Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.1.3.1 (alkaline phosphatase)
 47,916 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective review of the records of 1,507 patients with a diagnosis of cholecystitis was conducted for the five-year period, 1972 to 1977. Of this group of patients, a histopathologic diagnosis of acute cholecystitis was established in 154 patients (10.2%). Common duct calculi were detected in 17 of these 154 patients, an incidence of 11%. Preoperative evaluation by means of serum bilirubin and alkaline phosphatase levels and intravenous cholangiography was unsatisfactory for consistent demonstration of choledocholithiasis in the presence of acute cholecystitis. Intraoperative cholangiography was found to be the most reliable method for detection of common duct calculi and was successfully employed in 14 of 17 patients with choledocholithiasis. The remaining three patients had palpable stones.
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PMID:Choledocholithiasis associated with acute cholecystitis. 46 4

In a prospective series of 155 patients with acute cholecystitis preoperative liver function tests were determined with the aim of predicting the presence of common duct stones. Elevated serum bilirubin, aminotransferases and alkaline phosphatase levels were observed in 32, 34 and 22% of cases, respectively. The frequency of common duct stones was 17.4%. The sensitivity of bilirubin and aminotransferases with regard to ductal stones was higher (70-81%), but alkaline phosphatase showed the best predictive values (46%). The probability of common duct stones increased with higher degrees of elevation in the case of alkaline phosphatase, but not in the case of bilirubin or aminotransferases, A frequency of 31-67% of choledocholithiasis was found when one or all of the tests were positive. After random assignment the patients were operated on early or after delay. In the delayed surgery group more failures occurred in the conservative treatment of acute cholecystitis if the tests were elevated (36%) than if normal (15%, p less than 0.05). The frequencies of common duct stones were 11 and one in these groups (p less than 0.001). There was no increase in postoperative morbidity after early surgery (15%) compared with delayed surgery (22%, p greater than 0.1), when liver function was disturbed. Liver function tests thus allow patients with common duct stones to be selected for early surgery in acute cholecystitis.
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PMID:Abnormal liver function tests in acute cholecystitis; the predicting of common duct stones. 74 32

In a retrospective survey of 202 patients with acute cholecystitis 40 patients (19,8%) were found to have common duct stones. No close correlation between common duct stones and either serum bilirubin or serum alkaline phosphatase could be demonstrated. Therefore it was concluded that peroperative cholangiography is necessary in operations for acute cholecystitis.
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PMID:Common duct stones in patients with acute cholecystitis. 85 22

In this case report, it is emphasized that duration of exposure to an oral contraceptive is not of prime importance. The patient was a 30-year-old woman complaining of sudden onset of severe epigastric pain which radiated to the right upper abdomen and the right shoulder. She had been using anovulatory pills for 18 months. A mass was felt in the right upper abdomen. The white cell count was 21,000/cu mm. Acute cholecystitis was the original diagnosis. In the next 4 days the bilirubin rose to 2.9 mg% and the alkaline phosphatase to 23.1 KA units. At laparotomy the gallbladder was found to be normal. Hepatomegaly was noted. A liver biopsy was taken. Subsequently a liver scan showed a large defect in the right lobe of the liver. Selective angiography of the right hepatic artery showed a large vascular mass. The diagnosis was changed to hepatic adenoma with secondary hemorrhage. Before further surgery the patient suffered a cardiorespiratory arrest and died. At autopsy a hepatic adenoma was found in the right lobe. A large embolus was found blocking the pulmonary arteries. The embolus was considered the cause of the sudden death.
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PMID:Fatal outcome of an hepatic adenoma following short term oral contraceptive use. 92 51

A case of unusual cholecystitis that developed on completion of interleukin-2 and lymphokine-activated killer cell therapy is described. A 62-year-old man was treated with interleukin-2 and lymphokine-activated killer cells for disseminated renal cell carcinoma. During the course of the immunotherapy, his serum alkaline phosphatase level increased, as did the peripheral eosinophil count (0.31). Subsequently, clinical and radiologic evidence of acute cholecystitis was noted. The removed gallbladder showed acalculus cholecystitis with extensive diffuse infiltrates of numerous eosinophils and T lymphocytes, but sparse polymorphonuclear leukocytes. The authors name this unusual cholecystitis acalculus lymphoeosinophilic cholecystitis and believe it to be associated with interleukin-2 and lymphokine-activated killer cell therapy. The pathogenic relationship is discussed.
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PMID:Acalculus lymphoeosinophilic cholecystitis associated with interleukin-2 and lymphokine-activated killer cell therapy. 222 49

An increasingly important subset of patients with biliary tract disease are those with acute cholecystitis. The indications for both routine or selective intraoperative cholangiography (IOC) during elective cholecystectomy may not be appropriate for this group. The utility of IOC in the presence of acute cholecystitis was examined. The medical records of 223 patients with histologically confirmed acute cholecystitis were reviewed. Clinical and laboratory criteria included age, sex, white blood cell count (WBC), serum bilirubin and alkaline phosphatase levels. In 52 (23%) patients, IOC was not attempted and was technically unsuccessful in 15 (7%) patients. IOC was successful in 156 (70%) patients and, of these, six (4%) had a false-positive examination. The remainder are divided into two groups. Group 1 (131 patients) had true-negative IOC, whereas Group 2 (19 patients) had true-positive IOC as evidenced by stone recovery upon surgical exploration. When comparing Group 2 with Group 1, the mean preoperative laboratory values are higher; these differences do not reach statistical significance. Further, within Group 2, five (26%) patients did not demonstrate any clinical or laboratory elevations suggestive of common duct pathology. Thus, in acute cholecystitis, laboratory criteria do not appear to discriminate between the presence or absence of choledocholithiasis. IOC is advocated as an integral component of the operative procedure.
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PMID:The utility of intraoperative cholangiography with acute cholecystitis. 272 79

