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PubMed1980

Gray-scale ultrasonography as a screening procedure in the detection of gallbladder disease.

The sonographic and surgical findings in 180 patients who underwent cholecystectomy for gallbladder disease were reviewed and correlated. Four abnormal groups were established. In Group I, the gallbladder was visible and contained structures which cast an acoustic shadow. In Group II, there was constant shadowing in the region of the gallbladder fossa, but the gallbladder itself was not visible. In Group III, there was a constant, immobile, echo-dense, nonshadowing area in the gallbladder wall. In Group IV, nonshadowing echoes were seen within the gallbladder lumen. The overall accuracy of ultrasound was 98.9%; the false-negative rate was 2.2%, the false-positive rate 2.8%. 5.6% of Group I patients had normal oral cholecystograms. Because of its high accuracy, minimal preparation, speed of diagnosis, and cost-effectiveness, the authors recommend that ultrasonic cholecystography be considered as a screening method, particularly for small polyps (< 4 mm).

Cholelithiasis↗

PubMed1990

Percutaneous extraction of gallstones in 20 patients.

Percutaneous cholecystolithotomy (PCL) was accomplished successfully without general anesthesia in 17 of 20 consecutive symptomatic patients from an outpatient gallstone center who were at risk for or had refused cholecystectomy. The other three patients underwent cholecystectomy because of a gallbladder collapse before admission, a tight stone-bearing phrygian cap, and a cannula slippage, respectively. A subhepatic approach was preferentially used after the fundus of the gallbladder was stabilized with a percutaneous anchor to prevent invagination and bile leakage. Retrograde slippage of the anchor into the tract in the first six patients was remedied by elongating the anchor from 2 to 3 cm. Calculi were removed in one session (11 patients) or two consecutive sessions (six patients). Morbidity included rehospitalization for stitch infection (n = 1) and dehydration (n = 1), cannula slippage (n = 1), broken guide wire (n = 1), vasovagal reaction (n = 1), and unextractable anchors (n = 3). Gallbladder endoscopy enabled identification of stones not visible at cholecystography. Hospitalization lasted 3-5 days; outpatient gallbladder drains were removed in 2-3 weeks in 10 patients and 4-6 weeks in seven (older) patients. No retained stones were seen at 6 months. The authors recommend PCL for patients at risk for surgery.

Adult↗

PubMed1991

Percutaneous rotational contact biliary lithotripsy: initial clinical results with the Kensey Nash lithotrite.

The percutaneous rotary lithotrite introduces a new concept to fragmentation and percutaneous removal of gallstones. A fluid vortex is generated, pulling calculi into a high-speed blade that fragments stones to predominantly under 500 microns. The results of treating the first 10 patients with this instrument reveal that large stone burdens as well as small stones (2-3 mm) of any composition can be removed if the gallbladder is of sufficient size to accommodate the six-pronged basket. Rotation times of 7-39 minutes were required. Nine of 10 procedures were completed; access was lost in one case. One major complication occurred. At repeat oral cholecystography, the gallbladder was visualized after 3-6 weeks in eight of the nine patients. Ursodeoxycholic acid was administered from 3 to 12 months to five patients with either residual stones or aggregates. The hospital stay ranged from 48 to 72 hours. All patients (except the patient who underwent surgery) resumed light activity in 3-4 days and strenuous activity and full diet within 3 weeks.

Cholelithiasis↗

PubMed2000

Gastrointestinal radiology in the United States: An overview of the past 50 years.

Gastrointestinal radiology has expanded its scope beyond conventional abdominal radiography, barium studies, and cholecystography. Ultrasonography allows imaging of solid abdominal organs and the intestine without the use of radiation. Computed tomography now allows comprehensive assessment of abdominal and pelvic inflammatory and infectious processes, obstruction, tumor detection and staging, and display of vasculature and blunt trauma effects that were not possible 50 years ago. Magnetic resonance imaging provides multiplanar imaging to the same degree, without the use of radiation. Barium studies of the gastrointestinal tract, enteroclysis for small-bowel assessment, and conventional radiography still have a role, despite the extensive use of fiberoptic endoscopy. Fluoroscopy is still important, but great advances in technologies have changed gastrointestinal radiology irrevocably.

Digestive System↗

PubMed1978

Diet and cholesterol gallstones. A further study.

In a first study, a population of 1,045 women from 20 to 61 years old has been studies. 24 (2.3%) were known to have gallstones. After excluding these 24 cases, 214 were drawn from the same population and accepted an oral cholecystography. 11 cases of stones (5.1%) were discovered. The diet of these 11 patients and of the 202 women without gallstones was not significantly different. In a second study, the diet of 50 patients with known gallstones and the diet of 50 matched controls have been compared. No significant difference between the two groups can be demonstrated for calories, protein, fat or carbohydrates intake. These results are compared to previous results which showed overconsumption of food in gallstone patients. The method for all studies being similiar, it seems that the dietetic factors are now less important in cholesterol stones pathogenesis than during the period which followed the second world war starvation in southeast France. The assumption that undernutrition diminishes the chance for a women to develop gallstones is proposed.

Adult↗

PubMed1982

The effect of some iodine-containing radiocontrast agents on iodothyronine secretion from the perfused canine thyroid.

The effects of the iodine-containing radiocontrast agents ipodate, iopanoic acid, and iothalamate on the secretion of T4, T3, and rT3 were studied using perfused canine thyroid lobes. The experiments were performed as paired comparisons, with one thyroid lobe acting as a control. At 10(-5) M, the two agents used for cholecystography (ipodate and iopanoic acid) inhibited the TSH-stimulated secretion of T3 [ipodate, 69 +/- 8% of control (P less than 0.05); mean +/- SE; n =4] and rT2 [iopanoic acid 59 +/- 9% (P less than 0.01); iopanoic acid, 61 +/- 9% (P less than 0.05)], whereas T4 secretion was not significantly altered. Iothalamate (10(-3)M), an agent predominantly excreted through the kidneys, did not alter T4, T3, or rT3 secretion. This pattern is compatible with an inhibitory effect on intrathyroidal T4 deiodination to T3 and rT3 by ipodate and iopanoic acid, similar to the inhibition of T3 deiodinases in peripheral tissues by these compounds. At a concentration of 10(-3) M, ipodate induced a hitherto unrecognized pattern of thyroid hormone secretion: a very rapid, sustained and reversible inhibition of the secretion of all three iodothyronines. The mechanism behind this response remains to be elucidated.

Animals↗

PubMed1985

Inhibitory effect of iopanoic acid on the thyrotropin-stimulated release of cyclic adenosine 3',5'-monophosphate and of 3,5,3'-triiodothyronine from perifused rat thyroids.

Using a perifusion system, we studied the effect of iopanoic acid, an iodinated contrast agent used in oral cholecystography, on the release of cAMP, T3, T4, and rT3 from perifused rat thyroid pieces. A 0.1 mg/ml iopanoic acid solution significantly inhibited the TSH-stimulated release of cAMP (without iopanoic acid, 8175 +/- 373; with iopanoic acid, 5169 +/- 355 fmol/mg thyroid X 3 h, mean +/- SE) and T3 (without iopanoic acid, 971 +/- 32; with iopanoic acid, 659 +/- 32 pg/mg thyroid X 3 h) in the presence of 3-isobutyl-1-methylxanthine. T4 and rT3 releases were not significantly affected. Inhibition of TSH-stimulated T3 release by iopanoic acid was also observed at a concentration of 0.01 mg/ml. Propylthiouracil completely abolished the inhibitory effect of iopanoic acid on TSH-stimulated cAMP release but not on TSH-stimulated T3 release. TSH-stimulated cAMP release was augmented by iodide at a concentration of 1 X 10(-3) M in the presence of 3-isobutyl-1-methylxanthine but suppressed by iodide at a concentration of 1 X 10(-5) M. TSH-stimulated T3 release was suppressed slightly at both concentrations of iodide. These results suggest that iopanoic acid may have an inhibitory effect on the TSH-stimulated cAMP and T3 release from perifused rat thyroids. This effect can probably be attributed to the iodide contained in the agent and to the inhibited intrathyroidal conversion of T4 to T3.

1-Methyl-3-isobutylxanthine↗

PubMed1981

Effect of Iopanoic acid on the pituitary-thyroid axis: time sequence of changes in serum iodothyronines, thyrotropin, and prolactin concentrations and responses to thyroid hormones.

