Low skeletal muscle mass and high visceral adiposity are associated with recurrence of acute cholecystitis after conservative management:A propensity score-matched cohort study

Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity have various effects in several diseases.We aimed to clarify the relationship between RAC and body parameters.Methods:Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled.The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC.The areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI groups.We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC.Results:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)groups.In the propensity score-matched cohort there were 57 patients in each group.In Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),respectively.Conclusions:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.

Duplicated gallbladder with acute cholecystitis:a case of unusual presentation and diagnostic challenges

Anomalies in the gallbladder can lead to misidentifying anatomical structures,heightening the risk of complications in laparoscopic and open cholecystectomy procedures.Failure to recognize these variations increases the chances of iatrogenic bile duct injuries and other complications.

Assessment of systemic immune-inflammatory index and other inflammatory parameters in predicting mortality in patients with acute cholecystitis:A retrospective observational study

Objective:To investigate the effectiveness of the systemic immune-inflammatory(SII)index and other inflammatory parameters in predicting mortality among patients with acute cholecystitis(AC).Methods:279 Patients presented to the emergency department with abdominal pain and diagnosis of AC between September 2021 and September 2023 were included in the study.Demographic data,laboratory parameters,clinical follow-ups,and outcomes of the patients were recorded.Results:The mean age of the patients was(55.0±16.3)years and 36.6%were male.63.8%Had gallbladder/choledochal stones and 49.5%underwent surgery.The mortality rate was 6.1%.Advanced age(P=0.170)and prolonged hospitalization(P=0.011)were statistically significant risk factors for mortality.Decreased lymphocyte count(P=0.020)and increased C-reactive protein(CRP)levels(P=0.033)were found to be risk factors for mortality.According to the mortality predictor ROC analysis results,the cut-off for SII index was 3138(AUC=0.817,sensitivity=70.5%,specificity=84.7%),the cut-off for neutrophil count was 15.28×10^(3)/mm^(3)(AUC=0.761,sensitivity=52.9%,specificity=95.0%),the cut-off for leukocyte count was 19.0×10^(3)/mm^(3)(AUC=0.714,sensitivity=52.9%,specificity=98.0%),cut-off for CRP was 74.55(AUC=0.758,sensitivity=70.5%,specificity=79.0%),cut-off for aspartate transaminase(AST)was 33.0 IU/L(AUC=0.658,sensitivity=82.3%,specificity=50.3%).Conclusions:The SII index may be a good predictor of mortality with high sensitivity and specificity.Elevated levels of neutrophils,leukocytes,CRP,and AST are other inflammatory parameters that can be used to predict mortality associated with AC.

Xanthogranulomatous cholecystitis:Difficulty in differentiating from gallbladder cancer

AIM: To compare cases of xanthogranulomatous cholecystitis(XGC) and advanced gallbladder cancer and discuss the differential diagnoses and surgical options.METHODS: From April 2000 to December 2013, 6 XGC patients received extended surgical resections. During the same period, 16 patients were proven to have gallbladder(GB) cancer, according to extended surgical resection. Subjects chosen for analysis in this study were restricted to cases of XGC with indistinct borders with the liver as it is often difficult to distinguish these patients from those with advanced GB cancer. We compared the clinical features and computed tomography findings between XGC and advanced GB cancer. The following clinical features were retrospectively assessed: age, gender, symptoms, and tumor markers. As albumin and the neutrophil/lymphocyte ratio(NLR) are prognostic in several cancers, we compared serum albumin levels and the NLR between the two groups. The computerized tomography findings were used to compare the two diseases, determine the coexistence of gallstones, the pattern of GB thickening(focal or diffuse), the presence of a hypoattenuated intramural nodule, and continuity of the mucosal line.RESULTS: Based on the preoperative image findings, we suspected GB carcinoma in all cases includingXGC in this series. In addition, by pathological examination, we found that the group of patients with XGC developed inflammatory disease after surgery. Patients with XGC tended to have abdominal pain(4/6, 67%). However, there was no significant difference in clinical symptoms, including fever, between the two groups. Serum albumin and NLR were also similar in the two groups. Serum tumor markers, such as carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9), tended to increase in patients with GB cancer. However, no significant differences in tumor markers were identified. On the other hand, gallstones were more frequently observed in patients with XGC(5/6, 83%) than in patients with GB cancer(4/16, 33%)(P = 0.0116). A hypoattenuated intramural nodule was found in 3 patients with XGC(3/6, 50%), but in only 1 patient with GB cancer(1/16, 6%)(P = 0.0024). The GB thickness, continuous mucosal line, and bile duct dilatation showed no significant differences between XGC and GB cancer.CONCLUSION: Although XGC is often difficult to differentiate from GB carcinoma, it is possible to obtain an accurate diagnosis by careful intraoperative gross observation, and several intraoperative frozen sections.

