scholarly journals Pathomorphological aspects of the diagnosis and treatment of acute cholecystitis

2020 ◽  
Vol 47 (2) ◽  
pp. 72-78
Author(s):  
V. I. Mamchich ◽  
E. A. Dyadyk ◽  
S. Ya. Radkevich ◽  
M. A. Chaika
Keyword(s):  
Acute Cholecystitis ◽  
Postgraduate Education ◽  
Gallbladder Wall ◽  
Vascular Changes ◽  
Morphological Examination ◽  
Acute Calculous Cholecystitis ◽  
National Medical ◽  
Morphological Studies ◽  
Post Traumatic ◽  
Subhepatic Abscess

Aim: to find out the possibilities of pathomorphological studies of destructive forms of acute cholecystitis in identifying the characteristics of etiology and pathogenesis factors for the clinical use of the data. Materials and methods. From 2016 to 2018, 266 patients with acute cholecystitis (AC) were operated on in the clinic of the Department of Surgery and Proctology of Shupik National Medical Academy of Postgraduate Education on the basis of Kyiv Regional Clinical Hospital. General clinical methods, ultrasound, X-ray methods, CT, MRI, mini-invasive methods, operative methods — mainly laparoscopic interventions, up to 10% — laparotomy surgeries were used in the diagnosis. The removed gall bladders underwent morphological examination. Results and discussion. Acute calculous cholecystitis was diagnosed in 245 operated patients (92%), stoneless — in 21 (8%). Catarrhal, serous, serous-fibrinous forms were found out in 32 patients (12%), destructive — in 234 (88%). Acute phlegmonous cholecystitis was detected in 147 patients (55%), gangrenous — in 56 (21%), perforated — in 11 (4%), including subhepatic abscess — 8 (3%). According to clinical, biochemical, intraoperative and macromorphological signs, enzymatic forms of AC were diagnosed in 37 patients (11%), emphysema in 4 (2%), vascular in 3 (1.5%) and post-traumatic in 1 (0.5%). In 96 patients with phlegmonous and gangrenous forms of AC, immune-allergic and vascular changes in the gallbladder wall were revealed by special pathomorphological techniques. Conclusion AC is a polyetiological disease with complex pathogenesis and nonspecific histomorphological changes. Phlegmonous (147 (55%) patients), gangrenous — 56 (21%) prevail among destructive forms of AC, perforated forms — 11 (4%), and subhepatic abscess with AC — 8 (3%) are rarely found. Clinical and instrumental intraoperative research methods allow to pre-diagnose special forms of AC, among which the most commonly diagnosed are enzymatic cholecystitis — 37 (11%) patients, the more rare are emphysema — 4 (2%), vascular — 3 (1.5%), and post-traumatic AC — 1 (0.5%). Morphological studies make it possible to verify the degree of inflammation and destruction of the gallbladder wall, to identify immune-allergic and vascular changes in the gallbladder wall. Results of microscopic and pathomorphological studies in patients with AC allow in the postoperative period to adjust antibiotic therapy, prevention of thromboembolic complications, allergic and immunological manifestations to reduce postoperative complications and mortality.

scholarly journals Acute Calculous Cholecystitis: What is new in diagnosis and therapy?

HPB Surgery ◽  
1992 ◽  
Vol 6 (2) ◽  
pp. 69-78 ◽  
Author(s):  
Dirk J. Gouma ◽  
Huug Obertop
Keyword(s):  
Acute Cholecystitis ◽  
Ultrasound Guidance ◽  
Gallbladder Wall ◽  
Percutaneous Cholecystostomy ◽  
Endoscopic Retrograde ◽  
Extensive Experience ◽  
Acute Calculous Cholecystitis ◽  
First Choice ◽  
Prospective Trials ◽  
Calculous Cholecystitis

The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.

scholarly journals Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 383
Author(s):  
Kojiro Omiya ◽  
Kazuhiro Hiramatsu ◽  
Yoshihisa Shibata ◽  
Masahide Fukaya ◽  
Masahiro Fujii ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Magnetic Resonance ◽  
Acute Cholecystitis ◽  
Signal Intensity ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Gallbladder Wall ◽  
High Signal ◽  
Mri Findings ◽  
Open Conversion ◽  
Preoperative Magnetic Resonance

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

scholarly journals Successful treatment of emphysematous cholecystitis by laparoscopic surgery

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Hitoshi Funahashi ◽  
Tetsuya Komori ◽  
Naoki Sumita
Keyword(s):  
Laparoscopic Surgery ◽  
Acute Cholecystitis ◽  
Rare Variant ◽  
Successful Treatment ◽  
Gold Standard ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Emphysematous Cholecystitis ◽  
Bacterial Proliferation ◽  
Calot’S Triangle

