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Sample records for cholelithiasis

  1. 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.

  2. 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.

  3. Polymorphism in transmembrane region of MTCA gene and cholelithiasis

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    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.

  4. 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.

  5. 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.

  6. AN EPIDEMIOLOGICAL SURVEY OF CHOLELITHIASIS IN SHANGHAI

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    叶忻; 韩天权; 王保钢; 肖志坤

    2003-01-01

    Objective To obtain a general overview of gallstone disease in Shanghai.Methods3415 citizens aged>20 in the community of Shanghai were randomly selected to undergo a clinical epidemiological study and an ultrasound examination to screen for cholelithiasis.ResultsOverall prevalence rate of gallstones was 6.5%(8.6% in women and 5.1% in men). Among the 3415 persons investigated, 65 had already undergone cholecystectomy.The percentage of asymptomatic gallstone was 70.5%. Prevalence of gallstone diseases(gallstones plus cholecystectomy) increased with age significantly.ConclusionCompared to the research in Shanghai ten years ago, especially for the persons older than 50 years, the gallstone disease has become more frequent. The proportion of asymptomatic gallstones and the awareness is increasing.

  7. 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.

  8. 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

  9. Obstructive cholelithiasis and cholecystitis in a kinkajou (Potos flavus).

    Science.gov (United States)

    Potier, Romain; Reineau, Olivier

    2015-03-01

    A 14.5-yr-old female kinkajou (Potos flavus) was diagnosed with cholelithiasis after an episode of vomiting; diagnostics included biochemical analysis and abdominal ultrasound exam. Despite antimicrobial treatment, cholelithiasis led to cholecystitis. A cholecystotomy was performed to remove choleliths and inspissated bile. Morphological and spectroscopic properties of the choleliths were similar to those of gallstones from the brown pigment family and Streptococcus sp. and Escherichia coli were isolated from the bile. Biliary tract infection is directly related to pathogenesis of brown pigment gallstones. Serial ultrasound exams revealed that cholecystitis developed secondary to the presence of gallstones in the biliary tree. Despite full recovery postsurgery, the patient died 15 mo later from gallbladder necrosis. Based on the progression of this case, a cholecystectomy would be preferred over a cholecystotomy in similar cases, and the efficacy of long-acting antibiotics may not be adequate in nontarget species. Gallstones and biliary tract infection are rarely described in small domestic carnivores, and this is the first reported case in a kinkajou.

  10. Sex differences in prevalence and risk factors of asymptomatic cholelithiasis in Korean health screening examinee

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    Kim, Sung Bum; Kim, Kook Hyun; Kim, Tae Nyeun; Heo, Jun; Jung, Min Kyu; Cho, Chang Min; Lee, Yoon Suk; Cho, Kwang Bum; Lee, Dong Wook; Han, Ji Min; Kim, Ho Gak; Kim, Hyun Soo

    2017-01-01

    Abstract The aim of this study was to evaluate sex difference in the prevalence and risk factors for asymptomatic cholelithiasis in Korean health screening examinees. Examinees who underwent examination through health promotion center at 5 hospitals of Daegu-Gyeongbuk province in 2014 were analyzed retrospectively. All examinees were checked for height, weight, waist circumference, and blood pressure, and underwent laboratory tests and abdominal ultrasound. Diagnosis of cholelithiasis was made by ultrasound. Of the total of 30,544 examinees, mean age was 47.3 ± 10.9 years and male to female ratio was 1.4:1. Asymptomatic cholelithiasis was diagnosed in 1268 examinees with overall prevalence of 4.2%. In age below 40 years, females showed higher prevalence of asymptomatic cholelithiasis than males (2.7% vs. 1.9%, P = 0.020), whereas prevalence of asymptomatic cholelithiasis was higher in males than females older than 50 years (6.2% vs. 5.1%, P = 0.012). Multiple logistic regression analysis revealed age (≥50 years), obesity, and high blood pressure as risk factors for asymptomatic cholelithiasis in males and age, obesity, hypertriglyceridemia, and chronic hepatitis B infection in females (P < 0.05). Overall prevalence of asymptomatic cholelithiasis was 4.2% in Korean health screening examinees. Females showed higher prevalence of asymptomatic cholelithiasis than males younger than 40 years, whereas it was higher in males older than 50 years. Age and obesity were risk factors for asymptomatic cholelithiasis in both sexes. Males had additional risk factors of high blood pressure and females had hypertriglyceridemia and chronic hepatitis B infection. PMID:28353587

  11. 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.

  12. 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.

  13. [Study of crystalline structures of the bile in the diagnosis of cholelithiasis].

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    Postolov, P M; Bykov, A V; Mishin, S G

    1990-10-01

    Under analysis were results of polarization microscopy of bile in 111 patients with cholelithiasis, 8 patients with acalculous cholecystitis and 8 practically healthy people. It was found that in healthy people there are no crystalline structures in the initial state of bile. The composition of bile from patients with cholelithiasis is characterized by the presence of three types of crystals: solid crystals of cholesterol monohydrate, calcium bilirubinate granules and calcium carbonate microspherolites. Polarization microscopy of bile may be used as a sufficiently simple method of diagnostics of stone disease.

  14. 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.

  15. 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。

  16. MODERN PHYSICAL THERAPY IN THE EARLY POSTOPERATIVE REHABILITATION OF PATIENTS WITH CHOLELITHIASIS

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    O. A. Poddubnaya

    2013-01-01

    Full Text Available Early postoperative rehabilitation of patients with cholelithiasis is aimed at improving the function of bile secretion, adaptability and normalization of psycho-vegetative state body, which in the aggregate prevents progression of the disease and reduces the risk of postcholecystectomy violations. Use in rehabilitation activities fresh mineral water, magnetic-laser and EHF-therapy allows to receive significant improvement of the studied parameters in a significant improvement and normalization of clinical and laboratory indicators, increase adaptive capacity and normalization of psychoemotional and vegetative status of the organism. It is provides immediate high efficiency of the activities (94.7% of early postoperative rehabilitation of patients with cholelithiasis, which reduces the risk of the development of postcholecystectomy violations and prevents progression of the disease.

  17. Umbilical hernia with cholelithiasis and hiatal hernia: a clinical entity similar to Saint's triad.

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    Yamanaka, Takahiro; Miyazaki, Tatsuya; Kumakura, Yuji; Honjo, Hiroaki; Hara, Keigo; Yokobori, Takehiko; Sakai, Makoto; Sohda, Makoto; Kuwano, Hiroyuki

    2015-01-01

    We experienced two cases involving the simultaneous presence of cholelithiasis, hiatal hernia, and umbilical hernia. Both patients were female and overweight (body mass index of 25.0-29.9 kg/m(2)) and had a history of pregnancy and surgical treatment of cholelithiasis. Additionally, both patients had two of the three conditions of Saint's triad. Based on analysis of the pathogenesis of these two cases, we consider that these four diseases (Saint's triad and umbilical hernia) are associated with one another. Obesity is a common risk factor for both umbilical hernia and Saint's triad. Female sex, older age, and a history of pregnancy are common risk factors for umbilical hernia and two of the three conditions of Saint's triad. Thus, umbilical hernia may readily develop with Saint's triad. Knowledge of this coincidence is important in the clinical setting. The concomitant occurrence of Saint's triad and umbilical hernia may be another clinical "tetralogy."

  18. 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

  19. 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.

  20. 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.

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

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    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.

  2. A genome-wide association study of total bilirubin and cholelithiasis risk in sickle cell anemia.

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    Jacqueline N Milton

    Full Text Available Serum bilirubin levels have been associated with polymorphisms in the UGT1A1 promoter in normal populations and in patients with hemolytic anemias, including sickle cell anemia. When hemolysis occurs circulating heme increases, leading to elevated bilirubin levels and an increased incidence of cholelithiasis. We performed the first genome-wide association study (GWAS of bilirubin levels and cholelithiasis risk in a discovery cohort of 1,117 sickle cell anemia patients. We found 15 single nucleotide polymorphisms (SNPs associated with total bilirubin levels at the genome-wide significance level (p value <5 × 10(-8. SNPs in UGT1A1, UGT1A3, UGT1A6, UGT1A8 and UGT1A10, different isoforms within the UGT1A locus, were identified (most significant rs887829, p = 9.08 × 10(-25. All of these associations were validated in 4 independent sets of sickle cell anemia patients. We tested the association of the 15 SNPs with cholelithiasis in the discovery cohort and found a significant association (most significant p value 1.15 × 10(-4. These results confirm that the UGT1A region is the major regulator of bilirubin metabolism in African Americans with sickle cell anemia, similar to what is observed in other ethnicities.

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

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    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.

  4. 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.

  5. Effects of variant UDP-glucuronosyltransferase 1A1 gene,glucose-6-phosphate dehydrogenase deficiency and thalassemia on cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    Yang-Yang Huang; Ching-Shui Huang; Sien-Sing Yang; Min-Shung Lin; May-Jen Huang; Ching-Shan Huang

    2005-01-01

    AIM: To test the hypothesis that the variant UDPglucuronosyltransferase 1A1 (UGT1A1) gene, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and thalassemia influence bilirubin metabolism and play a role in the development of cholelithiasis.METHODS: A total of 372 Taiwan Chinese with cholelithiasis who had undergone cholecystectomy and 293 healthy individuals were divided into case and control groups,respectively. PCR and restriction fragment length polymorphism were used to analyze the promoter area and nucleotides 211, 686, 1 091, and 1 456 of the UGT1A1 gene for all subjects and the gene variants for thalassemia and G6PD deficiency.RESULTS: Variation frequencies for the cholelithiasis patients were 16.1%, 25.8%, 5.4%, and 4.3% for A(TA)6TAA/A(TA)7TAA (6/7), heterozygosity within the coding region, compound heterozygosity, and homozygosity of the UGT1A1 gene, respectively. Comparing the case and control groups, a statistically significant difference in frequency was demonstrated for the homozygous variation of the UGT1A1 gene (P = 0.012, χ2 test), but not for the other variations. Further, no difference was demonstrated in a between-group comparison of the incidence of G6PD deficiency and thalassemia (2.7% vs 2.4% and 5.1% vs 5.1%, respectively). The bilirubin levels for the cholelithiasis patients with the homozygous variant-UGT1A1 gene were significantly different from the control analog (18.0±6.5 and 12.7±2.9 μmol/L, respectively; P<0.001, Student's ttest).CONCLUSION: Our results show that the homozygous variation in the UGT1A1 gene is a risk factor for the development of cholelithiasis in Taiwan Chinese.

  6. 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.

  7. Fetal Cholelithiasis: Antenatal Diagnosis and Neonatal Follow-Up in a Case of Twin Pregnancy – A Case Report and Review of the Literature

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    Hurni, Yannick; Vigo, Francesco; von Wattenwyl, Begoña Lipp; Ochsenbein, Nicole; Canonica, Claudia

    2017-01-01

    Fetal cholelithiasis is a rare finding during a third-trimester ultrasound with an average incidence rate of 0.07–1.15%. We report a case of fetal cholelithiasis in twins, observed in a patient with monochorionic diamniotic twin pregnancy hospitalized at our unit for signs of premature labor. We present the outcome of the 2 neonates with a clinical and sonographic follow-up. In addition, we offer a comprehensive review of the literature available to date. PMID:28210714

  8. 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.

  9. 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

  10. 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.

  11. Study on Salmonella Typhi occurrence in gallbladder of patients suffering from chronic cholelithiasis-a predisposing factor for carcinoma of gallbladder.

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    Walawalkar, Yogesh D; Gaind, Rajni; Nayak, Vijayashree

    2013-09-01

    Cholelithiasis is frequently associated with carcinoma of gallbladder, and the presence of Salmonella Typhi in gallbladder of patients suffering from cholelithiasis is implicated as a predisposing factor for carcinogenesis. This study was conducted on patients suffering from chronic cholelithiasis from a region in North India-endemic area for enteric fever with high incidence of gallstones and gallbladder cancer. Since culture studies rarely reveal the chronic Salmonella Typhi persistence, we use PCR assay to specifically amplify the H1-d flagellin gene sequence homologous with Salmonella Typhi. Seven cases (17.5%), none of which were positive for culture, showed positive PCR results for Salmonella Typhi, 4 (10%) of which were tissue, 2 bile (5%), and 1 gallstone (2.5%). The chronic existence of Salmonella Typhi in gallbladder disease was confirmed. Thus, the study would indicate the importance of vaccination so as to prevent chronic infection and need for early diagnostic tools to prevent any further complications.

  12. [Biliary calculi in the golden hamster. XXXVII. The prophylactic action of the creosote bush (Larrea tridentata) in pigmented cholelithiasis produced by vitamin A].

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    Granados, H; Cárdenas, R

    1994-01-01

    In the present work the results of an experiment performed in the golden hamster (Mesocricetus auratus), strain ChCM, are presented, in which the possible preventive action of pigment cholelithiasis by a powdered, desiccated, hydroalcoholic extract of leaves of "gobernadora" (Larrea tridentata) was studied. The extract was added to the lithogenic diet (basic diet + 25,000 I.U. of Vitamin A) at the 4% level; the hamsters were fed with the experimental diets during 70 days. The results showed that the group which received the diet with "gobernadora" did not develop pigment cholelithiasis, whereas the group that received the lithogenic diet alone developed cholelithiasis in 63% of cases. It is suggested that the active principle present in the leaves of "gobernadora", responsible for the prevention of the cholelithiasis is nordihydroguiaretic acid (NDGA), a potent antioxidant. On the other hand, the hamsters that received the diet containing "gobernadora" showed serious signs of toxicity and pathological changes, such as a marked reduction of growth, pronounced irritability and aggressiveness, and a marked hypoplasia both testicular and of the accessory sex glands.

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

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    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.

  14. 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.

  15. Alteration in transforming growth factor-β receptor expression in gallbladder disease: implications of chronic cholelithiasis and chronic Salmonella typhi infection

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    Yogesh D. Walawalkar

    2016-08-01

    Full Text Available Gallbladder cancer prevalence is ever increasing with Salmonella typhi chronic infection being one of the predisposing factors. Altered ratios or expression of transforming growth factor-β (TGF-β receptors and changes in its function are associated with loss in anti-proliferative effects of TGF-β and cancer progression. Using reverse transcriptase polymerase chain reaction we monitor any changes in TGF-β receptor gene expression. We simultaneously screen for S. typhi within the samples. From 73 patients undergoing cholecystectomy 39-50% had significant expression (P<0.05 of TGF-β receptor (TβR- I and TβR-II during chronic cholelithiasis as compared to the remaining 19-23% with acute chronic cholelithiasis. There was no significant increase in TβR-III receptor expression. Patient’s positive for S. typhi (7/73 did not show any significant changes in expression of these receptors, thus indicating no direct relation in regulating the host TGFβ-signaling pathway. Further analysis on expression of downstream Smad components revealed that patients with up-regulated TGFβ receptor expression show >2-fold increase in the RSmads and Co-Smads with a >2-fold decrease in I-Smads. Thus gain of TβR-I and II expression in epithelial cells of the gallbladder was associated with chronic inflammatory stages of the gallbladder disease.

  16. Colelitíase no paciente pediátrico portador de doença falciforme Cholelithiasis in children with sickle cell disease

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    Ana Paula S. Gumiero

    2007-12-01

    Full Text Available OBJETIVO: Considerando a alta freqüência da colelitíase no paciente pediátrico com doença falciforme e a controvérsia na literatura sobre a abordagem da condição, o presente texto objetiva revisar a literatura disponível. FONTE DE DADOS: Revisão dos estudos sobre colelitíase no paciente falciforme, publicados no período entre 1980 e 2007, em língua inglesa e portuguesa, envolvendo pacientes na faixa etária de zero a 18 anos e utilizando os bancos de dados Medline e Lilacs. SÍNTESE DOS DADOS: A colelitíase é a complicação digestiva mais comum no paciente falciforme e sua incidência aumenta com a faixa etária. Os mecanismos fisiopatológicos são conhecidos, assim como os métodos diagnósticos. A conduta terapêutica consensual na colelitíase sintomática é a colecistectomia, preferencialmente por via laparoscópica. Nos casos assintomáticos, a maioria dos autores recomenda a conduta cirúrgica, para evitar complicações, confusão no diagnóstico diferencial de dor abdominal futura e menor risco cirúrgico. Contudo, não existe consenso na literatura, havendo base para a adoção de conduta expectante. CONCLUSÕES: A doença falciforme tem grandes variações em sua apresentação clinica, história natural e gravidade da hemólise. Algumas populações podem apresentar menor freqüência de colelitíase e menor número de pacientes sintomáticos, possivelmente em razão de variações de haplótipos, fatores ambientais e diferentes manejos clínicos. Ainda não existem dados suficientes na literatura ou estudos randomizados e controlados que possibilitem definir o momento ideal para a colecistectomia no paciente falciforme com litíase assintomática. Dessa maneira, dependendo de características individuais e da população, podem ser aceitos o seguimento clínico ou a indicação precoce de colecistectomia.OBJECTIVE: Given the high frequency of cholelithiasis in children with sickle cell disease and the controversies

  17. Prevalence of cholelithiasis in patients with chagasic megaesophagus Prevalência de colelitíase em pacientes com megaesôfago chagásico

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    Eduardo Crema

    2011-06-01

    Full Text Available INTRODUCTION: The prevalence of cholelithiasis in the general population ranges from 9 to 18%. This prevalence is known to be higher in the presence of parasympathetic nerve damage of the biliary tract either due to surgery (vagotomy or neuronal destruction (Chagas disease. The objective of this study was to evaluate the association of cholelithiasis and chagasic or idiopathic megaesophagus. METHODS: The ultrasound scans of 152 patients with megaesophagus submitted to cardiomyotomy and subtotal esophagectomy surgery were evaluated. The presence of cholelithiasis was compared between chagasic and idiopathic esophagopathy and ultrasound and clinical findings were correlated with age, sex and race. RESULTS: A total of 152 cases of megaesophagus, including 137 with chagasic megaesophagus and 15 with idiopathic megaesophagus, were analyzed. The mean age was 56.7 years (45-67 in the 137 patients with chagasic megaesophagus and 35.6 years (27-44 in the 15 cases of idiopathic megaesophagus, with a significant difference between the two groups (p INTRODUÇÃO: A prevalência de colelitíase observada na população em geral varia de 9 a 18%. Sabe-se que a prevalência de colelitíase é elevada quando existe lesão nervosa parassimpática das vias biliares, causada tanto por procedimentos cirúrgicos (vagotomias,quanto por destruição neuronal, como observado na forma digestiva da doença de Chagas. Propusemo-nos verificar a associação entre megaesôfago de etiologia chagásica e a presença de colelitíase. MÉTODOS: Avaliou-se prospectivamente o exame ultrassonográfico de 152 pacientes portadores de megaesôfago submetidos à cirurgia de cardiomiotomia e esofagectomia subtotal. Analisou-se comparativamente a esofagopatia chagásica e a idiopática com a presença de colelitíase, correlacionando os dados ultrassonográficos com os achados clínicos, idade, sexo e raça. RESULTADOS: Foram analisados 152 casos de megaesôfago, sendo 137 de etiologia

  18. 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

  19. CLA-enriched diet containing t10,c12-CLA alters bile acid homeostasis and increases the risk of cholelithiasis in mice.

    Science.gov (United States)

    Letona, Amaia Zabala; Niot, Isabelle; Laugerette, Fabienne; Athias, Anne; Monnot, Marie-Claude; Portillo, Maria P; Besnard, Philippe; Poirier, Hélène

    2011-08-01

    Mice fed a mixture of CLA containing t10,c12-CLA lose fat mass and develop hyperinsulinemia and hepatic steatosis due to an accumulation of TG and cholesterol. Because cholesterol is the precursor in bile acid (BA) synthesis, we investigated whether t10,c12-CLA alters BA metabolism. In Expt. 1, female C57Bl/6J mice were fed a standard diet for 28 d supplemented with a CLA mixture (1 g/100 g) or not (controls). In Expt. 2, the feeding period was reduced to 4, 6, and 10 d. In Expt. 3, mice were fed a diet supplemented with linoleic acid, c9,t11-CLA, or t10,c12-CLA (0.4 g/100 g) for 28 d. In Expt. 1, the BA pool size was greater in CLA-fed mice than in controls and the entero-hepatic circulation of BA was altered due to greater BA synthesis and ileal reclamation. This resulted from higher hepatic cholesterol 7α-hydroxylase (CYP7A1) and ileal apical sodium BA transporter expressions in CLA-fed mice. Furthermore, hepatic Na(+)/taurocholate co-transporting polypeptide (NTCP) (-52%) and bile salt export pump (BSEP) (-77%) protein levels were lower in CLA-fed mice than in controls, leading to a greater accumulation of BA in the plasma (+500%); also, the cholesterol saturation index and the concentration of hydrophobic BA in the bile were greater in CLA-fed mice, changes associated with the presence of cholesterol crystals. Expt. 2 suggests that CLA-mediated changes were caused by hyperinsulinemia, which occurred after 6 d of the CLA diet before NTCP and BSEP mRNA downregulation (10 d). Expt. 3 demonstrated that only t10,c12-CLA altered NTCP and BSEP mRNA levels. In conclusion, t10,c12-CLA alters BA homeostasis and increases the risk of cholelithiasis in mice.

  20. Cholelithiasis with atrophy of the right lateral hepatic lobe in a horse Colelitíase com atrofia do lobo lateral direito em um cavalo

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    Renato de Lima Santos

    2007-04-01

    Full Text Available A 22 year-old horse developed cholelithiasis with marked atrophy of the right lateral hepatic lobe. The horse had a history of intermittent colic since three years of age, and one of the first episodes of colic was associated with icterus. The size of the right lateral hepatic lobe was extremely reduced. There was a large choledocholith in the common hepatic duct, and several hepatoliths and choleliths in the intra- and extra-hepatic billiary ducts. Microscopically, there was severe atrophy of the right lobe with diffuse proliferation of connective tissue and billiary ducts. The left lateral lobe had peri-portal fibrosis with proliferation of billiary ducts, and billiary stasis. Chemical analysis of the calculi detected amorphous and triple phosphate, bilirubin, calcium, and iron.Um cavalo de 22 anos de idade desenvolveu quadro de colelitíase severa com atrofia do lobo lateral direito. O animal tinha histórico de cólica recorrente, desde os três anos de idade, sendo que um dos primeiros episódios de cólica foi acompanhado de icterícia. O lobo hepático lateral direito estava extremamente diminuído de volume. Havia um grande coledocólito localizado no ducto hepático comum e inúmeros hepatólitos e colélitos nos ductos biliares intra e extra-hepáticos. Microscopicamente, foi observada atrofia acentuada do lobo direito, com proliferação difusa de tecido conjuntivo fibroso e de ductos biliares. O lobo lateral esquerdo apresentava fibrose periportal difusa associada à proliferação acentuada de ductos biliares e estase biliar. Análise química das concreções detectou fosfato triplo e amorfo, bilirrubina, cálcio e ferro.

  1. [THE IDENTIFICATION OF ALTERATIONS IN THE AREA OF GREAT DUODENAL PAPILLA AND MICRO-CHOLELITHIASIS AS A TECHNIQUE OF PREVENTION OF POST-CHOLECYSTECTOMY SYNDROME AFTER MINI-INVASIVE CHOLECYSTECTOMY].

    Science.gov (United States)

    Leontiev, A S; Korotevich, A G; Repnikova, R V; Merzliakov, M V; Safronova, G A; Arkhipova, S V; Faiev, A A

    2015-06-01

    The article presents the results of endoscopic and laboratory analyses of bile in 90 patients after mini-invasive cholecystectomy The significant amount of endoscopic diagnosed alterations in the area of major duodenal papilla that amounted to 64.4% of examined patients and also occurrence of micro-cholelithiasis and insoluble precipitates in analyzed bile of 83.3% of patients. The derived data testifies necessity of application of pre-operational endoscopic diagnostic of alterations in the area of major duodenal papilla and in post-operative period as well completing it by analysis of native bile preparation.

