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Query: UMLS:C0008325 (cholecystitis)
 3,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Uptake of radionuclide by the liver next to the gallbladder in cholescintigraphy has been described as a useful secondary sign with a high positive predictive value for the diagnosis of acute cholecystitis. We retrospectively examined 780 consecutive cholescintigrams to (1) determine the positive predictive value at 1 hr of this sign for acute cholecystitis and (2) ascertain if the presence or absence of this finding could differentiate acute from gangrenous cholecystitis. Pericholecystic hepatic activity was present at 1 hr in 48 (34%) of 141 scans in which the gallbladder was not visualized, and cholecystectomy was performed within 6 days of scintigraphy. Forty-five of these patients had acute and three had chronic cholecystitis (94% positive predictive value for acute cholecystitis). In addition, 57% of patients with gangrenous cholecystitis exhibited pericholecystic hepatic activity, and the frequency of this finding was significantly higher (p less than .006) in gangrenous than in acute cholecystitis. In summary, pericholecystic hepatic uptake is a valuable secondary sign in the cholescintigraphic diagnosis of acute cholecystitis. The significance of the finding is (1) a high positive predictive value for acute disease at 1 hr and (2) a statistically significant increased frequency in patients with gangrenous cholecystitis.
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PMID:Diagnosis of acute cholecystitis by cholescintigraphy: significance of pericholecystic hepatic uptake. 271 56

The clinico-pathologic features of six cases of chronic cholecystitis with focal lymphoid hyperplasia (CCLH) are described and compared with five examples of malignant lymphoma involving the gallbladder. The clinical presentation of CCLH was identical to that of conventional chronic cholecystitis with cholelithiasis. Microscopically there was chronic inflammation and fibrosis in the wall of the gallbladder as well as extensive lymphoid hyperplasia with many lymphoid follicles having germinal centers. The five patients with malignant lymphoma also had chronic cholecystitis; four had a previous diagnosis of lymphoma established by a lymph node biopsy and were also found to have liver involvement during cholecystectomy. The gallbladders with malignant lymphoma showed acute and chronic cholecystitis and a monotonous lymphoid proliferation easily distinguishable from CCLH. We conclude that CCLH displays characteristic pathologic features and should be separated from the chronic and xanthogranulomatous types of cholecystitis.
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PMID:Chronic cholecystitis with lymphoid hyperplasia. 278 Nov 78

Gallbladder epithelium is unique among the gastrointestinal cell types because proteins and protein levels in the fluid bathing the luminal side of the cells (bile) are different from and can be compared with those in the fluid bathing the basal side (serum). To help identify cellular changes that occur during the development of gallbladder cancer, we obtained gallbladder tissue, serum, and bile specimens from 20 patients with invasive adenocarcinoma of the gallbladder, three with high-grade dysplasia (carcinoma in situ), six with low-grade dysplasia, 12 with hyperplasia, and 10 with acute or chronic cholecystitis. We obtained serum samples from 40 patients with invasive adenocarcinoma and bile samples from 29 of these patients; serum samples from three with high-grade dysplasia and bile specimens from two of these; serum and bile samples from five with low-grade dysplasia; serum or bile samples from 126 with metaplasia, hyperplasia, or cholecystitis, including serum samples from 121 and bile samples from 110; and serum and bile samples from eight with normal biliary tracts. The study was conducted in Mexico City, Mexico, and La Paz, Bolivia. We performed flow cytometric DNA analysis on gallbladder tissue specimens and measured levels of carcinoembryonic antigen (CEA) and CA 19-9 antigen in the serum and bile specimens. Analysis of the cell cycle compartments by flow cytometry revealed marked variations of the proliferation index for the different disease states (P less than .0001). The proliferation index increased with progression from cholecystitis to invasive adenocarcinoma. Of the bile and serum measurements, only serum CA 19-9 values were correlated with flow cytometry measurements (r = -.49, P = .005). Overall, the serum and bile measurements were in agreement (P less than .01). However, with the exception of the correlations among serum measurements for the patients with invasive adenocarcinoma, most of the correlations could be explained by differences in the disease state. In particular, the progression from normal tissue to invasive adenocarcinoma involved no change in bile CA 19-9 level and only a slight change in bile CEA level but much larger changes in serum CEA and CA 19-9 levels. It appears that the progression from normal tissue to invasive adenocarcinoma results in increased production of these antigens and often in loss of cell polarity as well, i.e., inability to prevent leakage of the antigens into the serum.
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PMID:Pathophysiology of tumor progression in human gallbladder: flow cytometry, CEA, and CA 19-9 levels in bile and serum in different stages of gallbladder disease. 279 83

