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PubMed1992

Accuracy of ultrasound and oral cholecystography in assessing the number and size of gallstones: implications for non-surgical therapy.

Prior to non-surgical therapy of gallstones it is important to assess their number and size. In order to evaluate the accuracy of ultrasound (US) and oral cholecystography (OCG) in counting and measuring gallstones, a prospective blind study was conducted to compare the results of US (n = 99) and OCG (n = 36), either alone or in combination (n = 34), with the number and size of gallstones retrieved after cholecystectomy. The number of gallstones was accurately estimated by US and OCG in 74% and 69% of the cases, respectively. In assessing the presence of up to three, five or 10 gallstones both US and OCG proved reliable. In measuring the size of gallstones, there was 19% accuracy with US compared with only 3% with OCG. With an accepted measurement error of 3 mm these values increased to 80% for US and 44% for OCG. US proved more reliable than OCG in discriminating gallstones smaller or larger than 10 mm and smaller or larger than 20 mm, but with US, detection of gallstones larger than 30 mm was problematic. Both US and OCG underestimated gallstone size. The combination of both techniques did not significantly improve the assessment of either number or size of gallstones compared with the results obtained with US or OCG alone. It is concluded that (1) both US and OCG have some limitations in assessing the number and size of gallstones, (2) the combination of both examinations does not improve accuracy, and (3) patient selection for non-surgical treatment of gallstones can be started by US alone.

Adult↗
PubMed1979

Effects of three-day oral cholecystography on serum iodothyronines and TSH concentrations: comparison of the effects among some cholecystographic agents and the effects of iopanoic acid on the pituitary-thyroid axis.

The effects of repeated doses of oral cholecystographic agents on serum thyroxine (T4), 3,3',5-triiodothyronine (T3), 3,3',5'-triiodothyronine (rT3) and thyrotrophin (TSH) concentrations were studied in 37 euthyroid male subjects. Iobenzamic acid, tyropanoic acid, iopanoic acid, and ipodate sodium, in a dosage of 3 g for 3 days, respectively, induced a significant decrease in serum T3 and an increase in rT3 within 24 h after the initial dose, followed by an increase in TSH and a slight increase in T4. The extent of the changes in rT3 varied between the agents, ipodate causing the greatest change, but without any relation to the changes in T3 or T4. Responses of serum T4, T3, rT3 and TSH concentrations to exogenous thyrotrophin-releasing hormone (TRH) and bovine TSH were also studied before and after 3-day doses of iopanoic acid. In 11 subjects given iopanoic acid, the response to TSH to TRH (500 micrograms, iv) was increased but the T3 response was unchanged. A dose of TSH (10 U.S.P. units, im) caused a significant increase in serum T3 and a decrease in TSH concentrations in 5 subjects both before and after cholecystography. It is thus suggested that in euthyroid subjects given multiple doses of oral cholecystographic agents, (1) the primary and consistent events are the reciprocal changes of serum T3 and RT3, although the extent of the changes is not coordinately reciprocal; (2) the responsiveness of the pituitary thyrotrophs and thyroid to TRH is preserved; and (3) the high basal and TRH-induced TSH in the serum may be ascribed to the decrease in the serum T3 concentration.

Administration, Oral↗
PubMed1978

Surgical and pathologic correlation of cholecystosonography and cholecystography.

To define the accuracy of varying ultrasonic patterns in the diagnosis of gallstones, the records of 145 patients with ultrasound examination of the gallbladder prior to cholecystectomy were reviewed. Three abnormal scan categories were established: category 1--shadowing opacities that move with gravity within the gallbladder lumen; category 2--nonvisualization of the gallbladder lumen; and category 3--nonshadowing opacities within the gallbladder lumen. The accuracy of these criteria for gallstone diagnosis was found to be 100%, 96%, and 61%, respectively. Overall accuracy was 96% for gallbladder disease, with a 4% false negative rate. Oral cholecystography demonstrated an accuracy of 93% in this series. A preoperative ultrasound diagnosis of gallstones should probably be limited to category 1 and 2 appearances only.

Cholecystography↗
PubMed1979

Persistent gallbladder opacification after iopanoic acid cholecystography: diagnostic implications for acalculous cholecystitis.

Recent reports in the surgical literature state that persistent dense visualization of an otherwise normal-appearing gallbladder 36 hr after the administration of iopanoic acid is highly suggestive of acalculous cholecystitis. To determine the incidence and significance of persistent gallbladder visualization, 324 patients and 66 asymptomatic controls were evaluated. An equal percentage (about 10%) of both groups showed persistent dense gallbladder opacification 36 hr after iopanoic acid ingestion. The results do not support the contention that patients with acalculous cholecystitis can be identified by simply obtaining an additional abdominal radiograph the day after oral cholecystography.

Cholecystitis↗
PubMed1979

Cholecystokinetic cholecystography: comparison of the effect of intramuscular ceruletide to a fatty meal.

A comparison study of 80 patients using either intramuscular ceruletide or a fatty meal to contract the gallbladder after oral cholecystography is described. The maximum mean percentage reduction of the gallbladder area was significantly greater with ceruletide (59%) compared to a fatty meal (29%). At all time intervals, a 40% or more reduction in gallbladder area occurred in a higher percentage of patients receiving ceruletide, with improvement in cystic and/or common duct visualization occurring at an earlier time than with a fatty meal. There were no adverse effects after gallbladder contraction when large or small calculi were present.

Ceruletide↗
PubMed1988

Oral cholecystography vs gallbladder sonography: a prospective, blinded reappraisal.

In a prospective, blinded study of 205 patients, oral cholecystography (OCG) and sonography were compared in terms of how well each screened patients for gallbladder diseases. Among 23 patients who had pathologic confirmation of the diagnosis at cholecystectomy, OCG correctly diagnosed 20 cases (87%) while sonography diagnosed 18 (78%). Among 54 patients with an abnormal OCG and/or sonogram, OCG detected 47 (87%) while sonography detected 44 (81%). These small differences in detection rates were not statistically significant. On the basis of these results, we cannot conclude that either sonography or OCG has a diagnostic advantage in screening patients for gallbladder disease. The large numbers of false-negative examinations found on both sonography and OCG suggest that in a patient with persistent symptoms, the alternative study should be performed if the first examination is negative.

Administration, Oral↗
PubMedDate not supplied

[Role of intravenous cholangio-cholecystography in the diagnosis of asymptomatic choledocholithiasis].

INTRODUCTION: Standard diagnostic procedures (anamnesis, physical examination, laboratory analyses, ultrasound diagnosis), commonly used in diagnosis and preparation for surgical intervention of patients with cholelithiasis, are in most cases a reliable indicator for evaluation of the disease and conditions planned for surgery. DISCUSSION: In some cases by application of these narrow diagnostic models, some conditions, anatomic variations and biliary tract malformations remain unrecognized. Asymptomatic ("silent") choledocholithiasis (2.02%) represents a special diagnostic and therapeutic problem. CONCLUSION: Our extended diagnostic protocol includes routine intravenous cholangio-cholecystography as a standard diagnostic procedure for evaluation of cholecysto-choledocholithiasis prior planning cholecystectomy.

Cholangiography↗
PubMed1978

Infusion cholecystography--an aid in the diagnosis of acute cholecystitis.

Early operation of patients with acute cholecystitis is nowadays accepted as the treatment of choice. One prerequisite for this policy is, however, the availability of diagnostic procedures that can rapidly secure or, even more important, exclude the diagnosis to avoid unnecessary operations. Infusion cholecystography was here shown to be an accurate method giving decisive information in patients with clinically suspected acute cholecystitis. The gallbladder was not visualized in 26 out of 45 patients with inconclusive clinical signs of acute cholecystitis. The diagnosis of acute cholecystitis was confirmed at operation or by a typical clinical course in these 26 patients. In the 19 patients with visualized gallbladder diagnosis other than acute cholecystitis were established by acute operation or by other means.

Acute Disease↗
PubMedDate not supplied

Radiological concepts of cholecystokinin cholecystography.

Cholecystokinin-cholecystography originated in Stockholm in 1955. At the present time the radiological procedure is conducted under supervision of medical research teams in the United States. The cholecystokininpancreozymin preparation is imported for clinical investigation under "Investigational Drug" regulations. Dr. Donald Hanscom, gastroenterologist, who is conducting clinical investigations in the Midwest, submitted radiographs, publications and evaluations from his files for this manuscript. This gastrointestinal hormone "squeezes out a diagnosis" as it is observed fluoroscopically. Dr. LeRoy B. Garbe, radiologist, evaluates these findings in the cases presented. The effects of cholecystokinin on the contrast-filled gall bladder give enhanced diagnostic information for the patient suffering with chronic cholecystitis and cystic ductitis.

Cholangitis↗
PubMed2003

Use of oral cholecystography agents in the treatment of hyperthyroidism of subacute thyroiditis.

