Endoscopic transpapillary catheterization of the gallbladder followed by external shock wave lithotripsy and solvent infusion for the treatment of gallstone disease.

Herein we describe the techniques and early results of attempted endoscopic transpapillary catheterization of the gallbladder (ETCG) in combination with external shock wave lithotripsy (ESWL) and solvent infusion in the treatment of 23 consecutive, symptomatic patients with gallstones. Despite anticipated difficulty in advancing wires and catheters through the cystic duct, impeded by tortuosity of its lumen, ETCG was successfully accomplished in 20 of the 23 patients (86.9%). Through an indwelling catheter, obstructed gallbladders were drained in 4 patients and combined treatment with ESWL and infused solvents was carried out in 18 patients. Combined treatment resulted in elimination of gallstones from the gallbladders of 14 of 18 patients (77.7%). Treatment was complicated by mild pancreatitis in only 1 of 20 successfully catheterized patients; there was no mortality.

Prophylactic cholecystectomy during splenectomy for beta thalassemia homozygous in Greece.

The impact of prophylactic cholecystectomy upon early mortality and morbidity of splenectomy for patients with beta TH H was investigated. The results of our study suggested that it is a safe procedure that is not associated with any increase in operative mortality and postoperative complications. This was true even when beta TH H was complicated by pigment cirrhosis and ascites. In view of increasing longevity of those patients with beta TH H, as well as the increased risk for gallstones even after splenectomy, we recommend the use of prophylactic cholecystectomy as a standard approach for all patients undergoing splenectomy for beta thalassemia homozygous.

The effect of preoperative treatment with cimetidine on postoperative wound sepsis.

The results of preoperative treatment of uncomplicated duodenal ulcer patients with Cimetidine are presented. Cimetidine given preoperatively increases the pH of gastric aspirates and alters the bacterial flora of the stomach at the time of operation, resulting in an increased incidence of postoperative wound sepsis. Discontinuing Cimetidine 2 days before surgery is a safe step against the risk wound sepsis.

Long term consequences of bacterial colonization of the biliary tract after choledochostomy.

We studied 48 patients--36 who underwent cholecystectomy and choledochotomy-choledochostomy for cholesterol gallstones and 12 patients as controls who underwent different types of extrabiliary operations. In our material, we observed that, in a high proportion of instances, infected bile during the early postoperative period remained contaminated for six months postoperatively--in an obviously unobstructed bile duct. In patients in whom Escherichia coli was isolated both early and late postoperatively, a statistical significancy was found. This phenomenon consists of a favorable condition for precipitation of calcium bilirubinate, triggering new pigment stone formation.