RESUMEN
BACKGROUND: Ascaris lumbricoides is one of the most common intestinal infections in developing countries, including Kosovo. In contrast to migration to the bile duct, migration of the worm to the gallbladder, due to the narrow and tortuous nature of the cystic duct, is rare. When it does occur, it incites acalculous cholecystitis. CASE PRESENTATIONS: This case series describes a 16-month-old Albanian girl, a 22-month-old Albanian girl, a 4-year-old Albanian girl, and a 10-year-old Albanian boy. Here we report our experience with gallbladder ascariasis including clinical manifestations, diagnostic procedures, and treatment. Fever, diarrhea and vomiting, dehydration, pale appearance, and weakness were the manifestations of the primary disease. In all patients, a physical examination revealed reduced turgor and elasticity of the skin. Abdomen was at the level of the chest, soft, with minimal palpatory pain. The liver and spleen were not palpable. A laboratory examination was not specific except for eosinophilia. There were no pathogenic bacteria in coproculture but Ascaris was found in all patients. At an ultrasound examination in all cases we found single, long, linear echogenic structure without acoustic shadowing containing a central, longitudinal anechoic tube with characteristic movement within the gallbladder. Edema of the gallbladder wall was suggestive of associated inflammation. There were no other findings on adjacent structures and organs. All patients received mebendazole 100 mg twice a day for 3 days. They also received symptomatic therapy for gastroenteritis. Because of elevated markers of inflammation all patients were treated with antibiotics, assuming acute cholecystitis, although ultrasound was able to confirm cholecystitis in only two of our four patients. Since the length of stay was dependent on the primary pathology it was 7 to 10 days. At control ultrasounds on 14th day, third and sixth month, all patients were free of ascariasis. CONCLUSIONS: Gallbladder ascariasis should be considered in all patients presenting with abdominal pain, distension, colic, nausea, anorexia, and intermittent diarrhea associated with jaundice, nausea, vomiting, fever, and severe radiating pain. Eosinophilia, ova, and parasites on stool examination as well as an anechogenic tube with characteristic movement within the bile duct found on abdominal ultrasound are conclusive for diagnosis. Mebendazole is an effective drug for the treatment. Surgical treatment is rarely needed.
Asunto(s)
Colecistitis Alitiásica , Ascariasis , Ascaris lumbricoides , Vesícula Biliar , Mebendazol/administración & dosificación , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/tratamiento farmacológico , Colecistitis Alitiásica/parasitología , Colecistitis Alitiásica/fisiopatología , Animales , Antibacterianos/administración & dosificación , Antinematodos/administración & dosificación , Ascariasis/diagnóstico , Ascariasis/tratamiento farmacológico , Ascariasis/parasitología , Ascariasis/fisiopatología , Ascaris lumbricoides/efectos de los fármacos , Ascaris lumbricoides/aislamiento & purificación , Niño , Preescolar , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/parasitología , Humanos , Lactante , Masculino , Resultado del Tratamiento , Ultrasonografía/métodosRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Niño , Dolor Abdominal/complicaciones , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Colecistitis Alitiásica/complicaciones , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/fisiopatología , Paromomicina/uso terapéutico , Dolor Abdominal/inmunología , Dolor Abdominal/fisiopatología , Ascitis/complicaciones , Ascitis/diagnóstico , Cryptosporidium/aislamiento & purificación , UltrasonografíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto Joven , Colecistitis Alitiásica/complicaciones , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/patología , Dependencia de Heroína/complicaciones , Factores de Riesgo , Colecistitis Alitiásica/fisiopatología , Colecistitis Alitiásica , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/diagnóstico , Angiopatías Diabéticas/complicacionesRESUMEN
The study involved 58 patients with chronic noncalculous cholecystitis (CNC) divided into two groups. Group I included 30 CNC patients with metabolic syndrome (MS), group II 28 CNC patients without MS. The control group consisted of 2O healthy people. MS was diagnosed according to Internationial Diabetes Federation guidelines (2005). The following anthroponetric parameters were determined: body mass index (BMI), waist to hip ratio, blood lipid profile (total cholesterol, triglycerides, high density lipoproteins (HDL), and low density lipoproteins (LDL)). Leptin and insulin levels were measured using com- mercial ELISA kits <
Asunto(s)
Colecistitis Alitiásica , Bilis , Vesícula Biliar , Resistencia a la Insulina/fisiología , Leptina/sangre , Síndrome Metabólico , Colecistitis Alitiásica/complicaciones , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/metabolismo , Colecistitis Alitiásica/fisiopatología , Adulto , Bilis/metabolismo , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/fisiopatología , Humanos , Masculino , Síndrome Metabólico/complicaciones , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/metabolismo , Persona de Mediana Edad , Estadística como Asunto , Ultrasonografía/métodosAsunto(s)
Colecistitis Alitiásica/patología , Colecistitis Aguda/patología , Vesícula Biliar/patología , Colecistitis Alitiásica/complicaciones , Colecistitis Alitiásica/fisiopatología , Colecistitis Alitiásica/cirugía , Accidentes de Tránsito , Colecistectomía , Colecistitis Aguda/complicaciones , Colecistitis Aguda/fisiopatología , Colecistitis Aguda/cirugía , Diagnóstico Diferencial , Eosinofilia/etiología , Epitelio/ultraestructura , Vesícula Biliar/irrigación sanguínea , Gangrena , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Sepsis/etiología , Úlcera/etiología , Úlcera/patología , Trombosis de la Vena/etiología , VénulasRESUMEN
Introducción: la colecistitis aguda alitiásica (CAA) se da con mayor frecuencia en pacientes críticos, en el periodo postoperatorio inmediato, tras traumatismos o quemaduras extensas. Tiene una alta tasa de morbimortalidad. La isquemia, la infección y la estasis vesicular son determinantes en su patogenia. Material y método: estudio retrospectivo que incluye todos los casos de CAA diagnosticados en la unidad de cuidados intensivos de nuestro centro en el periodo comprendido entre enero de 1997 y diciembre de 2012. Resultados: se incluyen a 7 pacientes, todos asociaron infección viral o bacteriana. Todos debutaron con dolor abdominal localizado en hipocondrio derecho, ictericia y coluria. La ecografía abdominal en todos los casos demostró engrosamiento e hipervascularización de la pared vesicular. La evolución fue satisfactoria en todos los casos sin necesidad de cirugía. Conclusiones: la presentación del cuadro es oligosintomática en el seno de enfermedades sistémicas de gravedad variable. La CAA se debe sospechar ante todo cuadro de dolor abdominal con ictericia/coluria e hipertransaminasemia en pacientes críticos o que cursan infecciones graves (AU)
Introduction: Acute acalculous cholecystitis (AAC) occurs more frequently in critically ill patients, in the immediate postoperative period, after trauma or extensive burns. It has a high rate of morbidity and mortality. Ischemia, infection and vesicular stasis are determinants in its pathogenesis. Material and method: Retrospective study including all cases of AAC diagnosed in our pediatric intensive care unit between January 1997 and December 2012. Results: We included 7 patients, all associated with viral or bacterial infection. All of them suffered from abdominal pain, mainly localized in the right upper quadrant, jaundice and dark urine. Abdominal ultrasound showed thickening and hypervascularity of the gallbladder wall in all cases. The outcome was satisfactory without surgery in all patients. Conclusions: The clinical presentation is oligosymptomatic within severe systemic diseases. The AAC should be suspected in the appearance of any abdominal pain with jaundice/dark urine and hypertransaminasemia in patients suffering from critical or serious infections (AU)
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Niño , Adolescente , Colecistitis Alitiásica/complicaciones , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/fisiopatología , Ictericia/complicaciones , Ictericia/diagnóstico , Dolor Abdominal/complicaciones , Dolor Abdominal/diagnóstico , Fluidoterapia/métodos , Fluidoterapia , Indicadores de Morbimortalidad , Estudios Retrospectivos , Cuidado Intensivo Neonatal/tendencias , Micrococcus/aislamiento & purificación , Brucella melitensis/aislamiento & purificación , Enterococcus faecalis/aislamiento & purificación , Nutrición Parenteral/métodos , Analgesia , Vitamina K/uso terapéuticoRESUMEN
AIM: To study the specific features of the clinical course of gastroesophageal reflux disease (GERD) associated with duodenogastroesophageal reflux (DGER) in patients with chronic acalculous cholecystitis (CAC) and cholelithiasis (CL), as well as qualitative and quantitative characteristics. SUBJECTS AND METHODS: The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, mucosal microbial biocenosis in the esophagus, stomach, and duodenum were studied in detail in 83 patients with GERD that was associated with DGER and ran concurrently with CAC or CL. RESULTS: Impaired duodenal propulsive activity as a concomitance of the signs of gastrostasis and duodenal dyskinesia with dyscoordination of both anthroduodenal and duodenojejunal propulsion and with the development of duodenogastric reflux and DGER, which in turn determine esophageal and gastric pH values is shown to be of importance in CAC and CL, which match GERD. Abnormal microbiocenosis in the upper digestive tract is characterized by the higher quantitative and qualitative content of the mucous microflora. Opportunistic microorganisms exhibit cytotoxic, hemolytic, lecithinase, caseinolytic, urease, and RNAase activities. CONCLUSION: The found specific features of the course of GERD associated with DGER in patients with biliary tract abnormalities lead us to search for novel therapeutic approaches based on the correction of digestive motor tonic disorders and abnormal microbiocenoses of the mucous flora in the esophagus, stomach, and duodenum.
Asunto(s)
Colecistitis Alitiásica/fisiopatología , Colelitiasis/fisiopatología , Reflujo Duodenogástrico/fisiopatología , Reflujo Gastroesofágico/fisiopatología , Colecistitis Alitiásica/microbiología , Adulto , Colelitiasis/microbiología , Enfermedad Crónica , Reflujo Duodenogástrico/microbiología , Duodeno/microbiología , Duodeno/fisiopatología , Esófago/microbiología , Esófago/fisiopatología , Femenino , Reflujo Gastroesofágico/microbiología , Humanos , Concentración de Iones de Hidrógeno , Persona de Mediana EdadRESUMEN
Study of biological cycles in chronic cholecystitis with dysfunction of gallbladder has a great practical importance. The results of chronoanalysis testify a dominance of 24-hours cycle in structure of cycles of functional activity of organs of hepatobiliary system. The comparative analysis of trust intervals reveals the intensification of internal connections, expressed intensification of synchronization of cycles of functional activity of system and a breach of synchronism of central regulation and self-regulation, testifying overstrain of proper adaptive possibilities and unconcordance in system of regulation. This manifestations of desynchronization provokes development and progress of dysfunction of gallbladder and dysbalance of vegetative nervous system, that make worse the present disturbances.
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Colecistitis Alitiásica/fisiopatología , Sistema Biliar/fisiología , Fenómenos Cronobiológicos , Vesícula Biliar/fisiopatología , Hígado/fisiología , Animales , Estudios de Casos y Controles , Enfermedad Crónica , Humanos , Hígado/irrigación sanguínea , Circulación Hepática/fisiologíaRESUMEN
AIM: To study effects of laserpuncture in combined treatment of chronic non-calculous cholecystitis on motor function gallbladder, clinical symptoms. MATERIALS AND METHODS: 73 patients of chronic non-calculous cholecystitis were divided in to groups: 35 patients were received treated only by the means of standard therapy (the control group), 38 patients were received a course laserpuncture as part of complex treatment (the study group). RESULTS: Influence laser radiation on acupuncture points was found to induce positive therapeutic effect, such as: decrease the durations of clinical symptoms, correction of motor function gallbladder. CONCLUSION: Laserpuncture is an effective method of non-calculous cholecystitis treatment and can be included in relevant combined schemes.
Asunto(s)
Colecistitis Alitiásica/radioterapia , Vesícula Biliar/fisiopatología , Terapia por Luz de Baja Intensidad/métodos , Reflejoterapia/métodos , Colecistitis Alitiásica/diagnóstico por imagen , Colecistitis Alitiásica/tratamiento farmacológico , Colecistitis Alitiásica/fisiopatología , Adulto , Anciano , Enfermedad Crónica , Terapia Combinada , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/efectos de los fármacos , Vesícula Biliar/efectos de la radiación , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Ultrasonografía , Adulto JovenRESUMEN
This paper was designed to report the results of investigations into the therapeutic effectiveness of "Kluchi" sulfate magnesiumcalcium mineral water used to treat 194 patients presenting with chronic acalculous cholecystitis and different types of biliary tract dysfunction. The control group was comprised of 92 patients who took a diet. It was shown, that mineral water "Kluchi" exerted well apparent beneficial action on the motor function of the gallbladder and the sphincter apparatus. Moreover, drinking the mineral water improved colloidal stability of bile. It is concluded that the therapeutic application of "Kluchi" sulfate magnesium-calcium mineral water results in the reduction of bile lihogenicity, produces anti-inflammatory and choleretic effects, and promotes normalization of the motor and tonic condition of the biliary tract.
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Colecistitis Alitiásica/tratamiento farmacológico , Balneología , Sulfato de Calcio/administración & dosificación , Sulfato de Magnesio/administración & dosificación , Aguas Minerales/administración & dosificación , Colecistitis Alitiásica/metabolismo , Colecistitis Alitiásica/fisiopatología , Adulto , Bilis/metabolismo , Sistema Biliar/metabolismo , Sistema Biliar/fisiopatología , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND/AIMS: The aim is to compare the radionuclide (DC) and ultrasonographic (US) method in the assessment of gallbladder (GB) motility. METHODOLOGY: The study was performed in 15 controls (C), 10 patients with acute cholecystitis (AC), 20 patients with chronic acalculous cholecystitis (CAC), 26 patients with chronic cholecystitis with calculosis (CCC) as well as in 15 patients with GB dyskinesia (D). GB emptying period (EP), ejection fraction (EF) and ejection rate (ER) were estimated with dynamic cholescintigraphy (DC) and US. RESULTS: The DC and US finding in the patients with AC was typical in all the patients, i.e. GB was not visualized at all on DC, while on US, stone was visible in the cystic duct. There were significant differences (p<0.05) between the EF and ER values obtained between C and the three groups of patients CAC, CCC and D, using both methods. However, there were no significant differences in EF, EP and ER values among CAC, CCC and D (p>0.05). There was also high correlation between the results obtained with both methods in all the groups of patients studied. CONCLUSIONS: The results obtained by both methods are valuable for the assessment of GB motility. Although there are no significant differences and there is a high correlation between the values, radionuclide method is more precise, because it can register motility continuously.
Asunto(s)
Técnicas de Diagnóstico del Sistema Digestivo , Enfermedades de la Vesícula Biliar/diagnóstico , Vaciamiento Vesicular , Vesícula Biliar/diagnóstico por imagen , Radiofármacos , Ácido Dietil-Iminodiacético de Tecnecio Tc 99m , Ultrasonografía Doppler en Color , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/fisiopatología , Adulto , Anciano , Discinesia Biliar/diagnóstico , Discinesia Biliar/fisiopatología , Colecistitis Aguda/diagnóstico , Colecistitis Aguda/fisiopatología , Enfermedad Crónica , Femenino , Vesícula Biliar/fisiopatología , Enfermedades de la Vesícula Biliar/fisiopatología , Humanos , Litiasis/diagnóstico , Litiasis/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cintigrafía , Serbia , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
This study investigates the potential correlation between acalculous biliary pain and mechanical stress during the bile-emptying phase. This study is built on the previously developed mathematical model used to estimate stress in the gallbladder wall during emptying [Li, W. G., X. Y. Luo, et al. Comput. Math. Methods Med. 9(1):27-45, 2008]. Although the total stress was correctly predicted using the previous model, the contribution from patient-specific active stress induced by the cholecystokinin (CCK) test was overlooked. In this article, we evaluate both the active and passive components of pressure in a gallbladder, which undergoes isotonic refilling, isometric contraction and emptying during the infusion of CCK. The pressure is estimated from in vivo ultrasonographical scan measurements of gallbladder emptying during CCK tests, assuming that the gallbladder is a thin ellipsoidal membrane. The passive stress is caused by the volume and shape changes during refilling at the gallbladder basal pressure, whereas the active stress arises from the pressure rise during the isometric gallbladder contraction after the CCK infusion. The effect on the stress estimates of the gallbladder to the liver is evaluated to be small by comparing numerical simulations of a gallbladder model with and without a rigid 'flat top' boundary. The model was applied to 51 subjects, and the peak total stress was found to have a strong correlation with the pain stimulated by CCK, as measured by the patient pain score questionnaires. Consistent with our previous study for a smaller sample, it is found that the success rate in predicting of CCK-induced pain is over 75%.
