Gallbladder Wall Research Articles

Thickened Gallbladder Wall, Abdominal Pain, and Fever: A Rare Presentation of Dengue in Rural Australia

Thickened Gallbladder Wall, Abdominal Pain, and Fever: A Rare Presentation of Dengue in Rural Australia

Dengue fever with atypical manifestations in a child with beta thalassemia major post splenectomy

Dengue is one of the significant public health concerns in endemic countries. With plasma leakage as the primary pathophysiology in the process of severe dengue infection with hemoconcentration and thrombocytopenia being the significant laboratory diagnostic features in children, the presentation in children with underlying hemato-oncological conditions is atypical and often, anemia is found in these children, instead of hemoconcentration. We describe a young boy with beta thalassemia major who underwent splenectomy for hypersplenism 5-months ago with dengue illness, characterized by features mimicking a severe post splenectomy opportunistic infection with fever, loose stools and abdomen tenderness. Leucopenia, thrombocytopenia, minimal pleural effusion, ascites and gall bladder wall edema prompted us to think of dengue and was found to be positive. Child improved with appropriate supportive care measures. Pediatricians should be aware of the differences in the presentation of tropical infections in children with hemato-oncological disorders. Tropical infections should be kept in mind even in children with underlying hemato-oncological conditions, to ensure diagnosis and appropriate management.

Spontaneous Ischemic Cholecystitis in a Patient with Hereditary Hemorrhagic Telangiectasia (HHT)

Background/Objectives: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by abnormal blood vessel formation, leading to recurrent epistaxis, cutaneous and mucosal telangiectases, and visceral arteriovenous malformations (AVMs). Hepatic involvement may result in complications such as high-output heart failure, portal hypertension, and biliary ischemia. We report an uncommon case of ischemic cholecystitis in a patient with HHT. Methods: A 57-year-old male with HHT type 1, including gastric telangiectases and hepatic AVMs, presented with anemia, melena, epigastric pain, and a history of recurrent epistaxis. Imaging revealed gastric telangiectases and liver AVMs, consistent with HHT. Following an episode of severe epistaxis and aspiration pneumonia, the patient developed right upper quadrant pain. Results: Abdominal CT and ultrasound identified thickening of the gallbladder wall, segmental enhancement defects, and a perivesicular fluid effusion, suggestive of acalculous cholecystitis. A laparoscopic cholecystectomy was performed, revealing ischemic cholecystitis with necrotic gallbladder walls. Conclusions: This case underscores the potential for ischemic cholecystitis in patients with HHT and liver involvement, particularly under conditions of acute hemodynamic instability. Clinicians should be vigilant in recognizing this rare complication, especially in patients with established HHT and associated hepatic vascular anomalies.

Review of the role of ultrasound in assessing plasma leakage in dengue fever and a proposed scanning protocol

AbstractBackgroundThe clinical course of dengue can range from mild to severe and predicting the course can be challenging. The World Health Organisation (WHO) recommends prognostication via the presence of warning signs, to aid in disposition and management. Plasma leakage is a key warning sign in dengue, and ultrasound can be utilised as a screening tool.ObjectivesThe objectives were to describe the literature on the use of ultrasound in dengue, summarise the findings, and propose a standardised point‐of‐care ultrasound protocol.MethodsWe reviewed the current literature on the role of ultrasound in dengue and its key features.ResultsUltrasound is a useful tool in the evaluation of patients with dengue and has been shown to be able to detect plasma leakage even prior to clinical and laboratory findings. In particular, gallbladder wall thickening is an early sign that can aid the clinician in prognosticating patients.ConclusionDetecting plasma leakage early with ultrasonography can help the clinician determine appropriate disposition and management. We propose a standardised point‐of‐care ultrasound protocol (FASD) for early detection of plasma leakage in dengue, in the routine care of dengue patients.

Domestic ferrets (Mustela putorius furo) with cholecystitis commonly show hyperbilirubinemia and common bile duct dilation, gallbladder sludge, and gallbladder wall thickening on ultrasound.