We have previously shown that some oral cholecystographic agents induce marked increase in basal and TRH-stimulated TSH concentrations in normal subjects. To define the relationship between circulating iodothyronines and pituitary secretion after oral cholecystography, temporal changes in the responses of serum TSH and PRL to a fixed dose of TRH (500 micrograms iv) and in serum T4, T3, and rT3 concentrations were assessed before, immediately after, and then at weekly intervals after the three daily doses of iopanoic acid (Ip). Both basal and TRH-stimulated TSH concentrations were significantly increased at the end of the period of Ip administration when the serum T3 concentration was decreased, were still above the pretreatment level 1 week after the course of Ip when the serum T3 had returned to pre-Ip levels, and returned toward normal 2 weeks after the course of Ip. The changes in serum T3 concentration were accompanied by reciprocal changes in rT3 concentration. PRL secretion was not significantly changed. To evaluate further the relationship between the enhanced TSH secretion and the changes in serum iodothyronine concentrations, subjects were given oral doses of T3 (5 micrograms every 4 h) or T4 (50 micrograms every 8 h) during the administration of Ip. In the subjects given Ip plus T3, serum T3 concentrations were maintained at pre-Ip levels, and both basal and TRH-stimulated TSH concentrations were not different from the control. Administration of T4 did not completely prevent the Ip-induced increment of TSH secretion. It is suggested that in subjects given Ip, 1) the serum T3 level is, at least partly, a determining factor for TSH secretion; and 2) the set-point of TSH secretion is appropriately tuned to either reduction or elevation of serum T3 concentration by a mechanism that is different from that in fasting subjects.

Adult↗

PubMed1983

Effects of cholecystographic agents and sulfobromophthalein on binding of thyroid hormones to serum proteins.

A number of interactions between thyroid hormones and cholecystographic agents have previously been demonstrated. In the present study we show that cholecystographic agents also interfere with the binding of thyroid hormones to serum proteins. A commercial kit (Tri-Tab) was used in which the uptake of labeled hormone from serum by a silicate adsorbent tablet is measured. In the presence of cholecystographic agents or sulfobromophthalein (BSP), the amount of labeled hormone bound to adsorbent increased in a dose-dependent fashion, reflecting displacement from protein-binding sites. The order of potency was BSP greater than ipodate greater than iopanoate greater than tyropanoate. Displacement of hormone was confirmed by a second methodology in which graded amounts of unlabeled T4 were added to the system. This allowed a Scatchard analysis to be performed for binding sites on T4-binding globulin. The cholecystographic agents and BSP caused displacement of the Scatchard slopes, again demonstrating interference with binding to serum protein sites. A method is described in which the change in Scatchard slope produced by an inhibitor is employed to compute the association constant between T4-binding sites on T4-binding globulin and the inhibitors. The values were: BSP, 14.6 X 10(3) M-1; ipodate, 4.7 X 10(3) M-1, iopanoate, 2.2 X 10(3) M-1; and tyropanoate, 0.1 X 10(3) M-1. Because of these relatively low values and the rapidity with which these agents are normally cleared from serum, it seems likely that effects on free hormone levels would be transient and of small magnitude during routine cholecystography. Also, ipodate, in the 1 g/day dose that has been employed experimentally to treat hyperthyroidism, should have a negligible effect on protein binding. On the other hand, when high levels of these compounds are used in experimental settings to study other aspects of thyroid hormone metabolism, changes in protein binding can occur and confound interpretation of results.

Blood Proteins↗

PubMed1978

Hepatobiliary imaging: a comparison of 99Tcm-dihydrothioctic acid and 99Tcm-pyridoxylidene glutamate in the non-jaundiced patient.

A comparison of two hepatobiliary imaging agents, 99Tcm-dihydrothioctic acid (99Tcm-DHT) and (99Tcm-pyridoxylidene glutamate (99Tcm-PG) has been carried out in 44 non-jaundiced patients. Thirty-one patients were admitted for investigation of upper abdominal pain and 13 patients were volunteers who were undergoing treatment for unrelated conditions. Satisfactory liver images were obtained with both agents in patients without liver disease, but they were inferior to those seen after 99Tcm-sulphur colloid. 99Tcm-PG produced clearer images of the gall-bladder and bile ducts than 99Tcm-DHT. Non-visualization of the gall-bladder was interpreted as gall-bladder disease; in patients with inflammatory gall-bladder disease no gall-bladder image was seen (nine 99Tcm-DHT, nine 99Tcm-PG). The gall-bladder was also not demonstrated in two of the volunteers' group (one 99Tcm-DHT, one 99Tcm-PG), nor was a gall-bladder seen in five patients whose abdominal pain was not due to acute cholecystitis. Despite this, there was agreement between the results of imaging and oral cholecystography in 21 out of 22 subjects. 99Tcm-PG is non-toxic, cheap and rapidly excreted by the liver into the bile. A 99Tcm-PG scan would be useful when rapid diagnosis is required in suspected acute cholecystitis when conventional contrast radiology is unlikely to be of value.

Adult↗

PubMed1992

An audit of ultrasound diagnosis of gallbladder calculi.

