Diagnostic capabilities of the x-ray endoscopic method of study in cholelithiasis]

The developed variants of the roentgenoendoscopic method for the examination of the pancreatobiliary system were employed in 256 patients with various diseases of the gallbladder and biliary duct. The results of application of these methods in 85 patients with cholelithiasis are presented. Different potentialities of the roentgenoendoscopic method and ultrasonic scanning for the assessment of the biliary system status in cholelithiasis were revealed. The findings recommend supplementing ultrasonic examinations with an optimal variant of the roentgenoendoscopic examination.     

Electron microscopic observations on the cholesterol distributed in the epithelial cells of the gallbladder.

Epithelial cells of eight human gallbladders with cholesterosis were examined. In the supranuclear portion of the epithelial cells of one case, many spicular, circular and plate-like crystalline structures are present. Spicular and circular structures have not a limiting membrane, but plate-like structures are apparently bounded by a limiting membrane that clearly shows trilamellar structure. After digitonin treatment, the spicular and circular crystalline structures become denser. On the other hand, the plate-like structures do not become denser by digitonization. In the epithelial cells that contain no crystalline structure, there also occur many reaction precipitates after digitonization. These findings may suggest that free cholesterol is highly present in the epithelial cells of gallbladder with cholesterosis and that it, in some case, precipitates in the form of spicular or circular structure for the rapid fixation process.     

22(R)-hydroxycholesterol and pioglitazone synergistically decrease cholesterol ester via the PPARγ–LXRα–ABCA1 pathway in cholesterosis of the gallbladder

Cholesterosis is a disease of cholesterol metabolism characterized by the presence of excessive lipid droplets in the cytoplasm. These lipid droplets are mainly composed of cholesterol esters derived from free cholesterol. The removal of excess cholesterol from gallbladder epithelial cells (GBECs) is very important for the maintenance of intracellular cholesterol homeostasis and the preservation of gallbladder function. Several lines of evidence have indicated that the activation of either peroxisome proliferator-activated receptor gamma (PPARγ) or liver X receptor α (LXRα) relates to cholesterol efflux. While pioglitazone can regulate the activation of PPARγ, 22(R)-hydroxycholesterol can activate LXRα and is a metabolic intermediate in the biosynthesis of steroid hormones. However, the effect of 22(R)-hydroxycholesterol in combination with pioglitazone on cholesterosis of the gallbladder is unclear. GBECs were treated with pioglitazone, 22(R)-hydroxycholesterol or PPARγ siRNA followed by Western blot analysis for ATP-binding cassette transporter A1 (ABCA1), PPARγ and LXRα. Cholesterol efflux to apoA-I was determined, and Oil Red O staining was performed to monitor variations in lipid levels in treated GBECs. Our data showed that 22(R)-hydroxycholesterol can modestly up-regulate LXRα while simultaneously increasing ABCA1 by 56%. The combination of 22(R)-hydroxycholesterol and pioglitazone resulted in a 3.64-fold increase in ABCA1 expression and a high rate of cholesterol efflux. Oil Red O staining showed an obvious reduction in the lipid droplets associated with cholesterosis in GBECs. In conclusion, the present findings indicate that the anti-lipid deposition action of 22(R)-hydroxycholesterol combined with pioglitazone involves the activation of the PPARγ–LXRα–ABCA1 pathway, increased ABCA1 expression and the efflux of cholesterol from GBECs. Thus, 22(R)-hydroxycholesterol synergistically combined with pioglitazone to produce a remarkable effect on lipid deposition in cholesterosis GBECs.     

Cholecystitis in Teenage Girls

Cholecystectomy was carried out in 17 teenage girls for cholecystitis at Virginia Mason Hospital, Seattle, between 1971 and 1980. The incidence increased with increasing age. Gallbladder disease was associated with recent pregnancy or birth control pill use (71%), obesity (65%) and family history of gallbladder disease (47%). All but one patient had at least one of these risk factors. No patient had congenital anomalies, blood dyscrasias or other underlying illness. Patients most commonly had recurrent attacks of abdominal pain; seven had symptoms for more than six months. Although the clinical presentations were often mild, six patients had jaundice, three had chemical pancreatitis, one had hemorrhagic pancreatitis, one had pancreatic pseudocyst and abscess and one had a common duct stone. One patient had cholesterosis and 16 had cholelithiasis. All patients were cured by operation. During the same time period, only two boys, both aged 14 years, nonobese and with no family history of gallbladder disease, underwent cholecystectomy, both for acaculous cholecystitis.     