Hepatobiliary scanning is considered to be a highly accurate method for the diagnosis of acute cholecystitis. False-positive scans (failure to visualize the gallbladder in the absence of cholecystitis) have been reported to occur in fasted patients receiving total parenteral nutrition (TPN). To determine the prevalence of false-positive scans in this patient population and identify factors that might be associated with scan outcome, hepatobiliary imaging was performed in fasted patients receiving TPN and without clinical evidence of acute cholecystitis. Gallbladder nonvisualization occurred in 18 of 50 (36%) patients. In the group whose gallbladders did not visualize, a significantly higher male to female ratio (15:3 versus 17:15; p = 0.016), alkaline phosphatase (346 +/- 84 IU/L versus 212 +/- 32 IU/L, p less than 0.04), total bilirubin (1.7 +/- 0.3 mg/dl versus 1.0 +/- 0.2 mg/dl, p less than 0.02), and lower serum albumin (2.4 +/- 0.01 gm/dl versus 2.8 +/- 0.2 gm/dl, p less than 0.02) levels were noted. In 18 patients, gallbladder ultrasonography was also performed, and the presence of sludge or a thickened gallbladder wall did not correlate with scan outcome. The prevalence of false-positive hepatobiliary scans in fasted patients receiving TPN is significant and does not always correlate with a syndrome of acute gallbladder inflammation. The results of such scans must therefore be interpreted with caution in these patients.
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PMID:The value of hepatobiliary scans in fasted patients receiving total parenteral nutrition. 311 94

The technetium Tc 99m-labeled iminodiacetic acid cholescintigram is an extremely accurate examination for detecting early obstruction of the common bile duct in acutely ill patients suspected of having acute cholecystitis or possible obstruction days to years after cholecystectomy. The examination accurately detected common bile duct obstruction in 63 of 65 patients in these two diagnostic categories (positive predictive value, 96.9%). Sonographic evaluations in 43 of these patients failed to reveal ductal dilatation or other abnormality in 26 cases (false-negative rate, 63.4%), and was nondiagnostic because of overlying bowel gas in two cases. The success of the radionuclide examination is attributed to its ability to detect functional impedance to bile flow hours to days before anatomic ductal dilatation occurs, and occasionally even before the alkaline phosphatase level and other liver chemistry values suggest the presence of an obstruction.
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PMID:The early diagnosis of common bile duct obstruction using cholescintigraphy. 390 Apr 52

The clinical records of 216 patients with proven acute cholecystitis treated by cholecystectomy form the basis of this retrospective study. Common bile duct stones were present in 12.4 per cent of these patients. Thirty per cent of the patients with elevated SGOT values, 26.2 per cent of the patients with elevated alkaline phosphatase, and 23.1 per cent of the patients with elevated amylase had common duct stones. The authors found that 17.6 per cent of patients with bilirubin between 1.5 and 2.9 mg/dl had common duct stones, whereas 71.4 per cent of common bile ducts with a bilirubin greater than 5 mg/dl contained stones. Six of 28 patients with common duct stones had normal bilirubin. Cholangiograms were normal in 115 of the 154 cholangiograms performed; six of these common ducts were explored, and no common duct stones found (false-negative cholangiograms 0.0%). Cholangiograms showed stones in 24 patients; common bile duct stones were recovered from 20 of these patients (accuracy rate 83%, false-positive cholangiograms 17%). Wound infections occurred in seven patients (3.7%). Sepsis resulted in death of three patients, and the other two deaths resulted from multi-system failure. This study demonstrates operative cholangiograms to be the most accurate method of detection of common duct stones, and its routine use in patients undergoing cholecystectomy is recommended.
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PMID:Acute cholecystitis. Evaluation of factors influencing common duct exploration. 395 67

The development of peritonitis in hospitalized patients, especially those with significant associated illness, can be a difficult and delayed diagnosis. To ascertain the clinical presentation of acute cholecystitis in this group, a retrospective analysis was performed. Over a 10-year period 18 patients were identified who developed either posttraumatic or postoperative acute cholecystitis. The condition occurred in 12 patients admitted for some form of trauma and in six patients after elective surgery. Fever and right upper quadrant pain and tenderness were present in most. These physical findings were generally accompanied by leukocytosis (average = 16,200), hyperbilirubinemia (average = 4.2), and elevated alkaline phosphatase (average = 214). At laparotomy gangrenous cholecystitis was found in the majority, reflecting delayed diagnosis. Eleven patients had acalculous disease, and seven patients calculous cholecystitis. Three patients died, yielding a 17 per cent mortality. The majority with acalculous disease had significant underlying illness. Shock, multiple transfusions, or infection preceded acute cholecystitis in this group. Those with calculous cholecystitis were usually not as ill prior to its development. The morbidity of acute cholecystitis in previously hospitalized patients can be reduced by an awareness of the predisposing factors in those with acalculous disease. Emphasis should be placed on signs and symptoms rather than laboratory values to ensure early diagnosis and treatment of acute cholecystitis in hospitalized patients regardless of the presence or absence of gallstones.
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PMID:Posttraumatic and postoperative acute cholecystitis. 395 69


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