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PubMed2001

Value of CEA level determination in gallbladder bile in the diagnosis of liver metastases secondary to colorectal adenocarcinoma.

CONTEXT: The relevance of colorectal adenocarcinoma lies in its high incidence, with the liver being the organ most frequently affected by distant metastases. Liver metastases occur in 40 to 50% of patients with colorectal adenocarcinoma, accounting for approximately 80% of deaths in the first three postoperative years. Nevertheless, despite this, they are occasionally susceptible to curative treatment. OBJECTIVE: The present investigation focused on the relationship between the level of carcinoembryonic antigen (CEA) in gallbladder bile and the presence of liver metastases secondary to colorectal adenocarcinoma. DESIGN: Diagnostic test study. SETTING: Surgical Gastroenterology Discipline at the São Paulo Hospital, São Paulo, Brazil. SAMPLE: Forty-five patients with colorectal adenocarcinoma were studied, 30 without liver metastases (group I), and 15 with liver metastases (group II). Diagnosis of liver metastases was made through computed tomography, magnetic resonance imaging and computed tomography during arterial portography. Samples of peripheral blood, portal system blood, and gallbladder bile were collected from patients during the surgical procedure. A control group composed of 18 organ donors underwent the same material collection procedures. CEA level determination was made through fluoroimmunoassay. RESULTS: Mean CEA value in peripheral serum was 2.0 ng/ml (range: 0.7 to 3.8 ng/ml) in the control group, 11.4 ng/ml (range: 0.5 to 110.3 ng/ml) in group I, and 66.0 ng/ml (range: 2.1 to 670 ng/ml) in group II. In the portal system, serum mean values found were 1.9 ng/ml (range: 0.4 to 5.0 ng/ml) in the control group, 15.3 ng/ml (range: 0.8 to 133.3 ng/ml) in group I, and 70.8 ng/ml (range: 1.8 to 725 ng/ml) in group II. Mean values found in gallbladder bile were 4.1 ng/ml (range: 1.0 to 8.6 ng/ml) in the control group, 14.3 ng/ml (range: zero to 93.0 ng/ml) in group I, and 154.8 ng/ml (range: 14.0 to 534.7 ng/ml) in group II. CONCLUSIONS: The CEA level in gallbladder bile is elevated in patients with liver metastases. Determination of CEA both in peripheral serum and in gallbladder bile enabled patients with liver metastases to be distinguished from those without such lesions. The level of CEA in gallbladder bile, however, seems to lead to a more accurate diagnosis of liver metastases secondary to colorectal adenocarcinoma.

Adenocarcinoma↗

PubMed1993

Clinical gallbladder disease in NIDDM subjects. Relationship to duration of diabetes and severity of glycemia.

OBJECTIVE: To examine the relationship between the prevalence of gallbladder disease and severity of glycemia among diabetic individuals and to provide insight into whether the diabetes-gallstone association is a causal one, because NIDDM patients have an increased prevalence of clinical gallbladder disease. RESEARCH DESIGN AND METHODS: We examined 462 diabetic individuals identified during the San Antonio Heart Study, a population-based survey of diabetes and cardiovascular disease in Mexican Americans and non-Hispanic whites. Diabetes was diagnosed according to National Diabetes Data Group criteria. RESULTS: The prevalence of self-reported gallbladder disease was 34.2% in diabetic women and 7.2% in diabetic men. Although duration of diabetes was positively related to the prevalence of gallbladder disease (P < 0.01), type of therapy was not associated, and fasting glucose concentration was inversely associated with gallbladder disease. CONCLUSIONS: Factors other than hyperglycemia may account for the increased prevalence of gallbladder disease in diabetic subjects.

Adult↗

PubMed1998

TRH microinjection into DVC enhances motility of rabbits gallbladder via vagus nerve.

