Cholelithiasis

Background Increasingly, laparoscopic biliary surgeons are undertaking laparoscopic cholecystectomy and laparoscopic common bile duct exploration for patients with cholelithiasis and choledocholithiasis. In laparoscopic common bile duct exploration a flexible choledochoscope is ordinarily used, and with this instrument the surgeon usually fails to remove large impacted stones. In contrast with use of a rigid nephroscope it is possible to remove all common bile duct stones irrespective of size and degree of impaction. The present study evaluates the efficiency of rigid nephroscope for managing common bile duct stones laparoscopically. Methods In the present study laparoscopic common bile duct exploration for stones was performed in 80 patients via standard laparoscopic cholecystectomy port sites. Patients with a common bile duct diameter >10 mm were included in this study. The rigid nephroscope was passed through the epigastric port and negotiated into the common bile duct through a choledochotomy. Stones were removed with graspers. Large hard stones were fragmented by pneumatic lithotripsy. Results Of the 80 patients treated in this manner, 72 (90%) had multiple common bile duct calculi, and 8 (10%) had a solitary common bile duct calculus. Mean common bile duct diameter was 15.3 mm (range: 10–37 mm). Conversion to open common bile duct exploration was necessary in 1 case (1.25%) because of difficult dissection secondary to extensive dense adhesions. In 7 patients (8.75%) a pneumatic lithotripter was used to fragment stones. Choledochotomy was managed by placing a T-tube in 21 (26.25%) patients, by effecting primary closure in 58 (72.5%) patients, and by choledochoduodenostomy in 1 (1.25%) patient. The mean operative time in this series was 83 min (range: 53–135 min). The mean postoperative hospital stay was 4.2 days (range: 3–19 days). One patient (1.25%) developed cholangitis 5 months after laparoscopic common bile duct exploration; the cause was a residual common bile duct stone. Conclusions A rigid nephroscope can be used for managing all types of common bile duct calculi irrespective of site, size, composition, or degree of impaction. Its use can be expected to become the standard for laparoscopic common bile duct exploration, especially for removing large calculi from a dilated common bile duct.

The Patient Treatment File of the Department of Veterans Affairs comprises the computerized records of all inpatients treated in all Veterans Affairs hospitals distributed throughout the United States. This database was used to study the association between liver disease and clinically manifest cholelithiasis. The computerized medical records of 38,459 patients with various forms of liver disease and 69,336 controls without the diagnosis were extracted from the annual files between 1990 and 1993. In a multiple logistic regression analysis, the occurrence of cholelithiasis served as the outcome variable, whereas different forms of liver disease and demographic characteristics, such as age, gender, and ethnicity, served as predictor variables. Among the control population, cholelithiasis was reported in 5.2% (3,571 of 69,336) of subjects. Cholelithiasis occurred in 7.5% (2,898 of 38,459) of patients with all liver disease, 9.5% (1,642 of 17,287) of patients with alcoholic liver cirrho...

In the early 1970s an increased prevalence of gallstones was reported in adults and children with immunoglobulin deficiency. As the advent of ultrasonography has largely changed the diagnostic approach to gallstones, we have reevaluated the prevalence of cholelithiasis in a group including 37 patients with common variable immunodeficiency and seven patients with other forms of primary immunodeficiency. All patients were receiving intravenous gammaglobulin replacement since 1983 or, in more recent cases, soon after the diagnosis was made, and therefore had relatively few infections. All patients underwent a hepatobiliary ultrasonogram and blood sampling. Data were compared, after age and sex standardization, with those obtained by the GREPCO in a free-living population of 1239 men and 1081 women. Only two women with immunoglobulin deficiency had gallstones. One of these was obese and had had one pregnancy. Both were asymptomatic. None of the patients studied had a history of cholecystectomy or evidence of biliary sludge. Thus, the observed prevalence rates of gallstone disease were 8.7% in women and 0% in males, respectively, against expected values of 9.5% and 3.2%. Immunodeficient patients expressed several putative risk factors for gallstones in the low range (body mass index, total and HDL cholesterol, and blood glucose in both sexes, and triglycerides in men). We conclude that gallstone disease is not more frequent in patients with immunodeficiency syndromes undergoing immunoglobulin therapy than in the general population.

BACKGROUND: The incidence (0.6% to 1.3%) of primary hepatolithiasis (PHL), also known as Oriental cholangiohepatitis, is increasing in Western countries and the treatment remains challenging. We analyzed the outcomes of patients undergoing hepatic resection (HR) for PHL at a single Western center. STUDY DESIGN: The records of all patients undergoing HR for PHL between August 1998 and January 2012 were reviewed. Patients were required to have preserved liver function (Child-Pugh class A) with no evidence of portal hypertension. Diagnosis of disease recurrence was based on radiographic and clinical findings. RESULTS: Of the 30 patients who underwent HR, 63.3% presented with earlier failed therapeutic strategies. The majority of the patients were female (63.3%), presented with cholangitis (66.6%), left-sided (66.6%), and unilateral (90.0%) disease, and underwent left-sided hepatic resection (76.6%). Previously created choledochoduodenostomies (13.3%) were all revised into Roux-en-Y hepaticojejunostomy anastomoses in conjunction with the HR. The incidence of concomitant cholangiocarcinoma was 23.3%, with a mean tumor size of 4.2 cm. Perioperative morbidity and mortality rates were 6.6% and 0%, respectively. At a median follow-up of 35 months, all patients had complete intrahepatic stone clearance. One patient required postoperative ERCP. Of the 7 patients with cholangiocarcinoma, 2 had cancer recurrence within the first year of the HR. The remaining patients are disease-free at a median follow-up of 21 months. CONCLUSIONS: Hepatic resection is a safe and definitive treatment option in the management of PHL. It achieves excellent short-and long-term results. The high incidence of concomitant cholangiocarcinoma makes a compelling argument for resection of all involved hepatic segments, when possible.

Seven patients with radiolucent stones in the gallbladder and two patients with radiolucent stones in the biliary tree were treated with oral cholic acid and purified soya-bean lecithin for 6 months. In two patients the stones disappeared and in one patient the stones were reduced in size. In five patients fasting bile samples were obtained before and during treatment and assayed for cholesterol, bile acid, and phospholipid. In all five patients the lithogenic index of bile was reduced during treatment. The biliary deoxycholic acid concentration was increased and chenodeoxycholic acid concentration decreased during treatment.

The present study reviewed the occurrence of gall bladder carcinoma in patients who underwent a cholecystectomy for gallstone disease. Methods: A retrospective study of demographical and clinical information for patients who underwent a cholecystectomy and operative cholangiogram for gallstones predominantly in three major hospitals located in the northern area of Melbourne was carried out. Results: Gall bladder carcinomas were observed in 14 patients (3.2%; 95% confidence interval (CI): 1.8-5.3%) consisting of 11 women and three men of median age 78.5 years (interquartile range: 77-81) from a series of 439 patients with a male-to-female ratio of 1-2. The results of the present study show that primary carcinoma of the gall bladder in this descriptive retrospective cohort was always associated with single or multiple cholesterol gallstones that were impacting on the gall bladder wall. Cholesterol 'solitaire' gallstones were ovoid in shape with diameters > 3 cm along their longest axis, whereas multiple cholesterol gallstones varied in size and number from two or three large stones (1-2 cm), to numerous smaller stones (variable size to 0.5 cm). No patient with gall bladder carcinoma had either brown or black pigment gallstones. Conclusion: It is postulated that gall bladder carcinoma may be intimately associated with large or numerous cholesterol gallstones that in the first instance may interfere with the mechanical functioning of the gall bladder. The size as well as the number of gallstones present in the gall bladder may contribute significantly to the promotion of a gallstone filling defect of the gall bladder that may cause chronic mechanical damage to the gall bladder mucosa. The present report supports the hypothesis that gall bladder carcinoma is an age-dependent malignancy, present mostly in women, that may be intimately associated with long-standing benign gallstone disease of the gall bladder.

Background: Peripapillary choledochoduodenal fistula (PCDF) is occasionally detected during endoscopic retrograde cholangiopancreatography. Cholelithiasis and biliary bougienage are two suspected causes of PCDF. Methods: The medical records for 841 patients who underwent endoscopic retrograde cholangiopancreatography between 1993 and 2002 were reviewed for evaluation of PCDF. Results: A total of 327 patients had common bile duct stones, and 16 of these had a PCDF at the papilla of Vater. None of the 16 patients had a history of pancreatitis, duodenal ulcer, or had undergone endoscopic retrograde cholangiopancreatography previously. Seven of the 16 had not undergone biliary surgery. Conclusions: This study indicates that PCDF is a relatively common complication of common bile duct stones and cholangitis. According to the present results, PCDF is more frequently associated with common bile duct stones than with biliary surgery and bougienage.

The diagnostic and therapeutic approaches used for patients referred for bile duct injuries and other major complications after laparoscopic cholecystectomy (LC) were reviewed and the results of a coordinated radiologic, endoscopic, and surgical approach were assessed.

Pre-operative prediction of a difficult laparoscopic cholecystectomy (LC) can help the patient as well as the surgeon prepare better for the intra-operative risk and the risk of conversion to open cholecystectomy. In 105 eligible patients who underwent LC during May 2001 to January 2003, patient characteristics, clinical history, laboratory data, ultrasonography results and intra-operative details were prospectively analyzed to determine predictors of difficult LC. Of 105 patients, 12 (11.4%) required conversion to open cholecystectomy. Significant predictors of conversion were body mass index> 30 Kg/m2, male gender, past history of acute cholecystitis or acute pancreatitis, past history of upper abdominal surgery, and gall bladder wall thickness exceeding 3 mm. Clinical and ultrasonograpic factors can help predict difficult LC and likelihood of conversion of LC to open surgery.