Xanthogranulomatous cholecystitis: What every radiologist should know

Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.

Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients:Meta-analysis

BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.

Infiltrative xanthogranulomatous cholecystitis mimicking aggressive gallbladder carcinoma: A diagnostic and therapeutic dilemma

Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis. The perioperative findings in aggressive cases may be indistinguishable from those of gallbladder or biliary tract carcinomas. Three patients presented mass lesions that infiltrated the hepatic hilum,provoked biliary dilatation and jaundice,and were indicative of malignancy. Surgical excision was performed following oncological principles and included extirpation of the gallbladder,extrahepatic bile duct,and hilar lymph nodes,as well as partial hepatectomy. Postoperative morbidity was minimal. Surgical pathology demonstrated XGC and absence of malignancy in all three cases. All three patients are alive and well after years of follow-up. XGC may have such an aggressive presentation that carcinoma may only be ruled out on surgical pathology. In such cases,the best option may be radical resection following oncological principles performed by expert surgeons,in order that postoperative complications may be minimized if not avoided altogether.

Xanthogranulomatous cholecystitis:a premalignant condition?

BACKGROUND:Xanthogranulomatous cholecystitis(XGC)is an uncommon variant of chronic cholecystitis,characterized by marked thickening of the gallbladder wall and dense local adhesions.It often mimics a gallbladder carcinoma(GBC), and may coexist with GBC,leading to a diagnostic dilemma. Furthermore,the premalignant nature of this entity is not known.This study was undertaken to assess the p53,PCNA and beta-catenin expression in XGC in comparison to GBC and chronic inflammation. METHODS:Sections from paraffin-embedded blocks of surgically resected specimens of GBC(69 cases),XGC(65), chronic cholecystitis(18)and control gallbladder(10)were stained with the monoclonal antibodies to p53 and PCNA, and a polyclonal antibody to beta-catenin.p53 expression was scored as the percentage of nuclei stained.PCNA expression was scored as the product of the percentage of nuclei stained and the intensity of the staining(1-3).A cut-off value of 80 for this score was taken as a positive result. Beta-catenin expression was scored as type of expression-membranous,cytoplasmic or nuclear staining. RESULTS:p53 mutation was positive in 52%of GBC cases and 3%of XGC,but was not expressed in chronic cholecystitis and control gallbladders.p53 expression was lower in XGC than in GBC(P<0.0001).PCNA expression was seen in 65%of GBC cases and 11%of XGC,but not in chronic cholecystitis and control gallbladders.PCNA expression was higher in GBC than XGC(P=0.0001),but there was no significant difference between the XGC,chronic cholecystitis and control gallbladder groups.Beta-catenin expression was positive in the GBC,XGC, chronic cholecystitis and control gallbladder groups.But the expression pattern in XGC,chronic cholecystitis and control gallbladders was homogenously membranous,whereas in GBC the membranous expression pattern was altered to cytoplasmic and nuclear.CONCLUSION:The expression of p53,PCNA and beta-catenin in XGC was significantly different from GBC and similar to chronic cholecystitis,thus indicating the inflammatory nature of XGC and may not support a premalignant nature of the lesion.

Acute acalculous cholecystitis immediately after gastric operation:Case report and literatures review

Acute acalculous cholecystitis(AAC)is a rare complication of gastric surgery.The most commonly accepted concepts regarding its pathogenesis are bile stasis,sepsis and ischemia,but it has not been well described how to identify and manage this disease in the early stage.We report three cases of AAC in elderly patients immediately after gastric surgery,which were treated with three different strategies.One patient died 42 d after emergency cholecystectomy,and the other two finally recovered through timely cholecystostomy and percutaneous transhepatic gallbladder drainage,respectively.These cases informed us of the value of early diagnosis and proper treatment for perioperative AAC after gastric surgery.We further reviewed reported cases of AAC immediately after gastric operation,which may expand our knowledge of this disease.

Acute cholecystitis immediately after radical gastrectomy:A report of three cases

Acute cholecystitis is not a common complication of gastrectomy.Its clinical presentations and management strategies in old patients have not been well described in available literature.This report describes the clinical features,management strategies,and treatment outcome of acute cholecystitis immediately after gastrectomy.Acute cholecystitis immediately after gastrectomy in old patients has different clinical presentations,such as fever and high plasma C-reaction protein level.Abdominal computed tomography(CT) scan and ultrasonography showed acute cholecystitis in our cases,which was treated with antibiotics and ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGD).The results indicate that abdominal CT scan and ultrasonography can effectively diagnose acute cholecystitis after gastrectomy,which can be effectively treated with antibiotics and PTGD.

Gangrenous cholecystitis: A silent but potential fatal disease in patients with diabetic neuropathy. A case report

Gangrenous cholecystitis(GC) is a severe and potentially deadly complication of acute cholecystitis. We present a 83-year-old gentleman with a past medical history of type 2 diabetes mellitus with significant associated neuropathy, presenting to a community hospital in a major metropolitan area with 10 days nausea and vomiting and a benign abdominal exam. While the patient was admitted for hyperglycemia, he was subsequently found to have severe GC requiring urgent surgical intervention.

Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: A case report

Although the etiology of eosinophilic cholecystitis is still obscure, the postulated causes include allergies, parasites, hypereosinophilic syndrome, and eosinophilic gastroenteritis. It is sometimes accompanied by several complications, but a simultaneous onset with pericarditis is very rares. A 28-year-old woman complained of acute right hypocondrial pain and dyspnea associated with systemic eruption. Several imaging modalities revealed acute cholecystitis and pericarditis with massive pericardial effusion. A marked peripheral blood eosinophilia was observed, and the eruption was diagnosed as urticaria. Her serum had a high titer of antibody against Ascaris lumbricoides . Treatment with albendazole drastically improved all clinical manifestations along with normalization of the imaging features and eosinophilia. We report herein a rare case of simultaneous onset of acute cholecystitis and pericarditis associated with a marked eosinophilia caused by parasitic infection.

Individualized nomogram improves diagnostic accuracy of stage Ⅰ-Ⅱ gallbladder cancer in chronic cholecystitis patients with gallbladder wall thickening

BACKGROUND： Early diagnosis of gallbladder cancer（GBC） can remarkably improve the prognosis of patients. This study aimed to develop a nomogram for individualized diagnosis of stage Ⅰ-Ⅱ GBC in chronic cholecystitis patients with gallbladder wall thickening.METHODS： The nomogram was developed using logistic regression analyses based on a retrospective cohort consisting of 89 consecutive patients with stage Ⅰ-Ⅱ GBC and 1240 patients with gallbladder wall thickening treated at one biliary surgery center in Shanghai between January 2009 and December 2011. The accuracy of the nomogram was validated by discrimination, calibration and a prospective cohort treated at another center between January 2012 and December 2014（n=928）.RESULTS： Factors included in the nomogram were advanced age, hazardous alcohol consumption, long-standing diagnosed gallstones, atrophic gallbladder, gallbladder wall calcification, intraluminal polypoid lesion, higher wall thickness ratio and mucosal line disruption. The nomogram had concordance indices of 0.889 and 0.856 for the two cohorts, respectively. Internal and external calibration curves fitted well. The area under the receiver-operating characteristic curves of the nomogram was higher than that of multidetector row computed tomography in diagnosis of stage Ⅰ-Ⅱ GBC（P〈0.001）.CONCLUSION： The proposed nomogram improves individualized diagnosis of stage Ⅰ-Ⅱ GBC in chronic cholecystitis patients with gallbladder wall thickening, especially for those the imaging features alone do not allow to confirm the diagnosis.

