To the Editor.—
After reading Palmer's article regarding microscopic examination of biliary drainage in evaluating suspected gallbladder disease (229:1803, 1974), I was not entirely satisfied that the complete story was portrayed.
He states, in reference to normal oral cholecystograms, "Cholecystography is not quite good enough to warrant total trust." He then states that "Even when results of repeated cholecystography are entirely normal...."
When we suspect gallbladder disease, a fatty meal is given (if the gallbladder visualizes, and no stones are present) to examine how the gallbladder contracts. Areas of spasm, abnormal contraction, globular configuration (indicating spasms of the cystic or common bile duct) and contraction less than 50% of original size are all used as evidence that gallbladder disease is present. Patients operated on have exhibited chronic cholecystitis, adenomyomatosis, and cholesterolosis. A normal gallbladder has never been removed when these criteria were used.
I have used duodenal drainage in many
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