BACKGROUND: The effects of surgical pneumoperitoneum on lower-limb venous hemodynamits have already been studied; however, the effects of intermittent compression boots are not known in such venous-stasis conditions. METHODS: In 12 volunteers and 12 patients, the venous hemodynamic effects of intermittent leg compression were studied under external abdominal pressure or during laparoscopic cholecystectomy, respectively. Femoral venous diameter and velocity were measured. Venous pressure was monitored during the surgical procedures.

Over the last few years, weight loss has been recognised as a key factor in the control and prevention of coronary heart disease, hypertension, type 2 diabetes, hyperlipidaemia, cardiorespiratory failure and other chronic degenerative diseases. It has been shown that even a modest loss of 5% of initial body weight can reduce, eliminate or prevent these disorders in a large proportion of overweight patients. The early benefits of weight loss can be explained by the direct effects of a low calorie diet, but the long-term effects can only partially be attributed to diet, physical exercise or behavioural modifications. Long-term studies have shown that a sustained moderate weight loss of 10% improves glycemic control as a result of reduced insulin resistance, the better control or prevention of hypertension, increased HDL-and decreased LDL-cholesterol and VLDL triglycerides, improved diastolic function and the propagation of a cardiac stimulus that reduces the risk of ventricular arrhyt...

Most surgeons in general surgical practice in NSW who encounter common bile duct (CBD) stones at laparoscopic cholecystectomy (LC) prefer not to explore the CBD laparoscopically (A. Das, unpubl. data 1999). We suspect that this finding reflects a geographically widespread sentiment. A combination of two strategies can usually be used to avoid the need for laparoscopic CBD exploration: (i) selective preoperative endoscopic retrograde cholangio-pancreatography (ERCP) for suspected stones; and (ii) postoperative ERCP when unexpected stones are found at operative cholangiography (OC). The problem with this approach is that: (i) many patients have a negative and, therefore, unnecessary preoperative ERCP with the attendant risks; 1-7 and (ii) conventional postoperative ERCP (i.e. without a stent) carries the risks of failure to cannulate, pancreatitis, perforation and bleeding. Even a surgeon who is enthusiastic for laparoscopic transcystic or direct choledochoscopic exploration of the CBD, will not always be able to perform these procedures on certain patients and in certain circumstances. Ultimately, the optimum management of choledocholithiasis depends on the setting in which it is discovered, the resources of the institution, and the skill and experience of the attending surgeon. 14 Over the past 3 years, we have evaluated a combined approach to take advantage of the strengths and avoid the weaknesses of both the laparoscopic and endoscopic techniques, with the aim of finding a surgical technique to deal with CBD stones that is applicable to all general surgeons. In some settings, the facilitated ERCP might need to be performed elsewhere.

Background. Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Postoperative pain, however, can prolong hospital stay and lead to increased morbidity. In the context of a multimodal approach to analgesia, intraperitoneal local anesthetic administration optimizes analgesia and facilitates early postoperative recovery, and it may be associated with a decreased risk of side effects. Methods. A total of 71 patients was randomized to receive either intraperitoneal analgesic (IPA group) or not (controls). At the completion of cholecystectomy, 10 mL of levobupivacaine 0.5% were infused intraperitoneally in the IPA group and 8 h postoperatively, whereas in the controls, 10 mL of 0.9% NaCl were administered in the corresponding points of time. Differences in pain scores between groups were the primary endpoints. Opioid consumption and adverse effects were the secondary endpoints. Results. The 2 groups were homogenous in respect to age, sex, body mass index (BMI), and duration of operation. No conversion, complication, or mortality was recorded. The IPA group had a lesser visual analog scale score at rest and at movement compared with controls at all points of time measured. Moreover, fentanyl consumption in the recovery room was significantly greater in the control group, and the consumption of meperidine and the percentage of the patients that requested rescue analgesia in the ward was significantly greater in the control group. Local analgesic intraperitoneal injection as well as parecoxib for postoperative analgesia had no significant adverse effects. Conclusion. Our study showed that 2 separate doses of intraperitoneally administered levobupivacaine significantly decreased postoperative pain and the need for opioids compared with placebo. This technique is simple, safe, and without adverse effects. (Surgery 2009;146:475-82.) From the

