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Objective:To observe the clinical efficacy and influence of modified Chaihu Shugansan combined with ursodeoxycholic acid tablets on inflammatory factors in treatment of chronic cholecystitis cholelithiasis （stagnation of liver and gallbladder Qi）. Method:One hundred and ten patients were randomly divided into control group （60 cases） and observation group （60 cases）. Both groups received lifestyle intervention， and oral ursodeoxycholic acid tablets， 50 mg/time， taken in the morning and evening meals. Patients in control group additionally took Yidanshu capsules orally， 4 capsules/time， 3 times/day. Patients in observation group additionally took modified Chaihu Shugansan orally， 1 dose/day. The treatment courses continued 3 months in both groups. Before and after treatment， traditional Chinese medicine （TCM） symptom scores were graded， the ultrasound status of chronic gallbladder inflammation， gallbladder contraction function and stones was graded， the levels of interleukin-6 （IL-6）， IL-8， tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>） and nuclear transcription factor-<italic>κ</italic>B（NF-<italic>κ</italic>B）Were detected， and safety was evaluated. The efficacy for TCM syndromes， imaging efficacy and the efficacy for eliminating gallbladder stones were compared between the two groups. Result:The efficacy for TCM syndrome， efficacy on color ultrasound for chronic cholecystitis and the efficacy on imaging for cholelithiasis in the observation group were all better than those in the control group（<italic>Z</italic>=2.104<italic>，Z</italic>=2.076，<italic>Z</italic>=2.101，<italic>P</italic><0.05）. The thickness of gallbladder wall and volume of the gallbladder of the observation group were smaller than those of the control group （<italic>P</italic><0.01）， and gallbladder contraction function was higher than that in control group （<italic>P</italic><0.01）. Levels of IL-6， IL-8， TNF-<italic>α</italic> and NF-<italic>κ</italic>B in observation group were lower than those in control group （<italic>P</italic><0.01）. Conclusion:modified Chaihu Shugansan combined with ursodeoxycholic acid in the treatment of chronic cholecystitis and cholelithiasis （liver and gall Qi stagnation） is better than Yidanshu capsule combined with ursodeoxycholic acid sour scheme in terms of clinical efficacy， imaging efficacy， and elimination of gallbladder stones. It can reduce inflammation， and enhance gallbladder contraction， with high safety in clinical use.
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Objective: To explore the clinical effect of modified Chaihu Guizhi Ganjiang Tang in the treatment of chronic cholecystitis with gallbladder heat and spleen cold syndrome. Method: Totally 129 cases with chronic cholecystitis treated in our hospital from March 2017 to July 2018 were selected as study objectives and randomly divided into observation group (65 cases)and control group (64 cases). After the shedding and exclusion cases were subtracted, 61 patients in observation group and 61 patients in control group actually completed this study. The routine treatment was provided to both groups, and modified Chaihu Guizhi Ganjiang Tang was additionally given to observation group. All of the cases received treatments for 3 weeks. The two groups' clinical effect, traditional Chinese medicine(TCM)syndrome scores, inflammatory factors[interleukin (IL)-6, tumor necrosis factor (TNF)-α] levels in serum, gallbladder function, gastrointestinal function indicators[motilin (MTL), vasoactive intestinal peptide (VIP)] before and after treatments, as well as toxic side reaction were compared. Result: Totally 7 cases were lost during the study period. The overall effective rate of the observation group was 95.08%(58/61), which was significantly higher than 80.33%(49/61)of the control group (Pα concentrations after treatment were significantly lower than those before treatment (PPPConclusion: Modified Chaihu Guizhi Ganjiang Tang treats patients with chronic cholecystitis with bile heat and spleen cold syndrome by effectively relieving inflammatory response and accelerating the recovery of gastrointestinal function and gallbladder systolic function, with an exact curative effect and high patient tolerance.
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Objective: To explore the effect of Chaishao Shugan Lidan Paishitang on inflammation, stress response and gastrointestinal function in gallstones patients with chronic cholecystitis. Method: Gallstones patients with chronic cholecystitis treated in our hospital from March 2017 to May 2018 were randomly divided into two groups, with 65 cases in each group. The control group was orally given ursodeoxycholic acid combined with metronidazole. In addition to the therapy of the control group, the Observation group was also given Chaishao Shugan Lidan Paishitang. Traditional Chinese medicine symptom scores, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), hypersensitive C-reactive protein (hs-CRP), superoxide disproportionation alcohol (SOD), propylene glycol (MDA) and carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), gastric dynamic element (MOT), gastrin-releasing (GAS) and somatostatin (SS), alanine aminotransferase (ALT), aspertate aminotransferase (AST), total bilirubin (TBIL) and total bile acid (associates), and total cholesterol (TC) levels before and after treatment were observed in two groups, and the curative effect, reactions and relapse were also observed. Result: The inflammatory effect, stone ablation effect and clinical effect of observation group were significantly better than those of control group (Z=2.329, PZ=2.686, PZ=2.940, PPα, hs-CRP, IL-6, CEA, CA19-9, SS and MDA in observation group were lower than those in control group (PPχ2=5.140, PConclusion: The treatment of gallstones patients with chronic cholecystitis by Chaishao Shugan Lidan Paishitang has a good curative effect, and can alleviate clinical symptoms, inhibit oxidative stress and inflammation, improve liver and bile functions and gastrointestinal function, and reduce the recurrence rate.
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Se registra el caso de una paciente femenina de 73 años con antecedente de colecistitis crónica, quien al examen físico presentaba una tumoración palpable en hipocondrio derecho que se extendía a fosa ilíaca derecha. La ecografía abdominal mostró aumento del tamaño vesicular que alcanzaba fosa ilíaca derecha con contenido multilitiásico; se confirmó dicho hallazgo con estudio tomográfico. Se realizó laparotomía exploradora con hallazgo operatorio de vesícula gigante de paredes engrosadas, tensa, adherida a órganos circundantes, de dificultosa disección, que requirió punción para drenaje de su contenido. Se efectuó, además, colecistectomía convencional según técnica de Pribram, y se obtuvo una pieza quirúrgica de aproximadamente 15 × 10 cm, con informe de anatomía patológica de colecistitis crónica. En contraste con la presentación habitual de la colecistitis crónica, el caso de referencia obedece a una presentación atípica con una vesícula gigante.
We report the case of a 73-year old female patient with a history of chronic cholecystitis with a palpable mass extending from the right hipochondrium to the right iliac region. An abdominal ultrasound showed an enlarged gallbladder extending to the right iliac region with multiple gallstones confirmed by computed tomography scan. An exploratory laparotmy was performed. A giant gallbladder with thickened walls and presence of adhesions to the neighbor organs that were difficult to remove were found and required drainage. A conventional cholecystectomy was performed using the Pribram's technique. A surgical specimen measuring 15 x 10 cm was sent to the pathologist who made a diagnosis of chronic cholecystitis. This case is an atypical presentation of chronic cholecystitis due to a giant gallbladder.
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Humans , Female , Aged , Cholecystectomy , Gallbladder/diagnostic imaging , Thorax/diagnostic imaging , Tomography, X-Ray Computed , Abdominal Pain/complications , Cholecystitis/complications , Ultrasonography , Abdomen/diagnostic imaging , LaparotomyABSTRACT
Aims & Objectives: To compare three port–laparoscopic cholecystectomy (3 LC) with four port–laparoscopic cholecystectomy in term of safety, efficacy, post–op pain, hospital stay and complication rates. Material & Methods: The present study was conducted in the department of Surgery, S.N. Medical College, Agra (U.P.). Total 104 adult patients of cholelithiasis with chronic cholecystitis were included in the study. These 104 patients were randomly divided into two group (I & II) consisting of 52 patients in each group. Study was conducted for a period of 1 year from Jan. 2017 to Jan. 2018. Group–I: performed 3 port LC (3 port–laparoscopic cholecystectomy) Group–II: performed 4 port LC (4 port–laparoscopic cholecystectomy). The present study is being conducted to compare the various merits and demerits of 3 port LC and 4 port LC performed by same surgical team in the same scenario in our setup in our medical college. Results: Statistically significant different was found between the two group in term of visual analogue score for pain at 6 and 24 hr, analgesic requirement, duration of hospital stay and back to work and cosmetic outcome all being less in the three port LC group. Result of other variable were comparable in the two groups. Conclusion: Three port laparoscopic cholecystectomy resulted in less port site pain and better cosmetic outcome require fewer analgesic, fewer surgical scar and without increase in complication with shorter duration of hospital stay.
