BACKGROUND/AIMS: Cholecystectomy remains the best treatment for acute cholecystitis but may cause high morbidity or mortality in critically ill or elderly patients. METHODS: We performed ultrasonography-guided percutaneous cholecystostomy under local anesthesia in 18 elderly or critically ill patients with suspected acute cholecystitis between 1996 and 1999. RESULTS: Among the 18 patients, 16 had cholecystitis(11 calculous and 5 acalculous); in 2 patients, the procedure was only diagnostic. In 13 of 16 patients with acute cholecystitis, immediate relief of symptoms and significant improvement of laboratory signs of cholecystitis occurred. Persistent signs of cholangitis due to combined common bile duct and intrahepatic duct stones lead to laparotomy in 2 patients. One of these patients died due to pneumonia. Among 13 patients with cholecystitis, 5 patients underwent elective cholecystectomy(4: calculous, 1: acalculous) in 5 and 7 postprocedure days. One laparoscopic cholecystectomy was performed in these patients in 3 months. There was no any operative complication in elective cholecystectomy for these patients. The other 8 patients are symptom-free with an intact gallbladder after mean follow-up period of 17 months. In 2 patients, postprocedure radiologic signs of right pleural effusion were noted but resolved in 10 days in both patients. In one patient minor bleeding was noted but improved by observation only. Mortality rate of a patient with cholecystitis, treated by percutaneous cholecystostomy, was 12.5 percent( 2 of 16). CONCLUSION: These results indicate that percutaneous cholecystostomy is an effective temporary measure in elderly or critically ill patients.
Aged ; Anesthesia, Local ; Cholangitis ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Cholecystostomy* ; Common Bile Duct ; Critical Illness ; Follow-Up Studies ; Gallbladder ; Hemorrhage ; Humans ; Laparotomy ; Mortality ; Pleural Effusion ; Pneumonia

BACKGROUND: Color M-mode doppler echocardiography has been suggested as a new noninvasive technique for assessing left ventricular diastolic function. The present study was performed to define the feasibility and value of color M-mode echocardiography for the assessment of left ventricular diastolic function in patients with acute coronary syndrome. METHODS: Thirty six patients with acute myocardial infarcion and twenty three patients with unstable angina were included (M/F=41/18, 61+/-12.2 years). Doppler study was performed using ATL HDI-3000 within 24 hours after the attack. In color M-mode study, ROP was measured with 'Front wave method' and 'Baseline shift method'. The patients were grouped into three groups based on E/A ratio and deceleration time (DT) in transmitral flow and S/D ratio in pulmonary venous flow; Group I=Normal pattern (E/A>1, S/D>1, DT>140 ms), Group II=Impaired relaxation pattern (E/A<1, DT>140 ms) and Group III=Pseudonormal/Restrictive pattern (E/A>1.5, S/D<1, with or without DT< or =140 ms). RESULT: Twenty two, thirty four, and three patients were assigned to Group I, II, III, respectively. The ROP could be measured with 'Front wave method' in 50 patients (84.7%), but with 'Baseline shift method' only in 19 patients (32.2%). ROP with 'Front wave method' was 65+/-25.7, 61+/-35.6, 71+/-35.2 cm/sec in Group I, II, III, respectively. There was no statistically significant difference in the value of ROP between group I and II (p>0.05). CONCLUSION: The ROP seems not to reflect the diastolic function in acute coronary syndrome, although it is measurable with the 'Front wave method' in most cases. The measurement of the ROP with 'Baseline shift method' is not feasible in the patients with acute coronary syndrome.
Acute Coronary Syndrome* ; Angina, Unstable ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Humans ; Relaxation