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PubMed1977

Cholelithiasis in a male rhesus monkey (Macaca mulatta) fed a cholesterol-containing diet.

In this report we describe the development of cholelithiasis in a male rhesus monkey fed a cholesterol-containing diet for 24 months. This represents the only case of cholelithiasis in this species of nonhuman primate that we have observed out of a population of over 500 rhesus monkeys fed similar cholesterol-containing diets. Associated with the appearance of gallstones was the production of bile saturated with cholesterol, and the excretion of bile with an abnormal bile acid composition.

Animals↗
PubMed1989

Cholelithiasis. Clinical characteristics in children. Case analysis and literature review.

Thirty-five cases of cholelithiasis diagnosed at a children's hospital over a 7.5-year period are reviewed and compared to 693 cases of pediatric gallstones reported in the literature. Symptomatology and associated medical history are more important in diagnosing cholelithiasis than are laboratory tests. Hemolytic disease is the most common associated condition in our series (46%) as well as in the literature (30%), but the frequency of the various associated conditions varies with age. Isolated gallstone disease does occur, particularly in the young infant. Jaundice is the most common symptom in children less than 1 year of age, being present in greater than 90 percent of symptomatic patients previously reported. Overall, the most common symptom in our series is vomiting (60%). Right upper quadrant pain in the absence of vomiting does not appear to be significant, as this occurred in only one patient (3%) in our series.

Abdomen↗
PubMedDate not supplied

Cholelithiasis in infants: association with parenteral nutrition.

Reported herein are two cholelithiasis-afflicted infants with a common inability to tolerate enteral feeding necessitating parenteral nutrition. One of the infants received parenteral nutrition for 5 months because of intestinal dysfunction and enterocolitis secondary to extensive aganglionosis, while the second child was premature and placed on parenteral nutrition because of bowel dysfunction after surgery to repair high jejunal atresia and a right diaphragmatic hernia. The relationship between parenteral nutrition and cholelithiasis is discussed.

Cholelithiasis↗
PubMed1986

Hepatic trimethadione-oxidizing capacity remains normal in patients with extrahepatic cholelithiasis.

In the present study, using trimethadione (TMO) as an indicator substrate, we estimated pre- and post-operative differences in hepatic drug-oxidizing capacity in patients with extrahepatic cholelithiasis. Only total and direct bilirubin values were significantly higher in preoperative patients than in the controls. After operative procedures, those parameters did not show significant differences from corresponding control values. The serum dimethadione (DMO)/TMO ratios estimated 4 h after administration of 4 mg/kg of TMO. Neither pre- nor post-operative serum DMO/TMO ratios were significantly different from those in the controls. These results suggest that the hepatic drug-oxidizing capacity in patients with extrahepatic cholelithiasis remains unchanged even though the bilirubin level deviated from normal.

Bilirubin↗
PubMed1990

Cholelithiasis in infants, children, and adolescents.

During the past two decades, cholelithiasis has been recognized in increasing numbers of pediatric patients. This diagnosis should be considered in the event of upper abdominal complaints, particularly when one or more risk factors are evident. The etiology may be unknown or may be related to risk factors, including hemolytic conditions. In recent years, it has become evident that approximately 80% of gallstones in children are not due to hemolytic disease and that the remaining 20% are related to recurring hemolysis. The diagnosis of gallstones is best confirmed with ultrasonography. Routine ultrasonographic evaluation should be performed at intervals for all children who received TPA for more than 4 weeks, particularly those who have had ileal resection or have had chronic enteritis (Crohn disease). Cholecystectomy is the procedure of choice for symptomatic children with cholelithiasis, regardless of age. Cholecystectomy is recommended for the asymptomatic child younger than 3 years of age when echogenic shadows have been present for at least 12 months following resumption of oral feedings or when the gallstones are radiopaque. Also, cholecystectomy is advised for asymptomatic children who are older than 3 years of age if ultrasonographic studies confirm that echogenic foci with shadowing are true stones and not echogenic sludge. Complications of common bile duct obstruction, pancreatitis, perforation with bile peritonitis, and life-threatening sepsis may thus be prevented. Morbidity and mortality following cholecystectomy are expected to be relatively low in the pediatric age group.

