Abstract：
BACKGROUND:Variously described as Courvoisier's law, sign, or even gallbladder, this eponymous "law" has been taught to medical students since the publication of Courvoisier's treatise in 1890. METHODS:We reviewed Courvoisier's original "law," the modern misconceptions surrounding it, and the contemporary evidence supporting and explaining his observations. RESULTS:Courvoisier never stated a "law" in the context of a jaundiced patient with a palpable gallbladder. He described 187 cases of common bile duct obstruction, observing that gallbladder dilatation seldom occurred with stone obstruction of the bile duct. The classic explanation for Courvoisier's finding is based on the underlying pathologic process. With the presence of gallstones come repeated episodes of infection and subsequent fibrosis of the gallbladder. In the event that a gallstone causes the obstruction, the gallbladder is shrunken owing to fibrosis and is unlikely to be distensible and, hence, palpable. With other causes of obstruction, the gallbladder distends as a result of the back-pressure from obstructed bile flow. However, recent experiments show that gallbladders are equally distensible in vitro, irrespective of the pathology, suggesting that chronicity of the obstruction is the key. Chronically elevated intraductal pressures are more likely to develop with malignant obstruction owing to the progressive nature of the disease. Gallstones cause obstruction in an intermittent fashion, which is generally not consistent enough to produce such a chronic rise in pressure. CONCLUSION:We hope that reminding clinicians of Courvoisier's actual observations will reestablish the usefulness of this clinical sign in the way he intended.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Fitzgerald JE,White MJ,Lobo DNdoi
10.1007/s00268-008-9908-ysubject
Has Abstractpub_date
2009-04-01 00:00:00pages
886-91issue
4eissn
0364-2313issn
1432-2323journal_volume
33pub_type
传,历史文章,杂志文章abstract：BACKGROUND:Hernia is especially prevalent in developing countries where the population is obliged to undertake strenuous work in order to survive, and International Cooperation Programmes are helping to solve this problem. However, the quality of surgical interventions is unknown. The objective of the present study was...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-012-1768-9
更新日期：2012-12-01 00:00:00
abstract：BACKGROUND:Artificial intelligence is touted as the future of medicine. Classical algorithms for the detection of common bile duct stones (CBD) have had poor clinical uptake due to low accuracy. This study explores the challenges of developing and implementing a machine-learning model for the prediction of CBD stones i...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-020-05820-8
更新日期：2021-02-01 00:00:00
abstract：BACKGROUND:Complications following esophagectomy are a significant source of morbidity. The aim of this study was to investigate the utility of the neutrophil:lymphocyte ratio (NLR) in the early identification of complications following esophagectomy, as compared to other routinely available parameters. METHODS:We per...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-016-3427-z
更新日期：2016-06-01 00:00:00
abstract：:The radiological features of common benign conditions of the breast and the radiological procedures used in the investigation of benign breast disorders are presented. ...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/BF01658415
更新日期：1989-11-01 00:00:00
abstract：:Histologically differentiated adenocarcinoma satisfies one of the criteria for limited surgery for mucosal carcinoma of the stomach: however, the histology of the endoscopic biopsy specimen is often different from that of the resected specimen. The medical records of 1018 early gastric carcinomas were retrospectively ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002689900483
更新日期：1998-08-01 00:00:00
abstract：BACKGROUND:Preoperative assessment of geriatric-specific determinants of health may enhance perioperative risk stratification among elderly patients. This study examines effects of geriatric-specific variables on postoperative outcomes in patients undergoing elective major abdominal operations. METHODS:Patients includ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-020-05515-0
更新日期：2020-08-01 00:00:00
abstract：:A mathematic model is created to determine the economic cost per year of anticipated prolongation of life that would result from a program of abdominal ultrasonographic (US) screening for abdominal aortic aneurysm. The protocol involves US screening at age 60, 67, and 74 years with additional annual follow-up US and e...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF01659032
更新日期：1989-05-01 00:00:00