AIM: In this study, we describe our experience in treating subacute thyroiditis patients with 2 OCAs (sodium ipodate and sodium iopanoate). METHODS: We studied 10 consecutive patients with subacute thyroiditis treated with 1 of the 2 oral cholecystography agents (OCAs). RESULTS: Hyperthyroidism was controlled and symptoms improved markedly in each case without any evidence of subsequent relapse of thyroiditis after withdrawal of OCAs. Three of the 10 patients had been treated previously with corticosteroids and had demonstrated relapse of thyroiditis and hyperthyroidism after tapering or withdrawal of steroids. We observed no side effects of treatment with OCAs. CONCLUSION: Our data suggest that OCAs are effective and safe agents for management of hyperthyroidism in patients with subacute thyroiditis, even when they have relapsed after treatment with corticosteroids.

Acute Disease↗
PubMed1977

A comparison of iocetamic acid and sodium iopodate in cholecystography.

Cholecystography was carried out on 456 consecutive patients using varying dosage schedules of cholebrine (iocetamic acid) tablets and biloptin (sodium iopodate) tablets. The density of gall-bladder gave the impression of a slightly greater opacification with cholebrin tablets. Quality of common duct demonstration was equally good with both media, with those patients having a morning dose of contrast giving the best demonstration.

Administration, Oral↗
PubMed1990

Comparison of oral cholecystography (OCG) with real time ultrasonography in the diagnosis of cholelithiasis at the Tikur Anbessa Hospital, Addis Ababa, Ethiopia.

A prospective study of the accuracy of real time ultrasonography in the detection of gallstones was undertaken in 180 patients from February 1987 to February 1988. The ultrasound findings were compared with single dose oral cholecystography (OCG), and with the surgical findings where surgery was undertaken. Ultrasonography gave more accurate results than OCG, with an overall accuracy in the surgically proven patients of 97.1%, no false positive findings and a 2.9% false negative rate. OCG gave an accuracy of 80% with no false positive findings and a 20% false negative rate. Ultrasound was particularly valuable where there was non visualisation of the gall bladder at OCG, giving an overall accuracy of 93.3% in such patients. Ultrasonography is a non invasive, simple, safe and economic diagnostic test of high accuracy in the diagnosis of cholelithiasis and of particular benefit in those patients unsuited for OCG.

Cholecystography↗
PubMedDate not supplied

[Methodologic procedures in the study of the biliary system using cholecystography].

New methods of x-ray investigation of the biliary system (BS) were proposed. A method of hydrostatic load in per os cholecystography, a method of the combined use of per os and iv cholecysto-cholangiography with hydrostatic load, and the use of finely divided suspension are simple and reliable, permitting one to obtain objective information on the BS.

Adult↗
PubMed1987

Oral cholecystography and sonography of gallbladder in cholecystectomy patients.

In comparing the diagnostic specificity and sensitivity of oral cholecystography with that of sonography in 479 patients in a community hospital, the oral cholecystogram, when used with a double dose of contrast agent, showed greater specificity (1.00) and sensitivity (0.99) than the sonogram (0.54 and 0.94, respectively). Because of lower cost, the oral cholecystogram should be used as the initial diagnostic study when cholelithiasis is suspected, unless specific contraindications exist.

Adolescent↗
PubMedDate not supplied

Clinical comparison of two contrast agents for oral cholecystography: radiologic efficacy and drug safety of iopanoic acid and iopronic acid.

Oral doses of either iopronic acid (4.5 g Oravue, Squibb) or iopanoic acid (3 g Telepaque, Winthrop) were given to 98 patients requiring cholecystography. Radiographs were taken 13 to 16 hours after treatment showed good to excellent gallbladder opacification in 44 percent of patients after the first dose of iopronic acid and in an additional 29 percent after a second dose. Similar opacification occurred in 42 percent of patients after the first dose of iopanoic acid and in 34 percent after a second dose. Drug-related abnormalities in blood and urine tests occurred about equally in both groups and one patient in each group exhibited a clinically adverse reaction (diarrhea). Thus, the performance (radiographic efficacy and drug safety) of the new contrast agent, iopronic acid, was similar to a widely used drug, iopanoic acid.

Administration, Oral↗
PubMed1979

Flow-chart for sequential cholecystography.

A protocol designed to integrate oral cholecystography with ultrasonography and scintiscanning of the gallbladder is presented. The planned use of these modalities will permit a 95% clinically useful assessment on a single visit to the x-ray department.

Cholecystography↗