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PubMed2002

Characteristics and cholinergic control of the 'minute rhythm' in ovine antrum, small bowel and gallbladder.

Eight adult conscious rams were used to characterize further the minute rhythm and to determine the role of cholinergic receptors in nervous control of this event. In chronic experiments, the myoelectrical and motor activity of the gastrointestinal tract and gallbladder were recorded. Physiological experiments were performed in fasted or non-fasted rams before, during and after feeding, and the occurrence of minute rhythm during various phases of the migrating motor myoelectric complex was observed. The pattern occurred most frequently in the small intestine, where it exhibited mostly the propagating character. It was also detectable in the ileum. In the gallbladder, the minute rhythm arrived systematically and its character was irregular, propagating, retropropagating or stationary. In all episodes observed, it was well correlated with that in the small intestine. In the pyloric antrum, the minute rhythm was identified occasionally. During pharmacological experiments, 0.15 M NaCl or graded doses of hexamethonium, atropine and pirenzepine were administered intravenously during various phases of the migrating motor myoelectric complex, in fasted and non-fasted animals, before and during feeding. The drugs inhibited the minute rhythm in the small bowel for a longer period than in the gallbladder. However, the smallest dose of pirenzepine (0.02 mg/kg) exerted a non-significant effect both in the small intestine and in the gallbladder. It is concluded, that in normal conditions the minute rhythm occurs regularly in the entire small intestine and in the gallbladder. In the small intestine the pattern is organized more precisely. The minute rhythm is controlled by nicotinic receptors and by muscarinic receptor subtypes.

Animals↗

PubMed2003

Gallbladder cancer in northern Jordan.

BACKGROUND AND AIM: To highlight the epidemiological, clinical, and pathological features of gallbladder cancer in Jordan as a model for the Middle East. Only scattered reports are available from this region. METHODS: The histopathological reports and the hospital records for all cholecystectomies performed at Princess Basma Teaching Hospital between 1994-2000 were retrospectively reviewed to identify all patients with gallbladder carcinoma. All the histological slides for the cancer group were reviewed and reclassified by a single pathologist. RESULTS: Of 4502 cholecystectomies performed, 33 cases (0.73%) of gallbladder carcinoma were found. The mean age was 61.4 years (range 39-80 years). The male : female ratio was 1 : 3.7. Biliary colic and/or acute cholecystitis were the main presentations. Gallstones were present in 88% (29/33) of the patients. The spectrum of histological subtypes was similar to other series. Only three cases were diagnosed preoperatively, making the incidence of incidental gallbladder cancer 0.66% (30/4502). Simple cholecystectomy was performed for 13 patients. The remaining 20 patients underwent cholecystectomy and portal lymphadenectomy with (five cases) or without (15 cases) extrahepatic resection of the bile ducts. The mean follow up was 22 months (SD +/- 18.95 months; range 1-96 months). The 2-year survival rates for stages I, II, III, and IV were 100%, 42.9%, 10.8%, and 0%, respectively (P = 0.0013). CONCLUSIONS: The importance of a high index of suspicion when dealing with cholelithiasis in elderly patients, particularly with large sized stones, cannot be over-emphasized. Proper gross inspection in the theater should be a routine procedure performed by all surgeons. Routine ultrasound for suspected gallbladder stones should always be performed under the supervision of senior radiologists.

Adult↗

PubMed2000

Overexpression of p53 protein in gallbladder carcinoma in North India.

AIMS: p53 mutations are one of the most frequent genetic alterations in human cancers and are thought to play a role in pathogenesis of several malignancies. Overexpression of p53 in gallbladder cancer has not previously been reported from North India which has one of the highest incidence of this malignancy in the world. The present work is aimed at studying the overexpression of p53 in gallbladder carcinoma occurring in North India. METHODS: p53 overexpression by immunohistochemistry was studied in 20 operative specimens of gallbladder carcinoma. The clinico-pathological observations of these patients were correlated with the extent of p53 overexpression. RESULTS: Seventy per cent (14/20) of specimens of gallbladder carcinoma overexpressed p53 protein. There was a significant correlation between presence of gallstones, T stage, grade of tumour and liver invasion with p53 overexpression. There was no significant correlation with other factors studied viz. age, sex, nodal status and histological type. CONCLUSIONS: The results show a strong association between gallstones and p53 protein overexpression in gallbladder carcinoma. The causal relationship in this association, however, still remains unproven.

Adult↗

PubMed2000

Effects of lorglumide and atropine on MgSO(4)-induced gallbladder emptying in conscious dogs.

