Clinical, radiological and pathological findings in 31 patients with xanthogranulomatous cholecystitis have been reviewed. The spectrum of presentation was similar to that of cholelithiasis but fewer patients had biliary colic (17 per cent) and there were more complications (32 per cent). Four patients had a biliary fistula and four a perforated gallbladder with abscess formation. Patients characteristically had gallstones. Appearances often mimicked carcinoma of the gallbladder at ultrasonography and/or laparotomy, with xanthogranulomatous tissue extending to adjacent structures. Xanthogranulomatous cholecystitis and carcinoma of the gallbladder coexisted in three patients. The possibility should be considered that an 'inoperable tumour' of the gallbladder may in fact be xanthogranulomatous cholecystitis, a benign condition that frozen-section biopsy may confirm.
Atherosclerotic subclavian artery disease is detected in about 5% of patients referred for coronary artery bypass (CABG) surgery. The internal mammary artery, a branch of the subclavian artery, is the most frequently utilized graft to restore coronary circulation because of its longevity. Stenosis or occlusion of the subclavian artery can cause retrograde blood flow in the ipsilateral internal mammary artery, known as "steal," compromising coronary circulation supplied by the graft. Steal may be asymptomatic or may result in symptoms of myocardial ischemia. Symptomatic subclavian artery stenosis post bypass is referred to as coronary subclavian steal syndrome post-CABG. The incidence is not well defined, and the benefits of screening patients referred for CABG are not known. Despite the various modalities available to detect subclavian artery stenosis, current guidelines fail to provide guidance about screening high-risk patients for this entity. Detection of subclavian artery disease prior to CABG can reduce complications posed by post-mammary artery graft cardiac ischemia. This review discusses the utility of preoperative subclavian artery screening prior to CABG.
Cholelithiasis is a common disease and perforation and carcinoma of the gallbladder are well recognized complications. Xanthogranulomatous cholecystitis is an uncommon form of cholecystitis which is being recognized with increasing frequency. We report a case in which gallbladder perforation was diagnosed by ultrasound in a patient in whom all four conditions coexisted.
A 73-year-old woman presented with a 1-month history of rapidly worsening dementia following an episode of abdominal pain. Nine days before admission to hospital an abdominal swelling had been noticed. On examination she was pyrexial with a neutrophilia; there was a large, tender, fluctuant epigastric mass, pointing through erythematous skin.
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