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PubMed1994

[Effect of cisapride on clearance of gallstone fragments after extracorporeal shockwave lithotripsy of gallstones].

Stone fragments remaining in the gallbladder are an important problem after ESWL. Cisapride (CIS) improves gallbladder contraction and hence we decided to investigate whether clearance of stone fragments after ESWL for radiolucent gallbladder stones can be increased by cisapride. Six to 15 months (median 12) after ESWL 48 patients with remaining gallstone fragments of less than 5 mm in diameter were randomized either to Group A, who received cisapride 10 mg t.i.d. orally for 3 months in addition to oral litholysis (OLL) with ursodeoxycholic acid 500 mg/day and chenodeoxycholic acid 500 mg/day, or to Group B, who continued solely with OLL. All patients had started OLL within the fortnight-preceding ESWL. Gallbladder contractility, as measured by oral cholecystography with a fatty meal, was intact in all patients prior to ESWL. Maximal diameter and number of fragments were assessed by ultrasound (5 mHz) in different positions of the patient at the beginning of the study and after 3 months. Total clearance of fragments, which includes clearance of all sludge, occurred in only 3 patients, two of whom received only OLL. After 3 months the number of fragments decreased in 6 patients in Group A and in 7 patients in Group B. Three patients stopped taking cisapride before completion of the study, two because of diarrhoea, and one because of dysuria. All symptoms were readily reversible after discontinuing cisapride. In conclusion, cisapride combined with OLL does not enhance clearance of the gallbladder when fragments are still present one year after ESWL.

Administration, Oral↗

PubMed1994

Current practice in biliary surgery: the Indian scenario.

OBJECTIVE: Documentation of current biliary surgical practices of surgeons in India. METHODS: A postal questionnaire survey of the consultants in surgery in all the medical colleges in India was done to establish their current practice regarding cholecystectomy and to assess the influence of recent studies on their practice. RESULTS: The response rate was 23% (264/1127). About half of the surgeons did both ultrasonography and oral cholecystography for the diagnosis of cholelithiasis. Acute cholecystitis was managed conservatively by 80% of surgeons. Antibiotics were used by all surgeons but 87% of them used antibiotics for more than one day. Peroperative cholangiography was done in all cases by 20% of those who had the facilities available. Incidental appendectomy was done by 26% of surgeons. Drain was used in all cases by 78% of surgeons. Patients were discharged after suture removal by 77% of surgeons. CONCLUSIONS: The practices of the Indian surgeon surveyed were against the recommendations in current literature which did not seem to have had much impact on them regarding their practice of biliary surgery.

Cholecystectomy↗

PubMed1994

[Dissolution of gallstones with methyl-tert-butyl ether. An alternative to surgery in high risk patients].

We treated 27 symptomatic patients by dissolving cholesterol gallstones with methyl tert-butyl ether. Three patients were treated twice. Mean age was 70.2 years. Most patients had elevated risk for surgery. A 5 French polyethylene catheter was introduced percutaneously, transhepatic to the gallbladder. The placement of the catheter was successful in 26 of 30 procedures (87%). Cholecystography showed complete dissolution of stones in 22 of 26 patients treated (85%). Mean treatment time was 11.7 h. In four patients the treatment was stopped before dissolution was complete. Side effects were nausea, pain, fever and vasovagal reaction. 15 patients were followed up for a mean of 22.7 months after dissolution. Ten patients had no biliary symptoms, five patients suffered symptomatic relapse and three had asymptomatic recurrence of stones. We conclude that dissolution of gallstones by methyl tert-butyl ether is an adequate alternative to surgery in selected high risk patients.

Aged↗

PubMed1993

[Attempt at evaluation of certain parameters of gastric secretion in patients with duodenogastric reflux].

There were four groups of patients: duodenal ulcer patients (32), duodeno-gastric reflux patients (31), patients with duodenal ulcer and reflux (33) and 12 healthy men. All of them aged 20-40. In all patients we performed gastroscopy, cholecystography, Kay's test for secretion and isotope proteolytic secretion test. High activity of proteolytic secretion in both groups of reflux patients was found. There were also the high percentage of false positive scores in endoscopy estimation of reflux, in comparison to the non-invasive isotope method. We suggest: reflux may be the important factor in duodenal ulcer pathogenesis; endoscopy cannot be used in duodeno-gastric reflux estimation.

Adult↗

PubMed1993

Experience with laparoscopic cholecystectomy at the Toa Payoh Hospital.