Many series suggest that ultrasound is an accurate method for demonstrating cholelithiasis. However, these series were often prospective and the examinations performed by experienced sonographers. This audit addresses whether the accuracy is maintained in daily practice. We reviewed the ultrasound scans of 128 patients who underwent cholecystectomy for cholelithiasis and compared the findings. The operative and ultrasound findings were at variance in eight of the 128 patients (6.2%). Five were reported as having gallstones on ultrasound but none were found at cholecystectomy, a false positive rate for ultrasound of 3.9%. Three had abnormal gallbladders with no gallstones on ultrasound but gallstones were found at operation, a false negative rate of 2.3%. To avoid false positive diagnoses, suboptimal examinations should be repeated and the scan should be repeated immediately pre-operatively if only small calculi are seen. Alternative imaging should be performed if necessary, either cholescintigraphy in the acute situation or elective oral cholecystography. Some false negative examinations may be avoided by performing repeat examinations if the gallbladder is thick-walled and tender. With these provisos we conclude that ultrasound correctly diagnoses cholelithiasis in daily practice.

Cholecystectomy↗

PubMed2001

Imaging of the gastrointestinal tract.

Gastrointestinal imaging has undergone immense and profound changes since the days when radiologists had only plain abdominal radiography, barium studies and cholecystography to offer as a means of investigating the gastrointestinal tract. Advances in technology have made huge differences in the ways and means of investigating the various pathologies afflicting the gastrointestinal tract. Ultrasound provides assessment of the solid organs and the intestine without the use of ionizing radiation. Computed tomography (CT) provides unparalleled imaging of congenital, inflammatory, traumatic and neoplastic processes, providing information on the solid organs and tubular structures, including the vasculature. Information is provided to aid immediate management or to stage lesions for subsequent or combined therapies. Magnetic resonance imaging (MRI) gives unprecedented multiplanar images and soft tissue resolution. There is still a place for plain radiography and barium studies but this is decreasing as technology advances.(c) 2001 Prous Science. All rights reserved.

Journal Article↗

PubMed1987

Inhibitory effect of various radiographic contrast agents on secretion of thyroxine by the dog thyroid and on peripheral and thyroidal deiodination of thyroxine to tri-iodothyronine.

In previous studies we have found that the cholecystographic contrast agent ipodate induced a rapid, sustained and reversible inhibition of thyroxine (T4) secretion from perfused dog thyroid lobes. This type of inhibition of thyroid secretion has not been observed previously. To evaluate whether this effect is unique for ipodate, ten other iodine-containing radiographic contrast agents were tested. The four agents used for cholecystography (iocetamate, iodipamide, ioglycamate and iotroxate) all induced rapid inhibition of T4 secretion from TSH-stimulated perfused dog thyroid lobes, while none of six agents predominantly excreted through the kidneys (amidotrizoate, metrizamid, metrizoate, iodamide, diodone and ioxithalamate) influenced T4 secretion significantly. All the cholecystographic agents inhibited T4 deiodinases from dog thyroid and liver. Diodone also inhibited the deiodinases while none of the other compounds tested had any effect. The results indicate that the structure necessary to inhibit thyroid secretion is common to a number of cholecystographic agents and that it could be related to the structure responsible for the inhibitory effect of cholecystographic agents on T4 deiodinases.

Animals↗

PubMed1994

Pharmacological treatment of gallstones. Practical guidelines.

Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Medical treatment is indicated for patients who are not fit or are afraid of surgery. For any form of medical treatment to be effective gallstones must be cholesterol rich, thus radiolucent, and the cystic duct must be patent, as indicated by gallbladder opacification on oral cholecystography. Three forms of medical treatment are currently available for clinical use--oral bile acids, bile acids as adjuncts to lithotripsy and contact dissolution using methyltertbutylether. The choice of treatment depends mainly on gallstone size. Gallstones < 6 mm in diameter are best treated with oral bile acids, chenodeoxycholic acid 15 mg/kg/day or ursodeoxycholic acid 10 mg/kg/day given alone or in combination (5 mg/kg/day each). Careful patient selection and bedtime administration of the whole daily bile acid dose enhance treatment, and may achieve up to 75% complete dissolution annually. Single stones < 30 mm in diameter or multiple stones (n < 3) are best treated with lithotripsy combined with oral bile acid for dissolution of fragments. Annual dissolution rates are about 80 and 40% for single and multiple stones, respectively. Stones of any size and number can be dissolved by direct contact dissolution using methyltertbutylether. Dissolution has been reported to be complete in almost 100% of stones, but debris is frequently left behind in the gallbladder. Following dissolution using any form of treatment, gallstones recur in about 50% of patients, and cannot be reliably prevented by low dose bile acid or dietary manipulations. Failing prevention, early detection and retreatment of recurrent stones is the best alternative option as a long term strategy.

