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

Acute acalculous cholecystitis is a well-known complication in postoperative and particularly in severely traumatized unit patients. All that is known so far of "stress"-cholecystitis is based on episodic case reports and retrospective analyses. An incidence between 0.5 and 4.2%, a complicated clinical course and a lethality up to 75% have been reported. In intensive-care unit patients a clinical diagnosis of suspected acute cholecystitis is rarely reliable; greater reliance is placed on the ultrasound findings as seen in our prospective study. According to the literature, the established ultrasound criteria of cholecystitis include: hydrops, thickening of the gallbladder wall, sludge, subserosal oedema, pericholecystic fluid collection and fragmentation of the gallbladder wall. Other factors, however, may also lead to morphological changes of the gallbladder, and hence there is no agreement about the definitive sonomorphology of this entity. The variability of sonomorphological criteria is reviewed and compared to the results of a series of our own.
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PMID:[Sonomorphology of stress cholecystitis]. 150 40

Though laparoscopic cholecystectomy has become widespread, questions remain as to its success rate, its role in acute cholecystitis, the role of cholangiography, and whether laser use is necessary. To attempt to answer these questions, the first 100 patients undergoing laparoscopic cholecystectomy at Emory University using electrosurgical diathermy were reviewed. Patients underwent cholecystectomy for biliary colic (87), gallstone pancreatitis (1), and acute cholecystitis (12). The average length of hospital stay was 29 hours (range: 12 hours to 5 days). Laparoscopic cholecystectomy was not possible in 7 patients because of gangrenous cholecystitis (2), adhesions from previous surgery (2), equipment failure (2), and choledochoduodenal fistula found at surgery (1). Two patients developed bile leaks from accessory bile ducts that healed spontaneously. There were no other complications. The average time required to complete the laparoscopic cholecystectomy was 115 minutes (range: 45 to 238 minutes) and was not significantly different in those patients undergoing intraoperative cholangiography (117 minutes) versus those without (109 minutes). Common duct stones were uncommon in this series. Thirty-three patients underwent intraoperative cholangiogram. One patient was found to have a common duct stone, which was pushed into the duodenum using a Fogarty catheter (American Edwards Laboratories; Anasco, Puerto Rico) inserted through the cystic duct at the time of laparoscopic cholecystectomy. Twelve patients with acute cholecystitis underwent an attempt at laparoscopic cholecystectomy that was successful in nine. These procedures were difficult and lengthy (mean of 143 minutes). Causes for failure were gangrenous cholecystitis (2) and equipment failure (1). In conclusion, laparoscopic cholecystectomy can be performed with a high success rate (93%) and low morbidity (2%). No complications seemed attributable to electrosurgical dissection.
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PMID:Electrosurgical laparoscopic cholecystectomy. 153 95

Between Apr. 18, 1990, and Apr. 26, 1991, 258 patients were treated for symptomatic cholelithiasis by laparoscopic cholecystectomy. In 252 patients the diagnosis was chronic calculous cholecystitis, in 3 acute cholecystitis and in 3 hydrops of the gallbladder. There were no deaths. Major complications occurred early in the study--one patient suffered a cardiac arrest because of gas embolism and one had leakage from the stump of the cystic duct, which was treated by percutaneous drainage. Both patients recovered without further complications. The hospital stay averaged 2.9 days. The authors discuss important technical points for the safe performance of laparoscopic cholecystectomy and consider the results obtained by leading groups in the field and by one multicentre survey in the United States. Almost 25,000 cases of laparoscopic cholecystectomy are evaluated.
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PMID:Laparoscopic cholecystectomy: a review of 258 patients. 153 50

A great variety of drugs is reported to induce gallbladder disease by various pathogenetic mechanisms. Early epidemiological studies indicated a doubled risk of gallbladder disease in women taking oral contraceptives. More recent studies, however, have failed to confirm those findings; these conflicting results might be explained by the different methods used to define gallbladder disease. It was shown that the lithogenic index of the bile is increased during intake of oral contraceptives. Estrogens cause hypersecretion of cholesterol in bile, due to increase in lipoprotein uptake by the hepatocyte. Progesterone inhibits acyl coenzyme A-cholesterol acyl transferase (ACAT) activity, causing delayed conversion of cholesterol to cholesterol esters. Of the lipid lowering drugs, only clofibrate has been shown to increase the risk for gallstone formation. The other fibric acid derivatives have similar properties, but clinical experience is not as extensive. They seem to be inhibitors of the ACAT enzyme system, thereby rendering bile more lithogenic. Conflicting epidemiological data exist regarding the induction of acute cholecystitis by thiazide diuretics. Ceftriaxone, a third-generation cephalosporin, is reported to induce biliary sludge in 25 to 45% of patients, an effect which is reversible after discontinuing the drug. The sludge is occasionally a clinical problem. It was clearly demonstrated that this sludge is caused by precipitation of the calcium salt of ceftriaxone excreted in the bile. Long term use of octreotide is complicated by gallstone formation in approximately 50% of patients after 1 year of therapy, due to gallbladder stasis. Hepatic artery infusion chemotherapy by implanted pump is shown to be associated with a very high risk of chemically induced cholecystitis. Prophylactic cholecystectomy at the time of pump implantation is therefore advocated. Some drugs, such as erythromcyin or ampicillin, are reported to cause hypersensitivity-induced cholecystitis. Furthermore, there are reports on the influence of cyclosporin, dapsone, anticoagulant treatment, and narcotic and anticholinergic medication in causing gallbladder disease.
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PMID:Drug-induced gallbladder disease. Incidence, aetiology and management. 153 97

