WorldWideScience

Sample records for bleeding gallbladder bed

  1. Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial.

    Science.gov (United States)

    Mahabaleshwar, Varun; Kaman, Lileswar; Iqbal, Javid; Singh, Rajinder

    2012-10-01

    Ultrasonic dissection has been suggested as an alternative to monopolar electrocautery in laparoscopic cholecystectomy because it generates less tissue damage and may have a lower incidence of gallbladder perforation. We compared the 2 methods to determine the incidence of gallbladder perforation and its intraoperative consequences. We conducted a prospective randomized controlled trial between July 2008 and December 2009 involving adult patients with symptomatic gall stone disease who were eligible for laparoscopic cholecystectomy. Patients were randomly assigned before administration of anesthesia to electrocautery or ultrasonic dissection. Both groups were compared for incidence of gallbladder perforation during dissection, bile leak, stones spillage, lens cleaning, duration of surgery and estimation of risk of gallbladder in the presence of complicating factors. We included 60 adult patients in our study. The groups were comparable with respect to demographic characteristics, symptomatology, comorbidities, previous abdominal surgeries, preoperative ultrasonography findings and intraoperative complications. The overall incidence of gallbladder perforation was 28.3% (40.0% in the electrocautery v. 16.7% in the ultrasonic dissection group, p = 0.045). Bile leak occurred in 40.0% of patients in the electrocautery group and 16.7% of patients in ultrasonic group (p = 0.045). Lens cleaning time (p = 0.015) and duration of surgery (p = 0.001) were longer in the electrocautery than the ultrasonic dissection group. There was no statistical difference in stone spillage between the groups (p = 0.62). Ultrasonic dissection is safe and effective, and it improves the operative course of laparoscopic cholecystectomy by reducing the incidence of gallbladder perforation.

  2. Gallbladder Cancer

    Science.gov (United States)

    ... your gallbladder and liver to your small intestine. Cancer of the gallbladder is rare. It is more ... the abdomen It is hard to diagnose gallbladder cancer in its early stages. Sometimes doctors find it ...

  3. Gallbladder duplication

    Directory of Open Access Journals (Sweden)

    Yagan Pillay

    2015-01-01

    Conclusion: Duplication of the gallbladder is a rare congenital abnormality, which requires special attention to the biliary ductal and arterial anatomy. Laparoscopic cholecystectomy with intraoperative cholangiography is the appropriate treatment in a symptomatic gallbladder. The removal of an asymptomatic double gallbladder remains controversial.

  4. GALLBLADDER CARCINOMA

    OpenAIRE

    Blaž Trotovšek; Valentin Sojar; Dragan Stanisavljevič; Aleš Tomažič

    2003-01-01

    Background. Carcinoma of the gallbladder is a tumour with a dismal prognosis and 5-years overall survival rate less than 5%. Among the tumours of the gastrointestinal tract it is fifth in the row and its incidence is approximately 1.2/105. Tumour occurs more often (2–6 times) in women and in people over 50 years old (90%). According to the Slovenian Registry of Cancer for year 1998 the incidence of gallbladder carcinoma was 2.7/105 and it occurred 4 times more often among women. The most impo...

  5. Carcinoma gallbladder.

    Science.gov (United States)

    Biswas, P K

    2010-07-01

    Carcinoma gallbladder (CaGb) is a rare disease. The aetiology of CaGb is yet not known. However the risk of CaGb is increased in anomalous pancreaticobiliary duct junction (APBDJ), gall stones, xanthogranulomatus cholecystitis, calcified or porcelain gallbladder, cholelithiasis with typhoid carriers, gallbladder adenoma, red meat consumption and tobacco uses. There are protective effects of vegetables on CaGb. Most of the cases present with advanced disease. In early carcinoma of a gallbladder sign and symptoms mimic benign disease. The diagnosis is established by ultrasonography, computerized tomography and guided fine needle aspiration cytology (FNAC). Biochemical tests are of very little value in making a diagnosis. The treatment depends on the clinical stage at presentation. Surgery offers the best chance of cure. In stage T1a, laparoscopic or open cholecystectomy alone is curative, and in T1b, cholecystectomy with hepatoduodenal lymph node dissection without combined resection of an adjacent organ is required. Segment S4a+5 hepatectomy combined with extrahepatic bile duct resection (BDR) and D2 lymph node dissection is a highly recommended operation for the treatment of T2 and T3 CaGb. The dye injection method is useful in determining the appropriate extent of hepatic resection for advanced CaGb. Resurgery is required only in those cases where tumour has invaded the serosa and/ or adjacent structures when diagnosed postoperatively. Biliary bypass is required for palliation. Prognosis depends on early diagnosis and appropriate surgical excision.

  6. Mycobacterial Infection of the Gallbladder Masquerading as Gallbladder Cancer with a False Positive Pet Scan

    Directory of Open Access Journals (Sweden)

    Adeeb Majid

    2013-01-01

    Full Text Available Isolated mycobacterial infection of gall bladder is an extremely rare entity. Only anecdotal reports are evident in the literature. A preoperative diagnosis of mycobacterial infection of gallbladder is therefore very difficult. The case of a 72-year-old male who underwent surgery for suspected gallbladder cancer is presented. The diagnosis of cancer was based on radiological findings and an abnormal uptake of fluorine-18-fluoro-2-deoxy-D-glucose (FDG on positron emission tomography (PET scan whilst being followed up for colorectal cancer. He underwent cholecystectomy and gallbladder bed resection. Histopathology was consistent with mycobacterial infection of the gallbladder.

  7. Gallbladder removal - open

    Science.gov (United States)

    Cholecystectomy - open; Gallbladder - open cholecystectomy; Cholecystitis - open cholecystectomy; Gallstones - open cholecystectomy ... a medical instrument called a laparoscope ( laparoscopic ... Open gallbladder surgery is used when laparoscopic surgery cannot ...

  8. Intraabdominal contamination after gallbladder perforation during laparoscopic cholecystectomy and its complications.

    Science.gov (United States)

    Kimura, T; Goto, H; Takeuchi, Y; Yoshida, M; Kobayashi, T; Sakuramachi, S; Harada, Y

    1996-09-01

    Gallbladder perforation often occurs during laparoscopic cholecystectomy. The frequency and causes of gallbladder perforation as well as the relevant clinical background factors were investigated in 110 patients undergoing laparoscopic cholecystectomy. We also evaluated intraperitoneal contamination by bacteria and gallstones at the time of gallbladder perforation and investigated whether perforation caused early or late postoperative complications. Intraoperative gallbladder perforation occurred in 29 of the 110 patients (26.3%). It was caused by injury with an electric knife during dissection of the gallbladder bed, injury during gallbladder retraction with grasping forceps, injury during gallbladder extraction from the abdomen, and slippage of cystic duct clips (potentially causing bile and stone spillage). Perforation was more frequent in patients with positive bile cultures and in those with pigment stones (p gallbladder perforation is sometimes unavoidable during laparoscopic cholecystectomy, the risk of severe complications appears to be minimized by early closure of perforation, retrieval of as many of the spilled stones as possible, and intraperitoneal lavage.

  9. Multidetector CT diagnosis of massive hemobilia due to gallbladder polyposis in a child with metachromatic leukodystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Wanner, Matthew R.; Karmazyn, Boaz [Indiana University School of Medicine, Riley Hospital for Children, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Fan, Rong [Indiana University School of Medicine, Riley Hospital for Children, Department of Pathology and Laboratory Medicine, Indianapolis, IN (United States)

    2015-12-15

    Hemobilia secondary to gallbladder polyposis is rare in children but has been reported in a few children with metachromatic leukodystrophy. We present a case with preoperative multidetector computed tomography (MDCT) diagnosis of massive hemobilia caused by gallbladder polyposis in a patient with metachromatic leukodystrophy. Our report highlights the importance of both awareness of the association of gallbladder polyposis with other syndromes such as metachromatic leukodystrophy as well as the possibility of this entity presenting with life-threatening bleeding. (orig.)

  10. Fatal intra-abdominal hemorrhage as a result of avulsion of the gallbladder: a postmortem case report

    International Nuclear Information System (INIS)

    Usui, Akihito; Kawasumi, Yusuke; Hosokai, Yoshiyuki; Saito, Haruo; Igari, Yui; Funayama, Masato

    2013-01-01

    Gallbladder injuries are extremely rare in blunt trauma, with a reported incidence of <2%. We report an autopsy case of fatal hemorrhagic shock due to intra-abdominal bleeding resulting from complete avulsion of the gallbladder associated with liver cirrhosis. Multiplanar images derived from multislice computed tomography (MSCT) performed as part of pre-autopsy screening showed complete avulsion of the gallbladder without any other associated intra-abdominal injuries, facilitating forensic autopsy planning. In this report, we discuss the role of MSCT in cases of fatal intra-abdominal bleeding caused by avulsion of the gallbladder and discuss the mechanism of this injury

  11. Isolated complete avulsion of the gallbladder (near traumatic cholecystectomy: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Pavlidis Theodoros E

    2011-08-01

    Full Text Available Abstract Introduction Injury of the gallbladder after blunt abdominal trauma is an unusual finding; the reported incidence is less than 2%. Three groups of injuries are described: simple contusion, laceration, and avulsion, the last of which can be partial, complete, or total traumatic cholecystectomy. Case presentation A case of isolated complete avulsion of the gallbladder (near traumatic cholecystectomy from its hepatic bed in a 46-year-old Caucasian man without any other sign of injury is presented. The avulsion was due to blunt abdominal trauma after a car accident. The rarity of this injury and the stable condition of our patient at the initial presentation warrant a description. The diagnosis was made incidentally after a computed tomography scan, and our patient was treated successfully with ligation of the cystic duct and artery, removal of the gallbladder, coagulation of the bleeding points, and placement of a drain. Conclusions Early diagnosis of such injuries is quite difficult because abdominal signs are poor, non-specific, or even absent. Therefore, a computed tomography scan should be performed when the mechanism of injury is indicated.

  12. Gallbladder torsion. Case report

    DEFF Research Database (Denmark)

    Brasso, K; Rasmussen, O V

    1991-01-01

    Gallbladder torsion is a rare surgical emergency occurring primarily in elderly women. The anatomical background is a variation in the attachment of the gallbladder to the inferior margin of the liver. Increasing life span will probably lead to an increasing number of cases, and gallbladder torsion...... must be kept in mind in patients with sudden onset of pain in the upper right quadrant, nausea, vomiting, and a palpable mass. None of the laboratory routines or non-invasive examinations enables one to make the right preoperative diagnosis. Treatment is cholecystectomy. Promptly treated, the prognosis...

  13. Gallbladder Cancer—Health Professional Version

    Science.gov (United States)

    Cancer that arises in the gallbladder is uncommon. Almost all gallbladder cancers are adenocarcinomas. The most common symptoms caused by gallbladder cancer are jaundice, pain, and fever. Find evidence-based information on gallbladder cancer treatment.

  14. Gallbladder removal - laparoscopic

    Science.gov (United States)

    ... Gallbladder anatomy Laparoscopic surgery - series References Jackson PG, Evans SRT. Biliary system. In: Townsend CM Jr, Beauchamp ... A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among ...

  15. Spontaneous external gallbladder perforation

    International Nuclear Information System (INIS)

    Noeldge, G.; Wimmer, B.; Kirchner, R.

    1981-01-01

    Spontaneous perforation of the gallbladder is one complication of cholelithiasis. There is a greater occurence of free perforation in the peritoneal cavity with bilary pertonitis, followed by the perforation into the stomach, small intestine and colon. A single case of the nowadays rare spontaneous perforation in and through the abdominal wall will be reported. Spontaneous gallbladder perforation appears nearly asymptomatic in its clinical course because of absent biliary peritonitis. (orig.) [de

  16. Gastrointestinal bleeding

    Science.gov (United States)

    ... Sigmoidoscopy Alternative Names Lower GI bleeding; GI bleeding; Upper GI bleeding; Hematochezia Images GI bleeding - series Fecal occult blood test References Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman- ...

  17. Value of gallbladder-preserving partial cholecystectomy in treatment of abnormal gallbladder morphology complicated by sand-like calculous cholecystitis: a reports of 18 cases

    Directory of Open Access Journals (Sweden)

    LIANG Fasheng

    2016-10-01

    Full Text Available Objective To investigate the value of laparoscopic gallbladder-preserving partial cholecystectomy in the treatment of abnormal gallbladder morphology complicated by sand-like calculous cholecystitis. Methods A total of 18 patients with abnormal gallbladder morphology complicated by sand-like calculous cholecystitis who underwent laparoscopic and choledochoscopic partial cholecystectomy in Dalian Friendship Hospital from July 2010 to January 2014 were enrolled. All the patients had abnormal gallbladder morphology manifested as folded gallbladder or adenomyosis, and the lesions were located in the distal end of the gallbladder. Before the surgery, gallbladder contraction test was performed for the diseased part and the normal part of the gallbladder to be preserved. During the surgery, choledochoscopy showed an unobstructed cystic duct and good elasticity in the gallbladder wall, and there was no marked chronic inflammation. After the diseased part of the gallbladder was removed, 4-0 absorbable suture was used for two-layer consecutive suture of the gallbladder. The t-test was used for comparison of continuous data between groups. Results All the patients underwent the surgery successfully. The mean time of operation was 98.0±9.0 minutes, and the mean time to first flatus was 22.8±2.5 hours. The patients were able to get out of the bed and drink water at 6 hours after surgery and to have meals at 24 hours after surgery. They fully recovered and were discharged at 5-7 days after surgery, and no patient experienced the complications such as bile leakage. The patients were followed up for 6-80 months; the patients′ preoperative clinical symptoms disappeared, and there was no recurrence of calculi. At 6-12 months after surgery, the patients experienced compensated cholecystectasis, and there was a significant increase in the mean volume of the gallbladder after surgery (30.29±4.23 cm3 vs 21.72±4.34 cm3, t=-13.00, P<0.001. There was a

  18. Gallbladder ablation by radiologic intervention

    International Nuclear Information System (INIS)

    Becker, C.D.; Quenville, N.F.; Burhenne, H.J.

    1988-01-01

    Thirty pigs underwent cystic duct occlusion by means of transcatheter endoluminal bipolar radiofrequency electrocoagulation under fluoroscopic guidance. Twenty animals subsequently underwent gallbladder ablation with alcohol and sotradecol; ten animals served as controls. Serial histologic blocking of the common bile duct, cystic duct, and gallbladder in all animals revealed no adverse effects of the sclerosants on the bile ducts or the structures adjacent to the gallbladder. The combination of 95% alcohol plus 3% sotradecol resulted in necrosis of the gallbladder mucosa within 2 weeks (two of two animals) and complete eradication of the mucosa and fibrotic obliteration of the gallbladder lumen within 8 weeks (six of eight animals)

  19. Vaginal Bleeding

    Science.gov (United States)

    ... or period, is a woman's monthly bleeding.Abnormal vaginal bleeding is different from normal menstrual periods. It ... therapy) Cancer of the cervix, ovaries, uterus or vagina Thyroid problems Bleeding during pregnancy can have several ...

  20. Focal sparing around the gallbladder in fatty liver

    International Nuclear Information System (INIS)

    Chen, Kemin; Hiramatsu, Yoshihiro; Yunoki, Masanori; Hirano, Yoko

    1989-01-01

    In evaluating fatty liver with CT, the residual normal liver tissues without fat deposits are occasionally detected on CT as high attenuation regions, especially surrounding the gallbladder. This study examined the incidence of this phenomenon in terms of the diagnostic value of CT in fatty liver. Fifty-seven patients with fatty liver were examined with CT. The incidence of focal sparing area was the highest in the gallbladder bed (42/57, 74%), followed by the interlobar fissure or subcapsular area (13, 23%), quadrate lobe (8, 14%), caudate lobe (2, 4%), and right lobe (one, 1.8%). These CT appearances were of spot, band, ring, and the mixed type. In 38 patients, fatty liver was too moderate to be detected without CT attenuation numbers. Among them, 27 patients (71%) had focal sparing area surrounding the gallbladder. This CT appearance seemed to be of significance in preventing the missing of moderate fatty liver. (Namekawa, K)

  1. Laparoscopic completion radical cholecystectomy for T2 gallbladder cancer.

    Science.gov (United States)

    Gumbs, Andrew A; Hoffman, John P

    2010-12-01

    The role of minimally invasive surgery in the surgical management of gallbladder cancer is a matter of controversy. Because of the authors' growing experience with laparoscopic liver and pancreatic surgery, they have begun offering patients laparoscopic completion partial hepatectomies of the gallbladder bed with laparoscopic hepatoduodenal lymphadenectomy. The video shows the steps needed to perform laparoscopic resection of the residual gallbladder bed, the hepatoduodenal lymph node nodes, and the residual cystic duct stump in a setting with a positive cystic stump margin. The skin and fascia around the previous extraction site are resected, and this site is used for specimen retrieval during the second operation. To date, three patients have undergone laparoscopic radical cholecystectomy with hepatoduodenal lymph node dissection for gallbladder cancer. The average number of lymph nodes retrieved was 3 (range, 1-6), and the average estimated blood loss was 117 ml (range, 50-200 ml). The average operative time was 227 min (range, 120-360 min), and the average hospital length of stay was 4 days (range, 3-5 days). No morbidity or mortality was observed during 90 days of follow-up for each patient. Although controversy exists as to the best surgical approach for gallbladder cancer diagnosed after routine laparoscopic cholecystectomy, the minimally invasive approach seems feasible and safe, even after previous hepatobiliary surgery. If the previous extraction site cannot be ascertained, all port sites can be excised locally. Larger studies are needed to determine whether the minimally invasive approach to postoperatively diagnosed early-stage gallbladder cancer has any drawbacks.

  2. Gallbladder varices in extrahepatic portal venous obstruction: demonstration by intravenous

    International Nuclear Information System (INIS)

    Gulati, M.

    2002-01-01

    Full text: We performed a prospective study to determine frequency of presence of gallbladder varices (GBV) by intravenous CT portography (CTP) in patients with extrahepatic portal venous obstruction (EHPVO). 90 patients (age range: 2-55 years) with EHPVO (initially diagnosed on abdominal sonography) underwent CTP using a subsecond helical CT scanner. Axial overlapping sections of 2mm were obtained with collimation 3mm and table speed 4.5mm/sec (pitch 1.5). Presence and patterns of GBV were studied. CTP demonstrated GBV in 54 (60%) of 90 patients.GBV were said to be present when one or more of the following findings were seen: diffuse wall enhancement (26/90), pinpoint areas of enhancement in GB wall (33/90), obvious large collaterals in GB wall (8/90) and pericholecystic collaterals (49/90). Presence of GBV did not correlate with the site and extent of EHPVO. Contiguous intrahepatic collaterals extending from GB bed to intrahepatic portal vein branches were seen in 41 of 54 (76%) of patients with GBV, suggesting the role of GBV serving as bridging portoportal collaterals. Hepatic perfusion defects were seen in 5/54 patients with GBV and were not seen in remaining 36/90 patients of EHPVO. GB calculi were seen in only 4/54 cases with GBV (as determined on sonography) suggesting no increase in risk for cholelithiasis. GBV commonly develop as bridging collaterals in patients with EHPVO. CTP is very useful in detecting these varices and planning biliary surgery, given the frequency of iatrogenic surgical bleeding in these patients. Copyright (2002) Blackwell Science Pty Ltd

  3. [Endoscopic extraction of gallbladder calculi].

    Science.gov (United States)

    Kühner, W; Frimberger, E; Ottenjann, R

    1984-06-29

    Endoscopic extraction of gallbladder stones were performed, as far as we know for the first time, in three patients with combined choledochocystolithiasis. Following endoscopic papillotomy (EPT) and subsequent mechanical lithotripsy of multiple choledochal concrements measuring up to 3 cm the gallbladder stones were successfully extracted with a Dormia basket through the cystic duct. The patients have remained free of complications after the endoscopic intervention.

  4. Internal Bleeding

    Science.gov (United States)

    ... Fractures (Part II) Additional Content Medical News Internal Bleeding By Amy H. Kaji, MD, PhD, Associate Professor, ... Emergency First Aid Priorities Cardiac Arrest Choking Internal Bleeding Severed or Constricted Limbs or Digits Soft-Tissue ...

  5. Perimenopausal Bleeding and Bleeding After Menopause

    Science.gov (United States)

    ... Patients About ACOG Perimenopausal Bleeding and Bleeding After Menopause Home For Patients Search FAQs Perimenopausal Bleeding and ... 2011 PDF Format Perimenopausal Bleeding and Bleeding After Menopause Gynecologic Problems What are menopause and perimenopause? What ...

  6. Sludge and stone formation in the gallbladder in bedridden elderly patients with cerebrovascular disease: influence of feeding method.

    Science.gov (United States)

    Onizuka, Y; Mizuta, Y; Isomoto, H; Takeshima, F; Murase, K; Miyazaki, M; Ogata, H; Otsuka, K; Murata, I; Kohno, S

    2001-05-01

    The incidence of gallbladder sludge or gallstone formation in bedridden patients with cerebrovascular disease (CVD) remains obscure. The aim of this study was to determine the incidence, relationship to feeding method, and mechanisms of gallbladder sludge and gallstone formation in elderly patients with CVD. Using ultrasonography, we determined the development of gallbladder sludge and gallstone over a 12-month period, the area of the gallbladder, the gallbladder contractile response to cerulein, and fasting levels of plasma cholecystokinin (CCK) in 40 bedridden elderly patients with CVD. The patients were divided into three groups based on the feeding method: oral ingestion (OI), nasogastric feeding (NF), and total parenteral nutrition (TPN). Gallbladder sludge and gallstone were not observed in any of the 14 OI patients, but occurred in 6 and 1 of the 11 NF patients, and in 14 and 3 of the 15 TPN patients, respectively. Fasting gallbladder areas were significantly larger in the TPN group than in the other two groups. The TPN group showed a marked decrease in cerulein-induced gallbladder contractility. Fasting plasma CCK levels were lower in the TPN group than in the OI group. Our results indicate that elderly patients with CVD confined to bed over long periods are not necessarily at risk of gallbladder sludge or gallstone formation, and the development of these features may be associated with the feeding method. The predisposition of CVD patients on TPN to gallbladder disease is probably caused by failure of gallbladder contraction, resulting from insufficient secretion of CCK and impaired sensitivity of the gallbladder to CCK.

  7. Gallbladder function in diabetic patients

    International Nuclear Information System (INIS)

    Shreiner, D.P.; Sarva, R.P.; Van Thiel, D.; Yingvorapant, N.

    1986-01-01

    Gallbladder emptying and filling was studied in eight diabetic and six normal control patients. None of the patients had gallstones. Cholescintigraphy was performed using [/sup 99m/Tc]disofenin, and gallbladder emptying was studied using a 45-min i.v. infusion of the octapeptide of cholecystokinin (OP-CCK) 20 ng/kg X hr. The peak filling rate was greater in diabetic than in normal subjects; however, emptying of the gallbladder in response to OP-CCK was significantly less in the diabetic subjects (51.6 +/- 10.4% compared with 77.2 +/- 4.9%). When the diabetic group was subdivided into obese and nonobese diabetics, the obese diabetics had a much lower percentage of emptying than the nonobese diabetics (30.0 +/- 10.4% compared with 73.1 +/- 9.3%). These findings suggest that obese diabetics may have impaired emptying of the gallbladder even in the absence of gallstones. The more rapid rate of gallbladder filling in obesity may indicate hypotonicity of the gallbladder. The combination of these abnormalities may predispose the obese diabetic to the development of gallstones

  8. Migration of Gelfoam to the gallbladder after liver biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Riddle, Chris [The Hospital for Sick Children, Image Guided Therapy, Department of Diagnostic Imaging, Toronto (Canada); Dalhousie University, School of Medicine, Halifax (Canada); Ahmed, Bilal [University of Toronto School of Medicine, Toronto (Canada); Doyle, John [The Hospital for Sick Children, Department of Hematology/Oncology, Toronto (Canada); Connolly, Bairbre L. [The Hospital for Sick Children, Image Guided Therapy, Department of Diagnostic Imaging, Toronto (Canada)

    2008-07-15

    Liver biopsy is a common procedure, with an inherent risk of bleeding. There are different ways to help avoid hemorrhage, including biopsy through a transjugular venous route or embolization of the tract with liquid or solid materials. We describe an image-guided percutaneous core needle liver biopsy with tract embolization using thick Gelfoam slurry in a pediatric oncology patient. Imaging studies acquired after the biopsy indicated that the Gelfoam mixture had likely migrated to the gallbladder and common bile duct. We report this rare occurrence with its striking imaging in order to make those performing biopsies aware of this possibility. (orig.)

  9. [Fortuitous discovery of gallbladder cancer].

    Science.gov (United States)

    Chiche, L; Metairie, S

    2001-12-01

    The prognosis of gallbladder cancer is basically dependent on the histological stage at diagnosis. In practice, the discovery of a small cancer of the bladder, generally during cholecystectomy give the patient a better care for curative treatment. The advent of laparoscopy has increased the number of cholecstectomies and could increase the frequency of this situation but also raises the difficult problem of metastatic dissemination. In the literature the figures on parietal metastasis after laparoscopy have ranged from 125% to 19%. The median delay to diagnosis of recurrence is 6 months. The cause of this phenomenon (role of the pneumoperitoneum) remains poorly elucidated. Risk factors for the development of a metastasis on the trocar orifice are: rupture of the gallbladder perioperatively and extraction of the gallbladder without protection. It is important to keep in mind this exceptional but serious risk and apply rigorous operative technique. In case of suspected gallbladder we do not advocate laparoscopy. Surgery (hepatectomy, lymphodenectomy, possibly resection of the biliary tract) would be indicted for all stages except pTis and T1a, taking into consideration the localization of the tumor and the patient's general status. It is also classical to recommend resection of the trocar orifices after laparoscopic cholecystectomy. There is a dual challenge today for small-sized gallbladder cancer: improving treatment and avoiding poorer prognosis due to the specific problems raised by laparoscopy.

  10. Gallbladder Agenesis with Refractory Choledocholithiasis.

    Science.gov (United States)

    Tjaden, Jamie; Patel, Kevin; Aadam, Aziz

    2015-01-01

    Congenital agenesis of the gallbladder is a rare anomaly which is usually asymptomatic and found incidentally. In some cases, however, patients are symptomatic. Common symptoms include right upper quadrant abdominal pain, nausea, and vomiting. Jaundice is present in some symptomatic cases and is due to associated choledocholithiasis (Fiaschetti et al. 2009). In this case, a 63-year-old female presents with jaundice and episodic right upper quadrant abdominal pain with nausea and vomiting. Bilirubin and alkaline phosphatase were found to be markedly elevated. Upper endoscopic ultrasound (EUS) revealed choledocholithiasis, and the patient required multiple endoscopic retrograde cholangiopancreatography (ERCP) sessions before successful extraction of all stones. Subsequent surgical exploration revealed congenital agenesis of the gallbladder. Although this is a rare finding, patients with agenesis of the gallbladder are at increased risk of developing de novo choledocholithiasis which may be challenging to extract.

  11. Gallbladder Agenesis with Refractory Choledocholithiasis

    Directory of Open Access Journals (Sweden)

    Jamie Tjaden

    2015-01-01

    Full Text Available Congenital agenesis of the gallbladder is a rare anomaly which is usually asymptomatic and found incidentally. In some cases, however, patients are symptomatic. Common symptoms include right upper quadrant abdominal pain, nausea, and vomiting. Jaundice is present in some symptomatic cases and is due to associated choledocholithiasis (Fiaschetti et al. 2009. In this case, a 63-year-old female presents with jaundice and episodic right upper quadrant abdominal pain with nausea and vomiting. Bilirubin and alkaline phosphatase were found to be markedly elevated. Upper endoscopic ultrasound (EUS revealed choledocholithiasis, and the patient required multiple endoscopic retrograde cholangiopancreatography (ERCP sessions before successful extraction of all stones. Subsequent surgical exploration revealed congenital agenesis of the gallbladder. Although this is a rare finding, patients with agenesis of the gallbladder are at increased risk of developing de novo choledocholithiasis which may be challenging to extract.

  12. Gallbladder agenesis in a Chihuahua.

    Science.gov (United States)

    Kamishina, Hiroaki; Katayama, Masaaki; Okamura, Yasuhiko; Sasaki, Jun; Chiba, Satoshi; Goryo, Masanobu; Sato, Reeko; Yasuda, Jun

    2010-07-01

    A 4-year-old neutered male Chihuahua was presented with a history of anorexia and vomiting. Continuous elevation of liver enzymes was found on repeated blood examinations and the dog was referred to us for further evaluation. The absence of gallbladder was suspected on ultrasonography. Exploratory laparotomy and retrograde cholangiography confirmed gallbladder agenesis and a possible hypoplasia of the right medial and lateral liver lobes. Histologically, proliferation of bile ductules associated with portal fibrosis and pseudolobular formation were apparent in the liver lobes.

  13. Gallbladder adenoma with focal adenocarcinoma.

    Science.gov (United States)

    Ciurea, S; Matei, E; Petrisor, P; Luca, L; Boros, Mirela; Herlea, V; Popescu, I

    2008-01-01

    The majority of polypoid lesions of the gallbladder are cholesterolosis pseudopolyps. True neoplastic GB polyps are represented mainly by adenomas. The case of a 52-year old male patient with an adenomatous polyp of the GB with focal adenocarcinoma is presented.

  14. Unusual presentation of gallbladder perforation

    Directory of Open Access Journals (Sweden)

    G. Jayasinghe

    2016-01-01

    Conclusions: Percutaneous abscesses arising from the gallbladder are a rare but potentially serious consequence of acute cholecystitis, and may present in a wide variety of locations. Therefore it is imperative to conduct a full body inspection in the septic patient, even when a source has been identified.

  15. Traumatic Gallbladder Rupture Treated by Laparoscopic Cholecystectomy

    Science.gov (United States)

    Egawa, Noriyuki; Ueda, Junji; Hiraki, Masatsugu; Ide, Takao; Inoue, Satoshi; Sakamoto, Yuichiro; Noshiro, Hirokazu

    2016-01-01

    Abstract Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy. PMID:27462188

  16. Traumatic Gallbladder Rupture Treated by Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Noriyuki Egawa

    2016-05-01

    Full Text Available Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy.

  17. Realtime ultrasonographic findings in gallbladder carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Y. T.; Woo, S. K.; Suh, I. J.; Lim, J. H.; Kim, H. K.; Kim, S. Y.; Ahn, C. Y. [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    2010-05-15

    It is well known that realtime ultrasonography is the primary diagnostic modality to evaluate gallbladder diseases. The authors studied ultrasonographic findings of 10 pathologically proven gallbladder carcinoma patients, and it was compared with the findings of 4 cases of ERCP and 2 cases of CT which were performed at the same period. The results were as follows: 1. They were 6 males and 4 females with over 50 years of age except a 41 year old female. 2. The ultrasonographic classifications of the cases were 4 of fungating mass types, 3 of mass filling gallbladder types, 2 wall thickening types and 1 of mixed type, wall thickening and fungating mass. 3. Seven cases of cholecystitis, 6 cases of intrahepatic biliary duct dilatation, 5 cases of gallstone, 4 cases of common bile duct dilatation, 4 cases of sludge bile, 2 cases of gallbladder dilatation, 1 case of right sub phrenic and pericholecystic abscess due to perforated gallbladder. 4. Five cases of mesenteric infiltrations, 3 cases of hepatic infiltration adjacent to gallbladder, 2 cases of lymphatic metastasis to right lobe of liver and 2 cases of pericholedochal and pericaval lymph node metastasis. 5. The indistinct margin between gallbladder and surrounding organ adjacent to gallbladder mass or gallbladder wall thickening suggest cancer infiltration to adjacent organ such as liver or omentum. 6. If gallstone is engulfed in thickened gallbladder wall, the wall thickening suggests gallbladder carcinoma. 7. The differentiation between fungating mass and sludge bile, and the determination of mass could be done by positional change. 8. The preoperative ultrasonic diagnositc accuracy was in 9 out of 10 cases (90%). 9. Because of the frequent cystic duct obstruction by associated inflammation, the diagnostic accuracy of ERCP for gallbladder carcinoma was low.

  18. Gallbladder Volvulus Presenting as Acute Appendicitis

    Directory of Open Access Journals (Sweden)

    Zachary Bauman

    2015-01-01

    Full Text Available We encountered a case of gallbladder volvulus in an 88-year-old thin female in which the initial presentation was more consistent with that of acute appendicitis. After complete work-up, including physical exam, lab work, and computed tomography, the definite diagnosis of gallbladder volvulus was not made until intraoperative visualization was obtained. Gallbladder volvulus is a rare but serious condition, which requires a high clinical suspicion so prompt surgical intervention can be undertaken.

  19. Realtime ultrasonographic findings in gallbladder carcinoma

    International Nuclear Information System (INIS)

    Ko, Y. T.; Woo, S. K.; Suh, I. J.; Lim, J. H.; Kim, H. K.; Kim, S. Y.; Ahn, C. Y.

    2010-01-01

    It is well known that realtime ultrasonography is the primary diagnostic modality to evaluate gallbladder diseases. The authors studied ultrasonographic findings of 10 pathologically proven gallbladder carcinoma patients, and it was compared with the findings of 4 cases of ERCP and 2 cases of CT which were performed at the same period. The results were as follows: 1. They were 6 males and 4 females with over 50 years of age except a 41 year old female. 2. The ultrasonographic classifications of the cases were 4 of fungating mass types, 3 of mass filling gallbladder types, 2 wall thickening types and 1 of mixed type, wall thickening and fungating mass. 3. Seven cases of cholecystitis, 6 cases of intrahepatic biliary duct dilatation, 5 cases of gallstone, 4 cases of common bile duct dilatation, 4 cases of sludge bile, 2 cases of gallbladder dilatation, 1 case of right sub phrenic and pericholecystic abscess due to perforated gallbladder. 4. Five cases of mesenteric infiltrations, 3 cases of hepatic infiltration adjacent to gallbladder, 2 cases of lymphatic metastasis to right lobe of liver and 2 cases of pericholedochal and pericaval lymph node metastasis. 5. The indistinct margin between gallbladder and surrounding organ adjacent to gallbladder mass or gallbladder wall thickening suggest cancer infiltration to adjacent organ such as liver or omentum. 6. If gallstone is engulfed in thickened gallbladder wall, the wall thickening suggests gallbladder carcinoma. 7. The differentiation between fungating mass and sludge bile, and the determination of mass could be done by positional change. 8. The preoperative ultrasonic diagnositc accuracy was in 9 out of 10 cases (90%). 9. Because of the frequent cystic duct obstruction by associated inflammation, the diagnostic accuracy of ERCP for gallbladder carcinoma was low.

  20. Gallbladder Agenesis with Refractory Choledocholithiasis

    OpenAIRE

    Tjaden, Jamie; Patel, Kevin; Aadam, Aziz

    2015-01-01

    Congenital agenesis of the gallbladder is a rare anomaly which is usually asymptomatic and found incidentally. In some cases, however, patients are symptomatic. Common symptoms include right upper quadrant abdominal pain, nausea, and vomiting. Jaundice is present in some symptomatic cases and is due to associated choledocholithiasis (Fiaschetti et al. 2009). In this case, a 63-year-old female presents with jaundice and episodic right upper quadrant abdominal pain with nausea and vomiting. Bil...

  1. Primary Carcinoma of the Gallbladder

    OpenAIRE

    Paraskevopoulos, John A.; Dennison, Ashley R.; Johnson, Alan G.

    1991-01-01

    Carcinoma of the gallbladder is a relatively rare malignancy which is difficult to diagnose. The advent of improved imaging methods and the expansion of interventional radiology however, combined with advances in surgical technique, has produced a change in attitude towards this tumour. The available world literature since 1960 has been reviewed and is presented in this article. However, whilst the outlook for diagnosis and treatment is improving, clearly the association with cholelithiasis (...

  2. Incidental gallbladder cancer: what management?

    Directory of Open Access Journals (Sweden)

    Sidi Mohammed Bouchentouf

    2011-11-01

    Full Text Available Gallbladder cancer (GBC represents 3.8% of all gastrointestinal cancers and usually known to be of a poor prognosis. In 0.2–2.9% of cases, this cancer is found in cholecystectomy specimens. A better understanding of spread mode of this tumor helps a better surgical management. The aim of the present review is to underline the management of GBC based on the comprehension of risk factors and anatomic features. A Medline, PubMed database search was performed to identify articles published from 2000 to 2011 using the keywords ‘carcinoma of gallbladder’, ‘incidental gallbladder cancer’, ‘gallbladder neoplasm’ and ‘cholecystectomy’. Some pathological situations such as chronic lithiasis and biliopancreatic junction abnormalities have been clearly identified as predisposing to GBC. Laparoscopy increases peritoneal and parietal tumor dissemination, thus, it should not be performed when GBC is suspected. Most determinant prognostic factors are nodal, perineural and venous involvement, invasion of the cystic duct and the tumor differentiation. The simple cholecystectomy is sufficient for tumors classified as T1a; for other cancers exceeding the muscularis, radical re-resection is required due to the high risk of recurrence. This aggressive surgery improved the overall survival of patients. There is still no standard adjuvant treatment; patients should be included in prospective trials.

  3. Gallbladder stones and gallbladder polyps associated with increased risk of colorectal adenoma in men.

    Science.gov (United States)

    Liu, Yen-Ling; Wu, Jin-Shang; Yang, Yi-Ching; Lu, Feng-Hwa; Lee, Chih-Ting; Lin, Wan-Ju; Chang, Chih-Jen

    2018-04-01

    Most cases of colorectal cancer develop via an adenoma to carcinoma sequence. Gallbladder polyps share some risk factors with colorectal polyps. Little is known about the relationship between gallbladder diseases and different status of colorectal polyps by gender. This study was to investigate the association of gallbladder stones and polyps with colorectal adenomas by gender in a Taiwanese population. A total of 7066 eligible subjects who underwent a total colonoscopy as a part of health check-up between January 2001 and August 2009 were recruited. Colonoscopic findings were classified into polyp-free, non-neoplastic polyps and colorectal adenomas. Gallbladder stones and gallbladder polyps were diagnosed based on ultrasonographic findings. There was a significant difference in the status of colon polyps between subjects with and without gallbladder polyps. However, the status of colon polyps was not significantly different between subjects with or without gallbladder stones. After adjusting obesity, fasting plasma glucose, and other variables, there was a positive relationship between gallbladder polyps and colorectal adenomas (odds ratio [OR]: 1.396, 95% confidence interval [CI]: 1.115-1.747) but not non-neoplastic polyps in all subjects. In men, gallbladder polyps (OR: 1.560, 95% CI: 1.204-2.019) and gallbladder stones (OR: 1.465, 95% CI 1.081-1.984) were positively associated with colorectal adenomas. In women, neither gallbladder polyps nor gallbladder stones were significantly related to colon polyps. Both gallbladder polyps and gallbladder stones were associated with an increased risk of colorectal adenomas in men but not in women. Gender difference was significant for the association between gallbladder lesions and colorectal polyps. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  4. Abnormal uterine bleeding

    Science.gov (United States)

    Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding ... ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2015. www. ...

  5. Design and application of a new series of gallbladder endoscopes that facilitate gallstone removal without gallbladder excision

    Science.gov (United States)

    Qiao, Tie; Huang, Wan-Chao; Luo, Xiao-Bing; Zhang, Yang-De

    2012-01-01

    In recent years, some Chinese doctors have proposed a new concept, gallstone removal without gallbladder excision, along with transition of the medical model. As there is no specialized endoscope for gallstone removal without gallbladder excision, we designed and produced a new series of gallbladder endoscopes and accessories that have already been given a Chinese invention patent (No. ZL200810199041.2). The design of these gallbladder endoscopes was based on the anatomy and physiology of the gallbladder, characteristics of gallbladder disease, ergonomics, and industrial design. This series of gallbladder endoscopes underwent clinical trials in two hospitals appointed by the State Administration of Traditional Chinese Medicine. The clinical trials showed that surgeries of gallstones, gallbladder polyps, and cystic duct calculus could be smoothly performed with these products. In summary, this series of gallbladder endoscopes is safe, reliable, and effective for gallstone removal without gallbladder excision. This note comprehensively introduces the research and design of this series of gallbladder endoscopes.

  6. Isolated gallbladder rupture following blunt abdominal injury

    African Journals Online (AJOL)

    2015-05-26

    May 26, 2015 ... Kaohsiung Medical University, Kaohsiung, Taiwan. Abstract. Isolated traumatic gallbladder rupture subsequent to blunt abdominal injury is rare. Most literatures on the subjects consist of case reports. We reported a rare case of isolated gallbladder rupture and discussed the possible predisposing factors to ...

  7. Beware the left-sided gallbladder

    African Journals Online (AJOL)

    An abdominal ultrasound scan showed multiple stones in the gallbladder with no evidence of acute cholecystitis and a common bile duct (CBD) diameter of 4 mm. Owing to the atypical nature of her pain, a computed tomography (CT) scan was requested which showed a left-sided gallbladder containing gallstones (Fig. 1).

  8. Association of Aflatoxin and Gallbladder Cancer

    DEFF Research Database (Denmark)

    Koshiol, Jill; Gao, Yu-Tang; Dean, Michael

    2017-01-01

    BACKGROUND & AIMS: Aflatoxin, which causes hepatocellular carcinoma, may also cause gallbladder cancer. We investigated whether patients with gallbladder cancer have higher exposure to aflatoxin than patients with gallstones. METHODS: We measured aflatoxin B1 (AFB1)-lysine adducts in plasma sampl...

  9. The role of the gallbladder in humans

    Directory of Open Access Journals (Sweden)

    J.L. Turumin

    2013-07-01

    Full Text Available The basic function of the gallbladder in humans is one of protection. The accumulation of the primary bile acids (cholic acid and chenodeoxycholic acid in the gallbladder reduces the formation of the secondary bile acids (deoxycholic acid and lithocholic acid, thus diminishing their concentration in the so-called gallbladder-independent enterohepatic circulation and protecting the liver, the stomach mucosa, the gallbladder, and the colon from their toxic hydrophobic effects. The presence or absence of the gallbladder in mammals is a determining factor in the synthesis of hydrophobic or hydrophilic bile acids. Because the gallbladder contracts 5-20 min after food is in the stomach and the “gastric chyme” moves from the stomach to the duodenum 1-3 h later, the function of the gallbladder bile in digestion may be insignificant. The aim of this article was to provide a detailed review of the role of the gallbladder and the mechanisms related to bile formation in humans.

  10. Chronic Diarrhea: A Concern After Gallbladder Removal?

    Science.gov (United States)

    Chronic diarrhea: A concern after gallbladder removal? I had my gallbladder removed six months ago, and I'm still having diarrhea. Is this ... mild diarrhea after cholecystectomy is not cause for concern, but speak to your doctor if you are ...

  11. Value of gallbladder B-scan ultrasonography.

    Science.gov (United States)

    Tabrisky, J; Lindstrom, R R; Herman, M W; Castagna, J; Sarti, D

    1975-05-01

    The gallbladder B-scans of 20 patients who had subsequent surgery were separated into three categories based upon certain sonographic criteria. Our data, in this limited series, revealed gallbladder pathology in each patient who had any one or combination of the following scan characteristics: (1) internal echos, (2) irregular wall, or (3) absence of recognizable gallbladder sonolucency. The category which demonstrated a normal sonographic gallbladder, namely a smooth wall and no internal echos, contained a number of false negatives which proved to have either small stone cholelithiasis or extraphepatic ductal obstruction. Within the described limitations, the B-scan can be a valuable test in confirming the significance of a radiographically nonvisualized gallbladder or in detecting a biliary tract lesion in a patient with a disease entity that precludes radiographic visualization by conventional techniques.

  12. Surgical treatment of gallbladder polypoid lesions

    Directory of Open Access Journals (Sweden)

    Pejić Miljko A.

    2003-01-01

    Full Text Available INTRODUCTION Polypoid lesions of the gallbladder can be divided into benign and malignant categories. Malignant polypoid lesions include carcinomas of the gallbladder, which is the fifth most common malignancy of the gastrointestinal tract and the most common malignancy of the biliary tract. Benign polypoid lesions of the gallbladder are divided into true tumors and pseudotumors. Pseudotumors account for most of polypoid lesions of the gallbladder, and include polyps, hyperplasia, and other miscellaneous lesions. Adenomas are the most common benign neoplasms of the gallbladder. Cholesterol polyps are the most common pseudotumors of the gallbladder. The polyps can be single or multiple, usually less than 10 mm in size. They have no predilection for any particular gallbladder site, and usually are attached to the gallbladder wall by a delicate, narrow pedicle. No malignant potential has been identified for this type of pseudotumor. Adenomas are the most common benign neoplasms of the gallbladder. They have no predilection site in the gallbladder, and may also be associated with gallstones or cholecystitis. The premalignant nature of adenomas remains controversial. Ultrasonography (US has been demonstrated to be significantly better in detecting polypoid lesions of the gallbladder as compared with computed tomography and cholecystography. A mass fixed to the gallbladder wall of normal thickness, without shadowing, is seen in case of gallbladder polyp. Since gallbladder cancers usually present as polypoid lesions, differentiation between benign polypoid lesion and malignant lesion can be very difficult, even with high-resolution imaging techniques. PATIENTS AND METHODS Retrospectively we have analyzed 38 patients with ultrasonographicaly detected gallbladder polyps during the period from January 1995 to December 2000, who were treated at surgical department of Health Centre in Uzice and at Surgical clinic of Clinical Centre in Nis. We have analyzed

  13. Resected Pleomorphic Carcinoma of the Gallbladder

    Directory of Open Access Journals (Sweden)

    Masanari Shimada

    2012-12-01

    Full Text Available Pleomorphic carcinoma is a rare lesion and the literature contains few reports of pleomorphic carcinoma of the gallbladder. The present study reports a rare case of primary pleomorphic carcinoma of the gallbladder for which we were able to perform curative surgery. A 77-year-old woman with dementia developed nausea and anorexia, and computed tomography demonstrated irregular thickening of the gallbladder wall. Drip infusion cholangiography and endoscopic retrograde cholangiopancreatography revealed no stenosis of the common and intrahepatic bile ducts. We suspected carcinoma of the gallbladder without lymph node metastasis and invasion to the common bile duct. We guessed it to be resectable and performed open laparotomy. At operation, the fundus of the gallbladder was adherent to the transverse colon, but no lymph node and distant metastases were detected. Therefore, we performed curative cholecystectomy with partial colectomy. Histopathology and immunostaining showed coexistence of an adenocarcinoma, squamous cell carcinoma and sarcomatous tumor of spindle-shaped cell, as well as transition zones between these tumors. We diagnosed stage I pleomorphic carcinoma of the gallbladder. No recurrence has been observed for one and a half years. The biological behavior of pleomorphic carcinoma of the gallbladder remains unknown. It will be necessary to accumulate more case reports of this tumor in order to define diagnostic criteria.

  14. Single-Organ Gallbladder Vasculitis

    Science.gov (United States)

    Hernández-Rodríguez, José; Tan, Carmela D.; Rodríguez, E. René; Hoffman, Gary S.

    2014-01-01

    Abstract Systemic vasculitis (SV) involving abdominal structures usually has a poor prognosis. Gallbladder vasculitis (GV) has been reported as part of SV (GB-SV) and focal single-organ vasculitis (GB-SOV). We analyzed clinical and histologic characteristics of patients with GV to identify features that differentiate GB-SOV from the systemic forms of GV. To identify affected patients with GV we used pathology databases from our institution and an English-language PubMed search. Clinical manifestations, laboratory and histologic features, treatment administered, and outcomes were recorded. Patients were divided in 2 groups, GB-SOV and GB-SV. As in previous studies of single-organ vasculitis, GB-SOV was only considered to be a sustainable diagnosis if disease beyond the gallbladder was not apparent after a follow-up period of at least 6 months. Sixty-one well-characterized patients with GV were included (6 from our institution). There was no significant sex bias (32 female patients, 29 male). Median age was 52 years (range, 18–94 yr). GB-SOV was found in 20 (33%) and GB-SV in 41 (67%) patients. No differences were observed in age, sex frequency, or duration of gallbladder symptoms between groups. Past episodes of recurrent right-upper quadrant or abdominal pain and lithiasic cholecystitis were more frequent in GB-SOV patients, whereas acalculous cholecystitis occurred more often in GB-SV. In GB-SV, gallbladder-related symptoms occurred more often concomitantly with or after the systemic features, but they sometimes appeared before SV was fully developed (13.5%). Constitutional and musculoskeletal symptoms were reported only in GB-SV patients. Compared to GB-SOV, GB-SV patients presented more often with fever (62.5% vs 20%; p = 0.003) and exhibited higher erythrocyte sedimentation rate levels (80 ± 28 vs 37 ± 25 mm/h, respectively; p = 0.006). All GB-SV patients required glucocorticoids and 50% of them also received cytotoxic agents. Mortality in

  15. Vaginal bleeding in pregnancy

    Science.gov (United States)

    Pregnancy - vaginal bleeding; Maternal blood loss - vaginal ... Up to 1 in 4 women have vaginal bleeding at some time during their pregnancy. Bleeding is more common in the first 3 months (first trimester), especially with twins.

  16. Bleeding Disorders in Women

    Science.gov (United States)

    ... might be heavy, print and use a menstrual chart to track your bleeding and talk to your ... you’re “low in iron.” Heavy bleeding after dental surgery, other surgery, or childbirth. Prolonged bleeding episodes ...

  17. Concomitant endometrial and gallbladder metastasis in advanced multiple metastatic invasive lobular carcinoma of the breast: A rare case report.

    Science.gov (United States)

    Bezpalko, Kseniya; Mohamed, Mohamed A; Mercer, Leo; McCann, Michael; Elghawy, Karim; Wilson, Kenneth

    2015-01-01

    At time of presentation, fewer than 10% of patients have metastatic breast cancer. The most common sites of metastasis in order of frequency are bone, lung, pleura, soft tissue, and liver. Breast cancer metastasis to the uterus or gallbladder is rare and has infrequently been reported in the English literature. A 47 year old female with a recent history of thrombocytopenia presented with abnormal vaginal bleeding. Pelvic ultrasound revealed multiple uterine fibroids and endometrial curettings revealed cells consistent with lobular carcinoma of the breast. Breast examination revealed edema and induration of the lower half of the right breast. Biopsy of the right breast revealed invasive lobular carcinoma. Bone marrow aspiration obtained at a previous outpatient visit revealed extensive involvement by metastatic breast carcinoma. Shortly after discharge, the patient presented with acute cholecystitis and underwent cholecystectomy. Microscopic examination of the gallbladder revealed metastatic infiltrating lobular carcinoma. The final diagnosis was invasive lobular carcinoma of the right breast with metastasis to the bone marrow, endometrium, gallbladder, regional lymph nodes, and peritoneum. The growth pattern of invasive lobular carcinoma of the breast is unique and poses a challenge in diagnosing the cancer at an early stage. Unlike other types of breast cancer, it tends to metastasize more to the peritoneum, ovary, and gastrointestinal tract. Metastasis to the endometrium or gallbladder is rare. Metastatic spread should be considered in the differential diagnosis of patients with invasive lobular breast carcinoma presenting with abnormal vaginal bleeding or acute cholecystitis. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. A comprehensive review on Primary gallbladder tuberculosis.

    Science.gov (United States)

    Gupta, Ashish; Gupta, Amit; Anjum, Rohik; Agrawal, Saumya; Mallik, Dhiraj

    2018-04-30

    Tuberculosis (TB) is an infectious disease that can affect any organ system of the body. Abdominal TB can be gastrointestinal, lymph nodal, visceral or peritoneal. The gallbladder (GB) is rarely involved in abdominal TB as a primary organ. Extensive research literature on gallbladder TB is limited to case reports. There has been no review on this rare abdominal pathology. GB tuberculosis is a difficult diagnosis preoperatively. It is a rare differential among the more common gallbladder pathologies such as cholelithiasis, or a gallbladder malignancy. Typical histopathology of the resected specimen helps to establish this rare diagnosis. Subjecting every specimen to histopathological examination followed by medical treatment offers the chance of cure. Through this review, the authors attempt to provide an insight into this disease entity.

  19. Adenocarcinoma of the gallbladder in guinea pigs

    International Nuclear Information System (INIS)

    Hoch-Ligeti, C.; Congdon, C.C.; Deringer, M.K.; Stewart, H.L.

    1979-01-01

    Adenocarcinoma of the gallbladder developed in 17 of 68 untreated and in 26 of 83 irradiated guinea pigs of inbred strains 2 and 13. The carcinomas spread widely by direct extension and through lymphatic and blood vessels to lymph nodes, mesenteries, omenta, abdominal wall, liver, lungs, bones, and spleen. Whole-body exposure to gamma or x radiation increased both the number of tumors and metastases in male inbred guinea pigs but not in females. Significantly fewer (9 of 98) noninbred than inbred guinea pigs developed gallbladder carcinomas after irradiation. In 9 untreated noninbred guinea pigs gallbladder carcinomas were not found. Inasmuch as the effect of irradiation was not dose-dependent, an indirect systemic effect of irradiation was postulated. This is the first report on the occurrence of spontaneous gallbladder adenocarcinomas in guinea pigs

  20. Gallbladder Cancer Incidence and Death Rates

    Science.gov (United States)

    ... Campaigns Initiatives Stay Informed Gallbladder Cancer Incidence and Death Rates Recommend on Facebook Tweet Share Compartir Quick ... a late stage with a poor outcome, often death. The journal Cancer Epidemiology, Biomarkers and Prevention published ...

  1. The gallbladder and biliary ducts

    International Nuclear Information System (INIS)

    Amberg, J.R.; Juhl, J.H.; Univ. of California, San Diego, Medical Center, Veterans Administration Hospital, La Jolla, CA)

    1987-01-01

    There is an extensive menu for investigating the hepatobiliary area. From the simplicity of the plain film to the expense of magnetic resonance imaging to the invasiveness of percutaneous transhepatic cholangiography, all modalities can contribute to the goal of a correct diagnosis. Not all are needed in each patient; thus a careful evaluation of the clinical needs is required before proceeding. It is also apparent that changes are occurring rapidly. The current importance of gallbladder ultrasonography and computerized tomography and the decline of oral cholecystography and intravenous cholangiography in biliary tract diagnosis was impossible to anticipate a decade ago. Because not all modalities are available in all communities, it is important to tailor the diagnostic algorithm to local skills and equipment

  2. Radiologic evaluation of carcinoma of the gallbladder

    International Nuclear Information System (INIS)

    Kim, I. Y.; Kim, K. W.; Yoo, H. S.; Lee, J. T.; Park, C. Y.

    1983-01-01

    Thirty five cases of pathlogically proven carcinoma of the gallbladder at Yonsei Univ. College. of Med. Severance Hospital in the period from May, 1978 to Oct, 1982 were analyzed radiologically and clinically. The brief results are as follows: 1. The ratio of male to female was 1 : 1.2 and prevalent in the sixth decade of life. 2. Clinical feature show RUQ pain in 24 cases. Epigastric pain in 13 cases and jaundice in 6 cases, symptom duration is variable from 1 week to over year. 3. Oral and IV cholangiography were performed in 17 cases. Nonvisualization of gallbladder was observed in 14 cases. Filling defect in gallbladder was observed in 2 cases and air biliarygram is observed in 1 case. 4. UGI series was performed in 11 cases. Postbulbar indentation was observed in 9 cases, gastric antrum indentation in 2 cases, postbulbar indentation with adhesion in 2 cases and normal finding was observed in 2 cases. 5. PTC was performed in 7 cases. Nonvisualization of gallbladder was observed in 7 cases, abrupt obstruction at porta hepatis in 3 cases, abrupt eccentric obstruction extrahepatic duct at cystic duct level in 2 cases, lobulated mass effect in extrahepatic duct at the level of cystic duct opening in 1 case. Round swing of extrahepatic duct with dilatation was observed in 1 case. 6. ERCP was performed in 11 cases. Nonvisualization of gallbladder was observed in 8 cases, irregular large intraluminal filling defect in 2 cases, multiple stone in 1 case, abrupt narrowing proximal CBD in 3 cases, extrinsic mass effect in CHD was observed in 1 case. 7. Celiac angiography was performed in 3 cases. Cystic artery hypertrophy was observed in 1 case and halo appearance in gallbladder area was observed in 1 case. 8. Ultrasound for investigation of carcinoma of gallbladder was performed in 16 cases. Homogenous echoes in gallbladder was observed in 6 cases, Bull's eye appearance in 4 cases, fungasting mass in

  3. Cholelitholytic therapy and diverticula of the gallbladder

    Energy Technology Data Exchange (ETDEWEB)

    Wolpers, C.

    1984-04-01

    Fifty patients with cholesterol stones in their gallbladder, with few symptoms were treated with the bile acids cheno- or ursodeoxycholic acid. 38 had a 'normal' gallbladder, 12 had diverticula of the gallbladder. After the complete dissolution of the stones the bile acid treatment was stopped. The follow-up period lasted up to 7 years. No recurrence was observed in the gallbladder of 18 patients, but 32 developed new stones. With a second bile acid treatment we could dissolve the new stones of 13 patients, up to now without further relapses. After the second bile acid treatment of 9 months and x-ray controls 19 patients (38%) developed insoluble material in their gallbladders, independent of the presence of diverticula. We tried to eliminate calcium sediments with cholecystokinin-like substances. Temporary success was achieved in three of five patients only, and one person only remained free of further relapses. There is no reason to exclude patients with cholesterol stones and diverticula of the gallbladder from litholytic therapy. 10 figs.

  4. Cholelitholytic therapy and diverticula of the gallbladder

    International Nuclear Information System (INIS)

    Wolpers, C.

    1984-01-01

    Fifty patients with cholesterol stones in their gallbladder, with few symptoms were treated with the bile acids cheno- or ursodeoxycholic acid. 38 had a 'normal' gallbladder, 12 had diverticula of the gallbladder. After the complete dissolution of the stones the bile acid treatment was stopped. The follow-up period lasted up to 7 years. No recurrence was observed in the gallbladder of 18 patients, but 32 developed new stones. With a second bile acid treatment we could dissolve the new stones of 13 patients, up to now without further relapses. After the second bile acid treatment of 9 months and x-ray controls 19 patients (38%) developed insoluble material in their gallbladders, independent of the presence of diverticula. We tried to eliminate calcium sediments with cholecystokinin-like substances. Temporary success was achieved in three of five patients only, and one person only remained free of further relapses. There is no reason to exclude patients with cholesterol stones and diverticula of the gallbladder from litholytic therapy. (orig.) [de

  5. Color doppler sonography in thickened gallbladder wall

    International Nuclear Information System (INIS)

    Han, Sang Suk; Choi, Seok Jin; Seo, Chang Hae; Eun, Choong Ki

    1996-01-01

    The thickening of the gallbladder wall is a valuable finding for the diagnosis of cholecystitis, but may be seen in non-cholecystic disease as well as in acute or chronic cholecystitis. The purpose of this study is to determine the value of color Doppler sonography in differentiating the causes of thickened gallbladder wall. Ninety eight patients with thickened gallbladder wall(more than 3mm) which was not due to gallbladder cancer were prospectively evaluated with color Doppler sonography. Sixty-six cases, confirmed by pathologic reports and clinical records, were analyzed for correlation between thickened gallbladder wall and color flow signal according to the underlying causes. Of the 66 patients, 28 cases were cholecystitis and 38 cases had non-cholecystic causes such as liver cirrhosis, ascites, hepatitis, pancreatitis, renal failure, and hypoalbuminemia. Of the 28 patients with cholecystitis(12 acute, 16 chronic), 23(82%) had color Doppler flow signals in the thickened gallbladder wall. Of the 38 patients with non-cholecystic causes, eight(21%) had color Doppler flow signals. There was a statistically significant difference of color Doppler flow signals between the cholecystitis and non-cholecystic groups(p=0.0001). No significant difference of color Doppler flow signals was found between cases of acute and chronic cholecystitis. Of the 23 patients with color Doppler flow signals in 28 cases of cholecystitis, 18(78.3%) showed a linear pattern and five(21.7%) showed a spotty pattern. Of the eight patients with color Doppler flow signals in the 38 non-cholecystic cases, four(50%) showed a linear pattern and four(50%) showed a spotty pattern. In cholecystitis, a linear color Doppler flow signal pattern is a much more frequent finding than a spotty pattern. Color Doppler sonography is a useful and adequate method for determining whether a thickened gallbladder wall is the result of cholecystitis or has non-cholecystic causes

  6. Peptic ulcer in the gallbladder. A case report

    DEFF Research Database (Denmark)

    Larsen, E H; Diederich, P J; Sørensen, Flemming Brandt

    1985-01-01

    Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented....

  7. Peptic ulcer in the gallbladder. A case report

    DEFF Research Database (Denmark)

    Larsen, E H; Diederich, P J; Sørensen, Flemming Brandt

    1985-01-01

    Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented.......Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented....

  8. Torsion of the gallbladder: a case report

    Directory of Open Access Journals (Sweden)

    Ijaz Samia

    2008-07-01

    Full Text Available Abstract Introduction Torsion of the gallbladder is a rare condition that most commonly affects the elderly. Pre-operative diagnosis is the exception rather than the rule. Any delay in treatment can be fatal as the gallbladder may rupture, leading to biliary peritonitis. Case presentation We present the case of an 80-year-old woman who was admitted with right upper quadrant pain initially thought to be secondary to acute cholecystitis. Subsequent ultrasound and computed tomography scans of the abdomen revealed signs suggestive of acute cholecystitis but neither modality detected any gallstones. As the patient's symptoms failed to resolve on conservative management, she was taken to theatre for an open cholecystectomy. Intra-operatively, the gallbladder had undergone complete torsion and appeared gangrenous. A routine cholecystectomy followed and she recovered from the operation without incident. Conclusion It is rare to diagnose torsion of the gallbladder pre-operatively despite advances in diagnostic imaging. However, this differential diagnosis should be borne in mind particularly in the elderly patient, without proven gallstones, who fails to improve on conservative management. An emergency cholecystectomy is indicated in the event of diagnosing torsion of the gallbladder to avert the potentially lethal sequelae of biliary peritonitis.

  9. Gallbladder cancer: South American experience.

    Science.gov (United States)

    Arroyo, Gerardo F; Gentile, Alberto; Parada, Luis A

    2016-10-01

    Large differences in terms of incidence and mortality due to gallbladder cancer (GBC) have been reported worldwide. Moreover, it seems that GBC has unique characteristics in South America. We surveyed the literature looking for information about the epidemiology, basic and translational research, and clinical trials performed in South America in order to critically analyze the magnitude of this health problem in the region. Compared to other geographic areas, age-standardized mortality rates (ASMR) for GBC in women are very high, particularly in many western areas of South America. Genetic, as well as dietary and environmental factors likely contribute to the pathogenesis of this disease in the area. Compared to other regions the profile of abnormalities of key genes such as KRAS and TP53 in GBC seems to slightly differ in South America, while the clinical behavior appears to be similar with a median overall survival (OS) of 6.5 to 8 months in advanced GBC. In contrast to Europe and USA, prophylactic cholecystectomy is a common practice in western areas of South America. GBC particularly affects women in South America, and represents a significant public health problem. It appears to have peculiarities that pose an urgent need for additional research aimed to discover risk factors, molecular events associated with its development and new treatment options for this lethal disease.

  10. Gallbladder Cancer Treatment (PDQ®)—Patient Version

    Science.gov (United States)

    Types of treatment for gallbladder cancer include surgery, radiation, and chemotherapy. Treatment of gallbladder cancer that has spread to other parts of the body, cannot be removed by surgery, or has come back after treatment is often within a clinical trial. Find out about treatment options for gallbladder cancer.

  11. Detecting gallbladders in chicken livers using spectral analysis

    DEFF Research Database (Denmark)

    Jørgensen, Anders; Mølvig Jensen, Eigil; Moeslund, Thomas B.

    2015-01-01

    This paper presents a method for detecting gallbladders attached to chicken livers using spectral imaging. Gallbladders can contaminate good livers, making them unfit for human consumption. A data set consisting of chicken livers with and without gallbladders, has been captured using 33 wavelengths...