AIM:To investigate the effects of TRH in DVC on motility of the gallbladder in rabbits.METHODS:fter fasted for 15h-18h, rabbits were anesthetized with urethane (1.0g/kg).Gallbladder pressure (GP) was measured by a frog bladder perfused with normal saline.RESULTS:After microinjection of TRH (8.8nmol,1&mgr;l) into DVC,GP was raised and the frequency of phasic contraction of gallbladder (FPCGB) increased. All the doses of TRH (0.13, 0.25, 0.50, 0.80, 1.30nmol, 1&mgr;l) injected into DVC could excite the motility of gallblader. As the dose of TRH was enlarged, the amplitude and duration of the reaction increased. Effects of TRH in DVC on motility of the gallbladder could be completely abolished by atropine (0.2mg/g, i.v.) or vagotomy, but could not be inhibited by phentolamine iv (1.5mg/g) or propranolol iv (1.5mg/g)or by transecting the spinal cord.CONCLUSION: Thyrotropin-releasing hormone in DVC can excite motility of gallbladder. This effect was mediated by vagus nerves and peripheral M receptor. Its physiological significance may be related to maintaining the phasic contraction of gallbladder in interdigestive period.

Journal Article↗

PubMed1999

[Detection of Helicobacter pylori by polymerase reaction in bile samples from gallbladder and bile stones].

Some papers report helicobacter pylori existence in bile from surgical specimens obtained during gallbladder or bile ducts surgery. The aim of this work was search by PCR, H. Pylori presence in bile specimens from patients suffering of gallbladder stones or by bile ducts stones. Bile samples were obtained by gallbladder punction during cholecystectomy in 26 patients, 19 of them with gallbladder stones and 7 also with gallbladder stones and bile duct stones. Age ranged from 22-69 years old, median 49.6 years old. Samples were sent to specialized biomolecular laboratory to perform PCR techniques. Two of 26 patients (7.6%) had positive reaction for the presence of DNA of H. Pylori in bile samples. Our research suggest that DNA of H. Pylori can be founded in bile samples patients with gallbladders and duct stones in Argentina.

Adult↗

PubMed1999

Nifedipine is not feasible for biliary pain in patients with gallbladder stones.

OBJECTIVE: Biliary pain is generally treated with NSAIDs and spasmolytics, but some patients do not tolerate them. Nifedipine has been suggested to have some analgesic effect and it has been used successfully in many painful smooth muscle disorders. Our aim was to evaluate the effect of nifedipine for biliary colics and gallbladder volume. PATIENTS AND METHODS: Twenty-seven patients suffering from uncomplicated symptomatic gallbladder stones were prospectively randomized to receive either oral nifedipine (10 mg 3 times daily) or placebo in a double-blind manner. Liver chemistry and ultrasonography were examined before and after the 8-week study period. The patients completed each day a diary of their pain, headache, palpitation, burning feeling in skin, dizziness, and their use of painkillers. RESULTS: Biliary pain seemed to be less intensive and shorter in duration, but without statistical significance, whereas headache tended to be more common (p = 0.077) in nifedipine group than that in placebo group. This difference would have reached statistical significance with over 155 patients randomized. Overall additional drug use was similar in both groups, and was increased in nifedipine group for headache (p = 0.05). The fasting gallbladder volume tended to decrease (p = 0.085) during the nifedipine treatment but not with placebo. Serum liver chemistry remained within normal range. CONCLUSIONS: This small study shows that nifedipine may decrease slightly biliary pain intensity and duration, and contrary to previous findings in healthy volunteers, it seems to decrease resting gallbladder volume in patients with symptomatic uncomplicated gallbladder stones, but did not reduce the need of traditional pain medication partly because of increased need for headache. Thus it is not a feasible choice for routine use against biliary pain in symptomatic gallbladder stones, which is why the study was not continued to reach statistical significance in respect to biliary pain.

Adult↗

PubMed1976

Puncture of the gallbladder during peritoneoscopy - technique and diagnostic relevance (author's transl).