abstract：:Lower esophageal sphincter pressure has been assessed pre-operatively, intra-operatively,and more than 6 months postoperatively in 34 patients having antireflux surgery for gastro-esophageal reflux disease. The sphincter pressures associated with the outcome in relation to pH measured reflux and the symptoms of recurr...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF02071543
更新日期：1992-03-01 00:00:00
abstract：BACKGROUND:Incidental gallbladder cancer (GBC) is frequently discovered on the specimen when cholecystectomy for a benign disease is performed. The objective of the present study was to assess the management of incidental GBC patients in a French registry. METHODS:Data on patients with GBC treated between 1998 and 200...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-011-1134-3
更新日期：2011-08-01 00:00:00
abstract：BACKGROUND:Connective tissue growth factor (CTGF) expression changes variously in different human malignancies. The role of CTGF in hepatocellular carcinoma (HCC) is still not clear. The purpose of this study was to investigate the role of serum CTGF in patients with HCC and its correlation with HCC angiogenesis. METH...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-010-0648-4
更新日期：2010-10-01 00:00:00
abstract：BACKGROUND:This study was undertaken to determine the efficacy of the clinical indications for performing staging laparoscopy for locally advanced gastric cancer to detect peritoneal metastasis or positive cytology findings. METHODS:The study included 231 patients with T4 gastric cancer without hematogenous or clinica...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-011-1290-5
更新日期：2011-12-01 00:00:00
abstract：BACKGROUND:It has been reported that the paraesophagogastric devascularization with esophageal transection procedure, also known as the modified Sugiura procedure, was effective in the treatment of variceal bleeding. However, it was not widely accepted by other surgeons because of the high rate of rebleeding, complicat...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-014-2478-2
更新日期：2014-08-01 00:00:00
abstract：BACKGROUND:The extent to which obesity and genetics determine postoperative complications is incompletely understood. METHODS:We performed a retrospective study using two population cohorts with electronic health record (EHR) data. The first included 736,726 adults with body mass index (BMI) recorded between 1990 and ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-019-05202-9
更新日期：2020-01-01 00:00:00
abstract：:The treatment results of mycobacterial cervical lymphadenitis in 69 patients between 1990 and 1993 are reviewed. All patients underwent surgical procedures consisting of total excision or selective nodal dissection for lymphadenopathies and curettage for fluctuant cases, followed by antituberculous chemotherapy applie...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002689900265
更新日期：1997-06-01 00:00:00
abstract：:In a prospective multicenter study, 186 patients with squamous cell esophageal carcinoma, who after evaluation were considered suitable for surgery, were randomized to 4 treatment groups: Group 1, surgery alone; Group 2, pre-operative chemotherapy (cisplatin and bleomycin) and surgery; Group 3, pre-operative irradiati...
journal_title：World journal of surgery
pub_type： 临床试验,杂志文章,多中心研究,随机对照试验
doi：10.1007/BF02067069
更新日期：1992-11-01 00:00:00
abstract：BACKGROUND:The aim of this study was to evaluate the available resources for trauma care at health centers (HCs) and referral hospitals (RHs) in rural Cambodia and to examine whether the resources at HCs are allocated on the basis of actual need based on the referral distance and number of severely injured patients ref...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-008-9900-6
更新日期：2009-04-01 00:00:00
abstract：BACKGROUND:Seroma formation is a frequent postoperative complication following open ventral hernia repair (OVHR), especially in cases requiring wide subcutaneous dissection (WSD). The aim of this study was to evaluate the effectiveness of a new low-thrombin fibrin sealant for seroma prevention. METHODS:A total of 60 c...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-014-2691-z
更新日期：2014-11-01 00:00:00
abstract：BACKGROUND:Enhanced recovery (ERAS) guidelines do not differentiate between left- and right-sided colectomies, but differences in recovery have been reported for the two procedure types. We aimed to compare compliance with the ERAS protocol and outcomes after right versus left colectomy. METHODS:Between June 2011 and ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-016-3563-5
更新日期：2016-10-01 00:00:00
abstract：BACKGROUND:Donor variational arteries often require complex reconstruction. METHODS:We analysed the incidence of different variations, types of arterial reconstructions and their impact on post-operative results from 409 patients undergoing liver transplantation at Karolinska Institute between 2007 and 2015. RESULTS:...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-020-05406-4