To report clinical signs, biological anomalies, treatment, and outcome in domestic ferrets with cholecystitis, describe the ultrasonographic features of cholecystitis, and compare the ultrasonographic appearance of the hepatobiliary system between diseased and healthy ferrets. 11 ferrets with confirmed cholecystitis and abdominal ultrasonography were retrospectively included. Ten healthy ferrets were prospectively recruited to undergo hepatobiliary abdominal ultrasonography. Comparisons of explanatory variables (group, age, body weight, and sex) were performed. The most common clinical signs were nonspecific, and icterus was observed in 1/4 of diseased ferrets. Compared with healthy individuals, diseased ferrets showed a larger common bile duct (CBD; ≥ 2.8 mm), a thicker CBD wall (≥ 0.7 mm), a thicker gallbladder (GB) wall, more frequent echoic GB luminal content, visible intrahepatic bile ducts, and a greater GB volume. Bile culture was positive in 9/11 mostly for Escherichia coli (8/9). Bile cytology indicated septic purulent cholecystitis in 7/7 ferrets. Survival time after antibiotic treatment ranged from 6 to 104 weeks, with a median of 36 weeks. Ferrets with cholecystitis presented with nonspecific clinical signs and frequently showed hyperbilirubinemia. Ultrasonography findings such as enlarged CBD, thickened CBD wall, thicker GB wall, GB sludge, visible intrahepatic bile ducts, and enlarged GB may suggest cholecystitis. Escherichia coli was commonly isolated from bile. The medium-term mortality rate was high despite targeted antibiotherapy. This is the first study describing the clinical signs, biological anomalies, ultrasonographic findings, and outcomes after treatment in a series of domestic ferrets with cholecystitis.

063. Characteristics and Predisposing Factors of Bile Duct Injury in Hasan Sadikin General Hospital

Background: Iatrogenic bile duct injuries (BDI) are associated with fatal complications and increased mortality. Bile duct injuries can be caused by imprecise bile duct cutting, dislodged surgical clips, tearing or obstruction by fibrosis as a result of thermal injury by electrocautery resulting in biliary leakage and/or stricture. The aim of this study is to identify characteristics and predisposing factors of bile duct injury in our center. Methods: This study is a cohort retrospective study, with 42 cases of iatrogenic BDI following cholecystectomy (after both open and laparoscopic approaches); both happened in or were referred to Hasan Sadikin Hospital from September 2023 to September 2024. Patients were classified according to age, gender, BMI, Strasberg – Bismuth classification, laboratory values, and imaging findings. Results: In this study, there were 43 subjects, with majority of subjects aged ?40 years old (58%). There was no difference in gender, with 22 males and 21 females. The mean BMI was 26.1 ± 5.1 kg/m2. Majority of the cases were type E2 Strasberg – Bismuth classification (76.7%). This study found age ?40 years old (p value = 0.00), abnormal preoperative liver function (p value = 0.01), and gallbladder wall thickening (p value = 0.01) as significant predisposing factors of BDI. Conclusion: Age ?40 years old, abnormal preoperative liver function, and gallbladder wall thickening are significant predisposing factors of BDI. Data of anatomical variations and surgeon’s expertise should be beneficial for improvement of future studies.

Danning tablets for the treatment of multiple gallbladder polyps: Study protocol of multicentre, randomised, open-labelled, controlled trial

IntroductionGallbladder polyps (GPs) are protrusions of the gallbladder wall into the lumen, and are commonly detected during ultrasound examinations. Traditional management of multiple GPs (MGPs) has been conservative, including lifestyle interventions, regular monitoring, and surgical intervention in certain cases, but this approach poses risks of polyps enlargement and increase of number, as well as patients’ psychological burdens. Danning Tablets, a traditional Chinese medicine, have emerged as a potential non-surgical treatment for GPs, showing promise in reducing polyp size and alleviating symptoms, backed by their anti-inflammatory and antitumor properties demonstrated in preclinical studies. This suggests the need for further research into Danning Tablets as an alternative treatment for MGPs. Methods and analysisThe study is designed as a prospective, randomized, controlled, open-label trial. The study will be conducted across multiple centres specializing in gastroenterology and hepatology. Participants will be recruited from these centres, ensuring a diverse patient demographic. Adult patients diagnosed with MGPs, based on ultrasound findings, will be included. Exclusion criteria include patients with a history of gallbladder cancer, previous gallbladder surgery, or serious comorbid conditions. The control group will receive standard care, including dietary and lifestyle advice, while the intervention group will receive Danning Tablets and standard care. The dosage and administration of Danning Tablets will follow established clinical guidelines. The primary outcome will be the change in size of the largest gallbladder polyps on week 24 ​± ​1, measured by ultrasound. The secondary outcomes will include symptom improvement and recording of any adverse events. The study will span over a period of 6 months, with periodic assessments at baseline, 4, 8, 12, and 24 weeks.

