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PubMed1992

The role of eicosanoids in experimental and clinical gallbladder disease.

The mammalian gallbladder has been shown by many authors to synthesize and release arachidonic acid metabolites. Many factors influence gallbladder eicosanoid release including sex of the animal, neural influences, age of the animal, pathologic stimuli (gallstones, inflammation), chemical mediators, hormones and the presence of hypercholesterolemia. The net result of these factors is release of gallbladder eicosanoids which act as paracrine substances to influence the gallbladder physiologic functions of water transport and motility. This review examines the experimental in vivo and in vitro experimental studies that have examined the various factors that alter mammalian gallbladder eicosanoid release in normal and pathologic states.

Animals↗
PubMedDate not supplied

Estrogen replacement therapy and gallbladder disease in postmenopausal women.

OBJECTIVE: To examine the role of estrogen replacement therapy on the development of gallbladder disease in postmenopausal women. DESIGN: Systematic review of the English literature was conducted. All studies that addressed the association between hormone replacement therapy and gallbladder disease published from 1970 to the present were reviewed. RESULTS: Seven observational studies, two clinical trials, two case series, and one nonrandomized and three randomized investigations were reviewed. The results of each study were reported and analyzed. CONCLUSIONS: Estrogen replacement therapy in postmenopausal women increased the chances for gallstone formation.

Bile↗
PubMed1982

Risk factors for postoperative respiratory complications and their predictive value. A study in 40-75 year-old men undergoing elective surgery for peptic ulcer or gallbladder disease.

Age, body weight, smoking, chronic bronchitis and duration of anaesthesia were assessed as risk factors for respiratory complications following surgery for peptic ulcer or gallbladder disease. The studies were made on 53 men aged 40-75 years. All variables were associated with increased postoperative risk of chest X-ray abnormality or arterial hypoxaemia or clinically overt respiratory complications. In the statistical analysis, however, none of the factors proved to be useful as a predictor of postoperative respiratory complications. The observed high frequencies of X-ray abnormalities (54%) and arterial hypoxaemia (43%) after operation indicate potential dangers. They may be reduced by cessation of smoking before the operation and reduction of weight.

Adult↗
PubMed2002

[Cost-effectiveness analysis of a preventive program for gallbladder disease in Chile].

BACKGROUND: Chilean women have one of the highest mortality rates from gallstone disease in the world. There is no primary prevention for the disease and the benefits of prophylactic cholecystectomy in high risk groups have not been studied. AIM: To analyze the cost and effectiveness of a screening program for gallbladder disease in the Chilean women population. METHODS: A decision analytic model is used to compare lifetime cost and effectiveness of standard care with three screening strategies. The first two strategies consider "universal ultrasound screening" for all women 40 years old and laparoscopic cholecystectomy for those with gallstones ("elective intervention") or with calculous > or = 3 cm ("high risk intervention"). The third strategy is based on "selective screening" for obese women. RESULTS: The lifetime probability of a 40 years old Chilean woman of dying from gallbladder disease is reduced by 70% in the universal screening/elective intervention, by 63% in the high risk intervention and by 18% in the selective screening strategy. Her lifetime expectancy increases by 5.25, 4.64 and 1.24 months respectively. The incremental cost-effectiveness ratio of each screening strategy is US$ 180, US$ 147 and US$ 481 respectively. CONCLUSION: A screening program for gallbladder disease in a high risk population achieves significant benefits at a low incremental cost and acceptable cost-effectiveness.

Adult↗
PubMed1990

A case-control study of the relationship between smoking, diet, and gallbladder disease.

Eighty-four women with roentgenographically confirmed gallbladder disease and 171 control women hospitalized at a trauma hospital in Athens, Greece, were interviewed regarding demographic, reproductive, smoking, and dietary characteristics. A food-frequency approach was used to elicit consumption of 120 food or beverage items during the period before the onset of the current illness or hospitalization. The patients were substantially less likely to be regular cigarette smokers before the current admission. Additionally the patients reported significantly less frequent consumption of total items contained in the following food groups: sugars; pulses, nuts, beans; fish; and dairy products. On average they also consumed significantly fewer alcoholic beverages. On the other hand, the patients reported more frequent consumption of items in the following food groups: cereals, potatoes, fruits, meats, fats and oils, and coffee/tea. After controlling for confounding between food groups through multiple logistic regression models, the patients were still found to be less frequent consumers of vegetables and alcoholic beverages but more frequent consumers of potatoes and items in the cereal group. These analyses also confirmed the reduced likelihood of the patients being smokers.

Adult↗
PubMed1978

Gallbladder wall thickening: a new sign of gallbladder disease visualized by gray scale cholecystosonography.

