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PubMed1989

Gall bladder disease: an analytical report of 250 cases.

Two hundred and fifty cases of biliary tract disease were studied as regards case history, physical and laboratory investigations, surgery and follow-up. It was found that females especially multipara were frequently affected; majority of cases were in 3rd to 5th decade of their life, rise in age showing decline in incidence. Majority of cases (82.4%) were vegetarians and had used vegetable fats (oriental diet). Most of the cases (98.8%) belonged to middle and poor class and were lean and thin. Pain in the right upper quadrant of the anterior abdominal wall had been the commonest symptom, in about half the cases it got aggravated by fatty meals. A mass was felt in the right hypochondrium in 29.6% and Murphy's sign was positive in 55.5% of cases. Radio-opaque calculi were present in 8% of cases, in another 10.8% the calculi were demonstrated by oral cholecystography, radiography could detect calculi in 47 (25.4%) cases and its overall diagnostic success rate has been low (56.8%). Ultrasonography proved more valuable tool for diagnosis; bile culture was positive in 8.8% of cases only for Esch coli, proteus, klebsiella, staphylococci or paracolon. Right subcostal incision gave the best results. Chronic cholecystitis with cholelithiasis (74%) was more common than acalculus cholecystitis (26%), incidence of carcinoma was 2.8%, and in 5 out of 7 cases malignancy was associated with cholelithiasis. Early diagnosis and cholecystectomy for gallstones can prevent malignancy. Surgery on the whole proved beneficial and it can be more rewarding if pre-operatively other causes of dyspepsia are either excluded or confirmed. Excluding cases of malignancy, the mortality has been quite low and thus acceptable.

Adolescent↗

PubMed1989

[A clinical evaluation of the indications and utility of percutaneous gallbladder drainage].

Percutaneous gallbladder drainage (PGD) was performed in 78 patients with diseases of the bile duct system and pancreas, including 48 patients with acute cholecystitis. The procedure was utilized for the treatment of acute inflammation and obstructive jaundice, and this study was initiated to evaluate its utility and the potential indications. Following PGD, the inflammatory changes improved, and the clinical symptoms subsided, especially in cases of acute cholecystitis, in which it appears to have an excellent therapeutic value. Compared to cases of acute cholecystitis treated without PGD and used as controls, the clinical symptoms, laboratory findings and ultrasonographic findings were evaluated. Ultrasonographic findings, including signs of gallbladder swelling, thickening of the gallbladder wall, and as sonolucent layer in the wall were shown to be useful as positive indicators for the use of PGD. PGD also effective in cases of acute cholangitis, and cases of obstructive jaundice in which therapy was difficult using other bile drainage methods. PGD was also useful in establishing a visualization of the gallbladder and for cytological sampling of the bile in cases with negative cholecystography.

Acute Disease↗

PubMed1989

[Polypoid lesions of the gallbladder].

26 cases of polypoid lesions of the gallbladder are reported. 19 were benign lesions, among them, there were 12 (63%) cholesterol polyp, 4 adenoma, 1 inflammatory polyp, and 2 others. 95% of benign lesions were less than 1 cm in diameter, 63% of which were less than 0.5 cm in diameter, 15 cases were multiple lesions; all cases were not associated with gallstones. 7 cases were carcinoma of the gallbladder, of which, 5 were more than 1 cm in diameter, 2 were less than 1 cm which were carcinoma in situs; 3 were associated with gallstones. The accuracy of preoperative diagnosis of polypoid lesions of the gallbladder made by B-mode ultrasonography, cholecystography, CT, endoscopic ultrasonography were 84%, 53%, 80% and 75% respectively. It is concluded that preoperative diagnosis of polypoid lesions on the gallbladder mainly depends on the B-mode ultrasonography; the lesions less than 0.5 cm in diameter should not be treated by operation for the time being; the lesions between 0.5-1 cm should be followed up by B-mode ultrasonography; the operation may be considered if stones present; the lesions more than 1 cm should be resected since malignancy could not be excluded.