The aim of the study was to examine the possible involvement of cholecystokinin (by lorglumide) and cholinergic mechanisms (by atropine) in magnesium sulphate (MgSO(4))-induced gallbladder contraction of conscious dogs. The gallbladder (GB) volume was determined by ultrasonography. The optimal dose of 80 mg kg(-1)of MgSO(4)was determined from a MgSO(4)dose-response curve using doses of 10, 20,40, 80, 120 mg kg(-1). The largest dose of MgSO(4)was less effective than the optimal dose. Peak gallbladder contraction (32 per cent) was achieved at 30 minutes. Atropine (50 microg kg(-1)s.c.) or lorglumide (1 mg kg(-1)p.o.) fully prevented GB contraction. In conclusion, supraoptimal doses of MgSO(4)have a diminishing effect. The sustained contraction of the gallbladder in response to the optimal dose of MgSO(4)can be explained by an additive effect of the cholecystokinin release and a cholinergic trigger mechanism. Ultrasonography and MgSO(4)stimulation proved to be a valuable technique for examination of gallbladder motility.

Animals↗

PubMed2004

[Cholangiocellular and gallbladder carcinoma].

Risk factors for cholangiocellular and gallbladder carcinomas are bile stones and chronic inflammation of the biliary system. Gallbladder cancer and intrahepatic cholangiocellular carcinomas can be diagnosed with a high sensitivity by ultrasonography, CT and MRI, while the most sensitive diagnostic methods for perihilar or distal cholangiocellular carcinomas are ERC or MRC. The only curative option for patients with gallbladder- or bile duct cancer is surgical resection. Outside clinical studies there is currently no indication for neoadjuvant or adjuvant chemotherapy or radiochemotherapy. Gallbladder and bile duct carcinomas are moderately chemotherapy-sensitive tumors. The objective response rates in phase II studies with 5-FU or gemcitabine monochemotherapy are between 10 - 30 %. Higher response rates between 20 - 50 % have been observed in phase II studies with combination chemotherapy, in particular with the combination of gemcitabine/cisplatin. Because of the low incidence of gallbladder and bile duct carcinomas there are currently no large phase III trails investigating the impact of chemotherapy on survival and quality of life or comparing the activity of different chemotherapy protocols. Patients in good general physical conditions or with tumor-associated symptoms should be treated with palliative chemotherapy (whenever possible in clinical studies), while chemotherapy should be avoided in patients with severe non-tumor-associated morbidity. Endoscopic procedures, such as PTC- or ERC-stenting and photodynamic therapy, are important supportive therapies which can help to maintain the bile flow and consequently improve survival and quality of life of patients with malignant bile duct obstructions.

Animals↗

PubMed1990

[Ultrasound evaluation of gallbladder function using planimetry].

Fourteen patients with gallstones (13 female, 1 male; mean age 45.1 +/- 14.6 years; mean body weight 105.7% +/- 18.7% of ideal body weight) were included in the present study. Prior to and 45 min. after administration of a standard fatty meal, patients were examined by ultrasound. The mean gallbladder volume decreased from 20.94 +/- 10.0 cm3 to 6.83 +/- 3.5 cm3 (ejection fraction (EF) = 61.7 +/- 27.9%), the mean cross-sectional area from 12.0 +/- 3.4 cm2 to 6.0 +/- 2.8 cm2 (percentage changes 48.0% +/- 25.5%). A correlation is shown to exist between the ejection fraction of gallbladder emptying and the decrease of gallbladder area (r = 0.91; p less than 0.001). The simple measurement of the gallbladder area of a section through the long axis adequately demonstrates gallbladder contraction.

Adult↗

PubMed1989

Sphincter of Oddi and filling of the gallbladder. A necropsy study.

The importance of the sphincter of Oddi for the filling of the gallbladder has not been definitely established. It was the aim of this study to establish the extent to which gallbladder filling is affected by the total absence of resistance at the sphincter of Oddi. The external bile ducts were dissected out in 20 autopsies. After elimination of the sphincter of Oddi and division of the cystic duct at the junction to the gallbladder, infusion of water into the common hepatic duct under physiological flow conditions showed that no water passed the spiral valve of the cystic duct. Water flow stopped here in all 20 cases, i.e. 100% (95% confidence limits 83-100). If gallbladder filling is not possible it may be difficult to accomplish non-invasive procedures for the elimination of stones in the gallbladder.

Aged↗

PubMed1995

Gallbladder perforation in pregnancy.