The use of gray scale equipment in a prospective study of radiologically non-visualizing gallbladders, permitted detection of a new echographic aspect of gallbladder disease. Along with even, discrete bile thickening and the presence of sand-sized calculi, thickening of the gallbladder wall incholecystitis is another ultrasonographic sign of gallbladder disease that can be visualized successfully by gray scale ultrasound.

Cholecystography↗
PubMed1989

[Superselective angiography of the cystic artery for diagnosis of gallbladder diseases].

Superselective angiography of the cystic artery was attempted with 18 patients for the purpose of improving angiographic diagnosis of gallbladder diseases. The success rate of cystic angiography using a fine catheter (5 Fr. size) and a specially coated guidewire was 72% (13/18). In comparison with usual hepatic angiography findings obtained by cystic angiography proved easier to evaluate, because the angiograms thus obtained avoided visualization of the hepatic artery and showed good opacification of the fine branches of the cystic artery. It is concluded that angiographic diagnosis of gallbladder diseases can be improved by use of superselective cystic angiography.

Angiography↗
PubMed1985

Detection of occult gallbladder disease by duodenal drainage collected endoscopically. A clinical and pathologic correlation.

The bile of 100 patients with abdominal pain (suspected of having gallbladder disease) was collected from the duodenum at the time of esophagogastroduodenoscopy and examined for cholesterol and calcium bilirubinate crystals. Sixty of these patients had both negative oral cholecystograms and negative gallbladder sonograms, as well as no other objective evidence of gallbladder pathology. These patients are the subject of this report. Thirty-eight per cent of the 60 patients demonstrated crystals in bile collected at the time of endoscopy. None of the patients treated medically showed any improvement. Eight of the patients (35%) underwent cholecystectomy with 75 per cent of the gallbladders showing histologic pathology, and the remainder showing no pathology. However, all patients undergoing surgery who responded to a questionnaire improved whether or not pathology was found in the gallbladder. In contradistinction, of the patients undergoing surgery in whom no crystals were seen in the bile collected from the duodenum, pathology was found in only one third of the gallbladders and these patients' symptoms improved with surgery. Two thirds of the remaining patients had no pathologic changes in their gallbladder and only 50 per cent of these patients showed any improvement following surgery. However, patients who did not have crystals in their bile and were treated without surgery had a 58 per cent improvement rate with medical treatment alone. Duodenal drainage collected at the time of endoscopy and examination of the bile for cholesterol and bilirubinate crystals is a valuable adjunct in predicting which patients will respond favorably to cholecystectomy when there is no radiographic evidence of gallbladder disease.

Bile↗
PubMed1985

Gallbladder disease in the morbidly obese.

During a 7 year period, 200 consecutive morbidly obese patients underwent a standardized gastric exclusion procedure. Group A was composed of the first 120 patients and Group B of the last 80 patients. In Group A, 22 patients had undergone a previous cholecystectomy and 12 patients had a cholecystectomy at the time of gastric exclusion because of positive diagnostic studies or palpation of stones. Of the remaining 87 patients in this initial group who were at risk for the development of gallbladder disease, 24 (27.6 percent) required a cholecystectomy in the first 3 postoperative years (mean 15.6 months). Twelve patients had acute cholecystitis, 3 patients had choledocholithiasis, and 1 patient had acute gallstone pancreatitis. In Group B, 18 patients had a previous cholecystectomy, 15 had positive diagnostic studies (ultrasonography and oral cholecystography) preoperatively, and 47 had negative studies. Cholecystectomy was routinely performed at the time of gastric exclusion surgery in the 62 patients with gallbladders in Group B. Of the 47 patients who had normal preoperative diagnostic studies, 40 (85.1 percent) had abnormal histologic findings in the gallbladder. Only seven patients in Group B had a normal gallbladder (14.7 percent). We conclude that gallbladder disease is considerably more frequent in the morbidly obese population (91.3 percent) than has previously been recognized, that diagnostic studies are frequently inaccurate, and that postoperative gallbladder disease is common (28.7 percent). On the basis of these results, routine cholecystectomy at the time of gastric exclusion surgery is recommended.

Adolescent↗
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↗
PubMedDate not supplied

Age profiles of benign gallbladder disease in 2,000 patients.

