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Gajdošík M, Chmelík M, Halilbasic E, Pfleger L, Klepochová R, Trauner M, Trattnig S, Krššák M. In Vivo 1 H MR Spectroscopy of Biliary Components of Human Gallbladder at 7T. J Magn Reson Imaging 2020; 53:98-107. [PMID: 32501627 PMCID: PMC7754442 DOI: 10.1002/jmri.27207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Previous in vivo proton MR spectroscopy (MRS) studies have demonstrated the possibility of quantifying amide groups of conjugated bile acids (NHCBA), olefinic lipids and cholesterol (OLC), choline-containing phospholipids (CCPLs), taurine and glycine conjugated bile acids (TCBA, GCBA), methylene group of lipids (ML), and methyl groups of bile acids, lipids, and cholesterol (BALC1.0, BALC0.9, and TBAC) in the gallbladder, which may be useful for the study of cholestatic diseases and cholangiopathies. However, these studies were performed at 1.5T and 3T, and higher magnetic fields may offer improved spectral resolution and signal intensity. PURPOSE To develop a method for gallbladder MRS at 7T. STUDY TYPE Retrospective, technical development. POPULATION Ten healthy subjects (five males and five females), two patients with primary biliary cholangitis (PBC) (one male and one female), and one patient with primary sclerosing cholangitis (PSC) (female). FIELD STRENGTH/SEQUENCE Free-breathing single-voxel MRS with a modified stimulated echo acquisition mode (STEAM) sequence at 7T. ASSESSMENT Postprocessing was based on the T2 relaxation of water in the gallbladder and in the liver. Concentrations of biliary components were calculated using water signal. All data were corrected for T2 relaxation times measured in healthy subjects. STATISTICAL TESTS The range of T2 relaxation time and concentration per bile component, and the resulting mean and standard deviation, were calculated. RESULTS The concentrations of gallbladder components in healthy subjects were: NHCBA: 93 ± 66 mM, OLC: 154 ± 124 mM, CCPL: 42 ± 17 mM, TCBA: 48 ± 35 mM, GCBA: 67 ± 32 mM, ML: 740 ± 391 mM, BALC1.0: 175 ± 92 mM, BALC0.9: 260 ± 138 mM, and TBAC: 153 ± 90 mM. Mean concentrations of all bile components were found to be lower in patients. DATA CONCLUSION This work provides a protocol for designing future MRS investigations of the bile system in vivo. EVIDENCE LEVEL 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Martin Gajdošík
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
- Department of Biomedical EngineeringColumbia University Fu Foundation School of Engineering and Applied ScienceNew YorkNew YorkUSA
| | - Marek Chmelík
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Faculty of HealthcareUniversity of PrešovPrešovSlovakia
- Department of RadiologyGeneral Hospital of LevočaLevočaSlovakia
| | - Emina Halilbasic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Lorenz Pfleger
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Radka Klepochová
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Medical University of Vienna, Christian Doppler Laboratory for Clinical Molecular ImagingMOLIMAViennaAustria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Siegfried Trattnig
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Medical University of Vienna, Christian Doppler Laboratory for Clinical Molecular ImagingMOLIMAViennaAustria
| | - Martin Krššák
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
- Medical University of Vienna, Christian Doppler Laboratory for Clinical Molecular ImagingMOLIMAViennaAustria
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Yang CB, Zhang S, Jia YJ, Duan HF, Ma GM, Zhang XR, Yu Y, He TP. Clinical Application of Dual-Energy Spectral Computed Tomography in Detecting Cholesterol Gallstones From Surrounding Bile. Acad Radiol 2017; 24:478-482. [PMID: 27916593 DOI: 10.1016/j.acra.2016.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 01/23/2023]
Abstract
RATIONALE AND OBJECTIVE This study aimed to investigate the clinical value of spectral computed tomography (CT) in the detection of cholesterol gallstones from surrounding bile. MATERIALS AND METHODS This study was approved by the institutional review board. The unenhanced spectral CT data of 24 patients who had surgically confirmed cholesterol gallstones were analyzed. Lipid concentrations and CT numbers were measured from fat-based material decomposition image and virtual monochromatic image sets (40-140 keV), respectively. The difference in lipid concentration and CT number between cholesterol gallstones and the surrounding bile were statistically analyzed. Receiver operating characteristic analysis was applied to determine the diagnostic accuracy of using lipid concentration to differentiate cholesterol gallstones from bile. RESULTS Cholesterol gallstones were bright on fat-based material decomposition images yielding a 92% detection rate (22 of 24). The lipid concentrations (552.65 ± 262.36 mg/mL), CT number at 40 keV (-31.57 ± 16.88 HU) and 140 keV (24.30 ± 5.85 HU) for the cholesterol gallstones were significantly different from those of bile (-13.94 ± 105.12 mg/mL, 12.99 ± 9.39 HU and 6.19 ± 4.97 HU, respectively). Using 182.59 mg/mL as the threshold value for lipid concentration, one could obtain sensitivity of 95.5% and specificity of 100% with accuracy of 0.994 for differentiating cholesterol gallstones from bile. CONCLUSIONS Virtual monochromatic spectral CT images at 40 keV and 140 keV provide significant CT number differences between cholesterol gallstones and the surrounding bile. Spectral CT provides an excellent detection rate for cholesterol gallstones.
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Affiliation(s)
- Chuang-Bo Yang
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road #-2, Xianyang, 712000, China
| | - Shuang Zhang
- Department of Basic Chemicals, School of Medicine, Shaanxi Institute of International Trade & Commerce, Xi'an, 712046, China
| | - Yong-Jun Jia
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road #-2, Xianyang, 712000, China
| | - Hai-Feng Duan
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road #-2, Xianyang, 712000, China
| | - Guang-Ming Ma
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road #-2, Xianyang, 712000, China
| | - Xi-Rong Zhang
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road #-2, Xianyang, 712000, China
| | - Yong Yu
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road #-2, Xianyang, 712000, China
| | - Tai-Ping He
- Department of Diagnostic Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Weiyang western road #-2, Xianyang, 712000, China.
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Li SY, Huang P, Cosgrove D, Xu H, Xu LL, Liang X, Cai XJ. Pseudoenhancement of Gallbladder Sludge: A Confusing Artifact Caused by Nonlinear Propagation of Ultrasound Through Microbubbles. Ultraschall Med 2016; 37:307-309. [PMID: 26882481 DOI: 10.1055/s-0041-107995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Hill PA, Harris RD. Clinical Importance and Natural History of Biliary Sludge in Outpatients. J Ultrasound Med 2016; 35:605-610. [PMID: 26903661 DOI: 10.7863/ultra.15.05026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/09/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Gallbladder sludge is a common diagnosis on routine abdominal sonography, yet its clinical importance is uncertain, especially in outpatients. To determine its natural history and potential future complications in this setting, we reviewed the imaging and clinical histories of nonhospitalized patients with a diagnosis of sludge on sonography. METHODS We conducted a retrospective search of our institutional radiology information system for all sonographic reports using the key words "biliary sludge without gallstones" over a 3-year period. For each of the 104 patients with isolated biliary sludge on initial sonography, we reviewed the electronic medical records and all imaging for the development of pancreaticobiliary complications. RESULTS We found an overall prevalence of biliary sludge in outpatients of 1.8%. Of the 104 patients reviewed with a mean follow up of 630 days (21 months), 25 developed a pancreaticobiliary complication, including cholelithiasis, cholecystitis, choledocholithiasis, and pancreatitis. The most frequent complication was cholecystitis, with a total of 14 diagnoses (12 chronic acalculous and 2 acute with gallstones). An additional 6 patients developed gallstones without cholecystitis features; 4 patients developed pancreatitis; and 1 developed choledocholithiasis. Biliary sludge remained quiescent or resolved in 76% of patients. CONCLUSIONS Biliary sludge always represents a pathologic process, but its clinical implications among outpatients have not been previously investigated. Our ambulatory population developed pancreaticobiliary complications at similar rates as prior mixed-patient setting studies. Regardless of the patient setting, biliary sludge is likely of more clinical importance than previously regarded.
