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At least 145 records · Page 8Linked to original sources

Infusion tomography of the gallbladder: mechanism of gallbladder wall opacification in experimental acute cholecystitis.

A canine model of acute cholecystitis was used to determine the mechanism of opacification of the gallbladder wall by infusion tomography. The experimental data indicate that opacification of the thickened wall of the gallbladder in acute cholecystitis is a function of hypervascularity and transport of the radiopaque material across the capillary wall by polymorphonuclear cells. Tissue-fluid equilibration of the contrast agent may also play a role.

Acute Disease↗

An increased frequency of gallbladder stones in rheumatoid arthritis patients. Factors related to gallbladder stone formation.

OBJECTIVE: In this study, we determined the frequency of gallbladder stone (GBS) in rheumatoid arthritis (RA) patients and evaluated factors which could affect the formation of GBS--such as lipids and the GB motilities of the patients. METHODS: One hundred and thirteen RA patients (92F, 21M, mean disease duration: 8.9 years) and 117 healthy controls (94F, 23M) were included. In all RA patients, the clinical findings were recorded down; biochemical parameters and body mass index (BMI) were determined; and, abdominal ultrasonography was performed. In addition, 16 RA patients and 20 controls who were age-matched were randomly chosen for GB emptying monitored by ultrasound at 30-minute intervals for 2 hours after a mixed meal. Fasting volume (FV), residual volume (RV) and ejection fraction (EF) for all GBs were assessed. RESULTS: There was a tendency towards a higher frequency of GBS including cholecystectomy (11 GBS, 11 cholecystectomy, 19.5%) in RA patients when compared to controls (8 GBS, 5 cholecystectomy, 11.1%) (p = 0.08). The frequency of GBS plus cholecyctectomy in female RA patients (22.8%) was significantly higher than the control group (11.7%, p = 0.044). Logistic regression analysis showed that only older age was significantly associated with the presence of GBS in RA (OR:1.05, p = 0.048). There was no difference between the 2 groups in FV (p > 0.05). RV, PRV and EF were significantly higher in RA patients than in the control group (p < 0.05). CONCLUSION: We diagnosed a higher frequency of GBS in female RA patients when compared to controls. Impaired GB motility in RA patients might contribute to an increased incidence of GBS development.

Anti-Inflammatory Agents, Non-Steroidal↗

Cytopathology of precursor lesions of invasive carcinoma of the gallbladder: a study of bile aspirated from surgically excised gallbladders.

Bile aspirated from 374 gallbladders immediately after they were excised for cholelithiasis or cholecystitis was examined cytologically. Smears from 250 cases were considered adequate for cytologic analysis, and the findings were correlated with the histologic diagnosis. Poor correlation was obtained with hyperplasia (28%) and dysplasia (25%). In contrast, cytohistologic correlation was good for cases of carcinoma in situ (four of six cases) and invasive carcinoma (seven of seven cases). Several reasons are given for the discordance between cytologic and histologic diagnosis of hyperplasia and dysplasia. The experience gained in this study may serve in the preoperative identification of these cancer precursors in high-risk patients.

Adenocarcinoma↗

[Interdigestive gallbladder volume and and meal-induced gallbladder emptying in patients with diabetes].

The aim of the study was to find whether the type of diabetes and the duration of this disease causes any influence on gallbladder (GB) emptying, after exclusion of possible effect of obesity and a hyperglycaemia over 7 mmol/l (126 mg%) on this phenomenon. The investigations were carried out in 44 subjects with diabetes mellitus, among them 22 with type I and 22 with type II. These groups were divided according to disease duration: shorter or longer than 3 years. Two control groups (CI, CII) comprised each 20 healthy subjects. The age of CI and CII corresponded to the age of diabetes groups type I and II, respectively. All subgroups as well as the control groups were matched according to sex percentage structure, body mass index (BMI) and body surface (BS). In groups with type I and II diabetes, the number of cases with diabetic neuropathy was comparable. There was not found any significant (p > 0.05) influence of diabetes on the interdigestive GB volume, neither non-standardized nor standardized with regard to standard BS (1.73 m2). In comparison to the control groups, after a test meal, there was in all diabetic groups a statistically significant (0.001 > p < 0.05) reduction of GB emptying observed. This diminution was most expressed in the group with long-lasting type I diabetes.

