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PubMed1977

Ultrasonic and radiographic cholecystography.

To define the relative merits of radiographic and ultrasonic cholecystography, we studied 208 randomly selected patients with possible cholelithiasis. The patients underwent both procedures, and the results were interpreted in blind fashion. Two hundred patients had satisfactory confirmation of their diagnosis, by either a well visualized radiographic cholecystogram or operation or both. The overall accuracy of the ultrasonic examination was 93 per cent, with a false-negative rate of 11 and an indeterminate rate of 4 per cent. The indeterminate rate was 24 per cent for the single-dose oral cholecystogram and 8 per cent for the double-dose oral cholecystogram. Both ultrasonic cholecystography and radiographic cholecystography are useful to detect gallstones. Our findings support using single-dose oral cholecystography as the routine first examination. If the gallbladder is not satifactorily visualized, ultrasonic cholecystography can be performed immediately. In an emergency or for patients who might be pregnant, ultrasonic cholecystography is available as the initial examination.

Administration, Oral↗
PubMed1978

Preliminary abdominal films in oral cholecystography: are they necessary?

A survey of 45 radiologists with a special interest in gastrointestinal radiology showed that only 8% used a preliminary abdominal film for oral cholecystography. Review of 467 cases of oral cholecystography with preliminary films over a 1 year period disclosed 88 confirmed cases of cholelithiasis. Of these 88 cases, 27% had opaque gallstones visible on the preliminary film. In one-third of the cases, the opaque gallstones had a classic diagnostic appearance, while the remainder required oral cholecystography for confirmation. Opaque calculi were obscured by oral contrast material in 2% of cases. Other significant pathology on the preliminary films was found in 5.5% of the 467 cases.

Administration, Oral↗
PubMed1978

Gray-scale ultrasonic cholecystography. A primary screeing procedure.

The accuracy of ultrasonic cholecystography is well established. However, oral cholecystography remains the primary screening examination. Ultrasonic and oral cholecystograms were performed in 100 consecutive patients to determine if ultrasound could be used as a primary screening procedure, particularly in patients with acute right-upper-quadrant pain, suggestive of acute cholecystitis. Ultrasound compared favorably with oral cholecystography in accuracy and specificity. It was also cost-effective, saving one to two days of hospitalization.

Acute Disease↗
PubMed1979

Infusion cholecystography in the diagnosis of acute cholecystitis.

The use of infusion cholecystography as an aid in the diagnosis of acute cholecystitis was investigated in 21 patients. Seventeen of 18 patients (94 per cent) with positive cholecyst-tomograms who underwent laparotomy had confirmation of acutely inflamed gallbladders both macroscopically and histologically. These findings suggest that infusion cholecystography can make a significant contribution in reducing the incidence of misdiagnosis in acute cholecystitis, and that the investigation should be part of the management of patients in whom early surgery is planned.

Acute Disease↗
PubMed1978

Oral cholecystography in chronic renal insufficiency.

Thirty-two patients with chronic renal insufficiency (CRI) had oral cholecystography. Eleven of 15 patients (73%) with moderately advanced renal impairment had diagnostically inadequate single-dose cholecystograms. In contrast, all 11 patients on chronic hemodialysis had diagnostically opacified gallbladders following a single dose of contrast. Six other patients had biliary disease, either calculi (5 patients) or neoplasia (1 patient). These data suggest that CRI diminishes the likelihood of diagnostic gallbladder opacification, even in the absence of gallbladder disease, and that if the metabolic consequences of CRI are controlled by dialysis, the chances of diagnostic opacification are significantly improved (P less than 0.005). As oral cholecystography may not only result in inadequate opacification, but also carry the potential of renal toxicity, abdominal ultrasound should prove a safer and possibly more effective alternative in such patients.

Biliary Tract Diseases↗
PubMed1977

Cholecystokinin cholecystography in the diagnosis of chronic acalculous cholecystitis and biliary dyskinesia. A cirtical appraisal.

Now that the active fragment of the cholecystokinin molecule has been made available for use in clinical pracitce, reports on the value of cholecystokinin cholecystography must be re-evaluated to determine if the procedure is worthwhile in patients with persistent symptoms and a normal conventional oral cholecystogram. Such an analysis discloses that there is no uniform agreement on what consitutes an abnormal examination and raises serious questions concerning the scientific validity of much of the data. It is apparent that there is no immutable evidence to date to indicate that cholecystokinin cholecystography is an accurate technique to determine which patients in this category will benefit from cholecystectomy.

Adolescent↗
PubMed1978

The development of cholecystography: the first fifty years.