To define the optimal diagnostic approach for suspected chronic cholecystitis comprehensive management strategies were developed. Using a computer model, the frequency of appropriate surgery, inappropriate surgery, complications, death, and medical costs were compared in populations of patients with various disease prevalences. The optimal strategy began with ultrasonography, followed by an oral cholecystogram when the ultrasonogram was inconclusive. Oral cholecystogram also was employed when additional diagnostic studies failed to provide another explanation for the patient's symptoms. Compared with strategies using only ultrasonography or oral cholecystography, the combination strategy lowered the frequency of inappropriate surgery from 7.1 to 4.4% and direct medical costs from $1,877 to $1,766 per patient in a population with a 20% prevalence of chronic cholecystitis. The differences persisted at higher prevalences of cholecystitis and when sensitivities and specificities of the tests were varied over ranges reported in the literature. Diagnostic accuracy and direct medical costs could be improved by a more frequent interpretation of subtle abnormal ultrasonographic findings as inconclusive and by a more liberal use of oral cholecystography. This analysis demonstrates that a strategy combining ultrasonography and oral cholecystography is superior to the use of either test alone and is cost-efficient.
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PMID:Chronic cholecystitis. An analysis of diagnostic strategies. 310 29

Using cuprolinic blue as a stain along with enzymic digestion, heparan sulphate has been identified as the main glycosaminoglycan in the basement membrane of human gallbladder epithelium. The amount of glycosaminoglycans was quantified by counting the number of molecular profiles cm-2 in electron micrographs of mildly, moderately and severely inflamed gallbladders. There is a significant increase (P = 0.009) in the amount of glycosaminoglycans in the basement membranes of severely inflamed gallbladders compared with cases of mild chronic cholecystitis. Differences, although present, are less significant when mild and moderate or moderate and severe cholecystitis are compared. The findings suggest that there is a continuous accumulation of heparan sulphate in the basement membrane in chronic cholecystitis which increases in amount with the severity of inflammation.
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PMID:Glycosaminoglycans in human gallbladder basement membrane: nature and quantitative changes in chronic cholecystitis. 319 22

Based upon literature data and an analysis of immediate and remote results of treatment of 50 children with acalculous cholecystitis the authors point to the advisability of operative interventions in patients with organic disturbances of the bile outflow. An analysis of the clinical picture, effects of the conservative therapy and results of subsidiary investigations enabled the authors to establish indications to surgery. The surgical methods must be determined by the character of pathology of the gallbladder, bile ducts and concomitant diseases. The immediate and long-term results of the surgical treatment of chronic cholecystitis resulting from organic disturbances of bile excretion confirm expediency of active surgical tactics in the presence of indications and of strict dispensary observation after operations for this disease.
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PMID:[Chronic acalculous cholecystitis in children]. 325 65

To assess the pathological basis of the changes seen on ultrasound examination of the gallbladder wall in cholecystitis, the appearances of the gallbladder wall were analysed in 17 patients with acute cholecystitis and 27 patients with chronic cholecystitis, and correlated with the pathological specimens removed at surgery. A thin echo reduced layer within the echogenic gallbladder wall corresponds to a complex of subserosal oedema, haemorrhage and inflammatory cell infiltration, or to muscular hypertrophy. Indistinctness or a low echogenicity rind along the inner margin represents mucosal sloughing or obliteration of the mucosal folds. Uniformly decreased echogenicity of the wall is caused by severe inflammatory change with sloughing of the mucosa or obliteration of the mucosal folds. These ultrasound signs are considered to be valuable signs of cholecystitis.
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PMID:Ultrasound changes of the gallbladder wall in cholecystitis: a sonographic-pathological correlation. 330 88