ROLE OF USG IN EARLY DETECTION AND PREDICTING SEVERITY OF DENGUE INFECTION

Background: Early detection and severity assessment are crucial for managing dengue fever. Ultrasound (USG) imaging can help identify key features such as capillary leakage and organ involvement, aiding in diagnosis and prognosis. Aims: To correlate ultrasound findings with the severity of dengue infection. To evaluate USGs sensitivity in detecting early capillary leakage and its prognostic value. Methods: The study involved 66 patients (40 males, 26 females aged 12-70) with serologically confirmed dengue, observed from August 2022 to October 2023. USG was performed within 3 days of fever onset and again after 1 week. Results: Day 1-3: Gallbladder wall thickening (60.6%) and pericholecystic fluid were common. Pleural effusion (34.8%) was observed in milder cases. Day 7: Gallbladder wall thickening persisted in 89.4%. New findings included ascites (24.2%), bilateral pleural effusion (31.8%), and pericardial effusion (9.1%). Severe cases showed hepatomegaly and splenomegaly. Conclusion: USG is a valuable tool for early detection and severity assessment of dengue fever. Key findings like gallbladder wall thickening and pleural effusion can help predict disease severity and guide clinical management.

Reduction of the risk of biliary lithiasis caused by various weight reduction options in obesity

At present obesity is a major public health challenge globally, which accounts for a significant portion of all healthcare costs. Obesity and its complications, insulin resistance and dyslipidemia, have been identified as independent risk factors for cholelithiasis. Cholelithiasis is mainly caused by four factors: bile cholesterol overload caused by excess cholesterol made in the liver due to genetic factors; systolic dysfunction of the gallbladder wall; bowel dysfunction with excess absorption of cholesterol or cholesterol overload caused by impaired hepatic bile circulation; and accelerated growth of cholesterol crystals and solid cholesterol crystals. Rapid weight loss (≥1.5 kg/week) due to low-calorie diets as the main treatment method, or after bariatric surgery is one of the risk factors for gallstone formation. Bariatric surgery is effective for the treatment of obesity and its complications, but bariatric surgery does not reduce the incidence of cholelithiasis. On the contrary, many studies showed that bariatric surgery may increase the incidence of cholelithiasis. The rapid weight loss causes fat mobilization and then increases serum cholesterol and triglyceride levels. On the other hand, bowel dysfunction due to bariatric surgery is accompanied by decreased cholecystokinin levels, causing impaired gallbladder contractility. Cholelithiasis requires close attention after bariatric surgery, with 10% of patients undergoing bariatric surgery having to undergo cholecystectomy postoperatively due to a high risk of cholelithiasis. UDCA is a natural bile acid that is prescribed to be taken orally (by mouth). UDCA inhibits the absorption of cholesterol in the bowel, enhances the biosynthesis of bile acids, and reduces biliary cholesterol secretion. UDCA is a choleretic agent, as all bile acids, but differs from other dihydroxy bile acids in being non-cytotoxic. The use of UDCA while following a low-calorie diet and after bariatric surgery significantly reduces the risk of gallstone formation and cholecystectomy with associated complications.

Negative 18F-FDG and Positive 68Ga-FAPI-04 Findings in a Patient With Acute Exacerbation of Chronic Cholecystitis.

