Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0008325 (cholecystitis)
 3,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The study covers twenty-two patients with chronic calculous cholecystitis (CCC) subjected to operative treatment. Diverticula are discovered in three of them (1.4 per cent), and pseudodiverticula of the gallbladder--in eighteen (8.2 per cent). In all patients presenting diverticula and pseudodiverticula of the gallbladder, the clinical course of the disease is typical of CCC, and in three it is characterized by the clinical picture of obstructive jaundice. Concrements are documented echographically in all cases. Intraoperatively, numerous adhesions, gallbladder kinking at infundibulum level with inflated gallbladder type "Hartmann's pouch" are established in all 18 patients presenting pseudodiverticula. Two of them have empyema of the gallbladder, and in one a colonic-vesical fistula is detected. All patients are subjected to operative management. The immediate postoperative and long-term results are estimated as very good.
 ...
PMID:[Diverticula and pseudodiverticula of the gallbladder in chronic calculous cholecystitis]. 912 Oct 64

Acute cholecystitis due to Campylobacter fetus subsp. fetus is very uncommon. We report a case of cholecystitis and obstructive jaundice in which cultured bile grew this organism. The patient had a 4-year history of hepatocellular carcinoma, resulting in common bile duct obstruction due to abdominal lymph node metastasis. Microscopic examination of her bile showed multiple Gram-negative curved organisms and C. fetus subsp. fetus was isolated under microaerophilic conditions. Therefore, we should be aware of this organism and use microaerophilic culture in association with the result of microscopic examination of bile specimens.
 ...
PMID:Campylobacter fetus subsp. fetus cholecystitis in a patient with advanced hepatocellular carcinoma. 918 60

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. In severe cases, inflammation extends to adjacent structures, and XGC is sometimes confused with a malignant neoplasm. We recently diagnosed XGC as the preoperative cause of Mirizzi syndrome in a patient based on the clinical course. The patient was admitted because of obstructive jaundice, with gallbladder carcinoma as the suspected cause. The gallbladder was swollen with gallstones and the serum level of carbohydrate antigen 19-9 (CA19-9) was 3070 U/ml at admission. A percutaneous transhepatic cholangiodrainage (PTCD) was done, and the common hepatic duct as well as the right and left hepatic ducts were found to be obstructed. Later, the CA19-9 level and swelling of the gallbladder decreased and the obstruction of the bile ducts disappeared. A cholecystectomy was performed and the intraoperative pathohistological diagnosis of chronic cholecystitis was made from frozen sections. The pathohistological diagnosis of XGC was made from paraffin-embedded sections. Mirizzi syndrome such as that seen in our patient is a rare complication of XGC. XGC occasionally causes extensive inflammation; thus, performing a conventional cholecystectomy can be unsafe. However, in our opinion, a total, not subtotal, cholecystectomy should be done whenever possible because the incidence of gallbladder carcinoma accompanied with XGC is higher than that with ordinary cholecystitis or gallstones.
 ...
PMID:Mirizzi syndrome caused by xanthogranulomatous cholecystitis: report of a case. 930 94

In this prospective multicenter study, the effect of early ERCP within 72 hours after the beginning of symptoms in the treatment of acute biliary pancreatitis was investigated. 100 patients with acute biliary pancreatitis but without biliary sepsis or obstructive jaundice were randomized in this trial. 48 patients of the invasive group received urgent ERCP within 72 hours after the beginning of pain. 52 patients of the conventional group received ERCP only if biliary sepsis or obstructive jaundice occurred during the clinical course of the disease (which was the case in 10 patients). Sphincterotomy and stone extraction were undertaken if bile duct stones were identified during ERCP. In the invasive group, ERCP was successfully performed in 44 cases (92%). In 19 of these patients (43%), common bile duct stones were identified and a sphincterotomy was performed. The stones could be removed completely during the first ERCP examination in 16 cases. In the conventional group, 2 patients died from pancreatitis within 3 months, versus 4 patients in the invasive group. Cholecystitis occurred significantly more often in the conventional group (11 versus 4; odds ratio OR = 5.1), but no patient with cholecystitis or cholangitis died. Cholangitis (OR = 3.3) and sepsis (OR = 3.5) were slightly more frequent in the conventional group (not significant) while renal failure (OR = 0.5) and pulmonary failure (OR = 0.8) were slightly more frequent in the invasive group (not significant). Jaundice (6 patients) only occurred in the conventional group. In this multicenter study, it is concluded that early ERCP is not superior to conventional treatment in patients with acute biliary pancreatitis. On the other hand, patients with biliary complications (jaundice, sepsis, cholangitis) should receive urgent ERCP. However, most bile duct stones which initiate a pancreatitis pass spontaneously into the duodenum. The vast majority of patients suffering from biliary pancreatitis without biliary sepsis or obstructive jaundice require only elective ERCP when remaining bile duct stones are assumed. The lethality of biliary pancreatitis without initial biliary complications (sepsis, jaundice) tends to be elevated rather than diminished by emergency ERCP.
 ...
PMID:Urgent ERCP in all cases of acute biliary pancreatitis? A prospective randomized multicenter study. 938 73