Cholecystitis is the most common disease of gastro intestinal tract contributing for 10% disease burden. Most of the time it is infective in origin. In view of the emerging multi drug resistance organisms, there is a need for guidance in empirical antimicrobial therapy in every clinical setting. To study the bacteriological profile and their antimicrobial susceptibility pattern in cholecystitis and cholelithiasis patients. A cross sectional study was conducted at Mamatha General Hospital, Kammam over a period of 2 years from September 2010 to September 2012. A total number of 62 clinically diagnosed cases of cholecystitis and cholelithiasis subjected to elective cholecystectomy were included in the study. Bile and gall stone samples were collected and processed aerobically, anaerobically according to standard microbiological techniques. Antimicrobial susceptibility testing was performed on all isolates by Kirbybauer disc diffusion method and susceptibility pattern were recorded. A total number of 62 cases of cholecystitis were included in the study shows female preponderance of disease. Maximum number of cases belongs to 41 to 50 years age group. Out of 62 patients 62 bile samples and 58 gall stones specimen were collected and analyzed. Bile culture was positive in 24 cholelithiasis cases (41.37%), Gallstone culture was positive in 9 cases (15.51%). The two bile samples yielded anaerobic growth. Escherichia coli was the predominant organism in both samples. Bacterial isolates showing maximum susceptibility to ampicillin-sulbactum (100%), amikacin (80%). To optimized empirical antimicrobial therapy in cholecystitis and cholelithiasis patients prior knowledge of the prevalence of various bacteria and their antimicrobial susceptibility pattern in is required.

BACKGROUND: Laparoscopic cholecystectomy (LC) the preferred treatment for gallstones was not available in Ghana until 2005. OBJECTIVE: To report experience from Ghana of laparoscopic cholecystectomy in the treatment of galestones. METHODS: In a prospective study of patients with gallstones, information was obtained on demography, duration of various stages of the operation, analgesia and complication of patients with gallstones. All patients had general anaesthesia using endotracheal intubation, muscle relaxant and intermittent positive pressure ventilation. A standard four-trocar technique and maximum pneumoperitoneum pressure of 14mmHg were maintained during surgery. RESULTS: There were 50 women and two men aged 17-72 years (mean 44.2 years). All had symptomatic gallstones treated by interval LC. The main indications were biliary colic 23(44%) and previous cholecystitis 15(29%). There were scars from previous abdominal surgery in 22 (42%), mainly pfannenstiel. The Verres needle was used to obtain pneumoperitoneum in 40 (77%). Only one patient (1.9%) had the operation converted to open cholecystectomy. Most patients, 47/51 (92%), were discharged in 24 hours. The mean durations of various stages were: anaesthesia (110 minutes), pneumo-peritoneum (67.5 minutes) and reverse trendelenburg (47.8 minutes). The mean operating time reduced from 81 to 68 minutes in the last 20 patients. Complications were sore throat 11(21.6%), infection of the umbilical wound 3(5.9%), right shoulder tip pain (3; 5.9%) and bile leak 1(2%). There was no peri-operative mortality. CONCLUSION: Elective laparoscopic cholecystectomy can be performed with good results in patients with symptomatic gallstones in Accra. WAJM 2010; 29(2): 113-116.

A 6-year-old neutered male domestic shorthair cat was presented for acute onset of vomiting. Exploratory laparotomy identified a duplex gallbladder and left cholecystectomy was performed. Histopathology confirmed biliary mucocele and hepatic cholestasis. While rare, biliary mucoceles should be considered as a differential diagnosis for feline extrahepatic bile duct obstruction.

Aim: This investigation examined the effects of a solution injected to the gallbladder bed on operative time, bleeding, incidence of gallbladder perforation, and postoperative pain. Methods: One hundred sixty-four consecutive patients with cholelithiasis were randomized into two clinically comparable groups. In group 1 (84 patients), 40 ml of salineadrenaline-lidocaine solution was injected between the gallbladder and liver. In group 2 (80 patients), laparoscopic cholecystectomy was performed without hydrodissection. The time taken to dissect the gallbladder from the liver, bleeding from the liver bed, incidence of gallbladder perforation and spillage of bile and stones, duration of operation, amount of gas used for the laparoscopic cholecystectomy, conversion to open cholecystectomy, postoperative pain and pain localization were recorded. Results: The mean dissection time, amount of gas used, incidence of gallbladder perforation, spillage of stones, and liver bed bleeding were not significantly different between the groups. There also was no significant difference between the groups regarding postoperative pain and pain localization. Conclusion: Hydrodissection did not reduce time to dissect the gallbladder from the liver or risk of gallbladder perforation. Similarly, adrenaline and lidocaine injection between the gallbladder and the liver did not effect bleeding from the dissection area and did not alter postoperative pain or pain localization.