  12. Bile acid composition of gallbladder contents in dogs with gallbladder mucocele and biliary sludge.

    Science.gov (United States)

    Kakimoto, Toshiaki; Kanemoto, Hideyuki; Fukushima, Kenjiro; Ohno, Koichi; Tsujimoto, Hajime

    2017-02-01

    OBJECTIVE To examine bile acid composition of gallbladder contents in dogs with gallbladder mucocele and biliary sludge. ANIMALS 18 dogs with gallbladder mucocele (GBM group), 8 dogs with immobile biliary sludge (i-BS group), 17 dogs with mobile biliary sludge (m-BS group), and 14 healthy dogs (control group). PROCEDURES Samples of gallbladder contents were obtained by use of percutaneous ultrasound-guided cholecystocentesis or during cholecystectomy or necropsy. Concentrations of 15 bile acids were determined by use of highperformance liquid chromatography, and a bile acid compositional ratio was calculated for each group. RESULTS Concentrations of most bile acids in the GBM group were significantly lower than those in the control and m-BS groups. Compositional ratio of taurodeoxycholic acid, which is 1 of 3 major bile acids in dogs, was significantly lower in the GBM and i-BS groups, compared with ratios for the control and m-BS groups. The compositional ratio of taurocholic acid was significantly higher and that of taurochenodeoxycholic acid significantly lower in the i-BS group than in the control group. CONCLUSIONS AND CLINICAL RELEVANCE In this study, concentrations and fractions of bile acids in gallbladder contents were significantly different in dogs with gallbladder mucocele or immobile biliary sludge, compared with results for healthy control dogs. Studies are needed to determine whether changes in bile acid composition are primary or secondary events of gallbladder abnormalities.

  13. Vaginal or uterine bleeding - overview

    Science.gov (United States)

    ... and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding ... There are many causes of abnormal vaginal bleeding. HORMONES ... Doctors call the problem abnormal uterine bleeding (AUB) . AUB ...

  14. Parastomal gallbladder hernia in a septic patient

    Directory of Open Access Journals (Sweden)

    Joseph Frankl, BS

    2017-09-01

    Full Text Available Parastomal gallbladder herniation is a rare complication of enterostomies with only 6 previously reported cases. Most cases have occurred in elderly women. Patients typically presented with acute abdominal pain and the majority was managed operatively. Here, we report the clinical course of an 88-year-old female who presented with signs of sepsis and minimal abdominal symptoms. She was subsequently found to have a parastomal gallbladder herniation and Klebsiella pneumoniae bacteremia. Given the patient's multiple comorbidities, she was managed nonoperatively with manual reduction of the parastomal hernia and antibiotics.

  15. Ultrasonographic ejection fraction of normal gallbladder

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jin Hun; Kim, Seung Yup; Park, Yaung Hee; Kang, Ik Won; Yoon, Jong Sup [Hangang Sacred Heart Hospital, Halym College, Chuncheon (Korea, Republic of)

    1984-06-15

    Real-time ultrasonography is a simple, accurate, noninvasive and potentially valuable means of studying gallbladder size and emptying. The authors calculated ultrasonographically the ejection fraction of 80 cases of normally functioning gallbladder on oral cholecystography, from June 1983 to April 1984, at the department of radiology, Hangang Sacred Heart Hospital. The results were obtained as follows; 1. Ultrasonographic Ejection Fraction at 30 minutes after the fatty meal was 73.1{+-}16.85. 2. There was no significant difference in age and sex, statistically.

  16. Gallbladder Boundary Segmentation from Ultrasound Images Using Active Contour Model

    Science.gov (United States)

    Ciecholewski, Marcin

    Extracting the shape of the gallbladder from an ultrasonography (US) image allows superfluous information which is immaterial in the diagnostic process to be eliminated. In this project an active contour model was used to extract the shape of the gallbladder, both for cases free of lesions, and for those showing specific disease units, namely: lithiasis, polyps and changes in the shape of the organ, such as folds or turns of the gallbladder. The approximate shape of the gallbladder was found by applying the motion equation model. The tests conducted have shown that for the 220 US images of the gallbladder, the area error rate (AER) amounted to 18.15%.

  17. Bleeding esophageal varices

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000268.htm Bleeding esophageal varices To use the sharing features on ... veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins break open. Any ...

  18. GI bleeding - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100162.htm GI bleeding - series—Normal anatomy To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Gastrointestinal Bleeding A.D.A.M., Inc. is accredited by ...

  19. Bleeding into the skin

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003235.htm Bleeding into the skin To use the sharing features on this page, please enable JavaScript. Bleeding into the skin can occur from broken blood ...

  20. Vaginal bleeding between periods

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003156.htm Vaginal bleeding between periods To use the sharing features ... this page, please enable JavaScript. This article discusses vaginal bleeding that occurs between a woman's monthly menstrual ...

  1. Heavy Menstrual Bleeding (Menorrhagia)

    Science.gov (United States)

    ... Us Information For… Media Policy Makers Blood Disorders Heavy Menstrual Bleeding Recommend on Facebook Tweet Share Compartir ... It can also be bleeding that is very heavy. How do you know if you have heavy ...

  2. Bleeding during Pregnancy

    Science.gov (United States)

    ... in pregnancy? • What problems with the placenta can cause bleeding during pregnancy? • Can bleeding be a sign of preterm labor? • ... the hospital. What problems with the placenta can cause bleeding during pregnancy? Several problems with the placenta later in pregnancy ...

  3. Congenital Duplex Gallbladder Anomaly Presenting as Gangrenous ...

    African Journals Online (AJOL)

    Valued eMachines Customer

    A 43 year old female patient, Mrs. M.S, presented with a three week history of .... they develop gangrenous calculus cholecystitis as they may simulate a liver abscess ... Congenital anomalies of the gallbladder and anatomical variations of their ...

  4. Determinants of gallbladder kinetics in obesity

    NARCIS (Netherlands)

    Mathus-Vliegen, E. M. H.; van Ierland-van Leeuwen, M. L.; Terpstra, A.

    2004-01-01

    Obese subjects are at risk of developing gallstones both by being overweight and by reducing their body weight. The aim of the present study was to investigate factors related to disturbances in gallbladder emptying measured by ultrasound. Detailed information about weight loss attempts, age at

  5. Evaluation of rectal bleeding factors associated with prostate brachytherapy

    International Nuclear Information System (INIS)

    Aoki, Manabu; Miki, Kenta; Sasaki, Hiroshi; Kido, Masato; Shirahama, Jun; Takagi, Sayako; Kobayashi, Masao; Honda, Chikara; Kanehira, Chihiro

    2009-01-01

    The purpose of this study was to analyze rectal bleeding prognostic factors associated with prostate brachytherapy (PB) or in combination with external-beam radiation therapy (EBRT) and to examine dosimetric indications associated with rectal bleeding. The study included 296 patients followed up for >36 months (median, 48 months). PB was performed alone in 252 patients and in combination with EBRT in 44 patients. PB combined with EBRT is indicated for patients with a Gleason score >6. The prescribed dose was 144 Gy for monotherapy and 110 Gy for PB+EBRT (44-46 Gy). Although 9.1% who received monotherapy had 2.3% grade 2 rectal bleeding, 36.3% who received combined therapy had 15.9% grade 2 rectal bleeding. Combined therapy was associated with higher incidence of rectal bleeding (P=0.0049) and higher percentage of grade 2 bleeding (P=0.0005). Multivariate analysis revealed that R-150 was the only significant factor for rectal bleeding, and modified Radiation Therapy Oncology Group (RTOG) grade in monotherapy and biologically equivalent dose (BED) were significant for combined therapy. Moreover, grade 2 rectal bleeding increased significantly at D90 >130 Gy. Although R-150 was the significant prognostic factor for rectal bleeding and modified RTOG rectal toxicity grade, BED was the significant prognostic factor for modified RTOG rectal toxicity grade. (author)

  6. Characteristics of gallbladder cancer in South India.

    Science.gov (United States)

    Sachidananda, Sandeep; Krishnan, Arunkumar; Janani, K; Alexander, P C; Velayutham, Vimalraj; Rajagopal, Surendran; Venkataraman, Jayanthi

    2012-09-01

    Gallbladder cancer is common in north India. It is also a well established fact that gall bladder cancer is frequently associated with gallstone disease in north India, similar to reports from the West. The magnitude of the problem of gallbladder cancer in south India and its link to gallstone disease is not clearly established. The aim of the study was to determine retrospectively, the characteristics of individuals with GBC in south India and to determine its association with gallstone disease. Retrospective data was obtained from records of proven cases of gallbladder cancer and patients undergoing cholecystectomy for gallstone disease between Jan 2001 and Dec 2010. Data retrieved included age, gender, and clinical presentation, findings on imaging, histology and details of management. The number of proven cases of gallbladder cancer each year ranged from 8 to 17. There were 38 men and 23 women. Male female ratio was 1.6:1. There were more men in the successive decades. Right upper quadrant pain (42 %) followed by jaundice (27 %) and a presence of a palpable mass (12 %) were the common clinical presentation. Pre-operative diagnosis of gall bladder cancer was possible in 80 %. Twelve patients had co-existing gallstones (19.6 %). Forty patients (50 %) had stage IV disease; only 6 patients had Stage I operable disease (9.8 %). During the same time 758 patients had cholecystectomy for gallstone disease. Only one patient had an incidental gall bladder cancer, who had an extended cholecystectomy. Gallbladder cancer is uncommon in south India and its association with gallstone is also low.

  7. Gallbladder microbiota variability in Colombian gallstones patients.

    Science.gov (United States)

    Arteta, Ariel Antonio; Carvajal-Restrepo, Hernan; Sánchez-Jiménez, Miryan Margot; Diaz-Rodriguez, Sergio; Cardona-Castro, Nora

    2017-03-31

    Gallbladder stones are a very frequently occurring condition. Despite bile bactericidal activity, many bacteria have been detected inside the gallbladder, and gallstones facilitate their presence. Between 3% and 5% of the patients with Salmonella spp. infection develop the carrier stage, with the bacteria persisting inside the gallbladder, shedding bacteria in their feces without signs of infection. The aim of this study was to isolate bacteria from Colombian patients with gallstones, using standard culturing methods, and to identify Salmonella spp. carriers by molecular techniques. A total of 149 patients (120 female and 29 male) diagnosed with gallstones who underwent cholecystectomy and who did not have symptoms of acute inflammation were included. Gallbladder tissue and bile were cultured and used for DNA extraction and Salmonella spp. hilA gene detection. Of the 149 patients 28 (19%) had positive cultures. Twenty-one (75%) patients with positive cultures were from Medellin's metropolitan area. In this geographical location, the most frequent isolations were Pseudomonas spp. (38%), Klebsiella spp. (23%), and Proteus spp. (9%) in addition to unique cases of other bacteria. In Apartado, the isolates found were Enterobacter cloacae (50%), Raoultella terrigena (32%), and both Enterobacter cloacae and Raoultella terrigena were isolated in one (18%) male patient. Five (3.3%) of the 149 patients had positive polymerase chain reaction (PCR) results for the hilA gene of Salmonella spp., all of whom were female and residents of the Medellín metropolitan area. The gallbladder microbiota variability found could be related to geographical, ethnic, and environmental conditions.

  8. Carcinoma involving the gallbladder: a retrospective review of 23 cases - pitfalls in diagnosis of gallbladder carcinoma

    Directory of Open Access Journals (Sweden)

    Giang Tran H

    2012-01-01

    Full Text Available Abstract Background Carcinoma of the gallbladder (GBC clinically mimics benign gallbladder diseases and often escapes detection until advanced stage. Despite the frequency of cholecystectomy, diagnosis of GBC remains problematic in many situations. We sought to identify pathologic features that contribute to the difficulty in recognition of GBC. Methods We identified 23 patients (ranged from 45 to 86 years, male to female ratio 1:4.5 with carcinoma involving the gallbladder referred to an academic medical center over a period of 10 years for study. This includes 10 cases of primary GBC, 6 cases of metastatic tumor to gallbladder, 6 cases of directly invasive adenocarcinoma arising elsewhere in the biliary tree, and one case of unidentified origin adenocarcinoma. Primary tumors include adenocarcinoma not otherwise specified (NOS in 6 cases, papillary adenocarcinoma in 2 cases, and single cases of undifferentiated carcinoma and combined adenocarcinoma and neuroendocrine carcinoma (NEC. Metastatic tumors to gallbladder were from a wide range of primary sites, predominantly the gastrointestinal tract. Results These cases illustrate seven potential pitfalls which can be encountered. These include: 1 mistakenly making a diagnosis of adenocarcinoma of gallbladder when only benign lesions such as deeply penetrating Rokitansky-Aschoff sinuses are present (overdiagnosis, 2 misdiagnosing well-differentiated invasive carcinoma with minimal disease as benign disease (underdiagnosis, 3 differentiating between primary NEC of gallbladder and metastasis, 4 confusing primary mucinous adenocarcinoma of gallbladder with pseudomyxoma peritonei from a low grade appendiceal neoplasm disseminated to gallbladder, 5 confusing gangrenous necrosis related to cholecystitis with geographic tumoral necrosis, 6 undersampling early, grossly occult disease, and 7 misinterpreting extracellular mucin pools. Conclusions Clinical history and a high index of suspicion are

  9. Gallbladder Nonvisualization in Cholecystectomy: A Factor for Conversion.

    Science.gov (United States)

    Slack, Daniel R; Grisby, Shaunda; Dike, Uzoamaka Kimberly; Kohli, Harjeet

    2018-01-01

    Many risk factors have been identified in minimally invasive cholecystectomies that lead to higher complications and conversion rates. No study that we encountered looked at nonvisualization of the gallbladder (GB) during surgery as a risk factor. We hypothesized that nonvisualization was associated with an increased risk of complications and could be an early intraoperative identifier of a higher risk procedure. Recognizing this could allow surgeons to be aware of potential risks and to be more likely to convert to open for the safety of the patient. We looked at minimally invasive cholecystectomies performed at our institution from January 2015 through April 2016 and had the performing resident fill out a survey after the surgery. Outcomes were conversion rates, intraoperative complications, and blood loss and were analyzed via Pearson χ 2 test or Mann-Whitney U test. The primary outcome showed a conversion rate of 37% in nonvisualized GBs versus 0% in visualized ( P = .001). Secondary outcomes showed significant differences in GB perforations (74% vs 13%, P = .001), omental vessel bleeding (16% vs. 0%, P = .005), and EBL (46 mL vs 29 mL, P = .001). Intraoperative nonvisualization of the GB after adequate positioning caused significantly increased risk of intraoperative complications and conversion. This knowledge could be useful during intraoperative assessment, to decide whether a case should be continued as a minimally invasive procedure or converted early to help reduce risk to the patient. Further randomized controlled studies should be performed to further demonstrate the value of this assessment.

  10. Nonvariceal upper gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang; Golzarian, Jafar

    2007-01-01

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  11. Nonvariceal upper gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Burke, Stephen J.; Weldon, Derik; Sun, Shiliang [University of Iowa, Department of Radiology, Iowa, IA (United States); Golzarian, Jafar [University of Iowa, Department of Radiology, Iowa, IA (United States); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa, IA (United States)

    2007-07-15

    Nonvariceal upper gastrointestinal bleeding (NUGB) remains a major medical problem even after advances in medical therapy with gastric acid suppression and cyclooxygenase (COX-2) inhibitors. Although the incidence of upper gastrointestinal bleeding presenting to the emergency room has slightly decreased, similar decreases in overall mortality and rebleeding rate have not been experienced over the last few decades. Many causes of upper gastrointestinal bleeding have been identified and will be reviewed. Endoscopic, radiographic and angiographic modalities continue to form the basis of the diagnosis of upper gastrointestinal bleeding with new research in the field of CT angiography to diagnose gastrointestinal bleeding. Endoscopic and angiographic treatment modalities will be highlighted, emphasizing a multi-modality treatment plan for upper gastrointestinal bleeding. (orig.)

  12. Upper gastrointestinal bleeding.

    Science.gov (United States)

    Feinman, Marcie; Haut, Elliott R

    2014-02-01

    Upper gastrointestinal (GI) bleeding remains a commonly encountered diagnosis for acute care surgeons. Initial stabilization and resuscitation of patients is imperative. Stable patients can have initiation of medical therapy and localization of the bleeding, whereas persistently unstable patients require emergent endoscopic or operative intervention. Minimally invasive techniques have surpassed surgery as the treatment of choice for most upper GI bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Spontaneous cholecystocutaneous fistula as a primary manifestation of gallbladder adenocarcinoma associated with gallbladder lithiasis - case report.

    Science.gov (United States)

    Micu, Bogdan Vasile; Andercou, Octavian Aurel; Micu, Carmen Maria; Militaru, Valentin; Jeican, IonuŢ Isaia; Bungărdean, Cătălina Ileana; Mogoantă, Stelian ŞtefăniŢă; Miclăuş, Dan Radu; Pop, Tudor Radu

    2017-01-01

    Spontaneous cholecystocutaneous fistula (SCF) is a rare complication of neglected calculous biliary disease and also an extremely rare complication of gallbladder neoplasm. This pathology has become even rarer because of prompt diagnosis and expedient surgical intervention for gallstones. So far, there is one published report of a SCF due to gallbladder adenocarcinoma. We present the case of a woman aged 87 years, admitted to the Vth Department of Surgery, Clinical Municipal Hospital of Cluj-Napoca (Romania) for a tumoral mass located in the epigastrium. In the epigastrium, the patient had three skin orifices of about 1-2 mm each, through which purulent secretion occurred. The abdominal ultrasound highlighted a cholecystocutaneous fistula with the presence of a subcutaneous gallstone. Intraoperatively, we found a cholecystocutaneous fistula, a 1 cm subcutaneous gallstone, gallbladder with thickened walls containing a cylinder-shaped gallstone of 5÷3 cm. Fistulectomy, gallstones extraction and cholecystectomy were performed. The histopathological examination highlighted gallbladder adenocarcinoma. In conclusion, SCF can be the first significant manifestation of gallbladder cancer associated with neglected calculous biliary disease.

  14. Bed Bugs

    Science.gov (United States)

    Prevent, identify, and treat bed bug infestations using EPA’s step-by-step guides, based on IPM principles. Find pesticides approved for bed bug control, check out the information clearinghouse, and dispel bed bug myths.

  15. Cholecystitis of a duplicated gallbladder complicated by a cholecystoenteric fistula

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Brady K. [University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY (United States); Chess, Mitchell A. [University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY (United States); Advanced Imaging, Batavia, NY (United States)

    2009-04-15

    Gallbladder duplications are uncommon anatomic variants that are sometimes mistaken for other entities on imaging. We present a surgically confirmed case of cholecystitis in a ductular-type duplicated gallbladder complicated by the formation of an inflammatory fistula to the adjacent duodenum. Both US and magnetic resonance cholangiopancreatography were performed preoperatively, in addition to intraoperative cholangiography, which confirmed the presence of a duplicated gallbladder. (orig.)

  16. Gallbladder visualization on CT shortly after abdominal angiography with iodixanol

    International Nuclear Information System (INIS)

    Tajima, Hiroyuki; Murakami, Ryusuke; Goto, Shinsuke; Aoyama, Toshiya; Kaizu, Toshihide; Ichikawa, Taro; Kumazaki, Tatsuo; Onda, Masahiko

    1996-01-01

    Fifteen patients underwent CT examination shortly after abdominal angiography with iodixanol. Gallbladder opacification was observed in 13 patients in the absence of clinical evidence of renal impairment. Among them, 2 patients showed a strong opacification on CT. There was no significant relationship between visualization of the gallbladder and the total dose of contrast medium. Gallbladder opacification on CT examination shortly after angiography shows that the hepatobiliary tract is important in the excretion of iodixanol. (author)

  17. Isolated gallbladder injury in a case of blunt abdominal trauma.

    Science.gov (United States)

    Birn, Jeffrey; Jung, Melissa; Dearing, Mark

    2012-04-01

    The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.

  18. Isolated Gallbladder Injury in a Case of Blunt Abdominal Trauma

    OpenAIRE

    Birn, Jeffrey; Jung, Melissa; Dearing, Mark

    2012-01-01

    The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.

  19. Cancer of the gallbladder-Chilean statistics.

    Science.gov (United States)

    Villanueva, Luis

    2016-01-01

    Chile has the world's highest rate of incidence as well as death from cancer of the gallbladder and biliary ducts. The problem is most acute in the southern provinces. These areas constitute the low average income associated with low educational attainment and a high rate of obesity compared with the rest of Chile. We could also include genetic factors related to processes of lithogenesis to these elements which are more common among the Mapuche. This population sub-group could benefit from special government programmes for early diagnosis and treatment of lithiasic disease and for the management of risk factors such as obesity. In this way, we could reduce the mortality rate of gallbladder cancer.

  20. Primary neuroendocrine neoplasm of the gallbladder

    OpenAIRE

    Kanakala, Venkatesh; Kasaraneni, Ramesh; Smith, David A; Goulbourne, Ian A

    2009-01-01

    Carcinoid tumours are distinct neuroendocrine tumours with characteristic clinical and histological behavioural properties which arise mainly in the gastrointestinal tract (73.7%) or bronchopulmonary system (25.1%). Neuroendocrine tumours of the gallbladder are rare—to date there have been only 42 cases reported in the literature. This case was an incidental finding which was recognised during routine histopathological examination after laparoscopic cholecystectomy for symptomatic cholelithia...

  1. Usefulness of lavage cytology during endoscopic transpapillary catheterization into the gallbladder in the cytological diagnosis of gallbladder disease.

    Science.gov (United States)

    Naito, Yoshiki; Okabe, Yoshinobu; Kawahara, Akihiko; Taira, Tomoki; Isida, Yusuke; Kaji, Ryouhei; Sata, Michio; Ureshino, Hiroki; Mikagi, Kazuhiro; Kinoshita, Hisafumi; Yasumoto, Makiko; Kusano, Hironori; Kage, Masayoshi; Yano, Hirohisa

    2009-06-01

    Many studies have reported methods of cell collection involving percutaneous transhepatic cholangiodrainage (PTCD) and fine-needle aspiration cytology for the diagnosis of gallbladder disease. However, few studies have described the use of a transpapillary approach, i.e., endoscopic transpapillary catheterization into the gallbladder (ETCG). In this study, we analyzed cells collected by ETCG to evaluate its usefulness in the cytological diagnosis of gallbladder disease. The subjects were 19 patients who had undergone ETCG for the diagnosis of gallbladder disease. Of these patients, 11 and 8 had gallbladder cancer and benign gallbladder disease, respectively. We also evaluated the diagnostic accuracy of PTCD cytology performed in 15 patients with gallbladder cancer.Specimens were cytologically diagnosed as normal or benign, indeterminate, suspected malignancy, malignant, and inadequate in 47% (9/19), 11% (2/19), 0% (0/19), 37% (7/19), and 5% (1/19) of patients, respectively. Specimens were diagnosed as malignant, indeterminate, normal or benign, and inadequate in 7, 2, 1, and 1, respectively, of the 11 patients diagnosed with gallbladder cancer. The sensitivity and specificity of ETCG cytology were 78 and 100%, respectively, whereas the diagnostic accuracy of PTCD cytology was 20% (3/15). None of the patients developed complications of ETCG. Despite its technical difficulty, ETCG for bile cytology allows the collection of adequate cell numbers from patients with benign disease or gallbladder cancer and facilitates a cytological diagnosis, making it a useful method for collecting cells. (c) 2009 Wiley-Liss, Inc.

  2. Severe Bleeding: First Aid

    Science.gov (United States)

    ... 12, 2017. Jevon P, et al. Part 5 — First-aid treatment for severe bleeding. Nursing Times. 2008;104:26. Oct. 19, 2017 Original article: http://www.mayoclinic.org/first-aid/first-aid-severe-bleeding/basics/ART-20056661 . Mayo ...

  3. Abnormal Uterine Bleeding FAQ

    Science.gov (United States)

    ... acid —This medication treats heavy menstrual bleeding. • Nonsteroidal anti-inflammatory drugs—These drugs, which include ibuprofen, may help control heavy bleeding and relieve menstrual cramps. • Antibiotics—If you have an infection, you may be ...

  4. Upper GI Bleeding in Children

    Science.gov (United States)

    Upper GI Bleeding in Children What is upper GI Bleeding? Irritation and ulcers of the lining of the esophagus, stomach or duodenum can result in upper GI bleeding. When this occurs the child may vomit blood ...

  5. Gallbladder visualization on CT shortly after angiography with ioxaglate

    International Nuclear Information System (INIS)

    Tajima, H.; Kaizu, T.; Ichikawa, T.; Kumazaki, T.

    1994-01-01

    Thirty-five patients underwent CT examination 15 to 30 min after abdominal angiography with ioxaglate. The gallbladder was visualized in 12 patients in the absence of clinical evidence of renal impairment. Gallbladder opacification on CT examinations shortly after angiography shows that the hepatobiliary tract is important in the excretion of ioxaglate. (orig.)

  6. Gallbladder Polyps: An Ambiguous Cause of Biliary Colic

    African Journals Online (AJOL)

    However, ultrasonography revealed multiple hyperechoic mass lesions protruding in the gallbladder lumen suggestive of gallbladder polyps [Figure 1], largest one measured 8.2 mm [Figure 2]. Subsequently, the patient underwent conventional 4-port laparoscopic cholecystectomy. Histopathology revealed the benign ...

  7. Effect of pirenzepine on gallbladder emptying in humans

    Energy Technology Data Exchange (ETDEWEB)

    Keshavarzian, A.; Fitzpatrick, M.L.; Anagnostides, A.; Chadwick, V.S.

    1986-11-01

    The effect of the selective antimuscarinic agent, pirenzepine, on gallbladder function was studied in six healthy volunteers, using /sup 99m/Tc HIDA (N-(2,6-diethylthenyl) carbamoylmethyl iminodiacetic acid) hepatobiliary scanning. Pirenzepine, in doses that inhibit gastric acid secretion, did not alter gallbladder emptying responses to sham feeding stimulation or to a test meal.

  8. Gallbladder mucocoele and concurrent hepatic lipidosis in a cat.

    Science.gov (United States)

    Bennett, S L; Milne, M; Slocombe, R F; Landon, B P

    2007-10-01

    A 3-year-old Domestic Shorthair cat was presented with weight loss, anorexia and icterus. Feline hepatic lipidosis and gallbladder mucocoele were diagnosed; this is the first report of gallbladder mucocoele in the cat. The case was managed successfully with cholecystojejunostomy, gastrostomy tube placement and tube feeding for 3 months. The cat has survived over the long term with minimal complications.

  9. CT appearance of liver and gallbladder in type II diabetics

    International Nuclear Information System (INIS)

    Li Jingshan; Li Wei; Zhang Yuzhong; Zhao Xiuyi; Zhang Xuelin

    2005-01-01

    Objective: To evaluate CT findings of liver and gallbladder in type II diabetics and to discuss diabetic, and investigate the correlation between type II diabetics, and investigate the correlation between the diabetes and the lesions found in the liver or gallbladder. Methods: Retrospective analysis was made on the CT findings of hepatic and gallbladder lesions in 586 cases of II diabetes. Results: In total 586 type II diabetics, cholecystitis and/or gallstone were revealed in 33.45% patients; and hepatic alteration was noted in 20.48% cases. Hepatic abnormalities were found in 58.67% cases in the cholecystitis/gallstone group, significantly different from the group with unremarkable gallbladder, in which hepatic lesions were found only in 1.28% cases. Conclusion: The hepatic alteration is secondary to the gallbladder lesions in type II diabetics. (authors)

  10. Effect of a high-fat-high-cholesterol diet on gallbladder bile acid composition and gallbladder motility in dogs.

    Science.gov (United States)

    Kakimoto, Toshiaki; Kanemoto, Hideyuki; Fukushima, Kenjiro; Ohno, Koichi; Tsujimoto, Hajime

    2017-12-01

    OBJCTIVE To investigate the effects of dietary lipid overload on bile acid metabolism and gallbladder motility in healthy dogs. ANIMALS 7 healthy Beagles. PROCEDURES In a crossover study, dogs were fed a high-fat-high-cholesterol diet (HFCD) or a low-fat diet (LFD) for a period of 2 weeks. After a 4-month washout period, dogs were fed the other diet for 2 weeks. Before and at the end of each feeding period, the concentrations of each of the gallbladder bile acids, cholecystokinin (CCK)-induced gallbladder motility, and bile acid metabolism-related hepatic gene expression were examined in all dogs. RESULTS The HFCD significantly increased plasma total cholesterol concentrations. The HFCD also increased the concentration of taurochenodeoxycholic acid and decreased the concentration of taurocholic acid in bile and reduced gallbladder contractility, whereas the LFD significantly decreased the concentration of taurodeoxycholic acid in bile. Gene expression analysis revealed significant elevation of cholesterol 7α-hydroxylase mRNA expression after feeding the HFCD for 2 weeks, but the expression of other genes was unchanged. CONCLUSIONS AND CLINICAL RELEVANCE Feeding the HFCD and LFD for 2 weeks induced changes in gallbladder bile acid composition and gallbladder motility in dogs. In particular, feeding the HFCD caused an increase in plasma total cholesterol concentration, an increase of hydrophobic bile acid concentration in bile, and a decrease in gallbladder sensitivity to CCK. These results suggested that similar bile acid compositional changes and gallbladder hypomotility might be evident in dogs with hyperlipidemia.

  11. Acquired bleeding disorders

    African Journals Online (AJOL)

    B one marrow aplasia ... Laboratory approach to a suspected acquired bleeding disorder. (LER = leuko- .... lymphocytic leukaemia, and lymphoma). ... cells), a bone marrow aspirate and trephine biopsy (BMAT) is not ..... transplantation.

  12. Small Bowel Bleeding

    Science.gov (United States)

    ... pouchings in the wall of the colon), or cancer. Upper GI (esophagus, stomach, or duodenum) bleeding is most often due ... begins transmitting images of the inside of the esophagus, stomach, and small bowel to a ... Bowel Disease Irritable Bowel Syndrome ...

  13. Abnormal Uterine Bleeding

    Science.gov (United States)

    ... especially the progestin-only pill (also called the “mini-pill”) can actually cause abnormal bleeding for some ... Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality ...

  14. Incarcerated umbilical cord hernia containing the gallbladder

    Directory of Open Access Journals (Sweden)

    Ann M. Kulungowski

    2017-06-01

    Full Text Available A 16 day-old boy infant with an umbilical mass underwent operative exploration of the umbilicus. The mass proved to be a gallbladder incarcerated in a hernia of the umbilical cord. Distinguishing an omphalocele from an umbilical cord hernia is not obvious and can be arbitrary. Morphologically, the two terms both describe congenital abdominal wall defects covered by a membrane, typically containing abdominal organs. Subtle differences and clinical features between omphalocele and umbilical cord hernia are highlighted in this report.

  15. Particle bed reactor modeling

    Science.gov (United States)

    Sapyta, Joe; Reid, Hank; Walton, Lew

    The topics are presented in viewgraph form and include the following: particle bed reactor (PBR) core cross section; PBR bleed cycle; fuel and moderator flow paths; PBR modeling requirements; characteristics of PBR and nuclear thermal propulsion (NTP) modeling; challenges for PBR and NTP modeling; thermal hydraulic computer codes; capabilities for PBR/reactor application; thermal/hydralic codes; limitations; physical correlations; comparison of predicted friction factor and experimental data; frit pressure drop testing; cold frit mask factor; decay heat flow rate; startup transient simulation; and philosophy of systems modeling.

  16. The International Bleeding Risk Score

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Laine, L.; Dalton, H.

    2017-01-01

    The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding.......The International Bleeding Risk Score: A New Risk Score that can Accurately Predict Mortality in Patients with Upper GI-Bleeding....

  17. Torsion of gallbladder: a diagnostic predicament

    International Nuclear Information System (INIS)

    Andrabi, S.I.H.; Ahmed, M.; Rathore, M.A.

    2007-01-01

    A 69 years old woman was admitted under the case of physicians with lethargy and anemia. While in-hospital, she developed severe pain in the right hypochondrium with vomiting. Past medical history included peripheral vascular disease, appendicectomy and tuberculous meningitis. On examination, she had tachycardia, hypotension was pale, apyrexic, clinically anicteric and markedly tender over right upper quadrant with mild guarding. Her hemoglobin was 8.5 gm/dl, white cell count was 25,000 per L and had a raised C Reactive Protein of 110. Her liver functions were normal. Plain abdominal radiograph revealed dilated small bowel in the upper abdomen. Provisional diagnosis of acute cholecystitis was made and conservative management was started initially, using intravenous cefuroxime. She deteriorated rapidly, developed metabolic acidosis and atrial fibrillation. CT scan did not reveal a significant abnormality. There were no gallstones and no evidence of acute cholecystitis. An emergency laparotomy revealed a gangrenous gallbladder and twisted more than 3600 anticlockwise on its pedicle. Cholecystectomy was performed and she was managed in intensive care unit. She developed abdominal compartment syndrome requiring re-exploration and a laparostomy. On the fifth post-op day her abdomen was successfully closed with a mesh. Despite intensive monitoring and vigorous management, she developed multi-organ failure and died five weeks after her first operation. Histology confirmed venous infarction of an acalculous gallbladder without cholelithiasis. (author)

  18. Clinical Relationship between Steatocholecystitis and Gallbladder Contractility Measured by Cholescintigraphy

    Directory of Open Access Journals (Sweden)

    Chang Seok Bang

    2015-01-01

    Full Text Available Objective. Contractility of gallbladder is known to be decreased in fatty gallbladder diseases. However, clinical estimation data about this relationship is still lacking. The aim of this study was to investigate the association between steatocholecystitis and contractility of gallbladder. Methods. Patients with cholecystitis (steatocholecystitis versus nonsteatocholecystitis who underwent cholescintigraphy before cholecystectomy were retrospectively evaluated in a single teaching hospital of Korea. The association of steatocholecystitis with contractility of gallbladder, measured by preoperative cholescintigraphy, was assessed by univariable and multivariable analysis. Results. A total of 432 patients were finally enrolled (steatocholecystitis versus nonsteatocholecystitis; 75 versus 357, calculous versus acalculous cholecystitis; 316 versus 116. In the multivariable analysis, age (OR: 0.94, 95% CI: 0.90–0.99, P=0.01 and total serum cholesterol (OR: 1.02, 95% CI: 1.01–1.04, P=0.04 were related to steatocholecystitis in patients with acalculous cholecystitis. Only age (OR: 0.97, 95% CI: 0.94–0.99, P=0.004 was significantly related to steatocholecystitis in patients with calculous cholecystitis. However, ejection fraction of gallbladder reflecting contractility measured by cholescintigraphy was not related to steatocholecystitis irrespective of presence of gallbladder stone in patients with cholecystitis. Conclusion. Ejection fraction of gallbladder measured by cholescintigraphy cannot be used for the detection or confirmation of steatocholecystitis.

  19. Magnetic resonance imaging of the fetal gallbladder and bile

    International Nuclear Information System (INIS)

    Brugger, Peter C.; Weber, Michael; Prayer, Daniela

    2010-01-01

    To study the magnetic resonance imaging (MRI) appearance of the fetal gallbladder with special reference to fetal gallbladder sludge. In a retrospective study of 512 fetuses without gastrointestinal abnormalities, we classified the gallbladder MR appearances into patterns based on the signal intensity (SI) of bile on T1-weighted and T2-weighted sequences. We analysed the ratio of T1-weighted SI of bile. Maximum gallbladder width was correlated with gestational weeks (GW) using non-linear regression analysis and compared between various imaging patterns with one-way ANOVA. Five age-dependent patterns of the MRI appearance were found: (1) SI of bile was T2-weighted hyperintense and T1-weighted hypointense (78.5%); (2) presented with T2-weighted hyperintensity and T1-weighted signal isointense to liver (10.4%); (3) moderate hyperintense T2-weighted SI, T1-weighted SI hyperintense to liver (4.9%); (4) SI was T2-weighted isointense and T1-weighted hyperintense to liver (3.7%); (5) pronounced T2-weighted hypointensity and marked T1-weighted hyperintensity (2.5%). Pattern 1 was exclusively found before 27 GW, while patterns 2-5 increased in frequency after 30 GW. The MRI appearance of the fetal gallbladder is variable; fetal bile shows age-dependent SI changes that may cause non-visualisation of the gallbladder. This may be due to sludge and/or accumulation of paramagnetic substances suspended within gallbladder mucus. (orig.)

  20. Magnetic resonance imaging of the fetal gallbladder and bile

    Energy Technology Data Exchange (ETDEWEB)

    Brugger, Peter C. [Medical University of Vienna, Integrative Morphology Group, Center for Anatomy and Cell Biology, Vienna (Austria); Weber, Michael [Medical University of Vienna, Department of Radiology, Vienna (Austria); Prayer, Daniela [Medical University of Vienna, Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Vienna (Austria)

    2010-12-15

    To study the magnetic resonance imaging (MRI) appearance of the fetal gallbladder with special reference to fetal gallbladder sludge. In a retrospective study of 512 fetuses without gastrointestinal abnormalities, we classified the gallbladder MR appearances into patterns based on the signal intensity (SI) of bile on T1-weighted and T2-weighted sequences. We analysed the ratio of T1-weighted SI of bile. Maximum gallbladder width was correlated with gestational weeks (GW) using non-linear regression analysis and compared between various imaging patterns with one-way ANOVA. Five age-dependent patterns of the MRI appearance were found: (1) SI of bile was T2-weighted hyperintense and T1-weighted hypointense (78.5%); (2) presented with T2-weighted hyperintensity and T1-weighted signal isointense to liver (10.4%); (3) moderate hyperintense T2-weighted SI, T1-weighted SI hyperintense to liver (4.9%); (4) SI was T2-weighted isointense and T1-weighted hyperintense to liver (3.7%); (5) pronounced T2-weighted hypointensity and marked T1-weighted hyperintensity (2.5%). Pattern 1 was exclusively found before 27 GW, while patterns 2-5 increased in frequency after 30 GW. The MRI appearance of the fetal gallbladder is variable; fetal bile shows age-dependent SI changes that may cause non-visualisation of the gallbladder. This may be due to sludge and/or accumulation of paramagnetic substances suspended within gallbladder mucus. (orig.)

  1. Surgical strategies in patients with gallbladder cancer: nihilism to optimism.

    Science.gov (United States)

    Sikora, Sadiq S; Singh, Rajneesh K

    2006-06-15

    Gallbladder cancer is an aggressive disease with dismal results of surgical treatment and a poor prognosis. However, over the last few decades selected groups have reported improved results with aggressive surgery for gallbladder cancer. Review of recent world literature was done to provide an update on the current concepts of surgical treatment of this disease. Long-term survival is possible in early stage gallbladder carcinoma. Tis and T1a gallbladder carcinoma can be treated with simple cholecystectomy only. However, in T1b and beyond cancers, aggressive surgery (extended cholecystectomy) is important in improving the long-term prognosis. Laparoscopic cholecystectomy should not be performed where there is a high index of suspicion of malignancy due to the frequent association with factors (such as gallbladder perforation and bile spill) which may lead to implantation of cancer cells and dissemination. Surgical resection for advanced carcinoma gallbladder is recommended only if a potentially curative R0 resection is possible. Aggressive surgery with vascular and multivisceral resection has been shown to be feasible albeit with an increase in mortality and morbidity. However, the true benefit of these radical resections is yet to be realized, as the actual number of long-term survivors of advanced gallbladder carcinoma is few. Surgery for gallbladder carcinoma, like other malignancies, has the potential to be curative only in local or regional disease. Pattern of loco-regional spread of disease dictates the surgical procedure. Radical surgery improves survival in early gallbladder carcinoma. The long-term benefit of aggressive surgery for advanced disease is unclear and may be offset by the high mortality and morbidity. Copyright 2006 Wiley-Liss, Inc.

  2. Gallbladder perforation complicating typhoid fever: report of two cases.

    Science.gov (United States)

    Gali, B M; Ali, N; Agbese, G O; Duna, V D; Dawha, S D; Ismai, G I; Mohammed, M

    2011-01-01

    Gallbladder perforation (GBP) is rare and as a complication of typhoid fever is extremely rare. We present two consecutive patients with GBP diagnosed incidentally at laparotomy. Information on the management of two patients with gallbladder perforation seen at Federal Medical Centre Azare in June and October 2008 was extracted from their case records. The two patients were both males aged 13 years and 16 years. They both presented with high fever of more than 2 weeks duration; and abdominal pain and distension. Both patients had features of generalised peritonitis. Pre-operative diagnoses of typhoid enteric perforation were made based on a positive Widal test. Intra-operative findings however, were that of bile peritonitis and gallbladder perforation. Both had cholecystectomy. Culture of the bile aspirate yielded Salmonella typhi. Gallbladder perforation secondary to typhoid fever should be considered as a differential diagnosis in patients with suspected typhoid enteric perforation in typhoid fever endemic region.

  3. Gallbladder volvulus in a child with mild clinical presentation

    International Nuclear Information System (INIS)

    Inoue, Seiichiro; Odaka, Akio; Hashimoto, Daijo; Tamura, Masanori; Osada, Hisato

    2011-01-01

    Gallbladder volvulus in children is rare. Pre-operative diagnosis is considered difficult because of the nonspecific symptoms and inflammatory blood analysis findings. Sometimes diagnosis is confirmed at laparotomy. Many reports mention that the chief complaints of this disease are sudden and severe abdominal pain. We report a case of gallbladder volvulus in a boy with mild clinical symptoms and laboratory data of nonspecific inflammation. A reconstructed coronal CT abdominal view showed clearly the gallbladder torsion. Laparoscopic cholecystectomy was performed and postoperative course was uneventful. Recent reports have suggested the effectiveness of MRI. This case highlights the utility of a reconstructed coronal view of abdominal CT in successful pre-operative diagnosis for gallbladder volvulus in children. (orig.)

  4. Gallbladder volvulus in a child with mild clinical presentation

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Seiichiro; Odaka, Akio; Hashimoto, Daijo [Saitama Medical University, Department of Hepato-Biliary-Pancreatic and Pediatric Surgery, Saitama Medical Center, Kawagoe, Saitama (Japan); Tamura, Masanori [Saitama Medical University, Department of Pediatrics, Saitama Medical Center, Saitama (Japan); Osada, Hisato [Saitama Medical University, Department of Radiology, Saitama Medical Center, Saitama (Japan)

    2011-01-15

    Gallbladder volvulus in children is rare. Pre-operative diagnosis is considered difficult because of the nonspecific symptoms and inflammatory blood analysis findings. Sometimes diagnosis is confirmed at laparotomy. Many reports mention that the chief complaints of this disease are sudden and severe abdominal pain. We report a case of gallbladder volvulus in a boy with mild clinical symptoms and laboratory data of nonspecific inflammation. A reconstructed coronal CT abdominal view showed clearly the gallbladder torsion. Laparoscopic cholecystectomy was performed and postoperative course was uneventful. Recent reports have suggested the effectiveness of MRI. This case highlights the utility of a reconstructed coronal view of abdominal CT in successful pre-operative diagnosis for gallbladder volvulus in children. (orig.)

  5. Computed tomography of the pancreas and gallbladder

    International Nuclear Information System (INIS)

    Onizuka, Hideo; Matsuura, Keiichi

    1982-01-01

    The authors viewed the present status of CT diagnosis in pancreatic and biliary diseases, referring to its future. CT imaged neither normal intrahepatic biliary ducts nor normal pancreatic ducts because of a relatively low resolution. The accuracy of CT in diagnosing obstructive jaundice has been 85 - 100%. CT showed a higher reproducibility than that of ultrasound in follow-up of intrahepatic gallstones. On the other hand, ultrasound was superior to CT in detecting gallstones. Diagnosis of cholecystitis by CT was usually impossible. Detecting early stage of gallbladder cancer by CT is very rarely, but it was of value for investigating the extent of advanced cancers. This tendency was also observed in biliary duct carcinoma, acute and chronic pancreatitis, and carcinoma of the pancreas. Consequently, it was concluded that CT is not appropriate for the purpose of early detection of pancreatic and other cancers. The use of CT with NMR is expected in future. (Ueda, J.)

  6. Gallbladder Cancer in the 21st Century

    Directory of Open Access Journals (Sweden)

    Rani Kanthan

    2015-01-01

    Full Text Available Gallbladder cancer (GBC is an uncommon disease in the majority of the world despite being the most common and aggressive malignancy of the biliary tree. Early diagnosis is essential for improved prognosis; however, indolent and nonspecific clinical presentations with a paucity of pathognomonic/predictive radiological features often preclude accurate identification of GBC at an early stage. As such, GBC remains a highly lethal disease, with only 10% of all patients presenting at a stage amenable to surgical resection. Among this select population, continued improvements in survival during the 21st century are attributable to aggressive radical surgery with improved surgical techniques. This paper reviews the current available literature of the 21st century on PubMed and Medline to provide a detailed summary of the epidemiology and risk factors, pathogenesis, clinical presentation, radiology, pathology, management, and prognosis of GBC.

  7. [Laparoscopic cholecystectomy with transgastric gallbladder extraction].

    Science.gov (United States)

    Jurczak, Florent

    2011-11-01

    To describe and evaluate a new cholecystectomy technique combining classical dissection with currently available mini-instrumentation (3 and 5 mm) and gallbladder removal through a short gastrotomy. After a feasibility study, we set up a protocol for this procedure using instrumentation currently available on the market. We performed 106 procedures, including 99 in a prospective study between January 2008 and July 2010. Cholecystectomy was performed with the described technique in 99 of 106 eligible patients (22 males and 77 females, mean age 45.8 years (range 18-77); median BMI 26.4 kg/m2 (range 22-36)). Forty-eight patients had at least one gallstone larger than 10 mm. There were no postoperative gastric complications and recovery was always rapid. This procedure is technically feasible, safe and reproducible. The results are good, with minimal abdominal wall trauma. Normal physical activity can be resumed rapidly with no risk of incisional hernia.

  8. Effects of growth hormone deficiency and recombinant growth hormone therapy on postprandial gallbladder motility and cholecystokinin release.

    NARCIS (Netherlands)

    Moschetta, A.; Twickler, M.; Rehfeld, J.F.; Ooteghem, N.A. van; Castro Cabezas, M.; Portincasa, P.; Berge-Henegouwen, G.P. van; Erpecum, K.J. van

    2004-01-01

    In addition to cholecystokinin, other hormones have been suggested to be involved in regulation of postprandial gallbladder contraction. We aimed to evaluate effects of growth hormone (GH) on gallbladder contractility and cholecystokinin release. Gallbladder and gastric emptying (by ultrasound) and

  9. Radiotherapy for advanced carcinoma of the gallbladder

    International Nuclear Information System (INIS)

    Shimizu, Teppei; Tanaka, Yoshiaki; Iijima, Mitsuharu; Matsuda, Tadayoshi

    1994-01-01

    The results of radiotherapy in 37 patients who were treated for carcinoma of the gallbladder from April 1975 to April 1992 are presented. To analyze the treatment results, patients were divided into four groups depending on treatment modality: intraoperative radiotherapy (IORT) with surgical resection in 9 (resection group), IORT with palliative surgery in 5 (palliative surgery group), hyperthermo-chemo-radiotherapy for inoperable cases in 11 (HCR group), external irradiation for inoperable cases in 12 (ExRT alone group). Most of the patients in the resection group received ExRT. The HCR group showed better local response than the groups treated with palliative surgery and ExRT alone. The mean length of survival in the resection, palliative surgery, HCR and ExRT alone groups was 315 days, 144 days, 246 days and 74 days, respectively. Although no statistically significant difference in survival was observed between the resection and HCR groups, the relapse-free interval of the resection group was significantly longer than that of the other groups. The application of IORT for surgically resectable tumors contributed to improved prognosis and better quality of life. Although IORT for patients with unresectable tumors had little effect on survival, it was considered to play a palliative role in improving the quality of life. The HCR group had a significantly longer survival time and relapse-free interval than the palliative surgery and ExRT alone groups. In conclusion, the application of HCR for inoperable carcinoma of the gallbladder contributed to the improvement of prognosis and quality of life. (author)

  10. Influence of gallstones and ursodeoxycholic acid therapy on gallbladder emptying

    International Nuclear Information System (INIS)

    Forgacs, I.C.; Maisey, M.N.; Murphy, G.M.; Dowling, R.H.

    1984-01-01

    Altered gallbladder motility could predispose to, or result from, gallstone formation and could also explain the alleged relief of biliary colic seen during bile acid therapy. Therefore, in 14 controls, 25 patients with radiolucent gallstones, and 14 patients with radiopaque gallstones, the authors used two techniques to measure gallbladder contraction--radionuclide imaging and real-time ultrasound--in response to one of two stimuli--a Lundh meal or intravenous cholecystokinin-octapeptide. Using the radionuclide technique, postprandial gallbladder emptying (t1/2) was prolonged both in patients with radiopaque and radiolucent gallstones when compared with controls. In patients with radiolucent stones, the t1/2 of gallbladder emptying became further prolonged after 1 mo of therapy with ursodeoxycholic acid. A similar pattern of results was seen after cholecystokinin-octapeptide and also with real-time ultrasound. Thus, after both stimuli and using two independent techniques, gallbladder contraction was reduced in patients with gallstones. The slower and less complete gallbladder emptying with ursotherapy might explain the reduction in biliary colic noted during treatment

  11. Gallbladder shape extraction from ultrasound images using active contour models.

    Science.gov (United States)

    Ciecholewski, Marcin; Chochołowicz, Jakub

    2013-12-01

    Gallbladder function is routinely assessed using ultrasonographic (USG) examinations. In clinical practice, doctors very often analyse the gallbladder shape when diagnosing selected disorders, e.g. if there are turns or folds of the gallbladder, so extracting its shape from USG images using supporting software can simplify a diagnosis that is often difficult to make. The paper describes two active contour models: the edge-based model and the region-based model making use of a morphological approach, both designed for extracting the gallbladder shape from USG images. The active contour models were applied to USG images without lesions and to those showing specific disease units, namely, anatomical changes like folds and turns of the gallbladder as well as polyps and gallstones. This paper also presents modifications of the edge-based model, such as the method for removing self-crossings and loops or the method of dampening the inflation force which moves nodes if they approach the edge being determined. The user is also able to add a fragment of the approximated edge beyond which neither active contour model will move if this edge is incomplete in the USG image. The modifications of the edge-based model presented here allow more precise results to be obtained when extracting the shape of the gallbladder from USG images than if the morphological model is used. © 2013 Elsevier Ltd. Published by Elsevier Ltd. All rights reserved.

  12. 3D shape decomposition and comparison for gallbladder modeling

    Science.gov (United States)

    Huang, Weimin; Zhou, Jiayin; Liu, Jiang; Zhang, Jing; Yang, Tao; Su, Yi; Law, Gim Han; Chui, Chee Kong; Chang, Stephen

    2011-03-01

    This paper presents an approach to gallbladder shape comparison by using 3D shape modeling and decomposition. The gallbladder models can be used for shape anomaly analysis and model comparison and selection in image guided robotic surgical training, especially for laparoscopic cholecystectomy simulation. The 3D shape of a gallbladder is first represented as a surface model, reconstructed from the contours segmented in CT data by a scheme of propagation based voxel learning and classification. To better extract the shape feature, the surface mesh is further down-sampled by a decimation filter and smoothed by a Taubin algorithm, followed by applying an advancing front algorithm to further enhance the regularity of the mesh. Multi-scale curvatures are then computed on the regularized mesh for the robust saliency landmark localization on the surface. The shape decomposition is proposed based on the saliency landmarks and the concavity, measured by the distance from the surface point to the convex hull. With a given tolerance the 3D shape can be decomposed and represented as 3D ellipsoids, which reveal the shape topology and anomaly of a gallbladder. The features based on the decomposed shape model are proposed for gallbladder shape comparison, which can be used for new model selection. We have collected 19 sets of abdominal CT scan data with gallbladders, some shown in normal shape and some in abnormal shapes. The experiments have shown that the decomposed shapes reveal important topology features.

  13. Ultrasonographic study of gallbladder wall thickness in acute viral hepatitis

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Jin Sook; Kim, Kyung Jung; Park, Yang Hee; Kang, Ik Won; Yoon, Jong Sup [Hanyang Sacred Heart Hospital, Hallym University Medical Center, Seoul (Korea, Republic of)

    1984-09-15

    Prospective study of gallbladder wall thickness by ultrasonography was performed in 38 patients of acute viral hepatitis and 50 normal subjects as a control group from June 1983 to April 1984. The results were as follows; 1. In normal population, the range of gallbladder wall thickness is from 1 mm to 3 mm with peak incidence in 2 mm (66%, 33 case). Mean thickness of gallbladder wall is about 1.9 {+-} 0.6 mm. 2. In acute viral hepatitis, the range of gallbladder wall thickness is from 2 mm to 8 mm with peak incidence in 3 mm (34%, 13 case), second peak in 4 mm (29%, 11 case). Mean thickness of gallbladder wall is about 3.6 {+-} 1.6 mm, which is thicker than normal with statistical significance. (p<0.005) 3. In acute viral hepatitis, the mean thickness of gallbladder wall is about 4.4 {+-} 1.8 mm in the group of SGOT/SGPT level above 400 IU, and 2.8 {+-} 0.8 mm in the group of SGOT/ SGPT level below 400 IU. This difference is significant statistically. (p<0.05)

  14. Ultrasonographic study of gallbladder wall thickness in acute viral hepatitis

    International Nuclear Information System (INIS)

    Lim, Jin Sook; Kim, Kyung Jung; Park, Yang Hee; Kang, Ik Won; Yoon, Jong Sup

    1984-01-01

    Prospective study of gallbladder wall thickness by ultrasonography was performed in 38 patients of acute viral hepatitis and 50 normal subjects as a control group from June 1983 to April 1984. The results were as follows; 1. In normal population, the range of gallbladder wall thickness is from 1 mm to 3 mm with peak incidence in 2 mm (66%, 33 case). Mean thickness of gallbladder wall is about 1.9 ± 0.6 mm. 2. In acute viral hepatitis, the range of gallbladder wall thickness is from 2 mm to 8 mm with peak incidence in 3 mm (34%, 13 case), second peak in 4 mm (29%, 11 case). Mean thickness of gallbladder wall is about 3.6 ± 1.6 mm, which is thicker than normal with statistical significance. (p<0.005) 3. In acute viral hepatitis, the mean thickness of gallbladder wall is about 4.4 ± 1.8 mm in the group of SGOT/SGPT level above 400 IU, and 2.8 ± 0.8 mm in the group of SGOT/ SGPT level below 400 IU. This difference is significant statistically. (p<0.05)

  15. Primary Gallbladder Small Lymphocytic Lymphoma as a Rare Postcholecystectomy Finding

    Directory of Open Access Journals (Sweden)

    Kyriakos Psarras

    2014-01-01

    Full Text Available Introduction. Primary lymphoma of the gallbladder is an extremely rare entity with approximately 50 cases reported so far. In many of these cases the presenting symptoms were mimicking symptomatic gallstone disease and the diagnosis was made postoperatively, especially when the preoperative imaging results were far from suspicious for malignant disease. Patients and Methods. We report a case of primary lymphoma of the gallbladder in an 85-year-old man with gallstone disease, who was admitted for elective cholecystectomy 2 months after an episode of acute cholecystitis and pancreatitis. Histological evaluation of the specimen revealed a small lymphocytic lymphoma of the gallbladder. This type of primary gallbladder lymphoma has not been previously reported. Discussion. The most common primary lymphomas of the gallbladder are MALT lymphomas and diffuse large B-cell lymphomas, although a variety of other histological types have been reported. The association of these lesions with chronic inflammation is the most convincing theory for their pathogenesis. For lesions confined to the gallbladder, cholecystectomy is considered to be sufficient, while supplementary chemotherapy significantly improves prognosis in more advanced disease.

  16. Vaginal bleeding in late pregnancy

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000627.htm Vaginal bleeding in late pregnancy To use the sharing ... JavaScript. One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it ...

  17. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Ahmed, Aamer B; Afshari, Arash

    2017-01-01

    : The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia...... and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide...

  18. Gallbladder Dynamics Before and After Extracorporeal Shock Wave Lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myung Hea; Suk, Jae Dong; Moon, Dae Hyuk; Kim, Myung Hwan; Min, Young Il [Asian Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    1991-03-15

    Extracorporeal shock wave lithotripsy (ESWI.) with adjunctive oral litholytic therapy has proven to be a useful treatment in selected patients with gallbladder stones. To study the effect of ESWL on gallbladder dynamics, {sup 99m}Tc-DISIDA hepatobiliary scintigraphy was done for 25 patients with symptomatic gallstones and 10 normal controls. Of these 25 patients, 15 were treated with ESWL and adjunctive oral litholytic agents (ESWL group) and 10 were treated only with oral litholytic agents (UDCA group). After overnight fast and gallbladder visualization on a routine hepatobiliary scintigraphy with 7 mCi of {sup 99m}Tc-DISIDA, subjects were given fatty meal and imaged with a gamma camera interfaced to a computer (I frame/minute for 70 minutes). A gallbladder time-activity curve was generated and latent period (LP), ejection period (EP), ejection fraction (EF) and ejection rate (ER) were calculated, ESWL group were studied before, l day after and 2 weeks after ESWL, and UDCA group were studied before and 2 weeks after starting oral medication Mean basal EF was significantly reduced in patients but other parameters were not reduced. In ESlVL group, mean EF and mean ER at 1 day after ESWL were reduced. In 3 of them, gallbladder was not visualized at all. Two weeks after ESWL, however, all parameters were recovered to basal level. In UDCA group, all parameters were not changed significantly during medication. We can conclude that ESWL has such immediate adverse effect on gallbladder dynamics as reducing contractility and nonvisualization of gallbladder but it has no long-term effect.

  19. Pinworms and postmenopausal bleeding.

    OpenAIRE

    al-Rufaie, H K; Rix, G H; Pérez Clemente, M P; al-Shawaf, T

    1998-01-01

    The human pinworm Enterobius vermicularis is normally found within the human gastrointestinal tract. Pregnant females migrate out of their host's anus at night to lay their eggs perianally. As a consequence of this nocturnal migration some worms find their way into adjacent orifices, most commonly the female genitourinary tract, producing irritative symptoms such as vulvovaginitis. A case of pinworm infestation of the uterus presented as postmenopausal bleeding.

  20. Histopathology of gallbladder lesions of confiscated livers from cattle slaughtered in urmia abattoir

    Directory of Open Access Journals (Sweden)

    amir amniattalab

    2015-11-01

    Full Text Available During one month carcasses of 323 cattle (213 bulls and 110 cow were inspected by referring to Urmia slaughter-house. Livers and gallbladders of 47 cattle had macroscopic changes. Histopathologic sections were prepared from injured tissues and for bacteriology, contents of injured and normal gallbladders were cultured. Major macroscopic changes that were observed in damaged livers and gallbladders were: increasing of gallbladder thickness, petechiae, choleliths in gallbladder, hepatolithiasis, hepatic fascioliasis and presence of dicrocoelium in gall bladder. Histological sections were stained by hematoxylin and eosin, periodic acid schiff and masson’s trichrome staining methods. Cholecystitis, hyperplasia of seromucosal glands’ congestion, hemorrhage, fat necrosis and increased thickness of gallbladder layers were observed. Also Escherichia coli was isolated from 4 gallbladders. In females, the incidence of microscopic changes including cholecystitis, increasing of mucosal layer thickness, hyperplasia of seromucosal glands, hemorrhage in layers except the mucosal layer and presence of bacteria in culture of gallbladder contents was more than males (p

  1. Scintigraphic evaluation of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Park, Yong Tai; Lee, Choon Keun; Lee, Sun Wha; Choi, Woo Suk; Yoon, Yup; Lim, Jae Hoon

    1988-01-01

    Gastrointestinal bleeding remains a major diagnostic problem. Although advances have been made in the medical and surgical methods of managing gastrointestinal bleeding, the commonly employed techniques of barium radiography, endoscopy, and angiography may not successfully localize the site and define the cause of gastrointestinal bleeding. Two widely available technetium-99m-labeled radiopharmaceuticals, sulfur colloid and red blood cells are currently used in the evaluation of patients who are bleeding from the gastrointestinal tract. Surgically confirmed 19 patients with use of 99m Tc-sulfur colloid (7 cases) and 99m Tc-RBC (12 cases) were retrospectively evaluated. The overall sensitivity of scintigraphy in detection of bleeding and localization of bleeding site was 68% and 84%, respectively. The authors conclude that bleeding scintigraphy is a safe, sensitive, and non-invasive method as an effective screening test before performing angiography or surgery.

  2. Porcelain gallbladder: The rare end of the spectrum of chronic cholecystitis.

    OpenAIRE

    Anand JALIHAL; Mohannur Sokanathan MATHIAZHAGAN; Vui Heng CHONG

    2012-01-01

    Porcelain gallbladder is an uncommon manifestation of chronic cholecystitis. The wall of the gallbladder becomes hard, calcified and brittle with a bluish–white tinge which resembles a porcelain ceramic. This condition is associated with increased risk of malignancy. We report two cases, both female patients (both 56 years old) who were diagnosed with porcelain gallbladder. One presented with a pyogenic liver abscess and the other was diagnosed to have gallbladder carcinoma on the background ...

  3. Laparoscopic cholecystectomy in double gallbladder with dual pathology

    Directory of Open Access Journals (Sweden)

    Sumanta Kumar Ghosh

    2014-01-01

    Full Text Available Double gallbladder is a rare embryological anomaly of clinical significance. Despite availability of modern imaging, only 50% of recently reported cases had preoperative diagnosis, which is desirable in every case to avoid serious operative complications. Double pathology in double gallbladder is extremely rare with only 3 reporting′s available till date to the best of author′s knowledge. With a preoperative diagnosis of double gallbladder, laparoscopic cholecystectomy can be safely and successfully performed with meticulous dissection, aided by operative cholangiogram. However in all such attempts a lower threshold should be kept for conversion to open surgery. Awareness about this anomaly amongst radiologists and surgeons is of crucial importance. Double gallbladder does not present with any specific symptom, neither it increases disease possibility in either lobe. Prophylactic cholecystectomy has no role in asymptomatic cases diagnosed accidentally. Author reports a case of a symptomatic young male with double gallbladder who presented with short history of dyspepsia, abdominal pain and fever. Definite preoperative diagnosis was reached with ultrasound scan and magnetic resonance cholangio pancreatography and subsequently dealt with laparoscopically. Calculous cholecystitis affected one lobe and acalculous empyema the other. While the 1st lobe drained though a cystic duct into common bile duct (CBD, the 2nd was without any communication with either CBD or its counterpart, thus remained as a blind vesicle.

  4. Laparoscopic cholecystectomy in double gallbladder with dual pathology.

    Science.gov (United States)

    Ghosh, Sumanta Kumar

    2014-04-01

    Double gallbladder is a rare embryological anomaly of clinical significance. Despite availability of modern imaging, only 50% of recently reported cases had preoperative diagnosis, which is desirable in every case to avoid serious operative complications. Double pathology in double gallbladder is extremely rare with only 3 reporting's available till date to the best of author's knowledge. With a preoperative diagnosis of double gallbladder, laparoscopic cholecystectomy can be safely and successfully performed with meticulous dissection, aided by operative cholangiogram. However in all such attempts a lower threshold should be kept for conversion to open surgery. Awareness about this anomaly amongst radiologists and surgeons is of crucial importance. Double gallbladder does not present with any specific symptom, neither it increases disease possibility in either lobe. Prophylactic cholecystectomy has no role in asymptomatic cases diagnosed accidentally. Author reports a case of a symptomatic young male with double gallbladder who presented with short history of dyspepsia, abdominal pain and fever. Definite preoperative diagnosis was reached with ultrasound scan and magnetic resonance cholangio pancreatography and subsequently dealt with laparoscopically. Calculous cholecystitis affected one lobe and acalculous empyema the other. While the 1st lobe drained though a cystic duct into common bile duct (CBD), the 2nd was without any communication with either CBD or its counterpart, thus remained as a blind vesicle.

  5. Successful topical dissolution of cholesterol gallbladder stones using ethyl propionate.

    Science.gov (United States)

    Hofmann, A F; Amelsberg, A; Esch, O; Schteingart, C D; Lyche, K; Jinich, H; Vansonnenberg, E; D'Agostino, H B

    1997-06-01

    Topical dissolution of cholesterol gallbladder stones using methyl tert-butyl ether (MTBE) is useful in symptomatic patients judged too ill for surgery. Previous studies showed that ethyl propionate (EP), a C5 ester, dissolves cholesterol gallstones rapidly in vitro, but differs from MTBE in being eliminated so rapidly by the liver that blood levels remain undetectable. Our aim was to test EP as a topical dissolution agent for cholesterol gallbladder stones. Five high-risk patients underwent topical dissolution of gallbladder stones by EP. In three patients, the solvent was instilled via a cholecystostomy tube placed previously to treat acute cholecystitis; in two patients, a percutaneous transhepatic catheter was placed in the gallbladder electively. Gallstone dissolution was assessed by chromatography, by gravimetry, and by catheter cholecystography. Total dissolution of gallstones was obtained in four patients after 6-10 hr of lavage; in the fifth patient, partial gallstone dissolution facilitated basketing of the stones. In two patients, cholesterol dissolution was measured and averaged 30 mg/min. Side effects were limited to one episode of transient hypotension and pain at the infusion site; no patient developed somnolence or nausea. Gallstone elimination was associated with relief of symptoms. EP is an acceptable alternative to MTBE for topical dissolution of cholesterol gallbladder stones in high-risk patients. The lower volatility and rapid hepatic extraction of EP suggest that it may be preferable to MTBE in this investigational procedure.

