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PubMedDate not supplied

[Prospective research on fetal cholelithiasis: incidence, predisposing conditions, echographic diagnosis, and clinical features].

The Authors report a prospective study on fetal cholelithiasis, analyzing its differences with the more widely known cholelithiasis of paediatric age. The study shows that the number of cases diagnosed by ultrasonography is higher than expected (0.39%, 3 cases on 764 pregnancies). The Authors could find no correlation between fetal cholelithiasis and any maternal, obstetrical and fetal factor. They have focused attention on sonographic imaging showing clinical-instrumental correlation between echogenic material, clinical features and their evolution. The study confirms that the most common evolution results in spontaneous resolution of fetal endocholecystic pathological images. Finally, wide review of the international literature is reported on the rare, but possible clinical manifestations and their complications.

Cholelithiasis↗
PubMed1976

[Bile composition in patients with high risk of cholelithiasis].

Clinical and epidemiological experience has shown that some subjects, such as diabetics and cirrhotics, are particularly prone to cholelithiasis. The cause of this association was sought, with particular reference to the biliary lipid pattern, since this was considered as a pathogenetic factor in high-risk patients of this kind. It was found that diabetics, like subjects with biliary lithiasis, have a high biliary cholesterol saturation index; this was not the case in cirrhosis. This increase was apparently due both to a fall in bile acids and an increase in bile cholesterol. On the other hand, no significant difference was found between diabetics and controls as far as the pool of bile acids was concerned. No important differences in bile acid pattern were noted. Deoxycolate tended to increase in subjects with cholelithiasis and fall (along with lithocolate) in those with cirrhosis. These findings were, however, devoid of statistical significance. The high incidence of cholelithiasis in diabetics is physiopathologically confirmed by significant "lithogenic" changes in bule lipid composition, whereas the high incidence in cirrhosis is not open to this explanation and probably rests on a different pathogenetic basis. The importance of bile saturation is clear, however, together with its therapeutic and prophylatic implications (chenodeoxycholic acid). The possible influence of unknown factors cannot be ruled out.

Adult↗
PubMed1964

[CHOLECYSTITIS AND CHOLELITHIASIS IN CHILDREN].

Cholecystitis and cholelithiasis in children would appear to be a rare surgical finding; however, the authors have encountered 15 cases. Although in approximately half the children with this condition the symptomatology is sufficient to draw attention to the biliary tract, in the other half the presence of periumbilical or right lower quadrant abdominal tenderness can easily be misleading. Only by considering the use of cholecystography will one be in a position to make a diagnosis of cholelithiasis in these latter cases.Among the possible causally associated factors in the adult, sex (female) and obesity alone may be applicable in children. Cholecystectomy with peroperative cholangiography is the treatment of choice, even though the occurrence of migratory calculi in the common bile duct is exceptional.

Adolescent↗
PubMed2007

Frequency of infection in cholelithiasis.

OBJECTIVE: To determine the frequency of infection in cholelithiasis and find common infecting organisms with their antibiotic sensitivity. DESIGN: A descriptive study. PLACE AND DURATION: This study was conducted in Surgical Unit - I, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan, from April 2001 to March 2002. PATIENTS AND METHODS: First 100 cases of cholelithiasis, selected and operated by open or laparoscopic cholecystectomy were included in this study. Patients with acute cholecystitis, history of jaundice, stones and / or dilated common bile duct were excluded from the study. Ultrasound was the main tool for pre-operative diagnosis. During cholecystectomy, bile was aspirated and specimens were sent to laboratory for microbiological examination. The results were recorded on a proforma. RESULTS: Out of 100, 36 patients had positive bile culture. The most common organism was E. coli (17 patients) followed by Klebsiella (9), Pseudomonas (6), Staphylococcus aureus (2), Salmonella (1) and Bacteroids fragalis (1) patient. In this study, most of the biliary organisms were highly sensitive to the 2nd generation cephalosporins and quinolones. CONCLUSION: From the bacteriological assessment, it seems that both endogenous and exogenous contamination were the causes of wound sepsis. It was also found that the infection of bile did not increase the risk of postoperative wound infection when prophylactic perioperative antibiotics were used.

Adult↗
PubMed1984

Cholelithiasis in patients with major sickle hemoglobinopathies.

Cholelithiasis is a common complication of homozygous sickle cell disease. The frequency of gallstones appearing in patients with heterozygous sickle hemoglobinopathies is unknown. We performed sonographic tests on 65 unselected patients with major sickle hemoglobinopathies. Cholelithiasis was found in 11 (26%) of the 42 patients with hemoglobin SS, in three (20%) of the 15 with Hb SC, and in one (12.5%) of the eight with Hb S-beta-thalassemia. There was a correlation between the presence of gallstones and increasing age. All patients with major sickle hemoglobinopathies are at risk for the development of biliary tract disease.

Adolescent↗
PubMed1989

Concomitant cholecystectomy for asymptomatic cholelithiasis.

The outcome of 68 patients with asymptomatic cholelithiasis undergoing laparotomy for other conditions was reviewed to determine those most likely to become symptomatic postoperatively. Thirty-seven patients (54%) became symptomatic postoperatively. Eight patients (22%) required cholecystectomy within 30 days of operation or within the same hospitalization. These patients fasted for a longer period of time postoperatively (15 +/- 21 vs 4 +/- 3 days) than those undergoing later cholecystectomy. Significantly more of these patients required transfusion (38% vs 7%), mechanical ventilation (50% vs 11%), and total parenteral nutrition (50% vs 18%). Cholelithiasis frequently becomes symptomatic after laparotomy for other intra-abdominal conditions. Patients who require mechanical ventilation, transfusions, and parenteral nutrition and who are slow to resume enteral nutrition are more likely to require early cholecystectomy. Concomitant cholecystectomy adds minimal morbidity to other procedures and should be undertaken unless specific contraindications exist, particularly in this high-risk group.

Adult↗
PubMed1991

Cholelithiasis after treatment for childhood cancer.

The authors evaluated the risk of development of cholelithiasis in 6050 patients treated at a single hospital for various childhood cancers with different therapeutic modalities, including chemotherapy, surgery, radiation therapy, and bone marrow transplantation, from 1963 to 1989. Patients with underlying chronic hemolytic anemia or preexisting gallstones were excluded. Nine female and seven male patients with a median age of 12.4 years (range, 1.2 to 22.8 years) at diagnosis of primary cancer had gallstones develop 3 months to 17.3 years (median, 3.1 years) after therapy was initiated. Cumulative risks of 0.42% at 10 years and 1.03% at 18 years after diagnosis substantially exceed those reported for the general population of this age group. Treatment-related factors significantly associated with an increased risk of cholelithiasis were ileal conduit, parenteral nutrition, abdominal surgery, and abdominal radiation therapy (relative risks and 95% confidence intervals = 61.6 [27.9-135.9], 23.0 [9.8-54.1], 15.1 [7.1-32.2], and 7.4 [3.2-17.0], respectively). There was no correlation with the type of cancer, nor was the frequency of conventional predisposing features (e.g., family history, obesity, use of oral contraceptives, and pregnancy) any higher among the affected patients in this study than in the general population. Patients with cancer who have risk factors identified here should be monitored for the development of gallstones.

Adolescent↗
PubMed2006

Serum adiponectin levels in cholesterol and pigment cholelithiasis.