Gallbladder cancer is usually associated with gallstone disease, late diagnosis, unsatisfactory treatment, and poor prognosis. We report here the worldwide geographical distribution of gallbladder cancer, review the main etiologic hypotheses, and provide some comments on perspectives for prevention. The highest incidence rate of gallbladder cancer is found among populations of the Andean area, North American Indians, and Mexican

Background: Paroxysmal supraventricular tachycardia is a common dysrhythmia that occurs at all ages. Its management is determined by presenting symptoms and previous history of the patient. Patients present with a continuum of symptoms ranging from palpitations to syncope. The incidence of supraventricular tachycardia increases with age. Objectives: To discuss the etiology, precipitating factors, and acute management of supraventricular tachycardia; and to discuss nodal reentry circuits and representative electrocardiographic findings. Case Report: We present the case of an 84-year-old man with gallstone pancreatitis, choledolcholithiasis, and cholecystitis complicated by paroxysmal supraventricular tachycardia. We review this dysrhythmia, emphasizing its significance in elderly patients. Conclusion: Supraventricular tachycardia is a common dysrhythmia that can result in syncope or myocardial infarction. We present a case of an elderly man with new-onset atrioventricular (AV) nodal reentry tachycardia, possibly precipitated by overdrive of his autonomic nervous system due to pain and infection. As the percentage of the elderly in our population is growing rapidly and the incidence of AV nodal reentry tachycardia increases with age, emergency physicians should be familiar with this dysrhythmia-its etiology, precipitating factors, presentations, and treatment. It will present more frequently in the future. Published by Elsevier Inc.

Introduction: Cholelithiasis is very common, but giant gallstones-gallstones bigger than 5 cm in diameter, are very rare. It is very challenging to remove them laparoscopically, especially in emergency situations. Case Report: A 69-year-old female complained of right upper abdominal pain with vomiting for 1 day. Abdominal ultrasound indicated acute cholecystitis and a single, extremely large gallstone (9cm). Emergency laparoscopic cholecystectomy was performed successfully. Discussion: Gallstone over 5 cm in diameter is very rare. Laparoscopic Cholecystectomy (LC) is very difficult for these cases, especially in the emergency situations. Laparoscopic cholecystectomy can, however, be safely performed in experienced hands. To the best of our knowledge, this is one of the biggest gallstones managed laparoscopically. Conclusion: Although the presence of giant gallstones poses technical challenges, laparoscopic cholecystectomy can be safely performed in the experienced hands. However, if the anatomy cannot be delineated clearly, open surgery remains the safe option.

A single oral dose of haloperidol was given to 19 patients prior to cholecystectomy. The concentration of haloperidol was assessed in serum, urine, fatty tissue, liver tissue, choledochal bile and bile bladder contents. The biological half-life of the drug in the serum was 25.1 +/- 12.9 hours, which is comparable to that in healthy volunteers. Only minute amounts of the drug were excreted with the urine. The drug concentration was only slightly elevated in choledochal bile but in the bile bladder contents it was about 11 times higher than that in the serum. The low concentration of haloperidol in the bile indicated that there was no substantial enterohepatic recirculation of the drug in this patient material. The concentration of haloperidol in fatty tissue was about 20 times, and in liver tissue 900 times higher than that in the serum. The corresponding figures for intramuscular administration of haloperidol were 10 and 325, respectively. A possible relationship between the side-effects and the route of administration is discussed.

Pre-operative prediction of a difficult laparoscopic cholecystectomy (LC) can help the patient as well as the surgeon prepare better for the intra-operative risk and the risk of conversion to open cholecystectomy. In 105 eligible patients who underwent LC during May 2001 to January 2003, patient characteristics, clinical history, laboratory data, ultrasonography results and intra-operative details were prospectively analyzed to determine predictors of difficult LC. Of 105 patients, 12 (11.4%) required conversion to open cholecystectomy. Significant predictors of conversion were body mass index> 30 Kg/m2, male gender, past history of acute cholecystitis or acute pancreatitis, past history of upper abdominal surgery, and gall bladder wall thickness exceeding 3 mm. Clinical and ultrasonograpic factors can help predict difficult LC and likelihood of conversion of LC to open surgery.

