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)

Technetium 99m-labelled hepatobiliary imaging agents provide high resolution images not previously possible with rose bengal labelled with iodine 131. This has prompted a re-examination of the utility of these radioactive pharmaceuticals. We have found that the newer methodology provides a rapid, innocuous and accurate means of excluding acute cholecystitis from the diagnosis in patients with symptoms suggestive of this disease and of assessing surgically altered biliary anatomy. In the presence of moderate bilirubinemia, up to about 85.5 to 103 mumol/L [5 to 6 mg/dL], a definitive distinction can be made between medical and surgical jaundice.
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PMID:Clinical experience with the newer hepatobiliary radiopharmaceuticals. 67 75

To ground the surgical technic and pathognomic postoperative management some etiopathogenetic problems of acute cholecystitis have been studied. The gallbladder contents and abdominal cavity exudate and their effect upon the amylase activity and microflora have been analyzed. The analysis has shown that in the pathogenesis of acute cholecystitis in elderly and senile patients the fermentative component plays an important part, which results in a rapid destruction of the gallbladder against the background of vascular disorders. Such cases need an earlier decompression of the biliary tract and the postoperative management should be aimed at the suppression of pancreatic secretion. As to the majority of the cases of acute cholecystitis, which not infrequently possesses some features of a longlasting chronic process, the operation should be postponed till inflammatory manifestations subside.
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PMID:[Change in the amylase activity and microflora in the bile in cholecystitis]. 69 2

A case of acute postoperative cholecystitis following subtotal gastrectomy for carcinoma has been observed. The combination of temporary intraoperative shock and probably vagal denervation of the gallbladder initiated secondary acute cholecystitis. After an emergency type cholecystectomy the patient recovered.
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PMID:[Secondary acute cholecystitis (author's transl)]. 69 53

Truncal vagotomy provokes acute cholecystitis in the stone-containing gallbladder of dogs. An apparently similar sequence has been fortuitously observed in three patients. These circumstances suggest that where cholelithiasis is encountered in a clinical situation in which truncal vagotomy is performed, cholecystectomy or stone removal and cholecystostomy be done as a synchronous adjunctive procedure.
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PMID:Vagotogenic cholecystitis. 70 68

Technetium-99-m-diethyl-IDA (Solco HIDA) cholescintigraphy was performed on 50 patients with suspected acute cholecysitis. The final diagnosis was acute cholecytitis in 34 cases, other biliary tract disease in 5 cases and nonbiliary disease in 11 cases. A nonfilling gallbladder was regarded as indicative of acute cholecystitis. The sensitivity in detecting acute cholecystitis was about 90%, the specificity about 80%; the predictive value of a positive test was about 90% and that of a negative test about 80%. The false positives consisted of two cases of acute pancreatitis with normal gallbladders and one case of coincidental chronic gallbladder disease and duodenal ulcer. The false negatives were examined after one week's treatment. A severe common bile duct obstruction could be detected in cholescintigraphy, but a slight obstruction was not always distinguishable from conditions in which the bile flow was normal.
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PMID:Cholescintigraphy in the diagnosis of acute cholecystitis. 70 72

A retrospective review of 88 male patients older than 60 years of age with billiary tract disease showed a mortality of 6.8%. More than 40% of the patients (39 of 88) had acute cholecystitis. Medical therapy failed for almost all of the patients (38 of 39) with acute inflammatory disease and they then required an operation during their initial hospitalization. In this acute disease group, 21% had empyema of the gallbladder, 18% had gangrenous cholecystitis or free perforation of the gallbladder, and 15% had subphrenic or liver abscesses. Escherichia coli and Klebsiella were obtained from 78% of the bile cultures, and obligate anaerobes were present in 25% of them. A delay in diagnosis and operation occurred in 33% of the patients with acute disease. Factors responsible for this delay included a deceptively benign clinical presentation and the requirement for prolonged resuscitation. Since response to conservative measures is unlikely in the elderly patient with acute cholecystitis, optimal management consists of resuscitation and prompt operation for control of infection.
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PMID:Acute cholecystitis in the elderly: a surgical emergency. 70 35

The pathology, clinical features, diagnosis, and management of acute cholecystitis are outlined with reference to 311 cases out of a total of 631 patients treated for gallstones over a 15-year period. Operative procedures and the choice of antibiotics are discussed.
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PMID:Acute gallbladder disease. 71 75

Early operation of patients with acute cholecystitis is nowadays accepted as the treatment of choice. One prerequisite for this policy is, however, the availability of diagnostic procedures that can rapidly secure or, even more important, exclude the diagnosis to avoid unnecessary operations. Infusion cholecystography was here shown to be an accurate method giving decisive information in patients with clinically suspected acute cholecystitis. The gallbladder was not visualized in 26 out of 45 patients with inconclusive clinical signs of acute cholecystitis. The diagnosis of acute cholecystitis was confirmed at operation or by a typical clinical course in these 26 patients. In the 19 patients with visualized gallbladder diagnosis other than acute cholecystitis were established by acute operation or by other means.
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PMID:Infusion cholecystography--an aid in the diagnosis of acute cholecystitis. 72 17

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

The diagnostic yields of intravenous cholangiography (IVC) and 99mTc-diethyl-IDA cholescintigraphy (CS) were compared in 50 patients; 19 had acute cholecystitis, 5 pancreatitis, 4 obstructive disease of the common bile duct, 5 chronic gallbladder disease, 6 parenchymal liver disease and 11 had other intra-abdominal diseases. The comparison of IVC and CS covered three aspects: the definition of the biliary tract structures, their morphologic changes and an assessment of bile flow through the cystic duct and the common bile duct. The definition of the main intrahepatic bile ducts was better with IVC; that of the common bile duct and the gallbladder was better with CS. Morphologic details such as calculi or local changes in duct calibre were detected only in IVC. Measurements of common bile duct calibre obtained from operative cholangiograms correlated better with those from the IVCs than with those from the CSs. CS was more sensitive in the diagnosis of cystic duct obstruction. Bile flow in the common bile duct was estimated in the cases where the gallbladder did not fill. Delayed emptying of the common bile duct was revealed in IVC in 1 and in CS in 3 out of 6 cases with disturbed bile flow. The morphologic findings in IVC gave indication of the obstructive condition in the 1 case with retarded flow and in 2 additional cases. CS provided functional information for which the concentration of the tracer was sufficient except in one case. IVC provided morphologic and functional information, but the excretion of the contrast medium was insufficient for a morphologic assessment of the common bile duct in 16 cases and for a functional assessment in 11 cases.
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PMID:Intravenous cholangiography and cholescintigraphy in the diagnosis of hepatobiliary disease. 73 87


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