A retrospective analysis was done of 88 cases of laparoscopic cholecystectomy performed by the first author from November 1990 to March 1992 at the Toa Payoh Hospital. There were 61 female and 27 male patients; the average age was 47.1 years. The most common presenting symptom was biliary colic (85.3%), followed by acute cholecystitis (10.2%) and gallstone pancreatitis (4.5%). In the vast majority of patients, the diagnosis was established by ultrasound (96.6%) while the remainder was diagnosed by oral cholecystography (3.4%). The operation was performed using the usual 4 puncture approach with the single-handed technique of dissection. Antibiotic prophylaxis with a broad-spectrum agent was used in all patients and there was no incidence of wound infection. A low complication rate of 4.5% was experienced--consisting of 1 case each of subcutaneous emphysema, abdominal colic, fever and bile duct injury. There was no mortality in our series. The conversion rate was 9.1% and this was due to our policy of performing laparotomy whenever the safety of laparoscopic surgery was in doubt. The mean duration of postoperative hospitalisation was 3 days and 7 days after laparoscopic and converted cholecystectomies respectively. The majority of patients (61.4%) returned to work after 2 weeks.

Adult↗

PubMed1993

[Per oral gallstone dissolution therapy].

In this paper the author describe present status and problems of Per oral cholesterol gallstone dissolution therapy by bile acid. 1) Both ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) decrease the cholesterol output in bile, but their action mechanism somewhat differs. 2) Clinical results of UDCA treatment in our hospital during past 17 years are as follows. Complete dissolution rate Approx. 20% Partial dissolution rate Approx. 20% 3) In the attempt to increase the complete dissolution rate, bedtime administration method (one time administration instead of 3 times, every day), combination therapy of UDCA and CDCA and UDCA plus simvastatin (HMG-CoA reductase inhibitor) were tried. The results of these trial were not superior compared with ordinary UDCA therapy (3 times after each meal administration). 4) The author concluded from the results that small size (< 1 cm in diameter), Ia in ultrasonographic classification, floating by oral cholecystography, and radiolucent gallstones are the most suited for bile acid dissolution therapy.

Administration, Oral↗

PubMed1993

[Computed X-ray tomography in predicting the efficacy of oral cholelithiasis with bile acids].

The efficacy of oral cholelitholytic therapy with chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) in 137 patients with gallstones was compared with their CT patterns. The best dissolving results were obtained from patients with the stones in isodense and faint category (< 50 Hu) on CT. All the stones with high density or heterogeneous calcification on CT were insoluble, therefore, they were contraindicated for oral cholelitholytic therapy. According to the above, criteria, the rate for dissolution ranged from 27.7% (38/137) to 66.7% (38/57), and that for complete dissolution ranged from 9.49% (13/137) to 40.7% (11/27). The attenuation value classified as complete dissolution ranged from -2 to 35 Hu(14 +/- 12 Hu, n = 13). CT analysis improved the predictability of dissolving gallstones in comparison with plain abdominal radiography or oral cholecystography (OCG). Besides, gallstones, which showed no obvious filling defect on OCG but distinct echo and shadow on B-type ultrasonography, were also insoluble.

Adult↗

PubMed1993

[Cholecystolithiasis and choledocholithiasis cured by methyl tert butyl ether (MTBE) combined with EST].

A 70-year old male patient was admitted to hospital with fever and right upper quadrant pain. Ultrasonography and cholecystography revealed acute cholecystitis associated with multiple stones not only in the gallbladder but also in the common bile duct. Percutaneous trans-gallbladder drainage (PTGBD) was performed because of his persisting complaints and severe inflammatory change of the gallbladder. Operation was not considered due to his cardiac problem, so we tried direct dissolution treatment of the gallstones by using Methyl tert butyl ether (MTBE) through the percutaneous transhepatic catheter. Following maximal aspiration of the gallbladder contents, same amount of MTBE was infused into and the patient was kept in the right-side-down position for an hour. After 30 times of MTBE treatment, all stones in the gallbladder were thoroughly dissolved without any side effect. A residual stone in the common bile duct was easily taken out by endoscopic sphincterotomy.

Aged↗

PubMed1977

[Changes in the biliary tracts in various phases of the course of peptic ulcer before and after gastric resection].

