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PubMed1978

The validity of 99mTc-pyridoxylideneglutamate (P.G.) cholescintigraphy as a diagnostic test for cholecystitis.

The purpose of this investigation was to determine the diagnostic value (validity) of technetium-99m-pyridoxylideneglutamate cholescintigraphy (99mTc-PGC) in patients with and without cholecystitis and to compare its validity to those of oral cholecystography (OC) and ultrasonography (US). 99mTc-PGC was applied to 50 patients with acute, subacute, and/or chronic cholecystitis with cystic duct obstruction proven histologically and operatively, and also to 27 non-diseased volunteers and 43 patients with right upper quadrant abdominal pain who subsequently were proven free of gallbladder disease. In addition, 38 patients had OC, and 31 had US performed. The results shows that the sensitivity and specificity of 99mTc-PGC were 100%. Whereas for OC the sensitivity was 87%, specificity was 100%. For US the sensitivity was 70%, and specificity was 93%. The repeatability of 99mTc-PGC, OC, and US were 100%, 97% and 81% respectively. These data show that 99mTc-pyridoxylideneglutamate cholescintigraphy is a valid diagnostic tool in the evaluation of patients with cholecystitis, and is also safe and simple.

Adolescent↗

PubMed1981

Diagnostic imaging of choledochal cysts.

A review of the literature concerning the diagnostic accuracy of various imaging modalities for choledochal cysts indicates that both ultrasound and scintigraphic methods have approximately 80% accuracy. Oral cholecystography and intravenous cholangiography methods have between 60 and 80% accuracy. Ultrasound is recommended as the initial preoperative test of choice, with hepatobiliary scintigraphy or CT scanning being most useful for postoperative evaluation.

Bile Duct Diseases↗

PubMedDate not supplied

The biliary and urinary excretion of sodium tyropanoate and sodium ipodate in dogs: pharmacokinetics, influence of bile salts and choleretic effects with comparison to iopanoic acid.

The biliary and urinary excretion of sodium tyropanoate (Bilopaque) and sodium ipodate (Oragrafin) were studied in unanesthetized bile-fistula dogs using stepwise, increasing, intravenous infusions of the contrast materials. A constant intravenous infusion of sodium taurocholate was administered at the rate of either 0.5 or 2.0 mu moles per min per kg throughout each experiment. The biliary excretion of sodium tyropanoate or sodium ipodate was not effected by the rate of sodium taurocholate infusion. The maximum rate of biliary excretion of sodium ipodate was significantly greater than that of sodium tyropanoate with the low taurocholate infusion, but there was no significant difference between the two with the high taurocholate infusion. With the low taurocholate infusion the maximum biliary excretion rate of sodium tyropanoate (0.956 mu moles per min per kg) and sodium ipodate (1.472 mu moles per min per kg) were significantly greater than the maximum biliary excretion of iopanoic acid (Telepaque) (0.671 mu moles per min per kg). With the high taurocholate infusion the maximum biliary excretion rates of the three contrast agents were not statistically different. Both sodium tyropanoate and sodium ipodate produced an increase in canalicular bile flow (8-11 ml per millimole). These data suggest that in clinical cholecystography sodium tyropanoate and sodium ipodate are not excreted in bile more rapidly than iopanoic acid, except when the rate of biliary excretion of bile salts is low; that is, except in patients who are fasting or those who are on a fat-free diet.

Animals↗

PubMed1982

Choledochal cysts in children: radiologic features.

Choledochal cysts, although uncommon, are found most frequently in children. Radiologic studies have always played an important role in diagnosis because of the nonspecific clinical features. The abdominal roentgenogram may show in the right upper abdomen a mass, the cystic nature of which can be demonstrated by intravenous urography, hepatic angiography, sonography, and computerized tomography. Large choledochal cysts will displace the duodenal loop inferiorly and to the left, as seen on upper gastrointestinal contrast studies. Oral cholecystography and intravenous cholangiography are currently not indicated because of the poor diagnostic yield and the significant toxicity of intravenous media in children. Operative cholangiography is desired by the surgeon for demonstration of the pathologic anatomy. Real-time sonography and cholescintigraphy with technetium Tc 99m iminodiacetic acid derivative allow specific preoperative diagnosis and will eliminate the need for more invasive studies, such as arteriography, endoscopic cholangiopancreatography, and percutaneous transhepatic cholangiography. The radiologic findings in six patients are summarized.