  2. 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

  3. Inflammatory diseases of the gall bladder and biliary system. Part I: Imaging - cholelithasis - inflammation of the gall bladder; Entzuendliche Erkrankungen der Gallenblase und der Gallenwege. Teil I: Bildgebende Verfahren - Cholelithiasis - Entzuendungen der Gallenblase

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    Helmberger, H. [Krankenhaus Dritter Orden Muenchen-Nymphenburg (Germany). Abteilung fuer Diagnostische und Interventionelle Radiologie/Nuklearmedizin; Kammer, B. [Haunersches Kinderspital der Ludwig-Maximilians-Universitaet Muenchen (Germany). Abteilung Paediatrische Radiologie

    2005-05-01

    Cholelithiasis is the most common affliction of the gallbladder and biliary tract. Including its complications, gallstone disease represents the basis for cholecystitis and cholangitis in the majority of cases. Inflammatory diseases of the biliary system are divided into acute and chronic forms originating from the gallbladder as well as from the biliary tract. Although acute calculous cholecystitis is the most common form, gangrenous, and emphysematous inflammation of the gallbladder as well as gallbladder empyema are included in this group of diseases. In the chronic forms, calculous and acalculous inflammation is also differentiated. Recent developments in cross-sectional imaging in sonography, computed tomography, and magnetic resonance imaging offer numerous tools for depicting the biliary system with high diagnostic accuracy. Invasive imaging modalities of the biliary system are mainly used for therapeutic aspects. (orig.) [German] Die Cholelithiasis ist die haeufigste Erkrankung von Gallenblase und Gallenwegen. Zusammen mit seinen Komplikationen stellt das Gallensteinleiden zugleich in der Mehrzahl der Faelle die Ursache entzuendlicher Erkrankungen des Gallesystems dar. Dabei wird zwischen akuten und chronischen Formen sowohl der Gallenblase als auch der Gallenwege unterschieden. Zu den akuten Cholezystitiden zaehlen neben der begleitenden Entzuendung beim Gallensteinleiden auch die gangraenoese und emphysematoese Cholezystitis sowie das Gallenblasenempyem. Auch bei den chronischen Formen werden Entzuendungen ohne und mit Steinleiden differenziert. Mit den modernen Schnittbildverfahren Sonographie, Computertomographie und Magnetresonanztomographie stehen zahlreiche Moeglichkeiten der Bildgebung des Gallensystems mit hoher diagnostischer Aussagekraft zur Verfuegung. Die Verfahren der direkten Darstellung des Gallesystems kommen hauptsaechlich im Rahmen der Therapie zum Einsatz. (orig.)

  4. 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.

  5. 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

  6. 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

  7. 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。

  8. 升清胶囊对胆汁促成核蛋白及生化指标影响的临床研究%Clinical study on effects of Shengqing capsule on nucleoprotein α1-acid glycoprotein and biochemical indicators of bile in patients with cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    杨吉勇; 张静喆

    2012-01-01

    Objective To investigate effects and clinical significance of Chinese herbal drugs Shengqing capsule on nucleoprotein α1~acid glycoprotein and biochemical indicators of bile in patient with cholelithiasis. Methods A retrospective analysis was conducted in 40 patients with cholecystolithiasis or cholangiolithiasis definitely diagnosed by B-mode ultrasonic diagnostic equipment or computerized tomography between June 2007 and March 2009. T tube was placed via biliary drainage operation or ERCP+ENBD in biliary surgery. All patients were randomly divided into experimental group and control group, each group had 20 patients. Two groups received conventional treatments (including antibiotic treatments), and experimental group took Shengqing capsule after the first day of operation, T tube patients took Shengqing capsule for 14 d, ENBD patients took Shengqing capsule for 5 d. Then, bile from T tube and ENBD were collected on 1st, 3rd, 5th, 14th after operation respectively, and α1-acid glycoprotein, total bilirubin, un-conjugated bilirubin, cholesterol, phospholipid, total bile acid, calcium of bile were detected. Results Shengqing capsule reduced AAG in experimental group, there was a significant difference between two groups (/k0.05). Compared with control group, Shengqing capsule in experimental group reduced TBIL、 UCB、 CH、 Ca2* (P<0.05), and increased PL ? TBA of bile (P<0.05). Conclusion Shengqing capsule can reduce nucleoprotein AAG content in patients bile with cholelithiasis significantly, which improve biochemical indicators efficiently, and inhibit the formation of calculus in bile.%目的 探讨中药升清胶囊对胆汁中重要的促成核蛋白α1-酸性糖蛋白(α1-acid glycoprotein,AAG)及生化指标的影响及其临床意义.方法 对2007年6月至2009年3月期间收治的40例胆囊结石或肝内外胆管结石患者进行回顾性分析.术前经B超或CT等检查确诊.术中行胆道手术放置T管或行内镜逆行胰胆管造影和

  9. 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

  10. 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

  11. 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.

  12. Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment.

    Science.gov (United States)

    de Bari, Ornella; Wang, Tony Y; Liu, Min; Paik, Chang-Nyol; Portincasa, Piero; Wang, David Q-H

    2014-01-01

    Epidemiological and clinical studies have found that gallstone prevalence is twice as high in women as in men at all ages in every population studied. Hormonal changes occurring during pregnancy put women at higher risk. The incidence rates of biliary sludge (a precursor to gallstones) and gallstones are up to 30 and 12%, respectively, during pregnancy and postpartum, and 1-3% of pregnant women undergo cholecystectomy due to clinical symptoms or complications within the first year postpartum. Increased estrogen levels during pregnancy induce significant metabolic changes in the hepatobiliary system, including the formation of cholesterol-supersaturated bile and sluggish gallbladder motility, two factors enhancing cholelithogenesis. The therapeutic approaches are conservative during pregnancy because of the controversial frequency of biliary disorders. In the majority of pregnant women, biliary sludge and gallstones tend to dissolve spontaneously after parturition. In some situations, however, the conditions persist and require costly therapeutic interventions. When necessary, invasive procedures such as laparoscopic cholecystectomy are relatively well tolerated, preferably during the second trimester of pregnancy or postpartum. Although laparoscopic operation is recommended for its safety, the use of drugs such as ursodeoxycholic acid (UDCA) and the novel lipid-lowering compound, ezetimibe would also be considered. In this paper, we systematically review the incidence and natural history of pregnancy-related biliary sludge and gallstone formation and carefully discuss the molecular mechanisms underlying the lithogenic effect of estrogen on gallstone formation during pregnancy. We also summarize recent progress in the necessary strategies recommended for the prevention and the treatment of gallstones in pregnant women.

  13. 牛磺熊去氧胆酸与熊去氧胆酸对预防保胆术后结石复发的临床研究%A Comparative Clinical Study for the Relapse of Cholelithiasis after Gallbladder-preserving Lithotomy between Tauroursodeoxycholic Acid and Ursodeoxycholic Acid

    Institute of Scientific and Technical Information of China (English)

    陈建飞; 赵期康; 李晋忠; 黄坤全; 刘京山

    2014-01-01

    Objective To evaluate the clinical effect between tauroursodeoxycholic acid ( TUDCA) and ursodeoxycholic acid ( UDCA) on preventing the relapse of cholelithiasis after gallbladder-preserving lithotomy via choledochoscope . Methods A total of 313 patients of cholecystolithiasis in Peking University Shougang Hospital undergoing gallbladder -preserving lithotomy via choledochoscope were divided into TUDCA and UDCA group by odd and even numbers of their medical record .The TUDCA group took 500 mg TUDCA (commodity name: Taurolite, Bruschettini S.r.l., Italy, import approval number: H20070200/H20110233) once per night, for 5 days consecutively, and withdrew the drug for 10 days, 15 days was considered a cycle;the UDCA group took 500 mg UDCA ( commodity name:Ursofalk, Dr.Falk Pharma GmbH, German, import approval number: H20050181) once per night .The total course of treatment of the two groups was 180 d.Nursing and diet therapies were the same in the two groups .The cases were checked at regular intervals after surgery with B ultrasonography and were followed up .The recurrence rate of calculi , the change of the thickness of gallbladder wall and the rate of gallbladder contraction were recorded . Results The two groups were followed up for 12-30 months.The 2-year recurrence rates of cholecystolithiasis were 3.7% and 12.4% respectively in the two groups ( log-rankχ2 =5.304, P =0.021 ). Conclusion The effect of TUDCA is better than that of UDCA in preventing the relapse of cholecystolithiasis for patients with gallbladder-preserving lithotomy via choledochoscope .%目的:评价牛磺熊去氧胆酸( TUDCA)与熊去氧胆酸( UDCA)对保胆取石术后患者预防胆囊结石复发的差异性及其临床价值。方法2010年10月~2011年12月,我院内镜微创保胆手术成功的313例胆囊结石按病历号奇偶分为TUDCA组(n=161)和UDCA组(n=152),术后2周TUDCA组口服牛磺熊去氧胆酸胶囊(商品名:滔罗特,意大利

  14. 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.

  15. Functional properties of laser effects on morphology of liver, gall bladder and bile ducts in cholelithiasis

    Directory of Open Access Journals (Sweden)

    Bakhtior Shamirzaev

    2012-05-01

    Full Text Available In 85 patients with calculous cholecystitis the preoperative preparation before laparoscopic cholecystectomy included irradiation of the area of gall bladder and epigastric puncture with low power magneto-infrared laser. The investigations performed revealed significant reduction of the liver and gall bladder changes both on the light optic and electron microscopic levels due to effects of low power laser irradiation.

  16. The Progression of Cholelithiasis to Gallstone Ileus: Do Large Gallstones Warrant Surgery?

    Science.gov (United States)

    Freeman, Michael H; Mullen, Matthew G; Friel, Charles M

    2016-06-01

    Gallstone ileus is a rare cause of small bowel obstruction, classically occurring in patients with recurrent cholecystitis. The incidence of biliary enteric fistula and gallstone ileus in patients with large, asymptomatic gallstones is not known. We report a case of gallstone ileus, which occurred in the setting of a large, asymptomatic gallstone. This case suggests that large gallstones may warrant cholecystectomy, even in asymptomatic patients.

  17. 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.

  18. Prevalence of gallstone disease in first-degree relatives of patients with cholelithiasis

    Institute of Scientific and Technical Information of China (English)

    Adolfo Francesco Attili; Adriano De Santis; Fabia Attili; Enrico Roda; Davide Festi; Nicola Carulli

    2005-01-01

    AIM: To evaluate the influence of familiality on the prevalence of gallstone disease (GD) in Italy.METHODS: Families of 79 subjects with gallstones (cases) and of 79 subjects without gallstones (controls)were investigated for the presence of gallstones by ultrasonography. Index cases and index controls were matched for age, sex, and operative unit. Sixty-three and sixty-two husbands and wives of index cases and index controls, respectively, were also studied.RESULTS: Overall,the prevalence of GD was significantly higher (X2=14.52, P<0.001) in the 202 first-degree relatives of subjects with gallstones than that in the 201 first-degree relatives of subjects without gallstones (28.6% vs 12.4%, relative risk (RR) 1.80, 95% confidence interval (CI) 1.29-2.63). In particular,prevalence of GD was significantly higher in mothers,fathers, and sisters of index cases than that in the respective family members of index controls. The highest RR was observed in mothers (RR=2.35, 95%CI 1.38-4.3).Prevalence of GD was not obviously different in brothers and also in husbands and wives of index cases and index controls. Family members of index cases did not differ from family members of control cases with respect to the most important risk factors for gallstones (age, diabetes,BMI, and number of pregnancies) with an exception of a higher prevalence of diabetes in fathers of index controls than in fathers of index cases.CONCLUSION: This study confirms that familiality plays a very important role in the pathogenesis of gallstones.

  19. 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.

  20. Comparison of the minimally invasive surgical methods of the cholelithiasis treatment: single-port and four-port laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    V. N Klymenko

    2015-08-01

    Full Text Available Aim and methods. In this paper, a comparative analysis of the results obtained in the performance of single-port laparoscopic surgery (SILS and the traditional four-port laparoscopic cholecystectomy was presented. Average duration of surgery, intra and postoperative complications, duration of pain, hyperthermia, a cosmetic effect were assessed and compared. Results. SILS technique reduces the duration and intensity of post-operative discomfort associated with pain in the wound; achieve early almost complete physical and social adaptation, and return to the normal rhythm of life; get the best cosmetic result.

  1. 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.

  2. 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.

  3. Laparoscopic Combined with ERCP in Treatment of Cholelithiasis and Nursing Experience%腹腔镜联合ERCP术治疗胆石症的护理体会

    Institute of Scientific and Technical Information of China (English)

    蒋素燕; 项春晖

    2013-01-01

      目的:探讨 ERCP+EST +腹腔镜胆囊切除治疗胆囊结石合并胆总管结石患者的护理方法。方法:对本院2011年6月-2012年6月收治的经 ERCP+EST +腹腔镜胆囊切除治疗胆囊结石合并胆总管结石患者的围手术期的心理护理、临床护理与监测、健康教育进行回顾性分析。结果:89例例胆囊结石合并胆总管结石患者手术成功,恢复良好。结论:对于胆囊结石合并胆总管结石患者先进行 ERCP+EST 术,在先将胆总管内的结石取出后再进行腹腔镜胆囊切除手术,使得患者避免了传统手术导致的切口疼痛,多管引流导致的活动限制、术后禁食时间长,带 T 管时间长、易发生胆道感染的缺点,并且使住院天数减少,患者舒适度增加、痛苦小、恢复快等优点而成为胆道系统结石治疗的首选方法。%Objective:To explore the ERCP+EST + laparoscopic treatment of gallstones and bile duct stones in patients with nursing method. Method:in our hospital in 2011 June to 2012 June were treated by ERCP+EST + laparoscopic treatment of gallstones and bile duct stones in patients during peri operation period of psychological nursing,clinical nursing,health education and monitoring retrospective analysis. Result:89 cases of patients with gallstones and common bile duct stones in patients with successful operation,good recovery. Conclusion:The gallbladder and bile duct stones in patients with first ERCP+EST operation,prior to the removal of calculus of common bile duct after laparoscopic cholecystectomy operation,allows the patient to avoid the traditional operation led to the incision pain,multiple drainage resulted in activity limitations,postoperative fasting time is long,with a T tube long,easy occurrence of biliary infection of the disadvantages,and reduced hospital stay,patient comfort is increased,less pain,rapid recovery has become the preferred method of treatment of biliary tract stones.

  4. The Summarization of the Treatment of Cholelithiasis of Traditinal Chinses Medcine%胆石症中医药治疗研究概述

    Institute of Scientific and Technical Information of China (English)

    刘红旭; 佘靖

    2001-01-01

    @@ 胆石症是临床常见病、多发病,其发生率存在地区差异.在中国,大陆地区的发生率在2.4%-16.8%之间,香港地区约为26%,台湾地区高达53.5%(1,2).由于相当多数的患者不愿或不能接受手术治疗,手术后残余结石发生率很高,内科治疗仍占有重要的地位.以熊去氧胆酸为代表的溶石疗法因疗程长、副作用大、疗效有限而受到限制,且主要针对胆固醇结石,而我国胆石症则以混合结石和胆色素结石为主.因此,中医药治疗胆石症在我国占有重要的地位.胆石症属中医胁痛、痞满、胆胀等范畴.本文就国内胆石症中医治疗研究作简要概述.

  5. Disease: H01213 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H01213 Gallbladder disease; Cholecystitis; Cholelithiasis Gallbladder disease is on...e of the most common digestive disorders. Cholecystitis is an inflammation of the gallbladder wall, that is ...almost always associated with cholelithiasis, or gallstones. Cholecystitis and cholelithiasis appear to be c

  6. 升清胶囊对豚鼠胆石病相关基因的影响%Effects of Shengqing Capsules on cholelithiasis-related genes in guinea pigs

    Institute of Scientific and Technical Information of China (English)

    朱培庭; 张静喆; 章学林; 袁作彪; 张红英; 高炬

    2005-01-01

    目的:探讨中药升清胶囊在分子层面防治胆石病的机制.方法:雌性豚鼠60只,随机分成正常组(喂正常饮食作为对照)、模型组(喂低蛋白饮食致石)和中药组(喂低蛋白饮食致石加中药升清胶囊治疗).6周后处死并取材,观察动物成石情况,检测肝组织胆红素尿苷二磷酸葡萄糖醛酸基转移酶(bilirubin UDP-glucuronosyltransferase, B-UGT)mRNA及胆固醇7α羟化酶(cholesterol 7α-hydroxylase, CYP7A1)mRNA表达.结果:各组豚鼠成石比例分别为正常组2/14、模型组为9/11、中药组为4/14,组间有显著差异(P<0.05),正常组和中药组豚鼠的肝组织B-UGT mRNA及CYP7A1 mRNA表达明显高于模型组(P<0.05).结论:中药升清胶囊可能是通过上调肝组织中B-UGT mRNA和CYP7A1 mRNA的表达,干预胆红素和胆固醇代谢,抑制致石性胆汁形成,起到预防胆结石的作用.

  7. 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.

  8. 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.

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

    OpenAIRE

    Jorge Luís Estepa Pérez; Tahiluma Santana Pedraza; Juan Carlos Estepa Torres

    2012-01-01

    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. T...

  10. Telesonography Adaptation and Use to Improve the Standard of Patient Care Within a Dominican Community

    Science.gov (United States)

    2009-05-06

    Ascites; Blunt Abdominal Trauma; Cholelithiasis; Cholecystitis; Cholangitis; Pancreatitis; Hydronephrosis; Abdominal Aortic Aneurysm; Hepatitis; Portal Hypertension; Urolithiasis; Abnormal Uterine Bleeding; Ovarian Mass; Ovarian Torsion

  11. 胆汁酸代谢经典途径酶基因表达与豚鼠胆石病关系的研究%Study on the Association of Gene Expression of Cholesterol 7α- and Sterol 12α-Hydroxylase with Cholelithiasis in Gui-nea PiRs.

    Institute of Scientific and Technical Information of China (English)

    邓漾; 韩天权; 商俊; 姜志宏; 张圣道

    2001-01-01

    目的:研究豚鼠肝脏胆汁酸代谢经典途径关键酶--胆固醇7α-羟化酶(CYP7a1)和甾醇12αt-羟化酶(CYP8b1)的基因表达与胆汁脂质含量及胆固醇结石形成的关系.方法:采用点杂交技术检测对照组(n=8)(普通豚鼠饲料喂养)、未成石组(,n:13)和成石组豚鼠(n=9)(致石饲料喂养)肝脏CYP7a1和CYP8b1 mRNA的相对含量,并对三组豚鼠胆汁脂质成份进行检测和分析.结果:1、与对照组豚鼠(n=8)相比,成石组豚鼠(n=8)肝脏CYP7a1 mRNA的相对含量显著减少(0.39±0.19比0.73±0.36,P=0.03),CYP7a1的mRNA相对量与胆汁胆固醇摩尔浓度、胆固醇在胆汁胆固醇、胆汁酸和磷脂三者中的摩尔百分数、胆汁中胆汁酸摩尔浓度皆无明显相关.2、对照组(n=8)、未成石组(,n=8)和成石组豚鼠(n=8)肝脏CYP8b1 mRNA的相对含量无显著差异.3、未成石组(n=13)和成石组豚鼠(n=9)胆汁胆固醇浓度明显高于对照组(,n=8),分别为:0.50mmol/L±0.09mmol/L比0.39mmol/L±0.11mmtol/L,P=0.03;0.50mmol/L±0.10mmol/L比0.39mmo1/L±0.11 mmol/L;P=0.04).未成石组和成石组豚鼠胆汁磷脂浓度明显低于对照组(n:8),分别为:0.30mmol/L+±0.09m3mmol/L比0.48mmtol/L±0.14mmol/L,P=0.002:0.27mmol/L+±0.11mmol/L比0.48mmol/L±0.14mmol/L,P=0.003).结论:CYP7al基因表达下降可能是致石饲料引起豚鼠胆石形成的原因.胆汁中胆固醇浓度的增加是豚鼠胆石形成的一个先决条件,而胆汁磷脂浓度的降低是胆石形成的另一个危险因索.CYP8b1基因表达在豚鼠胆石形成过程中似乎不起重要作用.

  12. 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.

  13. 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.

  14. Bacillus cereus bacteremia and hemolytic anemia in a patient with hemoglobin SC disease.

    Science.gov (United States)

    Rodgers, G M; Barrera, E; Martin, R R

    1980-08-01

    A patient with hemoglobin SC disease and cholelithiasis was found to have Bacillus cereus bacteremia. Hemolytic anemia developed, for which common causes of hemolysis were excluded, suggesting a relationship with the bacteremia. Following in vitro incubation, type O erythrocytes were hemolyzed by the culture, but not by a bacteria-free filtrate. This case confirms the association between sickle cell disorders and cholelithiasis with B cereus infections. In addition, it provides evidence for in vivo hemolysis with B cereus bacteremia, an organism not previously associated with hemolytic anemia.

  15. Three-Port Laparoscopic Cholecystectomy in a Brazilian Amazon Woman with Situs Inversus Totalis: Surgical Approach

    Directory of Open Access Journals (Sweden)

    Mauro Neiva Fernandes

    2008-05-01

    Full Text Available Situs inversus totalis (SIT is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT.

  16. Three-port laparoscopic cholecystectomy in a brazilian Amazon woman with situs inversus totalis: surgical approach.

    Science.gov (United States)

    Fernandes, Mauro Neiva; Neiva, Ivan Nazareno Campos; de Assis Camacho, Francisco; Meguins, Lucas Crociati; Fernandes, Marcelo Neiva; Meguins, Emília Maíra Crociati

    2008-05-24

    Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT.

  17. [Development of vibration-induced intrahepatic cholestasis in pilots and new ways of correcting these disorders].

    Science.gov (United States)

    Preobrazhenskiĭ, V N; Vasilenko, V V; Taianovskiĭ, V Iu

    1999-01-01

    Data of analysis of the role of vibration in the development of hepatobiliary pathology in helicopter pilots are reported. Vibration was found to drastically deteriorate colloid-osmotic qualities of the bile and increase the lithogenesis risk. Exposure to vibration over 10 and more years of the flying career may instigate cholelithiasis. Dynamic USI with functional testing for early diagnostics and correction with ursodeoxycholic acid (ursosan) of disorders in the colloid-osmotic properties of the bile and can be proposed as one of the methods to prevent cholelithiasis.

  18. 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.

  19. Clinical course of 63 children with hereditary spherocytosis: a retrospective study

    Directory of Open Access Journals (Sweden)

    Maria Christina Lopes Araujo Oliveira

    2012-01-01

    Full Text Available BACKGROUND: Hereditary spherocytosis (HS is an inherited hemolytic anemia that is caused by deficiency or dysfunction of erythrocyte cytoskeletal proteins. AIM: The aim of this study was to describe the clinical course of hereditary spherocytosis in patients treated in the Pediatric Hematology Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais. METHODS: Sixty-three under 16-year-old patients with hereditary spherocytosis were retrospectively evaluated between January 1988 and December 2007. Hereditary spherocytosis was diagnosed based on clinical history, physical examination and on a positive osmotic fragility curve. Patients underwent screening for cholelithiasis by ultrasonography. They were classified into three groups: mild, moderate and severe. The events of interest were need for blood transfusion, cholelithiasis, splenic sequestration, aplastic crisis, and splenectomy. Differences between subgroups were evaluated by the two-sided log-rank test. RESULTS: The mean age at diagnosis was 5.2 years and most patients were classified as moderate (54%. Patients with the severe form of the disease were younger (p-value = 0.001 and needed more blood transfusions (p-value = 0.004. Seventeen patients (27% developed cholelithiasis, 14 (22.2% splenic sequestration and three (4.8% aplastic crises. Twenty-two patients (34.9% were splenectomized with the main indication being splenic sequestration in nine patients (41%. CONCLUSIONS: The clinical course of patients with hereditary spherocytosis in this study was relatively benign however cholelithiasis was a common complication.

  20. 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

  1. Computed tomography demonstration of cholecystogastric fistula

    Directory of Open Access Journals (Sweden)

    Chung Kuao Chou, MD, MPH

    2016-06-01

    Full Text Available Cholecystogastric fistula is a rare complication of chronic cholecystitis or long-standing cholelithiasis. It results from the gradual erosion of the approximated, chronically inflamed wall of the gall bladder and stomach with fistulous tract formation. The present case describes the direct visualization of a cholecystogastric fistula by computed tomography in a patient without prior biliary system complaints.

  2. 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.

  3. Imaging findings of intragastric gallstone and bouveret's syndrome : case report

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seong Youb; Seong, Hun; Park, Jong Yeon; Seo, Chang Hye; Jang, Kyung Jae; Cho, Seong Rak [Department of Radiology, Dae Dong Hospital, Pusan (Korea, Republic of)

    2000-01-01

    Gallstone ileus is a well-known complication of cholelithiasis, but is relatively rare. Most ectopic gallstones are located in the small bowel; they are rarely found in the stomach and duodenum. We describe the imaging findings of a case of intragastric gallstone, as well as a case in which duodenal obstruction was caused by a large gallstone (Bouveret's syndrome). (author)

  4. Multi-Locus Variable-Number Tandem Repeat Profiling of Salmonella enterica Serovar Typhi Isolates from Blood Cultures and Gallbladder Specimens from Makassar, South-Sulawesi, Indonesia

    NARCIS (Netherlands)

    Hatta, M.; Pastoor, R.; Scheelbeek, P.F.D.; Sultan, A.R.; Dwiyanti, R.; Labeda, I.; Smits, H.L.

