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)

Forty-five patients with varying biliary pathology were injected with one gram of intramuscular cefazolin sodium prior to surgery. Serum, gallbladder bile, and common duct bile levels were measured. The type of biliary disease did not influence serum levels (mean, 29 mug per milliliter) which reached a peak one hour after injection. Mean common duct bile levels were reduced from 52 mug per milliliter in nonjaundiced patients to 4 mug per milliliter in those with jaundice (p less than 0.001). Patients with radiologically functioning gallbladders had significantly higher mean gallbladder bile levels (21 mug per milliliter; p less than 0.005). Surprisingly, the mean gallbladder bile level in acute cholecystitis was 25 mug per milliliter. As the minimum inhibitory concentration of cefazolin for organisms commonly found in the bile is 0.5 to 6 mug per milliliter, we suggest that cefazolin sodium may be of value in the treatment of biliary disease, particularly acute cholecystitis.
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PMID:The influence of biliary disease on the excretion of cefazolin in human bile. 84 50

The gallbladder is conventionally regarded as an absorptive organ such that dilute hepatic bile is both stored and concentrated. We studied 35 patients who had recovered from a percutaneous transhepatic gallbladder drainage performed for acute cholecystitis. After an overnight fast, gallbladder bile was dark brown in color and had a wide scatter in the lipid composition. Two hours after a meal, the gallbladder bile was opalescent white in color and had the composition of an extracellular fluid. This phenomenon was uniformly observed in all 35 patients and was also consistently reproducible when five patients were repeatedly studied. We used normal dog gallbladder epithelial cell monolayers grown in culture and examined sodium flux. Control gallbladder cells absorbed sodium. When secretin (0.5-2.5 x 10(-7) M) was added, there was a prompt reversal of sodium flux, resulting in net secretion. We conclude that secretion is a physiological function of the gallbladder mucosa. After feeding, the neural and humoral factors divert stored and newly secreted bile into the duodenum and induce active de novo secretion thus producing a gallbladder bile that is opalescent white with no lipids. Our results also have important implications on the origin of the pathological "white bile," the pathogenesis and treatment of gallbladder sludge, as well as the kinetic analysis of compounds undergoing enterohepatic recirculation.
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PMID:Gallbladder mucosal function: studies in absorption and secretion in humans and in dog gallbladder epithelium. 163 18

Sixty patients were treated in the emergency ward for biliary colic. Cholelithiasis was proven by ultrasonography. Twenty patients (group I) were treated by placebo. Twenty patients (group II) were treated by papaverine, and 20 patients were treated by diclofenac sodium (Voltaren) (group III). Twenty more patients (group IV) with low back pain (LBP) were treated with diclofenac sodium (Voltaren) as a control to assess the analgesic effect of Voltaren. Two interesting observations were made: Voltaren was proven more efficient for pain relief (P less than 0.002), and none of the patients treated with Voltaren were in need of hospitalization and immediate surgery. In comparison, nine patients of the other two groups progressed to acute cholecystitis and needed surgical intervention. The possible anticolic and anti-biliary inflammation properties and the indications for use of Voltaren are discussed.
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PMID:Biliary colic treatment and acute cholecystitis prevention by prostaglandin inhibitor. 210 77

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

A 75-year-old woman came to our emergency clinic complaining of abdominal pain. Acute cholecystitis was diagnosed, and parenteral antibiotic therapy was initiated. Because of palpitation, she had a consultation with the cardiology clinic. Echocardiography showed a 2.7 x 2.2 cm mobile thrombus attached to the apex of the right ventricle. Since no thromboembolic complications were present, we decided to begin administering heparin and oral anticoagulant. After the administration of unfractionated heparin for 48 hours, the patient was shifted to low-molecular weight heparin because it is easier to use and requires no follow-up. The patient received low-molecular weight heparin in addition to sodium warfarin for 5 days. Administration of heparin was then stopped and treatment was continued with sodium warfarin. In the series of weekly echocardiography evaluations, a gradual reduction was noted in the apical mass, which was initially considered to be a thrombus, and 3 weeks later evaluation revealed that the thrombus in the right ventricle had disappeared completely. No thromboembolic complications were observed during the follow-up period.
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PMID:Successful treatment of right ventricular thrombus with heparin and sodium warfarin therapy: a case report. 1716 99