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Affiliation(s)
- Paul Armstrong Hill
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA.
| | - Robert D Harris
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA
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Selezneva EY, Mechetina TA, Orlova YN, Koricheva ES, Voinovan IN, Bezaeva IV, Dubtsova EA, Bordin DS. COMPARATIVE RESEARCH OF EFFICACY OF MONOTHERAPY WITH UDCA AND THE COMBINATION OF UDCA GIMEKROMONOM C IN PATIENTS WITH BILIARY SLUDGE2 STAGES. Eksp Klin Gastroenterol 2016:94-98. [PMID: 29889382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED Aim of research: Evaluate clinical advantages of combined therapy using Ursodeoxycholic acid (UDCA) with spasmolytic of patients with second stage biliary sludge (BS) - in a form of echo-heterogeneous bile containing clots. MATERIALS AND METHODS 42 patients with 2nd stage BS were examined. 1st group (21 patients) was treated by UDCA monotherapy, 2,d group (21 patients) received combined therapy: UDCA with Hymecromone for 4 weeks. 4 week later, clinical and echographical assessment of the therapy provided was conducted. RESULTS patients who received the combined therapy had more expressed decrease of pain syndrome in the right hypochondrium than those who received the monotherapy. During the study of gallbladder contraction function (GCF) any reliable evidence of its change wasn't found in both groups, thus the combined therapy (UDCA + Hymecromone) does not increase GCF. According to ultrasonography, an improvement of gallbladder content (transition from the 2nd stage BS to the 1st and reduction of an amount and size of clots and suspension) was observed in 81% patients from the Ist group (UDCA), and in 95% patients from the 2nd group (UDCA + Hymecromone). CONCLUSION research data show increased effectiveness of treatment of patients with 2nd stage BS while using the combi- nation of UDCA and Hymecromone.
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Krzemień G, Książczyk T, Szmigielska A, Bombiński P, Roszkowska-Blaim M, Werner B, Brzewski M. Ceftriaxone-associated acute gallbladder enlargement - an unexpected diagnosis in the child with urinary tract infection. Dev Period Med 2015; 19:182-185. [PMID: 26384120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Biliary sludge and/or biliary pseudolithiasis occur in patients treated with ceftriaxone with prevalence of 3-57%. Biliary obstruction can be the cause of the acute gallbladder enlargement. It is a minor complication, that usually does not give clinical symptoms and resolves once the drug is discontinued. The authors present a case of a 5-month old boy treated for the acute pyelonephritis. Routine ultrasound, performed on the 5th day of treatment with ceftriaxone, showed gallbladder enlargement. In the consecutive studies small gallblader sludge was visible. Patient had no symptoms related to the gallbladder enlargement. Ultrasound performed 6 weeks from the drug discontinuation was completely normal. CONCLUSIONS Patients treated with ceftroiaxone should be monitored for biliary sludge and pseudolithiasis.
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Affiliation(s)
- Grażyna Krzemień
- Department of Pediatrics and Nephrology, The Medical University of Warsaw, Poland
| | - Tomasz Książczyk
- Department of Pediatrics and Cardiology, The Medical University of Warsaw, Poland
| | | | | | | | - Bożena Werner
- Department of Pediatrics and Cardiology, The Medical University of Warsaw, Poland
| | - Michał Brzewski
- Department of Pediatrics Radiology, The Medical University of Warsaw, Poland
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Wen F, Lu Z, Mao X, Liang H, Guo Q. Bridging across the ampulla with metal stents: evidences for intestinal bile reflux. Hepatogastroenterology 2013; 60:1903-1905. [PMID: 24719925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIMS To investigate the early intestinal bile reflux following the implantation of metal stent across the ampulla and the mechanism of reflux cholangitis. METHODOLOGY Twenty-three patients with implantation of metal stent across the ampulla were recruited. Prior to the implantation, the white blood cell count, neutrophil percentage, total blood bilirubin, direct bilirubin and the trypsin content in the bile were recorded; 2-5 days after implantation these indices were measured again, as well as the 99mTc -DTPA radioactivity. RESULTS A high percentage (82.61%) of patients showed 99mTc in the bile in 2 hours, which accounts for 1.73% of total intake. In 4 cases the radioactivity was not found. Bile lipase and amylase levels were significantly higher than that in prior to the stent implantation. There were no changes in the white blood cell count and neutrophil percentage after stent implantation. Additionally, the total blood bilirubin and direct bilirubin decreased. CONCLUSIONS After the implantation of metal stent across the ampulla, there is evidence for the early intestinal bile reflux, without signs for the reflux cholangitis.
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Affiliation(s)
- Yasuyuki Tamai
- Department of Gastroenterology, Matsusaka Chuo General Hospital, Japan.
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Ivanchenkova RA, Egorov AV, Leonovich AE, At'kova ER. [Innovations in the diagnosis and treatment of cholelithiasis]. Eksp Klin Gastroenterol 2012:66-73. [PMID: 23402157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM To determine the density of densitometric gallstones and biliary sludge in order to clarify the possibility of lithotherapy in patients with gallstone disease (GSD). MATERIALS AND METHODS 70 patients were carried out a comprehensive clinical examination with determination of densitometric density of gallstones and/or biliary sludge by means of computer tomography (CT), ultrasound of the abdomen, biochemical blood analysis. Assigned to the complex lithotherapy (Ursofalk and Kholit) in standard dosages, the results were evaluated in a year. RESULT It was found that the density of bile in patients with GSD was ranging from +4 to +10 HU, sludge - +17,5 HU, gall stones - over +20 HU. The main factor of the exoediency of conservative therapy of GSD is to determine the density of gallstone by CT, which should not exceed +54 HU (+29,6 +/- 3,4 HU). Visualization of stones on CT is much higher (30%) than in Rg (10%), and its density is observed at more than +75,0 HU. Sludge particle less than 2.0 mm, but having a density more than +20,0 HU, should be viewed as a gallstone. Kholit, a herbal medicine, improves functional and structural indicators of biliary tract, digestive processes of cavity, and may be recommended as a monotherapy in stage I of GSD, as well as a component of combination therapy of cholelithiasis.
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Filimonov RM, Korotkova DI, Buslavskaia IO, Filimonova TR. [The application of sinusoidal modulated currents for the treatment of biliary sludge in an outpatient clinic]. Vopr Kurortol Fizioter Lech Fiz Kult 2011:21-23. [PMID: 22403950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The objective of the present study was to evaluate therapeutic effects of sinusoidal modulated currents (SMC) applied for the treatment of patients at different stages of biliary sludge (BS) under conditions of an outpatient clinic. Biliary sludge is currently considered to be a precursor of cholelithiasis known to be a leading pathology of the digestive system responsible for the high surgery rate. It was shown that the introduction of the technique based on sinusoidal modulated currents into the clinical practice of an outpatient clinic increases the efficacy of management of the patients presenting with stage 1 and 2 biliary sludge and showing neither well-apparent clinical symptoms nor signs of metabolic disorders that imply the necessity of more thorough examination and combined application of sinusoidal modulated currents and mediacmental therapy.