    2011-01-01

    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

  5. Drug: D07004 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available 78], Scutellaria root [DR:D06688], Peony root [DR:D06739], Jujube [DR:D06758], Immature orange [DR:D06706], Rhubarb [DR:D06756], Ging...er [DR:D06744] Cholelithiasis; Cholecystitis; Icterus; Disorder of hepatic function

  6. Colelitiasis y coledocolitiasis obstructiva en un gato doméstico: Informe de un caso

    OpenAIRE

    J. Jesús Racanco Delgado; Rosa Elena Méndez Aguilar; Joaquín Aguilar Bobadilla; Gerardo Salas Garrido

    2009-01-01

    The clinical characteristics and complementary methods that led to the cholelithiasis and obstructive choledocholithiasis diagnosis in a domestic cat, as well as the clinical-pathological changes are described. This condition is one of the causes of the extrahepatic bile duct obstruction syndrome (EBDO) with low incidence in dogs and cats.

  7. Bouveret syndrome: Primary demonstration of cholecystoduodenal fistula on MR and MRCP study

    Directory of Open Access Journals (Sweden)

    Rajkumar Singh Negi

    2015-01-01

    Full Text Available Bouveret syndrome is an unusual complication of cholelithiasis which results in upper gastrointestinal obstruction due to a gallstone impacted in the duodenum through a bilio-enteric fistula. We present this rare entity which was primarily diagnosed on magnetic resonance (MR and MR cholangiopancreaticography (MRCP study.

  8. Changes in appetite hormone (ghrelin) levels of saliva and serum in acute appendicitis cases before and after operation.

    Science.gov (United States)

    Cetinkaya, Ziya; Aydin, Suleyman; Cerrahoglu, Yusuf Z; Ayten, Refik; Erman, Fazilet; Aygen, Erhan

    2009-02-01

    This study was designed to measure the levels of serum and saliva ghrelin concentrations before and after surgery in an attempt to clarify whether this hormone plays any significant roles in acute appendicitis and cholelithiasis patients when compared with healthy controls. Samples were obtained from 20 patients with appendicitis, 10 patients with cholelithiasis before and after operation, and 16 healthy controls. The levels of ghrelin (acylated) were measured by means of a RIA assay. The results revealed that preoperative levels of ghrelin in saliva and serum were significantly decreased with respect to post-op in patients undergoing appendectomy, and control levels. This was also the case when the preoperative ghrelin concentrations in patients with appendicitis were compared with those having choelithiasis. Taken together, decreased ghrelin concentration in preoperative appendicitis might be a causative factor for the "loss of appetite" observed in an acute inflammatory condition such as acute appendicitis. However, further studies are necessary to reveal the exact mechanisms behind this observation.

  9. [Hereditary spherocytosis. Review. Part II. Symptomatology, outcome, complications, and treatment].

    Science.gov (United States)

    Donato, Hugo; Crisp, Renée Leonor; Rapetti, María Cristina; García, Eliana; Attie, Myriam

    2015-04-01

    Hereditary spherocytosis must always be suspected in children with anemia, hyperbilirubinemia, splenomegaly or cholelithiasis, in the asymptomatic individual with an affected relative, and in the neonate with hyperbilirubinemia with no blood group incompatibility; its early detection is key to avoid kernicterus. Follow-up of these patients is based on periodical control and supply of information on the adequate management of hemolytic or aplastic crisis, and early detection of cholelithiasis. The decision to perform splenectomy is usually associated with quality of life rather than life-threatening risk, and it should result from a consensus between patient, parents and physicians. The postsplenectomy follow-up is based on control of compliance with the prophylactic antibiotic therapy and the early diagnosis of infectious disorders.

  10. Computed tomography of the gallbladder.

    Science.gov (United States)

    Havrilla, T R; Reich, N E; Haaga, J R; Seidelmann, F E; Cooperman, A M; Alfidi, R J

    1978-06-01

    Computed tomography (CT) was used to study 79 patients with suspected gallbladder disease. First and second generation scanners were used to determine the efficacy of CT in detecting cholecystitis or cholelithiasis. Manifestations of gallbladder disease such as hydrops, opaque and nonopaque gallstones, chronic cholecystitis with thickened inflammatory walls, and secondary liver abscesses can be easily detected. It is a useful technique for individuals in whom the gallbladder has failed to opacity on oral cholecystography. The scanning method is described, and estimates of reliability are given including its accuracy, limitations, and place in the management of gallbladder disease, especially cholelithiasis. When conventional radiographic examinations or ultrasound fail to give definitive diagnostic information, CT can be a useful alternative with an overall diagnostic accuracy greater than 80%.

  11. Clostridium perfringens Bacteremia in an 85-Year-Old Diabetic Man

    OpenAIRE

    Mirrakhimov, Aibek E.; Gopika Chandra; Prakruthi Voore; Maliha Khan; Oleksandr Halytskyy; Ahmed Elhassan; Ali, Alaa M.

    2014-01-01

    Emphysematous cholecystitis is an uncommon and dangerous complication of acute cholecystitis. Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis. The disease is best treated with emergent surgery and parenteral antibiotics. We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

  12. Clostridium perfringens Bacteremia in an 85-Year-Old Diabetic Man.

    Science.gov (United States)

    Mirrakhimov, Aibek E; Chandra, Gopika; Voore, Prakruthi; Khan, Maliha; Halytskyy, Oleksandr; Elhassan, Ahmed; Ali, Alaa M

    2014-01-01

    Emphysematous cholecystitis is an uncommon and dangerous complication of acute cholecystitis. Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis. The disease is best treated with emergent surgery and parenteral antibiotics. We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

  13. Clostridium perfringens Bacteremia in an 85-Year-Old Diabetic Man

    Directory of Open Access Journals (Sweden)

    Aibek E. Mirrakhimov

    2014-12-01

    Full Text Available Emphysematous cholecystitis is an uncommon and dangerous complication of acute cholecystitis. Common risk factors for this disease include male gender, old age, presence of diabetes mellitus and cholelithiasis. The disease is best treated with emergent surgery and parenteral antibiotics. We present the case of an 85-year-old nursing home resident who presented to our institution with a 3-day history of gradually worsening abdominal discomfort.

  14. Anesthetic management of a case with hereditary spherocytosis for splenectomy and open cholecystectomy

    Directory of Open Access Journals (Sweden)

    Sonal S Khatavkar

    2016-01-01

    Full Text Available Hereditary spherocytosis (HS is a familial hemolytic disorder with marked heterogeneity of clinical features ranging from asymptomatic condition to a fulminant hemolytic anemia. HS is characterized by the strong family history of anemia, jaundice, splenomegaly and cholelithiasis. Anesthetic Management of HS with liver dysfunction is very challenging since most of the anesthetic drugs are metabolized by the liver. Hereby, we report anesthetic management in a case of HS with splenomegaly and gall stones for elective splenectomy and cholecystectomy.

  15. 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...

  16. A CALCULUS CHOLECYSTITIS PERFORATING AT THE NECK

    Directory of Open Access Journals (Sweden)

    Jayashri

    2014-08-01

    Full Text Available Gallbladder perforation is a rare complication of cholecystitis and cholelithiasis. The high morbidity and mortality rates associated with this condition are due to delays in diagnosis and treatment since signs and symptoms of perforation do not differ significantly from those of uncomplicated cholecystitis. We report a case of 17 year old boy who presented with perforation at the neck of gall bladder with extrusion of a stone. It was associated with bile infected with S. typhi.

  17. An incidental case of triple gallbladder

    Institute of Scientific and Technical Information of China (English)

    Banu Alicioglu

    2007-01-01

    Triplication of the gallbladder is a very rare congenital anomaly of the biliary tract; there are only elevenreported cases to date. Gallbladder multiplications are not likely to be discovered unless associated with cholelithiasis, sludge, cholecystitis and carcinoma. Here we report an incidentally diagnosed triplicate gallbladder in a patient with sigmoid diverticulitis; two of the triplicate gallbladder were demonstrated with ultrasound and computed tomography, and an additional galballder was found at surgery.

  18. On the optimization of clinicosonographic and biochemical diagnostics of gall-bladder disease

    Directory of Open Access Journals (Sweden)

    N.V. Yekimova

    2010-09-01

    Full Text Available Determination of serum lipidic spectrum (increase of total cholesterol, atherogenic rate for dynamic control of possible transformation in cholelithiasis is necessary to be included in examination of patients with cholecystitis. Changes in serum lipidic level (increase of total cholesterol, rate of total cholesterol to cholesterol of lipoproteins of high density and decrease of lipoproteins of high density in healthy people promote forming risk group of gall-bladder cholestherosis

  19. 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.

  20. Spontaneous resolution of a gallstone ileus.

    Science.gov (United States)

    Roberts, Ja; Lambrianides, Al

    2012-03-01

    Gallstone ileus is an uncommon complication of cholelithiasis, usually associated with an internal biliary fistula. Management of gallstone ileus is surgical with enterolithotomy the procedure of choice, followed by fistula closure either as a one or two stage procedure. In this case a 66 year old female presented with colicky abdominal pain, computed tomography (CT) clearly showing a gallstone ileus and cholecystoduodenal fistula. Despite this the patient refused surgery and went on to have spontaneous resolution of the obstruction and passage of gallstones.

  1. Laparoscopic-Assisted Enterolithotomy for Gallstone Ileus

    OpenAIRE

    Gupta, Rahul A.; Shah, Chetan R.; Balsara, K P

    2013-01-01

    Gallstone ileus is a rare complication of cholelithiasis seen usually in elderly population with comorbidities. Most of the cases present as acute intestinal obstruction with the diagnosis being made intraoperatively. There exists controversy regarding appropriate emergency surgical treatment of gallstone ileus as to whether biliary tract surgery should be done during the first operation. Laparoscopy in recent years is also being used for management of such cases. We report a case of gallston...

  2. Laparoscopic Treatment of Gallstone Ileus

    OpenAIRE

    Huseyin Y. Bircan; Bora Koc; Umit Ozcelik; Ozgur Kemik; Alp Demirag

    2014-01-01

    Gallstone ileus is a rare complication of cholelithiasis that has high morbidity and mortality. An intestinal obstruction can be caused by migration of a large gallstone through a biliary enteric fistula or by impaction within the intestinal tract. In this study, we present the case of an 81-year-old woman with a mechanical bowel obstruction by a gallstone that was treated by laparoscopy.

  3. Laparoscopic treatment of gallstone ileus.

    Science.gov (United States)

    Bircan, Huseyin Y; Koc, Bora; Ozcelik, Umit; Kemik, Ozgur; Demirag, Alp

    2014-01-01

    Gallstone ileus is a rare complication of cholelithiasis that has high morbidity and mortality. An intestinal obstruction can be caused by migration of a large gallstone through a biliary enteric fistula or by impaction within the intestinal tract. In this study, we present the case of an 81-year-old woman with a mechanical bowel obstruction by a gallstone that was treated by laparoscopy.

  4. Spontaneous resolution of a gallstone ileus

    OpenAIRE

    Roberts, JA; Lambrianides, AL

    2012-01-01

    Gallstone ileus is an uncommon complication of cholelithiasis, usually associated with an internal biliary fistula. Management of gallstone ileus is surgical with enterolithotomy the procedure of choice, followed by fistula closure either as a one or two stage procedure. In this case a 66 year old female presented with colicky abdominal pain, computed tomography (CT) clearly showing a gallstone ileus and cholecystoduodenal fistula. Despite this the patient refused surgery and went on to have ...

  5. 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.

  6. Salmonella typhi

    OpenAIRE

    Mochammad, Hatta

    2008-01-01

    This manuscript could use as research on infectious diseases 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 complicat...

  7. Computer Assisted Diagnosis of Chest Pain. Preliminary Manual

    Science.gov (United States)

    1984-04-27

    recent change In appetite) "NORMAL (57) DECREASED. BOWELS: [recent change in bowel habits ) NORMAL 159) CONSTIPATED fi60tf cough...irritation from food or drink, by reflux of gastric contents, or by infection (the latter is uncommon in healthy people). There is a good response to...have a physical etiology for chest pain. Disorders that present with epigastric pain such as gastritis , peptic ulcer, pancreatitis, and cholelithiasis

  8. Spontaneous external gallbladder perforation

    Energy Technology Data Exchange (ETDEWEB)

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

    1981-04-01

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

  9. No Stone Left Unturned: Using Choledocholithiasis to Open a Papillary Stenosis via a Choledochodudenal Fistula.

    Science.gov (United States)

    West, Sara; Shellenberger, M Joshua

    2016-01-01

    In a patient found to have cholelithiasis and choledocholithiasis, a choledochoduodenal fistula was used to gain access to the bile duct. Due to severe stenosis and atrophy of the major papilla, cannulation was not possible. Stones were purposely impacted in the native ampulla to cause bulging and stretching of the stenosis. Once the stenosis was stretched, the bile and pancreatic duct were accessed via the native ampulla, allowing for stone removal.

  10. No Stone Left Unturned: Using Choledocholithiasis to Open a Papillary Stenosis via a Choledochodudenal Fistula

    OpenAIRE

    West, Sara; Shellenberger, M. Joshua

    2016-01-01

    In a patient found to have cholelithiasis and choledocholithiasis, a choledochoduodenal fistula was used to gain access to the bile duct. Due to severe stenosis and atrophy of the major papilla, cannulation was not possible. Stones were purposely impacted in the native ampulla to cause bulging and stretching of the stenosis. Once the stenosis was stretched, the bile and pancreatic duct were accessed via the native ampulla, allowing for stone removal.

  11. 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...

  12. 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...

  13. Relationship between parameters of lipid peroxidation during obstructive jaundice and after bile flow restoration.

    Science.gov (United States)

    Dudnik, L B; Tsupko, A N; Shupik, M A; Akhaladze, G G; Galperin, E I; Latonova, L V; Pantaz, E A; Alessenko, A V

    2008-01-01

    Restoration of bile flow after 9-day cholestasis in rat liver normalized the content of lipid peroxidation products. The removal of the cholestatic factor after 12-day cholestasis was not followed by recovery of these parameters. We showed that measurement of serum concentration of lipid peroxidation products in patients with cholelithiasis during the preoperative period holds promise for selection of the optimum time for surgical treatment and prediction of the risk of postoperative complications.

  14. Cholecystic fistula with atypical symptoms

    DEFF Research Database (Denmark)

    Bang, U.C.; Hasbak, P.; From, G.

    2008-01-01

    We report a patient with spontaneous cholecystocolonis fistula secondary to cholelithiasis. A 93 year-old woman was admitted because of weight loss, diarrhoea and upper abdominal pain. Ultrasound examination revealed air in the biliary tract and cholescientigraphy revealed a fistula between the g...... the gallbladder and right colon. Using endoscopic retrograde cholangiopancreatography a calculus was extracted from the bile duct and the symptoms disappeared Udgivelsesdato: 2008/1/14...

  15. 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.

  16. Anesthetic management of a patient with sickle β+ thalassemia

    Directory of Open Access Journals (Sweden)

    Saswata Bharati

    2011-01-01

    Full Text Available Sickle cell disease is a congenital condition and its most common clinical manifestation is anemia due to chronic hemolysis. Persistent and accelerated hemolysis associated with multiple transfusions is a recognized risk factor for the development of cholelithiasis. The occurrence of gallstones is one of the most important manifestations of sickle cell disease in the digestive tract. Most gallstones are pigmented and characteristically occur at younger ages and the prevalence of cholelithiasis increases progressively with age, affecting 50% of young adults. Cholecystectomy is the most common surgical procedure performed in sickle cell disease patients. Anesthesia in this population of patients for major surgeries deserves special attention due to various complications particularly silent infarctions of end organs are common. We are reporting a 14-year-old girl diagnosed with sickle cell anemia and β+ thalassemia with cholelithiasis went for cholecystectomy under general anesthesia. Although the patient has both β+ thalassemia and sickle cell disease component, the latter is of more concern for anesthesia.

  17. 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.

  18. Evaluation of Risk Factors for Hepatosteatosis in Gall Stone Disease

    Directory of Open Access Journals (Sweden)

    Osman Anıl Savaş

    2015-09-01

    Full Text Available Aim: It has been reported that non-alcoholic fatty liver disease (NAFLD was associated with cholecystectomy and cholecystectomy that may be a risk factor for the development of non-alcoholic fatty liver disease. In this sense, we studied the other risk factors for nonalcoholic fatty liver disease in patients with cholelythiasis. Methods: In this study, we included 204 consecutive patients who underwent elective cholecystectomy between June 2011 and January 2014 due to cholelythiasis. We retrospectively evaluated the files of the patients, including operative findings, history, laboratory and radiological imaging findings obtained from the hospital information system and the archived contents of the files. Results: There was no significant relationship between the number and size of the stones and hepatic steatosis (p=0.83 and p=0.96, respectively. Besides, there was no statistically significant relationship between gender and hepatosteatosis. In multivariate regression, obesity, type 2 diabetes mellitus (DM and cholelithiasis were identified as an independent risk factor for NAFLD. Conclusion: NAFLD and cholelithiasis are common in the general population and have common risk factors. Obesity, female gender, age, type 2 DM, hypertriglyceridemia, insulin resistance, metobolic syndrome, fast weight loss, and bile stasis are risk factors for cholelithiasis. (The Medical Bulletin of Haseki 2015; 53: 237-40

  19. Unusual duodenal perforation following endoscopic retrograde cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Martin Kobborg

    2011-02-01

    Full Text Available Perforation is a known but rare complication to Endoscopic retrograde cholangiopancreatography (ERCP with endoscopic sphincterotomy (ES. Most of the perforations are located in the periampullary area due to ES. This report presents an unusual perforation in the third part of the duodenum following ES. The patient an eigthy-sixt-year-old man underwent ERCP with ES. The patient had Magnetic Resonance Cholangio-pancreatography (MRCP and Computerized Tomography (CT verified cholelithiasis and intra- and extrahepatic cholestasis. The perforation was not found under the ERCP procedure but was clinically revealed when the patient developed pneumoscrotum after the procedure. A CT-scan with oral contrast later confirmed the duodenal perforation.

  20. 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.

  1. Hereditary Spherocytosis in a Middle-aged Man Complicated with Common Bile Duct Stones.

    Science.gov (United States)

    Sawahara, Hiroaki; Iwamuro, Masaya; Harada, Ryo; Yoshioka, Masao; Niguma, Takefumi; Mimura, Tetsushige; Yamamoto, Kazuhide

    2015-01-01

    Hereditary spherocytosis is the most common form of hemolytic anemia and is characterized by spherical, osmotically fragile erythrocytes that are selectively trapped by the spleen. Hereditary spherocytosis is typically diagnosed in childhood. We herein experienced a rare case of hereditary spherocytosis diagnosed in middle age. The patient presented with cholelithiasis and hyperbilirubinemia. He had no anemia and was asymptomatic with mild splenomegaly. In the differential diagnosis of these symptoms, the possibility of hereditary spherocytosis should be considered, even in patients who are middle-aged and lack anemia.

  2. Monoclonal gammopathy in hereditary spherocytosis: Possible pathogenetic relation

    Energy Technology Data Exchange (ETDEWEB)

    Schafer, A.I. (Univ. of Chicago); Miller, J.B.; Lester, E.P.; Bowers, T.K.; Jacob, H.S.

    1978-01-01

    Two cases of monoclonal gammopathy in patients with hereditary spherocytosis led us to consider the possible pathogenetic relation between these two disorders. Twelve adult patients with hereditary spherocytosis had significant hypergammaglobulinemia in comparison to normal subjects. Retrospective analysis of previous illness in 140 patients with multiple myeloma showed a significant association between IgA myeloma and previous gallbladder disease. We propose that the chronic reticuloendothelial stimulation due to extravascular hemolysis, possibly potentiated by the inflammation associated with cholelithiasis and cholecystitis, may foster neoplastic transformation of immunocytes in patients with hereditary spherocytosis, ultimately leading to the development of monoclonal gammopathy.

  3. The use of intraoperative cholangiogram during laparoscopic double cholecystectomy

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    Gustavo E. Guajardo-Salinas

    2010-09-01

    Full Text Available ouble gallbladder is a rare finding in patients with symptomatic cholelithiasis or acute cholecystitis. The incidence has been described as 1 in every 4000-5000 patients during autopsy. To identify the gallbladder (GB duplication prior to surgical removal of the GB is of upmost importance. It is not unusual to identify this diagnosis intraoperatively, but by using US, ERCP or MRCP more than 50% of the cases are diagnosed preoperatively. The use of intraoperative cholangiogram helps to identify the anatomy and confirm the diagnosis during laparoscopic cholecystectomy in patients with gallbladder duplication.

  4. [Gallstone ileus. Abdominal CT usefulness].

    Science.gov (United States)

    Sukkarieh, F; Brasseur, P; Bissen, L

    2004-06-01

    The authors report the case of a 93-year old woman referred to the emergency department and presenting with an intestinal obstruction. Abdominal CT reveals a biliary ileus caused by the migration and the impaction of a 3 cm gallstone in the small bowel. Surgical treatment by enterolithotomy was successful. In over 90% of cases, gallstone ileus is a complication of cholelithiasis and accounts for 25% of intestinal obstruction in patients over 65 years. To reduce morbidity and mortality, early diagnosis and prompt treatment are essential. Abdominal CT-scan is the gold standard technique.

  5. Laparoscopic-assisted enterolithotomy for gallstone ileus.

    Science.gov (United States)

    Gupta, Rahul A; Shah, Chetan R; Balsara, K P

    2013-06-01

    Gallstone ileus is a rare complication of cholelithiasis seen usually in elderly population with comorbidities. Most of the cases present as acute intestinal obstruction with the diagnosis being made intraoperatively. There exists controversy regarding appropriate emergency surgical treatment of gallstone ileus as to whether biliary tract surgery should be done during the first operation. Laparoscopy in recent years is also being used for management of such cases. We report a case of gallstone ileus diagnosed preoperatively and successfully treated by laparoscopic-assisted enterolithotomy.

  6. Gallstone ileus one quarter of a century post cholecystectomy.

    Science.gov (United States)

    Saedon, Mahmud; Gourgiotis, Stavros; Salemis, Nikolaos S; Majeed, Ali W; Zavos, Apostolos

    2008-01-01

    Gallstone ileus is a rare but potentially serious complication of cholelithiasis. It is usually preceded by history of biliary symptoms. It usually occurs as a result of a large gallstone creating and passing through a cholecysto-enteric fistula. Most of the time, the stone will pass the GI tract without any problems, but large enough stones can cause obstruction. The two most common locations of impaction are the terminal ileum and the ileocaecal valve because of the anatomical small diameter and less active peristalsis. We present an unusual case of small bowel obstruction secondary to gallstone ileus 24 years after an open cholecystectomy.

  7. 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.

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

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    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.

  9. 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.

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

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    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.

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

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    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.

  12. LPAC syndrome associated with deletion of the full exon 4 in a ABCB4 genetic mutation in a patient with hepatitis C

    OpenAIRE

    2014-01-01

    Low-phospholipid-associated cholelithiasis syndrome (LPAC) is associated with ABCB4 genetic mutation. ABCB4 encodes MDR3 protein, involved in biliary phosphatidylcholine excretion. Higher prevalence in women, biliary symptoms in young adults and ursodesoxycholic acid (UDCA) response are the main features. We report the case of a 48-year-old man with hepatitis C, genotype 1b, fibrosis F3, null responder to Peg-IFNα2b/ribavirin and nephritic colic. In 2011 he developed jaundice, pruritus and ep...

  13. 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.

  14. Epidemiology of the American Indians' burden and its likely genetic origins.

    Science.gov (United States)

    Carey, Martin C; Paigen, Beverly

    2002-10-01

    It was not known until recently whether the endemic of cholesterol gallstones among certain southwestern American Indian tribes was unique among this ethnic group. With use of ultrasonography of the gallbladder and standard diagnostic criteria, gallstones are now found in epidemic proportions in 13 diverse American Indian tribes and communities living in Arizona, Oklahoma, and the Dakotas. We speculate that this predisposition is polygenic involving "thrifty" genes that conferred survival advantages when Paleo-Indians migrated from present-day Siberia to the Americas during the last Great Ice Age approximately 50,000 to 10,000 years ago. A reasonable hypothesis is that functioning of these genes promoted more efficient calorie utilization and storage in the form of adipose tissue. Beneficial results would have been operative during the isolation of Paleo-Indians in the Bering Strait land bridge (Beringia) when thrifty genes would have ensured sufficient fat reserves for survival of prolonged winters, successful pregnancy outcomes, and extended lactation periods. The authors' conjoint work on genetics of experimental cholesterol cholelithiasis in inbred mice promises help in pinpointing orthologous genetic loci (LITH genes) in the human genome. Moreover, the shared environments and homogeneity of American Indian tribes and communities should facilitate discovery of the ensembles of their common and rarer cholesterol gallstone genes. It is anticipated that knowledge of expression, polymorphisms, and functionality of LITH genes will help resolve the molecular mechanisms of this complex heterogeneous trait and thereby provide targets for novel therapies to prevent cholesterol cholelithiasis worldwide.