Visualization of the gallbladder by x-ray was first achieved in 1923 by the intravenous introduction into the body of a halogenated compound which was excreted by the liver into the bile ducts and gallbladder [1--4]. This was the first time that visualization of an organ had been accomplished by introducing a substance into the body and obtaining a roentgenogram after the substance had been metabolized and localized primarily in one organ. Previously, visualization of an organ had been achieved only by introducing a substance opaque to the x-ray directly into the lumen and obtaining a roentgenogram to outline its inner wall. By 1925 visualization of the gallbladder had also been accomplished by the oral administration of halogenated compounds [5,6]. The drugs employed for intravenous and oral cholecystography had been synthesized specifically for that purpose based on earlier experimental work of other investigators. The following account describes in detail the experimental background of cholecystography, its origin, and its development and use during the ensuing fifty years.

Administration, Oral↗
PubMed1979

[Improvement of oral cholecystography and cholangiography with ceruletid (author's transl)].

Following oral cholecystography in 100 patients, the conventional "fatty meal" was replaced by an intramuscular injection of Ceruletid in a dose of 0.4 microgram/kg body weight. The synthetic decapetide Ceruletid is a substance with a hormone-like effect on the gastro-intestinal tract. It contracts smooth muscle in the gut and stimulates secretion in the stomach and the exocrine pancreas. Compared with other substances producing contraction which are given orally, Ceruletid acts more quickly and more powerfully in producing contraction of the gall bladder muscle. In 86% of positive cholecystograms, this resulted in satisfactory demonstration of the bile duct, 66% better than for oral substances. Many abnormalities, particularly localised adenomyomatosis, can only be diagnosed after good contraction of the gall bladder. Side effects, such as nausea, dizziness and a feeling of heat were transitory. In three patients it led to vomiting. The rapid and certain effect of Ceruletid during oral cholecystography requires reassessment of the role of intravenous cholangiography in diagnosis. Particularly amongst out-patients, with a high proportion of normal gall bladders, it is possible to complete the examination in one stage by demonstrating the bile duct with Ceruletid.

Bile Ducts↗
PubMedDate not supplied

Combined cholangiography and cholecystography using sodium iopanoate.

Cholangiography and cholecystography were performed in fasted dogs and human subjects using sodium iopanoate given intraduodenally in doses of 10 and 20 mg/kg. The same studies were performed after intraduodenal administration of fat or after intravenous administration of cholecystokinin (CCK) in dogs and after a fatty meal, to stimulate endogenous release of CCK, in human subjects. In both the animals and human subjects, peak blood iodine concentrations were reached by 30 minutes after iopanoate administration. At a dose of 10 mg/kg, radiographic visualization of both bile ducts and gallbladder was inconsistent. At 20 mg/kg (one-half the clinical dose for standard oral cholecystography,) the common bile duct was visualized within 60 minutes and the gallbladder within 90 minutes. Gallbladder density increased over the next 6 hours. Prior administration of fat or CCK led to earlier and denser gallbladder opacification. The common bile ducts opacified with the use of iopanoate were small in caliber, averaging only 3 mm. This probably reflects the fact that, unlike iodipamide, iopanoate has little or no choleretic effect. Therefore, because it would not increase the volume of bile in the duct, iopanoate would not increase duct size.

Adult↗
PubMed1976

Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques.

A prospective study was designed to assess the accuracy of gray scale ultrasonography in the evaluation of cholelithiasis. A series of 111 patients with nonvisualization on first-day oral cholecystography underwent ultrasonic cholecystography, and the results were compared with subsequent second-day visualitzation or surgical findings. In 75 cases sufficient data were present to assess the accuracy of the method. Ultrasound correctly diagnosed 68 (91%) of these cases with regard to gallstones. Only 6 gallbladders could not be visualized ultrasonically and all subsequently proved to have gallstones. It is concluded that improved ultrasonic technique is of considerable value in investigating the nonvisualized gallbladder. Valuable information conderning other upper abdominal pathology was often discovered.

Cholecystography↗
PubMed1978

Single dose oral cholecystography.

The routine use of single dose oral cholecystography is suggested for the examination of outpatients. A diagnosis is more quickly obtained for the great majority of patients and there is a lower incidence of side effects. An effective method of contrast administration and filming is discussed. The medical, personal, and economic impact of single dose oral cholecystography is contrasted with that for routine consecutive dose examinations in an outpatient population.

Administration, Oral↗
PubMed1978

Prolonged gallbladder opacification after oral cholecystography.