Algorithms↗

PubMed1980

Ultrasonic pseudocalculus effect in psotcholecystectomy patients.

Nonvisualization of the gallbladder in ultrasonic cholecystography is noted in 15%--25% of patients with proven cholelithiasis. In this setting, the ultrasonic diagnosis of cholelithiasis and choledocholithiasis is made by detection of strong echoes with distal acoustic shadowing (calculus pattern). A similar pattern was detected in 17 of 26 postcholecystectomy patients, only one of whom had retained bile duct calculi. In the absence of surgical clips in the right upper abdomen (60% in our series), it is assumed that this ultrasonic pseudocalculus effect is caused by postoperative scar at the site of the gallbladder bed. Our data indicate that ultrasonic diagnosis of retained bile duct calculi in postcholecystectomy patients should be made with extreme caution.

Bile Duct Diseases↗

PubMed1981

High accuracy sonographic recognition of gallstones.

Recent advances in the imaging capabilities of gray scale sonography have increased the accuracy with which gallstones may be diagnosed. Since the sonographic diagnosis of gallstones is often followed by surgery without further confirmatory studies, the avoidance of false-positive diagnoses assumes major importance. In an attempt to improve diagnostic accuracy, 420 gallbladder sonograms were evaluated for gallstones. Positive diagnoses were limited to cases in which the gallbladder was well visualized and contained densities that produced acoustic shadowing or moved rapidly with changes in position. Gallstones were diagnosed in 123 cases and surgery or autopsy in 70 of these patients confirmed stones in 69. There was one false-positive, an accuracy rate for positive diagnosis of 98.6%. Five cases were called indeterminate for stones; one of these had tiny 1 mm stones at surgery. The other four cases had no surgery. Of 276 cases called negative for stones. None of the 146 cases with negative sonograms and oral cholecystography or intravenous cholangiography had stones diagnosed by these methods. Because of its ease and simplicity, sonography is attractive as the initial study in patients suspected of having gallstones. With the criteria used here, a diagnosis of gallstones in the gallbladder can be offered with great confidence.

Cholelithiasis↗

PubMed1988

Physical characteristics of gallstones removed at cholecystectomy: implications for extracorporeal shock-wave lithotripsy.

The criteria by which patients are selected for new, nonsurgical forms of gallstone therapy will influence the use of these techniques. We estimated the number of patients with gallbladder stones who are potentially suitable for extracorporeal shock-wave lithotripsy according to the current Food and Drug Administration protocol for the United States trials of the Dornier gallbladder lithotriptor. Exclusion criteria include patients with (1) more than three stones, (2) stones less than 0.5 cm or more than 3.0 cm in diameter, (3) radiopaque stones, and (4) a nonfunctioning gallbladder. The gallbladder contents in 100 consecutive patients undergoing cholecystectomy were analyzed according to the number, size, and calcium content of the stones as determined by specimen radiographs. Because none of these patients underwent preoperative oral cholecystography, an estimated percentage of functioning gallbladders was taken from the literature. Preoperative symptoms were not considered in determining a patient's eligibility for gallbladder lithotripsy. On the basis of these criteria, we estimated that 85% of our surgical patients would have been excluded from extracorporeal shock-wave lithotripsy according to the current Food and Drug Administration protocol for the Dornier gallbladder lithotriptor.

Calcium↗

PubMed1990

Percutaneous cholecystolithotomy with endoscopic lithotripsy by using a pulsed-dye laser: preliminary experience.

Percutaneous cholecystolithotomy with endoscopically directed lithotripsy with a pulsed-dye laser was performed in eight patients for the treatment of symptomatic gallstones. All patients had stones that were not amenable to therapy by less invasive techniques. During the first stage of a two-stage procedure, a cholecystostomy catheter was placed percutaneously. During the second stage, performed at least 10 days later, the stones were fragmented with a laser and removed. Fragmentation of the stones was successful in all patients. In six patients, the gallbladder was completely cleared of stones, as assessed with endoscopy and cholecystography. In two patients, residual fragments remained in the gallbladder. No laser-related complications occurred. This preliminary experience suggests that the pulsed-dye laser is safe and effective in endoscopically directed lithotripsy of gallbladder stones.

Adult↗