Gallbladder perforation is an infrequent but potentially fatal disease. It is extremely rare during pregnancy. We report two cases of gallbladder rupture in the immediate postpartum period and review the literature. The first patient was a 28-year-old polysubstance abuser who presented at 29 weeks' gestation with generalized abdominal pain and ascites. Over a 48-hour period, her abdominal pain increased, and preterm labor and delivery occurred. She had an exploratory laparotomy the day after delivery for persistent abdominal pain and ascites, and a ruptured, gangrenous gallbladder was found. This patient died secondary to complications of the disease. Our second patient had a history of cholelithiasis and developed abdominal pain on the third postpartum day. Three days later, she was taken for exploratory laporatomy and was found to have a ruptured gallbladder. She did well postoperatively. The signs and symptoms of a ruptured gallbladder can be quite confusing in pregnancy. Ultrasonography, ascitic fluid analysis, computed tomography, and magnetic resonance imaging are useful adjuncts in diagnosis. A high index of suspicion, prompt recognition, and early surgical intervention are the mainstays of therapy.

Adult↗

PubMed1976

Effects of oral contraceptives on the gallbladder bile of normal women.

In view of the reported association between use of oral contraceptives and gallbladder disease, the effects of contraceptive steroids on the lipid composition of gallbladder bile were studied in 22 healthy women. Each subject was studied during routine use of oral contraceptives and also during normal menstrual cycles on no medication. Gallbladder bile was significantly more saturated with cholesterol during contraceptive therapy than during normal menstrual cycling (125 versus 92 per cent, P less than 0.001). Chenodeoxycholic acid accounted for a significantly smaller proportion (35 versus 42 per cent P less than 0.001) and cholic acid a significantly greater proportion (50 versus 41 per cent (P less than 0.001) of total bile acids during contraceptive steroid therapy. These findings show that exogenous sex steroids in doses and formulations routinely prescribed induce important alterations in the composition of human gallbladder bile, and suggest a biochemical basis for the increase in gallbladder disease observed among women using oral contraceptives.

Adult↗

PubMed2003

Association of anomalous pancreaticobiliary ductal junction with gallbladder carcinoma in Chinese patients: an ERCP study.

BACKGROUND: Anomalous pancreaticobiliary ductal junction, a rare congenital anomaly, is associated with various biliary and pancreatic diseases. The aim of this study was to determine the frequency of anomalous pancreaticobiliary ductal junction in Chinese patients with gallbladder cancer. METHODS: One thousand eight hundred seventy-six patients underwent ERCP between April 2000 and September 2001 with biliary and pancreatic duct opacification in 1082. Among the latter patients, those with proven gallbladder carcinoma were identified. Anomalous pancreaticobiliary ductal junction was defined as a common channel greater than 15 mm in length or a contractile segment totally distal to the union of the biliary and pancreatic ducts. When the common bile duct appeared to join the main pancreatic duct, the anomalous pancreaticobiliary ductal junction was denoted as B-P subtype; if the main pancreatic duct appeared to join the common bile duct, it was denoted P-B subtype. RESULTS: Fifty-four patients had gallbladder carcinoma, 7 of whom (3 men, 4 women) had anomalous pancreaticobiliary ductal junction (P-B subtype 6, B-P subtype 1). The mean (SD) length of the common channel was 21.0 mm (11.2 mm) with a range of 12 to 45 mm. One patient had early cystic dilation of bile duct. Three other patients had anomalous pancreaticobiliary ductal junction; 1 had an associated choledochal cyst and 2 a normal biliary tree. The overall frequency of anomalous pancreaticobiliary ductal junction was 0.9% (10/1082 cases). The frequency of anomalous pancreaticobiliary ductal junction was significantly higher in patients with gallbladder carcinoma (p < 0.001; OR, 50.7; 95% CI [12.7, 202.3]). CONCLUSIONS: Anomalous pancreaticobiliary ductal junction is strongly associated with gallbladder cancer among Chinese patients.

Aged↗

PubMed2000

Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications.

BACKGROUND: The nature of polypoid lesions of the gallbladder is difficult to define before operation, and surgical indications still remain controversial. The aim of this study was to identify characteristics of each type of polypoid lesion of the gallbladder and indications for surgery. METHODS: Clinical data were retrospectively correlated with the histopathologic characteristics of polypoid lesions in 100 patients who had cholecystectomy. RESULTS: There were 74 benign polypoid lesions, including 39 cholesterol polyps, 20 adenomas, and 15 with adenomyomatous hyperplasia and 26 malignant polypoid lesions. Twenty-seven percent of patients with benign polyps and 73 percent of patients with malignant polyps were over 60 years of age. Polypoid lesions of the gallbladder were diagnosed by preoperative ultrasonography in only 36 patients (36%). All types of polypoid lesions of the gallbladder, whether benign or malignant, were frequently solitary, and gallstones coexisted in the majority of patients with all polypoid lesions of the gallbladder except cholesterol polyps. The lesions were > 10 mm in 88% of the malignant polyps and in only 15% of the benign polyps. CONCLUSIONS: The risk factors for malignancy were the age of the patient ( >60 years), the coexistence of gallstones, and the size of the polypoid lesions (>10 mm in diameter). In asymptomatic patients, cholecystectomy can be justified if there are risk factors for malignancy.