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Trna J, Vege SS, Pribramska V, Chari ST, Kamath PS, Kendrick ML, Farnell MB. Lack of significant liver enzyme elevation and gallstones and/or sludge on ultrasound on day 1 of acute pancreatitis is associated with recurrence after cholecystectomy: a population-based study. Surgery 2011; 151:199-205. [PMID: 21975288 DOI: 10.1016/j.surg.2011.07.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 07/06/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND In a population-based study, we examined recurrence rates of acute pancreatitis (AP) after cholecystectomy performed to prevent recurrences of AP. METHODS We abstracted data from medical records of all Olmsted county residents who underwent cholecystectomy at Mayo Clinic for the management of presumed gallstone or idiopathic AP between 1990 and 2005 (n = 239). Based on (i) significantly elevated liver enzymes (≥threefold increase of alanine aminotransferase or aspartate aminotransferase) on day 1 and (ii) the presence of gallstones/sludge in the gall bladder, we categorized patients into 4 groups: A (i + ii), B (i but not ii), C (ii but not i), and D (neither i nor ii). Recurrence rates of AP after cholecystectomy were determined in all groups. RESULTS The median follow-up after cholecystectomy was 99 months (range, 8-220). AP recurred in 13 of 142 patients (9%) in group A, 1 of 17 patients (6%) in group B, 13 of 57 patients (23%) in group C, and 14 of 23 patients (61%) in group D (P < .0001 D vs. all other groups and P = .001 C vs. groups A and B). No difference was seen in recurrence rates in groups A vs. B (P = 1.0). Recurrences were more frequent in patients with normal liver enzymes (A + B vs. C + D; P = .000003) and in patients without sonographic evidence of gallstones/sludge (A + C vs. B + D; P = .0008). CONCLUSION When AP is associated with significantly elevated liver enzymes on day 1, recurrence rates after cholecystectomy are low (9%). However, postcholecystectomy recurrence rates of AP are high in those without such laboratory abnormalities (34%), especially in those without gall bladder stones/sludge (61%) on abdominal ultrasonography. Our results raise doubts about the efficacy of cholecystectomy to prevent recurrent AP in patients with the absence of either a significant elevation of liver tests on day 1 of AP or gallstones and/or sludge in the gall bladder on initial ultrasound examination.
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Affiliation(s)
- Jan Trna
- Department of Internal Medicine and Hepatogastroenterology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Moshkivs'kyĭ HI. [Ultrasonographic diagnosis and characteristic of postoperative accumulations of a liquid]. Klin Khir 2010:23-26. [PMID: 21090358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Ultrasonographic semiotics of extraorgan localized postoperative accumulations of a liquid occurring after performance of interventions on a liver was studied up. There was established the dependence of their localization on the operation kind. The differential diagnosis algorithm of some pathologic conditions (haematoma, biloma, seroma) was elaborated.
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Kara T, Akpinar E, Sarikaya B, Dagoglu G, Akhan D. Bile sludge that mimics hydatid cyst membranes: a potential pitfall for ultrasound. J Gastrointestin Liver Dis 2010; 19:126. [PMID: 20593042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Taylan Kara
- Department of Radiology, Beykehim Hospital, Selcuklu, Konya
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Lotfi M, Keramati P, Assdsangabi R, Nabavizadeh SA, Karimi M. Ultrasonographic assessment of the prevalence of cholelithiasis and biliary sludge in beta-thalassemia patients in Iran. Med Sci Monit 2009; 15:CR398-CR402. [PMID: 19644415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Thalassemia is a hereditary disease related to hemoglobin synthesis. The aim of this study was to determine the prevalence of gallbladder sludge and stones in beta-thalassemic children. MATERIAL/METHODS One hundred fifty-three beta-thalassemia patients on a long-term transfusion/chelation program were selected by a cluster randomized method and were evaluated ultrasonographically for the presence of sludge and biliary lithiasis. Relationships between the prevalence of gallbladder sludge and stones with age, sex, age at the start and the frequency of transfusion, mean pretransfusion Hb and ferritin levels, age at start of deferoxamine injection, splenectomy, and degree of splenomegaly were evaluated statistically. RESULTS Gallstones and biliary sludge were detected in 12.4% and 13.1% of the patients, respectively. There was a significant increase in the prevalence of gallstones with increasing age, transfusion periods of <21 days, severe splenomegaly, splenectomy, and deferoxamine injection started after 5 years of age. Such a relationship was not detected for hemoglobin and ferritin levels. Multiple logistic regression analysis revealed that the frequency of transfusions and age at the start of deferoxamine injections were the only positive factors that predicted the subsequent development of gallstones. CONCLUSIONS Longer survival of beta-thalassemic patients leads to a higher prevalence gallbladder sludge and stones. Therefore a proper follow-up of patients with abdominal ultrasonography and improving the transfusion/chelation program should be mandatory.
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Affiliation(s)
- Mehrzad Lotfi
- Department of Radiology, Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. lotfi
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Jamry A. [Diagnosis of biliary leakage after laparoscopic cholecystectomy in aspect of indication to endoscopic treatment]. Pol Merkur Lekarski 2009; 26:153-155. [PMID: 19388524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Clinically significant biliary leak (BL) following laparoscopic cholecystectomy (LCH) occurs in fewer than 5% patients, nevertheless, due to nonspecific symptoms and low diagnostic accuracy in commonly available imaging modalities, may constitute a diagnostic problem. Penetration of pure bile to peritoneal cavity does not product specific symptoms and signs and can be detected by sonography only in 58% patients. In addition, distinguishing between bile and other fluid is possible only by cholescintigraphy (CS). Thus, accurate diagnosis in early postoperative period may be difficult and may delay adequate treatment. Because of that, despite the current tendency to avoid drainage after elective LCH, it appears to be a simple method for early detection of the above pathology and determining of need for endoscopic retrograde cholangiopancreatography (ERCP).
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Affiliation(s)
- Andrzej Jamry
- District Hospital in Starachowice, Endoscopic Department, Poland.
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Il'chenko AA. [Clinical significance of biliary sludge]. TERAPEVT ARKH 2009; 81:41-43. [PMID: 19253708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Boëchat MCB, Silva KSD, Llerena JC, Boëchat PRM. Cholelithiasis and biliary sludge in Downs syndrome patients. SAO PAULO MED J 2007; 125:329-32. [PMID: 18317602 PMCID: PMC11020560 DOI: 10.1590/s1516-31802007000600005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 11/07/2007] [Accepted: 11/14/2007] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Although studies have demonstrated increased frequency of gallbladder abnormalities among Downs syndrome (DS) patients in some countries, there is only one paper on this subject in the Brazilian literature. The aim of this study was to demonstrate the prevalence, clinical characteristics and evolution of lithiasis and biliary sludge among DS patients in a maternity and childrens hospital in Rio de Janeiro. DESIGN AND SETTING This was a cross-sectional study followed by a retrospective cohort study on all individuals with an ultrasound diagnosis of gallbladder abnormalities. METHODS 547 DS patients (53.2% male, 46.8% female) attending the Instituto Fernandes Figueira in 2001 underwent abdominal ultrasound examination at ages of between one day and three years (mean: five months). Clinical and ultrasound data were analyzed. RESULTS In 50 patients (9.1%), the ultrasound demonstrated gallbladder abnormalities (6.9% lithiasis and 2.1% biliary sludge). Spontaneous resolution was observed in 66.7% of the patients with biliary sludge and 28.9% with lithiasis. Cholecystectomy was carried out on 26.3% of the patients with gallstones. CONCLUSION The results from this study and comparison with the literature suggest that DS patients are at risk of developing lithiasis and biliary sludge and should be monitored throughout the neonatal period, even if there are no known risk factors for gallstone formation. Most frequently, these gallbladder abnormalities occur without symptoms and spontaneously resolve in most non-symptomatic patients. DS patients should be monitored with serial abdominal ultrasound, and cholecystectomy is indicated for symptomatic cases or when cholecystitis is present.
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Soysal A, Eraşov K, Akpinar I, Bakir M. Biliary precipitation during ceftriaxone therapy: frequency and risk factors. Turk J Pediatr 2007; 49:404-407. [PMID: 18246742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Ceftriaxone, a third-generation cephalosporin, is widely used for treating infection during childhood. It is mainly eliminated in the urine, but approximately 40% of a given dose is unmetabolized and secreted into bile. The aim of this study was to investigate the frequency, clinical characteristics, and outcome of biliary sludge (BS) in addition to potential contributing risk factors in children who receive ceftriaxone. Biliary ultrasonography was performed at the time of randomization before ceftriaxone treatment was started, on the 5th and 10th days, and at the end of the treatment. If BS was detected, patients were followed-up weekly by sonographic examination until the BS or biliary lithiasis (BL) disappeared. A total of 114 children (56 girls, 58 boys; age range: 2-180 months, mean 47.5 +/- 46.3 mos) were enrolled in the study. Fourteen (12%) subjects developed BS and 10 (9%) developed BL on the 5th day of treatment. On the 10th day of treatment, 20 (18%) subjects developed BS and 15 (13%) developed BL. In total, 35 (31%) of all subjects developed biliary precipitation (BP), of whom 20 (57%) were diagnosed as BS and 15 (43%) as BL. All subjects who developed BP were found to be asymptomatic during the course of therapy. Patient age over 12 months, daily total dose of ceftriaxone of more than 2 g, and duration of treatment longer than five days were found to be associated with BP. Ceftriaxone frequently causes transient BPs and its probability increases if the child is over 12 months of age, the dose is over 2 g/day, or the duration is over five days. Neither radiologic investigation nor the discontinuation of treatment with ceftriaxone is necessary as long as the patient is asymptomatic.
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Affiliation(s)
- Ahmet Soysal
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey
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Abstract
Cholelithiasis rarely occurs in childhood. Ceftriaxone is a widely used antimicrobial agent in pediatrics due to the broad spectrum. Reversible biliary sludge and/or lithiasis, named as pseudolithiasis, have been reported in patients treated with ceftriaxone. We observed ceftriaxone-associated pseudolithiasis in 8 patients with meningitis. The aim of this study was to report the clinical characteristics of these patients and to evaluate the related factors for the development of ceftriaxone-associated pseudolithiasis in children. The study group consisted of 7 boys and 1 girl. All patients received ceftriaxone 100 mg/kg/day for meningitis. The ultrasonographic evaluation was performed on 5th-10th days after the initiation of the therapy. Biliary sludge was detected in one patient, and gallstone was detected in three patients, while biliary sludge with gallstone was detected in four patients. Six of the cases were diagnosed during summer time. Thus, high temperature may cause loss of fluid, leading to easier formation of sludge. Ceftriaxone treatment was discontinued after sonographic demonstration of pseudolithiasis. Gallbladder sonograms were found to be normal in all patients at the follow-up sonographic examinations performed after 30 days of the diagnosis without specific treatment. Clinicians should screen all pediatric patients living in areas with high temperature and receiving ceftriaxone treatment (over 100 mg/kg) by ultrasonography for biliary sludge or gallstone formation even if they are asymptomatic.
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Affiliation(s)
- Nilgun Araz
- Department of Pediatrics, Child Hospital, and Department of Internal Medicine, Gaziantep University, Medical Faculty, Turkey.
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Affiliation(s)
- Stephen L Barnes
- University of Kentucky, Department of Surgery, Lexington, KY 40536-0293, USA.
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Jonas E, Näslund E, Freedman J, Befrits R, Blomqvist L, Siösteen AK, Jacobsson H, Hultcrantz R. Measurement of parenchymal function and bile duct flow in primary sclerosing cholangitis using dynamic 99mTc-HIDA SPECT. J Gastroenterol Hepatol 2006; 21:674-81. [PMID: 16677152 DOI: 10.1111/j.1440-1746.2005.04084.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIM Primary sclerosing cholangitis is a chronic cholestatic disease characterized by obliterative fibrosis of intrahepatic and/or extrahepatic bile ducts. The unpredictable clinical course of the disease can be relentless, leading to premature death in a large percentage of patients. Prognostic index formulas, the revised Mayo model being the most frequently used, have been developed to predict clinical course and prognosis. The aim of this study was to investigate the potential value of dynamic (99m)Tc-HIDA SPECT in patients with primary sclerosing cholangitis by correlating scintigraphic results with cholangiographic and biochemical findings and prognostic scoring systems used in clinical practice. METHODS In 18 patients with primary sclerosing cholangitis, segmental parenchymal and bile duct functions were measured using dynamic (99m)Tc-HIDA SPECT. Quantitative scintigraphic results were compared to cholangiographic findings, as graded by a biliary classification system, the Child-Pugh score and revised Mayo prognostic score, as well as the individual biochemical parameters included in the scoring systems. RESULTS In individual segments, scintigraphic quantitative parameters indicative of bile flow showed a statistically significant correlation with the state of the bile-flow path for the respective segments as assessed by the biliary classification system. The revised Mayo score correlated with the scintigraphic quantitative parameters indicative of parenchymal function and bile flow as calculated for the whole liver. CONCLUSIONS Dynamic (99m)Tc-HIDA SPECT, capable of assessing different aspects of liver function for the total liver, as well as for individual segments, has potential value in the management of patients with primary sclerosing cholangitis.
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Affiliation(s)
- Eduard Jonas
- Division of Surgery, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
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De Vargas Macciucca M, Lanciotti S, De Cicco ML, Coniglio M, Gualdi GF. Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: diagnostic protocol assessment based on personal experience and review of the literature. Radiol Med 2006; 111:167-80. [PMID: 16671375 DOI: 10.1007/s11547-006-0018-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to identify and classify the ultrasonographic and computed tomography (CT) signs of simple and complicated acute cholecystitis and to define the correct diagnostic protocol. MATERIALS AND METHODS We retrospectively reviewed 35 patients (23 men and 12 women; mean age 66.6 years) presenting with acute cholecystitis who were assessed by emergency ultrasonography (US) (30/35 cases) and spiral CT (12/35 cases); all patients underwent emergency surgery. The US signs were analysed and classified as major criteria (wall thickening and stratification, distension, Murphy's sign), minor criteria (bile stones, sludge, and biliary tract dilatation), and complication signs (gas collections, aerobilia, fluid collection, difficult or missed identification of the gallbladder). Imaging results were compared with histological findings (gold standard), and accuracy, sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) were assessed for each modality. Concordance between the US and CT findings was also evaluated for cases undergoing both examinations; additional findings provided by one or the other modality were also assessed. RESULTS US had an accuracy of 66.6%, a sensitivity of 37.5%, a specificity of 70%, a PPV of 100%, and an NPV of 58.3%. CT had 100% accuracy, sensitivity, and specificity. Concordance between US and CT was observed for diagnosis of complications, but CT provided additional findings in all cases. The majority of complicated cases undergoing US examination (68.7%) revealed more than two major criteria and one minor criterion or at least one sign of complication. CONCLUSIONS If more than two major signs associated with one minor sign or at least one sign of complication are present at US, CT is mandatory to recognise and thoroughly evaluate the type of complication and indicate appropriate treatment.
