Clinical comparison of two contrast agents for oral cholecystography: radiologic efficacy and drug safety of iopanoic acid and iopronic acid.
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Oral doses of either iopronic acid (4.5 g Oravue, Squibb) or iopanoic acid (3 g Telepaque, Winthrop) were given to 98 patients requiring cholecystography. Radiographs were taken 13 to 16 hours after treatment showed good to excellent gallbladder opacification in 44 percent of patients after the first dose of iopronic acid and in an additional 29 percent after a second dose. Similar opacification occurred in 42 percent of patients after the first dose of iopanoic acid and in 34 percent after a second dose. Drug-related abnormalities in blood and urine tests occurred about equally in both groups and one patient in each group exhibited a clinically adverse reaction (diarrhea). Thus, the performance (radiographic efficacy and drug safety) of the new contrast agent, iopronic acid, was similar to a widely used drug, iopanoic acid. (+info)
Reliability of pre- and intraoperative tests for biliary lithiasis.
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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. (+info)
Sonographic diagnosis of bicameral gallbladders: a report of three cases.
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Three cases of bicameral gallbladder are reported; the fundal chamber could be visualized by oral cholecystography in only one of these cases. However, all structures were well visualized sonographically. Ultrasonography is thus regarded as essential for the diagnosis of bicameral gallbladders and for detecting any calculi within them. (+info)
Elevated cholecystokinin-like activity in the duodenal mucosa in patients with cholecystolithiasis.
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Cholecystokinin (CCK)-like activities in the duodenal mucosa of the patients with cholecystolithiasis were determined with the bioassay method we established. The results obtained are as follows: The gall bladder of the patients with cholecystolithiasis following oral administration of egg yolk has contraction rates comparable to those of the normal subjects in the control group, whereas the contraction rate of the gall bladder of the patients with cholecystolithiasis following administration of caerulein was markedly lower than that of the normal subjects in the control group. The variations in the contraction of the gall bladder in time lapse following administration of caerulein to the patients with cholecystolithiasis strongly denied the possibility of either insufficient release of CCK or accelerated dissimilation of CCK in those patients. Based on the above findings, it was concluded that the sensitivity of the gall bladder to CCK decreases in the patients with cholecystolithiasis and that, in order to replenish it, the feed-back mechanism reacts to sufficiently promote the production of CCK in the duodenal mucosa. The similar mechanism was noted in the variations of the findings of normal subjects as age advanced. (+info)
Iodine contamination of the serum protein-bound iodine: incidence and clinical significance.
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Iodine contamination as defined by the combination of a raised (PBI-T(4)I) difference and low (131)I neck uptake was found in 38 (17.5%) of 217 euthyroid patients. Of these, 17 had PBI levels of greater than 20 mug/dl but in the remainder levels were clinically feasible. In only 21 was there a history of exposure to iodine. Two of 12 hypothyroid patients had PBI levels well within normal limits. False elevation of the PBI is thus shown to be common. It is neither always obvious nor can it be easily avoided. The PBI is not an acceptable alternative to T(4) estimation by other methods. (+info)
Gilbert's syndrome in patients with gallbladder stones.
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Patients with Gilbert's syndrome suffer from an abnormality which makes them jaundiced from time to time. A number also develop gallstones and come to cholecystectomy. If this condition has not been recognized these patients may subsequently run the risk of unnecessary operations on their bile ducts from the mistaken assumption that the intermittent episodes of jaundice which are a feature of the syndrome are due to a stone which has been left behind. Such a case history is reported here.In an attempt to determine how frequently these conditions coexist a prospective study was carried out on patients about to undergo cholecystectomy for stones in the gallbladder. Gilbert's disease was found to be present in 2 of 67 males (3.2% +/- 0.8%) but not in 184 females. Hence it seems that about 1 in every 30 males subjected to cholecystectomy may be expected to have this abnormality.It is suggested that this places an obligation on the clinician to have liver function tests done on at least two occasions preoperatively in male patients with cholelithiasis in an attempt to detect this abnormality and avoid this surgical pitfall. (+info)
Early cholecystectomy for acute cholecystitis.
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A series of 65 cases of acute cholecystitis from among 500 patients on whom cholecystectomy was performed by the author is presented. Early cholecystectomy was the operation of choice in 63 and cholecystostomy in two. The operative mortality for cholecystectomy was 1.6%; the postoperative morbidity was low and there were no serious complications such as common bile duct injury or biliary fistula. Operation for acute cholecystectomy is recommended within 48 hours of diagnosis to avoid serious complications such as perforation and suppurative cholangitis. (+info)
Acute emphysematous cholecystitis.
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Acute emphysematous cholecystitis is an uncommon condition caused by gas-forming organisms and characterized by the presence of gas in the wall and lumen of the gallbladder. Its incidence is higher among male diabetics. AEC in an elderly North American diabetic man with Indian ancestry is reported with a brief review of the world literature. The diagnosis was made preoperatively with the aid of plain radiographic films of the abdomen. A gangrenous distended gallbladder was removed at operation. Clostridium perfringens was cultured from the gallbladder contents and wall. If AEC is suspected, intensive antimicrobial therapy and fluid and electrolyte replacement should be given prior to early surgical intervention. (+info)