Recent reports state that prolonged gallbladder opacification after an otherwise normal oral cholecystogram is abnormal and reliably indicates acalculous cholecystitis. In 122 patients on a variety of diets, the frequency with which prolonged gallbladder opacification is detectable one and two days after oral cholecystography was studied prospectively. Prolonged opacification was seen in 75% of patients and did not occur more commonly in those patients with documented gallbladder disease. Prolongation of gallbladder opacification after oral cholecystography is common and cannot be used as the sole criterion for the diagnosis of cholecystitis.

Adult↗
PubMed1979

The value of plain radiographs prior to oral cholecystography.

The diagnostic significance of a routine preliminary plain radiograph of the right upper abdominal quadrant prior to oral cholecystography was evaluated retrospectively. The plain radiograph was decisive in the diagnosis in only one case out of 1,022 consecutive cholecystographic examinations (0.1%) (95% confidence limits: 0.00-0.55%). The sensitivity of oral cholecystography, now approximately 90%, would drop by only 0.43% (95% confidence limits: 0.01-2.14%) if the routine plain radiograph were omitted.

Cholecystography↗
PubMed1978

Cholecystokinetic cholecystography: efficacy and tolerance studies of ceruletide.

The effect of intravenous and intramuscular administration of ceruletide on gallbladder contraction was investigated in 67 normal volunteers and patients. Of the 45 normal volunteers, 33 received the drug intravenously and 12 intramuscularly in graded ascending doses. By either means of injection, ceruletide produced a substantial contraction of the gallbladder with a measurable reduction in gallbladder area. Based on findings in these groups, the 22 patients requiring oral cholecystography for clinical evaluation received 0.3 microgram/kg intramuscularly. The intramuscular administration of synthetic ceruletide after oral cholecystography, in a dose of 0.o microgram/kg, afforded a safe and effective means of gallbladder contraction, with resultant cystic and common bile duct visualization. Side effects occurred less frequently when the drug was administered intramuscularly and were minimal and self-limiting. Peak contraction (40% or greater reduction in size) occurred as early as 5-15 min after after intramuscular injection and in most instances within 30 min.

Adult↗
PubMed1978

[Echographic or radiographic cholecystography? (author's transl)].

In a prospective echographic and radiographic investigation of 281 patients and in a retrospective evaluation of 86 operated patients, echography and radiography gave approximately equally accurate diagnoses. By using both methods no pathological finding will be overlooked. For reasons of radiation protection, echographic examinations should be carried out first. If the echographic results agree with the clinical findings the radiological cholecystography can be dispensed with. Radiological investigation should be carried out if the echographic findings are at variance with the clinical findings. Consequently echographic cholecystography certainly cannot replace radiography, but it does contribute in that radiographic examination can be used selectively.

Cholecystography↗
PubMedDate not supplied

[Oral cholecystography: is the fatty meal compulsory (author's transl)].

An investigation on 1000 cases of oral cholecystography allowed us to collect 640 non pathologic opacifications of the gallblader and among them only 3 cases of pathological common bile ducts (0,47 percent). Consequently when the gallbladder appears normal on the oral cholecystography, the fatty meal seems to be non compulsory but only when clinical findings are in favor of a pancreatic disease or if there are pancreatic calcifications or if surgery has been performed anteriorly on the bile ducts, the liver or the pancreas.

Adult↗
PubMed1979

Diagnostic imaging procedures in acute pancreatitis. Comparison of ultrasound, intravenous cholangiography, and oral cholecystography.

To evaluate the role of intravenous cholangiography (IVC), ultrasound andoral cholecystography in the diagnosis of gallstone pancreatitis, 20 patients with acute pancreatitis were studied during the first three days of an attack. The IVC successfully demonstrated the common bile duct and gallbladder in 17 (85%) 20 patients. The ultrasound studies showed the gallbladder in all 18 patients in whom the gallbladder was present. The common duct was not seen by ultrasound in any patient and the pancreas was abnormal in all patients. In the three patients with gallbladder stones these were identified on both IVC and ultrasound. Common duct stones in three patients were seen only by IVC (two of these patients had concurrent gallbladder stones and one after cholecystectomy). Oral cholecystography was of limited usefulness, although the 50% visualization rate was higher than the literature suggests.

Acute Disease↗
PubMed1975

Layering of contrast material in oral cholecystography.

Serial erect roentgenograms of the gallbladder during oral cholecystography were taken in 50 patients before and after a fatty meal. In the presence of good opacification, layering of opaque and nonopaque bile was noted in most cases 2 hours after the fatty meal. The degree of layering was related to the extent of gallbladder contraction produced by the fatty meal and the degree to which the gallbladder refilled by the inflow of nonopaque liver bile. The layering phenomenon thus appears to be a manifestation of a normally functioning gallbladder and occurs when the gallbladder refills with fresh nonopaque bile.

Bile↗