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Sample records for cholelithiasis

  1. Situs inversus with cholelithiasis.

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    Pathak K; Khanna R; Khanna N

    1995-01-01

    Situs inversus totalis is a form of heterotaxia which is usually detected accidentally while investigating for any associated condition. If undetected, this condition can create a diagnostic puzzle. We report one such case in which situs inversus was associated with cholelithiasis.

  2. Situs inversus with cholelithiasis.

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    Pathak K

    1995-04-01

    Full Text Available Situs inversus totalis is a form of heterotaxia which is usually detected accidentally while investigating for any associated condition. If undetected, this condition can create a diagnostic puzzle. We report one such case in which situs inversus was associated with cholelithiasis.

  3. Changes of Intestinal Permeability in Cholelithiasis Patients

    Institute of Scientific and Technical Information of China (English)

    Shao-long Sun; Shuo-dong Wu; Dong-xu Cui; Bao-lin Liu; Xian-wei Dai

    2009-01-01

    @@ In normal condition,intestine mucosa possesses barrier function.When the barrier function of intestine mucosa was damaged,intestinal bacteria,endotoxin,or other substances would enter blood.It is generally accepted that biliary bacteria origins from the intestine either via duodenal papilla or intestinal mucosa.In this study,we aimed to investigate the intestinal permeability changes of cholelithiasis patients to elucidate the possible pathogenesis of cholelithiasis.

  4. Cholelithiasis associated with haemolytic-uraemic syndrome

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    Deepak Kejariwal

    2006-01-01

    Cholelithiasis occurs infrequently in the paediatric age group. Hereditary spherocytosis, sickle cell anaemia and thalassemia are the haemolytic disorders most commonly associated with development of gall stones in paediatric age group. The question is whether an isolated episode of haemolysis can cause gallstones.

  5. STUDYING OF FUNCTIONAL CONDITION OF THE SMALL INTESTINE IN CHOLELITHIASIS

    OpenAIRE

    Ya. M. Vakhrushev; A. P. Lukashevich; A. Yu. Gorbunov

    2015-01-01

    Aim. Complex research of the functional condition of the small intestine in different stages of cholelithiasis.Materials and methods. 47 patients with different stages of cholelithiasis were examined. There were 29 patients with the first (prestone) stage and 18 — with the second (stone) stage of cholelithiasis. In an assessment of the functional condition of the small intestine were used clinical data and results of the load tests by sugars. Cavitary digestion was studied by load test with p...

  6. Polymorphism in transmembrane region of MTCA gene and cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    Shou-Chuan Shih; Yann-Jinn Lee; Hsin-Fu Liu; Ching-Wen Dang; Shih-Chuan Chang; Shee-Chan Lin; Chin-Roa Kao

    2003-01-01

    AIM: To study the significance of polymorphism of MHC class I chain-related gene A (MICA) gene in patients with cholelithiasis.METHODS: Subjects included 170 unrelated adults (83males) with cholelithiasis and 245 randomly selected unrelated adults (130 males) as controls. DNA was extracted from peripheral leukocytes and analyzed for polymorphism of 5 alleles (A4, A5, A5.1, A6 and A9) of the MICA gene.RESULTS: There was no significant difference in phenotype,allele, and genotype frequencies of any of the 5 alleles between cholelithiasis patients and controls.CONCLUSION: This study demonstrates that MICA allelesstudied bear no relation to cholelithiasis.

  7. STUDYING OF FUNCTIONAL CONDITION OF THE SMALL INTESTINE IN CHOLELITHIASIS

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    Ya. M. Vakhrushev

    2015-01-01

    Full Text Available Aim. Complex research of the functional condition of the small intestine in different stages of cholelithiasis.Materials and methods. 47 patients with different stages of cholelithiasis were examined. There were 29 patients with the first (prestone stage and 18 — with the second (stone stage of cholelithiasis. In an assessment of the functional condition of the small intestine were used clinical data and results of the load tests by sugars. Cavitary digestion was studied by load test with polysaccharide (soluble starch, membrane digestion — with disaccharide (sucrose, absorption — with monosaccharide (glucose. Glucose level in blood was determined on an empty stomach, then after oral reception of 50g of glucose, sucrose or starch in 30, 60 and 120 minutes.Results. Researchers showed that in the most of patients with cholelithiasis there were disturbances in clinical and functional condition of the small intestine. In an assessment of the cavitary digestion the level of glycemia was authentically lowered by 43% in prestone stage and by 66% in stone stage of cholelithiasis in comparison with control. In an assessment of membrane digestion in patients with the stone stage of cholelithiasis the level of glycemia was lowered in comparison with group of control and with the prestone stage by 30% and 19% respectively.Conclusion. In prestone stage of cholelithiasis there were decrease of the cavitary digestion primary, and in stone stage of cholelithiasis — all stages of hydrolysis-resorptive process in the small intestine were disturbed.

  8. Cholelithiasis after treatment for childhood cancer

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    Mahmoud, H.; Schell, M.; Pui, C.H. (St. Jude Children' s Research Hospital, Memphis, TN (USA))

    1991-03-01

    The authors evaluated the risk of development of cholelithiasis in 6050 patients treated at a single hospital for various childhood cancers with different therapeutic modalities, including chemotherapy, surgery, radiation therapy, and bone marrow transplantation, from 1963 to 1989. Patients with underlying chronic hemolytic anemia or preexisting gallstones were excluded. Nine female and seven male patients with a median age of 12.4 years (range, 1.2 to 22.8 years) at diagnosis of primary cancer had gallstones develop 3 months to 17.3 years (median, 3.1 years) after therapy was initiated. Cumulative risks of 0.42% at 10 years and 1.03% at 18 years after diagnosis substantially exceed those reported for the general population of this age group. Treatment-related factors significantly associated with an increased risk of cholelithiasis were ileal conduit, parenteral nutrition, abdominal surgery, and abdominal radiation therapy (relative risks and 95% confidence intervals = 61.6 (27.9-135.9), 23.0 (9.8-54.1), 15.1 (7.1-32.2), and 7.4 (3.2-17.0), respectively). There was no correlation with the type of cancer, nor was the frequency of conventional predisposing features (e.g., family history, obesity, use of oral contraceptives, and pregnancy) any higher among the affected patients in this study than in the general population. Patients with cancer who have risk factors identified here should be monitored for the development of gallstones.

  9. Cholelithiasis after treatment for childhood cancer

    International Nuclear Information System (INIS)

    The authors evaluated the risk of development of cholelithiasis in 6050 patients treated at a single hospital for various childhood cancers with different therapeutic modalities, including chemotherapy, surgery, radiation therapy, and bone marrow transplantation, from 1963 to 1989. Patients with underlying chronic hemolytic anemia or preexisting gallstones were excluded. Nine female and seven male patients with a median age of 12.4 years (range, 1.2 to 22.8 years) at diagnosis of primary cancer had gallstones develop 3 months to 17.3 years (median, 3.1 years) after therapy was initiated. Cumulative risks of 0.42% at 10 years and 1.03% at 18 years after diagnosis substantially exceed those reported for the general population of this age group. Treatment-related factors significantly associated with an increased risk of cholelithiasis were ileal conduit, parenteral nutrition, abdominal surgery, and abdominal radiation therapy (relative risks and 95% confidence intervals = 61.6 [27.9-135.9], 23.0 [9.8-54.1], 15.1 [7.1-32.2], and 7.4 [3.2-17.0], respectively). There was no correlation with the type of cancer, nor was the frequency of conventional predisposing features (e.g., family history, obesity, use of oral contraceptives, and pregnancy) any higher among the affected patients in this study than in the general population. Patients with cancer who have risk factors identified here should be monitored for the development of gallstones

  10. Neonatal Bartter syndrome with cholelithiasis and hydrocephalus: Rare association.

    Science.gov (United States)

    Özdemir, Özmert Ma; Çıralı, Ceren; Yılmaz Ağladıoğlu, Sebahat; Evrengül, Havva; Tepeli, Emre; Ergin, Hacer

    2016-09-01

    Neonatal Bartter syndrome (NBS) is a rare autosomal recessive renal tubular disorder. This disease is characterized by hypokalemia, hypochloremia, and metabolic alkalosis that is often associated with failure to thrive and recurrent episodes of dehydration. The combination of BS and cholelithiasis in an infant is very rare. Herein, we report a premature male infant with NBS who developed cholelithiasis and hydrocephalus on clinical follow up. We recommend that periodic routine hepatobiliary ultrasonograpic screening for cholelithiasis should be performed in patients with NBS. PMID:27682612

  11. The Association of Cholelithiasis and Colorectal Cancer

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    C Sărăcuț

    2014-02-01

    Full Text Available Background: In the literature there are a number of studies that suggest a possible correlation between cholelithiasis/cholecystectomy and colorectal cancer. The exposure of the colon mucosa to the action of bile acids that potentially have a carcinogenic effect due to the change in anatomy after cholecystectomy, seems to be the explanation of this association. The purpose of this paper was to search for such a correlation in our study group. Methods: We performed a retrospective cross-sectional study, analyzing the patients admitted to the First Surgical Clinic of the County Emergency Clinical Hospital Tîrgu Mureș, between January 1st, 2005 - December 31st, 2010. Analyzing the medical records, operation protocols and histopathological results, we paid attention to demographics, location of neoplasia, the time elapsed since the cholecystectomy to the discovery of neoplasia, histological types, trying to perform correlations between these parameters and the lithiasic factor. Results: Out of the 534 patients admitted and operated with the diagnosis of colorectal cancer, 15.6% (n = 83 showed a history of gallbladder stone affection. Most patients came from urban areas, the average age was 67.2 (range 39-88 years, females were more affected. The most common locations were: the sigmoid colon (26.5%, rectum (36.3% and the most common histological form was moderately differentiated adenocarcinoma. Conclusions: Similar to other studies, our work suggests a slight increase in the incidence of colorectal cancer in patients that underwent a cholecystectomy, without drawing a firm conclusion. We deem it necessary to see if diet changes of the Romanian population affect this relationship

  12. Cholelithiasis in patients on the kidney transplant waiting list

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    André Thiago Scandiuzzi Brito

    2010-01-01

    Full Text Available OBJECTIVES: To evaluate the prevalence of cholecystopathy in chronic renal patients awaiting kidney transplants. INTRODUCTION: The prevalence and management of cholelithiasis in renal transplant patients is not well established. METHODS: A total of 342 chronic renal failure patients on the waiting list for a kidney transplant were studied. Patients were evaluated for the presence of cholelithiasis and related symptoms, previous cholecystectomies and other abdominal surgeries, time on dialysis, and general data (gender, age, number of pregnancies, and body mass index. RESULTS: Cholelithiasis was found in 41 out of 342 patients (12%. Twelve of these patients, all symptomatic, had previously undergone cholecystectomies. Five out of 29 patients who had not undergone surgery were symptomatic. Overall, 17 patients (41.5% were symptomatic. Their mean age was 54 (range 32-74 years old; 61% were female, and their mean body mass index was 25.4. Nineteen (76% out of 25 women had previously been pregnant, with an average of 3.6 pregnancies per woman. CONCLUSIONS: The frequency of cholelithiasis was similar to that reported in the literature for the general population. However, the high frequency of symptomatic patients points toward an indication of routine pre-transplant cholecystectomy to avoid serious post-transplant complications.

  13. Recurrent intussusception, coeliac disease and cholelithiasis: A unique combination

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    Sinha C

    2007-01-01

    Full Text Available Authors report an 11-month-old female child, who presented with recurrent episodes of colicky abdominal pain and diarrhea. An abdominal ultrasound revealed small bowel intussusception. She was also noted to have a thick walled gall bladder and a solitary gallstone. Further investigations confirmed the diagnosis of coeliac disease. The combination of small bowel intussusception, coeliac disease and cholelithiasis is unique and has not been reported in the literature.

  14. Sonographically determined clues to the symptomatic or silent cholelithiasis

    International Nuclear Information System (INIS)

    To determine an association between sonographically determined contractility with the symptomatic or silent nature of gallstone. Adult gallstone patients without (group I) and with biliary symptoms (group II) were compared with age and gender-matched controls. Demographic data, body mass index, risk factors, size, number and mobility of gallstone, gallbladder wall thickness (GBWT), volume and Ejection Fraction (EF) were determined on ultrasound before and after a standardized fatty meal (BFM and AFM). Demographic data, risk factors and gallstone characteristics were analyzed by Pearson Chi-square test and the gallbladder characteristics were analyzed by One-way ANOVA and Post Hoc tests by multiple comparisons on SPSS 11 with significance p=0.05. The gallbladder contractility as measured by changes in wall thickness and volume changes BFM and AFM, and ejection fraction was similar in controls and asymptomatic cholelithiasis groups and significantly reduced in symptomatic patients (p<.001). Multiparity (p=0.002), female gender (p=0.018), age less than 50 years (0.05), impacted calculi (p=0.001), multiple calculi (<.001) and calculi 5 mm (p<0.001) were associated with pain. A sluggishly emptying gallbladder was more significantly associated with symptomatic cholelithiasis compared to controls and asymptomatic cholelithiasis state in this series. Consideration of age, gender, impaction of calculi, number and size of calculi is important in causing symptom state and management options. (author)

  15. Prevalence of pancreaticobiliary reflux in symptomatic cholelithiasis and its significance

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    TP Bohara

    2014-01-01

    Full Text Available Aims: Pancreaticobiliary reflux (PBR is reflux of pancreatic enzymes into the biliary tree which occurs as a result of an anamoly of pancreaticobiliary junction (PBJ or functionally impaired sphincter. PBR is associated with changes in biliary epithelium and is known to cause benign and malignant biliary pathology. Various authors have reported prevalence of PBR in patients with normal PBJ ranging from 20 % to 83.5 %. With aim to detect the prevalence of PBR in patients with symptomatic cholelithiasis in Nepalese population we conducted this study. Materials and methods: Thirty patients undergoing elective laparoscopic cholecystectomy (LC for symptomatic cholelithiasis were included in the study. History, physical findings and relevant investigations including liver function test, serum amylase and abdominal ultrasound were recorded. Bile sample for amylase was taken from gall bladder during LC percuatneously before manipulation of calot’s triangle and common bile duct. Bile amylase level above serum amylase level was considered positive for PBR. Results: Mean age of the patient was 37.27 (± 14.41 years. Out of 30, 6 (20 % patients were male and 24 (80 % were female. Mean BMI was 21.58 (± 3.2. PBR reflux was present in 66.7 % of patients out of which 2 were male and 18 were female that was not statistically significant (p = 1.41 when compared with patients without PBR. Conclusion: PBR occurs in patient with cholelithiasis and has role in pathogenesis of gallstones disease and gall bladder carcinoma. Long term surveillance would be required to ascertain the significance of detection of PBR after LC. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9666

  16. Microbiology of gallbladder bile in uncomplicated symptomatic cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    Vasitha Abeysuriya; Kemal Ismil Deen; Tamara Wijesuriya; Sujatha Senadera Salgado

    2008-01-01

    BACKGROUND: Few studies have assessed microlfora and their antibiotic sensitivity in normal bile and lithogenic bile with different types of gallstones. METHODS: We performed a case control study of 70 bile samples (35 cholesterol and 35 pigment stones from 51 females and 19 males, aged 21-72 years with a median age of 37 years) from patients who underwent laparoscopic cholecystectomy for uncomplicated cholelithiasis, and 20 controls (14 females and 6 males, aged 33-70 years with a median age of 38 years) who underwent laparotomy and had no gallbladder stone shown by ultrasound scan. The bile samples were aerobically cultured to assess microlfora and their antibiotic susceptibility. The procedures were undertaken under sterile conditions. RESULTS: Thirty-eight (54%) of the 70 patients with gallstones had bacterial isolates. Nine isolates (26%) were from cholesterol stone-containing bile and 29 isolates (82%) from pigment stone-containing bile (P=0.01, t test). Twenty-eight of these 38 (74%) bile samples were shown positive only after enrichment in brain heart infusion medium (BHI) (P=0.02, t test). The overall bacterial isolates from bile samples revealed E. coli predominantly, followed by P. aeruginosa, Enterococcus spp., Klebsiella spp. and S. epidermidis. There were no bacterial isolates in the bile of controls after either direct inoculation or enrichment in BHI. CONCLUSIONS: Bacterial isolates were found in pigment stone-containing bile. Non-lithogenic bile revealed no bacteria, showing an association between gallstone formation and the presence of bacteria in bile. Antibiotic sensitivity patterns of isolated organisms were similar irrespective of the type of stone.

  17. Intraductal and invasive adenocarcinoma of duct of Luschka, mimicking chronic cholecystitis and cholelithiasis

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    Cheema Muhammad

    2009-01-01

    Full Text Available Abstract Background Intraductal and invasive adenocarcinoma of duct of Luschka is rare. To the best of our knowledge, this is the second case report of intraductal and invasive carcinoma arising from ducts of Luschka. Case presentation Patient presented to hospital with signs and symptoms of chronic cholecystitis and cholelithiasis. Ultrasound examination revealed thickening of gallbladder wall with abnormal septation around liver bed. Patient underwent laparoscopic cholecystectomy and resection of the adjacent liver bed. Histologic examination confirmed an intraductal and invasive adenocarcinoma arising from Luschka ducts. Conclusion Adenocarcinoma of ducts of Luschka should be considered among differential diagnoses for the patients with typical clinical presentations of chronic cholecystitis and cholelithiasis.

  18. Internal biliary fistula due to cholelithiasis: A single-centre experience

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    Arife Polat Duzgun; Mehmet Mahir Ozmen; Mehmet Vasfi Ozer; Faruk Coskun

    2007-01-01

    AIM: To discuss about the perioperative problems encountered in patients with internal biliary fistula (IBF)caused by cholelithiasis.METHODS: In our hospital, 4130 cholecystectomies were carried out for symptomatic cholelithiasis from January 2000 to March 2004 and only 12 patients were diagnosed with IBF. The perioperative data of these 12IBF patients were analyzed retrospectively.RESULTS: The incidence of IBF due to cholelithiasis was nearly 0.3%. The mean age was 57 years.Most of the patients presented with non-specific complaints. Only two patients were considered to have IBF when gallstone ileus was observed during the investigations. Nine patients underwent emergency laparotomy with a pre-operative diagnosis of acute abdomen. In the remaining three patients, elective laparoscopic cholecystectomy was converted to open surgery after identification of IBF. Ten patients had cholecystoduodenal fistula and two patients had cholecystocholedochal fistula. The mean hospital stay was 13 d. Two wound infections, three bile leakages and three mortalities were observed.CONCLUSION: Cholecystectomy has to be performed in early stage in the patients who were diagnosed as cholelithiasis to prevent the complications like IBF which is seen rarely. Suspicion of IBF should be kept in mind, especially in the case of difficult dissection during cholecystectomy and attention should be paid in order to prevent iatrogenic injuries.

  19. 胆石病动物模型研究%Research on the animal model of cholelithiasis

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    蔡端

    2012-01-01

      An animal model of cholelithiasis is necessary for the research on gallstone formation and treatment of cholelithiasis. Cholelithiasis can be induced in many vertebrate animals and different strains of animals have different capacity to form cholelithiasis. An animal model of cholelithiasis can be established by many procedures, such as biliary obstruction and infection, foreign body core implantation, drug injection, autonomic nerve stimulation, lithogenic diet and so on. Low-protein diet feeding is used mostly to establish an animal model of pigment stone. Recently, more attention has been paid to the directional control in the formation of animal model of cholelithiasis in spite of less progress. The animal model of cholelithiasis does have a role in the study of gallstone formation, pathogenesis and clinical treatment of cholelithiasis.%  研究胆石成因和胆石病的防治方法常需制作胆石病动物模型。许多脊椎动物可产生胆石病,但不同种系的动物致石能力不同。运用胆道梗阻感染法、异物核心埋藏法、药物注射法、植物神经刺激法和喂饲法可成功地制作胆石病的动物模型,其中低蛋白饮食喂饲法是诱发胆色素结石的常用方法。近年来已对胆石模型的定向控制技术引起重视,但进展尚少。胆石模型在研究胆石成因、病理和临床治疗上有一定价值。

  20. Cholelithiasis and Nephrolithiasis in HIV-Positive Patients in the Era of Combination Antiretroviral Therapy.

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    Kuan-Yin Lin

    Full Text Available This study aimed to describe the epidemiology and risk factors of cholelithiasis and nephrolithiasis among HIV-positive patients in the era of combination antiretroviral therapy.We retrospectively reviewed the medical records of HIV-positive patients who underwent routine abdominal sonography for chronic viral hepatitis, fatty liver, or elevated aminotransferases between January 2004 and January 2015. Therapeutic drug monitoring of plasma concentrations of atazanavir was performed and genetic polymorphisms, including UDP-glucuronosyltransferase (UGT 1A1*28 and multidrug resistance gene 1 (MDR1 G2677T/A, were determined in a subgroup of patients who received ritonavir-boosted or unboosted atazanavir-containing combination antiretroviral therapy. Information on demographics, clinical characteristics, and laboratory testing were collected and analyzed.During the 11-year study period, 910 patients who underwent routine abdominal sonography were included for analysis. The patients were mostly male (96.9% with a mean age of 42.2 years and mean body-mass index of 22.9 kg/m2 and 85.8% being on antiretroviral therapy. The anchor antiretroviral agents included non-nucleoside reverse-transcriptase inhibitors (49.3%, unboosted atazanavir (34.4%, ritonavir-boosted lopinavir (20.4%, and ritonavir-boosted atazanavir (5.5%. The overall prevalence of cholelithiasis and nephrolithiasis was 12.5% and 8.2%, respectively. Among 680 antiretroviral-experienced patients with both baseline and follow-up sonography, the crude incidence of cholelithiasis and nephrolithiasis was 4.3% and 3.7%, respectively. In multivariate analysis, the independent factors associated with incident cholelithiasis were exposure to ritonavir-boosted atazanavir for >2 years (adjusted odds ratio [AOR], 6.29; 95% confidence interval [CI], 1.12-35.16 and older age (AOR, 1.04; 95% CI, 1.00-1.09. The positive association between duration of exposure to ritonavir-boosted atazanavir and incident

  1. Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

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    Chen-Wang Chang; Wen-Hsiung Chang; Ching-Chung Lin; Cheng-Hsin Chu; Tsang-En Wang; Shou-Chuan Shih

    2009-01-01

    AIM: To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis. METHODS: The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct (CBD) stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed. RESULTS: In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 (51.0%) had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 (41.2%) had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitis in the group undergoing urgent surgery (total 74 patients), the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin (1.14 ± 1.27 mg/dL vs 2.66 ± 1.97 mg/dL, P < 0.001) and white cell count (9480 ± 4681/μL vs 12840 ± 5273/μL, P = 0.018). CONCLUSION: Acute hepatocel lular injury in cholelithiasis and cholecystitis without choledocholithiasis is mi ld and t ransient . Hyperbi l irubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.

  2. Analysis Algerian's Gallstones with Infrared Spectrum and Methods of Prevention and Treatment for Cholelithiasis in Algeria

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    To analyze the type of Algerian's gallstones and put forward relative measures of prevention and treatment, The NICOLET 170SX FT-IR spectrometer was used to measure the infra-red spectrum and analyze the feature of spectrum of Algerian's gallstones. The results shown that Algerian have cholesterol gallstones. Reasons to form Algerian's multiple cholesterol gallstones were investigated. We have put forward five suggestions to prevent and treat cholelithiasis.

  3. Validating the 5Fs mnemonic for cholelithiasis: time to include family history.

    LENUS (Irish Health Repository)

    Bass, Gary

    2013-11-01

    The time-honoured mnemonic of \\'5Fs\\' is a reminder to students that patients with upper abdominal pain and who conform to a profile of \\'fair, fat, female, fertile and forty\\' are likely to have cholelithiasis. We feel, however, that a most important \\'F\\'-that for \\'family history\\'-is overlooked and should be introduced to enhance the value of a useful aide memoire.

  4. Management of cholelithiasis in Italian children:A national multicenter study

    Institute of Scientific and Technical Information of China (English)

    Claudia Della Carte; Diego Falchetti; Gabriella Nebbia; Marisa Calacoci; Maria Pastore; Ruggiero Francavilla; Matilde Marcellini; Pietro Vajro; Raffaele Iorio

    2008-01-01

    AIM:To evaluate the management of Italian children with cholelithiasis observed at Pediatric and Surgical Departments linked to Italian Society of Pediatric Gastroenterology Hepatology and Nutrition.METHODS:One-hundred-eighty children (90 males,median age at diagnosis 7.3 years; range,0-18 years)with echographic evidence of cholelithiasis were enrolled in the study; the data were collected by an anonymous questionnaire sent to participating centers.RESULTS:One hundred seventeen patients were treated with ursodeoxycholic acid; in 8 children dissolution of gallstones was observed,but the cholelithiasis recurred in 3 of them.Sixty-five percent of symptomatic children treated became asymptomatic.Sixty-four patients were treated with cholecystectomy and in only 2 cases a postoperative complication was reported.Thirty-four children received no treatment and were followed with clinical and echographic controls; in no case the development of complications was reported.CONCLUSION:The therapeutic strategies were extremely heterogeneous.Ursodeoxycholic acid was ineffective in dissolution of gallstones but it had a positive effect on the symptoms.Laparoscopic cholecystectomy was confirmed to be an efficacy and safe treatment for pediatric gallstones.

  5. Polarization-correlation diagnostics and differentiation of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2

    Science.gov (United States)

    Marchuk, Yu F.; Fediv, O. I.; Ivashchuk, I. O.; Andriychuk, D. R.

    2012-01-01

    The principles of optical modeling of human bile polycrystalline structure are described. The main types of polycrystalline structures are detailed. It has been proposed and founded the scenarios of formation of bile microscopic images polarization structure in coherent radiation. The results of investigating the interrelation between statistical moments of the 1st-4th order are presented that characterize the coordinate distributions of intensity of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  6. LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS DUE TO CHOLELITHIASIS IN GERIATRIC PATIENTS

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    D. Vasincu

    2007-07-01

    Full Text Available This study is focused on the results of laparoscopic cholecystectomy for acute cholecystitis due to cholelithiasis in geriatric patients. The records of all patients from „St. Joan” Emergency Hospital Iaşi from January 2001 to December 2005 and from General Surgery Clinic in S. Orsola - M. Malpighi Hospital Bologna – Italia from January 2003 to December 2004 who undergo cholecystectomy were reviewed. The entire series consists of 557 patients. This report identifies 161 patients who were aged 65 years or older at the time of laparoscopic cholecystectomy. The results are reported in three progressive age groups: 65 to 74, 75 to 84, and over 85 years. At 101 geriatric patients was practiced laparoscopic cholecystectomy. Gallstones were present in all patients. In this series of laparoscopic cholecystectomy, 32.6% had an emergency procedure and the remainder had an elective or semielective procedure. The conversion rate was 5.6%. 74.2% of the patients were discharged home after 3-5 days of postoperative observation. Laparoscopic cholecystectomy is a safe procedure and should be recommended for all geriatric patients who have acute cholecystitis due to cholelithiasis before the development of complications.

  7. The effect of UGT1A1 promoter polymorphism in the development of hyperbilirubinemia and cholelithiasis in hemoglobinopathy patients.

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    Suad AlFadhli

    Full Text Available Present study was aimed to explore the effect of (TAn UGT1A1 gene promoter polymorphism on bilirubin metabolism, bilirubinaemia, predisposition to cholelithiasis and subsequent cholecystectomy, in Sickle-Cell Anemia (SCA and beta-Thalasemia major (bTH in Kuwaiti subjects compared to other population. This polymorphism was analyzed and correlated to total bilirubin and cholelithiasis in 270 age, gender, ethnically matched subjects (92 bTH, 116 SCA and 62 Controls using PCR, dHPLC, fragment analysis and direct sequencing. Four genotypes of UGT1A1 were detected in this study (TA6/6, TA6/7, TA6/8 and TA7/7. (TA6/8 was found only in four individuals; hence it was not included in the analysis. There was a statistically significant association of genotypes with serum total bilirubin levels in both bTH and SCA groups (p<0.001. Subjects with (TA7/7 had the highest total serum bilirubin level (178.7 ± 3.5 µmole/l. A significant association was observed between allele (TA7 and cholelithiasis development (p = 0.0001. The 40%, 67.5% and 100% of SCA with (TA6/6, (TA6/7 and (TA7/7 respectively developed cholelithiasis and were subsequently cholecystectomized. Our results confirm UGT1A1 (TA7 allele as one of the factors accounting for the hyperbilirubinemia and cholelithiasis observed in SCA and bTH.

  8. INTRAHEPATIC CHOLELITHIASIS

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    M. MEHDI HAFIZI

    1987-05-01

    Full Text Available A case o f Intrahepatic stone and its t r eat ment i s present e d . The t ype s o f i ntrahepatic s tones , t h e etiological f act o r , t he ways of di agno s is and t reatment a re b eing discussed. The disease is common in far Eastern c ountri es a nd Asian Are a, with c lonorchi s s i nens is inf estation, but s peci ally in Iran when the s tones i s a lone in Intrahepatic ducts without extrahepatic duc t stone,as this case repor t , i s very rare.

  9. Colelitíase e cirrose hepática Cholelithiasis and hepatic cirrhosis

    OpenAIRE

    Paulo Roberto Ott Fontes; Mauro Nectoux; Rene Jacobsen Eilers

    1998-01-01

    Considerando que são duas doenças freqüentes na população, a associação entre cirrose hepática e colelitíase também é um achado comum. É importante o conhecimento desta situação porque a evolução clínica da cirrose pode ser complicada pela presença de colelitíase e, ao contrário, uma colelitíase sintomática pode ser de difícil tratamento nos pacientes cirróticos. Os autores fazem uma revisão da literatura enfocando os aspectos clínicos e terapêuticos desta associação.The cholelithiasis and he...

  10. Cholelithiasis, cholecystectomy and risk of hepatocellular carcinoma: A meta-analysis

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    Lingyun Guo

    2014-01-01

    Full Text Available Available evidence of the relationship between cholelithiasis, cholecystectomy, and risk of liver cancer and hence we conducted a meta-analysis to investigate the relationships. PubMed, EMBASE, and ISI Web of Knowledge were searched to identify all published cohort studies and case-control studies that evaluated the relationships of cholelithiasis, cholecystectomy and risk of liver cancer and single-cohort studies which evaluated the incidence of liver cancer among patients who understood cholecystectomy (up to February 2013. Comprehensive meta-analysis software was used for meta-analysis. A total of 11 observational studies (six cohort studies and five case-control studies were included in this meta-analysis. The result from meta-analysis showed that cholecystectomy (risk ratio [RR]: 1.59, 95% confidence interval [CI]: 1.01-2.51, I2 = 72% and cholecystolithiasis (RR: 5.40, 95% CI: 3.69-7.89, I2 = 93% was associated with more liver cancer, especially for intrahepatic cholangiocarcinoma (ICC (cholecystectomy: RR: 3.51, 95% CI: 1.84-6.71, I2 = 26%; cholecystolithiasis: RR: 11.06, 95% CI: 6.99-17.52, I2 = 0%. The pooled standardized incidence rates (SIR of liver cancer in patients who understood cholecystectomy showed cholecystectomy might increase the incidence of liver cancer (SIR: 1.57, 95% CI: 1.13-2.20, I2 = 15%. Based on the results of the meta-analysis, cholecystectomy and cholecystolithiasis seemed to be involved in the development of liver cancer, especially for ICC. However, most available studies were case-control studies and short-term cohort studies, so the future studies should more long-term cohort studies should be well-conducted to evaluate the long-term relationship.

  11. Short and Long Term Outcomes Associated with Fetal Cholelithiasis: A Report of Two Cases with Antenatal Diagnosis and Postnatal Follow-Up

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    Juan Troyano-Luque

    2014-01-01

    Full Text Available The aims of this study were to present and discuss ultrasound findings of prenatal fetal cholelithiasis in two cases with different etiology and evolution. Case 1: a pregnant woman from sub-Saharan Africa, suffering from Lyme disease, was treated with ceftriaxone sodium. Six weeks later, biliary sludge associated with polyhydramnios was detected in the fetus and the fetal growth percentile was 14. Emergency caesarean was performed at 36 weeks of gestation due to fetal distress. Biliary sludge persists in the two-and-a-half-year-old child. Case 2: the fetus of a Caucasian woman with normal pregnancy showed multiple cholelithiasis associated with polyhydramnios at 31 weeks of gestation. At 39 weeks and 4 days, cesarean section was performed due to lack of dilation. The biliary disease resolved spontaneously at seven months of age, with no associated abnormalities. In conclusion, prenatal diagnosis of cholelithiasis is straightforward, but prognosis cannot be defined yet. Serious complications do not arise in 70% of cases, but severe diseases may ensue in 20%. Persistence of cholelithiasis after one year of age results in cholelithiasis in childhood and beyond. Biliary sludge is associated with worse prognosis than cholelithiasis when it appears before 28 weeks of gestation.

  12. Polarization-phase diagnostics of latent course of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2

    Science.gov (United States)

    Fediv, O. I.; Ivashchuk, O. I.; Marchuk, Yu. F.; Andriychuk, D. R.

    2012-01-01

    The principles of optical model of human bile polycrystalline structure are described. The three optical levels - isotropic, liquid-crystal and solid-crystal have been proposed. It has been introduced and proposed the scenarios of phase distribution formation in the boundary field of laser radiation, transformed by bile layers. The experimental scheme of direct measurement of coordinate phase distributions has been presented. The results of investigating the interrelation between the values of correlation and fractal parameters are presented. They characterize the coordinate distributions of phase shifts between the orthogonal components of the amplitude in the points of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  13. Assessment of characteristics of patients with cholelithiasis from economically deprived rural Karachi, Pakistan

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    Naeem Muhammad

    2012-06-01

    Full Text Available Abstract Background Gallstones have been regarded as one of the most expensive diseases in Gastroenterology, posing a great economic burden on developing nations. The majority of Pakistani people live in rural areas where healthcare facilities are not available or are very primitive. We aim to assess the characteristics among cholelithiasis patients from rural Karachi so that a prevention campaign can be launched in rural underprivileged settings to reduce the economic burden of this preventable disease. Method A total of 410 patients were included in the study after giving verbal consent as well as written consent. Variables such as age, weight, height, body mass index (BMI, blood pressure, waist circumference, number of children, monthly family income, number of siblings, and number of family members, were considered in this questionnaire. All data was analysed by SPSS ver. 16.0. Mean and standard deviation (SD were calculated for continuous variables. Frequency and percentages were calculated for categorical variables. Results Nearly 85.4% of the participants were female. The mean ± S.D. for age was 43.8 ± 9.59. Nearly 61% of the patients were illiterate. All of our patients were from low socioeconomic status and their mean salary ± S.D. was 6915 ± 1992 PKR (1 US $ = 90.37PKR. 75% of them were smokers with mean consumption ± S.D. of 7.5 ± 10 cigarettes per day. Fibre in diet was not used by 83.65% of patients. 40.2% were living in combined families. 61% were living in purchased homes. A positive history of diabetes mellitus was given by 45.1%, family history of cholelithiasis by 61% and history of hypertension by 31.7% of subjects. Soft drink consumption was given by 45.1% of patients; while only 8.5% used snacked daily. Tea was consumed by 95.1% of the subjects. Daily physical activity for 30 minutes was reported by only 13.4% of participants. Conclusion In conclusion, rural dwellers from low socioeconomic

  14. Complicated Cholelithiasis: An Unusual Combination of Acute Pancreatitis and Bouveret Syndrome

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    Ioannis Baloyiannis

    2012-07-01

    Full Text Available Bouveret syndrome is a rare form of gallstone ileus. The purpose of the present study was to present the unusual case of a female patient with complicated cholelithiasis manifested as a combination of acute pancreatitis and concomitant Bouveret syndrome. A 61-year-old female patient was admitted to the emergency department complaining of mid-epigastric and right upper quadrant abdominal pain radiating band-like in the thoracic region of the back as well as repeated episodes of vomiting over the last 24 h. The initial correct diagnosis of pancreatitis was subsequently combined with the diagnosis of Bouveret syndrome as a computed tomography scan revealed the presence of a gallstone within the duodenum causing luminal obstruction. After failure of endoscopic gallstone removal, a surgical approach was undertaken where gallstone removal was followed by cholecystectomy and restoration of the anatomy by eliminating the fistula. The concomitant pancreatitis complicated the postoperative period and prolonged the length of hospital stay. However, the patient was discharge on the 45th postoperative day. Attempts for endoscopic removal of the impacted stone should be the initial therapeutic step. Surgery should be reserved for cases refractory to endoscopic intervention and when definite treatment is the actual challenge.

  15. Cholelithiasis and its long-term roentgenological aspects; Hiroshima and Nagasaki

    International Nuclear Information System (INIS)

    All pertinent radiographs of 83 RERF Adult Health Study patients with radiographically-confirmed cholelithiasis and who met fixed diagnostic and selection criteria, were reviewed retrospectively. The changes in calculus by type and age, the clinical course by age, the correlation of the clinical course and calculus type, and the relation of the clinical course to the X-ray changes were studied. Among all patients at the time of their first radiological examination, 62 (74.7%) were asymptomatic and 21 (25.3%) were symptomatic. Patients in the older age group had fewer symptoms than the younger ones. There was no definite correlation between the radiological changes and the clinical course. Of the biliary calculi 61 (73.5%) remained unchanged radiologically; 16 (19.3%) increased in size and/or number; and 3 (3.6%) decreased in size and/or number. Over the 1 month to 18 1/2 years of observation, there was no notable difference in the changes in appearance among three types of calculi (solitary, multiple, and ''sand-like''). The changes in radiologic appearance were less frequent in the older than in the younger age group. (author)

  16. The process of cholesterol cholelithiasis induced by diet in the prairie dog: a physicochemical characterization.

    Science.gov (United States)

    Holzbach, R T; Corbusier, C; Marsh, M; Naito, H K

    1976-06-01

    The rapid induction of cholesterol cholelithiasis in a new experimental model, the prairie dog, has recently been reported by two groups. In this model they were able to induce gallstones in as brief a period as 2 weeks, using a 1.2 per cent cholesterol diet. This unprecedented time intensity or telescoping of the induction process provided a unique opportunity for observation of physicochemical changes occurring rapidly over a short period of time and to correlate these with degree of biliary cholesterol saturation. To make such observations, 97 adult male and female prairie dogs were used in the present study. Seventy-two were fed the high cholesterol diet and sacrificed at intervals over a 14-day period; the remaining 25 were used as controls. The primary objective of this work was to determine whether or not there was any relationship between the in vivo events induced in prairie dog bile and our recently reported detailed observations of cholesterol precipitation phenomena in synthetic bile analogs. In these studies, solutions of physiologically relevant composition were constructed, which, when plotted according to convention on a tri-linear graph, fell within the zone of metastable or suspended supersaturation. These solutions revealed a consistent and previously undescribed liquid crystal to solid crystal phase transition during their approach to equilibrium at 37 degrees C. The in vivo studies of prairie dog bile following rapid induction of supersaturation revealed identical changes. At first, the supersaturated biles were isotropic followed by a period of turbidity and invariable formation of mesophase. After a few days, the liquid crystals decreased and solid cholesterol crystallites appeared. The most striking aspect of these observations is that the in vitro work has now predicted not only static, but dynamic processes as well, with respect to cholesterol precipitation beginning with the metastably supersaturated state and eventuating in gallstone

  17. Ultrasonographic and clinical features of fetal cholelithiasis. Three case reports; La litiasi biliare fetale: Diagnosi ecografica e interpretazione clinica. Descrizione di tre casi

    Energy Technology Data Exchange (ETDEWEB)

    Agnifili, Alessio; Gola, Piersante; Marino, Maria; Verzaro, Roberto; Carducci, Giuseppe; Mancini, Ermanno; Rizzo, Franz Maria [L`Aquila, Univ. (Italy). Scuola di Specializzazione in Chirurgia dell`Apparato Digerente en Endoscopia Digestiva; Carducci, Augusto; Biasini, Giancarlo [L`Aquila, Univ. (Italy). Servizio di Medicina Nucleare

    1997-04-01

    Fetal cholelithiasis was first diagnosed in 1983 and since then there have been only few reports about the presence of gallstones in the fetus. Maternal conditions, fetal or obstetrical predisposing risk factors have been proposed to have a causative role, by the pathogenesis of fetal gallstones remains unknown. Clinical sequelae of fetal gallstones are poorly understood as well as the role of fetal cholelithiasis in predisposing the adult to gallstones. They report on 3 patients whose cholelithiasis was diagnosed by obstetrical ultrasonography. Repeated ultrasound scans were performed in each patient until resolution of the US images. The goal of US was to correctly identify the number, size and US features of the material within the gallbladder. The presence of distal shadowing or comet-tail artifact was assess. Multiple, small echogenic foci without distal shadowing were recognized in the fetal gallbladder in their patients. In the third case echogenic foci disappeared during pregnancy. In all the cases, US showed no biliary tract abnormality, and neither the mothers nor the patients had clinical or laboratory findings consistent with liver or biliary diseases. The authors discuss a diagnostic protocol to detect and follow-up gallstones in the perinatal period by ultrasonography. In their experience, fetal cholelithiasis confirmed to be a self-limiting disease without complications and did not require any form of therapy. However a close follow-up is indicated in these patients until spontaneous resolution is demonstrated by US.

  18. The elephants of Zoba Gash Barka, Eritrea: part 4. Cholelithiasis in a wild African elephant (Loxodonta africana).

    Science.gov (United States)

    Agnew, Dalen W; Hagey, Lee; Shoshani, Jeheskel

    2005-12-01

    A 4.0-kg cholelith was found within the abdominal cavity of a dead wild African elephant (Loxodonta africana) in Eritrea. Analysis of this cholelith by histochemistry, electron microscopy, electrospray mass spectroscopy, and energy-dispersive x-ray spectroscopy revealed it was composed of bile alcohols but no calcium, bilirubin, or cholesterol. Bacteria were also found in the cholelith. Similar, but smaller, bile stones have been identified previously in other wild African elephants and an excavated mammoth (Mammuthus columbi). Choleliths have been reported only once in a captive Asian elephant (Elephas maximus). Elephants, along with hyraxes (Procavia capensis) and manatees (Trichechus manatus), are unique among mammals in producing only bile alcohols and no bile acids, which may predispose them to cholelithiasis, particularly in association with bacterial infection. Dietary factors may also play an important role in cholelith formation. PMID:17312726

  19. Short and Long Term Outcomes Associated with Fetal Cholelithiasis: A Report of Two Cases with Antenatal Diagnosis and Postnatal Follow-Up

    OpenAIRE

    Juan Troyano-Luque; Ana Padilla-Pérez; Ingrid Martínez-Wallin; Margarita Álvarez de la Rosa; Salvatore Andrea Mastrolia; José Luis Trujillo; Tirso Pérez-Medina

    2014-01-01

    The aims of this study were to present and discuss ultrasound findings of prenatal fetal cholelithiasis in two cases with different etiology and evolution. Case 1: a pregnant woman from sub-Saharan Africa, suffering from Lyme disease, was treated with ceftriaxone sodium. Six weeks later, biliary sludge associated with polyhydramnios was detected in the fetus and the fetal growth percentile was 14. Emergency caesarean was performed at 36 weeks of gestation due to fetal distress. Biliary sludge...

  20. 胆石症动物模型的应用与研究进展%Application and research advances in cholelithiasis animal models

    Institute of Scientific and Technical Information of China (English)

    赵刚; 张洪义

    2010-01-01

    胆石症动物模型已经成为在胆石病病因、预防、诊断和治疗等方面开展研究的重要平台和工具.由于胆结石的形成与肝胆系统结构功能异常、脂代谢失衡和免疫功能障碍的关系日益受到关注,因此学者们利用胆石症动物模型在上述领域的研究逐渐增多.近年来,模型动物对胆结石的遗传易感性也引起广泛研究兴趣.国内学者还利用胆石症动物模型进行中医药防治胆石病的探索.此外,建立大动物胆石症模型并应用于侵入性和有创性研究的成果也屡有报道.随着科技进步和研究的需要,将有更多适于胆石病研究的动物模型得以建立并被广泛应用.%As a tool, cholelithiasis animal models have become an important platform for pathogenetic, preventative, diagnostic and therapeutic research. As biliary calculus formation has a close relationship with dysfunction of hepatic and biliary systems, inability of lipid metabolism homeostasis and impairment of immunologic barriers, increasing studies have been carried out with the use of animal models in these fields. Animal genetic susceptibility to cholelithiasis has greatly attracted people's attention in recent years and cholelithiasis animal models have been used in Chinese traditional medicine development and authentication. Furthermore, reports on invasive and traumatic research have been published in which large animal models were used. It is supposed that technical progress and scientists' demands would result in wide application of more kinds of cholelithiasis animal models.

  1. Comparison of oral cholecystography (OCG) with real time ultrasonography in the diagnosis of cholelithiasis at the Tikur Anbessa Hospital, Addis Ababa, Ethiopia.

    Science.gov (United States)

    Tilahun, E; Whittaker, L R

    1990-01-01

    A prospective study of the accuracy of real time ultrasonography in the detection of gallstones was undertaken in 180 patients from February 1987 to February 1988. The ultrasound findings were compared with single dose oral cholecystography (OCG), and with the surgical findings where surgery was undertaken. Ultrasonography gave more accurate results than OCG, with an overall accuracy in the surgically proven patients of 97.1%, no false positive findings and a 2.9% false negative rate. OCG gave an accuracy of 80% with no false positive findings and a 20% false negative rate. Ultrasound was particularly valuable where there was non visualisation of the gall bladder at OCG, giving an overall accuracy of 93.3% in such patients. Ultrasonography is a non invasive, simple, safe and economic diagnostic test of high accuracy in the diagnosis of cholelithiasis and of particular benefit in those patients unsuited for OCG. PMID:2191856

  2. Laparoscopic treatment of cholelithiasis in cirrhotic patients Experiencia en el tratamiento laparoscópico de la colelitiasis del cirrótico

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    M. Flores Cortés

    2005-09-01

    Full Text Available Objective: to assess the safety and efficacy of laparoscopy in the treatment of symptomatic cholelithiasis in patients with Child´s Class A and Class B cirrhosis. Study design: descriptive and retrospective study. Patients: we studied 14 patients (mean age 60 yrs with Child´s Class A and Class B hepatic cirrhosis who underwent laparoscopic cholecystectomy. We analyzed the occurrence of intraoperative and postoperative complications. Results: eight patients were women (57.14% and 6 were men (42.85%. Eight of the 14 patients presented with Child's Class B cirrhosis and 6 patients with Class A. Cholecystectomy was programmed for all patients. The average duration of surgery was 77 min. Intraoperative complications occurred in 2 patients (14.28% in the form of liver bed bleeding. Postoperative complications were observed in 3 patients (21.42%, 2 presented with ascites which led to a worsening of Child's Class in one of them, and the third patient presented with angina-like symptoms (acute, sharp pain in the chest irradiating to the back. Mean length of hospital stay was 3 days. No postoperative morbidity or mortality occurred, and there were no conversions. Conclusions: LC (laparoscopic cholecystectomy is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Child's Class A and Class B cirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant, and both duration of surgical procedure and hospital stay are short.Objetivo: evaluar la seguridad y eficacia del uso de la laparoscopia en pacientes cirróticos en estadio A y B de Child-Pugh con colelitiasis sintomática. Diseño del estudio: estudio descriptivo, retrospectivo. Pacientes: catorce pacientes con una edad media de 60 años diagnosticados de cirrosis hepática en estadios A y B que se les practicó colecistectomía laparoscópica. Se estudia la aparición de complicaciones intraoperatorias y postoperatorias tras la

  3. 75岁以上老年人胆石症手术治疗临床分析%Clinical analysis of cholelithiasis surgerical threatment in patients 75 years of age and older

    Institute of Scientific and Technical Information of China (English)

    殷国贤

    2012-01-01

      Objective To investigate the experience of chololithiasis surgical threatmena in patients 75 years of age and older. Methods Retrospectively analyze the clinical characteristics of cholelithiasis, surgical methods and treatment effects in 28 cases of 75 years of age and older. Results Twenty-three cases(82.1%) coexisted with other diseases,2Twenty-two cases(78.6%) went to hospital as a result of acute attack. Eleven cases(39.3%) were performed emergency operations. One case(3.6%) coexisted with gallbladder carcinoma. Surgical methods included holecystectomy, exploratory of biliary tract. However, one cases(3.7%) died in perioperative period. Conclusion Basing on sufficient preoperative preparation, and more attention paid to other diseases coexisted with cholelithiasis, the operation is still relatively safe and effective way of treating cholelithiasis in patients 75 years of age and older.%  目的探讨75岁以上老年人胆石症手术治疗经验.方法回顾性分析28例75岁以上老年人胆石症的临床特点、手术方式及疗效.结果23例(82.1%)患者并存其他疾病,22例(78.6%)以急性发作就诊,11例(39.3%)行急诊手术,1例(3.6%)并存胆囊癌.术式以胆囊切除术、胆道探查术为主.围手术期死亡1例(3.6%).结论经过充分术前准备及围手术期并存症的合理处理,手术仍是治疗75岁以上老年人胆石症相对安全、有效的治疗方法.

  4. Incidência de colelitíase em necropsias realizadas em hospital universitário no município de Campinas-SP Incidence of cholelithiasis: a necropsy study performed in Campinas university hospital, SP

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    Mario Mantovani

    2001-08-01

    Full Text Available OBJETIVO: avaliar a incidência de colelitíase em pacientes submetidos à necropsia no Hospital das Clínicas da UNICAMP e relacioná-la com a ocorrência de outras doenças associadas. MÉTODO: Os autores analisaram a incidência de colelitíase em 2.355 necropsias realizadas pelo Departamento de Anatomia Patológica da UNICAMP, no período de 1975 a 1998, considerando-se somente os casos com idade acima de 10 anos. O teste do qui-quadrado e a "odds ratio" (OR foram utilizados para análise de correlação com outras afecções. RESULTADOS: A incidência foi de 243 (10,3% casos de colelitíase; com 110 (7,9% casos em homens e 133 (13,6% em mulheres (p=0,00001, resultando numa proporção de 1:1,7. A incidência aumentou com a idade (pBACKGROUND: the aim of the present study is to evaluate the incidence of cholelithiasis on necropsies performed at the Unicamp Clinical Hospital and relate them to other associated diseases. METHOD: The authors analyzed the incidence of cholelithiasis on 2355 autopsies performed at the Pathological Anatomy Department of UNICAMP, between 1975 and 1998, among patients older than 10 years old. Chi-square and odds ratio tests were used to analyze correlation with other diseases. RESULTS: There were 243 (10,3% cases of cholelithiasis, in 110 men (7,9% and 133 (13,6% women (p=0,00001, a proportion of 1:17. This incidence increased with age (p<0,000000001, and differed significantly between ethnical groups being, 195 (11,1% among whites and 48 (7,8% among non whites (p=0,02. Regarding other hepatic diseases, estheatosis was present in 33 (13,5%, malignant neoplasms in 31 (12,7%; cirrhosis in 30 (12,3%, virus hepatitis and cronical liver congestion in 16 each (6,5%. Malignant neoplasm, liver infarction, and hepatic dystrophic disease showed a significantly statistical association with the incidence of cholelithiasis. Only seven (0,29% cases of gallbladder cancer were detected. CONCLUSIONS: Our results show a progressive

  5. SERUM TOTAL BILIRUBIN, NOT CHOLELITHIASIS, IS INFLUENCED BY UGT1A1 POLYMORPHISM, ALPHA THALASSEMIA AND S GENOTYPE: FIRST REPORT ON COMPARISON BETWEEN ARAB-INDIAN AND AFRICAN S GENES

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    Said Y ALkindi

    2015-10-01

    Full Text Available Background: We explored the potential relationship between steady state serum bilirubin levels and the incidence of cholelithiasis in the context of UGT1A1 gene A(TAnTAA promoter polymorphism in Omani sickle cell anemia (SCA patients, homozygotes for African (Benin and Bantu and Arab-Indian bS haplotypes, but sharing the same microgeographical environment and comparable life style factors.   Methods: 136 SCA patients were retrospectively studied in whom imaging data including abdominal CT scan, MRI or Ultrasonography was routinely available. Available data on the mean steady state hematological/biochemical parameters (n=136,  bs haplotypes(n=136, a globin gene status (n=105 and UGT1A1 genotypes(n=133 were reviewed from the respective medical records.   Results: The mean serum total bilirubin level was significantly higher in the homozygous UGT1A1(AT7 group as compared to  UGT1A1(AT6 group. Strikingly, cholelithiasis was not influenced by age, gender, alpha globin genotype or bS haplotypes in this SCA cohort.   Conclusion: As observed in other population groups, the UGT1A1 (AT7 homozygosity was significantly associated with raised serum total bilirubin level, but the prevalence of gallstones in the Omani SCA patients was not associated with a thalassaemia, UGT1A1 polymorphism, or bs haplotypes.

  6. Surgical Treatment of Intrahepatic Cholelithiasis 78 cases of Curative Effect Observation%手术治疗肝内胆管结石78例疗效观察

    Institute of Scientific and Technical Information of China (English)

    朱先锐

    2013-01-01

      目的:观察手术治疗肝内胆管结石的治疗效果,总结临床经验及方法.方法:对2009年10月~2012年5月收治确诊的78例肝内胆管结石的临床资料进行回顾性分析.结果:本组78例患者术后发生近期并发症10例,占12.8%,术后残留结石14例,残留结石率17.9%,术后均获得6~17个月随访,疗效评定:优良者73例,优良率93.6%;差5例,占6.4%.结论:术前明确结石部位狭窄部位及程度等情况,结合术中B超及胆道镜检查,选择合理的术式可提高肝内胆管结石的治愈率,降低结石残余率、复发率及再手术率.%Objective:To observe the surgical treatment of intrahepatic cholelithiasis the treatment effect, to summarize clinical experience and methods. Methods:October 2009 to May 2012 78 cases were diagnosed intrahepatic cholelithiasis clinical data were retrospectively analyzed. Results:78 cases of postoperative complication occurred in 10 cases,12.8%, Postoperative residual stones in 14 cases, the residual stone rate 17.9%, after surgery the 6 ~ 17 months follow-up,Good person 73 cases, the excellent-good rate is 93.6%;Difference in 5 cases, accounting for 6.4%. Conclusion: Preoperative stone location and degree of stenosisetc,Combined with B-type ultrasonic ultrasound and intraoperative bile duct endoscopy, Reasonable choice of surgical procedures can improve the cure rate of intrahepatic cholelithiasis and lower rate of residual stones, recurrence rate and reoperation rate.

  7. 扶正利胆方对贲门癌术后胆囊结石发生的影响%Investigation of Fuzheng-lidan herbs on cholelithiasis after cardiac cancer resection

    Institute of Scientific and Technical Information of China (English)

    阎晓路; 高哲; 邓新娜

    2015-01-01

    目的:观察扶正利胆方对贲门癌术后胆囊结石发生的影响探讨其作用机制。方法将120例贲门癌术后患者随机分为2组。治疗组60例术后第10 d开始口服扶正利胆方,连服3个月;对照组60例行常规抗炎、补液等治疗。2组均于术前3 d,术后1、3、6个月测空腹血清胆囊收缩素( CCK)浓度,并做胆囊超声测定空腹及脂肪餐后30 min、l h后胆囊最大纵切面积、长径、短径,计算胆囊超声容积、胆囊收缩率等,并记录胆囊结石发生人数,比较2组手术后胆囊的容积、胆囊收缩率、空腹血清CCK浓度及术后胆囊结石发病率。结果治疗组术后较对照组胆囊容积减小,胆囊收缩率增高,差异均有统计学意义(P<0.05)。治疗组术后较对照组空腹血清CCK浓度明显升高,差异有统计学意义(P<0.05)。术后6个月治疗组胆囊结石发生病率较对照组低,差异有统计学意义(P<0.05)。结论扶正利胆方可以提高贲门癌术后患者血清CCK浓度,改善胆囊收缩功能,降低胆囊结石发病率。%Objective To investigate the effects and mechanism of Fuzheng-lidan herbs on cholelithiasis after cardiac cancer resection.Methods 120 patients after cardiac cancer resection were randomly divided into two groups.60 patients in treatment group received Fuzheng-lidan herbs 10 d after operation, continuous oral administra-tion for 3 months.60 patients in control group received routine therapy, including anti-inflammation and fluid infu-sion.The concentration of fasting serum cholecystokinin ( CCK) was detected 3 d before operation and 1, 3, 6 months after operation in two groups.The maximum longitudinal section area, long diameter and short diameter of gallbladder were measured by cholecystosonography at empty stomach and 30 min, 1 h after fat meals, as well as gallbladder vol-ume, gallbladder shrinkage rate, etc.The number of people with cholelithiasis

  8. 扶正利胆方对贲门癌术后胆囊结石发生的影响%Investigation of Fuzheng-lidan herbs on cholelithiasis after cardiac cancer resection

    Institute of Scientific and Technical Information of China (English)

    阎晓路; 高哲; 邓新娜

    2015-01-01

    Objective To investigate the effects and mechanism of Fuzheng-lidan herbs on cholelithiasis after cardiac cancer resection.Methods 120 patients after cardiac cancer resection were randomly divided into two groups.60 patients in treatment group received Fuzheng-lidan herbs 10 d after operation, continuous oral administra-tion for 3 months.60 patients in control group received routine therapy, including anti-inflammation and fluid infu-sion.The concentration of fasting serum cholecystokinin ( CCK) was detected 3 d before operation and 1, 3, 6 months after operation in two groups.The maximum longitudinal section area, long diameter and short diameter of gallbladder were measured by cholecystosonography at empty stomach and 30 min, 1 h after fat meals, as well as gallbladder vol-ume, gallbladder shrinkage rate, etc.The number of people with cholelithiasis was recorded.The gallbladder volume, gallbladder shrinkage rate, fasting serum CCK concentration and cholelithiasis morbidity after operation were com-pared between two groups.Results After operation, the gallbladder volume was decreased and gallbladder shrinkage rate was increased in treatment group as compared with those in control group.The differences were statistically signif-icant (P<0.05).The concentration of fasting serum CCK after treatment was obviously increased in treatment group as compared with that in control group (P<0.05).The morbidity of cholelithiasis 6 months after operation in treat-ment group was lower than that in control group (P<0.05).Conclusion Fuzheng-lidan herbs can enhance fast-ing serum CCK concentration of patients after cardiac cancer resection, improve gallbladder contractability, and de-crease cholelithiasis morbidity.%目的:观察扶正利胆方对贲门癌术后胆囊结石发生的影响探讨其作用机制。方法将120例贲门癌术后患者随机分为2组。治疗组60例术后第10 d开始口服扶正利胆方,连服3个月;对照组60例行常

  9. 胆石症患者胆道感染的病原学分析与治疗探讨%Etiological analysis and treatment of biliary tract infections suffered by cholelithiasis patients

    Institute of Scientific and Technical Information of China (English)

    马红梅; 戴丐国; 连建安; 姜斌骅

    2014-01-01

    OBJECTIVE To investigate the etiological status of biliary tract infections among cholelithiasis patients and offer corresponding measures for treatment so as to improve the level of clinical treatment .METHODS The clinical data of 370 cases of cholelithiasis patients from Jan 2010 to Jan 2013 were retrospectively analyzed ,and the pathogen distribution and drug resistance were analyzed among those patients who suffered from biliary tract infec-tions ;PPMS software was adopted for statistical analysis ,t-test was adopted for testing measurement data and Chi-square was adopted for testing enumeration data .RESULTS Totally ,79 cases of the 370 cases of cholelithiasis patients suffered from biliary tract infections ,with the infection rate of 21 .35% ;a total of 79 strains of pathogens were detected ,gram-positive bacteria were 32 strains ( 40 .51% ) with the top 3 pathogens of Enterococcus f aeca-lis ,Streptococcus pyogenes and Staphylococcus aureus ,accounting for 13 .92% ,11 .39% and 11 .39% respective-ly ;gram-negative strains were 47 strains (59 .49% ) ,with the top 3 pathogens of Escherichia coli ,K lebsiella and Pseudomonas aeruginoosa ,accounting for 18 .99% ,16 .46% and 11 .39% respectively ;all the drug resistance rates of dominant gram-negative bacteria to meropenem ,imipenem and ceftriaxone were between 0-11 .11% ,be-sies ,the resistance rates of E .coli ,and P .aeruginosa to cefotaxime were 13 .33% and 22 .22% respectively ,and the drug resistance rate of K lebsiella to levofloxacin was 15 .38% ;the dominant gram-positive bacteria had low drug resistance rate between 0 and 11 .11% to vancomycin ,teicoplanin and cefminox ,the drug resistance rates of E .f aecalis and Staphylococcus aureus to cefotaxime were 18 .18% and 11 .11% respectively ,and the drug resist-ance rates of S .pyogenes to ampicillin-sulbactam was 11 .11% .CONCLUSION Gram-negative bacteria are the dom-inant pathogens causing biliary tract infection to cholelithiasis patients ,and it is

  10. Laparoscopic cholelithotomy and polypectomy of gallbladder polyps for cholelithiasis and/or cholecystic polyps: An analysis of 53 cases%腹腔镜保胆取石术和息肉切除术临床分析53例

    Institute of Scientific and Technical Information of China (English)

    徐新保; 张辉; 张洪义; 刘承利; 何晓军; 肖梅; 张宏义; 冯志强

    2012-01-01

    AIM: To discuss the indications, methods, and therapeutic effect of laparoscopic cholelithotomy and polypectomy in treating cholecystolithiasis and polyps.METHODS: The clinical data for 53 patients with cholelithiasis and cholecystic polyps who were treated by laparoscopic cholelithotomy and polypectomy between January 2009 and September 2011 were analyzed. Of the 53 patients, 39 suffered from only cholecystolithiasis (including 12 with a single stone and 27 with multiple stones), 8 suffered from cholecystic polyps (including 3 with adenomatous polyps and 5 with cholesterol polyps), and 6 simultaneously suffered from cholecystolithiasis and cholecystic polyps. Of 39 patients suffering from cholecystolithiasis, 2 had liver cirrhosis, 1 had primary hepatocellular carcinoma, and 3 had acute cholecystitis. Before the stones were removed, the bottom of the gallbladder was incised in 37 of 39 cases with cholelithiasis, and the neck of the gallbladder was incised in the remaining two patients. Of 8 patients with cholecystic polyps, 5 had cholesterol polyps and underwent polyp removal, and the other 3 had adenomas of the gallbladder and underwent partial cholecystectomy around the adenoma. In six patients with combined cholecystolithiasis and cholecystic polyps, the bottom of the gallbladder was excised to remove the stones and polyps. The incisions were sutured continuously with a 4/0 prolene suture in 10 cases, and interrupted or continuous suturing was performed with a 3/0 absorption suture in the other 43 cases. Both choledochoscopy and laparoscopy were used in 33 cases, and only laparoscopy was used in the other 20 patients during operation to see if the stones and polyps had been removed. Celiac drainage tube was placed under the right hepatic lobe in 19 cases during operation and was removed one to five days later. Thirty-three patients with cholecystolithiasis took choleretic drugs for one week to 4 weeks after operation, and the other 12 cases with

  11. The role of ABCB4 gene in the pathogenesis of low phospholipid associated cholelithiasis%ABCB4基因在低磷脂相关性胆石病发病机制中的作用

    Institute of Scientific and Technical Information of China (English)

    李波

    2012-01-01

    人类肝细胞毛细胆管膜上ABCB4基因编码生成多药耐药蛋白3.该蛋白负责将磷脂从毛细胆管膜内侧转运到胆管腔,与胆汁酸盐微粒形成混合微粒以溶解胆固醇.当ABCB4基因缺陷时,胆汁中磷脂减少或缺乏,可使胆固醇呈过饱和状态促进胆固醇结晶形成.人类ABCB4基因突变导致的胆石病称为低磷脂相关性胆石病.其特征是青少年时出现明显胆石病症状和胆囊切除术后反复发作症状.低磷脂相关性胆石病是罕见的单基因突变的染色体隐性遗传病.突变的方式包括纯合子和杂合子突变,集中于在外显子编码区、内含子区域和5' UTR(untranslated region)区域.%The adenosine triphosphate-binding cassette subfamily member 4 (ABCB4) gene encodes multidrug resistance rotein 3 (MDR3),which is expressed on the cannalicular membranes of hepatocytes and translocates major phospholipids from the inner to the outer leaflet.Phospholipids are the major carrier and solvent of cholesterol,and in combination with bile salts form mixed micelles.Defects in ABCB4 function cause a low phospholipid content in bile,resulting in cholesterol supersaturation and crystal formation.Low phospholipid-associated cholelithiasis (LPAC) is characterized by the association of ABCB4 mutations and a low biliary phospholipid concentration,resulting in symptomatic gallstones starting before age 40 years,a high serum gamma glutamyl transferase (γ-GT) activity,intrahepatic microlithiasis,and recurrent biliary symptoms despite cholecystectomy.LPAC is an autosomal recessive condition caused by a rare single-gene mutation,commonly occurring in ABCB4,and can include homozygous and heterozygous point mutations in introns,coding exons,and 5 UTR regions.

  12. Assoziation von Genpolymorphismen mit der Cholelithiasis

    OpenAIRE

    Lauer, Nadine

    2009-01-01

    OBJECTIVES: The beta3-adrenergic receptor (ADRB3) is a transmembrane receptor highly expressed in adipose tissue and thought to be involved in the regulation of lipolysis. ADRB3 is also highly expressed in gallbladder tissue where it may be involved in gallbladder contraction. Because polymorphisms of ADRB3 are present in populations with a high prevalence of gallstones (e.g. Pima-Indians, obese subjects), we hypothesized that known polymorphisms for ADRB3 (Trp64Arg) may represent an independ...

  13. 胆石症感染患者血小板参数与凝血指标的临床意义%Clinical Significance of Cholelithiasis Infection Patients with Coagulation and Platelet Parameters

    Institute of Scientific and Technical Information of China (English)

    颜丙松; 姬文超; 陈宗凯; 栾晓琳; 曲林林; 李文超; 孙传东

    2015-01-01

    Objective To evaluate the relationship and the clinical significance of the change of prothrombin time (PT) and platelet(PLT) count in cholelith disease infected patients. Methods Col ected 123 cases of cholelithiasis infection patients and 40 healthy from September 2013 to January 2014 and check-up against prothrombin time (PT) and platelet (PLT)count. Results Mild cholelith disease infection group compared with control group, the PLT is lower than the control group ( <0.05), but there was no statistical y dif erence in PT;moderate cholelith disease infection group compared with control group, PT is longer and the PLT decrease significantly ( <0.05, <0.01), while cholelith disease infection in severe group compared with control group, PT1 extended obviously, further reduce PLT, was statistical y significant ( <0.01), the abnormal degree was positively related with cholelith disease infection degree.Conclusion Prothrombin time (PT) and platelet count (PLT) joint inspection can cor ect evaluation cholelith disease infection degree, which has important clinic meaning in observation of the clinical treatment ef ect and prognosis.%目的探讨凝血酶原时间(PT)与血小板(PLT)计数的变化在胆石症感染患者病情变化中的关系及临床意义。方法收集2013年9月~2014年1月123例胆石病感染患者与40例健康体检者对照凝血酶原时间(PT)与血小板(PLT)计数。结果胆石症感染轻度组与对照组比较,PLT低于对照组(<0.05),PT差异无统计学意义,胆石症感染中度组与对照组比较,PT延长PLT减少差异有统计学意义(<0.05,<0.01),而胆石症感染重度组与对照组比较,PT明显延长,PLT进一步减少,有统计学意义(<0.01),异常程度与胆石症感染程度呈正相关。结论凝血酶原时间(PT)与血小板计数(PLT)联合检验可正确评价胆石症感染程度,对临床治疗效果的观察和预后有重要参考意义。

  14. 十二指肠乳头旁憩室致复发性胆管结石40例疗效%Surgical treatment of recurrent cholelithiasis caused by peripapillary duodenal diverticulum

    Institute of Scientific and Technical Information of China (English)

    闫宏宪; 田建国

    2016-01-01

    Objective To study the diagnosis and therapy of recurrent cholelithiasis caused by peripapillary duodenal diverticulum.Methods The clinical data of 40 patients with repeated formation of bile duct stones caused by peripapillary duodenal diverticulum were retrospectively reviewed,and the data on surgical treatment were analyzed.Results All the patients underwent duodenal diverticulum operation and subtotal gastrectomy (Billroth Ⅱ).Twenty-one patients in addition underwent R-Y cholangiojejunostomy,14 patients and 5 patients underwent choledochotomy with T-tube drainage and duodenotomy with Oddi sphincterotomy,respectively.In forty patients,three patients presented temporarily biliary fistula,two patients lost touch,three-eighty fully recover from an illness in three years.Conclusion Recurrence of bile duct stones caused by peripapillary diverticulum may be cured by duodenal diverticulum operation combined with bile duct surgery,which is a feasible and efficacious treatment.%目的 探讨十二指肠乳头旁憩室致复发性胆管结石的诊断和治疗.方法 回顾性分析2010年11月至2014年11月河南省人民医院收治的40例因十二指肠乳头旁憩室致反复胆管结石发作患者的临床资料,并对相关治疗情况进行归纳总结.结果 所有患者均行十二指肠憩室化手术,其中21例加行胆管空肠R-Y吻合术;14例行胆管切开探查取石T管引流术,5例行十二指肠切开术和Oddi括约肌切开成形术.40例患者术后临床症状基本消失,行胆管空肠肠吻合患者有3例出现一过性胆漏,通畅引流后痊愈.除2例失联外,所有患者经3年随访,余38例并未见结石复发,患者主观感觉良好,疗效满意.结论 十二指肠乳头旁憩室是复发性胆管结石的一个不可忽视的病因,在十二指肠憩室化基础上的胆道相关手术是治疗此种疾病的有效方法.

  15. Curative effect analysis of patients with long term use of sleeping pills complicated with cholelithiasis treated with cholecystolithotomy with reservation of gallbladder%长期服用安眠药物合并胆石症患者保胆取石术疗效分析

    Institute of Scientific and Technical Information of China (English)

    吴先麟; 张光全; 廖忠; 何方; 赵元勋

    2015-01-01

    Objective:To explore the curative effect of patients with long term use of sleeping pills complicated with cholelithiasis treated with cholecystolithotomy with reservation of gallbladder.Methods:22 patients with cholecystolithiasis and long term use of sleeping pills were selected as the experimental group.18 patients with cholecystolithiasis and without long term use of sleeping pills were selected as the control group.They were treated with cholecystolithotomy with reservation of gallbladder.We compared the efficacy.Results:At 1,3,5 years after operation,in the experimental group,the stone recurrence rate respectively was 0%,0%, 4.6%.In the control group,the stone recurrence rate respectively was 0%,14.3%,16.7%(P<0.05).Conclusion:The stone recurrence rate in patients with long term use of sleeping pills complicated with cholelithiasis treated with cholecystolithotomy with reservation of gallbladder was low.%目的:探讨长期服用安眠药物合并胆石症患者保胆取石术的疗效。方法:收治有服用安眠药物史胆囊结石患者22例为试验组,收治未服用安眠药物史胆囊结石患者18例为对照组,两组均采用保胆取石治疗,比较疗效。结果:术后1、3、5年,试验组结石复发率分别为0、0、4.6%,对照组结石复发率分别为0、14.3%、16.7%(P<0.05)。结论:长期服用安眠药物合并胆石症患者保胆取石术的结石复发率低。

  16. Acute Biliary Pancreatitis 68 Cases Induced by Treating Cholelithiasis Treated with Bi-microscope Combined with Choledoch Probe Incision for LCDE%双镜联合胆总管探查切开取石术治疗胆石症引起的急性胆源性胰腺炎68例疗效观察

    Institute of Scientific and Technical Information of China (English)

    阮本元

    2014-01-01

    [目的]探讨腹腔镜联合胆道镜胆总管探查切开取石术(laparoscopic common bile duct exploration,LCBDE)治疗胆石症引起的急性胆源性胰腺炎(acute biliary pancreatitis,ABP)的临床效果。[方法]选择我院行LCBDE的68例胆石症引起的ABP患者为实验组,同期行开腹胆总管切开取石T管引流术( open choledocholithotomy T-tube drainage, OCTD )的87例胆石症引起的ABP患者为对照组。比较两组手术时间、术后恢复情况、取石结果及并发症情况。[结果]实验组68例均成功完成LCBDE,无中转开腹;取净胆管内结石61例,T管拔除为术后4周;残余结石7例于术后6周经T管窦道胆道镜再次取残余结石。对照组87例行OCTD成功79例,失败8例6周后经胆道镜取尽石;OCTD术中取净结石者71例,T管拔除为术后6周,未取尽者于术后6周经T管窦道胆道镜再次取尽残余结石。两组在术后恢复、并发症发生方面,实验组优于对照组(P<0.05,P<0.01)。[结论] LCBDE一期治疗胆石症引起的ABP安全可行,创伤小,恢复快,疗效好。%[Objective]To discuss the clinical effect of laparoscopic common bile duct exploration(LCBDE)on acute biliary pancreatitis(ABP)induced by treating cholelithiasis. [Method] Select 68 cases of ABP having LCBDE induced with cholelithiasis as experimental group, and other 87 cases of open choledocholitho tomy T-tube drainage(OCTD) as control group;both had routine treatment before operation. Compare their operational time, bed time, post-operation gastro-intestinal recovery time, drainage tube removing time, time of leaving hospital, results of calculus removal and complications. [Result] In experimental group, the operational time was 115~205min,(143.62 ±28.73)min in average, both successful y finishing LCBDE, without conversion to open laparotomy. Calculus removal result: 61 cases were al removed the calculus in the bile duct, the T tube was removed 4w

  17. Effect Observation of Laparoscopic Cholecystectomy Combined with Endoscopic Sphincterotomy in Treatment of Cholelithiasis Complicated by Choledochal Stricture End or Thin Choledocholith%腹腔镜胆囊切除术联合十二指肠镜下乳头切开术治疗胆石症合并胆总管末端狭窄或细径胆总管结石效果观察

    Institute of Scientific and Technical Information of China (English)

    汪海; 王怀志; 魏从光; 宋永庆; 谢景军

    2015-01-01

    Objective To investigate the clinical effect of laparoscopic cholecystectomy ( LC) combined with en-doscopic sphincterotomy ( EST) in treatment of cholelithiasis complicated by choledochal stricture end or thin choledocho-lith. Methods A total of 87 patients with cholelithiasis complicated by choledochal stricture end or thin choledocholith admitted during July 2008 and July 2013 were divided into observation group ( n=45 ) and control group ( n=42 ) ac-cording to the therapy methods. The control group was given conventional open surgery, while the observation group was given LC combined with EST. The removed stones condition, intraoperative bleeding volume, operation time, hospital stay, postoperative complications and calculus recurrence in the two groups were observed and compared. The level chan-ges of direct bilirubin, white blood cell count, alanine transarninase (ALT) and C-reactive protein on postoperative 3rd and 7th d in the two groups were also observed and compared. Results All the stones were cleared, and no stone was left in the two groups. Compared with those in the control group, less intraoperative bleeding volume, shorter operation time and hospital stay were found in observation group, and the differences were statistically significant (P 0. 05 ). Conclusion The laparoscopic cholecystectomy combined with endoscopic sphincterotomy in treatment of cholelithiasis complicated by choledochal stricture end or thin choledocholith has a higher stone clearance rate, shorter operation time and hospital stay and less intraoperative bleeding volume. It has quicker digestion of postoperative obstructive jaundice and recovery of liver function with less inflammatory response.%目的:研究胆石症合并胆总管末端狭窄或细径胆总管结石患者应用腹腔镜胆囊切除术( laparoscopic cholecystectomy, LC)联合十二指肠镜下乳头切开术( endoscopic sphincterotomy, EST)治疗的临床效果。方法选择武警河南总队医院2008年7

  18. Prevalence of cholelithiasis in patients with chronic inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Wolfgang Kratzer; Mark M Haenle; Richard A Mason; Christian von Tirpitz; Volker Kaechele

    2005-01-01

    AIM: To investigate the effect of chronic inflammatory bowel disease (CIBD) specific risk factors for cholecystolithiasis,as duration and involvement pattern of the disease and prior surgery in patients with Crohn's disease (CD) and ulcerative colitis (UC).METHODS: A total of 222 patients with CD (135 females,87 males; average age, 35.8±11.8 years; range 17-81 years)and 88 patients with UC (39 females, 49 males; average age, 37.2±13.6 years; range 16-81 years) underwent clinical and ultrasound examinations. Besides age, sex and degree of obesity, patients' CIBD specific parameters, including duration and extent of disease and prior operations were documented and evaluated statistically using logistic regression.RESULTS: The overall prevalence of gallbladder stone disease in patients with CD was 13% (n = 30). Only age could be shown to be an independent risk factor (P = 0.014).Compared to a collective representative for the general population in the same geographic region, the prevalence of cholecystolithiasis was higher in all corresponding age groups. Patients with UC showed an overall prevalence of gallbladder stone disease of only 4.6%.CONCLUSION:Only age but not disease-specific factors such as duration and extent of disease, and prior surgery are independent risk factors for the development of cholecystolithiasis in patients with CIBD.

  19. [Computed X-ray tomography in predicting the efficacy of oral cholelithiasis with bile acids].

    Science.gov (United States)

    Fu, X B

    1993-02-01

    The efficacy of oral cholelitholytic therapy with chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) in 137 patients with gallstones was compared with their CT patterns. The best dissolving results were obtained from patients with the stones in isodense and faint category (OCG). Besides, gallstones, which showed no obvious filling defect on OCG but distinct echo and shadow on B-type ultrasonography, were also insoluble. PMID:8391902

  20. MICROBIOLOGICAL PROFILE OF BILE IN CHOLELITHIASIS AND THEIR IMPLICATION IN CAUSING POST OPERATIVE WOUND INFECTIONS

    Directory of Open Access Journals (Sweden)

    Shahi

    2014-12-01

    Full Text Available BACKGROUND: Cholecystitis is a common indication for major abdominal surgeries. It may occur with or without obstruction of common bile duct. Obstruction leads to secondary bacterial infection of bile. Bactibilia is an important predisposing factor for post-operative complications. Hence, this study was designed to determine the prevalence of bacteria in bile samples of cholecystitis patients and to correlate bactibilia and post-operative wound infection. MATERIALS AND METHODS: Bile samples collected intra-operatively were subjected to gram stain, culture, and antibiotic sensitivity testing. The patients were followed-up for post-operative complications. If post-operative wound infection was found, cultures were done and correlated with bacteria isolated from bile samples. RESULTS: Bactibilia was found in 43/100 (43% of patients. Polymicrobial flora was found in 7% of bile samples. Escherichia coli, citrobacter, Klebsiella pneumoniae and pseudomonas were the predominant organisms isolated. Post-operative wound infection was found in ten (10% patients who had bactibilia. Amikacin, gentamicin, ceftriaxone sulbatum, pipracillin tazobactum, imipenem were among most effective in prophylactic regimen. CONCLUSION: The organisms responsible for bactibilia were found to cause post-operative infections in the same patient warranting the use of prophylactic antibiotics in every patient undergoing cholecystectomy. All patients undergoing cholecystectomy should receive prophylactic antibiotic to prevent post-operative wound infections.

  1. Vascular emergencies in cholelithiasis and cholecystectomy:our experience with two cases and literature review

    Institute of Scientific and Technical Information of China (English)

    Narasimhaiah Srinivasaiah; Maneesh Bhojak; Ralph Jackson; Sean Woodcock

    2008-01-01

    BACKGROUND: Complications from gallstones and laparoscopic cholecystectomy can be serious and fatal if there is a delay in recognition and treatment. We aim to present two unusual, life threatening vascular complications as a result of gallstones and laparoscopic cholecystectomy. Their management is highlighted with a brief review of literature. METHODS: Data for the article were gathered from clinical case note review. Radiology database was used for images. A brief literature review was undertaken using Pubmed search. The keywords used included hemobilia, pseudoaneurysm, arterio-biliary ifstula and laparoscopic cholecystectomy. RESULTS: The article highlights two individual case reports. The ifrst case constitutes an 81-year woman who had cystic arterial erosion causing hematemesis, while the second patient was a 57-year man who presented with hemobilia from a pseudoaneurysm of right hepatic artery (RHA) following laparoscopic cholecystectomy. Cystic arterial erosion was treated with subtotal cholecystectomy with duodenal defect closure while the pseudoaneurysm underwent radiological intervention. CONCLUSIONS: Cystic artery erosion and pseudoaneurysm causing arteriobiliary ifstula are rare vascular complications related to the biliary tree. A high index of suspicion and timely intervention is important. Trauma to arteries should be avoided during laparoscopic cholecystectomy.

  2. The effect of Macrotyloma uniflorum seed on bile lithogenicity against diet induced cholelithiasis on mice

    Directory of Open Access Journals (Sweden)

    Papiya Bigoniya

    2014-01-01

    Conclusions: M. uniflorum seed exerted antilithogenic influence by decreasing the cholesterol hyper-secretion into bile and increasing the bile acid output, thus decreasing the formation of LG bile in mice. The effect was maximum in the AE as it also reduced papillary proliferation of gallbladder and fatty degeneration of the liver. The potential antilithogenic effect of the AE of M. uniflorum may be due to antioxidant property of its rich total polyphenol and tannins content.

  3. [Robotic surgery and NOTES--Natural Orifice Translumenal Endoscopic Surgery in treatment of cholelithiasis--revolution or failed conception].

    Science.gov (United States)

    Ciesielczyk, Błazej; Cwaliński, Jarosław; Janusz, Piotr

    2008-10-01

    At the beginning of 90th years of the last century a laparoscopy technique initiated a new chapter in surgical treatment becoming the realistic alternative of classical laparotomies. Nowadays, after 20. years from first laparoscopic cholecystectomy new treatment methods such as Natural Orifice Translumenal Endoscopic Surgery (NOTES) and robotic surgery are gaining more and more great interest. The first robots created in the middle of 90 years were used only for keeping a camera and they were steered with voice, however with the development of technology was possible constructing precise machines, which were able to carry complicated procedures out (fundoplication, gastrectomy or colectomy), also from a long distance. At present two types of robots are being applied in the medical practice: da Vinci and Zeus. NOTES is a method that make possible to perform operations trough natural orifice of the body with an endoscope and appropriate instrumentation. Actually three fundamental ways of reaching the peritoneum are being used: through the stomach, through the rectum and through the vagina. Some authors tried also to use transbladder approach. The main advantage of the NOTES technique is a possibility of performing the procedure without necessity of cutting the abdominal wall, what decreases postoperative pain, eliminates the problem of an infecting wound, minimizes risk of postoperative hernias and reduces amount of postoperative adhesions. Problems related to the NOTES technique are mostly need of inventing new and better equipment, assurance tightness of the surgical access, development of an efficient antiseptic prophylaxis and also standardize learning methods. Dynamic development of the NOTES method allows overcoming some of these limitations by using innovative technical solutions and new systems e.g. TULA, NOTUS, ShapeLock, ViaCath, MAGS and many others. The aim of this study is a deep analysis of the recent technical solutions, rules of the therapy and schedules of management valid in the NOTES method and the robotic surgery suggested by the leading clinics. The article is also an attempt to answer the question if this new surgical procedures become as great revolution as laparoscopy. PMID:19145941

  4. Dynamic and ultrastructural study of sphincter of Oddi in early-stage cholelithiasis in rabbits with hypercholesterolemia

    Institute of Scientific and Technical Information of China (English)

    Jing Guo Wei; Yao Cheng Wang; Fan Du; Hou Jun Yu

    2000-01-01

    AIM To study the relationship between preformation of gallstone and the kinetics and ultrastructure of sphincter of Oddi.METHODS Adult female rabbits were used and divided into 3 groups, and fed with either normal or high cholesterol diet for four or eight weeks.Each group contained eight rabbits. The manometry of sphincter of Oddi, biliary cineradiography, gallbladder volume measurement and ultrastructure observation under electron microscope were performed.RESULTS In groups Ⅰ and Ⅱ, the basal pressure in low-pressure ampulla or high pressure zone of sphincter of Oddi was elevated, the amplitude of phasic contraction was decreased and the volume of gallbladder were increased, with a significant difference (P<0.01) from those of control. Gallstones were found in group Ⅱ rabbits (7/8). Under cineradiography, low-pressure ampulla showed a spasmodic status without apparent peristaltic contraction. Under electron microscope, inside the muscular cells of sphincter of Oddi,loosening of microfilament and swelling of plasmosomes which congregated at the top were observed. The amount showed no obvious change under nitric oxide synthase (NOS) stain.CONCLUSION Twisting of the microfilament and disarrangement of kink macula densa inside the muscular cells suggested that the sphincter of Oddi was under spasmodic status. The impaired diastolic function caused and aggravated the stasis of cystic bile. The swelling plasmosome could be one of the important factors in elevating the tonic pressure of sphincter of Oddi.

  5. Cholelithiasis and the risk of intrahepatic cholangiocarcinoma: a Meta-analysis%胆道结石并发肝内胆管癌风险的Meta分析

    Institute of Scientific and Technical Information of China (English)

    朱征海; 蔡浩; 顾盐炎; 赵万文; 胡伟东; 陈超波

    2015-01-01

    目的 明确肝外胆管结石及胆囊结石并发肝内胆管癌(Intrahepatic cholangiocarcinoma,ICC)风险,为胆道结石的临床治疗提供参考.方法 计算机检索PubMed、EmBase以及CBM等数据库,查找胆道结石以及胆囊结石并发ICC风险的队列研究或者病例对照研究.应用STATA软件对所获得研究数据行Meta分析,根据研究间异质性选择固定效应模型或者随机效应模型.采用Egger检验评估发表偏倚.结果 共有6篇病例对照研究纳入分析,包括123 713例患者,其中ICC 4 753例,无瘤对照118 960例.Meta分析结果显示,胆管结石为ICC发病的高危因素(OR:17.64,95% CI:11.14 ~27.95),除外肝内胆管结石,肝外胆管结石导致的ICC发病风险仍较高(OR:11.79,95% CI:4.17~ 33.35).此外,胆囊结石也是ICC发病危险因素(OR:2.07,95% CI:1.17 ~3.67).结论 肝外胆管结石与胆囊结石均为ICC发病的重要危险因素.%Objective To clarify the association of pre-existing choledocholithiasis or cholecystolithiasis and the development of intrahepatic cholangiocarcinoma(ICC).Methods A computerized literature search was performed in Pubmed,EmBase and CBM.Cohort and case control studies on the risk of choledocholithiasis or cholecystolithiasis developing ICC was included.Meta-analysis was performed using STATA version 12.0.Either a fix or random effect model was used according to heterogeneity among studies.Egger's test was performed to assess publication bias.Results A total of 6 case control studies fulfilled our inclusion criteria including 123,713 patients,4,753 for ICC and 118,960 for tumor free controls.Bile duct stone contributed to the development of ICC (OR:15.64,95% CI 9.33-26.23).Apart from hepatolithiasis,there was still a high risk of ICC development for choledocholithiasis (OR:11.05,95 % CI:4.02 ~ 30.37).Cholecystolithiasis is also a risk factor for ICC (OR:2.35,95 % CI:1.28 ~ 4.31).Conclusion Both choledocholithiasis and cholecystolithiasis are important prognostic factors for ICC.

  6. 胆道结石的CT平扫诊断与限制%Diagnosis and limitation of CT Scaning of Cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    王卓群

    2009-01-01

    目的:应用薄层CT平扫技术提高胆道结石检出率.材料和方法:回顾性分析有完整CT及B超检查资料且经手术证实的胆道结石96例,比较分析不同扫描技术对胆道结石的检出率.结果:胆囊结石53例,常规10ram层厚扫描漏诊12例,检出率为77.35%,局部追加3mm薄层扫描,漏诊5例,检出率为90,57%,B超漏诊1例,检出率为98.1l%;胆管结石43例,常规10mm扫描漏诊13例,检出率为69.98%,局部加扫3mm薄层,漏诊5例,检出率为88.37%,B超漏诊8例,检出率为81.40%.结论:3ram薄层CT平扫可以大大提高胆道结石的检出率.薄层扫描漏诊的主要原因是①部分结石密度与胆汁相似,②CT对泥沙样结石的空间分辨率较差.

  7. Care of surgical resection of cholelithiasis with cholecystitis%胆囊结石并胆囊炎手术切除的护理

    Institute of Scientific and Technical Information of China (English)

    周丽

    2014-01-01

    Objective To investigate the perioperative nursing care effect of gallstones and cholecystitis surgical resection. Methods 100 patients with gallstones and cholecystitis who were treated in this hospital between September 2012 and September 2013 were chosen in this study and randomly divided into two groups. The observation group of 50 patients received perioperative nursing care.The control group of the other 50 patients received conventional nursing care. The nursing effects of two groups were observed. Results The occurrence condition of the postoperative complications,the healing condition of the incision and the nursing satisfaction in the observation group were better than those in the control group(P<0.05). Conclusion The perioperative nursing care of gallstones and cholecystitis surgical resection can reduce the incidence of surgical complications and improve the treatment effect and the care satisfaction to establish a good image for the hospital. The perioperative nursing care of gallstones and cholecystitis surgical resection is well worth popularizing and applicating.%目的:探讨胆囊结石并胆囊炎手术切除的围期护理效果。方法选取2012年9月~2013年9月期间本院收治的100例胆囊结石并胆囊炎患者,随机分为两组。观察组50例,给予手术围期护理;对照组50例,给予常规护理。观察两组患者的护理效果。结果观察组在术后并发症的发生情况、切口的愈合情况和护理满意度上均优于对照组(P<0.05)。结论胆囊结石并胆囊炎手术切除的围期护理能够降低手术并发症的发生率,提高治疗效果和护理满意度,为医院树立了良好的形象,值得推广应用。

  8. Enhancement of interaction of BSEP and HAX-1 on the canalicular membrane of hepatocytes in a mouse model of cholesterol cholelithiasis

    OpenAIRE

    Kong, Jing; Liu, Bin-Bin; Wu, Shuo-Dong; Wang, Yu; Jiang, Qing-Quan; Guo, En-Ling

    2014-01-01

    We induced gallstones in C57L mice fed with a high cholesterol diet and examined the expression of bile salt export pump (BSEP) on the canalicular membrane of hepatocytes and its relation with PKCα and HAX-1.Twenty-four gallstone-prone C57L mice were randomly assigned to receive a high cholesterol diet or a regular diet. Gallstone formation was recorded. BSEP, PKCα and phospho-PKCα expression was examined by immunoblotting assays. Co-expression of BSEP and HAX-1 was studied by immunofluoresce...

  9. Cholelithiasis in Children and Surgery Indication. A Case Report Litiasis vesicular en niño e indicación de tratamiento quirúrgico. Presentación de un caso

    Directory of Open Access Journals (Sweden)

    Jorge Luís Estepa Pérez

    2012-02-01

    Full Text Available

    The case of a 9 years old male patient is presented. The patient is Bolivian, from Yacuiba, Tarija department and had a history of anemia in his infant stage. His mother brought him to the General Surgery Consultation in the ‘’ Ruben Zelaya’’ General Community Hospital because of dyspeptic stools, diarrhea and occasional abdominal pain with a 6 months evolution. Abdominal ultrasound was performed which confirmed the presence of gallstones, for which a cholecystectomy was performed. The patient evolved satisfactorily, thus allowing his hospitalary discharge in a 72 hours time lapse. Because of the weirdness of this case it was decided to have it published.

    Se presenta el caso de un paciente de 9 años de edad, sexo masculino, boliviano, natural de Yacuiba, departamento de Tarija, con antecedentes de padecer de anemia en su etapa de lactante, que acudió con su mamá a la consulta de Cirugía General del Hospital Integral Comunitario Rubén Zelaya por  presentar trastornos dispépticos, deposiciones diarreicas, dolor abdominal en ocasiones, con un tiempo de evolución de 6 meses. Se realizó una ecografía abdominal donde se confirmó la presencia de litiasis vesicular, para la cual se le realizó una colecistectomía. Presentó una evolución satisfactoria, lo cual permitió su alta hospitalaria a las 72 horas. Por lo poco común del caso se decide su publicación.

  10. Clinical study of Danning Tablets for prevention of recurrence of cholelithiasis after minimally invasive cholecystolithotomy%胆宁片预防微创保胆取石术后结石复发的临床观察

    Institute of Scientific and Technical Information of China (English)

    徐佳

    2012-01-01

    目的 探讨胆宁片在预防微创保胆取石术后对胆囊结石复发的作用.方法 收集我院2009年5月~2011年9月行保胆取石术98例患者的临床资料.患者术后被分为两组,54例口服胆宁片(治疗组),44例仅随访(对照组),B超观察两组结石复发情况.结果 术后随访6~12个月,治疗组结石复发率为3.7%(2/54),对照组结石复发率为6.8%(3/44),差异有统计学意义(P 0.05). Conclusion Correct judgment of surgical and non-surgical treatment indications, reasonable choice of early rehabilitation , the two treatment methods both can get high satisfaction.

  11. 载脂蛋白E基因多态性和胆囊结石形成关系的研究进展%Advances in the study on genetic polymorphism of a polipoprotein E and cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    唐兆贺; 汤文浩

    2001-01-01

    载脂蛋白E(ApoE)是一种影响脂蛋白代谢的遗传多态性蛋白,它有E2、E3和E4 3种异构体,分别由3个等位基因ε2、ε3和ε4编码.不同表型的ApoE通过调节脂代谢来影响胆囊胆固醇结石的形成,其中ApoE4是促进胆囊结石发生的高危因子.

  12. Relation of bile salt transporters BSEP, MRP2 and NTCP to cholelithiasis%胆囊结石形成与胆盐转运子BSEP、MRP2、NTCP关系的研究

    Institute of Scientific and Technical Information of China (English)

    孔凡民; 隋春阳; 李航宇; 李昱骥; 胡勇; 郭仁宣; 郭克建; 田雨霖

    2006-01-01

    目的探讨不同的胆盐转运子(BSEP、MRP2、NTCP)与胆囊结石形成的关系.方法胆囊结石病人的肝组织标本20例,正常肝组织标本10例.应用逆转录聚合酶链反应(RT-PCR)技术和Western blot技术检测BSEP、MRP2、NTCPmRNA和蛋白的表达.结果(1)胆囊结石病人的肝组织中的BSEP、MRP2和NTCP mRNA的表达较正常肝组织减少,光密度平均值分别为0.47±0.18、1.12±0.39和0.56±0.31,而正常肝的组织中相应的光密度值分别为0.90±0.42、2.48±0.89和0.76±0.28.统计分析结果显示,BSEP、MRP2在两组间均存在显著性差异(P<0.01),而NTCP在两组间无统计学差异(P>0.05).(2)所有组织中BSEP、MRP2蛋白均有表达,但胆囊结石病人的肝组织中BSEP、MRP2蛋白的表达要显著低于正常的肝组织(P<0.01).结论胆囊结石病人肝组织中BSEP、MRP2的mRNA和蛋白的表达均下降,BSEP、MRP2的表达降低可能与胆囊结石的形成有关.NTCP可能与结石的形成无关.

  13. Duodenal Ampulla Ulcer、Cholelithiasis Combine With Billiary-duodenal Fistula%十二指肠球部溃疡、胆石症合并胆囊十二指肠瘘1例

    Institute of Scientific and Technical Information of China (English)

    王崇文; 邹平稳; 张小燕; 付唆林

    2016-01-01

    胆囊十二指肠漏是胆囊十二指肠之间形成的病理性通道,临床上少见,由于其无特异的临床症状,且早期胃镜阳性检查难发现瘘口,易漏诊.本文对我院1例十二指肠球部溃疡、胆石症合并胆囊十二指肠瘘的临床资料进行回顾性分析,并对该疾病的诊断及治疗做经验性总结.

  14. 腹腔镜下胆囊切除术与常规开腹胆囊切除术治疗胆结石的临床效果研究%Research of clinical effects of laparoscopic cholecystectomy and conventional open cholecystectomy in the treatment of cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    贺志敬

    2015-01-01

    目的:比较腹腔镜下胆囊切除术与常规开腹胆囊切除术治疗胆结石的临床效果。方法90例胆结石患者,随机分为观察组(45例)与对照组(45例),观察组行腹腔镜下胆囊切除术治疗,对照组行常规开腹胆囊切除术治疗,比较两种术式手术时间、术中出血量、排气时间、下床时间、住院时间及并发症发生情况。结果观察组手术时间(53.35±5.11)min、术中出血量(43.85±12.64)ml、排气时间(11.34±5.30)h、下床时间(11.62±3.67)h、住院时间(6.28±2.67)d低于对照组(77.68±11.54)min、(75.20±18.32)ml、(19.65±7.43)h、(25.60±4.35)h、(8.85±1.30)d,差异均具有统计学意义(P lower operation time (53.35±5.11) min, intraoperative bleeding volume (43.85±12.64) ml, evacuation time (11.34±5.30) h, off-bed time (11.62±3.67) h, and hospital stay (6.28±2.67) d than those of the control group as (77.68±11.54) min, (75.20±18.32) ml, (19.65±7.43) h, (25.60±4.35) h, and (8.85±1.30) d, and their differences all had statistical significance (P<0.05). The total incidence of complications of the observation group as 4.44% (2/45) was lower than 17.78% (8/45) of the control group, and the difference had statistical significance (P<0.05).Conclusion Laparoscopic cholecystectomy has minimally invasive features, and it provides better indexes than conventional open cholecystectomy. This method contains high value in clinical application.

  15. 豚鼠胆汁酸盐输出泵(BSEP)基因克隆及其在胆结石豚鼠肝组织中的表达分析%Cloning of guinea pig bile salt export pump (BSEP) and analysis of its expressions in cholelithiasis guinea pig liver

    Institute of Scientific and Technical Information of China (English)

    黄名威; 唐乾利; 赫军; 俞渊; 王清坚; 黄炜

    2010-01-01

    目的 克隆并分析豚鼠BSEP基因全长cDNA序列,检测BSEP基因在胆结石豚鼠肝组织中的表达. 方法 采用3'、5'RACE方法扩增获得豚鼠肝组织BSEP基因全长cDNA,用生物信息学方法对其进行分析鉴定.实时荧光定量PCR检测BSEP基因在胆结石豚鼠肝组织的表达. 结果 豚鼠BSEP基因全长cDNA 5 579 bp,共包含28个外显子,开放性阅读框(ORF)长为3963 bp,编码蛋白长1 320个氨基酸.该基因在胆结石豚鼠肝组织的表达较正常豚鼠显著下调(P<0.01). 结论 BSEP基因在胆结石豚鼠肝组织中表达下调可能与结石形成有关.

  16. Early modification of sickle cell disease clinical course by UDP-glucuronosyltransferase 1A1 gene promoter polymorphism

    OpenAIRE

    Martins, R.; Morais, A.; Dias, A; Soares, I; Rolão, C; Ducla-Soares, J; Braga, L.; Seixas, T.; Nunes, B.; Olim, G; Romão, L; Lavinha, J; Faustino, P

    2008-01-01

    Elevated erythrocyte destruction in sickle cell disease (SCD) results in chronic hyperbilirubinaemia and, in a subset of patients, cholelithiasis occurs. We investigated whether the (TA)n promoter polymorphism in the UDP-glucuronosyltransferase 1A1 gene (UGT1A1) may modify bilirubin metabolism, influencing bilirubinaemia, predisposition to cholelithiasis and subsequent cholecystectomy, in a group of 153 young SCD patients (mean age 12.0 +/- 9.0 years) predominantly of Bantu beta S haplotype. ...

  17. Analysis of Cases of Nonvisualized Gallbladder by Ultrasonography *

    OpenAIRE

    Chung, Jae Bock; Yim, Dae Soon; Chon, Chae Yoon; Moon, Young Myoung; Kang, Jin Kyung; Park, In Suh; Choi, Heung Jai

    1987-01-01

    To define the significance of nonvisualization of the gallbladder by ultrasonography, we studied follow-up data on 31 cases in which the gallbladder could not be identified despite adequate fasting. Thirty one cases of gallbladder disease included 15 cases of chronic cholecystitis due to cholelithiasis (13 cases) and choledocholithiasis (2 cases), 4 cases of cholelithiasis which were not surgerized, and 3 cases of cancer. There were 4 cases of diagnostic error in which gallbladder nonvisualiz...

  18. Multiparameter correlation microscopy of blood plasma polycrystalline networks in the diagnosis of cancer tissues of female reproductive system

    Science.gov (United States)

    Koval, G. D.; Balazyuk, V. N.; Sidor, M. I.

    2013-09-01

    The principles of optical model of human bile polycrystalline structure are described. The results of investigating the interrelation between the values of statistical, correlation and fractal parameters are presented. They characterize the coordinate distributions of mutual polarization degree of the points of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  19. Association between thyroid function and gallstone disease

    Institute of Scientific and Technical Information of China (English)

    Henry V(o)lzke; Daniel M Robinson; Ulrich John

    2005-01-01

    AIM: To investigate those associations using data of the population-based Study of Health in Pomerania.METHODS: A study population of 3 749 residents aged 20-79 years without previously diagnosed thyroid disease was available for analyses. Serum TSH was used to assess thyroid function. Cholelithiasis was defined by either a prior history of cholecystectomy or the presence of gallstones on ultrasound. Logistic regression was performed to analyze independent associations between thyroid function and cholelithiasis.RESULTS: There were 385 persons (10.3%) with low (<0.3 mIU/L), 3 321 persons (88.6%) with normal and 43 persons (1.2%) with high serum TSH levels (>3 mIU/L).The proportion of cholelithiasis among males and females was 14.4% and 25.3%, respectively. Among males, there was an independent relation between high serum TSH and cholelithiasis (OR 3.77; 95%-CI 1.06-13.41; ,P<0.05). zAlso among males, there was a tendency towards an elevated risk of cholelithiasis in persons with low serum TSH (OR 1.40; 95%-CI 0.96-2.02; P = 0.07). In the female population, no such relation was identified.CONCLUSION: There is an association between thyroid and gallstone disease with a gender-specific relation between hypothyroidism and cholelithiasis.

  20. Studies on gallstone in China

    Institute of Scientific and Technical Information of China (English)

    Jing-Sen Shi; Jing-Yun Ma; Li-Hong Zhu; Bo-Rong Pan; Wang Zuo-Ren; Lian-Sheng Ma

    2001-01-01

    @@ INTRODCTlON Gallstone is one of the common primary diseases of bile system. Chinese researchers have done comprehensive and thorough studies on it, but there are still some problems we have not solved. It is necessary to review the achievements we have made in this field recently, to summarize the experiences and find the tendency so as to provide a sound foundation for the researches in the new century. Due to the popularization of molecular biological research methods, a rapid development of modern imaging techniques and medical equipment, the basic and clinical studies of cholelithiasis have set foot on the fast lane. Studies on the cause of cholelithiasis formation and its prevention have covered areas from epidemiological investigation at macroscopical level to molecular biological researches at microcosmic level. Clinical studies include prevention and treatment of cholelithiasis with traditional Chinese medicine, popularization of micro-injury surgery,treatment of complicated calculus of bile duct, and other aspects.

  1. Diagnostic imaging in Bouveret's syndrome. A report of two cases

    International Nuclear Information System (INIS)

    Bouveret's syndrome is an uncommon disorder that consists of localized obstruction of the pyloroduodenal region caused by the passage of a gallstone through a cholecystoenteric fistula. It is most common in elderly women with a previous history of cholelithiasis. As the clinical signs are nonspecific, radiological studies are of great importance in the attempt to reach an early diagnosis, thus improving the prognosis. We present two patients with a history of cholelithiasis in whom Bouveret's syndrome was diagnosed preoperatively by different imaging techniques. (Author) 8 refs

  2. Diagnostic imaging in Bouveret's syndrome. A report of two cases; Diagnostico por imagen del sindrome de Bouveret. A proposito de dos casos

    Energy Technology Data Exchange (ETDEWEB)

    Aguirre, I.; Echevarria, J. J.; Vidales, L.; Abaitua, J. M. [Hospital del Galdacano. Vizacaya (Spain)

    2001-07-01

    Bouveret's syndrome is an uncommon disorder that consists of localized obstruction of the pyloroduodenal region caused by the passage of a gallstone through a cholecystoenteric fistula. It is most common in elderly women with a previous history of cholelithiasis. As the clinical signs are nonspecific, radiological studies are of great importance in the attempt to reach an early diagnosis, thus improving the prognosis. We present two patients with a history of cholelithiasis in whom Bouveret's syndrome was diagnosed preoperatively by different imaging techniques. (Author) 8 refs.

  3. The role of intravenous cholangio-cholecystography in assessment of asymptomatic choledocholithiasis

    OpenAIRE

    Stojanović Dragoš Lj.; Stojanović Mirjana; Čaparević Zorica; Lalošević Đorđe J.; Bojković Gradimir; Milojević Predrag S.

    2003-01-01

    Introduction Standard diagnostic procedures (anamnesis, physical examination, laboratory analyses, ultrasound diagnosis), commonly used in diagnosis and preparation for surgical intervention of patients with cholelithiasis, are in most cases a reliable indicator for evaluation of the disease and conditions planned for surgery. Discussion In some cases by application of these narrow diagnostic models, some conditions, anatomic variations and biliary tract malformations remain unrecognized. Asy...

  4. Gall bladder dysmotility : a risk factor for gall stone formation in hypertriglyceridaemia and reversal on triglyceride lowering therapy by bezafibrate and fish oil

    NARCIS (Netherlands)

    Jonkers, IJAM; Smelt, AHM; Ledeboer, M; Hollum, ME; Biemond, I.; Kuipers, F; Stellaard, F; Boverhof, R; Meinders, AE; Lamers, CHBW; Masclee, AAM

    2003-01-01

    Background and aim: The aim of this study was to unravel the mechanisms responsible for the increased risk of gall stone disease in hypertriglycericlaemia (HTG) and to compare the effects of triglyceride lowering therapy by bezafibrate and fish oil on determinants of cholelithiasis (biliary lipid co

  5. Ligadura videolaparoscópica da artéria mesentérica inferior como tratamento de endoleak persistente após correção endovascular de aneurisma de aorta abdominal Videolaparoscopic ligation of inferior mesenteric artery as a treatment of persistent endoleak after endoluminal abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Gaudencio Espinosa

    2002-04-01

    Full Text Available Videolaparoscopy has been widely used in the treatment of pathologies as cholelithiasis, appendicitis and adrenal tumor. Nowadays, has also been used to treat type II endoleaks after endovascular repair of abdominal aortic aneurysms. The goal of this work is to report one case of inferior mesenteric artery endoleak treated by videolaparoscopy.

  6. System of polarization correlometry of biological liquids layers polycrystalline structure

    Science.gov (United States)

    Ushenko, A. G.; Boychuk, T. M.; Mincer, O. P.; Angelsky, P. O.; Bodnar, N. B.; Oleinichenko, B. P.; Bizer, L. I.

    2013-09-01

    A model of generalized optical anisotropy of human bile is suggested and a method of polarimetric of the module and phase Fourier of the image of the field of laser radiation is analytically substantiated, that is generated by the mechanisms of linear and circular birefringence of polycrystalline networks with a diagnosis and differentiation of cholelithiasis against a background of chronic cholecystitis.

  7. Risk factors for conversion during laparoscopic cholecystectomy - experiences from a general teaching hospital.

    NARCIS (Netherlands)

    Steeg, H.J.J. van der; Alexander, S.; Houterman, S.; Slooter, G.D.; Roumen, R.M.

    2011-01-01

    BACKGROUND AND AIMS: Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic cholelithiasis. Conversion, however, is sometimes necessary. The aim of this study was to determine predictive factors of conversion in patients undergoing LC for various indications in elective and

  8. 胆石症手术的护理

    Institute of Scientific and Technical Information of China (English)

    曹晓红; 张祖平

    2013-01-01

    胆石症是胆道系统常见病。本文通过对我院42例胆石症手术病人的观察与护理,总结出术后加强 T 型管及腹腔引流管的护理,采取有效措施预防并发症的发生是提高手术成功率的关键。%cholelithiasis is systematic common illnesses of biliary tract .The main body of a book is passed to my observation and nursing of 42 regular yard cholelithiasis operation patient ,is sums up out the nursing reinforcing the T type tube and the abdominal cavity drainage tube after the skill ,is takes effective measures taking precautions against complication's the key being to improve operation success rate hap-pened .

  9. Gall bladder carcinoma: Aggressive malignancy with protean loco-regional and distant spread

    OpenAIRE

    Dwivedi, Amit Nandan Dhar; Jain, Shivi; Dixit, Ruhi

    2015-01-01

    The most common malignancy of biliary tract is gallbladder cancer (GBC) which is the third most common cancer in gastrointestinal tract. It is a lethal disease for most patients in spite of growing awareness and improved diagnostic techniques. GBC has a very poor prognosis and the 5 year survival rate is < 10%. Although etiology of the carcinoma of the gallbladder is still obscure, various factors have been implicated, cholelithiasis being the most frequent. The incidence of GBC worldwide is ...

  10. Oral Cholecystography and Sonography of Gallbladder in Cholecystectomy Patients

    OpenAIRE

    Robles, Antonio; Devor, Daniel; Wang, Hansen; Warren, Charles

    1987-01-01

    In comparing the diagnostic specificity and sensitivity of oral cholecystography with that of sonography in 479 patients in a community hospital, the oral cholecystogram, when used with a double dose of contrast agent, showed greater specificity (1.00) and sensitivity (0.99) than the sonogram (0.54 and 0.94, respectively). Because of lower cost, the oral cholecystogram should be used as the initial diagnostic study when cholelithiasis is suspected, unless specific contraindications exist.

  11. Multi-locus variable-number tandem repeat profiling of Salmonella enterica serovar Typhi isolates from blood cultures and gallbladder specimens from Makassar, South-Sulawesi, Indonesia.

    Directory of Open Access Journals (Sweden)

    Mochammad Hatta

    Full Text Available Multi-locus variable-number tandem repeat analysis differentiated 297 Salmonella enterica serovar Typhi blood culture isolates from Makassar in 76 genotypes and a single unique S. Typhi genotype was isolated from the cholecystectomy specimens of four patients with cholelithiasis. The high diversity in S. Typhi genotypes circulating in Makassar indicates that the number of carriers could be very large, which may complicate disease prevention and control.

  12. Extracorporeal shock wave therapy in periodontics: A new paradigm

    OpenAIRE

    Munivenkatappa Lakshmaiah Venkatesh Prabhuji; Shaeesta Khaleelahmed; Sujatha Vasudevalu; K. Vinodhini

    2014-01-01

    The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morph...

  13. Evaluation of the response of cortisol, corticotropin and blood platelets kinetics after laparoscopic and open cholecystectomy

    OpenAIRE

    Crema Eduardo; Ribeiro Elisangela Neto; Hial Ana Marcela; Alves Júnior Juverson Terra; Pastore Ricardo; Silva Alex Augusto

    2005-01-01

    PURPOSE: To compare the behavior of serum cortisol and ACTH levels and platelet kinetics after laparoscopic and open cholecystectomy. METHODS: In this prospective study, 31 patients with symptomatic cholelithiasis submitted to elective cholecystectomy, 17 by the laparoscopic route and 14 by the open route, were compared. Peripheral blood samples were collected on admission of the patient, during anesthetic induction, and 2, 6, 12, 24 and 48 hours after the surgical incision. Platelets were co...

  14. Evaluation of the response of cortisol, corticotropin and blood platelets kinetics after laparoscopic and open cholecystectomy Avaliação da resposta do cortisol, da corticotropina e da cinética das plaquetas após colecistectomias laparoscópica e aberta

    OpenAIRE

    Eduardo Crema; Elisangela Neto Ribeiro; Ana Marcela Hial; Juverson Terra Alves Júnior; Ricardo Pastore; Alex Augusto Silva

    2005-01-01

    PURPOSE: To compare the behavior of serum cortisol and ACTH levels and platelet kinetics after laparoscopic and open cholecystectomy. METHODS: In this prospective study, 31 patients with symptomatic cholelithiasis submitted to elective cholecystectomy, 17 by the laparoscopic route and 14 by the open route, were compared. Peripheral blood samples were collected on admission of the patient, during anesthetic induction, and 2, 6, 12, 24 and 48 hours after the surgical incision. Platelets were co...

  15. Structurally abnormal insulin in a diabetic patient. Characterization of the mutant insulin A3 (Val----Leu) isolated from the pancreas.

    OpenAIRE

    Sakura, H; Iwamoto, Y; Sakamoto, Y; Kuzuya, T; Hirata, H

    1986-01-01

    We have recently identified a diabetic patient with marked fasting hyperinsulinemia. Family study revealed that the abnormality was an autosomal dominant trait. High-performance liquid chromatography (HPLC) profile of the patient's serum insulin showed that she had an abnormal insulin in addition to a normal insulin. We have purified her insulin(s) from the specimen of her pancreas, which was biopsied during an operation of cholelithiasis. Insulin was also immunologically purified from the se...

  16. Transumbilical single-incision laparoscopic hepatectomy: an initial report

    Institute of Scientific and Technical Information of China (English)

    HU Ming-gen; ZHAO Guo-dong; XU Da-bing; LIU Rong

    2011-01-01

    Transumbilical single-incision laparoscopic surgeries have attracted the attention of surgeon. Here we report a patient with multiple hepatic hemagiomas and symptomatic cholelithiasis who underwent laparoscopic left lateral hepatecomy and left hepatic hemangioma enucleation with single incision followed by cholecystectomy. The duration of the operation was 155 minutes and the blood loss was 100 ml. There were no complications during or after the treatment. This surgical treatment yields a good cosmetic effect and rapid recovery.

  17. 4) 一般・消化器外科領域における輸血準備(シンポジウム 血液製剤の輸血適応と問題点, 1986年, 第420回新潟医学会例会)

    OpenAIRE

    塚田, 一博; 武藤, 輝一; TSUKADA, Kazuhiro; Muto, Terukazu

    1987-01-01

    Bleeding volume and blood transfusion volume were studied according to surgical procedure in general and gastroenterological surgery. It seemed unnecessary for blood transfusion to be prepared under the type-and screen system of blood transfusion in breast carcinoma, cholelithiasis, thyroid diseases other than hyperthyroidism and carcinoma of the colon. To determine the proper use of plasma preparation (fresh frozen plasma, fresh plasma and etc.), which are widely used both during and after o...

  18. ESWL for difficult bile duct stones:A 15-year single centre experience

    Institute of Scientific and Technical Information of China (English)

    Rosangela; Muratori; Francesco; Azzaroli; Federica; Buonfiglioli; Flavio; Alessandrelli; Paolo; Cecinato; Giuseppe; Mazzella; Enrico; Roda

    2010-01-01

    AIM:To evaluate the efficacy of extracorporeal shock wave lithotripsy(ESWL)for the management of refractory bile duct cholelithiasis in a third level referral centre.METHODS:The clinical records of all patients treated with a second generation electromagnetic lithotripter (Lithostar Plus,SIEMENS)from October 1990 to April 2005 were evaluated.All patients were monitored during the procedure and antibiotics were administered in case of cholangitis.Theχ 2 test and logistic regression analysis were performed as...

  19. Is There a Place for Dietary Fiber Supplements in Weight Management?

    OpenAIRE

    Lyon, Michael R.; Kacinik, Veronica

    2012-01-01

    Inadequate dietary fiber intake is common in modern diets, especially in children. Epidemiological and experimental evidence point to a significant association between a lack of fiber intake and ischemic heart disease, stroke atherosclerosis, type 2 diabetes, overweight and obesity, insulin resistance, hypertension, dyslipidemia, as well as gastrointestinal disorders such as diverticulosis, irritable bowel disease, colon cancer, and cholelithiasis. The physiological effects of fiber relate to...

  20. High Fiber Diets: Their Role in Gastrointestinal Disorders

    OpenAIRE

    McDonald, Jane; Pirhonen, Diane; Rangam, Mary Ann

    1983-01-01

    High fiber diets may help prevent colon cancer and be used to treat constipation, diverticular disease, irritable bowel syndrome and Crohn's disease. Some research indicates that cholelithiasis, duodenal ulcers, hemorrhoids and hiatal hernias may be prevented or treated with dietary fiber. However, many claims about fiber's usefulness lack scientific validation. Physicians can help patients establish goals for the amount of fiber they eat and advise them to record their daily intake of fiber....

  1. Role of endoscopic ultrasound/SpyScope in diagnosis and treatment of choledocholithiasis in pregnancy

    Institute of Scientific and Technical Information of China (English)

    Mohit; Girotra; Niraj; Jani

    2010-01-01

    Cholelithiasis and choledocholithiasis occur frequently in pregnancy and their management can be complicated. Traditional endoscopic retrograde cholangiopancreatography(ERCP)is the first line treatment for choledocholithiasis,but in addition to its baseline risks,fluoroscopy poses an additional radiation risk to the fetus. Endoscopic ultrasound(EUS)is an accurate modality for detecting common bile duct stones,but its role has not been defined in pregnancy.We describe an alternative management strategy to co...

  2. Current Therapy and Future Directions in Biliary Tract Malignancies

    OpenAIRE

    Ciombor, Kristen K; Goff, Laura W.

    2013-01-01

    Cancers of the biliary tree represent a rare group of diseases with a devastating impact on patients. Gallbladder cancer is often associated with cholelithiasis. Cholangiocarcioma may arise in the setting of biliary inflammation such as primary sclerosing cholangitis but most commonly occurs in patients without a particular risk factor. Surgical removal of biliary cancer is essential for cure, but it is associated with a very high rate of recurrence and for many patients is not possible at th...

  3. Acute Cholecystitis Detected by Serial Emergency Department Focused Right Upper Quadrant Ultrasound

    Directory of Open Access Journals (Sweden)

    David Bosch

    2016-06-01

    Full Text Available Acute cholecystitis is a common etiology of acute right upper quadrant pain in patients presenting to the emergency department (ED. The use of ED-focused right upper quadrant ultrasound (RUQ US is becoming more widely utilized to evaluate abdominal pain thought to be hepatobiliary in nature. We describe a case series of two patients with acute cholecystitis detected by serial ED-focused RUQ US. Case 1: A woman presented to the ED with epigastric pain of acute onset. She was initially found to have a mild leukocytosis and cholelithiasis detected by ED-focused RUQ US. Seventy-five minutes later, the patient had a repeat bedside ultrasound by the same sonographer that showed visual evidence of acute cholecystitis that was later confirmed by surgical pathology. She was treated operatively. Case 2: A man with known cholelithiasis presents to the ED with acute-onset RUQ pain. Initial RUQ ultrasound performed by the Department of Radiology (University of Colorado Hospital was equivocal, showing cholelithiasis with a mildly thickened wall and no pericholecystic fluid. A repeat ED-focused RUQ ultrasound 5 hours later showed increased wall thickness and pericholecystic fluid. The patient was subsequently taken for same-day cholecystectomy. This case series demonstrates the dynamic and progressive nature of acute cholecystitis detected by ED-focused RUQ US. It also highlights how serial bedside ultrasonography can reduce harm, appropriately triage patients with hepatobiliary disease and lead to reductions in overall morbidity.

  4. CLINICO-PATHOLOGICAL STUDY OF CARCINOMA GALL BLADDER

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    Ravindra

    2015-12-01

    Full Text Available INTRODUCTION Gall bladder cancer is 5th most common cancer of GIT. It is associated with cholelithiasis in significant number of patients. Cholelithiasis is cause or effect of gall bladder cancer is still uncertain. There are many risk factors which are common to both gall stones and cancer. Preoperative diagnosis of gall bladder cancer is increased with better and new investigation facilities. AIM The study was aimed to assess clinicopathological behaviour, sociodemography, diagnostic modalities and treatment of cancer gall bladder. MATERIAL AND METHODS It was a type of prospective study which included 75 patients with clinical features suggestive of biliary disease. Various diagnostic modalities and treatment options were assessed along with sociodemography and clinical picture. RESULT Common clinical features were pain abdomen, obstructive jaundice and lump. Nearly one third of the patients were having anaemia and abnormal liver function tests. Majority had gall bladder fossa mass with liver extension and gall stones. The most common histopathological variety of carcinoma Gallbladder was Adenocarcinoma. CONCLUSION Carcinoma Gallbladder was found to affect predominantly the older female patients after the age of 40 years. Cholelithiasis was found in 69.3% patients of carcinoma Gallbladder. The most common clinical presentation was pain abdomen (90.7%. The most common histopathological variety of carcinoma Gallbladder was Adenocarcinoma. Majority of patients were treated with palliative measures.

  5. Biliary Surgery Via Minilaparotomy — A Limited Procedure for Biliary Lithiasis

    Directory of Open Access Journals (Sweden)

    Takukazu Nagakawa

    1993-01-01

    Full Text Available Cholelithiasis until now has been treated using solvents, lithotripsy via a biliary endoscope, laser or shock wave lithotripsy, and laparoscopic cholecystectomy. have developed a new surgical treatment for cholelithiasis in which a cholecystectomy is performed through a minilaparotomy. This paper presents this new technique and discusses the principles of surgery for cholelithiasis using this technique. This procedure is performed by a 2 to 3 cm subcostal skin incision in the right hypochondrium. More than 400 patients were treated by this technique. This procedure is not different in terms of blood loss .or operation time from conventional methods, and no significant complications have occurred. Intraoperative X-ray examination is performed routinely because of easy insertion of a tube from the cystic duct into the bile duct. Reduction of the length of the incision greatly facilitates postoperative recovery, shortening the hospital length-of-stay to within 3 days. The surgical manipulation of only a limited area of the upper abdomen is unlikely to induce postoperative syndromes, such as adhesions or ileus. Following this experience, a biliary drainage procedure based on cholangionmanomery and primary closure of the choledochotomy was introduced. This approach allowed even patients with choledocholithiasis to undergo a minilaparotomy and be discharged within one week.

  6. Identification of Serum Biomarkers for Biliary Tract Cancers by a Proteomic Approach Based on Time-of-Flight Mass Spectrometry

    International Nuclear Information System (INIS)

    Biliary tract cancers (BTCs) are lethal malignancies currently lacking satisfactory methods for early detection and accurate diagnosis. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) is a promising diagnostic tool for this disease. In this pilot study, sera samples from 50 BTCs and 30 cholelithiasis patients as well as 30 healthy subjects from a population-based case-control study were randomly grouped into training set (30 BTCs, 20 cholelithiasis and 20 controls), duplicate of training set, and blind set (20 BTCs, 10 cholelithiasis and 10 controls); all sets were analyzed on Immobilized Metal Affinity Capture ProteinChips via SELDI-TOF-MS. A decision tree classifier was built using the training set and applied to all test sets. The classification tree constructed with the 3,400, 4,502, 5,680, 7,598, and 11,242 mass-to-charge ratio (m/z) protein peaks had a sensitivity of 96.7% and a specificity of 85.0% when comparing BTCs with non-cancers. When applied to the duplicate set, sensitivity was 66.7% and specificity was 70.0%, while in the blind set, sensitivity was 95.0% and specificity was 75.0%. Positive predictive values of the training, duplicate, and blind sets were 82.9%, 62.5% and 79.2%, respectively. The agreement of the training and duplicate sets was 71.4% (Kappa = 0.43, u = 3.98, P < 0.01). The coefficient of variations based on 10 replicates of one sample for the five differential peaks were 15.8–68.8% for intensity and 0–0.05% for m/z. These pilot results suggest that serum protein profiling by SELDI-TOF-MS may be a promising approach for identifying BTCs but low assay reproducibility may limit its application in clinical practice

  7. Results obtained with ultrasound and X-ray cholecystography in the diagnosis of the gall bladder

    International Nuclear Information System (INIS)

    In 205 patients examination of the gall bladder was carried out by cholecystography (per os or iv./) and by gray-scale echography. By comparative evaluations the iv. cholecystography proved to be the most accurate method (97.5%). Per os cholecystography and echocholecystography exhibited similar results (96% and 95.6% resp.). In the cases of acute cholecystitis, pancreatitis and jaundice echography is proposed, whereas in chronic biliary diseases peroral cholecystography is advised as the first radiological examination. If X-ray examination uncovers a non-filling gall bladder, echography may provide direct proof of cholelithiasis. (L.E.)

  8. The role of intravenous cholangio-cholecystography in assessment of asymptomatic choledocholithiasis

    Directory of Open Access Journals (Sweden)

    Stojanović Dragoš Lj.

    2003-01-01

    Full Text Available Introduction Standard diagnostic procedures (anamnesis, physical examination, laboratory analyses, ultrasound diagnosis, commonly used in diagnosis and preparation for surgical intervention of patients with cholelithiasis, are in most cases a reliable indicator for evaluation of the disease and conditions planned for surgery. Discussion In some cases by application of these narrow diagnostic models, some conditions, anatomic variations and biliary tract malformations remain unrecognized. Asymptomatic ('silent' choledocholithiasis (2.02% represents a special diagnostic and therapeutic problem. Conclusion Our extended diagnostic protocol includes routine intravenous cholangio-cholecystography as a standard diagnostic procedure for evaluation of cholecysto-choledocholithiasis prior planning cholecystectomy.

  9. Technetium-99m pyridoxylideneglutamate (P. G. ) cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Stadalnik, R.C.; Matolo, N.M.; Jansholt, A.L.; Krohn, K.A.; DeNardo, G.L.; Wolfman, E.F Jr.

    1976-12-01

    Technetium-99m P.G. cholescintigraphy was performed in 27 human volunteers and 81 patients referred for hepatobiliary tract disease. The gallbladder, biliary system, and gastrointestinal tract were well visualized in the normal patients and volunteers. The gallbladder was not visualized in 22 patients with histologically proved cholecystitis with cystic duct obstruction. Nine patients with complete extrahepatic obstruction of the common bile duct were correctly diagnosed. Hepatocellular disease and incomplete obstruction, with and without jaundice, were diagnosed with this technique. Oral cholecystography is superior to this method for the detection of cholelithiasis in nonjaundiced patients.

  10. Výživa jako rizikový faktor pro akutní pankreatitidu

    OpenAIRE

    PECHUŠKOVÁ, Pavlína

    2013-01-01

    Acute pancreatitis or acute inflammation of the pancreas is not one of the most common diseases. Pancreas is a vital organ involved in many important digestive processes and its infliction may be fatal. Patients with acute pancreatitis represent 1-2 % of patients hospitalized at surgical departments (Dobiáš, 2012). The most common ethiological factors of acute pancreatitis are cholelithiasis and excessive consumption of alcohol (Havel, 2004; Lukáš, 2007; Kasper, 2009; Svačina, 2010; Šimek, 20...

  11. Clinical characteristics of Caroli's syndrome

    Institute of Scientific and Technical Information of China (English)

    Ozlem Yonem; Yusuf Bayraktar

    2007-01-01

    Caroli's syndrome is characterized by multiple segmental cystic or saccular dilatations of intrahepatic bile ducts associated with congenital hepatic fibrosis. The clinical features of this syndrome reflect both the characteristics of congenital hepatic fibrosis such as portal hypertension and that of Caroli's disease named as recurrent cholangitis and cholelithiasis. The diagnosis depends on both histology and imaging methods which can show the communication between the sacculi and the bile ducts. Treatment consists of symptomatic treatment of cholangitis attacks by antibiotics, some endoscopic,radiological and surgical drainage procedures and surgery. Liver transplantation seems the ultimate treatment for this disease. Prognosis is fairly good unless recurrent cholangitis and renal failure develops.

  12. Twenty-five years of ambulatory laparoscopic cholecystectomy.

    Science.gov (United States)

    Bueno Lledó, José; Granero Castro, Pablo; Gomez I Gavara, Inmaculada; Ibañez Cirión, Jose L; López Andújar, Rafael; García Granero, Eduardo

    2016-10-01

    It is accepted by the surgical community that laparoscopic cholecystectomy (LC) is the technique of choice in the treatment of symptomatic cholelithiasis. However, more controversial is the standardization of system implementation in Ambulatory Surgery because of its different different connotations. This article aims to update the factors that influence the performance of LC in day surgery, analyzing the 25 years since its implementation, focusing on the quality and acceptance by the patient. Individualization is essential: patient selection criteria and the implementation by experienced teams in LC, are factors that ensure high guarantee of success.

  13. Opisthorchiasis in Thailand: Review and current status

    Institute of Scientific and Technical Information of China (English)

    Natthawut Kaewpitoon; Soraya J Kaewpitoon; Prasit Pengsaa

    2008-01-01

    Opisthorchiasis caused by Opisthorchis viverrini (O.viverrini)remains a major public health problem in many parts of Southeast Asia including Thailand, Lao PDR,Vietnam and Cambodia. The infection is associated with a number of hepatobiliary diseases, including cholangitis,obstructive jaundice, hepatornegaly, cholecystitis, cholelithiasis and cholangiocarcinoma. The liver fluke infection was induced by eating raw or uncooked fish products that is the tradition and popular in the northeastern and northern region, particularly in rural areas of Thailand.Health education programs to prevent and control opisthorchiasis are still required in high-risk areas.

  14. Endoscopic management of biliary leaks after laparoscopic cholecystectomy.

    Science.gov (United States)

    Rustagi, Tarun; Aslanian, Harry R

    2014-09-01

    Laparoscopic cholecystectomy has become the procedure of choice for management of symptomatic cholelithiasis. Although it has distinct advantages over open cholecystectomy, bile leak is more common. Endoscopic retrograde cholangiopancreatography is the diagnostic and therapeutic modality of choice for management of postcholecystectomy bile leaks and has a high success rate with the placement of plastic biliary stents. Repeat endoscopic retrograde cholangiopancreatography with placement of multiple plastic stents, a covered metal stent, or possibly cyanoacrylate therapy may be effective in refractory cases. This review will discuss the indications, efficacy, and complications of endoscopic therapy.

  15. Meralgia paraesthetica: Laparoscopic surgery as a cause then and a cure now

    Directory of Open Access Journals (Sweden)

    Pradeep Jagdish Chopra

    2014-01-01

    Full Text Available Meralgia Paraesthetica (MP is a rare condition, in which the patient experiences a burning sensation along the distribution of the lateral femoral cutaneous nerve of the thigh, due to entrapment neuropathy at the lateral end of the inguinal ligament as it exits the pelvis. There are several causes of this condition including laparoscopic inguinal hernioplasty. Diagnosed clinically, intervention is indicated for failed conservative measures. We herewith report a patient with MP and symptomatic cholelithiasis, treated for both laparoscopically. This is the third reported case in the literature that has been treated laparoscopically.

  16. Obstructive choledocholithiasis requiring intervention in a three week old neonate: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Lindsay E. Peters

    2016-01-01

    Full Text Available The discovery of cholelithiasis in neonates is often incidental, however obstructing common bile duct stones are rare. Herein we report the case of a 3 week old neonate who presented with obstructive choledocholithiasis. The patient was treated conservatively with antibiotics and ursodeoxycholic acid but did not improve. He was therefore taken to surgery for cholecystectomy and stone extraction. The operation was successful and his transaminases and bilirubin levels declined. Trials of conservative management can be attempted in asymptomatic infants with choledocholithiasis. However, failure of the stone to pass or ongoing signs of cholecystitis should be met with operative intervention to remove the obstruction.

  17. ABO Blood Group. Related Investigations and Their Association with Defined Pathologies

    Directory of Open Access Journals (Sweden)

    Ursula Jesch

    2007-01-01

    Carriers of blood group O suffered from ulcus ventriculi and gastritis (X21 = 78.629, p <0.001, colitis ulcerosa and duodenitis (X21 = 5.846, p < 0.016, whereas male patients carrying blood group A tended to contract different types of tumours. In patients with intestinal tumours, females with blood group A were more likely to develop the pathology, whereas in males, the blood group O dominated. The development of cholelithiasis was found, above all, in patients with blood group O, which differed from other research where a correlation between this pathology and blood group A was found.

  18. Efficacy of respiratory-triggered fast spin echo MR cholangiopancreatography on intermediate MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Isomoto, Ichiro; Koshiishi, Takeshi [National Saga Hospital (Japan); Hayashi, Kuniaki

    1996-06-01

    MR cholangiopancreatography (MRCP) using a respiratory-triggered fast spin-echo technique was performed on intermediate MR imaging in 26 patients with suspected biliary disease. In almost all of 12 patients without dilated biliary tract, the hilum of the liver and extrahepatic bile duct were clearly visualized. All of 11 cases of cholelithiasis were demonstrated. In all 4 cases of obstructive jaundice, dilatation and obstruction of the bile ducts were clearly demonstrated. Respiratory-triggered fast spin-echo MRCP is a non-invasive technique for visualization of the biliary tract and biliary disease on intermediate MR imaging. (author)

  19. Clinical indications and accuracy of gray scale ultrasonography in the patient with suspected biliary tract disease.

    Science.gov (United States)

    Prian, G W; Norton, L W; Eule, J; Eiseman, B

    1977-12-01

    One hundred patients with suspected biliary tract disease underwent gray scale cholecystosonography (GSCS) and had diagnostic confirmation by oral cholecystogram (OCG) and/or operation. Ultrasonography demonstrated the gallbladder in 94 of the 100 patients; 2 patients had had previous cholecystectomy and 3 of the 4 remaining patients had documented stones with no confirmation of a nonvisualizing OCG in the other patient. Among the 88 patients with OCG, GSCS findings correlated in 91 per cent (2 per cent false-positive; 7 per cent false-negative). Among the 43 operative patients, GSCS was proven correct in 91 per cent (no false positive; 9 per cent false-negative). Of 12 patients with jaundice GSCS correlated with operative findings in 75 per cent (no false-positive; 25 per cent false-negative). Diagnostic errors occurred in patients with very small biliary calculi, particularly when a single stone was impacted in the cystic duct. Failure to identify the gallbladder with ultrasound signifies probable cholelithiasis in the patient without previous cholecystectomy. On the basis of this experience, we conclude that (1) GSCS is most useful when jaundice or acute illness precludes conventional studies; (2) GSCS provides an inexpensive, quick, accurate means of diagnosing cholelithiasis with a very high specificity (97 per cent) and moderate sensitivity (88 per cent); and (3) GSCS is the optimal diagnostic procedure for evaluating the biliary tract in the acutely ill, jaundiced, vomiting, allergic, and/or pregnant patient. PMID:596532

  20. Emergency surgeon-performed hepatobiliary ultrasonography.

    LENUS (Irish Health Repository)

    Kell, M R

    2012-02-03

    BACKGROUND: Acute hepatobiliary pathology is a common general surgical emergency referral. Diagnosis requires imaging of the biliary tree by ultrasonography. The accuracy and impact of surgeon-performed ultrasonography (SUS) on the diagnosis of emergent hepatobiliary pathology was examined. METHODS: A prospective study, over a 6-month period, enrolled all patients with symptoms or signs of acute hepatobiliary pathology. Patients provided informed consent and underwent both SUS and standard radiology-performed ultrasonography (RUS). SUS was performed using a 2-5-MHz broadband portable ultrasound probe by two surgeons trained in ultrasonography, and RUS using a 2-5-MHz fixed unit. SUS results were correlated with those of RUS and pathological diagnoses. RESULTS: Fifty-three consecutive patients underwent 106 ultrasonographic investigations. SUS agreed with RUS in 50 (94.3 per cent) of 53 patients. SUS accurately detected cholelithiasis in all but two cases and no patient was inaccurately diagnosed as having cholelithiasis at SUS (95.2 per cent sensitivity and 100 per cent specificity). As an overall complementary diagnostic tool SUS provided the correct diagnosis in 96.2 per cent of patients. Time to scan was significantly shorter following SUS (3.1 versus 12.0 h, P < 0.05). CONCLUSION: SUS provides a rapid and accurate diagnosis of emergency hepatobiliary pathology and may contribute to the emergency management of hepatobiliary disease.

  1. Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.

    Science.gov (United States)

    Parmar, Abhishek D; Coutin, Mark D; Vargas, Gabriela M; Tamirisa, Nina P; Sheffield, Kristin M; Riall, Taylor S

    2014-09-01

    Our objective was to determine the probability threshold for recurrent symptoms at which elective cholecystectomy compared to observation in older patients with symptomatic cholelithiasis is the more effective and cost-effective option. We built a decision model of elective cholecystectomy versus observation in patients >65 presenting with initial episodes of symptomatic cholelithiasis that did not require initial hospitalization or cholecystectomy. Probabilities for subsequent hospitalization, emergency cholecystectomy, and perioperative complications were based on previously published probabilities from a 5 % national sample of Medicare patients. Costs were estimated from Medicare reimbursements and from the Healthcare Cost and Utilization Project. Utilities (quality-adjusted life years, QALYs) were obtained from established literature estimates. Elective cholecystectomy compared to observation in all patients was associated with lower effectiveness (-0.10 QALYs) and had an increased cost of $3,422.83 per patient at 2-year follow-up. Elective cholecystectomy became the more effective option when the likelihood for continued symptoms exceeded 45.3 %. Elective cholecystectomy was both more effective and less costly when the probability for continued symptoms exceeded 82.7 %. An individualized shared decision-making strategy based on these data can increase elective cholecystectomy rates in patients at high risk for recurrent symptoms and minimize unnecessary cholecystectomy for patients unlikely to benefit. PMID:24919433

  2. Laparoscopic Cholecystectomy: An Experience of 200 cases

    Directory of Open Access Journals (Sweden)

    Sanjay K. Bhasin, J.G. Langer.

    2004-04-01

    Full Text Available The surgical management of gallstones has been revolutionized after the advent of laparoscopiccholecystectomysince 1985/87. This minimally invasive technique has virtually become the goldstandard in the management of cholelithiasis. We share our experience of 200 cases of laparoscopiccholecystectomyperformed in symptomatic cholelithiasis over a period of five years from 1998 to2002 in Govt. Medical College, Jammu. There were 32 males and 168 females in the study group.Maximum age of the patients was 65-yr and minimum 17-yr. Patients with high-risk medical problems;deranged LFT, CBD stones and acute cholecystitis were excluded from this study. Average operationtime was 61.3 minute (40-130 mt, post-operative analgesic used were 3.02 doses per patient (2-15doses, post-operative hospital stay was 4.34 days (2-26 days and time to return to work was 13.2days (10-40 days. Rate of conversion to conventional-cholecystectomy was 4%. There was nomortality and negligible/acceptable morbidity. No complications were observed in the follow up periodranging from 2 weeks to 6 months. The patients were quite satisfied with the outcome of the procedure.

  3. Therapy of gallstone disease:What it was,what it is,what it will be

    Institute of Scientific and Technical Information of China (English)

    Piero; Portincasa; Agostino; Di; Ciaula; Leonilde; Bonfrate; David; QH; Wang

    2012-01-01

    Cholesterol gallstone disease is a common clinical condition influenced by genetic factors,increasing age,female gender,and metabolic factors.Although laparoscopic cholecystectomy is currently considered the gold standard in treating patients with symptomatic gallstones,new perspectives regarding medical therapy of cholelithiasis are currently under discussion,also taking into account the pathogenesis of gallstones,the natural history of the disease and the analysis of the overall costs of therapy.A careful selection of patients may lead to successful nonsurgical therapy in symptomatic subjects with a functioning gallbladder harboring small radiolucent stones.The classical oral litholysis by ursodeoxycholic acid has been recently paralleled by new experimental observations,suggesting that cholesterol-lowering agents which inhibit cholesterol synthesis (statins) or intestinal cholesterol absorption (ezetimibe),or drugs acting on specific nuclear receptors involved in cholesterol and bile acid homeostasis,might be proposed as additional approaches for treating cholesterol gallstones.In this review we discuss old,recent and future perspectives on medical treatment of cholesterol cholelithiasis.

  4. Hemoperitoneo masivo consecutivo a perforación espontánea de la vesícula biliar: A propósito de un caso de muerte súbita Massive haemoperitoneum as a complication of spontaneous rupture of the gallbladder: Report of a sudden death

    Directory of Open Access Journals (Sweden)

    P.M. Garamendi

    2002-04-01

    Full Text Available Se presenta un caso de hemoperitoneo masivo consecutivo a perforación espontánea de la vesícula biliar asociada con colelitiasis, obstrucción del conducto cístico y colecistitis aguda hemorrágica que produjo como primera manifestación la muerte súbita en un varón adulto. En la literatura médica este tipo de situación clínica y anatomopatológica es excepcional. Los casos descritos de perforaciones espontáneas de la vesícula biliar con hemoperitoneo asociado son menos de 50 desde 1858. Desde 1952 solo existe otra referencia de 1991 de un hallazgo similar, aunque no asociado a colelitiasis, como causa de muerte súbita.We report a case of sudden death due to massive haemoperitoneum as a complication of spontaneous rupture of the gallbladder associated with cholelithiasis, obstruction of the cystic duct and acute haemorrhagic cholecystitis. Death occurred in an adult male previously asymptomatic. This is an unusual circumstance in the medical literature. Since 1858, less than 50 cases of spontaneous rupture of the gallbladder associated with haemoperitoneum have been reported. Since 1952, there is only one other case of sudden death with this clinical condition, reported in 1991, but not associated with cholelithiasis.

  5. Gallstones in children with sickle cell disease followed up at a Brazilian hematology center Litíase biliar em crianças com doença falciforme acompanhadas em um centro de hematologia no Brasil

    Directory of Open Access Journals (Sweden)

    Ana Paula dos Santos Gumiero

    2008-12-01

    Full Text Available BACKGROUND: Sickle cell disease causes chronic and recurrent hemolysis which is a recognized risk factor for cholelithiasis. This complication occurs in 50% of adults with sickle cell disease. Surgery is the consensual therapy for symptomatic patients, but the surgical approach is still controversial in asymptomatic individuals. AIMS: To determine the frequency and to describe and discuss the outcome of children with sickle cell disease complicated with gallstones followed up at a tertiary pediatric hematology center. METHODS: In a retrospective and descriptive study, 225 charts were reviewed and data regarding patient outcome were recorded. RESULTS: The prevalence of cholelithiasis was 45% and half the patients were asymptomatic. The mean age at the time of diagnosis of cholelithiasis and surgical treatment was 12.5 years (standard deviation = 5 and 14 years (standard deviation = 5.4, respectively. The prevalence of cholelithiasis was higher in patients with SS homozygous and Sb heterozygous thalassemia when compared to patients with sickle cell disease. In 50% of symptomatic patients, recurrent abdominal pain was the single or predominant symptom. Thirty-nine of 44 patients submitted to surgery reported symptom relief after the surgical procedure. Asymptomatic individuals who did not undergo surgical treatment were followed up for 7 years (standard deviation = 4.8, and none of them presented complications related to cholelithiasis during this period. CONCLUSIONS: The frequency of cholelithiasis in the study population was 45%. One-third of the patients were diagnosed before 10 years of age. Patients with the SS homozygous or Sb heterozygous phenotype were at a higher risk for the development of cholelithiasis than patients with sickle cell disease. About 50% of patients with gallstones were asymptomatic, the most of them did not undergo surgery and did not present complications during a 7-year follow-up period. Cholecystectomy must be

  6. [Etiological factors of acute pancreatitis].

    Science.gov (United States)

    Spicák, J

    2002-09-01

    Acute pancreatitis develops immediately after the causative impulse, while chronic pancreatitis develops after the long-term action of the noxious agent. A typical representative of acute pancreatitis is biliary pancreatitis, chronic pancreatitis develops in alcoholism and has a long latency. As alcoholic pancreatitis is manifested at first as a rule by a potent attack, it is classified in this stage as acute pancreatitis. The most frequent etiological factors in our civilization are thus cholelithiasis and alcoholism (both account for 20-50% in different studies). The assumed pathogenetic principles in acute biliary pancreatitis are the common canal of both efferent ducts above the obturated papilla, duodenopancreatic reflux and intrapancreatic hypertension. A detailed interpretation is however lacking. The pathogenesis of alcoholic pancreatitis is more complicated. Among others some part is played by changes in the calcium concentration and fusion of cellular membranes. Idiopathic pancreatitis occurs in up to 10%, part of the are due to undiagnosed alcoholism and cholelithiasis. Other etiologies are exceptional. Similarly as in cholelithiasis pancreatitis develops also during other pathological processes in the area of the papilla of Vater such as dysfunction of the sphincter of Oddi, ampulloma and juxtapapillary diverticulum, it is however usually mild. The incidence of postoperative pancreatitis is declining. Its lethality is 30% and the diagnosis is difficult. In the pathogenesis changes of the ion concentration are involved, hypoxia and mechanical disorders of the integrity of the gland. Pancreatitis develops in association with other infections--frequently in mumps, rarely in hepatitis, tuberculosis, typhoid and mycoses. Viral pancreatitis is usually mild. In parasitoses pancreatitis develops due to a block of the papilla Vateri. In hyperparathyroidism chronic pancreatitis is more likely to develop, recent data are lacking. As to dyslipoproteinaemias

  7. Gallbladder cancer: epidemiology and outcome

    Directory of Open Access Journals (Sweden)

    Hundal R

    2014-03-01

    Full Text Available Rajveer Hundal, Eldon A Shaffer Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada Abstract: Gallbladder cancer, though generally considered rare, is the most common malignancy of the biliary tract, accounting for 80%-95% of biliary tract cancers. An early diagnosis is essential as this malignancy progresses silently with a late diagnosis, often proving fatal. Its carcinogenesis follows a progression through a metaplasia-dysplasia-carcinoma sequence. This comprehensive review focuses on and explores the risks, management, and outcomes for primary gallbladder carcinoma. Epidemiological studies have identified striking geographic and ethnic disparities – inordinately high occurrence in American Indians, elevated in Southeast Asia, yet quite low elsewhere in the Americas and the world. Age, female sex, congenital biliary tract anomalies, and a genetic predisposition represent important risk factors that are immutable. Environmental triggers play a critical role in eliciting cancer developing in the gallbladder, best exemplified by cholelithiasis and chronic inflammation from biliary tract and parasitic infections. Mortality rates closely follow incidence; those countries with the highest prevalence of gallstones experience the greatest mortality from gallbladder cancer. Vague symptoms often delay the diagnosis of gallbladder cancer, contributing to its overall progression and poor outcome. Surgery represents the only potential for cure. Some individuals are fortunate to be incidentally found to have gallbladder cancer at the time of cholecystectomy being performed for cholelithiasis. Such an early diagnosis is imperative as a late presentation connotes advanced staging, nodal involvement, and possible recurrence following attempted resection. Overall mean survival is a mere 6 months, while 5-year survival rate is only 5%. The dismal prognosis, in part, relates to the

  8. [Etiological factors of acute pancreatitis].

    Science.gov (United States)

    Spicák, J

    2002-09-01

    Acute pancreatitis develops immediately after the causative impulse, while chronic pancreatitis develops after the long-term action of the noxious agent. A typical representative of acute pancreatitis is biliary pancreatitis, chronic pancreatitis develops in alcoholism and has a long latency. As alcoholic pancreatitis is manifested at first as a rule by a potent attack, it is classified in this stage as acute pancreatitis. The most frequent etiological factors in our civilization are thus cholelithiasis and alcoholism (both account for 20-50% in different studies). The assumed pathogenetic principles in acute biliary pancreatitis are the common canal of both efferent ducts above the obturated papilla, duodenopancreatic reflux and intrapancreatic hypertension. A detailed interpretation is however lacking. The pathogenesis of alcoholic pancreatitis is more complicated. Among others some part is played by changes in the calcium concentration and fusion of cellular membranes. Idiopathic pancreatitis occurs in up to 10%, part of the are due to undiagnosed alcoholism and cholelithiasis. Other etiologies are exceptional. Similarly as in cholelithiasis pancreatitis develops also during other pathological processes in the area of the papilla of Vater such as dysfunction of the sphincter of Oddi, ampulloma and juxtapapillary diverticulum, it is however usually mild. The incidence of postoperative pancreatitis is declining. Its lethality is 30% and the diagnosis is difficult. In the pathogenesis changes of the ion concentration are involved, hypoxia and mechanical disorders of the integrity of the gland. Pancreatitis develops in association with other infections--frequently in mumps, rarely in hepatitis, tuberculosis, typhoid and mycoses. Viral pancreatitis is usually mild. In parasitoses pancreatitis develops due to a block of the papilla Vateri. In hyperparathyroidism chronic pancreatitis is more likely to develop, recent data are lacking. As to dyslipoproteinaemias

  9. [Pancreatic choristoma in the gallbladder: report of two cases].

    Science.gov (United States)

    Beltrán, Marcelo A; Barría, Carlos; Naquira, Cecilia; Almonacid, Jorge; Cruces, Karina S

    2007-10-01

    Pancreatic choristoma is the occurrence of normal pancreatic tissue in an abnormal location without any anatomic continuity with the main body of the gland. Although heterotopia is uncommon in the gallbladder and biliary tract, anecdotic cases of gastric mucosa, liver, adrenal gland and pancreas among other tissues have been described. We report an eight year-old male and a 22 year-old female, electively operated for symptomatic cholelithiasis. On pathology, a nodule identified as a pancreatic endocrine and exocrine choristoma, was found in the gallbladder wall of both patients. We employed immunohistochemistry to characterize this choristoma. Tubular and epithelial structures were immunoreactive to cytokeratins 7, 8, 18, 19 and 20 and to CA19-9. Exocrine activity was documented by immunoreactivity to al-antitrypsin and al-chemotrypsin. Other immunohistochemical markers such as insulin and somatostatin were positive identifying endocrine activity.

  10. Concerted spatial-frequency and polarization-phase filtering of laser images of polycrystalline networks of blood plasma smears

    Science.gov (United States)

    Ushenko, Yu A.

    2012-11-01

    The complex technique of concerted polarization-phase and spatial-frequency filtering of blood plasma laser images is suggested. The possibility of obtaining the coordinate distributions of phases of linearly and circularly birefringent protein networks of blood plasma separately is presented. The statistical (moments of the first to fourth orders) and scale self-similar (logarithmic dependences of power spectra) structure of phase maps of different types of birefringence of blood plasma of two groups of patients-healthy people (donors) and those suffering from rectal cancer-is investigated. The diagnostically sensitive parameters of a pathological change of the birefringence of blood plasma polycrystalline networks are determined. The effectiveness of this technique for detecting change in birefringence in the smears of other biological fluids in diagnosing the appearance of cholelithiasis (bile), operative differentiation of the acute and gangrenous appendicitis (exudate), and differentiation of inflammatory diseases of joints (synovial fluid) is shown.

  11. Opisthorchis viverrini:The carcinogenic human liver fluke

    Institute of Scientific and Technical Information of China (English)

    Natthawut Kaewpitoon; Soraya J Kaewpitoon; Prasit Pengsaa; Banchob Sripa

    2008-01-01

    Opisthorchiasis caused by Opisthorchis viverrini remains a major public health problem in many parts of Southeast Asia,including Thailand,Lao PDR,Vietnam and Cambodia.The infection is associated with a number of hepatobiliary diseases,including cholangitis,obstructive jaundice,hepatomegaly,cholecystitis and cholelithiasis.Multi-factorial etiology of cholangiocarcinoma,mechanical damage,parasite secretions,and immunopathology may enhance cholangiocarcinogenesis.Moreover,both experimental and epidemiological evidences strongly implicate liver fluke infection as the major risk factor in cholangiocarcinoma,cancer of the bile ducts.The liver fluke infection is induced by eating raw or uncooked fish products that is the tradition and popular in the northeastern and northern region,particularly in rural areas,of Thailand.The health education programs to prevent and control opisthorchiasis are still required in the high-risk areas.

  12. Acute Calculous Cholecystitis Missed on Computed Tomography and Ultrasound but Diagnosed with Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography

    Directory of Open Access Journals (Sweden)

    Carina Mari Aparici

    2016-01-01

    Full Text Available We present a case of a 69-year-old patient who underwent ascending aortic aneurysm repair with aortic valve replacement. On postsurgical day 12, he developed leukocytosis and low-grade fevers. The chest computed tomography (CT showed a periaortic hematoma which represents a postsurgical change from aortic aneurysm repair, and a small pericardial effusion. The abdominal ultrasound showed cholelithiasis without any sign of cholecystitis. Finally, a fluorodeoxyglucose (FDG-positron emission tomography (PET/CT examination was ordered to find the cause of fever of unknown origin, and it showed increased FDG uptake in the gallbladder wall, with no uptake in the lumen. FDG-PET/CT can diagnose acute cholecystitis in patients with nonspecific clinical symptoms and laboratory results.

  13. Acute Calculous Cholecystitis Missed on Computed Tomography and Ultrasound but Diagnosed with Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography.

    Science.gov (United States)

    Aparici, Carina Mari; Win, Aung Zaw

    2016-01-01

    We present a case of a 69-year-old patient who underwent ascending aortic aneurysm repair with aortic valve replacement. On postsurgical day 12, he developed leukocytosis and low-grade fevers. The chest computed tomography (CT) showed a periaortic hematoma which represents a postsurgical change from aortic aneurysm repair, and a small pericardial effusion. The abdominal ultrasound showed cholelithiasis without any sign of cholecystitis. Finally, a fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT examination was ordered to find the cause of fever of unknown origin, and it showed increased FDG uptake in the gallbladder wall, with no uptake in the lumen. FDG-PET/CT can diagnose acute cholecystitis in patients with nonspecific clinical symptoms and laboratory results. PMID:27625897

  14. Diagnostic value of ultrasound and X-ray cholecystography (in 97 operated patients)

    Energy Technology Data Exchange (ETDEWEB)

    Kotsev, I.; Georgiev, J.; Kalchev, E.; Chobanov, G.; Tsonchev, I.; Pranchev, L. (Meditsinski Fakultet, Plovdiv (Bulgaria))

    1984-01-01

    Preoperative ultrasound biligraphy has been performed in 97 consecutive patients (69 with and 28 without biliary calculosis), subjected to bile duct operations. In 32 of them conventional X-ray biligraphy was performed as well. The sensitivity of ultrasonography in patients with cholelithiasis was 97 per cent, the specificity 92,6 per cent and the accuracy 95,7 per cent. The respective percentages for the X-ray examination were 66,7 and 76,5 per cent. The advantage of ultrasonography in patients, in whom the gallbladder escaped visualization on conventional X-ray examination is demonstrated. The economic and health effect, achieved by using ultrasonography is discussed. Ultrasonography is recommended as first diagnostic method for patients with diseases of the bile ducts. Its use as independent tool of diagnosis is also discussed.

  15. Effectiveness of ultrasound, computed tomography, hepatobiliary scintigraphy and nuclear magnetic resonance in diseases of the gallbladder and bile ducts

    Energy Technology Data Exchange (ETDEWEB)

    Fiegler, W.; Schoerner, W.; Felix, R.

    1984-09-01

    The effectiveness of ultrasound, computed tomography, hepatobiliary scintigraphy and nuclear magnetic resonance in diseases of the biliary tract is described. Ultrasound should be the first examination in clinical suspicion of cholelithiasis and has a higher accuracy than oral cholecystography. Computed tomography is very expensive and should be carried out in suspected gallbladder carcinoma, cholecystitis with abscess formation, tumour in the porta hepatis and pancreatic head and in sonographically unclear cases. Nuclear magnetic resonance can determine the ability of the gallbladder to concentrate bile. Ultrasound can distinguish with high accuracy between obstructive and inflammatory jaundice. In clinical suspicion of bile duct lesions an infusion cholangiogram must be carried out, if bilirubin is lower than 5 mg%; if bilirubin is higher, an ERC or PTC should be performed. If in biliary obstruction a suspicion of tumour in porta hepatis or head of the pancreas is present, computed tomography should be effected.