  6. New approach to gallbladder ultrasonic images analysis and lesions recognition.

    Science.gov (United States)

    Bodzioch, Sławomir; Ogiela, Marek R

    2009-03-01

    This paper presents a new approach to gallbladder ultrasonic image processing and analysis towards detection of disease symptoms on processed images. First, in this paper, there is presented a new method of filtering gallbladder contours from USG images. A major stage in this filtration is to segment and section off areas occupied by the said organ. In most cases this procedure is based on filtration that plays a key role in the process of diagnosing pathological changes. Unfortunately ultrasound images present among the most troublesome methods of analysis owing to the echogenic inconsistency of structures under observation. This paper provides for an inventive algorithm for the holistic extraction of gallbladder image contours. The algorithm is based on rank filtration, as well as on the analysis of histogram sections on tested organs. The second part concerns detecting lesion symptoms of the gallbladder. Automating a process of diagnosis always comes down to developing algorithms used to analyze the object of such diagnosis and verify the occurrence of symptoms related to given affection. Usually the final stage is to make a diagnosis based on the detected symptoms. This last stage can be carried out through either dedicated expert systems or more classic pattern analysis approach like using rules to determine illness basing on detected symptoms. This paper discusses the pattern analysis algorithms for gallbladder image interpretation towards classification of the most frequent illness symptoms of this organ.

  7. Sonographic changes of liver and gallbladder in acute viral hepatitis

    Directory of Open Access Journals (Sweden)

    Ebrahimi Daryani N

    2001-07-01

    Full Text Available Hepatomegaly, decrease in the liver paranchymal echo and increase in the gallbladder wall thickness has been shown in acute viral hepatitis. The present study was done to determine sonographic changes in acute viral hepatitis. We performed liver and bile ducts sonography and specific tests on 42 patients (mean age: 31.5 and 61% male with acute viral hepatitis. Gallbladder wall thickness was seen in 45.2% and hepatomegaly in 33.3% of patients and liver paranchymal echo was decreased in 19.3%. Age, sex, type of hepatitis, cholecystitis like symptoms, aspartate aminotransfrase, alanine aminotransfrase, alkaline phosphatase and bilirubin did not significantly corralate with these changes. Only raised prothrombin time was strongly correlated to the thickening of the gallbladder and decrease in the liver paranchymal echo and cholesistic like symptoms we can postulate that thickening of the gallbladder and decrease in the liver paranchymal echo is not dependent on the severity and speed of the paranchymal necrosis (as considered with ALT and AST but they depend on the liver function disturbance (as considered with PT because the thickening of the gall bladder is present in 45% of the patients and 10% of the normal population have gallbladder stones, one should not perform the diagnosis of acute cholecystitis, only on the basis of sonographic report without attention to the clinical and laboratory data.

  8. Diagnosis and management of gallbladder calculus disease.

    Science.gov (United States)

    Schmidt, Malte; Dumot, John A; Søreide, Odd; Søndenaa, Karl

    2012-11-01

    The number and rate of cholecystectomy are increasing worldwide, although indications for operative treatment remain empirical, and several issues in the understanding of the condition are not concisely outlined. Our intention is to summarize and interpret current opinion regarding the indications and timing of cholecystectomy in calculous gallbladder disease. Publications concerned with gallstone disease and related topics were searched for in MEDLINE using PubMed and summarized according to clinical scenarios with an emphasis on recent research. Only one randomized controlled trial has investigated the management (conservative vs. surgery) of patients with acute cholecystitis and several have compared early with deferred surgery. Two RCTs have examined treatment of uncomplicated, symptomatic gallstone disease. Apart from these, the overwhelming majority of publications are retrospective case series. Recent literature confirms that cholecystectomy for an asymptomatic or incidental gallstone is not justified. Symptomatic, uncomplicated gallstone disease may be classified into four severity groups based on severity and frequency of pain attacks, which may guide indication for cholecystectomy. Most patients below the age of 70 seem to prefer operative treatment. Acute cholecystitis may be treated with early operation if reduction of hospital days is an issue. Patients older than 70 years with significant comorbidities may forego surgical treatment without undue hazard. Symptoms following cholecystectomy remain in 25% or more and recent evidence suggest these are caused by a functional gastrointestinal disorder.

  9. Erlotinib in Treating Patients With Unresectable Liver, Bile Duct, or Gallbladder Cancer

    Science.gov (United States)

    2013-06-03

    Adult Primary Cholangiocellular Carcinoma; Adult Primary Hepatocellular Carcinoma; Advanced Adult Primary Liver Cancer; Cholangiocarcinoma of the Extrahepatic Bile Duct; Cholangiocarcinoma of the Gallbladder; Localized Unresectable Adult Primary Liver Cancer; Recurrent Adult Primary Liver Cancer; Recurrent Extrahepatic Bile Duct Cancer; Recurrent Gallbladder Cancer; Unresectable Extrahepatic Bile Duct Cancer; Unresectable Gallbladder Cancer

  10. Nonvisualization of the gallbladder lumen on sonogram: a sign of acute viral hepatitis

    International Nuclear Information System (INIS)

    Lim, Jae Hoon; Ko, Young Tae

    1986-01-01

    Six cases of nonvisulization of the gallbladder lumen in patients with acute viral hepatitis are presented. Follow-up ultrasonographic examinations done during the convalescent period in 2 patients showed normal gallbladders and this was correlated with improvement in enzyme levels. It is suggested that acute viral hepatitis should be considered in the differential diagnosis of nonvisualization of the gallbladder lumen on sonogram.

  11. Nonvisualization of the gallbladder lumen on sonogram: a sign of acute viral hepatitis

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Jae Hoon; Ko, Young Tae [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1986-04-15

    Six cases of nonvisulization of the gallbladder lumen in patients with acute viral hepatitis are presented. Follow-up ultrasonographic examinations done during the convalescent period in 2 patients showed normal gallbladders and this was correlated with improvement in enzyme levels. It is suggested that acute viral hepatitis should be considered in the differential diagnosis of nonvisualization of the gallbladder lumen on sonogram.

  12. Parietal seeding of unsuspected gallbladder carcinoma after laparoscopic cholecystectomy.

    Science.gov (United States)

    Marmorale, C; Scibé, R; Siquini, W; Massa, M; Brunelli, A; Landi, E

    1998-01-01

    Laparoscopic cholecystectomy (VALC) represents the treatment of choice for the symptomatic gallstones. However the occurrence of an adenocarcinoma of the gallbladder results a controindication for this surgical technique. We present a case of a 52 years old woman who underwent a VALC; histology revealed a gallbladder adenocarcinoma. For this reason the patient underwent a second operation that is right hepatic trisegmentectomy. Six months later the patient presented with a parietal recurrence at the extraction site of the gallbladder. We discuss the possible mechanism responsible for carcinomatous dissemination during laparoscopic surgery and we raccommend the use of some procedures in order to limit the risk and eventually to treat a neoplastic parietal seeding. These complications suggest the problem about the utility and the future played by video assisted laparoscopic surgery in the diagnosis and treatment of intraabdominal malignancies.

  13. Isolated gallbladder rupture following blunt abdominal trauma

    African Journals Online (AJOL)

    2011-11-03

    Nov 3, 2011 ... Road traffic accidents. (RTA) that are on the increase are now the primary causes of .... motor vehicular incidents from road traffic accidents[2,4] followed by significant falls[1,3,4,6] and direct kicks or blows ... torn from the liver bed but with intact cystic duct and artery; and total avulsion also termed “traumatic ...

  14. Rare bile duct anomaly: B3 duct draining to gallbladder

    Directory of Open Access Journals (Sweden)

    Seung Eun Lee

    2016-01-01

    Full Text Available A 10-year-old girl presented with recurrent right upper abdominal pain and dyspepsia. Magnetic resonance cholangiopancreatography revealed a dilated common channel of intrahepatic bile duct of segment 3 (B3 and segment 4 (B4 drained into the gallbladder directly. The patient underwent laparoscopic cholecystectomy and Roux-en Y hepaticojejunostomy (B3-jejunostomy. Among the anatomical variability of the biliary system, the cholecystohepatic ducts are controversial in existence and incidence. We report a very rare variant of a cholecystohepatic duct in which the B3 duct drained into gallbladder directly and to the best of our knowledge this is the first report.

  15. Extracorporeal shock wave lithotripsy for gallbladder stones - an experimental and clinical study -

    International Nuclear Information System (INIS)

    Kim, Kun Sang; Park, Sil Moo; Lee, Jung Hyo; Kim, Young Goo; Song, Kounn Sik; Lee, Kwan Seh; Lee, Jong Beum; Kim, Sang Joon; Chang, Sun Taik

    1988-01-01

    Although many alternative treatment technics have been proposed recently for gallstone to substitute cholecystectomy, the extracorporeal shock wave lithotripsy (ESWL) for gallbladder stones has rarely been tried. We have carried out a series of experiments to evaluate how effective the ESWL for gallbladder stones in and how safe this procedure is. At first, in vitro shock were application was carried out to 10 gallbladder stones which were obtained from human gallbladder. Secondly, gallbladder stones were implanted to canine gallbladder and treated with shock wave. Lastly, a total of 41 volunteers with confirmed gallbladder stones were treated with shock wave and combined oral administration of ursodeoxycholic acid. In the in vitro experiment, all of the 10 gallstones were fragmented with variable firing rates and duration. In animal experiment, the implanted stones were successfully fragmented and the organs included in the pathway of shock wave were proved to be intact histologically. In human study, complete disappearance of gallstones was noted in 78.6% of patients with single radiolucent gallbladder stones, smaller than 2.5cm in the longest diameter. Two patients underwent cholecystectomy after ESWL due to sudden colic attack. One patient had experienced an episode of mild transient obstructive jaundice. It may be concluded that the ESWL for gallbladder stones is an effective and safe method of treatment of gallbladder stones in the selected cases, for example, small radiolucent stones, and the further study is needed to establish improved technology of the ESWL for gallbladder stones.

  16. Extracorporeal shock wave lithotripsy for gallbladder stones - an experimental and clinical study -

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Sang; Park, Sil Moo; Lee, Jung Hyo; Kim, Young Goo; Song, Kounn Sik; Lee, Kwan Seh; Lee, Jong Beum; Kim, Sang Joon; Chang, Sun Taik [Chung-Ang University College of Medicine, Seoul (Korea, Republic of)

    1988-08-15

    Although many alternative treatment technics have been proposed recently for gallstone to substitute cholecystectomy, the extracorporeal shock wave lithotripsy (ESWL) for gallbladder stones has rarely been tried. We have carried out a series of experiments to evaluate how effective the ESWL for gallbladder stones in and how safe this procedure is. At first, in vitro shock were application was carried out to 10 gallbladder stones which were obtained from human gallbladder. Secondly, gallbladder stones were implanted to canine gallbladder and treated with shock wave. Lastly, a total of 41 volunteers with confirmed gallbladder stones were treated with shock wave and combined oral administration of ursodeoxycholic acid. In the in vitro experiment, all of the 10 gallstones were fragmented with variable firing rates and duration. In animal experiment, the implanted stones were successfully fragmented and the organs included in the pathway of shock wave were proved to be intact histologically. In human study, complete disappearance of gallstones was noted in 78.6% of patients with single radiolucent gallbladder stones, smaller than 2.5cm in the longest diameter. Two patients underwent cholecystectomy after ESWL due to sudden colic attack. One patient had experienced an episode of mild transient obstructive jaundice. It may be concluded that the ESWL for gallbladder stones is an effective and safe method of treatment of gallbladder stones in the selected cases, for example, small radiolucent stones, and the further study is needed to establish improved technology of the ESWL for gallbladder stones.

  17. Distinguishing benign from malignant gallbladder wall thickening using FDG-PET

    International Nuclear Information System (INIS)

    Oe, Ai; Kawabe, Joji; Torii, Kenji

    2006-01-01

    Because thickening of the gallbladder wall is observed not only in patients with gallbladder cancer but also in those with benign diseases such as chronic cholecystitis and gallbladder adenomyosis, it is difficult to distinguish between benign and malignant gallbladder wall thickening by conventional techniques of diagnostic imaging such as computed tomography (CT), magnetic resonance imaging (MRI), and abdominal ultrasonography (US). In the present study, we attempted to distinguish between benign and malignant gallbladder wall thickening by means of fluorine-18-fluorodeoxyglucose (FDG)-Positron emission tomography (PET). FDG-PET was performed in 12 patients with gallbladder wall thickening detected by CT or US, to determine whether it was benign or malignant. Emission scans were taken, beginning 45 minutes after intravenous administration of FDG, and standardized uptake value (SUV) was calculated as an indicator of glucose metabolism. Of the 12 patients, 4 showed positive uptake of FDG in the gallbladder wall. Of these 4 patients, 3 had gallbladder cancer. The remaining one, who had chronic cholecystitis, had false-positive findings. The other 8 patients had negative uptake of FDG in the gallbladder wall. Two of these 8 underwent surgical resection, which yielded a diagnosis of chronic cholecystitis. The other 6 patients exhibited no sign of gallbladder malignancy and have been followed without active treatment. FDG-PET appears able to distinguish between benign and malignant gallbladder wall thickening. (author)

  18. Cholescintigraphy in patients with acute cholecystitis before and after percutaneous gallbladder drainage

    DEFF Research Database (Denmark)

    Borly, L; Stage, J G; Grønvall, S

    1995-01-01

    gallbladder drainage. During the post-drainage cholescintigraphies, a cholecystokinin stimulation was performed to investigate gallbladder emptying in 12 selected patients. Gallbladder pressure and volume were measured before drainage in another group of 12 patients with acute cholecystitis. RESULTS......OBJECTIVE: To investigate gallbladder function by use of cholescintigraphy in patients with acute cholecystitis before and after percutaneous gallbladder drainage. DESIGN: A cholescintigraphy was performed in 40 patients with acute cholecystitis before and after the performance of percutaneous......: As expected, no gallbladder activity was observed in the cholescintigraphies before drainage, except in a patient with an occluding stone in the common bile duct. Cystic duct patency and gallbladder activity were seen in 80% of patients in cholescintigraphies performed after drainage but before any other...

  19. Spontaneous acalculous gallbladder perforation in a man secondary to chemotherapy and radiation: A rare case report.

    Science.gov (United States)

    Zhang, Jungang; Shen, Guoliang; Shi, Ying; Zhang, Chengwu; Hong, Defei; Jin, Li; Yang, Hongguo; Sun, Wei; Cai, Hanhui; Hu, Zhiming; Wu, Weiding

    2018-05-01

    Gallbladder perforation is a serious clinical condition and associated with high morbidity and mortality. A definitive diagnosis is contentious before surgery. We herein report a case of perforation of the gallbladder neck secondary to chemotherapy and radiation for nasopharyngeal carcinoma patient. Gallbladder perforation secondary to chemotherapy and radiation. To decrease the mortality associated with gallbladder perforation, Laparoscopic cholecystectomy and peritoneal lavage were performed followed for gallbladder perforation patient because of chemotherapy and radiation. The patient recovered fully without serious complication and discharged on the 10th postoperative day. A pathological examination of the resected gallbladder revealed cholecystitis in the thinning of the neck. Early diagnosis and surgical intervention of gallbladder perforation in relation to asopharyngeal carcinoma chemotherapy and radiation are of prime importance. The laparoscopic procedure is safe and feasible in the selected patients.

  20. Ultrasonographic differentiation of biliary atresia and neonatal hepatitis: Reestablishment of size criteria of the gallbladder

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Woo Sun; Cheon, Jung Eun; Koh, Young Hwan; Kim, In One; Yeon, Kyung Mo [Seoul National University College of Medicine and Institude of Radiation Medicion, Seoul (Korea, Republic of)

    2001-12-15

    To reestablish the size criterion of the gallbladder on ultrasonography (US) for the differentiation diagnosis of biliary atresia from neonatal hepatitis. Abdominal US ws performed in 201 patients with jaundice and 40 patients without evidence of jaundice or hepatobiliary illness (all with the age less than 4 months). US was performed in fasting (fasting for at least 4 hours) to measure the length of the gallbladder and calculated the area of the gallbladder lumen. The morphology of the gallbladder was classified into three types: normal, elongated and atretic. To evaluate the contractibility of the gallbladder, the length of the gallbladder and area of the gallbladder lumen was again measured 1 hour after feeding. The final diagnosis included biliary atresia in 79 patients and neonatal hepatitis in 83 patients. Differences in the length, area, and morphology of the gallbladder were statistically significant among three groups, the normal group, neonatal hepatitis group and biliary atresia group (length and area of gallbladder; normal group>neonatal hepatitis>biliary atresia). The differences in the length and area of gallbladder between pre- and postmeal state were statistically significant in the normal and neonatal hepatitis groups whereas those of biliary atresia were not significant (p=0.85). When the empirical size criterion of the gallbladder (<15 mm in length) was applied, the sensitivity, specificity and diagnostic accuracy for the differential diagnosis of biliary atresia from hepatitis were 52%, 82%, and 67%, respectively. Meanwhile, if the area criterion(<30 mm{sup 2} in area) was applied, the sensitivity, the specificity and diagnostic accuracy were 67%, 85%, and 75%, respectively. Ultrasonographic evaluation of the morphology as well as size of the gallbladder are helpful in the differential diagnosis of biliary atresia from neonatal hepatitis. Therefore, since the measurement of the area of gallbladder lumen on US reflect both size and morphology of

  1. [Study on genetic instability of nm23H1 gene in Chinese with original gallbladder tumor].

    Science.gov (United States)

    Lu, Hai Ying; Zhang, Guo Qiang; Li, Ji Cheng

    2006-06-01

    The aim of this study was to examine the microsatellite instability (MSI) and loss of heterozygosity (LOH) of locus D17S396 on chromosome 17 and their influence on the expression of nm23H1 in gallbladder tumors, which may provide experimental basis for the tumor occurrence and metastasis. Techniques such as DNA extraction from formalin-fixed paraffin-embedded tissues, polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP), ordinary silver stain were used to study MSI and LOH of locus D17S396. Envision immunohistochemistry and Leica-Qwin computer imaging techniques were used to assess the expression of gene nm23H1. In our experiment, the frequency of genetic instability of malignant gallbladder tumors was 42.55%, which was higher than that of gallbladder adenomas, while there were no genetic instability occurred in chronic cholecystitis tissue. The frequency of LOH seemed higher with the deteriorism of gallbladder tumor. Among 47 gallbladder carcinomas, the frequency of LOH and MSI were different between different differentiation cases (P gallbladder carcinoma, gallbladder adenoma and chronic cholecystitis tissue were different (P gallbladder carcinomas, the positive frequency of nm23H1 protein in LOH positive group was lower than that of LOH negative group (P gallbladder tumor. Both MSI and LOH of nm23H1 gene controlled the development of gallbladder tumor independently in different paths. MSI may be an early stage molecule marker of gallbladder carcinoma. LOH may be molecule marker for the deteriorism of gallbladder tissue, which could inhibit the expression of nm23H1 in local tissue of gallbladder carcinoma and endow it with high aggressive and poor prognosis. Increasing the amount of nm23H1 protein expression could effectively restrain gallbladder carcinoma metastasis and improve prognosis of patients.

  2. Gallbladder perforation during elective laparoscopic cholecystectomy: Incidence, risk factors, and outcomes

    Science.gov (United States)

    Altuntas, Yunus Emre; Oncel, Mustafa; Haksal, Mustafa; Kement, Metin; Gundogdu, Ersin; Aksakal, Nihat; Gezen, Fazli Cem

    2018-01-01

    OBJECTIVE: This study aimed to reveal the risk factors and outcomes of gallbladder perforation (GP) during laparoscopic cholecystectomy. METHODS: Videotapes of all patients who underwent an elective cholecystectomy at our department were retrospectively analyzed, and the patients were divided into two groups based on the presence of GP. The possible risk factors and early outcomes were analyzed. RESULTS: In total, 664 patients [524 (78.9%) females, 49.7±13.4 years of age] were observed, and GP occurred in 240 (36.1%) patients, mostly while dissecting the gallbladder from its bed (n=197, 82.1%). GP was not recorded in the operation notes in 177 (73.8%) cases. Among the studied parameters, there was no significant risk factor for GP, except preoperatively elevated alanine transaminase level (p=0.005), but the sensitivity and specificity of this measure in predicting GP were 14.2% and 7.4%, respectively. The two groups had similar outcomes, but the operation time (35.4±17.5 vs 41.4±18.7 min, p=0.000) and incidence of drain use (25% vs 45.8%, p=0.000) increased in the GP group. CONCLUSION: The present study reveals that GP occurs in 36.1% of patients who undergo laparoscopic elective cholecystectomy, but it may not be recorded in most cases. We did not find any reliable risk factor that increases the possibility of GP. GP causes an increase in the operation time and incidence of drain use; however, the other outcomes were found to be similar in patients with GP and those without. PMID:29607432

  3. Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding

    DEFF Research Database (Denmark)

    Ngu, JH; Laursen, Stig Borbjerg; Chin, YK

    2017-01-01

    Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study.......Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study....

  4. Postprandial gallbladder emptying in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Sonne, David P; Rehfeld, Jens F; Holst, Jens Juul

    2014-01-01

    -induced GLP1 secretion combined with the findings of reduced postprandial gallbladder emptying in patients with type 2 diabetes (T2DM) led us to speculate whether reduced postprandial GLP1 responses in some patients with T2DM arise as a consequence of diabetic gallbladder dysmotility. DESIGN AND METHODS......: In a randomised design, 15 patients with long-standing T2DM and 15 healthy age-, gender- and BMI-matched control subjects were studied during 75-g oral glucose tolerance test (OGTT) and three isocaloric (500 kcal) and isovolaemic (350 ml) liquid meals: i) 2.5 g fat, 107 g carbohydrate and 13 g protein; ii) 10 g...... secretion was similar after both OGTT and meals. CONCLUSIONS: In conclusion, patients with T2DM exhibited normal gallbladder emptying to meals with a wide range of fat content. Incretin responses were similar to that in controls, and an association with postprandial gallbladder contraction could...

  5. Heterotopic gastric mucosa involving the gallbladder and biliary tree

    Energy Technology Data Exchange (ETDEWEB)

    Madrid, Carmen; Berrocal, Teresa; Gorospe, Luis; Prieto, Consuelo [Department of Paediatric Radiology, Hospital Infantil ' ' La Paz' ' , Paseo de la Castellana 261, 28046 Madrid (Spain); Gamez, Manuel [Department of Paediatric Surgery, Hospital Infantil ' ' La Paz' ' , Madrid (Spain)

    2003-02-01

    A case of heterotopic gastric mucosa in the common bile duct, cystic duct and gallbladder is reported in a 3-year-old girl with abdominal pain and jaundice. Abdominal US and CT showed dilatation of the biliary tree and a well-defined mass in the common bile duct that narrowed its lumen. The gallbladder was contracted in both examinations. The common bile duct and the gallbladder were resected and a choledochojejunostomy was performed. Although gastric heterotopy has been described throughout the entire length of the gastrointestinal tract, it is a very uncommon finding in the gallbladder and extremely rare in the biliary tree. A firm diagnosis of gastric heterotopia is based on the presence of fundal mucosa replete with parietal and chief cells. To our knowledge, this is the fifth reported case of heterotopic gastric tissue within the common bile duct, and the first to describe the US and CT findings. A relevant literature review and brief outline of the histological and radiological features are included in the discussion. (orig.)

  6. Work in progress: nuclear magnetic resonance imaging of the gallbladder

    International Nuclear Information System (INIS)

    Hricak, H.; Filly, R.A.; Margulis, A.R.; Moon, K.L.; Crooks, L.E.; Kaufman, L.

    1983-01-01

    A preliminary study of the relation between food intake and intensity of gallbladder bile on nuclear magnetic resonance (NMR) images was made. Twelve subjects (seven volunteers, five patients) were imaged following a minimum of 14 hours of fasting. Six of seven volunteers were reimaged one hour after stimulation by either a fatty meal or an alcoholic beverage. An additional seven patients were imaged two hours after a hospital breakfast. It was found that concentrated bile emits a high-intensity spin echo signal (SE), while hepatic bile in the gallbladder produces a low-intensity SE signal. Following ingestion of cholecystogogue, dilute hepatic bile settles on top of the concentrated bile, each emitting SE signals of different intensity. The average T1 value of concentrated bile was 594 msec, while the T1 vaue of dilute hepatic bile was 2,646 msec. The average T2 values were 104 msec for concentrated bile and 126 msec for dilute bile. The most likely cause for the different SE intensities of bile is the higher water content, and therefore longer T1 or T2 relaxation times, of hepatic bile. It is suggested that NMR imaging has the ability to provide physiological information about the gallbladder and that it may prove to be a simple and safe clinical test of gallbladder function

  7. Heterotopic gastric mucosa involving the gallbladder and biliary tree

    International Nuclear Information System (INIS)

    Madrid, Carmen; Berrocal, Teresa; Gorospe, Luis; Prieto, Consuelo; Gamez, Manuel

    2003-01-01

    A case of heterotopic gastric mucosa in the common bile duct, cystic duct and gallbladder is reported in a 3-year-old girl with abdominal pain and jaundice. Abdominal US and CT showed dilatation of the biliary tree and a well-defined mass in the common bile duct that narrowed its lumen. The gallbladder was contracted in both examinations. The common bile duct and the gallbladder were resected and a choledochojejunostomy was performed. Although gastric heterotopy has been described throughout the entire length of the gastrointestinal tract, it is a very uncommon finding in the gallbladder and extremely rare in the biliary tree. A firm diagnosis of gastric heterotopia is based on the presence of fundal mucosa replete with parietal and chief cells. To our knowledge, this is the fifth reported case of heterotopic gastric tissue within the common bile duct, and the first to describe the US and CT findings. A relevant literature review and brief outline of the histological and radiological features are included in the discussion. (orig.)

  8. Non-operative Management of Gallbladder Perforation After Blunt ...

    African Journals Online (AJOL)

    management of isolated traumatic gallbladder perforation in a patient that was ... A transthoracic echocardiogram 2 days later revealed a right ventricular .... EPUB is an open e-book standard recommended by The International Digital Publishing Forum which is designed for reflowable content i.e. the text display can be ...

  9. Acute gallbladder torsion - a continued pre-operative diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Desrochers Randal

    2011-04-01

    Full Text Available Abstract Acute gallbladder volvulus continues to remain a relatively uncommon process, manifesting itself usually during exploration for an acute surgical abdomen with a presumptive diagnosis of acute cholecystitis. The pathophysiology is that of mechanical organo-axial torsion along the gallbladder's longitudinal axis involving the cystic duct and cystic artery, and with a pre-requisite of local mesenteric redundancy. The demographic tendency is septua- and octo-genarians of the female sex, and its overall incidence is increasing, this being attributed to increasing life expectancy. We discuss two cases of elderly, fragile women presenting to the emergency department complaining of sudden onset right upper quadrant abdominal pain. Their subsequent evaluation suggested acute cholecystitis. Ultimately both were taken to the operating room where the correct diagnosis of gallbladder torsion was made. Pre-operative diagnosis continues to be a major challenge with only 4 cases reported in the literature diagnosed with pre-operative imaging; the remainder were found intra-operatively. Consequently, a delay in diagnosis can have devastating patient outcomes. Herein we propose a necessary high index of suspicion for gallbladder volvulus in the outlined patient demographic with symptoms and signs mimicking acute cholecystitis.

  10. Lithium absorption by the rabbit gall-bladder

    DEFF Research Database (Denmark)

    Hansen, C P; Holstein-Rathlou, N H; Skøtt, O

    1991-01-01

    Lithium (Li+) absorption across the low-resistance epithelium of the rabbit gall-bladder was studied in order to elucidate possible routes and mechanisms of Li+ transfer. Li+ at a concentration of 0.4 mM in both mucosal and serosal media did not affect isosmotic mucosa-to-serosa fluid absorption...

  11. Gallbladder-associated symptomatic hepatic choristoma: Should you resect?

    Directory of Open Access Journals (Sweden)

    Salah Termos

    Full Text Available Introduction: Hepatic choristomas or ectopic livers are uncommon, and occur due to a failure of embryological liver development. They pose a risk of carcinogenesis, with transformation to hepatocellular carcinoma (HCC being described in the literature (Arakawa et al., 1999. It is often a silent clinical finding that can occur anywhere in the body and is usually diagnosed incidentally during abdominal surgical procedures or autopsies (Eiserth et al., 1940. We present the case of a patient with a symptomatic ectopic liver that was detected preoperatively, and removed laparoscopically with the gallbladder. Presentation of case: A 73-year-old lady was referred to our unit for a gallbladder tumor on ultrasound which was done for biliary colic. Tumor markers were normal. Computed tomography (CT scan showed an enhanced soft tissue lesion measuring about 3 × 1.5 cm interposed between the gallbladder and liver. Laparoscopic exploration revealed a bean-shaped hepatic choristoma attached to the liver on the medial wall of the gallbladder. The lesion was removed by en-bloc resection during laparoscopic cholecystectomy and extracted carefully in an endobag. Histopathological examination confirmed the absence of carcinogenesis. Discussion and conclusion: Hepatic choristomas (HC are a rare entity, usually identified during abdominal surgeries. It had been reported in several studies with different presentations. Awareness of this unexpected finding and familiarity of its potential complications and carcinogenesis will improve care delivery when encountered. Surgical treatment should be considered when the choristoma is not attached to the liver, in light of its potential transformation into HCC. Keywords: Case report, Hepatic choristoma (HC, Hepar succenturiatum, Ectopic liver (EL, Hepatocellular carcinoma (HCC, Gallbladder

  12. Single center experience in laparoscopic treatment of gallbladder perforation.

    Science.gov (United States)

    Sahbaz, Nuri Alper; Peker, Kivanc Derya; Kabuli, Hamit Ahmet; Gumusoglu, Alpen Yahya; Alis, Halil

    2017-12-01

    Gallbladder perforation (GBP) is a rare disease with potential mortality. Previous series have reported an incidence of approximately 2-11% and it still continues to be a significant problem for surgeons. To present our clinical experience with gallbladder perforation. The records of 2754 patients who received surgical treatment for cholelithiasis between 2010 and 2016 were reviewed retrospectively. One hundred thirty-three patients had gallbladder perforation. Age, gender, time from the onset of symptoms, diagnostic procedures, surgical treatment, morbidity and mortality rates were evaluated. 15.78% of patients had a body mass index > 35. 6.76% had chronic obstructive pulmonary disease, 6.76% had cardiac disease, 10.52% had diabetes and 4.51% had sepsis. American Society of Anesthesiology scores were I in 54.13%, II in 35.33%, III in 6.01% and IV in 4.51% of the patients. 27.81% of patients were diagnosed during surgery. The perforation site was the gallbladder fundus in 69.17%, body in 17.30%, Hartman's pouch in 10.53% and cystic duct in 3% of patients. Treatment modalities were laparoscopic cholecystectomy in 82.71%, open cholecystectomy in 3%, percutaneous drainage catheters + laparoscopic cholecystectomy in 3%, laparoscopic cholecystectomy + fistula repair in 10.53% and open cholecystectomy + fistula repair in 0.75% of patients. Mean length of hospital stay was 1.69 days. Mortality and morbidity rates were 8.27% and 10.52%, respectively. Histopathology results were acute cholecystitis in 69.93%, chronic cholecystitis in 20.30% and acute exacerbation over chronic cholecystitis in 9.77% of patients. Appropriate classification and management of perforated cholecystitis is essential. Laparoscopic cholecystectomy is a safe and feasible method to decrease morbidity in gallbladder perforations.

  13. Vitamin K deficiency bleeding of the newborn

    Science.gov (United States)

    Vitamin K deficiency bleeding of the newborn (VKDB) is a bleeding disorder in babies. It most often ... A lack of vitamin K may cause severe bleeding in newborn babies. Vitamin K plays an important role in blood clotting. Babies often ...

  14. Gallbladder filling and emptying during cholesterol gallstone formation in the prairie dog. A cholescintigraphic study

    International Nuclear Information System (INIS)

    Pellegrini, C.A.; Ryan, T.; Broderick, W.; Way, L.W.

    1986-01-01

    We studied gallbladder bile flow before, during, and after cholesterol gallstone formation in the prairie dog using infusion cholescintigraphy with /sup 99m/Tc-diethyl iminodiacetic acid. In 18 fasting animals partitioning of bile between gallbladder and intestine was determined every 15 min for 140 min, and gallbladder response to cholecystokinin (5 U/kg X h) was calculated from the gallbladder ejection fraction. Ten prairie dogs were then placed on a 0.4% cholesterol diet and 8 on a regular diet, and the studies were repeated 1, 2, and 6 wk later. The proportion of hepatic bile that entered the gallbladder relative to the intestine varied from one 15-min period to the next, and averaged 28.2% +/- 5.1% at 140 min. Partial spontaneous gallbladder emptying (ejection fraction 11.5% +/- 5.6%) was intermittently observed. Neither the number nor the ejection fraction of spontaneous gallbladder contractions changed during gallstone formation. By contrast, the percent of gallbladder emptying in response to cholecystokinin decreased from 72.1% +/- 5% to 25.9% +/- 9.3% (p less than 0.025) in the first week and was 14.3% +/- 5.5% at 6 wk (p less than 0.01 from prediet values, not significant from first week). Gallbladder filling decreased from 28.2% +/- 5.1% to 6.7% +/- 3% (p less than 0.01), but this change was only observed after 6 wk, when gallstones had formed. This study shows that bile flow into the gallbladder during fasting is not constant; the gallbladder contracts intermittently; gallbladder emptying in response to exogenous cholecystokinin is altered very early during gallstone formation; and gallbladder filling remains unaffected until later stages, when gallstones have formed

  15. Recurrent Bleeding After Perimesencephalic Hemorrhage.

    Science.gov (United States)

    Kauw, Frans; Velthuis, Birgitta K; Kizilates, Ufuk; van der Schaaf, Irene C; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-12-01

    Perimesencephalic hemorrhage (PMH) is a type of subarachnoid hemorrhage with excellent long-term outcomes. Only 1 well-documented case of in-hospital rebleeding after PMH is described in the literature, which occurred after initiating antithrombotic treatment because of myocardial ischemia. We describe a patient with PMH without antithrombotic treatment who had 2 episodes of recurrent bleeding on the day of ictus. To validate the radiologic findings, we conducted a case-control study. Six neuroradiologists and 2 neuroradiology fellows performed a blinded assessment of serial unenhanced head computed tomography (CT) scans of 8 patients with a perimesencephalic bleeding pattern (1 index patient, 6 patients with PMH, 1 patient with perimesencephalic bleeding pattern and basilar artery aneurysm) to investigate a potential increase in amount of subarachnoid blood. A 56-year-old woman with a perimesencephalic bleeding pattern and negative CT angiography had 2 episodes after the onset headache with a sudden increase of the headache. Blinded assessment of serial head CT scans of 8 patients with a perimesencephalic bleeding pattern identified the patient who was clinically suspected to have 2 episodes of recurrent bleeding to have an increased amount of subarachnoid blood on 2 subsequent CT scans. Recurrent bleeding after PMH may also occur in patients not treated with antithrombotics. Even after early rebleeding, the prognosis of PMH is excellent. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Treatment and prognosis in peptic ulcer bleeding.

    Science.gov (United States)

    Laursen, Stig Borbjerg

    2014-01-01

    successful endoscopic haemostasis improves outcome in patients with PUB with active bleeding, a non-bleeding visible vessel, or an adherent clot (Study II) 3. To examine the short- and long-term mortality in PUB compared to a matched control group including identification of predictive factors for adverse outcome, identification of underlying causes of death, and investigation of a possible association between treatment with blood transfusion and long-term mortality (Study III). Study I was conducted as a prospective validation study. During a two-year period 831 patients presenting with upper gastrointestinal haemorrhage were included. The study demonstrated that the Glasgow Blatchford Score (GBS) was superior to the other risk scoring systems at predicting need for hospital-based intervention. The GBS was found to be favourable for the assessment of Danish patients presenting with symptoms of upper gastrointestinal haemorrhage. According to the findings of Study 1 implementation of the GBS at a 1000-bed hospital would be associated with a 90.000 EUR annual saving through avoidance of admission of patients in very low risk of needing hospital-based intervention. None of the examined risk scoring systems were suitable for predicting risk of rebleeding or 30-day mortality. Study II was designed as a non-blinded, stratified, parallel group, randomized controlled trial. Patients were randomized in a 1:1 ratio to receive STAE within 24 hours from therapeutic endoscopy or to continue standard treatment. A total of 105 patients were included. After adjustment for possible imbalances STAE was associated with a clear trend of reduced rate of rebleeding (P=.079). Numbers needed to treat in order to avoid one case of rebleeding was 10. Study III was conducted as a prospective cohort study. The long-term survival of 455 patients admitted with peptic ulcer bleeding was compared to an age- and sex-matched control group consisting of 2224 individuals selected from the same geographical

  17. Relationships between parameters of gallbladder motility and brain electrical activity

    Directory of Open Access Journals (Sweden)

    Olena M Marfiyan

    2016-08-01

    Objective. Earlier we shown that Cholecystokinetic effect of balneotherapy on spa Truskavets’ may be the result of modulation of neuroendocrine-immune complex. The aim of present investigation: clarification relationships between parameters of gallbladder motility and ongoing Electroencephalogram (EEG as well as Heart Rate Variability (HRV. Material and Methods. At 22 men with chronic cholecystite combined with pyelonephrite we recorded twice basal and postprandial volume of gallbladder (Echoscopy by “Radmir”, EEG ("NeuroCom Standard" and HRV ("CardioLab+HRV". Results. Basal gallbladder volume correlated positively with HRV markers of Vagal tone (HF, RMSSD, pNN50 and relative Power Spectrum Density (PSD C4-δ while negatively with Amplitude of β-Rhythm and its absolute PSD in loci P3, P4, Fp1, C3, F3, F4 as well as PSD T3-δ and Frequency of α-Rhythm. Canonical correlation is very strong: R=0,96; Adjusted R2=0,85; χ2(15=61; p<10-5. Gallbladder volume after 5 min after taking of Cholekinetik (50 ml of 40% solution of xylitol, expressed as portion its basal volume, correlated positively with VLF, Deviation of θ-Rhythm and its relative PSD in loci F4, P4 and P3 while negatively with relative PSD O1-θ and absolute PSD P4-β and T6-β as well as Asymmetry of θ-Rhythm. Canonical correlation is very strong too: R=0,87; Adjusted R2=0,66; χ2(9=38; p<10-4. As distinct from early next postprandial volumes significantly less liable to neural regulatory influences: R makes 0,67 (p=0,003 and 0,60 (p=0,009 after 15 and 30 min respectively. In particular, both V15 and V30 equal positively correlated with HF and Laterality of α-Rhythm, however V15 correlated with Asymmetry of θ-Rhythm (r=-0,45 and its PSD in loci F3 (r=0,28 and C4 (r=0,27, while V30 correlated with Asymmetry of δ-Rhythm (r=-0,28 and PSD C4-β (r=-0,34. Conclusion. Fasting gallbladder volume is strong controlled by Vagal nerves as well as by neural structures generating β-Rhythm, whereas early (5

  18. Measurement of Gallbladder Volume with Ultrasonography in Pregnant Women

    Directory of Open Access Journals (Sweden)

    Sait Kapicioglu

    2000-01-01

    Full Text Available Fasting and postprandial gallbladder volumes were investigated using ultrasonography in three groups (10 subjects in each of healthy women: third trimester pregnant women, postpartum women up to 10 days after giving birth and nonpregnant controls. The scans were performed at 09:00 after a 12 h fast. After the basal measurement was taken, gallbladder volumes were rescanned in 15 min intervals for 60 mins. At the end of this period, all volunteers received a standard liquid test meal, and scans were performed again for 1 h. The mean basal gallbladder volume was 22.2±4.2 mL in the nonpregnant (control group. In the third trimester group, the basal volume was 37.8±10.5 mL – 70.5% higher than in the nonpregnant group (P<0.001. In the postpartum group, the mean basal volume was 37.9% lower (27.4±6.5 mL than that of the third trimester group (P<0.02. This basal volume was 23.6% greater than that of the control group (P<0.05. After administration of a test meal, the postprandial gallbladder volumes decreased during the first few minutes compared with baseline values. The volumes decreased by 10.2% to 39.8% (23.5±7.3 to 34.0±10.2; P<0.01 in the third trimester group, by 14.9% to 43.2% (16.6±4.3 to 23.3±5.5; P<0.01, 0.001 in the postpartum group and by 19.2% to 51.6% (11.9±3.5 to 17.9±3.6; P<0.02, 0.05, 0.01, 0.001 in the control group. Postprandial mean gallbladder volumes of the third trimester (P<0.02 and postpartum groups (P<0.02 to 0.01 were significantly different from those of the control group. In conclusion, incomplete emptying of the gallbladder after eating during the third trimester of pregnancy may contribute to cholesterol-gallstone formation, and pregnancy may thus increase the risk of gallstones.

  19. The evaluation of gallbladder contractibility for volume measurement by helical 3D-CT-cholangiography

    International Nuclear Information System (INIS)

    Hanaguri, Katsuro; Kimura, Hideaki; Kayashima, Yasuyo; Suemoto, Kouichiro; Makihata, Hiroshi; Maruhashi, Akira; Ohya, Toshihide; Ito, Katsuhide; Shen, Yun.

    1997-01-01

    As a new application of helical (spiral) scan, volume measurement has received a significant interest. Although it is important to evaluate gallbladder contractibility to decide on a treatment plan for a gallbladder lesion, qualitative analysis of gallbladder contractibility is very difficult owing to the fact that the volume of gallbladder can not be measured using usual DIC examination (plain X-P and tomography). In this study, the accuracy of volume measurement of helical CT was checked firstly by gallbladder phantom experiments. Then 128 cases of volume measurement of helical 3D CT Cholangiography (DIC-CT) were performed. Under the conditions of optimized scan technique (3 mm TH, 3 mm/s, 1 mm recon interval, Hispeed, GEMS), the difference of contractibility was obtained between clinical cases with and without thick wall. The experiment has shown that helical 3D CT volume measurement is very simple and highly accurate method which is useful for the evaluation of gallbladder contractibility. (author)

  20. Scintigraphic study on the motility of stomach and gallbladder in non-ulceric dyspepsia patients

    International Nuclear Information System (INIS)

    Fu Min; Xu Guomin; Xu Denren

    1992-01-01

    Cholecystography with 99m Tc-EHIDA was performed to assess the preprandial empty function of gallbladder and then solid meal labelled with 99m Tc-DTPA was given to assess the postprandial empty function of stomach in 25 patients with NUD. The examinations were repeated in 15 patients with hypomotilitic stomach and gallbladder following administration of Domperidone 20 mg t.i.d for four weeks. The results showed that the empty function of stomach was closely related to the amplitude and frequency of antrum contractile peristaltic waves, all NUD patients who had delayed gastric empty also had hypomotilitic gallbladder. This may be one of the pathophysiologic bases of NUD. The movements of stomach and gallbladder both preprandial and postprandial were synchronous. Domperidone can restore hypomotility of stomach and gallbladder in NUD patients to normal, and the movements of stomach and gallbladder still remained synchronous

  1. Fibrinogen concentrate in bleeding patients

    DEFF Research Database (Denmark)

    Wikkelsø, Anne; Lunde, Jens; Johansen, Mathias

    2013-01-01

    Hypofibrinogenaemia is associated with increased morbidity and mortality, but the optimal treatment level, the use of preemptive treatment and the preferred source of fibrinogen remain disputed. Fibrinogen concentrate is increasingly used and recommended for bleeding with acquired haemostatic...

  2. Treatment of acute variceal bleeding

    DEFF Research Database (Denmark)

    Bendtsen, Flemming; Krag, Aleksander Ahm; Møller, Søren

    2008-01-01

    The management of variceal bleeding remains a clinical challenge with a high mortality. Standardisation in supportive and new therapeutic treatments seems to have improved survival within the last 25 years. Although overall survival has improved in recent years, mortality is still closely related...... to failure to control initial bleeding or early re-bleeding occurring in up to 30-40% of patients. Initial procedures are to secure and protect the airway, and administer volume replacement to stabilize the patient. Treatment with vasoactive drugs should be started as soon as possible, since a reduction...... in portal pressure is associated with a better control of bleeding and may facilitate later endoscopic procedures. Vasopressin and its analogues Terlipressin and somatostatin and analogues are the two types of medicine, which has been evaluated. In meta-analysis, only Terlipressin have demonstrated effects...

  3. Side Effects: Bleeding and Bruising

    Science.gov (United States)

    Cancer treatments, such as chemotherapy and targeted therapy, can increase patients’ risk of bleeding and bruising, also called thrombocytopenia. Learn about steps to take if you are at increased risk of a low platelet count.

  4. Approach to upper gastrointestinal bleeding

    African Journals Online (AJOL)

    Benign ulcer. Mallory-Weiss tear .... pressure and direct thermal coagulation. Alternatively, use ... Forrest classification of peptic ulcer bleeding related to risks of rebleeding. (NBVV - non- .... esomeprazole for prevention of recurrent peptic ulcer ...

  5. A quadriplegic patient's cholescintigraphic findings: delayed gallbladder visualization and common bile duct dilation.

    Science.gov (United States)

    Shih, W. J.; Magoun, S.; Lu, G.

    1996-01-01

    A Tc-99m DISIDA cholescintigraphic study of a 37-year-old patient with a 20-year history of quadriplegia demonstrated dilation of the common bile duct and delayed gallbladder visualization. A concurrent sonographic study showed an enlarged gallbladder with stones and dilation of the common bile duct. These findings were proved by autopsy. Quadriplegia secondary to a high level of spinal cord injury may result in gallbladder dysfunction. Images Figure PMID:8776068

  6. On the growth rate of gallstones in the human gallbladder

    Science.gov (United States)

    Nudelman, I.

    1993-05-01

    The growth rate of a single symmetrically oval shaped gallbladder stone weighing 10.8 g was recorded over a period of six years before surgery and removal. The length of the stone was measured by ultrasonography and the growth rate was found to be linear with time, with a value of 0.4 mm/year. A smaller stone growing in the wall of the gallbladder was detected only three years before removal and grew at a rate of ˜ 1.33 mm/year. The morphology and metallic ion chemical composition of the large stone and of a randomly selected small stone weighing about 1.1 g, extracted from another patient, were analyzed and compared. It was found that the large stone contained besides calcium also lead, whereas the small stone contained mainly calcium. It is possible that the lead causes a difference in mechanism between the growth of a single large and growth of multiple small gallstones.

  7. Influence of sex and age on fasting and post-prandial gallbladder volumes

    International Nuclear Information System (INIS)

    Pazzi, P.; Putinati, S.; Barbieri, D.; Trevisani, L.; Limoni, G.; Lupi, L.; Bighi, S.

    1989-01-01

    Aging and female sex are major risk factors for cholesterol gallstones: in addition to hepatic secretion of lithogenic bile, decreased gallbladder contractility may play a role in such physiological conditions. This study was aimed at evaluating the effect of age and sex on gallbladder kinetics in healthy subjects. Gallbladder volume was measured on the US images of 157 fasting subjects using the sum-of-cylinders method. No significant difference was observed between males and females. On the contrary, age was shown to have a significant positive correlation with fasting gallbladder volume, particulary in males. In a second group of 63 healthy volunteers gallbladder volumes were evaluated both before and after a standard meal. The subjects were grouped according to age, and fasting gallbladder volume appeared to be significantly greater in the groups formed by older people. Gallbladder volumes were compared in younger groups (under 35), and gallbladder emptying resulted to be much more complete in males than in females. On the contrary, no significant differences was observed between males and famales over50 - which suggests a possible role of sex - and age-related hormonal factors. The above changes in gallbladder function may facilitate bile stasis which might in turn contribute to the increased risk for cholesterol gallstones notoriously associated with advanced age and female sex

  8. Arctigenin induced gallbladder cancer senescence through modulating epidermal growth factor receptor pathway.

    Science.gov (United States)

    Zhang, Mingdi; Cai, Shizhong; Zuo, Bin; Gong, Wei; Tang, Zhaohui; Zhou, Di; Weng, Mingzhe; Qin, Yiyu; Wang, Shouhua; Liu, Jun; Ma, Fei; Quan, Zhiwei

    2017-05-01

    Gallbladder cancer has poor prognosis and limited therapeutic options. Arctigenin, a representative dibenzylbutyrolactone lignan, occurs in a variety of plants. However, the molecular mechanisms involved in the antitumor effect of arctigenin on gallbladder cancer have not been fully elucidated. The expression levels of epidermal growth factor receptor were examined in 100 matched pairs of gallbladder cancer tissues. A positive correlation between high epidermal growth factor receptor expression levels and poor prognosis was observed in gallbladder cancer tissues. Pharmacological inhibition or inhibition via RNA interference of epidermal growth factor receptor induced cellular senescence in gallbladder cancer cells. The antitumor effect of arctigenin on gallbladder cancer cells was primarily achieved by inducing cellular senescence. In gallbladder cancer cells treated with arctigenin, the expression level of epidermal growth factor receptor significantly decreased. The analysis of the activity of the kinases downstream of epidermal growth factor receptor revealed that the RAF-MEK-ERK signaling pathway was significantly inhibited. Furthermore, the cellular senescence induced by arctigenin could be reverted by pcDNA-epidermal growth factor receptor. Arctigenin also potently inhibited the growth of tumor xenografts, which was accompanied by the downregulation of epidermal growth factor receptor and induction of senescence. This study demonstrates arctigenin could induce cellular senescence in gallbladder cancer through the modulation of epidermal growth factor receptor pathway. These data identify epidermal growth factor receptor as a key regulator in arctigenin-induced gallbladder cancer senescence.

  9. Guadecitabine and Durvalumab in Treating Patients With Advanced Liver, Pancreatic, Bile Duct, or Gallbladder Cancer

    Science.gov (United States)

    2018-04-27

    Extrahepatic Bile Duct Adenocarcinoma, Biliary Type; Gallbladder Adenocarcinoma, Biliary Type; Metastatic Pancreatic Adenocarcinoma; Recurrent Cholangiocarcinoma; Recurrent Gallbladder Carcinoma; Recurrent Hepatocellular Carcinoma; Recurrent Intrahepatic Cholangiocarcinoma; Recurrent Pancreatic Carcinoma; Stage III Gallbladder Cancer AJCC V7; Stage III Hepatocellular Carcinoma AJCC v7; Stage III Intrahepatic Cholangiocarcinoma AJCC v7; Stage III Pancreatic Cancer AJCC v6 and v7; Stage IIIA Gallbladder Cancer AJCC v7; Stage IIIA Hepatocellular Carcinoma AJCC v7; Stage IIIB Gallbladder Cancer AJCC v7; Stage IIIB Hepatocellular Carcinoma AJCC v7; Stage IIIC Hepatocellular Carcinoma AJCC v7; Stage IV Gallbladder Cancer AJCC v7; Stage IV Hepatocellular Carcinoma AJCC v7; Stage IV Pancreatic Cancer AJCC v6 and v7; Stage IVA Gallbladder Cancer AJCC v7; Stage IVA Hepatocellular Carcinoma AJCC v7; Stage IVA Intrahepatic Cholangiocarcinoma AJCC v7; Stage IVB Gallbladder Cancer AJCC v7; Stage IVB Hepatocellular Carcinoma AJCC v7; Stage IVB Intrahepatic Cholangiocarcinoma AJCC v7; Unresectable Gallbladder Carcinoma; Unresectable Pancreatic Carcinoma

  10. A Mimicker of Gallbladder Carcinoma: Cystic Gastric Heterotopia with Intestinal Metaplasia

    Directory of Open Access Journals (Sweden)

    Gonca ÖZGÜN

    2017-01-01

    Full Text Available Heterotopic gastric mucosa in the gallbladder is an unusual entity and is usually clinically silent. We report a 75-year-old female patient who presented with intermittent upper abdomial pain radiating to the back. Abdominal imaging studies showed a sessile polypoid lesion and a gallstone in the gallbladder. Gallbladder carcinoma was suspected and cholecystectomy performed. Intraoperative frozen section examination suggested mucinous tumor, suspicious for malignancy. However, the permanent sections revealed aberrant gastric tissue consisted of gastric pyloric and fundic glands of heterotopic gastric mucosa with intestinal metaplasia in the gallbladder.

  11. A Mimicker of Gallbladder Carcinoma: Cystic Gastric Heterotopia with Intestinal Metaplasia.

    Science.gov (United States)

    Özgün, Gonca; Adim, Şaduman Balaban; Uğraş, Nesrin; Kiliçturgay, Sadık

    2017-01-01

    Heterotopic gastric mucosa in the gallbladder is an unusual entity and is usually clinically silent. We report a 75-year-old female patient who presented with intermittent upper abdomial pain radiating to the back. Abdominal imaging studies showed a sessile polypoid lesion and a gallstone in the gallbladder. Gallbladder carcinoma was suspected and cholecystectomy performed. Intraoperative frozen section examination suggested mucinous tumor, suspicious for malignancy. However, the permanent sections revealed aberrant gastric tissue consisted of gastric pyloric and fundic glands of heterotopic gastric mucosa with intestinal metaplasia in the gallbladder.

  12. A powder-free surgical glove bag for retraction of the gallbladder during laparoscopic cholecystectomy.

    Science.gov (United States)

    Holme, Jørgen Bendix; Mortensen, Frank Viborg

    2005-08-01

    To test the use of a simple and cheap powder-free glove bag to extract the gallbladder during laparoscopic cholecystectomy (LC). The medical records of 142 consecutive patients who had their gallbladder removed using a powder-free glove bag were reviewed. No complications in the form of bile or stone spillage during extraction were observed. The absence of complications and the low cost make routine use of the glove bag a wise option for extracting the gallbladder during LC. The use of the glove bag seems to reduce the risk of contamination with bacteria, bile, and gallstones and may reduce contamination by malignant cells in case of unexpected gallbladder carcinoma.

  13. Ultrasound and CT findings of primary leiomyosacoma in the gallbladder: A case report

    International Nuclear Information System (INIS)

    Im, A Lan; Lee, Young Hwan; Yoon, Kwan Ha; Park, Dong Eun; Choi, Keum Ha; Lim, Se Woong

    2014-01-01

    Leiomyosarcoma of the gallbladder is a very rare subgroup for gallbladder sarcoma. Herein, we report the ultrasound, computed tomography and positron emission tomography-computed tomography imaging findings on a case of primary leiomyosarcoma of the gallbladder. Abdominal ultrasonography indicates a heterogeneous hyperechoic submucosal mass with hypervascularity and displacement of overlying mucosal layers by the mass. Computed tomography reveal that the tumor is a well-defined and heterogeneously enhancing solid mass with overlying thick mucosal layers. Positron emission tomography-computed tomography visualizes the large gallbladder mass as a hypermetabolic lesion.

  14. Comparison between ultrasonographic and clinical findings in 43 dogs with gallbladder mucoceles.

    Science.gov (United States)

    Choi, Jihye; Kim, Ahyoung; Keh, Seoyeon; Oh, Juyeon; Kim, Hyunwook; Yoon, Junghee

    2014-01-01

    Cholecystectomy is the current standard recommended treatment for dogs with gallbladder mucoceles. However, medical management with monitoring has also been recommended for asymptomatic dogs. The purpose of this retrospective study was to compare ultrasonographic patterns of gallbladder mucoceles with clinical disease status in a group of dogs. For each included dog, the ultrasonographic pattern of the mucocele was classified into one of six types: type 1, immobile echogenic bile; type 2, incomplete stellate pattern; type 3, typical stellate pattern; type 4, kiwi like pattern and stellate combination; type 5, kiwi like pattern with residual central echogenic bile; and type 6, kiwi like pattern. A total of 43 dogs were included. Twenty-four dogs, including 11 dogs with gallbladder rupture, were symptomatic. Nineteen dogs were asymptomatic. Cholecystectomy (n = 19), medical therapy (n = 17), or monitoring (n = 6) treatments were applied according to clinical signs and owners' requests. One dog suspected of having gallbladder rupture was euthanized. Frequencies of gallbladder mucocele patterns were as follows: type 1 = 10 (23%), type 2 = 13 (30%), type 3 = 5 (12%), type 4 = 11 (26%), type 5 = 4 (9%), and type 6 = 0. In dogs with gallbladder rupture, type 2 (8/13) was the most common. No significant correlations were found between ultrasonographic patterns of gallbladder mucoceles and clinical disease status or gallbladder rupture. Findings indicated that ultrasonographic patterns of gallbladder mucoceles may not be valid bases for treatment recommendations in dogs. © 2013 American College of Veterinary Radiology.

  15. Morphological alterations of the gall-bladder following extracorporeal shock-wave lithotripsy

    International Nuclear Information System (INIS)

    Schumacher, K.A.; Zoeller, A.; Swobodnik, W.; Janowitz, P.

    1990-01-01

    The present study reports on 51 patients with symptomatic cholecystolithiasis, who accordingly underwent extracorporeal shock-wave lithotripsy (ESWL). In all cases, computed tomography (CT) was performed prior to and after the therapeutic procedure to delineate changes in gall-bladder morphology. Slight edematous thickening of the gall-bladder wall was found in 15 patients. One patient presented a rupture of the gall-bladder with formation of a bilioma in the adjacent liver tissue. In case of calcific concrements, CT revealed a characteristic pattern of fragment distribution following shock-wave treatment, and fragments of various sizes exhibited distinct adhesion to the gall-bladder wall. (orig.) [de

  16. An alternative gallbladder extraction technique in laparoscopic cholecystectomy.

    Science.gov (United States)

    Tang, C N; Wong, D C T

    2006-05-01

    In this era of minimally invasive surgery, the challenge remains in finding techniques to reduce access trauma in terms of fewer and smaller size trocar ports. Our new described technique will allow a smaller subxiphoid port to be used to achieve extraction of the gallbladder without the need to change to a 5 mm laparoscope. We believe this method is easy to learn, safe and with no observable complications from our experience.

  17. Dysfunctional Uterine Bleeding (DUB) (For Teens)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Abnormal Uterine Bleeding (AUB) KidsHealth / For Teens / Abnormal Uterine Bleeding (AUB) ... Print en español Sangrado uterino anormal What Is Abnormal Uterine Bleeding? Abnormal uterine bleeding (AUB) is the name doctors ...

  18. Research variations the channel of gallbladder in relation to gender

    Directory of Open Access Journals (Sweden)

    Spasojević Goran

    2014-01-01

    Full Text Available Channel of the gallbladder (DC shows the different anatomical variations, the knowledge is important in the diagnosis and particularly abdominal surgery. The aim of this study was to investigate possible gender differences in the morphology of the gallbladder channel (DC. A total sample consists of 50 anatomical liver taken from autopsy cases of both sexes (32 men and 18 women. Samples of liver were fixed in 4% formalin for 4 weeks, and then studied microdissected under scrutiny. We were working length measurement channels of the gallbladder (DC and typing of junction of the cystic (DC with the common hepatic duct (DHC. We classify anatomical junction variations DC with DHC into three types: angular, parallel and spiral type, and then performed statistical analysis of the data with respect to gender. Results: The angular type compound we found approximately at 2/3 or 64% of the samples (men-60% of women-72%, the parallel type combination of a total of 22% of the sample (men-31% of women-6% and spiral type of 14% of the samples (males-9%, women 22%. Parallel and spiral type together make up about 1/3 of the cases. The average length of DC is 3.1 cm and the variation interval of 1.7 to 6.2 cm. We found that the difference circuit between DC and DHC the angular variable (parallel junction and spiral with respect to gender there but the difference was not statistically significant (p> 0.05.

  19. Trends in management of gallbladder disorders in children.

    Science.gov (United States)

    Lugo-Vicente, H L

    1997-07-01

    Gallbladder disorders have been recognized with increasing frequency in pediatric patients. This study aimed to identify recent trends in management and compare the effectiveness of laparoscopic (LC) over open cholecystectomy (OC) by a retrospective chart analysis of all cholecystectomies from 1990 through 1995. Information obtained included demographics, symptoms, predisposing conditions, associated illnesses, family history, imaging studies, type of cholecystectomy, complications, operative time, pain medication, diet recommencement, pathologic findings, and length of hospital stay. The type of cholecystectomy (OC vs. LC) was compared with the clinical variables using standard statistics. Eighty-three patients between 21 months and 18 years of age were identified; their mean age was 14.8 years. Females (76%) with classic biliary symptoms predominated;12% of the patients developed gallstone pancreatitis and 7% jaundice. Abnormal liver chemistry values, obesity, and elevated triglyceride levels comprised the most significant predisposing factors. Indications for surgery were cholelithiasis in 71 patients (86%), gallbladder dyskinesia in 10 (12%), and sludge/polyp in 2. Fifty-nine cholecystectomies (71%) were done laparoscopically and 24 (29%) open. Choledocholithiasis in 6 children (7%) was managed by open extraction with t-tube placement or endoscopic papillotomy followed by LC. No major ductal complication was identified. The predominant pathologic finding was chronic cholecystitis, including the subgroup with biliary dyskinesia. Statistical comparison showed that LC is superior to OC in regard to length of stay, diet resumption, use of pain medication, operating time, and cosmetic results. It is concluded that a contemporary diet, obesity, and abnormal liver chemistry are the main predisposing conditions of gallbladder disease in children in this decade. Females in their teenage years with typical symptoms continue to be the most commonly affected group

  20. Percutaneous Transcholecystic Biliary Interventions Using Gallbladder Anchors: Feasibility Study in the Swine

    International Nuclear Information System (INIS)

    Lopera, Jorge E.; Kirsch, David; Qian Zhong; Ruiz, Bernardo; Brazzini, Augusto; Gonzales, Arturo; Castaneda-Zuniga, Wilfrido

    2005-01-01

    The purpose of this study was to report our initial experience with a swine model for biliary interventions by using a percutaneous transcholecystic access after suture anchor of the gallbladder. Telepaque tablets were given to five pigs to opacify the gallbladder. Under fluoroscopy, the opacified gallbladder was punctured percutaneously and three suture anchors were used to fix the anterior wall of the gallbladder to the abdominal wall. Two weeks later, the gallbladder was punctured and access into the distal common bile was obtained through the cystic duct. Balloon expandable stents were deployed into the distal common bile duct. Follow-up cholangiograms were obtained at 1 and 2 weeks. Necropsy was performed after 2 weeks to evaluate the relationship between the gallbladder and abdominal wall. Suture anchor placement was successful in all five pigs. One pig with a deep and highly positioned gallbladder developed fever, anorexia, and vomiting secondary to excessive stretch of the gallbladder. Placement of the guidewire through the extremely tortuous and small cystic ducts proved to be the most challenging step of the procedure. Metallic stents were successfully deployed in all four pigs in which it was attempted. Four animals tolerated the procedures without changes in their clinical conditions and no symptoms. Successful follow-up cholangiograms were performed at 1 and 2 weeks post-stent deployment without complications. All stents remained patent during the follow-up period. Necropsy demonstrated close attachment and adherence of the gallbladders to the antero-lateral abdominal wall in all four animals. Suture anchoring of the gallbladder is feasible in most pigs with superficially located gallbladders. This technique allows a safe and repeat access into the biliary system using a transcholecystic approach

  1. Gallbladder Function and Hepatic Structural Changes in Children with Nonalcoholic Fatty Liver Disease

    Directory of Open Access Journals (Sweden)

    N.Yu. Zavgorodnya

    2016-04-01

    Full Text Available During the last decade, pediatric nonalcoholic liver disease has reached epidemic proportions, becoming one of the most frequent chronic liver diseases in the global child population. Purpose: to study the relationship of the functional state of the gallbladder with structural changes in the liver in children with nonalcoholic fatty liver disease. Materials and methods. We examined 34 children aged from 8 to 17 years old. Hepatic steatosis was determined using the FibroScan® 502 touch with controlled attenuation parameter (CAP. According to the results of transient elastometry and ultrasound of the abdomen with the gallbladder function study, patients were divided into 4 groups: the 1st group consisted of 7 patients with steatosis and hypofunction of gallbladder (20.5 %, group 2 included 6 patients with steatosis and gallbladder normofunction (17.65 %, group 3 consisted of 11 patients without hepatic steatosis with hypofunction of gallbladder (32.35 %, group 4 included 10 patients without hepatic steatosis with gallbladder normofunction (29.4 %. Results. The sonographic studies demonstrated children of the 1st group (steatosis with gallbladder hypokinesia to have significantly larger sizes of liver lobes compared to group 4 (children without steatosis with gallbladder normofunction. Also, the stiffness of the liver parenchyma was highest in patients with hepatic steatosis and gallbladder hypokinesia. Discussion. The combination of hepatic steatosis and hypokinesia of the gallbladder in children is accompanied by a significant increase in liver size, increased stiffness of the liver parenchyma and increasing degree of steatosis. The data indicate the relationship of the gallbladder function and the liver structural changes.

