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Query: UMLS:C0149520 (acute cholecystitis)
 2,784 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Using the modern anaerobic transport media and meticulous culture techniques, 74 patients undergoing biliary tract surgery were studied. The biliary system was found to be sterile in 58 patients (78%). Fifteen patients had 35 isolates of aerobic and facultative bacteria. The most common ones were Klebsiella, Enterococcus, and Escherichia coli. The only anaerobe isolated was Clostridium perfringens. Eight of 17 patients (47%) with acute cholecystitis and five of 49 patients (10%) with chronic cholecystitis, harbored bacteria in the biliary system. This study suggests that anaerobes are rare in the human biliary system; therefore, if antibiotic therapy is considered, aerobic coverage should suffice.
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PMID:Bacteriology of the human biliary tract and the duodenum. 19 58

Clinical experience with inflammatory cholecystopathy recognized in 137 patients studied by infusion tomography of the gallbladder is presented. Diagnostic accuracy was 96% in positive and 94% in negative histologically proven cases. Our results show that infusion tomography of the gallbladder is an accurate, rapid, and safe diagnostic aid in the evaluation of acute cholecystitis. In cases of chronic cholecystitis, infusion tomography may be confirmatory but should not be relied on as a final diagnostic test due to a high percentage of false negative cases.
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PMID:Acute cholecystitis: 137 patients studied by infusion tomography of the gallbladder. 40 25

In a series of 526 consecutive, unprepared patients examined by ultrasound, the gallbladder was visualized in 507 (96%). The average wall thickness was 2 mm or less in 97% of asymptomatic subjects without cholelithiasis and 3 mm or greater in 45% of those with choletithiasis. Pathologic correlation of increased thickness and chronic cholecystitis was made in a subgroup of 47 surgical patients. Local tenderness and mucosal thickening were found in 8 patients with acute cholecystitis. Use of electronic sector scanning is emphasized.
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PMID:Ultrasound evaluation of the gallbladder wall. 50 50

99mTc-HIDA is concentrated by the hepatocytes and excreted into the biliary system; the gallbladder, common bile duct, and early accumulation in the duodenum are visualized within 30 minutes of intravenous administration. The authors studied the utility of 99mTc-HIDA imaging in both acute and chronic cholecystitis and hepatobiliary disease in the presence of jaundice: (a) all normal gallbladders exhibited filling, (b) absence of visualization indicated gallbladder disease and/or cystic duct obstruction, (c) visualization of the gallbladder after cholecystokinin-induced emptying excluded an obstructed cystic duct and acute cholecystitis, and (d) a definitive diagnosis of hepatocellular disease, partial and complete obstruction, is possible in jaundiced patients with hyperbilirubinemias up to 5 mg%. Beyond that level, 99mT-HIDA imaging was of qualified value. The technique is useful in assessing biliary drainage in jaundiced patients with surgically altered biliary tract anatomy.
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PMID:Diagnosis of hepatobiliary disease by 99mTc-HIDA cholescintigraphy. 62

Cholescintigraphy was performed in 113 patients of whom 38 had normal gallbladders, 37 had acute cholecystitis and 38 had chronic cholecystitis. The radiopharmaceuticals used in the study were either 99mTc-dimethyl acetanilide iminodiacetic acid or 99mTc-paraisopropyl acetanilide iminodiacetic acid, both of which performed equally well. All patients with non-visualized gallbladders had cholecystitis, but visualization did not exclude disease. The rapidity of obtaining the results (within one hour), the complete absence of untoward reactions to the radiopharmaceuticals, the much lower frequency of subtle or indeterminate results, the ability to render useful information in the presence of moderate jaundice and the lack of interference from overlying intestinal contents establishes these radionuclide agents as superior to both radiographic oral and intravenous cholangiography in the investigation of the acute abdomen.
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PMID:Assessment of the utility of gallbladder imaging with 99mTc-IDA. 72 28

A bacteriologic analysis of the gallbladder bile in eighty patients who underwent operation was performed in a prospective study. In all twenty patients with a normal gallbladder as assessed by oral cholecystography and intraoperative palpation, cultured were negative. Among patients with chronic cholecystitis only 30 per cent had positive bile cultures and this rose to 47 per cent among patients with acute cholecystitis.
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PMID:Bacteriology of the gallbladder bile in normal subjects. 80 46