Hospital charts and operative notes on 2,000 consecutive cholecystectomies performed between 1965-1984 for benign gallbladder disease were reviewed and computer analyzed. Patients were divided into five age categories (1-29, 30-49, 50-69, 70-79, 80 years and above). Fifteen variables were examined for each age category, including total number, sex, presenting symptoms (jaundice, acute cholecystitis, pancreatitis), intraoperative findings (presence of stones, common bile duct width and stones), operative procedures, bile cultures, histology, postoperative course and mortality. In addition to critically assessing performance and permitting comparison with other series, this age-related analysis suggests the following conclusions: The female predominance in age category 1 diminishes in categories 4 and 5. Acute cholecystitis and suppurative cholangitis occur in 44% of age category 5, compared to 14-24% in other age categories. Intraoperative fluorocholangiography is mandatory; common bile duct stones were found in 14% of age category 1. Age category 2 seems to be the group least susceptible to choledochal pathology. Acalculous cholecystitis is closely related to gangrenous changes, especially (almost selectively) in age categories 4 and 5. The frequency of infected bile rises with age, and is found in 90% of patients in age category 5. Mortality from operations for benign gallbladder disease is ten times higher in patients over 70 years of age compared to younger patients. An ultrasonographic study should be performed before any major laparotomy, especially in the aged, in order to diagnose silent stones, and prepare the patient for concomitant cholecystectomy. Elective cholecystectomy in age categories 4 and 5 is still accompanied by high mortality rates.

Adolescent↗
PubMed1984

Genetics and epidemiology of gallbladder disease in New World native peoples.

Native peoples of the New World, including Amerindians and admixed Latin Americans such as Mexican-Americans, are highly susceptible to diseases of the gallbladder. These include cholesterol cholelithiasis (gallstones) and its complications, as well as cancer of the gallbladder. Although there is clearly some necessary dietary or other environmental risk factor involved, the pattern of disease prevalence is geographically associated with the distribution of genes of aboriginal Amerindian origin, and levels of risk generally correspond to the degree of Amerindian admixture. This pattern differs from that generally associated with Westernization, which suggests a gene-environment interaction, and that within an admixed population there is a subset whose risk is underestimated when admixture is ignored. The risk that an individual of a susceptible New World genotype will undergo a cholecystectomy by age 85 can approach 40% in Mexican-American females, and their risk of gallbladder cancer can reach several percent. These are heretofore unrecognized levels of risk, especially of the latter, because previous studies have not accounted for admixture or for the loss of at-risk individuals due to cholecystectomy. A genetic susceptibility may, thus, be as "carcinogenic" in New World peoples as any known major environmental exposure; yet, while the risk has a genetic basis, its expression as gallbladder cancer is so delayed as to lead only very rarely to multiply-affected families. Estimates in this paper are derived in part from two studies of Mexican-Americans in Starr County and Laredo, Texas.

Adolescent↗
PubMedDate not supplied

Laparoscopic management of gallbladder disease in children and adolescents.

BACKGROUND: Between July 1991 and April 1996, 40 children and adolescents age 17 or less underwent laparoscopic management of their gallbladder disease. Twenty-eight patients were females and 12 were males. Their average age was 12.7 years (range 2-17 years), and average weight was 50 kilograms, range 12.2-95.9 kilograms. Nine patients had gallstone pancreatitis and seven patients had sickle cell disease. Laparoscopic cholecystectomy was attempted in all patients with or without modifications of the standard technique dictated by the size of the patient. METHODS: The practice of intraoperative cholangiogram varied with the practicing surgeon. Those with clinical or biochemical evidence of common bile duct obstruction underwent preoperative endoscopic retrograde cholangiopancreatography to rule out other causes of hyperbilirubinemia and/or therapy for choledocholithiasis if present. Patients with unsuccessful intraoperative cholangiogram were followed clinically and were subjected to postoperative endoscopic retrograde cholangiopancreatography should they develop clinical or biochemical evidence of common bile duct obstruction. Thirty-six patients were completed laparoscopically (90%). Four patients were converted to open cholecystectomy (10%). Four patients required preoperative endoscopic retrograde cholangiopancreatography and were successfully treated. Postoperative endoscopic retrograde cholangiopancreatography was unsuccessful in one patient who required the procedure because of retained common bile duct stone. Four patients suffered complications (10%). Three patients continued to have abdominal pain that was not helped with surgery. CONCLUSIONS: Based on our experience, laparoscopic cholecystectomy with preoperative endoscopic retrograde cholangiopancreatography if required, is safe and effective in management of gallbladder disease in children and adolescents. However, careful preoperative evaluation is required to avoid persistent postoperative abdominal pain.

Adolescent↗
PubMed1991

Gallbladder disease and coronary artery disease: is there a link?

Both gallstones and coronary artery disease are associated with cholesterol. Therefore, the literature was searched for evidence that gallbladder disease can be considered a risk factor for coronary artery disease. The problem has been approached from several angles. Studies designed to discover whether lipid profiles associated with gallbladder disease are similar to those associated with coronary artery disease have shown contradictory results. Autopsy studies have indicated that atherosclerosis appeared to be more extensive in patients with gallstones, but, again it was unclear whether the relationship was causal or merely reflected coincidental factors of some other origin. A study attempting to find a relationship between gallstone formation and a low-cholesterol diet actually showed a higher rate of gallstone formation among the patients on the low-cholesterol diet. Possible explanations for the results of these various studies are offered.

Arteriosclerosis↗