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Affiliation(s)
- M De Vargas Macciucca
- Servizio di Radiologia, Dipartimento di Emergenza e Accettazione, Policlinico Umberto I, Roma, Italy.
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Rocca R, De Angelis C, Castellino F, Masoero G, Daperno M, Sostegni R, Rigazio C, Crocellà L, Lavagna A, Ercole E, Pera A. EUS diagnosis and simultaneous endoscopic retrograde cholangiography treatment of common bile duct stones by using an oblique-viewing echoendoscope. Gastrointest Endosc 2006; 63:479-84. [PMID: 16500400 DOI: 10.1016/j.gie.2005.11.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 11/07/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND MRCP and EUS have replaced ERCP in the diagnosis of biliary diseases, but the latter is needed for treatment. This study evaluates a new approach in the management of common bile duct stones, by using an oblique-viewing echoendoscope. METHODS Nineteen patients with acute abdominal pain associated with increased liver tests entered the study. Evaluation of the biliary tree was performed by using an oblique-viewing echoendoscope (JF-UM20; Olympus Europe GmbH, Hamburg, Germany). When biliary stones or sludge were found, bile duct cannulation and sphincterotomy were performed in the same session. RESULTS Bile duct stones were diagnosed by EUS in 4 patients and biliary sludge in 12; the subsequent cholangiography and sphincterotomy with stone extraction confirmed the diagnosis in all patients. Bile duct cannulation failed in 1 patient. EUS showed features of chronic pancreatitis in 3 cases. The mean time for the whole procedure (EUS plus endoscopic retrograde cholangiography with biliary treatment) was 27 minutes. No procedure-related complications were observed. CONCLUSION This new approach appears to be feasible and safe, providing an accurate diagnosis and, at the same time, an appropriate treatment of common bile duct stones when needed. With technical improvements, this extended EUS technique could be used as the first-line procedure in patients with biliopancreatic diseases.
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Affiliation(s)
- Rodolfo Rocca
- Gastroenterology Department, ASO Ordine Mauriziano Hospital, Torino, Italy
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Abstract
Ceftriaxone is a commonly used third-generation cephalosporin that has antimicrobial activity against many gram-positive and gram-negative organisms. Generally, ceftriaxone is a safe antibiotic; however, symptomatic biliary sludge has been reported in rare instances, most of which have involved children. It is uncommon for ceftriaxone to cause increases in laboratory indexes, such as bilirubin levels. We describe the case of a 53-year-old man who was treated with intravenous ceftriaxone 2 g every 12 hours. After 7 days of therapy, the patient's liver function test results, including total, direct, and indirect bilirubin levels, increased significantly from baseline, and the patient became jaundiced. A right upper quadrant ultrasound examination revealed biliary sludge and cholelithiasis without sonographic evidence of cholecystitis. Ceftriaxone was thought to be the responsible agent, and it was discontinued. The patient's jaundice subsided, and his liver function test results improved, returning to baseline within 14 days. Clinicians need to be aware of the association of ceftriaxone and biliary pseudolithiasis and hyperbilirubinemia, and monitor accordingly.
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Affiliation(s)
- Courtney L Bickford
- College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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Maev IV, Dicheva DT, Buragina TA, Penkina TV. [Frequency of the detection of billiary sludge in ulcerative disease]. Eksp Klin Gastroenterol 2006:20-4, 138. [PMID: 17612092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Patients with gastric and duodenal ulcer, in who never had the typical complaints, and anamnestic data about pathology of biliary system were examined. More than one third of the biliary sludge was found. Finding dates demonatrate an appearence of hypokinetic biliary dysfunction in patients with gastric and duodenal ulcer. The received results indicate the for necessity of obligatory ultrasonic research for the purpose of revealing biliary dysfunctions in patients with gastric ulcer; subsequent dynamic supervision and preservation of pathological changes to prevente cholelithiasis.
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Gupta V. Bile leak detection by radionuclide scintigraphy. Kathmandu Univ Med J (KUMJ) 2006; 4:82-85. [PMID: 18603875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Bile leak after liver injury has been reported to be a complication associated with significant mortality. Tc99m-IDA (Tc: Technetium) nuclear scan allows rapid and noninvasive diagnosis of bile leak. OBJECTIVE An accidental case was referred for the detection of suspicious bile leak. METHODS The ultrasound could not detect any abnormality. Dynamic Hepatobiliary Scintigraphy (DHBS) using radiolabeled tracer was performed. RESULTS DHBS promptly detected the site of leak. CONCLUSION This technique should be opted because it has been found to be quite sensitive, specific and accurate for detecting the bile leak, whereas, Ultrasound and CT imaging are less sensitive and nonspecific. Though, they are initially helpful in determining the presence of abdominal fluid collections, they are unable to differentiate between a seroma, lymphocele, hematoma or bile leak. Hepatobiliary scintigraphy is more accurate because it can demonstrate continuity of these fluid collections with the biliary tree. Further, hepatobiliary scintigraphy can provide real-time assessment of hepatocytes function and bile progression from the liver to the intestine.
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Affiliation(s)
- V Gupta
- Nuclear Medicine and Thyroid Physician, Amritsar, India.
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Abstract
'Sludge' is the solid material which results from the slow settling of particles dispersed in a liquid medium. Biliary sludge in the gallbladder can be detected by transabdominal ultrasonography, and the typical echoes derive mainly from pigment precipitates mixed with cholesterol crystals. A portion of biliary sludge contains comparatively large particles (1-3 mm) called microliths, the formation of which is an obligatory intermediate step in the development of all types of gallstone. Microlithiasis and sludge in bile may cause colicky pain, cholecystitis, cholangitis, and acute pancreatitis, and are thus of clinical relevance. In these patients treatment follows the guidelines of symptomatic gallstone disease, and strategies include long-term application of ursodeoxycholic acid, endoscopic papillotomy, or preferably laparoscopic cholecystectomy.
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Affiliation(s)
- Christoph Jüngst
- Department of Medicine I, Universitätsklinikum Bonn, Sigmund-Freud Str. 25, 53105 Bonn, Germany
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Mirbagheri SA, Mohamadnejad M, Nasiri J, Vahid AA, Ghadimi R, Malekzadeh R. Prospective evaluation of endoscopic ultrasonography in the diagnosis of biliary microlithiasis in patients with normal transabdominal ultrasonography. J Gastrointest Surg 2005; 9:961-4. [PMID: 16137592 DOI: 10.1016/j.gassur.2005.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Accepted: 03/14/2005] [Indexed: 01/31/2023]
Abstract
Prior investigators have proposed microlithiasis as a causative factor for occult gallbladder diseases. Endoscopic ultrasonography (EUS) is potentially far more sensitive than transabdominal ultrasonography (TUS) in visualizing small stones. The aim of this study was to investigate the role of endoscopic ultrasonography (EUS) in the diagnosis of microlithiasis in patients with upper abdominal pain and normal TUS. Thirty-five patients with biliary-type abdominal pain and normal TUS results were prospectively studied. All patients underwent radial EUS by means of a GF UM-20 echoendoscope (Olympus Optical, Tokyo, Japan). Of 35 patients, 33 were revealed to have gallbladder sludge or small stones, and 21 had CBD sludge or microlithiasis. Nine patients were not available for follow-up; of the remaining patients, 13 underwent combined endoscopic biliary sphincterotomy and cholecystectomy, 10 underwent cholecystectomy, and 3 underwent biliary sphincterotomy alone. In a postoperative follow-up at 9.2 months, 25 patients (96.2%) were symptom free. EUS is an important diagnostic tool in patients with unexplained biliary colic. Cholecystectomy with or without EUS is an effective treatment modality in these settings.
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Affiliation(s)
- Seyed Amir Mirbagheri
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Science, and Department of Surgery, Mehr General Hospital, Tehran, Iran
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Abstract
BACKGROUND & AIMS We studied 22 patients with symptomatic microlithiasis to determine whether a contributory role of the gallbladder in the early stage of cholesterol gallstone formation exists. We compared the merits of different methods (ultrasonography and microscopy) and sources (hepatic or gallbladder) of bile samples for diagnosing microlithiasis. METHODS Paired hepatic and gallbladder bile samples were studied with polarizing microscopy. Nucleation time, bile salts, phospholipid, cholesterol, cholesterol saturation index (CSI), bilirubin, total protein, albumin and mucin concentration were measured. All patients had abdominal ultrasound examination. RESULTS With polarizing microscopy as the standard, ultrasonography was positive in 13 patients (59%) and negative in 9 (41%). All gallbladder bile samples were positive for microlithiasis by microscopy. Only one hepatic bile sample was positive (P < .0001). There was a disproportional enrichment of total protein, albumin, and mucin (P < .05) in the gallbladder bile and a conversion of bilirubin diglucuronide to monoglucuronide (P < .01). Gallbladder samples had lower CSI but a faster nucleation time (P < .001), which correlates inversely with CSI, total protein, and mucin concentration. CONCLUSION Biochemical composition and physical chemical behavior of hepatic bile are modified during residence in the gallbladder, contributing to sludge formation. Gallbladder bile has a lower calculated CSI, higher deconjugation of bilirubin, protein and mucin concentration and crystals were present. Hepatic bile samples are inappropriate for microscopic detection of microlithiasis.
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Affiliation(s)
- Cynthia W Ko
- Department of Medicine, Veterans Affairs Medical Center, Seattle, Washington, USA
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Nakajima K, Kawano M, Kinami S, Fujimura T, Miwa K, Tonami N. Dual-radionuclide simultaneous gastric emptying and bile transit study after gastric surgery with double-tract reconstruction. Ann Nucl Med 2005; 19:185-91. [PMID: 15981670 DOI: 10.1007/bf02984603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The physiology of gastrointestinal transfer function after proximal gastrectomy with bypass-tract reconstruction is not well understood. We applied a simultaneous dual-radionuclide method with a hepatobiliary imaging and gastric emptying study to evaluate physiologic alterations occurring after surgery. METHODS Nineteen patients with early gastric cancer, including 9 preoperative control patients and 10 who had proximal gastrectomy and double-tract reconstruction surgery were examined by dual-radionuclide hepatobiliary and gastric emptying studies (99mTc PMT and 111In DTPA). Retention fraction in the stomach at 3 minutes (R3) and 60 minutes (R60) and gastric emptying half-time (GET) were calculated. Bile reflux and mixture of bile and food were also evaluated. RESULTS The retention fractions of R3 and R60 were significantly lower in the double-tract reconstruction group than those in the preoperative group. GET differed significantly between the double-tract and preoperative groups (20.7 min +/- 7.1 min and 36.2 min +/- 11.0 min, p = 0.0018). The mixture of bile and food was not good in the double-tract reconstruction group (p = 0.014 vs. preoperative). Patients with a large residual stomach showed slower initial emptying (p = 0.0068) and a better mixture of bile and food (p = 0.058) compared to those with a small residual stomach. The bile reflux was not significantly increased after surgery. CONCLUSION The dual-radionuclide gastrointestinal and hepatobiliary imaging was feasible and could demonstrate characteristic transit patterns of the foods and bile in the double-tract reconstruction procedure. A larger residual stomach, if possible, is desirable to provide better transfer and mixing of bile and foods.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Japan.
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Basaranoglu M, Balci NC. Recurrent cholangitis associated with biliary sludge and Phrygian cap anomaly diagnosed by magnetic resonance imaging and magnetic resonance cholangiopancreatography despite normal ultrasound and computed tomography. Scand J Gastroenterol 2005; 40:736-40. [PMID: 16036536 DOI: 10.1080/00365520510015421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 31-year-old woman presented with a one and half years' history of intermittent right upper quadrant (RUQ) pain, high fever and severely painful, warm and reddish swollen skin lesions on the fingers. Acute attack resolution occurred within 2 weeks after treatment with non-specific antibiotics. Low-grade fever (around 37.5 degrees C) and less painful swellings continued for 6 months after each attack. Abdominal ultrasound and computed tomography (CT) scans did not show any abnormality during the attacks. Biopsy of the skin lesions after the second attack revealed lymphocytic vasculitis. All laboratory studies including rheumatologic serology panel were normal. One month after the complete resolution of the second attack, the patient was observed to have high fever, the same skin lesions on the fingers as at the initial stage, nausea and marked abdominal pain in the RUQ. Routine laboratory studies including complete blood count, liver function tests and serum amylase and lipase levels were normal. An abdominal CT scan revealed a slight thickening of the gallbladder wall (3.9 mm). Two weeks later, abdominal magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) were performed because of persistent abdominal pain. They revealed both biliary tract and pancreatic gland alterations consistent with past cholangitis and pancreatitis with coexisting Phrygian cap anomaly and biliary sludge on the neck of the gallbladder.
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Affiliation(s)
- Metin Basaranoglu
- Department of Internal Medicine, Kadir Has University Hospital, Istanbul, Turkey.
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Ozturk A, Kaya M, Zeyrek D, Ozturk E, Kat N, Ziylan SZ. Ultrasonographic findings in ceftriaxone: associated biliary sludge and pseudolithiasis in children. Acta Radiol 2005; 46:112-6. [PMID: 15841750 DOI: 10.1080/02841850510015983] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To prospectively evaluate the incidence of biliary sludge and pseudolithiasis in children treated with ceftriaxone. MATERIAL AND METHODS Thirty-three children (14 girls, 19 boys) treated with ceftriaxone for prophylaxis (n=13) or for an infection (n=20) were included in this study. The incidences of biliary sludge and pseudolithiasis were investigated using ultrasonography. The ultrasonographic evaluations were performed prior to and on the 4th-5th days and on the 8th-10th days of treatment. The patients who had biliary sludge or pseudolithiasis were followed up with ultrasonographic evaluation periodically until these pathological phenomena disappeared. RESULTS Ceftriaxone was administrated intravenously at a dosage of 100 mg kg(-1) day(-1). Serial gallbladder sonograms were performed before treatment and on the 4th-5th and 8th-10th days of therapy. Nineteen children developed pseudolithiasis and sludge in the gallbladder, and all were asymptomatic. No significant differences were found between the patients with normal versus abnormal sonographic findings in regard to gender, age, duration of the therapy, oral restriction except the presence of surgery (P< 0.005). CONCLUSION The combination of oral restriction and surgical procedures may be a causal factor in ceftriaxone-associated biliary pseudolithiasis. It is emphasized that when gallstone and/or sludge are detected in the gallbladder in children by ultrasonographic examination, the administration of ceftriaxone must be sought beyond other causative factors.
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Affiliation(s)
- A Ozturk
- Department of Radiology, Harran University Faculty of Medicine, Sanliurfa, Turkey.
