography the gall-bladder was not visualized. Sonographic examination of gall-bladder is free of side effects and can be done on emergency, on jaundiced or pregnant patients, and it is enough reliable for the surgeon to make a decision to operate the gall-bladder. Low cost of the procedure is another point in favour of sonographic examination of the gall-bladder.

Cholangiography↗

PubMed1984

Sonographic and cholecystographic diagnosis of cholesterolosis of the gallbladder.

Cholesterolosis is difficult to detect preoperatively. Ultrasonography can reveal it as polypoid densities usually without shadows. Cholecystography reveals cholesterolosis as contrast medium defects attached to the gallbladder wall. In our material of 27 patients with cholesterolosis (operatively verified cases) ultrasonography was superior to cholecystography in detecting cholesterolosis.

Adult↗

PubMed1982

Acute cholecystitis: the diagnostic role for current imaging tests.

Acute cholecystitis is a relatively common clinical entity characterized histopathologically by obstruction of the cystic duct due to either edema or stone or both. Thorough clinical assessment and selection of the appropriate diagnostic tests are crucial in making an early diagnosis before surgical treatment. Many diagnostic tests are available for imaging the gallbladder. Hepatobiliary imaging using technetium Tc 99m IDA is the test of choice to either exclude or confirm the diagnosis of acute cholecystitis and it carries a discriminating power greater than that of cholecystography or ultrasonography. In most patients the exclusion of the diagnosis of acute cholecystitis can be made as early as 30 minutes and the confirmation within three hours. The confirmation of acute cholecystitis by radionuclide imaging obviates the need for either cholecystography or ultrasonography.

Acute Disease↗

PubMed1983

Oral cholecystographic findings and the incidence of wound infection after cholecystectomy.

Six hundred and sixty-one patients undergoing cholecystectomy were reviewed, and the over-all incidence of postoperative wound infection was found to be 18.6 per cent. Of the 274 patients who underwent cholecystography preoperatively, 150 were found to have functioning nonobstructed stone filled gallbladders. There were 12 postoperative wound infections in this group, 8 per cent. One hundred and twenty-four patients had nonfunctioning and obstructed gallbladders, 31 of whom, 25 per cent, had wound infections develop. The finding of an obstructed gallbladder upon oral cholecystography was associated with a high incidence of wound infection. This group should be considered for prophylactic antibiotics.

Adolescent↗

PubMedDate not supplied

Gallbladder examinations: a comparison between sonography and radiography.

For the past 50 years, oral cholecystography has been the standard study of radiographic evaluation of the gallbladder with a 98% accuracy level. In the last few years, ultrasound has achieved a similar degree of accuracy; this newer imaging modality has been predicted by some experts to soon become the initial procedure for gallbladder evaluation. It is essential to become aware of the advantages and disadvantages of both oral cholecystography and abdominal ultrasound to be able to use both of them to the best diagnostic advantage.

Cholecystitis↗

PubMed1981

The effect of drugs with different mechanisms of action on the contraction of the human gallbladder.

The effects of drugs with different mechanisms of action on the human gallbladder smooth muscle are reviewed. Sincalide, the C-terminal octapeptide fragment of cholecystokinin, caused a clinically important contraction of the gallbladder during oral cholecystography in 72% of the patients. Within 8-12 min cystic duct visualization occurred in 44% and common bile duct visualization, in 17%. On the other hand, the standard concentration meal (200 ml cream) caused a more reliable gallbladder contraction in 30 min. One tablet of Baralgin, i.v. proxyphylline (300 mg), and i.v. glycopyrrolate (0.2 mg) had no relaxing effect on the contracted gallbladder during oral cholecystography. Similarly, i.v. metoclopramide (20 mg) and i.v. prostaglandin E2 (25, 50, and 75 micrograms) were ineffective, whereas 1 ampule of Baralgin and 1 ampule of Palerol i.v. caused a significant dilatation. Litalgin i.v. 1 ampule, i.v. papaverine (40 mg), and sublingual nitroglycerin (0.5 mg) had a slight relaxing effect on the smooth muscle of the gallbladder. In an acute attack of pain in a patient with gallstones, i.v. administered Baralgin and Palerol seem to be effective; i.v. Litalgin, i.v. papaverine, and sublingual nitroglycerin may be of value in milder biliary tract disorders, but the benefit of i.v. proxyphylline, i.v. glycopyrrolate, and oral Baralgin is questionable. Metoclopramide can be used as an antiemetic drug in patients with gallstones.

Cholecystography↗

PubMed1980

[Contribution to the diagnosis of Dubin-Johnson syndrome].

Eight patients with Dubin-Johnson's syndrome have been reported. It appoints the greatest casuistry about the theme in our country. The coincidence covers all the aspects of the disease except by the fact that we emphasize, as a matter of interest, that we were able to visualize the gallblader and the biliary tract through oral cholecystography visualize the gallblader and the biliary tract through oral cholecystography or through intravenous cholangiography, in all the patients who have been studied. It doesn't agree with the class descriptions in which these exams have negative results. So we point out the possibility of this disease's existence in spite of the radiographic visulaization of biliary tract, particularly in those patients with moderated hepatic pigment-deposit. Refering to pathologic anathomy we remark the importance in the search of the pigment charactiristic of the Dublin-Johnson's syndrome in all the liver histopathologic exams. Besides, we consider it valuable to make the Fontana-Masson coloration in those patients who present negative pigment reaction to iron. The systematic examinations of the cytoplasmatic pigments will allow us to diagnose the disease even in the cases with minimum and latent characteristics.