An impacted gallstone in the cystic duct or in the Hartman's pouch with subsequent inflammation and edema resulting in extrinsic compression of the common hepatic or common bile duct with obstructive jaundice is known as Mirizzi's syndrome. The Mirizzi syndrome presents a difficult surgical challenge because of the dense adhesions and edematous inflammatory tissue cause distortion of the normal anatomy in Calot's triangle, leading to a great risk of bile duct injury. Therefore, a controversial issue the surgical strategy for the treatment of Mirizzi's syndrome since the introduction of laparoscopic cholecystectomy. The present study was undertaken to elucidate the applicability of microlaparotomy cholecystectomy in the management of Mirizzi's syndrome. Between December 1990 and December 1996 we operated on 16 patients for Mirizzi's syndrome. In 14 of these patients had type I of Mirizzi's syndrome, the remaining 2 had type II of this syndrome. In 13 of these patients the gallbladder were removed using 3-4 cm single microlaparotomy incisions. In the remaining 3 patients using 5.5 cm, 8 cm as well as 12 cm long incisions for the removal of the gallbladder, and placement T tube because of stenosis of the common hepatic duct, suture repair of the choledochal defect as well as choledochoplasty. In 12 of these patients the microlaparotomy cholecystectomy were done within 7 days of the onset of the obstructive cholecystitis. The postoperative stay of these patients were uneventful and they were discharged home 3 days after surgery. We conclude that early operation of the obstructive cholecystitis with Mirizzi's syndrome eliminates the serious stricture and fistula formation of Mirizzi's syndrome.
 ...
PMID:[Minimally invasive surgery in the management of Mirizzi syndrome]. 947 53

Only 34 cases of primary cystic duct carcinoma have previously been published in the literature. Most of these cases presented with upper abdominal pain and a palpable mass in the right upper quadrant due to gallbladder hydrops or cholecystitis. We report a case of cystic duct carcinoma with the clinical presentation of obstructive jaundice. The patient was treated by cholecystectomy, resection of the common bile duct and a Roux-en-Y hepaticojejunostomy. An extended lymph node dissection was not performed. Fourteen months after the operation the patient died with local carcinoma recurrence. A literature review comparing clinical signs, surgical treatment, and outcome of 14 Japanese and 21 reported Western cases, including ours, was performed. Extended lymph node dissection in addition to combined resection of the gallbladder and ductus hepaticocholedochus appears to offer a better prognosis and larger survival, including the chance of potential cure.
 ...
PMID:Carcinoma of the cystic duct leading to obstructive jaundice. A case report and review of the literature. 984 18

