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Biomedical subjects

C Wolpers

Publications and source records attributed to C Wolpers.

17 recordsLinked to original sources
PubMed1995

The development of human gallbladder stones shown in X-ray pictures and its importance for the therapy.

Prophylactic treatment of patients with gallbladder stones today is obsolete. After secured diagnosis the patients and their physicians are waiting for the development of painful symptoms, mostly for years. Follow-up studies of gallbladder stones over decades show that there is no stability: especially the cholesterol stones change their size, shape, composition, and number during the waiting period for surgery. With a litholytical treatment of the cholesterol stones one has the chance to interrupt such changing processes by dissolution, with or without perfectionism. One can stop the development of painful symptoms and reduce the burden of the stones. To prevent an improper use of this treatment, only young, correctly floating cholesterol stones and the 2nd generation of cholesterol stones should be treated prophylactically. The diagnosis of the floating stones is possible with ultrasound or X-rays. We show the dissolution of the 2nd generation of cholesterol stones in two polymorbid, old patients with high risk for surgical treatment. The changing of the composition of gallbladder stones is demonstrated by different surface calcifications of multiple and solitary cholesterol stones, flat for multiple and periodically ordered for solitary stones.

Adult↗
PubMed1993

Solitary versus multiple cholesterol gallbladder stones. Mechanisms of formation and growth.

The development and growth pattern of solitary and multiple cholesterol gallbladder stones was defined using cholecystography in a prospective study of 48 patients whose initial cholecystograms indicated a stone-free gallbladder and who developed gallstones within the subsequent 5 years. Radiological observations performed over 365 patient-years were complemented by macroscopic examination, radiograms, scanning electron microscopy, and chemical analysis of gallstones from these and other patients obtained at cholecystectomy. Solitary gallstones were found to develop after a precursor phase of over 2 years during which free-floating crystal laminae of cholesterol formed. These laminae subsequently aggregated loosely and underwent external compaction and internal remodeling by movement of cholesterol molecules to form compact spheroids. A single lamina was observed to function as a nucleus for the development of a solitary stone shaped as an ellipsoid. About 10% of solitary stones were found to have a solitary pigment stone in their center. In contrast, multiple cholesterol gallstones formed without a precursor phase. Innumerable, very thin cholesterol crystals appeared which very abruptly aggregated to form spheres of up to 1 mm in diameter. Within 3 months a second aggregation took place in which these spheres colaesced to form mulberry stones. Mulberry stones in turn were transformed either to faceted stones (if many were present in the gallbladder) or to barrel stones (if few were present) over a period of 3 years. It is proposed that temporary occlusion of the cystic duct leads to supersaturation of bile with calcium bilirubinate and/or calcium carbonate which in turn promotes deposition of either or both of these calcium salts on the surface of single or multiple gallstones. For multiple gallstones, this process or the deposition of additional cholesterol crystals seals the gallstone surface and is followed by metamorphosis of the stone center.

Adult↗
PubMed1989

[Gallbladder polyps and gallbladder stones].

Over a period of 32 years 689 patients with upper abdominal symptoms were examined radiologically at least twice for gall-bladder polyps and stones. All were without evidence of stones initially, but 181 had gall-bladder polyps on first examination. During a mean observation period of 9 1/2 years gall-bladder stones occurred in 18% (pigment stones in about 24%, solitary cholesterol stones in 30% and multiple ones in 46%), regardless of the presence or absence of gall-bladder polyps. There was no evidence for a change from polyps to stones. Cholesterolosis runs through four stages in the course of decades; accumulation of cholesterol esters in subepithelial foam-cell nests is characteristic. 95% of gall-bladder polyps are cholesterol polyps which gradually empty. Prophylactic cholecystectomy for gall-bladder polyps is justified only if they are more than 10 mm in diameter.

Adolescent↗
PubMed1986

[Changes in silent gallbladder stones. Roentgen-diagnostic and symptomatologic observations over 30 years].

Between 1950 and 1980, a total of 145 patients with pain-free gallstones in the gallbladder and open cystic duct were followed for a mean observation period of 13.5 years. Pigment stones made up 25.5% of the total, cholesterol the rest. Growth of stones was noted in 70% of cases, new stones in 14%, and calcification in 25%. Colics occurred in 29%, severe ulcerative cholecystitis in 4% and passage of stones with pancreatitis in 5.5%. Constant cystic duct occlusion occurred in 18%, causing mild gallbladder inflammation in 40% of them. Cholecystectomy should be limited to large, old stones, to prevent gallstone ileus. Recently formed cholesterol stones should be removed as soon as possible by litholysis. Otherwise expectant waiting with regular follow-up is indicated.

Adult↗
PubMed1986

[Solitary black pigment stones].

Solitary pigment stones of the gallbladder are rare (1.7%). 82.5% are radiopaque, 17.5% radiolucent. 64.8% of radiopaque solitary pigment stones have the structure of a cockade. Such cockades take years to develop. Solitary cholesterol stones with a nucleus of a radiopaque pigment stone should not be treated for litholysis. 8% of solitary cholesterol stones with a cross diameter below 15 mm. possess a radiolucent pigment stone nucleus. X-ray diagnosis for selecting litholytic treatment remains the safest method, especially if the radiologist compares his films regularly with the specimens after surgery.