Are outcomes for emergency index-admission laparoscopic cholecystectomy performed by hepatopancreatobiliary surgeons better compared to non-hepatopancreatobiliary surgeons?A 10-year audit using 1:1 propensity score matching

Background:Emergency index-admission cholecystectomy(EIC)is recommended for acute cholecystitis in most cases.General surgeons have less exposure in managing“difficult”cholecystectomies.This study aimed to compare the outcomes of EIC between hepatopancreatobiliary(HPB)versus non-HPB surgeons.Methods:This is a 10-year retrospective audit on patients who underwent EIC from December 2011 to March 2022.Patients who underwent open cholecystectomy,had previous cholecystitis,previous endoscopic retrograde cholangiopancreatography or cholecystostomy were excluded.A 1:1 propensity score matching(PSM)was performed to adjust for confounding variables(e.g.age≥75 years,history of abdominal surgery,presence of dense adhesions).Results:There were 1409 patients(684 HPB cases,725 non-HPB cases)in the unmatched cohort.Majority(52.3%)of them were males with a mean age of 59.2±14.9 years.Among 472(33.5%)patients with EIC performed≥72 hours after presentation,40.1%had dense adhesion.The incidence of any morbidity,open conversion,subtotal cholecystectomy and bile duct injury were 12.4%,5.0%,14.6%and 0.1%,respectively.There was one mortality within 30 days from EIC.PSM resulted in 1166 patients(583 per group).Operative time was shorter when EIC was performed by HPB surgeons(115.5 vs.133.4 min,P<0.001).The mean length of hospital stay was comparable.EIC performed by HPB surgeons was independently associated with lower open conversion[odds ratio(OR)=0.24,95%confidence interval(CI):0.12–0.49,P<0.001],lower fundus-first cholecystectomy(OR=0.58,95%CI:0.35–0.95,P=0.032),but higher subtotal cholecystectomy(OR=4.19,95%CI:2.24–7.84,P<0.001).Any morbidity,bile duct injury and mortality were comparable between the two groups.Conclusions:EIC performed by HPB surgeons were associated with shorter operative time and reduced risk of open conversion.However,the incidence of subtotal cholecystectomy was higher.

Candidal liver abscesses and cholecystitis in a 37-year-old patient without underlying malignancy

We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.

Xanthogranulomatous cholecystitis misdiagnosed as gallbladder carcinoma: retrospective analysis of 10 cases

Objective: To investigate the reasons for misdiagnosing xanthogranulomatous cholecystitis (XGC) as gallbladder carcinoma, and to provide differential points between these two diseases. Methods: Thirty-three patients with the final diag- nosis of XGC in our hospital over a period of 10 years (1996–2005) were reviewed, among which 10 (6 males and 4 females) were misdiagnosed as having gallbladder carcinoma either preoperatively or intraoperatively. Results: 10 misdiagnosed cases were examined preoperatively by B-ultrasound (BUS) and computed tomography (CT). BUS and CT revealed 5 cases of gallbladder carcinoma and 1 of chronic cholecystitis; 2 cases were diagnosed as gallbladder carcinoma on BUS but chronic cholecystitis on CT; other 2 cases were diagnosed as chronic cholecystitis on BUS but as gallbladder carcinoma on CT. Intra- operatively, thickening of the gallbladder wall was found in all of the patients; xanthogranulomatous tissue was found invading into other tissues including gallbladder bed and omentum majus. Intraoperative frozen section investigation was performed on 1 patient revealing that no tumor cell was found. Open cholecystectomy + partial hepatic wedge resection were performed on 3 patients; cholecystectomy + partial hepatic wedge resection + regional lymphadenectomy in the liver duodenum ligament on 6 patients; cholecystectomy + cholecystoenterostomy + colocolic anastomosis after partial resection of transverse colon on 1 patient. Postoperative pathological findings revealed XGC in all these patients. Conclusion: XGC is an uncommon variant of chronic cholecystitis of which clinical and imaging presentations closely resemble gallbladder carcinoma. Thus differentiation is essential by means of intraoperative frozen section investigation to ensure optimal surgical treatment since XGC has its pathological distinctions, which are not that of a precancerous change.

Hepatitis A virus-associated acute acalculous cholecystitis in an adult-onset Still’s disease patient:A case report and review of the literature

BACKGROUND Acute acalculous cholecystitis(AAC)is inflammation of the gallbladder without evidence of calculi.Although rarely reported,its etiologies include hepatitis virus infection(e.g.,hepatitis A virus,HAV)and adult-onset Still’s disease(AOSD).There are no reports of HAV-associated AAC in an AOSD patient.CASE SUMMARY Here we report a rare case of HAV infection-associated AAC in a 39-year-old woman who had a history of AOSD.The patient presented with an acute abdomen and hypotension.Elevated hepatobiliary enzymes and a thickened and distended gallbladder without gallstones on ultrasonography suggested AAC,but there were no signs of anemia nor thrombocytopenia.Serological screening revealed anti-HAV IgM antibodies.Steroid treatment did not alleviate her symptoms,and she was referred for laparoscopic cholecystectomy.The resected gallbladder was hydropic without perforation,and her clinical signs gradually improved after surgery.CONCLUSION AAC can be caused by HAV in AOSD patients.It is crucial to search for the underlying etiology for AAC,especially uncommon viral causes.

Effect of surgical timing on postoperative outcomes in patients with acute cholecystitis after delayed percutaneous transhepatic gallbladder drainage

BACKGROUND To date,the optimal timing for percutaneous transhepatic gallbladder drainage(PTGBD),particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy(LC)(within 72 hours of symptom onset)has not been determined.AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis(AC)in patients with delayed PTGBD.METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied.According to the interval between gallbladder drainage and cholecystectomy,the patients were divided into early and delayed LC groups.Outcomes including surgery time,postoperative complications and hospital stay,and patient satisfaction were analyzed and compared between the two groups using t-andχ^(2) tests.RESULTS There were no significant differences between the two groups in intraoperative blood loss,postoperative abdominal drainage tube placement time,pain index,or total disease duration(all P>0.05).Compared with those of the early LC group,the delayed group showed significant decreases in the length of procedure(surgery time),conversion rate to open surgery,degree of adhesions,surgical complications,postoperative hospital stay,and total treatment costs,and increased patient satisfaction despite a longer interval before PTGBD(all P<0.05).CONCLUSION For patients with grade II/III AC with delayed PTGBD,LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.

Treatment of cholecystitis with Chinese herbal medicines:A systematic review of the literature

AIM:To analyze the literature on the use of Chinese herbal medicines for the treatment of cholecystitis.METHODS:The literature on treatment of cholecystitis with traditional Chinese medicines(TCM) was analyzed based on the principles and methods described by evidence-based medicine(EBM).Eight databases including MEDLINE,EMbase,Cochrane Central(CCTR),four Chinese databases(China Biological MedicineDatabase,Chinese National Knowledge Infrastructure Database,Database of Chinese Science and Technology Periodicals,Database of Chinese Ministry of Science and Technology) and Chinese Clinical Registry Center,were searched.Full text articles or abstracts concerning TCM treatment of cholecystitis were selected,categorized according to study design,the strength of evidence,the first author's hospital type,and analyzed statistically.RESULTS:A search of the literature published from 1977 through 2009 yielded 1468 articles in Chinese and 9 in other languages;and 93.92% of the articles focused on clinical studies.No article was of levelⅠevidence,and 9.26% were of level Ⅱ evidence.The literature cited by Science Citation Index(SCI),MEDLINE and core Chinese medical journals accounted for 0.41%,0.68% and 7.29%,respectively.Typically,the articles featured in case reports of illness,examined from the perspective of EBM,were weak in both quality and evidence level,which inconsistently conflicted with the fact that most of the papers were by authors from Level-3 hospitals,the highest possible level evaluated based on their comprehensive quality and academic authenticity in China.CONCLUSION:The published literature on TCM treatment of cholecystitis is of low quality and based on low evidence,and cognitive medicine may functions as a useful supplementary framework for the evaluation.

Acute Cholecystitis Mimics Ischemic Cardiac Disease: A Case Report and Review of the Literature

Chest pain and shortness of breath are typical indicators of cardiac problem and may lead to life threatening conditions. Nevertheless, these symptoms may also be associated with a non-cardiac condition clinically such as cholecystitis. We have reported 4 cases in a period of 6 months wherein the patients presented with cardiac-like symptom show ever;they were subsequently diagnosed with non-cardiac problems. Two patients presented with severe chest pain and shortness of breath mimicking angina pectoris. They were admitted to the intensive care unit for emergency management. The ECG findings were normal. There were two other patients who also presented with severe chest pain and shortness of breath with ST segment elevation during the ECG examination. The abdominal ultrasound in all the 4 patients showed typical features of acute calculus cholecystitis. All patients were young (30 - 36 years of age) females who were obese (BMI ranging from 30 - 34). Cholecystectomy was performed which led to improved symptoms postoperatively and ECG changes became normal.