12 high-risk patients underwent percutaneous cholecystostomy for serious acute cholecystitis using a transhepatic approach under ultrasonic guidance. Eight patients had acute acalculous cholecystitis, and four had acute calculous cholecystitis. Following the drainage procedure a mean decrease in body temperature of 0.7 degrees centigrade was noted in 11 patients and a reduction of pain and defence in five out of nine patients. Two patients had a perforated gallbladder and pericholecystic abscess; both cases were successfully treated by percutaneous drainage. Four patients with acute acalculous cholecystitis died while in hospital for reasons unrelated to the procedure. The catheter became dislodged in three patients.
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PMID:[Percutaneous gallbladder drainage in acute cholecystitis]. 155 2

Acute cholecystitis is an often unrecognized and potentially life-threatening complication seen among ICU patients with multiple injury. To investigate the epidemiology of this entity and to evaluate significant etiologic precursors, a prospective clinical and sonographic study was performed in 45 consecutive patients (mean age, 29 years) treated for multiple trauma (mean ISS, 27) in the ICU. Eight of 45 patients developed a cholecystitis during intensive care treatment (18%). Six patients recovered with conservative therapy; in two instances a cholecystectomy was necessary. There was no mortality as a result of cholecystitis. A significant relationship between the severity of the initial trauma (p less than 0.05), the number of blood transfusions (p less than 0.01), and the incidence of acute cholecystitis was found. Other factors such as prolonged shock, respiratory failure, or parenteral alimentation were less prevalent and were not temporally related to the onset of the disease. All patients had large amounts of narcotics administered over a prolonged period, so that narcotic-induced biliary stasis appeared to be another eminent factor involved in the genesis of posttraumatic cholecystitis. Our results lead to the conclusion that acute cholecystitis occurs with an unexpectedly high incidence and that a high remission rate can be expected following conservative treatment provided that appropriate serial ultrasound examinations are performed.
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PMID:Acute cholecystitis: a complication in severely injured intensive care patients. 156 15

Ultrasonic examination (USE) conducted in 7,000 persons, among whom 3,000 had gastroenterological diseases, gave evidence for suspected diseases of the biliary tract in 1,471. Analysis of the results of the examination showed the method to be effective in 99% of patients with cholelithiasis and chronic recurring cholecystitis; the preoperative diagnosis of acute cholecystitis was confirmed in 98% of cases. The possibilities of USE in identifying the nature of jaundice were high, but the true topical diagnosis was established before the operation by the method only in 53% of 226 patients with obstructive jaundice. Stones in the common bile duct were discovered in 58 cases in a group of 100 patients, tumors in the extrahepatic biliary tract in 28 among 35 patients, and carcinoma of the pancreas in 33 among 35 patients.
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PMID:[Ultrasound study in the diagnosis of extrahepatic bile duct diseases]. 157 37

Selected papers published over the past year in the areas of radionuclide hepatobiliary imaging, gastric emptying, and gastrointestinal bleeding are reviewed. Two advances in cholescintigraphy are particularly emphasized and discussed. First, morphine-augmented cholescintigraphy has established itself as an accurate alternative to 2 to 4 hour delayed imaging for the diagnosis of acute cholecystitis. Second, sincalide-stimulated cholescintigraphy with calculation of a gallbladder ejection fraction has proven to be a useful test for confirming the clinical diagnosis of chronic acalculous cholecystitis. Other hepatobiliary papers reviewed include those on the utility of cholescintigraphy in gallbladder perforation, hepatocellular carcinoma, liver transplantation, enterogastric reflux, and for the diagnosis of the postoperative complications of laparoscopic cholecystectomy and gallstone lithotripsy. The second major area of review includes papers published over the past year on gastric emptying, including investigations of methodology, physiology and pathophysiology, and clinical utility. A few papers utilizing radionuclide techniques for localizing gastrointestinal bleeding will also be reviewed.
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PMID:Scintigraphy in the gastrointestinal tract. 158 Nov 25

Ascarids in the biliary tract may cause cholecystitis, pancreatitis and obstruction of the common bile ducts. We retrospectively evaluated clinical features, radiographic findings and surgical treatment of 15 patients. Obstructive jaundice in eight patients (53.3%), acute cholecystitis in five patients (33.3%), and chronic calculous cholecystitis in two patients (13.3%) had been shown in our series. In four of the patients with obstructive jaundice signs of acute cholangitis were observed. Of 15 patients, two had hepatic abscess besides biliary ascariasis and one had hydatid cyst. In our series, all of the patients were operated on. Choledochotomy and primary closure were performed on six patients (40%), choledochoduodenostomy on six patients (40%), T-tube drainage on two patients (13.3%) and only cholecystectomy on one patient (6.6%). No mortality was determined in our patients.
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PMID:Biliary ascariasis in fifteen patients. 164 42

This study analyzed the first 100 laparoscopic cholecystectomies performed at a university teaching hospital by a single surgeon. Patients presented with chronic cholecystitis (92), acute cholecystitis (5), acalculus cholecystitis (2), and asymptomatic cholelithiasis (1). The operative time ranged from 59 minutes to 185 minutes (mean: 110 minutes). Cholangiography was performed in 88 patients, and common bile duct stones were discovered in 3. Choledocholithiasis was managed successfully through the cystic duct in all cases. Two procedures were converted to open cholecystectomy. Operative complications included ductal injury in one patient, bile leak in two, wound cellulitis in four, and atelectasis in one. Ninety-seven patients were released within 24 hours after surgery. Mean hospital charges for laparoscopic cholecystectomy were $828 less than the cost incurred for open cholecystectomy. These early results support the view that laparoscopic cholecystectomy is a safe, cost-effective method for performing cholecystectomy with a remarkable improvement in patient recovery time.
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PMID:Results of laparoscopic cholecystectomy in a university hospital. 167 Feb 28


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