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Background: Gallbladder disease is one of the most common gastrointestinal diseases. Various studies have shown association between gallstone and alteration in serum lipids. The objective of this study was to evaluate histological patterns of cholecystectomy specimens and compare serum lipid profile of gallstone patients with controls.Methods: This study was conducted over a period of two years (April 2016 to April 2018). Records of 287 specimens who underwent cholecystectomy were analysed in which gallstones were found only in 186 patients. Out of 186 patients with gallstones, records of serum lipid profile were available in 32 patients which were compared with 32 control of similar age. Independent t- test was used to compare the data between cases and control.Results: Out of 287 cases, 68 were male and 219 were female with male to female ratio of 1:3.2. The predominant histopathological lesion was chronic cholecystitis (73.17%). Malignancy was observed in 0.7% cases. Serum total cholesterol, triglycerides and low density lipoprotein cholesterol were found to be higher and statistically significant in patients with gallstone compared to controls (p value 0.024, <0.001and 0.016 respectively). Serum High density lipoprotein cholesterol was lower in gallstone patient than in control but not statistically significant (p value 0.23).Conclusions: Chronic cholecystitis was the most common histopathological lesion. Serum total cholesterol, triglyceride and low density lipoprotein cholesterol level were elevated and statistically significant in patients with gallstone.
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Hyalinising cholecystitis is rare form of chronic cholecystitis. It comprises about 1.6% of the cholecystectomy specimens. Hyalinising cholecystitis is said to be associated with risk of gallbladder cancer. We hereby present a case of a 54-year-old woman who came with chief complain of pain in right upper abdomen. She was diagnosed as a case of chronic cholecystitis on ultrasonography. For this the patient underwent cholecystectomy during which the gallbladder was removed. The final diagnosis of hyalinising cholecystitis was given on histopathology.
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Objective To observe and analyze the characteristics and trends of the liver and gallbladder damage caused by long-term use of anti schizophrenia drugs through the observation of the abdominal ultrasound. Methods From August 2013 to April 2016, the patients diagnosed as schizophrenia and met criterions were enrolled in our hospital. The observation group I included patients taking anti schizophrenia drug for 3 to 5 years. The observation group II included patients taking anti schizophrenia drug more than 5 years. In addition, the control group recruited healthy person who were over 30 years old and had never taken anti-schizophrenia drug. The change in ultrasound of liver and gallbladder were recorded and analyzed. Results The rate of cholecystolithiasis, chronic cholecystitis in observation group II were higher than those in the other two groups (P<0.05), while there had no significant difference between observation group I and control group. The rate of pure fatty liver in observation group II were higher than those incontrol group (P<0.05), while there had no significant difference between observation group I and observation group II, and there had no significant difference between observation group I and control group. There had no significant difference among three groups regarding as the rate of hepatic cyst and hepatic cavernous hemangioma. Conclusion Long-term use of anti-schizophrenia drugs could increase the risk ofcholecystolithiasis, chronic cholecystitis and pure fatty liver .
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Mirizzi syndrome (MS) is a complication of chronic cholelithiasis,whose pathological changes are severe and complicated.The preoperative diagnosis rate of MS is rather low,and the intraoperative bile duct injury rate is rather high.In the past,MS was considered as a contraindication for laparoscopy,but in the recent decade,with the increasing understanding on pathological changes of MS,the improvement of laparoscopic technique and the accumulation of experience,laparoscopic therapy has been increasingly used in treating MS.The piling experience and knowledge have been modified and optimized the traditional treatment for MS mainly in the following 3 aspects.First,if the skills and experience permit,exploration and treatment of MS may be completed safely and efficiently in laparoscopic route.Second,biliary-enteric anastomosis should be avoided as much as possible in the treatment strategy of MS Ⅲ.Intraoperatively,the wall of cholecystobiliary fistula and the Hartmann's pouch should be retained as much as possible in order to aid in the closure of the destroyed bile duct.When exploration is not needed,MS Ⅲ can be successfully treated with this technique in most cases.When exploration is needed,bile duct incision both in upper and lower directions from the fistula and T tube placement through the fistula are suggested.Third,for MS Ⅳ,bile duct repair and T-tube drainage can be used as the preferred method,and biliary-enteric anastomosis can only be considered as a remedial measure when the bile duct is completely transected or the continuity is not satisfactory.
