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PubMed1987

Gallstones and uterine fibroids.

In a series published in 1961, an unusual frequency of hysterectomies for uterine leiomyomas (fibroids) was reported in women with gallstones. The purpose of this study was to confirm the association between gallstones and uterine leiomyomas with a patient control study and to investigate its physiopathologic basis comparing the cholesterol saturation of bile in women with gallstones, in women with leiomyomas but no gallstones and in those in the control group with no gallstones or leiomyomas. Patients admitted to the surgical department have, routinely, echography of the gallbladder before and manual exploration of the pelvic floor during surgical intervention. For the first part of the study, we collected information concerning the diagnosis of leiomyomas from the operating room registers and about the diagnosis of gallstones from the clinical records. In 1982, 42 of 139 women operated upon consecutively for gallstones and five of 69 operated upon for other diseases of the gastrointestinal tract had leiomyomas, a statistically significant difference (chi-square test, p less than 0.001). This difference persisted stratifying women with gallstones and those in the control group for age. In the second part of the study, we examined the bile collected at duodenal drainage after gallbladder stimulation with cholecystokinin, in 11 young women with radiolucent gallstones (echography and cholecystography), in ten women with leiomyomas (gynecologic examination and pelvic echography) but no gallstones (echography) and in 11 women with no leiomyomas (gynecologic examination or pelvic echography) or gallstones (echography). Cholesterol, phospholipids and total bile acids in the biliary tract were analyzed with standardized enzymatic methods. The cholesterol saturation index of the biliary tract was higher in patients with leiomyomas than in those in the control group (Wilcoxon rank sum test, p less than 0.01) and similar to that of women with radiolucent gallstones. These data suggest that gallstones and leiomyomas are associated diseases, probably sharing a common cause.

Adult↗

PubMed1985

[Agenesis of the gallbladder (diagnostic considerations. Apropos of a case].

The authors show a case of gall-bladder agenesis, in the preoperative diagnostics of which both echotomography and T.A.C. were used. From the data of the literature, as well as from the personal experience, one can understand the preoperative diagnosis presuming gall-bladder agenesis can be placed in presence od manifestations of biliary nature added to gall-bladder nonopacity at oral cholecystography and to absence of gall-bladder at echotomography and T.A.C. The certainty diagnosis, however, can be only obtained at laparotomy with the hand exploration, with the preoperative cholangiography and eventually the selective arteriography of hepatic artery.

Adult↗

PubMed1985

Cholelithiasis in sickle cell disease: a cholecystographic and ultrasonographic evaluation in Nigerians.

A prospective study designed to establish the incidence of gallstones among 48 Nigerian homozygous sickle cell disease patients was made using oral cholecystography and grey-scale ultrasonography. The age range was 2 to 35 years with a mean of 16 years. The youngest patient with gallstones was a 51/2-year-old boy. Gallstones were demonstrated on cholecystosonography in 12 of 48 patients (25%). The incidence of cholelithiasis was 7.7% in children 10 years or younger and 31.4% in patients above this age. There was no correlation between the incidence of cholelithiasis and serum bilirubin on one hand and positive history of abdominal pain on the other. Screening of patients over 15 years for gallstones is suggested with a view to performing elective cholecystectomy in patients who subsequently become symptomatic.

Adolescent↗

PubMed1985

Bile flow before and after cholecystectomy: a study with 99mTc-HIDA.

Computer-assisted 99mTc-HIDA cholescintigraphy was performed before and after elective cholecystectomy in 24 patients. Preoperative cholecystography had shown gallstones in a well visualized gallbladder in 12 of the patients, and in 12 the gallbladder had not been visualized. Liver function tests gave normal results in all 24 patients, and peroperative cholangiography showed no common duct stones in any patient. In the series with functioning gallbladder, comparison of the preoperative and postoperative scintigrams showed that cholecystectomy was followed by significantly earlier visualization of the lower part of the common duct and of the duodenum. The number of times that passage of activity to the duodenum was observed also rose significantly. Comparison of the time-activity curves showed that after cholecystectomy the liver activity reached its maximum value significantly earlier post-injection as compared with the preoperative values. All of these changes were absent in the series with nonfunctioning gallbladder. Removal of a functioning gallbladder results in accelerated, though still irregular flow of activity to the duodenum.

