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2.
J Ultrasound ; 21(2): 119-126, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29476456

RESUMO

PURPOSE: Conventional grayscale ultrasound (US) is accurate in the diagnosis of gallbladder disease (GD), but in some cases, it is not decisive. Contrast-enhanced ultrasound (CEUS) improves the diagnostic accuracy of US. The primary objective of this study is to assess the reliability of CEUS in the diagnosis of sludge; the secondary objective is to assess the ability of CEUS to diagnose cancer. METHODS: We retrospectively reviewed the US of 4137 patients positive for GD. In 43/4137 (1.04%), the use of could not discriminate between sludge and neoplasms. Then, we evaluated CEUS in only 39 of these patients, and in 4/43 (9%) cases it was not performable. After CEUS, the absence of enhancement was considered diagnostic for sludge, while contrast washout within 60 s diagnosed malignant lesions. RESULTS: Among the 39 patients, 16 had biliary sludge and 23 had lesions of the gallbladder wall; 9 of these were carcinomas and 14 were benign tumors. The absence of enhancement was present in 16/16 patients with sludge and in 0/23 patients with lesions of the gallbladder (sensitivity and specificity 100%). Washout was within 60 s in 9/9 gallbladder carcinomas and 2/14 benign lesions (sensitivity 100%; specificity 85%). CONCLUSIONS: US is confirmed to be accurate in the diagnosis of GD. In doubtful cases, CEUS is very accurate in biliary sludge diagnosis. An intralesional washout at 60 s is a pattern of malignancy that can orient towards a correct diagnosis, but it is limited by the presence of false positive results, especially for smaller lesions.


Assuntos
Bile/diagnóstico por imagem , Meios de Contraste , Doenças da Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/diagnóstico por imagem , Ultrassonografia , Adulto , Idoso , Carcinoma/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia/métodos
3.
BMJ Case Rep ; 20182018 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-29351939

RESUMO

Bile duct injury (BDI) is a well-recognised complication of laparoscopic cholecystectomy (LC). Following a BDI, bile usually leaks into the peritoneal space and causes biliary peritonitis. This manifests as non-specific abdominal pain and fever occurring several days after the surgery. It can be managed by laparoscopic washout with or without bile duct repair. We present a rare case of retroperitoneal bile leak post-LC. The mechanism of injury here was likely partial avulsion from excessive traction of the cystic duct during intraoperative cholangiogram. Diagnosing retroperitoneal bile leak can be difficult because it is extremely rare and the presenting symptoms can be similar to an intraperitoneal bile leak. A high index of clinical suspicion is required. In cases of suspected bile leak, any mismatch between the exploratory laparoscopic findings and imaging findings should alert surgeons to consider the rare possibility of a retroperitoneal bile leak.


Assuntos
Ductos Biliares/lesões , Bile/diagnóstico por imagem , Bile/metabolismo , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia/efeitos adversos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Espaço Retroperitoneal/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Ductos Biliares/diagnóstico por imagem , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Stents , Resultado do Tratamento , Vômito
4.
Pan Afr Med J ; 31: 237, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31447994

RESUMO

Biloma is used to describe abnormal accumulation of bile outside biliary tract. It is a very rare condition with extrahepatic diffused or encapsulated collection of bile, mostly post-operative or post traumatic. A 72-year-old woman was referred to our hospital with acute abdominal pain located in right upper quadrant. Clinical examination suspected abdominal collection. Imagery (ultrasound and computed tomography scan) demonstrated a large well-defined intra-abdominal collection. Percutaneous ultrasound guided drainage of abdominal collection revealed a bile fluid. Drain was removed a week later and complete resolution of symptoms was obtained in two weeks. Even in the absence of specific diagnostic indications, radiological images may play a key role in the evaluation of suspected biloma in patients with appropriate medical history and clinical characteristics.