Peritoneoscopic puncture of the gallbladder for transvesical cholecysto-cholangiography and for aspiration of bile for chemical and bacteriological analysis is performed rather rarely because of a seemingly high rate of complications. The risk however is low if an appropriate technique is used. In our series the gallbladder was punctured in 110 cases; a local peritonitis subsiding under conservative treatment occured as a complication in only one case. Peritoneoscopic puncture of the gallbladder is indicated in the following conditions: extrahepatic occlusion of the bile duct system of unknown origin, nonvisualization of the gallbladder during cholangiography, biliary dyskinesia, typical biliary colics with normal X-ray findings. In addition, gallbladder puncture should be done if any suspicion of gallbladder disease arises during peritoneoscopy. The procedure as well as technical variations for cholecysto-cholangiography and for X-ray investigation of the pancreatic duct system are described.

Bile↗

PubMedDate not supplied

[Gallbladder ascariasis with acute hepatitis. Conservative treatment].

We report two cases of gallbladder ascaridiasis associated with acute hepatitis, its clinical evolution with conservative treatment, making diagnosis by both laboratory and ultrasono-graphic studies. Case 1: was a male in his early forties who experienced symptoms of acute hepatitis and cholecystitis within a time lapse of 72 h of evolution. When laboratory tests and ultrasound (US) were done, an ascaris inside gallbladder was corroborated. There were also alterations compatible with acute non-viral hepatitis. Conservative treatment was done with observations within an 8-day period that hepatic examinations were normal as well as absence of helminthus inside gallbladder. Case 2: A 10-year-old female, who expelled worms 8 months previously had 11 days evidence of acute cholecystitis and hepatitis. An ultrasound of liver and biliary tract was done, with evidence of Ascaris lumbricoides inside gallbladder, with alterations in hepatic tests. This was medically treated, achieving expulsion of the Ascaris lumbricoides from inside the gallbladder and normalization of liver function tests. Gallbladder ascaridiasis management may be conservative. Patient general condition must be evaluated, as well or medical evolution and associated pathologies that may interfere in certain ways in surgery. Follow-up of these patients must be strict, with medical evaluation and laboratory controls.

Acute Disease↗

PubMed1983

Gallbladder disease in patients on long-term parenteral nutrition.

Recent anecdotal reports suggest that total parenteral nutrition may be associated with an increased incidence of both acalculous cholecystitis and cholelithiasis. The validity of this association, however, has not been tested in a large population of patients on long-term total parenteral nutrition. Therefore, we assessed the incidence of gallbladder disease among our patients 15 yr and older who had received a minimum of 3 mo of total parenteral nutrition. Of the patients meeting these criteria, 128 were on total parenteral nutrition a mean of 13.5 mo. Nineteen had gallbladder disease before receiving total parenteral nutrition, leaving 109 patients at risk. Of these patients, 25 (23%) developed gallbladder disease after the initiation of total parenteral nutrition. Because of their known propensity for cholelithiasis, 94 of our patients with ileal disorders (Crohn's disease or ileal resection, or both) were considered separately. The 40% incidence of gallbladder disease in these 94 patients was significantly higher than expected from a series of similarly defined patients with ileal disorders not receiving total parenteral nutrition (p less than 0.05). We propose that the enhanced risk of gallbladder disease among patients on long-term total parenteral nutrition results from multiple factors working in concert to promote gallbladder stasis.

Adolescent↗

PubMed1984

Gallbladder disease: risk factor for colorectal carcinoma?

The relation between gallbladder disease and the risk of colorectal carcinoma (CRC) is examined in light of 864 consecutive adult postmortem examinations analyzed for significant associations between the state of the gallbladder (normal, cholelithiasis, and cholecystectomy) and the presence of colorectal carcinoma. Our findings supported the known association between female sex and gallbladder disease (p = 0.02) and revealed a significant association between cholelithiasis and/or cholecystectomy and colorectal cancer (p less than 0.02). The frequency of CRC was higher in patients who had a cholecystectomy than in those still with stones, but this difference was not statistically significant. The data suggests a sex-linked dependence between the state of gallbladder and CRC. However, the proper statistical test for this dependence was not significant (p less than 0.25), no doubt as a result of the relatively small amount of data for persons with gallbladder disease. We conclude that the state of gallbladder may modify the risk for colorectal carcinoma.

Cholecystectomy↗

PubMed1993

Direct dissolution of gallstones with methyl tert-butyl ether by endoscopic cannulation of the gallbladder.

