Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0149520 (acute cholecystitis)
 2,784 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gallium has been shown to accumulate in metabolically active tissue including sites of infection. The purpose of this study was to evaluate gallium scanning in cholecystitis. Ten patients with cholecystitis were studied using conventional gallium scanning techniques. Five patients with acute cholecystitis showed intense gallium accumulation in the gallbladder area. One of five patients with chronic cholecystitis showed significant accumulation in the gallbladder. The limitations of this method are mainly the need for serial scanning to rule out gallium accumulation in the hepatic flexure of the colon and also the failure to detect consistently a chronically diseased fibrotic gallbladder. We conclude that gallium scanning of the gallbladder is an important adjunctive study in the evaluation of cholecystitis.
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PMID:Gallium gallbladder scanning in cholecystitis. 111 Apr 20

Technetium-99m-pyridoxylideneglutamate (99mTc-PG) is a nontoxic radiopharmaceutical that was found to undergo rapid biliary excretion in normal humans. The biliary tree and gallbladder were seen within 10-15 min of injection and by 20 min marked accumulation of radioactivity was noted in the gallbladder and gastrointestinal tract. Of ten "control" volunteers, seven had normal 99mTc-PG-cholescintigrams. In the remaining three, the gallbladder was not visualized. Gallbladder disease was not excluded in these three subjects. Of 24 patients referred for investigation of right upper quadrant abdominal pain, 13 proved to have gallbladder disease. All seven patients with acute cholecystitis and one of four patients with chronic cholecystitis had nonvisualization of the gallbladder on the cholescintigram whereas five patients with chronic cholecystitis or cholesterolosis had normal cholescintigrams. Six of the eight patients with nonvisualization of the gallbladder on cholescintigram had contrast radiologic studies (oral cholecystogram or intravenous cholangiogram or both), and in all six, nonvisualization of the gallbladder was also reported on the contrast study. cholescintigraphy was found to be greatly inferior to contrast radiologic studies in the detection of gallbladder stones. Eleven patients had complete extrahepatic biliary obstruction and this diagnosis was correctly made in all 11 by the cholescintigram. Fourteen patients had incomplete extrahepatic biliary obstruction. The correct diagnosis was made on the cholescintigram in seven but in the remaining seven it was not possible to distinguish between incomplete extrahepatic biliary obstruction and hepatocellular disease. Malignant lesions (carcinomas of head of pancreas, gallbladder, common bile duct or ampulla of Vater) were the cause of obstruction in 10 of the 25 patients with complete or incomplete obstruction and the diagnosis of obstruction due to malignancy was correctly made in 8 of these 10 by means of a scintigraphic equivalent to Courvoisier's sing. Finally, 11 patients had hepatocellular disease and a nonspecific pattern consistent with either imcomplete biliary obstruction or hepatocellular disease was observed on the cholescintigram in all 11. The 99mTc-PG cholescintigram is suggested for a role complementary to that of contrast radiologic studies in the preoperative investigation of patients with possible surgical disease of the biliary tract. Contrast radiologic techniques are advocated as being more appropriate in the nonjaundiced patient with suspected gallbladder disease whereas the 99mTc-PG cholescintigram is advocated as being more appropriate in the patient with jaundice. The value of the 99mTc-PG cholescintigram lies in the confidence with which complete extrahepatic biliary obstruction can be diagnosed. The "scintigraphic Courvoisier's sign" seems a useful indicator of malignant obstruction.
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PMID:Technetium-99m-pyridoxylideneglutamate: a new hepatobiliary radiopharmaceutical. II. Clinical aspects. 117 49