Adenocarcinoma, Papillary↗

PubMed1989

Medical dissolution of gallstones by ursodeoxycholic acid: a clinical trial on 14 patients.

Fourteen patients with radiolucent gallstones proved by oral cholecystography (OC) and ultrasonography were treated with daily doses of 600 mg of ursodeoxycholic acid (UDCA) for one year. Among them, 2 patients had complete dissolution of gallstones and another one had partial dissolution. The success rate was 21.4% (3/14). Of the remaining 11 patients who failed to respond to UDCA treatment, calcifications of varied degrees were demonstrated in every gallstone by computed tomography (CT). None of these 14 patients had statistically significant changes in serum lipids, liver function tests and hemograms during the course of treatment and only one (7.1%) patient had transient diarrhea. It was concluded that UDCA was effective and safe for medical dissolution of non-calcified gallstones. However, the underestimation of the calcification of gallstones by OC precluded successful medical dissolution by UDCA. Therefore, meticulous selection of non-calcified gallstones by CT rather than OC as candidates for dissolution may improve the success rate.

Adult↗

PubMed1989

[Extracorporeal shock-wave lithotripsy of gallstones].

We performed 16 extracorporeal shock-wave lithotripsies (ESWL) to fragment gallstones in 11 women and 2 men, aged 19 to 57 (mean 41 +/- 10) years, during the past 10 months. Criteria for selection included a history of biliary colic, not more than 3 stones with a total diameter of not more than 30 mm, and a functioning gallbladder. 210 patients were examined, of whom 98 were referred for additional screening by combined ultrasonography and oral cholecystography. This resulted in rejection of another 71 patients due to multiple stones (38%), nonfunctioning gallbladder (22%), calcified stones (12%), stones not visualized in the prone position (9%), excessively large stones (3%) and other reasons (16%). Only 27 patients fulfilled all the criteria. Under epidural or general anesthesia (11 and 2 patients, respectively), we administered 1200-3500 (mean 2250 +/- 750) shock waves at 20-24 KV with the Tripter X1 (Direx, Israel-USA). This is an ultrasound-guided, modular portable, shock-wave generator utilizing underwater high energy spark discharge. Chenodeoxycholic or ursodeoxycholic acid, 10 mg/kg/day, was started 1 week prior to ESWL and continued for 3 months after disappearance of fragments and debris. We encountered skin petechiae in all patients, transient hematuria in 8, mild biliary colic in 1 and a small liver hematoma in 1. To date, 3 patients are free of stones, while in 7 only sludge and tiny fragments are present which we expect to disappear as a result of the litholytic therapy. 3 patients had fragments larger than 5 mm and required a second ESWL. Thus ESWL, which was indicated in only 13% of screened patients, proved to be safe and can be expected to be successful in 75% of selected candidates.

Adult↗

PubMed1989

[Oral dissolving treatment of gallbladder calculi: focus in 1989].

Oral dissolution treatment with chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) is indicated in the case of cholesterol gallstones. However, three conditions must be satisfied for treatment to be effective: 1) the stones must be radiolucent; 2) the gallbladder must be functioning, i.e. opacified by oral cholecystography; 3) the stones must be smaller than 15 mm in diameter. Most authors consider that treatment is only justified when the stones are symptomatic. On the basis of these criteria, it has been estimated that about 20% of patients with gallstones presenting to gastroenterologists could be suitable for treatment. The mean percentage of efficacy is of the order of 50 to 60% at 18 months to 2 years. This percentage may be as high as 70-80% in the case of floating stones smaller than 1 cm. At the optimal dose (15 mg/kg/day), CDCA may induce diarrhoea and raised transaminases. Its prolonged administration can induce hepatic lesions. UDCA (7-10 mg/kg/day) generally does not have any side effect. The combination of CDCA/UDCA at the dose of 7-8 mg/kg/day of each agent may be more effective. After stopping treatment, a recurrence is observed in about 50% of cases within 5 years. Regular ultrasonographic follow-up (annually, for example) is therefore necessary to treat recurrences in time. Because of the criteria of efficacy and its adverse effects, oral dissolution treatment is only indicated in a very limited number of patients. However, it constitutes an essential complement to extracorporeal lithotripsy, which may represent its principal indication at the present time.