Adrenalina
    Agjentët infektivë
    Agnozioni
    Agravacioni
    Agregimi trombocitar
    Aktina
    Alergologjia
    Alfa fetoproteina
    Alicina
    Amniocenteza
    Analgjezia
    Anamneza
    Anatoksina
    Anatomia e njeriut
    Anatomia patologjike
    Anestezia
    Anesteziologjia
    Anketë
    Antiepileptikët
    Antigjeni
    Antitrupat
    Antroponoza
    Arteriet
    Astma bronkiale
    Astma kardiake
    Auskultacioni
    Autoimuniteti
    Bakteriet
    Bananja dhe shëndeti
    Barnat
    Basis cranii
    Biokimia
    Biokimia Klinike
    Biologjia
    Calculosis vesicae felleae
    Calvaria
    Centromera
    Chlamydiasis urogenitalis
    Cholelithiasis
    Citologjia
    Citrobacter
    Colica hepatica
    Colica renalis
    Condyloma acuminatum
    Çrregullimet e gjumit
    Dardha dhe shëndeti
    Decursus morbi
    Delecioni
    Derma
    Dermatologjia
    Dermatoma
    Desmozomet
    Determinantat antigjenike
    Dhimbja
    Diabeti
    Diagnoza
    Diagnoza diferenciale
    Difuzioni
    Difuzioni i thjeshtë
    Difuzioni pasiv
    Digiti hippocratici
    Diminuacioni
    Dioksidi i karbonit
    Disimulacioni
    Domatja
    Duhani
    Ekologjia
    Ekskretimi
    Ekzocitoza
    Elefantiaza
    Embolia
    Embriologjia
    Emergjenca
    Endocitoza
    Endokrinologjia
    Enët e gjakut
    Epiderma
    Epilepsia
    Epitopet
    Eritrocitet
    Eshtrat
    Etiologjia
    Evolucioni i sëmundjes
    Ex juvantibus
    Fagocitoza
    Fakte nga mjekësia
    Faktorët etiologjik të sëmundjes
    Fakulteti i Mjekësisë
    Farmakologjia
    Fasulja dhe shëndeti
    Favusi
    Fazat e sëmundjes
    Fëmija
    Femuri
    Fenotipi
    Fertiliteti
    Filtrimi
    Fizika
    Fiziologjia e njeriut
    Fiziologjia patologjike
    Flokët
    Frakturat
    Frymëmarrja
    Fshikëza e tëmthit
    Gastroenterologjia
    Gishtat e hipokratit
    Gjakderdhja
    Gjakderdhja arteriale
    Gjakderdhja kapilare
    Gjakderdhja venoze
    Gjaku
    Gjenetika
    Gjenomi
    Gjeografia
    Gjinekologjia
    Gjiri
    Gjuha
    Gjuha dhe letërsia shqipe
    Gjuhë Angleze
    Gjumi
    Glikokaliksi
    Glukagoni
    Glukoza
    Glukoza në urinë
    Grejfruti dhe shëndeti
    Gripi
    Hani domate dhe mbroni prostatën
    Haptenet
    Hematologjia
    Hemorroidet
    Hemostaza
    Herpes simplex genitalis
    Hiperalgjezia
    Hiperglikemia
    Hiperkeratoza
    Hipoalgjezia
    Hipoderma
    Hipoglikemia
    Histologjia
    Historia
    Homeostaza
    Hudhra
    Hudhra dhe shëndeti
    I porsalinduri
    I porsalinduri me kohë
    I porsalinduri para kohe
    I porsalinduri pas kohe
    Imunogjenet
    Imunoglobulinat
    Imunologjia
    Indet
    Infarkti i miokardit
    Infeksionet
    Insomnia
    Inspeksioni
    Insuficienca kardiake
    Insuficienca kongjestive e zemrës
    Insulina
    Jeta
    Junksionet
    Junksionet hermetike
    Kafka
    Kaliumi
    Kaliumi dhe zemra
    Kalkuloza e fshikëzës së tëmthit
    Kanceri
    Kanceri dhe shkallët e tij
    Kanceri i gjirit
    Kanceri i lukthit
    Kanceri i qafës së mitrës
    Kanceri i stomakut
    Karakteristikat e tumoreve beninje dhe malinje
    Karakteristikat kryesore të sëmundjes
    Karbohidratet
    Kardiologjia
    Këshilla
    Këshilla për largimin e zbokthit nga flokët tuaj
    Këshilla për pacientët me grip
    Këshilla për pacientët me shtypje të ulët gjakut
    Kimia
    Kirurgjia
    Kirurgjia vaskulare
    Klebsiella
    Klebsiella dhe Citrobacter
    Klizmat
    Klonet limfocitare
    Koka
    Kolesteroli
    Kolika hepatike
    Kolika renale
    Komplementi
    Koncepte nga ndihma e parë
    Kraniumi cerebral
    Kraniumi visceral
    Kromozomet
    Kuize
    Kuriozitete
    Larva Migrans
    Latanti
    Lëkura
    Lëngu intersticial
    Lëngu ndërqelizor
    Likopeni
    Limfoma Hodgkin
    Limfoma Non Hodgkin
    Limfomat
    Lipidet
    Logopedia
    Lukthi
    Makromolekulat
    Mbarimi i sëmundjes
    Mbijetesa
    Mbipesha
    Medicina
    Mekanizmi feedback negativ
    Mekanizmi feedback pozitiv
    Mekanizmi feedforward
    Mëlçia
    Membrana qelizore
    Mënyra e fillimit të sëmundjes
    Metabolizmi
    Metodat e ekzaminimit objektiv
    Metodat plotësuese të ekzaminimit
    Metodologjia e punës shkencore
    Mikrobiologjia
    Mikrovilet
    Miologjia
    Mitra
    Mjekësi Sociale
    Mjekësia
    Mjekësia ekzakte
    Mjekësia empirike
    Mjekësia Interne
    Mjekësia praktike
    Mjekësia teorike
    Mjekimi
    Mjekimi kauzal
    Mjekimi kirurgjik
    Mjekimi medikamentoz
    Mjekimi simptomatik
    Molekula
    Molla
    Molla dhe shëndeti
    Monoksidi i karbonit
    Morfologjia
    Mortaliteti
    Mortinataliteti
    Mosha
    Mushkëritë
    Nataliteti
    Ndihma e parë
    Në dhe të huaj
    Nefrologjia
    Neonatologjia
    Neonatus maturus
    Neonatus postmaturus
    Neonatus praetemporarius
    Neurologjia
    Nikotina
    Njeriu
    Obstetrika
    Oftalmologjia
    Oksigjeni
    Oksitocina
    Omega 3
    Onkologjia
    Organizmi
    Ortopedia
    Os Coxae
    Osmoza
    Osteoartriti
    Osteologjia
    Pagjumësia
    Pahidermia
    Palpacioni
    Pankreasi
    Pap testi
    Parandalimi
    Parandalimi i hemorroideve
    Paratopet
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Presentamos el caso de una mujer de 72 años, afebril, enviada a nuestro centro por ictericia y cuadro de dolor localizado en el hipocondrio derecho. Tras el estudio ecográfico (no mostrado), se visualizó dilatación de vía biliar intrahepática, colecistolitiasis y otra litiasis, de mayor tamaño, en la confluencia de ambos conductos biliares principales. En la analítica, existía una bilirrubina total de 11 mg/dl con un patrón colestásico. En la colangiopancreatografía retrógrada endoscópica (CPRE) se canalizó la vía biliar hasta llegar al segmento intrahepático, donde se introdujo contraste ( ), y se evidenció un defecto luminal ovoideo por compresión extrínseca (flecha hueca), que motivaba una dilatación de la vía biliar intrahepática (flecha). Se colocó un stent plástico de 10 cm y 8,5 Fr previo a la intervención quirúrgica.