Acute cholecystitis typically exhibits intense FDG uptake of the gallbladder wall. Radiolabeled fibroblast activation protein inhibitor (FAPI) is considered as a potential alternative agent for tumor-specific imaging. We report 18F-FDG and 68Ga-FAPI-04 PET/MR findings in a 44-year-old woman with acute exacerbation of chronic cholecystitis. The lesions show negative 18F-FDG uptake but intense 68Ga-FAPI-04 uptake in PET/MR. This case highlights the imperative for nuclear medicine clinicians to exercise vigilance when evaluating gallbladder lesions exhibiting intense 68Ga-FAPI-04 but negative 18F-FDG uptake.

Control and elimination of Schistosoma mansoni infection in adult individuals on Ukerewe island, northwestern Tanzania: baseline results before implementation of intervention measures

BackgroundCommunities living along the shoreline and on the islands of Lake Victoria in northwestern Tanzania remain endemic for schistosomiasis and suffer from the life-threatening morbidities associated with the disease. Nevertheless, the control measures particularly the mass drug administration do not cover the adult population. The current project on Ukerewe island aims to close this gap by involving adult community members in the control program. Here we report the baseline results of S. mansoni infection and associated hepatosplenic morbidities and factors before implementing the project activities.MethodsA cross-sectional analytical study was conducted with 4,043 participants aged ≥ 18 years living in 20 villages on Ukerewe island, northwestern Tanzania. Individual stool and urine samples were collected and examined using the Kato-Katz (KK) technique and point-of-care circulating cathodic antigen testing(POC-CCA) to identify S. mansoni eggs and antigens, respectively. All study participants underwent ultrasound evaluation of S. mansoni hepatosplenic morbidities using the Niamey protocol. Rapid diagnostic tests were used to diagnose HIV infection, hepatitis C and chronic hepatitis B. A questionnaire was used to collect demographic data and reported clinical symptoms of study participants.ResultsA total of 4,043 participants took part in the study, of which 49.7% (n = 2,009) and 50.3% (n = 2,035) were male and female, respectively. The overall prevalence of S. mansoni infection was 30.4% (95%CI:29.0-31.9%) and 84.7% (95%CI:83.3–85.9%), respectively, based on the KK technique and the POC-CCA test. The geometrical mean eggs per gram of faeces (GMepg) was 105.3 (95%CI:98.7-112.3% GMepg) with 53.9%, 32.4% and 13.7% of the participants having mild, had moderate and severe intensity of infection. The prevalence of hepatitis C, HIV, and hepatitis B was 0.4%, 2.2% and 4.7%, with 0.2%, 2.2% and 5.4% of the infected individuals coexisting with S. mansoni infection. The prevalence of splenomegaly, periportal fibrosis, hepatomegaly, and portal vein dilatation was 40.5%(95%CI: 38.8–42.1%), 48.1%(95%CI:64.4–49.7%), 66.2%(95%CI:4.6–67.7%) and 67.7%(95%CI:66.2–69.2%), with their prevalence varying depending on the demographic information and infection status of the participants. Other detectable ultrasound-related morbidities included ascites (1.7%), collateral veins (18.3%) and gall bladder wall thickness (40.4%). Age groups, gender, reported clinical characteristics, reported non-use of the drug praziquantel, liver imaging pattern, and place of residence remained independently associated with hepatosplenic morbidities.ConclusionThe current study setting is endemic for S. mansoni infection and the population has a high prevalence of the disease associated hepatosplenic morbidities characterized by hepatomegaly, splenomegaly, ascites, gall bladder wall thickening, periportal fibrosis and portal vein dilatation. Several demographic, clinical and epidemiological circumstances remained independently associated with S. mansoni infection and associated morbidities. These findings call for integrative intervention efforts, starting with whole community MDA that includes all out of schools community members.

Optimization of cholecystectomy timing during staged treatment of acute cholecystitis in elderly and senile patients with cholecystostomy