  2. The influence of gallbladder function on the symptomatology in gallstone patients, and the outcome after cholecystectomy or expectancy

    DEFF Research Database (Denmark)

    Larsen, Thomas Kjaergaard; Qvist, Niels

    2007-01-01

    gallstone disease. Fifty-six patients had a functioning gallbladder and 44 had a nonfunctioning gallbladder. Patients with a nonfunctioning gallbladder had significantly more vomiting and received more pain-killing injections during pain attacks. Otherwise, there were no differences in pain patterns...

  3. Gallbladder Volvulus: A rare cause of acute abdomen. A case report ...

    African Journals Online (AJOL)

    Gallbladder volvulus is a rare but serious event. Described for the first time by Wendal in 1898, the condition is the result of a congenital anomaly, in which the gallbladder is suspended by a mesentery which allows the rare possibility of its torsion which, when not handled urgently, results in gangrene and even peritonitis.

  4. The relationship between gallbladder dynamics and the migrating motor complex in fasting healthy subjects

    DEFF Research Database (Denmark)

    Qvist, N; Oster-Jørgensen, E; Rasmussen, L

    1988-01-01

    The relationship between gallbladder dynamics and the interdigestive migrating motor complex (MMC) was investigated in 10 healthy male volunteers by a hepatobiliary scintigraphy and gastroduodenal pressure recordings. Filling of the gallbladder commenced in late phase II or in phase III of the MM...

  5. Gallbladder Cryoablation: Proof of Concept in a Swine Model for a Percutaneous Alternative to Cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    McGregor, Hugh C. J., E-mail: hugh.mcgregor@ucsf.edu; Saeed, Maythem, E-mail: maythem.saeed@ucsf.edu; Surman, Andrew, E-mail: andrew.surman@ucsf.edu; Ehman, Eric C., E-mail: eric.ehman@ucsf.edu; Hetts, Steven W., E-mail: steven.hetts@ucsf.edu; Wilson, Mark W., E-mail: mark.wilson@ucsf.edu; Conrad, Miles B., E-mail: miles.conrad@ucsf.edu [University of California San Francisco, Department of Radiology and Biomedical Imaging (United States)

    2016-07-15

    PurposeTo investigate the feasibility of percutaneous gallbladder cryoablation (GBC) under CT guidance in a swine model with histopathologic correlation.Materials and MethodsInstitutional Animal Care and Use Committee approval was obtained for this study protocol. Five pigs underwent GBC. Under CT guidance, 3–4 cryoprobes were positioned percutaneously at the gallbladder margins. Thermocouple probes were placed percutaneously at the gallbladder fundus, neck, free wall, and gallbladder fossa. Two freeze–thaw cycles ranging from 10 to 26 min were performed. The subjects were sacrificed 5 h after cryoablation. The gallbladder and bile ducts were resected, stained, and examined microscopically.ResultsGBC was completed in all subjects. A 10-mm ablation margin was achieved beyond all gallbladder walls. Thermocouple probes reached at least −20 °C. Intra-procedural body temperature decreased to a minimum of 35 °C but recovered after the procedure. Intra- and post-procedural vital signs otherwise remained within physiologic parameters. Non-target ablation occurred in the stomach and colon of the first two subjects. Histology demonstrated complete denudation of the gallbladder epithelium, hemorrhage, and edema within the muscularis layer, and preservation of the microscopic architecture of the common bile duct in all cases.ConclusionPercutaneous gallbladder cryoablation is feasible, with adequate ablation margins obtained and histologic changes demonstrating transmural necrosis. Adjacent structures included in the ablation may require conservative ablation zones, hydrodissection, or continuous saline lavage.

  6. Successful Elimination of Ascaris lumbricoides from the Gallbladder by Conservative Medical Therapy

    OpenAIRE

    Misra, Manish Kumar; Singh, Sarabjeet; Bhagat, Tripta Sethi

    2012-01-01

    Migration of Ascaris lumbricoides into the gallbladder is rare, unlike ascariasis of the bile duct and when it does occur, treatment is generally by endoscopic or surgical extraction. We describe a case of the successful treatment of gallbladder ascariasis with conservative therapy.

  7. Successful Elimination of Ascaris lumbricoides from the Gallbladder by Conservative Medical Therapy.

    Science.gov (United States)

    Misra, Manish Kumar; Singh, Sarabjeet; Bhagat, Tripta Sethi

    2013-06-01

    Migration of Ascaris lumbricoides into the gallbladder is rare, unlike ascariasis of the bile duct and when it does occur, treatment is generally by endoscopic or surgical extraction. We describe a case of the successful treatment of gallbladder ascariasis with conservative therapy.

  8. emergency laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy

    International Nuclear Information System (INIS)

    Rangarajan, M.; Palanivelu, C.; Madankumar, M.V.

    2007-01-01

    This report describes a pregnant patient on whom emergency laparoscopic cholecystectomy was performed for empyema gallbladder. The patient was in her second trimester of pregnancy. The distended gallbladder was decompressed before dissection was commenced. There was no mortality, morbidity or conversion. There were no complications for either mother or child related to general anesthesia. (author)

  9. Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy.

    NARCIS (Netherlands)

    Janssen, I.M.; Swank, D.J.; Boonstra, O.; Knipscheer, B.C.; Klinkenbijl, J.H.G.; Goor, H. van

    2003-01-01

    BACKGROUND: Laparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and

  10. Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy

    NARCIS (Netherlands)

    Janssen, I. M. C.; Swank, D. J.; Boonstra, O.; Knipscheer, B. C.; Klinkenbijl, J. H. G.; van Goor, H.

    2003-01-01

    Laparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and

  11. Gallbladder Cryoablation: Proof of Concept in a Swine Model for a Percutaneous Alternative to Cholecystectomy

    International Nuclear Information System (INIS)

    McGregor, Hugh C. J.; Saeed, Maythem; Surman, Andrew; Ehman, Eric C.; Hetts, Steven W.; Wilson, Mark W.; Conrad, Miles B.

    2016-01-01

    PurposeTo investigate the feasibility of percutaneous gallbladder cryoablation (GBC) under CT guidance in a swine model with histopathologic correlation.Materials and MethodsInstitutional Animal Care and Use Committee approval was obtained for this study protocol. Five pigs underwent GBC. Under CT guidance, 3–4 cryoprobes were positioned percutaneously at the gallbladder margins. Thermocouple probes were placed percutaneously at the gallbladder fundus, neck, free wall, and gallbladder fossa. Two freeze–thaw cycles ranging from 10 to 26 min were performed. The subjects were sacrificed 5 h after cryoablation. The gallbladder and bile ducts were resected, stained, and examined microscopically.ResultsGBC was completed in all subjects. A 10-mm ablation margin was achieved beyond all gallbladder walls. Thermocouple probes reached at least −20 °C. Intra-procedural body temperature decreased to a minimum of 35 °C but recovered after the procedure. Intra- and post-procedural vital signs otherwise remained within physiologic parameters. Non-target ablation occurred in the stomach and colon of the first two subjects. Histology demonstrated complete denudation of the gallbladder epithelium, hemorrhage, and edema within the muscularis layer, and preservation of the microscopic architecture of the common bile duct in all cases.ConclusionPercutaneous gallbladder cryoablation is feasible, with adequate ablation margins obtained and histologic changes demonstrating transmural necrosis. Adjacent structures included in the ablation may require conservative ablation zones, hydrodissection, or continuous saline lavage.

  12. Distribution and effect of galanin on gallbladder and sphincter of Oddi motility in the pig

    DEFF Research Database (Denmark)

    Harling, H; Messell, T; Poulsen, Steen Seier

    1991-01-01

    This study was designed to determine the occurrence and topographical distribution of galanin-like immunoreactivity (GAL-LI) in the porcine gallbladder and sphincter of Oddi and to investigate the pharmacologic effect of GAL on gallbladder and sphincter of Oddi motility. By radioimmunoassay the c...

  13. [Detection of Clonorchis sinensis eggs in the ground gallbladder stones by microscopy].

    Science.gov (United States)

    Ma, Rui-Hong; Qiao, Tie; Luo, Xiao-Bing

    2012-08-30

    Sera, feces, bile and gallbladder stones were collected from 179 patients who accepted gallbladder-preserving cholelithotomy during the period of January to June 2010 at the general surgery department in the Second People's Hospital of Panyu District in Guangzhou. Rapid colloidal gold immunochromatography was used to detect IgG against Clonorchis sinensis. C. sinensis eggs were examined by fecal direct smear, and in bile sediments and ground gallbladder stones. The results showed that the positive rate of rapid colloidal gold immunochromatographic assay for IgG was 51.4%, and the egg positive rate in feces, bile sediments and gallbladder stones was 30.7%, 44.7% and 69.8%, respectively. The detection rate of fecal direct smear was the lowest, while that of the gallbladder stone examination was the highest (P stones.

  14. Adjuvant external beam radiation therapy with concurrent chemotherapy in the management of gallbladder carcinoma

    International Nuclear Information System (INIS)

    Kresl, John J.; Schild, Steven E.; Henning, George T.; Gunderson, Leonard L.; Donohue, John; Pitot, Henry; Haddock, Michael G.; Nagorney, David

    2002-01-01

    Purpose: This study was performed to evaluate the outcome of patients with gallbladder cancer who received postoperative concurrent chemotherapy and radiation therapy. Methods and Materials: Curative resection followed by adjuvant combined modality therapy with external beam radiation therapy (EBRT) and chemotherapy was attempted in 21 consecutive gallbladder carcinoma (GBC) patients at the Mayo Clinic from 1985 through 1997. All patients received concurrent 5-fluorouracil during EBRT. EBRT fields encompassed the tumor bed and regional lymph nodes (median dose of 54 Gy in 1.8-2.0-Gy fractions). One patient received 15 Gy intraoperatively after EBRT. A retrospective analysis was performed for the end points of local control, distant failure, and overall survival. Results: After maximal resection, 12 patients had no residual disease on pathologic evaluation, 5 had microscopic residual disease, and 4 had gross residual disease. One patient had Stage I disease, and 20 had Stage III-IV disease. With median follow-up of 5 years (range: 2.6-11.5 years), 5-year survival for the entire cohort was 33%. The 5-year survival rate of patients with Stage I-III disease was 65% vs. 0% for those with Stage IV disease (p 54 Gy (microscopic residual, 3 patients; gross residual, 1 patient; negative but narrow margins, 2 patients) vs. 65% for the 15 who received a lower dose (3, gross residual; 2, microresidual; 10, negative margins). Conclusion: Patients with completely resected (negative margins) GBC followed by adjuvant EBRT plus 5-fluorouracil chemotherapy had a relatively favorable prognosis, with a 5-year survival rate of 64%. These results seem to be superior to historical surgical controls from the Mayo Clinic and other institutions, which report 5-year survival rates of approximately 33% with complete resection alone. Both tumor stage and extent of resection seemed to influence survival and local control. More aggressive measures using current cancer therapies and integration

  15. Human gallbladder carcinoma: Role of neurotrophins, MIB-1, CD34 and CA15-3.

    Science.gov (United States)

    Artico, M; Bronzetti, E; Alicino, V; Ionta, B; Bosco, S; Grande, C; Bruno, M; Tranquilli Leali, F M; Ionta, G; Fumagalli, L

    2010-03-11

    Gallbladder carcinoma is the most common biliary tract tumor and the fifth most common gastrointestinal tract cancer .The prognosis of gallbladder carcinoma is poor and less than 5% of the patients are still alive five years postoperatively. Gallbladder specimens were obtained during surgical operations performed in eleven patients for resection of a gallbladder carcinoma, and during five autopsies (control cases selected among patients who died from for other causes, excluding those suffering from biliary or hepatic diseases). Immunohistochemical characterization and distribution of neurotrophins, with their respective receptors, were analyzed. The actual role played by these neurotrophic factors in the general regulation, vascular permeability, algic responsiveness, release of locally active substances and potential tumorigenesis in the gallbladder and biliary ducts compartment remains controversial. Our study revealed an increased immunohistochemical expression of NGF and TrKA in the epithelium and in the epithelial glands of the gallbladder carcinoma together with an evident immunoreactivity for BDNF in the same neoplastic areas. An evident immunoreactivity for NGF, TrKA and BDNF was observed in control specimens of gallbladder obtained during autopsies, whereas a weak or quite absent immunoreactivity was observed in the same specimens for NT4, TrKC and p75. On the contrary an appreciable immunoreactivity for p75 was observed in the specimens harvested from patients with gallbladder carcinoma. We also investigated the expression of some known tumor markers such as MIB-1 (anti Ki-67), CD34 and CA15-3, to identify a possible correlation between the expression of these molecular factors and the prognosis of gallbladder carcinoma. They resulted highly expressed in the stroma (CD34 and CA 15-3) and in the epithelium/epithelial glands (MIB-1) of the neoplastic areas and appeared to be almost absent in the control cases, suggesting that these markers, taken together

  16. Human gallbladder carcinoma: Role of neurotrophins, MIB-1, CD34 and CA15-3

    Directory of Open Access Journals (Sweden)

    M. Artico

    2010-03-01

    Full Text Available Gallbladder carcinoma is the most common biliary tract tumor and the fifth most common gastrointestinal tract cancer .The prognosis of gallbladder carcinoma is poor and less than 5% of the patients are still alive five years postoperatively.1 Gallbladder specimens were obtained during surgical operations performed in eleven patients for resection of a gallbladder carcinoma, and during five autopsies (control cases selected among patients who died from for other causes, excluding those suffering from biliary or hepatic diseases. Immunohistochemical characterization and distribution of neurotrophins, with their respective receptors, were analyzed. The actual role played by these neurotrophic factors in the general regulation, vascular permeability, algic responsiveness, release of locally active substances and potential tumorigenesis in the gallbladder and biliary ducts compartment remains controversial. Our study revealed an increased immunohistochemical expression of NGF and TrKA in the epithelium and in the epithelial glands of the gallbladder carcinoma together with an evident immunoreactivity for BDNF in the same neoplastic areas. An evident immunoreactivity for NGF, TrKA and BDNF was observed in control specimens of gallbladder obtained during autopsies, whereas a weak or quite absent immunoreactivity was observed in the same specimens for NT4, TrKC and p75. On the contrary an appreciable immunoreactivity for p75 was observed in the specimens harvested from patients with gallbladder carcinoma. We also investigated the expression of some known tumor markers such as MIB-1 (anti Ki-67, CD34 and CA15-3, to identify a possible correlation between the expression of these molecular factors and the prognosis of gallbladder carcinoma. They resulted highly expressed in the stroma (CD34 and CA 15-3 and in the epithelium/epithelial glands (MIB-1 of the neoplastic areas and appeared to be almost absent in the control cases, suggesting that these markers

  17. Presence and distribution of leptin and leptin receptor in the canine gallbladder.

    Science.gov (United States)

    Lee, Sungin; Lee, Aeri; Kweon, Oh-Kyeong; Kim, Wan Hee

    2016-09-01

    The hormone leptin is produced by mature adipocytes and plays an important role in regulating food intake and energy metabolism through its interaction with the leptin receptor. In addition to roles in obesity and obesity-related diseases, leptin has been reported to affect the components and secretion of bile in leptin-deficient mice. Furthermore, gallbladder diseases such as cholelithiasis are known to be associated with serum leptin concentrations in humans. We hypothesized that the canine gallbladder is a source of leptin and that the leptin receptor may be localized in the gallbladder, where it plays a role in regulating the function of this organ. The aim of this study was to demonstrate the presence and expression patterns of leptin and its receptors in normal canine gallbladders using reverse transcriptase-PCR (RT-PCR) and immunohistochemistry. Clinically normal gallbladder tissue samples were obtained from four healthy beagle dogs with similar body condition scores. RT-PCR and sequencing of the amplified PCR products revealed the presence of leptin mRNA and its receptors in the gallbladder. Immunohistochemical investigations demonstrated the expression of leptin and its receptors in the luminal single columnar and tubuloalveolar glandular epithelial cells. In conclusion, the results of this study demonstrated the presence of leptin and its receptors in the gallbladders of dogs. Leptin and its receptor were both localized throughout the cytoplasm of luminal and glandular epithelial cells. These results suggested that the gallbladder is not only a source of leptin, but also a target of leptin though autocrine/paracrine mechanisms. The results of this study could increase the understanding of both the normal physiological functions of the gallbladder and the pathophysiological mechanisms of gallbladder diseases characterized by leptin system dysfunction. Copyright © 2016 The Authors. Published by Elsevier GmbH.. All rights reserved.

  18. Bleeding diathesis in Noonan syndrome

    NARCIS (Netherlands)

    Staudt, Joost M.; van der Horst, Chantal M. A. M.; Peters, Marjolijn; Melis, Paris

    2005-01-01

    An 18-year-old girl with Noonan syndrome was operated on for prominent ears. Subcutaneous haematomas developed on both sides, and coagulation tests reported a bleeding diathesis. This is seldom mentioned in descriptions of the syndrome, but it has been shown that one-third of all patients with the

  19. Abnormal uterine bleeding in perimenopause.

    Science.gov (United States)

    Goldstein, S R; Lumsden, M A

    2017-10-01

    Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office or primary-care setting. The wider availability of diagnostic tools has allowed prompt diagnosis and treatment of an increasing number of menstrual disorders in an office setting. This White Paper reviews the advantages and disadvantages of transvaginal ultrasound, blind endometrial sampling and diagnostic hysteroscopy. Once a proper diagnosis has been established, appropriate therapy may be embarked upon. Fortunately, only a minority of such patients will have premalignant or malignant disease. When bleeding is sufficient to cause severe anemia or even hypovolemia, prompt intervention is called for. In most of the cases, however, the abnormal uterine bleeding will be disquieting to the patient and significantly affect her 'quality of life'. Sometimes, reassurance and expectant management will be sufficient in such patients. Overall, however, in cases of benign disease, some intervention will be required. The use of oral contraceptive pills especially those with a short hormone-free interval, the insertion of the levonorgestrel intrauterine system, the incorporation of newer medical therapies including antifibrinolytic drugs and selective progesterone receptor modulators and minimally invasive treatments have made outpatient therapy increasingly effective. For others, operative hysteroscopy and endometrial ablation are proven therapeutic tools to provide both long- and short-term relief of abnormal uterine bleeding, thus avoiding, or deferring, hysterectomy.

  20. Radiological diagnosis of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Neufang, K.F.R.; Gross-Fengels, W.; Lorenz, R.

    1990-01-01

    In the diagnosis of acute gastrointestinal bleeding, endoscopy holds the first place today. Radiological investigations are indispensable whenever endoscopy cannot precisely localise the bleeding site, whenever a tumour is present or suspected, in all cases of lower gastrointestinal bleeding, and in haemobilia. A tailored radiological approach is recommended. The radiological basis programme should be at least a complete abdominal ultrasound study and plain abdominal radiograms. CT and ERCP scans may become necessary in selected cases. As a rule, angiographical localisation of the bleeding site will be successful only in the acute stage; selective visceral arteriograms have to be obtained, which may be executed in the digital subtraction technique in patients who are cooperating and clinically stable. Angiodysplasias and aneurysms, however, may be demonstrated angiographically in the interval as well. Upper and/or lower G.I. tract studies with barium or water-soluble contrast media may be indicated in the interval in order to demonstrate tumours, metastatic lesions, diverticula and gut malformations. (orig.) [de

  1. Adjuvant Therapy for Gallbladder Carcinoma: The Mayo Clinic Experience

    International Nuclear Information System (INIS)

    Gold, Douglas G.; Miller, Robert C.; Haddock, Michael G.; Gunderson, Leonard L.; Quevedo, Fernando; Donohue, John H.; Bhatia, Sumita; Nagorney, David M.

    2009-01-01

    Purpose: To analyze the effect of adjuvant chemoradiotherapy on gallbladder carcinoma. Methods and Materials: We retrospectively reviewed the records from consecutive patients who underwent R0 resection of gallbladder carcinoma between January 1, 1985, and December 31, 2004. Patients had either Stage I (T1-T2N0M0) or Stage II (T3N0M0 or T1-T3N1M0) disease. Patients undergoing adjuvant therapy received 5-fluorouracil chemotherapy concurrently with radiotherapy (median dosage, 50.4 Gy in 28 fractions). Adverse prognostic factors and the effect of adjuvant treatment on overall survival (OS) were evaluated. Results: A total of 73 patients were included in the analysis; of these, 25 received adjuvant chemoradiotherapy. On univariate analysis, no adverse prognostic factors for OS reached statistical significance, but trends were noted for Stage N1 vs. N0 (p = .06), Nx vs. N0 (p = .09), Stage T3 vs. T1-T2 (p = .06), and histologic findings other than adenocarcinoma (p = .13). The median OS for patients receiving adjuvant chemoradiotherapy vs. surgery alone was 4.8 years and 4.2 years, respectively (log-rank test, p = .56). However, a significantly greater percentage of patients receiving adjuvant chemoradiotherapy had Stage II disease (p <.001). In the multivariate Cox model, increasing T and N category and histologic findings other than adenocarcinoma were significant predictors of decreased OS. Additionally, adjuvant chemoradiotherapy was a significant predictor of improved OS after adjusting for these prognostic factors (hazard ratio for death, 0.3; 95% confidence interval, 0.13-0.69; p = .004). Conclusion: After adjusting for the stage parameters and histologic findings, our data suggest that adjuvant chemoradiotherapy might improve OS for patients with gallbladder cancer.

  2. Lithium absorption by the rabbit gall-bladder

    DEFF Research Database (Denmark)

    Hansen, C P; Holstein-Rathlou, N H; Skøtt, O

    1991-01-01

    Lithium (Li+) absorption across the low-resistance epithelium of the rabbit gall-bladder was studied in order to elucidate possible routes and mechanisms of Li+ transfer. Li+ at a concentration of 0.4 mM in both mucosal and serosal media did not affect isosmotic mucosa-to-serosa fluid absorption...... was elicited from the mucosal side and was not accounted for by compensatory Li+ absorption; water and Na+ absorption rates decreased nearly in parallel. The effects of 0.4 mM amiloride and of substitution with 20 mM Li+ were only partly additive. It is concluded that Li+ absorption in the rabbit gall...

  3. [Endoscopic sphincterotomy in choledocholithiasis and an intact gallbladder].

    Science.gov (United States)

    Vladimirov, B; Petkov, R; Viiachki, I; Damianov, D; Iarŭmov, N

    1996-01-01

    Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).

  4. Prostaglandin release from in vitro guinea-pig gallbladder.

    Science.gov (United States)

    Booker, M L; LaMorte, W W

    1983-02-01

    In order to study prostaglandin release from guinea pig gallbladder, full thickness tissue sections were incubated for one hour in Krebs solution. Extraction and two dimensional chromatography of incubation media obtained in the presence of radio-labelled arachidonic acid demonstrated the presence of PGE2, PGF2 alpha, 6-keto-PGF1 alpha and thromboxane B2. These results were supported by radioimmunoassay of incubations conducted in the absence of exogenous arachidonate and in the presence of varying concentrations of unlabelled exogenous arachidonate. The previously reported predominance of PGE2 was only seen at high concentrations of exogenous arachidonate.

  5. Managing Chemotherapy Side Effects: Bleeding Problems

    Science.gov (United States)

    ... C ancer I nstitute Managing Chemotherapy Side Effects Bleeding Problems “My nurse said that chemotherapy could make ... with a clean cloth. Keep pressing until the bleeding stops. If you bruise: Put ice on the ...

  6. Postpolypectomy lower GI bleeding: descriptive analysis

    NARCIS (Netherlands)

    Sorbi, D.; Norton, I.; Conio, M.; Balm, R.; Zinsmeister, A.; Gostout, C. J.

    2000-01-01

    BACKGROUND: Postpolypectomy hemorrhage may warrant intensive care monitoring, transfusions, and surgery. We sought factors predicting significant bleeding requiring blood transfusion and the benefits of critical care monitoring. METHODS: Patients with postpolypectomy bleeding between April 1989 and

  7. The standardized surgical approach improves outcome of gallbladder cancer

    Directory of Open Access Journals (Sweden)

    Igna Dorian

    2007-05-01

    Full Text Available Abstract Background The objective of this study was to examine the extent of surgical procedures, pathological findings, complications and outcome of patients treated in the last 12 years for gallbladder cancer. Methods The impact of a standardized more aggressive approach compared with historical controls of our center with an individual approach was examined. Of 53 patients, 21 underwent resection for cure and 32 for palliation. Results Overall hospital mortality was 9% and procedure related mortality was 4%. The standardized approach in UICC stage IIa, IIb and III led to a significantly improved outcome compared to patients with an individual approach (Median survival: 14 vs. 7 months, mean+/-SEM: 26+/-7 vs. 17+/-5 months, p = 0.014. The main differences between the standardized and the individual approach were anatomical vs. atypical liver resection, performance of systematic lymph dissection of the hepaticoduodenal ligament and the resection of the common bile duct. Conclusion Anatomical liver resection, proof for bile duct infiltration and, in case of tumor invasion, radical resection and lymph dissection of the hepaticoduodenal ligament are essential to improve outcome of locally advanced gallbladder cancer.

  8. [Quality of DNA from archival pathological samples of gallbladder cancer].

    Science.gov (United States)

    Roa, Iván; de Toro, Gonzalo; Sánchez, Tamara; Slater, Jeannie; Ziegler, Anne Marie; Game, Anakaren; Arellano, Leonardo; Schalper, Kurt; de Aretxabala, Xabier

    2013-12-01

    The quality of the archival samples stored at pathology services could be a limiting factor for molecular biology studies. To determine the quality of DNA extracted from gallbladder cancer samples at different institutions. One hundred ninety four samples coming from five medical centers in Chile, were analyzed. DNA extraction was quantified determining genomic DNA concentration. The integrity of DNA was determined by polymerase chain reaction amplification of different length fragments of a constitutive gene (β-globin products of 110, 268 and 501 base pairs). The mean DNA concentration obtained in 194 gallbladder cancer samples was 48 ± 43.1 ng/µl. In 22% of samples, no amplification was achieved despite obtaining a mean DNA concentration of 58.3 ng/ul. In 81, 67 and 22% of samples, a DNA amplification of at least 110, 268 or 501 base pairs was obtained, respectively. No differences in DNA concentration according to the source of the samples were demonstrated. However, there were marked differences in DNA integrity among participating centers. Samples from public hospitals were of lower quality than those from private clinics. Despite some limitations, in 80% of cases, the integrity of DNA in archival samples from pathology services in our country would allow the use of molecular biology techniques.

  9. Gallbladder emptying in chronic pancreatitis a scintigraphic evaluation

    International Nuclear Information System (INIS)

    Buchpiguel, C.A.; Pedroso, M.; Sapioenza, M.; Watanabe, T.; Costa, P.; Yamashiba, C.; Melo, I.; Garcez, A.

    1997-01-01

    Full text: Our purpose was to evaluate the gallbladder (GB) emptying in pts with chronic pancreatitis and to determine whether or not the use of pancreatic extract has an impact in improving that function. The GB emptying was evaluated in 11 patients (pts) with mild to moderate chronic pancreatitis, and in 10 normal volunteers. Pts and controls who presented any kind of condition that could interfere with the gastric or gallbladder emptying were excluded. The GB ejection fraction was calculated at 30, 45, and 60 minutes after a standardized fatty meal ingestion. In the pts group, this evaluation was obtained in two different periods of time, without and with the addition of pancreatic extract. The gastric emptying was previously determined in all patients and controls with Technetium-99m-sulfur colloid mixed in the same fatty meal used for the hepatobiliary scans. The results disclosed that the GB ejection fraction at 60 minutes was significantly lower in patients compared to controls ( 0,05). The gastric emptying was similar between the two groups (p>0,05). In conclusion, mild to moderate chronic pancreatitis is associated with GB function impairment. Our results suggest that the delay in GB emptying does not depend exclusively on the alteration in the intestinal phase of the GB stimulation, but may be a result of multiple other factors

  10. [Laparoscopic cholecystectomy with transgastric gallbladder extraction: a new therapeutic approach].

    Science.gov (United States)

    Jurczak, F; Pousset, J-P; Raffaitin, P

    2009-02-01

    To evaluate a newly developed cholecystectomy technique which combines classical dissection with currently available mini-instrumentation (3 and 5 mm) and removal of the gallbladder through a short gastrotomy. After a feasibility study, we set up a protocol for this procedure using instrumentation currently available on the market. The resected gallbladder was removed through a short gastrotomy on the anterior gastric wall, thereby minimizing abdominal wall trauma and permitting the patient to resume physical activity more quickly with no risk of trocar herniation. Cholecystectomy was performed by the described technique in 18 of 23 eligible patients between April 2008 and August 2008. There were seven males and 11 females with a mean age of 48 (range: 28-77); median BMI was 30 kg/m2 (range: 22-36). Eleven patients had a gallstone larger than 12 mm. There were no postoperative complications and recovery was rapid for all patients in our study. This procedure is technically feasible, safe and reproducible; results are good with minimal trauma to the abdominal wall. Normal physical activity can be rapidly resumed with no risk of incisional hernia.

  11. Gallbladder wall thickening: MR imaging and pathologic correlation with emphasis on layered pattern

    International Nuclear Information System (INIS)

    Jung, S.E.; Lee, J.M.; Hahn, S.T.; Lee, K.; Rha, S.E.; Choi, B.G.; Kim, E.K.

    2005-01-01

    The aim of this study was to correlate MR findings of gallbladder wall thickening with pathologic findings on the basis of the layered pattern and to evaluate the diagnostic value of MR imaging in gallbladder disease. We retrospectively evaluated the source images of HASTE sequences for MR cholangiography in 144 patients with gallbladder wall thickening. The layered pattern of thickened wall was classified into four patterns. Type 1 shows two layers with a thin hypointense inner layer and thick hyperintense outer layer. Type 2 has two layers of ill-defined margin. Type 3 shows multiple hyperintense cystic spaces in the wall. Type 4 shows diffuse nodular thickening without layering. MR findings of a layered pattern of thickened gallbladder were well correlated with histopathology. Chronic cholecystitis matched to type 1, acute cholecystitis corresponded to type 2, adenomyomatosis showed type 3, and the gallbladder carcinomas showed type 4. All four layered patterns were associated with PPV of 73% or greater, sensitivity of 92% or greater and specificity of 95% or greater. Our results indicate that MR findings of gallbladder wall thickening are characteristic in each entity and correlate well with pathologic findings. The classification of the layered pattern may be valuable for interpreting thickened gallbladder wall. (orig.)

  12. Management of bleeding gastroduodenal ulcers

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Jørgensen, Henrik Stig; Schaffalitzky de Muckadell, Ove B

    2012-01-01

    Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved by the D......Description: A multidisciplinary group of Danish experts developed this guideline on management of bleeding gastroduodenal ulcers. Sources of data included published studies up to March 2011. Quality of evidence and strength of recommendations have been graded. The guideline was approved......) again as soon as cardiovascular risks outweigh gastrointestinal risks. Patients in need of continued treatment with ASA or a nonsteroidal anti-inflammatory drug should be put on prophylactic treatment with PPI at standard dosage. The combination of 75mg ASA and PPI should be preferred to monotherapy...

  13. Gastrointestinal Bleeding Secondary to Calciphylaxis

    Science.gov (United States)

    Gupta, Nancy; Haq, Khwaja F.; Mahajan, Sugandhi; Nagpal, Prashant; Doshi, Bijal

    2015-01-01

    Patient: Female, 66 Final Diagnosis: Calciphylaxis Symptoms: Gastrointesinal haemorrhage Medication: None Clinical Procedure: Hemodialysis • blood transfusions Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Calciphylaxis is associated with a high mortality that approaches 80%. The diagnosis is usually made when obvious skin lesions (painful violaceous mottling of the skin) are present. However, visceral involvement is rare. We present a case of calciphylaxis leading to lower gastrointestinal (GI) bleeding and rectal ulceration of the GI mucosa. Case Report: A 66-year-old woman with past medical history of diabetes mellitus, hypertension, end-stage renal disease (ESRD), recently diagnosed ovarian cancer, and on hemodialysis (HD) presented with painful black necrotic eschar on both legs. The radiograph of the legs demonstrated extensive calcification of the lower extremity arteries. The hospital course was complicated with lower GI bleeding. A CT scan of the abdomen revealed severe circumferential calcification of the abdominal aorta, celiac artery, and superior and inferior mesenteric arteries and their branches. Colonoscopy revealed severe rectal necrosis. She was deemed to be a poor surgical candidate due to comorbidities and presence of extensive vascular calcifications. Recurrent episodes of profuse GI bleeding were managed conservatively with blood transfusion as needed. Following her diagnosis of calciphylaxis, supplementation with vitamin D and calcium containing phosphate binders was stopped. She was started on daily hemodialysis with low calcium dialysate bath as well as intravenous sodium thiosulphate. The clinical condition of the patient deteriorated. The patient died secondary to multiorgan failure. Conclusions: Calciphylaxis leading to intestinal ischemia/perforation should be considered in the differential diagnosis in ESRD on HD presenting with abdominal pain or GI bleeding. PMID:26572938

  14. Infusion tomography and ultrasonography of the gallbladder in the diagnosis of acute cholecystitis

    International Nuclear Information System (INIS)

    Karp, W.; Owman, T.; Herlin, P.; Holmin, T.

    1979-01-01

    Sixty-three patients with the clinical suspicion of acute cholecystitis were examined with infusion tomography of the gallbladder. Ultrasonography was performed in 51 of these cases. The technique and diagnostic principles of both methods are discussed. The diagnostic value of the two methods when used in combination is stressed. Thus in a case of gangrenous cholecystitis when opacification of the gallbladder wall may not appear at infusion tomography, ultrasonography may demonstrate signs of gallbladder disease. Infusion tomography, on the other hand, may be of great value if ultrasonography is not informative. (orig.) 891 AJ/orig. 892 BRE [de

  15. Our experience with a new instrument for laparoscopic gallbladder extraction, the "Bergetrokar".

    Science.gov (United States)

    Höferlin, A; Höhle, K D

    1993-01-01

    Laparoscopic cholecystectomy has become a standardized technique within the last years. However, the extraction of the stone-filled gallbladder often becomes a time-consuming and difficult part of the operation. We have developed a new instrument for quick and safe extraction of the stone-filled gallbladder. The instrument, called "Bergetrokar", is a trocar cannula with a trumpet valve and cone-shaped tip which can be spread. The application of this device is simple. After using the "Bergetrokar" in about 180 cases we have not observed any perforation of the gallbladder or loss of stones. Extraction times were reduced.

  16. Ceftriaxone-associated gallbladder sludge. Identification of calcium-ceftriaxone salt as a major component of gallbladder precipitate

    International Nuclear Information System (INIS)

    Park, H.Z.; Lee, S.P.; Schy, A.L.

    1991-01-01

    Ceftriaxone, a third-generation cephalosporin, is partially excreted into bile. With its clinical use, the formation of gallbladder sludge detected by ultrasonography has been reported. Four surgical specimens were examined and no gallstones were found. Instead, fine precipitates of 20-250 microns were present. Microscopically, there was a small number of cholesterol monohydrate crystals and bilirubin granules among an abundant amount of granular-crystalline material that was not morphologically cholesterol monohydrate crystals. The chemical composition of the precipitates (n = 4) was determined. There was a small amount of cholesterol (1.7% +/- 0.8%) and bilirubin (13.9% +/- 0.74%). The major component of the precipitate was a residue. On further analysis using thin-layer chromatography, high-performance liquid chromatography, and electron microprobe analysis, the residue was identified as a calcium salt of ceftriaxone. The residue also had identical crystal morphology and chromatographic elution profile as authentic calcium-ceftriaxone standards. It is concluded that ceftriaxone, after excretion and being concentrated in the gallbladder bile, can form a precipitate. The major constituent has been identified as a ceftriaxone-calcium salt

  17. Single-organ gallbladder vasculitis: characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 61 patients.

    Science.gov (United States)

    Hernández-Rodríguez, José; Tan, Carmela D; Rodríguez, E René; Hoffman, Gary S

    2014-11-01

    Systemic vasculitis (SV) involving abdominal structures usually has a poor prognosis. Gallbladder vasculitis (GV) has been reported as part of SV (GB-SV) and focal single-organ vasculitis (GB-SOV). We analyzed clinical and histologic characteristics of patients with GV to identify features that differentiate GB-SOV from the systemic forms of GV. To identify affected patients with GV we used pathology databases from our institution and an English-language PubMed search. Clinical manifestations, laboratory and histologic features, treatment administered, and outcomes were recorded. Patients were divided in 2 groups, GB-SOV and GB-SV. As in previous studies of single-organ vasculitis, GB-SOV was only considered to be a sustainable diagnosis if disease beyond the gallbladder was not apparent after a follow-up period of at least 6 months. Sixty-one well-characterized patients with GV were included (6 from our institution). There was no significant sex bias (32 female patients, 29 male). Median age was 52 years (range, 18-94 yr). GB-SOV was found in 20 (33%) and GB-SV in 41 (67%) patients. No differences were observed in age, sex frequency, or duration of gallbladder symptoms between groups. Past episodes of recurrent right-upper quadrant or abdominal pain and lithiasic cholecystitis were more frequent in GB-SOV patients, whereas acalculous cholecystitis occurred more often in GB-SV. In GB-SV, gallbladder-related symptoms occurred more often concomitantly with or after the systemic features, but they sometimes appeared before SV was fully developed (13.5%). Constitutional and musculoskeletal symptoms were reported only in GB-SV patients. Compared to GB-SOV, GB-SV patients presented more often with fever (62.5% vs 20%; p = 0.003) and exhibited higher erythrocyte sedimentation rate levels (80 ± 28 vs 37 ± 25 mm/h, respectively; p = 0.006). All GB-SV patients required glucocorticoids and 50% of them also received cytotoxic agents. Mortality in GB-SV was

  18. Comparison of efficacy between choledochoscopic gallbladder-preserving cholelithotomy and laparoscopic cholecystectomy in treatment of gallstones: a meta-analysis

    Directory of Open Access Journals (Sweden)

    FAN Hua

    2015-10-01

    Full Text Available ObjectiveTo systematically evaluate the advantages and disadvantages of choledochoscopic gallbladder-preserving cholelithotomy (CGPC and laparoscopic cholecystectomy (LC in the treatment of gallstones. MethodsThe databases of CBM, CNKI, VIP, Wanfang Data, PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for randomized controlled trials (RCTs related to CGPC and LC in the treatment of gallstones published up to June 2015. Data extraction and quality evaluation were performed for the literature included, and Review Manager 5.3 was used for the meta-analysis. ResultsFive RCTs involving 685 patients were included. The results of the meta-analysis showed that CGPC group and LC group had significant differences in operation time (OR=8.85, 95% CI: 049-17.21, P=0.04 and incidence of postoperative diarrhea (OR=0.24, 95% CI: 0.11-0.53, P=0.000 4. However, no significant differences were seen between the two groups in intraoperative bleeding volume (OR=-12.37, 95% CI: -29.73-4.99, P=0.16, time to postoperative intestinal function recovery (OR=-7.19, 95% CI: -24.28-9.90, P=0.41, hospitalization days (OR=-0.17, 95% CI: -1.98-1.63, P=0.85, and hospital costs (OR=-1.14, 95% CI: -2.57-0.28, P=0.12. ConclusionThe operation time and incidence of postoperative diarrhea in CGPC are superior to those in LC, while no significant differences are observed in intraoperative bleeding volume, time to postoperative intestinal function recovery, hospitalization days, and hospital costs. Due to a limited number of articles included and publication bias, RCTs with a large sample size and high quality are needed to provide more effective data.

  19. Automated registration of tail bleeding in rats.

    Science.gov (United States)

    Johansen, Peter B; Henriksen, Lars; Andresen, Per R; Lauritzen, Brian; Jensen, Kåre L; Juhl, Trine N; Tranholm, Mikael

    2008-05-01

    An automated system for registration of tail bleeding in rats using a camera and a user-designed PC-based software program has been developed. The live and processed images are displayed on the screen and are exported together with a text file for later statistical processing of the data allowing calculation of e.g. number of bleeding episodes, bleeding times and bleeding areas. Proof-of-principle was achieved when the camera captured the blood stream after infusion of rat whole blood into saline. Suitability was assessed by recording of bleeding profiles in heparin-treated rats, demonstrating that the system was able to capture on/off bleedings and that the data transfer and analysis were conducted successfully. Then, bleeding profiles were visually recorded by two independent observers simultaneously with the automated recordings after tail transection in untreated rats. Linear relationships were found in the number of bleedings, demonstrating, however, a statistically significant difference in the recording of bleeding episodes between observers. Also, the bleeding time was longer for visual compared to automated recording. No correlation was found between blood loss and bleeding time in untreated rats, but in heparinized rats a correlation was suggested. Finally, the blood loss correlated with the automated recording of bleeding area. In conclusion, the automated system has proven suitable for replacing visual recordings of tail bleedings in rats. Inter-observer differences can be eliminated, monotonous repetitive work avoided, and a higher through-put of animals in less time achieved. The automated system will lead to an increased understanding of the nature of bleeding following tail transection in different rodent models.

  20. [Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding].

    Science.gov (United States)

    Belanová, Veronika; Gřiva, Martin

    2015-12-01

    The incidence of acute upper gastrointestinal bleeding is about 85-108/100,000 inhabitants per year, nonvariceal bleeding accounts for 80-90%. Antiplatelet and anticoagulation treatment are the significant risk factors for upper gastrointestinal bleeding. To evaluate the occurrence of upper gastrointestinal bleeding in the general community of patients in a county hospital. And to compare the role played by antiplatelet and anticoagulation drugs and other risk medication. Retrospective analysis of patients over 18 years of age who underwent endoscopy for acute upper gastrointestinal bleeding or anaemia (haemoglobinupper gastrointestinal tract during a hospital stay in 2013 (from January to June). We included 111 patients of average age 69±15 years, men 60%. Nonvariceal bleeding accounted for 90% of the cases. None of the patients with variceal bleeding (10% of patients) took antiplatelet or anticoagulation therapy. There were 100 patients with nonvariceal bleeding of average age 70±15, 61% men. With the symptoms of acute bleeding (hematemesis, melena) presented in 73% of patients. The most frequent cause of bleeding was gastric and duodenal ulcer (54%). 32% of patients with nonvariceal bleeding had antiplatelets, 19% anticoagulants and 10% used nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids. 30-days mortality of patients with nonvariceal bleeding was 11%, annual mortality was 23%. There was no significant difference in mortality, blood transfusion requirements or surgical intervention between the patients with antithrombotic agents and without them. 25% of patients (8 patients) using acetylsalicylic acid did not fulfil the indication for this treatment. Among the patients examined by endoscopy for symptomatic nonvariceal bleeding and/or anaemia (haemoglobingastrointestinal bleeding. With regard to that, it is alarming, that there still exists a nonnegligible percentage of patients taking acetylsalicylic acid even

  1. Prospective Evaluation of the Optimal Duration of Bed Rest After Vascular Interventions Using a 3-French Introducer Sheath

    Energy Technology Data Exchange (ETDEWEB)

    Aramaki, Takeshi, E-mail: t.aramaki@scchr.jp; Moriguchi, Michihisa, E-mail: m.moriguchi@scchr.jp; Bekku, Emima, E-mail: e.bekku@scchr.jp [Shizuoka Cancer Center, Division of Interventional Radiology (Japan); Endo, Masahiro, E-mail: m.endo@scchr.jp; Asakura, Koiku, E-mail: k.asakura@scchr.jp [Shizuoka Cancer Center, Division of Diagnostic Radiology (Japan); Boku, Narikazu, E-mail: n.boku@marianna-u.ac.jp [Shizuoka Cancer Center, Division of Medical Oncology (Japan); Yoshimura, Kenichi, E-mail: keyoshim@med.kobe-u.ac.jp [Kobe University Hospital, Center for Clinical Research (Japan)

    2015-02-15

    PurposeTo assess optimal bed-rest duration after vascular intervention by way of the common femoral artery using 3F introducer sheaths.Materials and MethodsEligibility criteria for this single-center, prospective study included clinically necessary angiography, no coagulopathy or anticoagulant therapy, no hypersensitivity to contrast medium, age >20 years, and written, informed consent. Enrolled patients were assigned to one of three groups (105/group) with the duration of bed rest deceased sequentially. A sheath was inserted by way of the common femoral artery using the Seldinger technique. The first group (level 1) received 3 h of bed rest after the vascular intervention. If no bleeding or hematomas developed, the next group (level 2) received 2.5 h of bed rest. If still no bleeding or hematomas developed, the final group (level 3) received 2 h of bed rest. If any patient had bleeding or hematomas after bed rest, the study was terminated, and the bed rest of the preceding level was considered the optimal duration.ResultsA total of 105 patients were enrolled at level 1 between November 2010 and September 2011. Eight patients were excluded from analysis because cessation of bed rest was delayed. None of the remaining subjects experienced postoperative bleeding; therefore, patient enrollment at level 2 began in September 2011. However, puncture site bleeding occurred in the 52nd patient immediately after cessation of bed rest, necessitating study termination.ConclusionTo prevent bleeding, at least 3 h of postoperative bed rest is recommended for patients undergoing angiography using 3F sheaths.

  2. Prospective Evaluation of the Optimal Duration of Bed Rest After Vascular Interventions Using a 3-French Introducer Sheath

    International Nuclear Information System (INIS)

    Aramaki, Takeshi; Moriguchi, Michihisa; Bekku, Emima; Endo, Masahiro; Asakura, Koiku; Boku, Narikazu; Yoshimura, Kenichi

    2015-01-01

    PurposeTo assess optimal bed-rest duration after vascular intervention by way of the common femoral artery using 3F introducer sheaths.Materials and MethodsEligibility criteria for this single-center, prospective study included clinically necessary angiography, no coagulopathy or anticoagulant therapy, no hypersensitivity to contrast medium, age >20 years, and written, informed consent. Enrolled patients were assigned to one of three groups (105/group) with the duration of bed rest deceased sequentially. A sheath was inserted by way of the common femoral artery using the Seldinger technique. The first group (level 1) received 3 h of bed rest after the vascular intervention. If no bleeding or hematomas developed, the next group (level 2) received 2.5 h of bed rest. If still no bleeding or hematomas developed, the final group (level 3) received 2 h of bed rest. If any patient had bleeding or hematomas after bed rest, the study was terminated, and the bed rest of the preceding level was considered the optimal duration.ResultsA total of 105 patients were enrolled at level 1 between November 2010 and September 2011. Eight patients were excluded from analysis because cessation of bed rest was delayed. None of the remaining subjects experienced postoperative bleeding; therefore, patient enrollment at level 2 began in September 2011. However, puncture site bleeding occurred in the 52nd patient immediately after cessation of bed rest, necessitating study termination.ConclusionTo prevent bleeding, at least 3 h of postoperative bed rest is recommended for patients undergoing angiography using 3F sheaths

  3. Bleeding

    Science.gov (United States)

    ... gov/pubmed/24641269 . Simon BC, Hern HG. Wound management principles. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 52. ...

  4. Radiofrequency Thermoablation of HCC Larger Than 3 cm and Less Than 5 cm Proximal to the Gallbladder without Gallbladder Isolation: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Antonio Orlacchio

    2014-01-01

    Full Text Available Radiofrequency ablation (RFA is an effective minimally invasive treatment for nonsurgical hepatocellular carcinoma (HCC, but ablation of tumors close to the gallbladder could be associated with several complications. We report our experience on the treatment of HCC close to the gallbladder with RFA. Eight RFA procedures were performed in eight patients with HCC larger than 3 cm and less than 5 cm close to the gallbladder. In all cases, a percutaneous approach was used. There were no major complications. Only in two patients a minimal wall thickening of the gallbladder was observed. Contrast enhanced computed tomography carried out after 30 days from the first procedure showed complete necrosis in seven patients (87%. Only one patient had local recurrence at 11 months of followup. Although limited, our experience suggests that, after careful preprocedural planning, in experienced hands and with appropriate technology, percutaneous RFA could be safely performed even for lesions larger than 3 cm located in close adjacency to the gallbladder.

  5. Piezoelectric extracorporeal lithotripsy of gallbladder stones: New inclusion criteria

    Energy Technology Data Exchange (ETDEWEB)

    Han, Joon Koo; Choi, Byung Ihn; Shin, Yong Moon; Yoon, Yong Kyu; Yoon, Yong Bum; Park, Yong Hyun; Kim, Chu Wan; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1994-08-15

    To establish the optimal inclusion criteria for the patients with gallbladder stones to extracorporeal shock wave lithotripsy(ESWL) by retrospectively analyzed our current results. Data obtained from 201 patients with gallbladder stones treated with ESWL and oral chemolytic agent from November 1988 to July 1992 were retrospectively analyzed. Ninety-six had radiolucent stones and 105 had radiopaque stones. We used piezoelectric lithotriptor(EDAP LT. 01) and there were no limitation in number of sessions or total number of shock waves. ESWL was repeated until the size of the largest fragment is smaller than 4 mm. Follow up ultrasound was done in every three months after the successful fragmentation. Average length of the follow up was 205 days. We analyzed the rate of successful fragmentation, number of shock waves needed to achieve successful fragmentation according to the size, number of stones as well as the presence of the calcification. Stone-free rate after 6 months was also calculated from all subgroups and compared to each other. The rate of successful fragmentation was 76.2% for radiolucent stones and 65.6% for radiopaque stones(p> 0.05) after 46,731 and 56,111 shock wave respectively(p > 0.05) The rate of successful fragmentation was highest in patients with single, radiolucent stone smaller than 2 cm(91.7%) followed by single radiolucent stone larger than 2 cm(83.3%), multiple calcified stones smaller than 2 cm (77.4%) and single calcified stone smaller than 2 cm(72.1%). The rate of complete stone clearance after 6 month follow-up was highest in patients with single radiolucent stone smaller than 2 cm (63.3%) and followed by multiple calcified stones smaller than 2 cm(37.3%), single calcified stone smaller than 2 cm(33.9%)(p < 0.05). To obtain better results with ESWL in patients with gallbladder stone, the authors propose a more strict inclusion criteria, which is the patient with a single, radiolucent stone smaller than 2 cm.

  6. Piezoelectric extracorporeal lithotripsy of gallbladder stones: New inclusion criteria

    International Nuclear Information System (INIS)

    Han, Joon Koo; Choi, Byung Ihn; Shin, Yong Moon; Yoon, Yong Kyu; Yoon, Yong Bum; Park, Yong Hyun; Kim, Chu Wan; Han, Man Chung

    1994-01-01

    To establish the optimal inclusion criteria for the patients with gallbladder stones to extracorporeal shock wave lithotripsy(ESWL) by retrospectively analyzed our current results. Data obtained from 201 patients with gallbladder stones treated with ESWL and oral chemolytic agent from November 1988 to July 1992 were retrospectively analyzed. Ninety-six had radiolucent stones and 105 had radiopaque stones. We used piezoelectric lithotriptor(EDAP LT. 01) and there were no limitation in number of sessions or total number of shock waves. ESWL was repeated until the size of the largest fragment is smaller than 4 mm. Follow up ultrasound was done in every three months after the successful fragmentation. Average length of the follow up was 205 days. We analyzed the rate of successful fragmentation, number of shock waves needed to achieve successful fragmentation according to the size, number of stones as well as the presence of the calcification. Stone-free rate after 6 months was also calculated from all subgroups and compared to each other. The rate of successful fragmentation was 76.2% for radiolucent stones and 65.6% for radiopaque stones(p> 0.05) after 46,731 and 56,111 shock wave respectively(p > 0.05) The rate of successful fragmentation was highest in patients with single, radiolucent stone smaller than 2 cm(91.7%) followed by single radiolucent stone larger than 2 cm(83.3%), multiple calcified stones smaller than 2 cm (77.4%) and single calcified stone smaller than 2 cm(72.1%). The rate of complete stone clearance after 6 month follow-up was highest in patients with single radiolucent stone smaller than 2 cm (63.3%) and followed by multiple calcified stones smaller than 2 cm(37.3%), single calcified stone smaller than 2 cm(33.9%)(p < 0.05). To obtain better results with ESWL in patients with gallbladder stone, the authors propose a more strict inclusion criteria, which is the patient with a single, radiolucent stone smaller than 2 cm

  7. Evaluation gallbladder function in patients with spinal cord injury using 99Tcm-DISIDA hepatobiliary imaging

    International Nuclear Information System (INIS)

    Xia Changsuo; Li Hong; Hong Guangxiang

    2005-01-01

    Objective: To investigate gallbladder function in patients with spinal cord injury (SCI). Methods: Eighteen normal control subjects, 16 other traumatic control subjects and 46 SCI patients were include. Gallbladder function was quantitatively evaluated by 99 Tc m labeled imino-diacetic acid analogue (DISIDA) hepatobiliary imaging using two parameters as filling fraction (FF) and ejection fraction (EF). The gallbladder function of SCI patients was further analyzed according to age, sex, body weight, injury gradient (with ASIA criteria), cord injury level and the duration of injury. Results: 52% of SCI patients had abnormal FF and 59% with abnormal EF. Significantly decreased FF and EF values were found in SCI patients, especially in those who were female, severe and high-level injuries of spinal cord. Conclusion: With the use of quantitative 99 Tc m -DISIDA hepatobiliary imaging, significant impairment of the gallbladder function was found in SCI patients. (authors)

  8. Gallbladder carcinoma late metastases and incisional hernia at umbilical port site after laparoscopic cholecystectomy.

    Science.gov (United States)

    Ciulla, A; Romeo, G; Genova, G; Tomasello, G; Agnello, G; Cstronovo, Gaetano

    2006-05-01

    A potentially serious complication of laparoscopic cholecystectomy is the inadvertent dissemination of unsuspected gallbladder carcinoma. There are increasing reports of seeding of tumor at the trocar sites following laparoscopic cholecystectomy in patients with unexpected or inapparent gallbladder carcinoma. Although the mechanism of the abdominal wall recurrence is still unclear, laparoscopic handling of the tumor, perforation of the gallbladder, and extraction of the specimen without an endobag may be risk factors for the spreading of malignant cells. The Authors report the case of late development of umbilical metastasis after laparoscopic cholecystectomy; the presence of an incisional hernia and the finding of a stone in subcutaneous tissue demonstrate the diffusion of tumor cells into subcutaneous tissue during the extraction of gallbladder. The patient underwent an excision of the metastases. She is disease free two years after surgical treatment.

  9. Galled by the Gallbladder?: Your Tiny, Hard-Working Digestive Organ

    Science.gov (United States)

    ... Galled by the Gallbladder? Your Tiny, Hard-Working Digestive Organ En español Send us your comments Most ... among the most common and costly of all digestive system diseases. By some estimates, up to 20 ...

  10. Does Impaired Gallbladder Function Contribute to the Development of Barrett's Esophagus and Esophageal Adenocarcinoma?

    LENUS (Irish Health Repository)

    Nassr, Ayman O

    2011-06-01

    Esophageal adenocarcinoma is aetiologically associated with gastro-esophageal reflux, but the mechanisms responsible for the metaplasia-dysplasia sequence are unknown. Bile components are implicated. Impaired gallbladder function may contribute to duodenogastric reflux (DGR) and harmful GERD.

  11. Cholecystokinin-Assisted Hydrodissection of the Gallbladder Fossa during FDG PET/CT-guided Liver Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Tewari, Sanjit O., E-mail: tewaris@mskcc.org [Memorial Sloan-Kettering Cancer Center, Molecular Imaging and Therapy Service, Department of Radiology (United States); Petre, Elena N., E-mail: petree@mskcc.org [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States); Osborne, Joseph, E-mail: osbornej@mskcc.org [Memorial Sloan-Kettering Cancer Center, Molecular Imaging and Therapy Service, Department of Radiology (United States); Sofocleous, Constantinos T., E-mail: sofoclec@mskcc.org [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States)

    2013-12-15

    A 68-year-old female with colorectal cancer developed a metachronous isolated fluorodeoxyglucose-avid (FDG-avid) segment 5/6 gallbladder fossa hepatic lesion and was referred for percutaneous ablation. Pre-procedure computed tomography (CT) images demonstrated a distended gallbladder abutting the segment 5/6 hepatic metastasis. In order to perform ablation with clear margins and avoid direct puncture and aspiration of the gallbladder, cholecystokinin was administered intravenously to stimulate gallbladder contraction before hydrodissection. Subsequently, the lesion was ablated successfully with sufficient margins, of greater than 1.0 cm, using microwave with ultrasound and FDG PET/CT guidance. The patient tolerated the procedure very well and was discharged home the next day.

  12. Type II perforation of the body of the gallbladder in acalculous ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    have necrosis or gangrene, but may have a small perforation. Gallbladder ... surgical conditions and so specific treatment is ... persisting obstruction leads to vascular compromise gangrene ... alternative especially in high-risk patients19.

  13. Transpapilary drainage of the gallbladder; Report of two cases and literature revision

    International Nuclear Information System (INIS)

    Angel G, Rafael; Bonilla G, Romulo Arturo; Mejia Prado, Andres Felipe; Rojas Rodriguez, Carlos Arturo; Ospina Nieto, John

    2005-01-01

    We present two patients with cholelithiasis, repeated bouts of acute cholecystitis and high surgical risk secondary to coexisting illness, in which transpapilary drainage of the gallbladder was done. The literature is reviewed

  14. Management and diagnosis of gallbladder polyps: a systematic review.

    Science.gov (United States)

    Babu, Benoy I; Dennison, Ashley R; Garcea, Giuseppe

    2015-05-01

    Recommendation for management of gallbladder polyps (GBPs) >1 cm is cholecystectomy. No consensus exists on management of GBPs extraction was used to retrieve specified end points. Literature search yielded 43 manuscripts with a dataset of 11,685 patients with GBPs. M:F ratio was 1.3:1. Average age (range) was 49 years (32-83). Patients with malignant GBPs had an average (range) age of 58 (50-66) years with M:F ratio of 0.78:1. Cholesterol polyps constituted 60.5% of GBPs followed by adenomas (15.2%) and cancer (11.6%). Malignant GBPs ≥1 cm, 1 cm is appropriate. For GBPs 10 mm.

  15. Six years' experience of minicholecystostomy for acute calculous gallbladder disease

    International Nuclear Information System (INIS)

    Lee, S.H.; Stoller, J.L.; Fache, J.S.; Gibney, R.G.; Burhenne, H.J.

    1990-01-01

    This paper assesses the value and outcome of combined surgical (mini-cholecystostomy) and radiologic stone extraction in high-risk patients with acute calculous gallbladder disease. Sixty-seven patients were treated over a 6-year period. Three were 37 women and 30 men (age range, 33-98 years; mean, 73 years). Fifty (74%) surgical procedures were performed under local anesthesia. Radiologic gallstone extraction was achieved in 49 patients (73%). Extra-corporeal shock wave lithotripsy was required in six patients to fragment large stones. Twelve patients (18%) also had bile duct stones, of which 8 (67%) were successfully cleared. There were 4 deaths (6%) within 30 days. Twelve cholecystectomies (18%) were performed between 3 and 19 weeks (mean, 9 weeks) after minicholecystostomy as a result of failed stone clearance. The long-term outcome for those patients whose gallstones were cleared are discussed

  16. Spontaneous Hepatic Infarction in a Patient with Gallbladder Cancer

    Directory of Open Access Journals (Sweden)

    Kang Min Lee

    2016-06-01

    Full Text Available Hepatic infarction is known as a rare disease entity in nontransplant patients. Although a few cases of hepatic infarction have been reported to be linked with invasive procedures, trauma, and hypercoagulability, a case of spontaneous hepatic infarction in a nontransplanted patient has hardly ever been reported. However, many clinical situations of patients with cancer, in particular biliary cancer, can predispose nontransplant patients to hepatic infarction. Besides, the clinical outcome of hepatic infarction in patients with cancer can be worse than in patients with other etiologies. As for treatment, anticoagulation treatment is usually recommended. However, because of its multifactorial etiology and combined complications, treatment of hepatic infarction is difficult and not simple. Herein, we report a case of fatal hepatic infarction that occurred spontaneously during the course of treatment in a patient with gallbladder cancer. Hepatic infarction should be considered as a possible fatal complication in patients during treatment of biliary malignancies.

  17. Indication and Usefulness of Bile Juice Cytology for Diagnosis of Gallbladder Cancer

    Directory of Open Access Journals (Sweden)

    Hiroshi Itsuki

    2018-01-01

    Full Text Available Aim. We examined the effectiveness of bile juice cytology for distinguishing between benign and malignant gallbladder lesions of the protruding type with various sampling points, sampling methods, and macroscopic forms in order to discuss the effectiveness of the endoscopic transpapillary gallbladder drainage (ETGD cytology. Methods. We studied 162 cases of patients with a lesion localized within the gallbladder. At first, we examined the effectiveness for diagnosis of ETBD cytology using ERC and then that of the first ETGD cytology after placing the ETGD. Next, we examined the diagnostic effectiveness of the washed ETGD cytology by using the ETGD. Finally, we examined complications. Results. In the final diagnoses, we identified 33 cases of adenocarcinoma, 10 cases of adenoma, 63 cases of ADM, 35 cases of nonneoplastic polyp, and 21 cases of chronic cholecystitis. It was found that the sensitivity of ETBD cytology was 3.6% and that of ETGD cytology was 59.1%. In the comparison of diagnostic effectiveness of cytologic diagnosis using samples of bile juice from the gallbladder collected by different methods, the sensitivities were 38.9% and 73.3% for the first and washed ETGD cytologies, respectively. In the comparison of the diagnostic effectiveness of gallbladder bile juice cytology using samples collected for different forms of lesion and by different methods, the sensitivities were 38.9% and 73.3%, respectively, for the first and washed ETGD cytologies for flat gallbladder wall thickening, while it was impossible to diagnose for lesions of GB polyp. Conclusion. For diagnosis of gallbladder cancer, we consider that the ETGD cytology should be taken into consideration for lesions of flat gallbladder wall thickening, for which it is difficult to distinguish between benign and malignant lesions.

  18. The assessment of gallbladder with various fatty meal in oral cholecystography

    International Nuclear Information System (INIS)

    Yeon, Jeong Hum; Kwon, Lee Seon; Kim, Myung Sook; Cheung, Kyung Mo; Kim, Hea Sung; Cheung, Hwan

    1993-01-01

    However, technical advances in ultrasono imaging have had a remarkable impact on the study of biliary system oral cholecystography is a contrast of the gallbladder which is very frequently performed even with the application of Extra Shock Wave Lithotripsy(ESWL) in clinical use. Oral GB requires a stringent preparation if it is to be fully successful and a considerable amount of time to complete all its procedures and its objects of the radiographs. 1) to obtain a firm diagnosis of the presence of gallstones. 2) to ease function of the gallbladder that is, its ability to concentrate and store bile After a times sequence of X - ray exposures taken in various positions to show the gallbladder to be satisfactorily filled, the patient is given a fatty meal, for instances two eggs or a cup of milk. The gallbladder which is drained by the cystic duct stores and concentrates the bile and is stimulated to contrast and excrete the bile by hormone 'cholecystokinin' secreted in the intestinal mucosa. To evaluate the effect of the fatty meal which caused the gallbladder to constrict and empty, and by so doing the contrast medium passes through the cystic and bile ducts which are shown in radiographs exposed from 15-30 minutes after the variety practice of fatty meal, such as soft-boiled 2 eggs, raw 2 eggs, 100g of peanuts, and 200ml of milk. If the concentration of the opaque medium in the gallbladder is adequate, then not only the size, shape and position of the gallbladder will be shown from firms taken at intervals, the rate of concentration of the opaque medium and of the emptying of gallbladder has been measured and analyzed

  19. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era

    OpenAIRE

    Zhang, Wei-jie; Xu, Gui-fang; Huang, Qin; Luo, Kun-lun; Dong, Zhi-tao; Li, Jie-ming; Wu, Guo-zhong; Guan, Wen-xian

    2015-01-01

    Background: Laparoscopic common bile duct exploration (LCBDE) for stone can be carried out by either laparoscopic transcystic stone extraction (LTSE) or laparoscopic choledochotomy (LC). It remains unknown as to which approach is optimal for management of gallbladder stone with common bile duct stones (CBDS) in Chinese patients. Methods: From May 2000 to February 2009, we prospective treated 346 consecutive patients with gallbladder stones and CBDS with laparoscopic cholecystectomy and LCBDE....