The objective of the present study was to identify admission clinical factors associated with gangrenous cholecystitis (GC) and factors associated with conversion to open cholecystectomy. We retrospectively evaluated 391 patients over a 17-month period who underwent urgent laparoscopic cholecystectomy for a diagnosis of acute cholecystitis. Eighty-nine patients with pathologically proven GC were compared with 302 patients without GC. On multivariable logistic regression, predictors of GC included male gender, white blood cell count greater than 14,000/mm3, heart rate greater than 90 beats per minute, and sodium 135 mg/dL or less. Conversion rate to open cholecystectomy was 7.9 per cent overall, 4 per cent for non-GC, and 19 per cent for GC (odds ratio, 0.2; 95% confidence interval, 0.1 to 0.4; P<0.00001). Conversion was predicted by increasing number of days to surgery, total bilirubin, and white blood cell count. Complication rate was higher in the GC group (10.1 vs 3.6% in the acute cholecystitis group, P=0.01). The increased rate of conversion observed with surgery delay suggests that early laparoscopic cholecystectomy may be preferable in most patients.
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PMID:Admission variables predictive of gangrenous cholecystitis. 2302 44

Abdominal wall hernias are common problems found in patients with cirrhosis because of persistently high intra-abdominal pressure. When abdominal hernias are neglected in such patients, they may become larger and could result in cosmetic problems and pressure effects that are also difficult to treat. We found a voluminous mass in the anterior abdominal wall of a 40-year-old patient with cirrhosis. The patient was operated on for acute cholecystitis 12 years earlier. Abdominal computed tomography revealed an epigastric hernia presenting as a grossly distended hernia sac filled with serous fluid and intestinal loops. The patient was not operated on and was discharged with sodium-restricted diet and diuretics.
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PMID:Giant abdominal wall hernia in a patient with cryptogenic cirrhosis. 2509 66

A 58-year-old man with Stage 3b chronic kidney disease and primary hyperparathyroidism treated with cinacalcet was admitted for acute cholecystitis. A cholecystostomy tube was placed, estimated glomerular filtration rate decreased, metabolic acidosis developed and ionized calcium increased from 1.33 to 1.76 mM despite cinacalcet administration. A sodium bicarbonate infusion corrected the metabolic acidosis restoring ionized calcium to normal despite no improvement in renal function. The correlation between the increase in serum bicarbonate and decrease in ionized calcium was r = -0.93, P < 0.001. In summary, severe hypercalcemia was attributable to metabolic acidosis increasing calcium efflux from bone while renal failure decreased the capacity to excrete calcium.
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PMID:Metabolic acidosis-induced hypercalcemia in an azotemic patient with primary hyperparathyroidism. 2585 94

Sodium glucose co-transporter (SGLT-2) inhibitor is a relatively new medication used to treat diabetes. At present, the Food and Drug Administration (FDA) has only approved three medications (canagliflozin, dapagliflozin and empagliflozin) in this drug class for the management of Type 2 diabetes. In May 2015, the FDA issued a warning of ketoacidosis with use of this drug class. Risk factors for the development of ketoacidosis among patients who take SGLT-2 inhibitors include decrease carbohydrate intake/starvation, acute illness and decrease in insulin dose. When identified, immediate cessation of the medication and administration of glucose must be done, and in some instances, starting an insulin drip might be necessary. We present a case of a patient with diabetes mellitus being on empagliflozin (SGLT-2 antagonist) who was admitted for acute cholecystitis. The hospital course was complicated by euglycemic diabetic ketoacidosis after being kept nothing per orem before a contemplated cholecystectomy.
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PMID:The DKA that wasn't: a case of euglycemic diabetic ketoacidosis due to empagliflozin. 2747 97