Asunto(s)
Colecistitis Alitiásica/fisiopatología , Vaciamiento Vesicular , Vesícula Biliar/fisiopatología , Modelos Biológicos , Músculo Liso/fisiopatología , Dolor/fisiopatología , Colecistitis Alitiásica/inducido químicamente , Colecistoquinina , Simulación por Computador , Humanos , Contracción Isométrica , Dolor/inducido químicamente , Estrés MecánicoRESUMEN
OBJECTIVE: The main objective of this study was to determine the effect of gallbladder emptying acquisition time on gallbladder ejection fraction (GBEF) measurement obtained by fatty meal cholescintigraphy (CS). METHODS: During fatty meal cholescintigraphy (CS), GBEF1 and GBEF2 were calculated 20 and 45 min, respectively, post meal ingestion on 50 healthy volunteers, 37 patients with chronic acalculous cholecystitis (CAC) and 20 non-CAC patients. GBEF1/GBEF2 was calculated and represented the percentage of GBEF occurred during 20 min after meal ingestion. The gallbladder was classified as ended pattern if it terminated contraction before the end of data acquisition or classified as continuous pattern if it continued to contract before the end of data acquisition. Mean GBEF in continuous pattern was compared with mean GBEF in ended pattern in each group. RESULTS: Gallbladder emptying had two phases; early rapid phase and late slow phase. About two-thirds of ejected volume occurred within the rapid phase. About half of gallbladders in each group were classified as ended pattern while the other half was classified as continuous pattern. There was no significant difference in mean GBEF values between both patterns in each group. CONCLUSION: GBEF measurement obtained by CS is not affected by further extension of gallbladder emptying data acquisition beyond the standard 45-60 min acquisition time.
Asunto(s)
Artefactos , Grasas de la Dieta , Vaciamiento Vesicular , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/fisiología , Colecistitis Alitiásica/diagnóstico por imagen , Colecistitis Alitiásica/fisiopatología , Adulto , Femenino , Vesícula Biliar/fisiopatología , Humanos , Masculino , Cintigrafía , Factores de TiempoRESUMEN
OBJECTIVE: The main purpose of this study was to determine the diagnostic value of gallbladder emptying variables in chronic acalculous cholecystitis (CAC). The variables investigated were latent period, gallbladder ejection fraction (GBEF) and patterns of gallbladder emptying. In addition, two other biliary system motility variables were investigated including the onset of gallbladder filling and biliary-to-bowel transit time. METHODS: Thirty-nine healthy volunteers underwent fatty meal cholescintigraphy (CS) prospectively to determine the normal values of these variables. Retrospectively, fatty meal CS studies of 88 patients suspected of having CAC were retrieved and reprocessed to obtain corresponding values of these variables, which then compared with normal values. RESULTS: The mean onset of gallbladder filling for patient groups was not significantly different from volunteer group mean. The mean+/-SD GBEF value for CAC group (29+/-20%) was significantly lower than volunteer group value (54+/-23%), whereas for non-CAC group (60+/-21%) it was not significantly different. The latent period was found invariable and not significant in CAC diagnosis. Two patterns of gallbladder emptying were noted: ended and continuous. The pattern of gallbladder emptying did not affect the mean GBEF and was found insignificant in the diagnosis of CAC. There was no significant difference in the number of cases with late biliary-to-bowel transit time between the groups. CONCLUSION: The single most important gallbladder emptying variable in diagnosing CAC is the GBEF. The latent period and the pattern of gallbladder emptying as well as the onset of gallbladder filling and biliary-to-bowel transit time are of no significant diagnostic value in CAC.
Asunto(s)
Colecistitis Alitiásica/diagnóstico por imagen , Colecistitis Alitiásica/fisiopatología , Grasas de la Dieta/farmacología , Vaciamiento Vesicular , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/fisiopatología , Colecistitis Alitiásica/inducido químicamente , Adulto , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Vesícula Biliar/efectos de los fármacos , Vaciamiento Vesicular/efectos de los fármacos , Humanos , Masculino , Cintigrafía , Adulto JovenRESUMEN
AIM: To study effects of laser puncture in combined treatment of chronic non-calculous cholecystitis on motor function of the gallbladder, bile physical characteristics and clinical symptoms. MATERIAL AND METHODS: 73 patients with chronic non-calculous cholecystitis were divided into two groups: 35 patients received standard therapy alone (control group) and 38 patients were exposed to laser puncture as a component of combined treatment. RESULTS: Laser radiation on acupuncture points has a positive therapeutic result, i.e. shorter clinical symptoms, correction of motor function of the gallbladder and bile physical characteristics. CONCLUSION: Laser puncture is an effective method of acalculous cholecystitis treatment and can be included in relevant combined schemes.