Adult↗

PubMed1979

[Acute acalculous gallbladder disease in children: acute cholecystitis or acute gallbladder distension (author's transl)].

Acute acalculous gallbladder disease is rarely encountered in children. Two observations permit a review of its clinical, diagnostic, and therapeutic aspects. Acute acalculous cholecystitis and acute gallbladder distension present clinically in a similar fashion, although, in the latter the fever is usually absent and there is a history of episodic pain. The pathogenesis of these affections remains uncertain but generalized infection and anomalies of the cystic duct seem to be favoring circumstances. The diagnosis, rarely initially made, could be confirmed by oral cholecystography showing an non visualized gallbladder. Surgery is necessary in order to confirme or refute the diagnosis. The therapeutic approach can be either the simple drainage of the gallbladder or a cholecystectomy. Due to the risk of allowing a cervicocystic obstacle persist, it seems that a cholecystectomy, which is well tolerated by the child, would be preferable.

Acute Disease↗

PubMed1979

The effect of intravenously administered glycopyrrolate and orally given analgetic-spasmolytic combination preparation on the contraction of the human gallbladder.

The effects of intravenously administered glycopyrrolate 0.2 mg (n = 10, Group I) or one orally given analgesic-spasmolytic combination preparation tablet (n = 10, Group II) on the contraction of human gallbladder during control oral cholecystography were compared with patients without any medication (n = 10, Group III). Neither drug had any effect on the gallbladder contraction and, hence, their usefulness in a patient with pain caused by gallstones is questionable. Heart rates and blood pressures were constant in Groups II and III but in Group I glycopyrrolate occasionally caused slight tachycardia and elevated blood pressure. Only in Group I 2 patients had mild side-effects (anticholinergic).

Administration, Oral↗

PubMed1979

[Fissures in biliary calculi. Personal contribution (author's transl)].

In a series of 70 patients suffering from biliary lithiasis, the roentgenologic findings of fissures in the calculi was observed in 5 cases examined by means of cholecystography and in 7 cases who underwent cholangiocholecystography. Fissures were demonstrated 11 times in calculi after surgery. The "Mercedes-Benz" sign was never observed at the abdominal examination without contrast medium. The presence of fissures may be an additional sign in the radiologic diagnosis of biliary calculi, but its value is not determinant.

Adult↗

PubMed1977

[Influence of radiopaque substance and concentration of contrast media as well as time of infusion on excretion of contrast medium and incidence of side effects (author's transl)].

Two hepatotropic contrast media in 3 different concentrations each are administered to a total of 727 patients for infusion cholecystography. It is the purpose of the study to investigate frequency of adverse reactions and quality of radiographic demonstration. In regard to tolerance, Endomirabil clearly shows advantages over Biligram. The radiologic demonstration of Endomirabil is somewhat better than with Biligram. The frequency of adverse reactions shows to be influenced by the concentration of the contrast medium as well as time of infusion, which particularly applies to Endomirabil, while in regard to the quality of visualization, ni dependence on either concentration of infusion time could be demonstrated.

Cholecystography↗

PubMed1967

[Evaluation of a new cholecystokinetic agent].

Boyden's test meal (egg yolk beaten with cream), used during cholecystography, remains in the stomach for a long time and could interfere with the radiological findings on barium meal examination performed after cholecystography.A new preparation based on corn oil emulsion (G.P. Prep) was evaluated in 33 patients with and without symptoms of gallbladder disease. The criteria used in the evaluation of results were three: reduction in the gallbladder dimensions, variations in the cholecystovertebral angle, and visualization of the extrahepatic bile ducts.The gallbladder dimensions were determined before and after contraction with the aid of a metallic perforated ruler (Colcher's) placed at the estimated level of the gallbladder at the time of exposure.