Adolescent↗
PubMed1996

A case of traumatic neuroma of the gallbladder in the absence of previous surgery and cholelithiasis.

We experienced a patient with traumatic neuroma of the gallbladder with no history of gallbladder surgery or cholelithiasis. A 74-year-old man was referred to our department after a gallbladder tumor was incidentally discovered during a preoperative screening examination for prostate hypertrophy. Ultrasonography, MRI, CT and endoscopic retrograde cholangiography revealed a protuberant lesion of the gallbladder. Laparoscopic cholecystectomy was attempted but adhesion between the liver and duodenum forced us to convert to open laparotomy. Cholecystectomy and adjacent liver tissue resection was performed. Diagnosis was made by frozen histology during operation. It revealed no malignancy. Postoperative pathological examination revealed traumatic neuroma associated with inflammation. To our knowledge, this is the first reported case of gallbladder neuroma without a history of gallstones or surgery in the English and Japanese literature since 1980. This traumatic neuroma should be considered in a differential diagnosis in treating gallbladder neoplasm, even in the absence of an operative history or cholelithiasis.

Aged↗
PubMed1992

Indications and timing of surgery for cholelithiasis associated with valvular heart disease.

Twenty patients with cholelithiasis associated with valvular heart disease were studied to assess the need and the optimal time for cholecystectomy. Twelve patients (11 symptomatic and 1 asymptomatic patients) underwent cholecystectomy. The remaining patients were asymptomatic. The levels of the total bilirubin in 9 patients, and of LDH in 15, were higher than normal. In most of the patients, the serum transaminase levels were higher than normal, but in few cases, the levels were higher than 200 IU/l. These abnormal values, however, were not consistently observed in these patients. No clear association between the type and form of valvular heart disease was demonstrated. The type of prostheses used for valve replacement in these patients were ball, tilting disc and leaflet. No significant differences in efficacy were observed among different types of prostheses. The incidence of silent stones is high in patients with valvular heart disease and heart surgery often causes deterioration in patients with cholelithiasis. The recovery of the patients who underwent cholecystectomy before valve replacement were better than those who underwent cholecystectomy after heart surgery. In conclusion, therefore, patients showing any abnormal results in liver function tests should be assessed in detail by abdominal echography and should receive surgical treatment of biliary tract before heart surgery if necessary.

Cholelithiasis↗
PubMed2000

Study of cholelithiasis after gastrectomy.

We studied cholelithiasis that occurred after gastrectomy in 52 patients (35 males and 17 females) encountered at our department between January, 1978 and December, 1998. Gastrectomy had been performed for gastric or duodenal ulcer in 35, gastric cancer in 14, gastroptosis in 2, and gastric trauma in 1 of these patients. Reconstruction after gastrectomy was performed by the Billroth II method (B-II method) in 31 patients, Billroth I method (B-I method) in 17, Roux-en-Y method (Roux-Y method) in 3, and esophagogastrostomy in 1. The period between gastrectomy and discovery of gallstones was 1-5 years in 9, 5-10 years in 10, and 10 years or longer in 33, or more than 60% of the patients. Gallstones were present in the gallbladder alone in 33, bile duct alone in 9, gallbladder and bile duct in 10; the percentage of bile duct stones was high. The type of stones was bilirubin-calcium stones in 21, black stones in 12, pure cholesterol stones in 1, combined stones in 4, mixed stones in 12, and others in 2; pigment stones accounted for 63.5%. Gallstones were symptomatic in 78.8% of the patients, and abdominal pain was the most frequent symptom. Bile was positive on bacterial culture in 68.4%, and Gram-negative bacilli were the most frequently isolated. Lymph node dissection, vagotomy, cholestasis, and biliary tract infection are considered to be related to cholelithiasis after gastrectomy.

Adult↗
PubMed2005

Laparoscopic treatment of cholelithiasis in cirrhotic patients.

