Place of routine operative cholangiography at cholecystectomy
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Cholecystography
Cholecystography
Gallbladder disease
Diatrizoate Meglumine
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One hundred and one patients with nonvisualized gallbladder at double dose oral cholecystography were examined with ultrasonography. In 41 of 44 operated patients, ultrasonography suggested gallbladder disease. Operation in all of these cases confirmed the diagnosis. In three of the patients with cholelithiasis operation revealed in addition gallbladder carcinoma. In three patients, in which ultrasonography demonstrated normal appearance of the gallbladder surgery revealed chronic cholecystitis and stone impacted in the cystic duct. The diagnostic value of ultrasonography as complementary method for evaluation of gallbladder disease, particularly in cases of nonvisualization of the gallbladder at ultrasonography is stressed. The high incidence of gallbladder carcinoma in the present material in patients with cholelithiasis point to the fact that this group of patients should be the subject for careful investigation.
Cholecystography
Gallbladder disease
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Normal findings in oral cholecystography and normal response of the gallbladder to cholecystokinin are established in 200 normal controls. These include absence of right upper quadrant pain in 98.5%, absence of spasm of the body of the gallbladder and of severe spasm in the fundus, a common bile duct diameter of 6 mm or less in those 182 that were visualized, and gallbladder size of less than 11 cm in length in about 97% and less than 4 cm in width in about 97%. If normal contraction occurs after cholecystokinin (or sincalide), an unusually large gallbladder is of no importance. Little or no gallbladder contraction in the presence of normal concentration is probably of no importance.
Cholecystography
Fundus (uterus)
Gallbladder disease
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The wall of an acutely obstructed gallbladder can be demonstrated by total-body opacification. In most instances, this technique will demonstrate a sharply or poorly defined wall 2–8 mm thick outlining the distended gallbladder, thus confirming the diagnosis of obstructive cholecystopathy. This technique eliminates uncertainty in the differential diagnosis of acute gallbladder disease caused by nonvisualization of the gallbladder on oral cholecystography or intravenous cholangiography.
Cholecystography
Gallbladder disease
Intravenous cholangiography
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Cholecystography
Gallbladder disease
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Normal findings in oral cholecystography and normal response of the gallbladder to cholecystokinin are established in 200 normal controls. These include absence of right upper quadrant pain in 98.5%, absence of spasm of the gallbladder neck or cystic duct in 94%, absence of any spasm of the body of the gallbladder and of severe spasm in the fundus, a common bile duct diameter of 6 mm or less in those 182 that were visualized, and gallbladder size of less than 11 cm in length in about 97% and less than 4 cm in width in about 97%. If normal contraction occurs after cholecystokinin (or sincalide), an unusually large gallbladder is of no importance. Little or no gallbladder contraction in the presence of normal concentration is probably of no importance. (JAMA240:2271-2272, 1978)
Cholecystography
Fundus (uterus)
Gallbladder disease
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Cholecystography
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Cholecystography
Gallbladder disease
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A rapid and safe method of roentgenographic evaluation of the acutely inflamed wall of the gallbladder, infusion tomography of the gallbladder, was performed 146 times, and the correlation with 67 subsequent cholecystectomies was reviewed. If the results of infusion tomogram of the gallbladder are abnormal, the gallbladder is diseased; if acute cholecystitis is present, the results of the examination will be abnormal in 96 per cent; if results of the infusion tomogram of the gallbladder are normal, the results are questionable, and oral cholecystography should be performed to evaluate the condition further. If the results of a repeat dosage oral cholecystogram are abnormal, the gallbladder probably is diseased, even if the results of an infusion tomographic examination of the gallbladder are normal.
Cholecystography
Gallbladder disease
Diatrizoate Meglumine
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Evaluation of the concentration of Priodax (brand of iodoalphionic acid) in the gallbladder during cholecystography has, up to the present time, been subject to variations incidental to different roentgen technics and the personal equation of the interpreter, all other conditions remaining equal. This paper reports a method which automatically eliminates these two variables and equalizes the results of Priodax cholecystography irrespective of technical factors and personal variations. This is accomplished by use of a stepped scale2 previously standardized against varying percentage concentrations of Priodax, beginning with the highest concentration possible and ending with the smallest concentration visible to the eye: in other words, the use of a simple, direct-reading five-step scale of known density variations, with which the opacified gallbladder image can be compared directly on the film. The thickness of the matching step obviously increases with the increase of dye concentration. Radiography is a study of contrasts in density. Since, ordinarily, the normal gallbladder cannot be differentiated from its surrounding tissues, a method for enhancing its contrast had to be devised. This was originally done by Graham and Cole (1) in 1924, with the aid of tetrabromphenolphthalein, which they injected intravenously. This procedure embodied an entirely new and original radiological principle, i.e., utilization of the specific functions of a system to engender a difference in density. Cholecystography is, therefore, largely a test of physiological capacity. Small variations in the opacified gallbladder as to size, shape, position, and capacity are unimportant if the organ is well visualized, shows a progressively intense opacification, is capable of altering in size, and empties after the administration of a fat-containing meal. Priodax is beta(4-hydroxy-3,5-diiodophenyl)-alpha-phenylpropionic acid. At the present time it is the product of choice for cholecystography, since it possesses the following advantages: Attendant nausea, griping, and diarrhea, when present, are usually mild. Vomiting is uncommon. There is less patient resistance; the medium is readily accepted and is simple to administer. It is readily absorbed from the gastro-intestinal tract, affording freedom from confusing opacification of the colon due to non-absorbed dye. The number of repeat or confirmatory examinations is minimized. The use of other drugs, such as paregoric, is eliminated. The dye is administered orally, in tablet form, usually in a set of six tablets, each containing 0.5 gm. of the dye, given five minutes apart, with water, the evening before the examination. The dye is picked up from the blood by the liver and excreted into the bile.
Cholecystography
Roentgen
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