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PubMed1992

[Preoperative esophagogastroduodenoscopy before elective surgical therapy of symptomatic cholelithiasis].

We evaluated the data of 1143 patients who underwent preoperative gastroscopy or upper gastrointestinal series before elective surgical treatment of cholelithiasis between January 1, 1981 and December 31, 1990. On these 824 women and 319 men we performed 1064 (93.1%) gastroscopies and only 78 (6.8%) upper gastrointestinal series. The incidence of pathological findings was 30.2% (345 patients), with 68.3% findings of inflammatory nature. In 28 patients (2.5%) cholecystectomy or bile duct exploration was combined with an additional gastrointestinal surgical procedure. In 227 cases (19.8%) biliary surgery was followed by pharmacological treatment of the gastrointestinal disease. Because of the high incidence of simultaneous disease of the upper gastrointestinum we believe that routine preoperative gastroscopy is indicated before elective surgical treatment of cholelithiasis.

Adult↗
PubMed1992

Surgical treatment for cholelithiasis.

In a retrospective study, the results of 1,631 consecutive operations for cholelithiasis were analyzed. With an overall mortality rate of 0.18 percent and a reoperation rate of 1.3 percent, conventional cholecystectomy proved to be a safe method. Mortality proved to be age dependent, with a zero mortality rate for patients less than 60 years of age. Choledochotomy had a 13-fold greater mortality rate than simple cholecystectomy (0.92 versus 0.07 percent). For acute cholecystitis, we observed an unusual zero mortality rate, whereas the mortality rate in chronic cholecystitis was 0.2 percent. All three patients who died had an accompanying cirrhosis of the liver. Morbidity, defined as reoperation during the same period of hospitalization, was mainly the result of retained stones after choledochotomy; endoscopic papillotomy was the treatment of choice. Cholecystectomy remains the "gold standard" in the treatment of cholelithiasis.

Adolescent↗
PubMed2004

[Surgery of cholelithiasis: from past to present].

Development of surgery of cholelithiasis is regarded. Classic surgical interventions on the gall bladder and bile ducts in complicated disease (acute cholecistitis, jaundice, cholangitis), postcholecistectomy syndrome, surgical trauma of the bile ducts are substantiated. To 1980s modern views on pathogenesis of the disease have been formed. However, unresolved problems of surgical policy, traumatism of open surgeries in complicated forms of the disease (postoperative lethality in acute cholecistitis was 37% and over) made results of treatment unsatisfactory. Correction of policy's problems, application of mini-invasive procedures, diapeutic approach and precision technique opened up-to-date period in surgery of cholelithiasis. It permitted to reduce postoperative lethality in acute and chronic course of the disease to 0.08 - 0.1%.

Cholecystectomy↗
PubMedDate not supplied

[Cholelithiasis in childhood: description of 2 cases].

Two cases of cholelithiasis in children are reported. The first patient was a 10-year-old girl with hyperinsulinism and hypoglycemia as associated medical conditions. The second one was a 3-year-old boy who had no definable cause for cholelithiasis. Both patients were symptomatic. Recurrent abdominal pain was the main symptom. A specific and accurate diagnosis was readily made by ultrasound in both children.

Age Factors↗
PubMed2005

A variant of the double gallbladder. A possible cause of cholelithiasis?

Congenital duplication of the gallbladder is a rare anatomical malformation, which is usually discovered as an incidental finding during cholecystectomy. We report a case of a double gallbladder in a 45-year-old woman, which was discovered during laparoscopic cholecystectomy for symptomatic cholelithiasis. As it was not possible to identify the anatomical structures safely, the procedure was converted to open cholecystectomy. Inspection of the resected gallbladder showed that it consisted of 2 chambers with separate cystic ducts, which communicated through an ostium. Both chambers contained multiple gallstones. The inadequate drainage of the second chamber could be considered as a predisposing factor for the development of cholelithiasis in this case.

Cholecystectomy, Laparoscopic↗
PubMed2005

Gall bladder carcinoma in patients undergoing cholecystectomy for cholelithiasis.

OBJECTIVE: To determine the proportion and timing for suspecting the diagnosis of gall bladder carcinoma in patients undergoing cholecystectomy for cholelithiasis. METHODS: A retrospective study conducted at the Aga Khan University Hospital, Karachi over a period of six years, included medical records of patients, with cholecystectomy for cholelithiasis and a histopathological diagnosis of gall bladder carcinoma. An extensive review was done with special reference to the features of suspected or unsuspected gall bladder carcinoma. Timing of suspicion was categorized on the basis of clinical features, investigations, operative and histopathological findings. RESULTS: Out of 1396 cholecystectomies performed during the period of study, sixteen patients (1.15%) were diagnosed as gall bladder carcinoma. Only three patients had pre-operative ultrasonographic features to raise suspicion for gall bladder malignancy whereas eight patients were suspected to have a malignant lesion, on the operative findings. Five patients were missed and the diagnosis was established after histopathological examination. CONCLUSION: The ultrasonography can miss a significant number of malignant lesions of the gall bladder and every cholecystectomy specimen should be examined histologically.

Adult↗
PubMed1992

[What is the contribution of surgery in cholelithiasis today?].

1631 patients with cholelithiasis were operated on between 1984 and 1989 at the St. Clara Hospital in Basel. Mortality and rate of reinterventions were evaluated. 1357 patients had cholecystectomy with a mortality of 0.07%, 217 patients needed an exploration of the common bile duct, which increased the mortality rate to 0.9%. 57 patients had a transduodenal papillotomy, biliodigestive anastomosis or a reoperation without any death. The overall mortality was 0.18%. The mortality for patients over 60 years was 0.4%, there were no deaths for patients under 60 years. The mortality did not increase when there was an acute inflammation of the gallbladder. Reinterventions had to be done in 1.3%. The most common reason for reoperation was a retained common duct stone, which was then removed by endoscopic sphincterotomy (0.86%). Operative injury of the common duct occurred in 0.6% (1 of 1631 patients). Cholecystectomy is still standard treatment of cholelithiasis because of its low mortality and reintervention rate.

Adolescent↗
PubMedDate not supplied

[The detection of dysplastic lesions of the gallbladder mucosa in polypoid cholelithiasis].

AIM: To investigate the hyperplastic and/or dysplastic lesions in the gallbladder mucosa. METHODS: We used the immunohistochemical Ardeleanu-Hsu-Bussolati and Gugliotta methods, with avidin and peroxide biotin, adapted in the laboratory of University Hospital "St. Spiridon" Iaşi. There were studied ten cases of polypoid cholelithiasis, with the following markers: Ki67, PCNA, and p53. RESULTS: The immunohistochemical methods using Ki67, PCNA and p53 protein allowed the evaluation of the abnormal proliferation abilities characteristic for some hyperplastic or dysplastic lesions, found in our cases of cholelithiasis. CONCLUSIONS: The utilization of these markers permitted us to establish a good correlation between the high activity of Ki67 and the morphological aggression indicators in hyperplastic and dysplastic gallbladder epithelium. There is also a correlation between the percentage of the cells marked with anti-PCNA antibody and the existence of p53 protein in these lesions.

Biomarkers, Tumor↗
PubMed1990

[The calcium content in the bile of patients with cholelithiasis, chronic hepatitis, liver cirrhosis and in healthy subjects].

Measurements of calcium levels in the blood of normal subjects and patients with cholelithiasis, chronic hepatitis, and liver cirrhosis have revealed that biliary calcium levels during the physicochemical stage of cholelithiasis are much higher than during the calculi formation stage and that in chronic hepatitis and liver cirrhosis C bile calcium content is much higher than B bile calcium content.

Bile↗
PubMed2006

[Mini-laparotomy in surgical treatment of cholelithiasis].

Current laparoscopic cholecystectomy (LCE) is the method of choice in surgical treatment of cholelithiasis. Before 1999 in contraindications for LCE, classic cholecystectomy was performed. Since 2000 a mini-invasive method of cholecystectomy is used. Overall 168 cholecystectomies through mini-laparotomy were performed with good results. Cholecystectomies through mini-laparotomy may be realized in any form of cholelithiasis. This method has advantages and disadvantages, and may be regarded as alternative method when LCE is contraindicated.

Aged↗
PubMed1991

[Late results of cholelitholytic therapy of patients with cholelithiasis using chenodeoxycholic and ursodeoxycholic acids].

Specially selected 78 patients with cholelithiasis received drugs of chenodeoxycholic and ursodeoxycholic acids. Concomitant cardiovascular disorders were in 38 of them. Upon the end of the treatment course (12 months, on the average) the patients were examined and it was found that the stones disappeared in 22 of them. Follow-up evidence is available for 18 of these. Choleliths redeveloped in 9 patients (in 11 months, on the average). Of those who got free of choleliths nobody had relapses for 4.5 years. Various methods used in them to prevent lithogeny (diet, drugs) provided no evidence in favour of one of them. 9 patients with recurrent cholelithiasis after cholelitholytic therapy had no gallstone colic for 4.5 years of the follow-up. Considering the fact that preparations from cheno- and ursodeoxycholic acids are effective in only part of the patients, they seem preferable in patients with concomitant disorders (cardiovascular, etc.) to avoid a high operative risk.

Chenodeoxycholic Acid↗
PubMed1991

[The early rehabilitation of patients, operated on for peptic ulcer and cholelithiasis, at Mirgorod health resort].

The authors analyzed the condition of 51 patients in the early period of operation for ulcer and cholelithiasis. It was found that most patients showed asthenic, dyspeptic and pam syndromes, anemia, hypoacidic or achylous gastritis, inflammation at the operative site. As a result of treatment at the Mirgorod health resort (physiotherapy, mineral water) there occurred a significant improvement in the patients' condition. It is concluded that rehabilitation of patients following surgical intervention on the 20th day of operation for ulcer and cholelithiasis at the Mirgorod health resort has good perspectives.