X-ray diagnosis of disturbed bronchial permeability in chronic bronchitis

The authors presented clinical and x-ray findings of combined investigation of 94 patients with chronic bronchitis. X-ray symptoms of disturbed bronchial permeability (DBP) in this pathology were studied. Bronchograms, bronchosonograms performed in different phases of respiration using broncholytic drugs, video tape recording, coherent-optic processing of bronchograms, and a method of digital processing of bronchograms proposed by the authors were employed. The importance of x-ray examination in the diagnosis of DBP was shown. The classification, nature, site and spreading of DBP were described. X-ray findings were compared with clinical and laboratory findings.     

Hemoptysis: Diagnosis and Management

Hemoptysis is one of the most important symptoms of cardiopulmonary disease—first, because bleeding even in small amounts may indicate the presence of such serious diseases as bronchogenic carcinoma or active tuberculosis, and second, because untreated massive hemorrhage is associated with a high mortality rate. The cause of hemoptysis may be suggested by the history, physical examination or chest x-ray findings, but often diagnostic procedures such as bronchoscopy, bronchography and pulmonary angiography are needed for definitive diagnosis. The importance of early localization of the bleeding site and surgical intervention in patients with massive hemoptysis is stressed.     

Abdominal Aortic Aneurysms—Unusual Clinical Manifestations

Misleading symptoms were responsible for failure to make the diagnosis of symptomatic abdominal aortic aneurysm in 15 patients. The presenting complaints appeared to be specific for other diseases, such as genitourinary disease, diverticulitis, intra-abdominal neoplasm and functional large intestinal disorders. A correct diagnosis was ultimately made in 12 patients and aneurysmectomy was performed. In three patients, who died of ruptured aneurysm, the diagnosis was not made until postmortem examination.An awareness of the atypical symptoms of aneurysms, careful physical examination and appropriate x-ray studies will lead to the diagnosis of symptomatic aortic aneurysms. Early resection will result in a lower mortality rate.     

Cancer of the stomach--new and "old" problems of diagnosis]

The author discusses present-day potentialities of radiodiagnosis of gastric carcinoma. Analysis of more than 2000 case histories brings him to a conclusion that the problem of the detection of this condition is particularly intricate for two reasons: the absence of active screening for gastric carcinoma in high-risk groups and inadequate attention to its endophytic forms. The author's data evidence that intramural growth of gastric carcinoma is responsible for up to 75% of all its anatomic forms. So high an incidence of endophytic carcinomas of the stomach necessitates a combination of the x-ray and endoscopic methods in gastro-oncology. Making use of the total scope of present-day diagnostic methods, including routine techniques, double-contrast examination, and, in recent years, x-ray computer-aided tomography and ultrasonic examinations, the author gives recommendations that will help solve quite a number of problems in radiodiagnosis of gastric carcinoma.     

Cholelithiasis and Cholecystitis in Childhood

Six cases of cholecystitis and cholelithiasis confirmed by x-ray examination and surgical operation were observed in a ten-year period. Due to the wide variability in signs and symptoms in children, cholecystitis and cholelithiasis can be diagnosed only with a high degree of clinical suspicion and roentgenological examination. Gallbladder disease is uncommon in childhood but should be considered in children with vague abdominal pains or bouts of unexplained jaundice. If a normal appendix is found at laparotomy in the “acute abdomen,” the surgeon would be wise to palpate other specific organs within the abdomen, including the liver and gallbladder.The treatment of choice is cholecystectomy. The prognosis for recovery is excellent if there is no complicating systemic disease.     

Antibiotic anaphylaxis

Pulmonary cancer when localized to the lung, is curable by operation. Tumors found by routine x-ray examination before they cause symptoms are much more often confined to the lung and as such are curable. Unlike other internal growths which are more hidden, lung tumors can often be seen early on x-ray films of the chest.X-ray films of the chest were made routinely on all patients entering a hospital, regardless of the nature of their illness. In all, some 40,000 films were made. Sixty patients were found to have unsuspected solitary lesions in the lung. Twenty-four of the lesions were diagnosed and treated by operation and removal. Twelve were diagnosed by other methods. Of the 36, eight were cancer of the lung, an incidence of 22 per cent. There were also 14 localized tuberculous nodules which are best treated by removal. Since early cancer is surgically curable, it is felt that everyone over the age of 40 should have a routine x-ray examination of the chest every six months. Solitary lesions of the lung found should be excised for diagnosis.     

Analysis of aberrant methylation on promoter sequences of tumor suppressor genes and total DNA in sputum samples: a promising tool for early detection of COPD and lung cancer in smokers

Background

Carcinoma of the gallbladder (GBC) clinically mimics benign gallbladder diseases and often escapes detection until advanced stage. Despite the frequency of cholecystectomy, diagnosis of GBC remains problematic in many situations. We sought to identify pathologic features that contribute to the difficulty in recognition of GBC.