Adolescent↗

PubMed1980

Acute and relapsing pancreatitis caused by bile pigment aggregates and diagnosed by biliary drainage.

Over a three-year period 10 patients were observed with acute and relapsing pancreatitis for which no conventional cause could be identified. In all 10 patients the gallbladders visualized on oral cholecystography and no stones were identified by cholecystography or ultrasonography but biliary drainage revealed aggregates of bile pigment granules. In eight of the 10 patients, cholecystectomy was eventually performed, recommended on the basis of the abnormal findings on biliary drainage. None of the eight patients who underwent cholecystectomy and followed for up to two years have had further bouts of pancreatitis. It is proposed that: 1. aggregates of bile pigment granules in the passage from gallbladder to duodenum can cause acute and relapsing pancreatitis; 2. preoperative identification of such aggregates can only be made by biliary drainage; 3. aggregates of pigment granules and cholesterol crystals should be looked for in the bile of all patients with pancreatitis without a clearcut etiology and 4. in the absence of other overt causes, the presence of crystals and pigment granules in bile of patients with pancreatitis justifies therapeutic cholecystectomy with a realistic expectation that pancreatitis will not recur after this operation.

Acute Disease↗

PubMed1994

[Therapeutic efficacy of ursodeoxycholic acid in persistent gallbladder lithiasis and persistent biliary sludge: preliminary results of a multicenter experience].

A prospective and multicenter study was performed to determine the efficacy and tolerance of ursodeoxycholic acid (UDCA) in the treatment of gallstones and biliary sludge. Criteria for entry into the trial were radiolucent gallbladder stones; until 20 mm of size and visualization of the gallbladder by oral cholecystography. Too were treatment the patients with persistent biliary sludge (PBS) defined by the persistence of the biliary sludge in two consecutive echography along three months. Without severe gallbladder disease. Then daily UDCA doses of 600 mg were suminstred divided in two postprandial times for a six months period. The control to the treatment were: basal ultrasonography (US) of the gallbladder and by follow-up gallbladder US for six months; clinical examination every month and cholecystography before and after the treatment. Of 110 admitted patients, 19 (17%) stopped the treatment for no-medical reasons and 91 (83%) arrived to the and point. After six months of treatment, complete dissolution was observed in 50% of the patients (46/91), partial in the 43% (39/91) and failed the treatment in 6.5% (6/91) who presented high density stones for computed tomography, CT (greater than 60 UH). According to pattern of lithiasis dissolution was complete in 100% (22/22) of the patients with PBS; 71.4% (10/14) in microlithiasis and 25% (14/55) in macrolithiasis. Minor adverse effects were acidism in the 7.7% (7/91) and diarrhea in the 1.1% (1/91). In the other hand, one patient presented acute pancreatitis (1/91; 1.1%), it must be discussed if was a complication of the lithiasis or an therapeutic effect. The UDCA was a safe and effective treatment without lethality in PBS and in microlithiasis while in case of macrolithiasis must be standardized response criterion, for example density stones for CT.

Adult↗

PubMed1996

Ultrasonic evaluation of gallbladder emptying with ceruletide.

In order to develop a practical and reproducible method to assess gallbladder function, gallbladder emptying was studied by ultrasound in 27 gallstone patients after i.m. administration of ceruletide (0.3 micrograms/kg), and the procedure was compared to oral cholecystography with fatty meal. Maximal percent gallbladder contraction was reached in all patients 30 min after ceruletide. Maximal percent contractions were 47.5 +/- 27.7 during ultrasound with ceruletide and 33.9 +/- 16.3 during oral cholecystography with fatty meal (p = 0.03). A significant linear relationship was found between the results obtained with the two different procedures (r = 0.57; p = 0.002). Serial ultrasound determinations of gallbladder emptying were performed in 16 patients. Day-to-day variation was below 20% in 11 subjects, and it ranged between 20 and 40% in 5 subjects. Minor side effects were observed in 9 patients. Ultrasound determination of gallbladder emptying after ceruletide appears to be a practical and reliable method to assess gallbladder function.

Adult↗

PubMed1991

A safe new procedure for high-risk patients with symptomatic gallstones.

Cholecystectomy is associated with an appreciable mortality rate in elderly high-risk patients. Patients aged over 60 years with symptomatic gallstones, at high operative risk, underwent cholecystotomy under local anaesthesia through a 3-cm incision. Stones were removed and clearance was demonstrated endoscopically and by tube cholecystography. Catheter drainage was continued for 7 days until a further cholecystogram confirmed clearance. The procedure was attempted in 26 patients with concomitant cardiovascular, respiratory or malignant disease. Successful removal of all gallbladder stones was possible in 24 patients. Four patients had common bile duct stones demonstrated on cholecystography, all of which were successfully treated by endoscopic sphincterotomy. All patients are symptom-free at a mean follow-up of 36 weeks with no recurrent stones on ultrasonography.

Aged↗