Aim. To determine optimal timing for laparoscopic cholecystectomy in elderly and senile patients with cholecystostomy.Materials and methods. Treatment results of 37 patients aged 60 years and over at different terms after cholecystostomy formation were analyzed. The degree of senile asthenia, concomitant diseases, technical features of surgical aid, dynamics of the postoperative period, as well as morphological features of inflammatory changes in the gallbladder wall were assessed.Results. Pre-asthenia was detected in 12 (32%) patients, mild senile asthenia – in 14 (38%) patients, and moderate senile asthenia – in 11 (30%) patients. Polymorbidity was determined in all patients, with 23 patients having four or more diseases. In 3 (8%), 15 (40.5%), 15 (40.5%), and 4 (11%) cases, laparoscopic cholecystectomy was performed 3–9 days, 10–30 days, 2–6 months, and 6 months or more (1 conversion) after cholecystostomy.Conclusion. In elderly and senile patients, laparoscopic cholecystectomy performed 10–30 days after cholecystostomy is optimal, safe, and affordable. Radical intervention in this period is not associated with technical difficulties. Reduced terms of external drainage of the gallbladder contribute to improving the elderly patient’s quality of life and their social adaptation, while shortening the period of postoperative recovery. When planning surgical interventions in a patient over 60 years old, account should be taken of comorbidities, polypragmasy, and senile asthenia.

Role of Ultrasound Imaging in Children with Dengue Fever: A Retrospective Study

Objective: To study ultrasound findings of children with dengue and analyze the possible correlation between ultrasound findings and severity of dengue in children.Methods: This retrospective study, which was conducted over one year, analyzed 50 pediatric dengue patients. Ultrasound findings such as gallbladder wall edema, pleural effusion and ascites were assessed. Cases were categorized into dengue without warning signs, dengue with warning signs, and severe dengue according to the World Health Organization's classification of dengue. Correlation between ultrasound abnormalities, severity of dengue, and thrombocytopenia were analyses. A p-value of less than 0.05 was taken as statistically significant.Results: Of 50 pediatric patients diagnosed with dengue participated in this study, 72% were boys, and 28% were girls with a male-to-female ratio of 1:0.38. Fever was the most frequent symptom (100%), followed by nausea/vomiting (84%) and body ache/myalgia (78%). Ultrasound findings revealed that gallbladder wall edema (48%), pleural effusion (44%), and ascites (50%) were significantly associated with severe dengue and dengue with warning signs (p<0.001). Thrombocytopenia was documented in 58% of cases and correlated significantly with ultrasound abnormalities such as gallbladder wall edema, ascites, and pleural effusion (p=0.0017).Conclusion: Ultrasound findings, such as gallbladder wall edema, pleural effusion and ascites, are significantly associated with severe dengue and dengue with warning signs. These features aid in early identification of high-risk patients.

Giant gallbladder cyst with acute cholecystitis: a case report

BackgroundGallbladder cysts are rare diseases with very few reported cases, and no clinical or histological definition has been established. Furthermore, cases of giant cysts outside the gallbladder wall are extremely rare. We report a rare case of giant gallbladder cyst with acute cholecystitis.Case presentationAn 85-year-old woman with appetite loss and right lower abdominal pain lasting 2 days presented to our hospital. At first, the patient’s abdominal pain was mild to moderate with no fever. Blood tests revealed a white blood cell count of 10,950/mm3, and the C-reactive protein (CRP) level was 14.35 mg/dl. A contrast-enhanced computed tomography (CT) scan of the abdomen revealed a grossly distended gallbladder (14.5 × 14.5 × 8.7 cm) with an incarcerated stone in the cystic duct. The patient was treated by percutaneous transhepatic gallbladder drainage (PTGBD) with 735 ml of drainage fluid. Oral contrast magnetic resonance cholangiopancreatography (MRCP) revealed that gallbladder swelling remained (14.0 × 6.5 cm) 3 days after PTGBD. We performed laparoscopic cholecystectomy 6 days after PTGBD. Because of the severe adhesion around the junction of the cystic and common bile ducts, we performed open cholecystectomy.The resected specimen was 14 × 11 cm in size and consisted of a gallbladder (6 × 7 cm) with a stone (2.4 × 1.8 cm) in the gallbladder and a large cystic lesion (18 × 18 cm) outside the gallbladder wall. The cystic lesion had a wall thickness of 6 to 12 mm and internal septal structures and contained hemorrhagic and necrotic tissue.Histological examination revealed that the specimens showed a mildly swollen gallbladder and a cystic lesion on the outside of the gallbladder wall, adjacent to the gallbladder wall, with wall thickening and inflammation. The cystic lesion suggested gallbladder duplication, gallbladder diverticulum or extension of the Rokitansky-Aschoff sinus (RAS). There was no malignancy. The patient’s postoperative course was uneventful, and she was discharged 5 days after the operation.ConclusionWe present a very rare case of giant gallbladder cyst with acute cholecystitis revealed by cholecystectomy.

