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PubMed1993

Agenesis of the gallbladder in symptomatic adults. A case and review of the literature.

Agenesis of the gallbladder, with normal bile ducts, is a rare congenital condition occurring in 13 to 65 per 100,000 population, probably from failure of the gallbladder bud to develop or vacuolize in utero. Adults are usually asymptomatic. We report a 40-year-old woman with gallbladder agenesis, found at operation for presumed gallbladder disease. We review 44 similar cases: dyspepsia was the predominant symptom in 15 of 44 patients (34%); 24 of 44 (54%) had symptoms suggestive of biliary colic, and 12 of 44 (27%) had jaundice. Common duct stones were found in eight of 12 patients who were jaundiced, but not in any other. A familial tendency was reported in five series. Our patient and one other had another congenital anomaly. Ultrasound was performed on five patients: three had a small, shrunken gallbladder and in two the gallbladder was absent. Ultrasound may suggest the diagnosis if absence of the gallbladder is demonstrated in conjunction with another congenital anomaly.

Adult↗

PubMed1995

Expression of cystic fibrosis transmembrane conductance regulator in human gallbladder epithelial cells.

BACKGROUND: Hepatobiliary complications in cystic fibrosis result predominantly from lesions of the biliary epithelium. These abnormalities affect the intrahepatic as well as extrahepatic bile ducts and the gallbladder. The protein cystic fibrosis transmembrane conductance regulator (CFTR), the gene product defective in cystic fibrosis, functions as a cAMP-activated chloride channel in the plasma membrane. As such, it may represent an important driving force for fluid transport across the epithelium. EXPERIMENTAL DESIGN: The purpose of this study was to investigate the expression of CFTR in human gallbladder epithelial cells and to examine the chloride ion transport properties of these cells. Immunolocalization was performed on tissue sections. The reverse transcription-PCR was used to analyze the expression of CFTR mRNA in freshly isolated and cultured gallbladder epithelial cells. The CFTR protein was detected by Western blotting and immunoprecipitation. The chloride ion transport properties of the cells were determined by 36Cl efflux studies. RESULTS: The CFTR protein was immunodetected in human gallbladder in situ and localized predominantly to the apical membrane of epithelial cells. High levels of CFTR mRNA and protein were maintained in gallbladder epithelial cells in primary cultured. Glycosylated forms of CFTR were present as confirmed by treatment with N-glycanase. Chloride efflux was stimulated by Ca(++)-dependent pathways but more intensely by cAMP-dependent pathways. Stimulation of chloride efflux by agonist of the cAMP-pathway was inhibited by diphenylamine carboxylic acid, a chloride channel blocker. Two physiologically active peptides--acting via cAMP, vasoactive intestinal peptide, and secretin--also stimulated chloride efflux in vitro. CONCLUSIONS: Our results are consistent with a high expression of endogenous functional CFTR protein in human gallbladder epithelial cells. Physiologically active peptides, vasoactive intestinal peptide and secretin, stimulate chloride conductance in these cells. These findings indicate that CFTR play an important role in the pathophysiology of the biliary epithelium, including the gallbladder epithelium.

Base Sequence↗

PubMedDate not supplied

Gallbladder sensitivity to CCK in duodenal ulcer disease, highly selective and truncal vagotomy.

BACKGROUND/AIMS: Following truncal vagotomy, a heightened contractile response of the gallbladder to cholecystokinin (CCK) has been reported in patients. We investigated whether the gallbladder responsiveness to the CCK analog cerulein is also affected in patients with a highly selective vagotomy (HSV) and in duodenal ulcer patients, since most patients had truncal vagotomy for recurrent peptic ulcer disease. MATERIALS AND METHODS: Gallbladder emptying (cholescintigraphy) and plasma cholecystokinin like immunoreactivity (CCK-LI) levels were studied during infusion of graded doses of the CCK analog cerulein. RESULTS: In duodenal ulcer patients (n = 9), patients with HSV (n = 9), patients with truncal vagotomy (n = 9) and control subjects (n = 9), infusion of stepwise increasing doses of cerulein (1-16 ng.kg-1.h-1) induced dose related changes in plasma CCK-LI. In patients with truncal vagotomy, the gallbladder contraction in response to 1, 2 and 4 ng.kg-1.h-1 of cerulein was significantly increased over controls; whereas the gallbladder contraction to cerulein in duodenal ulcer patients and patients with HSV was not significantly different from controls. CONCLUSIONS: Thus, in patients with truncal vagotomy, gallbladder contractile response to CCK is significantly enhanced, possibly due to denervation of hepatic vagal branches since gallbladder contraction after CCK infusion shows no difference between post HSV or duodenal ulcer patients and the controls.