更新日期：2020-06-01 00:00:00
abstract：BACKGROUND:Understanding the lymphatic drainage route in gastric cancer is crucial for complete lymph node retrieval from sites susceptible to metastasis. However, the lymphatic stream of the stomach is complex and remains incompletely characterized. METHODS:Patients with small (<4 cm) serosa-negative gastric cancer w...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-009-9985-6
更新日期：2009-06-01 00:00:00
abstract：BACKGROUND:Recurrent renal hyperparathyroidism (HPT) is a serious problem after parathyroidectomy (PTx). We evaluated the frequency of graft-dependent recurrent HPT and the clinical outcomes after removal of the autograft. METHODS:Between March 1980 and January 2009, 2660 patients underwent total PTx with forearm auto...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-010-0412-9
更新日期：2010-06-01 00:00:00
abstract：:Most adrenal incidentalomas are nonfunctioning cortical adenomas that do not require surgery. Operative treatment is indicated if the incidentaloma has malignant features as seen during the radiologic workup, is hormonally active, or grows during follow-up. A conservative attitude is justified in asymptomatic patients...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002689910095
更新日期：2000-05-01 00:00:00
abstract：BACKGROUND:Early mortality in ruptured abdominal aneurysm (rAAA) is high, but data on long-term outcome are scarce. The aim of this study was to investigate the long-term outcome in survivors after open surgery for rAAA in well-defined population. METHODS:This is a population-based, observational long-term follow-up (...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-020-05457-7
更新日期：2020-06-01 00:00:00
abstract：:The prognosis of patients who undergo resection for pancreatic ductal adenocarcinoma with curative intention is generally poor unless they have early-stage disease. Based on our 25-year experience, the results of 194 patients after a standardized Kausch-Whipple resection for adenocarcinoma of the pancreatic head were ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-002-6659-z
更新日期：2003-03-01 00:00:00
abstract：:It is a fundamental clinical observation that wounds do not heal in tissue that does not bleed, and they almost always heal in tissue that bleeds extensively. Continuous supply of oxygen to the tissue through microcirculation is vital for the healing process and for resistance to infection. Evaluation of tissue perfus...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s00268-003-7398-5
更新日期：2004-03-01 00:00:00
abstract：:Quality of life is an important outcome measure following surgery for ulcerative colitis. Quality of life incorporates not only the physical or functional outcome; it also considers the emotional and social well-being of patients. Quality of life may be measured using disease-specific or generic quality of life measur...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s002689900400
更新日期：1998-04-01 00:00:00
abstract：:Most people would agree that successful parathyroidectomy depends on two important variables: the surgeon's recognition and excision of the abnormal parathyroid gland(s) and the pathologist's confirmation that the removed tissue is parathyroid tissue. Frozen section is usually employed to confirm the identity of parat...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002680010218
更新日期：2000-11-01 00:00:00
abstract：:Fourteen patients with liver tumor malignancy and sixteen patients with malignant melanoma localized to one limb were studied regarding leukocyte activation with the release of polymorphonuclear neutrophilic (PMN) elastase and of neopterin and formation of cytokines (TNF-alpha and IL-6) during the surgical treatment. ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF00299787
更新日期：1995-11-01 00:00:00
abstract：INTRODUCTION:In India, half of the annual 200,000 road traffic deaths occur in hospitals, but the exact in-hospital trauma mortality rate remains unknown. A research consortium of universities, with a mandate to reduce trauma mortality, measured the baseline 30-day in-hospital mortality rate. METHODS:Between September...
journal_title：World journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1007/s00268-016-3452-y
更新日期：2016-06-01 00:00:00
abstract：:Trends are changing in the management of infants and children with indirect inguinal hernias. Advances in neonatal intensive care have resulted in the survival of many small premature infants who have a high incidence of inguinal hernia. The rate of incarceration, strangulation, and gonadal infarction in these babies ...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/BF01658863
更新日期：1989-09-01 00:00:00