Assuntos
Dor Abdominal/etiologia , Bile/diagnóstico por imagem , Drenagem/métodos , Dor Aguda/etiologia , Idoso , Feminino , Humanos , Mauritânia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos
5.
J Pediatr Endocrinol Metab ; 30(12): 1333-1336, 2017 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-29176025

RESUMO

A male neonate was born at 41 weeks of gestation with a birth weight of 3320 g. Artificial respiratory management was required due to respiratory disturbance 1 h after birth, and subsequently catecholamine-refractory low cardiac output-induced shock occurred. Severe combined pituitary hormone deficiency (CPHD) was considered based on the presence of his respiratory disturbance, hypoglycemia and micropenis. After hydrocortisone (HDC) administration, circulatory dynamics rapidly improved. Brain magnetic resonance imaging (MRI) showed aplasia of the anterior pituitary gland and ectopic posterior gland. γ-Glutamyltranspeptidase (γ-GTP) increased from day 10 after birth and direct bilirubin increased from day 18. On ultrasonography, sludge filling the common bile duct and gall bladder was observed. After initiating treatment with both ursodeoxycholic acid and recombinant human growth hormone (rhGH), cholestasis improved and the sludge disappeared at 3 months after birth. In newborns with CPHD, severe central adrenal insufficiency might induce cardiogenic shock after birth. Early diagnosis and intervention are necessary.


Assuntos
Bile/metabolismo , Doenças Biliares/etiologia , Hipopituitarismo/complicações , Hipopituitarismo/diagnóstico , Choque Cardiogênico/etiologia , Bile/diagnóstico por imagem , Doenças Biliares/complicações , Doenças Biliares/diagnóstico , Doenças Biliares/metabolismo , Humanos , Hipopituitarismo/terapia , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/terapia , Ultrassonografia
6.
BMJ Case Rep ; 20172017 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-28623190

RESUMO

Tuberculosis (TC) is very common and significant cause of morbidity and mortality worldwide. Isolated cystic duct lymph node TC cases without involvement of gallbladder are exceedingly rare. It is difficult to diagnose preoperatively because of lack of characteristic signs and symptoms of TC. We report a man aged 45 years who presented with right upper abdominal pain since 1week. It was associated with nausea and postprandial fullness. There was no evidence of jaundice and lymphadenopathy. Abdominal examination showed moderate right upper quadrant tenderness with positive Murphy's sign and splenomegaly but no signs of peritonism. Abdomen ultrasound revealed sludge in gallbladder, dilated pancreatic duct, coarse exotexture of liver, splenomegaly and no lymphadenopathy. He underwent laparoscopic cholecystectomy; histological report showed chronic caseating granulomatous lymphadenitis with Langhans type of giant cells in lymph node near cystic duct with chronic cholecystitis of gallbladder. Standard antituberculosis therapy was given for 12 months.


Assuntos
Ducto Cístico/patologia , Vesícula Biliar/cirurgia , Linfonodos/microbiologia , Tuberculose dos Linfonodos/complicações , Abdome/diagnóstico por imagem , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Bile/diagnóstico por imagem , Colecistectomia Laparoscópica/métodos , Diagnóstico Diferencial , Vesícula Biliar/patologia , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/etiologia , Doenças Raras , Resultado do Tratamento , Tuberculose dos Linfonodos/tratamento farmacológico , Ultrassonografia
8.
Radiology ; 283(2): 570-579, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27846377

RESUMO

Purpose To evaluate the prevalence of tumefactive sludge of the gallbladder detected at ultrasonography (US) and to assess whether any clinical and imaging differences exist between benign and malignant tumefactive sludge. Materials and Methods The institutional review board approved this retrospective study. The requirement for informed consent was waived. The study included a cohort (n = 6898) of patients with gallbladder sludge drawn from all adults (n = 115 178) who underwent abdominal US between March 2001 and March 2015. Tumefactive sludge was identified according to the following US findings: (a) nonmovable mass-like lesion and (b) absence of posterior acoustic shadowing at B-mode US and vascularity at color Doppler US. Follow-up examinations were arranged to ascertain whether the results showed true sludge or gallbladder cancer. Risk factors for malignant tumefactive sludge based on clinical and US characteristics were identified with multivariate logistic regression analysis. Results The prevalence of gallbladder and tumefactive sludge at abdominal US during the observation period was 6.0% (6898 of 115 178) and 0.1% (135 of 115 178), respectively. Twenty-eight (20.7%) patients were lost to follow-up. Of the 107 with tumefactive sludge, 15 (14%) were confirmed to have malignant tumefactive sludge. The risk factors for malignant tumefactive sludge were old age (odds ratio [OR], 1.06; P = .035), female sex (OR, 5.48; P = .014), and absence of hyperechoic spots within the sludge (OR, 6.78; P = .008). Conclusion Although the prevalence of tumefactive sludge at US was rare, a considerable proportion of patients had a malignancy. Careful follow-up is essential, especially for older patients, women, and those with an absence of hyperechoic spots at US. © RSNA, 2016 Online supplemental material is available for this article.