  15. 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.

  16. Levels of serum leptin, cholecystokinin, plasma lipid and lipoprotein differ between patients with gallstone or/and those with hepatolithiasis

    Institute of Scientific and Technical Information of China (English)

    Zheng-Ming Lei; Ming-Xin Ye; Wen-Guang Fu; Yue Chen; Cheng Fang; Jing Li

    2008-01-01

    BACKGROUND:A signiifcant relationship exists among food intake and nutritional status and cholelithiasis, including gallstone and hepatolithiasis. Leptin is associated with obesity. This study was to investigate the differences in serum leptin levels in patients with gallstone and hepatolithiasis and to evaluate the relationships among leptin, cholecystokinin (CCK), lipid and lipoprotein concentrations. METHODS:Body mass index (BMI), serum leptin, CCK, insulin, lipid and lipoprotein concentrations, and liver function were measured in 382 patients with gallstone (GS group), 83 patients with hepatolithiasis (HS group) and 30 healthy controls (control group). The values of these indices were compared among the groups. In each group, Pearson's product-moment correlation coefifcient among these indices were evaluated. RESULTS:There were notable differences in serum leptin, CCK, total cholesterol, total triglycerides, apolipoprotein-a (APO-a), globulin, direct reacting bilirubin, and BMI between the GS and HS groups (P CONCLUSIONS:Leptin participates in modulating lipid metabolism. There are notable differences in leptin, serum lipid, and CCK between patients with gallstone and those with hepatolithiasis. The role of leptin in the pathophysiological course of cholelithiasis needs further investigation.

  17. Laparoscopic Cholecystectomy: An Experience of 200 cases

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    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.

  18. Precholecystectomy esophagogastroduodenoscopy: is it of value?

    Science.gov (United States)

    Yavorski, C C; Acosta, J A; Ragland, J J

    1995-12-01

    Patients with cholelithiasis and history of atypical abdominal pain present the surgeon with a challenging clinical problem. We hypothesized that preoperative esophagogastroduodenoscopy before cholecystectomy would identify patients with concomitant upper gastrointestinal pathology. Retrospective review of 143 patients who presented with atypical abdominal pain, gallstones, and underwent EGD before their cholecystectomy between July 1989 and March 1994. A total of 1162 cholecystectomies were performed during the study period; 143 patients (12 per cent) underwent a preoperative EGD because of atypical abdominal pain. One hundred ten patients (77 per cent) had normal endoscopies. Thirty-three patients (23 per cent) had abnormal findings. Gastric polyps were found in three patients and esophageal varices in one patient. There were 36 findings in 29 patients, which included peptic ulcer disease, esophagitis, gastritis, and duodenitis. Seven patients had two abnormal findings. Moderate to severe disease was found in a total of 13 (9 per cent) patients. We recommend that patients who present with cholelithiasis and atypical abdominal pain undergo preoperative esophagogastroduodenoscopy, as we have found that at least 9 per cent of the patient population will have significant findings that may alter their management.

  19. Digestive comorbidity in patients with rheumatic diseases: Not only NSAID-induced gastropathy

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    A. E. Karateev

    2016-01-01

    Full Text Available Digestive comorbidity is a serious problem that significantly aggravates the course of rheumatic diseases. Diseases of the gastrointestinal tract (GIT, liver, and pancreatobiliary system may present a threat to life and substantially worsen its quality. The incidence of many digestive diseases, such as gastric ulcer (including its complicated forms, cholelithiasis, and acute pancreatitis, in patients with rheumatic diseases (at least in those with rheumatoid arthritis is considerably higher than in the population. The presence of this comorbidity poses substantial challenges during active anti-rheumatic therapy. Rheumatologists are very familiar with issues in the prevention of GIT complications due to the use of nonsteroidal anti-inflammatory drugs. However, new time presents new challenges. The widespread use of immunosuppressive agents and biologic agents requires careful monitoring of complications associated with liver and bowel diseases. This review considers a relationship of rheumatic diseases and anti-rheumatic therapy to comorbidities, such as cholelithiasis, acute pancreatitis, viral hepatitis B and C, and intestinal diverticula. 

  20. Seasonal variation in the onset of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Massimo Gallerani; Benedetta Boari; Raffaella Salmi; Roberto Manfredini

    2004-01-01

    AIM: A circannual variation in the onset of several acute diseases,mostly dealing with cardiovascular system, has been reported.The present study was to verify the possible existence of a seasonal variability in the onset of acute pancreatitis.METHODS: All patients consecutively admitted to the Hospital of Ferrara, Italy, between January 1998 to December 2002,whose discharge diagnosis was acute pancreatitis, were considered. According to the time of admission, cases were categorized into twelve 1-mo intervals and in four periods by season. x2 test for goodness of fit and partial Fourier series were used for statistical analysis.RESULTS: During the study period, 549 cases of acute pancreatitis were observed. A significant peak of higher incidence was found in March-May, both for total population,males and subgroups with and without cholelithiasis or alcoholism. Fourier analysis showed the existence of a circannual rhythmic pattern with its main peak in March (95%C.L.: February-April, P = 0.005), and a secondary one in September. Death occurred more frequently in DecemberFebruary, compared to the other periods (P = 0.029), and chronobiologic analysis yielded a seasonal peak in NovemberDecember (P<0.001).CONCLUSION: This study shows the existence of a circannual variation in the onset of acute pancreatitis, with a significanty higher frequency of events in the spring, especially for patients with cholelithiasis or alcoholism. Moreover, events occurring during the colder months seem to be characterized by a higher mortality rate.

  1. Refractory obstructive jaundice in a child affected with thalassodrepanocytosis: a new endoscopic approach

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    Barresi Luca

    2010-10-01

    Full Text Available Abstract Background Liver involvement, including elevated direct-reacting bilirubin levels, is common in patients with sickle cell disease. Fifty to seventy percent of sickle cell patients have pigmented gallstones due to precipitation of unconjugated bilirubin, and cholelithiasis or choledocholithiasis are common complications. The highest prevalence of these complications occurs in patients with Gilbert's syndrome because of the combined effect of increased bilirubin production and reduced bilirubin-diphosphate-glucuronosyltransferase enzyme activity. Cholelithiasis is also a common complication in patients with thalassemia. Endoscopic removal of choledochal stones does not always resolve the clinical picture, as in cases of dysfunction of the Vater's papilla, increased bile density due to persistently impaired bile flow or distortion of the choledocus due to dilatation, or inflammation secondary to gallstone. Case presentation We report here a case of severe and persistent obstructive jaundice in a child affected with thalassodrepanocytosis and Gilbert's syndrome, previously, and unsuccessfully, treated with endoscopic removal of choledochal stones. Deep and thorough biliary washing, and stenting with a new removable polytetrafluoroethylene (PTFE-covered flared-type stent led to complete resolution of the obstructive jaundice. Conclusions This report shows that an aggressive endoscopic approach in this select category of patients can help resolve the severe complication of hemolytic anemia, thus avoiding surgery.

  2. 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

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    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.

  3. Oral lichen planus: A retrospective study of 633 patients from Bucharest, Romania

    Science.gov (United States)

    Parlatescu, Ioanina; Gheorghe, Carmen; Tovaru, Mihaela; Costache, Mariana; Sardella, Andrea

    2013-01-01

    Objective: In this retrospective study, patients’ medical records were reviewed to investigate the profiles of 633 OLP cases in a group of Romania. Material and Methods: In this retrospective study, the following clinical data were obtained from the medical charts of patients: gender, age, clinical presentation of OLP, site affected, presence of symptoms, extraoral manifestations of lichen planus, presence of systemic diseases, and history of medications. Results: Most (78.67%) OLP patients were female and the mean age at presentation was 52 years. The white type of the disease (reticular/papular/plaque lesions) was the main form encountered in this sample (48.97%). Among patients with available hepatitis C virus test results, 9.6% were serum-positive. OLP was associated with gallbladder disease (i.e. cholecystitis, cholelithiasis) in 19% of patients. Six patients (0.95%) developed squamous cell carcinoma at a site with confirmed OLP lesions. Conclusions: To the best of our knowledge, no similar study has been conducted in a Romanian population. The present investigation revealed the predominance of OLP among middle-aged white women and the prevalence of bilateral involvement of the buccal mucosa with reticular white lesions. Anti-HCV circulating antibodies were more common in patients with OLP than in the general population and, notably, OLP was associated with gallbladder disease (cholecystitis, cholelithiasis) in 19% of patients. Key words:Oral lichen planus, oral mucosal diseases, retrospective study. PMID:23229244

  4. 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.

  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. Gallbladder cancer: epidemiology and outcome

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    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

  7. [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

  8. Liver Disorders in Inflammatory Bowel Disease

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    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.

  9. Helical CT cholangiography and MR cholangiography in postoperative patients with congenital choledochal cyst

    Energy Technology Data Exchange (ETDEWEB)

    Koshinaga, Tugumichi; Ikeda, Taro; Hagiwara, Noritsugu; Nonaka, Michiaki; Fukuzawa, Masahiro [Nihon Univ., Tokyo (Japan). School of Medicine

    2000-01-01

    Cholangitis and intrahepatic cholelithiasis have been reported as hepatic complications long after total cyst excision in patients with congenital choledochal cyst. The aim of this study was to identify the hepatic ductal features and compare the findings obtained by Helical CT cholangiography (HCTC) with those by MR-cholangiography (MRC). Hepatic ductal configurations of 12 patients who had undergone total excision of the extrahepatic bile duct were examined by HCTC and MRC. HCTC and MRC are useful for identifying hepatic ductal dilatation, although HCTC is better described for the anastomotic site of hepaticojejunostomy and hepatic ductal stenosis, in the postoperative follow-up of patients. Early detection of hepatic ductal configurations is of great importance in the long-term follow-up. (author)

  10. Medical image of the week: ascending cholangitis from biliary obstruction

    Directory of Open Access Journals (Sweden)

    Wong C

    2013-04-01

    Full Text Available A 79 year old man with a history of quadriplegia presented to an outside hospital in septic shock. He was found to have an elevated total bilirubin of 10 mg/dL, direct bilirubin of 7 mg/dL, alkaline phosphatase of 405 U/L, and lipase of 370 U/L. Imaging showed cholelithiasis with likely intra- and extrahepatic biliary duct dilatation. The patient underwent placement of a biliary drain with clinical improvement. Additional imaging was requested prior to endoscopic retrograde cholangiopancreatography (ERCP, but magnetic resonance cholangiopancreatography (MRCP was unavailable due to metallic implants. Interventional radiology performed a cholangiogram using the biliary drain which confirmed biliary obstruction. ERCP was then performed, with significant biliary sludge found and two stents placed.

  11. Magnetic Resonance Imaging of the Gallbladder: Spectrum of Abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Elsayes, K.M.; Oliveira, E.P.; Narra, V.R.; EL-Merhi, F.M.; Brown, J.J. [Dept. of Radiology, Univ of Michigan Health Center, Ann Arbor, Michigan (United States)

    2007-07-15

    Various pathologies involving the gallbladder can manifest clinically, producing nonspecific clinical symptoms and making diagnosis difficult and challenging. Real-time sonography is the most widely used diagnostic study for the gallbladder and the primary screening examination of choice. With increasing use of magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP), gallbladder pathology is frequently seen. Understanding the basic patterns of various disease manifestations and appearance on MRI is the key to making an accurate diagnosis. Given its inherent tissue contrast and contrast sensitivity, MRI in conjunction with MRCP can be a very valuable test in evaluating gallbladder pathology. Gallbladder pathology can be classified into congenital (such as absence), inflammatory (acute, hemorrhagic, and chronic cholecystitis), traumatic, benign (polyps) and malignant tumors (gallbladder carcinoma and lymphoma), and other disease processes can be seen in cholelithiasis, cholesterosis, thickened gallbladder wall, and Mirrizzi syndrome.

  12. An Unusual Association between Chronic Pancreatitis and Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Surya Prakash Bhatt

    2008-01-01

    Full Text Available Episodes of acute pancreatitis have been described during the course of ulcerative colitis and most of them are due to cholelithiasis or drugs. Idiopathic pancreatitis has rarely been associated with inflammatory bowel disease (IBD. We describe one such case. A 35-year-old male presented in 2001 with a ten year history of recurrent episodes of diarrhea without blood and mucus in the stools. Four years ago, he developed an episode of mild acute pancreatitis. At that time, the serum amylase level was three times the upper normal limit. He was treated conservatively. A month later, he was found to be diabetic and was put on insulin. He was non-alcoholic and there was no history of any chronic drug use. There was no similar family history.

  13. Pyogenic Liver Abscess. A Case Report

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Serra Valdés

    2013-06-01

    Full Text Available Liver abscesses account for 13% of all abdominal abscesses and 48% of those occurring in the viscera. The bacterial or pyogenic liver abscesses are the most frequent. A case of a 34-year-old woman of mixed race with history of gallstones (2011, extrahepatic obstructive jaundice caused by cholelithiasis (May 2012, cholangitis after endoscopic retrograde cholangiopancreatography (ERCP and cholecystectomy (August 2012 due to gallstones is presented. In September 2012, she began suffering from high fever with chills every day, usually in the evenings. In addition, she presented night sweats, loss of appetite, weight loss, nausea and pain in the right upper quadrant of the abdomen which was sharp, permanent and annoying sometimes. The signs and symptoms, history, ultrasound scan and multislice computed tomography confirmed the diagnosis of pyogenic liver abscess. The risk factors leading to the infection were well-identified. The patient progressed satisfactorily with the medical treatment provided.

  14. Angiosarcoma of the Gallbladder: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Alexandre N Odashiro

    2005-01-01

    Full Text Available A 62-year-old white woman with an unremarkable past medical history presented with acute cholecystitis. A cholecystectomy was performed, revealing an acute hemorrhagic and chronic cholecystitis associated with cholelithiasis. Two months after the operation, the patient developed a massive hemoperitoneum and died by hypo-volemic shock. At autopsy, an angiosarcoma measuring 5 cm in diameter was found in the liver, at the site of the gallbladder fossa. There were multiple hepatic, splenic, ovarian and peritoneal metastases and a massive hemoperitoneum consisting of 8 L of blood and blood clots. Review of the tissue sections from the patient's gallbladder confirmed the presence of an acute hemorrhagic and chronic cholecystitis and also revealed residual foci of an angiosarcoma. A review of eight previously reported cases of gallbladder angiosarcoma is also presented.

  15. System of polarization correlometry of polycrystalline layers of urine in the differentiation stage of diabetes

    Science.gov (United States)

    Ushenko, Yu. O.; Pashkovskaya, N. V.; Marchuk, Y. F.; Dubolazov, O. V.; Savich, V. O.

    2015-08-01

    The work consists of investigation results of diagnostic efficiency of a new azimuthally stable Muellermatrix method of analysis of laser autofluorescence coordinate distributions of biological liquid layers. A new model of generalized optical anisotropy of biological tissues protein networks is proposed in order to define the processes of laser autofluorescence. The influence of complex mechanisms of both phase anisotropy (linear birefringence and optical activity) and linear (circular) dichroism is taken into account. The interconnections between the azimuthally stable Mueller-matrix elements characterizing laser autofluorescence and different mechanisms of optical anisotropy are determined. The statistic analysis of coordinate distributions of such Mueller-matrix rotation invariants is proposed. Thereupon the quantitative criteria (statistic moments of the 1st to the 4th order) of differentiation of human urine polycrystalline layers for the sake of diagnosing and differentiating cholelithiasis with underlying chronic cholecystitis (group 1) and diabetes mellitus of degree II (group 2) are estimated.

  16. A COMPARATIVE STUDY BETWEEN OPEN CHOLECYSTECTOMY AND LAPAROSCOPIC CHOLECYSTECTOMY IN RURAL MEDICAL COLLEGE SET UP

    Directory of Open Access Journals (Sweden)

    Sinha

    2014-12-01

    Full Text Available laparoscopic cholecystectomy has established itself as the gold standard for cholecystectomy replacing decades old open cholecystectomy. This study compared open cholecystectomy and lap chole in a medical college in rural setup and consisted of 40 patients with a diagnosis of gall stone disease, that underwent Cholecystectomy at M V J Medical College and Research Hospital from Nov 2011 T0 Oct 2013 to compare the advantages and disadvantages of both the methods. Patients with cholelithiasis proven by USG with at least one attack of upper abdominal pain were included in the study. Patients with CBD stones and aged above 70 yrs were excluded from the study. The main advantages of LC were the reduced post-operative pain with less duration of analgesic intake, more rapid recovery and reduced hospital stay

  17. Unusual presentation and treatment of biliary ileus with long term follow up: case report and review of the literature.

    Science.gov (United States)

    Zulian, Viola; Vasquez, Giorgio; Feo, Carlo V

    2013-01-01

    Gallstone ileus is a rare complication of cholelithiasis. It accounts for 25% of nonstrangulated small bowel obstructions in patients over the age of 65 years. The morbidity and mortality rate of gallstone ileus remains very high, partly because of misdiagnosis or delayed diagnosis. The two surgical options are: a) enterolithotomy with removal of impacted stone, cholecystectomy, and fistula repair at the same surgical operation (i.e., "one-stage" procedure) and b) enterolithotomy with stone extraction followed or not by elective biliary surgery. The latter is the most popular surgical approach, whereas enterolithotomy combined with cholecistectomy and fistulectomy is indicated only in selected cases. In this article, a case of biliary ileus with unusual presentation treated by entherolithotomy alone with long term follow up is described, and the literature on this subject is reviewed and discussed.

  18. [Biliary ileus--potential complication of cholecystolithiasis].

    Science.gov (United States)

    Okolicány, R; Prochotský, A; Skultéty, J; Sekác, J; Mifkovic, A

    2008-11-01

    Biliary ileus is a rare complication of cholecystolithiasis. The condition occurs predominantly in the elderly with incidence rates of 1-4%, according to the literature data. Most commonly, it develops as a complication of cholelithiasis which remained untreated or was managed conservatively, or as a complication of a gallbladder decubitus necrosis. The condition results in a cholecysto-duodenal fistula. In this case, the cholecystolithiasis is latent or is clinically manifested in a third of the patients. A total of 1560 cholecystectomies (1345 L-CHE and 215 conventional CHE) were performed in our clinic during a five-year period. Biliary ileus was an indication for operation only in two subjects, during the studied period. In the both cases, the diagnosis was established intraoperatively, although upon re-examination of the visualization modalities views (upright native abdominal views, CT scans) the authors concluded that the primary cause of the ileus could have already been identified, based on the above views.

  19. 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.

  20. 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.

  1. Imaging features of thalassemia

    Energy Technology Data Exchange (ETDEWEB)

    Tunaci, M.; Tunaci, A.; Engin, G.; Oezkorkmaz, B.; Acunas, G.; Acunas, B. [Dept. of Radiology, Istanbul Univ. (Turkey); Dincol, G. [Dept. of Internal Medicine, Istanbul Univ. (Turkey)

    1999-07-01

    Thalassemia is a kind of chronic, inherited, microcytic anemia characterized by defective hemoglobin synthesis and ineffective erythropoiesis. In all thalassemias clinical features that result from anemia, transfusional, and absorptive iron overload are similar but vary in severity. The radiographic features of {beta}-thalassemia are due in large part to marrow hyperplasia. Markedly expanded marrow space lead to various skeletal manifestations including spine, skull, facial bones, and ribs. Extramedullary hematopoiesis (ExmH), hemosiderosis, and cholelithiasis are among the non-skeletal manifestations of thalassemia. The skeletal X-ray findings show characteristics of chronic overactivity of the marrow. In this article both skeletal and non-skeletal manifestations of thalassemia are discussed with an overview of X-ray findings, including MRI and CT findings. (orig.)

  2. Portal cavernoma cholangiopathy: diagnosis, imaging, and intervention.

    Science.gov (United States)

    Moomjian, Lauren N; Winks, Sarah G

    2017-01-01

    The term portal cavernoma cholangiopathy refers to the biliary tract abnormalities that accompany extrahepatic portal vein obstruction (EHPVO) and subsequent cavernous transformation of the portal vein. EHPVO is a primary vascular disorder of the portal vein in children and adults manifested by longstanding thrombosis of the main portal vein. Nearly all patients with EHPVO have manifestations of portal cavernoma cholangiopathy, such as extrinsic indentation on the bile duct and mild bile duct narrowing, but the majority are asymptomatic. However, progressive portal cavernoma cholangiopathy may lead to severe complications, including secondary biliary cirrhosis. A spectrum of changes is seen radiologically in the setting of portal cavernoma cholangiopathy, including extrinsic indentation of the bile ducts, bile duct stricturing, bile duct wall thickening, angulation and displacement of the extrahepatic bile duct, cholelithiasis, choledocholithiasis, and hepatolithiasis. Radiologists must be aware of this disorder in order to provide appropriate imaging evaluation and interpretation, to facilitate appropriate treatment and to distinguish this entity from its potential radiologic mimics.

  3. Extrahepatic right hepatic duct diverticulum:a rare entity

    Institute of Scientific and Technical Information of China (English)

    Eduardo SM Fernandes; Raquel L Bernardo; Moacir M Fernandes; Rogério MC Araújo; Renato Sebbe; Asterio Monte; José F Coelho; Antonio AP Souza; Joaquim Ribeiro Filho

    2010-01-01

    BACKGROUND: Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classiifcation in 1977. The classiifcation is the most extensively used, but does not include some rare variations. We present a case of hepatic duct diverticulum, one of the variations, and discuss its diagnosis and treatment. METHODS: A 57-year-old woman presented with upper abdominal pain and discomfort associated with nausea and vomiting. She was ifnally diagnosed with cholelithiasis and right hepatic duct diverticulum. RESULT: The patient underwent resection of the hepatic duct diverticulum and cholecystectomy, and was asymptomatic 26 months after surgery. CONCLUSIONS: Hepatic duct diverticulum is a rare form of choledochal cyst, not included in Todani's classiifcation. Todani's classiifcation including this and other uncommon variations of choledochal cysts must be reviewed. The best diagnostic imaging methods and treatment for choledochal cysts must be deifned.

  4. Imaging in laparoscopic cholecystectomy—What a radiologist needs to know

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Naman S., E-mail: nsdesai@partners.org [Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis street, Boston, MA, 02115 (United States); Khandelwal, Ashish, E-mail: drashish83@gmail.com [Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis street, Boston, MA, 02115 (United States); Virmani, Vivek, E-mail: drvivek.virmani@horizonnb.ca [Department of Radiology, Dr. Everett Chalmers Hospital, Priestman St, Fredericton, 700, NB E3B 5N5 (Canada); Kwatra, Neha S., E-mail: nkwatra@partners.org [Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis street, Boston, MA, 02115 (United States); Ricci, Joseph A., E-mail: jaricci@partners.org [Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114 (United States); Saboo, Sachin S., E-mail: ssaboo@partners.org [Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis street, Boston, MA, 02115 (United States)

    2014-06-15

    Laparoscopic cholecystectomy is the gold standard treatment option for cholelithiasis. In order to properly assess for the complications related to the procedure, an understanding of the normal biliary anatomy, its variants and the normal postoperative imaging is essential. Radiologist must be aware of benefits and limitations of multiple imaging modalities in characterizing the complications of this procedure as each of these modalities have a critical role in evaluating a symptomatic post-cholecystectomy patient. The purpose of this article is describe the multi-modality imaging of normal biliary anatomy and its variants, as well as to illustrate the imaging features of biliary, vascular, cystic duct, infectious as well as miscellaneous complications of laparoscopic cholecystectomy. We focus on the information that the radiologist needs to know about the radiographic manifestations of potential complications of this procedure.

  5. Clips migration to duodenum as a rare complication of laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Muammer Bilici

    2016-03-01

    Full Text Available Endoclip migration into the duodenum is an extremely rare complication of laparoscopic cholecystectomy. The patients usually present with bleeding ulcer. Here we report a 65-year-old female patient with a complaint of abdominal pain and dyspepsia due to clip migration into the duodenum after laparoscopic cholecystectomy secondary to symptomatic cholelithiasis 15 months previously. Ultrasonography and liver function tests were normal. Endoscopy showed metal clips in the second part of duodenum. The clips were removed endoscopically. No active bleeding was noted. In this case report, we present diagnosis and management of clips migration into wall of duodenum as a complication of laparoscopic cholecystectomy. [Cukurova Med J 2016; 41(0.100: 71-74

  6. Nutritive support in short Bowel syndrome (sbs

    Directory of Open Access Journals (Sweden)

    Simić Dušica

    2003-01-01

    Full Text Available Short bowel syndrome most commonly result after bowel resection for necrosis of the bowel. It may be caused by arterial or venous thrombosis, volvolus and in children, necrotizing enterocolitis. The other causes are Crohn,s disease intestinal atresia. The factors influencing the risk on short bowel syndrome are the remaining length of the small bowel, the age of onset, the length of the colon, the presence or absence of the ileo-coecal valve and the time after resection. Besides nutritional deficiencies there some other consequences of extensive resections of the small intestine (gastric acid hypersecretion, d-lactic acidosis, nephrolithiasis, cholelithiasis, which must be diagnosed, treated, and if possible, prevented. With current therapy most patients with short bowel have normal body mass index and good quality of life.

