1/7. The mirizzi syndrome: preoperative diagnosis by sonography and transhepatic cholangiography.Common hepatic duct obstruction from an impacted calculus in the cystic duct is an uncommon cause of jaundice. The complimentary role of both transhepatic cholangiography and sonography can facilitate and assist the physician in making a preoperative diagnosis of mirizzi syndrome and prevent an unnecessary choledochotomy and exploration of the common bile duct.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Metastatic melanoma of the gallbladder.Metastatic involvement of the gallbladder in melanoma is rare, but constitutes the most common metastatic lesion involving this organ. Two cases of metastatic melanoma to the gallbladder with radiographic evidence of gallbladder abnormality prior to surgery are presented. These cases are compared to the nine previously reported cases of metastatic melanoma to the gallbladder with abnormal cholecystograms. All eleven cases presented with signs and symptoms compatible with cholecystitis. Nine of the eleven patients had a previous melanoma primary and most had other extrabiliary metastases. Associated cholelithiasis appeared to be only incidental. In addition, nine reported cases of "primary" biliary melanoma were reviewed. Clinical and pathologic presentations in the latter cases were similar to the former cases with metastases. Seventy-eight percent had extrabiliary sites of metastasis at some time in the course of their disease, tending to refute the impression of "primary" biliary melanoma. melanoma in the gallbladder is much more likely to have metastasized from a regressed skin primary than to have arisen de novo. The two reported cases and the 18 cases from the literature indicate that the physician must consider gallbladder metastasis in melanoma patients presenting with symptoms compatible with cholecystitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. The development of human gallbladder stones shown in X-ray pictures and its importance for the therapy.Prophylactic treatment of patients with gallbladder stones today is obsolete. After secured diagnosis the patients and their physicians are waiting for the development of painful symptoms, mostly for years. follow-up studies of gallbladder stones over decades show that there is no stability: especially the cholesterol stones change their size, shape, composition, and number during the waiting period for surgery. With a litholytical treatment of the cholesterol stones one has the chance to interrupt such changing processes by dissolution, with or without perfectionism. One can stop the development of painful symptoms and reduce the burden of the stones. To prevent an improper use of this treatment, only young, correctly floating cholesterol stones and the 2nd generation of cholesterol stones should be treated prophylactically. The diagnosis of the floating stones is possible with ultrasound or x-rays. We show the dissolution of the 2nd generation of cholesterol stones in two polymorbid, old patients with high risk for surgical treatment. The changing of the composition of gallbladder stones is demonstrated by different surface calcifications of multiple and solitary cholesterol stones, flat for multiple and periodically ordered for solitary stones.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Oriental cholangiohepatitis.Oriental cholangiohepatitis (OCH) is a disease endemic to asia. U.S. military physicians and surgeons deployed to these regions should be aware of this regional disease. Western physicians encounter OCH with the increasing immigration of Asians to the united states. OCH should be suspected in patients with signs of cholangitis who have traveled from asia. Initial treatment is medical with antibiotics and identification of helminthic and parasitic infection. Unless there is inadequate response to medical treatment, surgery is delayed. Operation consists of exploration and drainage of the common bile duct. overall results are satisfactory with prompt recognition and appropriate medical and operative treatment.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/7. Unilobar intrahepatic lithiasis 22 years after cholecystectomy.Complaints of right upper quadrant pain, jaundice, and fever in the postcholecystectomy patient provide the physician with a challenging diagnosis. This case concerns a patient with intrahepatic lithiasis and fibrotic atrophy of the right lobe 22 years after open cholecystectomy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Portsite and intraabdominal metastases of unsuspected gallbladder carcinoma after laparoscopic cholecystectomy: report of a case.We herein report a rare case of portsite metastasis of gallbladder carcinoma which occurred after laparoscopic cholecystectomy. A 64-year-old man underwent laparoscopic cholecystectomy at another hospital for symptomatic cholecystolithiasis. The histological examination revealed an adenocarcinoma of the gallbladder infiltrating the entire wall. Despite the physician's advice the patient refused any additional treatment. Thirteen months after surgery he visited our hospital because of a palpable mass at the scar of the right trocar incision. The nodule was removed and histological examination confirmed metastasis from the gallbladder carcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. cholecystitis and cholelithiasis masking as abdominal crises in sickle cell disease.A case of sickle cell (HbSS) disease is presented in a patient with a history of recurrent admissions for abdominal pain, jaundice, and abnormal liver function tests. Although he was believed to have a sickle cell abdominal crisis, his abdominal X-ray films revealed three calcified stones. Each of these stones progressively passed through the common duct and into the duodenum while awaiting surgery. He has been followed for two years since his cholecystectomy without further hospitalizations. This case led to the investigation of cholelithiasis in sickle cell disease to dispel the following misconceptions. Some physicians and pediatricians believe that (1) cholelithiasis and cholecystitis are uncommon in sickle cell disease; (2) the complications of gallstones are not significant; (3) the operative risk in patients with sickle cell disease is high; (4) these patients with HbSS disease do not live long enough to get into trouble with gallstones. A review of the literature on cholelithiasis and HbSS disease presents adequate evidence to cause us to urge investigation of the gallbladder in all patients with HbSS disease and abdominal crises, and cholecystectomy as an elective procedure should stones be present.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |