PubMed · 7295498
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R M Kupfer, T C Northfield. 1981. Gallstone dissolution.. https://pubmed.ncbi.nlm.nih.gov/7295498/
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The aim of the study was to assess the value of quantitative attenuation values (Hounsfield units) and of gallstone pattern by computerized tomography in predicting response to bile acid therapy. We carried out a prospective study in a multicenter setting on 90 consecutive outpatients with radiolucent gallstones. All received bile acid therapy (UDCA 10 mg/kg/day or UDCA + CDCA 5 mg/kg/day of each) up to two years. Hounsfield units for gallstones were recorded using standardized criteria and six categories of patterns were defined: hypodense, isodense, homogenously dense, laminated, rimmed and speckled. We assessed gallstone dissolution rate (percent reduction in volume), response to therapy (> 25% reduction in volume), and final outcome of therapy. Eighty-one percent of patients with hypodense/isodense and all four patients with speckled stone pattern responded to therapy, whereas none of the 10 patients with laminated/rimmed and only 45% of patients with homogenously dense stone pattern did. Complete dissolution was achieved by 68%, 50%, 35%, 0% of the hypodense/isodense, speckled, homogenously dense, rimmed/laminated gallstones, respectively. The use of Hounsfield units did not show an advantage over gallstone pattern for predicting either response or final outcome to bile acid therapy. We conclude that computerized tomography analysis of gallstones is of value in predicting response to bile acid therapy and that gallstone pattern alone predicts response in most cases without the need for quantitative assessment.
The biosynthetic intermediates of bile acid, 3 alpha, 7 alpha, 12 alpha-trihydroxy- and 3 alpha, 7 alpha-dihydroxy-5 beta-cholestan-26-oic acids, were synthesized by means of the thermal elimination of beta-ketosulfoxides. The alpha, beta-unsaturated ketones as key compounds of the synthesis, 3 alpha, 7 alpha, 12 alpha-trihydroxy- and 3 alpha, 7 alpha-dihydroxy-5 beta-cholest-25-en-24-ones, were effectively derived from the beta-ketosulfoxides prepared from methyl cholate or chenodeoxycholate by reaction with methylsulfinylcarbanion. These unsaturated ketones were converted into 3 alpha, 7 alpha, 12 alpha, 26-tetrahydroxy- and 3 alpha, 7 alpha, 26-trihydroxy-5 beta-cholestanes by reductive deoxygenation and hydroboration, of which stereoisomers were chromatographically separated into 25S- and 25R- isomers. The oxidation of each of the above isomeric alcohols after the protection of the hydroxyl groups on the steroidal ring and the following hydrolysis gave the title 26-carboxylic acids.
Using radiological interventional techniques the gall bladder can be cleared of stones with a high success rate. As with any treatment option that leaves the gall bladder in situ there is an accompanying risk of stone recurrence, which is currently unknown for the radiological method. One hundred patients were studied prospectively to determine the recurrence rate of stones and clinical outcome after successful percutaneous cholecystolithotomy. Follow up included both clinical assessment and ultrasound examination at 3, 6, and 12 months and then annual intervals thereafter. The overall stone recurrence rate was 31% at a mean follow up of 26 months (range, 3-50 months). By actuarial life table analysis, the cumulative proportion of gall stone recurrence was 7, 19, 28, 35, and 44% at 6, 12, 24, 36, and 48 months respectively. Of the 31 patients with recurrent stones; 17 remain asymptomatic, seven have experienced biliary colic, two abdominal pain, three non-specific upper gastrointestinal symptoms, and two jaundice secondary to common duct stones. Thirteen of the stone free patients have remained symptomatic; six with abdominal pain and seven with nonspecific upper gastrointestinal symptoms. Eight patients have subsequently had a cholecystectomy. No significant difference was found between the sex of the patient or the number of stones before treatment and the stone recurrence rates. The cumulative stone recurrence rate was significantly less in the 56 patients who received adjuvant chemolitholysis (p < 0.05). These data show that stone recurrence after successful percutaneous cholecystolithotomy occurs in the minority, and is usually asymptomatic. It is concluded that the technique remains justified in the management of selected patients with gall stones.