Angiography↗

PubMed1968

The actions of caerulein on the smooth muscle of the gastrointestinal tract and the gall bladder.

1. In the intact conscious dog, caerulein causes emesis and evacuation of the bowel. The mean effective dose by the intravenous route is 0.4-0.5 mug/kg, and by the subcutaneous route 3-4 mug/kg.2. The gall bladder in situ or as an isolated preparation is highly sensitive to caerulein. A few ng/kg injected intravenously are sufficient to stimulate the gall bladder in situ and less than 1 ng/kg per min is effective when infused intravenously. The isolated gall bladder is contracted by caerulein in concentrations as low as 0.03-2 ng/ml. Krebs solution. There is no tachyphylaxis but, generally, a good dose-response relationship. Hence the gall bladder, especially that of the guinea-pig, appears to be very suitable for the bioassay of caerulein and related peptides.3. In situ, the musculature of the gastrointestinal tract is also highly sensitive to caerulein. Doses as low as 1-5 ng/kg, administered intravenously, have a spasmogenic action on jejunal loops of the dog, and slightly larger doses contract the small intestine of the cat. The stomach and the large intestine seem to be somewhat less sensitive to the polypeptide. Caerulein has a considerable spasmogenic action on the rat pylorus but relaxes the sphincter of Oddi of the guinea-pig.4. Isolated preparations of the gastrointestinal tract are relatively insensitive to caerulein and tachyphylaxis occurs readily.5. Blockade with atropine produces different effects in different intestinal segments and in different animal species. The spasmogenic action of caerulein on the gall bladder is atropine-resistant.6. The effects of caerulein are similar to those of cholecystokinin-pancreozymin in the organs tested in situ or as isolated preparations. Caerulein, however, is always more potent than cholecystokinin-pancreozymin, even on a molar basis. Compared with caerulein, human gastrin I has negligible activity.7. The possible use of caerulein in cholecystography is discussed.

Animals↗

PubMed1980

Endoscopic studies of dyspepsia in a general practice.

In an urban general practice serving 7800 patients, all patients presenting over five and a half years with dyspepsia lasting more than two weeks were investigated by fibreoptic endoscopy and cholecystography, and many by barium meal. Of the 393 patients with dyspepsia, 346 completed the investigation: 180 had specific disease of the oesophagus, stomach, duodenum, or gall bladder, including six with carcinoma. Al further 67 had mucosal disease, and only 99 patients had no abnormality. After the first year the number of patients presenting annually and the percentage of patients with specific lesions remained constant. The annual incidence for patients with dyspepsia was about 1% and for patients with specific lesions 0.4%, suggesting that each year those who became symptom free (either spontaneously or because of treatment) were balanced by a similar number who developed symptoms. In contrast to the conclusions of other workers that an "open-access" endoscopy service could not be justified because the number of patients with specific lesins fell during their survey, we suggest that such endoscopy services are indeed worth while for providing an accurate diagnosis of dyspepsia.

Cholecystography↗

PubMed1988

Percutaneous cholecystolithotomy.

A percutaneous method was used to remove stones from otherwise normal gall bladders, as assessed by cholecystography and ultrasonography. The procedure was performed in a single stage under general anaesthesia, adopting the method and instruments used for one stage percutaneous nephrolithotomy. A Foley catheter was left in the gall bladder and the system checked with contrast at 10 days to ensure free drainage and exclude residual calculi. Seven out of eight patients had a successful percutaneous cholecystolithotomy. An adequate track could not be secured in one man; he had an uneventful cholecystectomy under the same anaesthetic. Follow up at three months of the seven patients showed no calculi and no complications. Percutaneous cholecystolithotomy may prove complementary to extracorporeal shockwave lithotripsy in patients in whom there is difficulty focusing the shock waves on the gall bladder or who have had incomplete disintegration of stones.