Methods

We identified 23 patients (ranged from 45 to 86 years, male to female ratio 1:4.5) with carcinoma involving the gallbladder referred to an academic medical center over a period of 10 years for study. This includes 10 cases of primary GBC, 6 cases of metastatic tumor to gallbladder, 6 cases of directly invasive adenocarcinoma arising elsewhere in the biliary tree, and one case of unidentified origin adenocarcinoma. Primary tumors include adenocarcinoma not otherwise specified (NOS) in 6 cases, papillary adenocarcinoma in 2 cases, and single cases of undifferentiated carcinoma and combined adenocarcinoma and neuroendocrine carcinoma (NEC). Metastatic tumors to gallbladder were from a wide range of primary sites, predominantly the gastrointestinal tract.

Results

These cases illustrate seven potential pitfalls which can be encountered. These include: 1) mistakenly making a diagnosis of adenocarcinoma of gallbladder when only benign lesions such as deeply penetrating Rokitansky-Aschoff sinuses are present (overdiagnosis), 2) misdiagnosing well-differentiated invasive carcinoma with minimal disease as benign disease (underdiagnosis), 3) differentiating between primary NEC of gallbladder and metastasis, 4) confusing primary mucinous adenocarcinoma of gallbladder with pseudomyxoma peritonei from a low grade appendiceal neoplasm disseminated to gallbladder, 5) confusing gangrenous necrosis related to cholecystitis with geographic tumoral necrosis, 6) undersampling early, grossly occult disease, and 7) misinterpreting extracellular mucin pools.

Conclusions

Clinical history and a high index of suspicion are prerequisite to detecting GBC. Detection of GBC at an early stage is difficult because the symptoms mimic benign gallbladder diseases. Misinterpretation of subtle microscopic abnormalities contributes diagnostic failures in early cases. Careful attention to any evidence of mural thickening, thorough sampling, particularly in older patients, and close examination of any deeply situated glandular structures are critical. Correlations with radiographic and clinical findings are important helps to avoid misdiagnosis in this commonly resected organ.     

Clinico-roentgenologic manifestations of intestinal lesions in pseudotuberculosis

The authors presented the results of clinical and x-ray investigation of 102 patients with epidemic pseudotuberculosis (EP). The diagnosis was established on the basis of epidemiological evidence and the results of clinical and serological investigation. The affection of the digestive organs was observed not only in the abdominal type of EP but also in its other types. X-ray examination of the digestive organs revealed terminal ileitis in 56.8% of the patients alongside with functional disorders. X-ray examination plays a certain role in the differential diagnosis of EP from other diseases of the ileocecal region, in particular from acute appendicitis.     

X-ray characterization of changes of the lungs in juvenile rheumatoid arthritis

The results of chest x-ray were analyzed in 66 pediatric patients with juvenile rheumatoid arthritis (JRA). X-ray signs of pneumofibrosis were revealed in 37 (56%) patients. Besides, rare pulmonary changes (emphysema, rheumatic nodules, infiltrates) were detected in the JRA patients. The absence of clinical symptoms in the presence of x-ray changes necessitates the performance of chest x-ray in JRA for early detection of the pulmonary symptoms of this disease.     

Systems analysis of X-ray films of the vertebral column

The systems analysis of spinal X-ray films (SASXF) developed by the author solves the problem of an integral and, concurrently, detailed study of the spine of a patient on the basis of routine X-ray study. The examination of the patient gave rise to a patient's systems spinal model that considers the individual features of the vertebral column, which are most significant for a manual therapist's work. The standards of a X-ray study, a protocol form, and examination tools are described. An example of systems spinal model is given. The experience accumulated during studies of more than 2000 patients has shown that this procedure is highly effective in implementing medical manipulations by the methods of manual therapy.     

Systems analysis of X-ray films of the vertebral column

The systems analysis of spinal X-ray films (SASXF) developed by the author solves the problem of an integral and, concurrently, detailed study of the spine of a patient on the basis of routine X-ray study. The examination of the patient gave rise to a patient's systems spinal model that considers the individual features of the vertebral column, which are most significant for a manual therapist's work. The standards of a X-ray study, a protocol form, and examination tools are described. An example of systems spinal model is given. The experience accumulated during studies of more than 2000 patients has shown that this procedure is highly effective in implementing medical manipulations by the methods of manual therapy.     

A Comparative Study of Clinicopathological Features between Chronic Cholecystitis Patients with and without Helicobacter pylori Infection in Gallbladder Mucosa

Background

Helicobacter pylori has been isolated from 10%–20% of human chronic cholecystitis specimens but the characteristics of “Helicobacter pylori positive cholecystitis” remains unclear. This study aims to compare the clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa.

