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PubMed1992

Computed tomographic finding in adenomyomatosis of the gallbladder.

We report on an uncommon case of symptomatic generalized adenomyomatosis of the gallbladder. It was initially suspected by ultrasonography and further confirmed by computed tomography (CT). A postcontrast CT scan at the level of the gallbladder body demonstrated the characteristic rosary sign. The rosary sign is formed by the enhanced proliferative mucosal epithelium with the intramural diverticula surrounded by the unenhanced hypertrophied muscle coat of the gallbladder. Similar CT scans were obtained sequentially in the caudal direction. These CT scan findings indicated generalized adenomyomatosis of the gallbladder. The patient received a cholecystectomy. The pathologic report showed specific changes of adenomyomatosis corresponding to the findings on the CT scan. Generalized adenomyomatosis of the gallbladder, therefore, can be accurately diagnosed by CT.

Adult↗

PubMed1992

[The effect of chenotherapy on the reservoir function of the gallbladder in cholelithiasis patients].

The effect of chenodeoxycholic acid (CDCA) on the reservoir function of the gallbladder was studied in 46 patients with cholesterol cholelithiasis. There was a dependence between a clear increase of filling of the gallbladder in patients treated by this method with subsequent sharp reduction of its size and development of dyspepsia and diarrhea. In 14 patients increase of the gallbladder against the background of chemotherapy was not authentic but no dyspeptic phenomena occurred. Thus, decompensation of the reservoir function of the gallbladder in patients with cholelithiasis against the background of chemotherapy are manifested by a significant increase of the gallbladder size with subsequent emptying of bile into the duodenum and development of collagenous diarrhea.

Adolescent↗

PubMed2003

[Gallbladder motor activity in patients with virus hepatitis B].

In acute stage of virus hepatitis B patients often complain of dyspeptic discomfort. They may be a consequence of alimentary tract motor activity disorders including these of gallbladder. Routine ultrasonography in an early phase of virus hepatitis often reveals gallbladder wall thickening what may confirm the above thesis. Thus, a group of 15 patients in an acute phase of virus hepatitis B was subjected to examinations. Gallbladder motor activity was assessed by ultrasonographic method determining its total volume and ejection fraction and volume after test meal stimulus. First examination was performed in the first week since the appearance of yellowing of the walls, successive in 4 and 8 week of the disease. Obtained results were compared to the values obtained in the group of 25 healthy volunteers. It was found out that gallbladder volume was significantly decreased and ejection fraction increased in the acute phase of virus hepatitis B than in the controls. This may speak for gallbladder hyperreactivity in patients in the course of virus hepatitis B. These disorders decreased during two-month observation but even in the 8 week the investigated parameters differed from those found in the control group.

Acute Disease↗

PubMed1992

[Simultaneous sonographic study of postprandial gastric emptying and gallbladder contraction].

Postprandial gastric emptying and gallbladder contraction were assessed in 14 healthy subjects by means of ultrasonography after oral administration of a semi-liquid test meal (250 ml, 1450 kJ). For this purpose, cross-sectional areas of the gastric antrum and gallbladder volume were calculated and recorded over a period of 120 minutes using an annular-array-transducer. The semi-liquid test meal allowed suitable sonographic measurement of cross-sectional areas of the antrum in all 14 subjects. Mean half-time of gastric emptying was 47 minutes (range 17-72 minutes). Mean peak gallbladder contraction was 36% (range 17-60%) of initial volume and mean time to peak contraction was 65 minutes (range 20-120 minutes). The method described was found to be a practical and reliable procedure for the investigation of postprandial gastric emptying and gallbladder contraction. It is therefore of potential interest for application to a variety of clinical questions. A minor drawback involves the relative length and variability of time required for testing, owing to the wide range in the time-course of gastric emptying and gallbladder contraction across subjects. Normal ranges for defined test meals must be established in large control groups.

Adult↗

PubMedDate not supplied

[Assessment of gallbladder motility in patients with alcoholic hepatic cirrhosis after a fatty meal. A real-time ultrasonography study].

Gallbladder emptying after fatty meal administration was investigated by real-time ultrasonography in 10 patients with alcoholic cirrhosis of the liver, and 10 normal controls. Gallbladder volume was measured using the sum of cylinders method before and 5', 15', 20', 30', 60', 90', and 120' after fatty meal administration. Patients with liver cirrhosis presented the gallbladder volume significantly increased after 15' and 20', and significantly reduced after 60' and 90' in respect to controls. A significant difference was found between the groups in the two curves, patients showing a retarded contraction of gallbladder. The mechanism for sluggish gallbladder emptying in liver cirrhosis is unknown, however impaired emptying with bile stasis provides a potential pathophysiology basis for the high frequency of cholelithiasis in this disease.