Overlap of gallbladder dysfunction and irritable bowel syndrome: clinical and microbiological features and therapeutic possibilities

Objective — to analyse the clinical and microbiological features in patients with an overlap between gallbladder dysfunction (GBD) and irritable bowel syndrome (IBS) and a complex assessment of the effectiveness and safety of using ursodeoxycholic acid (Ursis) in these patients. Materials and methods. Under our observation were 115 patients with the overlap of GBD and IBS aged from 19 to 52. The majority of them were women (62.6%). All patients complained of abdominal pain, mostly without clear localization or in the right hypochondrium and along the course of the large intestine. Constipation was diagnosed in 83 (72.2%) patients, and meteorism in 89 (77.4%) patients. Therefore, 62 patients with the overlap of GBD and IBS, who had abdominal pain, constipation and meteorism, were selected for further study. During the study, all patients kept a diary in which the frequency and nature of bowel movements, the severity of abdominal pain, and the degree of meteorism were recorded. All patients before and after treatment underwent an ultrasound examination of the abdominal cavity, which included the study of the contractile function of the gallbladder, the emptying coefficient of the gallbladder, the thickness and density of its wall, and the density of bile. Changes in the main bacterial enterotypes were analyzed by qRT‑PCR using primers targeting 16S rRNA. We studied Bacteroidetes, Firmicutes, Actinobacteria, as well as the content of butyrate‑producing bacteria (Faecalibacterium prausnitzii and Akkermansia muciniphila) and methanogens (Methanobrevibacter smithii and Methanosphaera stadmanae). Results. Before treatment, all patients had abdominal pain of moderate intensity (6.9±0.7 points), mostly without clear localization, constipation, with a frequency of defecation (1.4±0.5) times a week, and meteorism. Before treatment, patients with an overlap of GBD and IBS had changes in the contractile function of the gallbladder with a decrease in the emptying ratio, a thickening of the gallbladder wall and an increase in its density and bile density, as well as a disturbance of the intestinal microbiome (an increase in the number of Firmicutes, Actinobacteria and methanogenic archaea and a decrease in Bacteroidetes and butyrate‑producing bacteria). Conclusions. The use of Ursis® medication in the complex therapy of patients with a GBD and IBS overlap is effective and safe. The aplication of Ursis® led to a more pronounced positive clinical dynamics (a decrease in the intensity of abdominal pain, normalization of the frequency of bowel movements, a decrease in meteorism and an improvement in general well‑being) than in the patients of the comparison group. After treatment with Ursis® the coefficient of emptying of the gallbladder increased, the thickness and density of its wall decreased. The use of the drug Ursis® in the complex therapy of patients with the overlap of GBD and IBS contributed to the improvement of intestinal flora: an increase in the number of Bacteroidetes and butyrate‑producing bacteria (Faecalibacterium prausnitzii and Akkermansia muciniphila), and a decrease in the content of methanogens (Methanobrevibacter smithii and Methanosphaera stadmanae).

Diffuse large B-cell lymphoma of the gallbladder with hepatoduodenal invasion exhibiting a necrotic tendency.

We report a case of diffuse large B-cell lymphoma (DLBCL) of the gallbladder with extensive hepatoduodenal invasion, which was challenging to diagnose histologically due to a strong tendency to be necrotic. An 71year-old man presented with upper abdominal pain and was referred to our hospital. Computed tomography revealed a distended gallbladder with air within the irregular gallbladder wall and an indistinct border with the hepatoduodenum, suggesting invasion. Esophagogastroduodenoscopy detected an ulceration in the duodenal bulb. However, histologic analysis failed to provide a definitive diagnosis due to the presence of necrotic tissue. Furthermore, direct biopsy from the gallbladder mucosa by endoscopic retrograde cholangiography revealed only necrotic tissue and no diagnosis. Contrast ultrasonography for the hepatic invasion revealed enhancement with blood flow, suggesting non-necrotic tissue. Subsequently, an ultrasound-guided core-needle biopsy was conducted to obtain tissue samples from the described lesion. The pathology showed atypical lymphocytes with irregular nuclei. Immunostaining indicated positive expression of CD10, CD20, Bcl-6, and C-Myc, consistent with a diagnosis of DLBCL. In our case, the lymphoma exhibited a strong tendency to be necrotic, making histologic diagnosis difficult. However, selective biopsy from the site of blood flow made the diagnosis possible and proved to be useful.