Adult↗

PubMed1998

Mechanism of gallbladder relaxation in the cat: role of norepinephrine.

We investigated the mechanisms of neurally mediated relaxation of cat gallbladder muscle. Muscle strips from the gallbladder corpus placed in the muscle bath with oxygenated Krebs' solution developed spontaneous active tension. Tension was measured with isometric force transducers, and muscle relaxation was expressed as percent decrease of active basal tension. Electrical field stimulation (EFS) evoked a tetrodotoxin-sensitive and hexamethonium-insensitive frequency-dependent relaxation with a maximal relaxation at 20 Hz. Gallbladder muscle strips also relaxed in response to increasing concentrations of vasoactive intestinal peptide (VIP), isoproterenol and, after pretreatment with phentolamine, norepinephrine. Nitric oxide synthase inhibitors N omega-nitro-L-arginine and N omega-nitro-L-arginine methyl ester at a concentration of 100 microM, which blocked EFS-induced relaxation in the lower esophageal sphincter, had no significant effect on EFS-induced gallbladder muscle relaxation. The VIP antagonists VIP10-28 and [4Cl-D-Phe6,Leu17]VIP at a concentration of 10 microM that blocked exogenous VIP-induced gallbladder relaxation also had no effect on the relaxation caused by EFS. In contrast, either propranolol or guanethidine at concentrations of > or = 1 microM significantly reduced EFS-evoked gallbladder relaxation (P < .01, analysis of variance). It is concluded that norepinephrine utilizing beta adrenergic receptors mediates EFS-stimulating postganglionic intramural neurons in the cat gallbladder.

Animals↗

PubMedDate not supplied

Hypoplasia of the left hepatic lobe associated with floating gallbladder: a case report.

Agenesis or hypoplasia of the hepatic lobe and floating gallbladder are both rare. We report an extremely rare case of hypoplasia of the left hepatic lobe accompanied by floating gallbladder. The patient was a 71-year-old woman, with no past history of related symptoms, who was admitted for further evaluation of postprandial epigastralgia, nausea, and diarrhea. Laboratory data on admission showed chronic liver disease with positive anti-hepatitis C virus antibody. Abdominal ultrasonography and computed tomography revealed the absence of the left hepatic lobe and displacement of the gallbladder to the left. On endoscopic retrograde cholangiography, the cystic duct originated from the right side of the bile duct, but the gallbladder was displaced to the left. Poor yolk-induced gallbladder contraction suggested the existence of hypotonic biliary dyskinesia. Angiography demonstrated no middle or left hepatic arteries, indicating congenital hypoplasia of the left hepatic lobe. Open cholecystectomy was carried out, and a diagnosis of hypoplasia of the left hepatic lobe accompanied by floating gallbladder and chronic hepatitis was confirmed. We believe that this is the first reported case of a hypoplasia of the left hepatic lobe coexisting with floating gallbladder.

Aged↗

PubMed1998

Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma.

BACKGROUND: We sought to determine the incidence of recurrence of carcinoma at the port site and the outcome of patients with such recurrences after exploratory laparoscopy/laparoscopic cholecystectomy for unsuspected gallbladder carcinoma and analyzed aspects of the laparoscopic procedure associated with recurrences at the port site. METHODS: Thirty-seven patients with preoperatively unknown adenocarcinoma of the gallbladder were analyzed. The patients were part of a large prospective study of the Swiss Association of Laparoscopic and Thoracoscopic Surgery including 10,925 patients undergoing laparoscopic cholecystectomy. RESULTS: Preoperatively undiagnosed adenocarcinoma of the gallbladder is rarely encountered in patients undergoing laparoscopic cholecystectomy (0.34%). The incidence of recurrence of carcinoma at the port site in these patients is 14% (5 of 37) and is similar whether the primary tumor is confined to the gallbladder (T1/T2) or locally advanced (T3/T4). The recurrences at the port site were diagnosed within 6 to 16 months (median 10 months) after the operation. Patients with an intraoperative perforation of the gallbladder had a higher incidence of recurrences at the port site (40%) than had patients without perforation (9%; P = .13). All patients with recurrences at the port site had distant metastases and all died of the disease 12 to 35 months (median 19 months) after cholecystectomy; all patients with such recurrences and stage T1/T2 tumors subsequently had peritoneal metastases. CONCLUSIONS: Patients with a preoperatively undiagnosed adenocarcinoma of the gallbladder undergoing laparoscopy or laparoscopic cholecystectomy have a high incidence of recurrences at the port site, and the incidence increases when a gallbladder perforation occurs during the operation. All patients with such recurrences died of the disease. The diagnosis of an isolated recurrence at the port site may therefore be an indicator of disseminated disease in most cases.