Adult↗

PubMed1975

Cholescintigraphy with 99mTc-penicillamine.

D-pencillamine labeled with 99mTc (Tc-Pen) was used for cholescintigraphy in dogs and man. Satisfactory images of the gallbladder were obtained using a scintillation camera fitted with a pinhole collimator. The results of cholescintigraphy and contrast cholecystography compared favorably. The authors suggest that Tc-Pen is taken up by the hepatocytes and excreted into the bile canaliculi which enter the gallbladder. Tc-Pen may prove to be an ideal agent for evaluation of hepatocellular function.

Animals↗

PubMed1976

Clinical evaluation of the rapid telephone access system for radiology reporting.

The Rapid Telephone Access System (RTAS) for radiology reporting was evaluated clinically among patients undergoing fluoroscopy, excretory urography, or cholecystography at a community-based teaching hospital. After the radiologist has dictated his report in the customary manner, it can be heard by the referring physician using any telephone. Reports can be reduced to hard copy by a typist, or an automatic typewriter can be programmed to print normal or standard reports. Time between dictation and access of the report was significantly reduced after installation of the RTAS (p less than 0.001). There was also a trend toward reduced hospital stay (p less than 0.05) for patients in the study group. The system has been readily accepted by radiologists and referring physicians.

Cholecystography↗

PubMed1978

The ultrasonic diagnosis of primary carcinoma of the gallbladder.

A case of primary carcinoma of the gallbladder with nodal metastases, diagnosed by ultrasound examination in a nonjaundiced patient, is described. The gallbladder mass was also visualized on oral cholecystography. The ultrasonic and pathologic findings are correlated.

Carcinoma↗

PubMed1979

Real-time high resolution ultrasound in the detection of biliary calculi.

A high-resolution real-time ultrasound sector scanner was used in the evaluation of patients with suspected gallbladder disease. This technique is noninvasive, requires minimal preparation, and takes less than five minutes for a thorough examination of the gallbladder and related anatomy. In 17 months, 959 patients were examined for suspected gallbladder disease and the gallbladder was adequately visualized in all but 5 patients. Follow-up information was obtained from surgery in 153 cases. There were 132 true-positive studies, 15 true-negative, 5 false-negative and one-false positive study. In a correlative study with oral cholecystography, calculi were detected ultrasonically in 5 cases that had been missed on the oral cholecystogram.

Cholecystography↗

PubMed1981

The radiological diagnosis of gallbladder disease. An imaging symposium.

Changes in the radiological diagnosis of gallbladder disease are occurring at a remarkable rate. In this symposium, several recognized authorities place the various diagnostic modalities and their interrelation in modern perspective. The present and future roles of oral cholecystography and intravenous cholangiography, the radiological diagnosis of chronic acalculous cholecystitis, and the use of ultrasonography and cholescintigraphy are analyzed.

Acute Disease↗

PubMed1983

Sonography of adenomyomatosis of the gallbladder: radiologic-pathologic correlation.

Sonograms of six patients with adenomyomatosis of the gallbladder were reviewed and correlated with oral cholecystographic and pathologic findings. The gallbladder was visualized in four of the six patients by oral cholecystography, which also revealed intramural diverticula. Five of the six patients showed sonographic evidence of diffuse or segmental thickening of the gallbladder wall and intramural diverticula, seen as anechoic or echogenic foci within the wall. Intramural diverticula containing bile appeared as anechoic spaces; those containing biliary sludge or gallstones appeared as echogenic foci with or without acoustic shadows or reverberation artifacts. There was good correlation between sonographic and pathologic findings in three patients. The authors conclude that adenomyomatosis of the gallbladder should be suspected when (a) there is diffuse or segmental thickening of the gallbladder wall and (b) intramural diverticula are seen as anechoic or echogenic foci with or without associated acoustic shadows or reverberation artifacts.

Adult↗

PubMed1984

Oral cholecystosonography: a method for facilitating the diagnosis of cholesterol gallstones.