A Comparative Study of Laparoscopic Versus Robotic Cholecystectomies Based on the Parkland Grading Scale.

Background Cholecystectomy, the surgical removal of the gallbladder, is a common procedure performed to treat conditions like gallstone disease and cholecystitis. Among the various techniques available, laparoscopic cholecystectomy (LC) and robotic cholecystectomy (RC) are minimally invasive methods, while open cholecystectomy (OC) involves a more extensive incision and is reserved for cases where less invasive options are unsuitable. This study focuses on evaluating and comparing the safety and efficacy of LC and RC across different grades of cholecystitis, categorized by the Parkland Grading Scale. The goal is to determine whether RC provides significant benefits over LC, particularly in cases of higher-grade cholecystitis. Methodology This ambispective observational case-control study was conducted from January to June 2024 at Manipal Hospitals, Vijayawada, India. It included patients aged 18 or older with acute cholecystitis who underwent LC or OC. Exclusions were made for chronic cholecystitis, prior surgeries affecting the procedure, incomplete records, or severe complications. Data, including demographics, preoperative symptoms, intraoperative details, and postoperative outcomes, were extracted from electronic medical records. Laparoscopic procedures used standard techniques, while robotic procedures employed the da Vinci surgical system. Outcomes measured included operative time, complications, conversion rates, length of stay, and readmission rates. Results There was no significant difference in pre-operative parameters like age, white blood cell (WBC) count, total bilirubin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), or history of previous surgery according to the Parkland Grading Scale. However, differences were noted in the Parkland Grading Scale regarding the thickness of the gallbladder wall, incidence of pericholecystic collection, and history of acute cholecystitis (p < 0.05). The most common complication was bleeding during the operation, which was more frequent in LC and was significant. Other complications, such as bile duct injury and vascular injury, were not observed in either procedure. Conclusion This study highlights that RC provides notable benefits compared to LC, especially for higher grades of cholecystitis, as per the Parkland Grading Scale. Although robotic procedures have longer operative times, they result in fewer intraoperative and postoperative complications, reduced conversion rates, and lower readmission rates. These advantages make RC a promising choice for treating complex cases of cholecystitis.

Examination of the thickness of the different components of gallbladder wall in cases with mucocele and/or cholecystitis.

To assess the thickness of each layer of the gallbladder wall with different diseases in dogs. 72 gallbladders. Retrospective study of dogs that underwent cholecystectomy. Histopathological specimens of the gallbladders were reviewed. Histopathological diagnosis was made as gallbladder mucocele or cholecystitis, and cholecystitis was further categorized into chronic cholecystitis, acute-on-chronic cholecystitis, acute cholecystitis, and necrotic cholecystitis. The thickness of each layer of the gallbladder wall was measured. 22 dogs were diagnosed with gallbladder mucocele without cholecystitis, 24 with gallbladder mucocele and cholecystitis, 20 with only cholecystitis, and 6 as normal. Histopathological subclassification of cholecystitis in 44 gallbladders led to diagnosis of chronic cholecystitis in 21 gallbladders, acute-on-chronic cholecystitis in 10 gallbladders, acute cholecystitis in 6 gallbladders, and necrotic cholecystitis in 7 gallbladders. The thickness of the entire wall of the gallbladder (P < .0001) and the thickness of the mucosa (P < .0001) and subserosa (P < .0001) were affected by the different disease processes. Layers of the gallbladder wall were affected by diseases present in the gallbladder. It resulted in a difference in the thickness of the wall of the gallbladder among the gallbladder diseases in this study. Histopathological changes should be taken into consideration before surgery while deciding what technique to use to perform a cholecystectomy.