Adult↗

Human gallbladder pressure and volume: validation of a new direct method for measurements of gallbladder pressure in patients with acute cholecystitis.

Increased gallbladder (GB) pressure is probably a part of the pathogenesis of acute cholecystitis, and measurements of GB pressure might therefore be of interest. The aim of this study was to validate a microtip pressure transducer for intraluminal GB pressure measurements. In vitro precision and accuracy was within 0.2 mmHg, (SD) and 0.6 +/- 0.1 mmHg (mean +/- SD), respectively. Pressure rise rate was 24.8 +/- 5.5 mmHg s-1. Zero drift was in the range 0.3 +/- 0.4 to 0.8 +/- 0.9 mmHg (mean +/- SD). GB pressure was investigated in 16 patients with acute cholecystitis treated with percutaneous ultrasonically guided cholecystostomy. Basal intraluminal GB pressure was 8.9 mmHg (2.1-12.2 mmHg; n = 9, open cystic duct) and 1.8 and 5.8 mmHg (n = 2, closed cystic duct). There was no significant difference between two different measurements in the same patients (n = 5). The pressure was significantly influenced by respiration (n = 8) and the pressure seems to be higher in the sitting position than in the supine position (n = 5). Cystic duct opening pressure was 10.4, 11.2 and 16.8 mmHg (n = 3). Pressure-volume responses showed that the GB up to a certain volume could accommodate increases in intraluminal volume with only slight changes in intraluminal pressure (n = 4). Except for the zero drift, this piece of equipment seemed to fulfil the requirements of being able to measure pressure in the GB. In vivo measurements showed a good clinical reproducibility of the method, and also that respiration and patient posture influenced the pressure measurements. Further, a GB pressure-volume relationship was demonstrated, and the possibility of a cystic duct opening pressure was described.

Acute Disease↗

Altered gallbladder bile composition in gallstone disease. Relation to gallbladder wall permeability.

The possible role of conjugated bile salts in the induction and mediation of acute aseptic cholecystitis has been assessed. Using an experimental model, we determined the passive permeability to fluorescently labelled dextran in the gallbladder wall when exposed to different bile salts, alone or together with lecithin. Both taurocholate (20 mM) and, in particular, taurodeoxycholate (20 mM) markedly increased the transmural passage of dextran, but this effect was inhibited by lecithin (50 mM). Bile from patients with cholesterol gallstones contained relatively more deoxycholates (19.4% +/- 8.6%) and less lecithin (35 +/- 20 mmol/l) than did bile from patients with uncomplicated gastric disease (14.1 +/- 6.0% deoxycholates and 53 +/- 26 mmol lecithin/l). Since deoxycholates are more inflammation-promoting than cholates in several systems, and lecithin is considered necessary for protection against the devastating effects of bile salts, these findings should not be overlooked in current hypotheses on the pathogenesis of acute calculous cholecystitis.

Adult↗

[Gallbladder polyps and gallbladder stones].

Over a period of 32 years 689 patients with upper abdominal symptoms were examined radiologically at least twice for gall-bladder polyps and stones. All were without evidence of stones initially, but 181 had gall-bladder polyps on first examination. During a mean observation period of 9 1/2 years gall-bladder stones occurred in 18% (pigment stones in about 24%, solitary cholesterol stones in 30% and multiple ones in 46%), regardless of the presence or absence of gall-bladder polyps. There was no evidence for a change from polyps to stones. Cholesterolosis runs through four stages in the course of decades; accumulation of cholesterol esters in subepithelial foam-cell nests is characteristic. 95% of gall-bladder polyps are cholesterol polyps which gradually empty. Prophylactic cholecystectomy for gall-bladder polyps is justified only if they are more than 10 mm in diameter.

Adolescent↗