During the past two years, floating stones within the gallbladder have been demonstrated in five patients, by both oral cholecystography and sonography. We suggest coupling administration of an oral cholecystographic contrast agent with ultrasound examination in cases of equivocal sonographic findings. The combined study--oral cholecystosonography--can facilitate the demonstration of small cholesterol stones by inducing the phenomenon of layering.

Cholecystography↗

PubMed1986

Diagnostic and therapeutic percutaneous gallbladder procedures.

The authors report their experience with 24 patients who underwent a variety of percutaneous procedures involving the gallbladder. Twenty diagnostic and 13 therapeutic procedures were performed under sonographic, computed tomographic (CT), or fluoroscopic guidance; these procedures included biopsy of the gallbladder, diagnostic cholecystography, diagnostic aspiration of bile, gallstone dissolution and removal, cholecystostomy for drainage, and gallbladder abscess drainage. The indications for percutaneous cholecystostomy (performed in 11 patients) included relief of hydrops and empyema, gallstone dissolution, mechanical gallstone removal, and drainage for malignant obstruction. Each procedure was successful. There was one complicating episode of cholecystitis and four previously described episodes of vagal hypotension. Bile peritonitis did not occur in any of the patients. The authors discuss the various percutaneous gallbladder procedures and specific technical considerations in performing them.

Adult↗

PubMed1990

Predicting gallstone composition with CT: in vivo and in vitro analysis.

Chemical composition of gallstones is of major importance in selecting patients for nonsurgical therapy. In a combined in vivo and in vitro study of predictive potential, 50 patients undergoing cholecystectomy were evaluated with computed tomography (CT) and either plain abdominal radiography or oral cholecystography (OCG). The largest stone surgically removed from each patient was subjected to in vitro CT and chemical analysis. The authors found an inverse relationship between CT attenuation numbers and cholesterol content and a good positive correlation between CT attenuation numbers and calcium content. In vivo CT analysis improved sensitivity, specificity, accuracy, and positive and negative predictive values compared to plain abdominal radiography and OCG in detection of cholesterol stones. Using their prediction rule (a CT number smaller than 140 HU indicates a pure cholesterol gallstone), the authors correctly classified gallstones in 17 (84%) of another 20 patients. In vivo CT analysis can enable reliable prediction of gallstone composition and should play an important role in the selection of patients for nonsurgical treatment.

Adult↗

PubMed1991

"Adenomatous polyps of the gallbladder" adenomas of the gallbladder.

The finding of adenomatous polyps of the gallbladder is a rare occurrence and an unusual clinical problem. Among 2,145 patients who underwent cholecystectomy for gallbladder disease only 9 (0.4 per cent) presented with adenomatous polyps. There were 6 women and 3 men, aged 17 to 70 years. Preoperative ultrasonographic diagnosis was made in only 1 of 7 patients with gallstones, in contrast polypoid lesions within a gallbladder without stones were easily confirmed by both ultrasonography and oral cholecystography in the remaining 2 patients. All polyps were 1.0 cm or less in size and without histologic evidence of malignant change. The clinical significance of this rare condition is discussed, with particular reference to a possible role in development of gallbladder carcinoma. Surgical treatment should be advocated regardless of clinical manifestation when the polyp exceeds 1.0 cm in diameter or rapid growth of the lesion is seen on ultrasonographic follow-up examinations.

Adenoma↗

PubMed1976

Acute renal failure due to radio-contrast agents.

Over a 2-year period, acute renal failure following radio-contrast studies was observed in 25 patients after intravenous urography in 13, angiography in 10, oral cholecystography in 1, and cholangiography in 1. 20 had impaired renal function prior to the study. Renal failure, oliguric in 16 patients, occurred within 24 h. Serum creatinines reached levels of 5.3-13.3 mg% in 3-10 days. Recovery occurred in 20 patients within 5-37 days. Among the 5 patients in whom renal failure function was not restored, 1 died of progressive underlying renal disease and 4 of other causes while still in acute renal failure. These observations demonstrate the not infrequent occurrence of severe oliguric renal failure following radio-contrast study in patients with preexisting renal disease.

Acute Kidney Injury↗