BACKGROUND: Altered adiponectin levels are associated with metabolic abnormalities. The aim of this study was to explore the role of adiponectin in cholelithiasis. METHODS: A radioimmunoassay was used to determine serum adiponectin levels in 58 patients with cholesterol gallstones and 47 with pigment gallstones, and 101 healthy controls. The chemical composition of extracted gallstones was determined by Fourier transform infrared spectroscopy. RESULTS: The mean(s.d.) adiponectin level was decreased in patients with cholesterol gallstones (7.6(4.1) microg/ml; P < 0.001) but raised in patients with pigment gallstones (17.9(9.0) microg/ml; P < 0.001) in comparison with healthy controls (11.7(6.5) microg/ml). Decreased adiponectin levels (odds ratio (OR) 0.85 (95 per cent confidence interval (c.i.) 0.76 to 0.96); P = 0.008) and female sex (OR 6.06 (95 per cent c.i. 2.10 to 17.46); P = 0.001) were associated with cholesterol gallstone formation. Increased adiponectin levels (OR 1.11 (95 per cent c.i. 1.01 to 1.22); P = 0.025) and increased age (OR 1.06 (95 per cent c.i. 1.01 to 1.12); P = 0.029) were associated with pigment gallstone formation. Raised serum aspartate aminotransferase concentration was a risk factor for both cholesterol (OR 1.16 (95 per cent c.i. 1.03 to 1.30); P = 0.013) and pigment (OR 1.23 (95 per cent c.i. 1.10 to 1.38); P < 0.001) gallstones. CONCLUSION: Gallstone formation is associated with altered serum adiponectin levels. Serum adiponectin might serve as a novel marker for cholesterol and pigment cholelithiasis.

Adiponectin↗
PubMedDate not supplied

A prospective morphologic evaluation of hepatic toxicity of chenodeoxycholic acid in patients with cholelithiasis: the National Cooperative Gallstone Study.

A sample of 126 patients with cholelithiasis was treated with chenodeoxycholic acid (CDCA) (375 or 750 mg g.d.) for 2 years. Hepatotoxicity was assessed by sequential light (LM) and electron microscopic (EM) analysis of liver biopsies obtained before and after 9 and 24 months of therapy. Patients were without symptoms of biliary colic for 3 months prior to biopsy, less than 70 years old, and had normal tests of liver function. All light microscopy was read blindly by two morphologists, and electron microscopy by one. Only four biopsies (3%) showed severe (3+) abnormalities preventing admission to the study. On evaluation, moderate (2+) LM changes were present in less than 12% of biopsies, while milder changes (1+) were seen more frequently. No severe, dose-related abnormalities were seen in LM over the 2 years of study. However, mild changes (hepatocyte ballooning and lipofuscin, binucleate cells, glycogen nuclei, ductular proliferation, enlarged and fibrotic triads, and sinusoidal congestion) became more prevalent with time (p less than or equal to 0.01) regardless of CDCA dose, according to 1 of the 2 morphologists. Because patients with "proven" cholelithiasis for greater than 2 years (33% of the study population) did not have a greater incidence of morphologic abnormalities than those with the diagnosis for less than 2 years, it is unlikely that these changes were due to the natural history of gallstone disease. Furthermore, electron microscopic findings demonstrated worsening intrahepatic cholestasis and a lesion in two patients which was identical to that produced in animals administered lithocholic acid, the 7-alpha-dehydroxylated metabolite of CDCA. the possibility that clinically significant hepatotoxicity could develop with CDCA therapy greater than 24 months thus cannot be excluded by this study.

Adult↗
PubMedDate not supplied

Postprandial dilatation of the gallbladder in cholelithiasis.

PURPOSE: We assessed the postprandial sonographic findings in patients with cholelithiasis whose gallbladders were completely contracted after fasting. METHODS: The gallbladders of 5 patients with recurrent abdominal pain were completely contracted despite overnight fasting and could not be adequately examined on sonography. The patients were given a fatty meal and re-examined after 30 minutes. RESULTS: In all patients, the gallbladder became distended after the meal, and gallstones were clearly demonstrated. CONCLUSIONS: Patients whose gallbladders are completely contracted after overnight fasting and cannot be adequately evaluated on sonography should be given a fatty meal and re-examined sonographically. This technique is efficient in preventing unnecessary additional patient visits for the evaluation of cholelithiasis.

Adult↗
PubMedDate not supplied

Cholelithiasis in the gravid Hispanic population.

