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

A case of myeloma presenting as acute cholecystitis unresponsive to conventional management is reported. The impairment of the immunological response is a well-known aspect of myeloma, although this usually takes the form of recurrent respiratory infections. It is unusual for acute on chronic cholecystitis, a predominantly Gram-negative infection, to present in this way.
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PMID:Cholecystitis associated with myelomatosis. 646 1

Hepatobiliary scintigraphy as an investigative procedure has a definite role in the investigation of the surgical patient with various biliary problems. As it outlines the functional anatomy of the biliary tract, it has been employed for some time in the diagnosis of acute cholecystitis. In addition, it has a place in the investigation of patients with chronic cholecystitis, common bile duct obstruction and biliary leaks and in evaluating the integrity of biliary bypass procedures.
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PMID:Hepatobiliary scintigraphy in surgical patients. 654 10

The influence of scan and pathological criteria on the specificity of cholescintigraphy was assessed by a prospective study of 211 patients with suspected acute cholecystitis who underwent cholescintigraphy. Sufficient data were available in all to confirm a final diagnosis. Cholescintigraphy was performed in the standard fashion using 5 mCi of Tc-99m disofenin. Sixty patients had acute cholecystitis, 64 had chronic cholecystitis, and 87 had no demonstrable gallbladder disease. As the scan and pathological criteria for acute cholecystitis were varied from strict to liberal, the sensitivity of cholescintigraphy decreased (100% to 95.3%), the specificity increased (85.1% to 98.6%, and the predictive value increased (68.4% to 96.8%). The use of strict scan and pathological criteria for acute cholecystitis obscures the advantages that accrue from such early detection of acute cholecystitis by cholescintigraphy, and thus are to be avoided. To understand the disparate opinions voiced in the literature, an appreciation is required for the effects of changes in criteria on the specificity and predictive value of cholescintigraphy.
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PMID:Influence of scan and pathologic criteria on the specificity of cholescintigraphy: concise communication. 661 58

A prospective study to evaluate the accuracy of early diagnosis and the efficacy of early operation for biliary tract stone disease was performed. One hundred fifty-two consecutive patients with signs and symptoms compatible with biliary colic or acute cholecystitis were admitted to the hospital and promptly evaluated with ultrasonography and hepatobiliary (Pipida) scanning. Patients with demonstrable stones or a nonvisualized gallbladder underwent operation within 48 hours of admission. Of 75 patients who underwent operation, 64 had acute and/or severe chronic cholecystitis. Associated biliary pancreatitis was present in 14 of 75 patients. Cholecystectomy with intraoperative cholangiography was performed for 73 of the 75 patients. One patient underwent cholecystectomy only and one patient underwent cholecystostomy. There were 18 common duct explorations. No transfusions were required and there were no deaths. The average duration of hospital stay for all patients who underwent operation was 6.5 days. The results indicate that an accurate diagnosis of acute biliary tract stone disease can be made rapidly with use of sonography and hepatobiliary scanning, that cholecystectomy with intraoperative cholangiography and common duct exploration as necessary can be performed safely (including cases of biliary pancreatitis) in the acute setting, and that with early operation the duration of stay is decreased and morbidity and mortality rates compare favorably with those of elective cholecystectomy. It is concluded that operation performed within at least 48 hours of admission is the treatment of choice for acute biliary tract stone disease.
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PMID:Early operation for acute biliary tract stone disease. 662 70

Patients with acute cholecystitis without common duct stones were studied pre- and postoperatively with 99mTc-HIDA scintigraphy. The resulting hepatic time-activity curves were analyzed. Preoperative serum bilirubin levels were closely correlated with hepatic discharge but not with hepatic uptake of the radiopharmaceutical. Cholecystectomy resulted in prompt improvement of hepatic discharge but did not affect uptake. In acute as well as in chronic cholecystitis cholangiograms taken before removal of the gallbladder were compared with those taken after. In acute cholecystitis the former view frequently showed medial displacement of the biliary tract and incomplete filling of its proximal part. Displacement of the duct was also apparent in comparisons of pre- and postoperative scintigrams. Jaundice in acute cholecystitis is due to reduced excretion which may be caused by pressure on the ducts by the distended gallbladder.
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PMID:Jaundice in acute cholecystitis without common duct stones. 665 71