In approximately 80 per cent of cases the gallbladder is closely applied to the superior medial aspect of the right colic flexure. This intimate anatomic relationship provides pathways for direct extension of both inflammatory and neoplastic lesions of the gallbladder to involve the adjacent colon. The resultant secondary colonic abnormalities noted in 15 patients have been analyzed and correlated with surgical-pathologic findings. In acute cholecystitis, barium enema examination shows evidence of indentation by an enlarged gallbladder, spasm and mucosal edema in the anterior hepatic flexure. Chronic cholecystitis results in involvement of the adjacent colon by fibrous adhesions and inflammatory reaction. These may further lead to the development of pseudotumors simulating primary carcinoma of the colon. Similar findings including cholecysto-colic fistulae may be the initial manifestations of carcinoma of the gallbladder. The spectrum of pathologic-roentgenographic alterations in the cholecysto-colic interface is described and illustrated. Recognition of these features is of critical importance for the correct interpretation of barium enema findings and the subsequent management of patients with gallbladder disorders.
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PMID:The cholecysto-colic relationships. A roentgen-anatomic study of the colonic manifestations of gallbladder disorders. 120 Feb 12

Duodenogastric reflux (DGR) as seen on hepatobiliary scintigraphy has been reported as a useful secondary sign for the diagnosis of acute cholecystitis. We evaluated the association of reflux with cases of acute cholecystitis as compared to those with chronic cholecystitis or other conditions. Thirty-six of 198 patients referred for hepatobiliary imaging showed DGR (18%). Among 26 patients with acute cholecystitis, 6 (23%) had DGR as compared to 9/40 (23%) cases with chronic cholecystitis, 3/12 cases with acute pancreatitis, 4/13 cases with previous cholecystectomy, and 3/8 cases with duodenal ulcer. No statistically significant differences were found between the prevalence of DGR in cases with acute cholecystitis and those with chronic cholecystitis or other nonacute cholecystitis diagnostic categories. Although acute cholecystitis is a condition frequently associated with DGR, such reflux is a nonspecific finding and should not be considered as a secondary sign of acute cholecystitis when interpreting hepatobiliary scans.
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PMID:Scintigraphic evaluation of duodenogastric reflux: significance in the diagnosis of acute cholecystitis. 134 21

Contrary to earlier predictions, it appears that acute cholecystitis should be considered a relative rather than an absolute contraindication to laparoscopic surgery. The most important parameter in determining the feasibility of attempting laparoscopic cholecystectomy in the setting of acute inflammation appears to be the experience of the surgeon. This also appears to be true when encountering individuals with elements of long-standing chronic cholecystitis. Although laparoscopic intervention in such patients is associated with a greater likelihood of conversion to open laparotomy, the incidence of major biliary and nonbiliary complications appears to be low. In addition, these patients enjoy the same benefits of laparoscopic surgery as those undergoing elective surgery.
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PMID:Laparoscopic management of acute and chronic cholecystitis. 138 96

Morphological changes of gall bladder were studied in 415 cholecystectomy specimens. There was a preponderance of females (male to female ratio--1:6.5). The mean age of the cases was 43.6 years. Most of the cases (63.4%) were in the 4th and 5th decades of life. The average duration of illness was 2.8 years. Associated cholelithiasis was present in 85.3% cases. Gall-stones were of mixed variety in 78.2% cases, cholesterol type in 15.3% cases and both types were present in 6.5% cases. Chronic cholecystitis was the main histological diagnosis (50.8%). Other lesions observed were adenomyomatosis (8.2%), adenomatous hyperplasia (10.1%), granulomatous cholecystitis (4.1%), cholesterosis (2.7%), acute cholecystitis (4.1%), acute on chronic infection (10.8%), sub-acute cholecystitis (2.4%) and carcinoma gall bladder (6.8%). The frequency of Rokitansky-Aschoff's sinuses was closely related with the degree of inflammatory response. In 13 (6.2%) cases the diagnosis of chronic follicular cholecystitis was made. All the cases of cholesterosis were multiparous females and of younger age. Of the malignant lesions, adenocarcinoma was the commonest (96.4%).
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PMID:Morphological changes in diseased gall bladder: a study of 415 cholecystectomies at Aligarh. 140 74