Assuntos
Bile/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/epidemiologia , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , República da Coreia/epidemiologia , Fatores de Risco , Sensibilidade e Especificidade
9.
Acad Radiol ; 24(4): 478-482, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27916593

RESUMO

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.


Assuntos
Bile/diagnóstico por imagem , Colesterol/análise , Cálculos Biliares , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , China , Precisão da Medição Dimensional , Feminino , Cálculos Biliares/química , Cálculos Biliares/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
10.
J Am Anim Hosp Assoc ; 52(3): 125-31, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27008319

RESUMO

Echogenic luminal contents are often noted during ultrasonographic examination of the gallbladder (GB) in canine patients, but the significance of biliary sludge is not well understood. GB contents were evaluated during 200 sequential ultrasonographic scans performed at a veterinary school, and sludge was quantified using a 1-5 scale. GB volume was retrospectively estimated from stored images. Medical records were used to determine patient demographics, clinicopathologic findings, and diagnoses/disorders. The majority of dogs (66.5%) had some hyperechoic material within the GB. Four dogs were diagnosed with a mucocele. For statistical purposes, dogs with uniformly nonechogenic bile or minimal sludge (80.5%) were compared to those with >25% sludge (17.5%). Dogs with >25% sludge were significantly older than those with minimal sludge (8 versus 11 yr). Serum cholesterol and bilirubin concentrations and activities of both alkaline phosphatase and gamma-glutamyl transferase were not correlated with the presence of GB sludge. Dogs with spontaneous hyperadrenocorticism or hypothyroidism were more likely to have >25% sludge (odds ratio: 5.04). In addition, >25% sludge was associated with increased GB volume, suggesting that changes in GB function or contractility may impact the formation of biliary sludge in dogs.


Assuntos
Bile/diagnóstico por imagem , Doenças do Cão/diagnóstico por imagem , Doenças da Vesícula Biliar/veterinária , Ultrassonografia/veterinária , Animais , Cães , Doenças da Vesícula Biliar/diagnóstico por imagem , Ultrassonografia/métodos
11.
J Vet Intern Med ; 30(3): 771-8, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26992049

RESUMO

BACKGROUND: Biliary sludge is associated with gallbladder (GB) dysmotility and mucus hypersecretion suggesting a link between biliary sludge and the formation of GB mucoceles (GBM). If biliary sludge progresses to GBM, treatment to reduce the production and progression of sludge is warranted. HYPOTHESIS/OBJECTIVES: The objective of this study was to determine the course of biliary sludge in dogs. ANIMALS: Seventy-seven healthy, client-owned dogs ≥4 years of age screened for biliary sludge; 45 affected dogs identified. METHODS: Prospective, observational design. Serial ultrasound examinations were evaluated at 3, 6, 9, and 12 months to monitor degree of sludge based on proportion of GB filled with sludge (mild [0.01-24.4%], moderate [24.5-49.4%], moderate to severe [49.5-74.4%], severe [74.5-100%]), gravity dependency of sludge, and GB dimensions. RESULTS: After 1 year of follow-up, the degree of sludge was mild (34%), moderate (47%), moderate to severe (13%), severe (3%), or absent (3%). There was no significant difference in median degree of sludge over 1 year (P = .36). There were no significant changes in the gravity dependency of sludge over 1 year. A subset of dogs, 24%, with initial gravity-dependent sludge developed a combination of nondependent and dependent sludge. Dogs had resolved (2%), decreased (19%), static (40%), increased (29%), or recurrent (10%) sludge at the conclusion of the study. CONCLUSIONS AND CLINICAL IMPORTANCE: Biliary sludge was prevalent, affected dogs remained asymptomatic, and it rarely resolves in healthy dogs over a period of 1 year. Some dogs developed nongravity-dependent sludge within 1 year, which might indicate changes in consistency of sludge.