  16. Reliability of pre- and intraoperative tests for biliary lithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Escallon, A. Jr.; Rosales, W.; Aldrete, J.S.

    1985-05-01

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.

  17. Diagnostic value of ultrasound and X-ray cholecystography (in 97 operated patients)

    International Nuclear Information System (INIS)

    Preoperative ultrasonnd biligraphy has been performed in 97 consecutive patients (69 with and 28 without biliary calculosis), subjected to bile duct operations. In 32 of them conventional X-ray biligraphy was performed as well. The sensitivity of ultrasonography in patients with cholelithiasis was 97 per cent, the specificity 92,6 per cent and the accuracy 95,7 per cent. The respective percentages for the X-ray examination were 66,7 and 76,5 per cent. The advantage of ultrasonography in patients, in whom the gallbladder escaped visualization on conventional X-ray examination is demonstrated. The economic and health effect, achieved by using ultrasonography is discussed. Ultrasonography is recommended as first diagnostic method for patients with diseases of the bile ducts. Its use as independent tool of diagnosis is also discussed

  18. Reliability of pre- and intraoperative tests for biliary lithiasis.

    Science.gov (United States)

    Escallon, A; Rosales, W; Aldrete, J S

    1985-05-01

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable. PMID:3888131

  19. Reliability of pre- and intraoperative tests for biliary lithiasis

    International Nuclear Information System (INIS)

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable

  20. Getting Out of a PCCL: Percutaneous Cholecystolithotomy as a Salvage Treatment Option for Gallstone Removal in Patients Deemed Unfit for Standard Surgical Approaches.

    Science.gov (United States)

    Calaway, Adam C; Borofsky, Michael S; Dauw, Casey A; Lingeman, James E

    2016-01-01

    Definitive management of acute cholecystitis or symptomatic cholelithiasis in exceedingly high-risk patients remains a clinical dilemma. In certain cases, treatment through a percutaneous approach following standard techniques and principles similar to those of percutaneous nephrolithotomy may be considered. However, one potential challenge, particularly among a high-risk population, is the possible necessity to stay on obligate anticoagulation for pre-existing medical reasons. To date, there have been no prior reports documenting the role of this procedure in patients on systemic anticoagulation, particularly clopidogrel. Here we report a case of a percutaneous cholecystolithotomy performed on an elderly patient unable to stop dual antiplatelet therapy (aspirin and clopidogrel) secondary to recent drug eluting stent placement for myocardial infarction. PMID:27579410

  1. Liver Disorders in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Victor Uko

    2012-01-01

    Full Text Available Disorders of the hepatobiliary system are relatively common extraintestinal manifestations of inflammatory bowel disease (IBD. These disorders are sometimes due to a shared pathogenesis with IBD as seen in primary sclerosing cholangitis (PSC and small-duct primary sclerosing cholangitis (small-duct PSC. There are also hepatobiliary manifestations such as cholelithiasis and portal vein thrombosis that occur due to the effects of chronic inflammation and the severity of bowel disease. Lastly, medications used in IBD such as sulfasalazine, thiopurines, and methotrexate can adversely affect the liver. It is important to be cognizant of these disorders as some do have serious long-term consequences. The management of these disorders often requires the expertise of multidisciplinary teams to achieve the best outcomes.

  2. A RARE CASE OF GIANT GALL STONE IN A YOUNG PREPUBERTAL FEMALE

    Directory of Open Access Journals (Sweden)

    Nisha

    2015-06-01

    Full Text Available The incidence of gallbladder stone disease ( C holelithiasis is rising high in our country due to changes in life style and food habits. Its prevalence is more in females as compared to males. Besides various well established causes of cholelithiasis , some important anatomical/genetic factors playing a pivotal role in the stone formation are : 1. Crypts or sinuses in the mucosal folds of gallbladder called crypts of luschka. 2. LiTh1 and LiTh2 genes concerned with cholesterol metabolism , and polymorphism of apo - lipoprotein B gene. These above mentioned factors need to be considered as important eti opathogenic basis in the gallstone formation especially in high risk patients. An extra mural compression of CBD by a giant gall stone with clinical features simulating as choledocolithiasis ( A n example of exception of Courvoisier’s law should also be kept in mind while planning the line of treatment.

  3. Early endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy can strain the occurrence of trocar site hernia

    Institute of Scientific and Technical Information of China (English)

    Fatih; Sumer; Cuneyt; Kayaalp; Mehmet; Ali; Yagci; Emrah; Otan; Huseyin; Kocaaslan

    2014-01-01

    This study reports a 69-year-old, obese, female patientpresenting with a biliary leakage after laparoscopiccholecystectomy for cholelithiasis. Closure of the um-bilical trocar site had been neglected during the lapa-roscopic cholecystectomy. Early, on postoperative dayfive, endoscopic retrograde cholangiopancreatography(ERCP) requirement after laparoscopic cholecystectomyresolved the biliary leakage problem but resulted with amore complicated clinical picture with an intestinal ob-struction and severe abdominal pain. Computed tomog-raphy revealed a strangulated hernia from the umbilicaltrocar site. Increased abdominal pressure during ERCPhad strained the weak umbilical trocar site. Emergencysurgical intervention through the umbilicus revealed anischemic small bowel segment which was treated withresection and anastomosis. This report demonstratesthat negligence of trocar site closure can result in veryearly herniation, particularly if an endoscopic interven-tion is required in the early postoperative period.

  4. Early endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy can strain the occurrence of trocar site hernia.

    Science.gov (United States)

    Sumer, Fatih; Kayaalp, Cuneyt; Yagci, Mehmet Ali; Otan, Emrah; Kocaaslan, Huseyin

    2014-11-16

    This study reports a 69-year-old, obese, female patient presenting with a biliary leakage after laparoscopic cholecystectomy for cholelithiasis. Closure of the umbilical trocar site had been neglected during the laparoscopic cholecystectomy. Early, on postoperative day five, endoscopic retrograde cholangiopancreatography (ERCP) requirement after laparoscopic cholecystectomy resolved the biliary leakage problem but resulted with a more complicated clinical picture with an intestinal obstruction and severe abdominal pain. Computed tomography revealed a strangulated hernia from the umbilical trocar site. Increased abdominal pressure during ERCP had strained the weak umbilical trocar site. Emergency surgical intervention through the umbilicus revealed an ischemic small bowel segment which was treated with resection and anastomosis. This report demonstrates that negligence of trocar site closure can result in very early herniation, particularly if an endoscopic intervention is required in the early postoperative period. PMID:25400872

  5. Osteopathic manipulative treatment in the management of biliary dyskinesia.

    Science.gov (United States)

    Heineman, Katherine

    2014-02-01

    Biliary dyskinesia is a functional gastrointestinal disorder of the gallbladder and sphincter of Oddi. Diagnosis is made on the basis of symptoms of biliary colic in the absence of cholelithiasis and gallbladder inflammation. Palpatory findings of tissue texture changes at midthoracic levels (T6-T9) may correspond to visceral dysfunction related to the biliary system. Osteopathic manipulative treatment (OMT) of the T6-T9 segments can remove the feedback related to the somatic component, thereby affecting nociceptive facilitation at the spinal level and allowing the body to restore autonomic balance. Few reports in the current literature provide examples of treatment for patients with biliary dyskinesia using OMT. The author describes the case of a 51-year-old woman who presented with symptoms consistent with biliary dyskinesia. Her biliary colic completely resolved after OMT. Osteopathic evaluation and OMT should be considered a safe and effective option for conservative management of biliary dyskinesia.

  6. Colecistectomia videolaparoscópica em paciente submetido a transplante cardíaco Laparoscopic cholecystectomy in heart transplant patient

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    Flávio Heuta Ivano

    2000-10-01

    Full Text Available Cardiac transplant has been performed with an increased frequency as the treatment for end-stage cardiac disease. Although cholelithiasis is more frequent in both pretransplant and posttransplant patients, no standard management approach exists. Pretransplant patients are well recognized for cardiac events, and posttransplant immunossupressed patients are at a considerable risk for septic complications. Because the first presentation of gallstones in this population is often acute cholecystitis, asymptomatic calculi cannot be considered benign and it seems reasonable to recommend pretransplant screening and posttransplant surveillance for gallstones. Prophylatic laparoscopic cholecistectomy should be undertaken in the stable patient to avoid the substantial mortality associated with postoperative acute cholecystitis and urgent cholecystectomy. In this case report we present a 44 year-old male with acute cholecystitis after cardiac transplantation who was submitted to a safe laparoscopic cholecystectomy one year and seven months later.

  7. Laparoscopic Cholecystectomy During Abdominoplasty: Case Report

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    Kazim DUMAN

    2013-04-01

    Full Text Available We aimed to present the phenomenon of laparoscopic cholecystectomy and abdominoplasty which we diagnosed at the same period the abdominal laxation, diastase of rectum and cholelithiasis that we think in the literature the first samples without leaving any trocar entrance mark.A 58 year old female patient has consulted to the polyclinic of plastic surgery due to prolapsus on the abdominal region. Gall bladder multiplestones were ascertained through abdominal ultrasonograpy. On request and to provide minimal cosmetic failure to the patient, cholecystectomy and abdominoplasty is performed at the same session. Patients with abdominal pathologies that may occur after operations requiring surgery such as abdominoplasty very serious impact on cosmetics. Concordantly, we strongly suggest to take abdominal USG, even if there is no additional complaints especially before the plastic surgery operations and abdominoplasty, for ascertain the existent patologies. [Cukurova Med J 2013; 38(2.000: 319-324

  8. [Effect of antihypoxant infusion on microbial endotoxin circulation in obstructive jaundice patients].

    Science.gov (United States)

    Iakovlev, A Ia; Niazmatov, A A; Zarechnova, N V; Zaĭtsev, R R; Emel'ianov, N V; Mokrov, K V; Chichkanova, A S

    2013-01-01

    The dynamics of microbial endotoxemia in group of 149 patients with cholelithiasis complicated by obstructive jaundice has been studied as dependent on the perioperative tactics of infusion therapy. The perioperative period in obstructive jaundice patients is complicated by a significant increase in lipopolysaccharidemia caused by translocation mechanisms and disorders of the liver detoxification function. In Group 1, 47 patients received infusion therapy including Ringer's solution and 10% glucose solution at a 1:1 ratio. In group 2, 55 patients received infusion therapy with only Sterofundin G-5 solution. In Group 3, 47 patients received the infusion therapy with remaxol in a dose of 800 ml/day. It is established that the infusion of Sterofundin G-5, and to a greater extent the infusion of remaxol, reduces the early postoperative degree of decompensation and accelerates recovery of the detoxifying function of Kupffer cells with respect to microbial endotoxin. PMID:23631281

  9. Assessment of liver hydatid cyst cases--10 years experience in Turkey.

    Science.gov (United States)

    Mergen, Haluk; Genç, Hüdai; Tavusbay, Cengiz

    2007-01-01

    We analysed 73 hydatid cyst patients according to their age, gender, localization, number of cysts, infectivity, symptoms, physical examination findings, presence of accompanying diseases, and diagnostic methods. Female/male ratio was 1.6/1. In total, 69% of cases had a single cyst and 31% multiple cysts. Of the cysts, 61% were in form of "eau de roche" and the rest infective. The mean age was 42.3 years, ranging from 18 to 85 years. The most common symptom was abdominal pain in 74% of patients. Right lobe involvement was encountered in 65% of cases, left lobe in 13%, and left and right in 8%. In 27% of patients, cholelithiasis was the most common accompanying disease. As an imaging technique ultrasound was the most commonly used diagnostic technique. PMID:17326896

  10. Resolution of a phytobezoar with Aldoph's Meat Tenderizer.

    Science.gov (United States)

    Baker, Erica L; Baker, William L; Cloney, David J

    2007-02-01

    A 58-year-old man went to his physician with complaints of midepigastric pain, flatulence, belching, and shortness of breath. During a physical examination, the patient was in no acute distress. The patient underwent an ultrasound examination, which revealed cholelithiasis, a laparoscopic cholecystectomy, which revealed chronic gallbladder disease, and esophagogastroduodenoscopy, which revealed gastritis, a hiatal hernia, and a phytobezoar. To treat the bezoar, the patient was given Adolph's Meat Tenderizer 1 teaspoonful in 8 oz of water before each meal for 7 days. This product contains papain, a proteolytic enzyme, that is thought to cleave protein linkages within bezoars. The patient's symptoms resolved with no adverse events reported, and follow-up endoscopy revealed resolution of the phytobezoar. Although a few other agents are used to treat phytobezoars, little clinical data exist on their safety and effectiveness. Adolph's Meat Tenderizer appears to be a safe and effective treatment for patients with a phytobezoar. PMID:17253920

  11. Diagnostic imaging of digestive tract involvement in cystic fibrosis. Part 1: hepatobiliary disease

    International Nuclear Information System (INIS)

    Cystic fibrosis is a severe hereditary disease characterized by epithelial chloride channel dysfunction, leading to the production of abnormally thick secretions. The abnormal gene is located on the long arm of chromosome 7. Hepatobiliary involvement derives from ductal obstruction causing cholestasis, steatosis, cirrhosis and portal hypertension. Biliary sludge, cholelithiasis and gallbladder sclerosis and atrophy are common findings. As the correlation between the hepatobiliary changes and their clinical and analytical impact is very limited, imaging techniques are essential in this disease. Ultrasound is the basic imaging tool, both for initial evaluation and follow-up of the hepatic and biliary involvement, although other techniques such as radionuclide imaging, magnetic resonance and computed tomography can be highly useful. Given the long-term, chronic nature of this disease, the use of aggressive techniques or irradiation should be carefully weighed. (Author) 38 refs

  12. [Mirizzi syndrome and its variants].

    Science.gov (United States)

    Meyer, G J; Runge, D; Gebhardt, J

    1990-04-01

    Between 1981 and 1987 5434 patients were studied by ERCP in Allgemeines Krankenhaus Hamburg-Barmbeck. 26 (i.e. 0.43%) suffered from Mirizze syndrome with the triad of cholelithiasis, cholecystitis and obstructive biliary disease. They were classified in four different types according to the variable localisation and origin of the biliary obstruction. 16 patients corresponded to the classical type (I and II) with compression, penetration, and obturation by the concrement, five patients matched borderline with infiltration (III) and five patients were classified as variants of this syndrome. A mild elevation of serum bilirubine and alkaline phosphatase indicated more likely the benign etiology of type I to III, however, a marked elevation of alkaline phosphatase in the variants suggested more likely a malignant underlying disease. The diagnosis was ascertained in all cases by ERC and sonography preoperatively and was verified by laparotomy (n = 18) and follow-up (n = 6).

  13. Extracorporeal shock wave therapy in periodontics: A new paradigm

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    Munivenkatappa Lakshmaiah Venkatesh Prabhuji

    2014-01-01

    Full Text Available The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome.

  14. 保留自主神经的胃癌D2淋巴结清扫技术%Surgical techniques of autonomic nerve preservation in lymph nodes dissection for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    胡祥

    2012-01-01

    Resection of the automonic nervous system in the process of lymph nodes dissection is a major factor leading to postoperative gastrointestinal dysfunction.The era of blind expansion of the wide excision has been questioned,and safety first,radical dissection of the metastatic lymph nodes,low invasive rate and organ function-saving surgery have been highly emphasized.Preserving the gastric autonomic nerve effectively reduces postoperative diarrhea,shortens the time for weight recovery,and prevents insulin secretion disorders and postoperative cholelithiasis.In the process of laparoscopic or open autonomic nerve preservation in lymph node dissection for gastric cancer,full understanding of the anatomy of the autonomic nervous system,recognizing the landmark of the nerves,proper designing the surgical space,dissecting according to the extracellular space in the membrane of the nerve fibers and nerve plexus are factors which ensures the quality and effects of the surgery.

  15. Treatment of a patient with obstructive jaundice and extrahepatic portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Qing Xu; Lei Gu; Zhi-Yong Wu

    2009-01-01

    BACKGROUND:Recurrence of inlfammation in the extrahepatic bile duct can lead to bile duct stenosis, obstructive jaundice and cavernous transformation of the portal vein. The latter can develop into extrahepatic portal hypertension (PHT). It is dififcult to establish the correct method for treating these conditions. METHODS:At another hospital, a 51-year-old man developed PHT as a result of endoscopic retrograde cholangiopancreatography and endoscopic nasobiliary drainage to relieve cholelithiasis and obstructive jaundice. We dealt with the biliary tract obstruction through percutaneous transhepatic cholangial drainage (PTCD), followed by selective devascularization and a shunt operation 2 weeks after the disappearance of jaundice. Three months after cholecystojejunostomy, there were no obvious changes around the bile duct. RESULT:The patient recovered uneventfully and was discharged 14 days after operation. CONCLUSION:For this patient, surgery in stages was the best choice. The most suitable method to decrease jaundice is PTCD.

  16. Spontaneous pneumobilia revealing choledocho-duodenal fistula: A rare complication of peptic ulcer disease

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    Massimo Tonolini

    2013-01-01

    Full Text Available Spontaneous pneumobilia without previous surgery or interventional procedures indicates an abnormal biliary-enteric communication, most usually a cholelithiasis-related gallbladder perforation. Conversely, choledocho-duodenal fistulisation (CDF from duodenal bulb ulcer is currently exceptional, reflecting the low prevalence of peptic disease. Combination of clinical data (occurrence in middle-aged males, ulcer history, absent jaundice and cholangitis and CT findings including pneumobilia, normal gallbladder, adhesion with fistulous track between posterior duodenum and pancreatic head allow diagnosis of CDF, and differentiation from usual gallstone-related biliary fistulas requiring surgery. Conversely, ulcer-related CDF are effectively treated medically, whereas surgery is reserved for poorly controlled symptoms or major complications.

  17. Hubungan Imunoekspresi NF-kB dengan Sinus Rokitansky Aschoff pada Kolesistitis Kronik

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    Herry Yulianti

    2014-06-01

    Full Text Available Carcinoma of the gallbladder is relatively uncommon but it is a very lethal disease. Gallbladder cancer constitutes 3−4% of all malignant lesions and ranks 5th among the digestive system tumors. Gallblader carcinoma is difficult to detect and diagnose in early stage because it usually has very slight symptoms or asymptomatic. It becomes increasingly necessary to make early diagnosis and identification of high-risk patient,as well as gallstone and history of chronic cholecystitis. Chronic cholecystitis is a chronic inflammation of gallbladder associated with cholelithiasis in more than 90% of cases. Cholelithiasis is one of the important etiological factors in carcinoma of the gallbladder. The histological examination of chronical cholecystitis shows the presence of Rokitansky Aschoff sinuses. Genetic approaches have proven that the components of inflammation such as primary inflammatory cytokines, interleukin-1 (IL-1, tumor necrosis factor (TNF, IL-6 and nuclear factor-kB (NF-kB play the key roles in carcinogenesis. The purpose of this study was to understand the correlation between the immunoexpression of NF-kB and Rokitansky Aschoff sinuses in chronic cholecystitis. The method was cross sectional of 30 cases of chronic cholecystitis from Department of Pathology Anatomy of Dr. Hasan Sadikin General Hospital Bandung/Faculty of Medicine Universitas Padjadjaran in 2010−2011. A section from 4 µm-thick paraffin embedded tissue of chronic cholecystitis was stained with hematoxylin eosin for histopatological evaluation and immunohistochemical using polyclonal NF-kB antibody. Immunoreactive cells was counted in five tumor areas of 400x field by light microscopy. The result showed a significant correlation between the immunoexpression of NFkB and Rokitansky Aschoff sinuses (p=0.000. In conclusion, there is a correlation between immunoexpression of NFkB and Rokitansky Aschoff sinuses because as the immunoexpression of NFkB increase, more Rokitansky

  18. Helicobacter species are associated with possible increase in risk of biliary lithiasis and benign biliary diseases

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    Pandey Manoj

    2007-08-01

    Full Text Available Abstract Background Hepato-biliary tract lithiasis is common and present either as pain or as asymptomatic on abdominal ultrasonography for other causes. Although the DNA of Helicobacter species are identified in the gallbladder bile, tissue or stones analyzed from these cases, still a causal relationship could not be established due to different results from different geographical parts. Methods A detailed search of pubmed and pubmedcentral was carried out with key words Helicobacter and gallbladder, gallstones, hepaticolithiasis, cholelithiasis and choledocholithiasis, benign biliary diseases, liver diseases. The data was entered in a data base and meta analysis was carried out. The analysis was carried out using odds ratio and a fixed effect model, 95% confidence intervals for odds ratio was calculated. Chi square test for heterogeneity was employed. The overall effect was calculated using Z test. Results A total of 12 articles were identified. One study used IgG for diagnosis while others used the PCR for Ure A gene, 16 S RNA or Cag A genes. A couple of studies used culture or histopathology besides the PCR. The cumulative results show a higher association of Helicobacter with chronic liver diseases (30.48%, and stone diseases (42.96%(OR 1.77 95% CI 1.2–2.58; Z = 2.94, p = 0.003, the effect of each could not be identified as it was difficult to isolate the effect of helicobacter due to mixing of cases in each study. Conclusion The results of present meta analysis shows that there is a slight higher risk of cholelithiasis and benign liver disease (OR 1.77, however due to inherent inability to isolate the effect of stone disease from that of other benign lesions it is not possible to say for sure that Helicobacter has a casual relationship with benign biliary disease or stone disease or both.

  19. Biliary carcinoembryonic antigen levels in diagnosis of occult hepatic metastases from colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Jaques Waisberg; Rog(e)rio T. Palma; Lu(i)s Contim Neto; Lourdes C. Martins; Maur(i)cio S. L. Oliveira; Carlos A. Nagashima; Antonio C. Godoy; Fabio S. Goffi

    2003-01-01

    AIM: To prospectively explore the role of carcinoembryonic antigen (CEA) in gallbladder bile in patients with colorectal carcinoma and the morphological and clinical features of neoplasia and the occurrence of hepatic metastases.METHODS: CEA levels in the gallbladder and peripheral blood were studied in 44 patients with colorectal carcinoma and 10 patients with uncomplicated cholelithiasis. CEA samples were collected from the gallbladder bile and peripheral blood during the operation, immediately before extirpating the colorectal neoplasia or cholecystectomy.Values of up to 5 ng/ml were considered normal for bile and serum CEA.RESULTS: In the 44 patients with colorectal carcinoma who underwent operation with curative intent, the average level of serum CEA was 8.5 ng/ml (range: 0.1 to 111.0 ng/ml) and for bile CEA it was 74.5 ng/ml (range: 0.2 to 571.0ng/ml). In the patients with uncomplicated cholelithiasis who underwent cholecystectomy, the average level of serum CEA was 1.9 ng/ml (range: 1.0 to 3.5 ng/ml) and for bile CEA it was 1.2 ng/ml (range: 0.3 to 2.9 ng/ml).The average duration of follow-up time was 16.5 months (range: 6 to 48 months). Four patients who underwent extirpation of the colorectal carcinoma without evidence of hepatic metastasis and with an average bile CEA value of 213.2 ng/ml presented hepatic metastases between three and seventeen months after removal of the primary colorectal neoplasia. Three of them successfully underwent extirpation of the hepatic lesions.CONCLUSION: High CEA levels in gallbladders of patients undergoing curative operation for colorectal carcinoma may indicate the presence of hepatic metastases. Such patients must be followed up with special attention to the diagnosis of such lesions.

  20. Does Endoscopic Ultrasound Have Anything to Offer in the Diagnosis of Idiopathic Acute Pancreatitis?

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    Gareth Morris-Stiff

    2009-03-01

    Full Text Available The aim of this study was to investigate the role of EUS where other investigative techniques had failed to identify the cause of biochemically proven acute pancreatitis. Setting All biliary EUS examinations performed between January 2000 and December 2004 were identified from the radiology computerised database. Patients Forty-two patients (25 male, 17 female; mean age: 53±3.2 years with negative prior radiological investigations underwent EUS. Main outcome measures Prior and later radiological investigations, hospital readmission, and the need for further surgical intervention were also analysed. Results EUS was normal in 17 patients (40.5% and demonstrated signs of recent acute pancreatitis but no other aetiological factor in 8 patients (19.0%. Cholelithiasis or microlithiasis was identified in 9 patients (21.4%, combined gallstones/microlithiasis and choledocholithiasis in was seen in 6 patients (14.3%. In one patient (2.4%, calculi were seen in the common bile duct but not the gallbladder. In a further case with recurrent acute pancreatitis (2.4%, chronic pancreatitis was diagnosed on EUS. All patients with common bile duct stones underwent ERCP and sphincterotomy, and stones were universally confirmed. One patient with gallbladder calculi alone required an ERCP after developing jaundice whilst awaiting cholecystectomy. Conclusions EUS provided additional diagnostic information in 17 of the 42 patients (40.5%. Moreover, exclusion of gallstones/microlithiais is also important as it facilitates a search for other causes of pancreatitis. In conclusion, most cases of cholelithiasis can be diagnosed with standard imaging modalities but when these fail to identify a cause, EUS has an important role to play.

  1. On the use of Disease Staging for clinical management: analysis of untimely admissions in the Abruzzo Region, Italy

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    Lamberto Manzoli

    2004-12-01

    Full Text Available

    Background and aims. The process of decentralization which recently occurred within the Italian National Health Service has transferred substantial responsibility and authority for health care administration to the individual regions. The project is aimed at developing regional benchmarks that can be used as a part of an ongoing system for analysis of resource use and quality of care in the Abruzzo Region of Italy.

    Methods. All 286 924 hospital admissions for the year 2001 in the region were analysed. Three diseases were chosen for in-depth review: diabetes mellitus; cholecystitis/cholelithiasis; and bacterial pneumonia. There were a total of 9391 admissions for these diagnoses. Severity, length of hospital stay and hospital mortality were analysed using Disease Staging methodology. In addition, the timeliness of hospitalisation was assessed by grouping admissions in three categories: premature or medically unnecessary, timely and late.

    Results. The rate of medically unnecessary admissions for diabetes mellitus was 72% throughout the region, and the percentage of late hospitalisations for cholelithiasis/cholecystitis was 43%. For both diseases, there were significant variations across Local Health Units in the proportion of late and early admissions. The rate of timely hospitalisations for bacterial pneumonia was higher than 86%.

    Conclusion. The analysis of discharge abstract data using Disease Staging revealed that in the Abruzzo region there are problems of inappropriate hospital admission, both early and late, for all diseases examined excepted bacterial pneumonia.

    Data confirmed the validity of Disease Staging to compare the performance of diverse hospitals in terms of length of stay and in-hospital mortality.

  2. Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

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    Cibele Helena Daher

    2015-06-01

    Full Text Available Abstract Objective: Longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes. Materials and Methods: Twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum. Results: Findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients. Conclusion: Alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant.

  3. Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

    International Nuclear Information System (INIS)

    Objective: longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes. Materials and methods: twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum. Results: findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients. Conclusion: alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant. (author)

  4. Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Daher, Cibele Helena; Gomes, Andrea Cavalanti; Kobayashi, Sergio; Chammas, Maria Cristina, E-mail: cibeledaher@hotmail.com [Universidade de Sao Paulo (In-Rad/HC-FMUSP), Sao Paulo, SP (Brazil). Hospital das Clinicas. Inst. de Radiologia; Cerri, Giovanni Guido [Universidade de Sao Paulo (FMUSP), Sao Paulo, SP (Brazil). Fac. de Medicina

    2015-05-15

    Objective: longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes. Materials and methods: twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum. Results: findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients. Conclusion: alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant. (author)

  5. 对比分析腹腔镜胆囊切除术与传统开腹切除术治疗胆结石的临床效果%The Clinical Effect of Laparoscopic Cholecystectomy and Conventional Open Surgery in the Treatment of Gallstones

    Institute of Scientific and Technical Information of China (English)

    杨贵江; 胡晓芳

    2016-01-01

    Objective To analyze laparoscopic cholecystectomy and conventional open surgery of the effect of surgery in the treatment of cholelithiasis.Methods126 cases of cholelithiasis patients were divided into two groups,observation group,and control group(63 cases) respectively, in the implementation of peritoneoscope gallbladder excision and traditional open cholecystectomy. The effect and recovery situation of the two groups were compared.ResultsIn the observation group of treatment efficiency(96.8%)and control group(81.0%),compared with significant difference(P<0.05). The operation time,hospitalization time,complications rates of the observation group were lower than that of the control group(P<0.05).Conclusion Laparoscopic gallbladder resection surgery in the treatment of patients with gallstones has significantly effect.%目的:分析腹腔镜胆囊切除术与传统开腹切除术治疗胆结石的效果。方法将胆结石患者126例分为两组,观察组、对照组(各63例)分别实施腹腔镜胆囊切除术与传统开腹切除术,比较两组疗效及恢复情况。结果观察组患者治疗有效率(96.8%)与对照组(81.0%)相比差异有统计学意义(P<0.05)。观察组手术时间、住院时间、并发症发生率均低于对照组(P<0.05)。结论腹腔镜胆囊切除术治疗胆结石患者效果满意。

  6. Clinical, hematological, and molecular characterization of sickle cell anemia pediatric patients from two different cities in Brazil Caracterização clínica, hematológica e molecular de crianças portadoras da anemia falciforme em duas diferentes cidades do Brasil

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    Isa Menezes Lyra

    2005-08-01

    Full Text Available This study focused on clinical, hematological, and molecular aspects of sickle cell anemia pediatric patients from two different cites in Brazil. Seventy-one patients from São Paulo and Salvador, aged 3 to 18 years, were evaluated. Hematological analyses, betaS globin gene haplotypes, and alpha2 3.7kb-thalassemia were performed. Numbers of hospitalizations due to vaso-occlusive crises, infections, stroke, and cholelithiasis were investigated. São Paulo had more hospitalizations from vaso-occlusion, cholelithiasis, and stroke than Salvador. The Ben/CAR genotype predominated in both cities. alpha2 3.7kb-thalassemia had a frequency of 28.2% in Salvador, mostly with Ben/CAR genotype (45.0%, while São Paulo had 22.5% with similar frequencies of the Ben/ CAR and CAR/CAR genotypes. Sickle cell anemia patients from São Paulo also had more episodes of stroke, which was observed among CAR/CAR, atypical, and BEN/CAR haplotypes. In Salvador stroke was only observed in the Ben/CAR genotype. Cholelithiasis had similar frequencies in the two cities. These data suggest a milder phenotype among patients in Salvador, possibly due to genetic, environmental, and socioeconomic factors. Further studies are needed to elucidate modulating factors and phenotype association.O objetivo desse estudo foi avaliar aspectos clínicos, hematológicos e moleculares de pacientes pediátricos portadores de anemia falciforme em duas cidades brasileiras: Salvador e São Paulo. Foram estudados 71 pacientes com idades variando entre 3 a 18 anos, analisando-se os seguintes aspectos: perfis hematológicos, haplótipos dos genes da globina beta, presença de talassemia alfa-2(3.7kb, número de internações por vaso-oclusão, infecção, presença de acidente vascular cerebral e litíase biliar. O genótipo Ben/CAR predominou nas duas cidades. Talassemia alfa-2(3.7kb teve freqüência de 28,2% em Salvador e 22,5% em São Paulo. Os pacientes de São Paulo apresentaram um número maior

  7. Gallbladder polyps: ultrasonographic and histopathological findings correlation

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    F. Rodriguez

    2014-11-01

    Full Text Available Gallbladder polyp is an increasingly common diagnosis, primarily as an abdominal ultrasound finding requested by another cause. Studies report a prevalence between 4% and 5.6%. The importance of an accurate diagnosis is related to the possibility of developing a malignancy desease. The objectvie is to correlate ultrasound and histopathologic findings in gallbladder polyp patients operated at the Hospital San Juan de Dios de La Serena. We reviewed retrospectively the medical records of patients undergoing cholecystectomy for gallbladder polyp from January 2000 to December 2010. a total of 40 patients underwent cholecystectomy for gallbladder polyp. 16 only had its tab clinic with abdominal ultrasonography report and the pathology report. 13 of them (81% were female. The mean age was 46 + / - 12 years. The reason for the ultrasonography was in 9 patients (56% abdominal pain in 3 patients (19%, a finding in asymptomatic patients, in one patient (6% biliary colic, none had jaundice, and in 3 patients (19% the cause was different. According to Abdominal ultrasound, the number of polyps was 1.1 + / - 0.3 per patient, and the average size was 5.8 + / - 1.8 mm. Histopathological examination showed the presence of polyps colesterolínicos in 11 of the 16 patients (69%. In the series described the abdominal ultrasonography showed a PPV = 0.68 for the diagnosis of gallbladder polyp. According to the report histopathological cholesterolosis diagnosed chronic cholecystitis in six cases (37.5%, chronic cholecystitis in six cases (37.5%, cholesterolosis in three cases (18.75% and cholelithiasis in one case (6 , 25%. Not demonstrated the presence of adenomas or foci of carcinoma in situ. In conclusion the described series does not allow to extrapolated or compare conclusions with other national and international series due to the small number of patients studied. There is a substantial sub-register of the pathology because the majority of patients undergoing

  8. Intent at day case laparoscopic cholecystectomy in Owerri, Nigeria: Initial experiences

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    Christopher Nonso Ekwunife

    2013-01-01

    Full Text Available Background and Objective: Laparoscopic cholecystectomy has been the default operation for cholelithiasis at Federal Medical Centre, Owerri for the past 2 years and the outcomes have been good. The duration of post operative stay has been decreasing. We therefore initiated a preliminary 2-year prospective study in May 2010 to determine the feasibility of carrying out day case laparoscopic cholecystectomy in our hospital. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were included in the study if they satisfied the following criteria: Age < 65 years, body mass index < 35 kg/m 2 , American Society of Anaesthesiology physical status class I and II, patient residence within 20 km radius of the hospital, patient acceptance of the procedure and absence of previous complicated upper abdominal surgery. Results: Twelve patients (10 females, 2 males were worked up with the intent of achieving same-day discharge of the patients. Five of the patients (41.7% were discharged on the day of operation. The reasons for overnight stay included inadequate pain control, insertion of drain and patient wishes. There was no conversion to open surgery, no major complications and no case of readmission to the hospital. Conclusions: Day case laparoscopic cholecystectomy in our environment could be safely promoted but will depend on improved facilities and patient enlightenment.

  9. Single port Billroth I gastrectomy

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    Jeremy R Huddy

    2013-01-01

    Full Text Available Introduction: Experience has allowed increasingly complex procedures to be undertaken by single port surgery. We describe a technique for single port Billroth I gastrectomy with a hand-sewn intracorporeal anastomosis in the resection of a benign tumour diagnosed incidentally on a background of cholelithiasis. Materials and Methods: Single port Billroth I gastrectomy and cholecystectomy was performed using a transumbilical quadport. Flexible tipped camera and straight conventional instruments were used throughout the procedure. The stomach was mobilised including a limited lymph node dissection and resection margins in the proximal antrum and duodenum were divided with a flexible tipped laparoscopic stapler. The lesser curve was reconstructed and an intracorporal hand sewn two layer end-to-end anastomosis was performed using unidirectional barbed sutures. Intraoperative endoscopy confirmed the anastomosis to be patent without leak. Results: Enteral feed was started on the day of surgery, increasing to a full diet by day 6. Analgesic requirements were a patient-controlled analgesia morphine pump for 4 postoperative days and paracetamol for 6 days. There were no postoperative complications and the patient was discharged on the eighth day. Histology confirmed gastric submucosal lipoma. Discussion: As technology improves more complex procedures are possible by single port laparoscopic surgery. In this case, flexible tipped cameras and unidirectional barbed sutures have facilitated an intracorporal hand-sewn two layer end-to-end anastomosis. Experience will allow such techniques to become mainstream.

  10. Medical risk factors associated with cholangiocarcinoma in Taiwan: a population-based case-control study.

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    Jeffrey S Chang

    Full Text Available BACKGROUND: Cholangiocarcinoma, including intra- and extrahepatic cholangiocarcinoma, is a rare but highly lethal cancer. Despite effort in finding the risk factors of cholangiocarcinoma, the causes of most cholangiocarcinoma remain unknown. This study utilized a population-based case-control design using data from the National Health Insurance Research Database (NHIRD of Taiwan to assess the medical conditions associated with cholangiocarcinoma. METHODS: 5,157 incident cases of cholangiocarcinoma diagnosed during 2004 to 2008 and 20,628 controls matched to the cases on sex, age, and time of diagnosis (reference date for the controls were identified from the NHIRD. Medical risk factors were ascertained from the NHIRD for each individual. Conditional logistic regression was performed to evaluate the association between cholangiocarcinoma and each medical risk factor. RESULTS: The results showed that factors associated with an increased risk of cholangiocarcinoma included cholangitis, cholelithiasis, cholecystitis, cirrhosis of liver, alcoholic liver disease, chronic non-alcoholic liver disease, hepatitis B, hepatitis C, diabetes, chronic pancreatitis, inflammatory bowel disease, and peptic ulcer. In addition, sex and age differences were observed. CONCLUSIONS: This study confirms the association between cholangiocarcinoma and several less established risk factors, including diabetes, inflammatory bowel disease, hepatitis B, hepatitis C, and peptic ulcer (proxy for the presence of Helicobacter Pylori. Future studies should focus on finding additional environmental and genetic causes of cholangiocarcinoma.

  11. A radiological evaluation of 1.005 cases of oral cholecystography

    International Nuclear Information System (INIS)

    Oral cholecystography has been proved useful and widely used as screening method in the gallbladder disease. The material consisted of 1,005 cases including 411 males and 591 females of oral cholecystography performed at Soonchunhyang College Hospital during the last two years from 1977 to 1979. The authors analyzed relationship of gallbladder shape to cholelithiasis and biliary dyskinesia. The results obtained are as follows: 1. Among 1,005 cases, 414 cases were male and 591 cases were female. The female was predominant than the male and highly affected between 41-50 years of age. 2. Shape of the gallbladder was classified into the 9 types; most popular type was pear type.3. Incidence of gallbladder was more common in septated and folding type than others. 4. Male to female ratio of gallstone was 54 :84 of total 138 cases, and peak age was 41 to 60 years (65.2%). 5. In 138 gallstone cases, opaque stones were 65 cases (47.1%) and nonopaque stone were 73 cases (52.9%). 6. The emptying rate of gallbladder was faster in the male than female, and faster in the older are group over 51 years than the younger age group below 30 years. Average emptying rate was 41.8%.7. Biliary dyskinesia was predominant between the age of 31-40 (37.3%). We classified the biliary dyskinesia into 3 type; hyperkinetic dyskinesia, hypotonic dyskinesia and hypertonic dyskinesia. Most prevalent type was hypotonic dyskinesia,24 cases (47.1%).

  12. A radiological evaluation of 1.005 cases of oral cholecystography

    Energy Technology Data Exchange (ETDEWEB)

    Choi, D. L.; Chung, M. K.; Kwon, K. H.; Chung, W. K.; Kim, K. J. [Soonchunhyang University College of Medicine, Chunan (Korea, Republic of)

    1980-06-15

    Oral cholecystography has been proved useful and widely used as screening method in the gallbladder disease. The material consisted of 1,005 cases including 411 males and 591 females of oral cholecystography performed at Soonchunhyang College Hospital during the last two years from 1977 to 1979. The authors analyzed relationship of gallbladder shape to cholelithiasis and biliary dyskinesia. The results obtained are as follows: 1. Among 1,005 cases, 414 cases were male and 591 cases were female. The female was predominant than the male and highly affected between 41-50 years of age. 2. Shape of the gallbladder was classified into the 9 types; most popular type was pear type.3. Incidence of gallbladder was more common in septated and folding type than others. 4. Male to female ratio of gallstone was 54 :84 of total 138 cases, and peak age was 41 to 60 years (65.2%). 5. In 138 gallstone cases, opaque stones were 65 cases (47.1%) and nonopaque stone were 73 cases (52.9%). 6. The emptying rate of gallbladder was faster in the male than female, and faster in the older are group over 51 years than the younger age group below 30 years. Average emptying rate was 41.8%.7. Biliary dyskinesia was predominant between the age of 31-40 (37.3%). We classified the biliary dyskinesia into 3 type; hyperkinetic dyskinesia, hypotonic dyskinesia and hypertonic dyskinesia. Most prevalent type was hypotonic dyskinesia,24 cases (47.1%)

  13. [Comparative diagnostic value of echography and oral radiologic examination of the gallbladder in relation to surgical findings].

    Science.gov (United States)

    Cervi, P M; Scutellari, P N; Calzolari, F; Pavani, F; Pelizzola, D; Pollinzi, V; Piffanelli, A; Tosi, S P

    1983-07-14

    For nearly 60 years, since it was introduced by Graham and Cole (1924), oral cholecystography (OCG) has been used as the imaging technique of choice in investigation of gallbladder disorders. Recently, the future of OCG has come into doubt, principally as a result of ultrasonography, with the advent of high-resolution real-time scanning. Stones are seen as echoes within the lumen of the gallbladder and are associated with an acoustic shadow, findings which are highly specific. On this basis, to evaluate the accuracy of ultrasonography in detecting cholelithiasis, the A. have performed by real-time cholecystosonography 60 patients with not diagnostic OCG in a group of 546 patients affected by gallbladder diseases. Our results have confirmed that sonography revealed 4 normal gallbladders, 51 gallstones and 1 primary gallbladder cancer, with 5 cases of false positive. The true false negative rate has been difficult to determine, as surgery is usually not performed after a negative study. The accuracy of cholecystosonography for gallstone diagnosis was found to be 88,1% for all three Crade's categories. PMID:6866302

  14. [Extreme hyperbilirubinemia associated with spherocytosis and choledocholithiasis].

    Science.gov (United States)

    Peralta-Zagal, J A; Hernández-Estrada, M

    1990-01-01

    Spherocytosis conditions the severe destruction of red blood cells. The spleen plays an active and fundamental role in this destruction since it is responsible for the fragility and lability of the red blood cell to the splenic medium. The clinical manifestations are: anemia, jaundice, splenomegaly, and hemolytic and aplastic crisis associated to viral infections. Choledocholithiasis is a manifestation of the disease which can be seen at an early stage, even in less severe cases. Choledocholithiasis is rare and this may be due to immediate surgical intervention. The levels of indirect bilirubin may vary but usually do not exceed 10 mg%, on the rising of direct bilirubin may cause suspicion of liver obstruction or damage. A case of a ten year old boy is reported who was found to have spherocytosis, with severe manifestations, who later developed cholelithiasis and total obstruction of the choledocho and in who the most important clinical manifestation was jaundice due to the increase of total bilirubin to 89 mg%, doubly checked. Both a splenectomy and a cholecystectomy were performed. Subsequent checkups were normal. These levels of bilirubin have not been previously reported. Hyperbilirubinemia; spherocytosis; choledocholithiasis.

  15. Computed tomographic findings of abdominal complications of Crohn's disease - pictorial essay

    International Nuclear Information System (INIS)

    Crohn's disease (CD) is a chronic, transmural, inflammatory disease of the gastrointestinal tract (CIT) most often affecting the terminal ileum and colon. Diarrhea, abdominal pain, anorexia, nausea, and weight loss are the most common clinical symptoms. Abdominal complications of CD, both intestinal and extraintestinal, are frequent and variable. The most common intestinal complications include ileocolitis with external or internal fistulas and abscess formation, strictures, and bowel obstruction. Less common are free perforation, intussusception, and malignancy. The extraintestinal complications include nephrolithiasis, cholelithiasis, fatty liver, portal vein gas, and thromboembolic events. Nowadays, computed tomography (CT) provides superb anatomic detail and diagnostic accuracy of various intra-abdominal pathological processes, and it thus has become an essential diagnostic tool in the evaluation and management of patients wit known CD for the assessment of bowel wall involvement, the mesenteric extent of the disease, and inn-abdominal complications. In addition, as CT is frequently performed to evaluate patients with acute abdomen, it may encounter clinically unsuspected complications in patients with CD. This article reviews the CT features of various intra-abdominal complications of CD. (author)

  16. Laparoscopic cholecystectomy: evolution, early results, and impact on nonsurgical gallstone therapies.

    Science.gov (United States)

    Brandon, J C; Velez, M A; Teplick, S K; Mueller, P R; Rattner, D W; Broadwater, J R; Lang, N P; Eidt, J F

    1991-08-01

    Laparoscopic cholecystectomy, a surgical technique first performed in France, has gained widespread acceptance among surgeons in the United States. The abdominal cavity is inflated by carbon dioxide, a video monitor is inserted via a laparoscope placed periumbilically, and the gallbladder is freed and removed from the liver bed by using small subcostal ports for access and dissection. Intraoperative cholangiography is routinely performed, but uncertainty exists about how best to manage choledocholithiasis. Compared with traditional cholecystectomy, initial reports describing laparoscopic cholecystectomy cite shorter recovery times because no large incisions are made, thus potentially reducing the cost and morbidity of cholecystectomy. A survey of 614 early cases supports these claims, with a reported complication rate of 1.5% and quick resumption of normal activities by patients. Because of its promise for reduced morbidity, laparoscopic cholecystectomy is challenging open cholecystectomy as the therapeutic gold standard for symptomatic cholelithiasis. Thus, the standard to which the nonsurgical gallstone therapies, such as lithotripsy and contact dissolution, will be compared may shift to laparoscopic cholecystectomy. As the laparoscopic complications are similar to those of traditional cholecystectomy, such as abscesses and bile leaks, their percutaneous treatment should not change. PMID:1830188

  17. Computed tomographic findings of abdominal complications of Crohn's disease - pictorial essay

    Energy Technology Data Exchange (ETDEWEB)

    Zissin, R. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel)]. E-mail: zisinrivka@clalit.org.il; Hertz, M. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv (Israel); Osadchy, A. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel); Novis, B. [Tel-Aviv Univ., Dept. of Gastroenterology, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel); Gayer, G. [Tel-Aviv Univ., Department of Diagnostic Imaging, Assaf Harode Medical Center, Zrifin, Sackler Faculty of Medicine, Tel Aviv (Israel)

    2005-02-15

    Crohn's disease (CD) is a chronic, transmural, inflammatory disease of the gastrointestinal tract (CIT) most often affecting the terminal ileum and colon. Diarrhea, abdominal pain, anorexia, nausea, and weight loss are the most common clinical symptoms. Abdominal complications of CD, both intestinal and extraintestinal, are frequent and variable. The most common intestinal complications include ileocolitis with external or internal fistulas and abscess formation, strictures, and bowel obstruction. Less common are free perforation, intussusception, and malignancy. The extraintestinal complications include nephrolithiasis, cholelithiasis, fatty liver, portal vein gas, and thromboembolic events. Nowadays, computed tomography (CT) provides superb anatomic detail and diagnostic accuracy of various intra-abdominal pathological processes, and it thus has become an essential diagnostic tool in the evaluation and management of patients wit known CD for the assessment of bowel wall involvement, the mesenteric extent of the disease, and inn-abdominal complications. In addition, as CT is frequently performed to evaluate patients with acute abdomen, it may encounter clinically unsuspected complications in patients with CD. This article reviews the CT features of various intra-abdominal complications of CD. (author)

  18. Role of ERCP in the era of laparoscopic cholecystectomy for the evaluation of choledocholithiasis in sickle cell anemia

    Institute of Scientific and Technical Information of China (English)

    Hussain Issa; Ahmed H Al-Salem

    2011-01-01

    AIM: To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in patients with sickle cell anemia (SCA) in the era of laparoscopic cholecystectomy (LC).METHODS: Two hundred and twenty four patients (144 male, 80 female; mean age, 22.4 years; range, 5-70 years) with SCA underwent ERCP as part of their evaluation for cholestatic jaundice (CJ).The indications for ERCP were: CJ only in 97, CJ and dilated bile ducts on ultrasound in 103, and CJ and common bile duct (CBD) stones on ultrasound in 42.RESULTS: In total, CBD stones were found in 88 (39.3%) patients and there was evidence of recent stone passage in 16.Fifteen were post-LC patients.These had endoscopic sphincterotomy and stone extraction.The remaining 73 had endoscopic sphincterotomy and stone extraction followed by LC without an intraoperative cholangiogram.CONCLUSION: In patients with SCA and cholelithiasis, ERCP is valuable whether preoperative or postoperative, and in none was there a need to perform intraoperative cholangiography.Sequential endoscopic sphincterotomy and stone extraction followed by LC is beneficial in these patients.Endoscopic sphincterotomy may also prove to be useful in these patients as it may prevent the future development of biliary sludge and bile duct stones.

  19. Signet Ring Cell Carcinoma of the Gallbladder with Skin Metastasis: A Case Report

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    Erdal KARAGÜLLE

    2010-05-01

    Full Text Available The aim of this case report is to attract the attention of related clinicians to similar cases because of their rarity. We believe this case and other similar cases in the literature could initiate studies that may explain the pathways of metastasis.A 50-year-old female patient underwent laparoscopic cholecystectomy because of symptomatic cholelithiasis. Postoperative pathologic examination of the specimen led to a diagnosis of signet ring carcinoma in the wall of gallbladder. After this incidental diagnosis, this patient underwent a second operation, which was a radical cholecystectomy. After pathological examination of the second operation material, we decided to call this patient for periodic controls, as the tumor was graded as stage I. A cutaneous lesion 33 months after the second operation was diagnosed as metastasis of signet ring cell carcinoma.Signet ring carcinoma of the gallbladder is a rarely seen malignancy. Cutaneous metastasis of this rare malignancy is also quite rare. There are only a few reports of cutaneous metastasis of signet ring carcinoma of the gallbladder. It is necessary to explain the reasons of this unusual metastasis with further studies.

  20. Comparison of open cholecystectomy with laparoscopic cholecystectomy using latest variables of pulmonary functions as parameters

    International Nuclear Information System (INIS)

    Comparison of open cholecystectomy with laparoscopic cholecystectomy using latest variables of pulmonary functions as parameters To compare open holecystectomy with laparoscopic cholecystectomy using latest variables of pulmonary functions as parameters. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Surgery, CMH Rawalpindi from May 2010 to Nov 2010. Patients and Methods: Patients with symptomatic cholelithiasis subjected to elective cholecystectomy were studied. The patients were divided into two groups. Open Cholecystectomy was performed on patients in group I, and laparoscopic cholecystectomy was performed in patients in group II. Respiratory function tests were performed preoperatively and on the morning of the 1st post-operative day. Results: Preoperative pulmonary function tests were normal and did not differ significantly between the two groups. After operation a significant reduction in the FEV1 (Forced Expiratory Volume in first second), FEV6 (Forced expiratory volume in first six seconds) and their ratio FEV1/FEV6 occurred after both open and laparoscopic cholecystectomy. However, mean reductions in FEV1, FEV6 and FEV1/FEV6 in the laparoscopic cholecystectomy group were significantly (p<0.05) less as compared with those after open holecystectomy. Conclusion: Laparoscopic cholecystectomy causes less impairment of lung function than cholecystectomy performed through a subcostal incision. (author)

  1. RNA sequencing-based analysis of gallbladder cancer reveals the importance of the liver X receptor and lipid metabolism in gallbladder cancer

    Science.gov (United States)

    Zuo, Mingxin; Rashid, Asif; Wang, Ying; Jain, Apurva; Li, Donghui; Behari, Anu; Kapoor, Vinay Kumar; Koay, Eugene J.; Chang, Ping; Vauthey, Jean Nicholas; Li, Yanan; Espinoza, Jaime A.; Roa, Juan Carlos; Javle, Milind

    2016-01-01

    Gallbladder cancer (GBC) is an aggressive malignancy. Although surgical resection may be curable, most patients are diagnosed at an advanced unresectable disease stage. Cholelithiasis is the major risk factor; however the pathogenesis of the disease, from gallstone cholecystitis to cancer, is still not understood. To understand the molecular genetic underpinnings of this cancer and explore novel therapeutic targets for GBC, we examined the key genes and pathways involved in GBC using RNA sequencing. We performed gene expression analysis of 32 cases of surgically-resected GBC along with normal gallbladder tissue controls. We observed that 519 genes were differentially expressed between GBC and normal GB mucosal controls. The liver X receptor (LXR)/retinoid X receptor (RXR) and farnesoid X receptor (FXR) /RXR pathways were the top canonical pathways involved in GBC. Key genes in these pathways, including SERPINB3 and KLK1, were overexpressed in GBC, especially in female GBC patients. Additionally, ApoA1 gene expression suppressed in GBC as compared with normal control tissues. LXR and FXR genes, known to be important in lipid metabolism also function as tumor suppressors and their down regulation appears to be critical for GBC pathogenesis. LXR agonists may have therapeutic value and as potential therapeutic targets. PMID:27167107

  2. [Laparoscopic choledochoduodenostomy].

