No abstract available.
Cholecystokinin* ; Gallbladder Emptying* ; Gallbladder* ; Meals*

BACKGROUND/AIMS: At present, the gallbladder dysfunction implies a disorder of decreased gallbladder contractility. Other motor disorder such as overactive gallbladder which shows excessive contraction cannot be excluded in the motility disorder of gallbladder. Thus, this study was done to define the diagnostic criteria and to develop the techniques to induce the excessive contraction of gallbladder. METHODS: CCK-op at 20 ng/kg by slow continuous infusion for 30minutes, that is known as most physiologic method for gallbladder contraction, was given for assessment of gallbladder emptying in 12 normal volunteers. Also, rapid bolus injection of cholecystokinin octapeptide (CCK-op) at 20 ng/kg or 40 ng/kg was performed to induce the excessive contraction of gallbladder. Gallbladder contractility was represented as the ejection fraction (GBEF) measured by cholecystokinin-cholescintigraphy. RESULTS: 1. With a slow continuous infusion of CCK-op, the mean GBEF was 78.2+/-5.6% (mean+/-SD). 2. With a rapid bolus injection of CCK-op, GBEF showed variable results (10-86%) among subjects who had normal gallbladder. 3. Based on the results obtained by slow continuous infusion of CCK-op in normal volunteers, overactive gallbladder was defined when GBEF approached more than 70% within 15minutes after bolus injection of CCK-op. The overactive gallbladder was noted in 6 (50%) subjects who received rapid bolus injection of CCK-op (40 ng/kg). 4. Abdominal pain developed only in high-dose (40 ng/kg) bolus injection group (6/12, 50%), concomitantly with increased bowel movements, irrespective of excessive gallbladder contractility. CONCLUSION: Excessive gallbladder contraction had no clinical significance in the experimentally induced clinical model.
Abdominal Pain ; Cholecystokinin ; Gallbladder Emptying ; Gallbladder* ; Healthy Volunteers ; Sincalide

Adult ; Aged ; Female ; Gallbladder ; physiopathology ; Gallbladder Emptying ; physiology ; Gallstones ; etiology ; physiopathology ; Humans ; Liver Cirrhosis ; complications ; physiopathology ; Male ; Middle Aged

BACKGROUND/AIMS: Studies in adults suggest that constipation may not be a purely colonic pathology and may be a component of a generalized gastrointestinal (GI) motor disorder in which proximal GI motility can be impaired. Pediatric data are scarce, and the natural history of the disorder remains undefined. We aimed to evaluate gallbladder motility in a subset of Asian children with chronic functional constipation. METHODS: Abdominal ultrasound was performed on 105 children, including 55 patients (aged 3 to 13 years) with chronic functional constipation who met the inclusion criteria and 50 age- and gender-matched controls. The gallbladder contractility index was calculated based on the preprandial and postprandial gallbladder areas. Preprandial and postprandial values for gallbladder volume and wall thickness were evaluated. RESULTS: The mean value of the contractility index for the patients (15.77+/-24.68) was significantly lower than the mean value for the controls (43.66+/-11.58) (p=0.001). The mean postprandial gallbladder volumes and areas were larger in children with gallbladder hypomotility (p<0.05). The mean duration of constipation (4.8 months) was significantly higher (p=0.004) in the children with gall-bladder hypomotility. CONCLUSIONS: Gallbladder motility is significantly impaired in children with chronic functional constipation. This study contributes to the understanding of the underlying pathophysiology, which will enable advancement in and improved management of children with chronic constipation and associated gallbladder hypomotility.
Adolescent ; Case-Control Studies ; Child ; Child, Preschool ; Chronic Disease ; Constipation/physiopathology/*ultrasonography ; Female ; Gallbladder/physiopathology/*ultrasonography ; Gallbladder Emptying/*physiology ; Humans ; Male ; Prospective Studies ; Time Factors

Chronic acalculous cholecystitis is a diagnosis of exclusion in patients complaining acalculous biliary pain. The possible causes of acalculous biliary pain are chronic gallbladder (GB) inflammation, GB dysfunction, cholesterolosis, cystic duct stenosis or microlithiasis. Recently, laparoscopic cholecystectomy is the choice of treatment for acalculous biliary pain. We experienced a 32-year-old woman whose initial symptoms were right upper quadrant pain and nausea only. The abdominal computed tomography, DISIDA scan, and upper and lower endoscopic examinations were nonspecific. Up to 48 hours after endoscopic retrograde cholangiopancreatography, contrast emptying of GB was delayed, implying dysfunctional GB. As the patient's right upper quadrant pain and tenderness became aggravated, the laparoscopic cholecystectomy was done and the final diagnosis of chronic acalculous cholecystitis was confirmed.
Acalculous Cholecystitis/*radiography ; Adult ; *Cholangiopancreatography, Endoscopic Retrograde ; Chronic Disease ; *Contrast Media ; English Abstract ; Female ; Gallbladder Emptying ; Humans

Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, erythromycin 10 mg/kg, atropine 3 micrograms/kg and L-NAME 10 mg/kg respectively. Each rabbit underwent manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was increased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and contraction amplitude, CCK increase basal pressure contraction amplitude and frequency, and erythromycin increase contraction amplitude, respectively. But comparing with that before cholecystojejunostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal factors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.
Animals ; Cholecystectomy ; adverse effects ; Common Bile Duct ; physiopathology ; Female ; Gallbladder Emptying ; physiology ; Jejunostomy ; adverse effects ; Male ; Manometry ; methods ; Muscle Contraction ; Postoperative Period ; Rabbits ; Random Allocation ; Sphincter of Oddi ; physiopathology

Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, erythromycin 10 mg/kg, atropine 3 micrograms/kg and L-NAME 10 mg/kg respectively. Each rabbit underwent manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was increased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and contraction amplitude, CCK increase basal pressure contraction amplitude and frequency, and erythromycin increase contraction amplitude, respectively. But comparing with that before cholecystojejunostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal factors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.
Cholecystectomy/*adverse effects ; Common Bile Duct/*physiopathology ; Gallbladder Emptying/*physiology ; Jejunostomy/*adverse effects ; Manometry/methods ; Muscle Contraction ; Postoperative Period ; Random Allocation ; Sphincter of Oddi/*physiopathology

OBJECTIVES: Gastric resection may predispose gallstone formation. However, the mechanism has not been clearly understood. To evaluate the relationship between gastric resection and gallstone formation, we compared gallbladder(GB) motility in gastrectomized patients and control subjects. METHODS: We compared the GB volume and ejection fraction of the 46 gastrectomized patients with 37 healthy controls using real time ultrasonography. RESULTS: GB volume increased significantly in the gastrectomized group in fasting (30.2 13.9 ml). The GB volume after a fatty meal was greater in the gastrectomized group (12.6 6.4 ml) than in the control group (4.3 3.3 ml) (p +ADw- 0.01). A significant reduction of ejection fraction was found in gastrectomized patients (56.9 13.0+ACU-) in comparison with the control group (75.5 16.1+ACU-) (p +ADw- 0.01). The GB ejection fraction had a poor correlation to the postoperative period (r +AD0- 0.232). CONCLUSION: A gastrectomy appears to be a risk factor of GB dysmotility, which may play a major role in gallstone formation in gastrectomized patients.
Adult ; Aged ; Cholelithiasis/ultrasonography ; Cholelithiasis/etiology+ACo- ; Comparative Study ; Eating ; Endosonography ; Fasting ; Female ; Gallbladder/ultrasonography ; Gallbladder/physiopathology+ACo- ; Gallbladder Emptying ; Gastrectomy/adverse effects+ACo- ; Gastrointestinal Motility ; Human ; Male ; Middle Age ; Probability ; Prospective Studies ; Reference Values ; Risk Assessment ; Stomach Neoplasms/surgery+ACo-

PURPOSE: From the early 1990s, operative mortality following pancreaticoduodenectomy have been decreased markedly. And severity of the postoperative complications also has been improved. Experienced hands in large volume hospitals and advances in supportive care have been considered as main reasons. Under this currency, indications for pancreaticoduodenectomy have been expanded, and extended pancreaticoduodenectomy has been tried more occasionally. METHODS: For 254 consecutive patients who underwent pancreaticoduodenectomy between Dec. 1998 and Mar. 2002, a retrospective analysis of operative mortality and postoperative complications was performed by reviewing of the medical records. RESULTS: Eighty-five patients were treated for common bile duct cancer, 58 patients for pancreatic cancer, 60 patients for ampulla of Vater cancer, 9 patients for duodenal cancer, 5 patients for advanced gastric cancer, 2 patient for gallbladder cancer, one patient for colon cancer and 34 patients for benign diseases or traumatic conditions. Standard pancreaticoduodecnectomies were performed in 169 patients, pylorus-preserving pancreaticoduodenectomies in 64 patients, total pancreatectomies in 15 patients and hepatopancreaticoduodenectomies in 6 patients. There was no postoperative 30-day or hospital mortality. Postoperative complications were occurred in 100 (39%) patients. The leading complication of this study is hemorrhage in 27 cases (11%) followed by pancreatic fistula in 17 cases (7%), delayed gastric emptying 16 cases (6%) and intraabdominal abscess in 11 cases (4%). There were no significant difference of the incidence of the complications between malignant diseases and benign, above 70-years old and below. Among them in 15 patients (15%) re-operative treatments were needed and in the remain conservative treatments were chosen. CONCLUSION: Operative mortality itself is no more limited factor for pancreaticoduodenectomy. Most of the complications following pancreaticoduodenectomy can be treated successfully and pancreaticoduodenectomy can be chosen as a safe and effective procedure not only in periampullary tumors but other benign diseases and even old age with same complication risk. But hemorrhagic complication and pancreatic fistula have been remained as serious problems on performing of pancreaticoduodenectomy.
Abscess ; Aged ; Ampulla of Vater ; Colonic Neoplasms ; Common Bile Duct ; Duodenal Neoplasms ; Gallbladder Neoplasms ; Gastric Emptying ; Hand ; Hemorrhage ; Hospital Mortality ; Humans ; Incidence ; Medical Records ; Mortality* ; Pancreatectomy ; Pancreatic Fistula ; Pancreatic Neoplasms ; Pancreaticoduodenectomy* ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms