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

This study reviews 27 patients with nonvisualization of the gallbladder on cholescintigraphy. The preoperative diagnosis of acute cholecystitis was confirmed pathologically in 23. A rim of increased hepatic activity (RIHA) adjacent to the gallbladder fossa was seen throughout the study in 35% with acute cholecystitis and in no patients with chronic cholecystitis. Nine patients with "complicated" cholecystitis (defined pathologically as a late stage of the spectrum of acute cholecystitis) had a positive RIHA in contrast to no patients with "noncomplicated acute cholecystitis" (p less than 0.05). The sensitivity/specificity of the RIHA for "complicated" acute cholecystitis was 45%/100% and the positive/negative predictive value was 100%/39%. Liver tissue that was attached to the gallbladder by adhesions and removed at surgery was reviewed histologically and correlated with the presence or absence of a RIHA. The RIHA seems to be a useful indicator of patients presenting at a later stage of the pathologic spectrum of acute cholecystitis and perhaps at increased risk for complications.
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PMID:Prognostic value and pathophysiologic significance of the rim sign in cholescintigraphy. 366 62

A case of acute acalculous cholecystitis in which sequential hepatobiliary scintigraphy demonstrated apparent transient biliary obstruction is presented. An initial technetium-99m diisopropyliminodiacetic acid ([99mTc]DISIDA) study in a patient suspected of acute cholecystitis showed persistent hepatic activity, nonvisualization of the gallbladder, and minimal intestinal activity seen only at 24 hr. Following a second injection of [99mTc]DISIDA administered shortly after the 24-hr image from the first study, the gallbladder and bowel were both visualized within 75 min. At subsequent surgery, acute and chronic cholecystitis were present without evidence of choledocholithiasis or other source of obstruction. Intrahepatic cholestasis following clearance of biliary obstruction may result in late bowel visualization on delayed cholescintigraphic images similar to that seen in partial obstruction. Accurate reflection of the state of hepatobiliary function may require reinjection with [99mTc]DISIDA.
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PMID:Sequential hepatobiliary scintigraphy demonstrating apparent transient biliary obstruction. 366 69

To test the hypothesis that there is an early stage of cholesterol gallstone formation in man characterized by symptoms of chronic cholecystitis, poor gallbladder emptying, and biliary cholesterol crystals, we studied cholecystokinin-stimulated gallbladder emptying by DISIDA scintigraphy and examined bile for cholesterol crystals in symptomatic patients with normal oral cholecystography and gallbladder sonography. Of 36 patients studied, 16 had biliary cholesterol crystals; their mean 30-min gallbladder ejection fraction was 25.9 +/- 14.8%. Among the 20 patients without crystals, the mean ejection fraction was 60.3 +/- 23.3%. Fifteen patients, 11 with crystals and four without, had cholecystectomy because of persistent symptoms. All with crystals preoperatively and three without had chronic cholecystitis histologically. One patient without crystals had normal histology. We conclude that poor gallbladder contractility, well-established as an etiologic factor in animal models of cholesterol cholelithiasis, is now linked to acalculous cholecystitis, an early stage of human cholesterol cholelithiasis.
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PMID:Gallbladder dyskinesia in chronic acalculous cholecystitis. 369 62

Serum bile acids were studied in 27 patients with chronic noncalculous cholecystitis. It was ascertained that the total concentration of bile acids under study was appreciably increased as compared with the data derived in the control group patients. There was noticeable differences between modulations in individual fractions of serum bile acids, attesting to an unusual distress of the synthetic function of hepatocytes. Alterations in the metabolism of cholates seen in chronic cholecystitis agreed well with the pattern of the disordered motor function of the gallbladder and were more pronounced in patients with hypokinesia.
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PMID:[Gas chromatographic determination of serum bile acid levels in chronic cholecystitis patients]. 370 50

This case report describes a false-positive hepatobiliary scan in a young woman suspected to have acute cholecystitis who apparently had none of the reasons stated in the literature for a false-positive scan. The literature review shows that the negative predictive value of hepatobiliary scanning for acute cholecystitis is nearly 100 percent, while the positive predictive value is also quite good if conditions known to cause false-positive scans are ruled out. Common causes of positive hepatobiliary scanning, other than acalculus cholecystitis, include chronic cholecystitis, cholecystitis, hepatitis, alcoholism, total parenteral nutrition, pancreatitis, prolonged fasting, and ingestion of food less than one hour prior to scanning. Whether the postpartum state affects the accuracy of hepatobiliary scanning is speculative.
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PMID:A false-positive hepatobiliary scan: case report and literature review. 381 64