  7. [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).

  8. 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.

  9. 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.

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    REGINALDO CENEVIVA

    2016-04-01

    Full Text Available ABSTRACT 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.

  12. Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

    Institute of Scientific and Technical Information of China (English)

    Masau Sekiguchi; Haruhisa Suzuki; Ichiro Oda; Shigetaka Yoshinaga; Satoru Nonaka; Makoto Saka; Hitoshi Katai

    2012-01-01

    Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection (ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively.We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure.In December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection.Intensive conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.

  13. Laparoscopic cholecystectomy in a patient with situs inversus totalis

    Institute of Scientific and Technical Information of China (English)

    Unal Aydin; Omer Unalp; Pinar Yazici; Baris Gurcu; Murat Sozbilen; Ahmet Coker

    2006-01-01

    Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon? We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone.Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies.Laparoscopic cholecystectomy was safely performed,despite of difficulties of situs inversus. The patient was discharged on postoperative day 1.It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery.

  14. [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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2014-05-01

    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 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.

  17. Anesthesia for a Patient with Myotonic Dystrophy

    Directory of Open Access Journals (Sweden)

    Dilek Kalaycı

    2016-09-01

    Full Text Available Myotonic dystrophy is the most common myotonic syndrome causing abnormalities of the skeletal and smooth muscles as well as problems related to the cardiac, gastrointestinal and endocrine systems. In affected people, reduced functional residual capacity, vital capacity, and peak inspiratory pressure are observed within the respiratory system. As would be expected, anesthetic management of these patients is challenging for anesthesiologists. In addition, delayed recovery from anesthesia and cardiac and pulmonary complications may develop in the intraoperative and early postoperative periods due to sensitivity to sedatives, anesthetic agents, and neuromuscular blocking agents. Myotonic dystrophy can be performed with the use of appropriate anesthesia procedures as well as carefully communication between anesthesiologists and surgeons. In conclusion, myotonic dystrophy has variations, which makes it important to preoperatively determine specific surgical and anesthetic management strategies for each patient. In this article, we present a patient with myotonic dystrophy who underwent laparoscopic cholecystectomy surgery for symptomatic cholelithiasis and to discuss the relevant literature.

  18. A Survey on Prevalence and Pathological Findings of Gallstones in Lori-Bakhtiari Sheep in Iran

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    Afshin Raoofi

    2012-01-01

    Full Text Available In a survey of 430 Lori-Bakhtiari sheep at a slaughterhouse in Iran, gallstones were found in the gallbladder of 7 sheep (1.6%. Biliary calculi were more frequent in adult and female sheep (<0.05. Chemical analysis of the gallstones revealed 6 sheep with pigment (bilirubin stones and 1 sheep with cholesterol stones. Chemical composition of bile in these sheep was evaluated. Bacteriologic analysis of the bile in the affected sheep revealed bacteria (Streptococcus spp., Klebsiella spp., Escherichia coli, and Salmonella spp. in 5 sheep. Microscopic examination of gallbladders revealed focal calcification, cystic glands, necrosis and atrophy of mucosal layer, edema, diffuse and focal infiltration of lymphocytes in submucosal layer, and hypertrophy of smooth muscles in sheep with gallstones. It was concluded that the prevalence of both types of gallstones in Lori-Bakhtiari sheep is low. Cholelithiasis can cause chronic inflammation of the gallbladder, but it is not likely to become clinically significant.

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

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    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.

  20. Senile cardiac amyloidosis: an underappreciated cause of heart failure

    Science.gov (United States)

    Shah, Shreena; Dungu, Jason; Dubrey, Simon William

    2013-01-01

    This case presents a patient with biopsy-proven, wild-type transthyretin (TTR) senile amyloidosis. The case was that of a man in his early 70s who presented with gradually progressive symptoms and signs of heart failure. The recent history included an episode of severe pancreatitis secondary to cholelithiasis and subsequently (and incidentally) noted hepatomegaly and marked ascites. Further evaluation of the aetiology of the heart failure, through echocardiography, coronary angiography and endomyocardial biopsy, led to an exact diagnosis of SSA. The patient is being treated with conventional heart failure medications while consideration is given to the use of diflusinal as an antiamyloidogenic small molecular stabiliser of TTR. Monitoring and further management advice are being coordinated by the National Amyloidosis Centre. PMID:23391947

  1. 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.

  2. 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.

  3. 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。

  4. 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.

  5. Two Anomalies in One: A Rare Case of an Intrahepatic Gallbladder with a Cholecystogastric Fistula

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    Mohammad F. Ali

    2017-03-01

    Full Text Available The gallbladder can be situated in a variety of anomalous positions. An intrahepatic gallbladder – the second most common ectopic location of the gallbladder – is one that is completely embedded within the liver parenchyma. Described in the literature as early as 1935, intrahepatic gallbladders predominantly result from a developmental anomaly but in some instances have been reported to be secondary to chronic inflammation. The significance of an intrahepatic gallbladder lies in the fact that 60% of the cases are associated with gallstones and may present a challenge for the general surgeon during cholecystectomy and other biliary operations in addition to causing misdiagnosis on imaging. Intrahepatic gallbladders are unusual, but the incidence of an intrahepatic gallbladder with a cholecystogastric fistula is rare. Cholecystogastric fistulas commonly are a complication of long-term cholelithiasis or chronic cholecystitis with subsequent gallstone ileus. Herein, we present the case of an 80-year-old man who presented with 2 months of progressive weakness, fatigue, decreased appetite, and intermittent right-sided abdominal pain, and was found to have a markedly distended and irregular intrahepatic gallbladder measuring 12.2 × 11.5 × 13.4 cm on CT, as well as a cholecystogastric fistula on esophagogastroduodenoscopy. During esophagogastroduodenoscopy, the gallbladder was entered directly via the fistulous tract. The patient was on i.v. antibiotics with tube feeds via a nasojejunal tube initially, followed by p.o. which he tolerated. He was eventually discharged with referral for surgical evaluation. Given the potential for cholelithiasis and fistulation, physicians should have a high index of suspicion and recommend timely endoscopic and/or surgical management to avoid future complications.

  6. 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.

  7. 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)

  8. 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

  9. 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

  10. 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

  11. 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.

  12. 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

  13. Diabetes: one of few remarkable differences in clinicopathologic features between cirrhotic and noncirrhotic Swedes with hepatocellular carcinoma.

    Science.gov (United States)

    Kaczynski, Jerzy; Hansson, Göran; Wallerstedt, Sven

    2006-04-01

    The prognosis of hepatocellular carcinoma (HCC) is usually very poor, so increased knowledge of clinicopathologic characteristics and etiologic factors may improve the clinical handling. Because HCC in many patients is unrecognized before death, it is of particular interest to study cases from a period with a high autopsy frequency. The records and liver biopsies from all patients with a diagnosis of primary liver cancer in Göteborg, Sweden, during a 22-year period were scrutinized. Only patients with evaluable non-neoplastic liver tissue were included in the final analysis. The majority (95%) of 478 HCC cases were autopsied and cirrhosis of the liver could be established in 71%. At presentation, general paramalignant symptoms such as malaise, weight loss, anorexia, and hepatomegaly (84%) were common irrespective of cirrhosis. Alcoholism and diabetes mellitus were each significantly more common among cirrhotics (29% and 20%, respectively; P diabetes and cirrhosis was independent of reported alcoholism. In an unselected population in a low HCC incidence area, there are few differences in clinicopathologic features between cirrhotic and noncirrhotic patients. Diabetes mellitus seems to play an etiologic role in HCC in cirrhotics, and cholelithiasis in noncirrhotics.

  14. [Laparoscopic choledochoduodenostomy].

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    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.

  15. 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.

  16. 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.

  17. 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.

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

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    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.

  19. 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.

  20. Hydatid cyst of the gallbaldder: A systematic review of the literature

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    Gómez, Roberto; Allaoua, Yousef; Colmenares, Rafael; Gil, Sergio; Roquero, Pilar; Ramia, José M

    2016-01-01

    AIM To evaluate all the references about primary gallbladder hidatidosis looking for best treatment evidence. METHODS Search: 1966-2015 in MEDLINE, Cochrane Library, SciELO, and Tripdatabase. Key words: “gallabladder hydatid disease” and “gallbladder hydatid cyst”. We found 124 papers in our searches but only 14 papers including 16 cases were about hydatid cyst of the gallbladder (GBHC). RESULTS Eight cases of GBHC were women and seven men. One not mentioned. Median age was 48.3 years. The most frequent clinical symptom was abdominal pain (94%) usually in the right upper quadrant. Ultrasound was performed in ten patients (62.5%) but in most cases a combination of several techniques was performed. The location of the cysts was intravesicular in five patients. Five patients presented GBHC and liver hydatid cysts. Two patients presented cholelithiasis and one choledocholithiasis. The most frequent surgical technique was cholecystectomy by laparotomy (81.25%). Simultaneous surgery of liver cysts was carried out in five cases. Eleven patients did not present postoperative complications, but one died. The mean hospital stay was seven days. No recurrence of GBHC was recorded. CONCLUSION In GBHC, the most frequent symptom is right hypocondrium pain (evidence level V). Best diagnostic methods are ultrasound and computed tomography (level V, grade D). Suggested treatment is open cholecystectomy and postoperative albendazole (level V, grade D) obtaining good clinical results and none relapses. PMID:27660675

  1. 腹腔镜胆囊切除术对胆结石治疗效果分析

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    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.

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

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    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.

  3. Primary Pure Squamous Cell Carcinoma of the Gallbladder Locally Invading the Liver, Duodenum, and Stomach: A Case Report and Literature Review

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    Alpuerto, Aldrin C.; Mora, Maximo E.

    2017-01-01

    Primary pure squamous cell carcinoma (SCC) of the gallbladder is an exceptionally rare type of tumor that comprises only 1% of all gallbladder cancer. SCC of the gallbladder portends a worse prognosis than the more common adenocarcinoma variant because of its aggressive invasion to local structures and because it is often diagnosed at an advanced stage. Owing to its rarity, diagnosis and management can be challenging. Herein, we present the case of a 75-year-old female complaining of abdominal pain, nausea, and vomiting. Computed tomography and ultrasonography results of the abdomen were consistent with acute cholecystitis and cholelithiasis. Histologic evaluation of the resected mass revealed a malignant tumor with prominent keratinization, confirming the diagnosis of an invasive primary pure SCC of the gallbladder. Microscopic examination showed direct infiltration to the liver, duodenum, and stomach. This case report describes the hospital course of a patient with SCC of the gallbladder and suggests that gallbladder cancer should be considered as part of the differential diagnosis in elderly patients presenting with acute cholecystitis. In addition, this article will review existing literature to examine the utility of different diagnostic techniques and treatment modalities available in the management of gallbladder cancer. PMID:28251014

  4. Outcome of laparoscopic cholecystectomy at a secondary level of care in Saudi Arabia

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    Abdulrahman S Al-Mulhim

    2011-01-01

    Full Text Available Background/Aim: The first option for gallbladder surgery is laparoscopic cholecystectomy. The aim of this study is to analyze the outcomes for all patients who underwent laparoscopic cholecystectomy at a secondary level of care. Patients and Methods: Between 2005 and 2008, 968 consecutive laparoscopic cholecystectomies were performed at King Fahad Hospital. We collected and analyzed data including age, gender, body mass index (kg/m 2 , the American Society of Anesthesiologists (ASA class, mode of admission (elective or emergency, indication for LC (chronic or acute cholecystitis [AC], co-morbid disease, previous abdominal surgery, conversion to open cholecystectomy, complications, operation time, and length of postoperative hospital stay. Results : Nine hundred and sixty-eight patients had laparoscopic cholecystectomy at the center. There were 824 females and 144 males; the age range was 15-64 (mean 32.9± 12.7 years. The operating time was 45 to 180 min (median 85 min; the complication rate was 4.03% (39 patients. Conclusion: Laparoscopic cholecystectomy could be performed safely in the majority of patients with cholelithiasis, by an experienced surgical team at a secondary level of care.

  5. Role of Liver Function Enzymes in Diagnosis of Choledocholithiasis in Biliary Colic Patients

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    Mohammad Hussein Mirshamsi

    2011-10-01

    Full Text Available Liver functional tests due to inflammatory process which induced by cholecystitis might changed and some clinicians suggested that these changes might help us to stone prediction in common bile ducts and decrease hazards of performing ERCP and other invasive procedures. Present study was performed for assessment of role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Present prospective study was performed between April 2010 and March 2011 on 350 patients who come to our hospital with cholecystitis or biliary colic diagnosis. Patients with cholesistitis diagnosis were underwent operation for removing gall bladder stone and retrograde cholangiopancreatography (ERCP was performed for patients with suspicious to biliary colic and common bile duct (CBD stones. Ultrasonography, Aspartate Aminotransferases (AST, Alanine Aminotransferases (ALT, Alkaline Phosphatase (ALP and direct and total serum bilirubin were measured for all of participated patients. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter (OR: 20; P=0.00 and elevated serum level of ALT (OR: 2; P=0.04 were remained into the model and were known as independent predictor of cholelithiasis. Elevated level of liver enzymes had not main role in CBD diagnosis and ERCP had no to perform for suspicious CBD stone only with elevated liver enzyme and even with normal ultrasonography findings. Endosonography as non invasive procedure recommend for patients before ERCP.

  6. Gangrenous cholecystitis: mortality and risk factors.

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    Önder, Akın; Kapan, Murat; Ülger, Burak Veli; Oğuz, Abdullah; Türkoğlu, Ahmet; Uslukaya, Ömer

    2015-02-01

    As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 ± 16.4 (21-88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P < 0.001, P = 0.001, P = 0.044, P = 0.005, P = 0.049, P = 0.009, P = 0.022, P = 0.011, and P = 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.

  7. Primary Pure Squamous Cell Carcinoma of the Gallbladder Locally Invading the Liver, Duodenum, and Stomach: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Aldrin C. Alpuerto

    2017-01-01

    Full Text Available Primary pure squamous cell carcinoma (SCC of the gallbladder is an exceptionally rare type of tumor that comprises only 1% of all gallbladder cancer. SCC of the gallbladder portends a worse prognosis than the more common adenocarcinoma variant because of its aggressive invasion to local structures and because it is often diagnosed at an advanced stage. Owing to its rarity, diagnosis and management can be challenging. Herein, we present the case of a 75-year-old female complaining of abdominal pain, nausea, and vomiting. Computed tomography and ultrasonography results of the abdomen were consistent with acute cholecystitis and cholelithiasis. Histologic evaluation of the resected mass revealed a malignant tumor with prominent keratinization, confirming the diagnosis of an invasive primary pure SCC of the gallbladder. Microscopic examination showed direct infiltration to the liver, duodenum, and stomach. This case report describes the hospital course of a patient with SCC of the gallbladder and suggests that gallbladder cancer should be considered as part of the differential diagnosis in elderly patients presenting with acute cholecystitis. In addition, this article will review existing literature to examine the utility of different diagnostic techniques and treatment modalities available in the management of gallbladder cancer.

  8. Application of Ultrasonography in Diagnosis of Acute Abdomen%超声在急腹症诊断中的应用价值

    Institute of Scientific and Technical Information of China (English)

    闫研

    2011-01-01

    目的探讨超声在急腹症诊断中的应用价值.方法回顾性分析285例急腹症的超声表现,并与手术病理及临床随访结果进行对照.结果285例急腹症中以急性胆囊炎、胆石症、胰腺炎、阑尾炎、泌尿系结石、妇科急症常见.其中235例经手术和病理证实,50例经临床随访证实.超声符合率94%,%Objective To analyse the application of ultrasonography in diagnosis of acute abdomen. Methods 285 patients with acute abdomen were diagnosed by ultrasonograph.The ultrasonic diagnosis were compared with surgical pathology or clinical follow-up results.Results The incidence of acute cholecystitis, cholelithiasis, pancreatitis, appendicitis,urinary stones, gynecological emergency are higher than others in the 285 acute abdomen patients, of which 235 cases were confirmed by surgery and pathology, and 50 cases were confirmed by clinical diagnosis.The ultrasonic diagnosis results were consistent with the final clinical results(94%).

  9. 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.

  10. A case of entero-cutaneous and vesico-enteral fistula due to radiation for uterine cervical carcinoma

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    Iwakawa, Kazuhide; Kadota, Takeshi; Kobayashi, Nobuaki [Ehime Univ., Shigenobu (Japan). School of Medicine; Ohnishi, Goro

    1994-11-01

    Late-phase complications of the intestinal and the urinary tracts due to radiation therapy are very difficult to manage, and ensuing fistulation sometimes necessitates surgrey. We report excellent surgical results for a fistula incuded by radiation therapy in a 61-years-old woman. There were previous histories of receiving combined surgical and radiation (up to 10,000 rad) therapy for a uterine cervical carcinoma at another hospital in 1990, and undergoing several surgical treatments for the consequenct vesico-enteral and vesico-colic fistulas. In January, 1993, the patient was admitted to the department of urology of this hospital because of an abdominal pain, and was transferred to the department under a diagnosis of entero-cutaneous and vesico-enteral fistulas. After local sump suction and skin care, resection of the fistula and involved small intestine conserving the urinary tract was performed, and the omentum was transferred to the resected space. Cholecystectomy was carried out for cholelithiasis. Histological studies revealed atrophy in the mucosal layer and edema in the submucosal layer. Her postoperative course has been satisfactory without any signs of fistulation as of one year after the operation. (author).

  11. Gallstone ileus in a patient with Crohn's disease: a case report.

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    Toelen, C; Huyghe, M

    2012-01-01

    Gallstone ileus is a rare complication of cholelithiasis. Only 0,3-0,5% of all patients with gallstones will eventually suffer from this condition. It is well known that there is an increased prevalence of gallstones among patients with Crohn's disease, but gallstone ileus remains even in these patients an unfrequent condition. Because of the rarity of this disease and its presentation as an intestinal (sub)obstruction, mostly without biliary symptoms, diagnosis and surgical treatment are often delayed. We report the case of a 75-year-old woman with a long history of Crohn's disease presenting with intermittent symptoms of intestinal obstruction since several weeks. Symptoms were thought to be due to recurrence of Crohn's disease, but the patient did not respond to steroid therapy. Resection of the diseased ileocolic segment was performed and a large impacted stone was detected proximal of the stenotic segment. With this case report we want to emphasize how easily diagnosis of gallstone ileus can be missed, especially in Crohn's patients and we would like to discuss the different treatment options.

  12. Sarcomatoid Peritoneal Mesothelioma: Clinicopathologic Correlation of 13 Cases.

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    Pavlisko, Elizabeth N; Roggli, Victor L

    2015-11-01

    Peritoneal mesothelioma is rare, and the sarcomatoid variant is more infrequent, with sarcomatoid peritoneal mesothelioma (SPe); however, the clinicopathologic features are not well characterized. To our knowledge, this is the first large series reporting the clinicopathologic features of SPe. We reviewed our database of 3106 malignant mesothelioma cases. Of 248 peritoneal mesotheliomas, 15 (4%) were sarcomatoid variant (0.5% of all mesotheliomas). Only cases with 100% sarcomatoid morphology diagnosed by open surgical biopsy and/or autopsy were included. Thus, 4 cases were excluded leaving 11 cases of SPe. Two additional cases of SPe previously published by 1 of the authors (V.L.R.), not included in the database, are added yielding 13 cases total. The median age at diagnosis was 66 years (range=48 to 85 y), and there was a male predominance (M:F=3.25:1). Survival from date of diagnosis to date of death was 5 months (range=0 to 12 mo). The most common presenting symptom was abdominal pain, and 3 of 4 women were suspected to have cholecystitis/cholelithiasis. All cases stained positive for cytokeratins, and 2 contained heterologous elements. Seven cases had objective markers of asbestos exposure, and 2 additional cases had occupations strongly associated with mesothelioma. Two cases with alleged household contact exposures could not be confirmed to be asbestos related by lung fiber analysis. SPe is a rare variant of mesothelioma attributed to asbestos exposure in 69% of our cases.

  13. 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.

  14. 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.

  15. Results of diagnosis of pancreatic cancer by computed tomography (CT)

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    Kimura, K.; Okuaki, K.; Ito, M.; Katakura, T.; Suzuki, K. (Fukushima Medical Coll. (Japan))

    1981-08-01

    Results of examination of pancreatic diseases, especially pancreatic cancer, conducted by CT during the past 3 years are summarized. The EMI CT Type 5000 or 5005 were used. During the 3 years from September 1976 to August 1979, a total of 1961 patients were examined by CT, and the upper abdomen was examined in 772 of these patients. In 97 patients, positive findings were obtained in the CT image of the pancreas. In 52 of these patients, the findings were confirmed operatively or by autopsy. Though cancer of the pancreas was diagnosed by CT in 30 patients, it was confirmed in 20 by surgical operation and in 1 by autopsy. Of the 9 misdiagnosed cases, 4 were cases of infiltration of the pancreas by carcinoma of the stomach or bile duct, and the other 5 were one case each of lipoma of the abdominal wall, normal pancreas, hyperplasia of Langerhans's islets of the pancreas tail, abscess between the pancreas and the posterior wall of the stomach, and choledocholithiasis. A case diagnosed by CT as cholelithiasis was a carcinoma measuring 5 x 5 x 6 cm located on the head of the pancreas, complicated by choledocholithiasis. The 22 patients with carcinoma of the pancreas were 9 with lesions less than 3.5 x 3.0 x 3.0 cm in size who could be radically operated, 6 who underwent exploratory laparotomy or autopsy, and 7 in whom operation was impossible. False negative and false positive CT results are also discussed.

  16. LPAC syndrome associated with deletion of the full exon 4 in a ABCB4 genetic mutation in a patient with hepatitis C

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    Blanca Fombuena

    2014-12-01

    Full Text Available Low-phospholipid-associated cholelithiasis syndrome (LPAC is associated with ABCB4 genetic mutation. ABCB4 encodes MDR3 protein, involved in biliary phosphatidylcholine excretion. Higher prevalence in women, biliary symptoms in young adults and ursodesoxycholic acid (UDCA response are the main features. We report the case of a 48-year-old man with hepatitis C, genotype 1b, fibrosis F3, null responder to Peg-IFNα2b/ribavirin and nephritic colic. In 2011 he developed jaundice, pruritus and epigastric pain. He showed increased serum levels of AST, ALT, GGT, bilirubin and alpha-fetoprotein, and viral load (14,600,000IU/mL. Pancreatic-CT, endoscopic ultrasonography and echo-Doppler showed non-cirrhotic chronic liver disease. The episode resolved spontaneously and one year later he suffered a similar episode. UDCA was started with excellent response. An immunohistochemistry study and sequencing of ABCB4 did not find alteration. MLPA® technique detected heterozygous deletion of the full exon 4 confirming LPAC syndrome diagnosis.

  17. Diagnosis and management of Crohn's disease.

    Science.gov (United States)

    Wilkins, Thad; Jarvis, Kathryn; Patel, Jigneshkumar

    2011-12-15

    Crohn's disease is a chronic inflammatory condition affecting the gastrointestinal tract at any point from the mouth to the rectum. Patients may experience diarrhea, abdominal pain, fever, weight loss, abdominal masses, and anemia. Extraintestinal manifestations of Crohn's disease include osteoporosis, inflammatory arthropathies, scleritis, nephrolithiasis, cholelithiasis, and erythema nodosum. Acute phase reactants, such as C-reactive protein level and erythrocyte sedimentation rate, are often increased with inflammation and may correlate with disease activity. Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status. Colonoscopy with ileoscopy, capsule endoscopy, computed tomography enterography, and small bowel follow-through are often used to diagnose Crohn's disease. Ultrasonography, computed axial tomography, scintigraphy, and magnetic resonance imaging can assess for extraintestinal manifestations or complications (e.g., abscess, perforation). Mesalamine products are often used for the medical management of mild to moderate colonic Crohn's disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment. Patients with moderate to severe Crohn's disease are treated with corticosteroids, azathioprine, 6-mercaptopurine, or anti-tumor necrosis factor agents (e.g., infliximab, adalimumab). Severe disease may require emergent hospitalization and a multidisciplinary approach with a family physician, gastroenterologist, and surgeon.