Adult↗

PubMed2002

Gallbladder carcinoma associated with gallstones.

The great majority of gallbladder carcinoma is associated with gallstones. This cancer is generally diagnosed in advanced stages, and the prognosis is very poor. In this study we analysed retrospectively 3119 patients with cholelithiasis alone, and 35 patients with gallbladder cancer. Thirty-three of 35 cancer cases (94%) were associated with gallstones. Cancer rate was 1% in patients with cholelithiasis. Mean age was significantly higher in patients with gallbladder cancer than in those with cholelithiasis alone, 66.5 and 53.3 respectively (p < 0.0001). Sixty four percent of cancer cases were between 61-70 years of age, and the rate of carcinoma was 2.8% in this group (p < 0.001). The cancer rate was found to be 0.29% inpatients under 60 years of age, and 2.56% in those over 60 years (p < 0.001). According to Nevin's classification, 88% of cancer cases were found in advanced stages. Seventeen (52%) cases were diagnosed preoperatively. Ninety four percent of patients with preoperative diagnosis were in advanced stages compared with 31% of patients with incidental diagnosis (p = 0.0002). Patients with early stages carcinoma were alive and free of disease 58 months after operation. Average survival was only 9.5 months in patients with advanced cancer. We conclude that the incidence of gallbladder carcinoma increases significantly in patients over 60 years of age. Today preoperative early diagnosis is almost impossible, and long-term survival is possible only for early cases incidentally discovered at postoperative pathological examination of removed gallbladders for gallstone disease. Radical surgery has not provided long-term survival. We recommend close follow-up of patients with cholelithiasis, and enlargement of indication for cholecystectomy in a selective manner, considering some criteria in patients older than 55 years of age who are known with long-standing cholelithiasis.

Adult↗

PubMed2001

Effect of circulating peptide YY on gallbladder emptying in humans.

BACKGROUND: To further establish its role in the ileal brake mechanism, we determined the effect of the distal gut hormone peptide YY (PYY) on gallbladder motility and plasma gut hormones during the cephalic phase of meal stimulation. METHODS: Eight healthy volunteers were studied in a randomized crossover design, with or without intravenous infusion of a physiological dose of PYY. On each occasion, subjects underwent modified sham feeding followed by real feeding. RESULTS: PYY reduced gallbladder emptying in response to modified sham feeding from 23 +/- 5% to 5 +/- 7% (P < 0.01) and integrated plasma pancreatic polypeptide from 2337 +/- 397 pmol/L x 90 min to 903 +/- 232 pmol/L x 90 min (P < 0.01). PYY enhanced plasma cholecystokinin in response to real feeding from 53 +/- 9 pmol/L x 90 min to 82 +/- 17 pmol/L x 90 min (P < 0.05), but did not significantly affect maximum gallbladder emptying and tended to decrease plasma pancreatic polypeptide. CONCLUSION: Circulating PYY suppresses the cephalic phase of postprandial gallbladder emptying, but not meal stimulated maximum emptying. The results support the hypothesis that the effect of PYY on gallbladder emptying is mediated by vagal-dependent rather than cholecystokinin-dependent pathways.

Adult↗

PubMed2005

Helicobacter pylori and other Helicobacter species in gallbladder and liver of patients with chronic cholecystitis detected by immunological and molecular methods.