Adult↗

PubMed1981

[A rare opening of great biliary ducts - esophagobiliary communication (author's transl)].

A case report of a congenital esophagobiliary communication with atresia of left ductus hepaticus is presented. The communication of the esophagus with the duct of the left liver lobus was examined by giving Esophotrast into esophagus and by intravenous cholangio-cholecystography and tomography. Atresia of the left ductus hepaticus was detected by intraoperative cholangiography. The case is presented because of its rarity and it has only an embryological explanation.

Abnormalities, Multiple↗

PubMed1984

Changes in gallstone morbidity in a community with decreasing frequency of cholecystectomies. A statistical study of the county of Stockholm, Sweden, 1969-1982.

From 1969 to 1982 there has been a continuous decrease in the cholecystectomy rate in the county of Stockholm, Sweden, from 265 per 100.000 population to 105. The change is greatest among young females. During the same period there has been a two-fold increase in gallbladder cancer. Although the total number of cases with common bile duct stones have decreased, they have increased in relation to the number of cholecystectomies. A similar trend is true for cases with and operations for acute cholecystitis. From 1970 to 1982 there has been a fairly constant number of cholecystographies and ultra sound scans of the biliary tract indicating that the diagnostic efforts have been unchanged, at least quantitatively. However, cases with positive diagnosis have decreased especially among young females. It is concluded that the decreased cholecystectomy rate in the county of Stockholm can be explained by a simultaneous decrease of the prevalence of gallstones, at least among the young, and a decrease of operations among those who have gallstones.

Adult↗

PubMed1978

The effect of papaverine on the contraction of the human gallbladder.

In a double-blind study, 40 mg of papaverine (Group I) or the same amount of placebo (1.0 ml of physiological saline, Group II)was injected intravenously in 19 patients to study the effect of papaverine on the contractility of the gallbladder in connection with routine oral cholecystography. In both groups a standard contraction meal (200 ml of cream) caused a significant contraction of the gallbladder (at 30 minutes). Thereafter, intravenously administered papaverine significantly inhibited further contraction caused by the fatty meal, but no significant dilatation was observed. This difference between the two groups lasted throughout the whole study period to 60 minutes after the drug administration. This time period mainly consisted of the distributional alpha-phase of the drug concentrations determined by gas chromatography in the serum. Because no dilation effect on the gallbladder was found, the clinical spasmolytic response to papaverine during an acute attack of pain in a patient with gallstones seems to be questionable.

Adult↗

PubMed1984

Roentgenographically controlled healing of gallbladder lesions in opisthorchiasis after praziquantel treatment.

In a study, gallbladder lesions due to Opisthorchis viverrini infection were controlled roentgenographically after treatment with praziquantel (2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a] isoquinolin- 4-one, EMBAY 8440, Biltricide). The place of study was the Khon Kaen Hospital, Northeast Thailand. Included in the study were 20 patients with impairment of gallbladder function; 7 of them were males and 13 females. Their age ranged from 27 to 60 years (mean 47.4), eggs per gram (EPG) ranged from 800 to 30,000 (geometric mean 4321). The laboratory parameters were within normal limits. Praziquantel 3 X 25 mg/kg per kg body weight was given on Day 0 and all patients were parasitologically cured within 60 days. Oral cholecystography was performed to evaluate the function and size of the gallbladder and intravenous cholangiography for the common bile duct on Days 0, 14, 60, 120 and 180. The results were: (a) very large and severe dysfunction of gallbladder seen in three patients returned to normal in 60, 60 and 180 days; (b) moderate dysfunction was present in 13 patients, all but one returned to normal: 6 in 14 days, 1 in 21 days, 2 in 60 days, 1 in 120 days and 2 in 180 days. The only patient who showed no change had diabetes mellitus and moderate dysfunction of the gallbladder for one year prior to treatment; (c) mild dysfunction: all 4 patients were normal in 14 days. The common bile duct was enlarged in 3 patients (1.2, 1.3, 1.5 cm); no significant changes were seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1983

"Micro-gallbladder"--a clue to cystic fibrosis.