Various investigators agree that the incidence of cholelithiasis is greater in patients with Chagas disease. The most plausible explanation for this is based on the parasympathetic denervation that occurs over the whole digestive tract due to Chagas disease. In order to analyze the occurrence of this alteration, gallbladder neuron counts were performed on cholelithiasis patients with and without Chagas disease who were being treated at the Department of Digestive Surgery, Universidade Federal do Triângulo Mineiro, Uberaba, Brazil. In the present study, a notable reduction in the number of neurons in the gallbladder wall was observed in Chagas patients, in comparison with non-Chagas subjects.

Mirizzi syndrome is an unusual presentation of prolonged cholelithiasis. This study aimed to analyze the diagnostic methods, operative strategies, and outcome of the surgical treatment of patients with Mirizzi syndrome. We retrospectively evaluated the patients with Mirizzi syndrome treated in our General Surgery Clinic. The data collected included demographic variables, clinical presentation, diagnostic methods, surgical procedures, and postoperative complications. The study included 13 male and 21 female patients, with a mean age of 67.2 years. The incidence of Mirizzi syndrome was determined as 0.6% (34/5632), and type II was more frequently observed (52.9%); no patient was determined as type IV. The incidences of types I and III were 35.2% and 11.7%, respectively. Among the preoperative diagnostic evaluations, ultrasonography was the initial imaging study that was performed in all patients. Computerized tomography, magnetic resonance cholangiopancreatography, and endoscopic retr...

Background Bile duct injuries (BDIs) during laparoscopic cholecystectomy (LC) still are reported with greater frequency than during open cholecystectomy (OC). Methods In 1999, a retrospective study evaluating the incidence of BDIs during LC in the area of Rome from 1994 to 1998 (group A) was performed. In addition, a prospective audit was started, ending in December 2001 (group B). Results In group A, 6,419 LCs were performed (222 were converted to OC; 3.4%). In group B, 7,299 LCs were performed (225 were converted to OC; 3.1%). Seventeen BDIs (0.26%) occurred in group A and 16 (0.22%) in group B. Overall, mortality and major morbidity rates were 12.1% and 30.3%, respectively, without significant differences between the two groups. Conclusions The incidence and clinical relevance of BDIs during LC in the area of Rome appeared to be stable over the past 8 years and were not influenced by the use of a prospective audit, as compared with a retrospective survey.

r = 0.66). A significant association was found between stone mobility ( r = 0.37), presence of adhesions ( r = 0.36), and the difficulty of the procedure. The predictive US evaluation was significantly correlated with some intraoperative technical steps [dissection of Calot’s triangle ( r = 0.41), dissection of the gallbladder bed ( r = 0.41)], and intraoperative bleeding ( r = 0.27). Our results suggest that preoperative US is a useful screening test for patients undergoing LC, and it can help predict technical difficulties. On the other hand, a relevant number of cases still exist wherein the concordance between the preoperative US classification and the surgical findings is unsatisfactory. In this group the surgeon cannot safely rely on the US examination alone.