Adenocarcinoma↗

PubMed1999

Melanoma of the gallbladder: a review of cases seen at Duke University Medical Center.

BACKGROUND: Both primary and metastatic melanoma of the gallbladder are rare. In cases involving isolated tumors of the gallbladder, there continues to be controversy regarding the establishment of primary status. Despite appropriate therapy, the diagnosis of either condition portends a poor prognosis, with few patients surviving more than 2 years. METHODS: A review of all patients seen at Duke University Medical Center since 1970 generated 1 case of primary and 19 cases of secondary melanoma of the gallbladder. These were analyzed with respect to presentation, clinical and pathologic diagnosis, treatment, and prognosis. RESULTS: The sole patient with a primary lesion presented with acute cholecystitis. Ultrasound demonstrated a mass in the lumen of the gallbladder. Cholecystectomy revealed melanoma, and the patient eventually died of disseminated disease 13.5 months later. Survival was poor for patients who presented with metastases to the gallbladder in the setting of widespread disease, with 0% survival at 1 year (n=11). Those with isolated, resectable lesions fared better overall, with 100% survival (n=6) at 1 year. One patient remains alive and free of disease 13.8 years later, which, to our knowledge, represents the longest documented survival for a patient with melanoma that has metastasized to the gallbladder. CONCLUSIONS: Surgery remains the mainstay of therapy for patients with gallbladder melanoma and appears to improve patient outcome in the setting of resectable disease. Hopefully, further investigations will lead to standardized protocols for the treatment of these lesions.

Adult↗

PubMed1996

DNA ploidy and S-phase fraction of neoplastic and non-neoplastic lesions of the human gallbladder.

Studies on the cell kinetics of the human gallbladder are difficult because of epithelial degeneration by bile. Using the epithelial isolation technique, however, we were able to determine the degree of degeneration and to examine the cell kinetics of gallbladder lesions in freshly resected surgical specimens. Normal and neoplastic epithelia were isolated nonenzymatically from freshly resected gallbladder. The nuclear DNA content and S-phase fraction were estimated in 110 patients with gallbladder lesions by flow cytometry (FCM). Normal tissues and all lesions except carcinomas were diploid. The S-phase fraction of gallstone cases was significantly higher (1.47 +/- 0.70%; mean +/- SD) than normal (0.79 +/- 0.39%) (P < 0.0006). All gallbladder carcinomas were multiploid, and their S-phase fraction was 11.63 +/- 3.65%. Cell renewal of normal gallbladder is low. In the gallstone cases, the S-phase fraction was increased, possibly correlated with carcinogenesis.

Adult↗

PubMed2001

Gallbladder muscle dysfunction in patients with chronic acalculous disease.

BACKGROUND & AIMS: The mechanisms responsible for the abnormalities of gallbladder emptying in patients with chronic acalculous gallbladder disease (AGD) have not been elucidated. This study was designed to determine whether a muscle defect could explain this gallbladder dysfunction. METHODS: Gallbladder contraction induced by a continuous intravenous cholecystokinin octapeptide (CCK-8) infusion was determined by ultrasonography in control subjects, patients with AGD, pigment stones, and cholesterol stones. Muscle cells were obtained by enzymatic digestion. (125)I-CCK-8 binding and [(35)S]guanosine triphosphate gamma S (GTP gamma S) binding studies were performed. RESULTS: In vivo gallbladder contraction induced by CCK-8 was significantly lower in AGD (29.4%) and cholesterol stones (28.8%) than in pigment stones (59.8%) and normal controls (57.8%; P < 0.01). In vitro muscle cell contraction induced by CCK-8 was also lower in AGD than in pigment stones. It remained impaired in AGD after stimulation with the G-protein activators GTP gamma S and AlF(4) and with the second messenger 1,2-dioctanoyl-sn-glycerol. However, GTP gamma S binding induced by CCK-8 and vasoactive intestinal polypeptide and the binding capacity of CCK receptors were not different between AGD and pigment stones. CONCLUSIONS: These findings suggest that there is a good correlation between in vivo and in vitro gallbladder response to CCK-8 in patients with AGD. Unlike those found in cholesterol stones, the muscle defects in AGD appear to reside in the contractile apparatus.