Asunto(s)
Colecistitis Alitiásica/radioterapia , Bilis/química , Vaciamiento Vesicular/efectos de la radiación , Vesícula Biliar/efectos de la radiación , Terapia por Luz de Baja Intensidad/métodos , Reflejoterapia/métodos , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/fisiopatología , Puntos de Acupuntura , Terapia por Acupuntura/métodos , Adulto , Anciano , Fenómenos Químicos , Enfermedad Crónica , Femenino , Vesícula Biliar/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
The purpose of this study was to identify the clinical characteristics of the patients in our institution who developed acute acalculous cholecystitis (AAC) after major trauma. Data of all trauma patients who developed AAC from January 2001 through June 2006 were analyzed. Five out of 1386 (0.3%) major trauma patients were diagnosed with AAC. One out of five patients had hypotension and shock and received vasopressor treatment. Prior to the diagnosis of AAC, all patients received ventilatory support, intravenous opioid analgesia, had pneumonia, and experienced tachycardia. No specific clinical characteristic was identified in patients with AAC; however, prolonged ventilatory support, pneumonia, use of opioids, and new onset arrhythmias were seen in the majority of patients.
Asunto(s)
Colecistitis Alitiásica/fisiopatología , Heridas y Lesiones/complicaciones , APACHE , Colecistitis Alitiásica/etiología , Colecistitis Alitiásica/terapia , Adulto , Anciano , Humanos , Puntaje de Gravedad del Traumatismo , Persona de Mediana Edad , Respiración Artificial , Factores de Riesgo , Heridas y Lesiones/clasificaciónRESUMEN
This is a case report of a necrotizing acalculous cholecystitis 7 weeks after multiple orthopedic trauma successfully treated by operative intervention.
Asunto(s)
Colecistitis Alitiásica/etiología , Traumatismo Múltiple/complicaciones , Dolor Abdominal/etiología , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica/patología , Colecistitis Alitiásica/fisiopatología , Adulto , Vesícula Biliar/patología , Gangrena , Humanos , Masculino , Necrosis , Huesos Pélvicos/lesiones , Fracturas del Radio/cirugía , Factores de Tiempo , Fracturas del Cúbito/cirugíaRESUMEN
Impaired Ca2+ homeostasis and smooth muscle contractility co-exist in acute cholecystitis (AC) leading to gallbladder dysfunction. There is no pharmacological treatment for this pathological condition. Our aim was to evaluate the effects of melatonin treatment on Ca2+ signaling pathways and contractility altered by cholecystitis. [Ca2+]i was determined by epifluorescence microscopy in fura-2 loaded isolated gallbladder smooth muscle cells, and isometric tension was recorded from gallbladder muscle strips. Malondialdehyde (MDA) and reduced glutathione (GSH) contents were determined by spectrophotometry and cycloxygenase-2 (COX-2) expression was quantified by western blot. Melatonin was tested in two experimental groups, one of which underwent common bile duct ligation for 2 days and another that was later de-ligated for 2 days. Inflammation-induced impairment of Ca2+ responses to cholecystokinin and caffeine were recovered by melatonin treatment (30 mg/kg). This treatment also ameliorated the detrimental effects of AC on Ca2+ influx through both L-type and capacitative Ca2+ channels, and it was effective in preserving the pharmacological phenotype of these channels. Despite its effects on Ca2+ homeostasis, melatonin did not improve contractility. After de-ligation, Ca2+ influx and contractility were still impaired, but both were recovered by melatonin. These effects of melatonin were associated to a reduction of MDA levels, an increase in GSH content and a decrease in COX-2 expression. These findings indicate that melatonin restores Ca2+ homeostasis during AC and resolves inflammation. In addition, this indoleamine helps in the subsequent recovery of functionality.