Adult↗

PubMedDate not supplied

Hepatocarcinoma, gallstone disease and gallbladder carcinoma: a case report of a rare incidental association.

We report a rare case of a patient operated on with a diagnosis of hepatic tumour and gallstone disease, which postoperatively was found to be a hepatocellular carcinoma associated with a gallbladder carcinoma. Spiral CT at admission showed only a hepatic mass in the 4th segment, compatible with hepatocellular carcinoma and gallbladder lithiasis. Cholecystectomy was performed followed by a wedge resection of the 4th segment of the liver. The histopathological examination revealed a well-differentiated hepatocellular carcinoma and, surprisingly, an adenocarcinoma of the gallbladder confined to the mucosa. The association of a hepatocellular carcinoma and gallbladder adenocarcinoma is extremely rare. This association, together with an analysis of the literature showing the increased incidence of gallstones in cirrhotic patients and the consequent greater surgical risk when undergoing subsequent cholecystectomy after liver resection, would suggest that cholecystectomy should be performed routinely during liver resection for hepatocellular carcinoma or cirrhosis, even for minor resections and when there are no evident signs of gallbladder disease.

Adenocarcinoma↗

PubMed1991

[Cell kinetic studies on the gallbladder epithelium in patient with anomalous arrangement of pancreatobiliary duct].

It is well known that the patients with anomalous arrangement of pancreatobiliary duct (AAPBD) are combined with biliary tract cancer. To clarify possible carcinogenesis of the gallbladder with AAPBD, DNA analysis of the gallbladder epithelium was performed in control (9 cases), AAPBD (26), gallbladder cancer confined in mucosa (10) and noncancerous epithelium around the gallbladder cancer (21). The mean values of DNA score, as already reported by us as an indicator of cell kinetics, were 12.1 (control), 27.2 (AAPBD, Type a), 13.3 (AAPBD, Type b), 14.8 (noncancerous epithelium around cancer) and 77.2 (gallbladder cancer confined in mucosa). The values of DNA score in the epithelium of AAPBD (Type a) showed significantly high level, which was next to that of cancer. Type a AAPBD may be supposed to have potential malignancy because of its accelerated cell cycle. But as Type b AAPBD without accelerated cell cycle combines cancer at least as often as Type a, further studies should be performed to reveal the relationship between cell cycle and malignancy.

Bile Ducts↗

PubMedDate not supplied

[Porcelain gallbladder and cancer (author's transl)].

The porcelain gallbladder is a rare entity. It reaches especially the old woman. Most of the porcelain gallbladders have a great clinical latence. A cancer of the gallbladder exists in eleven per cent of the cases: this justifies a systematic cholecystectomy of the calcified gallbladders, even if they are asymptomatic. Another digestive cancer exists in nine per cent of the cases. Three personal observations of porcelain gallbladder which are associated with a cancer are described: they confirm the facts of the literature.

Aged↗

PubMed1988

Carcinoma in a true diverticulum of the gallbladder.

Extensive search of the literature reveals the extreme rarity of true diverticulum of the gallbladder. Its frequency varies from 0.0008% of all resected gallbladders at the Mayo Clinic to 0.06% of a series of congenital anomalies of the gallbladder collected from the world literature. We are presenting a case of a true diverticulum of the gallbladder with sonographic demonstration and focal malignant alterations, neither one of which has been reported previously. The difference between true and false diverticula of the gallbladder is discussed.

Diverticulum↗

PubMed1987

Computed tomographic evaluation of gallbladder disease.

Evaluation of gallbladder diseases by computed tomography (CT) is limited compared with ultrasonographic evaluation. However, CT can bring about excellent information in advanced carcinoma of the gallbladder, severe and complicated cholecystitis, porcelain gallbladder, and indication for dissolution of gallbladder stones. Unique findings are also available in emphysematous cholecystitis, xanthogranulomatous cholecystitis, stones with gas (Mercedez-Benz sign), limy bile, and enhancement in acute cholecystitis. Combined use of CT and ultrasound apparently increase the accuracy of diagnosis in carcinoma and cholecystitis. This article is composed of sections on carcinoma, cholecystitis, stone, bile in the gallbladder, calcification, gas and fat, and miscellaneous topics including polypoid lesions, adenomyomatosis, hydrops, and wall thickening.

Cholecystitis↗

PubMed1986

The lack of effect of metoclopramide on gallbladder volume and contraction in diabetic cholecystoparesis.

Impaired gallbladder contraction has been previously shown in diabetes mellitus. In this study gallbladder contraction was measured by real-time ultrasonography in 20 subjects (eight healthy controls and 12 diabetics) studied twice on 2 consecutive days, before and after intravenous metoclopramide injection. Contraction was expressed by fasting gallbladder volume and residual gallbladder volume after maximal emptying. Fasting volumes were significantly larger in the diabetics (22.4 +/- 2.1 ml) as compared to the controls (16.15 +/- 1.69 ml) (p less than 0.001). Residual volumes were also significantly larger in the diabetics (12.4 +/- 2.09 ml) as compared to the controls (5.6 +/- 0.58 ml) (p less than 0.001). The rate of gallbladder emptying was significantly (p less than 0.001) slower in the diabetics (0.0326 +/- 0.0056) as compared to the controls (0.0498 +/- 0.0066), but no difference could be shown in the diabetics after administration of metoclopramide (0.0368 +/- 0.0048). No difference was found in the diabetic group before and after injection of 10 mg metoclopramide. The results imply that diabetic cholecystoparesis is not entirely related to autonomic neuropathy since it is not corrected by metoclopramide, a known cholinergic stimulant.

Adult↗

PubMed1984

[Gallbladder atony and celiac disease in adults. Radiographic and echographic study of 15 cases].

Gallbladder emptying was evaluated in 15 adult celiac disease patients by oral cholecystography or ultrasonography, after fatty meal or cholecystokinin stimulation. Gallbladder inertia was found in 13 cases. Our study agrees with previously reported results; however it is the first one in which this abnormality was demonstrated by ultrasonography. Our findings may suggest that gallbladder inertia is due to duodenal release of an inactive endogenous cholecystokinin. Control studies demonstrates that gallbladder inertia is reversible after gluten-free diet, recurs with relapse, and thus represents a true celiac disease sign, and not an associated condition. Finally, our cases suggest that gallbladder inertia may be radiologically evident before clinical features of malabsorption become apparent. Awareness of this possibility may persuade the radiologist to research in this condition an occult celiac disease.

Adult↗

PubMed1983

[Comparative diagnostic value of echography and oral radiologic examination of the gallbladder in relation to surgical findings].

For nearly 60 years, since it was introduced by Graham and Cole (1924), oral cholecystography (OCG) has been used as the imaging technique of choice in investigation of gallbladder disorders. Recently, the future of OCG has come into doubt, principally as a result of ultrasonography, with the advent of high-resolution real-time scanning. Stones are seen as echoes within the lumen of the gallbladder and are associated with an acoustic shadow, findings which are highly specific. On this basis, to evaluate the accuracy of ultrasonography in detecting cholelithiasis, the A. have performed by real-time cholecystosonography 60 patients with not diagnostic OCG in a group of 546 patients affected by gallbladder diseases. Our results have confirmed that sonography revealed 4 normal gallbladders, 51 gallstones and 1 primary gallbladder cancer, with 5 cases of false positive. The true false negative rate has been difficult to determine, as surgery is usually not performed after a negative study. The accuracy of cholecystosonography for gallstone diagnosis was found to be 88,1% for all three Crade's categories.

Cholecystography↗

PubMed1982

Biliary lipids, bile acids, and gallbladder function in the human female: effects of contraceptive steroids.

Individuals who take contraceptive steroids or estrogens are at increased risk of developing cholesterol gallstones. The mechanisms of the increased stone formation are incompletely understood. In this study we report biliary lipid composition and secretion, bile acid composition and kinetics, and gallbladder function in a group of healthy, nonobese women taking a contraceptive steroid preparation. A comparable group of healthy women served as controls. Bile-rich duodenal fluid was obtained after stimulation of gallbladder contraction; bile acid, phospholipid, and cholesterol concentrations were determined. Biliary lipid secretion rate was measured by the marker perfusion technique. Bile acid distribution was determined by gas-liquid chromatography. The pool size, FTR, and synthesis rate of each bile acid were measured by using CA and CDCA labeled with the stable isotope of carbon, 13C. In some of the subjects gallbladder storage and emptying were measured during the kinetic study, by real-time ultrasonography. Contraceptive steroid use was associated with a significant increase in biliary cholesterol saturation and in the lithogenic index of bile. The rate of cholesterol secretion in the contraceptive steroid group was 50% greater than in the control (p much less than 0.001) and the rate of bile acid secretion was reduced (p less than 0.02). The total bile acid pool size was significantly increased by contraceptive steroids. The major increase occurred in the CA pool (p less than 0.04). The daily rate of enterohepatic cycles of the bile acid pool was decreased by contraceptive steroids from 6.6 to 4.3 (p less than 0.01). The only effect of contraceptive steroids on gallbladder function was a slower emptying rate in response to intraduodenal amino acid infusion. No index of gallbladder function correlated significantly with any parameter of bile acid kinetics in this small group of subjects. The findings confirm the lithogenic effect of contraceptive steroids and indicate that its causes are an increase in cholesterol secretion and a decrease in bile acid secretion.

