PubMed · 6771194
This study reports a fatal ingestion of lithium carbonate and its distribution in tissues and biological fluids.
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C L Winek, J D Bricker, F W Fochtman. Lithium intoxication. A case study.. https://doi.org/10.1016/0379-0738(80)90138-3
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Bile-model systems containing cholesterol (CH), phosphatidylcholine (PC) and sodium cholate (NaC) at concentrations similar to those found in supersaturated human gall bladder bile ([CH]/[PC] = 0.60 +/- 0.01; CH saturation index, CSI = 1.58 +/- 0.03) were prepared by mixing PC-CH vesicles with NaC micellar solutions. Following mixing, the dispersion became transparent and gave rise to high resolution 1H-NMR spectra typical of mixed micellar systems. Cryo-transmission electron micrographs of specimens vitrified at that stage support the conclusion that the vesicles had become completely micellized. Following micellization, the metastable (cholesterol-supersaturated) bile-models spontaneously underwent a series of reorganizational steps: first, cholesterol-rich vesicles with a [CH]/[PC] ratio of 1.57 +/- 0.69 were formed, in co-existence with a mixed micellar system with [CH]/[PC] = 0.43 +/- 0.01 and CSI = 1.12 +/- 0.03. The resultant cholesterol-rich vesicles subsequently aggregated and cholesterol crystals of varying sizes and shapes appeared within the aggregates: needle-like structures were first observed, followed by clusters of those crystals and of helical crystals. Eventually, typical plate-like cholesterol crystals appeared, at which time some of the PC returned to the non-particulate (isotropic) phase. Consequently, the system contained cholesterol crystals coexisting with mixed micelles, whose composition was close to the limit of saturation (CSI = 1.08). These findings confirm the sequence of events preceding the appearance of cholesterol crystals, as previously proposed in our less detailed studies ((1990) Hepatology 12, 149S) and support the relevance of the morphologically similar results of Konikoff et al. ((1992) J. Clin. Invest. 90, 1155) obtained in a very dilute supersaturated bile-model.
The distribution of phospholipid and cholesterol between the vesicular and micellar phases in bile plays an important role in the formation of cholesterol gallstones. Conventional analytical procedures to determine the distribution are potentially unreliable because they disturb the distribution of these compounds between the two phases. In this work, we circumvent this problem by using NMR. 31P-NMR is used to quantify directly the micellar and the vesicular amount of lecithin. The previously described 1H-NMR method to determine directly the micellar lecithin (Groen et al., J Lipid Res 31: 1315-1321) has been optimized by the implementation of a spectral quantification method. The agreement between the 31P and 1H methods was excellent. In our hands, the method of Ellul et al. (FEBS Lett 300: 30-32) did not allow quantification of micellar cholesterol, although our fitting procedure offered the possibility of quantifying overlapping spectral peaks by the use of prior knowledge about all the parameters of the compounds visible in the spectrum. The micellar cholesterol concentration was so low compared to the overlapping lecithin peaks that no reliable quantification was possible. The same problem was encountered when using other characteristic cholesterol resonances for quantification. Our data suggest that cholesterol present in the vesicular phases is too immobile to give rise to high-resolution peaks and the amount of cholesterol present in the micellar phase is too low to allow quantitation by NMR. We conclude that 1H-NMR can be used to determine micellar lecithin, and 31P-NMR to determine micellar as well as vesicular lecithin in model bile.
Since its introduction in 1989, laparoscopic cholecystectomy has rapidly become the preferred alternative to open cholecystectomy for symptomatic cholelithiasis. Although possible complications of laparoscopic cholecystectomy are essentially the same as for open cholecystectomy, we report a case of an inadvertent subtotal cholecystectomy, a complication that we believe has not been previously reported.