Initial therapy of acute cholecystitis and cholangitis is directed towards general support of the patient, including fluid and electrolyte replacement, correction of metabolic imbalances and antibacterial therapy. Factors affecting the efficacy of antibacterial therapy include the activity of the agent against the common biliary tract pathogens and pharmacokinetic properties such as tissue distribution and the ratio of concentration in both bile and serum to the minimum inhibitory concentration for the expected micro-organism. Antimicrobial therapy is usually empirical. Initial therapy should cover the Enterobacteriaceae, in particular Escherichia coli. Activity against enterococci is not required since their pathogenicity in biliary tract infections remains unclear. Coverage of anaerobes, in particular Bacteroides spp., is warranted in patients with previous bile duct-bowel anastomosis, in the elderly and in patients in serious clinical condition. In patients with acute cholecystitis or cholangitis of moderate clinical severity, monotherapy with a ureidopenicillin--mezlocillin or piperacillin--is at least as effective as the combination of ampicillin plus aminoglycoside. In severely ill patients with septicaemia, an antibacterial combination is preferable. Therapy with aminoglycosides, mostly for Pseudomonas aeruginosa-related infections, should not exceed a few days because the risk of nephrotoxicity seems to be increased during cholestasis. Relief of biliary obstruction is mandatory, even if there is clinical improvement with conservative therapy, because cholangitis is most likely to recur with continued obstruction. Emergency invasive therapy is reserved for patients who fail to show a clinical response to antibacterial therapy within the first 36 to 48 hours or for those who deteriorate after an initial clinical improvement. Immediate surgery is indicated for gangrenous cholecystitis and perforation with peritonitis. Long-term administration of antibacterials is required for recurrent cholangitis, as seen in bile duct-bowel anastomosis. Oral cotrimoxazole (trimethoprim/sulfamethoxazole) is the preferred agent. Wound infection rates after biliary tract surgery can be significantly reduced by preoperative administration of prophylactic antibacterials. Newer generation beta-lactams have not proven to be of greater benefit than older agents such as cefuroxime or cefazolin. Antibacterial prophylaxis before endoscopic retrograde cholangiopancreatography (ERCP) should be reserved for patients with obstructive jaundice, since the risk of infectious complications seems to be strongly associated with this clinical condition. Failure to achieve full biliary drainage is the most important factor in predicting septicaemia, and prophylaxis should be prolonged until the bile duct is unobstructed. Piperacillin, cefazolin, cefuroxime, cefotaxime and ciprofloxacin are effective for this indication.
 ...
PMID:Biliary tract infections: a guide to drug treatment. 995 53

We report a case of an extrahepatic bile duct metastasis from a gallbladder cancer that mimicked Mirizzi's syndrome on cholangiography. A 67-yr-old woman was admitted to our hospital with a diagnosis of acute calculous cholecystitis. As obstructive jaundice developed after the admission, percutaneous transhepatic biliary drainage was performed to ameliorate the jaundice and to evaluate the biliary system. Tube cholangiography revealed bile duct obstruction at the hepatic hilus, and extrinsic compression of the lateral aspect of the common hepatic duct, with nonvisualization of the gallbladder. No impacted cystic duct stone was visualized on CT or ultrasonography. Laparotomy revealed a gallbladder tumor as well as an extrahepatic bile duct tumor. We diagnosed that the latter was a metastasis from the gallbladder cancer, based on the histopathological features. This case is unique in that the extrahepatic bile duct metastasis obstructed both the common hepatic duct and the cystic duct, giving the appearance of Mirizzi's syndrome on cholangiography. Metastatic bile duct tumors that mimic Mirizzi's syndrome have not been previously reported. The presence of this condition should be suspected in patients with the cholangiographic features of Mirizzi's syndrome, when the CT or ultrasonographic findings fail to demonstrate an impacted cystic duct stone.
 ...
PMID:An extrahepatic bile duct metastasis from a gallbladder cancer mimicking Mirizzi's syndrome. 1068 68

The experience of effective work of endoscopic service in district hospital, including surgeon and gynecologist in laparoscopic team is presented. The results of 1000 laparoscopic cholecystectomies were analyzed. In 868 cases the operation was performed for chronic and in 132 cases--for acute calculous cholecystitis. The additional endoscopic retrograde pancreatocholangiography and papillosphincterotomy (if it was necessary) was performed in patients with cholangitis and obstructive jaundice and also with choledocholithiasis, revealed during elective examination. In 33 cases in thick infiltrate of gall bladder neck or neck congenital anomalies, laparotomy was performed, 30 patients underwent minilaparotomy. Simultaneous operations were performed in 116 (11.6%) patients. In early postoperative period, the complications were seen in 8 patients. In 2 cases the injury of common hepatic duct was observed. Suppuration of paraumbilical wound was seen in 13 patients, postoperative paraumbilical hernia (4-6 months after operation)--in 18 patients. There were no cases of lethal outcomes.
 ...
PMID:[Experience of 1000 laparoscopic cholecystectomies in district hospital]. 1107 Jun 68

We present a woman 34 years old with echinococcosis of intra and extra hepatic biliary ducts including gallbladder. We found alive cysts, dead cysts and fragments of germinative membranes of a complicated cyst in left lobe (I - II) with clinical findings of obstructive jaundice; pain; cholecystitis and great dilation of biliary ducts. We performed left lobectomy, exploration of biliary ducts, transduodenal sphincteroplasty, cholecystectomy. We haven't had complications. We present ultrasound images of the pathologic pieces.
 ...
PMID:[Echinococcosis of intra- and extrahepatic bile ducts. Report of a case at the Central Military Hospital]. 1217 Feb 90


<< Previous 1 2 3 4 5 6 7 8 9 Next >>