By means of serial intravenous cholegraphy, oral cholecystography and the combined investigation of the stomach and gallbladder the state of the bile passages was examined in 157 patients with ulcerous diseas before and after gastric resection. Many patients (52.4%) with ulcerous disease showed congenital and acquired deformity of the gallbladder, some patients (7.6%)--adhesive deformity of the common hepatic and common bile ducts. In most patients functional (mainly the decreased concentration capacity and hyperkinetic dyskinesia) changes in the gallbladder were noted.

Adolescent↗

PubMed1977

[Effect of different types of vagotomy on the contractile activity of the gall bladder].

Based on the analysis of serial cholecystography, performed in 112 patients, the authors concluded that trunk and selective vagotomy associated with economic gastric resection, selective proximal vagotomy with and without drainage of the stomach do not essentially influence the contractile capacity of the gallbladder. Following selective and trunk vagotomy in early postoperative terms dilation of the gallbladder was noted, which, however, was transitory. Selective proximal vagotomy with and without drainage of the stomach does not influence the size of the gallbladder.

Dilatation↗

PubMed1995

Effect of Tolrestat on oesophageal transit time and cholecystic motility in type 2 diabetic patients with asymptomatic diabetic neuropathy.

The aim of the present study was to investigate the influence of Tolrestat, an aldose-reductase inhibitor, on both oesophageal and cholecystic motility in Type-2 diabetic patients with asymptomatic diabetic neuropathy. Sixty-six patients were randomly assigned to receive Tolrestat 200 mg once daily (33 patients) or were left without specific treatment (33 patients) for 12 months. Efficacy and safety evaluation were done at 4.5 and 12 months by persons blinded to the patient treatment regimen. Scintigraphic evaluation of oesophageal motility showed significant changes in transit time for Tolrestat at 12 months (p < 0.001). There was no significant effect of Tolrestat on cholecystic function in cholecystography, although diabetic patients taking Tolrestat showed a trend toward improvement. The vibration perception threshold at two sites of the dominant leg improved by at least 3 volts in the Tolrestat group and remained unchanged or slightly deteriorated in the control group. Tendon reflexes and blood pressure fall after standing were improved in the Tolrestat group. In conclusion, one-year treatment with Tolrestat significantly improved oesophageal motility and vibration perception in Type-2 diabetic patients with asymptomatic diabetic neuropathy.

Aged↗

PubMed1977

Long-term results of simple removal of pigment gallstones in childhood.

Twelve patients with gallstones were operated at Our Lady's Hospital for Sick Children in Dublin from 1960 to 1973. Seven patients were dealt with by cholecystolithotomy and followed up for periods ranging from 18 months to 13 years. All cases were in good health without any evidence of recurrences of calculi. Three cases 11 to 13 years after cholecystolithotomy showed normally functioning gall bladder on cholecystography.

Adolescent↗

PubMed1996

Prevalence of gallbladder disease and associated clinical variables in a low income population of Mexico City.

We present the results of a population-based survey carried out in a low income area of Mexico City. The aim of this study is to characterize the prevalence of clinically significant gallbladder disease (CSGD) using the self-reported history of cholecystectomy (CG) or cholelithiasis (CL) demonstrated by cholecystography and/or ultrasonography. The population of the studied area was 15,532 inhabitants, of whom 3505 (22.6%) were age eligible (35-64 year-old men and non-pregnant women). Home interviews were obtained in 2810 (80.2%). A physical and laboratory examination was performed in 2282 individuals (65.1%; 941 men and 1341 women). The prevalence of CSGD in men was 2.0% (95% confidence intervals 1.1-2.9%) and 9.2% in women (95% confidence intervals 7.7-10.7%). Patients with CSGD were older, men (p < 0.003) and women (p < 0.001). Women with CSGD had higher waist to hip circumference ratio (p < 0.06), higher fasting glucose (p < 0.03) as well as 2 h post challenge glycemia (p < 0.04) and insulinemia (p < 0.03). In the multiple logistic regression model only age (p < 0.001) and sex (p < 0.001) remained significantly associated. We conclude that CSGD is quite prevalent in this population. It is associated with age in both genders and in women, higher glucose and insulin levels. The prospective follow-up of this cohort is important since it could generate the information needed to implement a preventive program to diminish the impact of this condition.

Adult↗

PubMed1990

[Diffuse adenomyomatosis of the gallbladder].