Abstract Emphysematous cholecystitis (EC) is a severe and rare variant of acute cholecystitis characterized by ischemia of the gallbladder wall with gas-forming bacterial proliferation. Open cholecystectomy is traditionally the gold standard approach to treatment due to difficulty in isolating Calot’s triangle in the setting of intense inflammation. We present a case of EC successfully and safely treated by laparoscopic surgery.

scholarly journals Prediction of Patients with Acute Cholecystitis Requiring Emergent Cholecystectomy: A Simple Score

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Wael N. Yacoub ◽  
Mikael Petrosyan ◽  
Indu Sehgal ◽  
Yanling Ma ◽  
Parakrama Chandrasoma ◽  
...  
Keyword(s):  
Heart Rate ◽  
Logistic Regression ◽  
Acute Cholecystitis ◽  
High Probability ◽  
Acute Inflammation ◽  
Gallbladder Wall ◽  
Cutoff Score ◽  
Gangrenous Cholecystitis ◽  
Pathological Review ◽  
Low Probability

The objective was to develop a score, to stratify patients with acute cholecystitis into high, intermediate, or low probability of gangrenous cholecystitis. The probability of gangrenous cholecystitis (score) was derived from a logistic regression of a clinical and pathological review of 245 patients undergoing urgent cholecystectomy. Sixty-eight patients had gangrenous inflammation, 132 acute, and 45 no inflammation. The score comprised of: age > 45 years (1 point), heart rate > 90 beats/min (1 point), male (2 points), Leucocytosis > 13,000/mm3(1.5 points), and ultrasound gallbladder wall thickness>4.5 mm (1 point). The prevalence of gangrenous cholecystitis was 13% in the low-probability (0–2 points), 33% in the intermediate-probability (2–4.5 points), and 87% in the high probability category (>4.5 points). A cutoff score of 2 identified 31 (69%) patients with no acute inflammation (PPV 90%). This scoring system can prioritize patients for emergent cholecystectomy based on their expected pathology.

scholarly journals A morphological and molecular characterization of vine mealybug populations (Hemiptera, Pseudococcidae) from Tunisia

2012 ◽  
Vol 44 (1) ◽  
pp. 5 ◽  
Author(s):  
Ramzi Mansour ◽  
Vincenzo Cavalieri ◽  
Gaetana Mazzeo ◽  
Kaouthar Grissa Lebdi ◽  
Agatino Russo
Keyword(s):  
Phylogenetic Tree ◽  
Molecular Characterization ◽  
Adult Female ◽  
Morphological Examination ◽  
Molecular Analyses ◽  
Planococcus Ficus ◽  
Morphological Studies ◽  
Vine Mealybug ◽  
Morphological And Molecular Characterization

Some vine mealybug, <em>Planococcus ficus </em>(Signoret) populations in Tunisian vineyards have been morphologically and genetically characterized. The morphological examination was based on the main distinctive characteristics of species of <em>Planococcus</em>, namely the number and distribution of the multilocular disc pores and tubular ducts on the adult female. This showed the existence of two different vine mealybug populations in Tunisia. Likewise, in the molecular analyses, two separate clades were revealed in the neighbour-joining phylogenetic tree, supporting the morphological studies and suggesting that there are two distinct populations of <em>P. ficus</em> on grapevine in Tunisia.

scholarly journals The European experience of "Neurology journal club" at the Department of Neurology and Reflexology, Shupyk National Medical Academy of Postgraduate Education

2016 ◽  
pp. 3-8
Author(s):  
N. Svyrydova ◽  
K. Podhornaya ◽  
I. Kucheeva ◽  
V. Zabolotnaya ◽  
L. Borshchak ◽  
...  
Keyword(s):  
Interest Group ◽  
Professional Education ◽  
Journal Club ◽  
Postgraduate Education ◽  
Positive Experience ◽  
Medical Evidence ◽  
National Medical ◽  
Journal Clubs ◽  
European Experience ◽  
Medical Academy

World Medical evidence shows the positive experience of the neurological journal clubs and the quarterly report as an article on the Review provided material for practicing neurologists, to subsequently provided to effectively use the material in their clinics. Topics presented by Special Interest Group in the analysis of topical articles and reviews neurological areas participating in the program of professional education in Europe, to help in the education and practical work towards practicing neurologist.

Resolution of the Scientific Conference of the Ukrainian Association of Family Medicine and the National Medical Academy of Postgraduate Education named after P. L. Shupyk «Health in the Hands of Ukrainian Family Doctor» 08-09.12.2016

2016 ◽  
pp. 18-19
Author(s):  
Larysa Matіukha
Keyword(s):  
Family Medicine ◽  
Family Doctor ◽  
Postgraduate Education ◽  
Scientific Conference ◽  
National Medical ◽  
Medical Academy

Resolution of the scientific conference of the Ukrainian Association of Family Medicine and the National Medical Academy of Postgraduate Education named after P. L. Shupyk «Health in the hands of Ukrainian family doctor» 08-09.12.2016.