In this study, a series of 705 patients with chronic cholecystitis and 203 with acute cholecystitis were surgically treated. The age distribution for the two groups was similar. Operative cholangiography was performed upon 661 patients (94.0 per cent) with chronic cholecystitis and upon 182 patients (90 per cent) with acute cholecystitis. The common bile duct was explored in 146 patients (20.7 per cent) with chronic cholecystitis and in 41 patients (20.1 per cent) with acute cholecystitis, and bile duct calculi were found in 106 patients (15 per cent) with chronic cholecystitis and in 29 patients (14.2 per cent) with acute inflammation of the gallbladder. The total number of postoperative complications and the operative mortality were similar for the two groups. It is concluded that the incidence of common bile duct stones in patients with acute cholecystitis is the same as for those with chronic cholecystitis.
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PMID:Incidence of common bile duct stones in patients with acute and chronic cholecystitis. 669 Nov 68

Cefuroxime is a broad spectrum B-lactamase stable cephalosporin antibiotic. An intravenous injection of cefuroxime sodium 1.5 grams was administered to 45 patients after induction of anesthesia for cholecystectomy. Twenty-five patients had elective operations for chronic cholecystitis and 20 underwent urgent operations for acute cholecystitis. Of the 25 patients who underwent elective treatment, the cystic duct was patent in 13 and obstructed in 12. Antibiotic concentrations were measured by microbiologic assay in plasma, common bile duct bile, gallbladder bile and gallbladder wall. Organisms grown from the bile (Escherischia coli, eight; Proteus morganii, one; Streptococcus species, three, and Staphylococcus aureus, one) were sensitive to cefuroxime with the exception of one instance of Streptococcus faecalis. Cefuroxime levels were the same in specimens of patients with chronic or acute cholecystitis and reached therapeutic levels in the gallbladder wall, the main site of the inflammatory reaction. There was no difference in bile levels from gallbladders with patent or obstructed cystic ducts, suggesting that cefuroxime diffuses into the gallbladder and bile from the blood stream. There were no wound infections in this study when only a single dosage of antibiotic was administered intravenously.
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PMID:Excretion of cefuroxime in biliary disease. 670 41

As demonstrate investigations of the human gallbladder neural elements, normal (15 persons), after cholecystectomy resulted from dyskinesia (9 cases), diseases of the gallbladder cervix (28 cases), chronic (263 cases) and acute (16 cases) cholecystitis, using Falk--Hillarp--Govyrin, Karnovsky--Roots, Bielshowsky--Gros methods and incubation in 2% glyoxylin acid solution, a rich adrenergic and cholinergic innervation has been demonstrated in the organ studied at the states mentioned and their connection with the pathomorphological changes in the gallbladder wall. The analysis of 2,428 cases of chronic and acute cholecystitis has been performed in order to compare the clinical signs with changes in the central nervous system and the neural elements of the gallbladders removed. The importance of the gallbladder neural elements in the development of dyskinesia, diseases of the gallbladder cervix and chronic cholecystitis is mentioned.
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PMID:[Adrenergic and cholinergic innervation of the normal human gallbladder and in various diseases]. 671 87

Hepatobiliary imaging with the various technetium-labeled IDA compounds is more than 90% sensitive and specific for the diagnosis of acute cholecystitis. Causes of false-positive studies include chronic cholecystitis, cystic-duct obstruction by tumor, prolonged fasting, the nonfasting state, pancreatitis, alcoholism, parenteral hyperalimentation, and severe intercurrent illness. A case of congenital absence of the gallbladder is submitted as another cause of a false-positive scan.
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PMID:Congenital absence of the gallbladder: another cause of false-positive hepatobiliary image. 672 25

Prostaglandins (PGs) affect smooth-muscle contractility and are also involved in the inflammatory reaction. They may therefore affect gallbladder motility in cholecystitis. The contractile effects of PGs were recorded in organ baths on strips from 63 fresh, surgically removed human gallbladders. Spontaneous rhythmic contractions were reduced or abolished by indomethacin, which inhibits endogenous PG synthesis. In strips with chronic cholecystitis, concentration-dependent contractions were produced by PGF2, PGB2 and PGD2; the responses to PGE1 and PGE2 were sometimes variable but there were concentration-dependent contractions after treatment of the strips with indomethacin. The majority of strips with acute cholecystitis responded poorly to PGs even after pretreatment with indomethacin. We concluded from this preliminary study that PGs could affect gallbladder motility and that indomethacin probably reduces the endogenous production of PGs in the gallbladder.
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PMID:Effects of prostaglandins on motility of gallbladders removed from patients with gallstones. 673 80


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