  18. Exceptional Mirizzi syndrome in a young child: A laparoscopic approach

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    Marcos Prada-Arias

    2014-10-01

    Full Text Available Mirizzi syndrome is defined as an obstruction of the hepatic duct by an impacted biliary stone in the Hartmann's pouch of the gallbladder or in the cystic duct (Mirizzi type I. The gallstone may erode the bile duct causing a cholecystobiliary fistula (Mirizzi type II. This very rare complication of long standing cholelithiasis is mainly reported in adults. We report an exceptional case of a type I Mirizzi syndrome in a 3-year-old boy, incidentally discovered during a computed tomography study. Ultrasonography and cholangioresonance confirmed the diagnosis. At laparoscopy, partial fusion between the Hartmann's pouch and the hepatic duct was found. Despite difficult dissection, a total laparoscopic cholecystectomy was performed. Preoperative diagnosis of this syndrome is difficult owing to unspecific clinical presentation and low sensitivity of the standard radiological studies. To detect and correctly identify the type of Mirizzi syndrome during surgery is very important in order to avoid serious complications and to perform the most adequate surgical treatment. Open subtotal cholecystectomy is the recommended procedure in Mirizzi type I, laparoscopic total cholecystectomy being possible in some cases. Although this entity is exceptional in children, it must be known and considered by the Pediatric Surgeon because its development is possible.

  19. 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.

  20. 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. 

  1. EFFECT OF ORAL CLONIDINE PREMEDICATION ON HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY - A CLINICAL STUDY

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    Abu Lais Mustaque

    2016-04-01

    Full Text Available BACKGROUND Laparoscopic surgeries are the recent advances in the field of surgery and are the essence of today’s surgical practice. Laparoscopic cholecystectomy has revolutionised gall bladder surgeries and has become the treatment of choice for cholelithiasis. This procedure has minimised the numbers of open cholecystectomy performed these days. AIMS AND OBJECTIVES To study the effect of oral clonidine premedication on haemodynamic changes during laparoscopic cholecystectomy. MATERIALS & METHODS The present study was conducted in the Department of Anaesthesiology of Assam Medical College, Dibrugarh for a period of one year from July 2012 to June 2013 on patients undergoing laparoscopic cholecystectomy at operation theatre of Department of General Surgery of Assam Medical College and Hospital, Dibrugarh. A total of 150 adult patients of either sex between the age group of 18 to 40 years of ASA-1 and ASA-2 undergoing elective laparoscopic cholecystectomy were divided randomly into two groups of 75 patients each. RESULTS With the present study that oral premedication with Tab. Clonidine 150 mcg administered 90 minutes before surgery was able to prevent adverse haemodynamic changes during elective laparoscopic cholecystectomy under general anaesthesia. CONCLUSION Hence, from the findings of this study, we can reasonably recommend oral premedication with Tab. Clonidine 150 mcg in otherwise healthy patients undergoing laparoscopic cholecystectomy

  2. [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.

  3. 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.

  4. Hepatic encephalopathy in a pregnant mare: identification of histopathological changes in the brain of a mare and fetus.

    Science.gov (United States)

    Johns, I C; Del Piero, F; Wilkins, P A

    2007-08-01

    An 11-year-old Thoroughbred broodmare was evaluated for suspected hepatic dysfunction. Clinical signs of hepatic encephalopathy were evident at admission. Hepatic ultrasonographic evaluation revealed an increase in hepatic size, rounded borders and normal echogenicity. There was no evidence of cholelithiasis or bile duct distention. Increased activity of hepatic enzymes, increased bile acid and bilirubin concentration and an increased ammonia concentration were supportive of a diagnosis of hepatic disease and hepatic encephalopathy. Histopathological evaluation of a liver biopsy specimen was consistent with chronic active hepatitis. The mare was treated with intravenous fluids and antimicrobials, pentoxyfilline, branched-chain amino acids and dietary manipulation. Clinical improvement was observed initially; however, 3 weeks later, deterioration in the mare's condition necessitated euthanasia. Pathological lesions at necropsy were restricted to the liver and brain. The liver was diffusely firm with a prominent reticular pattern on the cut surface. A large choledocholith was present in the main bile duct of the left liver lobe. Histopathological examination of the liver revealed severe fibrosis, with hyperplastic bile ducts and mononuclear and neutrophilic inflammation. Pathological changes consistent with hepatic encephalopathy, (Alzheimer type II cells), were evident in the cerebrum of both the mare and the fetus.

  5. Spontaneous biliary tract perforations: an unusual cause of peritonitis in pregnancy. Report of two cases and review of literature

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    Ravi Bina

    2006-07-01

    Full Text Available Abstract Spontaneous perforations of the biliary tract are rare in adults and even more so during pregnancy. Perforation of the gall bladder is a potentially fatal complication of cholecystitis. The infrequency of perforation in the setting of calculous disease of the gall bladder is probably due to the thickened wall of the organ that has long been the seat of chronic inflammation. Common bile duct perforations have been reported in adults most commonly in association with choledocholithiasis. The diagnosis of biliary tract perforations is often delayed due to their non specific symptoms, which results in high morbidity. Early diagnosis and aggressive therapy are mandatory to alleviate this condition. Delayed diagnoses and treatment may have more serious consequences for pregnant women than for other patients. Very few cases of biliary tract perforations have been reported in pregnant women. We report two such cases in pregnancy: first of a gall bladder perforation associated with cholelithiasis and the second of a common bile duct perforation in pregnancy in which no apparent cause was found.

  6. 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

  7. 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.

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

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    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)

  9. 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.

  10. [Obesity and the immune system].

    Science.gov (United States)

    Muñoz, M; Mazure, R A; Culebras, J M

    2004-01-01

    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, sleep apnoea, menstrual changes, sterility and psychological alterations. There is also a greater susceptibility to suffer some types of cancer, infections, greater risk of bacteremia and a prolonged time of wound healing after surgical operations. All these factors indicate that obesity exerts negative effects upon the immune system. Immune changes found in obesity and their possible interrelations are described in this article. Changes produced during obesity affect both humoral and cellular immunity. It is known that adipose tissue, together with its role as energy reserve in form of triglycerides, has important endocrine functions, producing several hormones and other signal molecules. Immune response can be deeply affected by obesity, playing leptin an important role. Properties of leptin, alterations of leptin levels in different situations and its changes with different medical and surgical therapies for obesity are described in this article.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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)

  16. 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.

  17. LPAC syndrome associated with deletion of the full exon 4 in a ABCB4 genetic mutation in a patient with hepatitis C.

    Science.gov (United States)

    Fombuena, Blanca; Ampuero, Javier; Álvarez, Luis; Aparcero, Reyes; Llorca, Rocío; Millán, Raquel; Pastor, Helena; Andueza, Sara; Barbu, Veronique; Romero-Gómez, Manuel

    2014-12-01

    Low-phospholipid-associated cholelithiasis syndrome (LPAC) is associated with ABCB4 genetic mutation. ABCB4 encodes MDR3 protein, involved in biliary phosphatidylcholine excretion.Higher prevalence in women, biliary symptoms in young adults and ursodesoxycholic acid (UDCA) response are the main features. We report the case of a 48-year-old man with hepatitis C, genotype 1b, fibrosis F3, null responder to Peg-IFN-alpha-2b/ribavirin and nephritic colic. In 2011 he developed jaundice, pruritus and epigastric pain.He showed increased serum levels of AST, ALT, GGT, bilirubin and alpha-fetoprotein, and viral load (14,600,000 IU/mL). Pancreatic- CT, endoscopic ultrasonography and echo-Doppler showed noncirrhotic chronic liver disease. The episode resolved spontaneously and one year later he suffered a similar episode. UDCA was started with excellent response. An immunohistochemistry study and sequencing of ABCB4 did not find alteration. MLPA® technique detected heterozygous deletion of the full exon 4 confirming LPAC syndrome diagnosis.

  18. 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.

  19. The pitfalls of laparoscopic surgery: challenges for robotics and telerobotic surgery.

    Science.gov (United States)

    Ballantyne, Garth H

    2002-02-01

    After its debut in 1988, laparoscopic cholecystectomy rapidly became the standard of care for cholelithiasis, yet very few surgeons use minimally invasive techniques for other abdominal operations. Why do most surgeons continue to perform traditional open gastrointestinal operations? We believe that the answer to this question lies in the fact that advanced laparoscopic operations are difficult to learn, perform, and master. A number of inherent pitfalls of laparoscopy hinder the performance of these operations even after the surgeon has accumulated years of experience. These pitfalls include an unstable video camera platform, limited motion (degrees of freedom) of straight laparoscopic instruments, two-dimensional imaging, and poor ergonomics for the surgeon. Inexperienced or bored laparoscopic camera-holders move the camera frequently and rotate it away from the horizon. The long, straight laparoscopic instruments are limited in their motion by the fixation enforced by the abdominal wall trocars. Similarly, the standard two-dimensional video imaging used in most laparoscopic operations impedes the surgeon's depth perception, compounding the limitations of laparoscopic instruments. In addition, surgeons are forced to assume ergonomically awkward stances in performing many laparoscopic operations. These four factors hinder a surgeon's efforts to learn and to perform advanced laparoscopic operations, significantly lengthening the learning curve. The articles presented in this issue suggest that robotics and telerobotics offer solutions to these nagging pitfalls of laparoscopic surgery.

  20. 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.

  1. Results of the open surgery after endoscopic basketimpaction during ERCP procedure

    Institute of Scientific and Technical Information of China (English)

    Sezgin Yilmaz; Ogun Ersen; Taner Ozkececi; Kadir S Turel; Serdar Kokulu; Emre Kacar; Murat Akici; Murat Cilekar; Ozgur Kavak; Yuksel Arikan

    2015-01-01

    AIM: To report the results of open surgery for patientswith basket impaction during endoscopic retrogradecholangiopancreatography (ERCP) procedure.METHODS: Basket impaction of either classicalDormia basket or mechanical lithotripter basket with anentrapped stone occurred in six patients. These patientswere immediately operated for removal of stone(s) andimpacted basket. The postoperative course, length ofhospital stay, diameter of the stone, complication andthe surgical procedure of the patients were reportedretrospectively.RESULTS: Six patients (M/F, 0/6) were operateddue to impacted basket during ERCP procedure. Themean age of the patients was 64.33 ± 14.41 years.In all cases the surgery was performed immediatelyafter the failed ERCP procedure by making a right Yilmaz S et al . Surgery for basket impaction during ERCP subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13th day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

  2. [A rare case of obstructive jaundice and cholecystitis in hepatic fascioliasis in Italy].

    Science.gov (United States)

    Caprino, Paola; Ferranti, Fabrizio; Passa, Giuseppe; Quintiliani, Alberto

    2007-01-01

    The human infestation caused by Fasciola hepatica is a rare zoonosis, with an incidence of about 10 cases/year in Italy. We report a case of cholecystitis and obstructive jaundice in a patient affected by fascioliasis in which the diagnosis was secondary to the extraction of viable flukes from the bile duct during ERCP. The endoscopic examination permits, in addition to a rapid, correct diagnosis, direct clearance of the bile ducts. Oral drug therapy, when carried out following the endoscopic treatment, is aimed at killing any flukes potentially evading mechanical clearance. The healing achieved is confirmed by normalisation of antibody levels 6-12 months after therapy. Cholecystectomy is indicated and appropriate for the frequent occurrence of biliary colic related to acute and chronic cholecystitis and cholelithiasis, induced by the presence of the flukes. Infestation by Fasciola hepatica has to be considered among the differential diagnoses of obstructive jaundice. ERCP plays a major diagnostic and therapeutic role, and cholecystectomy, considering the pathogenetic effects of flukes on the organ, is mandatory.

  3. Physical activity benefits and risks on the gastrointestinal system.

    Science.gov (United States)

    Martin, Donald

    2011-12-01

    This review evaluates the current understanding of the benefits and risks of physical activity and exercise on the gastrointestinal system. A significant portion of endurance athletes are affected by gastrointestinal symptoms, but most symptoms are transient and do not have long-term consequences. Conversely, physical activity may have a protective effect on the gastrointestinal system. There is convincing evidence that physical activity reduces the risk of colon cancer. The evidence is less convincing for gastric and pancreatic cancers, gastroesophageal reflux disease, peptic ulcer disease, nonalcoholic fatty liver disease, cholelithiasis, diverticular disease, irritable bowel syndrome, and constipation. Physical activity may reduce the risk of gastrointestinal bleeding and inflammatory bowel disease, although this has not been proven unequivocally. This article provides a critical review of the evidence-based literature concerning exercise and physical activity effects on the gastrointestinal system and provides physicians with a better understanding of the evidence behind exercise prescriptions for patients with gastrointestinal disorders. Well-designed prospective randomized trials evaluating the risks and benefits of exercise and physical activity on gastrointestinal disorders are recommended for future research.

  4. 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.

  5. 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.

  6. [IMSS in numbers: demand of services in the emergency room, 2004].

    Science.gov (United States)

    2006-01-01

    The emergency room is one of the most productive services in any medical institution, where the demand of health services is diverse and complex in nature. Around 15 % of all the medical attentions provided at IMSS were done at the emergency room. There was an important increase in the number of consultations provided from 1995 to 2004; the death rate in the service also increased but the incapacity rate decreased. Adult and elderly women were among the most frequent users of emergency services. The main problems seen were respiratory infections (19.4%), trauma and poisoning (18.8%) and diarrheas (8%). Cholelithiasis, migraine, urinary infections and diabetes were more frequent in women, while trauma, accidents and conjunctivitis were more frequent in men. In relation to mortality, around 21% of all deaths registered at IMSS occurred in the emergency room. Diabetes and cardiovascular diseases appeared among the main death causes, especially in the adult and elderly population. Mortality was higher in men than in women.

  7. Outpatient laparoscopic cholecystectomy: A new gold standard for cholecystectomy?

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    J. Bueno Lledó

    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.

  8. Caroli's disease: Description of a case with a benign clinical course.

    Science.gov (United States)

    Tzoufi, Meropi; Rogalidou, Maria; Drimtzia, Ecaterini; Sionti, Irini; Nakou, Iliada; Argyropoulou, Maria; Tsianos, Epameinondas V; Siamopoulou-Mavridou, Antigone

    2011-01-01

    Caroli's disease is a rare congenital disorder characterized by cystic dilatation of the large in-trahepatic bile ducts. The most frequent complications due to biliary stasis are cholelithiasis, cholangitis and sepsis as well as an increased risk of cholangiocarcinoma. Patients may have a history of intermittent abdominal pain, pruritus and/or symptoms of cholangitis. It is rarely diagnosed in childhood. A 12-year-old boy with isolated Caroli's disease is described. This child presented at the age of 2 years, with 4 episodes of recurrent bacterial infections. Interestingly he remained asymptomatic for over 10 years, between the second and third episode. During the 4th episode, when he presented with fever and slight abdominal pain, the diagnosis was made on the basis of radiological findings: U/S, CT, MRI and especially with MRCP, in relation with a more typical picture, resembling cholangitis. Since then he has been followed-up systematically for ten years and remains in good clinical condition without further relapses and with unchanged radiological findings. This atypically benign course of Caroli's disease, with intermittent asymptomatic periods, without any treatment, is very rare.

  9. Caroli’s disease: Description of a case with a benign clinical course

    Science.gov (United States)

    Tzoufi, Meropi; Rogalidou, Maria; Drimtzia, Ecaterini; Sionti, Irini; Nakou, Iliada; Argyropoulou, Maria; Tsianos, Epameinondas V.; Siamopoulou-Mavridou, Antigone

    2011-01-01

    Caroli’s disease is a rare congenital disorder characterized by cystic dilatation of the large in-trahepatic bile ducts. The most frequent complications due to biliary stasis are cholelithiasis, cholangitis and sepsis as well as an increased risk of cholangiocarcinoma. Patients may have a history of intermittent abdominal pain, pruritus and/or symptoms of cholangitis. It is rarely diagnosed in childhood. A 12-year-old boy with isolated Caroli’s disease is described. This child presented at the age of 2 years, with 4 episodes of recurrent bacterial infections. Interestingly he remained asymptomatic for over 10 years, between the second and third episode. During the 4th episode, when he presented with fever and slight abdominal pain, the diagnosis was made on the basis of radiological findings: U/S, CT, MRI and especially with MRCP, in relation with a more typical picture, resembling cholangitis. Since then he has been followed-up systematically for ten years and remains in good clinical condition without further relapses and with unchanged radiological findings. This atypically benign course of Caroli’s disease, with intermittent asymptomatic periods, without any treatment, is very rare. PMID:24713723

  10. Predictors of adverse postoperative course of cholecystectomy in mini-incision access and laparoscopic cholecystectomy

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    V. N. Klimenko

    2014-04-01

    Full Text Available Background. Shift from laparotomy to laparoscopy qualitatively changed surgery aggressiveness, allowed to reduce the number and severity of postoperative complications. New methods of minimally invasive interventions introduction have generated a number of legitimate questions relating to the desirability, safety, possible range of applications, the effectiveness of interventions. However, no studies in the literature devoted to the development of criteria for predicting the likely complications of surgical data and adverse postoperative course. Aim of the study - to identify the most significant predictors of adverse postoperative course of the laparoscopic cholecystectomy and laparotomy cholecystectomy from the minimum access. Material and methods. Retrospective study included 102 patients with cholelithiasis who routinely were performed cholecystectomy. Cholecystectomy from minimum laparotomy access was performed in 48 (47,1% patients. 54 (52,9% patients underwent laparoscopic cholecystectomy. The groups were comparable by age, sex, height, weight, body mass index. Statistical processing of the material was carried out with software package Statistica 6.0. and MedCalc10.2.0.0. Parametric (t-test for dependent and independent variables, ANOVA ANOVA, paired Pearson correlation and nonparametric (Wald-Wolfowitz runs test, Kolmogorov-Smirnov two-sample test, Mann-Whitney U test, correlation Spearman statistic methods were used. Differences considered statistically significant at a value of p <0,05. Method for constructing operating characteristic curves (ROC-analysis was used for the risk of adverse postoperative course assess. Predictors of adverse postoperative period were measured with Cox proportional hazard model. Independent indicators of adverse postoperative course were built with multivariable Cox proportional hazard model, the variables included reverse stepwise method. Results. Positive prognostic value had the follow: initial ESR 20

  11. 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.

  12. Usefulness of endoscopic ultrasonography in the clinical suspicion of biliary disease Utilidad de la ultrasonografía endoscópica en la sospecha clínica de patología biliar

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    David del Pozo

    2011-07-01

    Full Text Available Background and aims: endoscopic ultrasound (EUS is a very sensitive and specific technique for the diagnosis of biliary diseases. This procedure has proven its usefulness in cases of high suspicion of biliary disease (history of gallstones and dilatation of the intrahepatic and/or extrahepatic bile ducts. We know less about its usefulness in cases of low suspicion of biliary pathology. The aim of this study was to assess the diagnostic accuracy of EUS in patients with low suspicion of biliary disease (patients with dilatation of the biliary tract were excluded. Methods: 33 patients with low suspicion of biliary disease were recruited in 12 months. All of them had no biliary findings in a previous abdominal ultrasound and computer tomography scan. All of them underwent EUS and were studied prospectively. The diagnosis was confirmed by surgery and/or by ERCP in patients with positive EUS or clinical follow-up in those with normal EUS. Time of follow-up was 9 months (range, 3-12 months. Results: seventeen patients (51.5% presented with abnormal biliary findings on EUS (7 choledocholithiasis, 3 cholelithiasis, 2 choledocholithiasis + cholelithiasis and 5 microlithiasis. Conclusion: EUS is a useful and safe procedure for diagnosing patients with low suspicion of biliary disease.Antecedentes y objetivos: la ultrasonografía endoscópica (USE es una técnica muy sensible y específica para el diagnóstico de enfermedades biliares. Este procedimiento ha demostrado su utilidad en casos de alta sospecha de enfermedad biliar (historia de colelitiasis y dilatación de la vía biliar intra- y/o extrahepática. Sabemos menos sobre su utilidad en casos de baja sospecha de patología biliar. El objetivo de este estudio fue evaluar la precisión diagnóstica de la USE en pacientes con baja sospecha de enfermedad biliar (los pacientes con dilatación de la vía biliar fueron excluidos. Métodos: 33 pacientes con baja sospecha de enfermedad biliar fueron

  13. 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.

  14. Chemical characterization of gallstones: an approach to explore the aetiopathogenesis of gallstone disease in Sri Lanka.

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    Harshi Weerakoon

    Full Text Available Records on gallstones and associated ailments in Sri Lankan community are scarce, despite frequent detection of gallstone disease. Identification of the chemical composition of gallstones in the local setting is important in defining aetiopathogenic factors which in turn are useful in implementing therapeutic and preventive strategies. This study aimed to describe the chemical composition of gallstones and the socio-demographic factors of a cohort of Sri Lankan patients with gallstone disease.Data on clinical and socio-demographic factors, and gallstones removed at surgery were collected from patients with cholelithiasis admitted to Teaching Hospital, Peradeniya, Sri Lanka from May 2011 to December 2012. External and cross sectional morphological features of gallstones were recorded by naked eye observation. Compositional analysis was carried out by Fourier Transform Infrared Spectroscopy, X - ray Powder Diffraction, and Atomic Absorption Spectrophotometry. Scanning Electron Microscopy was used to identify the microstructure of gallstones.Data of 102 patients were analyzed. Of them majority (n = 77, 76% were females with a female: male ratio of 3:1. Mean age of the study group was 46.1±11.6 years. All the patients had primary gallbladder stones. According to the physical and chemical analysis, majority (n = 54, 53% were pigment gallstones followed by mixed cholesterol gallstones (n = 38, 37%. Only 10 (9% had pure cholesterol gallstones. Calcium bilirubinate, calcium carbonate and calcium phosphate were the commonest calcium salts identified in pigment gallstones and core of mixed cholesterol gallstones.Presence of a pigment nidus in gallstones is a common feature in majority of Sri Lankan patients denoting the possible role of elevated unconjugated bilirubin in bile on the pathogenesis of GS. Hence it is imperative to explore this further to understand the aetiopathogenesis of GS among Sri Lankans.

  15. CLINICAL STUDY AND MANAGEMENT OF CHOLEDOCHOLITHIASIS

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    Suresh

    2014-10-01

    Full Text Available BACKGROUND AND OBJECTIVES: Choledocholithiasis complicates the working and management of cholelithiasis necessitating additional diagnostic procedures, increasing morbidity and mortality. CBD stone generally remain asymptomatic but when symptoms start appearing, cause a lot of suffering. There are various treatment modalities available presently. The objective of our study was to study the incidence, various modes of clinical presentations and different modalities of treatment in common bile duct stones. MATERIALS AND METHODS: 35 Patients were prospectively studied from July 2012 to June 2014 as in-patients in Victoria Hospital. RESULTS: CBD stones occurred predominantly in elderly females and presented from subclinical jaundice to complications in the form of biliary pancreatitis and cholangitis. USG abdomen with LFT was able to diagnose majority of the CBD stones preoperatively. Per operative cholangiogram was used selectively in case USG was inconclusive, ERCP was used in patients presenting with severe obstructive jaundice, pancreatitis, cholangitis, minimal CBD ductal dilation. Open exploration was the main focus with a wide variety of procedures performed according to specific indications. CONCLUSION: CBD was more common in elderly female patients probably due to neglected gall bladder stones. CBD stones can occur from occult asymptomatic stones only with altered LFT to symptomatic presentation in the form of cholangitis, pancreatitis. USG abdomen was inexpensive and easily available imaging modality to diagnose CBD stones with per operative cholangiogram being needed in minority of the cases. While ERCP was good in treating complications of CBD stones and early stages of the disease; the more advanced stage of the disease with gross CBD ductal dilation and multiple stones open CBD exploration were more productive.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. A FIVE-YEAR STUDY OF HEPATOBILIARY LESIONS IN A TERTIARY CARE HOSPITAL

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    Megha Sharma

    2016-06-01

    Full Text Available BACKGROUND The hepatobiliary system is composed of liver, biliary tree and gallbladder which occupy the right upper quadrant of the abdomen. The dominant primary diseases of the liver are viral hepatitis, alcoholic liver diseases, cirrhosis, NASH and hepatocellular carcinoma. Primary tumours as well as metastatic carcinomas flourish in hepatic environment. Disorders of the biliary tract affect a significant portion of the world population. Over 95% of biliary tract diseases are attributable to cholelithiasis (gall stones. Gall bladder stones can occur in any age group including infants and newborns. Benign lesions of gall bladder (most common being chronic cholecystitis are much more common than malignant lesions. AIM This study was carried out to study the various histopathological lesions of hepatobiliary system in Jammu and adjoining region. STUDY DESIGN This study is a prospective study conducted for a period of five years. MATERIAL & METHOD This study was done for a period of five years from 1 st Jan 2011 to 31 st Jan 2016 in the Department of Pathology, Govt. Medical College, Jammu and deals with lesions of hepatobiliary system including intrahepatic and extrahepatic biliary ducts, liver and gall bladder. RESULTS A total of 500 cases were studied of which gall bladder lesions constituted 350 cases (70%, 138 (27.6% cases were from liver (27.6%, whereas extrahepatic biliary system constituted 12 cases (2.4% only. In the present study, the overall prevalence of lesions of hepatobiliary system was observed to be higher in females i.e. 287 cases (57.4% as compared to males i.e. 213 cases (42.6%. Benign lesions were more common than malignant lesions. CONCLUSION The present study provides an insight into the varied lesions of hepatobiliary system in this region.

