Studies on cholelithiasis

1) The results of the cholecystography in 227 cases with cholelithiasis, using Biloptin and Biligrafin in combination were as follows; in 96 cases of total cases (42.3%) stones were radiologically imaged, in 59 cases (26.0%) no stone was imaged but some abnormal findings in the morphology of the gall bladder or bile ducts were observed and 72 cases (31.7%) were radiologically so called “negative cases.” 2) In the radiologically “negative cases”, the differential diagnosis is needed in consideration of other diseases in epigastrium, in which the image of gas formation of the intestinal canals in the right epigastrium plays an important role. In our study, the gas formation was observed in 66 of 72 radiologically negative cases (91.7%) and 34 cases of them were acute gangrenous cholecystitis. 3) Cholecystographic studies were also made in dogs which were made artificially allergic cholecystitis in application of the antigen-antibody reaction using the cell substance of coli bacilli; the radiological image of the gall bladder became less and less distinguishable on the time passing until in 72 hours from the beginning it turned to the negative case. la these cases, also the gas formation of the intestinal canals was apparently observed and in these experiments the correlations among cholecystitis, radiologically negative cases and the appearance of the gas formation of the intestinal canals in the right epigastrium were clarified. 4) The “Supersonogram”—an ultrasonic wave method in diagnosis—, exploited in our department, made it possible to obtain the recording of the tomogram of the living body and in this method the authors could also confirm the existence of gall stones, the localization, and the depth from the body surface. The stone-echo was obtained in 63 of 68 cases with cholelithiasis (92.6%) and it was a noticeable good result that in 27 of 31 radiologically negative cases (87.1%) the existence of stones was confirmed by “Supersonogram”. In our study it was apparent that the diagnostic result of cholelithiasis could be markedly improved by paying attention to the appearance of the abnormal gas formation of the intestinal canals in the right epigastrium radiologically on the one hand, and applying the “Supersonogram” on the other. The authors could obtain correct diagnosis of cholelithiasis, in 99.1% preoperatively by combining the previously mentioned methods and also in consideration of the clinical symptoms.