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PubMed1991

[Appendectomy, cholecystectomy, cholelithiasis and colorectal cancer. A retrospective case control study at the Côte-d'Or].

Several studies have shown that there might be a relationship between previous history of appendectomy or cholecystectomy and the subsequent risk of colorectal cancer. In order to investigate these hypotheses, a case-control study was set up to compare the history of appendectomy and cholecystectomy as well as the presence of cholelithiasis in patients with colorectal carcinoma vs patients with gastric carcinoma. The study was performed in the 727 patients included in the Registry of Digestive Cancers of the Côte d'Or and treated at the Dijon University Hospital during the period 1981-1987. These patients were well matched to those of the whole registry population for sex, age, stage, and residence distributions. In females, in comparison to the gastric cancer patients, a personal history of appendectomy was more commonly observed in case of right colonic cancer (odds ratio: 3.5; P less than 0.01) and a personal history of cholecystectomy in case of left colonic cancer, in particular when considering only those earlier than 10 years (odds ratio: 3.2; P less than 0.05). In contrast, the risk of rectal cancer was lower in case of a cholecystectomy performed more than 10 years earlier (odds ratio: 0.2; NS) and in case of cholelithiasis (odds ratio: 0.4; P less than 0.05). In males, there was no difference between cases and controls as for the proportion of appendectomies, cholecystectomies or cholelithiasis. These observations are consistent with the hypothesis that the appendix as a lymphoid organ plays a protective role in colon carcinogenesis, in particular in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

[Genetic epidemiology of cholelithiasis. A case-control study of a population].

Aim of this study is to evaluate the familial risk of cholelithiasis in non hospitalized subjects with and without gallstones. A population sample of 2.472 subjects was examined by echography for gallstones; 220 subjects (92 males and 128 females) had gallstones or had already been cholecystectomized for gallstones. These cases and an equal number of controls were interrogated about the diagnosis of gallstones in their family using a standardized questionnaire. The comparison of the frequency of symptomatic gallstones and cholecystectomies for gallstones in the relatives of cases and controls showed an increase of the relative risk of gallstones in sons of parents with cholelithiasis (OR 2.9, CI 95% 1.2-8.0) and in siblings of subjects with cholelithiasis (if sister with gallstones: OR 2.4, CI 95% 1.05-5.6; if brother with gallstones: OR 2.9, CI 95% 0.6-14.6). The stratification for sex of cases and controls, however, pointed out that the risk increased only in daughters and sisters of subjects with gallstones. There was no statistically significant difference of frequency of gallstones between spouses of cases and controls (chi square, p greater than 0.05). The results of this study confirm that there is a familial risk of gallstones, even if it is evident only in the female relatives of subjects with gallstones, and suggest that probably the main cause of this risk is genetic and not environmental.

Adult↗
PubMed1991

Cholelithiasis in cirrhosis: analysis of 500 cases.

The prevalence of cholelithiasis (gallstones or previous cholecystectomy) was evaluated in a series of 500 cirrhotic patients from Northern Italy (329 males and 171 females, mean age 58 +/- 11 (SD) yr and 61 +/- 10 yr, respectively). Cirrhosis was related to chronic alcohol abuse in 180 cases, non-A non-B (NANB) hepatitis in 160, hepatitis B virus (HBV) in 94 (including 38 with concomitant alcohol abuse), idiopathic hemochromatosis in 44, and miscellaneous causes in the remaining 22 (including 15 with primary biliary cirrhosis). One hundred and sixteen patients (23.2%) had gallstones, and 31 others (6.2%) had previously undergone cholecystectomy, with an overall prevalence of cholelithiasis of 29.4%. The frequency was similar in both sexes (91/329 males, 27.7% vs. 56/171 females, 32.7%; p = NS), showed a slight increase with age, and differed significantly according to etiology (p less than 0.05), with the highest prevalence in the miscellaneous group and the alcoholics (36.4% and 33.3%, respectively). No significant difference was found in the prevalence of cholelithiasis according to Child's A, B, or C class.

Aged↗
PubMedDate not supplied

[Gallbladder contraction in patients with asymptomatic cholelithiasis].

There are many discrepancies between reports about gallbladder motility in gallstones disease. We studied gallbladder volume and contraction in 65 patients with asymptomatic gallstones and compared with 65 healthy controls by ultrasonography. The mass of the stones was less of the 25% of the gallbladder volume. We related stone size and number with its motor function. The results of the gallbladder contraction (GC) in the control group was 79.5% (DS = 9.5) and in the cholelithiasis group was 59.9% (DS = 19) with (p < 0.01). We found that the cholelithiasis group was heterogeneous and on closer inspection the patients fell into two subgroups separated by the inferior limit of normal GC (60%). The subgroup I (41 patients) had a fasting volume (FV) of 26.6 ml (DS = 14.1), a postprandial volume (PV) of 6.5 ml (DS = 3.8) and a GC of 75.3% (DS = 8.5). The subgroup II (24 patients) had a FV of 27.3 ml (DS = 20.3), a PV of 16.9 ml (DS = 15) and a GC of 40.5% (DS = 11.8). There was significant differences in PV and GC (p < 0.01). We concluded that defective gallbladder emptying is evident in a subgroup of patients but gallbladder contraction may be normal in patients with cholelithiasis and there are, not correlation between GC and the number and size of the stones.

Adult↗
PubMed1990

[The characteristics of the course of cholelithiasis in diseases of the cardiovascular system].

The authors discuss the difficulties in diagnosing cholelithiasis. Considering the presence of disorders of the metabolic function of the liver, ultrasound examination is considered the most preferable method of diagnosis of cholelithiasis. Knowledge of the specificity of development and clinical manifestations of cholelithiasis in diseases of the cardiovascular system is of importance due to difficulties of diagnosis and high incidence of this kind of pathology among this group of patients.

Adult↗
PubMed1990

[The function of the hepatobiliary system in patients with cholelithiasis based on hepatocholescintigraphic data].

Function of the hepatobiliary system in 35 patients with cholelithiasis of mild and average grave types and in 36 examinees after cholecystectomy without complaints and with the post-cholecystectomy syndrome was assessed with dynamic hepatocholescintigraphy which was shown to be an effective method for assessment of the hepatobiliary system in patients with cholelithiasis and after cholecystectomy. In some patients with cholelithiasis a degree of hepatobiliary disorders, including the frequency of dyskinetic disturbances, grows progressively with the severity of pathology (from a mild clinical type to an average grave one) and is most expressed in patients suffering from the postcholecystectomy syndrome.

Adult↗
PubMed1990

[Cholescintigraphy in the evaluation of duodenogastric reflux in cholelithiasis].

A total of 103 patients with cholelithiasis and those operated on one year ago were investigated using modified cholescintigraphy permitting the determination of a size, duration and spreading of the gastroduodenal reflux. Dynamic cholescintigraphy was shown to be an effective method of the diagnosis and quantitative estimation of the gastroduodenal reflux in patients with cholelithiasis and patients after cholecystectomy. In patients with the postcholecystectomy syndrome the gastroduodenal reflux was detected more frequently, and its quantitative indicators were lower than those in patients with cholelithiasis.

Adult↗
PubMedDate not supplied

[Acute pancreatitis and cholelithiasis. A study of thirty cases (author's transl)].

The authors report a series of 30 cases of acute pancreatitis associated with cholelithiasis. There were 9 cases of necrotizing pancreatitis and the latter group included the 4 deaths observed in this series. Clinical, radiological and laboratory data were in favor of this association in 24 out of the 30 cases. Cholelithiasis appeared to be directly responsible for initiating the pancreatitis in 1/3 of cases. In another 1/3 of cases the mecanism was thought to be related to scarring of the sphincter of Oddi. In the remaining 1/3 of cases no direct relationship could be found. On the basis of these findings, the authors recommend that emergency surgery be reserved for these cases in which cholelithiasis appears to be the etiology. (The biliary syndrome overshadowing the pancreatic syndrome) and to postpone treatment of pancreatic lesions. In all other cases, the authors suggest to keep elective surgery, for after a period of initial conservative treatment with the hope of then treating together biliary and pancreatic lesions.

Acute Disease↗
PubMed1989

[Lithogenic properties of bile in cholelithiasis].

To specify lithogenic properties of bile in cholelithiasis as well as the effect of cholecystectomy on biochemical composition of bile, 168 patients with cholelithiasis have been examined. Fifty patients underwent preoperative investigation, some of them were followed up for 1-2 years after cholecystectomy (group 1). The rest postcholecystectomy patients were followed up for 10 years (group 2). Bile levels of cholesterol were evaluated by absolute and relative lipid concentrations. The conclusion is made on the absence of a direct correlation between bile cholesterol supersaturation and cholelithiasis as the above supersaturation occurs in healthy subjects as well. It is noticed that cholecystectomy does not warrant discontinuation of cholesterol supersaturation of bile.

Bile↗
PubMed1989

[Cholelithiasis in childhood].

11 patients with cholelithiasis treated at our department, since 1979, are presented. Although cholelithiasis is a typical disease in adults, its frequency in childhood is very low. The rate of cholelithiasis with hemolitic diseases were of 18% and idiopathic in 55%. The main clinical symptom was recurrent abdominal pain, refer to epigastric or right subcostal side. The diagnosis was done with echography and in all cases a cholecistectomy were performed. The results and complications of these cases are presented.

Adolescent↗
PubMedDate not supplied

[Cancer of the colon and cholelithiasis: bile bacteria, composition of the stones and the bile].

Our recent studies have shown a significant association between lithiasic biliary disease and colorectal cancer. This could be due to the existence of risk factors common to both disease or to a cause-effect correlation between them. This latter hypothesis is supported by the observation in gallstone patients of the increase of biliary and fecal concentrations in secondary biliary acids. These could have co-carcinogenic effect on the colon. With a view to singling out further elements which might help us to understand more clearly the possible cause-effect correlation between cholelithiasis and colon cancer, we examined 12 patients affected by both diseases. In these, we evaluated the composition of the gallbladder stones, by means of spectrophotometry and diffractometry. Bile samples were taken from the gallbladder and used to examine the lipidic composition and the cholesterol saturation index according to Carey. In addition bacteriological examinations were carried out. The results were compared with those of 10 patients with cholelithiasis but not cancer, 10 with cancer but not cholelithiasis and 10 with neither. Analysis of the results did not reveal significant differences in gallstone and bile composition between colon cancer patients with concomitant gallstones and control groups. However, in cancer patients with gallstones a higher incidence of bile bacteria (35.7%) was observed than in the other groups. Bile bacteria were observed more frequently in right colon cancer patients who had pigment stones in 75% of the cases. The results seem to evidence peculiarities in patients with a cancer of right colon.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Clinico-laboratory parallels in children with aggravated heredity of cholelithiasis].

A comprehensive examination of children with aggravated heredity regarding cholelithiasis revealed in the majority of them the first stage of cholelithiasis, namely abnormalities in physicochemical properties of the bile. It is demonstrated that formation of the pathology under consideration is promoted by combination of such factors as hereditary aggravation regarding cholelithiasis, complications of the perinatal period, vegetative disturbance, biliary dyskinesia, and derangement of the intestinal flora.

Adolescent↗
PubMed1988

Cholelithiasis after Billroth II gastric resection.

We evaluate whether Billroth II (BII) gastric resection is a predisposing condition in the formation of gallstones. In our department radiologic and echographic imaging is a routine examination before abdominal surgery. From 1980 to 1985, 202 patients underwent cholecystography or ultrasonography before BII gastric resections for peptic ulcers. The prevalence of cholelithiasis in a random sample of the population of the town near our institution was used to calculate the expected frequency of gallstones. The comparison of the expected and the observed frequencies of cholelithiasis in these patients did not show any statistically significant difference between men and women. All these patients were recalled for a follow-up of the long-term effects of gastric surgery, and 66% (133/202) returned and were examined. They underwent ultrasonography of the biliary tract. Again the observed and the expected (obtained as before) frequencies of cholelithiasis were compared. A statistically significant difference was apparent in male patients. We conclude that BII gastric resection could be a predisposing factor in the formation of gallstones in men.

Adult↗
PubMed1986

[Exploratory studies of the common incidence of cholelithiasis, status following cholecystectomy and colonic cancer].

For studying the postulated relationship between prior cholecystectomy, cholelithiasis, and occurrence of subsequent colorectal cancer, we examined in a retrospective study autopsy cases to get information about the frequency of them. The material consisted of 10,000 cases (female:male = 1,08:1) with an age maximum in the 8. decennium. Among them were 2457 (902 male and 1555 female) cases of cholelithiasis and 646 (211 male and 435 female) cases of cholecystectomy. 449 colorectal cancer were found, altogether. The incidence of cancer in cases without gallbladder disease amounts to 4.13%, in cases with cholelithiasis 5.37%, and after cholecystectomy 4.95%, respectively. The results must be discussed with care because Berkon's Fallacy. Further exploratory investigations are necessary.

Age Factors↗
PubMed1985

[Cholelithiasis associated with upper gastrointestinal pathology. Critical evaluation of the emerging incidence and diagnostic and therapeutic indications].

Although cases of upper G.E. tract diseases associated with simple cholelithiasis are described as specific syndromes in the literature (Saint's triad, Casten's syndrome, etc.) they may be usefully evaluated with the aim of checking the following parameters: a) incidence and importance of associated pathologies; b) etio-pathogenetic correlation between age, sex and incidence; c) clinical extent of the disease and factors determining choice of medical or surgical treatment; d) more specific presurgical diagnostic investigation for certain cases; e) effect of combined surgery on recovery. Recent research carried out (Choctaw) in which the term associated pathology was defined is described. A sample of 358 patients suffering from cholelithiasis was examined. Of these, 230 were suitable candidates for surgery and systemic presurgical examination by means of digestive tract X-ray investigation and fecal blood tests. 35% of cases were found to be associated pathologies including hiatal hernia, peptic ulcer, duodenal diverticula, gastric neoplasia and various diseases of the large intestine. These data were found to be statistically different from data collected from a similar group of patients complaining of abdominal colic who did not display symptoms of cholelithiasis although 17% had diseases of the upper G.E. tract. Combined surgery was carried out on 82% of patients and the subsequent follow-up period lasted for 1 to 3 years. A presurgical study programme aimed particularly at female patients over 50 was therefore designed. Post-surgical recovery was not affected by combined surgery.

Adolescent↗
PubMed1985

[Juxtapapillary duodenal diverticula and cholelithiasis].

One hundred and thirteen cases of juxtapapillary duodenal diverticula were found in 5573 cases which were examined by upper gastrointestinal barium meal X-ray examination. Seventy-nine percent of those 113 cases had complications, while 21% of the cases were suffered from juxtapapillary duodenal diverticula alone. Among the complications, cholelithiasis showed the highest incidence. (33 cases out of 113 cases, 29.2%). Twenty-four cases of juxtapapillary duodenal diverticula of which serum amylase and serum bilirubin values were found to be over the normal range, were subjected to the ERCP and hepatocholedocal RI scintigraphy using 99mTcPI. Fourteen cases out of the 24 cases had complication of cholelithiasis. In 4 cases (28.6%) in this group, delaying of bile-flow was observed. While in 3 cases (30%) out of 10 cases without cholelithiasis, bile-flow disturbance was found. According to above mentioned observations, the following steps were recommended for the treatment of juxtapapillary duodenal diverticula: When juxtapapillary duodenal diverticula is revealed, examinations should be carefully done in order to find out other complications. Treatment for juxtapapillary duodenal diverticula may be done simultaneously with operation of the complications. Surgical indication of the juxtapapillary duodenal diverticula alone should be decided by the result of bile-flow examination.

Adult↗
PubMed1986

Early definitive surgery for acute pancreatitis associated with cholelithiasis.

Since the natural history of pancreatitis associated with cholelithiasis is one of recurrence, surgery for the biliary tract disease is mandatory. But appropriate timing of the surgery remains controversial. Seventy-eight patients have been treated with early surgery once a diagnosis of cholelithiasis associated pancreatitis was made. Eighteen patients had previous episodes of nonalcoholic pancreatitis. Utilizing Ranson's prognostic signs, 52 patients had mild pancreatitis and 26 severe. Sixty-eight patients (87%) had surgery within 72 hours after admission and ten patients (13%) within 5 days. All patients had a cholecystectomy and operative cholangiogram performed. Fifty-six (72%) positive operative cholangiograms were obtained and common bile duct exploration revealed choledocholithiasis in 42 patients (75%). No mortality occurred, and four had six complications including mild persistent pancreatitis (two), wound infection (one), urinary tract infection (one), cardiac arrhythmia (one) and heart block requiring permanent pacemaker (one). The average hospital stay was 10.4 days. T-tube cholangiogram done prior to discharge was normal in all patients, and there have been no episodes of recurrent pancreatitis. Early definitive surgery for pancreatitis associated with cholelithiasis is recommended and can be accomplished with minimal morbidity and mortality coupled with judicious utilization of hospital resources.

Acute Disease↗
PubMed1984

Cholelithiasis and colorectal cancer.

To assess whether the higher risk of colorectal cancer is related to cholelithiasis rather than to cholecystectomy, a retrospective epidemiologic study was carried out on 350 patients operated for colorectal cancer. The incidence of a previous cholecystectomy or concomitant cholelithiasis was shown to be significantly higher in colorectal cancer patients with respect to controls (relative risk: 1.48 and 1.99 respectively). The association in both cases was more frequent for colorectal cancer. These results permit to hypothesize that the association with colorectal cancer does not concern previous cholecystectomy but rather cholelithiasis which is contemporaneously present or responsible for cholecystectomy.

Cholecystectomy↗