Methyl tert-butyl ether (MTBE) rapidly and effectively dissolves cholesterol gallbladder stones. Due to the invasive nature of transhepatic catheterization, we studied the safety and efficacy of MTBE stone dissolution, delivered by endoscopic, retrograde cannulation of the gallbladder. Extracorporeal shock-wave lithotripsy (ESWL) was employed in patients with multiple stones, to increase contact surface area and facilitate dissolution. We successfully cannulated the gallbladder in 13/17 patients (76.5%) attempted, with no associated complications. After cannulation, MTBE lysis was then conducted on all patients, and 10/13 patients (77%) cannulated were either stone-free at completion, or had only residual gallbladder sludge. Predissolution ESWL successfully fragmented stones in 6/7 patients (86%) in which it was attempted. Both ESWL and MTBE were well tolerated by all patients. Endoscopic retrograde cannulation of the gallbladder and MTBE dissolution is a promising alternative for the treatment of gallbladder stones in patients who will not receive surgery.

Aged↗

PubMedDate not supplied

Sonography of gallbladder abnormalities in acromegaly patients following octreotide and ursodiol therapy: incidence and time course.

PURPOSE: We studied the effects of octreotide and ursodiol on the gallbladders of patients with acromegaly. METHODS: We performed gallbladder sonography in patients with acromegaly at various intervals during treatment. Group I (18 patients) was treated with subcutaneous injections of the somatostatin analogue octreotide. Group II (10 patients) was treated with ursodiol while receiving octreotide therapy. RESULTS: Seventy-eight percent of patients receiving octreotide developed gallbladder abnormalities: sludge in 72% (13/18) and calculi in 39% (7/18). Ursodiol reversed the gallbladder abnormalities in 7 of 10 patients. CONCLUSIONS: A majority of patients receiving octreotide develop gallbladder abnormalities. Ursodiol appears to reverse the abnormalities in most cases.

Acromegaly↗

PubMed1986

The histogenesis of adenocarcinoma of the gallbladder.

A prospective study of 277 cholecystectomy specimens for evidence of isolated epithelial dysplasia of gallbladder mucosa is presented. In addition, 15 cases of primary adenocarcinoma of the gallbladder are retrospectively reviewed with particular reference to the presence of metaplasia and dysplasia adjacent to the infiltrating tumor, in order to establish the relationship between metaplasia, isolated epithelial dysplasia, and adenocarcinoma of the gallbladder. Only one case of isolated epithelial dysplasia was found in the 277 cholecystectomy specimens, and this arose within focal incomplete intestinal metaplasia. In the 15 cases of adenocarcinoma of the gallbladder, benign antral and/or incomplete intestinal metaplasia was found adjacent to the tumor in 11 cases. In 10 cases, dysplasia of this metaplastic epithelium was found in continuity with the tumor. The authors conclude that the most common pathway to adenocarcinoma is via dysplasia of metaplastic gallbladder epithelium.

Adenocarcinoma↗

PubMed1982

Ultrasound patterns of metastatic tumors in the gallbladder.

Eleven cases of sonographically detected metastatic disease to the gallbladder are reported. This paper represents the first comprehensive review of the ultrasonographic findings in this not infrequently encountered disease process. Four distinctive sonographic diagnostic patterns have evolved and are described. The suspicion of metastatic tumors in the gallbladder should be raised, particularly in the presence of focal gallbladder wall thickening in association with nonshadowing intraluminal soft tissue masses. In contrast to primary carcinomas of the gallbladder, cholelithiasis usually is absent. The differential diagnosis, which includes various benign conditions of the gallbladder, is discussed.

Adult↗

PubMed2003

Differential diagnosis of gallbladder cancer using positron emission tomography with fluorine-18-labeled fluoro-deoxyglucose (FDG-PET).