OBJECTIVE: Despite several recent reports on the detection of Helicobacter DNA in human bile, there are still uncertainties concerning the correlation of these findings with biliary tract and liver diseases. MATERIAL AND METHODS: Using molecular methods and immunohistochemistry (IHC), we investigated gallbladder and liver biopsy specimens from 22 adult Ukrainian patients with chronic cholecystitis for the presence of Helicobacter species. Patient sera were collected and tested for antibody reactivity to antigens of three Helicobacter spp. Detection of Helicobacter DNA was performed using a Helicobacter genus-specific 16S rDNA PCR. Amplified DNA was identified by PCR-denaturating gradient gel electrophoresis (DGGE) and DNA sequencing. Tissue sections of gallbladder and liver were examined by IHC with antibodies specific to H. pylori, the CagA and VacA cytotoxins of H. pylori, H. hepaticus and to Campylobacter jejuni. Patient sera were analysed by immunoblot for IgG antibodies to soluble surface proteins of H. pylori, H. hepaticus and H. bilis. RESULTS: Helicobacter DNA was found in 16/22 (73%) of the gallbladder samples and in 11/22 (50%) of the liver samples. IHC showed the presence of the H. pylori specific cytotoxins CagA and VacA inside the gallbladder epithelial cells without co-localization of H. pylori at the epithelial lining. Immunoblot analysis of the patient sera did not show any correlation between the presence of Helicobacter DNA and IgG antibody responses. CONCLUSIONS: The high prevalence of Helicobacter DNA and the positive findings by IHC in gallbladder and liver raise questions concerning an infectious role of Helicobacter in patients with chronic cholecystitis.

Adult↗

PubMed2006

Acute hepatic injury and renal failure after ingestion of snake gallbladder.

Ingestion of snake gallbladder has been practiced in ancient Chinese civilizations to improve vision and relieve arthritic pain. Although little is known about the composition of snake gallbladder, ingestion is still practiced in some Chinese cultures. Adverse effects of ingesting snake gallbladder have not yet been reported. Here, we present a case of acute hepatic injury and delayed-onset renal failure after ingestion of snake gallbladders. The patient subsequently recovered after supportive care, combined with plasma exchange and hemodialysis. He was the only survivor of the four victims suffering from intoxication of snake gallbladder in the last three years in our hospital.

Acute Kidney Injury↗

PubMed1993

A safe simple method for removal of the gallbladder through the umbilical trocar site during laparoscopic cholecystectomy.

After laparoscopic resection, the gallbladder must be removed, usually through the umbilical trocar site. Occasionally, there is difficulty in removing the gallbladder from the abdominal cavity due to its large dimensions or its contents. There are two main options to extract the gallbladder in such cases. One is evacuation of its content through the gallbladder neck protruding from the abdominal wall. The second is extension of the periumbilical fascial opening. In the first method, gallbladder content might sometimes spill into the peritoneal cavity or contaminate the incision site. In the second, there might not be enough control concerning the extent of injury caused to the periumbilical abdominal wall during enlargement of the fascial opening. A simple precise and safe method is suggested to enlarge the fascial incision by direct vision using transillumination.

Abdominal Muscles↗

PubMed1980

Bile acid pool size in relation to functional status of gallbladder and biliary lipid composition in Chinese.

Bile acid pool size was measured in 10 Chinese without gallstones, 14 with pigment stones, and 10 with mixed stones by an isotope dilutin technique. Functional status of gallbladder was evaluated by intravenous cholecystogram and its gross appearance at surgery. Biliary lipid composition was also determined. The control subjects had a bile acid pool size comparable to that of Caucasians. Regardless of the nature of gallstones, bile acid pools of stone patients with functioning gallbladder were within normal range, whereas the pools of those with non- or poorly-functioning gallbladder diminished to about two-thirds of the control. Thus, the diminution of bile acid pool size was apparently the consquence of loss of storage function of gallbladder rather than the cause of production of lithogenic bile. The common bile duct bile obtained from stone patients with nonfunctioning gallbladder had a relatively high lithogenic index, at least partly related to its low total lipid concentration.

Adult↗

PubMed1984

Effect of equimolar amounts of long-chain triglycerides and medium-chain triglycerides on plasma cholecystokinin and gallbladder contraction.

The present study was undertaken to compare the effects of equimolar amounts of long-chain triglycerides (LCT) and medium-chain triglycerides (MCT) on plasma cholecystokinin (CCK) concentrations and gallbladder contraction in man. On separate mornings and in random order six healthy volunteers ingested either 60 mmol LCT or 60 mmol MCT. Plasma CCK concentrations were measured by a sensitive and specific radioimmunoassay and gallbladder contraction by ultrasonography. Ingestion of LCT induced significant increases in plasma CCK from 2.8 +/- 0.5 to 6.5 +/- 0.7 pmol/l (p less than 0.005) and decreases in gallbladder volume from 33.4 +/- 5.9 to 13.2 +/- 4.2 cm3 (p less than 0.005). On the other hand, no significant changes in plasma CCK and gallbladder volume were found after MCT. Ingestion of MCT was followed by abdominal cramps and diarrhea, while LCT were without side effects. It is concluded that, in contrast to LCT, MCT do not induce CCK release and gallbladder contraction.

Adult↗