One hundred cases of patients who underwent urgent cholecystectomy after presenting with symptoms of acute or subacute gallbladder disease were retrospectively reviewed. Sixty patients had pathologically proved acute cholecystitis, and 40 had chronic cholecystitis alone. One patient had an incidental gallbladder carcinoma, and four had global gangrene of the gallbladder. Focal ischemia, transmural hemorrhage, or focal necrosis (indicating more severe disease) was present in 19 patients. Fifty-four percent of patients had thin-walled gallbladders. Among patients with more severe acute disease, 56% had thin walls. Conversely, 24% of thin-walled gallbladders and 22% of thick-walled gallbladders had evidence of focal necrosis or gangrene. We conclude that gallbladder wall thickness, although demonstrable on preoperative ultrasound examination in all patients, does not correlate directly with severity of disease or pathologic findings.
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PMID:Significance of wall thickness in symptomatic gallbladder disease. 141 89

One hundred fourteen patients with suspected acute cholecystitis underwent morphine-augmented cholescintigraphy. The 115 studies were reviewed first to determine the incidence of enterogastric reflux under these conditions. Overall, enterogastric reflux was observed in 85/115 (74%), occurring only after intravenous morphine sulfate in the majority (59%, 50/85). Noted prior to morphine in 41% (35/85), the degree of enterogastric reflux increased noticeably directly following drug administration in over half of these cases. Surgical diagnoses were established in 73/114 (64%) patients as follows: 56 (77%) acute cholecystitis, 15 (20%) chronic cholecystitis, and 2 (3%) another entity (normal gallbladder and tumor encasement). These pathologically proven cases were examined more closely to address the diagnostic significance of enterogastric reflux during morphine-augmented cholescintigraphy. Enterogastric reflux was demonstrated in the majority of not only those with acute cholecystitis (48/56, 86%), but also those with chronic cholecystitis (12/15, 80%). A frequent but nonspecific finding, enterogastric reflux appears to be a pathophysiologic phenomenon that may be enhanced synergistically, at least to some degree, in patients requiring morphine-augmented cholescintigraphy.
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PMID:Incidence and significance of enterogastric reflux during morphine-augmented cholescintigraphy. 146 66

The initial 950 consecutive laparoscopic cholecystectomies performed in one city at four hospitals by 30 general surgeons are reported, covering a period from April 4, 1990 to April 3, 1991. There were two operative deaths (0.2%), three common bile duct lacerations (0.3%), two subhepatic abscesses, two bowel perforations, and three bile leaks, two requiring laparotomy. Seven episodes of bleeding occurred, of which five required laparotomy, but none involved a major vessel. Sixty-five procedures were converted to open (6.7%). The mean operative time was 85.4 min. Intraoperative cholangiography was adequately completed in 49.8% and not attempted in 30.3%. Thirteen patients (2.7%) were found to have common duct stones. The pathologic diagnoses were chronic cholecystitis in 784 patients (82.5%), acute cholecystitis in 145 (15.3%), and cancer of the gallbladder in one (0.1%). Hospital stays ranged from 4 h to 31 days (mean 49.5 h). This procedure can be learned and performed safely in a community setting.
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PMID:Laparoscopic cholecystectomy: an initial community experience. 148 94

In a retrospective study, the results of 1,631 consecutive operations for cholelithiasis were analyzed. With an overall mortality rate of 0.18 percent and a reoperation rate of 1.3 percent, conventional cholecystectomy proved to be a safe method. Mortality proved to be age dependent, with a zero mortality rate for patients less than 60 years of age. Choledochotomy had a 13-fold greater mortality rate than simple cholecystectomy (0.92 versus 0.07 percent). For acute cholecystitis, we observed an unusual zero mortality rate, whereas the mortality rate in chronic cholecystitis was 0.2 percent. All three patients who died had an accompanying cirrhosis of the liver. Morbidity, defined as reoperation during the same period of hospitalization, was mainly the result of retained stones after choledochotomy; endoscopic papillotomy was the treatment of choice. Cholecystectomy remains the "gold standard" in the treatment of cholelithiasis.
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PMID:Surgical treatment for cholelithiasis. 151 58


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