Technetium 99m-pyridoxylideneglutamate (99mTc-PG) administered intravenously is excreted by hepatocytes into the bile canaliculi and enters the gallbladder through the cystic duct and consequently, can be used for scanning the hepatobiliary ductal system. A total of 166 patients representing 27 normal subjects, 84 patients referred for investigation for pain in the upper right quadrant of the abdomen and 55 jaundiced patients were evaluated with 99mTc-PG. In normal human volunteers, the agent reached the liver in five minutes, and the common bile duct, gallbladder, and duodenum within 15 minutes. Satisfactory images of the hepatobiliary tract were obtained using small dosages of 99mTc-PG. The gallbladder was not visualized when the cystic duct was occluded. In the presence of acute cholecystitis, cystic duct obstruction, or in chronic cholecystitis where other roentgenographic studies showd a nonfunctioning gallbladder, there was no concentration of 99mTc-PG in the gallbladder. In partial common bile duct obstruction is distended common bile duct was visualized along with delay in transit of radioactivity into the duodenum. Complete common bile duct obstruction was associatedwith no radioactivity in either the biliary or the gastrointestinal tracts up to 24 hours after injection. Hepatocellular disease was characterized by delayed liver clearance and delayed visualization of biliary and gastrointestinal tracts. 99mTc-PG scanning proved capable of differentiating between hepatocellular disease and extrahepatic biliary tract obstruction.
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PMID:Hepatobiliary scanning using 99mTc-pyridoxylideneglutamate. 83 70

Wound infection in 239 patients who underwent cholecystectomy were analyzed retrospectively. Seventeen per cent of the patients with acute cholecystitis had wound infection compared with 8.9 per cent of patients with chronic cholecystitis. Bacteriology of wound infections revealed Staphylococcus aureus in 76.4 per cent of the chronic cholecystitis group and in 12.5 per cent of the acute cholecystitis group. Wound infection in the acute cholecystitis group involved gram-negative rods predominantly. Organisms were isolated from bile culture in 71.4 per cent of acute cholecystitis patients compared with 59.6 per cent of chronic cholecystitis patients. Of patients with positive bile cultures 11.3 per cent had wound infections compared with 6.8 per cent of patients with negative bile cultures. The most common organisms isolated from bile cultures with resultant wound infections were S epidermis, S aureus, and Klebsiella sp. Wound infection after cholecystectomy for chronic cholecystitis arises from external sources and not contaminated bile. Antibiotic therapy should be directed accordingly.
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PMID:Wound infection. Acute versus chronic cholecystitis. 84 57

This study attempts to assess the frequency and severity of liver damage in patients with gallstone disease and the role of bacteria in the development of these changes. Needle biopsy of the liver demonstrated acute inflammation of portal triads in 19 of 126 patients with gallstones, a finding not present in control patients. Acute inflammation occurred more often in patients with acute cholecystitis and choledocholithiasis than in chronic cholecystitis. Cultures of the biliary tract or liver were positive in 23 of 64 patients. The frequency of positive bile cultures increased with the severity of the biliary tract disease. Five out of 6 positive liver cultures were from patients with acute cholecystitis or choledocholithiasis. The data suggest that impairment of bile flow is responsible for the acute hepatic inflammatory changes.
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PMID:Biliary bacteria and hepatic histopathologic changes in gallstone disease. 85 76

Liver biopsy was done at the time of operation in 125 consecutive upper abdominal procedures to assess the incidence of unsuspected or undiagnosed hepatic abnormalities. Specifically excluded were hepatic lesions unexpectedly identified at laparotomy. Sixty-seven percent of the liver biopsy specimens were abnormal, the most frequent findings being fatty metamorphosis, cholestasis, triaditis, fibrosis, inflammatory infiltrate, cholangitis, cirrhosis, and hepatitis. The most frequent operation performed was cholecystectomy. In 63 patients with chronic cholecystitis, there was a 51% incidence of abnormal liver histology, while in nine patients with acute cholecystitis, the incidence was 78%. In 83% of all other operations, abnormal liver biopsy specimens were identified. Bile leakage, hemorrhage, and infection did not occur in this series, despite inclusion of patients with severe biliary obstruction, abnormal clotting factors, and intra-abdominal sepsis. New techniques of histochemical enzyme analysis and electron microscopy are expected to enhance the clinical correlation of occult hepatic lesions. We conclude that liver biopsy in a safe, informative adjunct to all upper abdominal procedures.
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PMID:'Routine' liver biopsy in upper abdominal surgery. 88 45


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