Biomedical subjects
Publications and source records attributed to D J Sutor.
A simple apparatus is described for the anaerobic ultrafiltration of a few millilitres of bile or other biological fluids. The principle employed enables viscous liquids which would normally block the membrane to be ultrafiltered successfully.
Out of a group of 979 patients with urinary calculi, 175 had passed their stone(s). Comparison of data for stones which had been passed with data for the whole group shows many significant differences. Calculi composed entirely of calcium oxalate are more likely to be expelled than any other composition variety. The chance of this happening is 1 in 3 and it is even higher when the person is under 50 years of age. The probability of calculi composed of calcium oxalate+calcium phosphate being expelled is 1 in 5 and this also increases for younger patients. Infection stones consisting of calcium phosphate+struvite have only 1 in 19 chance of being passed. Many of the stones passed (130) are under 0.10 g in weight. However, there is a similar relationshp between composition and weight among both the stones that were passed and the whole group. In both groups, pure oxalate stones are the lightest, infection stones are the heaviest and stones composed of calcium phosphate and calcium phosphate+calcium oxalate are of intermediate weight.
In a collection of 615 stones containing struvite and in which the sequential deposition of the constituents from the nucleus to the surface had been determined, other substances were found to follow a marked deposition of struvite in 139 cases. In 122, the compound was accompanied by struvite, in 16, struvite was replaced by it and in 1, both types of deposition had occurred in different layers. All urinary stone constituents could accompany struvite and many could replace this compound.
Gallbladder bile obtained at operation from five patients with no symptoms of biliary disease was undersaturated with cholesterol in every case. However, gallbladder bile from patients with stones composed of 97-100% crystalline cholesterol was on average just saturated with cholesterol when the gallbladder was functioning and undersaturated when it was not. Regardless of gallbladder function, the patients with stones had on average significantly more cholesterol in their bile than in the control group, but the differences between the mean composition of bile from functioning and non-functioning gallbladders were not significant. Common duct bile from patients with non-functioning and functioning gallbladders was on average supersaturated with cholesterol, but there was significantly more bile salt and significantly less cholesterol in the bile from patients with non-functioning gallbladders. Only in the case of patients with functioning gallbladders did the mean composition of the common duct and gallbladder biles differ significantly. The former contained significantly more cholesterol and less bile salt than the latter. It is suggested that patients with non-functioning gallbladders may be 'autocholecystectomised' with the duct bile reverting to a more 'normal' composition.
Since medical treatment of gallstones is confined to cholesterol-rich stones, the ability of clinical radiographs to predict gallstone type was tested prospectively by comparing the preoperative radiological appearance of gallstones from 57 unselected patients with cholelithiasis coming to cholecystectomy with the subsequent analysis of the stones both by X-ray diffraction and by chemical techniques. Fifty-two per cent of the patients had 'non-functioning' gallbladders which failed to opacify after at least two contrast examinations and 25 out of 50 had radioopaque stones. Of the 25 patients with radiolucent stones, the stones in 20 ((80%) were predominantly cholesterol in type but radiology was misleading in five; three contained 40-55% calcium salts but were still radiolucent while two were amorphous and contained less than 10% cholesterol by weight on chemical analysis. While radiology was sometimes misleading when the stones were small and irregular, large radiolucent stones with a smooth profile were invariably cholesterol-rich stones. The results also show that in men calcified stones were commoner than in women and that in older women the gallstones contained more calcium salts and less cholesterol than in younger women less than 50 yr). This paper analyses critically the value and limitations of clinical radiology in predicting gallstone type.
The mean osmolality of bile from the common bile duct is similar to that of bile obtained from the gallbladder of patients with non-functioning gallbladders, and both means are significantly lower than the mean of bile in functioning gallbladders. The mean viscosity of bile from both functioning and non-functioning gallbladders is on average considerably greater than that from the common bile duct, and the mean viscosity of bile from non-functioning gallbladders is greater than that from functioning ones. The presence of much mucus in gallbladders containing stones is likely to account for these differences in viscosity. The composition of the gallstones does not appear to have any influence on these observations, but the number of patients in each group is too small for the differences to be significant.
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Determination of the sequential deposition of crystalline compounds in a representative collection of gallstones from 578 patients has shown that a change in composition of gallstones containing both cholesterol and calcium salt(s) has frequently occurred during growth. Generally a central stone area composed of one of these types of compound is surrounded by outer layers formed of a mixture of both, or vice versa. In a few stones, however, there is a change from one type of compound to the other occurring in successive layers. Both in stones containing cholesterol and calcium salt(s) and in those consisting entirely of calcium salt, there is often also a change in the type of calcium salt present. Such changes provide indirect evidence of changes in gallbladder bile composition during growth of stones, the origin and mechanism of which are not understood.
Dissolution of gallstones consisting of cholesterol, calcium carbonate, or calcium phosphate in different solvents left an amorphous organic gel-like substance (the matrix). Matrix from cholesterol stones could be colourless but was usually orange, yellow, or brown while that from calcium carbonate and calcium phosphate stones was almost invariably coloured black or dark brown. These pigments were also shown to be organic and amorphous. The amount of matrix present and its structure varied with the texture of the crystalline material. Irrespective of their composition, laminated pieces of material yielded compact laminated matrix of the same shape as the original piece and areas of loose crystalline material gave small pieces of non-cohesive matrix. Only large cholesterol crystals which usually radiate from the stone nucleus had no associated matrix.
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The crystalline constituents of gallstones determined by x-ray powder diffraction can be broadly classified as cholesterols and calcium salts. On this basis there are three main types of stones consisting of cholesterol, calcium salts, and mixtures of these. In a study of the composition of 481 gallstones from 11 countries, the percentage incidence of each was 59.9, 13.1, and 27.0 respectively. The presence of calcium compounds in 40.1% of the calculi showed the importance of these constituents in the nucleation and/or growth of many specimens. Men are just as likely as women to form stones consisting entirely of calcium salts, but female patients outnumber males by about 3:1 for both calculi of cholesterol and those of cholesterol with calcium salts. A description is given of the appearance, texture, and structure of calcium-containing stones subdivided according to the calcium salt(s) present.
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A new crystalline form of anhydrous cholesterol called cholesterol II has been found in gallstones. This material can change within a few weeks into the usual form of anhydrous cholesterol but pure synthetic cholesterol II is stable.