Cefmenoxime penetration into gallbladder bile and tissue.

Cefmenoxime concentrations in gallbladder bile and tissue were assessed in patients undergoing cholecystectomy. A 0.5-g intravenous dose produced mean concentrations in bile of 54.1 micrograms/ml at 62.9 min and 56.3 micrograms/ml at 194 min after the dose was given. A 1.0-g intravenous dose produced concentrations in bile of 117.9 micrograms/ml at 53 min and 169.7 micrograms/ml of 194 min after the dose was given. Mean concentrations in tissue ranged from 6.1 to 17.9 micrograms/g. Biliary tree penetration was dose and time dependent. Therapeutic concentrations were achieved.     

Multiseptate gallbladder with acute acalculous cholecystitis

Multiseptate gallbladder is a rare congenital malformation of the gallbladder. In some cases, right upper quadrant pain, recurrent abdominal pain, and gallstones were present. We present the sonographic findings in a case of multiseptate gallbladder with acute cholecystitis, which (to our knowledge) has not been reported before. We hypothesize that bile sludge accumulated and subsequent cholecystitis developed as a result of bile stasis in our case because the classic predisposing factors that have been described were absent.     

Effects of melatonin on gallbladder neuromuscular function in acute cholecystitis

Gallbladder stasis is associated to experimental acute cholecystitis. Impaired contractility could be, at least in part, the result of inflammation-induced alterations in the neuromuscular function. This study was designed to determine the changes in gallbladder neurotransmission evoked by acute inflammation and to evaluate the protective and therapeutic effects of melatonin. Experimental acute cholecystitis was induced in guinea pigs by common bile duct ligation for 2 days, and then the neuromuscular function was evaluated using electrical field stimulation (EFS; 5-40 Hz). In a group of animals with the bile duct ligated for 2 days, a deligation of the duct was performed, and after 2 days, the neuromuscular function was studied. The EFS-evoked isometric gallbladder contraction was significantly lower in cholecystitic tissue. In addition, inflammation changed the pharmacological profile of these contractions that were insensitive to tetrodotoxin but sensitive to atropine and omega-conotoxin, indicating that acute cholecystitis affects action potential propagation in the intrinsic nerves. Nitric oxide (NO)-mediated neurotransmission was reduced by inflammation, which also increased the reactivity of sensitive fibers. Melatonin treatment prevented qualitative changes in gallbladder neurotransmission, but it did not improve EFS-induced contractility. The hormone recovered gallbladder neuromuscular function once the biliary obstruction was resolved, even when the treatment was started after the onset of gallbladder inflammation. These findings show for the first time the therapeutic potential of melatonin in the recovery of gallbladder neuromuscular function during acute cholecystitis.     

The concentration of latamoxef achieved in the bile and gallbladder wall of patients with cholecystitis

This study reports the clinical and pharmacokinetic results following an injection of latamoxef (moxalactam disodium) in patients undergoing cholecystectomy for symptomatic cholelithiasis. Two groups were involved in the study. Group A consisted of 22 patients who received 1 g of intramuscular latamoxef at the time of premedication prior to surgery, and group B consisted of 12 patients each of whom received an intravenous dose of 0.5 g of latamoxef at the time of anaesthetic induction. Latamoxef levels were then measured in peripheral blood, gall bladder bile, common bile duct (CBD) bile and gall bladder wall. Despite a significant difference in the sampling times, inhibitory levels were obtained in the majority of samples in both groups, singularly high levels being assayed in CBD bile. We conclude that an intravenous dosage of latamoxef (0.5 g) given with anaesthetic induction is as effective as 1 g intramuscular dosage given with the pre-medication.     

超声引导下胆囊穿刺置管在急性胆囊炎中的应用价值

<正>急性胆囊炎是临床常见的外科急症,如治疗不及时易发生穿孔,严重者可危及生命。但急症手术并发症及死亡率较高,部分年老体弱患者不能耐受急症手术,单纯静脉滴注抗生素疗效不佳。超声引导下胆囊穿刺置管作为一种急性期的姑息性治疗手段能迅速改变患者的临床症状,降低急性期病死率,从而获得择期手术治疗的机会,对于部分非结石性胆囊炎能达到治愈目的[1]。近年来我院采用超声引导下胆囊穿刺置管治疗急性胆囊炎,有效地减少了并发症,降低了死亡率。现报道如下。     

Diagnosis of gallbladder perforation in acute acalculous cholecystitis in critically ill patients

In the presence of ascites ultrasound is not appropriate to distinguish between gallbladder perforation and acute acalculous cholecystitis. However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites. All patients had evidence of gallbladder perforation by ultrasound and underwent cholecystectomy: 2 patients had gallbladder perforation, but 2 had acalculous cholecystitis without perforation. markedly elevated serum alkaline phosphatase was the only discriminating finding indicating gallbladder perforation.     

Infusion tomography and ultrasonography of the gallbladder in the diagnosis of acute cholecystitis

Sixty-three patients with the clinical suspicion of acute cholecystitis were examined with infusion tomography of the gallbladder. Ultrasonography was performed in 51 of these cases. The technique and diagnostic principles of both methods are discussed. The diagnostic value of the two methods when used in combination is stressed. Thus in a case of gangrenous cholecystitis when opacification of the gallbladder wall may not appear at infusion tomography, ultrasonography may demonstrate signs of gallbladder disease. Infusion tomography, on the other hand, may be of great value if ultrasonography is not informative.     