Ultrasound examinations were performed to determine the prevalence of cholelithiasis in 585 pregnant Hispanic patients. The ultrasound findings were correlated with age and country of birth. The overall prevalence of gallstones was 5.3%. This is not statistically different from the prevalence of gallstones in age-matched groups from previously published studies not selected for country of birth or ethnic background. We found no statistically significant different in prevalence rates for gallstones between Mexican-born and non-Mexican-born pregnant Hispanic women in the 20-year to 49-year age group. Unlike prior studies, this study does not support the use of increased ultrasound examination for cholelithiasis in a pregnant Hispanic population.

Adult↗
PubMed1995

The complications of cholelithiasis caused by state authorization delays.

The impact of delay in elective cholecystectomy caused by preoperative state authorization requirements was retrospectively studied. The Student's t-test was used for statistical analysis. From 10/92 to 5/94, 146 patients were evaluated in an outpatient surgery clinic and elective cholecystectomy was planned. These patients were divided into two groups. Group 1 (101) patients waited for state authorization prior to cholecystectomy while group 2 (45) patients did not need state authorization. Group 1 patients waited an average of 112 days from the time of diagnosis to the time of surgery while group 2 patients waited an average of 21 days (P < 0.001). Group 1 patients were more likely to develop acute complications of cholelithiasis and require admission and urgent cholecystectomy than group 2 patients (22% vs 11%, P < 0.05). Group 1 patients requiring emergent treatment were found to have a longer hospital stay (P < 0.001), longer operative time (P < 0.05), and higher intraoperative blood loss (P < 0.005) than group 1 elective cases. Elective cholecystectomy patients who require state authorization have to wait longer prior to cholecystectomy and frequently develop acute complications of cholelithiasis requiring hospital admission and nonelective surgery. This translates into increased patient morbidity and added cost. State authorization requirements act as a barrier to providing timely care, add to cost, and must be considered in the current deliberations on health care policy.

Blood Loss, Surgical↗
PubMed1992

The operative risk factors of cholelithiasis in the elderly.

A total 725 patients with cholelithiasis were divided into three groups according to age, and the risk factors and morbidity rates compared. Group 1 consisted of those aged younger than 49 years, group 2 of those aged between 50 to 69 years, and group 3 of those aged over 70 years. In group 3, the incidence of calculi in the common bile duct was significantly higher than in the other two groups (p less than 0.05), and therefore, choledochotomy accompanying cholecystectomy was performed more often in this group (p less than 0.01). The rate of complications related to calculi and the presence of underlying disease were also higher in this group than in the two younger groups (p less than 0.05), as were preoperative abnormal liver or renal function tests, anemia and hypoproteinemia (p less than 0.05). The rate of positive bile cultures in group 3 was 75.6 per cent which was again significantly higher than in groups 1 and 2 (p less than 0.01). Postoperative complications appeared in 14.3 per cent of the group 3 patients, which was not statistically higher than in group 2 (9.7 per cent), but the percentages of both groups 2 and 3 were high compared to the 4.3 per cent of group 1 (p less than 0.01). The rates of complications directly attributable to the surgical procedures were 2.0 per cent in group 1, 4.8 per cent in group 2, and 5.1 per cent in group 3 with no significant differences between the three groups. There was no increase in the technical problems associated with the surgical procedures performed on the elderly patients and thus, if the operative risks are precisely evaluated and treated cautiously elderly patients should tolerate surgery for cholelithiasis well.

Aged↗
PubMed1994

Laparoscopic cholecystectomy in complicated cholelithiasis.

From January 1990 to December 1992, 129 patients presenting complicated cholelithiasis were included in a prospective study to assess the feasibility and efficiency of laparoscopic cholecystectomy. There were 84 females (65%) and 45 males (35%). Mean age was 60 years (range from 23 to 88). There were 90 acute cholecystitis (70%), 14 empyema (11%), 14 cholecystitis on scleroatrophic gallbladder (11%), and 11 mucocele (9%) cases. Laparoscopic cholecystectomy has been successfully performed in 106 cases (82%) (group I). In this group of patients, morbidity and mortality were 4.7% and 0.9% (n = 1), respectively. Mean hospital stay was 4.7 days after uneventful postoperative course. Two patients required reoperation for complications (1.8%). Twenty-three patients (18%) required enforced conversion to laparotomy after unsuccessful laparoscopic procedure (group II). Mean hospital stay was significantly higher in group II (10.8 days, P = 0.0001). There was no difference between the two groups according to sex, previous surgery, or indications. Laparoscopic cholecystectomy may be attempted and successfully realized in complicated cholelithiasis without morbidity increase. Main advantages of this procedure are a shorter hospital stay and a better recovery period.