    Science.gov (United States)

    Baĭramov, N Iu; Zeĭnalov, N A; Pashadze, V A

    2013-01-01

    The article presents the results of laparoscopic choledoch-duodenostomy (CDS) applied to 23 patients with benign strictures of distal part of common bile duct (CBD). 21 patients had cholelithiasis in combination with the CBD stricture. The rest 2 patients had acalculous postcholecystectomy stricture. The laparoscopic CDS was executed by 5 trocars: 4 were placed in standard cholecystectomy positions and the 5th was placed by the right pararectal line at the umbilicus level and was used for traction of duodenum and continuous aspiration. 2 sm long side-to-side CDS was performed with interrupted sutures. The mean operative time was 128±36 (90-205) min. There was no conversion. The mean hospital stay was 4.5 (3-9) days. There was no mortality. 2 patients developed an anastomosis bile leakage: one received the relaparoscopy and T-draining of the CDS, in another patient the leakage seased spontaneously. 82.7% of patients showed excellent and good long term results. 3 patients reported bad outcome and very bad result was registered in 1 patient. In conclusion, the laparoscopic CDS gives good outcomes in experienced hands and could be considered as an alternative to endoscopic sphincterotomy in patients with distal CBD stenosis.

  3. The diagnostic value of joint detection of serum CA19-9, CA125 and CA242 for cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Cui Da-Peng; Han Lei; Liu Zhen-Xian; Yang He; Zhang Ying-Chun

    2016-01-01

    Objective:To study the diagnostic value of joint detection of serum CA19-9, CA125 and CA242 for cholangiocarcinoma.Methods:A total of 35 patients with cholangiocarcinoma who received surgical resection in our hospital were selected as malignant group, 30 patients with cholelithiasis who received surgical resection in our hospital during the same period were selected as benign group, serum samples were collected before surgery to determine CA19-9, CA125 and CA242 content, and cholangiocarcinoma tissue and normal bile duct tissue were collected after surgery to determine the content of proliferation and invasion molecules. Results:Serum CA19-9, CA125 and CA242 levels of malignant group were significantly higher than those of control group; PROX-1, Ki-67, Bcl-2, Bad, Gab1, LOXL2, TRPM7 and CXCL12 levels in cholangiocarcinoma tissue were higher than those in benign bile duct tissue, and E-cadherin level was lower than that in benign bile duct tissue; serum CA19-9, CA125 and CA242 levels were positively correlated with PROX-1, Ki-67, Bcl-2, Bad, Gab1, LOXL2, TRPM7 and CXCL12 levels, and negatively correlated with E-cadherin level.Conclusion:Joint detection of serum CA19-9, CA125 and CA242 can not only provide reference for the diagnosis of cholangiocarcinoma, but can also provide basis for the evaluation of proliferation, invasion and other malignant biological behaviors.

  4. Diagnosis of acute surgical abdomen - The best diagnostic tool to reach a final diagnosiscin

    Institute of Scientific and Technical Information of China (English)

    Wong CS; Al-Ajami AK; Boshahri M; Naqvi SA

    2012-01-01

    Objective: To evaluate the best diagnostic tool (clinical, radiological, laboratory, or endoscopy) used to reach a final diagnosis of four most common presentations of acute abdomen to the surgical unit in the Limerick University Hospital, Limerick, Ireland. Methods: Data was analyzed retrospectively of prospective collected data of all patients who had been admitted at a single academic institution from July 2011 till September 2011. Radiology, operating theatre and histopathology, haematology and endoscopy databases were searched from the Hospital Inpatient Enquiry (HIPE) department for patients who had presented with acute abdominal pain. Patients’ charts were searched manually and final diagnosis of each patient was recorded. Results: Out of 30 confirmed final diagnosis of appendicitis or appendicular mass, 9/30 (30.0%) were diagnosed with radiological (either on ultrasonography or CT scan). The remaining 21 cases (70.0%) were diagnosed clinically. Majority cases of diverticulitis 16/22 (72.7%) was diagnosed radiologically compared to only 6/22 (27.3%) of those confirmed by endoscopy. All diagnosis of gallstone-related diseases (cholecytitis, biliary colic, or cholelithiasis and/or choledocholithiasis) and bowel obstruction were confirmed by radiological investigation. Conclusions: Appendicitis can be accurately diagnosed clinically based on history and clinical examination alone. Diagnosis of diverticular disease, gallstone disease, and bowel obstruction further requires radiology intervention to confirm the provisional diagnosis.

  5. COMPARATIVE EVALUATION OF QTC INTERVAL CHANGES WITH INTRAVENOUS ONDANSETRON AND PALONOSETRON IN PATIENTS UNDERGOING LAPROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Anju

    2015-06-01

    Full Text Available Post - operative nausea and vomiting (PONV is a common and distressing symptom after surgery performed under general anesthesia. 5HT 3 antagonists are routinely used for PONV but are dreaded to cause QTc interval prolongation. The aim of our study was to compare the incidence of QTc interval prolongation and quantify the amount of QTc prolongation from the baseline value with IV ondansetron and Palonosetron when given for PONV prevention. 60 patients undergoing elective laproscopic surgery for cholelithiasis were randomly divided into 2 groups of 30 patients each and received 4mg of Ondansetron and 0.075mg of Palonosetron intravenously respectively before induction of anesthesia. Intraoperatively serial ECG was recorded at various intervals 0min, 3min, 15min, 1hr and 2hrs along with other routine monitoring and QTc was calculated in secs by Bazett Formula. RESULTS: The QTc interval was prolonged in Ondansetron group at all - time intervals as compared to Palonosetron group where prolongation was observed only at 3 min though this difference was statistically insignificant (P>0.05 . The difference between Ondansetron and Palonosetron group was comparable.

  6. When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

    International Nuclear Information System (INIS)

    Objective: to evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis. (author)

  7. Choledocholithiasis: Evolving standards for diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Marilee L Freitas; Robert L Bell; Andrew J Duffy

    2006-01-01

    Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States.Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones.CBD stones may be discovered preoperatively, intraoperatively or postoperatively Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans (CT), and magnetic resonance cholangiopancreatography (MRCP). Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose CBD stones.The most common intervention for CBD stones is ERCP. Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised.The availability of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is often dictated by the clinical situation.

  8. Analysis of heterogeneous gallstones using laser-induced breakdown spectroscopy (LIBS) and wavelength dispersive X-ray fluorescence (WD-XRF).

    Science.gov (United States)

    Jaswal, Brij Bir S; Kumar, Vinay; Sharma, Jitendra; Rai, Pradeep K; Gondal, Mohammed A; Gondal, Bilal; Singh, Vivek K

    2016-04-01

    Laser-induced breakdown spectroscopy (LIBS) is an emerging analytical technique with numerous advantages such as rapidity, multi-elemental analysis, no specific sample preparation requirements, non-destructiveness, and versatility. It has been proven to be a robust elemental analysis tool attracting interest because of being applied to a wide range of materials including biomaterials. In this paper, we have performed spectroscopic studies on gallstones which are heterogeneous in nature using LIBS and wavelength dispersive X-ray fluorescence (WD-XRF) techniques. It has been observed that the presence and relative concentrations of trace elements in different kind of gallstones (cholesterol and pigment gallstones) can easily be determined using LIBS technique. From the experiments carried out on gallstones for trace elemental mapping and detection, it was found that LIBS is a robust tool for such biomedical applications. The stone samples studied in the present paper were classified using the Fourier transform infrared (FTIR) spectroscopy. WD-XRF spectroscopy has been applied for the qualitative and quantitative analysis of major and trace elements present in the gallstone which was compared with the LIBS data. The results obtained in the present paper show interesting prospects for LIBS and WD-XRF to study cholelithiasis better. PMID:26886588

  9. Laparoscopic common bile duct exploration and antegrade biliary stenting: Leaving behind the Kehr tube

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    Darío Martínez-Baena

    2013-03-01

    Full Text Available Introduction: single-stage laparoscopic surgery of cholelithiasis and associated common bile duct stones (CL-CBDS has shown similar results when compared to laparoscopic cholecystectomy combined with ERCP. Classically, choledochorrhaphy has been protected by a T-tube drain to allow external bypass of bile flow. However, its removal is associated with a significant complication rate. Use of antegrade biliary stents avoids T-tube removal associated morbidity. The aim of this study is to compare the results of choledochorrhaphy plus T-tube drainage versus antegrade biliary stenting in our series of laparoscopic common bile duct explorations (LCBDE. Material and methods: between 2004 and 2011, 75 patients underwent a LCBDE. Choledochorrhaphy was performed following Kehr tube placements in 47 cases and transpapillary biliary stenting was conducted in the remaining 28 patients. Results: postoperative hospital stay was shorter in the stent group (5 ± 10.26 days than in the Kehr group (12 ± 10.6 days, with a statistically significant difference. There was a greater trend to grade B complications in the stent group (10.7 vs. 4.3 % and to grade C complications in the Kehr group (6.4 vs. 3.6 %. There were 3 cases of residual common bile duct stones in the Kehr group (6.4 % and none in the stent group. Conclusions: antegrade biliary stenting following laparoscopic common bile duct exploration for CL-CBDS is an effective and safe technique that prevents T-tube related morbidity.

  10. Use of Disease Staging and analysis of untimely admissions in the Abruzzo Region, Italy: implications for clinical management

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    Lamberto Manzoli

    2004-06-01

    Full Text Available

    Dear Sir;
    The Section of Epidemiology and Public Health of the University “G. d’Annunzio” of Chieti, in collaboration with the Centre for Research in Medical Education and Health Care of Jefferson Medical College, Philadelphia, PA, USA, has analysed 350,000 hospital admissions for the year 2001 in the Abruzzo region. Four diseases were chosen for an in-depth analysis. These were: diabetes mellitus;
    cholecystitis/cholelithiasis; cancer of the female breast and bacterial pneumonia.The total admissions for these conditions were 11,000.
    Using the Disease Staging methodology to control for severity, a number of variables were analysed:
    length of hospital stay, hospital mortality, complications and repeated admissions. In addition, the timeliness of hospitalisation was analysed by grouping admissions into three categories: premature or medically unnecessary, timely, and late.An example of the first type is a patient with an elevated blood sugar but no other complications (Stage 1 Diabetes Mellitus.

  11. Pattern of gastrointestinal diseases in adult patients admitted to Samtah General Hospital, Gizan region, Saudi Arabia

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    Aderoju Emmanuel

    1999-01-01

    Full Text Available To determine the relative frequencies of gastrointestinal diseases (GI in patients admitted to Samtah General Hospital, Gizan, the records of 2,442 adults admitted to the medical and surgical services for gastrointestinal diseases during the period 1413 to 1416 were analyzed retrospectively. 1,028 patients had acute appendicitis. The remaining 1,414 patients were admitted for various other GI diseases. In these 1,414 patients the commonest diseases were gastrointestinal infections (36.4%, peptic ulcer disease (19%, gall bladder disease (18.5%, viral hepatitis and its sequelae (20.7%. Despite the high prevalence of cholelithiasis, acute pancreatitis was uncommon (0.1 %. Inflammatory bowel disease was rare. There was no gender - related difference in the prevalence of gastrointestinal infections, peptic ulcer disease and carcinoma of the stomach. Males were significantly more afflicted than females with viral hepatitis (p< 0.0001, cirrhosis of the liver (p< 0.0001, hepatocellular carcinoma (p< 0.0005, variceal bleeding (p< 0.0005, and peptic ulcer bleeding (p< 0.005. As a large proportion of our patients had preventable diseases, it is expected that immunization and other public health measures will reduce the frequency of these diseases in the future.

  12. Anti-Microbial, Anti-Biofilm Activities and Cell Selectivity of the NRC-16 Peptide Derived from Witch Flounder, Glyptocephalus cynoglossus

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    Chang Ho Seo

    2013-05-01

    Full Text Available Previous studies had identified novel antimicrobial peptides derived from witch flounder. In this work, we extended the search for the activity of peptide that showed antibacterial activity on clinically isolated bacterial cells and bacterial biofilm. Pseudomonas aeruginosa was obtained from otitis media and cholelithiasis patients, while Staphylococcus aureus was isolated from otitis media patients. We found that synthetic peptide NRC-16 displays antimicrobial activity and is not sensitive to salt during its bactericidal activity. Interestingly, this peptide also led to significant inhibition of biofilm formation at a concentration of 4–16 μM. NRC-16 peptide is able to block biofilm formation at concentrations just above its minimum inhibitory concentration while conventional antibiotics did not inhibit the biofilm formation except ciprofloxacin and piperacillin. It did not cause significant lysis of human RBC, and is not cytotoxic to HaCaT cells and RAW264.7 cells, thereby indicating its selective antimicrobial activity. In addition, the peptide’s binding and permeation activities were assessed by tryptophan fluorescence, calcein leakage and circular dichroism using model mammalian membranes composed of phosphatidylcholine (PC, PC/cholesterol (CH and PC/sphingomyelin (SM. These experiments confirmed that NRC-16 does not interact with any of the liposomes but the control peptide melittin did. Taken together, we found that NRC-16 has potent antimicrobial and antibiofilm activities with less cytotoxicity, and thus can be considered for treatment of microbial infection in the future.

  13. AGENESIS OF GALL BLADDER DIAGNOSED INTRA-OPERATIVEL Y: A CASE REPORT

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    Somorjit Singh

    2013-04-01

    Full Text Available ABSTRACT : BACKGROUND : Congenital absence of GB is a rare anomaly occurrin g in less than 1 in 1000 population. These patients’ complaints of tho se of more common biliary conditions and routine radiological and biochemical investigat ion makes difficult to diagnose preoperatively and patients undergo unnecessary operat ive intervention. MATERIALS AND METHODS : A 18 years old female with clinical features of Ch olecystitis diagnosed by USG as Contracted GB with Cholelithiasis was operated for O pen Cholecystectomy. Intra-operatively, the GB could not be seen even after thorough dissec tion. Post operative MRCP confirmed the diagnosis of absence of GB. RESULTS: The patient having the classical features of Gall St one disease with the routine investigative reports, had undergone Operation .As the gall bladder was not found , the procedure was terminated and post operative MRCP confirmed the diagnosis of absence of GB. CONCLUSION: The rare congenital anomaly of absence of GB may have common biliary conditions, and so patients may undergo unnecessary operative procedures. With the newer minimally invasive radiol ogic techniques, this situation can largely be avoided if awareness of this condition is improve d.

  14. Encapsulating peritonitis and familial Mediterranean fever

    Institute of Scientific and Technical Information of China (English)

    Resat Dabak; Oya Uygur-Bayrami(c)li; Didem K1l1(c) Ayd1n; Can Dolap(c)1oglu; Cengiz Gemici; Turgay Erginel; Cem Turan; Nimet Karaday1

    2005-01-01

    AIM: To investigate the relationship between encapsulating peritonitis and familial Mediterranean fever (FMF). METHODS: The patient had a history of type 2 diabetes and laparoscopic cholecystectomy was performed one year ago for cholelithiasis. Eleven months after the operation she developed massive ascites. Biochemical evaluation revealed hyperglycemia, mild Fe deficiency anemia, hypoalbuminemia and a CA-125 level of 2 700 IU. Ascitic evaluation showed characteristics of exudation with a cell count of 580/mm3. Abdominal CT showed omental thickening and massive ascites. At exploratory laparotomy there was generalized thickening of the peritoneum and a laparoscopic clip encapsulated by fibrous tissue was found adherent to the uterus. Biopsies were negative for malignancy and a prophilactic total abdominal hysterectomy and bilateral salpingooophorectomy were performed. RESULTS: The histopathological evaluation was compatible with chronic nonspecific findings and mild mesothelial proliferation and chronic inflammation at the uterine serosa and liver biopsy showed inactive cirrhosis. CONCLUSION: The patient was evaluated as sclerosing encapsulating peritonitis induced by the laparoscopic clip acting as a foreign body. Due to the fact that the patient had FMF the immune response was probably exaggerated.

  15. Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment

    Science.gov (United States)

    Udachan, Tejaswini V; Sasnur, Prasad; Baloorkar, Ramakanth; Sindgikar, Vikram; Narasangi, Basavaraj

    2015-01-01

    Introduction Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open for various reasons. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. But there is no clear consensus among the laparoscopic surgeons regarding the parameters predicting the difficult dissection and conversion to open cholecystectomy. Aim To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion. Materials and Methods This was a prospective study conducted from October 2010 to October 2014. Total of 180 patients meeting the inclusion criteria undergoing LC were included in the study. Four parameters were assessed to predict the difficult LC. These parameters were: 1) Gallbladder wall thickness; 2) Pericholecystic fluid collection; 3) Number of attacks; 4) Total leucocyte count. The statistical analysis was done using Z-test. Results Out of 180 patients included in this study 126 (70%) were easy, 44 (24.44%) were difficult and 3 (5.56%) patients required conversion to open cholecystectomy. The overall conversion rate was 5.6%. The TLC>11000, more than 2 previous attacks of cholecystitis, GB wall thickness of >3mm and Pericholecystic collection were all statistically significant for predicting the difficult LC and its conversion. Conclusion The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and Pericholecystic collection. PMID:26816942

  16. Involvement of SIK3 in glucose and lipid homeostasis in mice.

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    Tatsuya Uebi

    Full Text Available Salt-inducible kinase 3 (SIK3, an AMP-activated protein kinase-related kinase, is induced in the murine liver after the consumption of a diet rich in fat, sucrose, and cholesterol. To examine whether SIK3 can modulate glucose and lipid metabolism in the liver, we analyzed phenotypes of SIK3-deficent mice. Sik3(-/- mice have a malnourished the phenotype (i.e., lipodystrophy, hypolipidemia, hypoglycemia, and hyper-insulin sensitivity accompanied by cholestasis and cholelithiasis. The hypoglycemic and hyper-insulin-sensitive phenotypes may be due to reduced energy storage, which is represented by the low expression levels of mRNA for components of the fatty acid synthesis pathways in the liver. The biliary disorders in Sik3(-/- mice are associated with the dysregulation of gene expression programs that respond to nutritional stresses and are probably regulated by nuclear receptors. Retinoic acid plays a role in cholesterol and bile acid homeostasis, wheras ALDH1a which produces retinoic acid, is expressed at low levels in Sik3(-/- mice. Lipid metabolism disorders in Sik3(-/- mice are ameliorated by the treatment with 9-cis-retinoic acid. In conclusion, SIK3 is a novel energy regulator that modulates cholesterol and bile acid metabolism by coupling with retinoid metabolism, and may alter the size of energy storage in mice.

  17. Somatostatinoma of the Vater's papilla in a patient with von Recklinghausen's disease

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    Čolović Radoje

    2007-01-01

    Full Text Available Background. Somatostatinomas of the gastrointestinal tract secret hormone somatostatin which can cause "inhibitory syndrome" comprising diabetes mellitus, cholelithiasis and steatorrheic diarrhea. It is also secreted by the D cells of Langerhans's islands of the pancreas as well as endocrine cells of the stomack, small bowel, salivary glands and parafollicular cells of the thiroid gland. Somatostatinomas of the digestive tract appear within the pancreas and duodenum. Patients suffering from von Recklinghausens's disease are paticularly prone to the somatostatinomas of the duodenum. Case report. In this paper we presented a 51-year old female patient with von Recklinghausen's disease in whom, during the investigation for obstructive jaundice, tumor of the Vater's papilla was found. The patient was submitted to Whipple's duodenopancreatectomy. Histology and immunohistochemistry discovered type B glandular carcinoid tumor with strong antisomatostatin and mild antigastrin immunoreactivity. The patient stayed symptom-free more than four years now. Conclusion. Patients with von Recklinghausen's disease should be examined for other tumors, particularly carcinoids of the duodenum and papilla, especially if the signs of cholestasis are present.

  18. Management of patients after recovering from acute severe biliary pancreatitis.

    Science.gov (United States)

    Dedemadi, Georgia; Nikolopoulos, Manolis; Kalaitzopoulos, Ioannis; Sgourakis, George

    2016-09-14

    Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature. PMID:27678352

  19. Expression and function of renal and hepatic organic anion transporters in extrahepatic cholestasis

    Institute of Scientific and Technical Information of China (English)

    Anabel Brandoni; María Herminia Hazelhoff; Romina Paula Bulacio; Adriana Mónica Torres

    2012-01-01

    Obstructive jaundice occurs in patients suffering from cholelithiasis and from neoplasms affecting the pancreas and the common bile duct.The absorption,distribution and elimination of drugs are impaired during this pathology.Prolonged cholestasis may alter both liver and kidney function.Lactam antibiotics,diuretics,non-steroidal anti-inflammatory drugs,several antiviral drugs as well as endogenous compounds are classified as organic anions.The hepatic and renal organic anion transport pathways play a key role in the pharmacokinetics of these compounds.It has been demonstrated that acute extrahepatic cholestasis is associated with increased renal elimination of organic anions.The present work describes the molecular mechanisms involved in the regulation of the expression and function of the renal and hepatic organic anion transporters in extrahepatic cholestasis,such as multidrug resistanceassociated protein 2,organic anion transporting polypeptide 1,organic anion transporter 3,bilitranslocase,bromosulfophthalein/bilirubin binding protein,organic anion transporter 1 and sodium dependent bile salt transporter.The modulation in the expression of renal organic anion transporters constitutes a compensatory mechanism to overcome the hepatic dysfunction in the elimination of organic anions.

  20. 腹腔镜胆囊切除术对胆结石治疗效果分析

    Institute of Scientific and Technical Information of China (English)

    王福荣

    2013-01-01

    Objective To investigate the clinical therapeutic effect of laparoscopic cholecystectomy for cholelithiasis. Methods 98 cases with gallstones were randomly divided into control group and observation group,each group had 49 cases. Control group was treated with conventional open cholecystectomy, the observation group were treated by laparoscopic cholecystectomy. Results Two patients all successfully completed the operation,the success rate was 100%, the difference was not statistically significant (P>0.05). Compared with the control group, operation time, anal exhaust time, hospitalization time in the observation group was shorter, the difference was statistically significant (P0.05).观察组较对照组手术时间、肛门排气时间、住院时间短,术中出血量低,止痛药物应用率、术后并发症率低,差异均有统计学意义(均P<0.05).结论腹腔镜胆囊切除术,较传统的外科手术方法,所需手术时间短、术中出血量少、患者所承受的痛苦小、并发症发生率低等,值得大力推广.

  1. When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

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    Costa, Danilo Manuel Cerqueira; Salvadori, Priscila Silveira; Monjardim, Rodrigo da Fonseca; Bretas, Elisa Almeida Sathler; Torres, Lucas Rios; Caldana, Rogerio Pedreschi; Shigueoka, David Carlos; Medeiros, Regina Bitelli; D' ippolito, Giuseppe, E-mail: giuseppe_dr@uol.com.br [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina. Departamento de Diagnostico por Imagem

    2013-06-15

    Objective: to evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis. (author)

  2. THE METHODS OF CHOLEDOCHOLITHIASIS TREATMENT

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    N. V. Merzlikin

    2015-01-01

    Full Text Available The methods of choledocholithiasis treatment, which are currently used in clinics of the Russian Federa-tion, has been presented. The problems of diagnosis and treatment of gallstones (GSD in individuals of different age groups are spotlighted. In the study of treatment of cholelithiasis and choledocholithiasis, including arising complications, it can be concluded that so far the ideal method of treatment of this pa-thology has not been found. Up to now, the majority of doctor’s main treatment is surgical removal of gall stones by some method or other.This article also considers a conservative approach (drug: antispasmodics (selective and nonselective, and non-pharmacological: treatment, diet, describes the criteria and assessment of the effectiveness of therapeutic interventions that help in the question of further treatment: the continuation of drug therapy or assignment of surgical treatment. Invasive techniques that are covered in the article, namely, a tech-nique of remote and endoscopic lithotripsy, are high-tech and in demand at the moment, which, along with high efficiency removal of a stone, reduced the number and severity of postoperative complications. Additionally, in the analysis of the features of a particular method of treatment, advantages and disadvantages of different treatment methods are described, indications and contraindications (absolute and relative together with complications, possible outcomes, and further prognosis are high-lighted. 

  3. Transumbilical single-port laparoscopic cholecystectomy using traditional laparoscopic instruments: a report of thirty-six cases

    Institute of Scientific and Technical Information of China (English)

    Li-ping CAO; Ri-sheng QUE; Fan ZHOU; Guo-ping DING; De-xi JING

    2011-01-01

    Objective:To evaluate the feasibility and safety of the operation of transumbilical single-port laparoscopic cholecystectomy (TSPLC) by traditional laparoscopic instruments and summarize the initial experience.Methods:Sixty subjects with cholelithiasis were divided into two groups.One group (36 cases) underwent TSPLC and the control group (24 cases) underwent traditional three-port laparoscopic cholecystectomy (LC).Postoperative complications were observed and operation time,hospital days,visual analogue scale (VAS) after 6 and 24 h of operation,and subject satisfaction score were measured.Results:TSPLC and traditional LC were performed successfully in the two groups.The operation time in the TSPLC group was significantly longer than that in the control group.There was no statistically significant difference in hospital stay and VAS between the TSPLC and control groups.The subject satisfaction score in the TSPLC group was 91.2,significantly higher than that in the control group (P<0.01).All subjects recovered from the operation and no postoperative complication occurred during the period of two weeks after operation.Conclusions:TSPLC is a feasible and safe method for cholecystectomy,although it may be more time-consuming.However,it is welcomed by patients who are more concerned with cosmetic outcomes.Future studies are needed to confirm its disadvantages and contraindications.

  4. Somatostatinoma syndrome: a challenging differential diagnosis among pancreatic tumors

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    Paula Martinez Vianna

    2013-03-01

    Full Text Available Among the neuroendocrine neoplasia, the pancreatic somatostatin-producing tumors are very rare. Usually functional, these tumors produce the somatostatinoma syndrome, which encompasses diabetes mellitus, diarrhea/steatorrhoea, and cholelithiasis. Other symptoms may include dyspepsia, weight loss, anemia, and hypochlorhydria. All theses symptoms are explained by the inhibitory actions of the somatostatin released by tumoral cells originated from pancreatic delta cells or endocrine cells of the digestive tract. The diagnosis is easy to overlook since these symptoms are commonly observed in other more common syndromes. Besides the clinical features, diagnosis is based on serum determination of somatostatin, and imaging exams, such as ultrasound, computer tomography and positron emission tomography. Pathologic examination is characterized by the positivity of immunohistochemical reaction for synaptophysin, chromogranin, and somatostatin. These tumors can be classified according to tumor size, mitotic index, neural or vascular invasion, and distant metastases. The authors describe the case of a 61-year-old female patient who sought medical care because of a 6-month history of watery diarrhea, weight loss, and depression. She was diagnosed with diabetes mellitus 3 years ago. Imaging examination revealed a tumoral mass of 4 cm in its longest axis in the topography of the head of the pancreas and calculous cholecistopathy. The patient’s clinical status was unfavorable for a surgical approach. She died after 20 days of hospitalization. The definitive diagnosis was achieved with the autopsy findings, which disclosed a pancreatic somatostatinoma.

  5. Effect of perioperative somatostatin administration of sphincteroplasty-induced increase of amylase.

    Science.gov (United States)

    Roncoroni, L; De Bernardinis, M; Violi, V; Montanari, M; Peracchia, A

    1986-06-01

    Twenty patients undergoing sphincteroplasty for cholelithiasis were randomly divided into two groups of 10. The former (T) were treated with a 4-h somatostatin intravenous drip (250 micrograms/h), started at the beginning of operation, while the latter (C) made up the control group. Serum and urine amylase, amylase creatinine clearance ratio, and liver function tests were assessed for 2 days before surgery, after the operation and for a period of 5 postoperative days. Homogeneity between the two series was verified in experimental conditions. Statistical differences occurred postoperatively in amylase creatinine clearance ratio, which proved higher in C group, and gamma-GT, which was higher in T group. Short-term somatostatin administration proved effective in reducing the postoperative amylase creatinine clearance ratio, although more evident results are reported after long-term administration. Cholestasis or any serious impairment in liver function did not occur, suggesting the suitability of somatostatin use even in patients with jaundice. Since a relationship between postoperative amylase levels and risk of pancreatitis has not yet been proved, the value of somatostatin in the prevention of postoperative pancreatitis after sphincteroplasty needs to be further verified.

  6. Differential determination of serum isoamylase using an amylase inhibitor and its clinical application.

    Science.gov (United States)

    Kameya, A; Hayakawa, T; Noda, A; Kondo, T

    1985-01-01

    Diagnostic significance of a simple and rapid screening procedure for determining the relative amounts of pancreatic and salivary isoamylase using an amylase inhibitor was evaluated in 242 subjects (controls 84, acute pancreatitis nine, chronic pancreatitis 28, pancreatic cancer 14, peptic ulcer 25, liver cirrhosis 15, cholelithiasis 24, irritable colon syndrome 13, diabetes mellitus 13, mumps seven, and chronic renal failure 10). Electrophoretically separated isoamylases of saliva and pure pancreatic juice were all inhibited at similar degrees to the corresponding unfractionated amylases. Total amylase and pancreatic isoamylase were elevated in all nine patients with acute pancreatitis. Pancreatic isoamylase was decreased in 12 of 28 patients (43%) with chronic pancreatitis and increased in nine of 14 patients (64%) with pancreatic cancer. The mean pancreatic isoamylase activity in the patients with acute pancreatitis was significantly higher (p less than 0.01), while that of chronic pancreatitis was significantly lower (p less than 0.05) when compared with controls. The inhibition method offers simple, rapid, and specific analysis of serum isoamylase for the differential diagnosis of hyperamylasemia in cases of emergency. PMID:3966456

  7. Ascaris lumbricoides and its invasion of the accessory cystic duct: an unusual presentation.

    Science.gov (United States)

    Majid, Zain; Masood, Irfan; Pirzada, Muhammad Taqi

    2015-04-01

    Around the world, Ascaris lumbricoides is the most common helminthic infection. We describe the case of a 25-year-old woman, known to have had Ascaris infestation, presenting with abdominal pain, constipation and jaundice together with fever and tachycardia. There was tenderness in the right hypochondrium and liver function tests confirmed cholestatic jaundice. An abdominal ultrasound showed multiple linear echogenic foci in the distal small intestine along with cholelithiasis and a thick-walled gall bladder with a single stone compressing the common bile duct (Mirizzi syndrome). The patient underwent exploratory laparotomy; more than 100 worms were found inside the small intestine and they were removed by enterotomy and manual decompression. No worm could be palpated within the common bile duct (CBD). Cholecystectomy was performed, during which an accessory cystic duct was noted opening into the common bile duct superiorly to the main cystic duct. A 10 cm live worm was found coming out of it and was removed via forceps. Later on an endoscopic retrograde cholangio-pancreatogram (ERCP) showed a widened ampulla, a mildly dilated common bile duct, but without any filling defects. The patient made an uneventful postoperative recovery being discharged on the ninth day. Worms in an accessory cystic duct have not been report in the medical literature so far.

  8. Laparoscopic cholecystectomy: is it a conscious preference among Turkish patients with symptomatic gallstones?--prospective study.

    Science.gov (United States)

    Cingi, Asim; Düşünceli, Fikret; Güllüoğlu, Bahadir M; Yeğen, Cumhur; Aktan, A Ozdemir; Yalin, Rifat

    2004-10-01

    Laparoscopic cholecystectomy (LC) has the advantages of early return to full daily activity, early return to work, and better cosmetic result, as well as quickly resolving pain. Yet how this information about the procedure influences a patient's attitude toward laparocopy is not known. In this study we analyzed the factors that play role in the decision-making process of patients who choose laparoscopic surgery, and we also evaluated patients' knowledge of laparoscopy and their expectations. A questionnaire was used in evaluating 98 patients suffering from symptomatic cholelithiasis scheduled for elective laparoscopic cholecystectomy between January 2001 and January 2002. Females constituted 81% of the study population. Most of the patients (56%) were housewives. While 45% of the patients had an educational status of primary school degree only, 14% had graduated from a university. Forty-three patients described their level of knowledge about laparoscopy as "low" (had only heard about laparoscopy). In 61% of the patients the surgeon was the sole decision maker about the type of the operation. Almost none of the patients had a preference for the time of discharge from the hospital after surgery, and only three of the actively working patients offered a time interval for return to work. From this study we concluded that most patients have inadequate information about laparoscopic surgery, that the type of operation is dictated mostly by the surgeon, and that early discharge and early return to work are not important for many patients. PMID:15573265

  9. Dif ferences and signiifcance of motilin, vasoactive intestinal peptide and gastrin in blood and gallbladder tissues of patients with gallstones

    Institute of Scientific and Technical Information of China (English)

    Zhen-Hai Zhang; Shuo-Dong Wu; Yang Su; Jun-Zhe Jin; Ying Fan; Hong Yu; Li-Kui Zhang

    2008-01-01

    BACKGROUND:The disorders of gallbladder motility may play an important role in the formation of gallstones. Many neural and hormonal factors and their interactions regulate gallbladder motility and bile lfow into the duodenum. Further study in these factors may help to reveal the etiology of gallbladder diseases. This study was undertaken to assess the relationship of the levels of motilin, vasoactive intestinal peptide (VIP) and gastrin in blood and gallbladder tissues with the formation of cholelithiasis. METHODS:The levels of motilin, gastrin and VIP in blood and gallbladder tissues of 36 patients with gallbladder stones, 14 patients with gallbladder polyps, 10 healthy volunteers and 10 patients with common bile duct stones were measured by radioimmunoassay. RESULTS:The level of motilin in plasma and gallbladder tissues of the gallbladder stone group was higher than that of the control and gallbladder polyp groups (P CONCLUSIONS:The abnormal excretion of hormonal factors is closely related to gallstone formation. The high level of VIP in gallbladder tissues may be an important cause of gallbladder hypomotility. The abnormal level of serum gastrin may be related to the gastrointestinal symptoms of patients with gallstones.

  10. The role and mechanism of fatty acids in gallstones

    Institute of Scientific and Technical Information of China (English)

    Shuo-Dong Wu; Kazuhisa Uchiyama; Ying Fan

    2007-01-01

    BACKGROUND: Cholelithiasis is a common entity in China, but its etiology and pathogenesis have not been fully elucidated. Pigment stones of the intrahepatic and extrahepatic bile duct still form a high proportion in China, while they are rare in Europeans. To date, reports on fatty acids in stones remain few. We analyzed the quantity of fatty acids in different stones from Chinese and Japanese cases and discussed the role and mechanism of fatty acids in the formation of pigment stones. METHODS: Clinical data from 18 Chinese and 37 Japanese patients with different types of stones were analyzed using the procedure for extracting fatty acids from gallstones and high performance liquid chromatography. RESULTS: The total fatty acid and free fatty acid contents of pigment stones were markedly higher than those in black or cholesterol stones. The ratio of free saturated to free unsaturated fatty acids was highest in intrahepatic and less in extrahepatic pigment stones, which were signiifcantly different from the other two kinds of stones. CONCLUSIONS: This indicates that phospholipase participates in the course of pigment stone formation. The action of phospholipase A1 is more important than phospholipase A2.

  11. Concomitant Small Cell Neuroendocrine Carcinoma of Gallbladder and Breast Cancer

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    Paolo Aiello

    2014-01-01

    Full Text Available The neuroendocrine carcinoma is defined as a high-grade malignant neuroendocrine neoplasm arising from enterochromaffin cells, usually disposed in the mucosa of gastric and respiratory tracts. The localization in the gallbladder is rare. Knowledge of these gallbladder tumors is limited and based on isolated case reports. We describe a case of an incidental finding of small cell neuroendocrine carcinoma of the gallbladder, observed after cholecystectomy for cholelithiasis, in a 55-year-old female, who already underwent quadrantectomy and sentinel lymph-node biopsy for breast cancer. The patient underwent radiotherapy for breast cancer and six cycles of chemotherapy with cisplatin and etoposide. Eighteen months after surgery, the patient was free from disease. Small cell neuroendocrine carcinoma of the gallbladder has poor prognosis. Because of the rarity of the reported cases, specific prognostic factors have not been identified. The coexistence of small cell neuroendocrine carcinoma of the gallbladder with another malignancy has been reported only once. The contemporary presence of the two neoplasms could reflect that bioactive agents secreted by carcinoid can promote phenotypic changes in susceptible cells and induce neoplastic transformation.

  12. [Vegetarian nutrition: Preventive potential and possible risks. Part 1: Plant foods].

    Science.gov (United States)

    Ströhle, Alexander; Waldmann, Annika; Wolters, Maike; Hahn, Andreas

    2006-10-01

    Today vegetarian nutrition is more accepted and widespread in Europe than in former years. For a long time scientific research on vegetarian diets has focused mostly on malnutrition, whereas nowadays research centers increasingly on the preventive potential of plant-based diets. We followed a nutritive and a metabolic-epidemiological approach to obtain dietary recommendations. A MEDLINE research was performed for all plant food groups relevant for a vegetarian diet (key words: all relevant food groups, "vegetarian diet", "chronic disease", "cancer", "cardiovascular disease", "diabetes mellitus", "osteoporosis"). All relevant food groups were characterized regarding their nutrient content and rated with respect to the available metabolic-epidemiological evidence. Based on the evidence criteria of the WHO/FAO, cancer risk reduction by a high intake of vegetables and fruits is assessed as probable or possible, while a lowered risk of cardiovascular disease is convincing and a lowered risk of osteoporosis is probable. The evidence of a risk reducing effect of whole grain relating to colorectal cancer is assessed as possible, whereas it is probable relating to cardiovascular disease and diabetes mellitus type 2. There is an insufficient risk-reducing effect of legumes like soja relating to epithelial tumours and cardiovascular disease. The evidence of a risk-reducing effect of nuts to cardiovascular disease is assessed as probable, and in relation to cholelithiasis and diabetes mellitus type 2 as possible and insufficient, respectively. In conclusion, high consumption of fruits, vegetables, whole grains and nuts can lower the risk for several chronic diseases. PMID:17136332

  13. Port site and distant metastases of gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography

    Institute of Scientific and Technical Information of China (English)

    Jian-Bin Hu; Xiao-Nan Sun; Jing Xu; Chao He

    2008-01-01

    We report port site and distant metastases of unsuspected gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography (PET) in two patients. Patient 1, a 72-year-old woman was diagnosed as cholelithiasis and cholecystitis and received laparoscopic cholecystectomy. Unsuspected gallbladder cancer was discovered with histological result of well-differentiated squamous cell carcinoma of the gallbladder infiltrating the entire wall. A PET scan using F-18-fluorodeoxygluccee (FDG-PET) before radical resed:ion revealed residual tumor in the gallbladder fossa and recurrence at port site and metastases in bilateral hilar lymph nodes. Patient 2, a 69-year-old woman underwent laparoscopic cholecystectomy more than one year ago with pathologically confirmed unsuspected adenosquamous carcinoma of stage pTlb. At 7-mo follow-up after surgery, the patient presented with nodules in the periumbilical incision. Excisional biopsy of the nodule revealed adenosquamous carcinoma. The patient was examined by FDG-PET, demonstrating increased FDG uptake in the right lobe of the liver and mediastinal lymph nodes consistent with metastatic disease. This report is followed by a discussion about the utility of FDG-PET in the gallbladder cancer.

  14. A Tumor-Like Lesion Mimicking Mucinous (Colloid Carcinoma in Heterotopic Pancreas of the Prepyloric Antrum: A Formidable Challenge for Frozen Examination

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    Zafer Teke

    2010-05-01

    Full Text Available Context Heterotopic pancreas is defined as the presence of pancreatic tissue, outside its usual location, which lacks anatomical and vascular continuity with the pancreas proper. Despite the development of modern diagnostic procedures, it is still difficult to differentiate heterotopic pancreas from benign or malignant tumors and other tumor-like lesions. Frozen examination of mucinous lesions arising from heterotopic pancreas may represent a diagnostic problem. A decision may be very difficult and it is sometimes impossible to decide on the basis of the frozen sections whether a lesion is benign or malignant. Case report We report a tumor-like lesion mimicking a mucinous (colloid carcinoma arising in heterotopic pancreatic tissue in the prepyloric antrum of a 56-year-old woman which was found incidentally during an elective laparoscopic cholecystectomy for cholelithiasis. The tumor was treated by wedge resection and, in the frozen section examination, there were pancreatic ducts in the proper muscle layer, pancreatic acini with islets of Langerhans under the serosal surface and mucinous lakes close to the heterotopic pancreatic tissue and to a peripheral nerve. Conclusion The significance of this unusual lesion is its potential confusion with mucinous (colloid carcinoma or other mucous tumors. Such confusion is more likely to occur if the tissue sample is selective or limited, and the presence of pancreatic tissue cannot be verified. Therefore, we believe that a choice of local excision, wedge resection or more extensive eradication be determined only after intraoperative, pathological confirmation of the complete and accurate diagnosis.

  15. Complications and Monitoring – Guidelines on Parenteral Nutrition, Chapter 11

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    Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine

    2009-11-01

    Full Text Available Compared to enteral or hypocaloric oral nutrition, the use of PN (parenteral nutrition is not associated with increased mortality, overall frequency of complications, or longer length of hospital stay (LOS. The risk of PN complications (e.g. refeeding-syndrome, hyperglycaemia, bone demineralisation, catheter infections can be minimised by carefully monitoring patients and the use of nutrition support teams particularly during long-term PN. Occuring complications are e.g. the refeeding-syndrome in patients suffering from severe malnutrition with the initiation of refeeding or metabolic, hypertriglyceridemia, hyperglycaemia, osteomalacia and osteoporosis, and hepatic complications including fatty liver, non-alcoholic fatty liver disease, cholestasis, cholecystitis, and cholelithiasis. Efficient monitoring in all types of PN can result in reduced PN-associated complications and reduced costs. Water and electrolyte balance, blood sugar, and cardiovascular function should regularly be monitored during PN. Regular checks of serum electrolytes and triglycerides as well as additional monitoring measures are necessary in patients with altered renal function, electrolyte-free substrate intake, lipid infusions, and in intensive care patients. The metabolic monitoring of patients under long-term PN should be carried out according to standardised procedures. Monitoring metabolic determinants of bone metabolism is particularly important in patients receiving long-term PN. Markers of intermediary, electrolyte and trace element metabolism require regular checks.

  16. Pregnancy Following Bariatric Surgery-Medical Complications and Management.

    Science.gov (United States)

    Narayanan, Ram Prakash; Syed, Akheel A

    2016-10-01

    Bariatric surgery is most commonly carried out in women of childbearing age. Whilst fertility rates are improved, pregnancy following bariatric surgery poses several challenges. Whilst rates of many adverse maternal and foetal outcomes in obese women are reduced after bariatric surgery, pregnancy is best avoided for 12-24 months to reduce the potential risk of intrauterine growth retardation. Dumping syndromes are common after bariatric surgery and can present diagnostic and therapeutic challenges in pregnancy. Early dumping occurs due to osmotic fluid shifts resulting from rapid gastrointestinal food transit, whilst late dumping is characterized by a hyperinsulinemic response to rapid absorption of simple carbohydrates. Dietary measures are the mainstay of management of dumping syndromes but pharmacotherapy may sometimes become necessary. Acarbose is the least hazardous pharmacological option for the management of postprandial hypoglycemia in pregnancy. Nutrient deficiencies may vary depending on the type of surgery; it is important to optimize the nutritional status of women prior to and during pregnancy. Dietary management should include adequate protein and calorie intake and supplementation of vitamins and micronutrients. A high clinical index of suspicion is required for early diagnosis of surgical complications of prior weight loss procedures during pregnancy, including small bowel obstruction, internal hernias, gastric band erosion or migration and cholelithiasis. PMID:27488114

  17. The mechanisms in treatment of acute pancreatitis by traditional Chinese medicine

    Institute of Scientific and Technical Information of China (English)

    Xiping Zhang; Ying Wang; Yan Shi

    2006-01-01

    As common acute abdomen, most of acute pancreatitis(AP) are self-restricted. Only a few patients may develop into worse state with local complications or organ failures, and finally neastic acute pancreatitis (NAP). With the change of people's dietaries, cholelithiasis morbidity and popularization of wine in recent years, the number of AP patients has increased.Although people conducted enormous studies on pathogenesis of AP and brought forward many be valuable theories, yet the exact mechanism is still unclear by far. There are many therapies of AP which should be unexceptionally classified as operative therapy and non-operative therapy. With the increasing understanding of the disease in recent years, we found many defects of operation and good therapeutic effects of traditional Chinese medicine in AP. Traditional Chinese medicine as an auxiliary therapy has been generally paid close attention in clinical practices. Traditional Chinese medicine is a treasure-house of China. This article summarizes the main mechanisms of AP treatment by traditional Chinese medicine and the progress of laboratory studies. It aims to help people recognize the multiple-target treatment effects and conspicuous efficacy of traditional Chinese medicine and promote the popularization of traditional Chinese medicine in AP treatment.

  18. When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

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    Danilo Manuel Cerqueira Costa

    2013-07-01

    Full Text Available Objective: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis. Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others. Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14% cases presented changes after the second analysis, as follows: nephrolithiasis (10%, steatosis (3%, adrenal nodule (0.7% and cholelithiasis (0.3%. Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis.

  19. The role of sonography in imaging of the biliary tract.

    Science.gov (United States)

    Foley, W Dennis; Quiroz, Francisco A

    2007-06-01

    Sonography is the recommended initial imaging test in the evaluation of patients presenting with right upper quadrant pain or jaundice. Dependent upon clinical circumstances, the differential diagnosis includes choledocholithiasis, biliary stricture, or tumor. Sonography is very sensitive in detection of mechanical biliary obstruction and stone disease, although less sensitive for detection of obstructing tumors, including pancreatic carcinoma and cholangiocarcinoma. In patients with sonographically documented cholelithiasis and choledocholithiasis, laparoscopic cholecystectomy with operative clearance of the biliary stone disease is usually performed. In patients with clinically suspected biliary stone disease, without initial sonographic documentation of choledocholithiasis, endoscopic ultrasound or magnetic resonance cholangiopancreatography is the next logical imaging step. Endoscopic ultrasound documentation of choledocholithiasis in a postcholecystectomy patient should lead to retrograde cholangiography, sphincterotomy, and clearance of the ductal calculi by endoscopic catheter techniques. In patients with clinical and sonographic findings suggestive of malignant biliary obstruction, a multipass contrast-enhanced computed tomography (CT) examination to detect and stage possible pancreatic carcinoma, cholangiocarcinoma, or periductal neoplasm is usually recommended. Assessment of tumor resectability and staging can be performed by CT or a combination of CT and endoscopic ultrasound, the latter often combined with fine needle aspiration biopsy of suspected periductal tumor. In patients whose CT scan suggests hepatic hilar or central intrahepatic biliary tumor, percutaneous cholangiography and transhepatic biliary stent placement is usually followed by brushing or fluoroscopically directed fine needle aspiration biopsy for tissue diagnosis. Sonography is the imaging procedure of choice for biliary tract intervention, including cholecystostomy, guidance for

  20. Mirizzi syndrome with an unusual aberrant hepatic duct fistula: a case report.

    Science.gov (United States)

    Wang, Meng; Xing, Yufei; Gao, Quangen; Lv, Zhiqiang; Yuan, Jianmao

    2016-01-01

    Mirizzi syndrome (MS) is a rare complication of chronic cholelithiasis, which is always caused by a calculus in the cystic duct or neck of the gallbladder, resulting in mechanical compression of common bile duct and the gallbladder. It is clinically characterized by abdominal pain, fever, as well as obstructive jaundice. During cholecystectomy, MS is seen as a dangerous adherent and inflammatory tissue in the area of Calot's triangle. In the general population, aberrant right posterior hepatic duct, one of the causes of bile duct injury during duct surgery, is present in 4.8%-8.4% of people. Herein we report a rare case of a 76-year-old female patient, with hepatolithiasis of right posterior lobe and cholecysto-aberrant right posterior hepatic duct fistula. This is a special type of MS; however, interestingly, she did not have any symptoms, and the disease was found by physical examination incidentally. This case highlights another situation, namely, there may be difficulty in diagnosing MS and dissecting for operation. Therefore, to avoid the complication associated with this special situation, the surgeons need to diagnose carefully and adopt an optimal treatment strategy. PMID:27445508

  1. [Assessment of bariatric surgery results].

    Science.gov (United States)

    Barros, Lívia Moreira; Frota, Natasha Marques; Moreira, Rosa Aparecida Nogueira; de Araújo, Thiago Moura; Caetano, Joselany Áfio

    2015-03-01

    The objective was to evaluate the results of bariatric surgery in patients in the late postoperative period using the Bariatric Analysis and Reporting Outcome System (BAROS). This cross-sectional study was conducted from November 2011 to June 2012 at a hospital in the state of Ceará, Brazil. Data were collected from 92 patients using the BAROS protocol, which analyzes weight loss, improved comorbidities, complications, reoperations and Quality of Life (QoL). Data were analysed using the chi-squared test, Fischer's exact test and the Mann-Whitney test. There was a reduction in the Body Mass Index (47.2±6.8 kg/m2 in the pre-operatory and 31.3±5.0 kg/m2 after surgery, p<0.001). The comorbidity with the highest resolution was arterial hypertension (p<0.001), and QV improved in 94.6% of patients. The main complications were hair loss, incisional hernia and cholelithiasis. The surgery provided satisfactory weight loss and improvements in the comorbidities associated to a better QL. Use of the BAROS protocol allows nurses to plan interventions and maintain the good results. PMID:26098798

  2. Gallstone obstruction in anastomotic stricture: A very rare case

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    Burak Veli Ülger

    2015-03-01

    Full Text Available Gallstone ileus is a rare but serious complication of cholelithiasis. It is a rare cause of small bowel obstruction but it accounts up to 25% of non-strangulated small bowel obstructions in elderly. Obstruction usually occurs in the terminal ileum. Although the most frequent mechanism of gallstone ileus is migration of the gallstone through a gallbladder-duodenal fistula, there have been cases of bowel obstruction caused by gallstones without any findings of bilio-enteric fistula during the operation. The diagnosis is usually delayed due to nonspecific clinical signs and symptoms. Abdominal computerized tomography (CT scan is the optimal way to diagnose the gallstone ileus. It can identify the site and nature of the obstruction. The optimal surgical approach is a matter of debate. Enterolithotomy is the most performed operation. One stage operation should be performed in selected low risk patients. In this study, we report a 55 years old male patient who underwent surgical intervention due to gallstone ileus. During the operation, we observed that two individual gallstones lead to obstruction in anastomoticstricture which was due to the patient’s prior small bowel resection. Also, no fistula was found during the operation between the gall bladder and the gastrointestinal tract of patient. The gallstones were removed by enterolithotomy. Because there was no gallstone in the allbladder, we did not perform cholecystectomy. J Clin Exp Invest 2015; 6 (1: 72-74

  3. Pancreatitis aguda recidivante con enteropatía por gluten asociada: Características clínico-analíticas y evolutivas en 34 pacientes Relapsing acute pancreatitis associated with gluten enteropathy: Clinical, laboratory, and evolutive characteristics in thirty-four patients

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    L. Rodrigo

    2008-12-01

    AP, as compared to 27 (17% in group 2 (NS. The presence of cholelithiasis in group 1 involved 6 cases (18%, which was significantly lower than in group 2 - 72 cases (45% (p < 0.05. Four patients with GE developed pseudocysts (12% versus 13 (8% in group 2 (NS. Tissue transglutaminase (tTG was elevated only in 3 patients (9%. Nine patients (34% were DQ2 (+ and 4 (12% DQ8 (+; the rest (54% were all negative for both markers. From an endoscopic perspective there was diffuse duodenitis in 32 patients (95%. Duodenal biopsies revealed villous atrophy (Marsh 3 in 2 patients (6%; submucosal inflammatory infiltration (Marsh 2 in 10 (29.4%; increased intraepithelial lymphocytes (Marsh 1 in 8 cases (23.5%, and normal mucosa (Marsh 0 in 14 patients (41.2%. Response to GFD after 1 year was excellent in 30 patients (88%. Conclusions: relapsing AP with GE represents a relatively common association that is indistinguishable from other APs from a clinical-evolutive standpoint, except for a lower presence of cholelithiasis (p < 0.05. A specific diagnostic protocol is much needed in the identification of these patients since GFD is the only effective therapy to prevent new AP events from developing.