慢性胆囊炎急性发作的胆囊壁声像图表现

目的 探讨慢性胆囊炎急性发作患者胆囊壁改变的声像图表现。方法 将１０５例急诊手术后病理诊断为慢性胆囊炎急性发作与急性胆囊炎（各型）患者超声测量的囊壁厚度进行对照,分析囊壁厚度与疼痛发作时间长短的关系,观察“双环”征出现率及胆囊壁光滑度。     

Endoscopic transpapillary gallbladder drainage for management of acute cholecystitis with coagulopathy

Acute cholecystitis is a common and frequently occurring disease, and laparoscopic cholecystectomy is the preferred treatment method. Percutaneous transhepatic gallbladder drainage is regarded as the first-line palliative procedure for elderly patients with poor cardiopulmonary function who cannot tolerate general anesthesia. However, for patients with acute cholecystitis who are undergoing treatment with oral antithrombotics or who have abnormal coagulation mechanisms, endoscopic transpapillary gallbladder drainage may be a good choice. Endoscopic transpapillary gallbladder drainage is an endoscopic retrograde cholangiopancreatography-based technique that drains the gallbladder by placing a tube into the cavity of the gallbladder though the cystic gall duct. It is the application of the concept of natural orifice transluminal endoscopic surgery in the biliary system. This technique can not only achieve gallbladder drainage but can also minimize the risk of procedure-induced bleeding. In this paper, we describe a representative case to introduce the key points of this procedure and the associated clinical care, hoping to provide useful information for clinicians and nurses.     

Torsion of the gallbladder: a rare cause of acute cholecystitis

We present a case of acute torsion of the gallbladder in a young woman. Approximately 400 cases have been reported since 1898, mostly in elderly women, and the incidence appears to be increasing. The anatomy and pathophysiology that predispose patients to this rare surgical emergency are discussed. Several clinical and imaging findings can be used to distinguish gallbladder torsion from typical acute cholecystitis. By recognizing and treating gallbladder torsion early in its course, a low surgical morbidity and mortality can be achieved. The case presented highlights for emergency physicians some of the considerations in identification of patients with acute cholecystitis who are at highest risk of gangrene and perforation, their emergency treatment, and the timing of surgery.     

经皮经肝胆囊穿刺引流术在高龄高危急性胆囊颈部结石嵌顿中的急诊应用

目的 总结超声引导下经皮、经肝胆囊穿刺引流(PTGD)对高龄、高危急性胆囊颈部结石嵌顿患者的治疗经验.方法 回顾性分析2001-01～2008-12期间接受PTGD治疗的56例高龄、高危急性胆囊颈部结石嵌顿患者的临床资料.结果 56例均穿刺置管成功,其中6例因引流管脱落或堵塞而再次行PTGD.54例((96.43%)获得有效的胆囊引流,52例(92.85%)治愈.40例于急性胆囊颈部结石嵌顿治愈后2周至3个月行择期胆囊切除术.1例发生胆囊出血,2例出现胆汁腹腔漏.全组无一例因急性胆囊颈部结石嵌顿及相关的治疗而死亡.结论 PTGD是治疗高龄、高危急性胆囊颈部结石嵌顿患者的一项安全、简便、有效的方法.     

急性坏疽性胆囊炎行腹腔镜胆囊切除术中胆管损伤的预防

目的 探讨急性坏疽性胆囊炎行腹腔镜胆囊切除术中胆管损伤的预防措施.方法 选择2007年1月～2010年2月该院急性坏疽性胆囊炎行腹腔镜胆囊切除术患者62例的临床资料,回顾性分析术中预防胆管损伤的措施.结果 该组62例患者中完全腹腔镜下完成胆囊切除术52例.其中,胆囊管置管法25例,逆行法胆囊切除术15例,胆囊部分切除术...     

Pharmacokinetics of oral co-trimazine and the penetration of its components sulfadiazine and trimethoprim into peripheral human lymph

Five healthy informed male volunteers received oral doses of 820 mg sulfadiazine (SDZ) plus 180 mg trimethoprim (TMP) (co-trimazine) every 24 h. Concentrations in serum, peripheral lymph from the leg and urine were determined after the first dose, and on the 4th day to reflect approximate steady-state conditions. TMP was assayed microbiologically and unchanged SDZ by high-pressure liquid chromatography. There was a rise in concentrations from the first dose to the 4th day. The rise for SDZ was by a factor of 1.6 in both serum and lymph; the rise for TMP was also 1.6 in serum, but 1.5 in lymph. The peak concentrations at steady state were 27.7 mg/l (SD) +/- 4.3 SDZ, and 1.6 +/- 0.68 mg/l TMP. The serum values at that time were 31.7 +/- 5.8 mg/l SDZ and 2.3 +/- 0.51 mg/l TMP. The simultaneous concentrations of both SDZ and TMP were always somewhat lower in lymph than in serum, also at the end of the observation periods, i.e. 12 h after the first dose and 72 h after the final one. But the serum concentrations of both SDZ and TMP were only slightly higher than in lymph. After the final dose, the ratio between the 12-hour areas under the concentration curves of lymph and serum was 0.68 +/- 0.12 for SDZ and 0.59 +/- 0.14 for TMP. The values after the first dose were similar, 0.63 +/- 0.17 and 0.57 +/- 0.05, respectively. The elimination half-life in serum during steady state was 16.5 h for SDZ, 8.6 h for acetylated SDZ and 9.4 h for TMP. In lymph the corresponding values were 19.2, 19.2 and 8.9 h.