Adenomyomatosis is a rare benign proliferative disease of the gallbladder characterized by epithelial proliferation and formation of mucosal pouches through the thickened muscular layer of gall bladder wall. It appears in three different types: diffuse, segmental and localised adenomyomatosis. Diffuse type is the rarest. Etiology is unknown. Patients sometimes feel a dull pain in the upper right abdominal quadrant. Preoperative diagnosis is based on cholecystography and ultrasonography. Cholecystectomy is a method of treatment. Diagnosis is confirmed on histology. Very rarely, adenomyomatosis seems to bee a premalignant condition. We present four patients treated during the last two years, a woman and three men, 27-41 years old (average 37 years). All these patients had a dull pain in the right subcostal region, approximately 6 months before the diagnosis was established. One patient had chronic alcoholic pancreatitis with dilated pancreatic duct. Diagnosis of diffuse adenomyomatosis was made preoperatively on ultrasonography in all patients. Cholecystectomy was carried out Diagnosis was confirmed on histology. There was no carcinoma. In a patient with chronic pancreatitis Wirsungojejunostomy (Puestow) and choledochojejunostomy were also carried out.

Adenomyoma↗

PubMedDate not supplied

[Chronic gallbladder disease & its surgical therapy, personal experience].

The chronic alitiasic cholecystopathy represents an unusual trmorphological disease not well defined in literature; it is characterized by a chronic alteration of gallbladder without gallstones. The authors present a retrospective study on a group of 21 patients having undergone cholecistectomy from January 1992 to January 1995. The choice for the surgical treatment was made on the basis of blind gallbladder after i.v. cholangiography, and cholecystography and/or tickning of the gallbladder wall performed through ultrasonography, in patients with hystory of biliary pains not responding to the pharmacological therapy. The removed gallbladder has been histologically examined, observing the absence of gallstone and the presence of chronic inflammation of the gallbladder wall. The c.a.c. is a pathology whose etiopatogenesis is yet discussed, some authors assert in fact that on its basis there are functional symptoms. Although in the past these kinds of disease were considered functional disorders this study revealed that in some cases there are organic problems and that the surgical treatment is necessary.

Adolescent↗

PubMed1977

The surgical gallbladder.

A series of 412 personally performed cholecystectomies is analyzed and discussed. Surgical cases were divided into groups based on whether or not the gallbladder was visualized by cholecystography. A third group required immediate surgery without attempting radiologic investigation. We do not accept the diagnosis of dyskinesia which is a radiological finding as an indication for surgery and no such cases are included in the series. Quite a number of cases operated on for "chronic cholecystitis" were found at surgery to have other less common pathological lesions, as proved by later histologic examination of the excised gallbladders. Bilharzial gallbladder disease is discussed and the new terms bilharzial cholecystitis and bilharzioma of the gallbladder are suggested for the lesions described. We stress the need to explore, inspect and aspirate the common bile duct in every case of calculous cholecystitis as the only alternative to operative cholangiography. By so doing biliary fistulas were completely eliminated from the series.

Adult↗

PubMed1979

[Surgical treatment of cancer of the hepatic duct].

The authors experience with 96 patients treated for cancer of the hepatic porta arising from the hepatic duct is discussed. The most resultant technics of investigation in this pathology are retrograde endoscopic cholangio-cholecystography (in 30 patients) and transjugular cholangiography (in 3 patients). Thirteen patients were radically operated upon, they were subjected to a circular resection of the common bile duct the site of hepatic ducts branching with subsequent hepaticojejunostomy. It is believed that a higher degree of resectability in tumors of this zone may be possible on account of perfection of early diagnosis and widening of an extent of surgery.

Adult↗

PubMed1977

Prevalence of gallstones and gallbladder disease in Canadian Micmac Indian women.

The prevalence of gallstones and gallbladder disease was studied between October 1973 and June 1976 in Canadian Micmac Indian women aged 15 to 50 years in an inland rural community near Shubenacadie, NS. Of 132 women at risk 98 underwent cholecystography, 6 had a history of cholecystectomy (verified from hospital records) and 3 had cholecystectomy because of cholecystitis during the 3 years of the study. Of the 17 abnormal cholecystograms 10 showed radiolucent gallstones, and repeated studies documented gallstones in 6 of the 7 radiographs on which the gallbladder was not visualized. The prevalence of gallstones was found to be 211/1000, and that of gallbladder disease, 240/1000. The peak prevalence was at 30 to 39 years of age. The women with gallbladder disease were significantly more obese and of greater parity than those without gallbladder disease even when age was controlled. The Micmac Indian women of Nova Scotia appear to be at a much higher risk for the development of cholesterol gallstones and gallbladder disease than Caucasian women in Framingham, Massachusetts.

Adolescent↗