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OBJECTIVE:To systematically review the efficacy and safety of Danshu capsule in the treatment of chronic chole-cystitis,and provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,Cochrane Li-brary,Web of science,CJFD,CBM,VIP Database and Wanfang Database,randomized controlled trials(RCT)about Danshu capsule versus other medicines in the treatment of chronic cholecystitis were collected. Meta-analysis was performed by using Rev Man 5.2 software after data extracting and quality evaluating by Cochrane 5.1.0. RESULTS:Totally 12 RCTs were enrolled,involving 1140 patients. Results of Meta-analysis showed the cure rate of Danshu capsule in the treatment of chronic cholecystitis was higher than control group,there was statistically significant difference between 2 groups [RR=1.62,95%CI(1.33,1.96),P<0.001];total effec-tive rate in Danshu capsule group was higher than Ursodeoxycholic acid tablet group[RR=1.37,95%CI(1.14,1.64),P<0.001], Xiaoyan lidan tablet group [RR=1.40,95%CI(1.24,1.58),P<0.001],Jindan tablet group[RR=1.13,95%CI(1.04,1.23),P=0.005] and Danning tablet group[RR=1.16,95%CI(1.05,1.28),P=0.004],there were statistically significant differences among groups. Incidence of adverse reactions of Danshu capsule was lower than control group,there was statistically significant difference between 2 groups [RR=0.20,95%CI(0.12,0.34),P<0.001]. CONCLUSIONS:Both efficacy and safety of Danshu capsule are good in the treatment of chronic cholecystitis.
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Situs inversus totalis (SIT) is a rare anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal anatomy. Location of symptoms and signs arising from a diseased organ may vary. The diagnosis as well as to operate any pathology in such patient is difficult. Laparoscopic cholecystectomy in patient with situs inversus totalis is a challenge but not a contraindication. We have reported here case of an adult woman who presented with on and off pain located at the epigastrium. Clinical examination and laboratory investigations were unremarkable. During radiological evaluation, the patient was found to have situs inversus totalis and features of chronic cholecystitis with cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion by right handed surgeon. In conclusion, Laparoscopic cholecystectomy in these patients is technically more demanding and needs reorientation of visual-motor skills.
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BACKGROUND/AIMS: The objective of our study was to identify useful computed tomography (CT) findings for differentiating fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder. METHODS: We retrospectively identified cases of 41 patients with pathologically proven adenomyomatosis (n=21) or chronic cholecystitis (n=20) who had fundal thickening of the gallbladder on preoperative abdominal CT. Analysis of the CT findings included evaluation of the thickness, contour, border, intralesional cystic area, adjacent gallbladder wall thickening, presence of inner layer enhancement, enhancement grade, enhancement pattern, and presence of stones. Statistical analyses were performed using the Mann-Whitney U test and Fisher exact test. RESULTS: Oval contour, inner layer enhancement and intralesional cystic area were more frequently noted in adenomyomatosis than in chronic cholecystitis (p<0.05 for each finding). Flat contour and adjacent gallbladder wall thickening were more frequently observed in chronic cholecystitis than in adenomyomatosis. No differences between adenomyomatosis and chronic cholecystitis in terms of the thickness, enhancement grade, enhancement pattern and presence of stones were apparent. CONCLUSIONS: CT may help to differentiate fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder.
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Adult , Aged , Female , Humans , Male , Middle Aged , Adenomyoma/pathology , Cholecystitis/pathology , Chronic Disease , Diagnosis, Differential , Gallbladder , Gallbladder Neoplasms/pathology , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Literatures at home and abroad were collected and pharmacology studies of berberine on treatment of digestive diseases were summarized. Berberine has still huge potential for treatment of peptic ulcer, gastritis, enteritis and other applications, and it has promising prospect in development and utilization.