OBJECTIVE: To assess the safety and efficacy of laparoscopy in the treatment of symptomatic cholelithiasis in patients with Child's Class A and Class B cirrhosis. STUDY DESIGN: Descriptive and retrospective study. PATIENTS: We studied 14 patients (mean age 60 yrs) with Child's Class A and Class B hepatic cirrhosis who underwent laparoscopic cholecystectomy. We analyzed the occurrence of intraoperative and postoperative complications. RESULTS: Eight patients were women (57.14%) and 6 were men (42.85%). Eight of the 14 patients presented with Child's Class B cirrhosis and 6 patients with Class A. Cholecystectomy was programmed for all patients. The average duration of surgery was 77 min. Intraoperative complications occurred in 2 patients (14.28%) in the form of liver bed bleeding. Postoperative complications were observed in 3 patients (21.42%), 2 presented with ascites which led to a worsening of Child's Class in one of them, and the third patient presented with angina-like symptoms (acute, sharp pain in the chest irradiating to the back). Mean length of hospital stay was 3 days. No postoperative morbidity or mortality occurred, and there were no conversions. CONCLUSIONS: LC (laparoscopic cholecystectomy) is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Child's Class A and Class B cirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant, and both duration of surgical procedure and hospital stay are short.

Cholecystectomy, Laparoscopic↗
PubMed1989

Cholelithiasis in a teaching hospital: a review of clinical and post-mortem experiences.

Six hundred and eighty cadavers and 307 patients with gallstones who presented over a three-year period at a WA teaching hospital were studied to assess the prevalence, morbidity and mortality of cholelithiasis. In particular, the outcome of surgical treatment compared with that of conservative treatment was assessed. In the post-mortem series, 17.9%, of men and 29.7% of women either had gallstones or had undergone a cholecystectomy previously. In 12 patients (1.8% of patients over all or 10% of those patients with gallstones), the gallstones were responsible for the death of the patient. In the clinical series, of the 248 patients who were treated surgically, 68 patients suffered one or more non-specific postoperative complications and 10 patients suffered specific postoperative complications. However, only one (0.4% operative mortality) postoperative death occurred, the result of a stroke in a patient with previously-known cerebrovascular disease. Of the 59 patients whose gallstones were treated conservatively, 16 patients developed further complications of cholelithiasis with one patient dying of renal failure that was subsequent to biliary pancreatitis. This study shows that to perform cholecystectomy at an early stage in patients with biliary pain is safe and can abort the progression to more-serious complications.

Adult↗
PubMedDate not supplied

[Ceftriaxone-induced cholelithiasis].

The formation of biliary sludge and cholelithiasis after ceftriaxone administration is not uncommon. Prompt resolution of sludge has been demonstrated with discontinuation of the drug. Despite this, cholecystectomy has been performed in symptomatic patients. Ceftriaxone is popular drug in pediatrics, but the complication is not widely appreciated in the gastroenterology and surgical literature. For this adverse effect and for cost ceftriaxone should be used with more caution. We describe two cases of children with ceftriaxone induced cholelithiasis.

Ceftriaxone↗
PubMed1976

[Activity of the reparative processes in the liver in cholelithiasis].

The authors have studied the character and rate of reparative reactions in liver biopsy specimens from 207 patients suffering cholelithiasis. The activity of reparative processes in hepatic parenchyma is evidenced by an increased amount of binuclear and polyploid hepatocytes, the appearance of mitosis figures. It is evident that active reparative processes underlie the compensatory function of the liver in cholelithiasis.

Adult↗
PubMed1976

[Frequency and complications of cholelithiasis].

The authors studied a total of 16557 necropsy reports for 20 years, at the Chair of Pathologic Anatomy, Medical Faculty, Sofia, as regards the incidence and complications of cholelithiasis. In order to determine the effect of the applied modern antibiotic treatment, the material studied covers the decades 1932-1941 and 1963-1972. Cholelithiasis incidence grew about five times during the second period. A change in the incidence of certain complications is also observed--a) there is a considerable decrease in the number of liver abscesses during the antibiotic period (about three times); b) the number of the developed biliary cirrhosis grew (about three times). With age aspect, the peak incidence has shifted with a decade backwards during the second period, life prolongation being the reason for it.

Adult↗
PubMed1999

[Combined operations for cholelithiasis].

The experience of 1560 combined operations performed in N.N.Burdenko clinic from 1974 to March 1999 for cholelithiasis is analysed. The results of 7461 cholecystectomies are analysed depending on patients' age (17.8% of patients aged 65 years and older), urgency of the operations (there were 35.6% of patients of this age group who underwent surgery under strictly urgent conditions), and complicacy of the operation (combined operations were carried out in 837 patients with cholecystitis). Last years in the clinic each 10th cholecystectomy is carried out as an additional procedure in more complicated surgery, or it is combined with less complicated one. Thus, in 389 patients with more complicated diseases than cholelithiasis (approximately in a half of them tumors of various locations were observed), cholecystectomy was performed as a combined procedure (1st group), and in 448 patients (2nd group) it was the main procedure. In the 1st group 27% of patients were aged 65 years and older, the overwhelming majority of the operations were carried out by the same approach, mortality rate being 3.3%. In the 2nd group elderly patients made up 20.7%; 68.3% of patients were operated by two approaches, lethality rate being 0.2%. Thus, lethality after 837 combined operations made up 1.7%, total mortality rate after 7461 cholecystectomies made up 0.29%.

Aged↗
PubMed1999

[Current approaches to the diagnosis, treatment and expertise of cholelithiasis in pilots].

Data on the modern mechanisms of forming the cholelithiasis and the new methods of its treatment are presented. There have been examined 337 pilots of the helicopter aviation with the professional length of service of 10 year and more, the cholelithiasis has been revealed in 107 cases. In the course of treatment there have been used the preparations of ursodeoxycholic acid (urosan), remote shock-wave lithotripsy and laparoscopic cholecystectomy. There is demonstrated the high efficiency of these methods during examination of 106 patients who after passing the air-force medical board are pronounced for proceeding their flying activity.

Aerospace Medicine↗
PubMedDate not supplied

[Current aspects of the classification of cholelithiasis and the principles of the therapeutic procedure in its different forms].

A classification is submitted of cholelithiasis, taking account of stages of the illness, its main clinical forms and complications, with the diagnostic criteria and policy of treating it being pointed out. The use of the above classification ensures succession of surgeons' and therapists' work in questions of diagnosis, prophylaxis, and treatment of patients with cholelithiasis.

Cholelithiasis↗
PubMed2000

[Surgical treatment of cholelithiasis in the era of minimal invasiveness].

Three hundred and eighty-four patients with cholelithiasis have been operated on at the author's department in two years. There were 186 laparoscopic cholecystectomies, 162 micro-minilaparotomies and 36 traditional operations. All but one patients recovered. The author's opinion is, that laparoscopic and micro-minilaparotomic cholecystectomies are nearly identical operations in the treatment of cholelithiasis, but the indication of the two minimal invasive methods is not the same.

Adolescent↗
PubMed2000

[History of surgery for cholelithiasis: from the era of cholecystostomy to laparoscopic surgery].

Since Stalpert von der Wiel first incised the abdominal wall for bile drainage in a patient with an intraabdominal abscess due to gangrenous cholecystitis with calculi in 1684, the problems inherent in the treatment of cholelithisiasis have received attention from surgeons working in this field. However, the major event was the development of the technique of cholecystectomy by Langenbuch in 1882 opening a new era in surgery for cholelithiasis. Subsequently numerous advances were made in cholecystectomy, choledochotomy, choledochoenterostomy, and sphincteroplasty associated with progress in the diagnostic techniques and instrumentation necessary to perform surgery for cholelithiasis. However, the outcomes of these methods were criticized, and they were gradually abandoned due to development of minimally invasive endoscopic or laparoscopic surgery. The development of laparoscopic cholecystectomy revolutionized the history of biliary surgery. In the 21st century, the best treatment will be available to all patients with the use of ultramodern technologies such as telesurgery and robotic surgery.

Cholecystostomy↗