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Affiliation(s)
- Kian Giap Martin Tan
- Department of Nuclear Medicine & Bone Densitometry, The Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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Ziessman HA. ?Characterization of basal hepatic bile...? Eur J Nucl Med Mol Imaging 2004; 31:920-2; author reply 922-3. [PMID: 15014905 DOI: 10.1007/s00259-004-1508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ponce J, Pons V, Sopena R, Garrigues V, Ponce M, Ortiz V, Pertejo V. Quantitative cholescintigraphy and bile abnormalities in patients with acalculous biliary pain. Eur J Nucl Med Mol Imaging 2004; 31:1160-5. [PMID: 15029457 DOI: 10.1007/s00259-004-1464-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2003] [Accepted: 12/28/2003] [Indexed: 11/29/2022]
Abstract
Acalculous biliary pain has been related to gallbladder dysfunction that produces a gallbladder emptying defect-a condition which favours the development of lithiasis. It is therefore probable that microlithiasis is present in patients with gallbladder dysfunction. The aims of this study were to measure gallbladder emptying and investigate bile abnormalities in patients with acalculous biliary pain. In 92 consecutive patients, gallbladder emptying was assessed by quantitative cholescintigraphy (abnormal ejection fraction < or =40%). In 64 patients, a microscopic study was performed on duodenal bile, defining abnormality as the presence of cholesterol crystals in any amount and/or calcium bilirubinate granules and/or microspheroliths at a rate of >10 per slide. The ejection fraction was abnormal in 45 patients (49%) (median 25.1%, range 6.8-39.3%) and normal in the remaining 47 cases (median 71.3%, range 41.0-96.1%). Bile was abnormal in 32 of 64 patients (50%), the most frequent finding being calcium bilirubinate granules. In the patients with bile abnormalities, abnormal ejection fraction was more frequent (20 of 32) and the median ejection fraction was lower (30.9%, range 12.0-94.1%) than in the patients with normal bile (16 of 32 with an abnormal ejection fraction; median ejection fraction 50.7%, range 6.8-96.1%). Abnormal bile was frequent (55.5%) in patients with reduced ejection fraction, but was not uncommon in patients with normal ejection fraction (33.3%). Fewer patients showed no alteration (25%). It is concluded that in most patients, acalculous biliary pain coexists with gallbladder dysfunction or abnormal bile, the combination of both alterations being common.
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Affiliation(s)
- Julio Ponce
- Gastroenterology Unit (Service of Digestive Medicine), La Fe University Hospital, Avda. Campanar 21, 46009, Valencia, Spain.
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Krishnamurthy GT, Krishnamurthy S, Watson RD. Characterization of basal hepatic bile flow and the effects of intravenous cholecystokinin on the liver, sphincter, and gallbladder in patients with sphincter of Oddi spasm. Eur J Nucl Med Mol Imaging 2004; 31:85-93. [PMID: 14574515 DOI: 10.1007/s00259-003-1336-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Accepted: 08/19/2003] [Indexed: 11/24/2022]
Abstract
The major objectives of this project were to establish the pattern of basal hepatic bile flow and the effects of intravenous administration of cholecystokinin on the liver, sphincter of Oddi, and gallbladder, and to identify reliable parameters for the diagnosis of sphincter of Oddi spasm (SOS). Eight women with clinically suspected sphincter of Oddi spasm (SOS group), ten control subjects (control group), and ten patients who had recently received an opioid (opioid group) were selected for quantitative cholescintigraphy with cholecystokinin. Each patient was studied with 111-185 MBq (3-5 mCi) technetium-99m mebrofenin after 6-8 h of fasting. Hepatic phase images were obtained for 60 min, followed by gallbladder phase images for 30 min. During the gallbladder phase, 10 ng/kg octapeptide of cholecystokinin (CCK-8) was infused over 3 min through an infusion pump. Hepatic extraction fraction, excretion half-time, basal hepatic bile flow into the gallbladder, gallbladder ejection fraction, and post-CCK-8 paradoxical filling (>30% of basal counts) were identified. Seven of the patients with SOS were treated with antispasmodics (calcium channel blockers), and one underwent endoscopic sphincterotomy. Mean (+/-SD) hepatic bile entry into the gallbladder (versus GI tract) was widely variable: it was lower in SOS patients (32%+/-31%) than in controls (61%+/-36%) and the opioid group (61%+/-25%), but the difference was not statistically significant. Hepatic extraction fraction, excretion half-time, and pattern of bile flow through both intrahepatic and extrahepatic ducts were normal in all three groups. Gallbladder mean ejection fraction was 9%+/-4% in the opioid group; this was significantly lower (P<0.0001) than the values in the control group (54%+/-18%) and the SOS group (48%+/-29%). Almost all of the bile emptied from the gallbladder refluxed into intrahepatic ducts; it reentered the gallbladder after cessation of CCK-8 infusion (paradoxical gallbladder filling) in all eight patients with SOS, but in none of the patients in the other two groups. Mean paradoxical filling was 204% (+/-193%) in the SOS group and less than 5% (P<0.05) in both the control and the opioid group. After treatment, six of the SOS patients had complete pain relief and one, partial pain relief. The basal tonus of the sphincter is variable in patients with SOS, and allows relatively more of the hepatic bile to enter the GI tract than the gallbladder. Due to simultaneous contraction of the sphincter and gallbladder in response to CCK-8, most of the bile emptied from the gallbladder refluxes into intrahepatic ducts, and reenters the gallbladder immediately after cessation of hormone infusion. The characteristic features of gallbladder filling, emptying, and paradoxical refilling with cholecystokinin provide objective parameters for noninvasive diagnosis of SOS by quantitative cholescintigraphy.
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Affiliation(s)
- Gerbail T Krishnamurthy
- Department of Nuclear Medicine, Tuality Community Hospital, 335 SE 8th Avenue, Hillsboro, OR 97123, USA.
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Il'chenko AA, Vikhrova TV. [The problem of biliary sludge]. Klin Med (Mosk) 2003; 81:17-22. [PMID: 14520938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The authors review current literature on etiology, pathogenesis and classification of biliary sludge (BS); they analyse factors promoting formation of BS and show that ultrasonic investigation is the key diagnostic method, detecting various forms of BS and differentiating BS with parietal new-growths of the gallbladder, evaluating function of the latter and controlling efficacy of conservative therapy. Follow-up results demonstrate that BS can disappear spontaneously, be persistent in a part of patients, form stones in 20% patients. Clinical picture in BS has no specific symptoms but in 33-75% cases it is associated with development of biliary pancreatitis as a results of secondary dysfunction of the Oddi's sphincter. The latest findings on efficacy of litholytic therapy in BS and data on possible use of nonsteroid anti-inflammatory drugs as inhibitors of mucin production to prevent recurrent cholelithiasis are presented.
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Olatunji AA, Olatunji PO. Sludge, stones and sickle cell anaemia. Niger Postgrad Med J 2002; 9:186-8. [PMID: 12690676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A total of ninety-seven paediatric and adult patients with sickle cell anaemia and fourty-eight control subjects were investigated with the aim of determining the content of the gallbladder. The patients and control subjects were categorised according to the presence or otherwise of gallbladder stones, and, or sludge. The age last birthday, PCV and number of crises per year were recorded in order to determine their influence on the development of gallbladder stones and sludge. The gallbladder contents were examined using ultrasonographic technique. The age and number of crises per year was determined from the clinical record files and direct questioning of patients. Seventy patients had normal gallbladder content while eighteen had sludge, six had stones, and three had a combination of sludge and stones. None of the control subjects had sludge or stone. The age of patients increased from progressively from those with normal content through those with sludge to those with stones. The PCV and number of crises per year only differentiated between normal and abnormal gallbladder contents. While the prevalence of gallbladder stones in this study falls within the range in previous studies, a high prevalence of sludge was observed. The association between the occurrence of sludge and stones with age, PVC and number of crises per year suggests the need for a larger series and that they may identify a group of patients requiring closer monitoring.