  20. Association between Gallbladder Ultrasound Findings and Bacterial Culture of Bile in 70 Cats and 202 Dogs.

    Science.gov (United States)

    Policelli Smith, R; Gookin, J L; Smolski, W; Di Cicco, M F; Correa, M; Seiler, G S

    2017-09-01

    Bacterial cholecystitis often is diagnosed by combination of gallbladder ultrasound (US) findings and positive results of bile culture. The value of gallbladder US in determining the likelihood of bile bacterial infection in cats and dogs with suspected biliary disease is unknown. To determine the value of gallbladder US in predicting bile bacterial culture results, identify most common bacterial isolates from bile, and describe complications after cholecystocentesis in cats and dogs with suspected hepatobiliary disease. Cats (70) and dogs (202) that underwent an abdominal US and submission of bile for culture were included in the study. A cross-sectional study design was used to determine the association of gallbladder US abnormalities and the results of bile cultures, and complications of cholecystocentesis. Abnormal gallbladder US had high sensitivity (96%) but low specificity (49%) in cats with positive and negative results of bile bacterial culture, respectively. Cats with normal gallbladder US findings were unlikely to have positive bile bacterial culture (negative predictive value of 96%). Gallbladder US had lower sensitivity (81%), specificity (31%), positive predictive value (20%), and negative predictive value (88%) in dogs. The most common bacterial isolates were of enteric origin, the prevalence being higher in cats. Incidence of complications after cholecystocentesis was 3.4%. Gallbladder US has a high negative predictive value for bile culture results in cats. This modality is less predictive of infection in dogs. Percutaneous US-guided cholecystocentesis has a low complication rate. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  1. The assessment of gallbladder with various fatty meal in oral cholecystography

    Energy Technology Data Exchange (ETDEWEB)

    Yeon, Jeong Hum; Kwon, Lee Seon; Kim, Myung Sook; Cheung, Kyung Mo; Kim, Hea Sung; Cheung, Hwan [Seoul National University Hospital, Seoul (Korea, Republic of)

    1993-05-15

    However, technical advances in ultrasono imaging have had a remarkable impact on the study of biliary system oral cholecystography is a contrast of the gallbladder which is very frequently performed even with the application of Extra Shock Wave Lithotripsy(ESWL) in clinical use. Oral GB requires a stringent preparation if it is to be fully successful and a considerable amount of time to complete all its procedures and its objects of the radiographs. 1) to obtain a firm diagnosis of the presence of gallstones. 2) to ease function of the gallbladder that is, its ability to concentrate and store bile After a times sequence of X - ray exposures taken in various positions to show the gallbladder to be satisfactorily filled, the patient is given a fatty meal, for instances two eggs or a cup of milk. The gallbladder which is drained by the cystic duct stores and concentrates the bile and is stimulated to contrast and excrete the bile by hormone 'cholecystokinin' secreted in the intestinal mucosa. To evaluate the effect of the fatty meal which caused the gallbladder to constrict and empty, and by so doing the contrast medium passes through the cystic and bile ducts which are shown in radiographs exposed from 15-30 minutes after the variety practice of fatty meal, such as soft-boiled 2 eggs, raw 2 eggs, 100g of peanuts, and 200ml of milk. If the concentration of the opaque medium in the gallbladder is adequate, then not only the size, shape and position of the gallbladder will be shown from firms taken at intervals, the rate of concentration of the opaque medium and of the emptying of gallbladder has been measured and analyzed.

  2. Reproducibility of gallbladder ejection fraction measured by fatty meal cholescintigraphy

    International Nuclear Information System (INIS)

    Al-Muqbel, Kusai M.; Hani, M. N. Hani; Elheis, M. A.; Al-Omari, M. H.

    2010-01-01

    There are conflicting data in the literature regarding the reproducibility of the gallbladder ejection fraction (GBEF) measured by fatty meal cholescintigraphy (CS). We aimed to test the reproducibility of GBEF measured by fatty meal CS. Thirty-five subjects (25 healthy volunteers and 10 patients with chronic abdominal pain) underwent fatty meal CS twice in order to measure GBEF1 and GBEF2. The healthy volunteers underwent a repeat scan within 1-13 months from the first scan. The patients underwent a repeat scan within 1-4 years from the first scan and were not found to have chronic acalculous cholecystitis (CAC). Our standard fatty meal was composed of a 60-g Snickers chocolate bar and 200 ml full-fat yogurt. The mean ± SD values for GBEF1 and GBEF2 were 52±17% and 52±16%, respectively. There was a direct linear correlation between the values of GBEF1 and GBEF2 for the subjects, with a correlation coefficient of 0.509 (p=0.002). Subgroup data analysis of the volunteer group showed that there was significant linear correlation between volunteer values of GBEF1 and GBEF2, with a correlation coefficient of 0.473 (p=0.017). Subgroup data analysis of the non-CAC patient group showed no significant correlation between patient values of GBEF1 and GBEF2, likely due to limited sample size. This study showed that fatty meal CS is a reliable test in gallbladder motility evaluation and that GBEF measured by fatty meal CS is reproducible

  3. Reproducibility of gallbladder ejection fraction measured by fatty meal cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Al-Muqbel, Kusai M.; Hani, M. N. Hani; Elheis, M. A.; Al-Omari, M. H. [School of Medicine, Jordan University of Science and Technology, Irbid (Jordan)

    2010-12-15

    There are conflicting data in the literature regarding the reproducibility of the gallbladder ejection fraction (GBEF) measured by fatty meal cholescintigraphy (CS). We aimed to test the reproducibility of GBEF measured by fatty meal CS. Thirty-five subjects (25 healthy volunteers and 10 patients with chronic abdominal pain) underwent fatty meal CS twice in order to measure GBEF1 and GBEF2. The healthy volunteers underwent a repeat scan within 1-13 months from the first scan. The patients underwent a repeat scan within 1-4 years from the first scan and were not found to have chronic acalculous cholecystitis (CAC). Our standard fatty meal was composed of a 60-g Snickers chocolate bar and 200 ml full-fat yogurt. The mean {+-} SD values for GBEF1 and GBEF2 were 52{+-}17% and 52{+-}16%, respectively. There was a direct linear correlation between the values of GBEF1 and GBEF2 for the subjects, with a correlation coefficient of 0.509 (p=0.002). Subgroup data analysis of the volunteer group showed that there was significant linear correlation between volunteer values of GBEF1 and GBEF2, with a correlation coefficient of 0.473 (p=0.017). Subgroup data analysis of the non-CAC patient group showed no significant correlation between patient values of GBEF1 and GBEF2, likely due to limited sample size. This study showed that fatty meal CS is a reliable test in gallbladder motility evaluation and that GBEF measured by fatty meal CS is reproducible

  4. Liver and gallbladder cancer in immigrants to Sweden.

    Science.gov (United States)

    Hemminki, Kari; Mousavi, Seyed Mohsen; Brandt, Andreas; Ji, Jianguang; Sundquist, Jan

    2010-03-01

    The changes of cancer incidence upon immigration can be used as an estimator of environmental influence on cancer risk. We studied site-specific liver and biliary cancers in first-generation immigrants to Sweden with an aim to search for aetiological clues and to find evidence for indigenous incidence rates. We used the nation-wide Swedish Family-Cancer Database to calculate standardised incidence ratios (SIRs) in immigrants compared to native Swedes. A total of 1428 cancers were identified in immigrants whose median ages (years) at immigration were 27 for men and 26 for women and whose median diagnostic ages were 64 and 66, respectively. The highest SIRs of 6.7 for primary liver cancer were observed for men from East Asia and sub-Saharan Africa. Increased SIRs were recorded for male immigrants from previous Yugoslavia (1.78), Southern Europe (2.91), Turkey (2.15) and Asian Arab countries (2.89). For gallbladder cancer, only women from the Indian subcontinent (3.84) and Chile (2.34) had increased risk while some Northern European immigrants showed decreased risks. Primary liver cancer was increased in immigrants from endemic regions of hepatitis B virus infection but also from large regions lacking cancer incidence data, North Africa, Asian Arab countries, Turkey and previous Yugoslavia; these are probably intermediary risk regions for this infection. The consideration of these regions as risk areas would justify active diagnostic and vaccination programs. The increase in gallbladder cancer in Chileans and Indians suggests that some persistent damage was inflicted before emigration, characterisation of which will be a challenge for aetiological studies. Copyright 2009 Elsevier Ltd. All rights reserved.

  5. Practice Hospital Bed Safety

    Science.gov (United States)

    ... Home For Consumers Consumer Updates Practice Hospital Bed Safety Share Tweet Linkedin Pin it More sharing options ... It depends on the complexity of the bed." Safety Tips CDRH offers the following safety tips for ...

  6. Bed Bugs and Schools

    Science.gov (United States)

    Bed bugs have long been a pest – feeding on blood, causing itchy bites and generally irritating their human hosts. They are successful hitchhikers, and can move from an infested site to furniture, bedding, baggage, boxes, and clothing.

  7. Medical and surgical management of gallbladder sludge and mucocoele development in a Miniature Schnauzer

    Directory of Open Access Journals (Sweden)

    Harvey Saunders

    2017-06-01

    Full Text Available The factors enhancing mucocoele development in dogs remain poorly understood. A 7-year-old female spayed Miniature Schnauzer was presented to the Massey University Veterinary Teaching Hospital for progressive lethargy, inappetance and abdominal discomfort. Initial physical examination findings revealed a moderate degree of cranial abdominal pain, with subsequent diagnostic tests confirming the patient as having diabetes mellitus, with a concurrent marked hypertriglyceridaemia. In an attempt to localise the source of pain, an ultrasound examination of the abdomen was performed, revealing a marked degree of gallbladder sludge. With appropriate medical management including ursodeoxycholic acid and insulin therapy, the patient stabilised and was discharged. With persistence of clinical signs three months later, progression of the gallbladder sludge towards mucocoele development was suspected. Exploratory laparotomy was instigated, and an emergency cholecystectomy was performed. This case report therefore entails a suspected gallbladder mucocoele that developed in a diabetic patient with previously diagnosed biliary sludge. A unique feature of this case report is the presence of diabetes mellitus, which has been suggested to be a causative factor in the development of gallbladder mucocoeles. It is also hypothesised that gallbladder sludge and mucocoeles are associated, however it is yet to be ascertained whether this association is causal or contributory. The authors examined the possible relationship between this endocrinopathy and biliary sludge, and their possible effects on mucocoele development. Specific associated factors to sludge formation are also examined. The medical and surgical management of gallbladder mucocoeles is discussed.

  8. A case report of the clear cell variant of gallbladder carcinoma.

    Science.gov (United States)

    Maharaj, Ravi; Cave, Christo; Sarran, Kevin; Bascombe, Nigel; Dan, Dilip; Greaves, Wesley; Warner, Wayne A

    2017-01-01

    Clear cell gallbladder carcinoma accounts for less than 1% of all gallbladder malignancies and demonstrates its unique histopathological characteristics in patients with no prior medical illness or familial predisposition. Here we present a case of a 56-year-old female, with no prior medical conditions presented with a 2-month history of upper abdominal pain. Routine hematological and biochemical tests were unremarkable. An abdominal ultrasound revealed the presence of a gallbladder calculi, and a fundic mass while magnetic resonance cholangiopancreatography revealed a 8.0cm×3.5cm gallbladder mass. Computed tomography imaging excluded any distant haematogenous metastases. An open cholecystectomy with lymphadenectomy was proceeded by staging laparoscopy. Upon pathologic investigation, the morphologic and immunophenotypic features supported a diagnosis of clear cell variant of gallbladder carcinoma. Pathological prognostications for primary clear cell gall bladder carcinomas are not well defined due to the rarity of cases and possible misidentification as secondary metastases. Foci of adenocarcinoma within the tumor along with immunohistochemical staining probes can be informative in consideration of differential diagnosis. In these cases, clinical case management should be personalized for increased survival with the possible incorporation of next generation sequencing approaches to guide therapeutic algorithms. We discuss this exceedingly rare case of the clear cell variant of gallbladder carcinoma in detail, highlighting some of the diagnostic, and clinical challenges. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Expression of CCK Receptors in Carcinoma Gallbladder and Cholelithiasis: A Pilot Study.

    Science.gov (United States)

    Faridi, Mohammad Shazib; Jaiswal, Mahabir Saran Das; Goel, Sudhir K

    2015-07-01

    Gastrin and cholecystokinin (CCK) receptors are trophic for various gastrointestinal malignancies. Their role in gallbladder cancer has not been widely studied. To identify expression of CCK-A and CCK-B receptors in the tissue and blood of patients suffering from carcinoma (CA) gallbladder and gallstone disease and to compare expression of CCK A and B receptors in the gall bladder tissue and blood of healthy individuals and patients of CA gallbladder, and gallstone diseases. Forty nine subjects of both genders were recruited, comprising of 22 patients of CA gall bladder, 19 cases of cholelithiasis and, 8 normal gallbladders obtained from patients operated for trauma of the biliary system or Whipple's procedure. RNA extraction and cDNA formation for CCK-A and CCK-B receptors were carried out. Real Time PCR was performed on cDNA and threshold cycle (Ct) value of each sample was obtained and ΔCt was calculated. Chi-square test for comparing two groups and ANOVA test for comparing multiple groups were applied and if pgallbladder and there was no difference among them (p>0.05). This preliminary study showed higher expression of CCK-A receptors in patients of cholelithiasis and decreased expression of CCK-A receptors in patients of CA gallbladder as compared to normal gallbladder although it did not rise to statistical significance.

  10. Agenesis of the gallbladder with hypoplastic cystic duct diagnosed at laparoscopy.

    Science.gov (United States)

    Kwon, A-Hon; Yanagimoto, Hiroaki; Matsui, Yoichi; Imamura, Atsushi

    2006-08-01

    An 86-year-old man was admitted to our department with complaints of intermittent upper abdominal pain. Ultrasonography of the abdomen showed dilated extrahepatic bile ducts containing stones; however, the gallbladder was not clearly identified. Magnetic resonance cholangiopancreatography showed dilated extrahepatic ducts and choledocholithiasis without gallbladder visualization. The stone extraction was performed with endoscopic sphincterotomy. Three-dimensional images using spiral-computed tomography after intravenous-infusion cholangiography clearly demonstrated an obstruction of the cystic duct. The patient was scheduled for laparoscopic cholecystectomy. At laparoscopy, the gallbladder fossa was not identified on the undersurface of the liver. Despite a thorough examination of the intrahepatic (left-sided within the lesser omentum), retroperitoneal, retrohepatic (within the falciform ligament), retroduodenal, and retropancreatic areas using laparoscopic ultrasonography, the gallbladder was not found. After careful dissection of the hepatoduodenal ligament, the dilated extrahepatic bile duct and a 1-cm length of hypoplastic cystic duct were found. Gallbladder agenesis is usually accompanied by the lack of the cystic duct. The present case is the third report of gallbladder agenesis with a patent or hypoplastic cystic duct.

  11. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: A systematic review.

    Science.gov (United States)

    Berger-Richardson, David; Chesney, Tyler R; Englesakis, Marina; Govindarajan, Anand; Cleary, Sean P; Swallow, Carol J

    2017-03-01

    The risk of port-site metastasis after laparoscopic removal of incidental gallbladder cancer was previously estimated to be 14-30%. The present study was designed to determine the incidence of port-site metastasis in incidental gallbladder cancer in the modern era (2000-2014) versus the historic era (1991-1999). We also investigated the site of port-site metastasis. Using PRISMA, a systematic review was conducted to identify papers that addressed the development of port-site metastasis after laparoscopic resection of incidental gallbladder cancer. Studies that described cancer-specific outcomes in ≥5 patients were included. A validated quality appraisal tool was used, and a weighted estimate of the incidence of port-site metastasis was calculated. Based on data extracted from 27 papers that met inclusion criteria, the incidence of port-site metastasis in incidental gallbladder cancer has decreased from 18.6% prior to 2000 (95% confidence interval 15.3-21.9%, n = 7) to 10.3% since then (95% confidence interval 7.9-12.7%, n = 20) (P extraction site is at significantly higher risk than nonextraction sites. The incidence of port-site metastasis in incidental gallbladder cancer has decreased but remains high relative to other primary tumors. Any preoperative finding that raises the suspicion of gallbladder cancer should prompt further investigation and referral to a hepato-pancreato-biliary specialist. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Computer analysis of gallbladder ultrasonic images towards recognition of pathological lesions

    Science.gov (United States)

    Ogiela, M. R.; Bodzioch, S.

    2011-06-01

    This paper presents a new approach to gallbladder ultrasonic image processing and analysis towards automatic detection and interpretation of disease symptoms on processed US images. First, in this paper, there is presented a new heuristic method of filtering gallbladder contours from images. A major stage in this filtration is to segment and section off areas occupied by the said organ. This paper provides for an inventive algorithm for the holistic extraction of gallbladder image contours, based on rank filtration, as well as on the analysis of line profile sections on tested organs. The second part concerns detecting the most important lesion symptoms of the gallbladder. Automating a process of diagnosis always comes down to developing algorithms used to analyze the object of such diagnosis and verify the occurrence of symptoms related to given affection. The methodology of computer analysis of US gallbladder images presented here is clearly utilitarian in nature and after standardising can be used as a technique for supporting the diagnostics of selected gallbladder disorders using the images of this organ.

  13. Interposition of the gallbladder in the common hepatic duct: a rare dangerous anomaly. Case report.

    Science.gov (United States)

    Rosato, L; Ginardi, A; Mondini, G

    2011-01-01

    Anomalies of the gallbladder position in the biliary tract are rare, but they could be very dangerous during cholecystectomy. A 48-year-old man presented with a 2-week history of intermittent epigastric pain, scleral jaundice and elevation of liver function tests. After a magnetic resonance cholangiogram and an endoscopic retrograde cholangiogram with sphincterotomy, he was submitted to laparoscopic cholecystectomy, the conversion to laparotomy was decided for the suspect of gallbladder interposition. The anatomical anomaly was confirmed and a Roux-en-Y hepaticojejunostomy was executed, with end-to-side anastomosis between the confluence of the hepatic ducts and the fourth loop of jejunum, on a biliary stent. This catheter was removed in the tenth postoperative day; after cholangiography and CT abdominal scan the patient was discharged, without complications. The gallbladder interposition is a rare malformation which seems to arise from an embryonic anomaly occurring between the 4th and the 5th week and whose potential causes have not been detected. A similar outcome could be also determined by a Mirizzi syndrome, but in our case it is excluded because intra-operatively there was no inflammatory reaction that could justify the presence of a fistula between the gallbladder and the common hepatic duct. Once the gallbladder interposition is found, the surgical treatment consists in removing the gallbladder itself and the corresponding part of the common hepatic duct. The reconstruction is carried out by a Roux-en-Y hepaticojejunostomy with anastomosis at the hepatic hilum, positioning a biliary stent.

  14. Tyrosine hydroxylase positive nerves and mast cells in the porcine gallbladder

    Directory of Open Access Journals (Sweden)

    I. Stefanov

    2017-03-01

    Full Text Available The aim of this study was to detect the localisation of tyrosine hydroxylase (TH positive nerve fibres (THN and distribution of tyrosine hydroxylase positive mast cells (THMC in the wall of porcine gallbladder. THN were observed as single fibres, nerve fibres forming perivascular plexuses and nerve fibres grouped within the nerve fascicles. In the gallbladder`s fundus, body and neck, the TH+ fibres formed mucosal, muscular and serosal nonganglionated nerve plexuses. Toluidine blue (TB staining was used to confirm that the TH positive cells were mast cells. The number of THMC in the propria of gallbladder`s fundus, body and neck was significantly higher than in the muscular and serosal layers in both genders. The number of mast cells in the musculature was higher than in the serosa. The density and location of the THMC were similar to the TB positive (with gamma meta-chromasia mast cells in both males and females, and statistically significant difference was not established. In conclusion, original data concerning the existence and localisation of catecholaminergic nerves and THMC distribution in the porcine gallbladder’s wall are presented. The results could con-tribute to the body of knowledge of functional communication between autonomic nerves and mast cells in the gallbladder.

  15. A clinicopathological study of nine cases of gallbladder carcinoma in 1122 cholecystectomies in Johor, Malaysia.

    Science.gov (United States)

    Khoo, Joon Joon; Nurul, Akmar Misron

    2008-06-01

    An audit of 1122 cholecystectomies for a 6-year period from 2000 to 2005 was done to review cases of primary carcinoma of gallbladder. There were nine cases of primary carcinoma of gallbladder. Six were females and 3 males. Their ages ranged from 27 to 81 years. Pre-operatively, only 2 (11.1%) were clinically suspected of carcinoma while 3 were diagnosed as cholecystitis, two as cholelithiasis and one case each of ovarian cyst and intestinal obstruction. Intra-operatively, an additional four cases were suspected as gallbladder carcinoma with the remaining three cases diagnosed as only having gallstones. Altogether only 5 (55.6%) cases were associated with gallstones. Six (66.67%) cases of gallbladder carcinoma had abnormal macroscopical lesions noted; either papillary lesions or polypoid masses. The remaining 3 cases had thickening of the wall, consistent with chronic cholecystitis. Seven cases were found histologically to be adenocarcinoma. Of these, two were papillary carcinoma and one signet ring cell type adenocarcinoma. One case of squamous cell carcinoma and one case of adenosquamous carcinoma were noted. This study highlights the importance of careful macroscopical and microscopical evaluation of a routine pathological examination of gallbladder removed for cholecystitis or cholelithiasis. It provides the incidence of gallbladder carcinoma in patients who underwent cholecystectomies in a government hospital in Johor, Malaysia.

  16. Neuroendocrine tumors of the gallbladder: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Mezi Silvia

    2011-07-01

    Full Text Available Abstract Introduction Primary gallbladder neuroendocrine tumors are extremely rare, representing 0.2% of all neuroendocrine tumors. The diagnosis is incidental in most cases. Case presentation We describe the case of a 57-year-old Caucasian man who underwent laparoscopic cholecystectomy for the evaluation of a gallbladder polyp that had been incidentally detected by ultasonography. Histologically, his lesion was composed of monomorphic cells that contained small round nuclei and that were organized in small nodular, trabecular, and acinar structures. His cells were positive for chromogranin A and synaptophysin, and a diagnosis of "typical" carcinoid of the gallbladder was made. His post-operative computerized axial tomography, 111In-pentetreotide scintigraphy, and hormone-specific marker results were negative. He is disease-free 45 months after surgical treatment. Conclusions Characteristic pathological findings of the gallbladder neuroendocrine tumors predict the prognosis. Whereas classical carcinoids of the gallbladder only rarely have a metastatic or invasive phenotype, the "atypical" variants are more aggressive and are associated with a poorer prognosis. Given the difficulty in distinguishing between benign and malignant lesions in the pre-surgical setting, we tend to consider each polypoid-like lesion of the gallbladder to be a high-risk lesion if it is larger than 1 cm and, as a result, to emphasize the need for cholecystectomy in all cases, relying on the pathological and immunohistochemistry analyses for the final diagnosis.

  17. Gallbladder ejection fraction (GBEF): after 0.02(G/KG cholecystokinin (CCK) infusion over 30 minutes in patients with a low probability of gallbladder disease

    International Nuclear Information System (INIS)

    Docherty, P.; Micallef, L.; Gruenewald, S.; Larcos, G.

    2003-01-01

    Full text: Recent literature suggests that an infusion of 0.02 (g/Kg of CCK results in a narrower range of normal GBEF than an infusion 0.01(g/Kg of. Our aim was to investigate the effect of a 30-minutes infusion of 0.02 (g/Kg, in patients with a low probability of gallbladder disease. Sixty patients presenting with abdominal symptoms were referred to West mead Medical Imaging over a 9-month period for DISIDA biliary scans. 1-minute dynamic images were collected over 90 minutes. The CCK infusion was commenced when the gallbladder was well filled. GBEF was calculated from background corrected time activity curves over the gallbladder. Sixteen patients were excluded because of previous cholecystectomy or known gallbladder disease. Thirty-three patients were considered to have a low probability of gallbladder disease after final diagnoses were obtained from referring doctors. The mean GBEF for this group was 65.6%, SD 17.2 with a mean range 28-98% compared with mean 56.9%, SD 18.1 with a mean range 21-85% of our previous study using 0.01(gCCK. Females exhibited lower GBEFs than males while females under 50 gave the lowest mean. We concluded that the higher dose infusion causes more complete gallbladder emptying, and that there is a difference in GBEF between males and females of different ages. We question the validity of the same 'Normal' range being applied to both genders and all age groups. Copyright (2003) The Australian and New Zealand Society of Nuclear Medicine Inc

  18. Subdural hemorrhage: A unique case involving secondary vitamin K deficiency bleeding due to biliary atresia.

    Science.gov (United States)

    Miyao, Masashi; Abiru, Hitoshi; Ozeki, Munetaka; Kotani, Hirokazu; Tsuruyama, Tatsuaki; Kobayashi, Naho; Omae, Tadaki; Osamura, Toshio; Tamaki, Keiji

    2012-09-10

    Extrahepatic biliary atresia (EHBA) is a rare disease characterized by progressive and obliterative cholangiopathy in infants and is one of the major causes of secondary vitamin K deficiency bleeding (VKDB) due to cholestasis-induced fat malabsorption. Breast feeding increases the tendency of bleeding in EHBA patients because breast milk contains low amounts of vitamin K. A 2-month-old female infant unexpectedly died, with symptoms of vomiting and jaundice prior to death. She had been born by uncomplicated vaginal delivery and exhibited normal growth and development with breastfeeding. There was no history of trauma. She received vitamin K prophylaxis orally. In an emergency hospital, a CT scan showed a right intracranial hematoma and mass effect with midline shift to the left. In the postmortem examination, severe atresia was observed in the whole extrahepatic bile duct. Histologically, cholestasis, periductal fibrosis, and distorted bile ductules were noted. The gallbladder was not identified. A subdural hematoma and cerebellar tonsillar herniation were found; however, no traumatic injury in any part of the body was observed. Together, these findings suggest that the subdural hemorrhage was caused by secondary vitamin K deficiency resulting from a combination of cholestasis-induced fat malabsorption and breastfeeding. Subdural hemorrhage by secondary VKDB sometimes occurs even when vitamin K prophylaxis is continued. This case demonstrated that intrinsic factors, such as secondary VKDB (e.g., EHBA, neonatal hepatitis, chronic diarrhea), should also be considered in infant autopsy cases presenting with subdural hemorrhage. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. Gastric ulcer bleeding: diagnosis by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Voloudaki, Argyro; Tsagaraki, Kaliopi; Mouzas, John; Gourtsoyiannis, Nickolas

    1999-06-01

    A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas.

  20. Gastric ulcer bleeding: diagnosis by computed tomography

    International Nuclear Information System (INIS)

    Voloudaki, Argyro; Tsagaraki, Kaliopi; Mouzas, John; Gourtsoyiannis, Nickolas

    1999-01-01

    A case of CT demonstration of a bleeding gastric ulcer is presented, in a patient with confusing clinical manifestations. Abdominal CT was performed without oral contrast medium administration, and showed extravasation of intravenous contrast into a gastric lumen distended with material of mixed attenuation. It is postulated that if radiopaque oral contrast had been given, peptic ulcer bleeding would probably have been masked. CT demonstration of gastric ulcer bleeding, may be of value in cases of differential diagnostic dilemmas

  1. Upper gastrointestinal bleeding in patients with CKD.

    Science.gov (United States)

    Liang, Chih-Chia; Wang, Su-Ming; Kuo, Huey-Liang; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Lin, Hsin-Hung; Wang, I-Kuan; Yang, Ya-Fei; Lu, Yueh-Ju; Chou, Che-Yi; Huang, Chiu-Ching

    2014-08-07

    Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (Pupper gastrointestinal bleeding risk. In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin. Copyright © 2014 by the American Society of Nephrology.

  2. Management of acute gastric varices bleeding

    Directory of Open Access Journals (Sweden)

    Chen-Jung Chang

    2013-10-01

    Full Text Available Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10–30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.

  3. Serendipity in scintigraphic gastrointestinal bleeding studies

    International Nuclear Information System (INIS)

    Goergen, T.G.

    1983-01-01

    A retrospective review of 80 scintigraphic bleeding studies performed with Tc-99m sulfur colloid or Tc-99m labeled red blood cells showed five cases where there were abnormal findings not related to bleeding. In some cases, the abnormalities were initially confused with bleeding or could obscure an area of bleeding, while in other cases, the abnormalities represented additional clinical information. These included bone marrow replacement related to tumor and radiation therapy, hyperemia related to a uterine leiomyoma and a diverticular abscess, and a dilated abdominal aorta (aneurysm). Recognition of such abnormalities should prevent an erroneous diagnosis and the additional information may be of clinical value

  4. Minor Bleeds Alert for Subsequent Major Bleeding in Patients Using Vitamin K Antagonists.

    OpenAIRE

    Veeger , Nic J.G.M.; Piersma-Wichers , Margriet; Meijer , Karina; Hillege , Hans L.

    2011-01-01

    Abstract Vitamin K antagonists (VKA) have shown to be effective in primary and secondary prevention of thromboembolism, but the associated risk of bleeding is an important limitation. The majority of the bleeds are clinically mild. In this study, we assessed whether these minor bleeds are associated with major bleeding, when controlling for other important risk indicators, including the achieved quality of anticoagulation. For this, 5898 patients of a specialised anticoagulation cl...

  5. Provocative Endoscopy to Identify Bleeding Site in Upper Gastrointestinal Bleeding: A Novel Approach in Transarterial Embolization.

    Science.gov (United States)

    Kamo, Minobu; Fuwa, Sokun; Fukuda, Katsuyuki; Fujita, Yoshiyuki; Kurihara, Yasuyuki

    2016-07-01

    This report describes a novel approach to endoscopically induce bleeding by removing a clot from the bleeding site during angiography for upper gastrointestinal (UGI) hemorrhage. This procedure enabled accurate identification of the bleeding site, allowing for successful targeted embolization despite a negative initial angiogram. Provocative endoscopy may be a feasible and useful option for angiography of obscure bleeding sites in patients with UGI arterial hemorrhage. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  6. Menstrual Patterns and Treatment of Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders.

    Science.gov (United States)

    Dowlut-McElroy, Tazim; Williams, Karen B; Carpenter, Shannon L; Strickland, Julie L

    2015-12-01

    To characterize menstrual bleeding patterns and treatment of heavy menstrual bleeding in adolescents with bleeding disorders. We conducted a retrospective review of female patients aged nine to 21 years with known bleeding disorders who attended a pediatric gynecology, hematology, and comprehensive hematology/gynecology clinic at a children's hospital in a metropolitan area. Prevalence of heavy menstrual bleeding at menarche, prolonged menses, and irregular menses among girls with bleeding disorders and patterns of initial and subsequent treatment for heavy menstrual bleeding in girls with bleeding disorders. Of 115 participants aged nine to 21 years with known bleeding disorders, 102 were included in the final analysis. Of the 69 postmenarcheal girls, almost half (32/69, 46.4%) noted heavy menstrual bleeding at menarche. Girls with von Willebrand disease were more likely to have menses lasting longer than seven days. Only 28% of girls had discussed a treatment plan for heavy menstrual bleeding before menarche. Hormonal therapy was most commonly used as initial treatment of heavy menstrual bleeding. Half (53%) of the girls failed initial treatment. Combination (hormonal and non-hormonal therapy) was more frequently used for subsequent treatment. Adolescents with bleeding disorders are at risk of heavy bleeding at and after menarche. Consultation with a pediatric gynecologist and/or hematologist prior to menarche may be helpful to outline abnormal patterns of menstrual bleeding and to discuss options of treatment in the event of heavy menstrual bleeding. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  7. Association of BDNF and BMPR1A with clinicopathologic parameters in benign and malignant gallbladder lesions

    Science.gov (United States)

    2013-01-01

    Background Neurotrophic factors such as brain derived neurotrophic factor (BDNF) are synthesized in a variety of neural and non-neuronal cell types and regulate survival, proliferation and apoptosis. In addition, bone morphogenetic proteins (BMPs) inhibit the proliferation of pulmonary large carcinoma cells bone morphogenetic protein receptor, type IA (BMPR1A). Little is known about the expression of BDNF or BMPR1A in malignant gall bladder lesions. This study was to evaluate BDNF and BMPR1A expression and evaluate the clinicopathological significance in benign and malignant lesions of the gallbladder. Methods The BDNF and BMPR1A expression of gallbladder adenocarcinoma, peritumoral tissues, adenoma, polyp and chronic cholecystitis were Immunohistochemically determined. Results BDNF expression was significantly higher in gallbladder adenocarcinoma than in peritumoral tissues, adenoma, polyps and chronic cholecystitis samples. However, BMPR1A expression was significantly lower in gallbladder adenocarcinoma than in peritumoral tissues, adenomas, polyps and chronic cholecystitis tissues. The specimens with increased expression of BDNF in the benign lesions exhibited moderate- or severe-dysplasia of gallbladder epithelium. BDNF expression was significantly lower in well-differentiated adenocarcinomas with maximum tumor diameter 2 cm, metastasis of lymph node, and invasiveness of regional tissues in gallbladder adenocarcinoma. BMPR1A expression were significantly higher in the well-differentiated adenocarcinoma with maximal tumor diameter 2 cm, metastasis of lymph node, and invasiveness of regional tissues in gallbladder. Univariate Kaplan-Meier analysis indicated increased expression of BDNF or decreased expression of BMPR1A was associated with decreased disease specific survival (DSS) rates. Similarly, multivariate Cox regression analysis showed increased expression of BDNF or decreased expression of BMPR1A are independent predictors of poor DSS rates in gallbladder

  8. PREVALENCE OF INCIDENTAL GALLBLADDER CANCER IN A TERTIARY-CARE HOSPITAL FROM PERNAMBUCO, BRAZIL

    Directory of Open Access Journals (Sweden)

    Euclides Dias MARTINS-FILHO

    2015-09-01

    Full Text Available BackgroundGallbladder cancer is sometimes incidentally uncovered following cholecystectomy for gallstones diseases. The supposed highly variable prevalence of incidental gallbladder cancer through our country is unknown.ObjectiveTo explore the prevalence of incidental gallbladder cancer in our tertiary-care hospital.MethodsA cross-sectional study was carried out on patients who consecutively underwent cholecystectomy due to gallstones disease at Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira - FPS/IMIP, from January, 2007 to December, 2010. Data on incidental gallbladder cancer patients were explored for prevalence estimation and description of our experience with the management of this malignancy.ResultsOur analysis involved 2018 patients with a marked predominance of women (n=1.697; 84.1% over men (n=321; 15.9%. The 3-year prevalence estimate of 0.34% was recorded for incidental gallbladder cancer in our sample. Regarding tumor staging, there were 1 T1a, 1 T1b, and 5 T2 adenocarcinoma tumors. Laparoscopic cholecystectomy alone was performed for the T1a tumor, and additional radical surgery was performed in five others. One patient presented metastatic disease at the time of repeat surgery. The final pathology revealed residual/additional disease in all T2 tumors after radical surgery whereas the T1b patient underwent a salvage Whipple’s procedure due to a secondary distal cholangiocarcinoma. The patient with T1a tumor is alive after 3-year follow-up but all of the others died because of disease recurrence/progression up to 12 months.ConclusionThis study confirms the poor prognosis of Gallbladder cancer even when incidentally diagnosed following cholecystectomy and supposes a 3-year prevalence estimate of 0.34% for incidental gallbladder cancer in our Center from Pernambuco State, Brazil.

  9. Outcome of gallbladder preservation in surgical management of primary bile duct stones.

    Science.gov (United States)

    Tian, Ming-Guo; Shi, Wei-Jin; Wen, Xin-Yuan; Yu, Hai-Wen; Huo, Jing-Shan; Zhou, Dong-Feng

    2003-08-01

    To evaluate the methods and outcome of gallbladder preservation in surgical treatment of primary bile duct stones. Thirty-five patients with primary bile duct stones and intact gallbladders received stone extraction by two operative approaches, 23 done through the intrahepatic duct stump (RBD-IDS, the RBD-IDS group) after partial hepatectomy and 12 through the hepatic parenchyma by retrograde puncture (RBD-RP, the RBD-RP group). The gallbladders were preserved and the common bile duct (CBD) incisions were primarily closed. The patients were examined postoperatively by direct cholangiography and followed up by ultrasonography once every six months. In the RBD-IDS group, residual bile duct stones were found in three patients, which were cleared by a combination of fibrocholedochoscopic extraction and lithotripsy through the drainage tracts. The tubes were removed on postoperative day 22 (range: 16-42 days). In the RBD-RP group, one patient developed hemobilia and was cured by conservative therapy. The tubes were removed on postoperative day 8 (range: 7-11 days). Postoperative cholangiography showed that all the gallbladders were well opacified, contractile and smooth. During 54 (range: 6-120 months) months of follow-up, six patients had mildly thickened cholecystic walls without related symptoms and further changes, two underwent laparotomies because of adhesive intestinal obstruction and gastric cancer respectively, three died of cardiopulmonary diseases. No stones were found in all the preserved gallbladders. The intact gallbladders preserved after surgical extraction of primary bile duct stones will not develop gallstones. Retrograde biliary drainage is an optimal approach for gallbladder preservation.

  10. Radiofrequency thermal ablation of benign cystic lesion: an experimental pilot study in a porcine gallbladder model

    International Nuclear Information System (INIS)

    Song, Ho Taek; Rhim, Hyun Chul; Choi, Jung Bin; Oh, Jae Cheon; Cho, On Koo; Koh, Byung Hee; Kim, Yong Soo; Seo, Heung Suk; Joo, Kyung Bin

    2001-01-01

    To determine whether radiofrequency thermal ablation can be used to treat benign cystic lesions in a porcine gallbladder model. This experimental study of radiofrequency thermal ablation involved the use of 15 exvivo porcine gallbladders and 15-G expandable needle electrodes. To investigate optimal temperature parameters, three groups of five were designated according to target temperature:Group A: 70 deg C; Group B: 80 deg C; Group C: 90 deg C. After the target temperature was reached, ablation lasted for one minute. Gallbladder width, height and length were measured before and after ablation , and the estimated volume reduction ratios of the three groups were compared. Whether adjacent liver parenchyma around the gallbladder fossa was ablated by heat conducted from hot bile was also determined, and the thickness of the ablated area of the liver was measured. The volume reduction ratio in Group A, B and C was 42.7%, 41.7% and 42.9%, respectively (ρ>.05). In all 15 cases, gallbladder walls lost their transparency and elasticity at about 70 deg C. In nine of ten cases in Groups B and C, the hepatic capsule around the gallbladder fossa was retracted at about 80 deg C. The mean thickness of liver parenchymal damage adjacent to the gallbladder was 5.4 mm in Group B and 9.8 mm in Group C. In Group A livers, only one case showed minimal gradual parenchymal change. Microscopically, all three groups showed complete coagulation necrosis of the wall. On the basis of this feasibility study, radiofrequency thermal ablation is potentially suitable for the ultrasound-guided treatment of symptomatic cystic lesions including benign hepatic or renal cyst

  11. Helical CT in acute lower gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Ernst, Olivier; Leroy, Christophe; Sergent, Geraldine; Bulois, Philippe; Saint-Drenant, Sophie; Paris, Jean-Claude

    2003-01-01

    The purpose of this study was to assess the usefulness of helical CT in depicting the location of acute lower gastrointestinal bleeding. A three-phase helical CT of the abdomen was performed in 24 patients referred for acute lower gastrointestinal bleeding. The diagnosis of the bleeding site was established by CT when there was at least one of the following criteria: spontaneous hyperdensity of the peribowel fat; contrast enhancement of the bowel wall; vascular extravasation of the contrast medium; thickening of the bowel wall; polyp or tumor; or vascular dilation. Diverticula alone were not enough to locate the bleeding site. The results of CT were compared with the diagnosis obtained by colonoscopy, enteroscopy, or surgery. A definite diagnosis was made in 19 patients. The bleeding site was located in the small bowel in 5 patients and the colon in 14 patients. The CT correctly located 4 small bowel hemorrhages and 11 colonic hemorrhages. Diagnosis of the primary lesion responsible for the bleeding was made in 10 patients. Our results suggest that helical CT could be a good diagnostic tool in acute lower gastrointestinal bleeding to help the physician to diagnose the bleeding site. (orig.)

  12. First trimester bleeding and maternal cardiovascular morbidity

    DEFF Research Database (Denmark)

    Lykke, Jacob A; Langhoff-Roos, Jens

    2012-01-01

    First trimester bleeding without miscarriage is a risk factor for complications later in the pregnancy, such as preterm delivery. Also, first trimester miscarriage has been linked to subsequent maternal ischemic heart disease. We investigated the link between maternal cardiovascular disease prior...... to and subsequent to first trimester bleeding without miscarriage....

  13. Rectal bleeding in children: endoscopic evaluation revisited

    NARCIS (Netherlands)

    de Ridder, Lissy; van Lingen, Anna V.; Taminiau, Jan A. J. M.; Benninga, Marc A.

    2007-01-01

    Objectives Rectal bleeding is an alarming event both for the child and parents. It is hypothesized that colonoscopy instead of sigmoidoscopy and adding esophago-gastro-duodenoscopy in case of accompanying complaints, improves the diagnostic accuracy in children with prolonged rectal bleeding. Study

  14. RESEARCH Endoscopic injection sclerotherapy for bleeding varices ...

    African Journals Online (AJOL)

    Portal hypertension due to intrahepatic disease or extrahepatic portal vein obstruction (EHPVO) is an important cause of upper gastro- intestinal bleeding in children. About 50% of children with EHPVO present with bleeding from oesophageal varices.1-3 Improvements in the management of children with intrahepatic ...

  15. Duodenal diverticular bleeding: an endoscopic challenge

    Directory of Open Access Journals (Sweden)

    Eduardo Valdivielso-Cortázar

    Full Text Available Duodenal diverticula are an uncommon cause of upper gastrointestinal bleeding. Until recently, it was primarily managed with surgery, but advances in the field of endoscopy have made management increasingly less invasive. We report a case of duodenal diverticular bleeding that was endoscopically managed, and review the literature about the various endoscopic therapies thus far described.

  16. The role of radiotherapy for locally advanced gallbladder carcinoma

    International Nuclear Information System (INIS)

    Shin, Hyun Soo; Seong, Jin Sil

    2000-01-01

    A retrospective review of 72 patients with locally advanced gallbladder carcinoma, between January 1900 and December 1996, was performed. Survival results and prognostic factors are analyzed for the patients treated with a various modalities. The patients were classified by treatment modality: group 1 included to 27 patients treated with palliative surgery alone, and group 2 for 11 patient treated with palliative surgery and radiotherapy; group 3 for 18 patients not treated by any treatment modality, and group 4 for 16 patients treated with radiotherapy alone. Age distribution ranged from 35 to 80 years with a mean of 63 years. The stage was classified by TNM and Nevin's staging system; all patients had an advanced stage more than III. Palliative surgery was done in 3B patients and adjuvant radiation therapy (Rl1 was followed in 11. For 34 patients, in whom no resection was tried, definitive RT was done in 16. Radiation delivered to tumor site and draining nodes up to 45-612 Gy using 10 MY linear accelerator. Chemotherapy was given to 25 patients with 5-FU based regimens. Median survival time was 10.3 months and 3-year survival rates (3-YSR) were 13.0% in all patients. Survival rates according to the treatment modalities were as followed; in palliative surgery alone, 3-YSR was 2.5%; in palliative surgery and adjuvant RT, 3-YSR was 45.5%; in no treatment group, 3YSR were 8.3%; and definitive RT was 13.1%. It was better survival in additional RT after palliative surgery group than palliative surgery alone (p=0.0009). It was better survival in definitive RT group than no treatment group (p=0.022). Significant prognostic factors by multivariate analysis were treatment modalities, the type of tumor and TNM stage. Significant prognostic factors by multivariate analysis were treatment modalities, the type of tumor and the presence of jaundice. It is suggested that RT could be potentially effective as adjuvant treatment modalities after palliative surgery or primary

  17. Fluid-bed combustion

    Energy Technology Data Exchange (ETDEWEB)

    Hunt, G.; Schoebotham, N.

    1981-02-01

    In Energy Equipment Company's two-stage fluidized bed system, partial combustion in a fluidized bed is followed by burn-off of the generated gases above the bed. The system can be retrofitted to existing boilers, and can burn small, high ash coal efficiently. It has advantages when used as a hot gas generator for process drying. Tests on a boiler at a Cadbury Schweppes plant are reported.

  18. Universal definition of perioperative bleeding in adult cardiac surgery

    NARCIS (Netherlands)

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J.; Sellke, Frank W.; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-01-01

    Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and

  19. The microbiological and clinical characteristics of invasive salmonella in gallbladders from cholecystectomy patients in kathmandu, Nepal.

    Directory of Open Access Journals (Sweden)

    Sabina Dongol

    Full Text Available Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.

  20. Cholecystectomy or gallbladder in situ after endoscopic sphincterotomy and bile duct stone removal in Chinese patients.

    Science.gov (United States)

    Lau, James Y W; Leow, Chon-Kar; Fung, Terence M K; Suen, Bing-Yee; Yu, Ly-Mee; Lai, Paul B S; Lam, Yuk-Hoi; Ng, Enders K W; Lau, Wan Yee; Chung, Sydney S C; Sung, Joseph J Y

    2006-01-01

    In patients with stones in their bile ducts and gallbladders, cholecystectomy is generally recommended after endoscopic sphincterotomy and clearance of bile duct stones. However, only approximately 10% of patients with gallbladders left in situ will return with further biliary complications. Expectant management is alternately advocated. In this study, we compared the treatment strategies of laparoscopic cholecystectomy and gallbladders left in situ. We randomized patients (>60 years of age) after endoscopic sphincterotomy and clearance of their bile duct stones to receive early laparoscopic cholecystectomy or expectant management. The primary outcome was further biliary complications. Other outcome measures included adverse events after cholecystectomy and late deaths from all causes. One hundred seventy-eight patients entered into the trial (89 in each group); 82 of 89 patients who were randomized to receive laparoscopic cholecystectomy underwent the procedure. Conversion to open surgery was needed in 16 of 82 patients (20%). Postoperative complications occurred in 8 patients (9%). Analysis was by intention to treat. With a median follow-up of approximately 5 years, 6 patients (7%) in the cholecystectomy group returned with further biliary events (cholangitis, n = 5; biliary pain, n = 1). Among those with gallbladders in situ, 21 (24%) returned with further biliary events (cholangitis, n = 13; acute cholecystitis, n = 5; biliary pain, n = 2; and jaundice, n = 1; log rank, P = .001). Late deaths were similar between groups (cholecystectomy, n = 19; gallbladder in situ, n = 11; P = .12). In the Chinese, cholecystectomy after endoscopic treatment of bile duct stones reduces recurrent biliary events and should be recommended.

  1. Lead, cadmium and zinc in mineral structure of deposits of the gallbladder in men and women

    Directory of Open Access Journals (Sweden)

    Jerzy Kwapuliński

    2012-11-01

    Full Text Available Introduction: The former studies have shown the presence of As and Sb in deposits of the gallbladder. The aim of studies: The aim of the studies was to define the level of accumulation of Pb, Cd, Zn in deposits of the gallbladder as supplementary biological test for exposure assessment in a long run. Materials and methods: Pb, Cd and Zn content was investigated with inductive coupled plasmaatomic emission spectrometry were deposits of the gallbladder in men and women living in the Silesia Region. Results: The change of these elements content was analyzed in connection with behavioral factors ( diet, alcohol, coffee, obesity and tobacco addiction of the gender. Attention was drawn to the probability of interaction of Pb, Cd, Zn with other elements during their accumulation in deposits of the gallbladder. It appeared that deposits of the gall bladder can be used as an additional biological test in individual exposure assessment to Pb, Cd and Zn. It was noted that the level of content of Pb, Zn and Cd in deposits of the gallbladder is impacted by behavioral factors (diet, alcohol, coffee, obesity tobacco addiction. A characteristic impact of the tobacco addiction on the rise in the content of lead, cadmium and zinc was demonstrated as well as significant role of the presence of these elements in the total environmental pollution in relevant living areas.

  2. Design, development, and evaluation of a novel retraction device for gallbladder extraction during laparoscopic cholecystectomy.

    Science.gov (United States)

    Judge, Joshua M; Stukenborg, George J; Johnston, William F; Guilford, William H; Slingluff, Craig L; Hallowell, Peter T

    2014-02-01

    A source of frustration during laparoscopic cholecystectomy involves extraction of the gallbladder through port sites smaller than the gallbladder itself. We describe the development and testing of a novel device for the safe, minimal enlargement of laparoscopic port sites to extract large, stone-filled gallbladders from the abdomen. The study device consists of a handle with a retraction tongue to shield the specimen and a guide for a scalpel to incise the fascia within the incision. Patients enrolled underwent laparoscopic cholecystectomy. Gallbladder extraction was attempted. If standard measures failed, the device was implemented. Extraction time and device utility scores were recorded for each patient. Patients returned 3-4 weeks postoperatively for assessment of pain level, cosmetic effect, and presence of infectious complications. Twenty (51 %) of 39 patients required the device. Average extraction time for the first eight patients was 120 s. After interim analysis, an improved device was used in 12 patients and average extraction time was 24 s. There were no adverse events. Postoperative pain ratings and incision cosmesis were comparable between patients with and without use of the device. The study device enables safe and rapid extraction of impacted gallbladders through the abdominal wall.

  3. A dural metastatic small cell carcinoma of the gallbladder as the first manifestation: a case report.

    Science.gov (United States)

    Tonomura, Shuichi; Kitaichi, Tomoko; Onishi, Rina; Kakehi, Yoshiaki; Shimizu, Hisao; Shimada, Keiji; Kanemasa, Kazuyuki; Fukusumi, Akio; Takahashi, Nobuyuki

    2018-03-16

    A dural metastasis is one of the essential differential diagnoses of meningioma. In general, carcinomas of the breast and lung in females and prostate in males have been the most commonly reported primary lesions of dural metastases. However, dural metastasis of gallbladder carcinoma is extremely rare. Here, we report a unique case of a dural matter metastasis of gallbladder carcinoma as the first manifestation, which was autopsy-defined as small cell carcinoma. A 78-year-old man came to our hospital complaining of left hemianopia. Brain computed tomography (CT) revealed a sizeable parasagittal dural-based extra-axial tumor. However, the findings for meningioma were atypical by magnetic resonance imaging, suggesting a meningioma mimic. A contrast-enhanced CT scan of the abdomen revealed a large gallbladder carcinoma. The patient opted for the best supportive care and died 2 months later. The post-mortem examination revealed small cell carcinoma in gallbladder carcinoma. Moreover, an immunologically similar carcinoma was detected in the dural metastasis. To the best of our knowledge, this is the first case of a dural metastasis of gallbladder small cell carcinoma. A systemic examination is essential for clinicians when atypical findings of meningioma are observed, suggesting a meningioma mimic. We present this rare case with a review of the literature.

  4. Correlation of nutritional parameters of gallbladder cancer patients.

    Science.gov (United States)

    Rai, Arundhati; Tewari, Mallika; Mohapatra, S C; Shukla, H S

    2006-06-15

    Gallbladder cancer (GBC) is a highly fatal disease with poor prognosis and 5-year survival nutritional deterioration are associated with adverse outcomes in terms of cancer prognosis. Protein-calorie malnutrition is the single most common secondary diagnosis in a patient with cancer, and is a direct consequence of the anorexia of malignancy and altered host metabolism induced by the tumor. The present study of nutritional assessment is of particular interest for it helps in better understanding the extent of malnutrition in patients of GBC. A case-control study was designed comprising of 153 cases of GBC and 153 controls of gallstone disease (GSD). To assess the nutritional status of the GBC patients, anthropometric measurements such as height, weight, mid arm circumference, and skinfold thickness were recorded together with the biochemical parameters and their nutrient intake. The present study showed that GBC influences the nutritional status of the patients. Forty-three percent of GBC patients were malnourished with low body mass index (BMI). A significant reduction in all the anthropometric measures was observed for GBC patients compared to those with GSD. GBC patients had significantly low hemoglobin and serum albumin levels compared to the control group. The hemoglobin levels in case and control groups were 10.87 g/dl (+/-1.81 SD) and 11.62 g/dl (+/-1.89 SD), respectively (P anorexia and weight loss. Copyright 2006 Wiley-Liss, Inc.

  5. Surgical approach to gallbladder disease in rural Guatemala.

    Science.gov (United States)

    Imran, Jonathan B; Ochoa-Hernandez, Annie; Herrejon, Juan; Madni, Tarik D; Clark, Audra T; Huerta, Sergio

    2017-10-01

    In this article, we report the current surgical approach to gallbladder disease at a major referral hospital in rural Guatemala. Complications in a cohort of patients undergoing open versus laparoscopic cholecystectomy were catalogued. We reviewed cholecystectomies performed by surgeons at the Hospital Nacional de San Benito in El Peten, Guatemala, after the adoption of the laparoscopic approach. Laparoscopic cholecystectomies (LCs) between 2014 and 2015 (n = 42) were reviewed and matched by 58 randomly selected open cholecystectomies (OCs) during the same period. Patient demographics were similar in the LC and OC groups. Of the 63 patients who had elective surgery, 43 (68%) underwent OC. Conversion rate, hospital length of stay, and readmission rate were 4%, 4.8 days, and 5%, respectively. Complications were similar between groups. Despite the low number of LCs, their complications were not different from that of OCs. During the study period, a large number of cholecystectomies continued to be open, even in the elective setting. Published by Elsevier Inc.

  6. Expression of p21 and p27 in gallbladder cancer

    International Nuclear Information System (INIS)

    Alsheyab, Fawzi M.; Ziadeh, Moroug T.; Bani-Hani, Kamal E.

    2007-01-01

    To investigate the expression of p21 and p27 factors in gallbladder cancer (GBC), and to correlate their expression with clinicopathological parameters: age, gender, stage, invasion and grade. Thirty-two surgically resected specimens were collected between 1994-2001 from different health centers in north Jordan. Tissues belong to 25 females and 7 males were examined immunohistochemically. The study took place in the Pathology Department, Jordan University of Science and Technology, Jordan. Levels of p21 were found in 75% and p27 in 25%. Furthermore, p21 was expressed in 50% of the specimens which belong to patients with ages 64 years have p 21WAF1/CIP1 expression (p=0.001). The expression of p21 between advanced stages (stages III and IV) was 89.5% and early stages (stages I and II) was 53.8% (p=0.031). The p27 expression was markedly decreased in GBC cases (25%) and there were no significant correlation between p27KIP1 expression and all clinicopathological parameters including gender, World health Organization grades, stages and invasion, whereas expression of p21 was 75% and there was a significant correlation between p21 and clinicopathological parameters including gender, stages and invasion. (author)

  7. Early versus delayed laparoscopic cholecystectomy after percutaneous transhepatic gallbladder drainage.

    Science.gov (United States)

    Han, In Woong; Jang, Jin-Young; Kang, Mee Joo; Lee, Kyoung Bun; Lee, Seung Eun; Kim, Sun-Whe

    2012-03-01

    Percutaneous transhepatic gallbladder drainage (PTGBD) is a procedure to resolve acute cholecystitis (AC). It may decrease the technical difficulty of laparoscopic cholecystectomy (LC) and thus may facilitate successful surgery when a patients' condition improves. However, the timing of LC after PTGBD remains controversial. From 2004 to 2010, cholecystectomy after PTGBD was performed in 67 patients with AC. Group I members underwent LC within 72 h of PTGBD (n = 21), whereas group II members underwent LC at more than 72 h after PTGBD (n = 46). The open conversion rate was similar in the two groups. The perioperative complication rate was higher in group I than in group II, but with marginal significance (19.0 vs. 4.3%; p = 0.07). Mean operative time was longer in group I than in group II (79.3 ± 25.3 vs. 53.7 ± 45.3 min; p = 0.02). However, overall hospital stay was shorter in group I than in group II, but with marginal significance (10.8 ± 4.5 vs. 14.7 ± 9.3 days; p = 0.08). Pros and cons were well balanced between the two groups. Decisions on the timing of cholecystectomy after PTGBD should be made based on considerations of patient condition, hospital facilities, and surgical experience.

  8. Outcome and CT differentiation of gallbladder neuroendocrine tumours from adenocarcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae-Hyung [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Kim, Se Hyung [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Hospital and Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Lee, Kyoung Boon [Seoul National University Hospital, Department of Pathology, Seoul (Korea, Republic of); Han, Joon Koo [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of)

    2017-02-15

    To retrospectively investigate clinical outcome and differential CT features of gallbladder (GB) neuroendocrine tumours (NETs) from adenocarcinomas (ADCs). Nineteen patients with poorly-differentiated (PD) NETs and 19 patients with PD ADCs were enrolled. Clinical outcome was compared by the Kaplan-Meier method. We assessed qualitative and quantitative CT features to identify significant differential CT features of PD NETs from ADCs using univariate and multivariate analyses. Receiver operating characteristic (ROC) analysis was used for quantitative CT features. PD NETs showed poorer prognosis with significantly shorter median survival days than ADCs (363 vs. 590 days, P = 0.03). On univariate analysis, NETs more frequently manifested as GB-replacing type and showed well-defined margins accompanied with intact overlying mucosa. On multivariate analysis, well-defined margin was the sole significant CT differentiator (odds ratio = 27.817, P = 0.045). Maximum size of hepatic and lymph node (LN) metastases was significantly larger in NETs (11.0 cm and 4.62 cm) than ADCs (2.40 cm and 2.41 cm). Areas under ROC curves for tumour-to-mucosa ratio, maximum size of hepatic and LN metastasis were 0.772, 0.932 and 0.919, respectively (P < 0.05). GB PD NETs show poorer prognosis than ADCs. Well-defined margin, larger hepatic and LN metastases are useful CT differentiators of GB NETs from ADCs. (orig.)

  9. Fluidised bed combustion system

    International Nuclear Information System (INIS)

    McKenzie, E.C.

    1976-01-01

    Fluidized bed combustion systems that facilitates the maintenance of the depth of the bed are described. A discharge pipe projects upwardly into the bed so that bed material can flow into its upper end and escape downwardly. The end of the pipe is surrounded by an enclosure and air is discharged into the enclosure so that material will enter the pipe from within the enclosure and have been cooled in the enclosure by the air discharged into it. The walls of the enclosure may themselves be cooled

  10. Is it necessary to send gallbladder specimens for routine histopathological examination after cholecystectomy? The use of macroscopic examination

    NARCIS (Netherlands)

    van Vliet, Jaap L. P.; van Gulik, Thomas M.; Verbeek, Paul C. M.

    2013-01-01

    Gallbladder specimens are routinely sent for histopathological examination after cholecystectomy in order to rule out the presence of gallbladder carcinoma (GBC). However, there is no evidence for the benefit of this costly practice. Our aim was to determine whether a selective strategy based on

  11. Postpartum bleeding: efficacy of endovascular management

    International Nuclear Information System (INIS)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki

    2003-01-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12 th and 13 th day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding

  12. Postpartum bleeding: efficacy of endovascular management

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki [Asan Medical Center, Seoul (Korea, Republic of)

    2003-06-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12{sup th} and 13{sup th} day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding.

  13. Endoscopic management of bleeding peptic ulcers

    International Nuclear Information System (INIS)

    Farooqi, J.I.; Farooqi, R.J.

    2001-01-01

    Peptic ulcers account for more than half of the cases of non variceal upper gastrointestinal (GI) bleeding and therefore, are the focus of most of the methods of endoscopic hemostasis. Surgical intervention is now largely reserved for patients in whom endoscopic hemostasis has failed. A variety of endoscopic techniques have been employed to stop bleeding and reduce the risk of rebleeding, with no major differences in outcome between these methods. These include injection therapy, fibrin injection, heater probe, mono polar electrocautery, bipolar electrocautery, lasers and mechanical hemo clipping. The most important factor in determining outcome after gastrointestinal bleeding is rebleeding or persistent bleeding. The endoscopic appearance of an ulcer, however, provides the most useful prognostic information for bleeding. Recurrent bleeding after initial endoscopic hemostasis occurs in 15-20% of patients with a bleeding peptic ulcer. The best approach to these patients remains controversial; the current options are repeat endoscopic therapy with the same or a different technique, emergency surgery or semi elective surgery after repeat endoscopic hemostasis. The combination of epinephrine injection with thermal coagulation may be more effective than epinephrine injection alone. Newer modalities such as fibrin injection or the application of hemo clips appear promising and comparative studies are awaited. (author)

  14. THROMBIN GENERATION AND BLEEDING IN HEMOPHILIA A

    Science.gov (United States)

    Brummel-Ziedins, Kathleen E.; Whelihan, Matthew F.; Gissel, Matthew; Mann, Kenneth G.; Rivard, Georges E.

    2012-01-01

    Introduction Hemophilia A displays phenotypic heterogeneity with respect to clinical severity. Aim To determine if tissue factor (TF)-initiated thrombin generation profiles in whole blood in the presence of corn trypsin inhibitor (CTI) are predictive of bleeding risk in hemophilia A. Methods We studied factor(F) VIII deficient individuals (11 mild, 4 moderate and 12 severe) with a well-characterized five-year bleeding history that included hemarthrosis, soft tissue hematoma and annual FVIII concentrate usage. This clinical information was used to generate a bleeding score. The bleeding scores (range 0–32) were separated into three groups (bleeding score groupings: 0, 0 and ≤9.6, >9.6), with the higher bleeding tendency having a higher score. Whole blood collected by phlebotomy and contact pathway suppressed by 100μg/mL CTI was stimulated to react by the addition of 5pM TF. Reactions were quenched at 20min by inhibitors. Thrombin generation, determined by ELISA for thrombin – antithrombin was evaluated in terms of clot time (CT), maximum level (MaxL) and maximum rate (MaxR) and compared to the bleeding score. Results Data are shown as the mean±SD. MaxL was significantly different (phemophilia A. PMID:19563500

  15. Causes of lower gastrointestinal bleeding on colonoscopy

    International Nuclear Information System (INIS)

    Rehman, A.U.; Gul, R.; Khursheed, L.; Hadayat, R.

    2017-01-01

    Background: Bleeding from anus is usually referred as rectal bleeding but actually rectal bleeding is defined as bleeding from lower colon or rectum, which means bleeding from a place distal to ligament of Treitz. This study was conducted to determine the frequency of different causes of rectal bleeding in patients at Ayub Teaching Hospital, Abbottabad. Methods: One hundred and seventy-five patients with evidence of rectal bleed, without gender discrimination were selected by non-probability convenient sampling from the out-patient department and general medical wards. Patients with suspected upper GI source of bleeding; acute infectious bloody diarrhoea and any coagulopathy were excluded from the study. All patients were subjected to fibre optic colonoscopy after preparation of the gut and findings were recorded. Where necessary, biopsy samples were also taken. Diagnosis was based on colonoscopic findings. Results: A total of 175 patients (92 males and 83 females) with mean age 35.81±9.18 years were part of the study. Colonoscopy showed abnormal findings in 150 (85.7%) patients. The commonest diagnosis was haemorrhoids, which was found in 39 (22.3%) patients. It was followed by inflammatory bowel disease (IBD) in 30 (17.1%) patients, solitary rectal ulcer in 13 (7.4%) patients and polyps in 25 (14.3%) patients. Other less frequent findings were non-specific inflammation and fungating growths in rectum. Conclusion: Haemorrhoids was the leading cause of bleeding per rectum in this study, followed by evidence of IBD while infrequent findings of polyps and diverticuli indicate that these are uncommon in this region. (author)

  16. [The causes of recurrent ulcerative gastroduodenal bleeding].

    Science.gov (United States)

    Lipnitsky, E M; Alekberzade, A V; Gasanov, M R

    To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.

  17. Upper gastrointestinal bleeding - state of the art.

    Science.gov (United States)

    Szura, Mirosław; Pasternak, Artur

    2014-01-01

    Upper gastrointestinal (GI) bleeding is a condition requiring immediate medical intervention, with high associated mortality exceeding 10%. The most common cause of upper GI bleeding is peptic ulcer disease, which largely corresponds to the intake of NSAIDs and Helicobacter pylori infection. Endoscopy is the essential tool for the diagnosis and treatment of active upper GI hemorrhage. Endoscopic therapy together with proton pump inhibitors and eradication of Helicobacter pylori significantly reduces rebleeding rates, mortality and number of emergency surgical interventions. This paper presents contemporary data on the diagnosis and treatment of upper gastrointestinal bleeding.

  18. Scintigraphic demonstration of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Alavi, A.

    1980-01-01

    Acute gastrointestinal bleeding may be localized using noninvasive radionuclide methods. We have favored the use of technetium-99m sulfur colloid with sequential imaging because of the rapid clearance of background activity. Definition of the site of upper gastrointestinal bleeding, however, may be obscured by intense uptake of radioactivity by liver and spleen. The sensitivity of the method is such that the bleeding rates of 0.05-0.1 ml/min can be detected compared to a sensitivity of 0.5 ml/min for angiography.

  19. Complete pancreatic heterotopia of gallbladder with hypertrophic duct simulating an adenomyoma

    Science.gov (United States)

    Pilloni, Luca; Cois, Alessandro; Uccheddu, Alessandro; Ambu, Rossano; Coni, Pierpaolo; Faa, Gavino

    2006-01-01

    The gallbladder is an unusual location of pancreatic heterotopia, defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the main body of the gland. A 28-year-old man presented with anorexia, nausea and pain in the right upper abdomen. On physical examination, the abdomen was tender to palpation and Murphy sign was positive. The patient underwent a cholecystecomy. This case, in our opinion, is very interesting since it permits to consider a controversial issue in the pathology of the gallbladder. The histological appearance of ductal structure in pancreatic heterotopia resembles the histological picture of both Aschoff-Rokitansky (AR) sinuses and adenomyomas. This finding suggests that these lesions are linked by a common histogenetic origin. We suggest that the finding of an adenomyoma in the gallbladder should prompt an extensive sampling of the organ in order to verify the coexistence of pancreatic rests. PMID:16586554

  20. Gallbladder emptying evaluation in calcific chronic pancreatitis using Tc-99m DISIDA scintigraphy

    International Nuclear Information System (INIS)

    Pedroso, Martha Regina A.; Cunha, Renata M.; Guarita, Dulce R.; Buchpieguel, Carlos A.; Mott, Carlos B.; Laudanna, Antonio Atilio

    1997-01-01

    The aim of this study was to analyze the gallbladder motor function in chronic pancreatitis (C) patients. Gallbladder emptying was evaluated in 11 patients, without and with addition of pancreatic extract and in ten controls. The results were compared and analyzed statistically. The ejection fraction (E F) of the gallbladder (GB) at 30, 45 and 60 minutes were calculated by using Tc-9 9 m DISIDA scintigraphy. The E F of GB at 60 minutes was significantly higher in the controls when compared to patients, although the results between patients were similar without and with addition of pancreatic extract. The results suggest that the delay in the GB emptying does not depend on the eventual alteration in the intestinal phase of the vesicular stimulation, but it probably results from a mechanic factor, which depends on the chronic pathological process located in the head of the pancreas. (author)

  1. Intramural hypoattenuated nodules in thickened wall of the gallbladder; CT features according to their primary causes

    International Nuclear Information System (INIS)

    Lee, Jun Hyung; Ha, Hyun Kwon; Lee, Jeong Hyun; Lee, Jean Hwa; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu; Kim, Myung-Jin

    2001-01-01

    According to published reports, a common feature of xanthogranulomatous cholecystitis is the presence of intramural hypoattenuated nodules in thickened gallbladder wall. These nodules can, however, also be seen in pathological conditions such as acute cholecystitis, hyperplastic cholecystoses (cholesterolosis and adenomyomatosis), gallbladder cancer, and other inflammatory diseases such as tuberculosis. Retrospective review of the abdominal CT findings in 622 patients who for various reasons underwent cholecystectomy during a one-year period showed that intramural nodules were present in 60. In this pictorial essay we illustrate the imaging features of the many different pathological conditions which give rise to intramural hypoattenuated nodules in thickened wall of the gallbladder, correlating these features with the histopathological findings

  2. A case of Mirizzi syndrome that was successfully treated by laparoscopic choledochoplasty using a gallbladder patch.

    Science.gov (United States)

    Hiraki, Masatsugu; Ueda, Junji; Kono, Hiroshi; Egawa, Noriyuki; Saeki, Kiyoshi; Tsuru, Yasuhiro; Ide, Takao; Noshiro, Hirokazu

    2017-11-01

    The use of laparoscopic surgery in the treatment of Mirizzi syndrome is considered controversial due to the degree of technical difficulty. We herein describe the case of a 36-year-old woman who was admitted to our hospital due to appetite loss, nausea and back pain. Endoscopic retrograde cholangiography revealed a round-shaped filling defect at the confluence of the bile duct. The patient was diagnosed with Mirizzi syndrome Type II according to the Csendes classification. Before surgery, an endoscopic nasobiliary drainage tube was placed for intraoperative cholangiography. Based on the intraoperative findings, the anterior wall of Hartmann's pouch was excised to remove the impacted gallstone. The neck portion of the gallbladder wall was then used to make a gallbladder patch, which was sutured to cover the anterior wall of the common hepatic bile duct. Laparoscopic choledochoplasty using a gallbladder patch was a technically feasible treatment for Mirizzi syndrome Type II.

  3. Gallbladder Volvulus: A Rare Emergent Cause of Acute Cholecystitis, if Untreated, Progresses to Necrosis and Perforation

    International Nuclear Information System (INIS)

    Justin L, Regner; Angela, Lomas

    2016-01-01

    An 86 year-old woman with a past medical history significant for abdominal hernia and Alzheimer dementia presented to the Emergency Department with a 24 hour history of acute right upper quadrant pain associated with nausea and non-bilious emesis. Physical exam revealed right sided abdominal tenderness with associated mass. All laboratory values were within normal ranges. Both abdominal ultrasound and computed tomography of the abdomen/pelvis revealed a large distended gallbladder with wall thickening and gallstones. Based on presentation and radiologic findings, the emergency general surgery service was consulted for suspected acute cholecystitis. The patient was then admitted for intravenous antibiotics and scheduled for laparoscopic cholecystectomy the following day. Intra-operative findings revealed volvulus with acute necrosis of the entire gallbladder. The gallbladder had a long pedunculated cystic duct and artery that was detorsed before proceeding with resection. Postoperatively, the patient did well and was discharged a few days later tolerating a regular diet

  4. Gallbladder Volvulus: A Rare Emergent Cause of Acute Cholecystitis, if Untreated, Progresses to Necrosis and Perforation

    Energy Technology Data Exchange (ETDEWEB)

    Justin L, Regner, E-mail: Justin.Regner@BSWHealth.org; Angela, Lomas [Department of Surgery, Baylor Scott and White Health and Texas A& M Health Science Center College of Medicine, Temple, TX (United States)

    2016-03-25

    An 86 year-old woman with a past medical history significant for abdominal hernia and Alzheimer dementia presented to the Emergency Department with a 24 hour history of acute right upper quadrant pain associated with nausea and non-bilious emesis. Physical exam revealed right sided abdominal tenderness with associated mass. All laboratory values were within normal ranges. Both abdominal ultrasound and computed tomography of the abdomen/pelvis revealed a large distended gallbladder with wall thickening and gallstones. Based on presentation and radiologic findings, the emergency general surgery service was consulted for suspected acute cholecystitis. The patient was then admitted for intravenous antibiotics and scheduled for laparoscopic cholecystectomy the following day. Intra-operative findings revealed volvulus with acute necrosis of the entire gallbladder. The gallbladder had a long pedunculated cystic duct and artery that was detorsed before proceeding with resection. Postoperatively, the patient did well and was discharged a few days later tolerating a regular diet.

  5. Fluidized bed incinerator development

    International Nuclear Information System (INIS)

    Ziegler, D.L.; Johnson, A.J.

    1976-01-01

    A fluidized bed incinerator is being developed for burning rad contaminated solid and liquid waste materials. In situ neutralization of acid gases by the bed material, catalytic afterburning, and gas filtration are used to produce a clean flue gas without the use of aqueous scrubbing

  6. A clear cell adenocarcinoma of the gallbladder with hepatoid differentiation: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Zhang C

    2016-09-01

    Full Text Available Chengsheng Zhang,1,2 Wei Zhang,1,2 Dianbin Mu,1 Xuetao Shi,1 Lei Zhao1,2 1Department of Hepatobiliary Surgery, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Science, 2School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong Province, People’s Republic of China Abstract: An 80-year-old male was referred to our department for a gallbladder mass. He denied any history of alcohol consumption or cholecystitis and smoking. Hepatitis B surface antigen test and antihepatitis C antibody test were found to be negative. Serum carbohydrate antigen 19-9 (CA19-9 and carcinoembryonic antigen were elevated (CA19-9 was 59.92 U/mL and carcinoembryonic antigen was 12.64 ng/mL, whereas alpha-fetoprotein was below the normal limit (2.46 ng/mL. Computed tomography scan revealed a solid mass with measurements of 4.6×5.6×7.1 cm, which nearly filled the whole gallbladder space. Radical cholecystectomy, including segments IV B and V of the liver and lymphadenectomy, was performed. The neoplasm in gallbladder was completely resected, and the patient obtained a negative margin. Histological and immunohistochemical profile suggested a clear cell adenocarcinoma of the gallbladder with hepatoid differentiation. After reviewing the literature, we reported that this case is the first identified case of cell adenocarcinoma of the gallbladder with extensive hepatoid differentiation. However, clinical features of clear cell adenocarcinoma with hepatoid differentiation remain unclear due to the extremely rare incidence. There was no indication of adjuvant chemotherapy and no literature has been reported on the application of chemotherapy. This case showed a promising clinical outcome after curative resection, which indicated that surgical treatment could be potentially considered for suitable patients. Keywords: gallbladder, clear cell adenocarcinoma, hepatoid differentiation 

  7. Metabonomic study of human serum in gallbladder cancer by 1H NMR spectroscopy

    International Nuclear Information System (INIS)

    Sonkar, Kanchan; Sinha, Neeraj; Behari, Anu; Kapoor, V.K.

    2012-01-01

    Gallbladder carcinoma (GBC) is one of the most lethal malignancies of upper gastrointestinal tract and it has the highest mortality rate in Chile and India. It has a very high incidence rates in northern India therefore it is also called as an Indian disease. There are several factors which play important role in development of gallbladder cancer including long-standing stones in gallbladder and alterations in composition of bile. Studies on gallstones and gallbladder tissues revealed that benign group can easily be discriminated from malignant group. Many proteomic studies have been performed for different cancers and several responsible serum protein markers have been identified but there is no such metabonomics study that shows the presence of any biomarker associated with gallbladder carcinoma. Identification of such biomarker would help immensely in the diagnostic of GBC. For this study we have collected blood samples (70; including patients from Chronic Cholecystitis (CC), XanthoGranulomatous Cholecystitis (XGC) and Gallbladder Cancer (GBC)) post-operatively (immediately after surgery) from patient undergoing cholecystectomy in Department of Surgical Gastroenterology, SGPGIMS. Control samples were also collected from 20 volunteers after 12 hrs of fasting. 4 ml of blood sample was collected and was allowed to clot in plastic tube for 30 min at room temperature in incubator. The serum was collected by centrifugation and samples were stored at -80 deg C till NMR experiments. 400 μL of serum was used for recording NMR spectra. NMR spectra were recorded at Bruker Avance 800 MHz spectrometer using CPMG pulse sequence with water presaturation. Control serum shows presence of various amino acids and low molecular weight metabolites. Detailed multivariate analysis along with markers found in serum associated with GBC will be presented. (author)

  8. The Impact of Gallbladder Status on Biliary Complications After the Endoscopic Removal of Choledocholithiasis.

    Science.gov (United States)

    Kim, Myung Hi; Yeo, Seong Jae; Jung, Min Kyu; Cho, Chang Min

    2016-04-01

    Endoscopic sphincterotomy (EST) with stone extraction is the standard management for choledocholithiasis. However, the necessity for subsequent management of gallstone to prevent the biliary complications remained controversial and few data were evaluated for the impact of status of gallbladder on recurrent biliary complications. We retrospectively investigated the relationship between the status of gallbladder and the occurrence of biliary complications after endoscopic removal of choledocholithiasis. Between January 1998 and December 2008, we enrolled 453 patients with intact gallbladder who underwent EST for choledocholithiasis and allocated into two groups: calculous gallbladder (n = 256) and acalculous gallbladder (n = 197). By reviewing patients' medical records, we compared the occurrence of biliary complications according to the presence or absence of gallstone in GB in situ. In total, biliary complications occurred in 83 patients (18.3 %) during the follow-up period. Calculous GB group had higher rate of overall complications (22.7 vs. 12.7 %; p = 0.007) and GB-associated complications (11.3 vs. 2.5 %; p = 0.001) than acalculous GB group. On the multivariate analysis, only the presence of gallstone was shown to be significant risk factor for overall biliary complication (OR 2.029; 95 % CI 1.209-3.405; p = 0.007) and GB-associated complications (OR 5.077; 95 % CI 1.917-13.446; p = 0.001). Mean event-free period was shorter in calculous GB group than acalculous GB group for overall complications (1774 vs. 2159 days; p = 0.012) and GB-associated complication (2153 vs. 2591 days; p = 0.001). Prophylactic cholecystectomy may not be necessary to prevent biliary complication in patients with acalculous gallbladder after endoscopic removal of pigment stones from bile duct.

  9. Cholecystokinin receptors on gallbladder muscle and pancreatic acinar cells: a comparative study

    International Nuclear Information System (INIS)

    von Schrenck, T.; Moran, T.H.; Heinz-Erian, P.; Gardner, J.D.; Jensen, R.T.

    1988-01-01

    To compare receptors for cholecystokinin (CCK) in pancreas and gallbladder, we measured binding of 125I-Bolton-Hunter-labeled CCK-8 (125I-BH-CCK-8) to tissue sections from guinea pig gallbladder and pancreas under identical conditions. In both tissues, binding had similar time-, temperature-, and pH dependence, was reversible, saturable and inhibited only by CCK related peptides or CCK receptor antagonists. Autoradiography localized 125I-BH-CCK-8 binding to the smooth muscle layer in the gallbladder. Binding of 125I-BH-CCK-8 to gallbladder sections was inhibited by various agonists with the following potencies (IC50):CCK-8 (0.4 nM) greater than des(SO3)CCK-8 (0.07 microM) greater than gastrin-17-I (1.7 +/- 0.3 microM) and by various receptor antagonists with the following potencies: L364,718 (1.5 nM) greater than CR 1409 (0.19 microM) greater than asperlicin = CBZ-CCK-(27-32)-NH2 (1 microM) greater than Bt2cGMP (120 microM). Similar potencies were found for the agonists and antagonists for pancreas sections. Inhibition of binding of 125I-BH-CCK-8 by 11 different analogues of proglumide gave similar potencies for both pancreas and gallbladder. The potencies of agonists in stimulating and antagonists in inhibiting CCK-stimulated contraction or amylase release correlated closely with their abilities to inhibit 125I-BH-CCK-8 binding to gallbladder or pancreas sections or acini, respectively. The present results demonstrate and characterize a method that can be used to compare the CCK receptors in guinea pig gallbladder and pancreas under identical conditions. Moreover, this study demonstrates that gallbladder and pancreatic CCK receptors have similar affinities for the various agonists and antagonists tested and, therefore, provides no evidence that they represent different subtypes of CCK receptors that can be distinguished pharmacologically

  10. A comparison of imaging methods for the diagnosis of gallbladder and biliary duct carcinomas

    International Nuclear Information System (INIS)

    Kersjes, W.; Koester, O.; Heuer, M.; Schneider, B.; Bonn Univ.

    1990-01-01

    Fourteen patients with carcinomas of the gallbladder and eight patients with biliary duct carcinomas were examined by CT, sonography, percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiography (ERC) and angiography. The results were compared retrospectively. Sonography proved suitable as a screening method. For accurate demonstration, this should be supplemented by C.T.. PTC and ERC demonstrate intraductal extension of biliary carcinomas and of gallbladder carcinomas infiltrating the bile ducts. The value of angiography consists merely in the pre-operative demonstration of the vascular anatomy. (orig.) [de

  11. Bile salts stimulate mucin secretion by cultured dog gallbladder epithelial cells independent of their detergent effect.

    OpenAIRE

    Klinkspoor, J H; Yoshida, T; Lee, S P

    1998-01-01

    1. Bile salts stimulate mucin secretion by the gallbladder epithelium. We have investigated whether this stimulatory effect is due to a detergent effect of bile salts. 2. The bile salts taurocholic acid (TC) and tauroursodeoxycholic acid (TUDC) and the detergents Triton X-100 (12.5-400 microM) and Tween-20 (0.1-3.2 mM) were applied to monolayers of cultured dog gallbladder epithelial cells. Mucin secretion was studied by measuring the secretion of [3H]N-acetyl-d-glucosamine-labelled glycoprot...

  12. Biliary Dyskinesia as a Rare Presentation of Metastatic Breast Carcinoma of the Gallbladder: A Case Report

    Directory of Open Access Journals (Sweden)

    A. Markelov

    2011-01-01

    Full Text Available Background. Breast carcinoma is the most common malignancy in women worldwide. It is most commonly associated with metastases to the liver, lung, bone, and the brain. Invasive lobular carcinoma is a less common pathology with slightly higher metastases to the upper gastrointestinal tract. Invasive lobular carcinoma metastasis to the gallbladder is extremely rare. Method. In this paper we are presenting a case of a 67-year-old female with metastases of invasive lobular breast cancer to the gallbladder six years after her therapy. Conclusion. This case clearly signifies the nature of the micrometastatic foci of the invasive lobular carcinoma even many years after a successful treatment.

  13. Bleeding and starving: fasting and delayed refeeding after upper gastrointestinal bleeding.

    Science.gov (United States)

    Fonseca, Jorge; Meira, Tânia; Nunes, Ana; Santos, Carla Adriana

    2014-01-01

    Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score bleeding, eight rebled, two underwent surgery, 13 died. Ulcer was the major bleeding cause, 63 patients underwent endoscopic therapy. There was 142/532 possible refeeding records, no record 37% patients. Only 16% were fed during the first day and half were only fed on third day or later. Rockall upper gastrointestinal bleeding patients must be refed earlier, according to guidelines.

  14. Pelvic artery embolization in gynecological bleeding

    International Nuclear Information System (INIS)

    Hausegger, K.A.; Schreyer, H.; Bodhal, H.

    2002-01-01

    The most common reasons for gynecological bleeding are pregnancy-related disorders, fibroids of the uterus, and gynecological malignances. Transarterial embolization is an effective treatment modality for gynecological bleeding regardless of its etiology. Depending on the underlying disease, a different technique of embolization is applied. In postpartal bleeding a temporary effect of embolization is desired, therefore gelatine sponge is used as embolizing agent. In fibroids and malignant tumors the effect should permanent, therefore PVA particles are used. Regardless the etiology, the technical and clinical success of transarterial embolization is at least 90%. In nearly every patient a post-embolization syndrome can be observed, represented by local pain and fever. This post-embolization syndrome usually does not last longer than 3 days. If embolization is performed with meticulous attention to angiographic technique and handling of embolic material, ischemic damage of adjacent organs is rarely observed. Transarterial embolization should be an integrative modality in the treatment of gynecological bleeding. (orig.) [de

  15. AL Amyloidosis Complicated by Persistent Oral Bleeding

    Directory of Open Access Journals (Sweden)

    Luiz Antonio Liarte Marconcini

    2015-01-01

    Full Text Available A case of amyloid light chain (AL amyloidosis is presented here with uncontrolled bleeding after a nonsurgical dental procedure, most likely multifactorial in nature, and consequently treated with a multidisciplinary approach.

  16. Gastrointestinal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... are many possible causes of GI bleeding, including hemorrhoids , peptic ulcers , tears or inflammation in the esophagus, ... blood Show More Show Less Related Health Topics Hemorrhoids Peptic Ulcer National Institutes of Health The primary ...

  17. Percutaneous nephrolithotomy; alarming variables for postoperative bleeding

    Directory of Open Access Journals (Sweden)

    Shakhawan H.A. Said

    2017-03-01

    Conclusion: According to our present results stone complexity (GSS grade 3 and 4, history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation are alarming variables for post-PCNL bleeding.

  18. Intrathoracic Gastric Volvulus presenting with GIT Bleed

    OpenAIRE

    Rahul Kadam; VSV Prasad

    2017-01-01

    Intrathoracic gastric volvulus in neonatal period is a life-threatening surgical emergency. We report a case of neonate with respiratory distress and GI bleeding who was diagnosed to have congenital diaphragmatic eventration with Intrathoracic gastric volvulus.

  19. Transfusion strategy for acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Handel, James; Lang, Eddy

    2015-09-01

    Clinical question Does a hemoglobin transfusion threshold of 70 g/L yield better patient outcomes than a threshold of 90 g/L in patients with acute upper gastrointestinal bleeding? Article chosen Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21. Study objectives The authors of this study measured mortality, from any cause, within the first 45 days, in patients with acute upper gastrointestinal bleeding, who were managed with a hemoglobin threshold for red cell transfusion of either 70 g/L or 90 g/L. The secondary outcome measures included rate of further bleeding and rate of adverse events.

  20. Upper gastrointestinal bleeding in irbid, jordan

    International Nuclear Information System (INIS)

    Banisalamah, A.A.; Mraiat, Z.M.

    2007-01-01

    To define the various causes of nonvariceal upper gastrointestinal bleeding, to outline management modalities and to determine the final outcome of patients. A retrospective analysis of patients presenting with upper gastrointestinal (UGI) bleeding from January 2003 to December 2006 (4 years) was conducted. Patients with endoscopically proven variceal bleeding were excluded. Out of the 120 patients, most of the patients belonged to an age group of more than 50 years (mean 48.5 years). Haematemesis was the most common presentation and Acute Gastric Mucosal Lesion (AGML) was the most frequently encountered lesion. The cause of bleeding was not identified in 10 patients (undetermined group). Twenty-two (18.3%) underwent surgery and we had an overall mortality of 15.8%. AGML being the leading cause can be managed conservatively most of the time. There is a male preponderance and the incidence and mortality increases with advancing age. The undetermined group remains a diagnostic problem. (author)

  1. Radiation therapy and arterial infusion chemotherapy for advanced gallbladder cancer

    International Nuclear Information System (INIS)

    Hokodate, Hirofumi; Saito, Hiroya; Takeuchi, Shuhei; Horikawa, Masahiro; Takamura, Akio

    2009-01-01

    The standard therapy is not yet established for the unresectable advanced gallbladder cancer (AGC). Here described is the outcome of authors' therapeutic protocol for AGC during the time Jan., 1989-Dec., 2008. Subjects are 73 patients (M 32/F 41, average age 65 y) with AGC of Stage IV. One shot arterial infusion (AI) of EEP regimen (etoposide (VP16)/4'epiadriamycin (EPIR)/cisplatin (CDDP)) is conducted via hepatic artery proper or common at the first angiography and one week later, external radiation therapy (RT), with about 30-50 Gy/6 fractions (actually, 12-61.6 Gy). AI is weekly done with FP regimen (CDDP/5-fluorouracil (FU)) through the reservoir indwelled in the gastroduodenal artery for 6 months where a metal stent for the stegnosis of bile duct is used if necessary after RT, and in recent days, additionally with biweekly CDDP/gemcitabin (GEM) regimen depending on patient's state after FP. As a result, RT is conducted to 62 cases (RT alone 8 cases), AI, 64 (alone, 10), and RT+AI, 54. Response is found to be 49% (CR 7 cases and PR, 28). Survivals 1- and 3-year are 39 and 6%, respectively, and average survival time, 408 days. Survival rate in (RT+AI) is significantly superior to that in AI alone and in RT alone. Prognosis in patients with jaundice, hepatic or duodenal invasion is significantly inferior to those without the symptom, and in non-responded cases, to responded cases. Complications like hepatic abscess are seen in 4 cases at 6 months after treatment. Four actual case-reports are presented in details with their images. Combination of RT+AI is suggested to be of utility for AGC, of which multi-center trial is awaited with addition of newer anti-cancers developed recently. (K.T.)

  2. Gallbladder Agenesis in 17 Dogs: 2006-2016.

    Science.gov (United States)

    Sato, K; Sakai, M; Hayakawa, S; Sakamoto, Y; Kagawa, Y; Kutara, K; Teshima, K; Asano, K; Watari, T

    2018-01-01

    Gallbladder agenesis (GBA) is extremely rare in dogs. To describe the history, clinical signs, diagnosis, treatment, and outcomes of dogs with GBA. Seventeen client-owned dogs with GBA. Medical records from 2006 through 2016 were retrospectively reviewed. Dogs were included when GBA was suspected on abdominal ultrasonography and confirmed by gross evaluation. Signalment, clinical signs, clinicopathological data, diagnostic imaging, histopathology, treatment, and outcome were recorded. Dogs were of 6 different breeds, and Chihuahuas (10 of 17) were most common. Median age at presentation was 1.9 (range, 0.7-7.4) years. Clinical signs included vomiting (5 of 17), anorexia (2 of 17), ascites (2 of 17), diarrhea (1 of 17), lethargy (1 of 17), and seizures (1 of 17). All dogs had increased serum activity of at least 1 liver enzyme, most commonly alanine aminotransferase (15 of 17). Fifteen dogs underwent computed tomography (CT) cholangiography; common bile duct (CBD) dilatation was confirmed in 12, without evidence of bile duct obstruction. Gross evaluation confirmed malformation of the liver lobes in 14 of 17 dogs and acquired portosystemic collaterals in 5 of 17. Ductal plate malformation was confirmed histologically in 16 of 17 dogs. During follow-up (range, 4-3,379 days), 16 of 17 dogs remained alive. Dogs with GBA exhibit clinicopathological signs of hepatobiliary injury and hepatic histopathological changes consistent with a ductal plate abnormality. Computed tomography cholangiography was superior to ultrasound examination in identifying accompanying nonobstructive CBD distention. Computed tomography cholangiography combined with laparoscopic liver biopsy is the preferable approach to characterize the full disease spectrum accompanying GBA in dogs. Copyright © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  3. Helping mothers survive bleeding after birth

    DEFF Research Database (Denmark)

    Nelissen, Ellen; Ersdal, Hege; Ostergaard, Doris

    2014-01-01

    OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants, and ambul......OBJECTIVE: To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. DESIGN: Educational intervention study. SETTING: Rural referral hospital in Northern Tanzania. POPULATION: Clinicians, nurse-midwives, medical attendants...

  4. Management of patients with ulcer bleeding.

    Science.gov (United States)

    Laine, Loren; Jensen, Dennis M

    2012-03-01

    This guideline presents recommendations for the step-wise management of patients with overt upper gastrointestinal bleeding. Hemodynamic status is first assessed, and resuscitation initiated as needed. Patients are risk-stratified based on features such as hemodynamic status, comorbidities, age, and laboratory tests. Pre-endoscopic erythromycin is considered to increase diagnostic yield at first endoscopy. Pre-endoscopic proton pump inhibitor (PPI) may be considered to decrease the need for endoscopic therapy but does not improve clinical outcomes. Upper endoscopy is generally performed within 24h. The endoscopic features of ulcers direct further management. Patients with active bleeding or non-bleeding visible vessels receive endoscopic therapy (e.g., bipolar electrocoagulation, heater probe, sclerosant, clips) and those with an adherent clot may receive endoscopic therapy; these patients then receive intravenous PPI with a bolus followed by continuous infusion. Patients with flat spots or clean-based ulcers do not require endoscopic therapy or intensive PPI therapy. Recurrent bleeding after endoscopic therapy is treated with a second endoscopic treatment; if bleeding persists or recurs, treatment with surgery or interventional radiology is undertaken. Prevention of recurrent bleeding is based on the etiology of the bleeding ulcer. H. pylori is eradicated and after cure is documented anti-ulcer therapy is generally not given. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped; if they must be resumed low-dose COX-2-selective NSAID plus PPI is used. Patients with established cardiovascular disease who require aspirin should start PPI and generally re-institute aspirin soon after bleeding ceases (within 7 days and ideally 1-3 days). Patients with idiopathic ulcers receive long-term anti-ulcer therapy.

  5. Angiographic diagnosis and treatment of gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung

    1986-01-01

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  6. Angiographic diagnosis and treatment of gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Sung, Kyu Bo; Koo, Kyung Hoi; Bae, Tae Young; Chung, Eun Chul; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1986-02-15

    Diagnostic angiographic evaluations were done in 33 patients with gastrointestinal bleeding for recent 5 years at Department of Radiology, Seoul National University Hospital. On 11 patients of them, therapeutic interventional procedures were made and the results were analysed. 1. In a total of 33 cases, there were 18 cases of upper GI bleeding and 15 cases of lower GI bleeding. The most frequent causes were peptic ulcer in the former and intestinal typhoid fever in the latter. 2. Bleeding sites were localized angiographically in 28 cases, so the detection rate was 85%. Four of the five angiographically negative cases were lower GI bleeding cases. 3. The most frequent bleeding site was left gastric artery (7/33). The next was ileocecal branch of superior mesenteric artery (6/33). 4. Among the 11 interventional procedures, Gelfoam embolization was done in 7 cases and Vasopressin infusion was tried in 4 cases. They were successful in 4 and 3 cases, suggesting 57% and 47% success rates respectively.

  7. Transcatheter arterial embolization for traumatic bleeding control

    International Nuclear Information System (INIS)

    Ryu, Choon Wook; Lee, Sang Kwon; Suh, Kyung Jin; Kim, Tae Heon; Kim, Yong Joo; Kang, Duck Sik

    1989-01-01

    Angiography is essential for the detection of bleeding vessels in traumatic vascular injury. Immediately after the diagnosis, transcatheter embolization can be performed for the control of bleeding effectively and easily with proper use of embolic materials. Transcatheter embolization is believed to be the treatment of choice when emergency control is needed, where surgical approach is difficult and in those who are poor candidate for surgery. We have tried bleeding control in 18 cases of trauma over recent 4 years. The results were as follows; 1. Causes of bleeding(cases): Blunt or penetrating trauma (10), latrogenic trauma (8), (Postoperative (5), Needle biopsy (2), Percutaneous hepatic procedure (1)) 2. Embolized vessels: Renal artery branches (8), Hepatic artery branches (2), Arteries supplying chest wall (2), External carotid artery branches (3), Internal carotid artery (1), Circumflex humeral artery (1), Internal iliac artery branches (1). 3. Embolic agents: Gelfoam cubes (16), Stainless steel coils (3), Detachable latex balloon (1). 4. Successful bleeding control was achieved in 17 cases and reduction of the amount of bleeding in one case without significant complications

  8. [Hysteroscopic polypectomy, treatment of abnormal uterine bleeding].

    Science.gov (United States)

    de Los Rios, P José F; López, R Claudia; Cifuentes, P Carolina; Angulo, C Mónica; Palacios-Barahona, Arlex U

    2015-07-01

    To evaluate the effectiveness of the hysteroscopic polypectomy in terms of the decrease of the abnormal uterine bleeding. A cross-sectional and analytical study was done with patients to whom a hysteroscopic polypectomy was done for treating the abnormal uterine bleeding, between January 2009 and December 2013. The response to the treatment was evaluated via a survey given to the patients about the behavior of the abnormal uterine bleeding after the procedure and about overall satisfaction. The results were obtained after a hysteroscopic polypectomy done to 128 patients and were as follows. The average time from the polypectomy applied until the survey was 30.5 months, with a standard deviation of 18 months. 67.2% of the patients reported decreased abnormal uterine bleeding and the 32.8% reported a persistence of symptoms. On average 82.8% of the. patients were satisfied with the treatment. Bivariate and multivariate analysis showed no association between the variables studied and no improvement of abnormal uterine bleeding after surgery (polypectomy). There were no complications. Hysteroscopic polypectomy is a safe surgical treatment, which decreases on two of three patients the abnormal uterine bleeding in the presence of endometrial polyps, with an acceptable level of satisfaction.

  9. Transcatheter emboilization therapy of massive colonic bleeding

    International Nuclear Information System (INIS)

    Shin, G. H.; Oh, J. H.; Yoon, Y.

    1996-01-01

    To evaulate the efficacy and safety of emergent superselective transcatheter embolization for controlling massive colonic bleeding. Six of the seven patients who had symptom of massive gastrointestinal bleeding underwent emergent transcatheter embolization for control of the bleeding. Gastrointestinal bleeding in these patients was originated from various colonic diseases: rectal cancer(n=1), proctitis(n=1), benign ulcer(n=1), mucosal injury by ventriculoperitoneal shunt(n=1), and unknown(n=2). All patients except one with rectal cancer were critically ill. Superselective embolization were done by using Gelfoam particles and/or coils. The vessels embolized were ileocolic artery(n=1). superior rectal artery(n=2), inferior rectal artery (n=1), and middle and inferior rectal arteries(n=1). Hemostasis was successful immediately in all patients. Two underwnet surgery due to recurrent bleeding developed 3 days after the procedure(n=1) or in associalion with underlying rectal cancer(n=1). On surgical specimen of two cases, there was no mucosal ischemic change. Transcatheter embolization is a safe and effective treatment of method for the control of massive colonic bleeding

  10. Bleeding from gastrointestinal angioectasias is not related to bleeding disorders - a case control study

    Directory of Open Access Journals (Sweden)

    Lärfars Gerd

    2010-09-01

    Full Text Available Abstract Background Angioectasias in the gastrointestinal tract can be found in up to 3% of the population. They are typically asymptomatic but may sometimes result in severe bleeding. The reasons for why some patients bleed from their angioectasias are not fully understood but it has been reported that it may be explained by an acquired von Willebrand syndrome (AVWS. This condition has similar laboratory findings to congenital von Willebrand disease with selective loss of large von Willebrand multimers. The aim of this study was to find out if AVWS or any other bleeding disorder was more common in patients with bleeding from angioectasias than in a control group. Methods We compared bleeding tests and coagulation parameters, including von Willebrand multimers, from a group of 23 patients with anemia caused by bleeding from angioectasias, with the results from a control group lacking angioectasias. Results No significant differences between the two groups were found in coagulation parameters, bleeding time or von Willebrand multimer levels. Conclusion These results do not support a need for routine bleeding tests in cases of bleeding from angioectasias and do not show an overall increased risk of AVWS among these patients.

  11. Automatic gallbladder segmentation using combined 2D and 3D shape features to perform volumetric analysis in native and secretin-enhanced MRCP sequences.

    Science.gov (United States)

    Gloger, Oliver; Bülow, Robin; Tönnies, Klaus; Völzke, Henry

    2017-11-24

    We aimed to develop the first fully automated 3D gallbladder segmentation approach to perform volumetric analysis in volume data of magnetic resonance (MR) cholangiopancreatography (MRCP) sequences. Volumetric gallbladder analysis is performed for non-contrast-enhanced and secretin-enhanced MRCP sequences. Native and secretin-enhanced MRCP volume data were produced with a 1.5-T MR system. Images of coronal maximum intensity projections (MIP) are used to automatically compute 2D characteristic shape features of the gallbladder in the MIP images. A gallbladder shape space is generated to derive 3D gallbladder shape features, which are then combined with 2D gallbladder shape features in a support vector machine approach to detect gallbladder regions in MRCP volume data. A region-based level set approach is used for fine segmentation. Volumetric analysis is performed for both sequences to calculate gallbladder volume differences between both sequences. The approach presented achieves segmentation results with mean Dice coefficients of 0.917 in non-contrast-enhanced sequences and 0.904 in secretin-enhanced sequences. This is the first approach developed to detect and segment gallbladders in MR-based volume data automatically in both sequences. It can be used to perform gallbladder volume determination in epidemiological studies and to detect abnormal gallbladder volumes or shapes. The positive volume differences between both sequences may indicate the quantity of the pancreatobiliary reflux.

  12. Antifibrinolytics for heavy menstrual bleeding.

    Science.gov (United States)

    Bryant-Smith, Alison C; Lethaby, Anne; Farquhar, Cindy; Hickey, Martha

    2018-04-15

    Heavy menstrual bleeding (HMB) is an important physical and social problem for women. Oral treatment for HMB includes antifibrinolytic drugs, which are designed to reduce bleeding by inhibiting clot-dissolving enzymes in the endometrium.Historically, there has been some concern that using the antifibrinolytic tranexamic acid (TXA) for HMB may increase the risk of venous thromboembolic disease. This is an umbrella term for deep venous thrombosis (blood clots in the blood vessels in the legs) and pulmonary emboli (blood clots in the blood vessels in the lungs). To determine the effectiveness and safety of antifibrinolytic medications as a treatment for heavy menstrual bleeding. We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO and two trials registers in November 2017, together with reference checking and contact with study authors and experts in the field. We included randomized controlled trials (RCTs) comparing antifibrinolytic agents versus placebo, no treatment or other medical treatment in women of reproductive age with HMB. Twelve studies utilised TXA and one utilised a prodrug of TXA (Kabi). We used standard methodological procedures expected by Cochrane. The primary review outcomes were menstrual blood loss (MBL), improvement in HMB, and thromboembolic events. We included 13 RCTs (1312 participants analysed). The evidence was very low to moderate quality: the main limitations were risk of bias (associated with lack of blinding, and poor reporting of study methods), imprecision and inconsistency.Antifibrinolytics (TXA or Kabi) versus no treatment or placeboWhen compared with a placebo, antifibrinolytics were associated with reduced mean blood loss (MD -53.20 mL per cycle, 95% CI -62.70 to -43.70; I² = 8%; 4 RCTs, participants = 565; moderate-quality evidence) and higher rates of improvement (RR 3.34, 95% CI 1.84 to 6.09; 3 RCTS, participants = 271; moderate-quality evidence). This suggests that

  13. Monitoring and treatment of acute gastrointestinal bleeding.

    Science.gov (United States)

    Lenjani, Basri; Zeka, Sadik; Krasniqi, Salih; Bunjaku, Ilaz; Jakupi, Arianit; Elshani, Besni; Xhafa, Agim

    2012-01-01

    Acute gastrointestinal bleeding-massive acute bleeding from gastrointestinal section is one of the most frequent forms of acute abdomen. The mortality degree in emergency surgery is about 10%. It's very difficult to identify the place of bleeding and etiology. The important purpose of this research is to present the cases of acute gastrointestinal bleeding from the patients which were monitored and treated at The University Clinical Center of Kosova-Emergency Center in Pristina. These inquests included 137 patients with acute gastrointestinal bleeding who were treated in emergency center of The University Clinical Center in Pristina for the period from January 2005 until December 2006. From 137 patients with acute gastrointestinal bleeding 41% or 29% was female and 96% or 70.1% male. Following the sex we gained a high significant difference of statistics (p < 0.01). The gastrointestinal bleeding was two times more frequent in male than in female. Also in the age-group we had a high significant difference of statistics (p < 0.01) 63.5% of patients were over 55 years old. The mean age of patients with an acute gastrointestinal bleeding was 58.4 years SD 15.8 age. The mean age for female patients was 56.4 age SD 18.5 age. The patients with arterial systolic pressure under 100 mmHg have been classified as patients with hypovolemic shock. They participate with 17.5% in all prevalence of acute gastrointestinal bleeding. From the number of prevalence 2 {1.5%} patients have been diagnosed with peptic ulcer, 1 {0.7%} as gastric perforation and 1 {0.7%} with intestine ischemia. Abdominal Surgery and Intensive Care 2 or 1.5% died, 1 at intensive care unit and 1 at nephrology. As we know the severe condition of the patients with gastrointestinal bleeding and etiology it is very difficult to establish, we need to improve for the better conditions in our emergency center for treatment and initiation base of clinic criteria.

  14. [A Case of Intrahepatic Cholangiocarcinoma with Invasion to the Transverse Colon and Gallbladder, Forming an Intra-Tumor Abscess].

    Science.gov (United States)

    Okada, Nami; Kametaka, Hisashi; Koyama, Takashi; Seike, Kazuhiro; Makino, Hironobu; Fukada, Tadaomi; Sato, Yutaka; Miyazaki, Masaru

    2015-11-01

    An 81-year-old man was referred to our institution for evaluation of high fever and a liver tumor that had been detected by ultrasonography. Computed tomography revealed a low-density mass with peripheral ring-like enhancement in S5 of the liver. The liver mass was in contact with the gallbladder, and the boundary between the mass and the gallbladder was unclear. On the suspicion of liver abscess, percutaneous transhepatic drainage was performed. The cavity of the abscess communicated with the gallbladder. Because the cavity had no tendency to reduce in size, we performed surgical resection under a preoperative diagnosis of liver abscess or primary liver carcinoma invading to the gallbladder. Intraoperative findings revealed a liver tumor invading the transverse colon and gallbladder. Subsegmentectomy of S4a and S5 of the liver combined with gallbladder and transverse colon resection was performed. Histopathological findings indicated the growth of a mass forming type intrahepatic cholangiocarcinoma with invasion to the transverse colon and gallbladder, and the pathological stage of the tumor was pT3N0M0, fStage Ⅲ. Thus far, the patient is alive without recurrence 9 months after surgery. Here, we report an extremely rare case of intrahepatic cholangiocarcinoma that invaded other organs and was associated with an intra-tumor abscess.

  15. Bed Bugs FAQs

    Science.gov (United States)

    ... Europe. Bed bugs have been found in five-star hotels and resorts and their presence is not ... Health – Division of Parasitic Diseases Email Recommend Tweet YouTube Instagram Listen Watch RSS ABOUT About CDC Jobs ...

  16. Bed Bug Information Clearinghouse

    Science.gov (United States)

    Its purpose is to help states, communities, and consumers in efforts to prevent and control bed bug infestations. Currently includes only reviewed material from federal/state/local government agencies, extension services, and universities.

  17. Particle fuel bed tests

    International Nuclear Information System (INIS)

    Horn, F.L.; Powell, J.R.; Savino, J.M.

    1985-01-01

    Gas-cooled reactors, using packed beds of small diameter coated fuel particles have been proposed for compact, high-power systems. The particulate fuel used in the tests was 800 microns in diameter, consisting of a thoria kernel coated with 200 microns of pyrocarbon. Typically, the bed of fuel particles was contained in a ceramic cylinder with porous metallic frits at each end. A dc voltage was applied to the metallic frits and the resulting electric current heated the bed. Heat was removed by passing coolant (helium or hydrogen) through the bed. Candidate frit materials, rhenium, nickel, zirconium carbide, and zirconium oxide were unaffected, while tungsten and tungsten-rhenium lost weight and strength. Zirconium-carbide particles were tested at 2000 K in H 2 for 12 hours with no visible reaction or weight loss

  18. A comparative study of clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa.

    Directory of Open Access Journals (Sweden)

    Di Zhou

    Full Text Available BACKGROUND: Helicobacter pylori has been isolated from 10%-20% of human chronic cholecystitis specimens but the characteristics of "Helicobacter pylori positive cholecystitis" remains unclear. This study aims to compare the clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa. METHODS: Three hundred and twenty-six chronic cholecystitis patients were divided into two groups according to whether Helicobacter pylori could be detected by culture, staining or PCR for Helicobacter 16s rRNA gene in gallbladder mucosa. Positive samples were sequenced for Helicobacter pylori-specific identification. Clinical parameters as well as pathological characteristics including some premalignant lesions and the expression levels of iNOS and ROS in gallbladder were compared between the two groups. RESULTS: Helicobacter pylori infection in gallbladder mucosa was detected in 20.55% of cholecystitis patients. These patients had a higher prevalence of acid regurgitation symptoms (p = 0.001, more histories of chronic gastritis (p = 0.005, gastric ulcer (p = 0.042, duodenal ulcer (p = 0.026 and higher presence of Helicobacter pylori in the stomach as compared to patients without Helicobacter pylori infection in the gallbladder mucosa. Helicobacter pylori 16s rRNA in gallbladder and gastric-duodenal mucosa from the same individual patient had identical sequences. Also, higher incidences of adenomyomatosis (p = 0.012, metaplasia (p = 0.022 and higher enhanced expressions of iNOS and ROS were detected in Helicobacter pylori infected gallbladder mucosa (p<0.05. CONCLUSIONS: Helicobacter pylori infection in gallbladder mucosa is strongly associated with Helicobacter pylori existed in stomach. Helicobacter pylori is also correlated with gallbladder premalignant lesions including metaplasia and adenomyomatosis. The potential mechanism might be related with higher ROS

  19. Spontaneous perforation of gallbladder with intrahepatic biloma formation: sonographic signs and correlation with computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hollanda, Erick Sabbagh de; Torres, Ulysses dos Santos; Gual, Fabiana; Oliveira, Eduardo Portela de; Cardoso, Luciana Vargas; Criado, Divanei Aparecida Bottaro, E-mail: usantor@yahoo.com.br [Faculdade de Medicina de Sao Jose do Rio Preto (Famerp), SP (Brazil). Hospital de Base

    2013-09-15

    Spontaneous perforation of gallbladder is a severe and infrequent complication of acute cholecystitis that requires early and accurate diagnosis. Concomitant development of intrahepatic collections is rarely observed in such cases. The present report emphasizes the relevance of imaging studies in this setting, describing the typical sonographic and tomographic findings for the diagnosis of such condition. (author)

  20. Peroxisomes in intestinal and gallbladder epithelial cells of the stickleback, Gasterosteus aculeatus L. (Teleostei)

    NARCIS (Netherlands)

    Ruiter, A.J.H. de; Veenhuis, M.; Wendelaar Bonga, S.E.

    1988-01-01

    The occurrence of microbodies in the epithelial cells of the intestine and gallbladder of the stickleback, Gasterosteus aculeatus L., is described. In the intestine the organelles are predominantly located in the apical and perinuclear zone of the cells and may contain small crystalline cores. In

  1. Ursodeoxycholic acid reduces protein levels and nucleation-promoting activity in human gallbladder bile

    NARCIS (Netherlands)

    van Erpecum, K. J.; Portincasa, P.; Eckhardt, E.; Go, P. M.; vanBerge-Henegouwen, G. P.; Groen, A. K.

    1996-01-01

    Background & Aims: Ursodeoxycholic acid prevents gallstone formation in selected patients. The aim of this study was to examine whether decreased concentration and nucleation-promoting activity of various proteins contribute to this beneficial effect. Methods: Gallbladder bile of 13 patients with

  2. BAY K 8644-induced oscillations in rabbit gall-bladder transepithelial potential difference

    DEFF Research Database (Denmark)

    Hansen, C P; Holstein-Rathlou, N H; Frederiksen, O

    1986-01-01

    The effects of the Ca2+-channel activator BAY K 8644 (a novel dihydropyridine) on transepithelial potential difference (Pd), electrical resistance (Rt), and unidirectional Na+-fluxes were studied in the rabbit gall-bladder. It was observed that BAY K 8644 at concentrations between 10(-7) and 10...

  3. Quantification of mucin in human gallbladder bile: a fast, specific, and reproducible method

    NARCIS (Netherlands)

    Miquel, J. F.; Groen, A. K.; van Wijland, M. J.; del Pozo, R.; Eder, M. I.; von Ritter, C.

    1995-01-01

    It is generally accepted that gallbladder mucin (GBM) plays an important role in the pathogenesis of cholesterol gallstone (ChG) disease. However, it remains unclear whether ChG patients have higher GBM concentrations than controls. Discrepant findings regarding biliary mucin concentrations may be

  4. A comparative study of mud-like and coralliform calcium carbonate gallbladder stones.

    Science.gov (United States)

    Ma, Rui-Hong; Luo, Xiao-Bing; Wang, Xiao-Feng; Qiao, Tie; Huang, Hai-Yi; Zhong, Hai-Qiang

    2017-07-01

    To gain insight to underlying mechanism of the formation of calcium carbonate (CaCO 3 ) gallbladder stones, we did comparative study of stones with mud appearance and those with coralliform appearance. A total of 93 gallbladder stones with mud appearance and 50 stones with coralliform appearance were analyzed. The appearance, color, texture, and the detection of Clonorchis sinensis eggs by microscopic examination were compared between the two groups. Then, the material compositions of stones were analyzed using Fourier Transform Infrared spectroscopy and the spectrogram characteristics were compared. Moreover, microstructure characteristics of the two kinds of stones were observed and compared with Scanning Electron Microscopy. Mud-like gallbladder stones were mainly earthy yellow or brown with brittle or soft texture, while coralliform stones were mainly black with extremely hard texture, the differences between the two groups was significant (p mud-like gallbladder stones were CaCO 3 stones, and mainly aragonite; while all of the coralliform stones were CaCO 3 stones, and mainly calcite (p mud-like CaCO 3 stones was lower than that in coralliform CaCO 3 stones (p Mud-like CaCO 3 stones mainly happened to patients with cystic duct obstruction. Clonorchis sinensis infection was mainly associated with coralliform (calcite) CaCO 3 stones. Cystic duct obstruction was mainly associated with mud-like (aragonite) CaCO 3 stones. © 2017 Wiley Periodicals, Inc.

  5. A Clinician’s Guide to the Diagnosis and Management of Gallbladder Volvulus

    Science.gov (United States)

    Pottorf, Brian J; Alfaro, Leonardo; Hollis, Harris W

    2013-01-01

    Introduction: Gallbladder volvulus (GV), or torsion of the gallbladder, is an uncommon surgical emergency. This article reviews the world literature related to GV. We examine the history of gallbladder torsion and highlight the critical constellation of presenting signs and symptoms, which guide the acute care physician and surgeon to accurate and timely diagnosis of GV before surgical intervention. Methods: A comprehensive review of all published cases of GV was performed using the National Library of Medicine (PubMed) database. Results: Lists of typical symptoms and clinical presentations are provided to allow clinicians to establish an accurate preoperative diagnosis. Conclusion: GV is frequently undiagnosed before surgical intervention. However, clinical presentation and associated radiographic findings can lead to an accurate diagnosis if the clinician is aware of this uncommon condition. When the diagnosis has been established before operative intervention, expeditious laparoscopic cholecystectomy can be performed safely. Delays in diagnosis may mandate open cholecystectomy if laparoscopic extraction is contraindicated because of undesirable sequelae of gallbladder necrosis, specifically perforation, bilious peritonitis, and hemodynamic instability. PMID:23704849

  6. A Clinician's Guide to the Diagnosis and Management of Gallbladder Volvulus.

    Science.gov (United States)

    Pottorf, Brian J; Alfaro, Leonardo; Hollis, Harris W

    2013-01-01

    Gallbladder volvulus (GV), or torsion of the gallbladder, is an uncommon surgical emergency. This article reviews the world literature related to GV. We examine the history of gallbladder torsion and highlight the critical constellation of presenting signs and symptoms, which guide the acute care physician and surgeon to accurate and timely diagnosis of GV before surgical intervention. A comprehensive review of all published cases of GV was performed using the National Library of Medicine (PubMed) database. Lists of typical symptoms and clinical presentations are provided to allow clinicians to establish an accurate preoperative diagnosis. GV is frequently undiagnosed before surgical intervention. However, clinical presentation and associated radiographic findings can lead to an accurate diagnosis if the clinician is aware of this uncommon condition. When the diagnosis has been established before operative intervention, expeditious laparoscopic cholecystectomy can be performed safely. Delays in diagnosis may mandate open cholecystectomy if laparoscopic extraction is contraindicated because of undesirable sequelae of gallbladder necrosis, specifically perforation, bilious peritonitis, and hemodynamic instability.

  7. Changes in gallbladder bile composition and crystal detection time in morbidly obese subjects after bariatric surgery.

    Science.gov (United States)

    Gustafsson, Ulf; Benthin, Lisbet; Granström, Lars; Groen, Albert K; Sahlin, Staffan; Einarsson, Curt

    2005-06-01

    The aim of the present study was to elucidate the mechanisms of development of cholesterol crystals and gallstones during weight reduction in obese subjects. Twenty-five morbidly obese, gallstone-free subjects underwent vertical-banded gastroplasty. Gallbladder bile was collected at the time of the operation via needle aspiration and 1.1-7.3 months after the operation via ultrasound-guided transhepatic puncture of the gallbladder. The mean weight loss was 17 kg. Two patients developed gallstones and 10 patients displayed cholesterol crystals in their bile. In patients with a follow-up time of less than 2 months (n = 13), cholesterol saturation increased from 90% to 114% but tended to decrease in the patients with a follow-up time of more than 2 months. The extraction of the concanavalin-A-binding fraction from gallbladder bile obtained after weight reduction in 7 patients prolonged crystallization detection time from 6 to 10 days. The hexosamine concentration, a marker for mucin, was increased by about 100% in bile obtained in 6 of 7 patients after weight reduction. In conclusion, the results indicate that crystallization-promoting compounds (mucin) are of great importance in the development of cholesterol crystals and gallstones in obese subjects during weight reduction, probably because of defective gallbladder emptying.

  8. Clostridium perfringens bacteremia caused by choledocholithiasis in the absence of gallbladder stones

    OpenAIRE

    Atia, Antwan; Raiyani, Tejas; Patel, Pranav; Patton, Robert; Young, Mark

    2012-01-01

    A 67-years-old male presented with periumbilical abdominal pain, fever and jaundice. His anaerobic blood culture was positive for clostridium perfringens. Computed tomogram scan of the abdomen and abdominal ultrasound showed normal gallbladder and common bile duct (CBD). Subsequently magnetic resonance cholangiopancreaticogram showed choledocholithiasis. Endoscopic retrograde cholangiopancreaticogramwith sphincterotomy and CBD stone extraction was performed. The patient progressively improved...

  9. Changes in gallbladder bile composition and crystal detection time in morbidly obese subjects after bariatric surgery

    NARCIS (Netherlands)

    Gustafsson, Ulf; Benthin, Lisbet; Granström, Lars; Groen, Albert K.; Sahlin, Staffan; Einarsson, Curt

    2005-01-01

    The aim of the present study was to elucidate the mechanisms of development of cholesterol crystals and gallstones during weight reduction in obese subjects. Twenty-five morbidly obese, gallstone-free subjects underwent vertical-banded gastroplasty. Gallbladder bile was collected at the time of the

  10. Interaction of bovine gallbladder mucin and calcium-binding protein: effects on calcium phosphate precipitation

    NARCIS (Netherlands)

    Afdhal, N. H.; Ostrow, J. D.; Koehler, R.; Niu, N.; Groen, A. K.; Veis, A.; Nunes, D. P.; Offner, G. D.

    1995-01-01

    Gallstones consist of calcium salts and cholesterol crystals, arrayed on a matrix of gallbladder mucin (GBM), and regulatory proteins like calcium-binding protein (CBP). To determine if interactions between CBP and GBM follow a biomineralization scheme, their mutual binding and effects on CaHPO4

  11. Gallbladder contractility and mucus secretion after cholesterol feeding in the prairie dog

    NARCIS (Netherlands)

    Li, Y. F.; Moody, F. G.; Weisbrodt, N. W.; Zalewsky, C. A.; Coelho, J. C.; Senninger, N.; Gouma, D.

    1986-01-01

    The purpose of our study was to evaluate changes in gallbladder contractility and mucus secretion in vitro during the early stages of gallstone formation in prairie dogs. Thirty-two animals were divided into five groups. Control animals were fed a trace cholesterol diet. Experimental animals were

  12. surgery of the gall-bladder and the commo bile-duct* 1

    African Journals Online (AJOL)

    The surgical treatment of diseases of the gall-bladder consists largely of the treatment of stones and their complications. There is a voluminous literature on gallstones, but its analysis would serve little purpose in this paper. It is of greater value to analyse one's own experience, to discuss how we can diagnose lesions of.

  13. Actinomycosis of the Gallbladder Mimicking Carcinoma: a Case Report with US and CT Findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Han; Kim, Seong Hyun; Cho, Mee Yon; Rhoe, Byoung Seon; Kim, Myung Soon [Wonju Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju (Korea, Republic of)

    2007-04-15

    Actinomycosis should be included in the differential diagnosis when sonography and computed tomography findings show a mass engulfing the stone in the gallbladder and extensive pericholecystic infiltration with extension to neighboring abdominal wall muscle. A ctinomycosis is a chronic suppurative and granulomatous disease that is characterized by the formation of multiple abscesses, draining sinuses, abundant granulation and dense fibrous tissue. The disease is most frequently caused by Actinomyces israelii. These organisms are gram-positive anaerobic bacteria, and are considered opportunistic pathogens associated with infection, trauma or surgery. These events allow them to cross mucosal barriers as these organisms are normally present in healthy individuals, especially in the oral cavity, gastrointestinal tract, and female genital tract. In abdominopelvic actinomycosis, aggressive perilesional infiltration with a tendency to cross fascial planes or boundaries and extend to the abdominal wall has been well described as an important radiologic finding. Actinomycosis of the gallbladder is an extremely rare disease; only 21 cases have been reported in the English literature. Moreover, a diagnosis of actinomycosis of the gallbladder is difficult because this condition can be confused with carcinoma. We report here on a rare case of actinomycosis of the gallbladder that presented as a mass by sonography and computed tomography (CT)

  14. Actinomycosis of the Gallbladder Mimicking Carcinoma: a Case Report with US and CT Findings

    International Nuclear Information System (INIS)

    Lee, Young Han; Kim, Seong Hyun; Cho, Mee Yon; Rhoe, Byoung Seon; Kim, Myung Soon

    2007-01-01

    Actinomycosis should be included in the differential diagnosis when sonography and computed tomography findings show a mass engulfing the stone in the gallbladder and extensive pericholecystic infiltration with extension to neighboring abdominal wall muscle. A ctinomycosis is a chronic suppurative and granulomatous disease that is characterized by the formation of multiple abscesses, draining sinuses, abundant granulation and dense fibrous tissue. The disease is most frequently caused by Actinomyces israelii. These organisms are gram-positive anaerobic bacteria, and are considered opportunistic pathogens associated with infection, trauma or surgery. These events allow them to cross mucosal barriers as these organisms are normally present in healthy individuals, especially in the oral cavity, gastrointestinal tract, and female genital tract. In abdominopelvic actinomycosis, aggressive perilesional infiltration with a tendency to cross fascial planes or boundaries and extend to the abdominal wall has been well described as an important radiologic finding. Actinomycosis of the gallbladder is an extremely rare disease; only 21 cases have been reported in the English literature. Moreover, a diagnosis of actinomycosis of the gallbladder is difficult because this condition can be confused with carcinoma. We report here on a rare case of actinomycosis of the gallbladder that presented as a mass by sonography and computed tomography (CT)

  15. A case report of the clear cell variant of gallbladder carcinoma

    Directory of Open Access Journals (Sweden)

    Ravi Maharaj

    2017-01-01

    Conclusion: In these cases, clinical case management should be personalized for increased survival with the possible incorporation of next generation sequencing approaches to guide therapeutic algorithms. We discuss this exceedingly rare case of the clear cell variant of gallbladder carcinoma in detail, highlighting some of the diagnostic, and clinical challenges.

  16. Risk factors for gallbladder cancer: a case-control study.

    Science.gov (United States)

    Jain, Kajal; Sreenivas, V; Velpandian, T; Kapil, Umesh; Garg, Pramod Kumar

    2013-04-01

    Risk factors for gallbladder cancer (GBC) except gallstones are not well known. The objective was to study the risk factors for GBC. In a case-control study, 200 patients with GBC, 200 healthy controls and 200 gallstones patients as diseased controls were included prospectively. The risk factors studied were related to socioeconomic profile, life style, reproduction, diet and bile acids. On comparing GBC patients (mean age 51.7 years; 130 females) with healthy controls, risk factors were chemical exposure [odd ratios (OR): 7.0 (2.7-18.2); p < 0.001)], family history of gallstones [OR: 5.3 (1.5-18.9); p < 0.01)], tobacco [OR: 4.1 (1.8-9.7); p < 0.001)], fried foods [OR: 3.1 (1.7-5.6); p < 0.001], joint family [OR: 3.2 (1.7-6.2); p < 0.001], long interval between meals [OR: 1.4 (1.2-1.6); p < 0.001] and residence in Gangetic belt [OR: 3.3 (1.8-6.2); p < 0.001]. On comparing GBC cases with gallstone controls, risk factors were female gender [OR: 2.4 (1.3-4.3); p = 0.004], residence in Gangetic belt [OR: 2.3 (1.2-4.4); p = 0.012], fried foods [OR: 2.5 (1.4-4.4); p < 0.001], diabetes [OR: 2.7 (1.2-6.4); p = 0.02)], tobacco [OR 3.8 (1.7-8.1); p < 0.001)] and joint family [OR: 2.1 (1.2-3.4); p = 0.004]. The ratio of secondary to primary bile acids was significantly higher in GBC cases than gallstone controls (20.8 vs. 0.44). Fried foods, tobacco, chemical exposure, family history of gallstones, residence in Gangetic belt and secondary bile acids were significant risk factors for GBC. Copyright © 2012 UICC.

  17. New-Style Laparoscope and Endoscope Cooperative Gallbladder-Preserving Surgery for Polyps

    International Nuclear Information System (INIS)

    Li, M.; Wu, H.; Wei, S.

    2016-01-01

    Objective: To evaluate the feasibility and safety of a new style of Laparoscope and Endoscope Cooperative gallbladderpreserving Surgery (LECS), an improved method of minimally invasive gallbladder-preserving polypectomy. Study Design: An experimental study. Place and Duration of Study: Department of General Surgery, The Second Affiliated Hospital of Soochow University, China, from January 2009 to July 2013. Methodology: Clinical data of patients subjected to LECS and Laparoscopic Cholecystectomy (LC) was analysed. The inclusion criteria were normal size clear gallbladder bile with total volume (FV) of the gallbladder = 15 - 25 ml, the Residual Volume (RV) = 5 ml, and the Emptying Figure (EF) > 75 percentage, with polyps diagnosed definitively by B-type ultrasonic imaging or CT desirous of preserving gallbladder. Exclusion criteria were a history of midsection surgery, serious diseases of any organ, hepatic injury, or coagulation disturbance. Mean hospital stay and complications were also noted. Independent sample t-test, the frequency comparison used chi-square test (N > 5), and Fisher's exact test (N < 5) were used for statistical test. Results: The mean hospital stay after LECS was 3.50 ± 0.31 days, and 3.50 ± 0.31 days for the LC group. The mean age in LC and LECS group was 50 ± 25.4 and 44 ± 12.1 years, respectively. Complications after operation in the LECS were indigestion and diarrhea; LC group had indigestion (9.33 percentage), diarrhea (10.67 percentage), and gastroesophageal reflux (6.6.7 percentage). In the 3 months follow-up after discharging from the hospital, no patient had recurrence of any gallbladder disease; at 1 year follow-up, 1 patient (1.28 percentage) developed cholesterol crystals; at 3-year follow-up, 3 cases (3.84 percentage) were found to have recurring polyps (2-4 pieces), and 2 (2.56 percentage) patients developed cholesterol crystals. Conclusion: Minimally invasive gallbladder-preserving polypectomy which used a CHIAO

  18. Qualitative metabolomics profiling of serum and bile from dogs with gallbladder mucocele formation

    Science.gov (United States)

    Mathews, Kyle G.; Cullen, John; Seiler, Gabriela

    2018-01-01

    Mucocele formation is characterized by secretion of abnormally thick mucus by the gallbladder epithelium of dogs that may cause obstruction of the bile duct or rupture of the gallbladder. The disease is increasingly recognized and is associated with a high morbidity and mortality. The cause of gallbladder mucocele formation in dogs is unknown. There is a strong breed predisposition and affected dogs have a high incidence of concurrent endocrinopathy or hyperlipidemia. These observations suggest a significant influence of both genetic and metabolic factors on disease pathogenesis. In this study, we investigated a theory that mucocele formation is associated with a syndrome of metabolic disruption. We surmised that a global, untargeted metabolomics approach could provide unique insight into the systemic pathogenesis of gallbladder mucocele formation and identify specific compounds as candidate biomarkers or treatment targets. Moreover, concurrent examination of the serum and hepatic duct bile metabolome would enable the construction of mechanism-based theories or identification of specific compounds responsible for altered function of the gallbladder epithelium. Abnormalities observed in dogs with gallbladder mucocele formation, including a 33-fold decrease in serum adenosine 5’-monophosphate (AMP), lower quantities of precursors required for synthesis of energy transporting nucleotides, and increases in citric acid cycle intermediates, suggest excess metabolic energy and a carbon surplus. Altered quantities of compounds involved in protein translation and RNA turnover, together with accumulation of gamma-glutamylated and N-acetylated amino acids in serum suggest abnormal regulation of protein and amino acid metabolism. Increases in lathosterol and 7α-hydroxycholesterol suggest a primary increase in cholesterol synthesis and diversion to bile acid formation. A number of specific biomarker compounds were identified for their ability to distinguish between control

  19. Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

    NARCIS (Netherlands)

    Cooper, Natalie A. M.; Barton, Pelham M.; Breijer, Maria; Caffrey, Orla; Opmeer, Brent C.; Timmermans, Anne; Mol, Ben W. J.; Khan, Khalid S.; Clark, T. Justin

    2014-01-01

    Heavy menstrual bleeding (HMB) and post-menopausal bleeding (PMB) together constitute the commonest gynaecological presentation in secondary care and impose substantial demands on health service resources. Accurate diagnosis is of key importance to realising effective treatment, reducing morbidity

  20. Reliability measures in managing GI bleeding.

    Science.gov (United States)

    Sonnenberg, Amnon

    2012-06-01

    Multiple procedures and devices are used in a complex interplay to diagnose and treat GI bleeding. To model how a large variety of diagnostic and therapeutic components interact in the successful management of GI bleeding. The analysis uses the concept of reliability block diagrams from probability theory to model management outcome. Separate components of the management process are arranged in a serial or parallel fashion. If the outcome depends on the function of each component individually, such components are modeled to be arranged in series. If components complement each other and can mutually compensate for each of their failures, such components are arranged in a parallel fashion. General endoscopy practice. Patients with GI bleeding of unknown etiology. All available endoscopic and radiographic means to diagnose and treat GI bleeding. Process reliability in achieving hemostasis. Serial arrangements tend to reduce process reliability, whereas parallel arrangements increase it. Whenever possible, serial components should be bridged and complemented by additional alternative (parallel) routes of operation. Parallel components with low individual reliability can still contribute to overall process reliability as long as they function independently of other pre-existing alternatives. Probability of success associated with individual components is partly unknown. Modeling management of GI bleeding by a reliability block diagram provides a useful tool in assessing the impact of individual endoscopic techniques and administrative structures on the overall outcome. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  1. Intracranial hemorrhage in congenital bleeding disorders.