Cell Membrane↗

PubMed1993

[Differential diagnosis of gallbladder diseases by superselective angiography of the cystic artery].

To clarify differential points of angiographic findings, cystic angiograms of 46 patients with various gallbladder diseases were studied. In cases of gallbladder carcinoma, the angiographic findings differed in degree of the depth of cancer invasion and the shape of tumor. Abnormal findings in arterial phase were seen even in some cases of early carcinoma and tumor stains were clearly seen in all cases except for cases of superficial type of early carcinoma. In cases of cholecystitis, the findings on the degree of inflammation and wall thickening of the gallbladder varied. It was important for differential diagnosis between carcinoma and inflammation of the gallbladder to fully understand reciprocal relation of arterial and venous phase of the cystic angiogram. In cases of adenomyomatosis of the gallbladder, dilatation and tortuosity of the branches of the cystic artery and an increase of vascularity in the thickened wall were characteristic. Faint tumor stains were seen in some cases of cholesterol polyps of the gallbladder, which indicates that malignancy should not be diagnosed based only on the presence of such stains.

Adult↗

PubMed1998

[Diagnosis of the wall-thickened lesions of the gallbladder with dynamic MRI].

We studied 32 patients with the thickened lesions of the wall of the gallbladder by using dynamic MRI. We tried the differential diagnosis of gallbladder lesions according to the time intensity curve (TIC) and enhanced pattern. TIC of carcinoma was elevated more seeply from plain to arterial phase than the inflammatory diseases. The Inflammatory diseases were keeping three-layer structures of the wall of the gallbladder, but gallbladder carcinoma destroys the wall-structure. We could diagnose as direct liver invasion of the carcinoma clearly. We could exactly diagnose adenomyomatosis in dynamic MRI by small low intensity spots within the wall of the gallbladder. In the patients with gall stones, the wall of the gallbladder were more clearly observed in dynamic MRI compared with US and EUS.

Carcinoma, Adenosquamous↗

PubMed2002

Oral clarithromycin enhances gallbladder emptying induced by a mixed meal in healthy subjects.

Background: In humans, erythromycin has been demonstrated to accelerate gallbladder emptying due to its motilin-like effects on the gastrointestinal tract. Recently, it was shown that clarithromycin, another macrolide, used for the eradication of Helicobacter pylori infection, also stimulated gastrointestinal motility in the fasting state. We conducted a comparative study on the effects of a single oral dose of clarithromycin and of erythromycin on gallbladder emptying in healthy subjects. Methods: Gallbladder emptying variables (residual volume, ejection fraction, area under emptying curve) were measured by ultrasound in 21 healthy subjects (11 males, 10 females, mean age 42.5+/-10.6 years). A test meal (14 g fat, 425 kcal) was ingested 30 min after a single oral dose (500 mg) of either clarithromycin or erythromycin, and the measurements were repeated the following day with the other drug (cross-over double-blind study). A control group consisting of 12 subjects (seven males, five females, mean age 50.7+/-8.2 years) was used to evaluate gallbladder emptying following the same test meal without drug administration. Differences between groups were analyzed using two-tailed Student's t-test for unpaired observations. Results: Gallbladder emptying at 60, 75, and 90 min was greater after erythromycin (P<0.05 at 90 min) and clarithromycin than it was in controls. The ejection fraction was significantly greater after clarithromycin (76.5%) and erythromycin (79.7%) than it was in controls. Gallbladder refilling occurred earlier after clarithromycin than after erythromycin. Conclusions: The prokinetic effect of clarithromycin on the gallbladder appears to be of similar amplitude but of shorter duration than that of erythromycin.