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Affiliation(s)
- A A Olatunji
- Department of Radiology, University of Ilorin Teaching Hospital, Ilorin
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Hsieh TJ, Chiang IC, Kuo KK, Liu GC, Kuo YT. Spontaneous retroperitoneal biloma: a case report. Kaohsiung J Med Sci 2002; 18:412-6. [PMID: 12476686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
We report a rare case of spontaneous rupture of the biliary tree with biloma in the retroperitoneum. A 74-year-old man was admitted with back pain and general weakness. Computerized tomography (CT) and sonography showed a huge lesion in the right retroperitoneum, and a diagnosis of biloma was made after percutaneous aspiration. A percutaneous drainage catheter was initially inserted into the right retroperitoneal lesion under sonographic guidance to treat the biloma because of high surgical risk. When his general condition had improved, the patient underwent cholecystectomy and removal of the common bile duct stone; there was no evidence of leakage in the extrahepatic bile duct. Non-surgical intervention before definitive biliary surgery is considered the first choice for treating bilomas in high-risk patients.
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Affiliation(s)
- Tsyh-Jyi Hsieh
- Department of Radiology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
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Hepatobiliary and pancreatic: aspartate aminotransferase elevation in a bed-ridden old man. J Gastroenterol Hepatol 2002; 17:806, 811. [PMID: 12121513 DOI: 10.1046/j.1440-1746.2002.02856.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Affiliation(s)
- Visweswara R Tatini
- Department of Nuclear Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073-6769, USA
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Calvo MM, Bujanda L, Heras I, Calderon A, Cabriada JL, Orive V, Martinez A, Capelastegi A. Magnetic resonance cholangiography versus ultrasound in the evaluation of the gallbladder. J Clin Gastroenterol 2002; 34:233-6. [PMID: 11873102 DOI: 10.1097/00004836-200203000-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ultrasonography (US) is currently the reference technique for evaluating gallbladder pathology. The aim of this study was to prospectively determine the diagnostic efficacy of magnetic resonance cholangiography (MRCP) in evaluating the gallbladder, as compared with US. The study included 80 patients (mean age, 69.3 years; male-to-female ration, 1.3:1) who underwent prospective US and MRCP; 5 patients in whom MRCP was contraindicated were excluded. In all cases, US was performed before MRCP. Ultrasound was the reference technique for evaluating MRCP sensitivity and specificity. Magnetic resonance cholangiopancreatography provided good image quality in 65 patients (81.2%) and poor image quality in 15 (mostly because of poor patient cooperation). Artefacts did not influence visualization of the gallbladder or evaluation of the background pathology. The sensitivity of MRCP in diagnosing gallbladder stones (43 patients; 97.7%) was comparable to US (44 patients). In contrast, MRCP diagnosed biliary sludge or microlithiasis in 13 patients, versus 5 in the case of US. Magnetic resonance cholangiopancreatography is a good technique for diagnosing cholelithiasis and biliary sludge. However, its high cost, contraindications, and the need for patient cooperation limit the use of the technique in routine clinical gallbladder studies. Magnetic resonance cholangiopancreatography could contribute to the diagnosis of microlithiasis, provided that future studies confirm its greater sensitivity versus US.
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Affiliation(s)
- Mari M Calvo
- Department of Gastroenterology, Galdakao Hospital, Vizcaya, Spain.
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Abstract
We describe a 41-year-old man with a 1-week history of nausea and vomiting 1 month after chemoembolization of a liver metastasis. The patient subsequently became febrile and developed right upper quadrant abdominal and midback pain. Findings of initial laboratory and imaging studies (a noncontrast computed tomographic [CT] scan and ultrasound) were not remarkable. Hepatobiliary scintigraphy, performed to rule out cholecystitis, revealed an abnormal area in the right lobe of the liver consistent with a focal bile leak into an abscess cavity. The patient was subsequently treated for liver abscess. In conclusion, hepatobiliary scintigraphy should be considered as a first-line test in the work-up of patients whenever a postchemoembolization complication is considered likely.
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Affiliation(s)
- Scott T Williams
- Nuclear Medicine Section, Department of Radiology, Saint Vincent's Catholic Medical Centers of New York, New York 10011, USA
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Abstract
Gallbladder disease and pancreatitis are two nonobstetric abdominal-related complaints presenting during pregnancy; gallbladder-related surgery in pregnancy is second only to appendectomy. Pancreatitis is seen less often but its most common cause is gallstone-related pain. The purpose of this manuscript is to review the clinical assessment and management of these disorders in pregnancy and to make nurses aware of the most current clinical options and techniques.
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Affiliation(s)
- Diane J Angelini
- Department of Obstetrics and Gynecology, Brown University, Women and Infants' Hospital Providence, Rhode Island, USA
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Santambrogio R, Bianchi P, Pasta A, Palmisano A, Montorsi M. Ultrasound-guided interventional procedures of the liver during laparoscopy: technical considerations. Surg Endosc 2002; 16:349-54. [PMID: 11967695 DOI: 10.1007/s004640090082] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2000] [Accepted: 05/24/2001] [Indexed: 10/28/2022]
Abstract
BACKGROUND The increased application of laparoscopy to oncological cases has also expanded the applications of laparoscopic ultrasound (LUS). LUS-guided interventional procedures are often used for the staging of neoplastic disease. However, considerable expertise is required to perform the US-guided maneuvers. METHODS Based on our 7-year experience with laparoscopic ultrasound, we discuss a number of technical and practical aspects related to the performance of interventional procedures during LUS of the liver. RESULTS We performed 146 laparoscopic ultrasound exams in patients with neoplastic diseases. In all, 244 liver lesions were biopsied and 151 needle placements were made to perform radiofrequency ablation or ethanol injection. We discuss our choice of laparoscopic equipment and type of needle required (whether for biopsies or for interventional procedures). We also describe the technical characteristics of ultrasound probes and equipment, the correct approach to the patient, and the method that we employ to identify and then puncture the target lesion. CONCLUSION The proper technique for interventional procedures during laparoscopic ultrasound can be mastered relatively quickly by a surgeon who is already familiar with traditional ultrasound techniques.
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Affiliation(s)
- R Santambrogio
- Dipartimento di Medicina e Chirurgia San Paolo, Clinica Chirurgica, Università degli Studi di Milano, via A. di Rudinì 8, Milan, Italy.
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Affiliation(s)
- E Y Chen
- University of Washington, Seattle 98195, USA
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Floyd AK, Korsholm H. [Biloma]. Ugeskr Laeger 2001; 163:4754-5. [PMID: 11572052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Most cases of biloma are caused by liver trauma or surgical intervention. However, spontaneous cases have been reported. We present a patient with spontaneous biloma which may have developed secondary to stenosis of the common bile duct or infarction of the liver. The initial treatment was percutaneous drainage, followed by ERCP with papillotomy and stenting of the common bile duct. Despite this therapy symptoms recurred and the patient had to undergo resection of a liver segment. The treatment of biloma in general is discussed.
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Affiliation(s)
- A K Floyd
- Gastrokirurgisk afdeling, Aalborg Sygehus.
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Chang ML, Tai DI, Chiang PC, Cheng JC. Pathogenesis of sludge-related pancreatitis: sonographic implications. Pancreas 2001; 23:220-3. [PMID: 11484927 DOI: 10.1097/00006676-200108000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M L Chang
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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