BACKGROUND AND OBJECTIVES: The purpose of this paper is to evaluate the utility of positron emission tomography (PET) with fluorine-18-labeled fluoro-deoxyglucose (FDG) in the preoperative differential diagnosis of gallbladder tumors. We performed PET studies of gallbladder tumors in order to predict the malignancy of these tumors preoperatively. METHODS: Sixteen patients who had protuberant lesions in the gallbladder and who were scheduled to undergo surgery were studied with PET using FDG. Focally increased FDG uptake in the gallbladder region was considered malignant. The FDG-PET findings were compared with the histological findings of surgical pathology. RESULTS: Sensitivity of FDG-PET was 75% (6/8 patients). One of two false-negative cases suffered from diabetes mellitus, and in the other case, the lesion was small. Specificity was 87.5% (7/8 patients). A case with xanthogranulomatous cholecystitis (XGC) was the only false-positive case. CONCLUSIONS: FDG-PET may be able to provide important information for evaluating the malignancy of gallbladder tumors.

Adenocarcinoma↗

PubMed2006

Infection as a risk factor for gallbladder cancer.

Gallbladder cancer is a common hepato-biliary malignancy with poor prognosis. The main associated risk factors identified so far include cholelithiasis (especially mixed gall stone), chronic infections of the gallbladder, obesity, reproductive factors, diet, hepato-biliary anamolies, and environmental exposure to specific chemicals. Genetic and molecular predisposing factors have also been described. This article reviews the association of chronic infection and gallbladder cancer. Most of the studies have shown a good association of mixed bacterial and Salmonella infections in the carcinogenesis of cancer gallbladder especially in the area of high endemicity of typhoid. Bacterial degradation of bile and chronic inflammation may also play some role in the carcinogenic process. Mutations in multiple tumor suppressor gene and oncogenes (P53 and K-ras) have also been found in a few studies. This review seeks to bring out many hidden infective etiological aspects of the pathogenesis of gallbladder cancer. Review of the entire published literature suggests a need for further studies for better understanding of the disease.

Bacterial Infections↗

PubMed1994

Hepatic metastasis after laparoscopic cholecystectomy for polypoid gallbladder cancer followed by radical surgery.

While laparoscopic cholecystectomy is being increasingly performed on patients with gallbladder disease, this approach in cases of polypoid lesions in the gallbladder may not always be justified. We report here a case of early development of intrahepatic metastasis after laparoscopic cholecystectomy for polypoid gallbladder cancer; wedge resection of the gallbladder bed and dissection of regional lymph nodes had to be done. When a malignancy of the gallbladder is suspected during preoperative examinations, open cholecystectomy should be done.

Adenocarcinoma, Papillary↗

PubMed1996

Contracted gallbladder: a cause of false-positive hepatobiliary scan in patients with cystic fibrosis.

Gallbladder nonvisualization on hepatobiliary scintigraphy in cystic fibrosis is generally secondary to cystic duct obstruction from inspissated bile, mucus, or gallstones. We report gallbladder nonvisualization on hepatobiliary imaging in two patients with cystic fibrosis who had contracted gallbladders on ultrasonography. Repeat ultrasonography at 6 months revealed persistent gallbladder contraction. A contracted gallbladder therefore is a potential cause of a false-positive hepatobiliary scan which can be treated with conservative management.

Abdominal Pain↗

PubMed1996

Gallbladder abnormalities in medical ICU patients: an ultrasonographic study.

Patients in the intensive care unit (ICU) have many risks factors for gallbladder stasis or acute acalculous cholecystitis (ACC), including fasting, total parenteral nutrition, sedation, mechanical ventilation, infection and shock. We have performed a prospective study to estimate the prevalence of ultrasonographic gallbladder abnormalities in 30 consecutive medical ICU patients during the first 2 days of their stay in the ICU. Two patients had previously undergone cholecystectomy and were excluded from the study. Seventeen (61%) of the remaining 28 patients presented with gallbladder abnormalities. Considering three major criteria of ACC, 14 patients (50%) presented with either sludge (25%), wall thickening (22%) or hydrops (11%). However, none of the patients needed a surgical procedure during the study because of gallbladder disease. We conclude that an important proportion of ICU patients presented with gallbladder abnormalities shown by ultrasonography and that this may have implications for establishing a diagnosis of ACC using ultrasonographic criteria.

Female↗