Assuntos
Bile/diagnóstico por imagem , Doenças do Cão/patologia , Doenças da Vesícula Biliar/veterinária , Animais , Bile/química , Bile/fisiologia , Doenças do Cão/diagnóstico por imagem , Cães , Feminino , Doenças da Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/patologia , Masculino , Ultrassonografia/veterinária
12.
Clin Nucl Med ; 41(6): 488-9, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26859214

RESUMO

Chilaiditi sign is the incidental radiologic finding of intestinal interposition between the liver and diaphragm, whereas Chilaiditi syndrome describes the presence of accompanying clinical symptoms including abdominal pain, constipation, vomiting, and respiratory distress. We describe a case of radiotracer accumulation over the liver dome on Tc-mebrofenin hepatobiliary scan performed on a 72-year-old man with acute cholecystitis mimicking a bile leak. However, chest radiograph and CT revealed intestinal hepatodiaphragmatic interposition. This case illustrates the importance of being familiar with the scintigraphic appearance of the Chilaiditi sign and correlating abnormal nuclear medicine scan findings with other available radiologic modalities.


Assuntos
Síndrome de Chilaiditi/diagnóstico por imagem , Colecistite Aguda/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Idoso , Bile/diagnóstico por imagem , Colecistostomia , Diagnóstico Diferencial , Diafragma/diagnóstico por imagem , Humanos , Iminoácidos , Fígado/diagnóstico por imagem , Masculino , Compostos de Organotecnécio , Radiografia Torácica , Compostos Radiofarmacêuticos , Ruptura Espontânea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
J Ultrasound Med ; 35(3): 605-10, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26903661

RESUMO

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.


Assuntos
Bile/diagnóstico por imagem , Colecistite/epidemiologia , Colelitíase/epidemiologia , Anamnese/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Pancreatite/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Colecistite/diagnóstico por imagem , Colelitíase/diagnóstico por imagem , Comorbidade , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Hampshire/epidemiologia , Pancreatite/diagnóstico por imagem , Prevalência , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia/estatística & dados numéricos , Adulto Jovem
15.
J Nucl Med ; 57(4): 628-33, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26697965

RESUMO

UNLABELLED: During cholestasis, accumulation of conjugated bile acids may occur in the liver and lead to hepatocellular damage. Inspired by our recent development of N-(11)C-methyl-glycocholic acid-that is, (11)C-cholylsarcosine-a tracer for PET of the endogenous glycine conjugate of cholic acid, we report here a radiosynthesis of N-(11)C-methyl-taurine-conjugated bile acids and biodistribution studies in pigs by PET/CT. METHODS: A radiosynthesis of N-(11)C-methyl-taurine-conjugated bile acids was developed and used to prepare N-(11)C-methyl-taurine conjugates derived from cholic, chenodeoxycholic, deoxycholic, ursodeoxycholic, and lithocholic acid. The lipophilicity of these new tracers was determined by reversed-phase thin-layer chromatography. The effect of lipophilicity and structure on the biodistribution was investigated in pigs by PET/CT using the tracers derived from cholic acid (3α-OH, 7α-OH, 12α-OH), ursodeoxycholic acid (3α-OH, 7ß-OH), and lithocholic acid (3α-OH). RESULTS: The radiosyntheses of the N-(11)C-methyl-taurine-conjugated bile acids proceeded with radiochemical yields of 61% (decay-corrected) or greater and radiochemical purities greater than 99%. PET/CT in pigs revealed that the tracers were rapidly taken up by the liver and secreted into bile. There was no detectable radioactivity in urine. Significant reflux of N-(11)C-methyl-taurolithocholic acid into the stomach was observed. CONCLUSION: We have successfully developed a radiosynthesis of N-(11)C-methyl-taurine-conjugated bile acids. These tracers behave in a manner similar to endogenous taurine-conjugated bile acids in vivo and are thus promising for functional PET of patients with cholestatic diseases.


Assuntos
Ácidos e Sais Biliares/química , Ácidos e Sais Biliares/síntese química , Ácidos e Sais Biliares/farmacocinética , Compostos Radiofarmacêuticos/síntese química , Compostos Radiofarmacêuticos/farmacocinética , Taurina/análogos & derivados , Taurina/química , Animais , Bile/diagnóstico por imagem , Bile/metabolismo , Colestase/diagnóstico por imagem , Cromatografia em Camada Delgada , Feminino , Marcação por Isótopo , Lipídeos/química , Fígado/diagnóstico por imagem , Fígado/metabolismo , Radiometria , Cintilografia , Sus scrofa , Taurina/síntese química , Taurina/farmacocinética , Distribuição Tecidual
16.
Surg Endosc ; 30(7): 3128-32, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26487207