Adult↗
PubMedDate not supplied

Gallstones in the golden hamster. XXXVI. Pigment cholelithiasis produced by retinoic acid.

Previously we have reported on the pigmentary lithogenic action of vitamin A in the form of retinol acetate. In the present work the possible lithogenic action of retinoic acid was tested, since this differs from retinol in several metabolic aspects, which can contribute to the understanding of the pathogenesis of the pigment cholelithiasis produced by vitamin A. Two experiments were performed in which the lithogenicity of retinol acetate added to a colony chow at the level of 25,000 IU%, was compared with that of 3 dietetic levels of all-trans retinoic acid. In the first experiment seric triglycerides were determined in order to establish whether there is a relation between the hypertriglyceridemic effect of retinoids and their lithogenicity; in the second experiment GPT and GOT were determined as indicators of hepatotoxicity. The results showed that the retinoic acid at levels of 24,000 and 35,000 IU% of diet, produced a cholelithiasis incidence similar to that of 25,000 IU% of retinol acetate, whereas the retinoic acid level of 12,000 IU% was not lithogenic. The dietetic retinoic acid produced a reduction of hepatic vitamin A, that was directly proportional to the level supplied. There was no relation between the hypertriglyceridemic effect of retinoids and its lithogenicity. The retinoids produced a light increase in GPT, which was higher with retinol acetate, whereas GOT had not significative changes. It is concluded that all-trans retinoic acid produces pigment gallstones in the hamster, with an incidence similar to that produced by retinol acetate.

Alanine Transaminase↗
PubMed1991

[Use of infrared spectrophotometry of bile for diagnosis of cholelithiasis and predicting the chemical composition of the concrements].

Infrared spectrophotometry was applied in bile investigation from 47 cholelithiasis, 53 acalculous chronic cholecystitis and 23 control subjects. A cholelithiasis--specific shift in the absorption band appeared in the range of 900-1150 cm-1. Bile calculi removed at surgery from 110 relevant patients and bile from them were exposed to infrared spectrophotometry. The authors derived a correlation between the shape of the absorption band for bile in the range of 1500-1800 cm-1 and chemical composition of the concrement.

Bile↗
PubMed1991

[The cellular-humoral immune factors of patients with cholelithiasis uncomplicated and complicated by an inflammatory process].

82 patients-10 p. with uncomplicated cholelithiasis, 8 p. with chronic calculous cholecystitis, 34 p. with choledocholithiasis with stenosing papillo-odditis--and 30 healthy controls were examined, with monoclonal antibodies of the firm "Becton-Dickinson". The following immunocompetent cellular clones and subclones were examined: CD3+, CD16+, CD4+, CD8+, CD19+ CD4/CD8, HLA-DR+, CD3+. The results were read with analyzer for fluorescently marked activated cell clones "FACS-TAR". The serum IgA, IgM, IgG, C3-C4 complement fractions and circulating immune complexes were also examined. The analysis of the results shows that in the complicated cases of cholelithiasis with an inflammatory process in the biliary ducts several humoral and cellular immune factors take part.

Adult↗
PubMed1990

[Study of crystalline structures of the bile in the diagnosis of cholelithiasis].

Under analysis were results of polarization microscopy of bile in 111 patients with cholelithiasis, 8 patients with acalculous cholecystitis and 8 practically healthy people. It was found that in healthy people there are no crystalline structures in the initial state of bile. The composition of bile from patients with cholelithiasis is characterized by the presence of three types of crystals: solid crystals of cholesterol monohydrate, calcium bilirubinate granules and calcium carbonate microspherolites. Polarization microscopy of bile may be used as a sufficiently simple method of diagnostics of stone disease.

Adult↗
PubMed1991

Choledocholithiasis in Chinese immigrants with cholelithiasis.

During the period from January 1987 to December 1989, admissions for biliary tract disease at the New York Infirmary--Beekman Downtown Hospital were split almost evenly between Chinese immigrants from southeast Asia and all other ethnic groups (Caucasian, Hispanic, black, et cetera). However, the incidence of choledocholithiasis in patients undergoing cholecystectomy for cholelithiasis was much higher in the Chinese immigrant population, 37.2 versus 11.8 per cent, a highly significant difference (p = 0.001). In addition, we often found the disease to be of greater severity in Chinese patients. They were more likely to have large numbers of stones in the duct and more likely to have significant ductal enlargement. This increased risk was essentially constant regardless of age. Because of this threefold risk of choledocholithiasis when operating on a Chinese immigrant from southeast Asia for cholelithiasis, intraoperative cholangiography is mandatory, even in those without other indications for common bile duct exploration.

Adolescent↗