Administration, Oral↗

PubMed1987

Iododerma occurring after orally administered iopanoic acid.

A 45-year-old man with multiple myeloma developed iododerma after oral cholecystography with iopanoic acid. The lesions appeared two days after two exposures to iopanoic acid given within one week. To our knowledge, this is the first reported case of iododerma in association with multiple myeloma and orally ingested radiocontrast dye.

Administration, Oral↗

PubMed1988

Relationship between gallbladder histopathology and ability to concentrate biliary lipids and bilirubin. A study on gallstone patients with functioning gallbladder.

Biliary lipids and bilirubin were measured in hepatic and gallbladder bile obtained at routine cholecystectomy in 35 gallstone patients. The gallbladders had opacified at cholecystography and the cystic ducts were patent at operation. The histologic changes in the gallbladder wall were evaluated by an independent pathologist. Increasing abnormality of the gallbladder wall was shown to be associated with reduced gallbladder contents/hepatic bile ratio of biliary lipids and of bilirubin. The concentrating function of the human gallbladder thus appears to be impaired in proportion to the severity of histologic lesions in its wall. Taken together with earlier findings in vitro, this relationship suggests impaired absorption of electrolytes and water by the gallbladder mucosa, or diffusion of biliary constituents from the lumen of the inflamed gallbladder.

Bile↗

PubMed1987

[Diagnosis of liver diseases in dogs, cats and horses].

Clinical symptoms of hepatopathies are not specific and must be verified by further investigation. Laboratory diagnosis is a very useful method to decide if liver disease is present or not. In individual cases laboratory methods can give hints as to the aetiology of the illness. If necessary, biopsy, angiography or/and cholecystography can be carried out for further clarification of the diagnosis.

Animals↗

PubMed1987

[Benign tumor and pseudotumor of the gallbladder--report of 40 patients].

Benign tumor and pseudotumor of the gallbladder are infrequently reported in our country. In this paper, 5 patients with benign tumor (3 tubular adenoma, 1 leiomyoma and 1 fibroma) and 35 pseudotumor (26 cholesterol polyps and 9 inflammatory polyps) of the gallbladder are presented. Most patients presented a typical clinical manifestation of chronic cholecystitis. Oral cholecystography gave a lower detection rate. B-ultrasonography was able to show the presence of neoplasm in the gallbladder (37/40). Correct diagnosis was established by operation and pathology. In this series, all patients were cured by cholecystectomy. The authors believe that, for the neoplasms detected by B-ultrasonography with definite clinical symptoms or with a diameter of more than 1.0 cm, cholecystectomy is indicated. For those older or weaker patients with milder symptoms or with neoplasms less than 1.0 cm in diameter, periodic B-ultrasonography follow-up is suggested.

Adenoma↗

PubMed1978

Chenotherapy for gallstone dissolution. I. Efficacy and safety.

Clinical experience with chenodeoxycholic acid therapy for dissolving gallstones is reported, with particular attention to determinants of response. Of 12 patients receiving 15 mg/kg/day or more, ten responded (83%); only 15 of 40 patients (38%) receiving less than 15 mg/kg/day responded. Large solitary stones and stones in gallbladders that visualized poorly after oral cholecystography had a lower response rate. Radiopaque stones did not respond in 18 patients. Five of ten patients with stones in the common bile duct responded. Small, dose-related elevations in SGOT were the only biochemical abnormality observed. Liver biopsy specimens showed no notable abnormality. Diarrhea was an infrequent problem. Stones recurred in three of 15 patients during six to 48 months of observation without treatment. Chenodeoxycholic acid, when given in adequate dosage, continues to appear promising as medical therapy for asymptomatic radiolucent gallstones in radiologically visualizing gallbladders.