Correlation between electrical and morphological properties of canine pyloric circular muscle

1991 ◽  
Vol 260 (3) ◽  
pp. G390-G398 ◽  
Author(s):  
F. Vogalis ◽  
S. M. Ward ◽  
K. M. Sanders
Keyword(s):  
Single Cells ◽  
Electrical Coupling ◽  
Circular Muscle ◽  
Muscle Layer ◽  
Morphological Properties ◽  
Morphological Examination ◽  
Isolated Cells ◽  
Time Constants ◽  
Morphological Studies ◽  
Cable Properties

Electrical slow waves decay in amplitude as they conduct from the myenteric to the submucosal regions of the circular muscle layer in the canine pyloric sphincter. We used the partitioned chamber method to study the passive and active properties of pyloric muscles, and we found that length constants of circular muscles of myenteric region were significantly longer than muscles near the submucosal surface. These data suggested differences in either membrane resistance, junctional resistance, or cytoplasmic resistance. The first parameter was evaluated by measuring time constants in intact tissues and single cells isolated from the submucosal and myenteric regions. Membrane time constants were not different in the two regions, nor were differences found in the input resistances of isolated cells. Morphological studies failed to demonstrate differences in cell diameters in the two regions suggesting that cytoplasmic resistances are similar. These findings suggest that the different cable properties in the two regions may be due to differences in electrical coupling. Morphological examination revealed similar numbers of gap junctions between cells in the two regions, but large differences were noted in the size of muscular bundles. Muscles of the myenteric region were arranged into large, tightly packed bundles, whereas muscles of the submucosal region consisted of small bundles with an extensive extracellular space filled with connective tissue. We suggest that the difference in cable properties may be due to differences in electrical coupling between bundles. These data suggest that submucosal muscles function more like a multiunit smooth muscle, whereas myenteric muscles behave as a single unit.

Examining range disjunctions in Australian Terminalia (Combretaceae) with taxonomic revision of the T. canescens and T. cunninghamii species complexes

2015 ◽  
Vol 28 (1) ◽  
pp. 23 ◽  
Author(s):  
Russell L. Barrett
Keyword(s):  
Taxonomic Revision ◽  
Field Studies ◽  
Herbarium Specimens ◽  
Morphological Examination ◽  
Additional Species ◽  
Morphological Studies ◽  
Species Complexes ◽  
Taxonomic Changes ◽  
North And South ◽  
A New Species

Several range disjunctions have been identified in the Australian species of the genus Terminalia L. Field studies and examination of herbarium specimens of taxa with range disjunctions have demonstrated that taxonomic changes are justified. Detailed morphological studies of the Terminalia canescens (DC.) Radlk. species complex showed that four taxa should be recognised. The name Terminalia circumalata F.Muell. is resurrected as a taxon endemic to the Pilbara region, with T. canescens not occurring in that region. The distinction of Terminalia bursarina F.Muell., T. canescens and T. pterocarya F.Muell. is also supported. Terminalia cunninghamii C.A.Gardner has been considered to have a disjunct range between the far north and south-west of the Kimberley region of Western Australia. Terminalia kumpaja R.L.Barrett is described as a new species to accommodate the disjunct southern populations because morphological examination has shown them to be distinct. Terminalia kumpaja is restricted to the Dampier Botanical District. Full descriptions and illustrations of key identifying features are provided for these species. Keys to all Australian Terminalia species are presented. Additional species with disjunct distributions that warrant further study are noted. Lectotypes are selected for Terminalia circumalata and T. rogersii W.Fitzg.

Ultrasonography in Acute Gallbladder Perforation

1988 ◽  
Vol 29 (1) ◽  
pp. 41-44 ◽  
Author(s):  
M. Soiva ◽  
M. Pamilo ◽  
M. Päivänsalo ◽  
M. Taavitsainen ◽  
I. Suramo
Keyword(s):  
Acute Cholecystitis ◽  
Peritoneal Fluid ◽  
Gallbladder Wall ◽  
Control Group ◽  
Gallbladder Perforation ◽  
University Hospitals ◽  
Fluid Collections ◽  
Free Peritoneal Fluid

The files of patients with acute cholecystitis from two large university hospitals from the years 1978–1985 were employed to find the cases with acute gallbladder perforation for this study. Only those patients (n=9) were selected for the analysis of sonographic signs of acute gallbladder perforation who had less than 48 hours of symptoms before sonography, and were operated upon within 24 hours of the sonography. Patients (n=10) with non-complicated acute cholecystitis and identical in regard to the duration of the symptoms and the timing of the sonography and the operation formed a control group. The sonographic findings in patients with gallbladder perforation were pericholecystic fluid collections, free peritoneal fluid, disappearance of the gallbladder wall echoes, focal highly echogenic areas with acoustic shadows in the gallbladder, and an inhomogeneous, generally echo-poor gallbladder wall.

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