Adult↗
PubMed1985

[Cholelitholysis--gallbladder sediments and pigment stones].

Dissolution of cholesterol stones in the gallbladder can give rise to insoluble sediment and pigment stones. Thus can lead to a change of the type of gallstones. We have observed such a development during a period of 4 years in 23.5% of a group of 51 patients, whose cholesterol stones originally had been dissolved. Formation of pigment stones can be prevented, if calcium sediments with a grain size below 3 mm are removed early and forcefully enough out of the gallbladder. The voiding function of the gallbladder must be intact for such treatment, and this has to be tested before appropriate drug therapy is choosen.

Aged↗
PubMed1984

[Cholelitholysis and gallbladder diverticula].

Fifty patients with cholesterol stones in their gallbladder, with few symptoms were treated with the bile acids cheno- or ursodeoxycholic acid. 38 had a "normal" gallbladder, 12 had diverticula of the gallbladder. After the complete dissolution of the stones the bile acid treatment was stopped. The follow-up period lasted up to 7 years. No recurrence was observed in the gallbladder of 18 patients, but 32 developed new stones. With a second bile acid treatment we could dissolve the new stones of 13 patients, up to now without further relapses. After the second bile acid treatment of 9 months and x-ray controls 19 patients (38%) developed insoluble material in their gallbladders, independent of the presence of diverticula. We tried to eliminate calcium sediments with cholecystokinin-like substances. Temporary success was achieved in three of five patients only, and one person only remained free of further relapses. There is no reason to exclude patients with cholesterol stones and diverticula of the gallbladder from litholytic therapy.

Adult↗
PubMed1982

[Importance of cholegraphy for indicating litholysis].

Today patients with gallstones are treated surgically, by means of drugs, or by endoscopy. However, only cholesterol stones can be dissolved with bile acids. Besides the cholesterol stones in the gallbladder, insoluble pigment stones or insoluble stones with a high inorganic calcium content will be found. In every patient, the solubility of the gallbladder stones must be established by mineralogical analysis. Sonography is very helpful in detecting gallbladder stones, but it is impossible to perform a mineralogical analysis with this method. Plain radiography is likewise insufficient. The only way to obtain a relatively accurate selection of patients with soluble gallstones is the performance of roentgenography after cholecystography. Cholecystography for mineralogical analysis must always follow detection of gallstones by sonography.

Chenodeoxycholic Acid↗
PubMed1978

[Radiolucent pigment gallstones (author's transl)].

Pigment gallstones may be subdivided into three different types: radiolucent and radioopaque stones in the gallbladder and radiolucent stones in the common bile duct. 35 of our patients had radiolucent pigment stones in the gallbladder; 21 of these were followed for years by repeated X-ray examination. There is only little enlargement of these stones as time passes by, however the number of these stones increases continuously. Chemical analysis could be done on such stones in 24 cases. The stones were composed of granular calcium bilirubinate and of asphalt-like products derived from abnormal bilirubin degradation. 5 patients had pigment stones in the common bile duct. These stones contained little cholesterol and exhibited a spongy microstructure characterized by small tubules with a diameter of 1 micrometer. They contained more lipids and bilirubin than the stones collected from the gallbladder and on extraction with organic solvents no asphalt-like residues could be obtained.

Adult↗
PubMed1977

[Calcium palmitate and cholesterol gallstones].

Ca-palmitate is an abundant secondary constituent of cholesterol gallstones, especially of "multiple facet" and "barrel" stones. 60% of the 146 stones obtained by operation or autopsy contained crystalline Ca-palmitate. From these 70% were multiple and 11% solitary stones. The average percentage of Ca-palmitate calculated from 30 quantitative analyses amount to 1,75% with regard to the dry weight of stones. The occurrence of Ca-palmitate in gallbladder stones mainly depends on concrements which undergo structural alterations (formation of fissures for example) during their stay in the gallbladder and which are impregnated by bile. Ca-palmitate crystallizes within the fissures of these stones after concentration of included bile. There is no important hint that Ca-palmitate plays a role in stone nucleation. The occurence of Ca-palmitate in bile may be favoured by decreased micellar solubilization of palmitinic acid and by increased concentration of Ca as a result of inflammation.

Calcium↗
PubMed1976

[Selection of patients with gallstones for litholysis (author's transl)].

Drug therapy of cholelithiasis with chenodeoxycloic acid (CDC) will yield better results, if patients with new cholesterol stones are selected for therapy, since these stones dissolve quickly and completely. X-ray diagnosis of the different types of stones is discussed; radiolucent bilirubin stones with or without cholesterol covering and with low calcium content do present the most difficult diagnostic problems. Old cholesterol stones do not disolve completely. If litholysis is supposed to be succesful, the diameter of a solitary cholesterol stone should not be greater than 20 mm and the total volume of cholesterol stones should not occupy more than 50% of the gallbladder volume in order to allow sufficient contact of the stones with the bile. Litholysis may be stopped if calcium salts or pigments cover the surgace of the stone. At the present stage only 24% of all patients with gallstones are suited for CDC-therapy. Early diagnosis of cholelithiasis is essential, if CDC-therapy is to be applied more frequently and if this form of therapy is to have better effects.

Bile Pigments↗