Journal Article↗

PubMed1990

Microprocessor-assisted solvent transfer system for effective contact dissolution of gallbladder stones.

Dissolution of cholesterol gallbladder stones by manual lavage with methyl tert-butyl ether (MTBE) via a percutaneous indwelling gallbladder catheter is reviewed. The procedure is labor intensive and requires several hours, is associated with escape of solvent into the biliary tract, and is incomplete since residue remains. To solve these problems, a microprocessor-assisted solvent transfer (MST) system was developed. The system consists of a three-lumen catheter, dual peristaltic pumps, a pressure transducer, and a microprocessor controller which regulates pump rate according to the measured intraluminal gallbladder pressure. The two pumps simultaneously infuse and aspirate from the gallbladder via two of the catheter lumens; intraluminal pressure is monitored using the third lumen. An increase in intraluminal pressure above a set limit causes infusion to cease while aspiration continues, thus lowering the pressure and preventing overflow of gallbladder contents into the biliary tract. In vitro evaluation showed that the system's response was 156 fold faster than the natural rate of gallbladder emptying. The time required for gallstone dissolution by MTBE was measured in vitro using the MST system and found to be 48 +/- 23 (M +/- SE) min at 100 mL/min flow, 15 +/- 5 min at 150 mL/min flow, 12 +/- 4 min at 200 mL/min flow, and 6 +/- 1.4 min at 250 mL/min flow. No residual debris remained with flow rates greater than 150 mL/minute. These in vitro studies suggest that the MST system is capable of rapid, complete, and fully automatic contact dissolution of cholesterol gallbladder stones using MTBE or similar lipid solvents.

Cholelithiasis↗

PubMed1993

Motor cycles with phase III in antrum are associated with high motilin levels and prolonged gallbladder emptying.

We examined the relationship of interdigestive gallbladder emptying with the different phases of the migrating motor complex (MMC) and with plasma levels of cholecystokinin (CCK) and motilin. In 10 volunteers 20 cycles of the MMC were recorded. In 11 cycles phase III occurred in antrum and duodenum (group 1). In nine cycles phase III was observed only in duodenum (group 2). In group 1 gallbladder emptying started at 30% of total cycle length and continued until the end of the cycle. Maximal gallbladder emptying was 33.3 +/- 3.3% (SE). In group 2 gallbladder emptying also started at 30% of total cycle length but ended at 60%. Maximal gallbladder emptying in this group was 24.3 +/- 3.1% (P < 0.05). Motilin levels were higher in group 1 than in group 2 during phase IIB (240.1 +/- 28.5 and 142.1 +/- 30.9 pg/ml, respectively, P < 0.05) and during phase III (210.8 +/- 24.3 and 93.5 +/- 12.5 pg/ml, respectively, P < 0.05). We conclude that: 1) phase III activities starting in the antrum are preceded by greater and prolonged gallbladder emptying, higher motilin levels, and higher intraduodenal bile acid concentrations than phase III activities starting in the duodenum and 2) no relationship between interdigestive gallbladder motility and CCK levels could be demonstrated.

Adult↗

PubMed1998

Spontaneous passage of gallbladder calculi--facilitation by endoscopic sphincterotomy.

After endoscopic sphincterotopy (ES) gallbladder motility increases leading to expulsion of crystals and stones. But this is not a universal phenomenon. We evaluated cholangiographic findings in patients emptying their gallbladder after ES for common bile duct (CBD) stones. Cholangiographic features of twenty patients expelling gallbladder calculi after ES were studied. Controls included 20 age and sex matched patients with gallstones and CBD stones, who did not expel gallstones after ES. Of 20 cases in study group, 9 recovered more than 20 stones each in the stool within 7 days of ES. Repeat ERCP showed empty gallbladder in all, whereas CBD was full of stones in 11 of the 20 cases. In the study group, low insertion of the cystic duct was more common (10 vs 0, p < 0.04), the cystic duct made a narrow angle (20 +/- 5 degrees vs 50 +/- 10 degrees, p < 0.04) with CBD before insertion and cystic duct diameter was higher (5 mm vs 2.5 mm, p < 0.04) as compared to controls. We conclude that in patients undergoing ES with intact gallbladder and small gallbladder calculi, spontaneous emptying of gallbladder calculi occurs, if cystic duct is wider, has low insertion and makes narrow angle with CBD before insertion.

Adult↗

PubMed1995

CT finding of transient focal increased attenuation of the liver adjacent to the gallbladder in acute cholecystitis.

OBJECTIVE: The purpose of this article is to report the finding of transient focal increased attenuation of the liver adjacent to the gallbladder on enhanced CT scans in patients with acute cholecystitis. This finding should not be confused with primary liver abnormalities. MATERIALS AND METHODS: Five patients with acute cholecystitis were studied. Because a thickened gallbladder wall was seen on sonography, all patients were examined preoperatively with incremental dynamic helical CT to exclude carcinoma of the gallbladder. CT findings were compared with results of sonography for five patients, MR imaging for two patients, and surgery for five patients. RESULTS: Transient focal increased attenuation of the liver adjacent to the gallbladder was seen in the early phase of incremental dynamic CT in five patients and extended into the medial segment anterior to the porta hepatis. The areas showing increased attenuation adjacent to the gallbladder had a curvilinear shape around the gallbladder. No hepatic masses were seen on sonograms, on MR images, or at surgery. CONCLUSION: Transient focal increased attenuation of the liver may occur on CT scans in patients with acute cholecystitis. The increased attenuation associated with acute cholecystitis has a typical location and pattern. This finding is probably attributable to hepatic arterial hyperemia and to early venous drainage caused by the adjacent inflamed gallbladder. This finding should be differentiated from hypervascular hepatic tumors.

Acute Disease↗

PubMedDate not supplied

Expression of the c-erb-B2 and p53 protein in gallbladder carcinomas.

Gallbladder carcinoma is the most common malignancy of the biliary tract in Korea and known to be more common in East Asia and Latin America than in Europe and North America. However, their exact histopathological characteristics and carcinogenesis are not well-elucidated. A total of 71 cases of gallbladder carcinomas, two cases of gallbladder dysplasia and 20 cases of gallbladder adenoma were immunohistochemically studied to evaluate the expression of c-erb-B2 and p53 proteins in the light of their relationship with various prognostic factors. Thirty-three gallbladder carcinomas (46.5%) showed positive staining for c-erb-B2, but none of the dysplasia and adenoma were positive (p<0.05). c-erb-B2 was stained in the cell membrane of the cancer cells. Adjacent normal mucosa was negative for c-erb-B2 staining. Forty-eight gallbladder carcinomas (67.6%) showed positive staining in the nucleus for p53 protein. None of the cases with dysplasia, adenoma, and normal mucosa stained positive for p53 protein. There was no significant correlation between c-erb-B2 and p53 expression and age, gender, histological tumor grade, and tumor stage. In the multivariate analysis, tumor stage approached statistical significance (p=0.05), but c-erb-B2 and p53 expression was not significant (p=0.14 and p=0.29, respectively). The mean survival periods of the c-erb-B2 positive and negative groups were 26 months and 52 months, respectively (p=0.02). However, the mean survival periods of the p53 protein positive and negative patients were 34 months and 35 months, respectively (p=0.45). In conclusion, our results suggest that c-erb-B2 and p53 protein expression is strongly associated with neoplastic progression in gallbladder carcinomas, and that c-erb-B2 expression identifies patients with a worse prognosis.

Adenocarcinoma↗

PubMed1975

Bile acid pattern of gallbladder and hepatic bile in patients with and without cholesterol gallstones.

Bile acid composition of hepatic and gallbladder bile was examined in a group of 18 patients with uncomplicated cholelithiasis and a control group consisting of 13 patients with healed duodenal ulcers. Bile specimens were taken during laparotomy. Molar concentrations of the different bile acids in hepatic and gallbladder bile were determined. The ratios between the molar concentrations of the different bile acids were calculated. In order to compare these molar ratios in hepatic and gallbladder bile the quotients between identical molar ratios of hepatic and gallbladder bile were calculated in each subject. Bile acid concentration of the gallbladder bile was found to be lower in the gallstone patients. Trihydroxy or dihydroxy bile acid molar ratio was lower in the gallstone group. Hepatic to gallbladder relative trihydroxy to dihydroxy and cholate to deoxycholate bile acid ratios were elevated in the gallstone patients. This might indicate that an increased formation of deoxycholate is the main cause for the decreased trihydroxy to dihydroxy bile acid molar ratio observed in the gallbladder bile of patients with cholesterol gallstones.

Adult↗