Bile↗

PubMed1994

[Laparoscopic cholecystectomy makes difficult the analysis of gallbladder mucosa. Morphometric study].

Laparoscopic gallbladder surgery damages gallbladder mucosa, impeding an adequate histological examination. We studied gallbladder samples coming from 56 conventional and 44 laparoscopic cholecystectomies performed in patients with chronic cholecystitis without signs of acute inflammation. The length of each examined sample and the length of the portion where superficial epithelia was not found was measured. No differences in sample length was found between both types of cholecystectomy. However; the segment with superficial mucosa was significantly shorter in the samples coming from laparoscopic surgery. Seventeen samples did not contain mucosa at all and 14 of these (82%) came from laparoscopic procedures. Eighty six percent of samples coming from laparoscopic surgery were considered inadequate for histological study compared to 36% of samples coming from conventional cholecystectomy. It is concluded that laparoscopic cholecystectomy hampers the study of gallbladder mucosa and may have an impact on the diagnosis of neoplastic gallbladder lesions.

Cholecystectomy↗

PubMed1993

Cultured human gallbladder epithelia. Methods and partial characterization of a carcinoma-derived model.

BACKGROUND: Gallstone disease remains a leading cause of morbidity and mortality in humans. Despite extensive research into the physiology of the gallbladder, little is known about mucosal events that precede and contribute to stone formation. Here, we describe and partially characterize a cultured epithelial model of human gallbladder mucosa. EXPERIMENTAL DESIGN: Cells originally obtained from a well-differentiated gallbladder mucosal carcinoma were cultured in modified Eagle's minimum media (supplemented with fetal calf serum and antibiotics) on polycarbonate supporting matrices. RESULTS: Cell cultures were observed to come to confluence with 6 to 9 days. Light and transmission electron microscopy demonstrated the resultant epithelia to be predominantly one cell thick, to be polar in orientation, and to have apical villi. Epithelia exhibited cytokeratin markers consistent with their epithelia origin, functionally acidified the mucosal bathing solutions, and secreted mucin. Further experiments demonstrated transepithelial potential differences, mucosal-to-serosal transfer of sodium which could be inhibited with amiloride and 4-acetamido-4'-isothiocyanatostilbene-2-2'-disulfonic acid, and paracellular movement of neutral molecular probes inversely related to size. CONCLUSIONS: This culture model of human gallbladder mucosal carcinoma cells exhibits parameters consistent with native gallbladder and may offer a convenient new research tool for the study of the pathophysiology of gallstone formation.

4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfo↗

PubMed1995

Hepatopancreatoduodenectomy for squamous and adenosquamous carcinoma of the gallbladder.

The characteristics of squamous or adenosquamous cell carcinoma of the gallbladder differ quite markedly from those of adenocarcinoma, although the incidence is extremely low. Recently, we encountered both of the former types of gallbladder carcinoma: a 77-year-old man with squamous cell carcinoma and a 70-year-old man with adenosquamous cell carcinoma of the gallbladder. Both had a large mass in the gallbladder fossa region with infiltration to the liver and invasion of the duodenum. Hepatopancreatoduodenectomy was performed on both of these patients. The TNM stage of the former was IV (T4N0M0) and of the latter IV (T4N0M0) and of the latter IV (T4N1bM0). The former has remained well without recurrence for about 1 year and 4 months after the operation, while the latter died of recurrent disease 6 months after operation. The true reason for the difference in the prognosis of these two patients was not known. However, hepatopancreatoduodenectomy is considered to be a most adaptable operative procedure for squamous or adenosquamous cell carcinoma of the gallbladder in view of their mode of spread, and the presence of lymph node metastasis might be a factor of poor prognosis.

Aged↗

PubMed1994

[A preliminary study of gallbladder emptying in non-ulcer dyspepsia].

UNLABELLED: The relationship between non-ulcer dyspepsia (NUD) and gastric emptying was described in detail in our previous paper "study of gastric emptying and non-ulcer dyspepsia". The present study was designed to evaluate whether patients with non-ulcer dyspepsia present any alteration of gallbladder motility in response to a meal, and whether the altered gallbladder emptying coordinates with gastric emptying and is related with gastrointestinal symptoms. RESULTS: (1) There was no statistical difference of fasting gallbladder volume and GBEFmax between 38 NUD patients and 30 symptom-free controls. The gallbladder emptying rate in NUD patients however was either slower or faster than that of controls, it was associated with the dyspepsia symptoms of NUD patients. (2) Delayed gastric emptying did not affect gallbladder contraction.

Adult↗