Cholecystokinin cholescintigraphy: detection of abnormal gallbladder motor function in patients with chronic acalculous gallbladder disease.

CCK cholescintigrams were performed in 374 patients with recurrent postprandial right upper quadrant pain, biliary colic, and a normal gallbladder sonogram and/or cholecystogram. The results of these examinations were correlated with the patients' final medical/surgical diagnoses. Twenty-seven patients recruited as control volunteers without objective clinical evidence of biliary disease also underwent CCK cholescintigraphy to determine if the degree of gallbladder contraction post-CCK differs in symptomatic versus asymptomatic subjects. Decreased gallbladder motor function was identified (maximal gallbladder ejection fraction response to CCK less than 35%) in 94% of patients with histopathologically confirmed chronic acalculous cholecystitis or the cystic duct syndrome and in 88% of patients clinically believed to have chronic acalculous biliary disease. Decreased gallbladder motor function does not distinguish symptomatic from asymptomatic gallbladder disease.

CT-guided percutaneous catheter drainage of lymphocele complicating splenorenal anastomosis.

We report the successful management by CT-guided percutaneous catheter drainage of a lymphocele complicating a Warren-Zeppa distal splenorenal venous anastomosis. The early postoperative course of this 31-year-old male with homozygous alpha 1-antitrypsin deficiency was complicated by chylous ascites and a large lymphocele demonstrable on CT scanning. The persistent 10.5 cm diameter lymphocele was drained percutaneously 5 weeks later by a CT-guided catheter. Drainage of lymph continued at decreasing rates for 13 days when the catheter was removed. Complete resolution of the lymphocele was confirmed at 2 1/2 months. The successful treatment of a lymphocele by percutaneous catheter drainage may obviate major surgery and has not been previously documented.

Intrarenal blood flow in carotid sinus nerve stimulation and hemorrhage in dogs.

The present study was undertaken to compare the role of the sympathetic nervous system, in hemorrhage, with that of hypotension in producing renal blood flow (RBF) redistribution. Ten mongrel dogs were prepared for the determination of RBF distrubition by injecting 85Kr dissolved in saline into the renal artery to obtain renal radioactivity curves. RBF distribution was determined a) at control, b) during a 15-min period of hypotension produced by electrical stimulation (10 v-60Hz) of the left carotid sinus nerve (nerve of Hering), c) 15 min after hemorrhage to a blood pressure equivalent to that of stimulation and d) during hemorrhage plus a 15-min period of stimulation. Hypotension caused by stimulation left component I blood flow unchanged (at approximately 492 ml/min/100 g) but resulted in an increase in component II flow from 93 +/- 8 to 155 +/- 20 ml/min/100 g. Hemorrhage caused a 60% reduction in component I blood flow rate, leaving component II unchanged. Partial reversal of hemorrhage effects on distrubiton of RBF was obtained by restimulation of the nerve of Hering. It appears that RBF distribution, as controlled by the carotid sinus, may involve primarily component I flow, with the redistribution between components I and II during hemorrhage possibly involving other mechanisms.