  1. 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.

  2. 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.

  3. Megalin and cubilin in the human gallbladder epithelium.

    Science.gov (United States)

    Tsaroucha, Alexandra K; Chatzaki, Ekaterini; Lambropoulou, Maria; Despoudi, Kaliopi; Laftsidis, Prodromos; Charsou, Chara; Polychronidis, Alexandros; Papadopoulos, Nikolaos; Simopoulos, Constantinos E

    2008-09-01

    Although the role of cholesterol absorption by the gallbladder epithelium in gallstone formation is well established, the exact process is poorly understood. Potential candidates for regulation of transepithelial cholesterol transport are suggested to be two large membrane multiple ligand receptors, megalin and cubilin. We studied the expression of these two proteins in both acalculous and calculous human gallbladder epithelia. Adult human gallbladder tissues were received from 21 patients (9 men, 12 women) who had undergone cholecystectomy. The patients were divided into two groups: group A (calculous gallbladder group; 5 men, 6 women; mean age 64.4 +/- 11.1 years) with cholelithiasis, and group B (acalculous gallbladder group; 4 men, 6 women; mean age 55.3 +/- 16.1 years). In the gallbladder tissues megalin and cubilin expression was studied by immunohistochemistry and conventional RT-PCR, and gene expression levels were estimated by real-time RT-PCR. Both megalin and cubilin gene transcripts were found in total RNA preparations from acalculous gallbladder. In contrast, in preparations from calculous gallbladder, none or only one of the proteins was detected. Immunoreactive proteins were detected in the simple columnar acalculous gallbladder epithelium but not in the calculous gallbladder epithelium. Our results show different expression patterns of the two proteins in calculous gallbladders and acalculous gallbladders. In the latter both proteins are expressed, suggesting an association with gallstone formation and implying a putative role of the two proteins in cholesterol endocytosis. In other words, the presence of both proteins may be essential for the prevention of stone formation.

  4. 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

  5. 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.

  6. 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.

  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. 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.

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

    Science.gov (United States)

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

    2016-09-01

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

  11. Refractory thrombotic thrombocytopenic purpura following acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ebisa Bekele; Bethel Shiferaw; Alexandra Sokolova; Arpan Shah; Phillip Saunders; Alida Podrumar; Javed Iqbal

    2016-01-01

    Thrombotic thrombocytopenic purpura (TTP) is a rare blood disorder with an estimated incidence of 4–5 cases per million people per year. It is characterized by small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia and organ damage. There are reports in literature that TTP and acute pancreatitis are associated, indicating each can be the cause of the other. However, acute pancreatitis triggering TTP is very rare. A 71 years old female presented with abdominal pain of 3 days, followed by dark urine. She had icteric sclera, petechial rash and mild epigastric tenderness. Lab findings were significant for hemolytic anemia, thrombocytopenia and elevated lipase. CT of abdomen showed evidence of pancreatitis and cholelithiasis. After admission, patient developed symptoms of stroke. Further investigation showed elevated lactate dehydrogenase and normal coagulation studied with peripheral blood smear showed 5–6 schistocytes/high power field. Disintegrin and metalloproteinase with thrombospondin motifs-13 (ADAMTS13) activity showed less than 3% with high ADAMTS13 inhibitor 2.2. Patient required 6–7 weeks of daily plasmapheresis until she showed complete response. Our patient presented with clinical features of pancreatitis prior to having dark urine and petechial rash. Therefore, we strongly believe that our patient had pancreatitis which was followed by TTP. Patient's ADMTS13 activity was 6%after 10 plasma exchanges, signifying refractory TTP and higher risk for morbidity and mortality. There are limited data and consensus on the management of refractory TTP. TTP and acute pancreatitis are associated. However, refractory TTP following acute pancreatitis is rarely mentioned in the literature. We would like to emphasize the importance of having higher clinical suspicion of the association of both disease entities.

  12. Laparoscopic cholecystectomy accompanied by simultaneous umbilical hernia repair: A retrospective study

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    Kamer E

    2007-01-01

    Full Text Available Background : Umbilical defects may cause technical problems for general surgeons in patients during laparoscopic cholecystectomy (LC operations and may increase the incidence of incisional hernia. Aim : The objectives of this study were to determine the optimal repair method for umbilical hernias that already exist or are encountered incidentally and to present data regarding potential problems that may occur during LC. Settings and Design : Medical records of patients who had received simultaneous umbilical hernia repair (UHR with LC were investigated retrospectively. Materials and Methods : Cholelithiasis was accompanied by umbilical hernia in 64 (8.6% out of 745 patients who underwent LC and UHR simultaneously in our hospital between 2000 and 2004. Statistical Analysis Used : The Mann-Whitney U, Chi-square, One-Way Anova, Kaplan-Meier survival analysis, the log-rank test and t test were used for statistical analyses. Results : LC was followed by UHR using primary suture (Group 1, Mayo repair (Group 2 and flat mesh-based repair (Group 3 in 32 (50%, 18 (28.1% and 14 (21.9% patients, respectively. Mean body mass indexes (BMI of patients were 26.6 kg/m 2 , 29.2 kg/m 2 and 39.9 kg/m 2 in Groups 1, 2 and 3, respectively. Recurrence rates were 9.4%, 5.6% and none (0% in Groups 1, 2 and 3, respectively. Recurrence was observed in three (7.0% out of 43(67.2% patients with BMI≥30 kg/m 2 while umbilical hernia recurred in one (4.8% out of 21 (32.8% patients with BMI< 30 kg/m 2 . Overall morbidity and mortality rates were 14.1% and 0%, respectively. Conclusions : The outcomes of the UHR with mesh after laparoscopic surgeries appear to be better for either obese or non-obese patients than primary suture techniques in recurrence rates.

  13. 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.

  14. Laparoscopic cholecystectomy and the Peter Pan syndrome.

    Science.gov (United States)

    Orlando, G; Bellini, P; Borioni, R; Pace, A

    2000-08-01

    We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy (LC). This condition was due to the rupture of a pseudo-aneurysm of the right hepatic artery in the common bile duct, probably caused by a clip erroneously fired during LC on the lateral right wall of the vessel. It also caused the formation of multiple liver abscesses and the onset of sepsis. This life-threatening complication led to melena, fever, epigastric pain, pancreatitis, liver dysfunction, and severe anemia, requiring urgent hospitalization and operation. In the operating theater, the fistula was closed, the liver abscesses drained, and a Kehr tube inserted. Thereafter, the patient's general condition improved, and she is now well. LC is often considered to be the gold standard for the management of symptomatic cholelithiasis. However, recent data have undermined that opinion. The apparent advantages offered by LC in the short term (less pain, speedier recovery, shorter hospital stay, and lower costs) have been overwhelmed by the complications that occur during long-term follow-up. When the late downward trend in the bile duct and the vascular injury rate are taken into consideration, the learning curve is prolonged. Therefore, LC should be regarded as the surgical equivalent of a modern Peter Pan-i.e., it is like a young adult who should make definitive steps toward becoming an adult but does not succeed in doing so. We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy. Based on the facts in this case, we argue that the endoscopic procedure still needs to be perfected and cannot yet be considered the gold standard for selected cases of gallstone disease.

  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. Use of rigid tubal ligation scope: Serendipity in laparoscopic common bile duct exploration

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    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Aim : To assess the feasibility, safety of rigid tubal ligation scope in laparoscopic common bile duct (CBD exploration. Materials and Methods: Rigid nephroscope was used for laparoscopic CBD exploration until one day we tried the same with the rigid tubal ligation scope, which was passed easily into CBD both proximally and distally visualising the interior of the duct for presence of stone that were removed using endoscopic retrograde cholangiopancreaticography (ERCP basket. This serendipity led us to use this scope for numerous patients from then on. A total of 62 patients, including male and female, underwent laparoscopic CBD exploration after choledochotomy with rigid tubal ligation scope between March 2007 and December 2012 followed by cholecystectomy. All the patients had both cholelithiasis and choledocholithiasis with minimum duct diameter of 12 mm. A total of 48 patients were given T-tube through choledochotomy and closed, and the remaining 14 patients had primary closure of choledochotomy. Results: There were no intra-operative complications in any of the patients like CBD injury or portal vein injury. Post-operatively graded clamping of T-tube was done and was removed after 15 days in the patients who were given T-tube. None had retained the stone after T-tube cholangiography, which was done before removing the tube. Mean duration of follow up was 6 months. No patients had any complaints during the follow up. Conclusion: Laparoscopic CBD exploration is also feasible with rigid tubal ligation scope. With experienced surgeons, CBD injury is very minimal and stone clearance can be achieved in almost all patients. This rigid tubal ligation scope can be an alternative to other rigid and flexible scopes.

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

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    Wang M

    2016-07-01

    Full Text Available Meng Wang,1 Yufei Xing,2 Quangen Gao,1 Zhiqiang Lv,1 Jianmao Yuan1 1Department of General Surgery, The First People’s Hospital of Wujiang, Affiliated Wujiang Hospital of Nantong University, 2Digestive Clinical Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China Abstract: 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. Keywords: Mirizzi syndrome, aberrant hepatic duct, hepatolithiasis, anatomical hepatectomy

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. Management of choledocholithiasis: Comparison between laparoscopic common bile duct exploration and intraoperative endoscopic sphincterotomy

    Institute of Scientific and Technical Information of China (English)

    Qi Wei; Jian-Guo Wang; Li-Bo Li; Jun-Da Li

    2003-01-01

    AIM: Choledocholithiasis is present in 5 to 10 percent of patients who have cholelithiasis. Tn the area of laparoscopic cholecystectomy (LC), laparoscopic common bile duct exploration (LCBDE) and intraoperative endoscopic sphincterotomy (IOES) have been used to treat choledocholithiasis. The purpose of this study was to compare the clinical outcomes and hospital costs of LCBDE with IOES.METHODS: Between November 1999 and October 2002,patients with choledocholithiasis undergoing LC plus LCBDE (Group A, n=45) were retrospectively compared to those undergoing LC plus IOES (Group B, n=57) at a single institution.RESULTS: Ductal stone clearance rates were equivalent for the two groups (88 % versus 89 %, P=0.436). The conversion rate was higher for Group B (8.8 % versus 4.4 %,P=0.381), as was the morbidity (12.3 % versus 6.7 %,P=0.336). There were no other significant differences between the two groups. The complications were mainly related to endoscopic sphincterotomy (ES), and the hospital costs were significantly increased in this subset of Group B (median, 23 910 versus 14 955 RMB yuan, P=0.03). Although hospital stay was longer in Group A (median, 7 versus 6 days,P=0.041), the patients in Group A had a significantly decreased cost of hospitalization compared with those in Group B (median, L1 362 versus 15 466 RMB yuan, P=0.000).CONCLUSION: The results demonstrate equivalent ductal stone clearance rates for the two groups. LCBDE management appears safer, and is associated with a significantly decreased hospital cost. The findings suggest LCBDE for choledocholithiasis is a better option.

  3. 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.

  4. 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

  5. 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

  6. 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

  7. Clinical characteristics of aortic dissection and analysis of factors related to misdiagnosis%主动脉夹层临床特点及误诊因素分析

    Institute of Scientific and Technical Information of China (English)

    沈洪; 康瑜; 姚志峰; 陈永乐; 史静; 姚晨玲; 童朝阳; 魏来; 王春生

    2013-01-01

    回顾分析2003年1月至2008年6月中山医院收治的主动脉夹层361例的临床特点,并着重分析其中误诊的51例资料,探讨误诊相关因素.结果显示,361例患者中男273例,女88例,年龄16 ~ 77岁,临床主要表现为疼痛(87.8%).误诊51例(14.1%),其中男43例,女8例,年龄25 ~ 77岁.主要表现为疼痛症状者误诊疾病主要有急性冠状动脉综合征、急性胰腺炎、急性胆囊炎或胆囊结石;主要表现为非疼痛症状者误诊疾病主要为肺部感染、心力衰竭.提示,主动脉夹层临床症状表现多样,易引起误诊;心包积液是诊断主动脉夹层的有利因素.%The clinical data of 361 patients aged from 16-77 y with aortic dissection (AD) admitted from January 2003 to June 2008,including 273 males and 88 females,were retrospectively reviewed.The symptoms and physical signs of the AD were diverse,major clinical manifestation was pain (87.8%) and the painless diseases were seen in 12.2% of cases.The misdiagnosis occurred in 51 patients (14.1%),including 43 male patients and 8 females,aged from 25-77 y before admission ; 45 painful cases (88.2%) were misdiagnosed as acute coronary syndrome,acute pancreatitis,acute cholecystitis and cholelithiasis and 6 painless patients (11.8%) were misdiagnosed as pulmonary infection and congestive heart failure.The data indicate that AD may demonstrate diverse manifestations and severity leading to misdiagnosis and the symptom of pericardial effusion is helpful for accurate diagnosis.

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

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    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. 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

  10. Laparoscopic cholecystectomy in patients over 70 years of age: review of 176 cases Colecistectomía laparoscópica en pacientes mayores de 70 años: nuestra experiencia en 176 casos

    Directory of Open Access Journals (Sweden)

    F. J. Pérez Lara

    2006-01-01

    Full Text Available Introduction: we assessed the results of laparoscopic cholecystectomy in 176 patients over the age of 70 years. Patients and methods: the study included all patients older than 70 years of age who underwent laparoscopic surgery cholelithiasis during the previous ten years. Variables studied included age, sex, type of operation (programmed/emergency, comorbidity, anesthetic risk, intraoperative cholangiography, conversion to open surgery, number of trocars, reoperation, residual choledocholithiasis, postoperative hospital stay, morbidity and mortality. Results: the study included 176 patients (23.29% men and 76.71% women. The mean age was 74.86 years. The mean hospital stay was 1.27 days, with 16.98% morbidity and 0.56% mortality. Conclusions: laparoscopic cholecystectomy is a safe procedure in older patients. It results in faster recovery, a shorter postoperative stay and lower rates of morbidity and mortality than open bile duct surgery.Objetivo: el objetivo de nuestro estudio es el de evaluar los resultados obtenidos en 176 pacientes mayores de 70 años intervenidos mediante colecistectomía laparoscópica. Pacientes y métodos: se incluyen en el estudio todos los pacientes mayores de 70 años diagnosticados de colelitiasis intervenidos por laparoscopia en los diez últimos años. Analizamos los siguientes parámetros: edad, sexo, tipo de intervención (programada/urgente, comorbilidad, riesgo anestésico, colangiografía intraoperatoria, conversión a cirugía abierta, número de trócares, reintervención, coledocolitiasis residual, estancia hospitalaria postoperatoria y morbimortalidad. Resultados: incluimos en el estudio un total de 176 pacientes, de los cuales el 23,29% son varones y 76,71%, tienen una edad media de 74.86 años. En los resultados globales la estancia media hospitalaria es de 1,27 días, morbilidad 16,98% y mortalidad de 0,57%. Conclusiones: la colecistectomía laparoscópica es un procedimiento seguro en pacientes mayores

  11. 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)

  12. Two-dimensional electrophoresis for comparative proteomic analysis of human bile

    Institute of Scientific and Technical Information of China (English)

    Bo Chen; Jing-Qing Dong; Yong-Jun Chen; Jian-Ming Wang; Jun Tian; Chun-Ben Wang; Sheng-Quan Zou

    2007-01-01

    BACKGROUND:Proteomic analysis of bile lfuid holds promise as a method to identify biomarkers of bile tract diseases, especially for tumors. Two-dimensional electrophoresis (2-DE) is a popular and proven separation technique for proteome analysis, but using this strategy for bile lfuid analysis is still not fully developed. This study was undertaken to (a) establish a reliable method for general clean-up to make bile lfuid samples suitable for 2-DE;(b) obtain 2-D biliary maps with high reproducibility and resolution;and (c) identify protein patterns present in 2-D biliary maps for potential tumor biomarker discovery, with the intention of distinguishing malignant from benign causes of bile duct obstruction. METHODS: Bile lfuid samples were obtained from two patients suffering from malignant and benign bile tract obstruction (one patient with cholangiocarcinoma as the experimental case, the other with cholelithiasis as control). A variety of sample preparation options, including delipidation, desalination and nucleic acid removal, were adopted to remove contaminants that affect 2-DE results. After that, each 350 μg puriifed sample was loaded onto nonlinear IPG strips (18 cm, pH 3-10 and pH 4-7) for ifrst-dimension isoelectric focusing, and 12.5% SDS-PAGE electrophoresis for second dimension separation. Then 2-D maps were visualized after silver staining and analyzed with the Image Master 2-D software. RESULTS:A large number of protein spots were separated in 2-D maps from the experimental and control groups, with means of 250 and 216 spots on pH 3-10 IPG strips, and 182 and 176 spots on pH 4-7 strips, respectively. Approximately 16 and 23 spots were differentially expressed in matched pairs from the experimental and control cases using pH 3-10 and pH 4-7 strips. CONCLUSIONS: This study established a reliable sample preparation process suitable for 2-DE of bile lfuid. By this method, 2-D biliary maps with high reproducibility and resolution were obtained. The

  13. 冲击波对慢性非结石性胆囊炎患者胆囊收缩功能影响的临床观察%Clinical Observation of the Influence of Shock Wave to the Gallbladder Systolic Function of Chronic Acalculous Cholecystitis Patients

    Institute of Scientific and Technical Information of China (English)

    唐海涛; 李春恒; 赵红燕

    2015-01-01

    Objective This article aims to discuss about the influence of extracorporeal shock wave on the gallbladder systolic function of chronic acalculous cholecystitis patients. Methods Adopt the JDPN - VB model extracorporeal shock wave lithotripter by Shanghai Jiaotong University for the 40 cases of chronic acalculous cholecystitis patients;take the right upper quadrant as the shock wave path,and in prone position,to conduct the extracorporeal shock wave therapy to the cholelithiasis;with the therapy voltage of 8~ 10 kv and the times of shock wave of 1000,to conduct statistics to the changes of gallbladder systolic percentage before and one month after the shock wave therapy. Results The gallbladder systolic percentage is obviously increased for the 40 cases of chronic acalculous cholecystitis patients after the extracorporeal shock wave therapy than before,with obvious difference and the statistical sig-nificance(P ﹤ 0. 05). Conclusion The extracorporeal shock wave can effectively improve the gallbladder systolic function.%目的:探讨体外冲击波对慢性非结石性胆囊炎病人胆囊收缩功能的影响。方法对40例慢性非结石性胆囊炎患者采用上海交大 JDPN - VB 型体外冲击波碎石机,以右上腹部为冲击波路径,俯卧位,对病变胆囊进行体外冲击波治疗,治疗电压选择8~10 KV,冲击波次数为1000次,于治疗前及冲击波治疗后一个月统计胆囊收缩率变化情况。结果40例慢性非结石性胆囊炎患者经体外冲击波治疗后胆囊收缩率较治疗前明显升高,差异具有统计学意义( P ﹤0.05)。结论体外冲击波可以有效地改善胆囊的收缩功能。

  14. 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

  15. 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.

  16. Age-dependent safety analysis of propofol-based deep sedation for ERCP and EUS procedures at an endoscopy training center in a developing country

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    Amornyotin S

    2012-07-01

    Full Text Available Somchai Amornyotin,1,2 Somchai Leelakusolvong,2,3 Wiyada Chalayonnawin,1,2 Siriporn Kongphlay1,21Department of Anesthesiology, 2Siriraj GI Endoscopy Center, 3Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, ThailandIntroduction: Endoscopic retrograde cholangiopancreatography (ERCP and endoscopic ultrasonography (EUS procedures in elderly patients are on the rise, and they play an important role in the diagnosis and management of various gastrointestinal diseases. The use of deep sedation in these patients has been established as a safe and effective technique in Western countries; however, it is uncertain if the situation holds true among Asians. The present study aimed to evaluate the age-dependent safety analysis and clinical efficacy of propofol-based deep sedation (PBDS for ERCP and EUS procedures in adult patients at a World Gastroenterology Organization (WGO Endoscopy Training Center in Thailand.Methods: We undertook a retrospective review of anesthesia or sedation service records of patients who underwent ERCP and EUS procedures. All procedures were performed by staff endoscopists, and all sedations were administered by anesthesia personnel in the endoscopy room.Results: PBDS was provided for 491 ERCP and EUS procedures. Of these, 252 patients (mean age, 45.1 ± 11.1 years, range 17–65 years were in the <65 age group, 209 patients (mean age, 71.7 ± 4.3 years, range 65–80 years were in the 65–80 year-old group, and 30 patients (mean age, 84.6 ± 4.2 years, range 81–97 years were in the >80 age group. Common indications for the procedures were pancreatic tumor, cholelithiasis, and gastric tumor. Fentanyl, propofol, and midazolam were the most common sedative drugs used in all three groups. The mean doses of propofol and midazolam in the very old patients were relatively lower than in the other groups. The combination of propofol, midazolam, and fentanyl, as well as propofol and fentanyl

  17. Erythropoietic protoporphyria

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    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

  18. Iatrogenic gall bladder perforations in laparoscopic cholecystectomy: an audit of 200 cases.

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    Zubair, M; Habib, L; Mirza, M R; Channa, M A; Yousuf, M

    2010-07-01

    This study was done to evaluate the frequency of iatrogenic gall bladder perforation (IGBP) in laparoscopic cholecystectomy and to determine its association with gender, adhesions in right upper quadrant and types of gall bladder. This retrospective descriptive study included 200 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis at Jamal Noor Hospital and Hamdard University Hospital, Karachi from January 2007 to January 2009. Video recording of all 200 laparoscopic cholecystectomies were analyzed for the IGBP. The different factors; sex of the patient, type of gall bladder, presence of adhesions in the right upper quadrant, timing of perforation, site of perforation, cause of perforation and spillage of stones were recorded. Data was entered and analyzed on SPSS 15. Pearson Chi Square test was applied to check the significance of these factors in IGBP where applicable. In this study there were 173 females and 27 male patients. IGBP occurred in 51 patients (25.5%) and among them 40(23.12%) were females and 11(40.74%) males. Statistical analysis failed to prove male gender a significant factor in the IGBP (p=0.051). Spillage of stones occurred in 23 patients (11.5% in total study population). In 32(18.49%) patients with chronic calculus cholecystitis IGBP occured while in other cluster of 27 patients suffering from acute cholecystitis, empyema & mucocele, 19(70.37%) had IGBP. Hence the condition of gall bladder (acute cholecystitis, empyema and mucocele) was proved statistically a significant factor in IGBP (p=0.000). Adhesiolysis in right upper quadrant was required in 109 patients in whom 31 patients (28.44%) had IGBP while in 91 patients in whom no adhesiolysis was required, 20 patients (21.98%) had IGBP. Statistically no significant difference was present regarding this factor (p=0.296). In total of 51 patients of IGBP, fundus of gall bladder was the commonest site of perforation in 21(41.18%), followed by body of gall bladder in

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

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    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.

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

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    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.