  4. Biliary tree and cholecyst: post surgery imaging

    Energy Technology Data Exchange (ETDEWEB)

    Valek, Vlastimil [Department of Radiology, University Hopistal Brno, Jihlavska 20, 63900 Brno (Czech Republic)]. E-mail: v.valek@fnrbno.cz; Kala, Zdenek [Department of Surgery, University Hospital Brno, Jihlavska 20, 63900 Brno (Czech Republic); Kysela, Petr [Department of Surgery, University Hospital Brno, Jihlavska 20, 63900 Brno (Czech Republic)

    2005-03-01

    Recently, with improvements in surgical techniques there has been a substantial reduction in the incidence of biliary complications of hepatobiliary surgery. Nevertheless, bile duct injuries and other post-cholecystectomy complications are a serious problem and a major cause of morbidity and mortality. Early complications may include bile duct injury caused by mistakenly placed clips, erroneous cutting of bile ducts based on misinterpretation of biliary anatomy, periductal bile leakage that causes edema, fibrosis and secondary stricturing, and ischemia due to injury to the right hepatic artery. Bile duct strictures are the most common of the late complications and can develop a few months or many years after surgery. Early detection and accurate diagnosis have a fundamental importance for the successful treatment of these complications. Therefore, early and meaningful application of the imaging methods immediately after detection of the first symptoms is essential. Peroperative ultrasound and direct iodine contrast application into the biliary tree (operative cholangiography) are highly important for immediate visualization of the complications during surgery. Ultrasound can be used to aid in identification of ductal structures and the cholangiogram should be obtained to document the anatomy. Plain abdominal film could be made in the patients in poor clinical conditions after biliary surgery. Oral cholecystography has largely been replaced by ultrasonography (US) for evaluation of cholelithiasis and complications like post-cholecystectomy fluid collections. The same methodology replaced the conventional intravenous cholangiography. Nowadays computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiography (MRCP) and ultrasound (US) have essential roles as primary imaging modalities after biliary tree and gallbladder surgery in the evaluation of associated complications and residual biliary stones. We review the role

  5. Comparative study on the results of consecutive oral cholecystography and intravenous cholangiography

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    Lee, Sung Hee; Park, Yang Ok; Yoo, Ho Joon [Korea General Hospital, Seoul (Korea, Republic of)

    1974-04-15

    Since its introduction in 1924, oral cholecystography has been used as a screening method in the diagnosis of the gallbladder disease. Recently, intravenous cholangiography has become a most valuable method in the diagnosis of biliary tract pathology because of its advantage of simultaneous visualization of the gallbladder and bile ducts in a short time. However, opinions vary considerably as to the significance of nonvisualization of the gallbladder with oral cholecystography. In attempt to evaluate how much intravenous cholangiography does contribute to the diagnosis in the cases that the gallbladder cannot be opacified or can only faintly visualized by the oral method, we have made a clinical observation in 168 patients, in whom intravenous cholangiography had been performed within a week following oral cholecystography, at Korea General Hospital during the last three years from January 1969 to December 1971. The results obtained are summarized as follows; 1. The results of oral cholecystography in 168 cases were as follow; well opacification of the gallbladder in 10 cases, faint opacification in 46 cases and nonopacification in 112 cases. 2. In 37.5% (42 cases) of 112 gallbladder not opacified by the oral method, the gallbladder was subsequently opacified by the intravenous method, and 11.6% (14 cases) turned out to be normal when examined by the intravenous method. 3. Further demonstration of abnormalities could be obtained with the aid intravenous cholangiography in 28 cases (16.6%); cholelithiasis in 12 cases and choledocholithiasis in 16 cases. 4. In every cases of 14 patients whose gallbladder were virtually not opacified by both oral and intravenous methods bit the common bile ducts could be opacified by intravenous cholangiography, definite abnormalities were identified in the gallbladder at surgery.

  6. Comparative study on the results of consecutive oral cholecystography and intravenous cholangiography

    International Nuclear Information System (INIS)

    Since its introduction in 1924, oral cholecystography has been used as a screening method in the diagnosis of the gallbladder disease. Recently, intravenous cholangiography has become a most valuable method in the diagnosis of biliary tract pathology because of its advantage of simultaneous visualization of the gallbladder and bile ducts in a short time. However, opinions vary considerably as to the significance of nonvisualization of the gallbladder with oral cholecystography. In attempt to evaluate how much intravenous cholangiography does contribute to the diagnosis in the cases that the gallbladder cannot be opacified or can only faintly visualized by the oral method, we have made a clinical observation in 168 patients, in whom intravenous cholangiography had been performed within a week following oral cholecystography, at Korea General Hospital during the last three years from January 1969 to December 1971. The results obtained are summarized as follows; 1. The results of oral cholecystography in 168 cases were as follow; well opacification of the gallbladder in 10 cases, faint opacification in 46 cases and nonopacification in 112 cases. 2. In 37.5% (42 cases) of 112 gallbladder not opacified by the oral method, the gallbladder was subsequently opacified by the intravenous method, and 11.6% (14 cases) turned out to be normal when examined by the intravenous method. 3. Further demonstration of abnormalities could be obtained with the aid intravenous cholangiography in 28 cases (16.6%); cholelithiasis in 12 cases and choledocholithiasis in 16 cases. 4. In every cases of 14 patients whose gallbladder were virtually not opacified by both oral and intravenous methods bit the common bile ducts could be opacified by intravenous cholangiography, definite abnormalities were identified in the gallbladder at surgery

  7. Correlation between the Lactate Dehydrogenase Levels with Laboratory Variables in the Clinical Severity of Sickle Cell Anemia in Congolese Patients.

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    Tite Minga Mikobi

    Full Text Available Sickle cell anemia is an inflammatory disease and is characterized by chronic hemolysis. We sought to evaluate the association of lactate dehydrogenase levels with specific clinical phenotypes and laboratory variables in patients with sickle cell anemia.The present cross-sectional study was conducted in Sickle Cell Centre of Yolo in Kinshasa, the Democratic Republic of Congo. Two hundred and eleven patients with Sickle Cell Anemia in steady state were recruited. Seventy-four participants with normal Hb (Hb-AA were selected as a control group.The average rates of hemoglobin, hematocrit, and red blood cells tended to be significantly lower in subjects with Hb-SS (p<0.001. The average rates of white blood cells, platelets, reticulocytes and serum LDH were significantly higher in subjects with Hb-SS (p<0.001. The average rates of Hb, HbF, hematocrit and red blood cells of Hb-SS patients with asymptomatic clinical phenotype were significantly higher than those of the two other phenotypes. However, the average rates of white blood cells, platelets, reticulocytes, and LDH of Hb-SS patients with the severe clinical phenotype are higher than those of two other clinical phenotypes. Significant correlations were observed between Hb and white blood cell in severe clinical phenotype (r3 = -0.37 * between Hb and red blood cells in the three phenotypes (r1 = 0.69 * r2 * = 0.69, r3 = 0.83 *, and finally between Hb and reticulocytes in the asymptomatic clinical phenotype and severe clinical phenotype (r1 = -0.50 * r3 = 0.45 *. A significant increase in LDH was observed in patients with leg ulcer, cholelithiasis and aseptic necrosis of the femoral head.The increase in serum LDH is accompanied by changes in hematological parameters. In our midst, serum LDH may be considered as an indicator of the severity of the disease.

  8. Correlation between the Lactate Dehydrogenase Levels with Laboratory Variables in the Clinical Severity of Sickle Cell Anemia in Congolese Patients

    Science.gov (United States)

    Mikobi, Tite Minga; Lukusa Tshilobo, Prosper; Aloni, Michel Ntetani; Mvumbi Lelo, Georges; Akilimali, Pierre Zalagile; Muyembe-Tamfum, Jean Jacques; Race, Valérie; Matthijs, Gert; Mbuyi Mwamba, Jean Marie

    2015-01-01

    Background Sickle cell anemia is an inflammatory disease and is characterized by chronic hemolysis. We sought to evaluate the association of lactate dehydrogenase levels with specific clinical phenotypes and laboratory variables in patients with sickle cell anemia. Methods The present cross-sectional study was conducted in Sickle Cell Centre of Yolo in Kinshasa, the Democratic Republic of Congo. Two hundred and eleven patients with Sickle Cell Anemia in steady state were recruited. Seventy-four participants with normal Hb (Hb-AA) were selected as a control group. Results The average rates of hemoglobin, hematocrit, and red blood cells tended to be significantly lower in subjects with Hb-SS (p<0.001). The average rates of white blood cells, platelets, reticulocytes and serum LDH were significantly higher in subjects with Hb-SS (p<0.001). The average rates of Hb, HbF, hematocrit and red blood cells of Hb-SS patients with asymptomatic clinical phenotype were significantly higher than those of the two other phenotypes. However, the average rates of white blood cells, platelets, reticulocytes, and LDH of Hb-SS patients with the severe clinical phenotype are higher than those of two other clinical phenotypes. Significant correlations were observed between Hb and white blood cell in severe clinical phenotype (r3 = -0.37 *) between Hb and red blood cells in the three phenotypes (r1 = 0.69 * r2 * = 0.69, r3 = 0.83 *), and finally between Hb and reticulocytes in the asymptomatic clinical phenotype and severe clinical phenotype (r1 = -0.50 * r3 = 0.45 *). A significant increase in LDH was observed in patients with leg ulcer, cholelithiasis and aseptic necrosis of the femoral head. Conclusion The increase in serum LDH is accompanied by changes in hematological parameters. In our midst, serum LDH may be considered as an indicator of the severity of the disease. PMID:25946088

  9. CORRELATION OF GALLSTONE FORMATION WITH SERUM IRON LEVELS

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    Rohini Bipin Bhadre

    2016-07-01

    Full Text Available INTRODUCTION Gallstones are one of the most common problem associated with the gallbladder, affecting millions of people throughout the world. Bile is excreted from liver and gallbladder into Duodenum for digestion. After digestion, if the gallbladder is not emptied out completely, the Bile Juice that remains in the gallbladder can become too concentrated with cholesterol leading to gallstone formation. Cholesterol and calcium bilirubinate are the two main substances involved in gallstone formation. Gallstones derived from bile consists of mixture of cholesterol, bilirubin with or without calcium. Based on their chemical composition, gallstones found in the gallbladder are classified as cholesterol, pigmented or mixed stones. Iron deficiency has been shown to alter the activity of several hepatic enzymes, leading to increased gallbladder bile cholesterol saturation and promotion of cholesterol crystal formation. AIMS & OBJECTIVE Attempt to establish a correlation with gallstones and decreased serum iron levels. MATERIAL & METHODS This study was a prospective cohort study which included 100 consecutive patients with imaging studies suggestive of Cholelithiasis. The Gallstone surgically removed was crushed with mortar and pestle and then analysed for cholesterol, calcium, phosphate and bilirubin (pigment. Serum samples were analysed for Cholesterol, iron and iron binding capacity. RESULTS 86% patients had increased cholesterol levels (p=0.04 and 93% had decreased serum Iron levels (p=0.96. The most common type of gallstone was found to be Cholesterol type of gallstone followed by Mixed and Pigment gallstones. CONCLUSION Serum cholesterol levels were found to be raised in majority of the patients and serum iron was found to be low in these majority of the patients indicating iron deficiency may play a role in gallstone formation.

  10. Effects of parenteral nutrition with and without GH on the GH/IGF-1 axis after hepatectomy in hepatocellular carcinoma with liver cirrhsis

    Institute of Scientific and Technical Information of China (English)

    CAO Jie; LUO Shimin; LIANG Lijian; LAI Jiaming; CHEN Shanming

    2007-01-01

    Postoperative hepatic insulin-like growth factor-1(IGF-1)production may be severely disturbed in patients with liver cirrhosis.Complex alterations in the GH/IGF-1 axis are thought to play an important role in the protein catabolism that complicates major surgical procedures.The aim of this study was to explore the effects of parenteral nutrition (PN)with and without growth hormone(GH) on the GH/IGF-1 axis after hepatectomy for hepatocellular carcinoma(HCC)with cirrhosis and evaluate the potential roles of recombinant human GH(rhGH)therapy.Twenty-four patients with HCC with cirrhosis who underwent hepatectomy were randomly divided into two groups:a PN group (n=12)and an rhGH+PNgroup(n=12).Liver function,serum GH,IGF-1 and IGFBP-3 were measured before the operation and at postoperative days(POD)1 and 6.Insulin-like growth factor-1 and IGFBP-3 mRNA in the liver tissue was detected by RT-PCR.The liver Ki67 immunohistochemistry staining was studied.At the same time,12 patients with cholelithiasis or liver hemangioma who underwent operation served as normal control group.On POD 6,serum prealbumin,GH,IGF-1,IGFBP-3,hepatic IGF-1 mRNA,IGFBP-3 mRNA and liver Ki67 LI were higher in the rhGH+PN group than in the PN group.There was no significant difference in the 6-and 12-month tumor-free survival rate and the median tumor-free survival time between the PN group and the rhGH+PN group (P>0.05).These data indicate that rhGH+PN could ameliorate the changes in the GH/IGF-1 axis after hepatectomy for HCC in the setting of cirrhosis.

  11. Helicobacter pylori infection in patients with calcular cholecystitis: a hospital based study

    International Nuclear Information System (INIS)

    Background: Helicobacter pylori, a gram negative bacillus has been recognised as a public health problem and approximately half of the world population has H. pylori infection causes chronic gastritis, peptic ulcer disease and gastric malignancies. Objective of this study was to determine the frequency of H. pylori infection in patients of chronic calcular cholecystitis. Methods: This cross-sectional descriptive study was conducted at Liaquat University Hospital, Hyderabad, Pakistan from April 2010 to September 2010. All patients with history of gallstone presented with acute abdominal pain, dyspepsia, bloating and epigastric discomfort and diagnosed as calcular cholecystitis were further evaluated for the detection of H. pylori by serology and histopathology. Frequency and percentage of H. pylori infection in patients with calcular cholecystitis was calculated. Result: Total 100 patients of cholelithiasis underwent laparoscopic cholecystectomy were recruited. The pain in upper right part of the abdomen was observed in all 100 patients, fever in 75%, nausea and vomiting in 68%, loss of appetite in 45%, feeling of tiredness or weakness in 22%, headache in 38%, chills in 52%, backache in 58%, pain under the right shoulder in 45%, heartburn in 67%, belching in 54%, indigestion in 80%, dyspepsia in 90%, bloating in 88%, and epigastric discomfort in 85% patients. Eighty-two percent patients had family history of gallstones. The mean age of overall study population was 48.72 +- 8.78 years and mean age of H. pylori infected calcular cholecystitis patients was 47.98 +- 5.43 years in male and 48.76 +- 6.68 years in females. The H. pylori infection was identified in 55% patients with calcular cholecystitis, of which 32.7% were males and 67.3% were females (p=0.03, statistically significant). Majority of females (60%) had =40 U/ml antibody titre (p=0.917, non-significant). Conclusion: A possible relationship was identified between Helicobacter pylori and calcular

  12. Portal hypertension and an atypical reactive arthritis like presentation in a patient infected with hepatitis C virus genotype 3

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    Moushumi Lodh

    2014-01-01

    Full Text Available Background: Reactive arthritis (ReA is defined as a peripheral arthritis lasting longer than 1 month, associated with urethritis, cervicitis, or diarrhea. The reported annual incidence of ReA is approximately 30-40 cases per 100,000 adults, occurring commonly in the age group of 16 and 35 years. It is known to be associated with gastrointestinal infections with Shigella, Salmonella, and Campylobacter species and other microorganisms, as well as with genitourinary infections (especially with Chlamydia trachomatis. Case Report: This article reports the case of a 53-year-old, post-right total hip replacement, Indian man, with ReA, who presented with fever, respiratory distress, and abdominal discomfort. He complained of itching, tingling sensation, pain on urination, and retention of urine. He had right hip joint pain for 3 weeks, inability to move right leg since 10 days, and melena since 1 week. Laboratory tests revealed anemia, high liver and kidney function tests, elevated erythrocyte sedimentation rate, C reactive protein, procalcitonin and occult blood in stool. He tested positive for hepatitis C virus genotype 3. Gastroduodenoscopy revealed multiple apthoid ulcers at D2 and large gastric varix. Ultrasonography of whole abdomen revealed cholelithiasis and splenomegaly. Skin lesions and arthritis led to the diagnosis of associated ReA. The patient was managed conservatively and discharged in a stable condition. Conclusions: Our case is unlike classical ReA because the patient is older, HLA B27 negative, and without florid urethritis. Admitted for fever and lower urinary tract symptoms, along with respiratory distress, the primary objective of the emergency doctors was to prevent the patient from progressing to organ failure. The diagnosis of underlying atypical/incomplete ReA could easily have been missed without adequate awareness, dermatological consultation, and a skin biopsy.

  13. Xanthogranulomatous cholecystitis: challenges in management & feasibility of laparoscopic surgery

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    Vikram Singh Chauhan

    2013-04-01

    Full Text Available Objective: Xanthogranulomatous cholecystitis (XGC is a rare, unusual and destructive form of chronic cholecystitis. It is clinically indistinguishable from other forms of cholecystitis and hence difficult to diagnose. Due to its propensity to form dense adhesions with stuctures surrounding the gall bladder and mimic malignancy of gall bladder intra-operatively, it’s difficult to manage. This retrospective study was conducted with the aim to review the clinico-pathologic presentation of XGC and the possibility of its laparoscopic management. Patient and methods: All cases of histo-pathologically diagnosed XGC from January 2008 to December 2012 at Sharda Hospital, School of Medical Sciences & Research, Greater Noida were analyzed retrospectively. Results: Sixty two cases of biopsy proved XGC were studied.The mean age at presentation was 56.4 ± 14.3 years (range 30 – 72 years, with a male: female ratio of 1.6:1. Gall bladder wall thickening on ultrasonography was seen in 91.9% cases and all (100% had cholelithiasis. Laparoscopic cholecystectomy was possible in 18 (29% cases, with a high conversion rate of 71% to open surgery. Two cases of carcinoma gall bladder accompanying XGC were documented. Both the mean operative time and hospital stay for laparoscopic surgery were longer for cases with XGC (105 minutes & 4.2 days respectively. No mortality occurred during the study period. Conclusion: XGC is difficult to diagnose preoperatively due to lack of distinguishing clinical features and imaging study results. Due to dense peri-cholecystic adhesions laparoscopic surgery though feasible in some cases is difficult to perform with a high conversion rate. Overall morbidity is also increased due to same reasons.

  14. 血清胆固醇脂蛋白水平对胆囊胆结石中胆固醇浓度的影响

    Institute of Scientific and Technical Information of China (English)

    任清河; 崔宏伟

    2015-01-01

    目的:探讨血清总胆固醇(TC)、脂蛋白水平对胆囊胆结石中胆固醇浓度的影响。方法检测150例胆石症患者以及50例健康对照组人群的血清TC、低密度脂蛋白水平(LDL)、高密度脂蛋白水平(HDL)。采用傅立叶红外光谱法测定结石中胆固醇含量。结果胆囊结石患者较正常组患者的血清TC、LDL水平升高,而HDL水平降低,差异有统计学意义(P0.05)。结论血清TC、LDL水平的异常与胆囊胆固醇结石的形成有一定关系。%Objective To discuss the effects of the serum total cholesterol,Low-density lipoproteins and high-density lipoproteins serum cholesterol,LDL,and HDL levels on gallstone cholesterol concentration. Methods The levels of serum total cholesterol,LDL,and HDL of 150 patients with cholelithiasis and 50 cases of healthy Volunteers were examined using automatic biochemical analyzer. And the gallstones were examined throμgh Fourier transform infrared spectrometry. Results High serum cholesterol and LDL levels were associated with high cholesterol stone rates (P0.05)or gallbladder stone cholesterol concentrations (P>0.05). Conclusions There was a certain relationship between the abnormal in serum total cholesterol,Low-density lipoproteins, high-density lipoproteins and the formulation of gallbladder cholestrol stone.

  15. Metabolic and kidney disorders correlate with high atazanavir concentrations in HIV-infected patients: is it time to revise atazanavir dosages?

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    Cristina Gervasoni

    Full Text Available Ritonavir-boosted atazanavir (ATV/r is a relatively well tolerated antiretroviral drug. However, side effects including hyperbilirubinemia, dyslipidemia, nephrolithiasis and cholelithiasis have been reported in the medium and long term. Unboosted ATV may be selected for some patients because it has fewer gastrointestinal adverse effects, less hyperbilirubinemia and less impact on lipid profiles.We investigated the distribution of ATV plasma trough concentrations according to drug dosage and the potential relationship between ATV plasma trough concentrations and drug-related adverse events in a consecutive series of 240 HIV-infected patients treated with ATV/r 300/100 mg (68% or ATV 400 mg (32%.43.9% of patients treated with ATV/r 300/100 mg had ATV concentrations exceeding the upper therapeutic threshold. A significant and direct association has been observed between the severity of hyperbilirubinemia and ATV plasma trough concentrations (ATV concentrations: 271 [77-555], 548 [206-902], 793 [440-1164], 768 [494-1527] and 1491 [1122-1798] ng/mL in patients with grade 0, 1, 2, 3 and 4 hyperbilirubinemia, respectively. In an exploratory analysis we found that patients with dyslipidemia or nephrolitiasis had ATV concentrations significantly higher (582 [266-1148], and 1098 [631-1238] ng/mL, respectively (p<0.001, as compared with patients with no ATV-related complications (218 [77-541] ng/mL.A significant proportion of patients treated with the conventional dosage of ATV (300/100 had plasma concentrations exceeding the upper therapeutic threshold. These patients that are at high risk to experience ATV-related complications may benefit from TDM-driven adjustments in ATV dosage with potential advantages in terms of costs and toxicity.

  16. Ritonavir and Disulfiram May Be Synergistic in Lowering Active Interleukin-18 Levels in Acute Pancreatitis, and thereby Hasten Recovery

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    Richard Eric Kast

    2008-05-01

    Full Text Available This short note reviews the role of interleukin-18 (IL-18 in acute pancreatitis. IL-18 is a narrow yet important aspect of acute pancreatitis. Narrow because many other inflammatory mediators are active in acute pancreatitis, but important because: a many of the other inflammatory mediators arise secondary to IL-18; and B we happen to have several medicines, in use for other purposes for decades, that pre-clinical and murine studies have indicated happily have ability to lower active IL-18 formation. Also giving IL-18 particular importance is: c the cause of early mortality in acute pancreatitis is mostly due to systemic inflammation, for which IL-18 is an important driving force [1, 2, 3]. Alcohol abuse and cholelithiasis account for 90% of acute pancreatitis, with autoimmune, genetic, hyperlipidemia, obesity and other factors as less common predisposing factors [1, 2, 3]. Diverse secondary morbidity is seen, with chronic pain as a common sequela. Mortality rate is not trivial by multiorgan dysfunction that in extreme forms leads to multiorgan failure[1, 2, 3]. The clinical picture is dominated by fierce pain, hypotension, and susceptibility to secondary infection. Hepatitis and pneumonia are common. Endoscopic or surgical decompression procedures, necrotic tissue removal can help. Medical interventions seem limited to supportive measures, antibiotics for secondary infection, etc. and have not changed much in the last 50 years [1, 2, 3]. This short note presents data indicating that three old drugs, ritonavir, disulfiram, and captopril, have potential to lower IL-18 and may therefore be of benefit in treating pancreatitis.

  17. Role of preoperative sonography in predicting conversion from laparoscopic cholecystectomy to open surgery

    Energy Technology Data Exchange (ETDEWEB)

    Tosun, Alptekin, E-mail: tosun_alptekin@yahoo.com [Giresun University Hospital, Department of Radiology (Turkey); Hancerliogullari, Kadir Oymen [Giresun University Hospital, Department of Pediatric Surgery (Turkey); Serifoglu, Ismail [Bulent Ecevit University Hospital, Department of Radiology (Turkey); Capan, Yavuz [Gaziantep Primer Hospital, Department of Surgery (Turkey); Ozkaya, Enis [Dr. Sami Ulus Maternity and Children' s Health Training and Research Hospital, Department of Obstetrics and Gynecology (Turkey)

    2015-03-15

    Highlights: •The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. The study may be a guide for the surgeon to prefer laparoscopic or open surgery. -- Abstract: Background: Laparoscopic cholecystectomy is the first step treatment in cholelithiasis. The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. Methods: This study included 176 patients who had undergone laparoscopic cholecystectomy. Preoperative ultrasonographic findings were assessed and we gave points to each finding according to results from correlation analysis. After the scoring we investigated the relationship between ultrasonographic findings and conversion from laparoscopic cholecystectomy to open surgery. Results: Scoring significantly predicted failure in laparoscopic approach (AUC = 0.758, P = 0.003,). Optimal cut off score was found to be 1.95 with 67% sensitivity and 78% specificity. Score > 1.95 was a risk factor for failure in laparoscopic approach [odds ratio = 7.1(95% CI,2-24.9, P = 0.002)]. There were 8 subjects out of 36(22%) with high score underwent open surgery while 4 out of 128 (3%) subjects with low score needed open surgery (p = 0.002). Negative predictive value of 128/132 = 97%. Mean score of whole study population was 1.28 (range 0–8.8) and mean score of subjects underwent open surgery was 3.6 while it was 1.1 in successful laparoscopic approach group (p < 0.001). Mean Age and BMI were similar between groups (p > 0.05). Sex of subjects did not affect the success of surgery (p > 0.05). Conclusion: The contribution of preoperative ultrasonography is emphasized in many studies. Our study suggests quantitative results on conversion from laparoscopic cholecystectomy to open surgery. We believe that radiologists have to indicate the risk of conversion in their ultrasonography reports.

  18. Epidemiological factors in gall bladder cancer in eastern India-a single centre study.

    Science.gov (United States)

    Khan, Imran; Panda, Nilanjan; Banerjee, Manju; Das, Ruchira

    2013-03-01

    India has high incidence of Gallbladder carcinoma with regional variation in incidence possibly due to environmental factors. Prospective study of all the gall bladder cancer in our hospital over 18 months analysing how the epidemiological factors are influencing the disease. Incidence-Four cases per 100,000 populations per year. The peak incidence was in 41 to 50 years group (49.20 %). Male to female ratio was 1:3.8. Majority (69.84 %) were in lower socio-economic group. 61 out of 63 patients (96.62 %) were non-vegetarians. 60.34 % and 19.04 % patients weighed between 50 and 55 kg and 55and 60 kg respectively (p = 0.003). Male smokers had significantly higher risk (p = 0.000 1). Gall stones were present in 45 out of 63 cases(71.42 %).45 out of 63 patients were typhoid carriers (p < 0.05). Pain abdomen was the commonest complaint (87.30 %), followed by pallor, lump in right upper quadrant, nausea & vomiting and jaundice in 71.42 %, 69.84 %, 66.66 %, 31.74 % patients respectively. This data highlights high prevalence of gall bladder carcinoma in Eastern India. Better hygiene and water supply to prevent typhoid carriers, prevention of malnutrition, early intervention for cholelithiasis, importance of balanced diet, increase in awareness about risk of tobacco and alcohol consumption-all are highlighted as significant modifiable factors. PMID:24426702

  19. Crystallization from Gels

    Science.gov (United States)

    Narayana Kalkura, S.; Natarajan, Subramanian

    Among the various crystallization techniques, crystallization in gels has found wide applications in the fields of biomineralization and macromolecular crystallization in addition to crystallizing materials having nonlinear optical, ferroelectric, ferromagnetic, and other properties. Furthermore, by using this method it is possible to grow single crystals with very high perfection that are difficult to grow by other techniques. The gel method of crystallization provides an ideal technique to study crystal deposition diseases, which could lead to better understanding of their etiology. This chapter focuses on crystallization in gels of compounds that are responsible for crystal deposition diseases. The introduction is followed by a description of the various gels used, the mechanism of gelling, and the fascinating phenomenon of Liesegang ring formation, along with various gel growth techniques. The importance and scope of study on crystal deposition diseases and the need for crystal growth experiments using gel media are stressed. The various crystal deposition diseases, viz. (1) urolithiasis, (2) gout or arthritis, (3) cholelithiasis and atherosclerosis, and (4) pancreatitis and details regarding the constituents of the crystal deposits responsible for the pathological mineralization are discussed. Brief accounts of the theories of the formation of urinary stones and gallstones and the role of trace elements in urinary stone formation are also given. The crystallization in gels of (1) the urinary stone constituents, viz. calcium oxalate, calcium phosphates, uric acid, cystine, etc., (2) the constituents of the gallstones, viz. cholesterol, calcium carbonate, etc., (3) the major constituent of the pancreatic calculi, viz., calcium carbonate, and (4) cholic acid, a steroidal hormone are presented. The effect of various organic and inorganic ions, trace elements, and extracts from cereals, herbs, and fruits on the crystallization of major urinary stone and gallstone

  20. Clinical characteristics and prognostic factors of severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Lei Kong; Nn Santiago; Tian-Quan Han; Sheng-Dao Zhang

    2004-01-01

    AIM: To investigate the clinical characteristics and prognostic factors of a consecutive series of patients with severe acute pancreatitis (SAP).METHODS: Clinical data of SAP patients admitted to our hospital from January 2003 to January 2004 were retrospectively reviewed. Collected data included the age, gender, etiology,length of hospitalization, APACHE Ⅱ score at admission,local and organ/systemic complications of the patients.RESULTS: Of the 268 acute pancreatitis patients, 94 developed SAP. The mean age of SAP patients was 52 years, the commonest etiology was cholelithiasis (45.7%), the mean length of hospitalization was 70 d, the mean score of APACHE Ⅱ was 7.7. Fifty-four percent of the patients developed necrosis, 25% abscess, 58% organ/systemic failure. A total of 23.4% (22/94) of the SAP patients died. Respiratory failure was the most common organ clysfunction (90.9%) in deceased SAP patients, followed by cardiovascular failure (86.4%),renal failure (50.0%). In the SAP patients, 90.9% (20/22)developed multiple organ/systemic failures. There were significant differences in age, length of hospitalization,APACHE Ⅱ score and incidences of respiratory failure, renal failure, cardiovascular failure and hematological failure between deceased SAP patients and survived SAP patients.By multivariate logistic regression analysis, independent prognostic factors for mortality were respiratory failure,cardiovascular failure and renal failure.CONCLUSION: SAP patients are characterized by advanced age, high APACHE Ⅱ score, organ failure and their death is mainly due to multiple organ/systemic failures. In patients with SAP, respiratory, cardiovascular and renal failures can predict the fatal outcome and more attention should be paid to their clinical evaluation.

  1. Significance of cytomorphological and microbiological examination of bile collected by endoscopic cannulation of the papilla of vater

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    Misra Vatsala

    2009-07-01

    Full Text Available Background: Bile analysis yields important information such as "biliary microlithiasis" and biliary tract colonization by microorganisms like Salmonella typhi or paratyphi, Escherichia coli , etc., which may progresses to cholelithiasis and have been found to have a role in the development of gallbladder cancer in India. Aim: To perform microscopic, cytomorphological and microbiological examination of bile collected during endoscopic retrograde cholangiopancreatography in patients with benign and malignant lesions of the gallbladder. Materials and Methods: Bile was collected from 48 patients by a catheter inserted through the cystic duct during endoscopic retrograde cholangiopancreatography. Direct microscopy and grading of crystals was performed. Smears prepared from centrifuged deposits were stained with Giemsa, Papanicolaou stain and Gram′s stain for cytological and microbiological examination. Special staining for Helicobacter pylori was performed using Loeffler′s Methylene blue and Warthin Starry stain. The rest of the sample was used for culture and complete microbiological examination. Results: Thirty-six patients had inflammatory lesions while 12 had malignant lesions. Crystals were observed in 93% of the cases, 13 (28.8% had only cholesterol crystals, three (6.6% had bilirubinate and 29 (64.4% had both cholesterol and bilirubinate crystals. Smears from the centrifuged deposit mainly showed coccoid or cocobacillary bacteria on Gram′s staining (81.3%. Five of 12 (41.6% malignant cases showed epithelial atypia while none of the benign or inflammatory lesions showed such a change in hematoxylin and eosin and Pap-stained smears. Microbiologic analysis showed Staphylococcus aureus (14%, S. saprophyticus (5.5%, Peptococcus (5.5%, Peptostreptococcus (5.5%, Proteus mirabilis (5.5%, E. coli (17%, Enteorbacter cloacae (5.5% and H. pylori (2.8%. Conclusion: Complete microscopic and microbiological examination of bile directly obtained from

  2. Single-port laparoscopic surgery in children: A new alternative in developing countries

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    Ben Dhaou Mahdi

    2015-01-01

    Full Text Available Background: Single-incision laparoscopic surgery (SILS is a technique in laparoscopic surgery, which is based on the idea that all the laparoscopic trocars are inserted through a single umbilical incision. This paper documents a single-centre experience, which performed the single-port surgery in children using an improvised trans-umbilical glove-port with conventional rigid instruments. Materials and Methods: We prospectively studied the outcomes of SILS procedures between January 2013 and June 2014. Materials required making our homemade trans-umbilical port consisted on: A flexible ring, a rigid larger ring, one powder-free surgical glove, a wire-to-skin and standard standards laparoscopic trocars. Results: A total of 90 consecutive procedures had been done in our institution: 15 girls and 75 boys (mean age: 7.5 years. We used SILS on 59 appendectomies with an average operative time of 48 minutes. We needed conversion to conventional surgery in three cases (two with perforated appendicitis and one for difficulty to mobilize the appendix. SIL cholecystectomy was performed for four patients with symptomatic cholelithiasis; mean operative time was 60 min. All patients were discharged on postoperative day 2. Eighteen boys with non-palpable testis were explored and treated. Other procedures included: Varicocelectomy (n = 2, intra-abdominal lymph node biopsies (n = 2, ovarian cystectomy (n = 1, ovarian transposition (n = 1, aspiration of renal hydatid cyst (n = 1, explorative laparoscopy in research to Meckel′s diverticulum (n = 1 and intestinal intussusceptions (n = 1. No post-operative complications were seen in all cases. Conclusions: SILS in the paediatric population using conventional rigid instruments is feasible, safe and effective. It may be an alternative to the costly commercially available single-port systems especially in a developing country like Tunisia.

  3. Pneumobilia,chronic diarrhea,vitamin K malabsorption:A pathognomonic triad for cholecystocolonic fistulas

    Institute of Scientific and Technical Information of China (English)

    Savvoula Savvidou; John Goulis; Alexandra Gantzarou; George Ilonidis

    2009-01-01

    Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas,which comprise rare complications of cholelithiasis and acute cholecystitis,with a prevalence of about 2% of all biliary tree diseases.We report a case of a spontaneous CF in a 75-year-old diabetic male admitted to hospital for the investigation of chronic watery diarrhea and weight loss.Massive pneumobilia demonstrated on abdominal ultrasound and computerized tomography,along with chronic,bile acid-induced diarrhea and a prolonged prothrombin time due to vitamin K malabsorption,led to the clinical suspicion of the fistula.Despite further investigation with barium enema and magnetic resonance cholangio-pancreatography,diagnosis of the fistulous tract between the gallbladder and the hepatic flexure of the colon could not be established preoperatively.Open cholecystectomy with fistula resection and exploration of the common bile duct was the preferred treatment of choice,resulting in an excellent postoperative clinical course.The incidence of biliary-enteric fistulas is expected to increase due to the parallel increase of iatrogenic interventions to the biliary tree with the use of endoscopic retrograde cholangio-pancreatography and the increased rate of cholecystectomies performed.Taking into account that advanced imaging techniques fail to demonstrate the fistulas tract in half of the cases,and that CFs usually present with non-specific symptoms,our report could assist physicians to keep a high index of clinical suspicion for an early and valid diagnosis of a CF.

  4. Biliary cysts: Etiology, diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Beata Jablo(n)ska

    2012-01-01

    Biliary cysts (BC) are rare dilatations of different parts of a biliary tract.They account for approximately 1% of all benign biliary diseases.BC occur the most frequently in Asian and female populations.They are an important problem for pediatricians,gastroenterologists,radiologists and surgeons.Clinical presentation and management depend on the BC type.Cholangiocarcinoma is the most serious and dangerous BC complication.The other complications associated with BC involve cholelithiasis and hepatolithiasis,cholangitis,acute and chronic pancreatitis,portal hypertension,liver fibrosis and secondary liver cirrhosis and spontaneous cyst perforation.Different BC classifications have been described in the literature.Todani classification dividing BC into five types is the most useful in clinical practice.The early diagnosis and proper treatment are very important,because BC are associated with a risk of carcinogenesis.A malignancy risk increases with the age.Radiological investigations (ultrasonography,computed tomography,endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography) play an important role in BC diagnostics.Currently,prenatal diagnosis using ultrasonography is possible.It allows to differentiate biliary disorders in fetals and to perform the early surgical treatment that improves results.In most patients,total cyst excision with Roux-Y hepaticojejunostomy is the treatment of choice.Surgical treatment of BC is associated with high success rate and low morbidity and mortality.The early treatment is associated with a lower number of complications.Patients following BC surgery require permanent and careful postoperative observation using laboratory and imaging investigations because of possibility of biliary anastomosis stricture and biliary cancer in tissue remnant.

  5. Technical difficulties and success of endoscopic retrograde colangiopancreatography in a group of patients

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    Pedro Juan Vázquez González

    2011-04-01

    Full Text Available Background: Endoscopic Retrograde Cholangiopancreatography has been effective in the diagnosis and treatment of diseases of the biliopancreatic system. Objective: To determine the grade of technical difficulties and the success of cholangiopancreatography in a group of patients. Methods: prospective, descriptive, observational study that included all the patients who were tested through this procedure from January to December 2009 in the hospital “Dr. Gustavo Aldereguía Lima” from Cienfuegos. Inclusion and exclusion criteria were applied so the sample was composed by 34 patients. In order to define the technical difficulty of this test Madhotra’s difficulty modified test was used. Results: 67,6 % of the patients were males. Age comprised the interval from 31 to 90 years old patients with a mean age of 60.8±16 years. Cholestatic icterus was the predominant medical indication in (55,9 %, followed by choledocholitiasis (26,5 %. Echogram showed normal results in 41,2 % of the patients. The most frequent diagnosis of this test was postcholecystectomy with dilated biliary tract (17,6 % followed by choledocho and cholelithiasis (14,7 % each one. The grade of technical difficulty was 1 in 91,2 %, grade 2 in 8,8 %. A complete technical success was obtained in 55,9 %, partial success was obtained in 32,3 % and the attempt failed in 11,8 % of the patients. Conclusion: the grade of technical difficulty can influence upon the success of Endoscopic Retrograde Cholangiopancreatography. Its usefulness has been demonstrated with a minimum amount of complications for the patient.

  6. Abdominal ultrasonographic screening of adult health study participants

    International Nuclear Information System (INIS)

    To assess ultrasonography's capabilities in the detection of cancer and other diseases, abdominal ultrasonographic screening was performed for 3,707 Hiroshima and 2,294 Nagasaki atomic bomb survivors and comparison subjects who participated in the Adult Health Study from 1 November 1981 to 31 October 1985 in Hiroshima and from 1 August 1984 to 31 July 1986 in Nagasaki. A total of 20 cancers was detected, consisting of 7 hepatomas, 3 gastric cancers, 3 renal cancers, 2 cancers of the urinary bladder, and 1 cancer each of the ovary, pancreas, colon, ureter and liver (metastatic). The cancer detection rate was 0.33 %. The diagnoses of seven cancer subjects in each city were subsequently confirmed at autopsy or surgery; diagnoses of four cancer subjects in Hiroshima and two in Nagasaki were obtained from death certificates. Among the 20 cancer patients, 13 were asymptomatic. After the ultrasonographic detection and diagnosis of these 20 cancers, the medical records of each of the 20 cancer patients were reviewed for any evidence of cancer detection by other examining techniques, and the records of only 3 patients revealed such recent detection. The tumor and tissue registries were similarly checked, but no evidence of earlier diagnosis of their disease was found. Ten of the cancer patients had received ionizing radiation doses from the A-bombs ranging up to 3,421 mGy (DS86), but no correlation was established between cancer prevalence and the A-bomb doses. A variety of tumors, 259 in number and most probably benign, were also detected with ultrasonography. In addition, numerous other abnormalities were diagnosed, with prevalences of 7.7 % for cholelithiasis, 5.7 % for renal cysts, and 3.8 % for liver cysts. No statistical analysis was performed concerning the prevalence of the diseases detected. (author)

  7. Colecistectomía laparoscópica y la importancia de un laboratorio de entrenamiento en cirugía mínimamente invasiva, a propósito de su reciente creación en la Universidad de Costa Rica

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    Priscilla Blanco Benavides

    2013-03-01

    Full Text Available La colecistectomía es un procedimiento quirúrgico empleado para tratar la colelitiasis y constituye un tratamiento valioso porque esta patología tiene una alta prevalencia en Costa Rica. En contraste con la colecistectomía abierta, la colecistectomía laparoscópica se asocia con beneficios como menor mortalidad operatoria, menor dolor postoperatorio, menor duración de la estadía hospitalaria y menor tiempo de recuperación. La importancia de que el personal médico reciba entrenamiento en procedimientos de cirugía mínimamente invasiva, dentro de los cuales se encuentra la colecistectomía laparoscópica, ha llevado al desarrollo de laboratorios de entrenamiento en este tipo de cirugía. En Costa Rica, la reciente implementación de dichos centros de entrenamiento hace vislumbrar un futuro promisorio en el tratamiento de las colecistectomías.Cholecystectomy is a surgical procedure employed to treat cholelithiasis and is a valuable treatment in Costa Rica since this pathology has a high prevalence in the country. In contrast to open cholecystectomy, laparoscopic cholecystectomy is associated to benefits such as lower operatory mortality, lower post-operative pain, shorter hospital stay and shorter recuperation time. The importance of training in minimally invasive surgery procedures has led to the development of laboratories for medical personnel training in this type of surgery. In Costa Rica, recent implementation of such training centers envisions a better future for the development of cholecystectomies.

  8. Relationship between intraduodenal peri-ampullar y diver ticulum and biliar y disease in 178 patients undergoing ERCP

    Institute of Scientific and Technical Information of China (English)

    Shuo-Dong Wu; Yang Su; Ying Fan; Zhen-Hai Zhang; Hao-Lin Wang; Jing Kong; Yu Tian

    2007-01-01

    BACKGROUND:The presence of intraduodenal peri-ampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal peri-ampullary diverticulum and biliary disease, especially the formation of bile duct pigment stones. METHODS: A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy (EST) were studied retrospectively. They were divided into 6 groups according to the category of biliary disease, and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated. RESULTS:There were 44 patients with intraduodenal peri-ampullary diverticulum in 81 patients with primary bile duct pigment stones (54.32%), 4 in 8 patients with bile duct stones and gallbladder stones (50%), 7 in 33 patients with bile duct stones secondary to gallbladder stones (21.21%), 3 in 21 patients with inlfammation and stricture of the end of the bile duct and papilla (14.29%), 1 in 22 patients with carcinoma of the end of the bile duct and papilla (4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction (38.46%). CONCLUSIONS:The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inlfammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These ifndings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones.

  9. Role of nucleation of bile liquid crystal in gallstone formation

    Institute of Scientific and Technical Information of China (English)

    Hai-Ming Yang; Jie Wu; Jin-Yi Li; Lin Gu; Min-Fei Zhou

    2003-01-01

    AIM: To explore the role of bile liquid crystal in the process of gallbladder stone formation and to provide bases for preventing and treating cholelithiasis.METHODS: 46 guinea pigs, half males and half females,were randomly divided into control group and stone-causing group. Normal feed and stoneleading feed were used respectively to raise guinea pigs in the control group and stone-causing group. The guinea pigs were killed in three batches during the raising period. Under polarizing microscope, the pattern changes of bile liquid crystal in the gallbladder biles of the guinea pigs in the control group and stone-causing group were dynamicly observed respectively in single-blind trial.RESULTS: It was found that there were few crystals in the guinea pigs′biles of the control group, and their Malta cross was small and scattered, and existed in single form. With the increase of the feeding days, bile liquid crystals grew and Malta cross became bigger with their distribution densified, denser somewhere, but always existed in single form. While those of the stone-causing group had more bile liquid crystals, Malta cross was big and merged in strings.With the increase of the feeding days, bile liquid crystals grew in amount and strings of Malta cross increased and became bigger. The crosses in strings were arranged more and more regularly and they gradually changed into stone crystals.CONCLUSION: Formation of gallbladder stone is a process of nucleation from different substances, and the causing-stone gallbladder bile is a constantly supersaturated solution, and bile liquid crystal is a nucleation factor in the formation of gallbladder stones. The process of nucleation includes gathering, merging and phase-changing of bile liquid crystals.The process of gathering, merging of bile liquid crystal is the key to nucleation.

  10. Functions of the Gallbladder.

    Science.gov (United States)

    Housset, Chantal; Chrétien, Yues; Debray, Dominique; Chignard, Nicolas

    2016-01-01

    The gallbladder stores and concentrates bile between meals. Gallbladder motor function is regulated by bile acids via the membrane bile acid receptor, TGR5, and by neurohormonal signals linked to digestion, for example, cholecystokinin and FGF15/19 intestinal hormones, which trigger gallbladder emptying and refilling, respectively. The cycle of gallbladder filling and emptying controls the flow of bile into the intestine and thereby the enterohepatic circulation of bile acids. The gallbladder also largely contributes to the regulation of bile composition by unique absorptive and secretory capacities. The gallbladder epithelium secretes bicarbonate and mucins, which both provide cytoprotection against bile acids. The reversal of fluid transport from absorption to secretion occurs together with bicarbonate secretion after feeding, predominantly in response to an adenosine 3',5'-cyclic monophosphate (cAMP)-dependent pathway triggered by neurohormonal factors, such as vasoactive intestinal peptide. Mucin secretion in the gallbladder is stimulated predominantly by calcium-dependent pathways that are activated by ATP present in bile, and bile acids. The gallbladder epithelium has the capacity to absorb cholesterol and provides a cholecystohepatic shunt pathway for bile acids. Changes in gallbladder motor function not only can contribute to gallstone disease, but also subserve protective functions in multiple pathological settings through the sequestration of bile acids and changes in the bile acid composition. Cholecystectomy increases the enterohepatic recirculation rates of bile acids leading to metabolic effects and an increased risk of nonalcoholic fatty liver disease, cirrhosis, and small-intestine carcinoid, independently of cholelithiasis. Among subjects with gallstones, cholecystectomy remains a priority in those at risk of gallbladder cancer, while others could benefit from gallbladder-preserving strategies. © 2016 American Physiological Society. Compr Physiol

  11. Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

    Institute of Scientific and Technical Information of China (English)

    Ming-Jun Xin; Hong Chen; Bin Luo; Jia-Bang Sun

    2008-01-01

    AIM: To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (≥60 years of age).METHODS: We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007.RESULTS: In 169 patients with SAP, 94 were elderly and 16 died.Biliary and idiopathic etiologies were the first two causes that accounted for over 90% of SAP in the elderly.Biliary, hyperlipemic and alcoholic etiologies were the first three causes in the young.The proportion of comorbidity of cholelithiasis, biliary infection, hypertension and coronary heart disease in the aged was significantly higher than that in their young partners.The scores of APACHE Ⅱ and Ranson were also significantly higher in the elderly except the CT score.Organ failures were more common in the elderly, but the local pancreatic complications were not different between the two groups.Mortality of the aged was correlated with the severity of SAP, multiple co-morbidity and incidence of multiple organ dysfunction syndrome (NODS).NODS was the main cause of death.CONCLUSION: The etiology of SAP in the elderly is quite different from that in the young.Biliary and unknown factors are main causes in the aged.The elderly are subject to major organ failures but there is no difference in the occurrence of local pancreatic complications between the elderly and the young.It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with SAP.

  12. Prevention of gallstones by Lidan Granule: Insight into underlying mechanisms using a guinea pig model

    Science.gov (United States)

    WU, XIAO; LIANG, XIAOQIANG; DU, YIJIE; ZHANG, YAN; YANG, MENG; GONG, WEIYI; LIU, BAOJUN; DONG, JINGCHENG; ZHANG, NINGXIA; ZHANG, HONGYING

    2016-01-01

    The aim of the study was to examine the mechanism of action of Lidan Granule (LDG) for the prevention of gallstones using a guinea pig model. One hundred guinea pigs were divided into five groups randomly: control (standard diet and saline), model [lithogenic diet (LD) and saline], LDG-H (LD and 2 g/kg of LDG), LDG-L (LD and 1 g/kg of LDG), and ursodeoxycholic acid (UDCA) (LD and UDCA) as the positive control. At 6 weeks, the rate of gallstone formation and weight of the adrenal gland were recorded and serum levels of inflammatory cytokines were measured. Levels of corticotrophin-releasing hormone (CRH) in the hypothalamus, adrenocorticotropic hormone (ACTH) in the hypophysis, and serum cortisol were determined. Bile components were tested with colorimetry. At 6 weeks, the rate of gallstone formation was significantly decreased in the LDG-H (14.29%) and LDG-L (21.43%) groups compared to the model group (81.25%; P<0.01). LDG treatment decreased the serum levels of interleukin (IL)-1, IL-6, and tumor necrosis factor-α (P<0.01). LDG decreased bile cholesterol and increased bile acid and phospholipid levels in the bile (P<0.01). LDG treatment recovered the function of the hypothalamic-pituitary-adrenal (HPA) axis by increasing the expression of CRH (P<0.01) and ACTH (P<0.05). LDG made the bile less lithogenic, improved the function of the HPA axis, and regulated the expression of inflammatory cytokines for the prevention of cholelithiasis. PMID:27347405

  13. Epidemiological characteristics of inflammatory bowel disease in North-Eastern Poland

    Institute of Scientific and Technical Information of China (English)

    Alicja Wiercinska-Drapalo; Jerzy Jaroszewicz; Robert Flisiak; Danuta Prokopowicz

    2005-01-01

    AIM: To provide the clinical and epidemiological data of inflammatory bowel disease (IBD) patients of NorthEastern Poland.METHODS: A total of 248 IBD patients diagnosed and hospitalized in the Department of Infectious Diseases in Bialystok between 1990 and 2003 were included in the study. We analyzed age, sex, education, characteristics of job, type of the environment, discontinuation of employment due to IBD, colitis extent, need of surgical treatment, and coexistence of other diseases.RESULTS: Two hundred and thirty-three IBD patients (94%) were diagnosed as ulcerative colitis (UC), and only 15 (6%) were diagnosed as Crohn's disease (CD). Patients with CD were significantly younger at the time of diagnosis and male predominance was observed. The mean age of the patients at the time UC diagnosis was 44.9±1.1 years. Histogram of the age of patients showed the characteristic biphasic distribution with two peaks between 20 and 40 years and between 60 and 70 years. The predominant form of UC was left sided colitis, which affected almost 80% of the studied population. The most extensive form - pancolitis was present in 34 patients (15%). Only 6% of UC patients required surgery, whereas 36% of CD patients underwent surgery (P<0.005). Among coexisting disorders, cholelithiasis was the most prevalent and demonstrated in 35 patients (14%), pulmonary disorders were diagnosed in 2%, and psoriasis in 1.4%.Since 1998, the number of admitted IBD patients has slightly increased.CONCLUSION: Occurrence of UC in Poland is much higher than that of CD. The majority of UC cases are diagnosed in young people (20-40 years) with the predominance of male patients. The most common clinical form of UC is left sided colitis.

