PubMed · 7289946
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H R Roberton. 1981-08-08. Interpreting a non-functioning gallbladder.. https://doi.org/10.5694/j.1326-5377.1981.tb100855.x
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Energized by the growth of the basic sciences during the latter half of the 20th century, gastroenterology advanced from a modest clinical activity to an increasingly scientific discipline. The decisive change followed World War II, when the Office of Scientific Research and Development transferred university and industry wartime research contracts to the National Institutes of Health (NIH), followed by establishment of the National Science Foundation and the General Medicine Study Section (NIH). Other factors contributing to the progress of gastroenterology included: (1) the increasing body of scientific knowledge; (2) innovative technological advances; (3) philanthropic, pharmaceutical, and governmental (NIH) support of research; (4) emphasis on controlled clinical and laboratory studies; and (5) the enlarging global scientific communication network. Selected highlights on the evolving knowledge of gastrointestinal hormones and the discovery of cholecystography illustrate some of the pathways of gastroenterology's 20th century advance.
The preoperative diagnosis of less than ss depth gallbladder cancer is difficult. Its preoperative diagnosis rate was low (27.5%), and even lower with the presence of concomitant gallstone. In the latter case, the diagnosis rate was particularly low when the stones diameter was greater than 1 cm. Gallstones are frequently associated with macromorphologically invasive type of gallbladder cancer and this may be the reason for the lower diagnostic rate. We compared preoperative diagnosis rate of ultrasonography (US), computed tomography (CT) and drip infusion cholecystography (DIC) for each invasion depth. In US, the preoperative diagnosis rate for m depth invasion was 6/16 (37.5%), pm depth was 1/13 (7.7%), and ss depth was 14/41 (34.1%). In CT, its rate for m depth was 3/11 (27.3%), pm depth was 1/10 (10.0%), and ss depth was 11/37 (29.7%). In DIC, its rate for m depth was 3/11 (27.3%), pm depth was 1/10 (10.0%), and ss was depth 1/23 (4.3%). None of the currently used imaging techniques were very accurate in diagnosing gallbladder cancer. Thus, during preoperative work up, if one discovers a gallbladder full of stones, stones of greater than 1 cm in diameter, thickened gallbladder wall, or a non visualized gallbladder with DIC, gallbladder cancer must be highly suspected.
Computed tomography (CT) was performed on 88 patients before and after extracorporeal shock wave lithotripsy (ESWL) of gallstones to find the effects of ESWL on the gallbladder and surrounding liver tissue. Post-ESWL scans demonstrated a thickening of the gallbladder wall in 25 (28.4%) cases. In one patient an intrahepatic bilioma beside the gallbladder was seen 3 days after ESWL treatment. Hematoma of the gallbladder wall or the adjacent liver tissue was not seen, and neither a hydrops nor biliary-induced pancreatitis was observed. The authors conclude that while some patients undergoing ESWL will show some posttreatment abnormality on CT scans, the procedure is associated with a low frequency of serious gallbladder and liver trauma.