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 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Distension of the gallbladder and bacterial infection can perpetuate an attack of acute calculous cholecystitis and produce its local and systemic complications. This prospective randomized trial was conducted on patients with their first episode of acute calculous cholecystitis which was associated with pyrexia and tachycardia to examine whether ultrasound guided percutaneous aspiration and lavage of the gallbladder followed by intra-lumenal instillation of 500 mg ampicillin (PALA) enhanced recovery from cholecystitis. Twenty patients were randomized to receive 500 mg of ampicillin every 6 hours for 5 days and another 20 patients were randomized to receive this treatment in addition to PALA within 12 hours of admission. Twenty four hours after admission to hospital, all the patients treated with PALA were apyrexial and had no residual right hypochondrial tenderness or guarding, a result superior (p less than 0.001) to that of the group without PALA where at least 75% of patients were still showing these signs. Two days after admission the WBC count of the PALA group was significantly (p less than 0.05) lower than that of the other group (6.32 +/- 0.1 x 10(9)/L vs 10.31 +/- 0.4 x 10(9)/L, mean +/- SEM, n = 20). Four days after admission, all members of the PALA group were comfortably tolerating solid food for the previous 24 hours and were, therefore, discharged home whereas all members of the other group were still in hospital and 85% of them were discharged home after hospitalization for 6 to 7 days. Three members (15%) of this group deteriorated and underwent emergency surgery. The results show that addition of PALA to the conventional non-operative treatment of acute cholecystitis enhances recovery and avoids the complications necessitating emergency surgery.
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PMID:Percutaneous aspiration, lavage and antibiotic instillation. New approach in the management of acute calculous cholecystitis. 204 14

The pre and postoperative incidence of cholelithiasis were investigated in patients undergoing bariatric surgery at the University of Florida. The first part of the study was retrospective and revealed a pre and 24-month postoperative incidence of cholelithiasis of 30 and 40 percent respectively. Age and postoperative interval were not predictive of cholelithiasis. Patients with cholelithiasis had a significantly greater weight loss (130 +/- 61.0 lbs) than those without stones (109 +/- 59.9 lbs) P = 0.04. Men had a significantly greater weight loss than women (160 +/- 15 lbs SEM versus 99 +/- 7 lbs SEM) as well as a higher incidence of cholelithiasis (53 and 24%, respectively). In the second, prospective part of the study, cholecystectomy was performed in 73 consecutive patients concomitant with their bariatric procedure. Ninety six per cent of removed gallbladders had gross or histologic abnormalities including cholelithiasis in 27 per cent and cholesterolosis/cholecystitis in 69 per cent. The incidence of cholelithiasis was higher than that found in the retrospective series by preoperative ultrasound. The bariatric surgical patient is clearly at risk for the development of postoperative cholelithiasis and cholecystitis. The risk appears to be related to the amount of weight loss. In addition, some gallstones may remain undetected at the time of surgery. We therefore recommend prophylactic cholecystectomy at the time of bariatric surgery.
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PMID:The case for prophylactic cholecystectomy concomitant with gastric restriction for morbid obesity. 336 62

Eleven of 20 patients with chronic granulomatous disease (55%) developed serious gastrointestinal complications requiring surgical consultation or operation over a 10-year period with an average of 2.2 complications per patient. The mean age of onset of symptoms was 12 years (range 2.5 months to 25 years), and 91% of the patients were male. Admission for gastrointestinal complications constituted 18% of all admissions for these patients; the mean hospitalization time was 27.8 +/- 3.5 (SEM) days. Hepatic abscess, the most common complication, occurred in 16 instances. Perirectal abscess developed in three patients and gastric outlet obstruction developed in two patients. Other complications included appendicitis, acalculous cholecystitis, and Salmonella enteritis. Open hepatic debridement and external drainage combined with long-term intravenous antibiotics (mean 25.2 +/- 4.8 days) were curative in every case, but operative morbidity was frequent and severe. Twelve major complications accompanied open hepatic drainage in 14 cases including wound disruption, prolonged febrile course, subhepatic abscess, and recurrent hepatic abscess. Five secondary operations were required for treatment of these complications. Gastric outlet obstruction, by contrast, was successfully managed nonoperatively. Staphylococcus aureus was an etiologic agent in 66% of the cases, but many other aerobic gram-positive and gram-negative organisms were isolated. Anaerobic bacteria were unusual. Bacteremia occurred only once.
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PMID:Gastrointestinal complications of chronic granulomatous disease: surgical implications. 662 57

To define the risk of complications in cirrhotic patients with asymptomatic cholelithiasis and the possible benefit of incidental cholecystectomy during abdominal operations in these patients, a retrospective cohort of cirrhotic patients who had asymptomatic cholelithiasis and underwent abdominal operations for portal hypertension was analyzed. Of 338 patients operated on during the last 15 years, 34 patients were found with asymptomatic cholelithiasis, all of whom had long-term follow-up. At a mean follow-up of 70.5 +/- 8.6 months (SEM), 28 patients remained asymptomatic (82%), 6 patients have developed symptoms (18%), (4 patients had acute cholecystitis and 2 chronic cholecystitis), and 3 of these patients (8.8%) died due to complications of acute cholecystitis. The results suggest that the risk for the development of complications is low but that the mortality associated with acute episodes of cholecystitis is high. Incidental cholecystectomy is not justified in cirrhotic patients with asymptomatic cholelithiasis, but close follow-up with early elective operation when symptoms supervene should be recommended.
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PMID:Long-term evolution of asymptomatic cholelithiasis diagnosed during abdominal operations for variceal bleeding in patients with cirrhosis. 766 2