The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.
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PMID:Reliability of pre- and intraoperative tests for biliary lithiasis. 388 31

Gallbladder nonvisualization in cholescintigraphy has been shown to be a reliable finding in acute cholecystitis. In some cholescintigrams, we have observed faintly increased pericholecystic hepatic activity in conjunction with gallbladder nonvisualization. To determine the frequency and significance of the pericholecystic hepatic activity finding, we evaluated 334 consecutive adult patients who had cholescintigrams with technetium-99m diisopropylphenylcarboamoyl iminodiacetic acid. Pericholecystic hepatic activity was seen in 21% of the abnormal scans demonstrating gallbladder nonvisualization but in none of the other scans. Thirteen of these patients underwent surgery; 11 (85%) were found to have acute cholecystitis, and two (15%) had chronic cholecystitis. Four patients (31%) had acute gangrenous cholecystitis, and five (39%) had cholecystitis complicated by gallbladder perforation. The pericholecystic hepatic activity sign is not specific for gangrenous cholecystitis or gallbladder perforation but does reliably indicate inflammatory gallbladder disease and is associated with a relatively high incidence of cholecystitis complicated by perforation.
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PMID:Pericholecystic hepatic activity in cholescintigraphy. 402 46

Fourteen patients with a cystic duct syndrome (CDS) underwent cholecystokinin (CCK) cholescintigraphy. All patients presented with persistent postprandial right upper quadrant pain and biliary colic. None of the patients had an abnormal oral cholecystography, gallbladder (GB) ultrasound exam or upper GI series. Each patient (NPO after 12 a.m.) received 5 mCi of technetium-99m disofenin. When the GB maximally filled, 0.02 microgram/kg CCK was administered (3 min) intravenously. Background corrected gallbladder ejection fractions (GBEFs) were determined every 5 min X 4 by rationing the pre-CCK GB counts minus post-CCK GB counts to pre-CCK GB counts. GBEFs were: 12% (3 patients), 17% (2), 0%, 1.3%, 3%, 4%, 6%, 11%, 14%, 18.5%, and 22% (1 each). All patients underwent a surgical exploration and all had macro- or microscopically abnormal cystic ducts (five fibrotic, seven elongated and narrow, two kinked) with (12 patients) or without (2 patients) concomitant chronic cholecystitis. No patient with a partially occluded cystic duct with or without concomitant chronic cholecystitis had an ejection fraction that exceeded 22%. In an appropriate clinical setting, a low EF response to CCK should alert the physician to the presence of either chronic acalculous cholecystitis, CDS, or the combination of both.
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PMID:Cholecystokinin cholescintigraphic findings in the cystic duct syndrome. 404 55

A case of heterotopic gastric mucosa (pyloric gland) in the wall of the gallbladder was reported. A 58 year-old woman was admitted with a history of sudden attack of hypochondralgia radiating to the back, but she had no fever and jaundice. Ultrasonography demonstrated high echo at the neck and body of the gallbladder. Cholecystectomy was performed with a diagnosis of the gallbladder tumor containing gall stone. The surgical specimen revealed a 15 X 14 X 8mm subserosal tumor in the body and chronic cholecystitis, but showed no metaplastic differentiation in the mucosa. The cause was considered to be congenital. Heterotopic tissue in the wall of the gallbladder was very rare. In the literature, there were 29 cases of gastric mucosa and 27 cases of pancreatic tissue. The mean age of incidence were 31.9 and 42.0 year-old, respectively. There is no sex difference. The lesion was located in the cystic duct and the neck of the gallbladder in half the patients. Cholelithiasis and/or cholecystitis was complicated in many cases, and it might be associated with heterotopic tissue whereas the etiology is unknown.
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PMID:[Heterotopic gastric mucosa in the wall of the gallbladder: a case report and review of the literature]. 404 23

Gallbladders of 12 cases with chronic cholecystitis showing pseudopyloric glands (PPG) and of 18 cases with acute cholecystitis or chronic cholecystitis but without PPG were examined by the peroxidase - antiperoxidase (PAP) method using rabbit antibody against human lysozyme (LM). LM-immunoreactivity was detected in the cytoplasm of PPG and, to a lesser extent, in the pits of epithelial crypts that gave rise to PPG. No LM was found in normal gallbladders; in cases of cholecystitis without PPG, LM-immunoreactivity was restricted to infiltrating inflammatory cells. The presence of LM in PPG suggests that PPG represent functional metaplastic areas, involved in the non-specific defence mechanisms through participation of LM.
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PMID:Immunohistochemical demonstration of lysozyme in pseudopyloric glands in chronic cholecystitis. 640 87


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