Aged↗
PubMed1993

Surgery for cholelithiasis in cirrhotic patients.

Although biliary tract surgery for cholelithiasis is performed frequently in Japan, cirrhotic patients require special consideration. Postoperative complications after biliary tract surgery were studied in 23 patients with liver cirrhosis and associated cholelithiasis, 9 of whom had no complications, 8 had minor complications, and 6 had severe complications. Concerning the relation between Child's classification and postoperative complications, no complications were seen in four Child's type A patients, but seven of ten (70%) Child's type B patients and seven of nine (78%) Child's type C patients developed complications. Two (20%) of the Child's type B patients and four (44%) of the Child's type C were severe, and three of the latter group died. Regarding the preoperative laboratory findings, significant differences were seen between the patients without complications and those with severe complications in serum bilirubin, albumin, and ICG R15 values. Of the six patients with severe complications, five had choledocholithiasis, three of whom died of liver failure, while two developed biliary peritonitis caused by insufficient fistula formation after removal of the T-tube. Thus, for the treatment of choledocholithiasis in patients with severe cirrhosis, avoiding surgical invasion through the use of such techniques as endoscopic papillotomy is recommended whenever possible.

Biliary Tract Surgical Procedures↗
PubMed1991

Symptomatic cholelithiasis in pediatric renal transplant recipients.

We report two cases of symptomatic cholelithiasis in pediatric renal transplant recipients immunosuppressed with cyclosporine (CsA), prednisone and azathioprine. CsA was present in the bile and in the cholesterol gallstones of one patient. The diagnosis of cholelithiasis was established in both cases by abdominal ultrasound examination.

Child↗
PubMed1976

The effect of phenobarbital on biliary lipid metabolism and hepatic microsomal drug metabolism in patients with cholesterol cholelithiasis.

Six patients with cholesterol cholelithiasis were studied before and after 3 weeks treatment with phenobarbital, 120 mg/day. The kinetics of cholic and chenodeoxycholic acid and biliary lipid composition were not significantly affected by phenobarbital treatment although hepatic mixed-function oxidase was stimulated by the treatment as shown by increased breath output of 14CO2 after administration of (14C)aminopyrine. It is concluded that treatment with phenobarbital is unlikely to be effective therapy for patients with cholesterol cholelithiasis.

Adult↗
PubMed1975

Normal antipyrine metabolism in patients with cholesterol cholelithiasis. Evidence that the disease is not due to generalized hepatic microsomal dysfunction.

Plasma antipyrine half-lives and metabolic clearances were measured after a single oral dose of antipyrine in 10 control subjects, 12 patients with gallstones, and 9 patients having undergone cholecystectomy for cholesterol cholelithiasis, to determine whether impairment of hepatic antipyrine metabolism occurs in patients with cholesterol cholelithiasis. The plasma antipyrine half-life and metabolic clearances in the control subjects were 11.7 plus or minus 1.3 hours and 42.5 plus or minus 3.3 ml/min, respectively; in patients with gallstones, 12.3 plus or minus 1.3 hours and 36.0 plus or minus 3.2 ml/min, respectively; and in patients having undergone cholecystectomy, 13.2 plus or minus 1.8 hours and 33.8 plus or minus 4.2 ml/min, respectively. Values for antipyrine half-life and metabolic clearance were not statistically different in these three groups. This study suggests the presence of normal hepatic antipyrine metablosim in patients with cholesterolcholelithiasis.

Adult↗