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Summary: Gallbladder tuberculosis is an extremely rare disorder even in endemic region. It often mimics gallbladder malignancy as both of them share some common presentations. This entity is very rarely diagnosed pre-operatively as neither clinical features nor radiology are pathognomonic of gallbladder tuberculosis. The case reported here presented as chronic calculous cholecystitis with mass at gallbladder neck. Patient underwent laparotomy with suspicion of gallbladder carcinoma, which was eventually diagnosed as a case of gallbladder TB following histopathological examination of the resected specimen. He also had pulmonary TB in association and was completely cured with short course antitubercular chemotherapy.
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Cholecystitis/pathology , Cholecystitis/surgery , Gallbladder Diseases/diagnosis , Gallbladder Diseases/pathology , Gallbladder Diseases/surgery , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/pathology , Gallbladder Neoplasms/surgery , Histology , Humans , Laparotomy , Male , Tuberculosis/diagnosis , Tuberculosis/pathology , Tuberculosis/surgeryABSTRACT
Porcelain gallbladder is an uncommon manifestation of chronic cholecystitis. The wall of the gallbladder becomes hard, calcified and brittle with a bluish-white tinge which resembles a porcelain ceramic. This condition is associated with increased risk of malignancy. We report two cases, both female patients (both 56 years old) who were diagnosed with porcelain gallbladder. One presented with a pyogenic liver abscess and the other was diagnosed to have gallbladder carcinoma on the background of porcelain gallbladder with metastases in liver.
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Carcinoma , Cholecystitis , GallstonesABSTRACT
El objetivo del presente trabajo es determinar las especies bacterianas más prevalentes en muestras biliares de pacientes colecistectomizados en la clínica Cobija durante el segundo semestre de la gestión 2009, diferenciando entre aquellas que se presentan en el cuadro agudo y el cuadro crónico; además identificar el tipo de colecistitis más frecuente y si existe relación entre las mismas y la concentración bacteriana de aquellas muestras que resultaron positivas; también demostrar su relación con los factores de riesgo sexo y edad. El presente trabajo es una investigación de tipo descriptivo, analítico y transversal. La muestra fue 52 pacientes, que representa el 100% de aquellos sometidos a colecistectomía abierta en la clínica Cobija en los últimos seis meses del año 2009, de los cuales se recolectó la bilis durante el intraoperatorio y se procedió a su cultivo en Agar Sangre, caldo de tioglicolato; 24 horas después se verificó el crecimiento de colonias y se procede a su recuento y observación al microscopio, una vez identificados bacilos Gram negativos, se los cultivó en Agar Mc Conkey y posteriormente en kits bioquímicos de determinación de enterobacterias. Todo el procedimiento se realizó en el laboratorio de Bacteriología de la Facultad de Medicina Aurelio Meleán. Los resultados obtenidos indican que las bacterias más frecuentes en cuadros agudos son los bacilos Gram positivos y de los cuadros crónicos, los estreptococos. El sexo más susceptible es el femenino con la edad comprendida entre 30-34 y 50-54 años. Por último, se observó una relación directa entre concentraciones bacterianas mayores a 10000/ml con la colecistitis aguda. Concluimos que existe una relación entre el tipo de cuadro clínico de colecistitis y la concentración bacteriana. Además que el cuadro agudo puede desencadenarse con mayor frecuencia por bacilos Gram positivos y el crónico se relaciona con Streptococcus.