    Science.gov (United States)

    Tabibian, Shadi; Motlagh, Hoda; Naderi, Majid; Dorgalaleh, Akbar

    2018-01-01

    : Intracranial hemorrhage (ICH), as a life-threatening bleeding among all kinds of congenital bleeding disorders (CBDs), is a rare manifestation except in factor XIII (FXIII) deficiency, which is accompanied by ICH, early in life, in about one-third of patients. Most inherited platelet function disorders (IPFDs) are mild to moderate bleeding disorders that can never experience a severe bleeding as in ICH; however, Glanzmann's thrombasthenia, a common and severe inherited platelet function disorder, can lead to ICH and occasional death. This bleeding feature can also be observed in grey platelet syndrome, though less frequently than in Glanzmann's thrombasthenia. In hemophilia, intracerebral hemorrhage is affected by various risk factors one of which is the severity of the disease. The precise prevalence of ICH in these patients is not clear but an estimated incidence of 3.5-4% among newborns with hemophilia is largely ascertained. Although ICH is a rare phenomenon in CBDs, it can be experienced by every patient with severe hemophilia A and B, FXIII deficiency (FXIIID), FVIID, FXD, FVD, FIID, and afibrinogenemia. Upon observing the general signs and symptoms of ICH such as vomiting, seizure, unconsciousness, and headache, appropriate replacement therapies and cranial ultrasound scans must be done to decrease ICH-related morbidity and mortality.

  2. Management of Adult Choledochal Cyst Coexisting with Gallbladder Carcinoma: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Olusegun Isaac Alatise

    2016-01-01

    Full Text Available Choledochal cyst is a relatively rare condition. Even rarer is a choledochal cyst in association with a gallbladder carcinoma. This study reports a rare case of gallbladder carcinoma coexisting with a choledochal cyst in a Nigerian patient. Clinical records of the patient including preoperative evaluation, intraoperative findings, and postoperative care were reviewed. A 38-year-old woman presented with the recurrent right upper abdominal pain of 3 years duration associated with progressive weight loss, anorexia, recurrent vomiting, as well as, low-grade fever with chills and rigors. Physical examination revealed an anicteric woman with tenderness in the right hypochondrium and a positive Murphy's sign. A combination of abdominal ultrasound and computed tomography scan suggested a Type IV choledochal cyst and a distended gallbladder with thickened walls containing a heterogeneous hyperdense mass. Preoperative serum alkaline phosphatase was elevated while endoscopic retrograde cholangiopancreatography was inconclusive. At laparotomy, extrahepatic biliary dilatation and enlarged, the nodular gallbladder was found with a diffusely fibrotic pancreas. Intraoperative cholangiogram confirmed Type IV choledochal cyst. Excision of the common bile duct and radical cholecystectomy was performed, and a Roux-en-Y hepaticojejunostomy. Histopathology confirmed the diagnosis of gallbladder adenocarcinoma. She had adjuvant chemotherapy and is presently on follow-up. No evidence of recurrence after 5 years of follow-up. A high index of suspicion is required to detect a combination of these two rare entities. When detected, both conditions should be surgically addressed at the same sitting, and when combined with adjuvant chemotherapy, may increase the chances of achieving a cure.

  3. Rapid formation of cholesterol crystals in gallbladder bile is associated with stone recurrence after laparoscopic cholecystotomy.

    Science.gov (United States)

    Jüngst, D; del Pozo, R; Dolu, M H; Schneeweiss, S G; Frimberger, E

    1997-03-01

    Laparoscopic cholecystotomy (LCT) with subsequent extraction of gallstones and primary closure of the gallbladder has been introduced as an alternative therapy for patients with cholecystolithiasis and preserved gallbladder function. However, stone recurrence has to be considered as a major drawback that might be related to lithogenic factors of gallbladder bile or the composition of gallbladder stones. Therefore, these were studied in relation to stone recurrence within an observation period of 1 to 5 years (median, 3.6 years) in 50 patients after LCT. The concentrations of total and individual bile acids, phospholipids, cholesterol, total lipids, mucin, protein, and the cholesterol saturation indices in gallbladder bile were not significantly different between 10 patients with and 40 patients without stone recurrence. However, the crystal observation time was significantly (P < .02) shorter (range, 1-2 days; median, 1.5) in the bile of patients with stone recurrence compared to those without (range, 1-21 days, median 3.5). Moreover, all 10 stone recurrences were observed in the 28 patients with a crystal observation time in the bile of less than or equal to 2 days (approximate annual risk: 12%-15%), and no recurrences were observed in the 22 patients with a crystal observation time greater than 2 days (P < .0001) or in patients with pigment stones. The rapid formation of cholesterol monohydrate crystals in bile seems to be the major risk factor for recurrent stones after LCT. These are most likely cholesterol stones and, therefore, are amenable to oral bile-acid prevention or treatment.

  4. Cystoisospora belli Infection of the Gallbladder in Immunocompetent Patients: A Clinicopathologic Review of 18 Cases.

    Science.gov (United States)

    Lai, Keith K; Goyne, Hannah E; Hernandez-Gonzalo, David; Miller, Kennon A; Tuohy, Marion; Procop, Gary W; Lamps, Laura W; Patil, Deepa T

    2016-08-01

    Cystoisospora belli, previously known as Isospora belli, is an obligate intracellular coccidian parasite that is most often associated with gastrointestinal disease in immunocompromised patients. In this study, we detail the clinicopathologic features of 18 cases of Cystoisospora infection affecting the gallbladder in immunocompetent individuals and compare them with a control group. Each case was reviewed for cholecystitis (none, acute, chronic), epithelial disarray, presence of intraepithelial lymphocytes (none, rare [≤5 per 20 epithelial cells], present [>5 per 20 epithelial cells]), architectural distortion, intramucosal eosinophilia, and mural thickening/serositis. The mean age of patients with Cystoisospora infection was 33 years and the male to female ratio 1:4.3. Cholecystectomy was performed for biliary dyskinesia (n=7), abdominal pain (n=7), suspected cholelithiasis (n=5), and cholecystitis (n=3). In 2 cases, Cystoisospora was found in donor gallbladders resected at the time of liver transplantation. Each case was characterized by eosinophilic, oval or banana-shaped intraepithelial parasites within perinuclear parasitophorous vacuoles. Most cases showed epithelial disarray and minimal intraepithelial lymphocytosis. Of the 11 cases with an average follow-up of 15 months, none had evidence of disease related to Cystoisospora infection within the biliary tract or elsewhere in the gastrointestinal tract. We present the largest series of gallbladder cystoisosporiasis in immunocompetent patients to date. Cystoisospora infection is underrecognized in the gallbladders of immunocompetent patients, in part due to the subtle findings in routine cholecystectomy specimens. On the basis of the clinical follow-up, gallbladder cystoisosporiasis in immunocompetent individuals appears to be a self-limited infection.

  5. Distribution and Effect of Galanin on Gallbladder and Sphincter of Oddi Motility in the Pig

    Directory of Open Access Journals (Sweden)

    Henrik Harling

    1991-01-01

    Full Text Available This study was designed to determine the occurrence and topographical distribution of galanin-like immunoreactivity (GAL-LI in the porcine gallbladder and sphincter of Oddi and to investigate the pharmacologic effect of GAL on gallbladder and sphincter of Oddi motility. By radioimmunoassay the concentration of GAL-LI in the gallbladder was 2.75 ± 0.23, 9.73 ± 1.33 in the common bile duct and 5.10 ± 0.37 in the sphincter of Oddi (pmol/g ± SE. By immunohistochemistry GAL-LI was found exclusively in ganglionic cells and in nerve fibers among the smooth muscle bundles. Gallbladder and sphincter of Oddi pressures were recorded before and during 5-minute local intraarterial infusion of 4, 8, 19, 39, 78 and 194 ng GAL-Kg-1-min-1 in 12 anaesthetized pigs. GAL in doses ≥ 39 ng.kg-1.min-1 significantly reduced sphincter of Oddi phasic wave frequency (4.8 ± 0.4 vs. 2.1 ± 0.5; p = 0.004 and sphincter of Oddi motility index (70.2 ± 6.02 vs. 27.7 ± 8.3; p = 0.002 but did not affect gallbladder pressure. We conclude that the distribution of GAL-LI in the sphincter of Oddi and the effect that a pharmacologic dose of GAL has on sphincter of Oddi motor activity, suggests that GAL may be involved in the physiologic control of bile flow in the pig.

  6. Accuracy of rockall score for in hospital re bleeding among cirrhotic patients with variceal bleed

    International Nuclear Information System (INIS)

    Asgher, S.; Saleem, M.K.

    2015-01-01

    To assess the diagnostic accuracy of Roc kall scoring system for predicting in-hospital re-ble- eding in cirrhotic patients presenting with variceal bleed. Material and Methods: This descriptive case series study was conducted at Department of Medicine Combined Military Hospital Lahore from December 2013 to May 2014. We included patients with liver cirrhosis who presented with upper GI bleeding and showed varices as the cause of bleeding on endoscopy. Clinical and endoscopic features were noted to calculate Rockall score. Patients with score < 2 and > 8 were included. After treating with appropriate pharmacological and endoscopic therapy, patients were followed for re-bleeding for 10 days. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive values using 2 x 2 tables. Results: In the study, 175 patients were included. Mean age was 51.5 ± 1.22 years. Male to female ratio was 1.5 to 1.0 out of 175 patients, 157 patients (89.7%) were of low risk group (score = 2) while 18 patients (10.3%) were in high risk group (score > 8). In low risk group, re-bleeding occurred only in 2 patients (1.2%) while in high risk group, re-bleeding occurred in 14 patients (78%). Rockall score was found to have good diagnostic accuracy with sensitivity of 87.5%, specificity of 97.48%, positive predictive value of 77.8% and negative predictive value of 98.7%. Conclusion: In cases of variceal bleed, frequency of re-bleed is less in patients who are in low risk category with lower Rockall score and high in high risk patients with higher rockall score. The Rockall score has a good diagnostic accuracy in prediction of re-bleed in variceal bleeding. (author)

  7. Hemospray application in nonvariceal upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Smith, Lyn A; Stanley, Adrian J; Bergman, Jacques J

    2013-01-01

    BACKGROUND: Hemospray TM (TC-325) is a novel hemostatic agent licensed for use in nonvariceal upper gastrointestinal bleeding (NVUGIB) in Europe. GOALS: We present the operating characteristics and performance of TC-325 in the largest registry to date of patients presenting with NVUGIB in everyday...... in combination with other hemostatic modalities at the endoscopists' discretion. RESULTS: Sixty-three patients (44 men, 19 women), median age 69 (range, 21 to 98) years with NVUGIB requiring endoscopic hemostasis were treated with TC-325. There were 30 patients with bleeding ulcers and 33 with other NVUGIB...... pathology. Fifty-five (87%) were treated with TC-325 as monotherapy; 47 [85%; 95% confidence interval (CI), 76%-94%] of them achieved primary hemostasis, and rebleeding rate at 7 days was 15% (95% CI, 5%-25%). Primary hemostasis rate for TC-325 in patients with ulcer bleeds was 76% (95% CI, 59%-93%). Eight...

  8. Fibrinogen concentrate for bleeding - a systematic review

    DEFF Research Database (Denmark)

    Lunde, J; Stensballe, J; Wikkelsø, A

    2014-01-01

    Fibrinogen concentrate as part of treatment protocols increasingly draws attention. Fibrinogen substitution in cases of hypofibrinogenaemia has the potential to reduce bleeding, transfusion requirement and subsequently reduce morbidity and mortality. A systematic search for randomised controlled...... trials (RCTs) and non-randomised studies investigating fibrinogen concentrate in bleeding patients was conducted up to November 2013. We included 30 studies of 3480 identified (7 RCTs and 23 non-randomised). Seven RCTs included a total of 268 patients (165 adults and 103 paediatric), and all were...... determined to be of high risk of bias and none reported a significant effect on mortality. Two RCTs found a significant reduction in bleeding and five RCTs found a significant reduction in transfusion requirements. The 23 non-randomised studies included a total of 2825 patients, but only 11 of 23 studies...

  9. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed....... All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

  10. Bleeding stomal varices in portal hypertension

    Directory of Open Access Journals (Sweden)

    Karen Tran-Harding, MD

    2018-04-01

    Full Text Available We report a case of a 50-year-old man with a history of liver cirrhosis and colon cancer post end colostomy presenting to the emergency department with stomal bleeding and passage of clots into the colostomy bag. The patient was treated with transjugular intrahepatic portosystemic shunt (TIPS and concomitant embolization of the stomal varices via the TIPS shunt using N-butyl cyanoacrylate mixed with ethiodol. Although stomal variceal bleeding is uncommon, this entity can have up to 40% mortality upon initial presentation, given the challenges in diagnosis and management. Currently, there are no established standard treatments for stomal variceal bleeding. In addition, to the best of our knowledge, there are no cases in the current literature in which treatment of this entity is performed with a combination of TIPS shunt placement and N-butyl cyanoacrylate variceal embolization. Keywords: Stomal varices, TIPS, Cirrhosis, Colon cancer, Embolization, NBCA

  11. Bayesian network modelling of upper gastrointestinal bleeding

    Science.gov (United States)

    Aisha, Nazziwa; Shohaimi, Shamarina; Adam, Mohd Bakri

    2013-09-01

    Bayesian networks are graphical probabilistic models that represent causal and other relationships between domain variables. In the context of medical decision making, these models have been explored to help in medical diagnosis and prognosis. In this paper, we discuss the Bayesian network formalism in building medical support systems and we learn a tree augmented naive Bayes Network (TAN) from gastrointestinal bleeding data. The accuracy of the TAN in classifying the source of gastrointestinal bleeding into upper or lower source is obtained. The TAN achieves a high classification accuracy of 86% and an area under curve of 92%. A sensitivity analysis of the model shows relatively high levels of entropy reduction for color of the stool, history of gastrointestinal bleeding, consistency and the ratio of blood urea nitrogen to creatinine. The TAN facilitates the identification of the source of GIB and requires further validation.

  12. Endoscopic management of acute peptic ulcer bleeding.

    Science.gov (United States)

    Lu, Yidan; Chen, Yen-I; Barkun, Alan

    2014-12-01

    This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Successful Management of Neobladder Variceal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Atwal, Dinesh; Chatterjee, Kshitij, E-mail: kchatterjee@uams.edu [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Osborne, Scott [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Kakkera, Krishna; Deas, Steven [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States); Li, Ruizong [University of Arkansas for Medical Sciences, Division of Interventional Radiology, Department of Radiology (United States); Erbland, Marcia [University of Arkansas for Medical Sciences, Department of Internal Medicine, Residency Program: Slot 634 (United States)

    2016-10-15

    Hematuria from a neobladder can occur due to a variety of pathologies including tumors, stones, and fistulas. Variceal bleeding in a neobladder is a very rare condition with only one case reported in literature. We present a case of a patient with cirrhosis and portal hypertension and an ileocolic orthotopic neobladder presenting with hematuria. Computed tomographic angiography showed dilated varices around the neobladder which were successfully embolized. To the best of our knowledge, this is the first report case of variceal bleeding in a neobladder successfully managed with the combination of TIPS (transjugular intrahepatic portosystemic shunt) procedure and embolization.

  14. [Epidemiology of upper gastrointestinal bleeding in Gabon].

    Science.gov (United States)

    Gaudong Mbethe, G L; Mounguengui, D; Ondounda, M; Magne, C; Bignoumbra, R; Ntsoumou, S; Moussavou Kombila, J-B; Nzenze, J R

    2014-01-01

    The department of internal medicine of the military hospital of Gabon managed 92 cases of upper gastrointestinal bleeding from April 2009 to November 2011. The frequency of these hemorrhages in the department was 8.2%; they occurred most often in adults aged 30-40 years and 50-60 years, and mainly men (74%). Erosive-ulcerative lesions (65.2%) were the leading causes of hemorrhage, followed by esophageal varices (15.2%). These results underline the importance of preventive measures for the control of this bleeding.

  15. Pebble-bed reactor

    International Nuclear Information System (INIS)

    Lohnert, G.; Mueller-Frank, U.; Heil, J.

    1976-01-01

    A pebble-bed nuclear reactor of large power rating comprises a container having a funnel-shaped bottom forming a pebble run-out having a centrally positioned outlet. A bed of downwardly-flowing substantially spherical nuclear fuel pebbles is positioned in the container and forms a reactive nuclear core maintained by feeding unused pebbles to the bed's top surface while used or burned-out pebbles run out and discharge through the outlet. A substantially conical body with its apex pointing upwardly and its periphery spaced from the periphery of the container spreads the bottom of the bed outwardly to provide an annular flow down the funnel-shaped bottom forming the runout, to the discharge outlet. This provides a largely constant downward velocity of the spheres throughout the diameter of the bed throughout a substantial portion of the down travel, so that all spheres reach about the same burned-out condition when they leave the core, after a single pass through the core area

  16. Fluidised bed heat exchangers

    International Nuclear Information System (INIS)

    Elliott, D.E.; Healey, E.M.; Roberts, A.G.

    1974-01-01

    Problems that have arisen during the initial stages of development of fluidised bed boilers in which heat transfer surfaces are immersed in fluidised solids are discussed. The very high heat transfer coefficients that are obtained under these conditions can be exploited to reduce the total heat transfer surface to a fraction of that in normal boilers. However, with the high heat flux levels involved, tube stressing becomes more important and it is advantageous to use smaller diameter tubes. One of the initial problems was that the pumping power absorbed by the fluidised bed appeared to be high. The relative influence of the fluidising velocity (and the corresponding bed area), tube diameter, tube spacing, heat transfer coefficient and bed temperature on pumping power and overall cost was determined. This showed the importance of close tube packing and research was undertaken to see if this would adversely affect the heat transfer coefficient. Pressure operation also reduces the pumping power. Fouling and corrosion tests in beds burning coal suggest that higher temperatures could be reached reliably and cost studies show that, provided the better refractory metals are used, the cost of achieving higher temperatures is not unduly high. It now remains to demonstrate at large scale that the proposed systems are viable and that the methods incorporated to overcome start up and part lead running problems are satisfactory. The promising role of these heat transfer techniques in other applications is briefly discussed

  17. A diagnostic dilemma of atypical gallbladder appearance on Tc-99m HIDA cholescintigraphy resolved with SPECT/CT.

    Science.gov (United States)

    Sood, Ravi; Murguia, Jeff; Graham, Michael M; Bushnell, David; Squires, Shayne; Laroia, Sandeep T; Bansal, Anish

    2011-02-01

    Tc-99m HIDA cholescintigraphy is the diagnostic procedure of choice for acute cholecystitis. Acute cholecystitis is associated in vast majority of the cases with cystic duct obstruction. The demonstration of presence (cystic duct patency) or absence (cystic duct obstruction) of visualization of the gallbladder on cholescintigraphy is critical to the diagnosis of acute cholecystitis. The visualization of the gallbladder rules out acute cholecystitis in most of the cases. Although, in most cases, determination of visualization or nonvisualization of gallbladder is straight forward, occasionally it can be challenging. We describe a patient with suspected acute cholecystitis, in whom an unusual appearance of the gallbladder on hepatobiliary scintigraphy was clarified with SPECT/CT, an approach that is rarely used in Tc-99m HIDA cholescintigraphy.

  18. Serial analysis of gene expression identifies connective tissue growth factor expression as a prognostic biomarker in gallbladder cancer.

    Science.gov (United States)

    Alvarez, Hector; Corvalan, Alejandro; Roa, Juan C; Argani, Pedram; Murillo, Francisco; Edwards, Jennifer; Beaty, Robert; Feldmann, Georg; Hong, Seung-Mo; Mullendore, Michael; Roa, Ivan; Ibañez, Luis; Pimentel, Fernando; Diaz, Alfonso; Riggins, Gregory J; Maitra, Anirban

    2008-05-01

    Gallbladder cancer (GBC) is an uncommon neoplasm in the United States, but one with high mortality rates. This malignancy remains largely understudied at the molecular level such that few targeted therapies or predictive biomarkers exist. We built the first series of serial analysis of gene expression (SAGE) libraries from GBC and nonneoplastic gallbladder mucosa, composed of 21-bp long-SAGE tags. SAGE libraries were generated from three stage-matched GBC patients (representing Hispanic/Latino, Native American, and Caucasian ethnicities, respectively) and one histologically alithiasic gallbladder. Real-time quantitative PCR was done on microdissected epithelium from five matched GBC and corresponding nonneoplastic gallbladder mucosa. Immunohistochemical analysis was done on a panel of 182 archival GBC in high-throughput tissue microarray format. SAGE tags corresponding to connective tissue growth factor (CTGF) transcripts were identified as differentially overexpressed in all pairwise comparisons of GBC (P Cancer Genome Anatomy Project web site and should facilitate much needed research into this lethal neoplasm.

  19. Prospective analysis of delayed colorectal post-polypectomy bleeding.

    Science.gov (United States)

    Park, Soo-Kyung; Seo, Jeong Yeon; Lee, Min-Gu; Yang, Hyo-Joon; Jung, Yoon Suk; Choi, Kyu Yong; Kim, Hungdai; Kim, Hyung Ook; Jung, Kyung Uk; Chun, Ho-Kyung; Park, Dong Il

    2018-01-17

    Although post-polypectomy bleeding is the most frequent complication after colonoscopic polypectomy, only few studies have investigated the incidence of bleeding prospectively. The aim of this study was to investigate the incidence of delayed post-polypectomy bleeding and its associated risk factors prospectively. Patients who underwent colonoscopic polypectomy at Kangbuk Samsung Hospital from January 2013 to December 2014 were prospectively enrolled in this study. Trained nurses contacted patients via telephone 7 and 30 days after polypectomy and completed a standardized questionnaire regarding the development of bleeding. Delayed post-polypectomy bleeding was categorized as minor or major and early or late bleeding. Major delayed bleeding was defined as a > 2-g/dL drop in the hemoglobin level, requiring hospitalization for control of bleeding or blood transfusion; late delayed bleeding was defined as bleeding occurring later than 24 h after polypectomy. A total of 8175 colonoscopic polypectomies were performed in 3887 patients. Overall, 133 (3.4%) patients developed delayed post-polypectomy bleeding. Among them, 90 (2.3%) and 43 (1.1%) patients developed minor and major delayed bleeding, respectively, and 39 (1.0%) patients developed late delayed bleeding. In the polyp-based multivariate analysis, young age ( 10 mm (OR 2.45; 95% CI 1.38-4.36) were significant risk factors for major delayed bleeding, while young age (< 50 years; OR 2.6; 95% CI 1.35-5.12) and immediate bleeding (OR 3.3; 95% CI 1.49-7.30) were significant risk factors for late delayed bleeding. Young age, aspirin use, polyp size, and immediate bleeding were found to be independent risk factors for delayed post-polypectomy bleeding.

  20. Scintigraphic pattern of small bowel bleeding

    International Nuclear Information System (INIS)

    Anshu Rajnish Sharma; Charan, S.; Silva, I.

    2004-01-01

    Introduction: Small intestine is the longest part of gastrointestinal tract. Intra-luminal haemorrhage occurring anywhere in its long and tortuous course is difficult to trace. It is relatively inaccessible to endoscopic evaluation. Upper GI endoscopy can see only up to distal duodenum, whereas colonoscope can view maximum of 30 centimeters of terminal ileum after negotiating the scope through ileo-caecal valve. Hence, localization of bleeding source from small bowel remains a difficult clinical problem. This group of patients can be evaluated with scintigraphy for localizing the site of bleeding before undergoing either angiography or surgery. To our best of knowledge, there is no study, which has utilized scintigraphy for evaluation of small bowel bleed exclusively. The present study has been designed to know the efficacy of 99mTc-RBC scintigraphy in detecting small bowel bleed and to know whether it can differentiate between jejunal and ileal bleeding ? Materials and methods: Thirteen patients presenting with lower gastrointestinal bleeding (malena) were enrolled for the study. In all cases, upper GI endoscopy (UGIE) was unremarkable. Colonoscopic examination was either negative or suspected bleeding occurring proximal to ileo-caecal valve. Thus, in these patients, it is presumed clinically that bleeding is originating from small bowel. Barium meal follow through (BMFT) studies, however, could not delineate any etiological lesion in these patients. There were 8 men and 5 women (mean age 48 years). All patients were anemic (Hb- 6 gm%) and mean 3 units of blood were transfused.These patients were subjected to Tc-99m labeled red blood cells scintigraphy (15 mci, in-vivo method) for localization of source of bleeding. The scintiscan was acquired in two phases. A first pass phase acquired at a rate of 2 seconds per frame for 60 seconds followed by acquisition of static abdominal images (500 K, 256 x 256 matrix) at 5 minutes intervals up to 90 minutes on LFOV gamma

  1. Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal.

    Science.gov (United States)

    Lirio, Richard A

    2016-01-01

    Upper gastrointestinal (UGI) bleeding is generally defined as bleeding proximal to the ligament of Treitz, which leads to hematemesis. There are several causes of UGI bleeding necessitating a detailed history to rule out comorbid conditions, medications, and possible exposures. In addition, the severity, timing, duration, and volume of the bleeding are important details to note for management purposes. Despite the source of the bleeding, acid suppression with a proton-pump inhibitor has been shown to be effective in minimizing rebleeding. Endoscopy remains the interventional modality of choice for both nonvariceal and variceal bleeds because it can be diagnostic and therapeutic. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. in Spouted Bed

    Directory of Open Access Journals (Sweden)

    Bronislaw Buczek

    2013-01-01

    Full Text Available Samples of active coke, fresh and spent after cleaning flue gases from communal waste incinerators, were investigated. The outer layers of both coke particles were separately removed by comminution in a spouted bed. The samples of both active cokes were analysed by means of densities, mercury porosimetry, and adsorption technique. Remaining cores were examined to determine the degree of consumption of coke by the sorption of hazardous emissions (SO2, HCl, and heavy metals through its bed. Differences in contamination levels within the porous structure of the particles were estimated. The study demonstrated the effectiveness of commercial active coke in the cleaning of flue gases.

  3. The Safety of Hospital Beds

    Science.gov (United States)

    Gervais, Pierre; Pooler, Charlotte; Merryweather, Andrew; Doig, Alexa K.; Bloswick, Donald

    2015-01-01

    To explore the safety of the standard and the low hospital bed, we report on a microanalysis of 15 patients’ ability to ingress, move about the bed, and egress. The 15 participants were purposefully selected with various disabilities. Bed conditions were randomized with side rails up or down and one low bed with side rails down. We explored the patients’ use of the side rails, bed height, ability to lift their legs onto the mattress, and ability to turn, egress, and walk back to the chair. The standard bed was too high for some participants, both for ingress and egress. Side rails were used by most participants when entering, turning in bed, and exiting. We recommend that side rails be reconsidered as a means to facilitate in-bed movement, ingress, and egress. Furthermore, single deck height settings for all patients are not optimal. Low beds as a safety measure must be re-evaluated. PMID:28462302

  4. Does the routine echocardiographic exam have a role in the detection and evaluation of cholelithiasis and gallbladder wall thickening?

    Science.gov (United States)

    Daly, David D; El-Shurafa, Haytham; Nanda, Navin C; Dumaswala, Bhavin; Dumaswala, Komal; Kumar, Nilay; Mutluer, Ferit Onur

    2012-09-01

    Cholelithiasis is a very common disease in the United States. Most cases remain asymptomatic but a fraction of these patients can develop serious complications such as cholecystitis which may lead to gallbladder perforation and gallbladder cancer which is much less common. Here, we present three cases of cholelithiasis where transthoracic echocardiography was performed routinely. In each case, echocardiography detected cholelithiasis which prompted three-dimensional (3D) echocardiographic evaluation. Three-dimensional echocardiography allowed for more comprehensive examination of the gallbladder shape, size, and wall thickening and the measurement and composition of the stones in three dimensions, measurement of stone volumes, and minimized shadowing produced by stone calcifications. These cases suggest that routine echocardiography has value in detecting gallstones and that 3D echocardiography has incremental value over two-dimensional echocardiography due to pyramidal data sets which allow sequential slicing through the gallbladder and full gallbladder examination without a technologist who is trained in gallbladder imaging. These pyramidal data sets can be further viewed and cropped by a radiologist specialized in abdominal ultrasound. © 2012, Wiley Periodicals, Inc.

  5. Association of carcinoma of the gallbladder with typhoid carriage in a typhoid endemic area using nested PCR.

    Science.gov (United States)

    Nath, Gopal; Singh, Yogesh Kumar; Kumar, Kailash; Gulati, Anil Kumar; Shukla, Vijay Kumar; Khanna, Ajay Kumar; Tripathi, Sunil Kumar; Jain, Ashok Kumar; Kumar, Mohan; Singh, Tej Bali

    2008-08-30

    Although well studied the association between chronic typhoid carrier state and carcinoma of the gallbladder (CaGB) remains unproven. The study was performed at a tertiary care medical center in North India and involved 52 patients with CaGB, 223 patients with benign gallbladder diseases, 508 healthy individuals and, 424 corpses. For the detection of Salmonella enterica serovar Typhi, hepatobiliary specimens were subjected to DNA extraction for specific nested- PCR amplification of the S. Typhi flagellin gene. Anti-Vi S. Typhi antibodies were detected in serum samples from patients by indirect haemagglutination. Thirty five of the 52 (67.3%) CaGB patients were PCR-positive for the S. Typhi flagellin gene; significantly higher than for patients with benign gallbladder diseases (95/223, 42.6%; p or = 160) in their serum were 20/52 (38.5%) for CaGB patients, 31/223 (13.9%) for patients with benign gallbladder diseases, and 47/508 (9.2%) for healthy individuals. Specific nested-PCR amplification of the S. Typhi flagellin gene in hepato-biliary specimens was more sensitive for detection of S. Typhi carriage than anti-Vi antibody titres in serum. The results demonstrate an association between typhoid carriage and gallbladder diseases, both CaGB and benign. S. Typhi specific immunosuppression is also suggested in patients with gallbladder diseases.

  6. Emergency readmission following acute upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Strömdahl, Martin; Helgeson, Johan; Kalaitzakis, Evangelos

    2017-01-01

    OBJECTIVE: To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). PATIENTS AND METHODS: All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution...

  7. Continued bleeding following acute intracerebral hemorrhage

    NARCIS (Netherlands)

    Brouwers, H.B.

    2014-01-01

    In this Ph.D. thesis, ‘Continued bleeding following acute intracerebral hemorrhage’, we have discussed the background literature, risk factors, and underlying biology of hematoma expansion, as well as the clinical applicability of the CT angiography (CTA) 'spot sign' as an imaging marker of this

  8. Massive rectal bleeding from colonic diverticulosis

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    barium enema studies have indicated increasing world prevalence ... Other diagnostic modalities include barium enema, computerised ... This is in contrast to the findings in our patient when colonoscopy was carried out, in which the diverticula were more at the descending colon-left sided, and were found to be bleeding.

  9. Acute radiologic intervention in gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Lesak, F.

    1986-01-01

    A case of embolization of the gastroduodenal artery in a 38-year old man with chronic pancreatitis and uncontrollable bleeding is presented. The advantage of this interventional radiologic procedure is discussed and in selective cases it seems to be the choice of treatment. (orig.) [de

  10. Acute radiologic intervention in gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lesak, F.

    1986-01-01

    A case of embolization of the gastroduodenal artery in a 38-year old man with chronic pancreatitis and uncontrollable bleeding is presented. The advantage of this interventional radiologic procedure is discussed and in selective cases it seems to be the choice of treatment.

  11. Management of Acute Bleeding Per Rectum

    Directory of Open Access Journals (Sweden)

    Benita K.T. Tan

    2004-01-01

    Conclusion: Perianal conditions contributed to the majority of acute patient admissions. Colonic causes of bleeding were less common and were most stable. There were differences in the frequencies of aetiologies in our population compared to Western populations. Understanding the common pathologies and outcomes guides the management of our patients.

  12. Medical treatment for heavy menstrual bleeding

    Directory of Open Access Journals (Sweden)

    Yi-Jen Chen

    2015-10-01

    Full Text Available Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a “complaint of a large amount of bleeding during menstrual cycles that occurs over several consecutive cycles” and is objectively defined as menstrual blood loss of more than 80 mL per cycle that is associated with an anemia status (defined as a hemoglobin level of <10 g/dL. During their reproductive age, more than 30% of women will complain of or experience a heavy amount of bleeding, which leads to a debilitating health outcome, including significantly reduced health-related quality of life, and a considerable economic burden on the health care system. Although surgical treatment might be the most important definite treatment, especially hysterectomy for those women who have finished bearing children, the uterus is still regarded as the regulator and controller of important physiological functions, a sexual organ, a source of energy and vitality, and a maintainer of youth and attractiveness. This has resulted in a modern trend in which women may reconsider the possibility of organ preservation. For women who wish to retain the uterus, medical treatment may be one of the best alternatives. In this review, recent trends in the management of women with heavy menstrual bleeding are discussed.

  13. Systemic causes of heavy menstrual bleeding

    NARCIS (Netherlands)

    Verschueren, Sophie

    2017-01-01

    Heavy menstrual bleeding (HMB) is a common problem in fertile women. In addition to local factors, such as a polyp or a uterine fibroid, systemic causes may lead to HMB. These systemic causes are discussed in this thesis. For years, women with HMB were tested underlying thyroid disorder, but our

  14. Endometrial biopsy findings in postmenopausal bleeding

    International Nuclear Information System (INIS)

    Sarfraz, T.; Tariq, H.

    2007-01-01

    To study endometrial histopathology in women presenting with postmenopausal bleeding. A two-year study from January 2003 to December 2004 of 100 cases of postmenopausal bleeding was conducted at Combined Military Hospital, Sialkot. The histopathology of endometrial biopsy specimens was done to find out the causes of postmenopausal bleeding in these ladies. All these 100 patients had confirmed menopause and the average age was 55 years and above. The most common histopathological diagnosis was senile endometrial atrophy (27%), followed by simple cystic hyperplasia in (17%). Three cases of simple cystic hyperplasia had coexistent ovarian tumors. Glandular hyperplasia without atypia was seen in 6% and with atypia in 4%. Other causes were endometritis (13%), endometrial polyps (8%), proliferative phase endometrium (6%) and secretary phase endometrium (5%). Endometrial carcinoma was seen in (6%) cases, (8%) biopsy specimens were non-representative. Although senile endometrial atrophy was most commonly found in these ladies but a significant percentage of endometrial hyperplasia and endometrial cancer implies the need for investigating all cases of postmenopausal bleeding. Bimanual examination and pelvic ultrasonography should be combined with endometrial sampling so that rare pelvic pathologies may not be missed. (author)

  15. Do statins protect against upper gastrointestinal bleeding?

    DEFF Research Database (Denmark)

    Gulmez, Sinem Ezgi; Lassen, Annmarie Touborg; Aalykke, Claus

    2009-01-01

    AIMS: Recently, an apparent protective effect of statins against upper gastrointestinal bleeding (UGB) was postulated in a post hoc analysis of a randomized trial. We aimed to evaluate the effect of statin use on acute nonvariceal UGB alone or in combinations with low-dose aspirin and other...

  16. Gastrointestinal bleeding following NSAID ingestion in children

    African Journals Online (AJOL)

    Both presented with a history of fever and passage of bloody stools. There was a positive history of NSAID ingestion in both patients that was prescribed in the referring hospitals. ..... Bostwick HE, Halata MS, Feerick J, Newman LJ, Medow MS. Gastrointestinal bleeding in children following ingestion of low-dose. Ibuprofen.

  17. Dysfunctional uterine bleedings of a climacteric period

    International Nuclear Information System (INIS)

    Prilepskaya, V.N.

    1993-01-01

    Climacteric period of some women is complicated by dysfunctional uterine bleedings (DUB). Bearing in mind the fact that DUBS are caused by disorder of estrin rhysmic secretion, the paper presents the methods of differential diagnostics for investigations into functional disorders in the hypothalamus -hypophysis - ovaries - uterus system. The preference is given to roentgenologic and radioimmunologic diagnostic methods

  18. Clinical utility of new bleeding criteria: a prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Choi, Jae-Hyuk; Seo, Jeong-Min; Lee, Dong Hyun; Park, Kyungil; Kim, Young-Dae

    2015-04-01

    The aim of this study was to evaluate the clinical utility of the new bleeding criteria, proposed by the Bleeding Academic Research Consortium (BARC), compared with the old criteria for determining the action of physicians in contact with bleeding events, after percutaneous coronary intervention (PCI). The BARC criteria were independently associated with an increased risk of 1-year mortality after PCI, and provided a predictive value, in regard to 1-year mortality. The standardized bleeding definitions will be expected to help the physician to correctly analyze the bleeding events, to select an optimal treatment, and to objectively compare the results of multiple trials and registries. All the patients undergoing PCI from June to September 2012 were prospectively enrolled. Patients who experienced a bleeding event were further classified, based on three different bleeding severity criteria: BARC, Thrombolysis In Myocardial Infarction (TIMI), and Global Use of Strategies To Open coronary arteries (GUSTO). The primary outcome was the occurrence of bleeding events requiring interruption of antiplatelet therapy (IAT) by physicians. A total of 376 consecutive patients were included in this study. Total bleeding events occurred in 46 patients (12.2%). BARC type ≥2 bleeding occurred in 30 patients (8.0%); however, TIMI major or minor bleeding, and GUSTO moderate or severe bleeding occurred in 6 (1.6%) and 11 patients (2.9%), respectively. Of the 46 patients, 28 (60.9% of patients) required IAT. On receiver-operating characteristic curve analysis, bleeding defined BARC type ≥2 effectively predicted IAT, with a sensitivity of 89.3%, and a specificity of 98.5% (pdefinition may be a more useful tool for the detection of bleeding with clinical relevance, for patients undergoing PCI. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  19. Apparatus for controlling fluidized beds

    Science.gov (United States)

    Rehmat, A.G.; Patel, J.G.

    1987-05-12

    An apparatus and process are disclosed for control and maintenance of fluidized beds under non-steady state conditions. An ash removal conduit is provided for removing solid particulates from a fluidized bed separate from an ash discharge conduit in the lower portion of the grate supporting such a bed. The apparatus and process of this invention is particularly suitable for use in ash agglomerating fluidized beds and provides control of the fluidized bed before ash agglomeration is initiated and during upset conditions resulting in stable, sinter-free fluidized bed maintenance. 2 figs.

  20. Microcoil Embolization for Acute Lower Gastrointestinal Bleeding

    International Nuclear Information System (INIS)

    D'Othee, Bertrand Janne; Surapaneni, Padmaja; Rabkin, Dmitry; Nasser, Imad; Clouse, Melvin

    2006-01-01

    Purpose. To assess outcomes after microcoil embolization for active lower gastrointestinal (GI) bleeding. Methods. We retrospectively studied all consecutive patients in whom microcoil embolization was attempted to treat acute lower GI bleeding over 88 months. Baseline, procedural, and outcome parameters were recorded following current Society of Interventional Radiology guidelines. Outcomes included technical success, clinical success (rebleeding within 30 days), delayed rebleeding (>30 days), and major and minor complication rates. Follow-up consisted of clinical, endoscopic, and pathologic data. Results. Nineteen patients (13 men, 6 women; mean age ± 95% confidence interval = 70 ± 6 years) requiring blood transfusion (10 ± 3 units) had angiography-proven bleeding distal to the marginal artery. Main comorbidities were malignancy (42%), coagulopathy (28%), and renal failure (26%). Bleeding was located in the small bowel (n = 5), colon (n 13) or rectum (n = 1). Technical success was obtained in 17 patients (89%); 2 patients could not be embolized due to vessel tortuosity and stenoses. Clinical follow-up length was 145 ± 75 days. Clinical success was complete in 13 (68%), partial in 3 (16%), and failed in 2 patients (11%). Delayed rebleeding (3 patients, 27%) was always due to a different lesion in another bowel segment (0 late rebleeding in embolized area). Two patients experienced colonic ischemia (11%) and underwent uneventful colectomy. Two minor complications were noted. Conclusion. Microcoil embolization for active lower GI bleeding is safe and effective in most patients, with high technical and clinical success rates, no procedure-related mortality, and a low risk of bowel ischemia and late rebleeding

  1. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

    Leonhardt, Henrik; Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  2. Fluidized bed calciner

    International Nuclear Information System (INIS)

    Sheely, W.F.

    1986-01-01

    A unique way to convert radioactive scrap into useful nuclear fuel products was developed for the Department of Energy at Hanford. An advanced, fluidized bed calciner is used to convert metallic nitrate scrap or waste solutions into benign, solid and gaseous products. There are broad potential applications of this concept beyond those in the nuclear industry

  3. Nail Bed Injuries

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Nail Bed Injuries Email to a friend * required ...

  4. Bed Bug Myths

    Science.gov (United States)

    Learn the truth about bed bugs, such as how easy they are to see with the naked eye, their preferred habitat, whether they transmit diseases, their public health effects, and whether pesticides are the best way to deal with an infestation.

  5. Bleeding in cancer patients and its treatment: a review.

    Science.gov (United States)

    Johnstone, Candice; Rich, Shayna E

    2017-12-18

    Bleeding is a common problem in cancer patients, related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer, or anti-cancer treatments. Existing bleeds can also be exacerbated by medications such as bevacizumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants. Patients may develop acute catastrophic bleeding, episodic major bleeding, or low-volume oozing. Bleeding may present as bruising, petechiae, epistaxis, hemoptysis, hematemesis, hematochezia, melena, hematuria, or vaginal bleeding. Therapeutic intervention for bleeding should start by establishing goals of care, and treatment choice should be guided by life expectancy and quality of life. Careful thought should be given to discontinuation of medications and reversal of anticoagulation. Interventions to stop or slow bleeding may include systemic agents or transfusion of blood products. Noninvasive local treatment options include applied pressure, dressings, packing, and radiation therapy. Invasive local treatments include percutaneous embolization, endoscopic procedures, and surgical treatment.

  6. [Ultrasound-guided cutaneous intercostal branches nerves block: A good analgesic alternative for gallbladder open surgery].

    Science.gov (United States)

    Fernández Martín, M T; López Álvarez, S; Mozo Herrera, G; Platero Burgos, J J

    2015-12-01

    Laparoscopic cholecystectomy has become the standard treatment for gallbladder diseases. However, there are still some patients for whom conversion to open surgery is required. This surgery can produce significant post-operative pain. Opioids drugs have traditionally been used to treat this pain, but side effects have led to seeking alternatives (plexus, nerve or fascia blocks or wound). The cases are presented of 4 patients subjected to ultrasound-guided intercostal branches blocks in the mid-axillary line from T6 to T12 with levobupivacaine as an analgesic alternative in open surgery of gallbladder, with satisfactory results. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Hypersecretion of mucus glycoprotein by the gallbladder epithelium in experimental cholelithiasis.

    Science.gov (United States)

    Lee, S P

    1981-07-01

    In three models of cholelithiasis (dihydrocholesterol-fed rabbits, cholesterol-cholic acid-fed mice, and Lincomycin-treated guinea pigs), the quantity and chemical composition of gallbladder epithelial mucin have been studied using (1) a spectrum of histochemical glycoprotein stains, and (2) biochemical extraction, purification and analysis of the carbohydrate components of epithelial mucin. Despite the diverse mechanism of stone induction and difference in stone composition, a common pattern of response by the epithelial mucin was observed in all three models. There was a quantitative increase in epithelial mucus production at a time before stones were formed and this increase persisted till stones were formed. There was no difference, qualitatively, between mucus produced by normal and stone-forming gallbladders.

  8. Application of spectral computed tomography in diagnosis of liver and gallbladder diseases

    Directory of Open Access Journals (Sweden)

    LI Bolong

    2017-03-01

    Full Text Available Spectral computed tomography (CT is a perfect combination of diamond probe and strong computer processing technology and a technological revolution of traditional CT. This article reviews the application of spectral CT in the diagnosis of liver and gallbladder diseases. It summarizes the application value of monochromatic spectral CT imaging, spectral curve, material separation and quantitation, and effective atomic number in the diagnosis and differentiation of liver and gallbladder diseases and analyze the advantages of energy spectrum in identification of small lesions, low dose, and judgment of homology. It is pointed out that the application of spectral CT can be further explored in the aspects of early identification, differentiation, and prognosis of tumors.

  9. Mechanism-Based Modeling of Gastric Emptying Rate and Gallbladder Emptying in Response to Caloric Intake

    DEFF Research Database (Denmark)

    Guiastrennec, B; Sonne, David Peick; Hansen, M

    2016-01-01

    Bile acids released postprandially modify the rate and extent of absorption of lipophilic compounds. The present study aimed to predict gastric emptying (GE) rate and gallbladder emptying (GBE) patterns in response to caloric intake. A mechanism-based model for GE, cholecystokinin plasma concentr......Bile acids released postprandially modify the rate and extent of absorption of lipophilic compounds. The present study aimed to predict gastric emptying (GE) rate and gallbladder emptying (GBE) patterns in response to caloric intake. A mechanism-based model for GE, cholecystokinin plasma...... concentrations, and GBE was developed on data from 33 patients with type 2 diabetes and 33 matched nondiabetic individuals who were administered various test drinks. A feedback action of the caloric content entering the proximal small intestine was identified for the rate of GE. The cholecystokinin...

  10. Pain patterns after distension of the gallbladder in patients with acute cholecystitis

    DEFF Research Database (Denmark)

    Middelfart, H V; Jensen, P; Højgaard, L

    1998-01-01

    BACKGROUND: Visceral pain is characterized by poor pain localization and a referred or radiating pain pattern. Its clinical importance in the abdomen is stressed by the finding that about one-third of patients still complain of abdominal pain after cholecystectomy. A better understanding...... were performed. After each injection of saline the localization of pain and the presence of nausea and vomiting were registered. The injections continued until the patient felt abdominal pain necessitating cessation of the investigation or until the cystic duct opened (visualized on cholescintigraphy......). RESULTS: Distension of the gallbladder caused pain in 10 of the 12 patients. In 70% the pain was localized under the right costal margin or in the epigastrium. No mathematical formula could describe the pressure-volume relation in the gallbladder. The cystic duct opening pressure varied between 3 and 44...

  11. Pancreas and gallbladder agenesis in a newborn with semilobar holoprosencephaly, a case report.

    Science.gov (United States)

    Hilbrands, Robert; Keymolen, Kathelijn; Michotte, Alex; Marichal, Miriam; Cools, Filip; Goossens, Anieta; Veld, Peter In't; De Schepper, Jean; Hattersley, Andrew; Heimberg, Harry

    2017-05-19

    Pancreatic agenesis is an extremely rare cause of neonatal diabetes mellitus and has enabled the discovery of several key transcription factors essential for normal pancreas and beta cell development. We report a case of a Caucasian female with complete pancreatic agenesis occurring together with semilobar holoprosencephaly (HPE), a more common brain developmental disorder. Clinical findings were later confirmed by autopsy, which also identified agenesis of the gallbladder. Although the sequences of a selected set of genes related to pancreas agenesis or HPE were wild-type, the patient's phenotype suggests a genetic defect that emerges early in embryonic development of brain, gallbladder and pancreas. Developmental defects of the pancreas and brain can occur together. Identifying the genetic defect may identify a novel key regulator in beta cell development.

  12. Contraction and evacuation of the gallbladder studied simultaneously by ultrasonography and 99mTc-labelled diethyl-iminodiacetic acid scintigraphy

    International Nuclear Information System (INIS)

    Raadberg, G.; Asztely, M.; Moonen, M.; Svanvik, J.

    1993-01-01

    Emptying of the gallbladder was studied by the simultaneous use of 99m Tc-labelled diethyl-iminodiacetic acid (HIDA) scanning and real-time ultrasonography. In response to a liquid test meal the gallbladder volume was reduced for 80 min and then increased again, but the radionuclide evacuation continued and was more complete than could be explained by the reduction of gallbladder volume. In response to intravenous infusion of cholecystokinin, a maximal contraction of the gallbladder to 35% of the basal volume was obtained at 40 min, and 36% of the HIDA then remained in the gallbladder. In a separate series repeated intravenous injections of 99m Tc-HIDA were given after the test meal, and the isotope was found to enter the gallbladder even when the gallbladder contracted. The results support the view that the gallbladder acts like a ''bellows'' when contracting and that postprandial fluid secretion by the gallbladder mucosa may help to evacuate its contents. 11 refs., 4 figs

  13. To Bleed or Not to Bleed: That is the Question. The Side Effects of Apixaban.

    Science.gov (United States)

    Ciccone, Marco Matteo; Zito, Annapaola; Devito, Fiorella; Maiello, Maria; Palmiero, Pasquale

    2018-01-01

    Apixaban is a new oral anticoagulant (NOACs: Novel Oral Anticoagulant), like dabigatran, rivaroxaban, and edoxaban. All of them are prescribed to patients with non valvular atrial fibrillation or venous thromboembolism, to replace warfarin, because of the lower probability of bleeding, however they can cause bleeding by themselves. Bleeding is an adverse event in patients taking anticoagulants. It is associated with a significant increase of morbidity and risk of death. However, these drugs should be used only for the time when anticoagulation is strictly required, especially when used for preventing deep vein thrombosis. Prolonged use increases the risk of bleeding. In the ARISTOTLE Trial Apixaban, compared with warfarin, was associated with a lower rate of intracranial hemorrhages and less adverse consequences following extracranial hemorrhage. Many physicians still have limited experience with new oral anticoagulants and about bleeding risk managment. We reviewed the available literature on extracranial and intracranial bleeding concerning apixaban. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  14. Evaluation the Metoprolol Effects in Controlled Hypotension and Reduction of Bleeding During Head and Neck Surgery

    Directory of Open Access Journals (Sweden)

    P Rahimzadeh

    2012-05-01

    Full Text Available

    Background and objectives

    Intraoperative bleeding, which reduces visibility in the operative field, is one of the major problems of head and neck surgeries. Improvement of intraoperative visibility and reduction of bleeding is an important task for an anesthetist during head and neck surgery. It has been shown that preoperative beta-blockade decreases bleeding during the operation.

     

    Methods

    In a 18 month period,88 patients , who were candidate for nasal procedures in hazrat Rasul medical complex, were selected in a randomized open clinical trial study. They were divided to 4 groupes:

    50 mg metoprolol at night before surgery

    50 mg metoprolol in the morning of the surgery

    50 mg metoprolol at night before surgery and in the morning of the surgery

    placebo

    Heart rate, Systolic and diastolic blood pressure was measured in a non-invasive way just both upon arrival on the operation bed and after induction of anesthesia during operation. For evaluation of the visibility of the operative field during operation the quality scale proposed by Fromm and Boezzart was used.

     

    Results

    SPSS13 was used for assessment. There was significant relationship between metoprolol administration and bleeding during the operation. All patients who received two doses of metoprolol one in the last night and another in the morning of the operation day had only mild bleeding. There was statistically significant relation between agitation and time of administration of metoprolol.

     

    Conclution

    Nowadays, there are growing evidences that not only decrease in systolic blood pressure but also a low heart rate (< 60 beats per minute can minimize surgical bleeding. Both of the above mentioned effects could be induced by beta blockers.

    In this study, two

  15. Rectal Bleeding After High-Dose-Rate Brachytherapy Combined With Hypofractionated External-Beam Radiotherapy for Localized Prostate Cancer: The Relationship Between Dose-Volume Histogram Parameters and the Occurrence Rate

    International Nuclear Information System (INIS)

    Okamoto, Masahiko; Ishikawa, Hitoshi; Ebara, Takeshi; Kato, Hiroyuki; Tamaki, Tomoaki; Akimoto, Tetsuo; Ito, Kazuto; Miyakubo, Mai; Yamamoto, Takumi; Suzuki, Kazuhiro; Takahashi, Takeo; Nakano, Takashi

    2012-01-01

    Purpose: To determine the predictive risk factors for Grade 2 or worse rectal bleeding after high-dose-rate brachytherapy (HDR-BT) combined with hypofractionated external-beam radiotherapy (EBRT) for prostate cancer using dose–volume histogram analysis. Methods and Materials: The records of 216 patients treated with HDR-BT combined with EBRT were analyzed. The treatment protocols for HDR-BT were 5 Gy × five times in 3 days or 7 Gy × three, 10.5 Gy × two, or 9 Gy × two in 2 days. The EBRT doses ranged from 45 to 51 Gy with a fractional dose of 3 Gy. Results: In 20 patients Grade 2 or worse rectal bleeding developed, and the cumulative incidence rate was 9% at 5 years. By converting the HDR-BT and EBRT radiation doses into biologic effective doses (BED), the BED 3 at rectal volumes of 5% and 10% in the patients who experienced bleeding were significantly higher than those in the remaining 196 patients. Univariate analysis showed that a higher rectal BED 3–5% and the use of fewer needles in brachytherapy were correlated with the incidence of bleeding, but BED 3–5% was found to be the only significant factor on multivariate analysis. Conclusions: The radiation dose delivered to small rectal lesions as 5% is important for predicting Grade 2 or worse rectal bleeding after HDR-BT combined with EBRT for prostate cancer.

  16. 7 CFR 2902.15 - Bedding, bed linens, and towels.

    Science.gov (United States)

    2010-01-01

    ... PROCUREMENT Designated Items § 2902.15 Bedding, bed linens, and towels. (a) Definition. (1) Bedding is that... minimum biobased content is 12 percent and shall be based on the amount of qualifying biobased carbon in..., and silk are not qualifying biobased feedstocks for the purpose of determining the biobased content of...

  17. The correlation between the dilated extent of bile duct and gallbladder and low bile duct obstructive jaundice diseases

    International Nuclear Information System (INIS)

    Wang Zhongqiu; Lu Guangming; Li Jieshou; Li Weiqin

    2005-01-01

    Objective: To evaluate the diagnostic value about the dilated extent of bile duct and gallbladder in low biliary obstructive diseases. Methods: CT and ERCP findings of 105 patients with low biliary obstructive disease were retrospectively analyzed. The dilated extent of intrahepatic and extra- hepatic bile duct and gallbladder were classified into seven types: Type I: severe dilatation of intrahepatic and extrahepatic bile duct and gallbladder; Type II: severe dilatation of extrahepatic bile duct and gallbladder and slight dilated intrahapetic bile duct; Type III: severe dilatation of intrahepatic and extrahepatic bile duct without or slight dilatation of gallbladder; Type IV: severe extrahepatic bile duct dilatation without or slight dilatation of intrahepatic bile duct and gallbladder; Type V: severe intrahepatic bile duct dilatation without or with slight dilatation of extrahepatic bile duct and gallbladder; Type VI: severe gallbladder dilatation without or with slight intrahepatic and extra- hepatic bile duct dilatation; Type VII: without or with slight dilatation of intrahepatic and extrahepatic bile duct and gallbladder. The biliary system dilated extent of low biliary obstructive disease on CT and ERCP were compared with results of clinical, operation, and pathology. Results: Thirty-three cases of tumor and 72 cases of non-tumor were proved by clinical and operation in 105 patients with low biliary obstructive disease. In 33 tumor patients, 16 patients were identified as Type I, 10 patients Type II, 4 patients Type III, 1 patient Type IV, 2 patients Type VII. In 72 non-tumor patients, 4 patients were identified as Type I, 4 patients Type II, 9 patients Type III, 33 patients Type IV, 2 patients Type V, 11 patients Type VI, 19 patients Type VII. A large difference between I, II type and III-VII type biliary dilatation existed in tumor and non-tumor group (χ 2 =47.33, P<0.01). Conclusion:Low obstructive biliary diseases are closely correlated with the dilated

  18. Gallbladder Cancer Presenting with Jaundice: Uniformly Fatal or Still Potentially Curable?

    Science.gov (United States)

    Tran, Thuy B; Norton, Jeffrey A; Ethun, Cecilia G; Pawlik, Timothy M; Buettner, Stefan; Schmidt, Carl; Beal, Eliza W; Hawkins, William G; Fields, Ryan C; Krasnick, Bradley A; Weber, Sharon M; Salem, Ahmed; Martin, Robert C G; Scoggins, Charles R; Shen, Perry; Mogal, Harveshp D; Idrees, Kamran; Isom, Chelsea A; Hatzaras, Ioannis; Shenoy, Rivfka; Maithel, Shishir K; Poultsides, George A

    2017-08-01

    Jaundice as a presenting symptom of gallbladder cancer has traditionally been considered to be a sign of advanced disease, inoperability, and poor outcome. However, recent studies have demonstrated that a small subset of these patients can undergo resection with curative intent. Patients with gallbladder cancer managed surgically from 2000 to 2014 in 10 US academic institutions were stratified based on the presence of jaundice at presentation (defined as bilirubin ≥4 mg/ml or requiring preoperative biliary drainage). Perioperative morbidity, mortality, and overall survival were compared between jaundiced and non-jaundiced patients. Of 400 gallbladder cancer patients with available preoperative data, 108 (27%) presented with jaundice while 292 (73%) did not. The fraction of patients who eventually underwent curative-intent resection was much lower in the presence of jaundice (n = 33, 30%) than not (n = 218, 75%; P Jaundiced patients experienced higher perioperative morbidity (69 vs. 38%; P = 0.002), including a much higher need for reoperation (12 vs. 1%; P = 0.003). However, 90-day mortality (6.5 vs. 3.6%; P = 0.35) was not significantly higher. Overall survival after resection was worse in jaundiced patients (median 14 vs. 32 months; P jaundiced patients revealed a more favorable survival after resection in the presence of low CA19-9 Jaundice is a powerful preoperative clinical sign of inoperability and poor outcome among gallbladder cancer patients. However, some of these patients may still achieve long-term survival after resection, especially when preoperative CA19-9 levels are low and no lymphovascular invasion is noted pathologically.

  19. Nomogram for Predicting the Benefit of Adjuvant Chemoradiotherapy for Resected Gallbladder Cancer

    Science.gov (United States)

    Wang, Samuel J.; Lemieux, Andrew; Kalpathy-Cramer, Jayashree; Ord, Celine B.; Walker, Gary V.; Fuller, C. David; Kim, Jong-Sung; Thomas, Charles R.

    2011-01-01

    Purpose Although adjuvant chemoradiotherapy for resected gallbladder cancer may improve survival for some patients, identifying which patients will benefit remains challenging because of the rarity of this disease. The specific aim of this study was to create a decision aid to help make individualized estimates of the potential survival benefit of adjuvant chemoradiotherapy for patients with resected gallbladder cancer. Methods Patients with resected gallbladder cancer were selected from the Surveillance, Epidemiology, and End Results (SEER) –Medicare database who were diagnosed between 1995 and 2005. Covariates included age, race, sex, stage, and receipt of adjuvant chemotherapy or chemoradiotherapy (CRT). Propensity score weighting was used to balance covariates between treated and untreated groups. Several types of multivariate survival regression models were constructed and compared, including Cox proportional hazards, Weibull, exponential, log-logistic, and lognormal models. Model performance was compared using the Akaike information criterion. The primary end point was overall survival with or without adjuvant chemotherapy or CRT. Results A total of 1,137 patients met the inclusion criteria for the study. The lognormal survival model showed the best performance. A Web browser–based nomogram was built from this model to make individualized estimates of survival. The model predicts that certain subsets of patients with at least T2 or N1 disease will gain a survival benefit from adjuvant CRT, and the magnitude of benefit for an individual patient can vary. Conclusion A nomogram built from a parametric survival model from the SEER-Medicare database can be used as a decision aid to predict which gallbladder patients may benefit from adjuvant CRT. PMID:22067404

  20. Diagnosis of clinically unsuspected gallbladder perforation in an obese patient, by Tc-99m IDA cholescintigraphy

    International Nuclear Information System (INIS)

    Mesgarzadeh, M.; Haines, J.E.; Bobba, V.R.; Von Dollen, L.E.; Jarboe, G.; Krishnamurthy, G.T.

    1983-01-01

    A male Pickwickian syndrome patient was admitted to the hospital with sudden onset of abdominal pain. Physical examination was equivocal. Due to patient's ileus and morbid obesity (weight 450 lb), neither TCT scan nor ultrasound was possible. A Tc-99m PIPIDA hepatobiliary imaging study revealed intraperitoneal leakage of radioactive bile with collection of the activity in both abdominal gutters, indicating gallbladder rupture. Prompt surgery confirmed the diagnosis

  1. Analysis of Carcinogenic Heavy Metals in Gallstones and its Role in Gallbladder Carcinogenesis.

    Science.gov (United States)

    Mondal, Bikash; Maulik, Dhrubajyoti; Mandal, Mousumi; Sarkar, Gautam Narayan; Sengupta, Sanjay; Ghosh, Debidas

    2017-12-01

    Gallstone is a high-risk factor for gallbladder pre-malignancy or malignancy (GB PM-M) but which substances of gallstones definitely assist to turn out in to GB PM-M, remains unclear. This study aimed to find out the presence of carcinogenic heavy metals in gallstones and to explore the aetiopathogenesis of gallbladder pre-malignancy and malignancy. Presence of elements in gallstones was detected by energy dispersive X-ray spectroscopy (EDS) with scanning electron microscopy (SEM) and then level of carcinogenic heavy metals was estimated in gallstones using atomic absorption spectroscopy (AAS). The experiment was carried out in gallstone samples of 46 patients with gallbladder pre-malignant and malignant condition (PM-M group) and 65 sex and age-matched patients with chronic cholecystitis (C-C group). Gallstones were also classified in to three types such as cholesterol stone, mixed stone, and black pigment stone. EDS analysis detected presence of mercury, lead, and cobalt elements in all types of gallstones of both PM-M and C-C groups. AAS analysis revealed significantly higher amount of mercury (p heavy metals also varied among stone types of both groups. EDS phase analysis showed 'dense deposits' of these metals in gallstones. Presence of significantly higher amount of mercury, lead, cobalt, and cadmium in gallstones may play a pivotal role as risk factors in the development of gallbladder malignancy or pre-malignancy. 'Dense deposits' of these metals in the gallstones which is the first observation, may act as crucial doses of carcinogens.

  2. Bile salts stimulate mucin secretion by cultured dog gallbladder epithelial cells independent of their detergent effect.

    Science.gov (United States)

    Klinkspoor, J H; Yoshida, T; Lee, S P

    1998-05-15

    1. Bile salts stimulate mucin secretion by the gallbladder epithelium. We have investigated whether this stimulatory effect is due to a detergent effect of bile salts. 2. The bile salts taurocholic acid (TC) and tauroursodeoxycholic acid (TUDC) and the detergents Triton X-100 (12.5-400 microM) and Tween-20 (0.1-3.2 mM) were applied to monolayers of cultured dog gallbladder epithelial cells. Mucin secretion was studied by measuring the secretion of [3H]N-acetyl-d-glucosamine-labelled glycoproteins. We also attempted to alter the fluidity of the apical membrane of the cells through extraction of cholesterol with beta-cyclodextrin (2.5-15 mM). The effect on TUDC-induced mucin secretion was studied. Cell viability was assessed by measuring lactate dehydrogenase (LDH) leakage or 51Cr release. 3. In contrast with the bile salts, the detergents were not able to cause an increase in mucin secretion without causing concomitant cell lysis. Concentrations of detergent that increased mucin release (>100 microM Triton X-100, >0.8 mM Tween-20), caused increased LDH release. Incubation with beta-cyclodextrin resulted in effective extraction of cholesterol without causing an increase in 51Cr release. However, no effect of the presumed altered membrane fluidity on TUDC (10 mM)-induced mucin secretion was observed. 4. The stimulatory effect of bile salts on mucin secretion by gallbladder epithelial cells is not affected by the fluidity of the apical membrane of the cells and also cannot be mimicked by other detergents. We conclude that the ability of bile salts to cause mucin secretion by the gallbladder epithelium is not determined by their detergent properties.

  3. Sluggish gallbladder emptying and gastrointestinal transit after intake of common alcoholic beverages.

    Science.gov (United States)

    Kasicka-Jonderko, A; Jonderko, K; Gajek, E; Piekielniak, A; Zawislan, R

    2014-02-01

    To study the movement along the gut and the effect upon the gallbladder volume of alcoholic beverages taken in the interdigestive state. The study comprised three research blocks attended by 12 healthy subjects each. Within a given research block volunteers underwent three examination sessions held on separate days, being offered an alcoholic beverage, or an aqueous ethanol solution of an identical proof, or a corresponding volume of isotonic glucose solution; the order of administration of the drinks was randomized. The beverages tested were: beer (4.7% vol, 400 ml), red wine (13.7% vol, 200 ml), whisky (43.5% vol, 100 ml) within the "Beer", "Wine", and "Whisky" research block, respectively. Gastric myoelectrical activity was examined electrogastrographically, gastric emptying with ¹³C-sodium acetate breath test, orocaecal transit with lactulose H₂ breath test, gallbladder emptying with ultrasonography, breath ethanol with alcotest. The study showed that alcoholic beverages were emptied from the stomach significantly slower than isotonic glucose. Alcoholic beverages produced by fermentation only (beer, red wine) were emptied from the stomach more slowly than ethanol solutions of identical proof, while gastric evacuation of whisky (distillation product) and matching alcohol solution was similar. The slower gastric evacuation of alcoholic beverages and ethanol solutions could not be ascribed to a disorganization of the gastric myoelectrical activity. The orocaecal transit of beer and red wine did not differ from that of isotonic glucose, whereas the orocaecal transit of whisky and high proof ethanol was markedly prolonged. Red wine and whisky, and to a similar extent control ethanol solutions caused an inhibition and delay of gallbladder emptying. We concluded that alcoholic beverages taken on an empty stomach exert a suppressive effect upon the transport function of the digestive tract and gallbladder emptying. The extent of this action depends on the type of a

  4. VA National Bed Control System

    Data.gov (United States)

    Department of Veterans Affairs — The VA National Bed Control System records the levels of operating, unavailable and authorized beds at each VAMC, and it tracks requests for changes in these levels....

  5. Getting Rid of Bed Bugs

    Science.gov (United States)

    ... Directory Planning, Budget and Results Jobs and Internships Headquarters Offices Regional Offices Labs and Research Centers Bed ... to be careful in how you select a company. Related Information Collaborative Strategy on Bed Bugs - highlights ...

  6. No increased systemic fibrinolysis in women with heavy menstrual bleeding

    NARCIS (Netherlands)

    Wiewel-Verschueren, S.; Knol, H. M.; Lisman, T.; Bogchelman, D. H.; Kluin-Nelemans, J. C.; van der Zee, A.G.J.; Mulder, A.B.; Meijer, K.

    BackgroundBleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of

  7. Scintigraphic detection and localization of gastrointestinal bleeding sites

    International Nuclear Information System (INIS)

    Alavi, A.

    1988-01-01

    Successful management of acute gastrointestinal (GI) bleeding usually depends on accurate localization of the bleeding site. History and clinical findings are often misleading in determination of the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provide accurate diagnoses for the majority of patients bleeding from the upper GI tract, but lower GI bleeding still poses a serious diagnostic challenge. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases (3-5), has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding at a rate greater than 0.5 ml/min, and since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. The diagnosis of lower GI bleeding is usually easy to make. In contrast, localizing the site of bleeding may be extremely difficult. Using the techniques described the nuclear physician may be able to detect the bleeding site precisely. However, if the cautions detailed are not observed, the tracer studies will show GI bleeding, but not at the true bleeding site. This must be carefully understood and avoided. Done correctly, these tests can have a major impact on patient care

  8. A comparative evaluation of Imaging Efficiency for elevated lesions of gallbladder

    International Nuclear Information System (INIS)

    Shizuma, Toru; Karasawa, Eii; Azuma, Tsukasa; Takasaki, Ken; Hayashi, Naoaki

    1999-01-01

    Imaging Efficiency was analyzed in 118 cases of benign lesion, including adenoma and 36 cases of malignant lesion without lymph node metastasis (Stage I) of 154 cases histologically diagnosed as elevated lesions of the gallbladder (443 lesions). On ultrasonography, the maximum diameter of the benign lesions, except in the case of adenomyomatosis, was 17 mm; the minimum diameter in the case of adenocarcinoma was 7 mm. The frequency of malignancy among elevated mucosal lesions of gallbladder with a diameter of 13 to 16 mm, except in the case of adenomyomatosis was 42.1% (8/19 lesions). Of the 91 out of total 154 cases in which the elevated lesions were 10 mm or smaller in a diameter, malignant cases were observed in 5.5% (5/91 cases). Many of the malignant lesions had a solid pattern of internal echo and there was a significant difference in depiction rate on plain CT between benign and malignant lesions. We conclude that plan CT examination is helpful to differentiate benign from malignant lesions of the gallbladder. (author)

  9. Diagnostic value of CT features of the gallbladder in the prediction of gallstone pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Yie, Miyeon [Department of Radiology, Hallym University College of Medicine, 896 Pyungchon-dong, Dongan-gu, Anyang-city, Kyungki-do 431-070 (Korea, Republic of); Jang, Kyung Mi, E-mail: jkm7290@empal.com [Department of Radiology, Hallym University College of Medicine, 896 Pyungchon-dong, Dongan-gu, Anyang-city, Kyungki-do 431-070 (Korea, Republic of); Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710 (Korea, Republic of); Kim, Min Jeong; Lee, Yul [Department of Radiology, Hallym University College of Medicine, 896 Pyungchon-dong, Dongan-gu, Anyang-city, Kyungki-do 431-070 (Korea, Republic of); Choi, Dongil [Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710 (Korea, Republic of)

    2011-11-15

    Purpose: The aim of this retrospective study was to evaluate the diagnostic value of CT features of the gallbladder in the prediction of gallstone pancreatitis. Materials and methods: Eighty-six patients who underwent a diagnostic computed tomography (CT) scan for acute pancreatitis were included. The readers assessed the presence of pericholecystic increased attenuation of the liver parenchyma, enhancement of gallbladder (GB) and common bile duct (CBD) wall, pericholecystic fat strands, GB wall thickening, stone in the GB or CBD, and focal or diffuse manifestations of pancreatitis on abdominal CT scans. In addition, the maximal transverse luminal diameters of the GB and CBD were measured. Results: The presence of pericholecystic increased attenuation of the liver parenchyma, GB wall enhancement and thickening, pericholecystic fat strands, stone in the GB or CBD, and diffuse manifestations of pancreatitis achieved statistical significance for differentiation of gallstone induced pancreatitis from non-biliary pancreatitis (p < 0.05). The mean values of maximal transverse luminal diameter of GB and CBD were significantly higher in gallstone induced pancreatitis group (39.67 {+-} 7.26 mm, 10.20 {+-} 4.13 mm) than non-biliary pancreatitis group (27.01 {+-} 6.14 mm, 3.85 {+-} 2.51 mm, p < 0.0001). Conclusion: Gallbladder features of CT in patients with pancreatitis could be the valuable clues for the diagnosis of gallstone induced pancreatitis.

  10. Is there any role of positron emission tomography computed tomography for predicting resectability of gallbladder cancer?

    Science.gov (United States)

    Kim, Jaihwan; Ryu, Ji Kon; Kim, Chulhan; Paeng, Jin Chul; Kim, Yong-Tae

    2014-05-01

    The role of integrated (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (PET-CT) is uncertain in gallbladder cancer. The aim of this study was to show the role of PET-CT in gallbladder cancer patients. Fifty-three patients with gallbladder cancer underwent preoperative computed tomography (CT) and PET-CT scans. Their medical records were retrospectively reviewed. Twenty-six patients underwent resection. Based on the final outcomes, PET-CT was in good agreement (0.61 to 0.80) with resectability whereas CT was in acceptable agreement (0.41 to 0.60) with resectability. When the diagnostic accuracy of the predictions for resectability was calculated with the ROC curve, the accuracy of PET-CT was higher than that of CT in patients who underwent surgical resection (P=0.03), however, there was no difference with all patients (P=0.12). CT and PET-CT had a discrepancy in assessing curative resection in nine patients. These consisted of two false negative and four false positive CT results (11.3%) and three false negative PET-CT results (5.1%). PET-CT was in good agreement with the final outcomes compared to CT. As a complementary role of PEC-CT to CT, PET-CT tended to show better prediction about resectability than CT, especially due to unexpected distant metastasis.

  11. Ultrasound and magnetic resonance imaging findings in Schistosomiasis mansoni: expanded gallbladder fossa and fatty hilum signs

    Directory of Open Access Journals (Sweden)

    Luciana Cristina dos Santos Silva

    2012-08-01

    Full Text Available INTRODUCTION: There is no study relating magnetic resonance imaging (MRI to ultrasound (US findings in patients with Schistosomiasis mansoni. Our aim was to describe MRI findings inpatients with schistosomal liver disease identified by US. METHODS: Fifty-four patients (mean age 41.6±13.5years from an area endemic for Schistosomiasis mansoni were selected for this study.All had US indicating liver schistosomal fibrosis and were evaluated with MRI performed witha 1.5-T superconducting magnet unit (Sigma. RESULTS: Forty-seven (87% of the 54 patientsshowing signs of periportal fibrosis identified through US investigation had confirmed diagnosesby MRI. In the seven discordant cases (13%, MRI revealed fat tissue filling in the hilar periportalspace where US indicated isolated thickening around the main portal vein at its point of entryto the liver. We named this the fatty hilum sign. One of the 47 patients with MRI evidence ofperiportal fibrosis had had his gallbladder removed previously. Thirty-five (76.1% of the other46 patients had an expanded gallbladder fossa filled with fat tissue, whereas MRI of the remainingeleven showed pericholecystic signs of fibrosis. CONCLUSIONS: Echogenic thickening of thegallbladder wall and of the main portal vein wall heretofore attributed to fibrosis were frequentlyidentified as fat tissue in MRI. However, the gallbladder wall thickening shown in US (expandedgallbladder fossa in MRI is probably secondary to combined hepatic morphologic changes inschistosomiasis, representing severe liver involvement.

  12. Human beta-glucuronidase. Measurement of its activity in gallbladder bile devoid of intrinsic interference.

    Science.gov (United States)

    Ho, Y C; Ho, K J

    1988-04-01

    Our purpose is to develop a standard method for preparing the bile for beta-glucuronidase determination by removal of bile acids and conjugated bilirubin which interfere with its activity. The bile acids and conjugated bilirubin in their purified solutions and in the diluted gallbladder biles could be extracted completely with cholestyramine in powder form or tetrahexylammonium chloride (THAC) in chloroform or ethyl acetate. The enzyme was, however, partially precipitated with cholestyramine and denatured by chloroform but not by ethyl acetate. A standard procedure, therefore, includes extraction of the diluted gallbladder bile with THAC in ethyl acetate, followed by determination of the maximal velocity (Vmax) of the enzyme by a kinetic method employing phenolphthalein glucuronide as the substrate. The average Vmax of beta-glucuronidase in the 20 normal gallbladder biles was 165 +/- 86 nmol/min/ml (mean +/- SD), a 23.5-fold increase over the activity before extraction. The measured activity represented the true activity of the enzyme in the bile for recovery of activity of the enzyme added to the bile was practically complete.

  13. Trypsin level in gallbladder bile and ductitis and width of the cystic duct.

    Science.gov (United States)

    Vracko, J; Wiechel, K L

    2000-01-01

    The change from laparotomy to laparoscopy for cholecystectomy has raised the question of how to manage concomitant bile duct stones. The present-day interest--and controversy--has focused on a transcystic approach reported to be feasible in 66-96% of cases, but without explaining the necessary prerequisite: the widening of the cystic duct. The cystic duct, wide mainly in patients with bile duct stones, has been reported to be highly variable: from strictured to very wide. The present study aims at comparing the trypsin level in the gallbladder bile and the cystic duct morphology and width in patients with and without bile duct stones. A prospective series of 63 gallstone patients, 30 with and 33 without bile duct stones (controls), underwent cholecystectomy and bile duct clearance. The study includes the trypsin level in the gallbladder bile, the width and morphology of the cystic duct, and the size of the gallstones. The patients with bile duct stones had, in contrast to the controls, higher trypsin levels in the gallbladder bile (P extraction feasible.

  14. Incision extension is the optimal method of difficult gallbladder extraction at laparoscopic cholecystectomy.

    Science.gov (United States)

    Bordelon, B M; Hobday, K A; Hunter, J G

    1992-01-01

    An unsolved problem of laparoscopic cholecystectomy is the optimal method of removing the gallbladder with thick walls and a large stone burden. Proposed solutions include fascial dilatation, stone crushing, and ultrasonic, high-speed rotary, or laser lithotripsy. Our observation was that extension of the fascial incision to remove the impacted gallbladder was time efficient and did not increase postoperative pain. We reviewed the narcotic requirements of 107 consecutive patients undergoing laparoscopic cholecystectomy. Fifty-two patients required extension of the umbilical incision, and 55 patients did not have their fascial incision enlarged. Parenteral meperidine use was 39.5 +/- 63.6 mg in the patients requiring fascial incision extension and 66.3 +/- 79.2 mg in those not requiring fascial incision extension (mean +/- standard deviation). Oral narcotic requirements were 1.1 +/- 1.5 doses vs 1.3 +/- 1.7 doses in patients with and without incision extension, respectively. The wide range of narcotic use in both groups makes these apparent differences not statistically significant. We conclude that protracted attempts at stone crushing or expensive stone fragmentation devices are unnecessary for the extraction of a difficult gallbladder during laparoscopic cholecystectomy.

  15. Laparoscopic completion cholecystectomy and common bile duct exploration for retained gallbladder after single-incision cholecystectomy.

    Science.gov (United States)

    Kroh, Matthew; Chalikonda, Sricharan; Chand, Bipan; Walsh, R Matthew

    2013-01-01

    Recent enthusiasm in the surgical community for less invasive surgical approaches has resulted in widespread application of single-incision techniques. This has been most commonly applied in laparoscopic cholecystectomy in general surgery. Cosmesis appears to be improved, but other advantages remain to be seen. Feasibility has been demonstrated, but there is little description in the current literature regarding complications. We report the case of a patient who previously underwent single-incision laparoscopic cholecystectomy for symptomatic gallstone disease. After a brief symptom-free interval, she developed acute pancreatitis. At evaluation, imaging results of ultrasonography and magnetic resonance cholangiopancreatography demonstrated a retained gallbladder with cholelithiasis. The patient was subsequently referred to our hospital, where she underwent further evaluation and surgical intervention. Our patient underwent 4-port laparoscopic remnant cholecystectomy with transcystic common bile duct exploration. Operative exploration demonstrated a large remnant gallbladder and a partially obstructed cystic duct with many stones. Transcystic exploration with balloon extraction resulted in duct clearance. The procedure took 75 minutes, with minimal blood loss. The patient's postoperative course was uneventful. Final pathology results demonstrated a remnant gallbladder with cholelithiasis and cholecystitis. This report is the first in the literature to describe successful laparoscopic remnant cholecystectomy and transcystic common bile duct exploration after previous single-port cholecystectomy. Although inadvertent partial cholecystectomy is not unique to this technique, single-port laparoscopic procedures may result in different and significant complications.

  16. Infection of the left sided gallbladder simulating liver abscess and gastric antral tumor

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Woo; Ahn, Jae Sung [St Mary' s Hospital Catholic Medical College, Seoul (Korea, Republic of)

    1972-12-15

    The left sided gallbladder, being a rare occurrence, may create diagnostic problem especially when it becomes infected. Recently, we have experienced 2 cases of infection of left sided gallbladder at the Department of Radiology, St Mary's Hospital, Catholic Medical College. Case I was a 32-year-old housewife with dyspepsia, epigastric pain and recurring bouts of high fever of 2 months duration. Under the provisional diagnosis of liver abscess liver scan was performed which revealed well defined cold area in the left lobe supporting the provisional diagnosis. Tender cystic mass was aspirated and pus was drained. The injected air at the occasion of aspiration outlined well defined cystic structure. Because aspiration failed to control the symptoms, laparotomy was performed. Surgeon found a left sided gallbladder which was empyematous. Case II was a 38 year old business man admitted to the hospital because of tender ill defined mass in mid epigastrium. The patient was febrile (39.4 .deg. C) and anemic. An upper GI series disclosed an irregular filling defect involving the antrum of the stomach. The mass was primarily extrinsic but was closely fixed to the gastric wall. Surgical intervention revealed chronic cholecystitis and pericholecystitis with thick adhesion to the distal stomach.

  17. Connective tissue growth factor immunohistochemical expression is associated with gallbladder cancer progression.

    Science.gov (United States)

    Garcia, Patricia; Leal, Pamela; Alvarez, Hector; Brebi, Priscilla; Ili, Carmen; Tapia, Oscar; Roa, Juan C

    2013-02-01

    Gallbladder cancer (GBC) is an aggressive neoplasia associated with late diagnosis, unsatisfactory treatment, and poor prognosis. Molecular mechanisms involved in GBC pathogenesis remain poorly understood. Connective tissue growth factor (CTGF) is thought to play a role in the pathologic processes and is overexpressed in several human cancers, including GBC. No information is available about CTGF expression in early stages of gallbladder carcinogenesis. Objective.- To evaluate the expression level of CTGF in benign and malignant lesions of gallbladder and its correlation with clinicopathologic features and GBC prognosis. Connective tissue growth factor protein was examined by immunohistochemistry on tissue microarrays containing tissue samples of chronic cholecystitis (n = 51), dysplasia (n = 15), and GBC (n = 169). The samples were scored according to intensity of staining as low/absent and high CTGF expressers. Statistical analysis was performed using the χ(2) test or Fisher exact probability test with a significance level of P Connective tissue growth factor expression showed a progressive increase from chronic cholecystitis to dysplasia and then to early and advanced carcinoma. Immunohistochemical expression (score ≥2) was significantly higher in advanced tumors, in comparison with chronic cholecystitis (P < .001) and dysplasia (P = .03). High levels of CTGF expression correlated with better survival (P = .04). Our results suggest a role for CTGF in GBC progression and a positive association with better prognosis. In addition, they underscore the importance of considering the involvement of inflammation on GBC development.

  18. Postprandial gallbladder emptying is related to intestinal motility at the time of meal ingestion

    DEFF Research Database (Denmark)

    Oster-Jørgensen, E; Qvist, N; Pedersen, S A

    1992-01-01

    The characteristics of meal-induced gallbladder emptying in healthy individuals are subject to wide variation. We hypothesized that some of the observed variation might relate to ingestion of the meal during different phases of the migrating motor complex (MMC). Recording of gastrointestinal...... pressure was combined with scintigraphic recording of bile kinetics during infusion of 99mTc-HIDA. The material consisted of 12 healthy men. Group 1 (n = 6) had a fat-rich meal in phase I, and group 2 (n = 6) had the meal in a phase II. With the end of the meal ingestion as zero, the following results...... emerged. The subjects in group 1 had a median (range) lag period before beginning of gallbladder emptying of 13.5 (9.0-22.5) min. In group 2 gallbladder emptying began during the meal ingestion in four subjects, and the median lag period was 0 min (minimum, -9.0; maximum, 13.5 (p = 0.02)). The median...

  19. Comparing Bleeding Risk Assessment Focused on Modifiable Risk Factors Only Versus Validated Bleeding Risk Scores in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Guo, Yutao; Zhu, Hang; Chen, Yundai

    2018-01-01

    BACKGROUNDThere is uncertainty whether a focus on modifiable bleeding risk factors offers better prediction of major bleeding than other existing bleeding risk scores.METHODSThis study compared a score based on numbers of the modifiable bleeding risk factors recommended in the 2016 European...... guidelines ("European risk score") versus other published bleeding risk scores that have been derived and validated in atrial fibrillation subjects (HEMORR2HAGES, HAS-BLED, ATRIA, and ORBIT) in a large hospital-based cohort of Chinese inpatients with atrial fibrillation.RESULTSThe European score had modest...... predictive ability for major bleeding (c-index 0.63, 95% confidence interval 0.56-0.69) and intracranial hemorrhage (0.72, 0.65-0.79) but nonsignificantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56; P = .361). The HAS-BLED score was superior to predict bleeding events compared...

  20. Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration.

    Science.gov (United States)

    Singh, Pratibha

    2018-01-01

    Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn) was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic) were used to retrieve data. One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41-45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C) in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Endometrial aspiration is a simple, safe, and effective method to sample endometrium in cases of AUB avoiding risk of

  1. Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration

    Directory of Open Access Journals (Sweden)

    Pratibha Singh

    2018-01-01

    Full Text Available Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB, especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. Materials and Methods: We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic were used to retrieve data. Results: One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41–45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Discussion: Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Conclusion: Endometrial aspiration is a simple, safe, and

  2. A Prospective Study of the Conservative Management of Asymptomatic Preoperative and Postoperative Gallbladder Disease in Bariatric Surgery.

    Science.gov (United States)

    Pineda, Omar; Maydón, Hernán G; Amado, Mónica; Sepúlveda, Elisa M; Guilbert, Lizbeth; Espinosa, Omar; Zerrweck, Carlos

    2017-01-01

    Bariatric surgery is the most effective therapy for weight loss in patients with morbid obesity. One of the most common long-term complications includes cholelithiasis. There is not a clear consensus in how to treat an asymptomatic gallbladder disease before and after bariatric surgery. Prospective study with every patient submitted to bariatric surgery from 2012 to 2014. The gallbladder status was assessed with an ultrasound before and after surgery (12 months), and a conservative management was conducted for patients with asymptomatic disease (preoperative and de novo); the need for delayed cholecystectomy was reported. Secondarily, an analysis of weight loss (%EWL) and gallbladder status was performed. Two-hundred and two bariatric surgeries were performed. The global incidence of preoperative gallbladder disease was 34.3 %, with 14.2 % presenting sludge, 20.1 % asymptomatic gallstones, and 2.3 % symptomatic gallstones. The final analysis was based on 146 patients; female sex comprised 81.1 % of cases with a mean age of 38.5 years. After 12 months, de novo gallbladder disease was observed in 21.2 %. The overall rate of cholecystectomy because of symptomatic disease after 12 months was 3.4 % (2 % developed acute cholecystitis). There were no differences in %EWL between patients with de novo gallbladder disease and those without. Conservative management of asymptomatic gallbladder disease in candidates to bariatric surgery is safe and can be offered in every case, based on the low percentage of patients requiring further cholecystectomy after 12 months. Also, a conservative management can be offered to patients developing de novo sludge/cholelithiasis without related symptoms.

  3. Preoperative ultrasound measurements predict the feasibility of gallbladder extraction during transgastric natural orifice translumenal endoscopic surgery cholecystectomy.

    Science.gov (United States)

    Santos, Byron F; Auyang, Edward D; Hungness, Eric S; Desai, Kush R; Chan, Edward S; van Beek, Darren B; Wang, Edward C; Soper, Nathaniel J

    2011-04-01

    Extraction of a gallbladder through an endoscopic overtube during natural orifice translumenal endoscopic surgery (NOTES) transgastric cholecystectomy avoids potential injury to the esophagus. This study examined the rate of successful gallbladder specimen extraction through an overtube and hypothesized that preoperative ultrasound findings could predict successful specimen passage. Gallbladder specimens from patients undergoing laparoscopic cholecystectomy were measured, and an attempt was made to pull the specimens through a commercially available overtube with an inner diameter of 16.7-mm. A radiologist blinded to the outcomes reviewed the available preoperative ultrasound measurements from these patients. Ultrasound dimensions including gallbladder length, width, and depth; wall thickness; common bile duct diameter; and size of the largest gallstone (LGS) were recorded. Multiple logistic regression analysis was performed to determine whether ultrasound findings and patient characteristics (age, body mass index [BMI], and sex) could predict the ability of a specimen to pass through the overtube. Of 57 patients, 44 (77%) who had preoperative ultrasounds available for electronic review were included in the final analysis. Gallstones were present in 35 (79%) of these 44 patients. Intraoperative gallbladder perforation occurred in 18 (41%) of the 44 patients, and 16 (36%) of the 44 gallbladders could be extracted through the overtube. Measurement of LGS was possible for 23 patients, and indeterminate gallstone size (IGS) was determined for 12 patients. The rate for passage of perforated versus intact gallbladders was similar (40% vs. 23%; p = 0.054). The LGS (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.02-1.33; p = 0.021) and IGS (OR, 22.97; 95% CI, 1.99-265.63; p = 0.025) predicted failed passage on multivariate logistic regression analysis. The passage rate was 80% for LGS smaller than 10 mm or no stones present, 18% for LGS 10 mm or larger, and 8% for

  4. Effects of matrix metalloproteinase inhibitor doxycycline and CD147 antagonist peptide-9 on gallbladder carcinoma cell lines.

    Science.gov (United States)

    Wang, Shihang; Liu, Chao; Liu, Xinjiang; He, Yanxin; Shen, Dongfang; Luo, Qiankun; Dong, Yuxi; Dong, Haifeng; Pang, Zhigang

    2017-10-01

    Gallbladder carcinoma is the most common and aggressive malignancy of the biliary tree and highly expresses CD147, which is closely related to disease prognosis in a variety of human cancers. Doxycycline exhibited anti-tumor properties in many cancer cells. CD147 antagonist peptide-9 is a polypeptide and can specifically bind to CD147. The effect of these two drugs on gallbladder cancer cells has not been studied. The aim of this study is to investigate the effect of doxycycline and antagonist peptide-9 on gallbladder carcinoma cells and the possible mechanism of inhibition on cancer cell of doxycycline. To investigate the effects of doxycycline and antagonist peptide-9 on gallbladder carcinoma cells (GBC-SD and SGC-996), cell proliferation, CD147 expression, and early-stage apoptosis rate were measured after treated with doxycycline. Matrix metalloproteinase-2 and matrix metalloproteinase-9 activities were measured after treated with different concentrations of doxycycline, antagonist peptide-9, and their combination. The results demonstrated that doxycycline inhibited cell proliferation, reduced CD147 expression level, and induced an early-stage apoptosis response in GBC-SD and SGC-996 cells. The matrix metalloproteinase-2 and matrix metalloproteinase-9 activities were inhibited by antagonist peptide-9 and doxycycline, and the inhibitory effects were enhanced by combined drugs in gallbladder carcinoma cell lines. Taken together, doxycycline showed inhibitory effects on gallbladder carcinoma cell lines and reduced the expression of CD147, and this may be the mechanism by which doxycycline inhibits cancer cells. This study provides new information and tries to implement the design of adjuvant therapy method for gallbladder carcinoma.

  5. Treatment Modalities in Adolescents Who present With Heavy Menstrual Bleeding.

    Science.gov (United States)

    Alaqzam, Tasneem S; Stanley, Angela C; Simpson, Pippa M; Flood, Veronica H; Menon, Seema

    2018-03-07

    This study sought to determine the relationship of bleeding disorders to iron deficiency anemia. Additionally, this study was undertaken to examine all current treatment modalities used in a menorrhagia clinic with respect to heavy menstrual bleeding management to identify the most effective options for menstrual management in the setting of an underlying bleeding disorder. DESIGN, SETTING, PARTICIPANT, INTERVENTION, AND MAIN OUTCOME MEASURES: Retrospective chart review of adolescent <21 years with heavy menstrual bleeding attending a multidisciplinary hematology-adolescent gynecology clinic. Information included demographics, bleeding diathesis, hematologic parameters, treatment, and the diagnosis was extracted from each chart. Subjects were grouped into two categories based on the diagnosis of a bleeding disorder. Hemoglobin level, iron deficiency anemia, and need for transfusion were compared between a bleeding disorder and no bleeding disorder group. Subjects were grouped into categories depending on hormonal modality and treatment success of the groups were compared. 73 subjects tested for a bleeding disorder. Of the subjects completing testing, 34 (46%) were diagnosed with a bleeding disorders. 39 (54%) subjects had heavy menstrual bleeding due to other causes. There was no significant difference in hemoglobin between those with and without a bleeding disorder. Iron deficiency anemia was significantly higher in subjects without bleeding disorder. When comparing hormone therapy success, the levonorgestrel IUD (LNG-IUD) (89%) had the highest rate of menstrual suppression followed by norethindrone acetate 5-10mg/day (83%), and the transdermal patch (80%). All subjects using both tranexamic acid and hormonal therapy had 100% achievement of menstrual suppression. A high frequency of bleeding disorder was found in those tested. Subjects with a bleeding disorder were less likely to present with severe anemia requiring blood transfusion and less likely to have iron

  6. The role of endoscopy in pediatric gastrointestinal bleeding

    Science.gov (United States)

    Franke, Markus; Geiß, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-Jürgen; Bausch, Dirk; Fischer, Andreas

    2016-01-01

    Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no

  7. EFFECT OF POSITIONING ON BLEEDING COMPLICATION AND LOW BACK PAIN AFTER DIAGNOSTIC CORONARY ANGIOGRAPHY IN PATIENTS WITH CORONARY HEART DISEASE IN AN INTEGRATED HEART CARE CENTER IN INDONESIA

    Directory of Open Access Journals (Sweden)

    Theresia Febriana Christi Tyas Utami

    2018-05-01

    Full Text Available Background: Coronary angiography can cause complications of arterial and subcutaneous bleeding (hematoma and back pain. Changing the position of the patient (positioning in bed can reduce the pain post-diagnostic catheterization complications. Objective: This study was to examine the effect of positioning on bleeding complication and low back pain after diagnostic coronary angiography in patients with coronary heart disease patient in the Integrated Heart Care Center in Indonesia. Methods: This study was a true-experimental study with randomized posttest-only control group design. Thirty respondents were randomly selected using simple random sampling, which 15 respondents were randomly assigned in the experiment group and control group. The experiment group was given a positioning with 150, 300, 450 head-of-bed elevation in left and right lateral position. An arc tool was used to measure the height of head of bed elevation, a measuring cup to measure arterial bleeding using, a perforated transparent plastic with 5 cm diameter to measure subcutaneous bleeding (hematoma, and Numeric Pain Rating Scale to measure low back pain. Data were analyzed using Kolmogorov- Smirnov and Repeated Measured ANOVA. Results: Findings showed that positioning had no effect on arterial hemorrhage (ρ=1.000 and subcutaneous bleeding (hematoma (ρ=0.999. Repeated ANOVA test results revealed that positioning had a significant effect on low back pain (ρ=0.017. Conclusion: There was no significant effect of positioning on the occurrence of arterial and subcutaneous bleeding (hematoma, but there was a significant effect in reducing low back pain.

  8. Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

    DEFF Research Database (Denmark)

    Olesen, J B; Lip, G Y H; Hansen, P R

    2011-01-01

    Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme...

  9. Bleeding during gonioscopy after deep sclerectomy.

    Science.gov (United States)

    Moreno-Montañés, Javier; Rodríguez-Conde, Rosa

    2003-10-01

    To show a new complication after deep sclerectomy (DS). We described two eyes of two patients with open-angle glaucoma and cataract who were operated on of an uneventful phacoemulsification and DS with SK-gel implantation. Bleeding during gonioscopic examination occurred in both eyes 7 and 8 months after combined surgery. The blood originated from the vessels around the Descemet window, and was probably due to manipulation or rocking of the goniolens. Pressure was immediately applied to the gonioscopic lens and the hyphema was interrupted. These cases show the presence of new vessels around the Descemet window after DS with SK-gel. Bleeding from the Descemet window vessels can occur during gonioscopy even months after DS. We recommend conducting a careful gonioscopic examination in patients who have undergone DS to avoid this complication.

  10. Geomechanics of bedded salt

    International Nuclear Information System (INIS)

    Serata, S.; Milnor, S.W.

    1979-01-01

    Creep data from the literature search is reinterpreted by SGI, resulting in a better understanding of the temperature and stress state dependence of the octahedral creep rate and the octahedral shear strength. The concept of a transition strength between the elastic and the plastic states is in agreement with the data. The elastic and rheological properties of salt are described, and a set of constitutive equations is presented. The dependence of material properties on parameters such as temperature is considered. Findings on the permeability of salt are summarized, and the in-situ behavior of openings in bedded salt is described based on extensive engineering experience. A stress measuring system utilizing a finite element computer code is discussed. Geological factors affecting the stability of salt openings are considered, and the Stress Control Technique for designing stable openings in bedded salt formations is explained

  11. Gallbladder ascariasis in Kosovo - focus on ultrasound and conservative therapy: a case series.

    Science.gov (United States)

    Ismaili-Jaha, Vlora; Toro, Halim; Spahiu, Lidvana; Azemi, Mehmedali; Hoxha-Kamberi, Teuta; Avdiu, Muharrem; Spahiu-Konjusha, Shqipe; Jaha, Luan

    2018-01-13

    Ascaris lumbricoides is one of the most common intestinal infections in developing countries, including Kosovo. In contrast to migration to the bile duct, migration of the worm to the gallbladder, due to the narrow and tortuous nature of the cystic duct, is rare. When it does occur, it incites acalculous cholecystitis. This case series describes a 16-month-old Albanian girl, a 22-month-old Albanian girl, a 4-year-old Albanian girl, and a 10-year-old Albanian boy. Here we report our experience with gallbladder ascariasis including clinical manifestations, diagnostic procedures, and treatment. Fever, diarrhea and vomiting, dehydration, pale appearance, and weakness were the manifestations of the primary disease. In all patients, a physical examination revealed reduced turgor and elasticity of the skin. Abdomen was at the level of the chest, soft, with minimal palpatory pain. The liver and spleen were not palpable. A laboratory examination was not specific except for eosinophilia. There were no pathogenic bacteria in coproculture but Ascaris was found in all patients. At an ultrasound examination in all cases we found single, long, linear echogenic structure without acoustic shadowing containing a central, longitudinal anechoic tube with characteristic movement within the gallbladder. Edema of the gallbladder wall was suggestive of associated inflammation. There were no other findings on adjacent structures and organs. All patients received mebendazole 100 mg twice a day for 3 days. They also received symptomatic therapy for gastroenteritis. Because of elevated markers of inflammation all patients were treated with antibiotics, assuming acute cholecystitis, although ultrasound was able to confirm cholecystitis in only two of our four patients. Since the length of stay was dependent on the primary pathology it was 7 to 10 days. At control ultrasounds on 14th day, third and sixth month, all patients were free of ascariasis. Gallbladder ascariasis should be considered in

  12. Routine administration of antibiotics to patients suffering accidental gallbladder perforation during laparoscopic cholecystectomy is not necessary.

    Science.gov (United States)

    Guzmán-Valdivia, Gilberto

    2008-12-01

    Accidental rupture of the gallbladder is an event which occurs in up to 20% of laparoscopic cholecystectomies, mainly in those where dissection is difficult, or during extraction when the gallbladder is withdrawn directly through the laparoscope port. It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection. It is common practice, therefore, for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs. To compare 2 groups of similar patients, to determine whether administration of antibiotics, started during surgery, is actually useful in reducing the risk of residual abscess or infection in the surgical wound. The study considered a total of 166 patients who had suffered accidental perforation of the gallbladder during elective laparoscopic cholecystectomy. This total was divided at random into 2 groups: group A (80 patients) who received a dose of 1 g of Cefotaxime at the moment of gallbladder rupture, followed by 2 more doses at intervals of 8 hours in the immediate postoperative period; and group B (86 patients) who did not receive any antibiotic treatment at all. The dependent variables observed were surgical wound infection and residual abscess: and the control variables were age, sex, length of operation time, intercurrent illnesses, and American Society of Anesthesiologists (ASA) classification. Two patients (2.5%) in group A developed a surgical wound infection, against 3 cases (3.4%) in group B, the result having no statistical significance. No patients developed residual abscess. In a multivariant analysis, the following were identified as independent factors significantly associated with the onset of surgical wound infection (Pgallbladder during laparoscopic cholecystectomy is not necessary. In the case of patients with diabetes mellitus, those who are older than 60

  13. Risk Factors for Post-TAVI Bleeding According to the VARC-2 Bleeding Definition and Effect of the Bleeding on Short-Term Mortality: A Meta-analysis.

    Science.gov (United States)

    Wang, Jiayang; Yu, Wenyuan; Jin, Qi; Li, Yaqiong; Liu, Nan; Hou, Xiaotong; Yu, Yang

    2017-04-01

    In this study we investigated the effect of post-transcatheter aortic valve implantation (TAVI) bleeding (per Valve Academic Research Consortium-2 [VARC-2] bleeding criteria) on 30-day postoperative mortality and examined the correlation between pre- or intraoperative variables and bleeding. Multiple electronic literature databases were searched using predefined criteria, with bleeding defined per Valve Academic Research Consortium-2 criteria. A total of 10 eligible articles with 3602 patients were included in the meta-analysis. The meta-analysis revealed that post-TAVI bleeding was associated with a 323% increase in 30-day postoperative mortality (odds risk [OR]; 4.23, 95% confidence interval [CI], 2.80-6.40; P logistic regression analysis revealed that atrial fibrillation (AF) was independently correlated with TAVI-associated bleeding (OR, 2.63; 95% CI, 1.33-5.21; P = 0.005). Meta-regression showed that potential modifiers like the Society of Thoracic Surgeons (STS) score, mortality, the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), aortic valve area, mean pressure gradient, left ventricular ejection fraction, preoperative hemoglobin and platelet levels, and study design had no significant effects on the results of the meta-analysis. Post-TAVI bleeding, in particular, major bleeding/life-threatening bleeding, increased 30-day postoperative mortality. Transapical access was a significant bleeding risk factor. Preexisting AF independently correlated with TAVI-associated bleeding, likely because of AF-related anticoagulation. Recognition of the importance and determinants of post-TAVI bleeding should lead to strategies to improve outcomes. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  14. Heavy menstrual bleeding: An update on management.

    Science.gov (United States)

    Davies, Joanna; Kadir, Rezan A

    2017-03-01

    Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss (MBL) >80 mL per cycle, that interferes with a woman's physical, emotional, social wellbeing and quality of life. Aetiology is due to underlying uterine pathologies, coagulopathy, ovulation dysfunction, or iatrogenic. Up to 20% of women with HMB will have an underlying inherited bleeding disorder (IBD). Assessment of HMB should entail a menstrual and gynaecological history and a bleeding score to distinguish those women who require additional haematological investigations. A pelvic examination and ultrasound scan help to rule out presence of any underlying pathology. Management depends on the underlying cause and the woman's preference and her fertility wishes. Medical therapies include hormonal treatments; levonorgestrel-releasing intrauterine system (LNG-IUS) and combined hormonal contraceptives are most commonly used. Ulipristal acetate is an approved preoperative treatment for uterine fibroids, and has demonstrated efficacy in reducing MBL. Haemostatic therapies include tranexamic acid and DDAVP (1-deamino-8-D-arginine). DDAVP is used for HMB associated with certain IBDs. These therapies can be used in isolation or in combination with hormonal treatments. HMB associated with certain severe IBDs may require factor concentrate administration during menses to alleviate symptoms. Endometrial ablation is a minor surgical procedure that is associated with low operative morbidity and can be performed as an outpatient. Hysterectomy remains the definitive treatment of choice when medical therapies have failed and endometrial ablation is not suitable. Crown Copyright © 2017 Published by Elsevier Ltd. All rights reserved.

  15. The usefulness of MDCT in acute intestinal bleeding

    International Nuclear Information System (INIS)

    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Chang, Jay Chun; Jang, Han Won

    2006-01-01

    We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 or 17), whereas that of angiography was 46% (6 or 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiography did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted

  16. Geographic variation of gallbladder cancer mortality and risk factors in Chile: a population-based ecologic study

    Science.gov (United States)

    Andia, Marcelo E.; Hsing, Ann W.; Andreotti, Gabriella; Ferreccio, Catterina

    2010-01-01

    Chile’s gallbladder cancer rates are among the highest in the world, being the first cancer killer among Chilean women. To provide insights into the etiology of gallbladder cancer, we conducted an ecologic study examining the geographical variation of gallbladder cancer and several putative risk factors. The relative risk of dying from gallbladder cancer (relative to the national average mortality rate) between 1985 and 2003 was estimated for each of the 333 Chilean counties, using a hierarchical Poisson regression model, adjusting for age, sex, and geographical location. The risk of gallbladder cancer mortality was analyzed in relation to region (costal, inland, northern, and southern), poverty, Amerindian (Mapuche) population, typhoid fever, and access to cholecystectomy, using logistic regression analysis. There were 27,183 gallbladder cancer deaths, age-sex-adjusted county mortality rates ranging from 8.2 to 12.4 per 100,000 inhabitants, being higher in inland and southern regions; compare to the north-coastal, the northern-inland region had a 10-fold risk odds ratio (OR) (95% of confidence interval (95% CI): 2.4–42.2) and the southern-inland region had a 26-fold risk (OR 95%CI: 6.0–114.2). Independent risk factors for gallbladder cancer were: ethnicity (Mapuche) OR:3.9 (95%CI 1.8–8.7), typhoid fever OR:2.9 (95%CI 1.2–6.9), poverty OR:5.1 (95%CI 1.6–15.9), low access to cholecystectomy OR:3.9 (95%CI 1.5–10.1), low access to hospital care OR:14.2 (95%CI 4.2–48.7) and high urbanization OR:8.0 (95%CI 3.4–18.7). Our results suggest that gallbladder cancer in Chile may be related to both genetic factors and poor living conditions. Future analytic studies are needed to further clarify the role of these factors in gallbladder cancer etiology. PMID:18566990

  17. Variation in the risk for liver and gallbladder cancers in socioeconomic and occupational groups in Sweden with etiological implications.

    Science.gov (United States)

    Ji, Jianguang; Hemminki, Kari

    2005-09-01

    To examine the associations between socioeconomic/occupational factors and liver cancer at various anatomic sites (including primary liver, gallbladder and other cancers). We carried out a follow-up study on the economically active Swedish population, based on the Swedish Family-Cancer Database. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated in different social classes and occupations. For primary liver cancer, farmers were at a decreased risk; increased risks were observed for male sales agents, journalists, seamen, waiters, cooks and female beverage manufacture workers. Similar patterns were observed for gallbladder cancer; workers employed as journalists, sales agents, cooks and stewards, and public safety workers showed increased risk. Only male transport workers showed increased risk of cancers in other parts. Occupations with high consumption of alcohol and/or high prevalence of smoking associated with a risk of liver and gallbladder cancers. The present study suggests that the effects of socioeconomic factors on liver cancer of different subsites are similar; alcohol drinking is a risk factor of gallbladder cancer because of the covariation of primary liver and gallbladder cancers in occupational groups.

  18. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    Energy Technology Data Exchange (ETDEWEB)

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M. (Kuwait Univ. (Kuwait). Dept. of Nuclear Medicine); Al-Wafai, I.; Vallgren, S. (Kuwait Univ. (Kuwait). Dept. of Surgery)

    1989-06-01

    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of {sup 99m}Tc-DTPA, {sup 99m}Tc-RBCs and {sup 99m}Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both {sup 99m}Tc-DTPA and {sup 99m}Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only {sup 99m}Tc-DTPA was successful in detecting the bleeding site. The results indicate that {sup 99m}Tc-DTPA is the most useful {sup 99m}Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.).

  19. Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

    International Nuclear Information System (INIS)

    Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M.; Al-Wafai, I.; Vallgren, S.

    1989-01-01

    The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of 99m Tc-DTPA, 99m Tc-RBCs and 99m Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both 99m Tc-DTPA and 99m Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only 99m Tc-DTPA was successful in detecting the bleeding site. The results indicate that 99m Tc-DTPA is the most useful 99m Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.) [de

  20. Coal Bed Methane Primer

    Energy Technology Data Exchange (ETDEWEB)

    Dan Arthur; Bruce Langhus; Jon Seekins

    2005-05-25

    During the second half of the 1990's Coal Bed Methane (CBM) production increased dramatically nationwide to represent a significant new source of income and natural gas for many independent and established producers. Matching these soaring production rates during this period was a heightened public awareness of environmental concerns. These concerns left unexplained and under-addressed have created a significant growth in public involvement generating literally thousands of unfocused project comments for various regional NEPA efforts resulting in the delayed development of public and fee lands. The accelerating interest in CBM development coupled to the growth in public involvement has prompted the conceptualization of this project for the development of a CBM Primer. The Primer is designed to serve as a summary document, which introduces and encapsulates information pertinent to the development of Coal Bed Methane (CBM), including focused discussions of coal deposits, methane as a natural formed gas, split mineral estates, development techniques, operational issues, producing methods, applicable regulatory frameworks, land and resource management, mitigation measures, preparation of project plans, data availability, Indian Trust issues and relevant environmental technologies. An important aspect of gaining access to federal, state, tribal, or fee lands involves education of a broad array of stakeholders, including land and mineral owners, regulators, conservationists, tribal governments, special interest groups, and numerous others that could be impacted by the development of coal bed methane. Perhaps the most crucial aspect of successfully developing CBM resources is stakeholder education. Currently, an inconsistent picture of CBM exists. There is a significant lack of understanding on the parts of nearly all stakeholders, including industry, government, special interest groups, and land owners. It is envisioned the Primer would being used by a variety of

  1. Infant's bed climate and bedding in the Japanese home.

    Science.gov (United States)

    Nakamura Ikeda, Rie; Fukai, Kiyoko; Okamoto Mizuno, Kazue

    2012-06-01

    to assess the bed climate of infants in their homes in Japan. descriptive, exploratory, non-experimental research design. the data were collected at the participants' homes under normal circumstances. nineteen healthy infants between the ages of two and five months. Their mothers, who joined a parenting class organised by a maternity clinic in Okayama, Japan, consented to participate in this study. we visited the infants' homes and interviewed their mothers concerning the types and use of bedding. The temperature and relative humidity of the bed climate at the back and foot of the bedding, and in the room were measured every minute for four consecutive days. Differences among the bed climates measured during three seasons (spring, summer, and autumn) were assessed by one-way analysis of variance. The bed temperature was higher for infants than for adults. No significant difference in temperature was noted among the three seasons. The bed temperature was about 36.0°C when waterproof sheets and futon mattresses for children or adult were used. The average relative humidity of the bed climate at the back was highest in summer, followed by that in spring and autumn; the differences were significant. The use of waterproof sheets and futon mattresses for children in summer increased the relative humidity to 80% or more. The use of infant beds, sunoko drainboards, and cotton futon mattresses in summer was effective in reducing the bed humidity. these results suggest that nurse-midwives should advise the parents on comfortable bed climates for their infants, as well as how to select and use bedding for them. Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. Fluidised bed cereal cooking

    International Nuclear Information System (INIS)

    Jenkins, Simon Anthony

    2002-01-01

    Man has been cooking food for thousands of years for a number of reasons: to improve flavour and palatability, sterilise, increase digestibility, improve texture and colour. Increasingly more advanced techniques are employed today in food production plants to engineer foods with many different properties. With this in mind manufacturers are constantly seeking to improve processing techniques and apply new or different technologies (such as microwaves, RF and extrusion) to develop foods with new properties (like puffed texture starches) and to increase process efficiencies (energy efficiency, water reduction). This thesis reports on work undertaken to demonstrate the potential to achieve high temperature starch conversion of whole wheat grains in a fluidised bed, thereby reducing the amount of water required and processing time. Specifically, wheat from the farm at 14% water content is cooked in a fluidised bed. The fluidised bed heats the wheat quickly by convective heating. In addition, energy can be delivered directly to the grain by microwave heating during fluidisation. Degree of starch conversion is determined by measuring the reduction in size of endotherm of reaction as observed by Differential Scanning Calorimetry. The fluidising gas, processing temperature and starting moisture content were varied in order to investigate their effect on the cooking process. A mathematical model based on energy and species concentration equations was developed to help understand the internal grain processes. The model coupled the thermal energy equation with water diffusion. The effect of water evaporation was represented as a thermal sink in the energy equation. Popular kinetic models from literature were adapted to predict the degree of starch conversion. The model gives solutions consistent with experimental data and physical intuition. A commercial computational fluid dynamics package was used to study simple airflow and particle tracks in the fluidisation column. A

  3. Management of Patients with Acute Lower Gastrointestinal Bleeding

    Science.gov (United States)

    Strate, Lisa L.; Gralnek, Ian M.

    2016-01-01

    This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery

  4. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

    Science.gov (United States)

    Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

    2015-09-01

    Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended

  5. Management of bleeding in vascular surgery.

    Science.gov (United States)

    Chee, Y E; Liu, S E; Irwin, M G

    2016-09-01

    Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration. Trials specifically examining bleeding management in vascular surgery are lacking, and much of the literature and guidelines are derived from studies on patients with trauma. In general, it is recommended to adopt permissive hypotension with a restrictive fluid strategy, using a combination of crystalloid and colloid solutions up to one litre during the initial resuscitation, after which blood products should be administered. A restrictive transfusion trigger for red cells remains the mainstay of treatment except for the high-risk patients, where the trigger should be individualized. Transfusion of blood components should be initiated by clinical evidence of coagulopathy such as diffuse microvascular bleeding, and then guided by either laboratory or point-of-care coagulation testing. Prophylactic antifibrinolytic use is recommended for all surgery where excessive bleeding is anticipated. Fibrinogen and prothrombin complex concentrates administration are recommended during massive transfusion, whereas rFVIIa should be reserved until all means have failed. While debates over the ideal resuscitative strategy continue, the approach to vascular haemostasis should be scientific, rational, and structured. As far as possible, therapy should be monitored and goal directed. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Bleeding aneurysms of the celiac trunk

    International Nuclear Information System (INIS)

    Ziviello, M.; D'Isa, L.; Siani, A.; Maglione, F.; Cataldo, B.; Ziviello, R.; Capalbogiliberti, R.

    1988-01-01

    The authors report their experience in the study of bleeding aneurysms of the celiac arteries. Eleven patients were examined with US,CT, and angiography (8 hepatic artery aneurysms and 3 splenic artery aneurysms). Clinical findings included digestive bleeding, upper abdominal pain, palpable pulsating masses, and jaundice. Patient history included blunt abdominal trauma, penetrating trauma due to gunshot, acute pancreatitis, recent hepatic biospy. In all cases US showed an abdominal mass ranging in size from 2 to 10 cm. US findings included cyst-like lesions (8 cases), anobulated solid-like lesion, and complex lesion (2 cases). Continuity of the lesion with adjancent arterial vessels was noted in 5/11 cases, and pulsing activity in 3/11 cases. US patterns, although not specific, play an important role in the diagnosis when associated to other elements such as arterial continuity, mass pulsatility, patient history, and gastrointestinal bleeding. They suggest the need for more specific imaging exams, i.e. CT and angiography, and help avoid dangerous diagnostic biopsies. CT was performed to confirm US findings in 5 cases, and detected either hypodense cystic masses, or inhomogeneous masses with arterial enhancement after bolus injection of cm. CT was used to better demonstrate the lumen, patency of the vessel, the walls of the vessel, and the parietal thrombotic component. The typical arterial enhancement was the decisive finding for the diagnosis, even though a total continuity with arterial vessels was never observed. Angiography was the method of choice for the preoperative demonstration of hepatic artery aneurysms (10 cases) and for occlusive treatment with Gianturco coils (3 cases)

  7. An Unusual Case of Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Kristin N. Fiorino

    2011-01-01

    Full Text Available A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA, which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment.

  8. Somatostatin analogues for acute bleeding oesophageal varices

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C.; Hrobjartsson, A.

    2008-01-01

    or recent bleeding from oesophageal varices. DATA COLLECTION AND ANALYSIS: The outcome measures extracted were: mortality, blood transfusions, use of balloon tamponade, initial haemostasis and rebleeding. Intention-to-treat analyses including all randomised patients were conducted if possible; a random...... it was substantially reduced in the other trials, relative risk 0.36 (0.19 to 0.68). Use of balloon tamponade was rarely reported. AUTHORS' CONCLUSIONS: The need for blood transfusions corresponded to one half unit of blood saved per patient. It is doubtful whether this effect is worthwhile. The findings do...

  9. Taeniasis: A possible cause of ileal bleeding.

    Science.gov (United States)

    Settesoldi, Alessia; Tozzi, Alessandro; Tarantino, Ottaviano

    2017-12-16

    Taenia spp. are flatworms of the class Cestoda, whose definitive hosts are humans and primates. Human infestation (taeniasis) results from the ingestion of raw meat contaminated with encysted larval tapeworms and is considered relatively harmless and mostly asymptomatic. Anemia is not recognized as a possible sign of taeniasis and taeniasis-induced hemorrhage is not described in medical books. Its therapy is based on anthelmintics such praziquantel, niclosamide or albendazole. Here we describe a case of acute ileal bleeding in an Italian man affected with both Taenia spp. infestation resistant to albendazole and Helicobacter pylori -associated duodenal ulcers.

  10. The use of 111In-labelled platelets for scintigraphic localization of gastrointestinal bleeding with special reference to occult bleeding

    International Nuclear Information System (INIS)

    Gjerloeff Schmidt, K.; Waever Rasmussen, J.; Grove, O.; Andersen, D.

    1986-01-01

    Gamma-camera imaging of the abdomen after injection of autologous 111 In-labelled platelets was applied for localization of gastrointestinal bleeding in a study of 22 patients. In 15 studies showing scintigraphic signs of bleeding, the clinical presentation included occult bleeding in 6, melaena in 4, and bloody stools in 5 patients. Scintigraphy could be done repeatedly for up to 1 week after a single tracer injection. The time interval between the injection and scintigraphic visualization of bleeding ranged from 10 min to 68 h, being longest in cases of occult bleeding. In most cases the scintigraphic findings were supported by other diagnostic modalities, including surgical removal of presumed sources of bleeding. In seven studies without scintigraphic signs of bleeding, a probable source of bleeding was identified by other means in one patient. The 111 In-platelet method seems to be a promising method for localization of gastrointestinal bleeding which may prove particularly useful in cases of occult or recurrent bleeding

  11. The prognostic importance of jaundice in surgical resection with curative intent for gallbladder cancer.

    Science.gov (United States)

    Yang, Xin-wei; Yuan, Jian-mao; Chen, Jun-yi; Yang, Jue; Gao, Quan-gen; Yan, Xing-zhou; Zhang, Bao-hua; Feng, Shen; Wu, Meng-chao

    2014-09-03

    Preoperative jaundice is frequent in gallbladder cancer (GBC) and indicates advanced disease. Resection is rarely recommended to treat advanced GBC. An aggressive surgical approach for advanced GBC remains lacking because of the association of this disease with serious postoperative complications and poor prognosis. This study aims to re-assess the prognostic value of jaundice for the morbidity, mortality, and survival of GBC patients who underwent surgical resection with curative intent. GBC patients who underwent surgical resection with curative intent at a single institution between January 2003 and December 2012 were identified from a prospectively maintained database. A total of 192 patients underwent surgical resection with curative intent, of whom 47 had preoperative jaundice and 145 had none. Compared with the non-jaundiced patients, the jaundiced patients had significantly longer operative time (p jaundice was the only independent predictor of postoperative complications. The jaundiced patients had lower survival rates than the non-jaundiced patients (p jaundiced patients. The survival rates of the jaundiced patients with preoperative biliary drainage (PBD) were similar to those of the jaundiced patients without PBD (p = 0.968). No significant differences in the rate of postoperative intra-abdominal abscesses were found between the jaundiced patients with and without PBD (n = 4, 21.1% vs. n = 5, 17.9%, p = 0.787). Preoperative jaundice indicates poor prognosis and high postoperative morbidity but is not a surgical contraindication. Gallbladder neck tumors significantly increase the surgical difficulty and reduce the opportunities for radical resection. Gallbladder neck tumors can independently predict poor outcome. PBD correlates with neither a low rate of postoperative intra-abdominal abscesses nor a high survival rate.

  12. Relative measurement of heavy elements in the bile gallbladder and gallstone

    International Nuclear Information System (INIS)

    Moosavi, K.; Vatankhah, S.; Salimi, J.

    2006-01-01

    Particle Induced X-Ray Emission is a suitable method for the analysis of biological samples in which heavy trace elements are contained in light matrix elements. It is very important to know which factors or probably elements act as initial seed and lead to growing the sands. The goal of this study was to compare the relative values of Fe/K, Cu/K and Zn/K for gallstones, gallbladder, and bile of a specific patient for studying the origination of forming the gallstones. Materials and Methods Human gallbladder, bile, and gallstone samples were obtained by surgical operation from 15 patients and are bombarded by 2.0 MeV energy proton beams produced by van de Graaff accelerator in vacuum. All .. the gallstones were chosen of pigment type of stones and, all the patients were adults. In contrast with conventional methods, the shell and center of the sands has been analyzed separately. The PIXE spectrum analysis was performed using the nonlinear least square fitting code AXIL and GUPIX. Results: The results of detected minor and trace elements shows that the precipitation of calcium salt in the bile lead to reduction of crystals' formation. Elemental comparison of pigment type of gallstone and bile shows that the concentration of calcium in the shell of the stones is four times more than that in the bile. Conclusion: Precipitation of the calcium from the saturated bile on the cholesterols as a seed of gallstones led to reduced sands formation. Analysis of the gallbladder of the same patients revealed no relation between elemental concentrations of bile and gallstones

  13. Fluidized bed boiler feed system

    Science.gov (United States)

    Jones, Brian C.

    1981-01-01

    A fluidized bed boiler feed system for the combustion of pulverized coal. Coal is first screened to separate large from small particles. Large particles of coal are fed directly to the top of the fluidized bed while fine particles are first mixed with recycled char, preheated, and then fed into the interior of the fluidized bed to promote char burnout and to avoid elutriation and carryover.

  14. Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients.

    Science.gov (United States)

    Pingleton, S K; Hadzima, S K

    1983-01-01

    The incidence of upper gastrointestinal (GI) bleeding in mechanically ventilated ICU patients receiving enteral alimentation was reviewed and compared to bleeding occurring in ventilated patients receiving prophylactic antacids or cimetidine. Of 250 patients admitted to our ICU during a 1-yr time period, 43 ventilated patients were studied. Patients in each group were comparable with respect to age, respiratory diagnosis, number of GI hemorrhage risk factors, and number of ventilator, ICU, and hospital days. Twenty-one patients had evidence of GI bleeding. Fourteen of 20 patients receiving antacids and 7 of 9 patients receiving cimetidine had evidence of GI bleeding. No bleeding occurred in 14 patients receiving enteral alimentation. Complications of enteral alimentation were few and none required discontinuation of enteral alimentation. Our preliminary data suggest the role of enteral alimentation in critically ill patients may include not only protection against malnutrition but also protection against GI bleeding.

  15. Timing of onset of gastrointestinal bleeding in the ICU

    DEFF Research Database (Denmark)

    Granholm, A; Lange, T; Anthon, C T

    2018-01-01

    BACKGROUND: Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm....... For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding...... will describe baseline characteristics and assess the time to onset of the first clinically important episode of GI bleeding accounting for survival status and allocation to SUP or placebo. In addition, we will describe differences in therapeutic and diagnostic procedures used in patients with clinically...

  16. Use of heparin in the investigation of obscure gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Mernagh, J.R.; O'Donovan, N.; Somers, S.; Gill, G.; Sridhar, S.

    2001-01-01

    To determine if the administration of heparin improves the predictive value of angiography in the investigation of obscure gastrointestinal (GI) bleeding. 18 patients with a history of chronic GI bleeding were investigated with angiography. For 6 patients, the cause of GI bleeding was established with angiography; the 12 patients who had negative results were given heparin for 24 h and were reassessed with angiography. After heparin administration, the source of GI bleeding was determined with angiography for 6 of the remaining 12 patients. Thus, heparinization increased diagnostic yield from 33% (6 of 18) to 67% (12 of 18). No significant complications, such as uncontrolled GI bleeding, occurred. Heparinization improves the diagnostic yield of angiography when obscure GI bleeding is being investigated. (author)

  17. Abnormal Uterine Bleeding: American College of Nurse-Midwives.

    Science.gov (United States)

    2016-07-01

    Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach. © 2016 by the American College of Nurse-Midwives.

  18. Cholecystectomy for uncomplicated gallbladder stones does not follow evidence-based recommendations

    DEFF Research Database (Denmark)

    Pedersen, Benjamin; Ellebæk, Mark B.; Dorfelt, Allan

    2017-01-01

    pain. The objective of the present study was to investigate whether the indication “socially debilitating pain” was reported in the patien’s file when he or she was referred to surgery. METHODS: Hospital files for all patients referred to surgical evaluation for uncomplicated gallbladder stones from......, the indication of socially debilitating pain was described in the patient files. CONCLUSIONS: Our results may represent overtreatment and/or incorrect selection of patients suitable for surgery. More and larger prospective cohort studies are warranted to elucidate the indications for cholecystectomy...

  19. Gallbladder ascariasis in Kosovo – focus on ultrasound and conservative therapy: a case series

    OpenAIRE

    Ismaili-Jaha, Vlora; Toro, Halim; Spahiu, Lidvana; Azemi, Mehmedali; Hoxha-Kamberi, Teuta; Avdiu, Muharrem; Spahiu-Konjusha, Shqipe; Jaha, Luan

    2018-01-01

    Background Ascaris lumbricoides is one of the most common intestinal infections in developing countries, including Kosovo. In contrast to migration to the bile duct, migration of the worm to the gallbladder, due to the narrow and tortuous nature of the cystic duct, is rare. When it does occur, it incites acalculous cholecystitis. Case presentations This case series describes a 16-month-old Albanian girl, a 22-month-old Albanian girl, a 4-year-old Albanian girl, and a 10-year-old Albanian boy....

  20. [Gallbladder contractility in children with functional abdominal pain or irritable bowel syndrome].

    Science.gov (United States)

    Iwańczak, Franciszek; Siedlecka-Dawidko, Jolanta; Iwanczak, Barbara

    2013-07-01

    III Rome Criteria of functional gastrointestinal disorders in children, distinguished the disturbances with abdominal pain, to which irritable bowel syndrome, functional abdominal pains, functional dyspepsia and abdominal migraine were included. THE AIM OF THE STUDY was sonographic assessment of the gallbladder and its contractility in functional abdominal pain and irritable bowel syndrome in children. The study comprised 96 children aged 6 to 18 years, 59 girls and 37 boys. Depending on diagnosis, the children were divided into three groups. 38 children with functional abdominal pain constituted the first group, 26 children with irritable bowel syndrome were included to the second group, the third group consisted of 32 healthy children (control group). Diagnosis of functional abdominal pain and irritable bowel syndrome was made based on the III Rome Criteria. In irritable bowel syndrome both forms with diarrhea (13) and with constipation (13) were observed. Anatomy and contractility of the gallbladder were assessed by ultrasound examination. The presence of septum, wall thickness, thick bile, vesicle volume in fasting state and 30th and 60th minute after test meal were taken into consideration. Test meal comprised about 15% of caloric requirement of moderate metabolism. Children with bile stones and organic diseases were excluded from the study. Thickened vesicle wall and thick bile were present more frequently in children with irritable bowel syndrome and functional abdominal pain than in control group (p functional abdominal pain than in irritable bowel syndrome and control group (p = 0.003, p = 0.05). Vesicle contractility after test meal was greatest in children with functional abdominal pain. Evaluation of diminished (smaller than 30%) and enlarged (greater then 80%) gallbladder contractility at 30th and 60th minute after test meal demonstrated disturbances of contractility in children with irritable bowel syndrome and functional abdominal pain. In children