We report a patient with cystic fibrosis and biliary symptoms who demonstrates a tiny gallbladder on oral cholecystography and ultrasonography which should suggest the diagnosis of cystic fibrosis. The term "micro-gallbladder" has been introduced to describe the type of gallbladder seen in cystic fibrosis patients with biliary disease.

Adult↗

PubMed1984

[Gallbladder atony and celiac disease in adults. Radiographic and echographic study of 15 cases].

Gallbladder emptying was evaluated in 15 adult celiac disease patients by oral cholecystography or ultrasonography, after fatty meal or cholecystokinin stimulation. Gallbladder inertia was found in 13 cases. Our study agrees with previously reported results; however it is the first one in which this abnormality was demonstrated by ultrasonography. Our findings may suggest that gallbladder inertia is due to duodenal release of an inactive endogenous cholecystokinin. Control studies demonstrates that gallbladder inertia is reversible after gluten-free diet, recurs with relapse, and thus represents a true celiac disease sign, and not an associated condition. Finally, our cases suggest that gallbladder inertia may be radiologically evident before clinical features of malabsorption become apparent. Awareness of this possibility may persuade the radiologist to research in this condition an occult celiac disease.

Adult↗

PubMed1984

[Goldenhar syndrome. Discordance in monozygotic twins].

Child here described is a new-born male, the firstborn twin, who showed clinical-radiological manifestations compatible with an oculo-auriculo-vertebral syndrome or Goldenhar's syndrome. A comparison of chromosomes, identification of serological types and determination of antigens of histocompatibility (HLA) showed them to be similar in both twins, thus showing identity of monozygots . Of great importance in the anamnesis is a radiological study--cholecystography--which was practiced between 4th and 6th weeks of pregnancy. Differences shown and possible intervention of radiation as etiology mark the especial interest of this case.

Abnormalities, Radiation-Induced↗

PubMed1984

[Cholesterol crystals and biliary lithiasis. Importance of the study of bile collected by duodenal intubation].

Cholesterol crystallization in a necessary step in the formation of cholesterol gallstones. Our purpose was to study the relationship between the presence of biliary cholesterol crystals and radiolucent gallstones. Bile was obtained by duodenal intubation from 60 subjects free of hepatic disease: 40 patients had radiolucent gallstones and in the remaining 20 subjects no gallstones could be found either by oral cholecystography or by ultrasound examination. In each patient a bile sample was used to search for cholesterol crystals; in another sample, biliary cholesterol, phospholipids and bile acids were measured to calculate the lithogenic index. Among the 44 subjects with lithogenic bile, 34 had radiolucent gallstones. Twenty-two out of the 60 patients had both cholesterol crystals and radiolucent gallstones; 21 subjects out of the 22 had lithogenic bile. In patients with frequent biliary colic or subacute pancreatitis without visible gallstones, finding cholesterol crystals in bile might suggest medical or surgical specific treatment.

Adult↗

PubMed1984

Acute acalculous cholecystitis.

Sixty-eight patients with acute acalculous cholecystitis were reviewed. The results of history and physical examinations were usually nondiagnostic. IDA cholescintigraphy (93 per cent accuracy rate) was the only reliable diagnostic modality. The results of oral cholecystography, intravenous cholangiography and ultrasonography were considerably less reliable. One-half of the patients had gangrenous cholecystitis. Cholecystectomy was the preferred operation with an over-all mortality of 9 per cent. IDA cholescintigraphy is an important new modality for the diagnosis of acute acalculous cholecystitis which, in the past, has often been difficult to diagnose.

Acute Disease↗