The aim of this study is to determine the most prevalent bacterial species in samples from patients cholecystectomized bile clinic Blanket fort he second half of 2009 management, differentiating between those that oceur in the acute and chronic table, also identify the type cholecystitis more frequently and whether a relationship exists between them and the bacterial concentration of those samples were positive, also showed their relationship to the risk factors age and sex. This study is a descriptive research, analytical and longitudinal. Sample 52 patients undergoing cholecystectomy at the clinic shelter in the last six months of 2009, of which the bile was collected during surgery and proceeded to its cultivation on blood agar, thioglycollate broth, 24 hours after the growth was checked colony and proceeds to count and microscopic observation, once identified Gram negative, the Me Conkey agar and then in kit's biochemical determination of Enterobacteriaceae.The entire procedure was performed in the laboratory of Bacteriology, Faculty of Medicine Melean Aurelio. The results obtained indicate that the most common bacteria in acute cases are Gram positive and chronic conditions, the streptococci. Sex is more susceptible to female aged between 30-34 and 50-54 years. Finally, we observed a direct relationship between bacterial concentrations greater than 10000/ml with acute cholecystitis. We conclude that there is a relationship between the type of clinical picture of cholecystitis and bacterial concentration. In addition to the acute condition may be triggered more often by Gram-positive bacilli and Streptococcus related to chronic.
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0.05).The cluster analysis of 20 most frequent symptoms was consistent with the frequency analysis in TCM syndrome distribution.Conclusion Age,sex has no relation with the incidence of chronic cholecystitis.TCM syndromes of stagnated heat in liver and stomach and qi stagnation in liver and stomach of chronic cholecystitis are more common.Sex,age,occupation,educational level and whether or with gallbladder stone has no relation with the distribution of TCM syndromes.
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Isospora belli (I. belli) is a spore-forming protozoa that primarily infects enterocyte. The clinical manifestation may very from asmptomatic to self-limited diarrhea in healthy persons. Rarely, in the normal hosts,5 chronic persistent or intermittent symptom may continue for many years.1,2 Treatment with cotrimoxazole is usually effective in both normal patients19 and patients with AIDS20,21 Nevertheless, relapse is common and is believed to be associated with the presence of extraintestinal infection.3,4,17 Few cases of extraintestinal I. belli infection have been documented in patients with AIDS,3-5 and one case in an immuncompetent patient.24 This report presents a unique case of isosporiasis in a 58-year-old anti-HIV negative Thai female suffering from chronic recurrent diarrhea due to I. belli, despite two episodes of complete 4-week cotrimoxazole and another course of nitazoxanide. Abdominal computer tomographic examination and ultrasonography identified sclerosing cholangitis and chronic cholecstitis. Histologic examination of the cholecystectomy specimen recovered schizonts and merozoites in the parasitophorous vacuoles located in gallbladder epithelium.
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Objective To investigate the features of gallbladder carcinoma in two-phase spiral CT, and to analysis the values of two-phase spiral CT for the differential diagnosis between gallbladder carcinoma and chronic cholecystitis. Methods The two-phase spiral CT manifestations of 30 cases of gallbladder carcinoma, proved by surgery and pathology, and 30 cases of chronic cholecystitis were analyzed. Results According to the CT findings, the gallbladder carcinoma was categorized into 3 types: intraluminal mass of gallbladder in 6 out of 30 (20.0%), thickening of the gallbladder wall in 11 (33.7%), and mass replacing the normal gallbladder in 13(43.4%). The most common enhancement patterns of the wall in gallbladder carcinoma were hyperattenuation during the arterial phase, while isoattenuation with the adjacent hepatic parenchyma during the venous phase; or hyperattenuation during both phases. The most common enhancement pattern of the wall in chronic cholecystitis was isoattenuation during both phases, with clear hypoattenuation linear shadow in the gallbladder fossa. Other ancillary features of gallbladder carcinomas included: infiltration of the adjacent parenchyma, local lymphadenopathy and intrahepatic metastasis. Conclusion Two-phase spiral CT scan can identify the features of the gallbladder carcinoma and is helpful for the differential diagnosis of these two different disease entities.
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Objective To study the expressions of CA19-9 and CA125 and their clinicopathologic significances in gallbladder adenocarcinoma, pericancerous tissues and chronic cholecystitis. Methods EnVisionTM immunohistochemistry was used for assaying the expressive levels of CA19-9 and CA125 in the routinely paraffin-embedded sections of specimens from gallbladder adenocarcinoma (n=108), pericancerous tissues (n=46), and chronic cholecystitis (n=35). Results The positive rates of CA19-9 and CA125 were significantly higher in gallbladder adenocarcinoma (49.1%, 51.9%) than those in pericancerous tissues (26.1%, 15.2%) and chronic cholecystitis (14.3%, 5.7%), respectively (P