Methods

Three hundred and twenty-six chronic cholecystitis patients were divided into two groups according to whether Helicobacter pylori could be detected by culture, staining or PCR for Helicobacter 16s rRNA gene in gallbladder mucosa. Positive samples were sequenced for Helicobacter pylori-specific identification. Clinical parameters as well as pathological characteristics including some premalignant lesions and the expression levels of iNOS and ROS in gallbladder were compared between the two groups.

Results

Helicobacter pylori infection in gallbladder mucosa was detected in 20.55% of cholecystitis patients. These patients had a higher prevalence of acid regurgitation symptoms (p = 0.001), more histories of chronic gastritis (p = 0.005), gastric ulcer (p = 0.042), duodenal ulcer (p = 0.026) and higher presence of Helicobacter pylori in the stomach as compared to patients without Helicobacter pylori infection in the gallbladder mucosa. Helicobacter pylori 16s rRNA in gallbladder and gastric-duodenal mucosa from the same individual patient had identical sequences. Also, higher incidences of adenomyomatosis (p = 0.012), metaplasia (p = 0.022) and higher enhanced expressions of iNOS and ROS were detected in Helicobacter pylori infected gallbladder mucosa (p<0.05).

Conclusions

Helicobacter pylori infection in gallbladder mucosa is strongly associated with Helicobacter pylori existed in stomach. Helicobacter pylori is also correlated with gallbladder premalignant lesions including metaplasia and adenomyomatosis. The potential mechanism might be related with higher ROS/RNS production but needs further investigation.     

Algorithms of x-ray and ultrasonic diagnoses in urology]

Roentgenourologic methods and ultrasonic scanning (USS) should be combined in the radiologic diagnosis of urologic diseases. USS should be the first stage of examinations of urologic patients, and its results should be taken into account when planning and carrying out excretory urography. USS can be repeated before more sophisticated roentgenourologic examinations in order to single out the "zones of interest"; special programmes are possible for the purpose-pharmacoechography, dopplerography, etc. Development of tentative algorithms of x-ray and ultrasonic diagnosis of the major urologic diseases will help optimize the diagnostic process.     

Coordination chemistry of F430. Axial ligation equilibrium between square-planar and bis-aquo species in aqueous solution

X-ray absorption spectroscopic characterization of axial ligand coordination to factor F430, the nickel-tetrapyrrole cofactor of the S-methyl-coenzyme M (CH3SCoM) methyl reductase enzyme from methanogenic bacteria, is presented. The nickel of isolated F430 is hexacoordinate at 10 K in aqueous solution (as is the enzyme-bound cofactor), whereas the epimerized and ring-oxidized derivatives of F430 have four-coordinate nickel. Reduction of the ring-oxidized derivative, F560, with dithionite yields F430 in its native configuration, with axial ligands indistinguishable from those present when the cofactor is obtained directly from the holoenzyme. Thus, we conclude that the axial ligands to F430 in aqueous solution are water molecules. Analysis of the nickel extended x-ray absorption fine structure is consistent with this conclusion. Resonance Raman spectra obtained at room temperature contain features characteristic of both 4- and 6-coordinate forms of the cofactor. We have found that the resonance Raman, optical, and x-ray absorption spectra of aqueous solutions of F430 are temperature-dependent due to a ligand-binding equilibrium involving the square-planar and 6-coordinate bis-aquo forms of the cofactor. At low temperatures (less than 250 K) the 6-coordinate form predominates, whereas higher temperature solutions contain both 4- and 6-coordinate species in a dynamic equilibrium. Similar behavior is observed in other weakly coordinating solvents such as methanol and ethanol. The 4-coordinate form is predominant in solvents with strong electron-withdrawing substituents such as 2,2,2-trifluoroethanol and 2-mercaptoethanol. The relevance of this facile ligand exchange to the active site structure and enzymatic mechanism of the parent enzyme is discussed.     

Retroperitoneal Free Air

In the examination of 500 “well” executives, the number of unknown diseases found averaged 5.4 per person. Almost half of these executives had newly detected disease that was potentially significant to their health.Treatment was necessary in more than 47.7 per cent of them.One out of five of the total significant unknown defects found was either a peptic ulcer or gallstones; one out of five was a rectal adenoma; and one out of five was either hypertension or cardiac disease.One-third of the executives were overweight. Diabetes was found in every 20th person; and malignant disease was detected in one of every 41 people.For an examination to be “adequate” for the detection of unknown disease, the general physical examination must be complete and thorough. A proctoscopic is necessary, and certain basic laboratory screening procedures should be completed in each individual.Complete and routine x-ray studies of the gallbladder and gastrointestinal tract should be done, since they are the most important single diagnostic procedure, in detecting early, major, unsuspected, and often asymptomatic diseases.Routine consultations with specialists are a valuable asset in disease detection.Repeated periodic examinations help in detection of new unknown disease that was not present or not noted in earlier examinations.