Chenodeoxycholic Acid↗

PubMed1986

[Common channel for bile and pancreatic ducts. Presentation of 12 cases and discussion].

Between 1978 and 1985, 11 girls and one boy underwent an elective operation for a congenital choledochal dilatation associated with an anomalous biliopancreatic junction. In 10 out of these 12 cases the children suffered several episodes of abdominal pain, and the diagnosis was missed since a jaundice appeared. The ultrasonographic examination demonstrated in all cases a dilatation of both extra- and intrahepatic bile ducts. The preoperative diagnosis was always established by the mean of a transhepatic cholangiography (8 cases) or a percutaneous cholecystography (4 cases), which showed in every case a dilated choledochus, and a common biliopancreatic channel, 15 to 35 mm long. A high amylase level was found in the bile in 10/10 cases when it was measured. A cholecystokinin test was performed in 4 cases, resulting in each case in a considerable increase of amylase and lipase levels in bile. All children were treated by excision of the dilated choledochus and gallbladder, followed by an hepaticojejunostomy with a Roux en Y loop. The follow-up is 6 months to 5 years for 9 children: 8 are cured, and on girl, who had a major dilatation of the left intrahepatic bile ducts, suffered from episodic abdominal pain and an episode od cholangitis 6 years after the operation. The role of such a common channel in the pathogeny of congenital choledochal cysts, acute pancreatitis in children, and biliary carcinomas in young adults is discussed according to the literatures of the last 10 years.

Adolescent↗

PubMedDate not supplied

[Competitive interrelations between bilirubin and x-ray contrast agents in binding with human serum albumin].

It was shown that bilirubin can be a fluorescent probe for human serum albumin. Parameters of the interaction of bilirubin with albumin were determined. It was found that bilimin and iopanoate decrease affinity of bilirubin to strongly and poorly binding areas of human serum albumin, biliognost and endobil predominantly to its poorly binding sites, and iodamide and verografin exert no influence on binding of bilirubin with albumin. It is concluded that in the clinical practice it is necessary to take into consideration the possibility of an increase in the blood level of free bilirubin in patients during cholecystography with the use of contrast media.

Bilirubin↗

PubMed1986

[Estimation of the costs of radiographic and endoscopic examinations in gastroenterology using monographic studies].

This study is devoted to the study of rate-setting and cost price of fifteen radiological and endoscopic examinations in gastroenterology as based on monographic studies. In rate-setting the costs are the examinations actually performed in the department. In contrast, the cost price allocated to include only the expenses incurred by each examination and not those related to the time running between them. Both estimations converge when rooms and equipment are used maximally. Our results show that the amounts reimbursed by the Social Security system were always lower than those obtained from monographic studies, except for two radiological examinations for which expenses were adequate. However when cost prices are considered, all reimbursements would have to be increased for endoscopic examinations, but for Radiography, only those of cholangiography, cholecystography and small bowel barium series should be adjusted.

Costs and Cost Analysis↗

PubMedDate not supplied

Glucagon-dosed cholescintigraphy.

Cholescintigraphy is applied to the differential diagnosis of surgical and medical icterus. Particularly, in cases in which cholecystography is inapplicable due to iodine anaphylaxis and non visualization by cholecystogram is suspected, the technique is commonly applied for morphological diagnosis. However, functional diagnosis with cholescintigraphy is becoming increasingly important because transitions observable through dynamic study and time-activity curves with ROI are readily available. The author, who has been studying the function of the gallbladder through cholescintigraphy and has been using anticholinergic drug-dosed cholescintigraphy, reports 20 cases of glucagon-dosed cholescintigraphy in this communication.

Adult↗

PubMed1987

The secretion of cholecystokinin in the gallstone patient before and after removal of a functioning gallbladder.

Cholecystectomy will not always relieve the abdominal symptoms of the patient with gallstones. The functional effects of gallbladder removal in a patient with a patent cystic duct are not known in detail. Studies of the function of the gallbladder and pancreas have suggested feedback mechanisms for the release of cholecystokinin (CCK). A disturbed regulation of CCK release after cholecystectomy might induce pancreaticobiliary and gastrointestinal dysfunctions. In our study the concentrations of CCK in plasma were measured in 17 patients with gallstones. The measurements were taken with gallbladders opacified at cholecystography and with patent cystic ducts at the operation, in the fasting state, and during stimulation before and 17 weeks after the cholecystectomy. The CCK assay used measures sulfated CCK-8, CCK-22, and CCK-33 with equimolar potency but neither nonsulfated CCK nor any gastrins. Emtobil (containing peanut oil and sorbitol) was used for peroral stimulation of the CCK release. The basal concentration of CCK was 4 pmol/L and rose five times during a "test meal." No significant differences were seen in fasting or stimulated concentrations of plasma CCK before and after the cholecystectomy. Thus cholecystectomy in gallstone patients with functioning gallbladders does not seem to influence the regulation of CCK release.

Adult↗

PubMed1985

Scintiscanning in the evaluation of biliary enteric anastomoses.

The evaluation of symptomatic patients who have undergone biliary enteric anastomoses, particularly when the diversion was into the jejunum, is difficult. Conventional techniques for evaluation, such as oral cholecystography (OCG), intravenous cholangiography (IVC), ultrasonography (US), computer-assisted tomography scanning (CT scanning), or endoscopy are not adequate to provide definitive information on the patency of the anastomoses. Hepatobiliary scintiscanning using 99mTc-HIDA and BIDA (iminodiacetic acid derivatives) was performed on 12 patients. The patients were from 11 to 72 years of age and included ten men and two women. The scan results were correlated with US, CT scan, percutaneous transhepatic cholangiography (PTC), operative findings, and final diagnosis. Scanning was highly accurate in this group and could be performed successfully even in jaundiced patients (total serum bilirubin level up to 20.0 mg/dl). In patients in whom dilated bile ducts were demonstrated (by US, CT scan, or scintiscan), only the scintiscan revealed the true patency of the anastomoses. The advantages of the technique are that it is simple and noninvasive. Delayed transit of bile (scanning agent) to bowel is a very reliable indication of partial or complete obstruction. Scintiscanning is the only technique that demonstrated the functional state of biliary secretion and excretion into bowel in patients with previous biliary enteric anastomoses.

Adolescent↗

PubMed1985

Cholecystokinin cholescintigraphic findings in the cystic duct syndrome.

Fourteen patients with a cystic duct syndrome (CDS) underwent cholecystokinin (CCK) cholescintigraphy. All patients presented with persistent postprandial right upper quadrant pain and biliary colic. None of the patients had an abnormal oral cholecystography, gallbladder (GB) ultrasound exam or upper GI series. Each patient (NPO after 12 a.m.) received 5 mCi of technetium-99m disofenin. When the GB maximally filled, 0.02 microgram/kg CCK was administered (3 min) intravenously. Background corrected gallbladder ejection fractions (GBEFs) were determined every 5 min X 4 by rationing the pre-CCK GB counts minus post-CCK GB counts to pre-CCK GB counts. GBEFs were: 12% (3 patients), 17% (2), 0%, 1.3%, 3%, 4%, 6%, 11%, 14%, 18.5%, and 22% (1 each). All patients underwent a surgical exploration and all had macro- or microscopically abnormal cystic ducts (five fibrotic, seven elongated and narrow, two kinked) with (12 patients) or without (2 patients) concomitant chronic cholecystitis. No patient with a partially occluded cystic duct with or without concomitant chronic cholecystitis had an ejection fraction that exceeded 22%. In an appropriate clinical setting, a low EF response to CCK should alert the physician to the presence of either chronic acalculous cholecystitis, CDS, or the combination of both.

Adolescent↗