Surgical decision-making: key factors influencing the shift from laparoscopic to open cholecystectomy

Background: Recognizing the preoperatively and intraoperatively factors can aid surgeons in making timely decisions to shift from laparoscopic cholecystectomy (LC) to open cholecystectomy (OC). This study aims to identify the main factors leading to LC conversion to OC among Iraqi patients. Methods: One-year prospective research was performed using cross-sectional design between 1st April, 2023, and 3oth March, 2024, at Alkalis General Public Hospital and Al Hayat Private Hospital, Diyala, Iraq. Pre and intraoperative data were collected from the planned LC surgeries including demographics, medical history, laboratory and Ultrasound findings. Descriptive and bivariate analysis was carried out to compare variables between patients undergoing LC and those requiring conversion to OC. Results: Out of 172 LC patients (mean age 48.28±12.62), 52.9% were female, 55.8% obese, 50.6% aged 49+, 23.3% diabetic, and 19.8% had emergency cholecystectomy; 15 (8.7%) required conversion to open surgery. The conversion group was mainly men (66.7% vs. 46.5%, P = 0.001) and older (73.3% vs. 48.4% aged 49+, P = 0.003). Obesity (60.0% vs. 55.4%, P = 0.005) and diabetes (53.3% vs. 20.4%, P &lt; 0.001) were more common. Public hospital referrals were higher (86.7% vs. 52.2%, P &lt; 0.001). Elevated total bilirubin, direct bilirubin, and alkaline phosphatase levels were significant predictors of conversion to OC. Adhesions in Calot's triangle (20.0% vs. 13.4%, P = 0.021) were more common in the conversion group, along with unclear anatomy, thick gallbladder wall, bleeding, stone and bile spillage, and cystic duct injury. Conclusion: In conclusion, out of 172 LC patients, 15 (8.7%) required conversion to open surgery, predominantly older men with higher obesity, diabetes, and elevated bilirubin and alkaline phosphatase levels, and more adhesions in Calot's triangle.

Phase I Clinical Evaluation of Designed Ankyrin Repeat Protein [99mTc]Tc(CO)3-(HE)3-Ec1 for Visualization of EpCAM-Expressing Lung Cancer.

A high level of EpCAM overexpression in lung cancer makes this protein a promising target for targeted therapy. Radionuclide visualization of EpCAM expression would facilitate the selection of patients potentially benefiting from such treatment. Single-photon computed tomography (SPECT) using 99mTc-labeled engineered scaffold protein DARPin Ec1 has shown its effectiveness in imaging tumors with overexpression of EpCAM in preclinical studies, providing high contrast just a few hours after injection. This first-in-human study aimed to evaluate the safety and distribution of [99mTc]Tc(CO)3-(HE)3-Ec1 in patients with primary lung cancer. Twelve lung cancer patients were injected with 300.7 ± 103.2 MBq of [99mTc]Tc(CO)3-(HE)3-Ec1. Whole-body planar imaging (at 2, 4, 6 and 24 h after injection) and SPECT/CT of the lung (at 2, 4, and 6 h) were performed. The patients' vital signs and possible side effects were monitored up to 7 days after injection. The patients tolerated the injection of [99mTc]Tc(CO)3-(HE)3-Ec1 well, and their somatic condition remained normal during the entire follow-up period. There were no abnormalities in blood and urine tests after injection of [99mTc]Tc(CO)3-(HE)3-Ec1. The highest absorbed doses were in the kidneys, liver, pancreas, thyroid, gallbladder wall, and adrenals. There was also a relatively high accumulation of [99mTc]Tc(CO)3-(HE)3-Ec1 in the small and large intestines, pancreas and thyroid. According to the SPECT/CT, accumulation of [99mTc]Tc(CO)3-(HE)3-Ec1 in the lung tumor was found in all patients included in the study. Intensive accumulation of [99mTc]Tc(CO)3-(HE)3-Ec1 was also noted in regional metastases. [99mTc]Tc(CO)3-(HE)3-Ec1 can potentially be considered a diagnostic tracer for imaging EpCAM expression in lung cancer patients and other tumors with overexpression of EpCAM.