  14. Glucagon receptor gene mutations with hyperglucagonemiabut without the glucagonoma syndrome

    Institute of Scientific and Technical Information of China (English)

    Helen C Miller; Mark Kidd; Irvin M Modlin; Patrizia Cohen; Roberto Dina; Panagiotis Drymousis; Panagiotis Vlavianos; Günter Kl?ppel; Andrea Frilling

    2015-01-01

    Pancreatic neoplasms producing exclusively glucagonassociated with glucagon cell hyperplasia of the isletsand not related to hereditary endocrine syndromes havebeen recently described. They represent a novel entitywithin the panel of non-syndromic disorders associatedwith hyperglucagonemia. This case report describesa 36-year-old female with a 10 years history of nonspecificabdominal pain. No underlying cause was evidentdespite extensive diagnostic work-up. More recentlyshe was diagnosed with gall bladder stones. Abdominalultrasound, computerised tomography and magneticresonance imaging revealed no pathologic findings apartfrom cholelithiasis. Endoscopic ultrasound revealed a 5.5mm pancreatic lesion. Fine needle aspiration showedcells focally expressing chromogranin, suggestive butnot diagnostic of a low grade neuroendocrine tumor.OctreoScan? was negative. Serum glucagon was elevatedto 66 pmol/L (normal: 0-50 pmol/L). Other gut hormones,chromogranin A and chromogranin B were normal.Cholecystectomy and enucleation of the pancreatic lesionwere undertaken. Postoperatively, abdominal symptomsresolved and serum glucagon dropped to 7 pmol/L.Although H and E staining confirmed normal pancreatictissue, immunohistochemistry was initially thought to besuggestive of alpha cell hyperplasia. A count of glucagonpositive cells from 5 islets, compared to 5 islets from 5normal pancreata indicated that islet size and glucagoncell ratios were increased, however still within the widerange of normal physiological findings. Glucagon receptorgene (GCGR) sequencing revealed a heterozygous deletion,K349_G359del and 4 missense mutations. This case may potentially represent a progenitor stage of glucagon cell adenomatosis with hyperglucagonemia in the absence of glucagonoma syndrome. The identification of novel GCGR mutations suggests that these may represent the underlying cause of this condition.

  15. Gallstone-relatedcomplicationsafterRoux-en-Y gastricbypass:aprospectivestudy

    Institute of Scientific and Technical Information of China (English)

    Rachid G Nagem; Alcino Lázaro-da-Silva

    2012-01-01

    BACKGROUND: Gastric  bypass  is  a  widespread  bariatric procedure that carries a high incidence of gallstone formation postoperatively. Controversy exists regarding the importance and consequences of gallstones in these patients. There are surgeons  who  consider  gallstone-related  complications after  gastric  bypass  important  enough  to  require  routine removal of the gallbladder during gastric bypass (prophylactic cholecystectomy). However, this can lead to increased costs and risks. This study aimed to identify complications related to cholelithiasis after Roux-en-Y gastric bypass (RYGBP). METHODS: This is a prospective observational study of 40 morbidly obese patients free of gallbladder disease. The patients underwent open RYGBP at a public hospital in Brazil from February to October 2007. They were followed up clinically and ultrasonographically at 6 months and 1, 2, and 3 years after surgery. Of the patients, 38 patients were followed up for 3 years. RESULTS: Eleven  patients  (28.9%)  developed  cholelithiasis, four (10.5%) experienced biliary pain, and 2 suffered from acute  biliary  pancreatitis  (5.3%).  These  patients  had  their gallbladders removed laparoscopically. No patient presented with  acute  cholecystitis,  choledocholithiasis,  or  bile  duct dilation during the follow-up period. There were no deaths. CONCLUSIONS: Gallstone-related complications after RYGBP were relatively common. Some of these complications, like acute pancreatitis, are known to have potentially severe outcomes. It seems reasonable to perform cholecystectomy

  16. Role of preoperative sonography in predicting conversion from laparoscopic cholecystectomy to open surgery

    International Nuclear Information System (INIS)

    Highlights: •The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. The study may be a guide for the surgeon to prefer laparoscopic or open surgery. -- Abstract: Background: Laparoscopic cholecystectomy is the first step treatment in cholelithiasis. The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. Methods: This study included 176 patients who had undergone laparoscopic cholecystectomy. Preoperative ultrasonographic findings were assessed and we gave points to each finding according to results from correlation analysis. After the scoring we investigated the relationship between ultrasonographic findings and conversion from laparoscopic cholecystectomy to open surgery. Results: Scoring significantly predicted failure in laparoscopic approach (AUC = 0.758, P = 0.003,). Optimal cut off score was found to be 1.95 with 67% sensitivity and 78% specificity. Score > 1.95 was a risk factor for failure in laparoscopic approach [odds ratio = 7.1(95% CI,2-24.9, P = 0.002)]. There were 8 subjects out of 36(22%) with high score underwent open surgery while 4 out of 128 (3%) subjects with low score needed open surgery (p = 0.002). Negative predictive value of 128/132 = 97%. Mean score of whole study population was 1.28 (range 0–8.8) and mean score of subjects underwent open surgery was 3.6 while it was 1.1 in successful laparoscopic approach group (p < 0.001). Mean Age and BMI were similar between groups (p > 0.05). Sex of subjects did not affect the success of surgery (p > 0.05). Conclusion: The contribution of preoperative ultrasonography is emphasized in many studies. Our study suggests quantitative results on conversion from laparoscopic cholecystectomy to open surgery. We believe that radiologists have to indicate the risk of conversion in their ultrasonography reports

  17. BOUVERET'S SYNDROME (CASE PRESENTATION

    Directory of Open Access Journals (Sweden)

    Dipak

    2014-01-01

    Full Text Available Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. We describe a case of Bouv eret's Syndrome in an middle aged patient that was successfully treated with resection of distal part of stomach and 1 st part of duodenum by laparotomy. We will also review the literature on this uncommon condition. Biliary enteric fistula is as such a rar e complication and comparatively rare cause of intestinal obstruction. And even if becomes so; generally it lodges in the terminal ileum and rarely in duodenum. Obstructing proximal part of duodenum or distal part of stomach is a curiosity and i.e. Bouvere t’s syndrome. Generally patient presents with nausea, vomiting, haematemesis, abdominal distention or epigastric pain. G.I. bleeding, obstructive jaundice, pancreatitis or duodenal or gastric perforation are rare complications. The treatment is purely surg ical – either enterolithotomy or gastrotomy with associated cholecystectomy with repair of fistula or enterolithotomy with or without second stage cholecystectomy. It is worth to mention here that so far histological findings of Bouveret’s syndrome are no t described in the literature. Even though findings are not that much specific; but presence of foci of abscesses, dense mixed inflammatory exudates in all the coats of distal part of stomach, 1 st part of duodenum and gall bladder along with formation of l ymphoid follicles with prominent germinal centers in muscle coat are definitely mentionable and we feel these may give clue. On gross examination the thickness of stomach wall and duodenal wall are increased and there is narrowing of lumen. If there is sto ne in gall bladder; it may also show thickened out wall due to presence of chronic cholelithiasis with cholecystitis.

  18. Clinical features and differential diagnosis of pituitary tumours with emphasis on acromegaly.

    Science.gov (United States)

    Hennessey, J V; Jackson, I M

    1995-04-01

    age of diagnosis usually between the third and fifth decades. Conditions associated with acromegaly include glucose intolerance, diabetes mellitus, lipid abnormalities, cholelithiasis, goitre, and hyperthyroidism, respiratory complications, hypertension, cardiovascular disease, and calcium metabolism abnormalities. An association between acromegaly and cancer, especially of the colon, is now recognized. Epidemiological series have indicated that cancer of the colon, breast and other types of malignancy are a cause of death with increased frequency in acromegalics compared with expected rates. Hypopituitary symptoms secondary to the mass effect of macroadenomas in acromegalic patients are common. Among premenopausal women, menstrual irregularities and galactorrhoea have been reported in 40-70%, while more than half of the men complain of impotence and decreased libido.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7625986

  19. Duodenum inclusion in alimentary transit for preventing or correcting nutritional deficiencies resulting from Roux-en-y gastric bypass in obesity treatment.

    Science.gov (United States)

    Ceneviva, Reginaldo

    2016-01-01

    Nutritional and metabolic complications can develop after Roux-en-Y gastric bypass (RYGB) when there is an exaggerated response to the anatomical and functional changes or when there is inadequate nutritional supplementation. Severe malnutrition is rare, but deficiencies of vitamin B12, iron, calcium and thiamin, metabolic bone disease and gallstones are common after RYGB. Shortage of vitamin B12, iron, calcium and also cholelithiasis are caused at least partially by excluding the duodenum and proximal jejunum from food transit. We designed a new procedure, with the maintenance of the duodenum and proximal jejunum in the gastrointestinal transit through interposition of jejunal loop, as a primary operation to prevent such deficiencies or as corrective surgery for severe malnutrition after RYGB with failure in responding to conservative treatment. Complicações nutricionais e metabólicas podem se desenvolver após a derivação gástrica em Y de Roux (DGYR) quando há uma resposta exagerada às mudanças anatômicas e funcionais ou quando há suplementação nutricional inadequada. A desnutrição grave é rara, mas deficiências de vitamina B12, ferro, cálcio e tiamina, doença óssea metabólica e cálculos biliares são comuns após a DGYR. Dessas deficiências mencionadas, a de vitamina B12, de ferro, de cálcio e também a colelitíase, são causadas, ao menos parcialmente, pela exclusão do duodeno e jejuno proximal. Um novo procedimento com a manutenção do duodeno e do jejuno proximal no trânsito gastrointestinal, mediante interposição de alça jejunal, foi idealizado como operação primária para prevenir essas deficiências ou como cirurgia corretiva de desnutrição grave após DGYR com falha na resposta a exaustivas tentativas de tratamento conservador. PMID:27275596

  20. The role of hepatobiliary scintigraphy and oral cholecystography in predicting the performance of laparoscopic cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    Won, Kyoung Sook [Kangnung Hospital, Kangnung (Korea, Republic of); Ryu, Jin Sook; Moon, Dae Hyuk [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)] [and others

    1997-03-01

    Laparoscopic cholecystectomy can be performed safely in most patients with symptomatic cholelithiasis. Preoperative evaluation should assess the potential problems that affect the performance of laparoscopic cholecystectomy. Hepatobiliary scintigraphy or oral cholecystography can assess the gallbladder function and nonvisualization of gallbladder usually indicates acute or severe chronic cholecystitis. The purpose of this study was to evaluate the role of preoperative hepatobiliary scintigraphy or oral cholecystography in predicting the performance of laparoscopic cholecystectomy. The study group consists of 176 patients who underwent both hepatobiliary scintigraphy with Tc-99m DISIDA and oral choelcystography within one month before laparoscopic cholecystectomy. Nonvisualization of gallbladder was defined as persistent nonvisualization of gallbladder until 4 hours on hepatobiliary scintigraphy or 12 hours on oral cholecystography. Among 176 patients, gallbladder was not visualized in 38 patients on hepatobiliary scintigraphy and 41 patients on oral cholecystography. Concordance rate between hepatobiliary scintigraphy and oral cholecystography was 89.2%. The conversion rate to open cholocystectomy was significantly higher in patients with nonvisualization of gallbladder than in patients with gallbladder higher in patients with nonvisualization of gallbladder visualization (15.8% vs 2.9% on hepatobiliary scintigraphy, 12.2% vs 3.7% on oral cholecystography: p<0.01 and p<0.05 respectively). The operative complication rate was also significantly higher in patients with nonvisualization of gallbladder (13.2% vs 2.9% on hepatobiliary scintigraphy, 14.6% vs 2.2% on oral cholecystography : p<0.01 and p<0.001, respectively). Similarly, operation time was significantly prolonged in patients with nonvisualization of gallbladder (88.8{+-}41.9 min vs 62.5{+-}23.6 min on hepatobiliary scintigraphy : p<0.001, 89.4{+-}41.3 min vs 61.8{+-}22.8 min on oral cholecystography :p<0

  1. The role of hepatobiliary scintigraphy and oral cholecystography in predicting the performance of laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Laparoscopic cholecystectomy can be performed safely in most patients with symptomatic cholelithiasis. Preoperative evaluation should assess the potential problems that affect the performance of laparoscopic cholecystectomy. Hepatobiliary scintigraphy or oral cholecystography can assess the gallbladder function and nonvisualization of gallbladder usually indicates acute or severe chronic cholecystitis. The purpose of this study was to evaluate the role of preoperative hepatobiliary scintigraphy or oral cholecystography in predicting the performance of laparoscopic cholecystectomy. The study group consists of 176 patients who underwent both hepatobiliary scintigraphy with Tc-99m DISIDA and oral choelcystography within one month before laparoscopic cholecystectomy. Nonvisualization of gallbladder was defined as persistent nonvisualization of gallbladder until 4 hours on hepatobiliary scintigraphy or 12 hours on oral cholecystography. Among 176 patients, gallbladder was not visualized in 38 patients on hepatobiliary scintigraphy and 41 patients on oral cholecystography. Concordance rate between hepatobiliary scintigraphy and oral cholecystography was 89.2%. The conversion rate to open cholocystectomy was significantly higher in patients with nonvisualization of gallbladder than in patients with gallbladder higher in patients with nonvisualization of gallbladder visualization (15.8% vs 2.9% on hepatobiliary scintigraphy, 12.2% vs 3.7% on oral cholecystography: p<0.01 and p<0.05 respectively). The operative complication rate was also significantly higher in patients with nonvisualization of gallbladder (13.2% vs 2.9% on hepatobiliary scintigraphy, 14.6% vs 2.2% on oral cholecystography : p<0.01 and p<0.001, respectively). Similarly, operation time was significantly prolonged in patients with nonvisualization of gallbladder (88.8±41.9 min vs 62.5±23.6 min on hepatobiliary scintigraphy : p<0.001, 89.4±41.3 min vs 61.8±22.8 min on oral cholecystography :p<0.001). It is

  2. Hepatobiliary complications of inflammatory bowel disease%炎症性肠病肝胆并发症的研究进展

    Institute of Scientific and Technical Information of China (English)

    牛国超; 刘蕾; 张晓岚

    2012-01-01

    Inflammatory bowel disease (IBD) is a chronic idiopathic immune-mediated inflammatory disease of the gastrointestinal tract, including ulcerative colitis (UC) and Crohn's disease (CD). Extraintestinal manifestations (EIMs) are frequently encountered in IBD patients. Hepatobili-ary manifestations are common extraintestinal manifestations of IBD, including primary scle-rosing cholangitis (PSC), nonalcoholic fatty liver, cholelithiasis, primary biliary cirrhosis (PBC), small-duct PSC, IgG4-associated cholangitis (IAC), granulomatous hepatitis, amyloidosis, autoimmune hepatitis (AIH), PSC/AIH overlap syndrome, and portal vein thrombosis. In this paper, we describe the progress in understanding the hepatobiliary complications associated with IBD.%炎症性肠病(inflammatory bowel disease,IBD)包括溃疡性结肠炎(ulcerative colitis,UC)和克罗恩病(Crohn's disease,CD),是一种免疫介导的慢性特发性胃肠道炎症性疾病,常伴随有肠外表现(extraintestinal manifestations,EIMs),且涉及多个器官.肝胆系统病变是IBD常见的肠外表现,包括原发性硬化性胆管炎(primary sclerosing cholangitis,PSC)、非酒精性脂肪肝、胆石症、原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)、小胆管性PSC、IgG4相关性胆管炎(IgG4-associated cholangitis,IAC)、肉芽肿性肝炎、淀粉样变性、自身免疫性肝炎(autoimmune hepatitis,AIH)、PSC/AIH重叠综合征和门静脉血栓形成等.本综述从IBD相关的肝胆并发症方面简述了该领域的研究进展,以期能为认识IBD相关肝病的发病机制和临床治疗提供新的启示.

  3. Pancreatite aguda leve: avaliação pela ultra-sonografia. estudo prospectivo Mild acute pancreatitis: ultrasound evaluation: a prospective study

    Directory of Open Access Journals (Sweden)

    Márcio Martins Machado

    2002-07-01

    Full Text Available Resumo Neste estudo foram avaliados, por meio da ultra-sonografia, 21 pacientes com pancreatite aguda leve. Foram analisadas a presença ou ausência de hipoecogenicidade do pâncreas e a presença ou ausência de líquido peripancreático. Em 19 pacientes (90,5% foi identificada hipoecogenicidade pancreática, e em três (15,8% destes pacientes foi identificada a presença de pequena quantidade de líquido na pequena cavidade dos epíploons. Em dois pacientes (9,5% não se identificou qualquer alteração pancreática. Com relação à possível etiologia da pancreatite aguda, em 15 pacientes (71,5% pôde-se demonstrar a presença de colecistopatia calculosa, em quatro pacientes (19,0% havia história de alcoolismo crônico e não foram identificados cálculos na vesícula biliar, e em dois pacientes (9,5% não foi identificada qualquer causa aparente. Os autores concluem que a ultra-sonografia pode identificar alteração na maioria dos pacientes com pancreatite aguda leve e permite, ainda, o acompanhamento daqueles com pequenas coleções líquidas peripancreáticas.We analyzed the ultrasonographic findings of 21 patients with mild acute pancreatitis. The presence or absence of pancreatic hypoechogenicity and peripancreatic fluid collection was assessed. Pancreatic hypoechogenicity was identified in 19 patients (90.5% whereas small sac fluid collection was identified in 3 (15.8% of these patients. No abnormality was seen in 2 patients (9.5%. Regarding the etiology of acute pancreatitis, cholelithiasis was identified in 15 patients (71.5%, alcohol abuse was identified in 4 patients (19.0%, and in 2 patients (9.5% no probable etiology could be found. The authors conclude that ultrasonography may identify abnormalities in the majority of patients with mild acute pancreatitis and can be used to assess patients with peripancreatic fluid collections.

  4. 酒精性肝硬化和肝炎后肝硬化的临床特点分析%Analysis of Clinical Features of Alcoholic Cirrhosis and Posthepatitic Cirrhosis

    Institute of Scientific and Technical Information of China (English)

    吴新员

    2013-01-01

    Objective: To discuss the clinical features of alcoholic cirrhosis and posthepatitic cirrhosis. Method: Retrospective analysis was carried out by comparing 46 cases of alcoholic cirrhosis with posthepatitic cirrhosis patients hospitalized in the same period. Result: It was shown by auxiliary examination for alcoholic cirrhosis that glutamyltransferase ( GGT ) level increased, while aspartate aminotransferase ( AST )/ al-anine aminotransferase ( ALT ) and blood uric acid ( UA ) levels elevated remarkably. The incidence of hepatomegaly, adiposis hepatica, cholecystitis, cholelithiasis and pancreatitis in alcoholic cirrhosis group was higher than that in posthepatitic cirrhosis group. The difference was statistical significance ( P〈0. 05 ). Conclusion: The GGT in alcoholic cirrhosis patients increased remarkably, which indicating GGT is a characteristics index for alcoholic cirrhosis. Though alcoholic cirrhosis has better prognosis than posthepatitic cirrhosis , there is no clear difference between them in advanced stage. Thus, early detection, early diagnosis and early treatment can improve the prognosis of alcoholic cirrhosis significantly.%目的:探讨酒精性肝硬化与肝炎后肝硬化的临床特点.方法:对46例酒精性肝硬化患者与同期住院的肝炎后肝硬化患者为对照进行回顾性分析.结果:酒精性肝硬化辅助检查示谷氨酰基转移酶(GGT)升高,天冬氨酸氨基转移酶(AST)/血清丙氨酸基转移酶(ALT)、血尿酸(UA)等升高明显,肝大、脂肪肝、胆囊炎、胆石症、胰腺炎发生比例较肝炎后肝硬化高,与肝炎后肝硬化比较差异显著(P<0.05).结论:酒精性肝硬化患者的血清GGT升高显著.提示GGT是反映酒精性肝硬化的特征性指标.酒精性肝硬化预后比肝炎后肝硬化好,但晚期二者预后差别不大.因此,早发现、早诊断、早治疗可明显改善酒精性肝硬化患者的预后.

  5. Erythropoietic protoporphyria

    Directory of Open Access Journals (Sweden)

    Puy Hervé

    2009-09-01

    Full Text Available Abstract Erythropoietic protoporphyria (EPP is an inherited disorder of the haem metabolic pathway characterised by accumulation of protoporphyrin in blood, erythrocytes and tissues, and cutaneous manifestations of photosensitivity. EPP has been reported worldwide, with prevalence between 1:75,000 and 1:200,000. It usually manifests in early infancy upon the first sun exposures. EPP is characterised by cutaneous manifestations of acute painful photosensitivity with erythema and oedema, sometimes with petechiae, together with stinging and burning sensations upon exposure to sunlight, without blisters. These episodes have a variable severity depending on the exposure duration and may result in chronic permanent lesions on exposed skin. As protoporphyrin is a lipophilic molecule that is excreted by the liver, EPP patients are at risk of cholelithiasis with obstructive episodes, and chronic liver disease that might evolve to rapid acute liver failure. In most patients, EPP results from a partial deficiency of the last enzyme of the haem biosynthetic pathway, ferrochelatase, EC 4.99.1.1/FECH (encoded by the FECH gene. EPP appears to be inherited as an autosomal dominant disease, the clinical expression of which is modulated by the presence of the hypomorphic FECH IVS3-48C allele trans, but recessive inheritance with two mutated FECH alleles has also been described. In about 2% of patients, overt disease was recently shown to be caused by gain-of-function mutations in the erythroid-specific aminolevulinic acid synthase 2 (ALAS2/ALAS, EC 2.3.1.27 gene and named X-linked dominant protoporphyria. Diagnosis is established by finding increased levels of protoporphyrin in plasma and red blood cells, and detection of a plasma fluorescence peak at 634 nm. Investigations for hepatic involvement, ferrochelatase activity level, genetic analysis (FECH mutations, presence of the hypomorphic FECH IVS3-48C allele trans and ALAS2 mutations and family studies are

  6. Observation on Clinical Effect of the Treatment of Laparoscopic Hepatobiliary Calculus%腹腔镜微创治疗肝胆结石的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    李学庆

    2015-01-01

    目的:分析并研究腹腔镜微创治疗肝胆结石的临床效果。方法将我院2013年4月~2014年4月收治的98例肝胆结石患者随机分为观察组和对照组,每组49例,对照组以常规疗法治疗,观察组以腹腔镜微创治疗,观察比较两组治疗效果。结果观察组的治疗有效率高于对照组,为95.92%,对照组为77.55%,且观察组并发症发生率和复发率更低,P<0.05,具有统计学意义。结论临床治疗肝胆结石采用腹腔镜微创治疗效果更好,可以减轻患者的疼痛指数,提高治疗有效率。%Objective To analyze and study the clinical effect of the treatment of laparoscopic hepatobiliary calculus. Methods 98 cases of hepatic cholelithiasis patients were col ected in our hospital from April 2013 to April 2014,and were divided into the observation group and the control group randomly. Every group had 49 patents. Patients in the control group were given conventional treatment,and patients in the observation group were given aparoscopic minimal y invasive treatment. Then observed and compared the treatment efficacy of the two groups. Results The effective rate in the observation group was 95.92%,which was much higher than control group(77.55%). Rate of complications and the recurrence in the observation group was lower and the difference between two groups was significant(P<0.05). Conclusion The effects of Hepatobiliary stones by laparoscopic minimal y invasive in clinical is better,and this treatment can reduce pain index of patient and improve the treatment efficiency.

  7. 红细胞嘧啶5'-核苷酸酶缺乏症9例并文献复习%Erythrocyte pyrimidine 5'-nucleotidase deficiency:9 cases report and literature review

    Institute of Scientific and Technical Information of China (English)

    李大鹏; 姜波; 赵玉平; 许剑辉; 张凤奎; 郑以州; 竺晓凡; 薛艳萍

    2012-01-01

    To clarify the clinical and experimental characteristics of erythrocyte pyrimidine 5'-nu-cleotidase(P5'N)deficiency. Method:Nine patients with P5'N deficiency were retrospectively analyzed and related literatures were reviewed. Result; All of the patients had anemia. The concomitant symptoms including splenomegaly in 7 patients,jaundice in 6 patients,cholelithiasis in 2 patients and hepatomegaly in 1 patient. Two patients were complicated with β-thalassaemia trait. One patient was associated with pyruvate kinase(PK)deficiency. In 2 of 4 assessable patients, P5' N deficiency in first-degree relatives was detected. Four patients needed blood transfusions. One patient was splenectomised. Conclusion:The hereditary erythrocyte P5'N deficiency's major characteristic is the erythrocyte P5' N deficiency and marked red cell basophilic stippling. Acquired P5' N deficiency had been well described in associated with β-thalassaemia trait and other diseases.%目的:探讨红细胞嘧啶5'-核苷酸酶(P5'N)缺乏症患者的临床特征、实验室检查特点、治疗方法.方法:回顾性分析9例P5'N缺乏症患者的临床资料和实验室检查特点并复习相关文献.结果:9例患者均有不同程度贫血,其他症状包括:脾大7例,黄疸6例,胆石症2例,肝大1例.2例患者并发β-地中海贫血,1例并发丙酮酸激酶(PK)缺乏.4例可分析病例中2例患者的母亲同时存在P5'N缺乏.4例患者需要输血治疗.结论:遗传性P5'N缺乏症特点是红细胞P5'N活性下降,外周血可见嗜碱性点彩红细胞.获得性P5'N缺乏症可见于β-地中海贫血等疾病.

  8. CHRONIC HEPATITIS OR «DISGUISE» PAROXYSMAL NOCTURAL HEMOGLOBINURIA?

    Directory of Open Access Journals (Sweden)

    D. A. Dolgopolova

    2015-01-01

    Full Text Available Objective is description of a case of diagnostics of a paroxysmal nocturnal haemoglobinuria. Subjects and methods. The male patient of 50 years asked for medical care with complaints to emergence of yellowness a skin, urine darkening, not expressed general weakness. To the patient examination was conducted: clinical and biochemical blood tests, urine, miyelogramm, definition of an index of sphericity of erythrocytes, definition of free hemoglobin of plasma of blood, urine, gemosiderinuriya, flow citometry, immunological markers of rheumatic diseases, tool inspection, etc. Results. On the basis of complaints, a clinical picture of a disease, data of objective and tool inspections the final diagnosis is made: a paroxysmal nocturnal haemoglobinuria, a classical haemolytic form (on the International classification of diseases of the 10th revision – B 59.5. The comorbid diagnoses: anemia of heavy degree; transfusion dependence; thrombosis of a subclavial vein on the right (11.2011; cholelithiasis; chronic calculous cholecystitis in remission; chronic hepatitis of the mixed genesis (alcoholic, metabolic, moderate degree of activity. By the main diagnostic method which allowed to verify the diagnosis became flow citometry. According to an flow citometry erythrocytes I Tip (normal expression of CD59 – 87,0 %, II Type (partial deficiency of CD59 – 0,3 %, III Type (full deficiency of CD59 – 12,7 %; monocytes with deficiency of FLAER/CD14 – 93,3 %; granulocytes with deficiency of FLAER/CD24 – 97,7 %. Flow citometry was revealed by availability of APG-clone among erythrocytes, granulocytes and monocytes. Judging by the huge size of a clone (on granulocytes 97,7 %, it is possible to draw a conclusion that the patient was in the highest zone of risk of APG of crises. Conclusion. Practical interest of this supervision is caused by a rarity of this hematologic disease, the analysis of modern opportunities of diagnostics and complexity of a choice of

  9. Clinical features and differential diagnosis of pituitary tumours with emphasis on acromegaly.

    Science.gov (United States)

    Hennessey, J V; Jackson, I M

    1995-04-01

    age of diagnosis usually between the third and fifth decades. Conditions associated with acromegaly include glucose intolerance, diabetes mellitus, lipid abnormalities, cholelithiasis, goitre, and hyperthyroidism, respiratory complications, hypertension, cardiovascular disease, and calcium metabolism abnormalities. An association between acromegaly and cancer, especially of the colon, is now recognized. Epidemiological series have indicated that cancer of the colon, breast and other types of malignancy are a cause of death with increased frequency in acromegalics compared with expected rates. Hypopituitary symptoms secondary to the mass effect of macroadenomas in acromegalic patients are common. Among premenopausal women, menstrual irregularities and galactorrhoea have been reported in 40-70%, while more than half of the men complain of impotence and decreased libido.(ABSTRACT TRUNCATED AT 400 WORDS)

  10. Preoperative management of patients with suspected gallbladder cancer%可疑胆囊癌的术前处理

    Institute of Scientific and Technical Information of China (English)

    陈伟; 梁力建

    2011-01-01

    @@ 胆囊癌是胆道系统最常见的恶性肿瘤,其发病隐匿,临床症状缺乏特异性,早期常被并存的胆囊结石、胆囊息肉、慢性胆囊炎等症状所掩盖,发现时大部分患者已属中晚期,手术切除率低.加上胆囊癌高度恶性的生物学行为,对放、化疗不敏感,预后极差,患者总体5年生存率<5%;若患者能接受R0根治性切除术,5年生存率可提高至21%~69%[1].因此,对可疑胆囊癌患者完善相关检查,及早诊断和行根治性切除术是目前治愈胆囊癌的惟一方法.%Gallbladder cancer is a disease associated with high mortality. Improvement of early diagnosis is of great significance to prolong the survival. Risk factors for gallbladder cancer include gallstones, cholelithiasis, anomalous pancreaticobiliary junction, focal mucosal microcalcifications, and et al.Advances in endoscopic ultrasonography, magnetic resonance cholangiopancreatogram and helical computed tomography have enhanced preoperative diagnosis of gallbladder cancer. Understanding the characteristics of gallbladder cancer with the help of multiple imaging modalities can facilitate accurate diagnosis and may also help in sorting patients to undergo extended resection or an alternative therapy. Resection is currently the most effective and only potentially curative treatment for gallbladder cancer.However, owing to its non-specific symptoms, gallbladder cancer patients often suffer from late diagnosis, and few patients are suitable for surgery. Other treatment strategies such as chemotherapy, radiotherapy, percutaneous biliary drainage, palliative surgery are used in patients with advanced gallbladder cancer.For jaundiced gallbladder cancer patients, preoperative biliary drainage is still under debate. Since biliary inflammation adversely affects the prognosis of gallbladder cancer patients,antibiotics with high concentration in bile is recommended for selected patients. Palliative treatment and molecular target

  11. A 56-year-old woman with ampullary adenocarcinoma and acute pancreatitis Mujer de 56 años con adenocarcinoma de la ampolla de Vater y pancreatitis aguda

    Directory of Open Access Journals (Sweden)

    V. M. Santos

    2012-12-01

    Full Text Available A 56-year-old woman was admitted with jaundice, and laboratory data were indicative of pancreatitis, which recurred in spite of adequate clinical and nutritional management. The patient was an overweight diabetic using metformin, who had antecedents of cholelithiasis and recent cholecystectomy. Clinical and laboratory features were not conclusive about the cause of this acute pancreatitis. However, imaging data contributed to diagnosis suspicion, and the histopathology study of the transpapillary biopsy confirmed the ampullary adenocarcinoma. Whipple´s surgery was the procedure of choice, associated with radical lymphadenectomy, followed by an uneventful outcome. Recrudescence of signs and symptoms of acute pancreatitis, with elevated serum levels of bilirrubins and of hepatic canalicular enzymes, should enhance the suspicion index about periampullary tumors. High levels of CA 19-9 can constitute a useful marker of this condition. Transpapillary biopsy can characterize the diagnosis of ampullary malignancies.Se presenta el caso de una mujer de 56 años, que presentaba ictericia y cuyos exámenes de laboratorio fueran indicativos de pancreatitis. Presentó recurrencia a pesar de las medidas clínicas y nutricionales adecuadas. La paciente era diabética, con sobrepeso, tomaba metformina y con antecedentes de colelitiasis y reciente colecistectomía. Los datos clínicos y del laboratorio no fueron concluyentes acerca del origen de esta pancreatitis aguda. Sin embargo, los estudios de imagen contribuyeron a la sospecha del diagnóstico; los estudios de citologia exfoliativa y de biopsia transpapilar confirmaron un adenocarcinoma ampular. La cirugía de Whipple fue el procedimiento de opción, asociado con linfadenectomía radical, con resultado favorable. El recrudecimiento de señales y síntomas de pancreatitis aguda, con niveles séricos elevados de bilirrubina y de enzimas hepáticos debe reforzar el índice de sospecha acerca de tumores

  12. A new method of preventing bile duct injury in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Fang Xu; Cheng-Gang Xu; De-Zheng Xu

    2004-01-01

    AIM: Of all the complications of laparoscopic cholectecystomy,bile duct injury (BDI) is the most serious complication.The prevention of injury to the common bile duct (CBD) remains a significant concern in laparoscopic cholecystectomy (LC).Different kinds of methods have been advanced to avoid this injury but no single method has gained wide acceptance.Because of various limitations of current methodologies we began a study using cold light illumination of the extrahepatic biliary system (light cholangiography LCP) to better visualize this area and thereby reduce the risk of bile duct injury.METHODS: Thirty-six patients with cholelithiasis were divided into two groups.Group Ⅰ (16 cases) received LCP and group Ⅱ (20 cases) received methelenum coeruleum cholangiography (MCCP).In group Ⅰ cold light was used to illuminate the common bile duct by leading an optical fiber into the common duct with a duodenoscope at the time of LC.The light coming from the fiber in the CBD could clearly illuminate the location of CBD and hepatic duct establishing its location relative to the cystic duct.This method was compared with the dye injection technique using methelenum coeruleum.RESULTS: In group Ⅰ thirteen cases were successfully illuminated and three failed.The cause of three failed cases was due to the difficulty in inserting the fiber into the ampulla of Vater.No complications occurred in the thirteen successful cases.In each of these successful cases the location of the common and hepatic ducts was clearly seen differentiating the ductal system from surrounding anatomy.In ten cases both the left and right hepatic ducts could be seen and in three only the right hepatic ducts were seen.In four of the thirteen cases,cystic ducts were also seen.In group Ⅱ,eighteen of the twenty cases were successful.The location of extrahepatic ducts became blue differentiating the ductal system from surrounding anatomy.Two cases failed due to a stone obstructing the cystic duct

  13. Scintigraphic functional study of gallbladder dynamics in a developing country

    International Nuclear Information System (INIS)

    The frequency of cholelithiasis in Chile is high. The ethiopathogeny of this disease is multifactorial and the gallbladder physiology probably has a relevant role in it. The authors considered the characterization of gallbladder dynamics in a reference population in basal condition and after the physiological stimulus of a standard liquid food. 185 MBq of 99Tcm DISIDA was administered to 19 young adults following a biliary echographic study which produced normal results (11 males, 8 females with an average age of 21.7 years) and after 60 min of equilibration (when gallbladder activity was well delimited with almost nil hepatic activity) the area of interest was centred on the gallbladder area. The basal activity was evaluated over a period of 10 min; thereafter a liquid diet was ingested and activity in the area of interest was observed over 90 min. In all cases spontaneous passage of activity to the duodenal area in the fasting period was found. Two types of gallbladder emptying were characterized: Type I, fast emptying, (n=11) an ejection fraction at 30 min of 50%, and Type II, slow emptying (n=8) with a 30 min ejection fraction of only 17%. Both groups showed a biphasic component in the gallbladder kinetics; no significant differences between the sexes were detected. The consistency of the type of emptying in each individual was evaluated and found reproducible after 6 months. To characterize these findings further gallbladder kinetics were evaluated under a standard pharmacological stimulus of IV administration of octapeptide cholecystokinin (CCK-8) with a physiological dose of 14 pMol/kg per hour. Four individuals with secretory pattern type I and 6 individuals with excretory pattern type II were evaluated. Under CCK-8 stimulation the type I individuals did not change their basic pattern of excretion while type II individuals accelerated their excretion, with similar curves as described previously for type I. The authors conclude that hepatobiliary

  14. Laparoscopic cholecystectomy for gallstones: A comparison of outcomebetween acute and chronic cholecystitis

    International Nuclear Information System (INIS)

    Laparoscopic cholecystectomy (LC) is now a common method of treatingsymptomatic gallstones and it is increasingly being requested by the informedgeneral public. Our aim was to evaluate the role of LC for cholelithiasis andto establish its outcome and the effect of gender on the results. BetweenSeptember 1994 and June 99, all patients who underwent LC for cholelithiasiswere retrospectively reviewed. They were classified as having acute orchronic cholecystitis (AC or CC). There were 791 patients with CC (633females, 158 males) and 204 patients with AC (124 females, 80 males).Conversion to open cholecystectomy was needed in 0.76% and 11.8% of thepatients with CC and AC, respectively (P<0.00). Four percent of the femalepatients with AC needed conversion as compared to 23.8% in the males(P<0.00). The low conversion rate in CC limited gender comparison. Medianoperation time in the patients with CC was 53+-16 minutes as compared to74.5+-35.7 minutes in those with AC (P<0.00). Operation time in the malepatients with CC and AC was significantly higher than in the female patients,even after excluding the converted cases (P<0.00). Median postoperative stayfor patients with CC was 1.33+-0.9 days as compared to 1.9+-1.34 days inpatients with AC (P<0.00). No statistical significance in the hospital staywas found between males and females (in CC and AC). There was no mortality inthe series. There were three bile duct injuries in the patients with CC. Inpatients with successful LC, gallbladder perforation occurred in 18% and 31%of CC and AC patients, respectively, (P<0.003). Missed stones occurred in1.4% and 3.3% of the patients with successful LC for CC and AC, respectively.Bile collection, which was treated with open drainage, occurred in fourpatients with CC and one patient with AC. LC for symptomatic cholelithiasisis safe and feasible; it should be the first choice before resorting to opensurgery. In patients with AC as compared to CC, there is an increasedconversion rate

  15. Prevalence and risk factors of gallstones in adult health screening population

    International Nuclear Information System (INIS)

    Gallstone is the most common disease of the biliary system. Korean has experienced an increase in the percentage of cholesterol gallstones. The major risk factors associated with cholesterol gallstones are age, gender as well as obesity. This study was designed to determine the prevalence of gallstones in the last three years and evaluate the associated risk factors in the population who underwent health screening. The study population consisted of 2,484 males and 2,212 females who visited the health promotion center in Dalseogu, Daegu in Korea from January 2011 to December 2013. Each participant in the study had their biliary system gallbladder examined using ultrasonography. Classified as underweight, normal weight or overweight using the population of obese according to the body mass index, and classified according to mood diagnosis of diabetes presented by the American Diabetes Association. Fasting blood glucose and number of liver function, the divided the control group by referring to the normal liver function values used herein. The geological map, I was classified as NCEP APT Ⅲ. A showed of total 148 people were found to have gallstones. The prevalence of sex among 148 patients (3.15%) 84 men (1.79%) and 64 women (1.36%) which shows significantly there is little difference. 1.84% 40 years and below, 3.38% 40's showed age prevalence was 4.66% in 50's and above. In addition, Total-cholesterol was at the most in 52 people, LDL-cholesterol in 398 people, Triglyceride in 36 people, HDL-cholesterol in 19 people. The abnormal group, was created from the total-cholesterol categories from a physical examination of a subject that has been found to be gallstones in the gallbladder. A result of conducting the univariate analysis shows the prevalence of gallstones, a correlation that is meaningful. The logistic regression analysis of multiple ages was chosen to show risk factors age independent cholelithiasis. In spite of the conclusion, gallstones are not

  16. A comparative study of gallstones from children and adults using FTIR spectroscopy and fluorescence microscopy

    Directory of Open Access Journals (Sweden)

    Marks Robert S

    2002-02-01

    Full Text Available Abstract Background Cholelithiasis is the gallstone disease (GSD where stones are formed in the gallbladder. The main function of the gallbladder is to concentrate bile by the absorption of water and sodium. GSD has high prevalence among elderly adults. There are three major types of gallstones found in patients, White, Black and Brown. The major chemical component of white stones is cholesterol. Black and brown stones contain different proportions of cholesterol and bilirubin. The pathogenesis of gallstones is not clearly understood. Analysis of the chemical composition of gallstones using various spectroscopic techniques offers clues to the pathogenesis of gallstones. Recent years has seen an increasing trend in the number of cases involving children. The focus of this study is on the analysis of the chemical composition of gallstones from child and adult patients using spectroscopic methods. Methods In this report, we present FTIR spectroscopic studies and fluorescence microscopic analysis of gallstones obtained from 67 adult and 21 child patients. The gallstones were removed during surgical operations at Soroka University Medical Center. Results Our results show that black stones from adults and children are rich in bilirubin. Brown stones are composed of varying amounts of bilirubin and cholesterol. Green stones removed from an adult, which is rare, was found to be composed mainly of cholesterol. Our results also indicated that cholesterol and bilirubin could be the risk factors for gallstone formation in adults and children respectively. Fluorescence micrographs showed that the Ca-bilirubinate was present in all stones in different quantities and however, Cu-bilirubinate was present only in the mixed and black stones. Conclusions Analysis based on FTIR suggest that the composition of black and brown stones from both children and adults are similar. Various layers of the brown stone from adults differ by having varying quantities of

  17. Hemorrhagic cholecystitis and hemobilia: two infrequent complications of systemic lupus erythematosus Colecistitis hemorrágica y hemofilia: dos complicaciones infrecuentes del lupus eritematoso sistémico

    Directory of Open Access Journals (Sweden)

    Rocío García Pérez

    2011-08-01

    Full Text Available Introduction: the patients affected by systemic lupus erythematosus (SLE often suffer gastrointestinal symptoms. The differential diagnosis should contemplate pathology of the gall bladder. We present the case of a patient with hemorrhagic lithiasic cholecystitis and hemobilia. Case report: 24 year old female diagnosed with SLE under treatment with Sintrom®, Dacortin® and Dolquine® that presented acute lithiasic cholecystitis and hemobilia with a distal calculus. Cholecystectomy and aperture of the ductus choledochus were performed allowing to confirm the hemobilia and to extract the calculus. Discussion: the treatment of cholecystitis in the patients with SLE is controversial due to the fact that most reviewed cases have been solved with cholecystectomy, or in other cases with conservative treatment with corticosteroids. We believe that the presence of cholelithiasis in a patient with SLE with pain on the right hypochondrium and ultrasound confirming the suspicion of cholecystitis demands a surgical treatment since the cause may be vascular, lithiasic or combined. Besides, the possible complications will not respond to pharmaceutical treatment.Introducción: los pacientes afectos de lupus eritematoso sistémico (LES sufren con frecuencia síntomas gastrointestinales. Debe incluirse en su diagnóstico diferencial la patología de la vesícula biliar. Presentamos el caso de una paciente con colecistitis alitiásica y hemobilia. Caso clínico: mujer de 24 años diagnosticada de LES en tratamiento con Sintrom®, Dacortin® y Dolquine® que presentó cuadro de colecisititis aguda litiásica y hemobilia, con presencia de cálculo enclavado en papila. Se realizó colecistectomía y apertu-ra del colédoco, lo que permitió confirmar la hemobilia y extracción del cálculo. Discusión: el tratamiento de la colecistitis en los pacientes con LES es controvertido ya que, aunque la mayoría de los casos revisados se han resuelto con la colecistectom

  18. Effects of Choleretics on Bile Compositions Drained from Patients with Pigment Gallstone

    Institute of Scientific and Technical Information of China (English)

    SUN Bai-jun; CUI Nai-qiang; LI Dong-hua; WANG Qian

    2006-01-01

    Objective: To provide evidence for three-level prevention of cholelithiasis by means of observing the effects of some choleretics on bile compositions drained from patients with pigment gallstone.Methods: Twenty-seven patients suffering from primary pigment gallstones and having received treatment of choledochostomies plus T-tube or endoscopic nasal bile drainage (ENBD) were divided equally into three UDA group) and combination of LDL and UDA (the LDL+ UDA group) through oral intake(7 patients in each group). Besides, 6 post-operational patients got no treatment with any drug were allocated in the control group. Bile of all the patients was collected before treatment and on the 1, 3, 5, 7th day after the treatment started to detect levels of total bile acid (TBA), glycocholic acid (GCA), taurocholic acid (TCA), glycocholic cheno-desoxycholic acid (GCDCA), total bilirubin (TBIL), uncombined bilirubin (UCB), concentration of calcium ion (Ca2+ ) as well as the bacterio-genetic and endogenous β-glucuronidase activity for comparing.Results: Levels of TBA, GCA, TCA and GCDCA got gradually increased in the UDA group and the LDL+ UDA group after treatment ( P<0.05), while those in the LDL group remained unchanged, showing an insignificant difference as compared with those in the control group. In the LDL group and the LDL + UDA group, TBIL gradually increased while UCB gradually decreased in the course of treatment ( P<0.05). Moreover, levels of Ca2+ and endogenous β-glucuronidase activity got significantly lowered (P<0.05). Conclusion: Combined use of LDL and UDA could elevate levels of TBA, GCA, TCA, GCDCA, enhance the excretion of TBIL in patients with pigment gallstone after bile drainage, lower levels of UCB and Ca2+ and the activity of endogenous β-glucuronidase in the bile, so as to reduce the possibility of stone formation of bile, and therefore, it could be used to prevent the production of pigment gallstone, especially to prevent post

  19. Prevalence and risk factors of gallstones in adult health screening population

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Mi Hwa; Cho, Pyong Kon [Dept. of Radiological Science, Catholic University of Daegu, Daegu (Korea, Republic of); Kwon, Duck Moon [Dept. of Diagnostic Radiology, Daegu Health College, Daegu (Korea, Republic of)

    2014-12-15

    Gallstone is the most common disease of the biliary system. Korean has experienced an increase in the percentage of cholesterol gallstones. The major risk factors associated with cholesterol gallstones are age, gender as well as obesity. This study was designed to determine the prevalence of gallstones in the last three years and evaluate the associated risk factors in the population who underwent health screening. The study population consisted of 2,484 males and 2,212 females who visited the health promotion center in Dalseogu, Daegu in Korea from January 2011 to December 2013. Each participant in the study had their biliary system gallbladder examined using ultrasonography. Classified as underweight, normal weight or overweight using the population of obese according to the body mass index, and classified according to mood diagnosis of diabetes presented by the American Diabetes Association. Fasting blood glucose and number of liver function, the divided the control group by referring to the normal liver function values used herein. The geological map, I was classified as NCEP APT Ⅲ. A showed of total 148 people were found to have gallstones. The prevalence of sex among 148 patients (3.15%) 84 men (1.79%) and 64 women (1.36%) which shows significantly there is little difference. 1.84% 40 years and below, 3.38% 40's showed age prevalence was 4.66% in 50's and above. In addition, Total-cholesterol was at the most in 52 people, LDL-cholesterol in 398 people, Triglyceride in 36 people, HDL-cholesterol in 19 people. The abnormal group, was created from the total-cholesterol categories from a physical examination of a subject that has been found to be gallstones in the gallbladder. A result of conducting the univariate analysis shows the prevalence of gallstones, a correlation that is meaningful. The logistic regression analysis of multiple ages was chosen to show risk factors age independent cholelithiasis. In spite of the conclusion, gallstones are not

  20. Possible role of macrophage phenotype transition in pathogenesis of non-alcoholic fatty liver disease%巨噬细胞表型转换在NAFLD发生过程中的可能作用

    Institute of Scientific and Technical Information of China (English)

    邵小娟; 王晓敏; 王斌; 熊吉; 李青; 陈东风

    2013-01-01

    目的 探讨非酒精性脂肪性肝病(NAFLD)患者网膜脂肪、皮下脂肪中巨噬细胞数量及不同表型,以及其与NAFLD严重程度的关系及意义.方法 选择2012年4~12月于第三军医大学大坪医院野战外科研究所住院的NAFLD伴单纯性胆囊结石患者27例(NAFLD组),以及同期单纯性胆囊结石但排除NAFLD及其他一切肝病的肝功能正常的单纯性胆囊结石患者28例(非NAFLD组).对两组患者的年龄、性别、体质量指数(BMI)、腹围、血糖、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、三酰甘油(TG)、胰岛素抵抗指数(HOMA-IR)、胰岛素、游离脂肪酸(FFA)进行比较.使用CD68标记巨噬细胞、CD11C标记M1亚群巨噬细胞,CD206标记M2亚群巨噬细胞,免疫组织化学染色检测其网膜脂肪组织、皮下脂肪组织的巨噬细胞及M1亚群,M2亚群数量.结果 NAFLD组和非NAFLD组的年龄、性别、腹围、血糖、ALT、AST、总胆红素(TB)、FFA比较,差异无统计学意义(P>0.05).而BMI、胰岛素、HOMA指数、TG在NAFLD组明显高于非NAFLD组,差异有统计学意义(P0.05).结论 NAFLD患者存在胰岛素抵抗及血脂代谢紊乱,网膜脂肪及皮下脂肪中的巨噬细胞数量及其表型转换可能参与了NAFLD的疾病进展.%Objective To research the number of macrophage and macrophage phenotype transition in epiploic adipose tissue and subcutaneous adipose tissue in non-alcoholic fatty liver disease (NAFLD ) and their relation with the severity of NAFLD and signifi -cance .Methods 27 cases of NAFLD complicated with simple cholelithiasis admitted to the Daping Hospital affiliated to Third Mill -tary Medical University from April to December 2012 were selected as the NAFLD group .Contemporaneous 28 cases of simple cholelithiasis excluding NAFLD and other liver disease with normal liver function were used as the non-NAFLD group .Age ,sex ,BMI, abdominal circumference ,glucose ,ALT ,AST ,TG ,H0M A -IR ,and

  1. Predição da coledocolitíase pela associação de indicadores clínicos e laboratoriais em dois momentos do pré-operatório da colecistectomia Prediction of preoperative choledocholithiasis by the association of clinical and laboratory indicators in two distinct moments

    Directory of Open Access Journals (Sweden)

    Newton Pinto Araújo Neto

    2005-02-01

    melhor a conduta diagnóstica e terapêutica nesta doença.BACKGROUND: The purpose of this study was to determine the probability of choledocholithiasis from the association of clinical and laboratory indicators at two moments of the preoperative phase of cholecystectomy. METHODS: Between March 2001 and March 2002, 48 consecutive patients with cholelithiasis were submitted to cholecystectomy and intra-operative cholangiography (IOC. The patients were divided into two groups, with group A composed of 13 patients with choledocholithiasis and group B of 35 patients without this disease. They were investigated by clinical and laboratory indicators of choledocholithiasis, analyzed in two periods, taking as the cut point the 48 hours that preceded the surgery. Later on, these preoperative indicators were associated in the logistic regression equation in different combinations. RESULTS: Using the logistic regression equation, it was found that the association of two clinical indicators in both periods (jaundice and Murphy‘s sign and two laboratory indicators (the cut level of gamma glutamyl transpeptidase and direct bilirubin 48 hours before the surgery was the most suitable for predicting choledocholithiasis. The values obtained by this equation showed an agreement with groups A and B of 95.6%, and a disagreement of 4.4% (p= 0.0000007 and k = 0.89. This equation showed sensitivity of 92.3%, specificity of 97.0%, a positive predictive value of 92.3% and a negative predictive value of 97%. These values were close to those obtained by the CIO, which showed agreement with the groups studied of 95.8%, and disagreement of 4.2% (k = 0.90. CONCLUSION: The association of indicators of choledocholithiasis is recommended to establish the probability of there occurring choledocholithiasis associated with cholelithiasis. The use of this equation may provide better guidance for the diagnostic and therapeutic handling of this disease.

  2. Analysis of health examination results of elderly people over 65 years of age in a community of luoyang city%洛阳市某社区65岁以上老年人健康体检结果分析

    Institute of Scientific and Technical Information of China (English)

    褚建东

    2016-01-01

    Objective:Through the analysis of physical examination results,to understand the health status and diseases of the elderly,to provide a basis for targeted community intervention and improve the quality of life.Methods:6 807 elderly people over 65 years of age were selected.We analyzed the results of physical examination.Results:In the physical examination for five consecutive years,ranking top ten diseases were high cholesterol,hypertension,hypertriglyceridemia,coronary heart disease,diabetes,over height or obesity,cataract,fatty liver,pre diabetes and cholelithiasis orderly,the incidence rate was 36.78%,29.83%,28.36%,25.88%,19.38%,18.23%,15.62%,14.58%,13.38%,12.24%orderly.Conclusion:According to the health status and incidence in different age groups,we formulated targeted preventive measures,actively controlled the related risk factors,at the same time,and we took effective behavioral and pharmacological interventions,advocated a healthy lifestyle,to improve the health status and the quality of life of the elderly residents in the community.%目的:通过分析体检结果,了解老年人健康状况和疾病构成,为针对性的社区干预和改善生活质量提供依据。方法:选择65岁以上体检老年人6807例,分析其体检结果。结果:在连续5年体检中,排名前十位的疾病依次是高胆固醇血症、高血压病、高甘油三酯血症、冠心病、糖尿病、BMI示超重或肥胖、白内障、脂肪肝、糖尿病前期、胆石症,发病率依次为36.78%、29.83%、28.36%、25.88%、19.38%、18.23%、15.62%、14.58%、13.38%、12.24%。结论:根据不同年龄组的健康状况和发病率,制定有针对性的预防措施,积极控制相关危险因素,同时采取有效的行为和药物干预措施,倡导健康的生活方式,以改善和提高社区老年居民的健康状况和生活质量。

  3. Outpatient laparoscopic cholecystectomy: A new gold standard for cholecystectomy? Colecistectomía laparoscópica ambulatoria: ¿El nuevo "gold standard" de la colecistectomía?

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    J. Bueno Lledó

    2006-01-01

    Full Text Available Objective: to contribute our experience for five years in the implemetation of outpatient laparoscopic cholecystectomy (LC. Patients: between January 1999 and March 2004 we performed 504 outpatient LCs. We applied both exclusion and inclusion criteria, an anesthetic and surgical protocol, and discharge-specific criteria. Postoperative management in "fast track" regime. Postoperative period controlled by protocol, including phone calls after cholecystectomy. Results: the ambulatory percentage in the global series was 88.8%, and mean hospital stay was 6.1 hours. Fifty-one patients required overnight stays (10.1%, most of them for "social" causes. Five patients required admission (between 24 and 48 hours for different causes (conversion to laparotomy, intraoperative neumothorax, and postoperative medical complications. Six patients (1.1% were readmitted, and we observed 11.6% postoperative complications in the global series, with abdominal parietal pain being most frequent. Phone localization by 22.00 p.m. in the same day of surgery was 100% complete for outpatient cases. Postoperative surveillance within the first month after surgery was completed in 93.9%, and within th first year in 86.7% of patients. Conclusions: outpatient LC is safe and feasible, and probably represents a new "gold standard" in the treatment of symptomatic cholelithiasis.Objetivo: aportar nuestra experiencia durante cinco años en la implantación de la colecistectomía laparoscópica (CL en un programa de cirugía mayor ambulatoria (CMA. Pacientes: entre enero de 1999 y marzo de 2004, se realizaron 504 CL consecutivas en régimen ambulatorio. Se aplicaron criterios de exclusión e inclusión, un procedimiento anestésico-quirurgico protocolizado, y criterios específicos al alta hospitalaria. El manejo postoperatorio se realizó en régimen de "fast track" o de recuperación rápida. Seguimiento postoperatorio estricto mediante protocolo de revisiones, incluido localizaci

  4. Evaluation of the response of cortisol, corticotropin and blood platelets kinetics after laparoscopic and open cholecystectomy Avaliação da resposta do cortisol, da corticotropina e da cinética das plaquetas após colecistectomias laparoscópica e aberta

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    Eduardo Crema

    2005-10-01

    Full Text Available PURPOSE: To compare the behavior of serum cortisol and ACTH levels and platelet kinetics after laparoscopic and open cholecystectomy. METHODS: In this prospective study, 31 patients with symptomatic cholelithiasis submitted to elective cholecystectomy, 17 by the laparoscopic route and 14 by the open route, were compared. Peripheral blood samples were collected on admission of the patient, during anesthetic induction, and 2, 6, 12, 24 and 48 hours after the surgical incision. Platelets were counted in hematoxylin-eosin-stained specimens under a light microscope at 100X magnification. Cortisol and ACTH were measured by chemiluminescence. RESULTS: Cortisol and ACTH levels showed a significant increase (p0.05 between the post- and preoperative periods was observed for either group. CONCLUSION: A hormonal response was observed for both procedures studied, but the surgical stress was higher and longer lasting in open surgery compared to the laparoscopic approach. However, no significant variation in platelet kinetics in response to tissue injury was observed between the two procedures.OBJETIVO: Comparar o comportamento dos níveis séricos de cortisol, ACTH e da cinética das plaquetas nas colecistectomias laparoscópica e aberta. MÉTODOS: Esse estudo prospectivo compara 31 pacientes portadores de colelitíase sintomática que se submeteram a colecistectomia eletiva, sendo que 17 por via laparoscópica e 14 por via aberta. Amostras de sangue periférico foram colhidas na internação do paciente, na indução anestésica, às 2, 6, 12, 24 e 48 horas da incisão cirúrgica. A contagem de plaquetas foi realizada no microscópio óptico- aumento de 100X- pela coloração de Hematoxilina- eosina . As dosagens de cortisol e ACTH foram realizadas através da técnica de quimioluminescência. RESULTADOS: Observou-se que as concentrações de cortisol e ACTH elevaram-se significativamente (p< 0.05 nas primeiras horas em relação aos valores do pr

  5. 乙型肝炎后肝硬化与酒精性肝硬化患者临床特征的比较及防治%Comparison with Alcoholic Cirrhosis Clinical Characteristics of Patients with Cirrhosis and Hepatitis B Prevention

    Institute of Scientific and Technical Information of China (English)

    林铭华

    2016-01-01

    目的:分析乙型肝炎后肝硬化与酒精性肝硬化患者临床特征及防治措施。方法方便抽取2012年6月—2015年10月入住该院的74例乙型肝炎后肝硬化患者(A组)与56例酒精性肝硬化患者(B组)作为研究对象,对两组患者的临床资料进行分析,比较两组患者的临床特征以及并发症。结果酒精性肝硬化患者的食欲减退、腹胀、肝掌、蜘蛛痣、黄疸、肝肿大、肝性脑病、急性胰腺炎、胆石症、肝源性糖尿病的发生率分别为80.36%、46.43%、48.21%、58.93%、66.07%、23.21%、26.79%、12.50%、42.86%、19.64%,显著高于乙型肝炎后肝硬化患者;且两组患者的AST/ALT、GGT、ALP水平差异有统计学意义,P﹤0.05。结论为保证治疗效果,应结合乙型肝炎后肝硬化与酒精性肝硬化患者的临床特征,对其实施针对性防治措施。%Objective To analyze the clinical features and preventive measures of hepatitis b cirrhosis and alcoholic cir-rhosis. Methods Convenient selection from June 2012 to October 2015, 74 patients with hepatitis b cirrhosis (group A) and 56 patients with alcoholic cirrhosis (group B) were selected as the study subjects, the clinical data of two groups of patients analysis, the clinical features and complications of the two groups were compared. Results In patients with alcoholic cirrho-sis anorexia, abdominal distension,liver palms, spider nevus, jaundice, hepatomegaly, hepatic encephalopathy, acute pancre-atitis, cholelithiasis, hepatic diabetes incidence was 80.36%, 46.43%, 48.21%, 58.93%, 66.07%, 23.21%, 26.79%, 12.50%, 42.86%, 19.64%respectively, significantly higher than that of patients with liver cirrhosis after hepatitis B;And the levels of AST/ALT, GGT and ALP were significantly different between the two groups,P<0.05. Conclusion In order to ensure the treatment effect, the clinical characteristics of patients with cirrhosis and alcoholic cirrhosis should be combined, and the control measures

  6. [Surgical approach to posthepatitic cirrhotic patient today].

    Science.gov (United States)

    Meriggi, F; Forni, E

    1996-01-01

    A posthepatitic cirrhotic patient may undergo elective or urgent abdominal operation for an extra-hepatic or hepatic disease. According to the high postoperative morbidity (61%), surgery is indicated only for symptomatic or complicated cholelithiasis. A surgical procedure for refractory ascites has been devised to create a permanent peritoneo-venous shunt by a one way pressure-sensitive valve (Leveen). The procedure is simple and brings a long lasting relief with recovery in strength and nutrition and improved kidney function. Sclerotherapy is widely used to treat acute variceal bleeding while repeated sclerotherapy is used in the long-term management to eradicate varices. When indicated, liver transplantation is the best treatment to prevent variceal bleeding recurrence. Also portosystemic shunts effectively prevent recurrent variceal bleeding. They are, however, major operations with an important morbidity and mortality, particularly in poor risk patients. The most advocated shunts today are the Warren distal splenorenal shunt and the Sarfeh portacaval shunt using a small diameter prosthetic H-graft. The transjugular intrahepatic portosystemic stent-shunt (TIPSS) is a new treatment for portal hypertension and its complications. From a haemodynamic point of view it allows balanced hepatic perfusion. Postoperative mortality is rare; further bleeding and encephalopathy are reasonably acceptable. The most relevant complications concern dislocation of the prosthesis, stenosis and thrombosis of the shunt, which can be corrected by non-invasive dilatation. Encephalopathy is the main complication of surgical portosystemic shunts. It is usually controlled by protein diet restriction, and administration of lactulose or oral antibiotics. In severe forms the patients may be treated by an oesophageal transection with oesophagogastric devascularization, and by a postoperative suppression of the portosystemic shunt using external maneuvers. Posthepatitic liver cirrhosis is

  7. Clinical analysis and experience of single-incision laparoscopic cholecystectomy%单切口腹腔镜胆囊切除术的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    宋平; 唐滔; 陶绪雄; 阎玉矿

    2012-01-01

    Objective To discuss the feasibility of single incision laparoscopic cholecystectomy and its clinical application through analyzing the method,effect and experience of single incision laparoscopic surgery.Methods All 25 cases of cholecystitis and cholelithiasis patients with umbilical single incision laparoscopic cholecystectomy from September 2009 to April 2011 were enrolled.Results Twenty five patients with single incision laparoscopic cholecystectomy patients were completed surgery successfully,no transit conventional laparoscopy or laparotomy happened.The operation time was from 50 to 90 min.the average blood loss was 3 ml,and all patients were not placed abdominal drainage tube.Get out of bed and the liquid diet within 24 hours after surgery,the hospitalization time was 2-4 d,without special uncomfortable symptoms after operation,with no cases of wound infection,complications such as bleeding,bile duct injury did not occure,all patients were cured and discharged,and back to normal work and lives.Conclusions Single incision laparoscopic cholecystectomy is technically secure and viable,it is the combination of minimally invasive surgery and cosmetic surgery method.Compared to the traditional laparoscopic cholecystectomy,the operation of single incision laparoscopic surgery is difficult,and the operation time has been prolonged,while can achieved the same clinical effect as conventional laparoscopic cholecystectomy with three holes technique,and scar is hidden,cosmetic effect is very good.%目的 分析单切口腹腔镜胆囊切除术的手术方法及临床效果,探讨单切口腹腔镜胆囊切除术的可行性及临床应用前景.方法 总结我院2009年9月至2011年4月对25例胆囊炎并结石患者行单切口腹腔镜胆囊切除术治疗效果.结果 25例单切口腹腔镜胆囊切除术患者均顺利完成手术,无中转常规腹腔镜或开腹手术.患者手术时间50~90 min,平均出血量3ml,均未放置腹腔引流管.术后1d以内

  8. Clinical and nursing problems in Crohn’s disease

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    Iwona Wawrzycka

    2013-08-01

    Full Text Available Introduction: Crohn’s disease (CD is a transmural, typically granulomatous intestinal inflammation and may affect any part of the gastrointestinal tract, from the mouth to the anus. The complexity of the course of CD along with its complications (fistulas, perforation, and bleeding into the gastrointestinal tract requires doctors and nurses to have specialised knowledge that conditions the treatment of this disease. Aim of the research : To present the clinical image and nursing problems of CD patients, based on the analysis of medical documentation of the Clinical Department of General, Oncological and Endocrine Surgery. Material and methods: The group under study was formed out of 34 patients with diagnosed CD, hospitalised within the years 2003–2011. The criteria for inclusion into the group were as follows: diagnosed CD, age of 18–80, male and female gender. The criteria for exclusion were connected with other inflammatory diseases of the intestines, the age being below 18, or admission due to another reason, e.g. a planned cholelithiasis surgery during a remission of CD. Results : Analysis of medical documentation concerned 34 patients with CD. There were 15 women (44.1% and 19 men (55.9% in the group; the minimal age was 20 and the maximal 77; the average age was 47.2 and the median 47. The minimum length of stay was 1 day, the maximum 32 days, the average 8.29, and the median 6.5. Analysis of the data showed that the duration of hospitalisation increases with age. There is no statistical interrelation between the length of stay at the hospital and the nature of the stay (emergency, planned. The duration of the disease was most often from 2 to 5 years in 12 cases (35.3%, in 7 cases (20.6% this was 5 to 10 years, and in one person (2.9% it was above 10 years. In 23.5% of patients, it was aches and pains that were the cause of going to hospital; other symptoms such as bleeding, diarrhoea and vomiting were a separate rarer cause of

  9. Colecistectomía laparoscópica ambulatoria: Reporte preliminar de 100 casos

    Directory of Open Access Journals (Sweden)

    Marlen Vega-Vega

    2006-09-01

    ´s social security system does not have a program for ambulatory cholecystectomy. Aim: To demonstrate that in Costa Rica, laparoscopic cholecistectomy can be done safely in an ambulatory setting. Methods: Between february and july of this year a total of 100 patients with cholelithiasis, with ages between 16 and 61 and a previous ly signed informed consent, were included in a program of ambulatory laparoscopic cholecystectomy at the Surgery One Service at the Hospital San Juan de Dios. In general, these patients had no previous comorbilities. There were no patients with cholecystitis or thicken gallbladder walls on ultrasonography. The patients were admitted at 6am and had the procedure done some time during the next 4 hours, they were discharged at 4pm and seen 15 days later. Results: Of the 100 patients, 6 had to be hospitalized. The only complication was a biliary fistula. There were no reinterventions and there was no mortality. Conclusions: In Costa Rica, laparoscopic cholecystectomy can be done safely in an ambulatory setting, with an adecuate preoperative selection of patients and an adequate postoperative management.

  10. Incidental gallbladder cancer during laparoscopic cholecystectomy: Managing an unexpected finding

    Institute of Scientific and Technical Information of China (English)

    Andrea Cavallaro; Gaetano Piccolo; Vincenzo Panebianco; Emanuele Lo Menzo; Massimiliano Berretta; Antonio Zanghì; Maria Di Vita; Alessandro Cappellani

    2012-01-01

    AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography (CT)].Patients with gallbladder cancer (GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival (DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients (11 women and eight men) were found to have GBC.The male to female ratio was 1∶1.4 and the mean age was 68 years (range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis (1),pT1a (2),pT1b (4),pT2 (6),pT3 (4),pT4 (2); five cases with stage Ⅰa (T1 a-b); two with stage Ⅰb (T2 N0); one with stage Ⅱa (T3 N0); six with stage Ⅱb (T1-T3 N1); two with stage Ⅲ (T4 Nx Nx); and one with stage Ⅳ (Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage (≤ Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT (nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum (one case),porcelain gallbladder (one case),gallbladder adenoma (one case),and chronic cholelithiasis (eight cases

  11. 心理护理对胆结石患者围手术期的效果影响%Effect of psychological nursing in peri operation period in patients with gall-stones

    Institute of Scientific and Technical Information of China (English)

    端木青霞

    2014-01-01

    Objective To explore the psychological nursing in peri operation period of patients with gallstones effect. Methods Data was from 120 cases of cholelithiasis patients in our hospital operation treatment from 2011 August to 2013 August , accord-ing to table method they were randomly divided into two groups, with each group in 60 cases, treating with routine nursing as the control group while treating with psychological nursing as study group, the curative effect analysis, complications, psychological state and nursing satisfaction of the two groups were compared. Results The effective rate of the study group was higher than that of the control group;the complication (1.67%) was 1 cases, it was fewer than control group with 12 cases (20%), and the compar-ison was statistically significant (P<0.05); and the SAS and SDS scores of the study group were lower than that of the control group,the comparison has statistical significance (P<0.05);Simultaneously the nursing satisfaction was higher than that of the con-trol group, with significant differences(P<0.05). Conclusion The operation treatment for psychological nursing intervention in pa-tients with gallstone, can significantly improve the clinical efficacy, but also improve the psychological state and nursing satisfac-tion, it has a certain value in clinical application and research.%目的:探究心理护理对胆结石患者围手术期的效果影响。方法资料选自2011年8月-2013年8月在本院手术治疗胆结石患者120例,按随机数字表方法分为两组,每组60例,予常规护理作对照组,予心理护理作研究组,分析两组疗效、并发症、心理状态及护理的满意度。结果研究组有效率比对照组高;并发症(1.67%)1例,比对照组12(20.00%)例少,比较具统计学意义(P<0.05);且研究组SAS和SDS评分比对照组低,比较具统计学意义(P<0.05);同时研究组护理满意度比对照组高,比

  12. Investigation of risk factors of Hepatitis E-induced hemolytic anemia%戊型肝炎发生溶血性贫血的危险因素调查

    Institute of Scientific and Technical Information of China (English)

    牛心文

    2013-01-01

    OBJECTIVE To explore risk factors of hepatitis E-induced hemolytic anemia and to provide references for prevention and treatment. METHODS This study included 175 patients with hepatitis E, including 85 patients with hemolytic anemia in group A and 90 patients without hemolytic anemia in group B. Patients' medical history and basic information were recorded and multivariate regression analysis was conducted. RESULTS Univariate analysis results showed there was statistically significant difference in age of 45 or older, enlarged liver and spleen, G-6-PD deficiency, taking anticoagulants, bleeding history, hyperlipidemia, cholelithiasis, IBIL, DBIL, PTA, prothrombin time, ALT and AST between the two groups (P 0.05). Multivariate analysis showed that G-6-PD deficiency, hyperlipidemia, increased PTA, and extended prothrombin time were independent risk factors of hepatitis E-induced hemolytic anemia (P< 0.05). CONCLUSION G-6-PD deficiency, hyperlipidemia, increased PTA, and extended prothrombin time are risk factors of hepatitis E-induced hemolytic anemia. It is necessary to address those risk factors to reduce the occurrence of hemolytic anemia in future intervention.%目的 探讨戊型肝炎发生溶血性贫血的危险因素,为其防治提供参考.方法 共纳入175例戊型肝炎患者,其中85例患者发生溶血性贫血作为A组,90例患者未发生溶血性贫血作为B组.记录两组患者的病史及基本信息,应用多因素回归分析进行多因素分析.结果 单因素分析结果显示:两组间年龄≥45岁、肝脾大、G-6PD缺陷、服用抗凝药、既往出血史、高脂血症、胆石症、IBIL、DBIL、PTA、凝血酶原时间、ALT、AST比较差异有统计学意义(P<0.05);而性别、ALP、Ch、TP、A/G差异无统计学意义(P>0.05).进一步行多因素分析结果表明:G-6PD缺陷、高脂血症、PTA增加、凝血酶原时间延长是戊型肝炎患者发生溶血性贫血的独立危险因素(P<0.05).结论 G-6PD

  13. Obesidad y sistema inmune Obesity and the inmune system

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    M. Muñoz

    2004-11-01

    Full Text Available Junto al notable aumento de la prevalencia de la obesidad en los países desarrollados, aparece un incremento paralelo de las enfermedades crónicas asociadas. La morbilidad secundaria al sobrepeso y la obesidad incluye, además de diabetes tipo 2, dislipemia, hipertensión, enfermedad coronaria, enfermedad cerebro vascular, colelitiasis, osteoartritis, insuficiencia cardiaca, síndrome de apnea del sueño, alteraciones menstruales, esterilidad y alteraciones psicológicas, una mayor susceptibilidad a padecer algunos tipos de cáncer e infecciones, hay mayor riesgo de bacteriemia y una prolongación del tiempo de cicatrización de las heridas tras intervenciones quirúrgicas. Todo ello indica que la obesidad ejerce efectos negativos sobre los componentes del sistema inmune y su función. En esta revisión se describen las alteraciones inmunitarias asociadas con la obesidad, y su posible relación causal. Los cambios inmunológicos que se producen en la obesidad afectan tanto a la inmunidad humoral, sobre todo a la secreción de anticuerpos, como a la inmunidad celular. En la actualidad se sabe que el tejido adiposo, además de constituir un almacén de reservas energéticas en forma de triglicéridos, tiene importantes funciones como órgano endocrino y es productor de diversas hormonas y otras moléculas de señalización. La respuesta inmune puede verse profundamente afectada por la obesidad, jugando la leptina un importante papel. A lo largo del artículo se describen las propiedades de la leptina, las alteraciones de hipo e hiperleptinemia en diversas circunstancias y sus variaciones tras el tratamiento, médico o quirúrgico de la obesidad.With an increased prevalence of obesity in developed countries, associated chronic diseases rise in a parallel way. Morbidity secondary to overweight and obesity include type 2 diabetes, dislipemia, hypertension, heart disease, cerebrovascular disease, cholelithiasis, osteoarthritis, heart insufficiency

  14. Tratamento cirúrgico da obesidade mórbida Surgical treatment of morbid obesity

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    Edmundo Machado Ferraz

    2003-04-01

    with the bariatric surgical procedures performed at the University Hospital of the Federal University of Pernambuco. METHODS: Between November 1997 and February 2001, 228 patients underwent a surgical bariatric procedure. RESULTS: Gastric bypass with a Roux-en-Y limb (92% was constructed in 207 patients, vertical gastroplasty (Mason in three, five laparoscopic gastric banding, five laparoscopic Roux-en-y gastric bypass, seven Scopinaro procedures and one duodenal Switch. The age ranged from 20 to 59 years with a mean of 34 years. The body mass index was 35 to 98 with a mean of 46 Kg/m². Ninety-five men (42% and 133 women (58% were operated upon. The most important preoperative comorbidities were: arterial hypertension (68%, gastro esophageal reflux disease (34%, chronic venous insufficiency (36% degenerative artropathy (31%, dyslipidemia (21% and diabetes (19%. Cholelithiasis and cholecistectomy occurred in 20% of the patients. Wound complications were frequent. Wound infection and seroma were present in 8,1% and 33% each. Important postoperative complications occurred in 7,8%. We had four postoperative deaths (1,8%.The mean hospitalization time was 4.3 days. At 12 months of follow-up the average body weight lost was 41% of the preoperative weight. CONCLUSION: Surgical treatment of obesity was a safe and efficient alternative to control weight excess.

  15. An investigation on the misdiagnosis of acute pancreatitis in China%急性胰腺炎误诊文献分析

    Institute of Scientific and Technical Information of China (English)

    刁宗礼; 阴桢宏; 王婧; 张淑文; 王宝恩

    2009-01-01

    Objective To study the present situation of misdiagnosed acute pancreatitis(AP)in China and to im prove the identification of AP.Methods One hundred and forty.four documents of Chinese-language cases studies involving the misdiagnosis of AP published from 1988 to 2007 were identified by searching in the China National Knowledge Infrastructure(CNKI).Retrospective study of misdiagnosed diseases,clinical manifestations,risk fac tors and accessory examinations etc,Was made in 1098 patients with AP.Results(1)The patients related to the departments of internal medicine,surgery,obstetrics and gynecology,and pediatrics and so on.The misdiagnosed diseases were over 63 kinds.The first five places successively were:cholelithiasis combined with biliary infection (182 times),acute gastroenteritis(158 times),coronary heart disease(108 times),acute appendicitis(102 times),and intestinal obstruction(90 times).(2)Abdominal pain(878 cases)is the main manifestation in AP, and the first five regions of abdominal pain successively were:upper-middle abdomen(434 cases),whole abdomen (220 cases),right lower quadrant(79 cases),right upper quadrant(74 cases),left upper quadrant(71 cases). (3)Cholecystolithiasis(145 cases)was the first risk factor,and followed the order of fat meal(106 cases)>chronic cholecystitis(72 eases)>alcohol(67 times).(4)The number of cases diagnosed by operation was the most,up to 378;others successively were serum and urine amylase examinations(35 1 CtLSe8)and abdominal CT scan(135 cases),and abdominal ultrasound imaging(59 cases).Conclusions(1)The main causes of misdiag nasis were superficial understanding of predisposing condition,lack of correct analysis on clinical manifestations, and mistakes in the analysis Oil the accessory examinations.(2)Although amylase in serum or urine has limitation in diagnosis,it still Was the main method of diagnosis;and it Was necessary to be examined by abdominal CT or sur gical exploration for patients who were highly

  16. Manejo cirúrgico da síndrome de Mirizzi Surgical management of Mirizzi syndrome

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    Olival Cirilo Lucena da Fonseca-Neto

    2008-06-01

    com síndrome de Mirizzi, ela deve ser suspeitada na colelitíase crônica e prontamente identificada no intra-operatório para evitar lesões biliares inadvertidas. Apesar da era da colecistectomia laparoscópica, o método aberto deve ser o de escolha.BACKGROUND: Mirizzi syndrome is a rare complication of long standing cholelithiasis and was reported in 0,3 - 3% of patients undergoing cholecystectomy. If not recognized preoperatively, it can result in significant morbidity and mortality. AIM: To describe a series of five consecutive patients with Mirizzi syndrome submitted to surgical treatment and to comment on then aspects clinics. METHODS: A retrospective review of five consecutives cases of Mirizzi syndrome that arose between January 2002 and June 2008 was performed. The following items were evaluated: clinical presentation, laboratory results, preoperative evaluation, operative findings, presence of choledocholithiasis, type of Mirizzi syndrome according to the classification by Csendes, choice of operative procedures, and complications. RESULTS: Four patients were women (80% and a mean age was 53,4 years (38 to 62 years. The most frequent symptoms were abdominal pain (100% and nausea and vomiting (100% The patients with jaundice presented altered hepatic function tests (40% and only one without jaundice presented altered hepatic function. The diagnosis of Mirizzi syndrome was intra-operative in all patients (100%. Cholecystecholedochal fistula associated with choledocholithiasis was observed in three (60% cases. Mirizzi syndrome was classified as Csendes type I in two (40% patients, type II in one (20%, type III in one (20% and type IV in another (20%. Cholecystectomy was performed in all patients (100%, however, the partial cholecystectomy was observed in three (60%. Two (40% patients were submitted to side-to-side choledochoduodenostomy and another (20% to choledochojejunoanastomosis. Two (40% patients had an uneventful recovery and were discharged in good

  17. Feasibility and efficacy analysis of laparoscopic surgery in treating liver cirrhosis merger cystic and calculus%腹腔镜手术治疗肝硬化合并胆囊结石的可行性及疗效分析

    Institute of Scientific and Technical Information of China (English)

    滕方遒

    2011-01-01

    Objective: To explore the feasibility and efficacy analysis of laparoscopic surgery in treating liver cirrhosis merger cystic and calculus. Methods: 68 liver cirrhosis merger cystic and calculus patients in our hospital were selected, and they were randomly divided into two groups, patients in treatment group were treated by laparotomy, patients in observation group were treated by laparoscopic, each 34 cases. The indexes before and after operation of the two groups were compared. Results: There were no significant differences of the two groups in sex, age composition and liver function clas -sification (.P>0.05). The control group in peri-operative bleeding [(192.1 ±42.6) ml], operation time [(122.6±25.4) min], postoperative fasting time [(2.7±0.9) d] and postoperative hospitalization time [(9.3 ±1.8) d] were higher than those of the observation group[(79.9±38.7)ml, (63.3±21.8)min, (1.0±0.6)d, (4.2±l.l)d], there were significant differences between the two groups (P0.05). Conclusion: Laparoscopic operation in the treatment of patients with cholelithiasis combined with liver cirrhosis scheme is safe and feasible, which can ob -tain satisfactory curative effect, and it is deserved clinical widely.%目的:探讨腹腔镜手术治疗肝硬化合并胆囊结石的可行性及疗效分析.方法:选取我院68例肝硬化合并胆囊结石患者,随机分为两组,开腹治疗组为对照组(34例),腹腔镜组为观察组(34例),分别比较两组患者手术前后的各项指标.结果:两组患者在性别、年龄构成比和肝功能分级方面比较,差异均无统计学意义(P>0.05),具有可比性.对照组术中出血量[(192.1±42.6)ml]、手术时间[(122.6±25.4)min]、术后禁食时间[(2.7±0.9)d]和术后住院时间[(9.3±1.8)d]均高于观察组[(79.9±38.7)ml、(63.3±21.8)min、(1.0±0.6)d、(4.2±1.1)d],两组比较差异有统计学意义(P<0.05);对照组在术后1、7 d总胆红素[(33.7±9.9)、(19.6±6.2)μmol/L

  18. Diagnostic value of joint detection of serum CA1 9-9,CA125 and CA242 for cholangiocarci-noma%血清 CA 19-9、CA 125、CA242联合检测对胆管癌诊断价值的评价

    Institute of Scientific and Technical Information of China (English)

    崔大鹏; 韩磊; 刘振显; 杨贺; 张迎春

    2016-01-01

    Objective:To study the diagnostic value of joint detection of serum CA1 9-9,CA125 and CA242 for cholan-giocarcinoma.Methods:A total of 35 patients with cholangiocarcinoma who received surgical resection in our hospital were se-lected as malignant group;30 patients with cholelithiasis who received surgical resection in our hospital during the same period were selected as benign group.Serum samples were collected before surgery to determine CA1 9-9,CA125 and CA242 content;and cholangiocarcinoma tissue and normal bile duct tissue were collected after surgery to determine the content of proliferation and invasion molecules.Results:Serum CA1 9-9,CA125 and CA242 levels of malignant group were significantly higher than those of control group (P <0.05);PROX-1,Ki-67,Bcl-2,Bad,Gab1,LOXL2,TRPM7 and CXCL12 levels in cholangiocar-cinoma tissue were significantly higher than those in benign bile duct tissue (P <0.05);and E-cadherin level was significantly lower than that in benign bile duct tissue (P <0.05);serum CA1 9-9,CA125 and CA242 levels were positively correlated with PROX-1,Ki-67,Bcl-2,Bad,Gab1,LOXL2,TRPM7 and CXCL12 levels,and negatively correlated with E-cadherin level. Conclusions:Joint detection of serum CA1 9-9,CA125 and CA242 can not only provide reference for the diagnosis of cholangio-carcinoma,but also can provide basis for the evaluation of proliferation,invasion and other malignant biological behaviors.%目的::研究血清 CA19-9、CA125、CA242联合检测对胆管癌的诊断价值.方法:选择在我院接受手术切除的35例胆管癌患者作为恶性组,同期在我院接受手术切除的30例胆石症患者作为良性组,术前采集血清标本并测定 CA19-9、CA125、CA242含量,术后采集胆管癌组织和正常胆管组织并测定增殖、侵袭分子的含量.结果:恶性组血清中 CA19-9、CA125、CA242的含量显著高于对照组(P <0.05);胆管癌组织中 PROX-1、Ki-67、Bcl-2、Bad、Gab1、LOXL2、TRPM7、CXCL12

  19. 实施人体原位肝移植早期经验(附33例报告)%The early period experience of orthotopic liver transplantation(a report of 33 cases).

    Institute of Scientific and Technical Information of China (English)

    郑树森; 梁廷波; 黄东胜; 王伟林; 张珉; 沈岩; 沈倩云; 吴健; 徐林珍; 徐红

    2001-01-01

    目的总结临床肝移植与肝肾联合移植的初步经验。方法回顾性分析了1993年4月至2000年9月开展的29例人体原位肝移植与4例肝肾联合移植的治疗结果。33例中男30例,女3例,年龄19~56岁。原发病分别为乙型肝炎后肝硬化10例,肝脏巨大恶性平滑肌肉瘤1例,巨大肝细胞性肝癌11例,小肝癌3例,高位胆管癌2例,胆汁性肝硬化1例,结肠癌肝转移1例,先天性多囊肝、多囊肾1例,慢性重症肝炎3例。供受体血型相同者26例,相符者7例。供体均为心跳停止者,供肝获取采用腹主动脉和肠系膜上静脉插管,UW液灌注,快速联合脏器获取技术,术后免疫抑制剂为环孢素A(CsA)、激素、硫唑嘌呤(Aza)、霉酚酸酯(MMF)、抗淋巴细胞球蛋白(ALG)、FK506组成的二联、三联或四联用药方案。结果术后并发急性肾功能衰竭6例,急慢性排斥反应8例,颅内出血5例,脑血栓1例,感染22例次,肝上、肝下下腔吻合口扭曲梗阻2例。存活最长已超过18个月。结论开展肝移植的初期应严格掌握适应证,选择条件较好的受体;围手术期的严密监测与正确处理,人工肝的辅助治疗等是肝移植成功的重要条件。%Objective To sum up the early clinic experience of liver and combined liver- kidney transplantation. Methods The data base of 29 cases liver transplantation and 4 cases combined liver- kidney transplantation,on whom operations were performed form Apr 1993 to Sep 1999, was analyzed retrospectively. The recipients included 30 male, 3 female and 19 - 56 years old. The original disease consisted of 10 liver cirrhosis of post - hepatitis B, 1 large leimoysosarcoma, 3 small hepatocellular carcinoma,2 klatskin tumor, 1 congenital multiple cysts of liver and kidney, 1 secondary tumor from colon cancer, 1 liver cirrhosis from cholelithiasis, 11 large hepatocellular carcinoma and 3 chronic serious hepatitis B,The blood

  20. MUTIRÕES DE COLECISTECTOMIA POR VIDEOLAPAROSCOPIA EM REGIME DE CIRURGIA AMBULATORIAL INTENSIVE PROGRAM OF VIDEOLAPAROSCOPY CHOLECYSTECTOMY ON AN AMBULATORY SURGERY BASIS

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    J.S. Santos

    2001-01-01

    Full Text Available Introdução: As listas de espera para colecistectomia, associadas à elevada demanda dos leitos e salas cirúrgicas dos Hospitais Universitários, são incentivos para adoção de novos programas de assistência. Objetivo: Avaliar o processo de organização e os resultados clínicos dos Mutirões de Colecistectomia por Videolaparoscopia, em regime de Cirurgia Ambulatorial. Pacientes e Métodos: Dentre os 314 pacientes portadores de colelitíase sintomática que aguardavam cirurgia no HCFMRP-USP, 160 foram selecionados para tratamento em regime ambulatorial. Uma equipe multiprofissional, formada por cirurgiões, anestesistas, enfermeiros e assistentes sociais, programou 4 mutirões para serem realizados em fins de semana, em função da disponibilidade do bloco cirúrgico e da sala de recuperação pós-anestésica. Mediante avaliação retrospectiva, foram analisados 79 prontuários dos pacientes operados nos Mutirões I e II (Grupo A e 79 dos 80 operados nos Mutirões III e IV (Grupo B. Análise estatística: teste de Wilcoxon e exato de Fisher (pIntroduction: The growing list of patients awaiting cholecystectomy, together with the great demand for beds and operating rooms at University Hospitals have encouraged the adoption of different solutions. Objective: To evaluate the process of organization and the clinical results of intensive programs of cholecystectomy by videolaparoscopy on an ambulatory surgery basis. Methods: Among the 314 patients with symptomatic cholelithiasis who were waiting for surgery at HCFMRP-USP, 160 were selected for treatment on an ambulatory basis. A multiprofessional team consisting of surgeons, anesthesiologists, nurses and social workers scheduled 4 intensive programs to be performed on weekends according to the availability of the surgical block and of the post-anesthesia recovery room. In a retrospective evaluation, the authors analyzed 79 medical records of patients operated upon in the intensive programs I

  1. 胰腺癌和慢性胰腺炎的相关因素%Investigation of risk factors for pancreatic carcinoma and chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    梁灿灿; 姚萍; 赵子慧

    2012-01-01

    AIM: To compare risk factors for pancreatic cancer and chronic pancreatitis to find clues to the early diagnosis of pancreatic cancer.METHODS: The clinical data for 265 patients with pancreatic carcinoma and 294 patients with chronic pancreatitis who were treated at our hospital from January 2005 to October 2010 were analyzed comparatively. Univariate and mul-tivariate analyses were performed to examine factors affecting the incidence of pancreatic carcinoma using logistic regression models.RESULTS: Univariate analysis showed that age, nation, smoking, smoking >20 cigarettes/day, drinking, alcohol >40 g/d, alcohol >10 years, diabetes, cholelithiasis, blood and urine amylase, fasting blood sugar level, AST level, ALT level, CA19-9 level differed significantly between the two groups. Multivariate analysis showed thatage (OR = 1.607, P 35 KU/L (OR = 1.004> P 6.4 mmol/L (OR = 1.453, P < 0.05) were independent risk factors for pancreatic carcinoma. Using regression analysis, 251 (94.7%) of 265 cases of pancreatic carcinoma and 282 (95.9%) of 294 cases of chronic pancreatitis were predicted. The total accuracy is 95.3%.CONCLUSION: Chronic pancreatitis patients with significant risk factors for pancreatic cancer should be regularly monitored for early detection of pancreatic cancer.%目的:对比胰腺癌(pancreatic carcinoma,PC)和慢性胰腺炎(chronic pancreatitis,CP)的相关因素,为临床早期发现PC提供一定帮助.方法:对比分析新疆医科大学第一附属医院2005-01/2010-06住院胰腺癌(pancreatic carcinoma,PC)患者265例及同期住院期间慢性胰腺炎(chronic pancreatitis,CP)患者294例,并进行单因素分析及多因素的非条件Logistic回归分析胰腺癌相关因素.结果:单因素分析显示:年龄、民族、吸烟、吸烟>20支/d、饮酒、饮酒>40 g/d且>10年、糖尿病、胆石症、血、尿淀粉酶、空腹血糖水平、门冬氨酸氨基转移酶、丙氨酸氨基转移酶、CA19-9水平在2组

  2. The etiology and endoscopic management of acute recurrent pancreatitis%急性胰腺炎复发诱因及内镜治疗

    Institute of Scientific and Technical Information of China (English)

    蒋丽丽; 李兆申

    2010-01-01

    52 years old; the RAG had a mean age of 44 years old, the age difference between the two groups had statistical significance (P<0.01). In 201 patients with severe AP, 104(20.31%) patients had AP attacked once, 97 (33.22%) had AP recurrently attacked , the difference between the two groups was statistically significant (P < 0.01). There were 46 cases in SAG complicated with pancreatic pseudocysts, and 44 cases in RAG complicated with pancreatic pseudocysts, the incidence between the two groups was statistically significant (P < 0.05). Biliary origin, hypertriglyceridemia were risk factors for recurrent AP. 139 patients with recurrent AP underwent ERCP, and 15 patients developed post-ERCP pancreatitis, 1 patient developed post-endoscopic sphincterotormy bleeding. Follow-up of 118 recurrent AP patients showed the overall remission rate of endoscopic treatment was 78.8%. Conclusions The patients in RAG were younger than those in SAG. The incidence of severe AP and pancreatic pseudocyst was higher in RAG. Cholelithiasis and hypertriglyceridemia were high risk factors of recurrent AP. Endoscopic management was an effective treatment for recurrent AP.

  3. Benign obstruction of the common hepatic duct (Mirizzi syndrome: diagnosis and operative management Obstrução benigna do ducto hepático comum (síndrome de Mirizzi: diagnóstico e tratamento operatório

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    Jaques Waisberg

    2005-03-01

    Full Text Available BACKGROUND: Mirizzi syndrome is a rare complication of prolonged cholelithiasis, characterized by narrowing of the common hepatic duct due to mechanical compression and/or inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct. OBJECTIVES: To describe a series of eight consecutive patients with Mirizzi syndrome, at a single institution, submitted to surgical treatment and to comment on their aspects with emphasis on the diagnosis and treatment. METHODS: Four women and four men, with a mean age of 61.6 years (42 to 82 years, presenting Mirizzi syndrome were operated between 1997 and 2003. The following items were evaluated: clinical presentation, laboratory results, preoperative evaluation, operative findings, presence of choledocholithiasis, type of Mirizzi syndrome according to the classification by Csendes, choice of operative procedures, and complications. RESULTS: The most frequent symptoms were abdominal pain (87.5% and jaundice (87.5%. All the patients presented altered hepatic function tests. The diagnosis of Mirizzi syndrome was intra-operative in seven (87.5% patients, and preoperative in one (12.5%. Cholecystocholedochal fistula associated with choledocholithiasis was observed in three (37.5% cases. Mirizzi syndrome was classified as Csendes type I in five (62.5% patients, type II in one (12.5%, type III in one (12,5% and type IV in another (12.5%. Cholecystectomy, as an isolated surgical procedure, was performed in four (50.0% patients. One (12.5% patient was submitted to partial cholecystectomy and closure of the fistulous orifice with the central part of the infundibula. Two (25.0% patients were submitted to cholecystectomy and side-to-side choledochoduodenostomy and another (12.5% to side-to-side choledochoduodenostomy remaining the gallbladder in situ. Seven (87.5% patients had an uneventful recovery and were discharged in good conditions. One (12.5% patient presented a

  4. Results of laparoscopic cholecystectomy in a third-level university hospital after 17 years of experience Resultados de la colecistectomía laparoscópica en un hospital universitario de tercer nivel tras 17 años de experiencia

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    P. Priego

    2009-01-01

    Full Text Available Objective: the aim of the study is to determine the results obtained with laparoscopic cholecystectomy at Ramón y Cajal Hospital after 17 years of experience, comparing current results with those at the beginning of the experience. Material and methods: between 1991 and December 2007, 3,933 laparoscopic cholecystectomies were performed at the "Ramón y Cajal Hospital"; 1,849 patients were operated on between 1991 and 2000, and 2,084 between 2001 and 2007. Patients studied included 69.8% of women and 30.2% of men, with a mean age of 56.95 years (range 9-94 years. In all, 54.68% of patients had a concomitant disease before surgery (hypertension, diabetes, ischemic heart disease, respiratory disease.... Surgery was performed by a staff surgeon for 58.04% of cases, and by a resident in the remaining 41.96%. Surgical indications were cholelithiasis in 75.5%, pancreatitis in 13.3%, cholecystitis in 6.3%, choledocholithiasis in 3.05%, and others in 1.2% of cases. Results: mean hospital stay was 3.06 days. Conversion to open surgery was required for 8.3% of cases (331 patients. The major surgical complication rate was 2.34%, with the most frequent being hemoperitoneum (1%. Common bile duct injury occurred in thirteen cases (0.3%, 51 patients (1.3% were soon re-operated, and 5 patients died (0.13%. When the results of both decades (1991-2000 vs. 2001-2007 were compared, we observed differences in the number of procedures performed by residents (31.7 vs. 51.1%, p = 0.00001, number of laparoscopic cholecystectomies for cholecystitis (4.9 vs. 7.53%, p = 0.001, conversion rate (5.46 vs. 11%, p = 0.000001, and mean hospital stay (2.43 vs. 3.7 days, p = 0.001. Conclusion: these results should be interpreted with caution as this is a retrospective study with multiple uncontrolled variables (high number of surgeons and continuous learning curve. The lower conversion rate and mean hospital stay in the first decade of the learning curve are amazing, although this

  5. 腹腔镜胆囊切开取石(息肉)术93例报告%The clinical analysis of laparoscopic cholelithotomy and polypectomy of gallbladder : with a report of 93 cases

    Institute of Scientific and Technical Information of China (English)

    徐新保; 张洪义; 张辉; 张宏义; 刘承利; 肖梅; 冯志强

    2012-01-01

    目的:总结腹腔镜保胆取石(息肉)术的手术经验.方法:回顾分析2009年1月至2012年3月为93例患者行腹腔镜下保胆取石(息肉)术的临床资料.单纯胆囊结石65例,其中单发21例,多发44例,合并肝硬化2例、肝硬化伴肝癌2例、直肠癌术后肝转移1例、遗传性球形红细胞增多症1例,伴急性胆囊炎5例;胆囊息肉16例,其中单发10例(3例腺瘤性息肉,7例胆固醇性息肉),多发6例,均为胆固醇性息肉;胆囊结石合并息肉12例,均为胆固醇性息肉.结果:92例手术获得成功,1例因术后第5天胆囊切口裂漏胆再次行腹腔镜胆囊切除术.手术时间60 ~ 180 min,平均(106±35) min.术后1例颈部切开取石患者出现上腹疼痛,引流出淡黄色腹水,量约15 ml/d,超声检查提示小网膜腔少量积液,考虑少量胆漏,术后第5天腹痛缓解,腹腔引流管无液体引出,拔除引流管后无不适.余患者均恢复顺利.术后住院2~14 d,平均(4.1±2.7)d,患者均痊愈出院.术后随访3 ~ 42个月,2例患者分别于术后12、18个月胆囊内复发少量泥沙样结石(均未服利胆药物),予以利胆排石药物治疗,1个月后复查腹部超声,结石消失.结论:腹腔镜下保胆取石(息肉)术保留了胆囊及胆囊功能,利于维护患者消化系统的正常功能.合并肝硬化、肝脏恶性肿瘤的患者,如胆囊结石导致腹痛反复发作,严重影响患者生活,且肝硬化、肝脏恶性肿瘤处于稳定期,也可谨慎考虑施行腹腔镜保胆手术,以改善患者生活质量.%Objective; To summarize the experience of 93 cases of laparoscopic cholelithotomy and polypectomy of gallbladder. Methods :The clinical data of 93 patients with cholelithiasis and cholecystic polyps who were treated by laparoscopic cholelithotomy and polypectomy between Jan. 2009 and Mar. 2012 were retrospectively analyzed. Of the 93 patients,65 cases suffered from only cholecysto-lithiasis including 21 patients with single

  6. Technical difficulties and success of endoscopic retrograde colangiopancreatography in a group of patients Dificultad técnica y éxito de la colecistopancreatografía retrógrada endoscópica en un grupo de pacientes

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    Mabel Vega Galindo

    2011-04-01

    Full Text Available Background: Endoscopic Retrograde Cholangiopancreatography has been effective in the diagnosis and treatment of diseases of the biliopancreatic system. Objective: To determine the grade of technical difficulties and the success of cholangiopancreatography in a group of patients. Methods: prospective, descriptive, observational study that included all the patients who were tested through this procedure from January to December 2009 in the hospital “Dr. Gustavo Aldereguía Lima” from Cienfuegos. Inclusion and exclusion criteria were applied so the sample was composed by 34 patients. In order to define the technical difficulty of this test Madhotra’s difficulty modified test was used. Results: 67,6 % of the patients were males. Age comprised the interval from 31 to 90 years old patients with a mean age of 60.8±16 years. Cholestatic icterus was the predominant medical indication in (55,9 %, followed by choledocholitiasis (26,5 %. Echogram showed normal results in 41,2 % of the patients. The most frequent diagnosis of this test was postcholecystectomy with dilated biliary tract (17,6 % followed by choledocho and cholelithiasis (14,7 % each one. The grade of technical difficulty was 1 in 91,2 %, grade 2 in 8,8 %. A complete technical success was obtained in 55,9 %, partial success was obtained in 32,3 % and the attempt failed in 11,8 % of the patients. Conclusion: the grade of technical difficulty can influence upon the success of Endoscopic Retrograde Cholangiopancreatography. Its usefulness has been demonstrated with a minimum amount of complications for the patient.Fundamento: la colangiopancreatografía retrógrada endoscópica resulta eficaz para el diagnóstico y tratamiento de enfermedades del sistema biliopancreático. Objetivo: determinar el grado de dificultad técnica y el éxito de la colangiopancreatografía en un

  7. 2008~2010年中国西部地区试点乡镇卫生院前15位住院疾病比较研究%A Comparative Study on Top 15 Inpatient Diseases in Pilot Township Health Centers in Western China from 2008 to 2010

    Institute of Scientific and Technical Information of China (English)

    李鸿浩; 王莉; 李幼平; 杨晓妍; 钟大可; 王应强; 沈建通; 方锐

    2011-01-01

    和地区性的乡院疾病谱统计、调查资料及循证研究,且现有研究的调查方法或数据统计口径不一、质量参差不齐.④建议国家和各省市开展并完善乡院疾病谱统计与分析工作,培训相关人员,完善信息系统建设.%Objective To provide baseline datum for further evidence-based selecting essential health technology or essential medicine by comparing the top 15 inpatient diseases in the three pilot township clinics in western China from 2008 to 2010. Methods With the key words as disease spectrum, constitution of disease, inpatient disease category, inpatient diseases and so on, such databases as CBM, CNKI, VIP, WanFang and official websites of Ministry of Health were searched on computer, and the manual search was also conducted in combination to extract the related datum of provinces where the pilot township health centers were situated. The Excel software was used for data classification and analyses. Results (1) Among the 16 included literatures including 15 journal papers and 1 master thesis, 4 scored from zero to 3.5, 9 scored from 3.5 to 6.75, and the left 3 scored 7 or more than 7; (2) The common inpatient diseases in the township health centers in eastern, central and western regions in China were different. The upper respiratory tract infection, acute/chronic bronchitis, acute/chronic gastritis and appendicitis were the common inpatient diseases in the township health centers throughout China. The pneumonia, emphysema, cholelithiasis, cholecystitis, and acute/chronic gastroenteritiswere the common inpatient diseases in the township health centers in southwest and northwest regions. The top 15 inpatient diseases in the three pilot township clinics in this study covered all the common inpatient diseases in the township health centers in southwest and northwest regions in China; (3) The total number of the top 15 inpatient diseases of the three pilot township health centers in western China between 2008 and

  8. Anestesia em paciente portador de distrofia muscular de Duchenne: relato de casos Anestesia en un paciente portador de distrofia muscular de Duchenne: relato de casos Anesthesia for Duchenne muscular dystrophy patients: case reports

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    Rodrigo Machado Saldanha

    2005-08-01

    bloqueadores neuromusculares, constituye una opción segura y eficiente en los portadores de DMD.BACKGROUND AND OBJECTIVES: Reporting two cases of anesthesia in Duchenne Muscular Dystrophy (DMD patients, which is an uncommon, progressive and disabling disease, and discussing anesthetic approaches, impairment of pulmonary and cardiac functions, the possibility of malignant hyperthermia, increased sensitivity to neuromuscular blockers and increased postoperative morbidity are some challenges faced by anesthesiologists. CASE REPORTS: First case was a pediatric patient with DMD and rhabdomyosarcoma, scheduled for tumor excision and cervical emptying. During preanesthetic evaluation, history, clinical and additional exams, no changes were detected except for the cervical tumor. We decided for total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. Surgery lasted 180 minutes without intercurrences. The second case was a male patient, 24 years old, with DMD and cholelithiasis with surgical indication who, during preoperative evaluation, has revealed severe restrictive pneumopathy with decreased capacity and respiratory reserves and the need for nasal BIPAP at night. For this patient we decided for tracheal intubation with minimum sedation and topic anesthesia, followed by total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. At the end, patient was extubated still in to operating room and nasal BIPAP was immediately placed, being patient referred to the ICU. Patient was discharged from ICU in the 2nd PO day and from hospital in the 3rd PO day. CONCLUSIONS: Total intravenous anesthesia with propofol and remifentanil administered by continuous infusion without neuromuscular blockers is a safe and effective option for DMD patients.