Biliary complement concentrations and activity are lower in patients with infected bile than in those with sterile bile in cholecystitis. Plasma complement is increased during the acute phase response to inflammation. To determine whether low biliary complement in infected bile is a specific response to biliary tract infection or part of a general systemic reaction, we analyzed bile complement proteins (C3 and C4) and activity (C4H50) and acute phase reactants fibronectin, C-reactive protein, and alpha 1-antitrypsin concentrations in acute and chronic cholecystitis. Results were correlated with bile cultures and gallbladder histology using the Wilcoxon rank sum test. While biliary C3, C4, and C4H50 were significantly lower in infected bile than in sterile bile, none of the acute phase reactants were different. The biliary acute phase reactants were all significantly higher in acute cholecystitis than in chronic disease, but there was no difference in the biliary C3, C4, or C4H50 levels. There was no clear relationship between plasma levels of complement and the acute phase reactants. The dissociation between biliary complement and acute phase reactants indicates that bile complement is not a reflection of a systemic reaction to inflammation. We propose that biliary complement is a specific host defense mechanism against bacterial infection in the biliary tract.
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PMID:Complement in local biliary tract defense: dissociation between bile complement and acute phase reactants in cholecystitis. 349 84

Upper abdominal sonography was used as a routine emergency study to diagnose acute cholecystitis in 135 patients clinically suspected of having the disease. Ten radiologists with various experience in sonography performed the studies. Fifty-six patients had acute cholecystitis. Altogether 52 cholecystectomies were performed, mainly within 48 h of admission. Acute cholecystitis was diagnosed correctly in 52 cases (sensitivity, 93%) and excluded correctly in 75 cases (specificity, 95%; overall accuracy, 94%). Of the four patients with a false-negative study, calculi without signs of cholecystitis were detected in three, and distention and tenderness without calculi in one case. The final diagnoses in four false-positive studies were chronic cholecystitis in two cases, carcinoma of the gallbladder in one case, and pancreatitis in one case. The results of sonography as a continual emergency service provided by a staff with various experience are equal to those published in other studies performed mainly by an expert staff with long experience.
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PMID:The value of routine sonography in clinically suspected acute cholecystitis. 351 96

Despite the recent advances in hepatobiliary imaging, the diagnosis of chronic acalculous gallbladder disease remains difficult. A retrospective study was undertaken to assess the value of a multiimaging approach in detecting chronic acalculous gallbladder disease and in predicting which patients would obtain symptomatic relief after cholecystectomy. Of 199 patients with chronic cholecystitis, 26 (13%) had no gallstones. Of these 26, only 17 (65%) had symptoms related to chronic cholecystitis; in the remainder, the histologic diagnosis was made incidentally. After cholecystectomy, 13 (76%) of the 17 symptomatic patients obtained long-term symptomatic relief, while in four, the symptoms recurred. Among patients with histologic changes of chronic cholecystitis, biliary scintigraphy was the most sensitive technique (sensitivity, 89%). The sensitivity of sonography and oral cholecystography was 61.5% and 66%, respectively. However, for identifying symptomatic patients who may obtain long-term symptomatic relief after cholecystectomy, the accuracy of sonography, oral cholecystography, and biliary scintigraphy was 82%, 86%, and 38%, respectively. When two tests were in agreement the accuracy was 88%. For chronic acalculous cholecystitis, more than one study must be performed in order to make the correct diagnosis and to predict good results from cholecystectomy.
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PMID:Chronic acalculous gallbladder disease: multiimaging evaluation with clinical-pathologic correlation. 352 95


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