RESUMO

INTRODUCTION: Bile leakage is a serious complication occurring in up to 10 % of hepatic resections. Intraoperative detection of bile leakage is challenging, and concomitant blood oozing can mask the presence of bile. Intraductal dye injection [methylene blue or indocyanine green (ICG)] is a validated technique to detect bile leakage. However, this method is time-consuming, particularly in the laparoscopic setting. A novel narrow band imaging (NBI) modality (SPECTRA-A; Karl Storz, Tuttlingen, Germany) allows easy discrimination of the presence of bile, which appears in clear orange, by image processing. The aim of this experimental study was to evaluate SPECTRA-A ability to detect bile leakage. METHODS: Twelve laparoscopic partial hepatectomies were performed in seven pigs. The common bile duct was clipped distally and dissected, and a catheter was inserted and secured with a suture or a clip. Liver dissection was achieved with an ultrasonic cutting device. Dissection surfaces were checked by frequently switching on the SPECTRA filter to identify the presence of bile leakage. Intraductal ICG injection through the catheter was performed to confirm SPECTRA findings. RESULTS: Three active bile leakages were obtained out of 12 hepatectomies and successfully detected intraoperatively by the SPECTRA. There was complete concordance between NBI and ICG fluorescence detection. No active leaks were found in the remaining cases with both techniques. The leaking area identified was sutured, and SPECTRA was used to assess the success of the repair. CONCLUSIONS: The SPECTRA laparoscopic image processing system allows for rapid detection of bile leaks following hepatectomy without any contrast injection.


Assuntos
Bile/diagnóstico por imagem , Hepatectomia/efeitos adversos , Laparoscopia/métodos , Hepatopatias/diagnóstico por imagem , Imagem de Banda Estreita/métodos , Animais , Ducto Colédoco/diagnóstico por imagem , Modelos Animais de Doenças , Processamento de Imagem Assistida por Computador , Hepatopatias/etiologia , Sus scrofa , Suínos
17.
Eksp Klin Gastroenterol ; (10): 94-98, 2016.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-29889382

RESUMO

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.


Assuntos
Colestase , Vesícula Biliar , Himecromona/administração & dosagem , Ácido Ursodesoxicólico/administração & dosagem , Adulto , Bile/diagnóstico por imagem , Colestase/diagnóstico por imagem , Colestase/tratamento farmacológico , Colestase/fisiopatologia , Quimioterapia Combinada , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/fisiopatologia , Humanos , Masculino
18.
Rev Esp Enferm Dig ; 107(12): 768-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26671594

RESUMO

A 58-year-old man with a history of a heavy alcohol intake was admitted to hospital for a 3-weeks history of abdominal discomfort, nausea, vomiting and an increased abdominal girth that appeared progressively after an abdominal trauma due to an accidental fall. On physical examination, jaundice was present and the abdomen was distended with no tenderness on palpation. Laboratory studies showed an increased white-cell count, an elevated C-reactive protein and abnormal liver-function tests. Abdominal ultrasonography showed a large fluid collection in the right side of the abdomen. An abdominal computed tomography scan revealed a gallbladder perforation communicating to a big subcapsular hepatic biloma of 9.5 by 25.0 by 35.0 centimeters, which was compressing the liver and other intraabdominal organs. Finally, our patient underwent an open cholecystectomy with drainage of the biloma, and a partial resection of the Glisson's capsule. Macroscopic and microscopic examination of the resected specimens confirmed the diagnosis of traumatic gallbladder perforation. Gallbladder traumatic injury is a rare entity. The diagnosis represents a challenge because of its low incidence, its association with other lesions of vital organs and the nonspecific and insidious symptoms that can produce. Treatment depends on the type and severity of the damage caused; nevertheless, cholecystectomy remains the treatment of choice in patients with rupture or avulsion of the gallbladder. To our knowledge, this is the first report in the English literature of an isolated blunt traumatic gallbladder injury that was associated with the development of a large biloma.


Assuntos
Traumatismos Abdominais/complicações , Bile , Vesícula Biliar/lesões , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/diagnóstico por imagem , Acidentes por Quedas , Bile/diagnóstico por imagem , Vesícula Biliar/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem
19.
Dev Period Med ; 19(2): 182-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26384120

RESUMO

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.


Assuntos
Antibacterianos/efeitos adversos , Bile/diagnóstico por imagem , Ceftriaxona/efeitos adversos , Doenças da Vesícula Biliar/induzido quimicamente , Doenças da Vesícula Biliar/diagnóstico por imagem , Pielonefrite/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Humanos , Lactente , Masculino , Pielonefrite/complicações , Ultrassonografia , Infecções Urinárias/complicações
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