  1. 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

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    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

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

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    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

  3. A laboratory and clinical study on Dahuanglingxian capsule in preventing gallstone recurrence after cholecystolithotomy%大黄灵仙胶囊预防保胆取石术后结石复发的基础与临床研究

    Institute of Scientific and Technical Information of China (English)

    李泉; 俞渊; 黄欣; 王兵; 王克净; 吕震; 李辉; 金萌; 唐乾利

    2014-01-01

    目的:通过临床研究观察验证大黄灵仙胶囊降低保胆取石术后复发率的影响作用,探讨大黄灵仙胶囊预防胆结石复发的作用机制。方法建立胆石症豚鼠模型,模拟结石形成过程,给豚鼠喂养脂餐,比较各组胆囊结石形成率,病理切片观察胆囊炎症情况,利用免疫组化检测各组豚鼠肝组织中胆固醇7a-羟化酶(CYP7A)表达的情况。将接受保胆取石手术患者分组,定期随访术后情况,B 超检测胆囊壁厚度、有无胆囊结石复发及胆泥形成情况、临床症状改善情况。结果服用大黄灵仙胶囊组豚鼠成石率12.50%,明显低于对照组55.00%,解剖发现服用大黄灵仙胶囊组豚鼠的胆囊黏膜炎症明显轻于未服药物组。检测发现,大黄灵仙胶囊组肝组织中 CYP7A 阳性表达率为(67.5±5.87)%,高于未服药物组(31.8±4.59)%。大黄灵仙胶囊组的保胆取石术后患者随访1年后,结石复发率明显低于未服药组,症状及胆囊炎症改善情况明显优于未服药组。结论大黄灵仙胶囊具有较好的预防结石形成作用,其主要机制可能为抑制胆囊黏膜炎症及上调肝组织中 CYP7A;同时在临床实验中,B 超的随访提示胆囊收缩功能较术前有所改善,二者表明,保胆取石术后病人中,大黄灵仙胶囊可能有提高胆石症手术的疗效,降低胆石症术后残石率及复发率的作用。%Objective To clinically study the effect of Dahuanglinxian capsule on reducing the stone recur-rence after cholecystolithotomy,and to discuss the action mechanism of Dahuanglinxian capsule on preventing recurrence. Methods The guinea pigs models of cholelithiasis were established,process simulation of stone formation were performed in guinea pigs by feeding with fat meal,and compared of the gallstone formation rate among groups,observed the biliary inflammation of pathological section

  4. 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

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    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.

  5. Anestesia geral versus raquianestesia para colecistectomia videolaparoscópica Anestesia general versus raquianestesia para colecistectomía videolaparoscópica General anesthesia versus spinal anesthesia for laparoscopic cholecystectomy

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    Luiz Eduardo Imbelloni

    2010-06-01

    posibilidad de realizar la colecistectomía laparoscópica bajo raquianestesia, comparándolo con la anestesia general. MÉTODO: Entre julio del 2007 y septiembre del 2008, 68 pacientes con síntomas de cálculo en la vesícula se incluyeron en el estudio. Pacientes estado físico ASA I y II, fueron aleatoriamente separados para ser operados de colecistectomía laparoscópica con neumoperitoneo con baja presión de CO2 bajo anestesia general (n = 33 o raquianestesia (n = 35. La anestesia general fue realizada con propofol, fentanil, rocuronio, sevoflurano e intubación traqueal. La raquianestesia fue realizada con 15 mg de bupivacaína hiperbárica con 20 µg fentanil hasta que el nivel sensitivo alcanzase T3· Los parámetros intraoperatorios, como el dolor postoperatorio, complicaciones, recuperación, satisfacción del paciente y coste, fueron comparados entre los grupos. RESULTADOS: Todos los procedimientos quirúrgicos se completaron con el método de elección y apenas un paciente fue convertido de la raquianestesia para la anestesia general. El dolor fue significativamente menor em 2, 4 y 6 horas después del procedimiento bajo raquianestesia, comparado con el grupo que recibió anestesia general. El coste de la raquianestesia fue significativamente menor. Todos los pacientes fueron liberados después de 24 horas. En la evaluación del postoperatorio, todos los pacientes quedaron satisfechos con la raquianestesia y recomendarían ese procedimiento. CONCLUSIONES: La colecistectomía laparoscópica con neumoperitoneo en baja presión de CO2 puede ser realizada con seguridad bajo raquianestesia. La raquianestesia estuvo asociada con un mínimo de dolor en el postoperatorio, mejor recuperación y un menor coste que la anestesia general.BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The objective of this study was to compare the possibility of performing laparoscopic cholecystectomy under spinal anesthesia versus

  6. 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

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    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

  7. Morbimortalidade da colecistectomia em pacientes idosos, operados pelas técnicas laparotômica, minilaparotômica e videolaparoscópica Morbimortality of elderly patients submitted to cholecystectomy by laparotomy, minilaparotomy or videolaparoscopy

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    José Guilherme Minossi

    2007-06-01

    Full Text Available RACIONAL: A colelitíase é uma das doenças mais freqüentes do aparelho digestivo, acometendo 20% da população adulta. A idade tem sido considerada importante fator preditivo de complicações após a colecistectomia. OBJETIVO: Avaliar a morbimortalidade da colecistectomia em pacientes idosos operados por técnica laparotômica, minilaparotômica e videolaparoscópica. MÉTODO: Foram analisados retrospectivamente 557 pacientes submetidos à colecistectomia associada ou não a outros procedimentos sobre as vias biliares no período de julho de 1985 a dezembro de 2003. Desses, 152 pacientes (27,3% tinham 60 ou mais anos e 120 (79% eram do sexo feminino. Noventa e dois doentes foram operados por laparotomia, 46 por videolaparoscopia e 14 por minilaparotomia. RESULTADOS: As complicações ocorreram com mais freqüência e gravidade nos pacientes mais idosos e operados por laparotomia, sendo que estes apresentaram maior índice de infecção urinária, da ferida cirúrgica e maior tempo de permanência hospitalar. Houve três casos de óbito, sendo dois após laparotomia e outro após videolaparoscopia, todos acima de 70 anos de idade. CONCLUSÃO: A idade é importante fator preditivo de complicações após a colecistectomia, tanto pela incidência aumentada da doença do trato biliar complicada, como pela maior morbimortalidade da operação no idoso, em decorrência de doenças associadas.BACKGROUND: Cholelithiasis is one of the most frequent diseases regarding the digestive system. It is present in about 20% of the adult population, being age an important predictive factor for complications after cholecystectomy. AIM: To evaluate the morbimortality rates concerning elderly patients who underwent cholecystectomy and who are submitted to conventional practices, minilaparotomy and laparoscopy. METHODS: Five hundred and fifty seven patients submitted to cholecystectomy, associated or not to other procedures on the biliary tract, were observed

  8. Effect of Huashilidan Decoction on CYP7A1、B-UGT in Choledocholithiasis After ERCP%化石利胆汤对ERCP术后胆总管结石患者CYP7A1和B-UGT影响研究

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    巩阳; 林一帆; 王长洪; 王立新; 麻树人; 陆宇平; 高文艳; 刘杨; 季芳

    2011-01-01

    目的:研究化石利胆汤对经逆行胰胆管造影术(Endoscopic Retrograde Cholan giopan creato graphy,ERCP)取石后的胆总管结石患者血液及胆汁中胆红素尿苷二磷酸葡萄糖醛酸基转移酶(bilirubin UDP glucronosy ltransferase,B-UGT)、胆固醇7α羟化酶(cholesterol 7 alpha hydroxylase,CYP7A1)的影响.方法:经ERCP 证实为胆总管结石并经(Endoscopic sphincterotomy,EST)、机械碎石、网篮球囊取石术等取石后的患者100例,随机分成服药组为常规西医治疗并口服化石利胆汤,对照组为术后只给予常规治疗,每组各50例.服药后第1天、第7天、1个月观察患者血CYP7A1、B-UGTmRNA的表达,及服药后第1天、第7天胆汁中CYP7Al、B-UGT的蛋白表达.结果:实验组服中药后血中CYP7AI、B-UGT mRNA及胆汁中CYP7A1、B-UGT蛋白表达较治疗前明显升高(P <0.05,对照组前后2基因及蛋白表达无变化.结论:化石利胆汤很可能足通过上调CYP7Al、B-UGT的mRNA及蛋白表达,抑制成石性胆汁的形成,从而起到治疗胆结石的作用.%Objective:To explore the effects of Huashilidan decoction on CYP7A1 ,B-UGT in choledocholithiasis after the treatment of ERCP. Method; One hundred patients with cholelithiasis undergoing ERCP and EST, were randomly divided into two groups, the control group and the huashilidan decoction, each group had fifty patients. The patients of control group were treated with the normal anti-inflammatory and rehydration therapy. The other was used with the huashilidan decoction. We scaled the genes skews of CYP7A1 ,B-UGT in the blood at the first day, the seventh day and the 30th day after the therapy; and scaled CYP7A1、B-UGT in the bile at the first day, the seventh day. Results: After the treatment, CYP7A1 ,B-UGT were greatly higher than those of the experiment group. But those of the control group didn' t change. Conclusion: Huashilidan decoction can reduce the rates of choledocholithiasis by intervene reglating the

  9. 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

  10. Embolia gasosa por dióxido de carbono durante cirurgia laparoscópica: relato de caso Embolia gaseosa por dióxido de carbono durante cirugía laparoscópica: relato de caso Carbon dioxide embolism during laparoscopic surgery: case report

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    Tania Berger

    2005-02-01

    fundamentales para una buena evolución del caso descrito.BACKGROUND AND OBJECTIVES: Carbon dioxide gas embolism is an uncommon but potentially lethal complication of laparoscopic surgery. Our report aimed at describing a case of pulmonary carbon dioxide embolism with favorable evolution. CASE REPORT: Hypertensive patient was submitted to laparoscopic surgery under general anesthesia due to cholelithiasis. After 150 minutes of pneumoperitoneum, patient developed tachycardia with severe hemodynamic deterioration, despite the use of vasopressor drugs. Arterial blood-gas revealed major difference between PaCO2 and P ET CO2. Carbon dioxide embolism was suspected and pneumoperitoneum was immediately deflated. Surgery was converted to a conventional technique. Patient has evolved with hemodynamic improvement and was extubated at surgery completion, being referred to post-anesthetic care unit (PACU. CONCLUSIONS: Early diagnosis and immediate treatment resulted in positive outcome in this case.

  11. 64-slice spiral CT diagnosis of juxtapapillary diverticulum of duodenum%64层螺旋CT在十二指肠乳头旁憩室中的诊断

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    陈穹; 王钢; 汪茂文; 钱春锋; 姚强; 路明; 汤友英

    2011-01-01

    目的 探讨64层螺旋CT在十二指肠乳头旁憩室(JDD)中的诊断价值.方法 回顾分析经64层螺旋CT扫描发现并经消化道造影或内窥镜逆行性胆胰管造影(ERCP)证实的JDD 34例,通过后处理软件进行多平面重建(MPR)、容积再现(VR),显示其与胆总管下端的关系,并结合临床进行分析.结果 34例JDD,共发现乳头上型19例,乳头缘型10例,乳头水平外侧缘型1例,乳头下型4例.34例JDD合并胆总管结石7例,胆总管下端炎性狭窄11例,胆囊结石7例,急性胆囊炎4例,慢性胆囊炎17例,合并急性胰腺炎1例,慢性胰腺炎2例,合并肝内胆管小结石3例.结论 64层螺旋CT强大的后处理功能,不仅使JDD的检出率明显提高,更可显示其与十二指肠乳头的关系,可对临床胆系疾病的发病原因提供有益的帮助.%Objective To explore the value of 64-slice spiral CT in the diagnosis of juxtapapillary diverticulum of duodenum (JDD). Methods CT data in 34 cases of JDD confirmed by gastrointestinal radiography or endoscopic retrograde cholangiopancre-atography(ERCP) were retrospectively analysed. The relationship between the diverticulum and distal common bile duct was showed with multiplanar reconstruction!MPR) and volume rendering ( VR) by post-processing software. Results Among 34 cases, there were 19 cases of papillary-superior, 10 cases of nipple-margin, 1 case of the lateral opposite of the papillary-margin and 4 cases of papillary-inferior. In 34 cases ,there were 7 cases in combination with common bile duct stones, 11 cases of distal common bile duct inflammatory stricture,7 cases of cholelithiasis, 4 cases of acute cholecystitis, 17 cases of chronic cholecystitis, 1 case of acute pancreatitis, 2 cases of chronic pancreatitis and 3 cases of intrahepatic bile duct calculus correspondingly. Conclusion 64-slice spiral CT post-processing technology can not only improve the detecting rate of JDD significantly, but also can display the relationship

  12. 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

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    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

  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. Comparison of the Efficacy of Different Glycaemic Control Methods for the Treatment of Patients with Diabetes Mellitus During Peroperative Period%不同血糖控制方法对糖尿病患者围手术期疗效的比较

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    周岩; 吴大方; 杨瑜莹

    2013-01-01

    [目的]比较采用胰岛素泵和诺和灵R笔芯与来得时笔芯(甘精胰岛素注射液)皮下注射CSⅡ、甘精胰岛素皮下注射联合口服降糖药两种方法对胆石症合并T2DM腹腔镜择期手术患者围手术期血糖控制和愈后的影响.[方法]胰岛素泵(A组)110例,胰岛素泵持续24 h皮下输入胰岛素的方式控制血糖;甘精胰岛素皮下注射(B组)123例,使用来得时笔芯及口服降糖药.[结果]A组患者在控制血糖达理想值所需平均时间、平均住院时间方面明显少于B组,组间差异显著(P<0.05),但降糖费用明显高于B组(P<0.05),平均总住院费用两组间无显著差异(P>0.05),两组患者低血糖发生率、抗生素使用时间等并发症相关因素指标以及血糖平稳程度,无显著差异(P>0.05).两组均无切口感染及酮症发生.[结论]两种方法控制围手术期病人血糖水平各有其长.甘精胰岛素联合口服药对围手术期患者的血糖控制安全、便捷,为T2DM患者围手术期血糖控制的理想方法之一.%[Objective] To compare the effect of two methods insulin pump CS Ⅱ vs glargine insulin injection combined with oral blood glucose lowering drugs on glycaemic control and prognosis of patients with cholelithiasis and type 2 diabetes mellitus(T2DM) during peroperative period of laparoscopy elective surgery. [Methods]Insulin pump CSⅡ group( n =110) received 24h continuous subcutaneous insulin injection through insulin pump for controlling blood glucose. Glargine insulin subcutaneous injection group( n =123) received Lantus cartridge and oral blood glucose lowering drugs. [Results] Mean time to reaching the ideal glucose value and average hospital day in patients of CSⅡ group were obviously lower than those in glargine insulin group, and there was significant difference between two groups( P 0. 05). There was no significant difference in the complication-related factors such as the incidence of hypoglycemia

  15. 胆道镜探查所致腹壁窦道相关并发症74例处理体会%Abdominal sinus-tract related complications and its treatment: A report of 74 cases

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    戴毅; 赵国刚

    2015-01-01

    Objective To explore complications and treatment of abdominal sinus-tract for choledochoscopic exploration. Methods The clinical data of 74 cases who have sinus-tract complications 76 times from January 2013 to December 2013 in Department of Hepatobiliary Surgery, Affiliated Suining Central Hospital of North Sichuan Medical College and Department of General Surgery, Affiliated Hospital of North Sichuan Medical College were analyzed retrospectively. Results Among 74 cases, there were 55 cases who's drainage were displaced by accident. Sinus-tract ruptured in 7 cases. Massive hamorrhage from sinus-tract occurred in 3 cases. Sinus-intestine fistula occurred in 4 cases. Stone was incarcerated in sinus-tract in 1 case. Sinus-tract was obviously tortuous in 3 cases. The angle between sinus-tract and lower bile tube was too small in 4 cases. Among 76 times, 56 times of sinus-tract were retained. Those patients had finished choledochoscopic exploration and stones extraction. A total of 20 times of sinus-tract had occlusion because of sinus related complication and the operation of choledochoscopic treatment was failed. One case was performed laparotomy due to bile peritonitis. Conclusion Abdominal sinus-tract related complications are important reasons which would cause interruption of postoperative choledochoscopy for biliary stone extraction. Certain procedures could take to retain sinus-tract and to complete cholelithiasis treatment. But,prevention is more important than treatment.%目的 探讨胆道镜探查所致腹壁窦道相关并发症的发生及其处理.方法 回顾性分析2013年1-12月遂宁市中心医院肝胆科和川北医学院附属医院普外科行胆道镜探查发生腹壁窦道并发症的74例(76例次)病人临床资料.结果 74例中,引流管意外脱出55例,窦道破裂7例,窦道出血3例,窦道小肠瘘4例,结石窦道内嵌顿1例,窦道严重迂曲3例,窦道与下段胆管成角过小4例.76例次中,56例次经过处理后恢复

  16. Colecistectomía laparoscópica ambulatoria: Reporte preliminar de 100 casos

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    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.

  17. 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

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    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

  18. 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

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    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

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

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    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

  20. 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。

  1. Tratamento laparoscópico de coledocolitíase Laparoscopic treatment of common bile duct lithiasis

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    Marcel Autran C. MACHADO

    2000-07-01

    Full Text Available Paciente com história de 18 meses de emagrecimento e icterícia foi encaminhado ao Serviço de Cirurgia Abdominal do Hospital do Câncer, São Paulo, SP., com hipótese diagnóstica de câncer de cabeça de pâncreas. Exames laboratoriais mostraram elevação de bilirrubinas e de enzimas canaliculares. Ultra-sonografia abdominal revelou dilatação de via biliar intra e extra-hepática. Tomografia computadorizada mostrou árvore biliar dilatada com presença de cálculo de cerca de 3 cm em colédoco distal. O paciente foi submetido a colecistectomia com coledocotomia, retirada do cálculo e anastomose colédoco-duodenal por laparoscopia. Evoluiu sem intercorrências, recebendo alta no sexto dia de pós-operatório. Conclui-se que o tratamento laparoscópico da coledocolitíase é factível em alguns pacientes, especialmente naqueles com dilatação de via biliar. A retirada de cálculos deve ser seguida de procedimento de drenagem da via biliar com dreno de Kehr. Em alguns pacientes com colédoco cronicamente dilatado, como o do presente caso, a anastomose colédoco-duodenal é o procedimento de escolha.With the advances of videolaparoscopic surgery, this approach had become the treatment of choice for cholelithiasis. However, about 5% to 10% may present common bile duct lithiasis. Most surgeons have still difficulties to deal with this situation and do prefer resolve with open surgery or with further endoscopic approach. We present a case of a 60-year-old man, with 18 months history of right upper quadrant pain, weight loss and jaundice. He was referred with diagnostic of pancreatic cancer. Laboratory investigation showed increased bilirrubin (10 mg/dL, alkaline phosphatase and GGT. Abdominal ultrasound showed atrophic gallbladder with dilated intra and extrahepatic biliary tree. Computerized tomography scan disclosed enlarged biliary tree with 3 cm stone in the distal common bile duct. The patient underwent a laparoscopic cholecystectomy

  2. 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

  3. Clinical analysis of laparoscopic cholelithotomy and polypectomy of gallbladder for pilots—7 cases attached%飞行人员腹腔镜保胆取石术和息肉切除术临床分析——附七例临床病例

    Institute of Scientific and Technical Information of China (English)

    徐新保; 张洪义; 张辉; 刘承利; 肖梅; 张宏义; 冯志强

    2012-01-01

    Objective To discuss the operative indication,methods and therapeutic effect of treating the cholecystolithiasis and polyps by laparoscopic cholelithotomy and polypectomy for pilots,and to study the effects of treatment on pilot's career.Methods The clinical data of 7 pilots with cholelithiasis and cholecystic polyps,who were treated by laparoscopic cholelithotomy and polypectomy in the period from Apr.2011 to Apr.2012,were analyzed.Four cases out of 7 pilots were the only cholecystolithiasis,including 3 cases of single stone and 1 case of multiple stones.One simple cholecystic polyps case was the cholecystic cholesterol polyps.Two cases were the combination of cholecystolithiasis and cholecystic cholesterol polyps.In all cases,the bottoms of the gallbladders were incised by electrosurgical hook to remove all stones and polyps.The incisions were continuously sutured with 4-0 prolene in 3 cases,and other 4 cases were interruptedly or continuously sutured with 3-0 absorbable lines.Choledochoscope or laparoscope was used to supervise the clearance of stone and polyps.All pilots were temporally grounded and observed for 1-3 months.Results All cases were successfully treated and no further celiotomy was needed to them.The operation time was 80-150 min and pilots' hospitalized stay was 3-7 d.All pilots recovered smoothly.In 3 to 18 months follow up for all pilots,no stone or polyp recurrence was found.Five pilots were qualified for flying while the other 2 were still in observation respectively due to vascular headache and cervical spondylosis.Conclusions Laparoscopic cholelithotomy and polypectomy can preserve gallbladder function,be in favor of maintaining normal digestive function and be beneficial to pilot's recovery for flying.%目的 探讨腹腔镜下飞行人员保胆取石和取息肉的手术适应证、方法和疗效以及对飞行人员术后复飞影响. 方法 2011年4月-2012年4月的7例飞行人员行腹腔镜下保胆取石和取息

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

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    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.

  5. Experience outline of 65 cases of laparoscopic cholelithotomy%腹腔镜保胆取石术65例体会

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

    目的 总结腹腔镜下保胆取石术的经验.方法 65例胆囊结石患者,其中胆囊结石合并肝硬化2例,合并肝硬化伴肝癌2例,合并直肠癌术后肝转移1例,合并遗传性球形红细胞增多症及严重脾功能亢进1例;胆囊结石伴急性胆囊炎5例.63例患者行胆囊底部切开取石术,2例行胆囊颈部切开取石术.术中使用胆道镜25例.术后放置腹腔引流管16例.术后服用利胆药物者55例,服药时间为1周至1个月.结果 64例患者手术获得成功,1例术后第5天因胆囊切口裂开漏胆而行腹腔镜胆囊切除术.1例颈部切开取石患者术后出现上腹疼痛,腹腔引流管每天引出约15ml淡黄色腹水,考虑少量胆漏所致,术后5d腹痛缓解,腹腔引流管无液体引出,拔除腹腔引流管后无不适.其余患者术后均恢复顺利.所有患者均获随访,随访3~42个月,其中1例于术后12个月胆囊内复发少量泥沙样结石,给予利胆排石药物治疗1个月后复查腹部超声显示胆囊结石消失.结论 腹腔镜下保胆取石术保留了胆囊及胆囊功能,有利于维护患者消化系统的正常功能.只要胆囊大小基本正常、胆囊壁增厚不明显、胆囊功能基本正常,并且患者及家属保胆愿望强烈,均可进行腹腔镜保胆取石术.%Objective To summarize the experience of 65 cases of laparoscopic cholelithotomy. Methods The clinical data of 65 patients with cholelithiasis treated by laparoscopic cholelithotomy between Jan. 2009 and Feb. 2012 were analyzed. Among them,2 cases were combined with liver cirrhosis,2 cases were with primary hepatocellular carcinoma, 1 with liver metastases from rectal cancer, 1 with hereditary spherocytosis and severe hypersplenism, and 5 with acute cholecystitis. Choledochoscope was used in 25 cases during operation. Celiac drainage tube was placed in 16 cases during operation. Choleretic drugs were administrated on 55 cases for 1-4 weeks after operation. Results The

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

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    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

  7. 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

  8. 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

  9. 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.

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

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    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

  11. 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

  12. 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

  13. 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

  14. MRCP对黏胆症术前诊断及术式选择的价值%Value of MRCP in the diagnosis and treatment planning of mucobilia

    Institute of Scientific and Technical Information of China (English)

    俞顺; 严茂林; 陈德周; 包强

    2015-01-01

    mucobilia..Methods The clinical records and MRCP of 11 patients with pathologically confirmed mucobilia were retrospectively analyzed..MRCP features including asymmetric intra-hepatic bile duct dilatation,.interruption of the extra-hepatic bile duct, hypointense bile duct lesion, intra-and extrahepatic bile duct stone were compared between 11 patients (5 men and 6 women) with mucobilia and 20 patients with cholelithiasis and cholangitisusing theFisher exact test. Results Fluctuating jaundice with recurrent episodes of fever and right upper quadrant abdominal pain was the most common manifestation of mucobilia. There was history of previous biliary tract surgery in 8 patients. The frequency of asymmetric intra-hepatic bile duct dilatation (11, 5), interrupted bile duct (0, 8), and hypointense bile duct lesion (8, 3) in mucobilia and gallstone cholangitis, respectively was significantly different (P=0.000, 0.045, 0.005). Intra- and extra-hepatic bile duct stone was detected in 8/11patients with mucobilia, not significantly different from the 16/20 patients with gallstone cholangitis (P=0.117). All patients with mucobilia underwent surgery including left hepatectomy for tumors in the proximal left lateral segmental duct (2), left hepatectomy with extra-hepatic bile duct resection and Roux-en-Y anastomosis for tumors in the bifurcation of left lateral and medial segmental ducts (2), or palliative biliary drainage for tumors in the left proximal hepatic duct near the porta hepatis (7). Conclusion The MRCP signs of mucobilia, mainly include asymmetric intra-hepatic bile duct dilatation, no sudden interruption of the extra-hepatic bile duct, signal of Bile duct lesion is relatively low. MRCP might be an effective means for the assessment of lesion extension and is helpful for selection of operation.

  15. 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

    Directory of Open Access Journals (Sweden)

    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

  16. 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

    Directory of Open Access Journals (Sweden)

    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.