Search

The article presents a case of 18-year follow-up of 59 y. o. patient with cholecystolithiasis and adenomiomatosis, with the development of complications of rapidly progressing xanthogranulomatous cholecystitis with malignancy.

The article presented a rare clinical observation of 55 years old patient, long-suffering from gall bladder adenomiomatosis, for which the subsequent development was complicated by lymphocytoplasmocytic cholecystitis.

The experience of treatment of 65 patients with cancer of the gall bladder (CGB) is analyzed. The tumor was revealed in women 7.2 times more often than in men. 95.3% patients were older than 60 years. Diagnosis of CBG is difficult before and during operation. Retrograde cholangiopancreatography increases reliability of diagnosis. The survival after radical cholecystectomy was 23.3 months.

A clinico-ultrasound description of presentation of melanoma metastases to the gallbladder in 8 patients is discussed. Secondary lesions to the bladder presented as exophytic outgrowths extending from the bladder wall into the lumen. Echo generated by the lesions was of medium intensity and low intensity around the edge of the elastic wall. They revealed dopplergaphic signs of blood flow. Complex application of echo- and dopplergraphy offered a means of differential diagnosis of metastatic lesions and other pathologies of the gallbladder presenting as exophytic outgrowths in the bladder wall in melanoma patients.

The paper deals with combined diagnosis of hepatic and biliary diseases, involving a wide range of nosological entities. It shows the potentialities of currently available diagnostic techniques for the most common diseases. The authors examined 175 patients with acute and chronic hepatitis, 120 with hepatic cirrhosis, 486 with cystic changes, 324 with benign tumors, 292 with malignant tumors, 21 with hepatic abscess, 527 with cholecystitis, 566 with cholelithiasis. Cancer of the gall-bladder was in 10 patients, its polyps were in 18, cancers of the common bile duct and bile papilla were in 6 and 4 patients, respectively. A complex of the used diagnostic techniques involved ultrasonic scanning, X-ray computed tomography, hepatobiliary scintigraphy, angiography, retrograde cholangiopancreatography, transhepatic cholangiography, etc. The authors have demonstrated that each method used is highly diagnostically effective. At the same time they have shown the limits of each technique in the diagnosis of certain diseases. The authors' data suggest that the total efficiency of the applied complex of diagnostic means approaches 100%.

The role of echography in the diagnosis of gallbladder tumors was investigated. Benign tumors (papilloma and adenoma) were diagnosed in 2 patients and carcinoma in 18 subjects. This technique failed to diagnose carcinoma in 2 patients. Two more procedures had false-positive results (in one patient multiple clots in the dramatically enlarged bladder were taken for the tumor while ++post-inflammatory granulation in the other patient was mistaken for the tumor as well). Echographical signs of gallbladder tumors were presented, as were the criteria permitting one to differentiate carcinoma from other pathological formations in the gallbladder (echogenic bile, cholesterol polyps, cholecystitis, adenomyomatosis). High informative value of echographic investigation in the diagnosis of gallbladder tumors was noted.

The article generalizes experience in the treatment of 226 patients with benign tumors and preneoplastic diseases of the gallbladder, who underwent cholecystectomy. The increased number of patients with the disease is noted, they accounted for 12.77% of all patients who were operated on for gallbladder diseases. Females 40 to 60 years of age have the disease most frequently. In most cases (n = 190) it is seen with calculi. In the absence of concomitant pathological conditions it is generally asymptomatic. The diagnosis is based on instrumental examination. Ultrasonic examination in combination with cholecystography is preferable. Operation is the recommended method of treatment.

Data on 148 cases of cancer of the gallbladder and extrahepatic bile ducts were studied. Jaundice proved the cardinal symptom. No clear-cut clinical picture of the disease was identified. Diagnostic procedure should start with ultrasonography. Cholangiectasia and the enlarged pancreatic head make the case for fiber bronchoscopy and hypotonic duodenography. Cancer-negative patients should further undergo transcutaneous transhepatic cholangiography and, if proving still negative, retrograde cholangiopancreatography. Resection of bile ducts with simultaneous lymphadenectomy is considered radical. The authors suggest a surgical procedure for cancer of the gallbladder which includes resection of the liver, hepatico-choledoctomy and cholecystectomy with formation of cholangio-jejuno-anastomosis using disposable transhepatic drains. Recanalization of bile ducts by transhepatic drain is considered optimal for palliation. Survival depends upon extent of surgery and level of bile duct obstruction.

The authors have summed up the experience in the use of CT diagnosis of gall bladder cancer. The investigation of 17 patients with cancer of this site showed a high informative value of the method. A retrospective comparative study of the results of CT and surgical interventions was carried out. It has been concluded that CT makes it possible not only to diagnose malignant lesions of the bile ducts but also to assess a possible scope of a forthcoming operation.