Robert E. Wise

Anatomic variation in the gallbladder and bile ducts

The origin of the gallbladder and extrahepatic ducts is separate and distinct from that of the intrahepatic ducts and precedes it by several weeks. At the 2.5~mm stage of embryonic developmerit, a bifid bud forms along the ventral margin of the primitive foregut and proliferates laterally into the adjacent mesenchyme (the septum transversum). The more caudal of these two diverticula initiates formation of the gallbladder and extrahepatic ducts and the more cranial initiates formation of the liver and intrahepatic ducts. By the S-mm stage, the originally hollow gallbladdercommon duct primordium and duodenum become solid, but they soon revacuolate. The common bile duct lumen is reestablished by the 7.5-mm stage, and the gallbladder and duodenal lumens are reestablished somewhat later. Portal and hepatic vein development and hepatocyte and Kupffer cell formation precede development of the intrahepatic bile ducts, the veins achieving the usual adult configuration by the 9.5-mm embryonic stage. By the l&mm stage, the intrahepatic ducts consist only of a blindly ending solid cord of cells extending from the choledochocystic duct toward the liver hilum. Formation of the intrahepatic ducts apparently occurs by induction at the point of contact of this blind-ending ductal anlage with the liver cells.’

Intravenous cholangiography: optimum dosage and methodology.

Cholangiography was performed in 442 patients using four dosage regimens of Cholografin: (a) a single-dose, full-strength injection in 10 minutes (150 examinations), (b) two dilute (76 examinations) or very dilute single doses (71 examinations) infused in 30 minutes, and (c) one dilute double dose infused in 30 minutes (145 examinations). Results showed that the double-dose infusion gave maximum visualization, followed by the single-dose injection and the two single-dose infusions. With the double-dose method, both the reaction rate and the incidence of SGOT elevation were twice that seen with any single-dose method, making the single-dose injection the procedure of choice despite slightly lower opacification.

The Intravenous Cholangiographic Diagnosis of Partial Obstruction of the Common Bile Duct

IN AN ATTEMPT to evaluate the role of intravenous cholangiography in the diagnosis of partial obstruction of the common bile duct, to determine the relationship of common duct size to partial obstructions of the duct, and to establish criteria for roentgenographic diagnosis, we have reviewed our experiences of the past two and one-half years. Since a significant number of postcholecystectomy patients either exhibit the same symptoms as before operation or develop new symptoms, the problem is worthy of attention. The implications are: (a) that the gallbladder disease was not responsible for the precholecystectomy complaints, (b) that the surgical procedure was incomplete and should have gone beyond simple removal of the gallbladder and at times beyond removal of common duct calculi, or (c) that mechanical or inflammatory injury to the common bile duct may have taken place at the time of or shortly after cholecystectomy. Walters (1) in 1956, was of the opinion that the most frequent causes of pain after cho...

Subtraction Technic: Video and Color Methods

The current high level of interest in angiographic procedures had led to a search for methods which yield more information from angiography than can be obtained with conventional viewing. Since conventional roentgen procedures cannot produce a higher level of information than that already attainable without increasing the dosage of contrast medium beyond a safe level, it appears logical to seek additional methods of improving informational yield. Photographic Subtraction The theoretical basis of subtraction of radiographs is not new, the original description having been published by Ziedses des Plantes in 1935 (1) with elaborations in 1938 and 1963 (2, 3). The technic cancels or subtracts, in theory at least, all the picture elements common to a pair of radiographs after one of them has been converted to a negative image or diapositive. The two radiographs are then superimposed in perfect registration and a third composite image is made photographically. if a density, usually in the form of an injected co...

An update on biliary imaging.

This article provides an overview of the gamut of biliary imaging techniques currently available to the clinician. It provides a brief history of biliary imaging, particularly intravenous cholangiography, including most commonly used contrast agents. This history is followed by a detailed discussion of modern-day practice modalities, including fluoroscopic and barium cholangiography, CT cholangiography, and magnetic resonance cholangiopancreatography.

T-tube cholangiography. Technical considerations for the surgeon.

This procedure has become routine in the postoperative evaluation of the biliary tract following cholecystectomy. Important technical and anatomic considerations in the performance and interpretation of the procedure are discussed.

Treatment of T-tube obstruction by catheterization.

The case is presented of a patient in whom a debris-blocked T-tube was unplugged by catheterization with a Teflon-coated Seldinger guide wire with a flexible tip fixed core. The technique is simple, painless, and safe, and may be utilized in place of a surgical procedure when it is necessary to keep a T-tube in place to ensure patency of the common bile duct.

Usefulness of calcium ipodate in the faintly opacified gallbladder.

Nonvisualization of the gallbladder followingoral cholecystography is an indication for intravenous cholangiography; however, the gallbladder may be only faintly opacified. The immediate use of supplemental calcium ipodate may provide a simple, safe, and reliable method of facilitating a definite diagnosis.

Examination of the colon using a synthetic purgative

Summary and ConclusionsExperience with Win 9059 (dihydroxyphenylisatin) has been presented. The compound has been found to be free of toxicity but productive of cramping of varying degrees in a high percentage of cases. No lasting deleterious effects upon the colon have been found. Evacuation of the colon is more complete than with tannic acid, and in the quantity used in our series Win 9059 was unsatisfactory for the routine barium-enema examination because of the complete evacuation of barium with resultant loss of mucosal pattern. This property has been found to be very advantageous in a preliminary cleansing enema prior to air-contrast examination resulting in a high percentage of good and excellent air-contrast studies of the colon.

The challenge of continuing medical education.

Continuing education is an important responsibility in the practice of radiology. The response to the growing demand for additional and new educational opportunities includes specialty societies and their programs of scientific paper presentations and refresher courses, audiovisual aids and seminars. Lacking, however, is organization of efforts leading toward programmed instruction, permitting renewal and expansion of knowledge on an organized and continuing basis. The Intersociety Educational Committee is attempting to coordinate educational efforts. A unified and effective educational process would eliminate much duplication of effort and increase efficiency.