Mice fed with diet containing 0·5 % cholesterol for 10 weeks resulted in cholesterol supersaturation in gallbladder bile which promoted the formation of cholesterol gallstones (CGS). In this study, dietary hypocholesterolaemic spices, garlic and onion (both raw or heat-processed) were examined for their antilithogenic potential by including at 0·6 and 2·0 % level, respectively, along with lithogenic (LG) diet for 10 weeks. Dietary garlic and onion reduced the CGS incidence by 15-39 %, the effect being maximum in the heat-processed onion group. Dietary garlic and onion markedly reduced biliary cholesterol. The cholesterol:phospholipid ratio which was 1·58 in the LG diet group was reduced to 0·73 -0·96 in the garlic and onion groups. The biliary cholesterol saturation index was 0·92, 1·25, 1·09 and 0·86, respectively, in the heat-processed onion, raw garlic, heat-processed garlic and raw onion groups, while it was 1·9 in the LG group. The hydrophobicity index of bile was 20·08, 2 0·079, 2 0·032 and 20·073, respectively, in the heat-processed onion, raw garlic, heat-processed garlic and raw onion groups, while it was þ0·054 in the LG group. Hepatic hydroxymethyl glutaryl-CoA reductase activity was lowered in the LG diet-fed group, while dietary garlic or onion countered this alteration and also increased the activities of hepatic cholesterol 7a-hydroxylase and sterol 27-hydroxylase. Serum and liver cholesterol were decreased by feeding garlic or onion compared to the LG diet. Thus, dietary Allium spices exerted antilithogenic influence by decreasing the cholesterol hyper-secretion into bile and increasing the bile acid output thus decreasing the formation of lithogenic bile in experimental mice.

Cholesterol gallstone disease is a common condition in western populations. The etiology is multifactorial with interaction of genetic and environmental factors. Obesity, aging, estrogen treatment, pregnancy and diabetes are consistently associated to a higher risk. A number of dietary factors have been involved in the pathogenesis of cholelithiasis. In this article we summarize several studies that have evaluated the role of diet as a potential risk factor for gallstone formation, including energy intake, cholesterol, fatty acids, fiber, carbohydrates, vitamins and minerals, and alcohol intake. Consumption of simple sugars and saturated fat has been mostly associated to a higher risk, while fiber intake and moderate consumption of alcohol, consistently reduce the risk. The association between cholesterol intake and gallstone disease has been variable in different studies. The effects of other dietary factors are less conclusive; additional studies are therefore necessary to clarify their relevance in the pathogenesis of gallstone disease. Recent discoveries of the role of orphan nuclear receptors in the regulation of fatty acid and hepatic cholesterol metabolism and excretion open new perspectives for a better understanding of the role of dietary constituents on cholesterol gallstone formation. Key teaching points: • The etiology of cholesterol gallstone disease is multifactorial with interaction between genome and environment. • It has been postulated that dietary constituents are important determinants for the formation of lithogenic bile. • Intake of high energy, simple sugar and saturated fat favors gallstone formation. Fiber and moderate consumption of alcohol reduce the risk. • The role of orphan nuclear receptors in the regulation of hepatic cholesterol metabolism and excretion open new leads for understanding the role of dietary constituents on cholesterol gallstone formation.

Rokitansky-Aschoff sinuses are the result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall and are usually referred to as adenomyomatosis. The role of this study is to demonstrate that Rokitansky-Aschoff sinuses of the gallbladder are a risk factor for the formation of black pigment gallstones. A total of 179 removed gallbladders, were hystologically examinated. Sixty-four of the 179 consecutive cholecystomized patients had typical adenomyomatosis. Thirty-eight of the 64 patients with adenomyomatosis had black pigment gallstones, alone (n ¼ 22) or in association with single (n ¼ 12) or multiple (n ¼ 4) cholesterol gallstones in the same gallbladder. Twelve of these patients did not have the typical risk factors for black stones (hemolysis, cirrhoses, gastrectomy, etc). Gallstones were examined by infrared spectroscopy and X-ray diffractometry. In addition, in a subset of 14 patients, the gallstones and the gallbladder wall were examined by scanning electron microscopy. At least in the initial phases of formation, Rokitansky-Aschoff sinuses were found close to small intraparietal vessels and sometimes they contained black pigment microstones. After the fourth to fifth decades of life, black gallstones can be found in the Rokitansky-Aschoff sinuses and in the main gallbladder lumen. Black pigment gallstones can form in Rokitansky-Aschoff sinuses of the gallbladder in absence of the typical risk factors for bilirubin suprasaturation of bile.